101
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Xia W, Hu C. Progress in Research on Tumor Metastasis Inhibitors. Curr Med Chem 2020; 27:5758-5772. [PMID: 31560282 DOI: 10.2174/0929867326666190927120847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 02/08/2023]
Abstract
Tumor metastasis is a significant cause of malignant cancer-related death. Therefore, inhibiting tumor metastasis is an effective means of treating malignant tumors. Increasing our understanding of the molecular mechanisms that govern tumor metastasis can reveal new anti-cancer targets. This article will discuss the breakthroughs in this area and the corresponding recent developments in anti-cancer drug discovery.
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Affiliation(s)
- Weiqi Xia
- College of Chemistry & Chemical Engineering, Shaoxing University, Shaoxing 312000, China
| | - Chunqi Hu
- College of Chemistry & Chemical Engineering, Shaoxing University, Shaoxing 312000, China
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102
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Song SY, Ha SJ, Park JH, Park SJ, Shin SH, Oak C, Choi JY, Yoon SW, Kim JA, Yoon SH, Son JW, Kim SJ, Yoo HS. A randomized, multi-center, open-label study to compare the safety and efficacy between afatinib monotherapy and combination therapy of afatinib and HAD-B1 for the locally advanced or metastatic NSCLC patients with EGFR mutations. Medicine (Baltimore) 2020; 99:e23455. [PMID: 33285743 PMCID: PMC7717758 DOI: 10.1097/md.0000000000023455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Afatinib is an epidermal growth factor receptor - tyrosine kinase inhibitor (EGFR-TKI) with proven efficacy for treating patients with advanced or metastatic non-small cell lung cancer (NSCLC). Unfortunately, responses are limited by acquired resistance. Because traditional Korean medicine may have synergistic effects when combined with chemotherapy or radiotherapy, the aim of our study is to elucidate the efficacy and safety of afatinib plus HangAmDan-B1 (HAD-B1) combination therapy in the treatment of patients with NSCLC, as well as EGFR mutations, who need afatinib therapy. METHODS/DESIGN This study is a randomized, multi-center, open clinical trial. A total of 178 eligible subjects, recruited at 8 centers, are randomly assigned to take Afatinib (20-40 mg) ± HAD-B1 (0.972 g/day) for 48 weeks. In the test group, HAD-B1 and afatinib will be used in combination. The primary outcome is a comparison of progression-free survival (PFS) between afatinib monotherapy and afatinib plus HAD-B1 combination therapy in patients with local advanced or metastatic (Stage IIIA, B, C/IV) NSCLC. Secondary outcomes are the overall survival rates, clinical responses, tumor size reductions, health-related qualities of life, and safety. DISCUSSION The result of this clinical trial will provide evidence for the efficacy and safety of using HAD-B1 in the treatment of EGFR-positive patients with locally advanced or metastatic NSCLC who require afatinib therapy. TRIAL REGISTRATION Clinical Research Information Service (CRIS), Republic of Korea (ID: KCT0005414), on September 23, 2020.
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Affiliation(s)
- Si-Yeon Song
- East West Cancer Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon
| | - Su-Jeong Ha
- East West Cancer Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon
| | - Ji-Hye Park
- East West Cancer Center, Seoul Korean Medicine Hospital of Daejeon University, Seoul
| | - So-Jung Park
- East West Cancer Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Pusan
| | - Chulho Oak
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Pusan
| | - Jun-Yong Choi
- Department of Internal Medicine, School of Korean Medicine & Korean Medicine Hospital of Pusan National University, Yangsan
| | - Seong Woo Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong
| | - Jung-A Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Kyung Hee University Gangdong Hospital, Seoul
| | - Seong Hoon Yoon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan
| | - Ji Woong Son
- Department of Internal Medicine, Konyang University Hospital, Daejeon
| | - Seung Joon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, Postech-Catholic Biomedical Engineering Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwa-Seung Yoo
- East West Cancer Center, Seoul Korean Medicine Hospital of Daejeon University, Seoul
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103
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Buja A, Rivera M, De Polo A, Brino ED, Marchetti M, Scioni M, Pasello G, Bortolami A, Rebba V, Schiavon M, Calabrese F, Mandoliti G, Baldo V, Conte P. Estimated direct costs of non-small cell lung cancer by stage at diagnosis and disease management phase: A whole-disease model. Thorac Cancer 2020; 12:13-20. [PMID: 33219738 PMCID: PMC7779199 DOI: 10.1111/1759-7714.13616] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 01/10/2023] Open
Abstract
Background Non‐small cell lung cancer (NSCLC) is the first cause of cancer‐related death among men and the second among women worldwide. It also poses an economic threat to the sustainability of healthcare services. This study estimated the direct costs of care for patients with NSCLC by stage at diagnosis, and management phase of pathway recommended in local and international guidelines. Methods Based on the most up‐to‐date guidelines, we developed a very detailed “whole‐disease” model listing the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of each stage of NSCLC. We assigned a cost to each procedure, and obtained an estimate of the total and average per‐patient costs of each stage of the disease and phase of its management. Results The mean expected cost of a patient with NSCLC is 21,328 € (95% C.I. −20 897−22 322). This cost is 16 291 € in stage I, 19530 € in stage II, 21938 € in stage III, 22175 € in stage IV, and 28 711 € for a Pancoast tumor. In the early stages of the disease, the main cost is incurred by surgery, whereas in the more advanced stages radiotherapy, medical therapy, treatment for progressions, and supportive care become variously more important. Conclusions An estimation of the direct costs of care for NSCLC is fundamental in order to predict the burden of new oncological therapies and treatments on healthcare services, and thus orient the decisions of policy‐makers regarding the allocation of resources. Key points Significant findings of the study The high costs of surgery make the early stages of the disease no less expensive than the advanced stages. What this study adds An estimation of the direct costs of care is fundamental in order to orient the decisions of policy‐makers regarding the allocation of resources.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Rivera
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Anna De Polo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | | | | | - Manuela Scioni
- Statistics Department, University of Padua, Padua, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Vincenzo Rebba
- "Marco Fanno" Department of Economics and Management, University of Padua, Padua, Italy
| | - Marco Schiavon
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Fiorella Calabrese
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Mandoliti
- U.O.C. Radioterapia oncologica, Ospedale Santa Maria della Misericordia, AULSS 5 "Polesana", Rovigo, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - PierFranco Conte
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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Sha H, Dong S, Yu C, Zou R, Zhu Y, Lu Y, Zhang J, Cao H, Chen D, Wu J, Feng J. In Vitro and in Vivo Efficacy of NBDHEX on Gefitinib-resistant Human Non-small Cell Lung Cancer. J Cancer 2020; 11:7216-7223. [PMID: 33193885 PMCID: PMC7646187 DOI: 10.7150/jca.46461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022] Open
Abstract
Gefitinib, a first-generation EGFR tyrosine kinase inhibitor (EGFR-TKI), is recommended for treatment of non-small cell lung cancer (NSCLC) patients who harbor activating EGFR mutations. However, the tumors of most patients initially sensitive to gefitinib will develop resistance within several months of therapy. Drug resistance is a major obstacle to NSCLC treatment. The novel glutathione transferase P1 (GSTPi) inhibitor 6-(7-nitro-2, 1, 3-benzoxadiazol-4-ylthio) hexanol (NBDHEX) has recently been shown to be active against tumors. In this study, we investigated the in vitro and in vivo efficacy of NBDHEX against NSCLC. Treatment with NBDHEX inhibited GSTpi enzymatic activity and promoted apoptosis of gefinitb-resistant NSCLC cells. Moreover, NBDHEX reduced tumor growth in mice. These findings indicated that NBDHEX is a good candidate for treatment of NSCLC patients, and that NBDHEX offers a new approach to cancer therapy.
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Affiliation(s)
- Huanhuan Sha
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China.,The Forth Clinical School of Nanjing Medical University, Nanjing, 210009, China
| | - Shuchen Dong
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China
| | - Chen Yu
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China
| | - Renrui Zou
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China.,The Forth Clinical School of Nanjing Medical University, Nanjing, 210009, China
| | - Yue Zhu
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China.,The Forth Clinical School of Nanjing Medical University, Nanjing, 210009, China
| | - Ya Lu
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China.,The Forth Clinical School of Nanjing Medical University, Nanjing, 210009, China
| | - Junying Zhang
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China
| | - Haixia Cao
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China
| | - Dan Chen
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China
| | - Jianzhong Wu
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China
| | - Jifeng Feng
- The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Baiziting42, Nanjing 210009, China
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Alafate W, Xu D, Wu W, Xiang J, Ma X, Xie W, Bai X, Wang M, Wang J. Loss of PLK2 induces acquired resistance to temozolomide in GBM via activation of notch signaling. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2020; 39:239. [PMID: 33176854 PMCID: PMC7657349 DOI: 10.1186/s13046-020-01750-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/26/2020] [Indexed: 12/14/2022]
Abstract
Background Glioblastoma (GBM) is a lethal type of primary brain tumor with a median survival less than 15 months. Despite the recent improvements of comprehensive strategies, the outcomes for GBM patients remain dismal. Accumulating evidence indicates that rapid acquired chemoresistance is the major cause of GBM recurrence thus leads to worse clinical outcomes. Therefore, developing novel biomarkers and therapeutic targets for chemoresistant GBM is crucial for long-term cures. Methods Transcriptomic profiles of glioblastoma were downloaded from gene expression omnibus (GEO) and TCGA database. Differentially expressed genes were analyzed and candidate gene PLK2 was selected for subsequent validation. Clinical samples and corresponding data were collected from our center and measured using immunohistochemistry analysis. Lentiviral transduction and in vivo xenograft transplantation were used to validate the bioinformatic findings. GSEA analyses were conducted to identify potential signaling pathways related to PLK2 expression and further confirmed by in vitro mechanistic assays. Results In this study, we identified PLK2 as an extremely suppressed kinase-encoding gene in GBM samples, particularly in therapy resistant GBM. Additionally, reduced PLK2 expression implied poor prognosis and TMZ resistance in GBM patients. Functionally, up-regulated PLK2 attenuated cell proliferation, migration, invasion, and tumorigenesis of GBM cells. Besides, exogenous overexpression of PLK2 reduced acquired TMZ resistance of GBM cells. Furthermore, bioinformatics analysis indicated that PLK2 was negatively correlated with Notch signaling pathway in GBM. Mechanically, loss of PLK2 activated Notch pathway through negative transcriptional regulation of HES1 and degradation of Notch1. Conclusion Loss of PLK2 enhances aggressive biological behavior of GBM through activation of Notch signaling, indicating that PLK2 could be a prognostic biomarker and potential therapeutic target for chemoresistant GBM.
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Affiliation(s)
- Wahafu Alafate
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China.,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Dongze Xu
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China
| | - Wei Wu
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China.,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Jianyang Xiang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China.,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Xudong Ma
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China.,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Wanfu Xie
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China
| | - Xiaobin Bai
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China
| | - Maode Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China. .,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China.
| | - Jia Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, P.R. China. .,Center of Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China.
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Terai H, Hamamoto J, Emoto K, Masuda T, Manabe T, Kuronuma S, Kobayashi K, Masuzawa K, Ikemura S, Nakayama S, Kawada I, Suzuki Y, Takeuchi O, Suzuki Y, Ohtsuki S, Yasuda H, Soejima K, Fukunaga K. SHOC2 Is a Critical Modulator of Sensitivity to EGFR-TKIs in Non-Small Cell Lung Cancer Cells. Mol Cancer Res 2020; 19:317-328. [PMID: 33106373 DOI: 10.1158/1541-7786.mcr-20-0664] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
EGFR mutation-positive patients with non-small cell lung cancer (NSCLC) respond well to treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKI); however, treatment with EGFR-TKIs is not curative, owing to the presence of residual cancer cells with intrinsic or acquired resistance to this class of drugs. Additional treatment targets that may enhance the efficacy of EGFR-TKIs remain elusive. Using a CRISPR/Cas9-based screen, we identified the leucine-rich repeat scaffold protein SHOC2 as a key modulator of sensitivity to EGFR-TKI treatment. On the basis of in vitro assays, we demonstrated that SHOC2 expression levels strongly correlate with the sensitivity to EGFR-TKIs and that SHOC2 affects the sensitivity to EGFR-TKIs in NSCLC cells via SHOC2/MRAS/PP1c and SHOC2/SCRIB signaling. The potential SHOC2 inhibitor celastrol phenocopied SHOC2 depletion. In addition, we confirmed that SHOC2 expression levels were important for the sensitivity to EGFR-TKIs in vivo. Furthermore, IHC showed the accumulation of cancer cells that express high levels of SHOC2 in lung cancer tissues obtained from patients with NSCLC who experienced acquired resistance to EGFR-TKIs. These data indicate that SHOC2 may be a therapeutic target for patients with NSCLC or a biomarker to predict sensitivity to EGFR-TKI therapy in EGFR mutation-positive patients with NSCLC. Our findings may help improve treatment strategies for patients with NSCLC harboring EGFR mutations. IMPLICATIONS: This study showed that SHOC2 works as a modulator of sensitivity to EGFR-TKIs and the expression levels of SHOC2 can be used as a biomarker for sensitivity to EGFR-TKIs.
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Affiliation(s)
- Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan. .,Division of Bioregulatory Medicine, Department of Pharmacology, Kitasato University, Tokyo, Japan.,Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan.,Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Junko Hamamoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Division of Bioregulatory Medicine, Department of Pharmacology, Kitasato University, Tokyo, Japan
| | - Katsura Emoto
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Masuda
- Department of Pharmaceutical Microbiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tadashi Manabe
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Kuronuma
- Biomedical Laboratory, Department of Research, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Keigo Kobayashi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keita Masuzawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinnosuke Ikemura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Sohei Nakayama
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Suzuki
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Osamu Takeuchi
- Biomedical Laboratory, Department of Research, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Yukio Suzuki
- Division of Bioregulatory Medicine, Department of Pharmacology, Kitasato University, Tokyo, Japan.,Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Sumio Ohtsuki
- Department of Pharmaceutical Microbiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Soejima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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107
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Wu Z, Chen S, Du X, Wu Y, Xie X. Hepatotoxicity with epidermal growth factor receptor tyrosine kinase inhibitors in non-small-cell lung cancer patients: A network meta-analysis. J Clin Pharm Ther 2020; 46:310-318. [PMID: 33031574 DOI: 10.1111/jcpt.13281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/23/2020] [Accepted: 09/07/2020] [Indexed: 01/16/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE The efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in patients diagnosed with non-small-cell lung cancer (NSCLC) has been confirmed by a large number of studies. However, hepatotoxicity caused by EGFR-TKIs has not been widely investigated. This review compares the hepatotoxicity of different EGFR-TKIs through a network meta-analysis. METHODS PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were systematically searched from their individual inceptions to 20 May 2020 with the goal of identifying randomized controlled trials (RCTs) reporting hepatotoxicity in NSCLC patients receiving EGFR-TKIs. A random-effects pairwise meta-analysis and network meta-analysis were performed within a frequentist framework. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. RESULTS Twelve eligible RCTs, including data from 6,280 patients diagnosed with NSCLC, were analysed. In our network meta-analysis, gefitinib was associated with a higher risk for hepatotoxicity compared to placebo (RR, 2.55; 95% CI, 1.32-4.89) and dacomitinib (RR, 2.60; 95% CI, 1.30-5.20) in terms of all-grades alanine transaminase (ALT) elevation. As for all-grades aspartate transaminase (AST) elevation, gefitinib and erlotinib showed a significantly increased risk for hepatotoxicity compared to afatinib, dacomitinib and placebo (erlotinib vs. afatinib: RR, 1.85; 95% CI, 1.05-3.24; erlotinib vs. dacomitinib: RR, 1.68; 95% CI, 1.19-2.36; erlotinib vs. placebo: RR, 3.38; 95% CI, 1.69-6.73; gefitinib vs. afatinib: RR, 2.23; 95% CI, 1.32-3.79; gefitinib vs. dacomitinib: RR, 2.03; 95% CI, 1.51-2.73; gefitinib vs. placebo: RR, 4.08; 95% CI, 2.11-7.91). There was a high risk of high-grade ALT elevation in patients treated with gefitinib compared to patients treated with erlotinib (RR, 4.31; 95% CI, 2.15-8.66), dacomitinib (RR, 6.95; 95% CI, 1.85-26.05) or placebo (RR, 8.38; 95% CI, 1.56-45.01). No statistically significant differences were identified among the five agents analysed in terms of all-grades TB elevation and high-grade AST elevation. The surface under the cumulative ranking curve (SUCRA) revealed that gefitinib showed a potentially higher risk for ALT and AST elevation compared to other EGFR-TKIs regardless of grade. WHAT IS NEW AND CONCLUSION Current evidence indicates that the association between afatinib or dacomitinib and risk of liver enzyme elevation remains uncertain in patients diagnosed with NSCLC. Some evidence suggests that gefitinib and erlotinib may be associated with a significantly increased risk for hepatotoxicity in patients with NSCLC. However, given that the elevation of liver enzymes was not definitely associated with EGFR-TKIs and publication bias, further studies are required to confirm these results.
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Affiliation(s)
- Ziyang Wu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Suhua Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xin Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yibo Wu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaohui Xie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
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108
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Zhang M, Wang Y, Wang J, Liu Z, Shi J, Li M, Zhu Y, Wang S. Design, Synthesis and Biological Evaluation of the Quinazoline Derivatives as L858R/T790M/C797S Triple Mutant Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors. Chem Pharm Bull (Tokyo) 2020; 68:971-980. [DOI: 10.1248/cpb.c20-00411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Mingguang Zhang
- College of Chemical Engineering, Nanjing Forestry University
- Jiangsu Chia Tai Fenghai Pharmaceutical Co., Ltd
| | - Yunyun Wang
- College of Chemical Engineering, Nanjing Forestry University
| | - Jia Wang
- Jiangsu Chia Tai Fenghai Pharmaceutical Co., Ltd
| | - Zhaogang Liu
- Jiangsu Chia Tai Fenghai Pharmaceutical Co., Ltd
| | - Jingmiao Shi
- Jiangsu Chia Tai Fenghai Pharmaceutical Co., Ltd
| | - Mingxin Li
- College of Chemical Engineering, Nanjing Forestry University
| | - Yongqiang Zhu
- Jiangsu Chia Tai Fenghai Pharmaceutical Co., Ltd
- College of Life Science, Nanjing Normal University
| | - Shifa Wang
- College of Chemical Engineering, Nanjing Forestry University
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109
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Leal JL, Solomon B, John T. Finding chinks in the osimertinib resistance armor. Transl Lung Cancer Res 2020; 9:2173-2177. [PMID: 33209638 PMCID: PMC7653108 DOI: 10.21037/tlcr-20-579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jose Luis Leal
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, Victoria, Australia
| | - Thomas John
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, Victoria, Australia
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110
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Seixas JD, Sousa BB, Marques MC, Guerreiro A, Traquete R, Rodrigues T, Albuquerque IS, Sousa MFQ, Lemos AR, Sousa PMF, Bandeiras TM, Wu D, Doyle SK, Robinson CV, Koehler AN, Corzana F, Matias PM, Bernardes GJL. Structural and biophysical insights into the mode of covalent binding of rationally designed potent BMX inhibitors. RSC Chem Biol 2020; 1:251-262. [PMID: 34458764 PMCID: PMC8341910 DOI: 10.1039/d0cb00033g] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/21/2020] [Indexed: 12/14/2022] Open
Abstract
The bone marrow tyrosine kinase in chromosome X (BMX) is pursued as a drug target because of its role in various pathophysiological processes. We designed BMX covalent inhibitors with single-digit nanomolar potency with unexploited topological pharmacophore patterns. Importantly, we reveal the first X-ray crystal structure of covalently inhibited BMX at Cys496, which displays key interactions with Lys445, responsible for hampering ATP catalysis and the DFG-out-like motif, typical of an inactive conformation. Molecular dynamic simulations also showed this interaction for two ligand/BMX complexes. Kinome selectivity profiling showed that the most potent compound is the strongest binder, displays intracellular target engagement in BMX-transfected cells with two-digit nanomolar inhibitory potency, and leads to BMX degradation PC3 in cells. The new inhibitors displayed anti-proliferative effects in androgen-receptor positive prostate cancer cells that where further increased when combined with known inhibitors of related signaling pathways, such as PI3K, AKT and Androgen Receptor. We expect these findings to guide development of new selective BMX therapeutic approaches.
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Affiliation(s)
- João D Seixas
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa Avenida Professor Egas Moniz 1649-028 Lisboa Portugal
| | - Bárbara B Sousa
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa Avenida Professor Egas Moniz 1649-028 Lisboa Portugal
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa Av. da República EAN 2780-157 Oeiras Portugal
| | - Marta C Marques
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa Avenida Professor Egas Moniz 1649-028 Lisboa Portugal
| | - Ana Guerreiro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa Avenida Professor Egas Moniz 1649-028 Lisboa Portugal
| | - Rui Traquete
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa Avenida Professor Egas Moniz 1649-028 Lisboa Portugal
| | - Tiago Rodrigues
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa Avenida Professor Egas Moniz 1649-028 Lisboa Portugal
| | - Inês S Albuquerque
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa Avenida Professor Egas Moniz 1649-028 Lisboa Portugal
| | - Marcos F Q Sousa
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa Av. da República EAN 2780-157 Oeiras Portugal
- IBET - Instituto de Biologia Experimental e Tecnológica Av. da República EAN 2780-157 Oeiras Portugal
| | - Ana R Lemos
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa Av. da República EAN 2780-157 Oeiras Portugal
- IBET - Instituto de Biologia Experimental e Tecnológica Av. da República EAN 2780-157 Oeiras Portugal
| | - Pedro M F Sousa
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa Av. da República EAN 2780-157 Oeiras Portugal
- IBET - Instituto de Biologia Experimental e Tecnológica Av. da República EAN 2780-157 Oeiras Portugal
| | - Tiago M Bandeiras
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa Av. da República EAN 2780-157 Oeiras Portugal
- IBET - Instituto de Biologia Experimental e Tecnológica Av. da República EAN 2780-157 Oeiras Portugal
| | - Di Wu
- Department of Chemistry, University of Oxford South Parks Road Oxford OX1 3QZ UK
| | - Shelby K Doyle
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology Cambridge MA 02142 USA
| | - Carol V Robinson
- Department of Chemistry, University of Oxford South Parks Road Oxford OX1 3QZ UK
| | - Angela N Koehler
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology Cambridge MA 02142 USA
| | - Francisco Corzana
- Departamento de Química, Universidad de La Rioja, Centro de Investigación en Síntesis Química 26006 Logroño Spain
| | - Pedro M Matias
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa Av. da República EAN 2780-157 Oeiras Portugal
- IBET - Instituto de Biologia Experimental e Tecnológica Av. da República EAN 2780-157 Oeiras Portugal
| | - Gonçalo J L Bernardes
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa Avenida Professor Egas Moniz 1649-028 Lisboa Portugal
- Department of Chemistry, University of Cambridge Lensfield Road Cambridge CB2 1EW UK
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111
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O’Leary C, Gasper H, Sahin KB, Tang M, Kulasinghe A, Adams MN, Richard DJ, O’Byrne KJ. Epidermal Growth Factor Receptor (EGFR)-Mutated Non-Small-Cell Lung Cancer (NSCLC). Pharmaceuticals (Basel) 2020; 13:E273. [PMID: 32992872 PMCID: PMC7600164 DOI: 10.3390/ph13100273] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 12/22/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) mutations are the most common oncogenic drivers in non-small-cell lung cancer (NSCLC). Significant developments have taken place which highlight the differences in tumor biology that exist between the mutant and wild-type subtypes of NSCLC. Patients with advanced EGFR-mutant NSCLC have a variety of EGFR-targeting agents available proven to treat their disease. This has led to superior patient outcomes when used as a monotherapy over traditional cytotoxic systemic therapy. Attempts at combining EGFR agents with other anticancer systemic treatment options, such as chemotherapy, antiangiogenic agents, and immunotherapy, have shown varied outcomes. Currently, no specific combination stands out to cause a shift away from the use of single-agent EGFR inhibitors in the first-line setting. Similarly, adjuvant EGFR inhibitors, are yet to significantly add to patient overall survival if used at earlier timepoints in the disease course. Liquid biopsy is an evolving technology with potential promise of being incorporated into the management paradigm of this disease. Data are emerging to suggest that this technique may be capable of identifying early resistance mechanisms and consequential disease progression on the basis of the analysis of blood-based circulating tumor cells.
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Affiliation(s)
- Connor O’Leary
- Princess Alexandra Hospital, Brisbane 4000, Australia; (H.G.); (K.J.O.)
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane 4000, Australia; (K.B.S.); (M.T.); (A.K.); (M.N.A.); (D.J.R.)
- Cancer and Ageing Research Program, Translational Research Institute, Brisbane 4000, Australia
| | - Harry Gasper
- Princess Alexandra Hospital, Brisbane 4000, Australia; (H.G.); (K.J.O.)
| | - Katherine B. Sahin
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane 4000, Australia; (K.B.S.); (M.T.); (A.K.); (M.N.A.); (D.J.R.)
- Cancer and Ageing Research Program, Translational Research Institute, Brisbane 4000, Australia
| | - Ming Tang
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane 4000, Australia; (K.B.S.); (M.T.); (A.K.); (M.N.A.); (D.J.R.)
- Cancer and Ageing Research Program, Translational Research Institute, Brisbane 4000, Australia
| | - Arutha Kulasinghe
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane 4000, Australia; (K.B.S.); (M.T.); (A.K.); (M.N.A.); (D.J.R.)
- Cancer and Ageing Research Program, Translational Research Institute, Brisbane 4000, Australia
| | - Mark N. Adams
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane 4000, Australia; (K.B.S.); (M.T.); (A.K.); (M.N.A.); (D.J.R.)
- Cancer and Ageing Research Program, Translational Research Institute, Brisbane 4000, Australia
| | - Derek J. Richard
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane 4000, Australia; (K.B.S.); (M.T.); (A.K.); (M.N.A.); (D.J.R.)
- Cancer and Ageing Research Program, Translational Research Institute, Brisbane 4000, Australia
| | - Ken J. O’Byrne
- Princess Alexandra Hospital, Brisbane 4000, Australia; (H.G.); (K.J.O.)
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane 4000, Australia; (K.B.S.); (M.T.); (A.K.); (M.N.A.); (D.J.R.)
- Cancer and Ageing Research Program, Translational Research Institute, Brisbane 4000, Australia
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112
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Petri L, Egyed A, Bajusz D, Imre T, Hetényi A, Martinek T, Ábrányi-Balogh P, Keserű GM. An electrophilic warhead library for mapping the reactivity and accessibility of tractable cysteines in protein kinases. Eur J Med Chem 2020; 207:112836. [PMID: 32971426 DOI: 10.1016/j.ejmech.2020.112836] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022]
Abstract
Targeted covalent inhibitors represent a viable strategy to block protein kinases involved in different disease pathologies. Although a number of computational protocols have been published for identifying druggable cysteines, experimental approaches are limited for mapping the reactivity and accessibility of these residues. Here, we present a ligand based approach using a toolbox of fragment-sized molecules with identical scaffold but equipped with diverse covalent warheads. Our library represents a unique opportunity for the efficient integration of warhead-optimization and target-validation into the covalent drug development process. Screening this probe kit against multiple kinases could experimentally characterize the accessibility and reactivity of the targeted cysteines and helped to identify suitable warheads for designed covalent inhibitors. The usefulness of this approach has been confirmed retrospectively on Janus kinase 3 (JAK3). Furthermore, representing a prospective validation, we identified Maternal embryonic leucine zipper kinase (MELK), as a tractable covalent target. Covalently labelling and biochemical inhibition of MELK would suggest an alternative covalent strategy for MELK inhibitor programs.
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Affiliation(s)
- László Petri
- Medicinal Chemistry Research Group, Research Centre for Natural Sciences, Magyar Tudósok Krt 2, H-1117, Budapest, Hungary
| | - Attila Egyed
- Medicinal Chemistry Research Group, Research Centre for Natural Sciences, Magyar Tudósok Krt 2, H-1117, Budapest, Hungary
| | - Dávid Bajusz
- Medicinal Chemistry Research Group, Research Centre for Natural Sciences, Magyar Tudósok Krt 2, H-1117, Budapest, Hungary
| | - Tímea Imre
- MS Metabolomics Research Group, Research Centre for Natural Sciences, Magyar Tudósok Krt 2, H-1117, Budapest, Hungary
| | - Anasztázia Hetényi
- Department of Medicinal Chemistry, University of Szeged, Dóm Tér 8, H-6720, Szeged, Hungary
| | - Tamás Martinek
- Department of Medicinal Chemistry, University of Szeged, Dóm Tér 8, H-6720, Szeged, Hungary
| | - Péter Ábrányi-Balogh
- Medicinal Chemistry Research Group, Research Centre for Natural Sciences, Magyar Tudósok Krt 2, H-1117, Budapest, Hungary
| | - György M Keserű
- Medicinal Chemistry Research Group, Research Centre for Natural Sciences, Magyar Tudósok Krt 2, H-1117, Budapest, Hungary.
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113
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Chung CT, Yeh KC, Lee CH, Chen YY, Ho PJ, Chang KY, Chen CH, Lai YK, Chen CT. Molecular profiling of afatinib-resistant non-small cell lung cancer cells in vivo derived from mice. Pharmacol Res 2020; 161:105183. [PMID: 32896579 DOI: 10.1016/j.phrs.2020.105183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 01/28/2023]
Abstract
Non-small-cell lung cancer (NSCLC) is a leading cause of cancer-related death worldwide. NSCLC patients with overexpressed or mutated epidermal growth factor receptor (EGFR) related to disease progression are treated with EGFR-tyrosine kinase inhibitors (EGFR-TKIs). Acquired drug resistance after TKI treatments has been a major focus for development of NSCLC therapies. This study aimed to establish afatinib-resistant cell lines from which afatinib resistance-associated genes are identified and the underlying mechanisms of multiple-TKI resistance in NSCLC can be further investigated. Nude mice bearing subcutaneous NSCLC HCC827 tumors were administered with afatinib at different dose intensities (5-100 mg/kg). We established three HCC827 sublines resistant to afatinib (IC50 > 1 μM) with cross-resistance to gefitinib (IC50 > 5 μM). cDNA microarray revealed several of these sublines shared 27 up- and 13 down-regulated genes. The mRNA expression of selective novel genes - such as transmembrane 4 L six family member 19 (TM4SF19), suppressor of cytokine signaling 2 (SOCS2), and quinolinate phosphoribosyltransferase (QPRT) - are responsive to afatinib treatments only at high concentrations. Furthermore, c-MET amplification and activations of a subset of tyrosine kinase receptors were observed in all three resistant cells. PHA665752, a c-MET inhibitor, remarkably increased the sensitivity of these resistant cells to afatinib (IC50 = 12-123 nM). We established afatinib-resistant lung cancer cell lines and here report genes associated with afatinib resistance in human NSCLC. These cell lines and the identified genes serve as useful investigational tools, prognostic biomarkers of TKI therapies, and promising molecule targets for development of human NSCLC therapeutics.
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Affiliation(s)
- Cheng-Ta Chung
- Graduate Institute of Biotechnology, National Tsing Hua University, Hsinchu, Taiwan; Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Zhunan, Taiwan
| | - Kai-Chia Yeh
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Zhunan, Taiwan
| | - Chia-Huei Lee
- National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan
| | - Yun-Yu Chen
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Zhunan, Taiwan
| | - Pai-Jiun Ho
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Zhunan, Taiwan
| | - Kai-Yen Chang
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Zhunan, Taiwan
| | - Chieh-Hsin Chen
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Zhunan, Taiwan
| | - Yiu-Kay Lai
- Graduate Institute of Biotechnology, National Tsing Hua University, Hsinchu, Taiwan.
| | - Chiung-Tong Chen
- Institute of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Zhunan, Taiwan.
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114
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Xiao J, Zhou L, He B, Chen Q. Impact of Sex and Smoking on the Efficacy of EGFR-TKIs in Terms of Overall Survival in Non-small-Cell Lung Cancer: A Meta-Analysis. Front Oncol 2020; 10:1531. [PMID: 32984005 PMCID: PMC7477328 DOI: 10.3389/fonc.2020.01531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 07/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background: To comprehensively understand the impact of sex and smoking on the efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy in terms of overall survival (OS) in non-small-cell lung cancer (NSCLC). Methods: PubMed, Cochrane Library, Embase, and Scopus were searched from inception to March 17, 2019. OS was analyzed based on hazard ratios (HRs) and 95% confidence intervals (CIs) and estimated using the random effects model. Results: Our meta-analysis included 22 studies involving 11,874 patients. In the primary analysis, we found no statistically significant efficacy difference for EGFR-TKI intervention between females and males (pooled HR 0.95, 95% CI 0.87–1.04, P = 0.30) and no obvious efficacy difference between never smokers and ever smokers (pooled HR 0.91, 95% CI 0.76–1.09, P = 0.31). In the subgroup analysis of placebo control treatment, we found that female NSCLC patients who received EGFR-TKI therapy had a longer OS than male patients (pooled HR 0.86, 95% CI 0.75–1.00, P = 0.04), while smoking status showed no significant effect on the efficacy of EGFR-TKI treatment in terms of the OS of NSCLC patients in all subgroup analyses. Conclusion: The efficacy of EGFR-TKI therapy for NSCLC patients is independent of smoking status but dependent on sex, and females have a longer OS than males.
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Affiliation(s)
- Jian Xiao
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Liang Zhou
- Department of Critical Care Medicine, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.,Department of Geriatrics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.,Ningxia Geriatrics Center, Yinchuan, China
| | - Bixiu He
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Qiong Chen
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
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115
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Xie X, Wang X, Wu S, Yang H, Liu J, Chen H, Ding Y, Ling L, Lin H. Fatal toxic effects related to EGFR tyrosine kinase inhibitors based on 53 cohorts with 9,569 participants. J Thorac Dis 2020; 12:4057-4069. [PMID: 32944317 PMCID: PMC7475571 DOI: 10.21037/jtd-19-4000a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background To estimate the incidence and susceptible factors of fatal toxic effects related to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Methods PubMed and Embase were thoroughly searched for clinical trials based on the following terms and corresponding Medical Subject Heading ones: “erlotinib”, “gefitinib”, “afatinib”, “dacomitinib”, “osimertinib”, and “non-small-cell lung cancer (NSCLC)”. A total of 53 eligible cohorts with 9,569 participants were collected. Results A total of 105 cases of fatal toxic effects related to EGFR-TKIs occurred in 53 cohorts. The overall incidence was 1.33% [95% confidence interval (CI): 1.08–1.63%]. The odds and incidence were apparently higher in Japanese group (compared with non-East Asian group) [2.72 vs. 1.30, P=0.015; odds ratio (OR): 2.26, 95% CI: 1.17–4.37, P=0.015], in first-line treatment group (compared with EGFR-TKI retreatment group) (1.54 vs. 0.69, P=0.028; OR: 2.41, 95% CI: 1.10–5.26, P=0.028), and in the trial phase II (compared with trial phase III) (1.82% vs. 1.11%, P=0.009; OR: 1.73, 95% CI: 1.15–2.62, P=0.009). Notably, the Japanese group was higher than non-East Asian group after controlling for the treatment-line and trial phase (OR: 2.16, 95% CI: 1.12–4.16, P=0.022). Interstitial lung disease (ILD) was predominant in 29 fatal causes followed by pneumonia, respiratory failure and diarrhea. Conclusions The overall incidence of fatal toxic effects related to EGFR-TKIs was 1.33%, and the major fatal cause was ILD, followed by pneumonia, respiratory failure and diarrhea. The susceptible factor of fatal toxic effects related to EGFR-TKIs was the Japanese group. This study provided a capability for clinicians to predict and detect high-risk populations of fatal toxic effects.
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Affiliation(s)
- Xianhe Xie
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xuewen Wang
- Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Sumei Wu
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Haitao Yang
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Junjin Liu
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huijuan Chen
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yin Ding
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liting Ling
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Heng Lin
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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116
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Qi YT, Hou Y, Qi LC. Efficacy of Next-Generation EGFR-TKIs in Patients With Non-Small Cell Lung Cancer: A Meta-Analysis of Randomized Controlled Trials. Technol Cancer Res Treat 2020; 19:1533033820940426. [PMID: 32723164 PMCID: PMC7391430 DOI: 10.1177/1533033820940426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The efficacy of next-generation epidermal growth factor receptor-tyrosine kinase inhibitors in patients with advanced non-small cell lung cancer who have failed first-generation epidermal growth factor receptor-tyrosine kinase inhibitors still remains under investigation. Objective: The aim of this meta-analysis was to systematically assess the efficacy and safety profiles of next-generation epidermal growth factor receptor-tyrosine kinase inhibitors in patients with advanced non-small cell lung cancer who failed first-generation epidermal growth factor receptor-tyrosine kinase inhibitors. Methods: We performed a comprehensive search of several electronic databases up to September 2018 to identify clinical trials. The primary end point was overall survival, progression-free survival, disease controlled rate, objective response rate, and adverse events. Epidermal growth factor receptor-tyrosine kinase inhibitor emergent severe adverse events (grade ≥ 3) were analyzed. Odds ratio along with 95% confidence interval were utilized for main outcome analysis. Results: In total, we had 3 randomized controlled trials in this analysis. The group of next-generation epidermal growth factor receptor-tyrosine kinase inhibitors had significantly improved progression-free survival (odds ratio = 0.34, 95% confidence interval = 0.29-0.40, P < .00001), as well as objective response rate (odds ratio = 10.48, 95% confidence interval = 3.87-28.34, P < .00001) and disease controlled rate (odds ratio = 6.03, 95% confidence interval = 4.41-8.25, P < .00001). However, there was no significant difference in overall survival with next-generation epidermal growth factor receptor-tyrosine kinase inhibitors (odds ratio = 1.05, 95% confidence interval = 0.85-1.31, P = .66). Meanwhile, the odds ratio for treatment-emergent severe adverse events (diarrhea, rash/acne, nausea, vomiting, anemia) between patients who received next-generation epidermal growth factor receptor-tyrosine kinase inhibitors and those who received first-generation epidermal growth factor receptor-tyrosine kinase inhibitors did not show safety benefit (P > .05). Conclusions: Next-generation epidermal growth factor receptor-tyrosine kinase inhibitors were shown to be the better agent to achieve higher response rate and longer progression-free survival in patients with non-small cell lung cancer as the later-line therapy for previously treated patients with first-generation epidermal growth factor receptor-tyrosine kinase inhibitors. Meanwhile, they did not achieve benefit in overall survival and safety compared with the chemotherapy group. Further research is needed to develop a database of all EGFR mutations and their individual impacts on the various treatments.
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Affiliation(s)
- Yi-Tian Qi
- Department of Radiology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Yi Hou
- Department of Tissue Engineering, School of Pharmacy, Jilin University, Changchun, China
| | - Liang-Chen Qi
- Department of Thoracic Surgery, China-Japan Union Hospital, Jilin University, Changchun, China
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117
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Ward RA, Fawell S, Floc'h N, Flemington V, McKerrecher D, Smith PD. Challenges and Opportunities in Cancer Drug Resistance. Chem Rev 2020; 121:3297-3351. [PMID: 32692162 DOI: 10.1021/acs.chemrev.0c00383] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There has been huge progress in the discovery of targeted cancer therapies in recent years. However, even for the most successful and impactful cancer drugs which have been approved, both innate and acquired mechanisms of resistance are commonplace. These emerging mechanisms of resistance have been studied intensively, which has enabled drug discovery scientists to learn how it may be possible to overcome such resistance in subsequent generations of treatments. In some cases, novel drug candidates have been able to supersede previously approved agents; in other cases they have been used sequentially or in combinations with existing treatments. This review summarizes the current field in terms of the challenges and opportunities that cancer resistance presents to drug discovery scientists, with a focus on small molecule therapeutics. As part of this review, common themes and approaches have been identified which have been utilized to successfully target emerging mechanisms of resistance. This includes the increase in target potency and selectivity, alternative chemical scaffolds, change of mechanism of action (covalents, PROTACs), increases in blood-brain barrier permeability (BBBP), and the targeting of allosteric pockets. Finally, wider approaches are covered such as monoclonal antibodies (mAbs), bispecific antibodies, antibody drug conjugates (ADCs), and combination therapies.
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Affiliation(s)
- Richard A Ward
- Medicinal Chemistry, Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | - Stephen Fawell
- Oncology R&D, AstraZeneca, Waltham, Massachusetts 02451, United States
| | - Nicolas Floc'h
- Bioscience, Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
| | | | | | - Paul D Smith
- Bioscience, Oncology R&D, AstraZeneca, Cambridge CB4 0WG, U.K
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118
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Akher FB, Farrokhzadeh A, Ravenscroft N, Kuttel MM. Mechanistic Study of Potent Fluorinated EGFR Kinase Inhibitors with a Quinazoline Scaffold against L858R/T790M/C797S Resistance Mutation: Unveiling the Fluorine Substituent Cooperativity Effect on the Inhibitory Activity. J Phys Chem B 2020; 124:5813-5824. [PMID: 32603111 DOI: 10.1021/acs.jpcb.0c03440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Fluorination has considerable potential with regard to the design of kinase inhibitors for anticarcinoma therapy. It was recently reported that fluorination increases the potency of inhibitors of the epidermal growth factor receptor (EGFR), mutations of which have been linked specifically to nonsmall-cell lung cancer. For the L858R/T790M/C797S triplet mutant (EGFRTM), a difluorinated inhibitor, 25g, was found to have 4.23 times greater potency against the EGFRTM than an unfluorinated inhibitor, 25a. This discovery necessitates a rational explanation for the underlying inhibitory mechanisms. Here, we apply multiple computational approaches to explore, validate, and differentiate the binding modes of 25a and 25g in the EGFRTM and investigate the cooperativity effect of fluorine substituents on the inhibitory activity. Our results showed that the EGFRTM in the presence of 25g undergoes a series of conformational changes that favor inhibitor binding to both the active and allosteric sites. Further, the cooperativity effect of fluorine substituents is positive: the complex stability is increased by each additional fluorine substituent. Estimated binding free energies show good correlation with the experimental biological activity. Subsequently, the decomposition energy analysis revealed that the van der Waals interaction is the principal force contributing to variations in the binding affinities of 25a and 25g to the EGFRTM. Per-residue energy-based hierarchical clustering analysis suggests that three hot-spot residues, L718, K745, and D855, are the key in achieving optimal binding modes for 25g with higher affinity in the EGFRTM compared to 25a. This study provides a rationale for the superior EGFRTM-inhibitory potency exhibited by 25g over 25a, which is expected to be useful for the future rational structure-based design of novel EGFRTM inhibitors with improved potency and selectivity.
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Affiliation(s)
- Farideh Badichi Akher
- Department of Computer Science, University of Cape Town, Cape Town 7701, South Africa.,Department of Chemistry, University of Cape Town, Cape Town 7700, South Africa
| | - Abdolkarim Farrokhzadeh
- School of Chemistry and Physics, University of KwaZulu-Natal, Private Bag X01, Pietermaritzburg 3209, South Africa
| | - Neil Ravenscroft
- Department of Chemistry, University of Cape Town, Cape Town 7700, South Africa
| | - Michelle M Kuttel
- Department of Computer Science, University of Cape Town, Cape Town 7701, South Africa
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Wang H, Wang X, Xu L, Zhang J, Cao H. High expression levels of pyrimidine metabolic rate-limiting enzymes are adverse prognostic factors in lung adenocarcinoma: a study based on The Cancer Genome Atlas and Gene Expression Omnibus datasets. Purinergic Signal 2020; 16:347-366. [PMID: 32638267 PMCID: PMC7524999 DOI: 10.1007/s11302-020-09711-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022] Open
Abstract
Reprogramming of metabolism is described in many types of cancer and is associated with the clinical outcomes. However, the prognostic significance of pyrimidine metabolism signaling pathway in lung adenocarcinoma (LUAD) is unclear. Using the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) datasets, we found that the pyrimidine metabolism signaling pathway was significantly enriched in LUAD. Compared with normal lung tissues, the pyrimidine metabolic rate–limiting enzymes were highly expressed in lung tumor tissues. The high expression levels of pyrimidine metabolic–rate limiting enzymes were associated with unfavorable prognosis. However, purinergic receptors P2RX1, P2RX7, P2RY12, P2RY13, and P2RY14 were relatively downregulated in lung cancer tissues and were associated with favorable prognosis. Moreover, we found that hypo-DNA methylation, DNA amplification, and TP53 mutation were contributing to the high expression levels of pyrimidine metabolic rate–limiting enzymes in lung cancer cells. Furthermore, combined pyrimidine metabolic rate–limiting enzymes had significant prognostic effects in LUAD. Comprehensively, the pyrimidine metabolic rate–limiting enzymes were highly expressed in bladder cancer, breast cancer, colon cancer, liver cancer, and stomach cancer. And the high expression levels of pyrimidine metabolic rate–limiting enzymes were associated with unfavorable prognosis in liver cancer. Overall, our results suggested the mRNA levels of pyrimidine metabolic rate–limiting enzymes CAD, DTYMK, RRM1, RRM2, TK1, TYMS, UCK2, NR5C2, and TK2 were predictive of lung cancer as well as other cancers.
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Affiliation(s)
- Haiwei Wang
- Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital,, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
- Key Laboratory of Technical Evaluation of Fertility Regulation for Non-human Primate,, National Health and Family Planning Commission, Fuzhou, Fujian, China.
| | - Xinrui Wang
- Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital,, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Technical Evaluation of Fertility Regulation for Non-human Primate,, National Health and Family Planning Commission, Fuzhou, Fujian, China
| | - Liangpu Xu
- Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital,, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Key Laboratory of Technical Evaluation of Fertility Regulation for Non-human Primate,, National Health and Family Planning Commission, Fuzhou, Fujian, China
| | - Ji Zhang
- State Key Laboratory for Medical Genomics, Shanghai Institute of Hematology, Rui-Jin Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Hua Cao
- Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Health Hospital,, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
- Key Laboratory of Technical Evaluation of Fertility Regulation for Non-human Primate,, National Health and Family Planning Commission, Fuzhou, Fujian, China.
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Zhou C, Li X, Wang Q, Gao G, Zhang Y, Chen J, Shu Y, Hu Y, Fan Y, Fang J, Chen G, Zhao J, He J, Wu F, Zou J, Zhu X, Lin X. Pyrotinib in HER2-Mutant Advanced Lung Adenocarcinoma After Platinum-Based Chemotherapy: A Multicenter, Open-Label, Single-Arm, Phase II Study. J Clin Oncol 2020; 38:2753-2761. [PMID: 32614698 DOI: 10.1200/jco.20.00297] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Targeted therapies against non-small-cell lung cancer (NSCLC) harboring HER2 mutations remain an unmet need. In this study, we assessed the efficacy and safety of pyrotinib in patients with HER2-mutant advanced NSCLC in a prospective, multicenter, open-label, single-arm, phase II study. PATIENTS AND METHODS Patients with stage IIIB or IV HER2-mutant lung adenocarcinoma who were previously treated with platinum-based chemotherapy were enrolled to receive pyrotinib at a dose of 400 mg/d for 21-day cycles. The primary end point was objective response rate per independent review committee (IRC). RESULTS Between October 20, 2016, and December 10, 2018, 60 patients received pyrotinib monotherapy. At baseline, 58 (96.7%) were stage IV, and 25 (41.7%) received at least 2 lines of prior chemotherapy. As of data cutoff on June 20, 2019, IRC-assessed objective response rate was 30.0% (95% CI, 18.8% to 43.2%). All subgroups of patients with different HER2 mutation types showed a favorable objective response rate. The objective response rates were similar between patients with and without brain metastases (25.0% v 31.3%). The median duration of response was 6.9 months (95% CI, 4.9 to 11.1 months). The median progression-free survival was 6.9 months (95% CI, 5.5 to 8.3 months) per IRC. The median overall survival was 14.4 months (95% CI, 12.3 to 21.3 months). Treatment-related adverse events of grade 3 or 4 occurred in 28.3% of patients, with the most common being diarrhea (20.0%; all grade 3). No treatment-related deaths were reported. CONCLUSION Pyrotinib showed promising antitumor activity and an acceptable safety profile in chemotherapy-treated patients with HER2-mutant NSCLC.
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Affiliation(s)
- Caicun Zhou
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xingya Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Guanghui Gao
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | | | - Jianhua Chen
- Cancer Hospital of Central South University, Changsha, China
| | - Yongqian Shu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | - Yun Fan
- Zhejiang Cancer Hospital, Hangzhou, China
| | - Jian Fang
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Jun Zhao
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianxing He
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fengying Wu
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Medicine Co, Ltd, Shanghai, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Medicine Co, Ltd, Shanghai, China
| | - Xiang Lin
- Jiangsu Hengrui Medicine Co, Ltd, Shanghai, China
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121
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Li AM, Boichard A, Felip E, Kurzrock R. New therapeutic approaches to overcoming resistant EGFR exon 20 alterations. Crit Rev Oncol Hematol 2020; 151:102990. [PMID: 32485428 PMCID: PMC7416421 DOI: 10.1016/j.critrevonc.2020.102990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
EGFR exon 20 alterations are rare events seen mainly in non-small cell lung cancer (NSCLC). They include EGFR T790 and C797S mutations (associated with secondary resistance to classic EGFR tyrosine kinase inhibitors (TKIs)), and EGFR exon 20 in-frame insertions (associated with resistance to first- and second-generation EGFR TKIs). In silico modeling of structural changes in aberrant proteins has informed selection of compounds with potential clinical activity: poziotinib (whose smaller size permits access to the restricted kinase pocket created by EGFR and ERBB2 exon 20 insertions); cetuximab (an antibody that attenuates dimerization caused by EGFR exon 20 insertions), and TAK-788 (another EGFR/ERBB2 TKI). Other alterations, such as EGFR T790 M, are responsive to osimertinib, while the EGFR C797S alteration seen in osimertinib resistance demonstrates preclinical sensitivity to combined brigatinib and cetuximab. These observations indicate that clinical resistance can be overcome by utilizing advanced genomic interrogation coupled with computer modeling.
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Affiliation(s)
- Alex M Li
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Amélie Boichard
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, 3855 Health Sciences Dr, La Jolla, CA, 92093, USA.
| | - Enriqueta Felip
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 129, 08035, Barcelona, Spain.
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, 3855 Health Sciences Dr, La Jolla, CA, 92093, USA.
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122
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Tripathi SK, Pandey K, Rengasamy KRR, Biswal BK. Recent updates on the resistance mechanisms to epidermal growth factor receptor tyrosine kinase inhibitors and resistance reversion strategies in lung cancer. Med Res Rev 2020; 40:2132-2176. [PMID: 32596830 DOI: 10.1002/med.21700] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/21/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022]
Abstract
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have led to a substantial improvement in the prognosis of lung cancer patients by explicitly targeting the activating mutations within the EGFR. Initially, patients harboring tumors with EGFR mutations show progression-free survival and improvement in the response rates toward all-generation EGFR-TKIs; however, these agents fail to deliver the intended results in the long-term due to drug resistance. Therefore, it is necessary to recognize specific cardinal mechanisms that regulate the resistance phenomenon. Understanding the intricate mechanisms underlying EGFR-TKIs resistance in lung cancer could provide cognizance for more advanced targeted therapeutics. The present review features insights into current updates on the discrete mechanisms, including secondary or tertiary mutations, parallel and downstream signaling pathways, acquiring an epithelial-to-mesenchymal transition (EMT) signature, microRNAs (miRNAs), and epigenetic alterations, which lead to intrinsic and acquired resistance against EGFR-TKIs in lung cancer. In addition, this paper also reviews current possible strategies to overcome this issue using combination treatment of recently developed MET inhibitors, allosteric inhibitors or immunotherapies, transformation of EMT, targeting miRNAs, and epigenetic alterations in intrinsic and acquired EGFR-TKIs resistant lung cancer. In conclusion, multiple factors are responsible for intrinsic and acquired resistance to EGFR-TKIs and understanding of the detailed molecular mechanisms, and recent advancements in pharmacological studies are needed to develop new strategies to overcome intrinsic and acquired EGFR-TKIs resistance in lung cancer.
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Affiliation(s)
- Surya K Tripathi
- Cancer Drug Resistance Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, India
| | - Kamal Pandey
- Cancer Drug Resistance Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, India
| | - Kannan R R Rengasamy
- Department of Bioresources and Food Science, Konkuk University, Seoul, South Korea
| | - Bijesh K Biswal
- Cancer Drug Resistance Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, India
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123
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Sartori G, Belluomini L, Lombardo F, Avancini A, Trestini I, Vita E, Tregnago D, Menis J, Bria E, Milella M, Pilotto S. Efficacy and safety of afatinib for non-small-cell lung cancer: state-of-the-art and future perspectives. Expert Rev Anticancer Ther 2020; 20:531-542. [PMID: 32529917 DOI: 10.1080/14737140.2020.1776119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Afatinib is a second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, acting as an irreversible and multitarget blocker of ErbB family members. Afatinib is currently approved for advanced non-small-cell lung cancer (NSCLC) harboring common and uncommon sensitizing EGFR mutations and for squamous NSCLC patients progressing after first-line platinum-based chemotherapy. AREAS COVERED This review summarizes the efficacy and safety profile of afatinib compared with chemotherapy and other EGFR TKIs, in order to evaluate its characteristics and potential role in the increasingly complex treatment landscape of EGFR-mutant lung cancer. Future perspectives and innovative drug combinations are also discussed. EXPERT OPINION Afatinib has been demonstrated to improve efficacy and quality of life compared with chemotherapy with a managed toxicity profile. However, in recent years, the increasing availability of different treatment options for advanced EGFR-mutant NSCLC has made the current treatment scenario more complicated, with an increasing need of new and deeper scientific data. In this light, the identification and validation of potential clinicopathological and/or molecular predictors of benefit, as well as the clarification of resistance mechanisms, may help to clarify the most appropriate treatment strategies and sequences for EGFR-mutant patients.
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Affiliation(s)
- Giulia Sartori
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Lorenzo Belluomini
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Fiorella Lombardo
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Alice Avancini
- Biomedical, Clinical and Experimental Sciences, Department of Medicine, University of Verona , Verona, Italy
| | - Ilaria Trestini
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Emanuele Vita
- Medical Oncology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico Universitario 'A. Gemelli' I.R.C.C.S ., Roma, Italy
| | - Daniela Tregnago
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Jessica Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova , Padova, Italy.,Medical Oncology Department, Istituto Oncologico Veneto IRCCS , Padova, Italy
| | - Emilio Bria
- Medical Oncology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico Universitario 'A. Gemelli' I.R.C.C.S ., Roma, Italy
| | - Michele Milella
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Sara Pilotto
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
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Demircan NC, Akın Telli T, Başoğlu Tüylü T, Arıkan R, Kocakaya D, Şahin AA, Ercelep Ö, Dane F, Yumuk PF. QT interval prolongation related to afatinib treatment in a patient with metastatic non-small-cell lung cancer. Curr Probl Cancer 2020; 44:100594. [PMID: 32505368 DOI: 10.1016/j.currproblcancer.2020.100594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/28/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
Afatinib improves survival in metastatic non-small-cell lung cancer driven by activating epidermal growth factor receptor mutations. QT interval prolongation is a possible side effect of targeted anticancer drugs, but this has not been reported before with afatinib. We report a case of metastatic pulmonary adenocarcinoma with epidermal growth factor receptor exon 19 deletion who was treated with first-line afatinib. The patient was started on afatinib with a total dose of 40 mg/day and experienced grade 3 (>500 ms) QT interval prolongation in the seventh week. Dose was interrupted and then reduced to 30 mg/day after the event repeated. QT prolongation occurred only once with the reduced dose and radiologic oligoprogression was detected. Local therapy was performed and afatinib was continued as 30 mg/day. To the best of our knowledge, this case marks the first QT interval prolongation associated with afatinib. It is prudent to perform a baseline cardiologic evaluation and electrocardiogram monitoring in non-small cell lung cancer patients treated with this drug.
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Affiliation(s)
- Nazım Can Demircan
- Marmara University School of Medicine, Department of Internal Medicine, Division of Medical Oncology, Istanbul, Turkey.
| | - Tuğba Akın Telli
- Marmara University School of Medicine, Department of Internal Medicine, Division of Medical Oncology, Istanbul, Turkey
| | - Tuğba Başoğlu Tüylü
- Marmara University School of Medicine, Department of Internal Medicine, Division of Medical Oncology, Istanbul, Turkey
| | - Rukiye Arıkan
- Marmara University School of Medicine, Department of Internal Medicine, Division of Medical Oncology, Istanbul, Turkey
| | - Derya Kocakaya
- Marmara University School of Medicine, Department of Pulmonary Medicine, Istanbul, Turkey
| | - Ahmet Anıl Şahin
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Özlem Ercelep
- Marmara University School of Medicine, Department of Internal Medicine, Division of Medical Oncology, Istanbul, Turkey
| | - Faysal Dane
- Marmara University School of Medicine, Department of Internal Medicine, Division of Medical Oncology, Istanbul, Turkey
| | - Perran Fulden Yumuk
- Marmara University School of Medicine, Department of Internal Medicine, Division of Medical Oncology, Istanbul, Turkey
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Chen JA, Riess JW. Advances in targeting acquired resistance mechanisms to epidermal growth factor receptor tyrosine kinase inhibitors. J Thorac Dis 2020; 12:2859-2876. [PMID: 32642199 PMCID: PMC7330402 DOI: 10.21037/jtd.2019.08.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Next-generation sequencing (NGS) of tumor samples and circulating tumor DNA has revolutionized diagnostic and therapeutic strategies in lung cancer. The identification of the epidermal growth factor receptor (EGFR) oncogenic driver has translated into successful therapy of advanced lung cancer using EGFR tyrosine kinase inhibitors (TKI). Unfortunately, responses are limited by acquired mechanisms of resistance. We review herein the current landscape of acquired resistance mechanisms to EGFR-TKI therapy and recent advances in therapeutic strategies to overcome acquired resistance.
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Affiliation(s)
- Justin A Chen
- Department of Internal Medicine, Division of Hematology and Oncology, UC Davis School of Medicine and UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Jonathan W Riess
- Department of Internal Medicine, Division of Hematology and Oncology, UC Davis School of Medicine and UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
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126
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Zeng X, Wan X, Xu J, Wang H, Chen H, Zeng Q, Zhang W, Zhao B. Therapeutic options for advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer: a Bayesian network secondary analysis. Aging (Albany NY) 2020; 12:7129-7162. [PMID: 32324592 PMCID: PMC7202525 DOI: 10.18632/aging.103066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/29/2020] [Indexed: 04/09/2023]
Abstract
The most favorable treatments for advanced EGFR-mutant NSCLC are less indicated. Forty-one studies were eligible for this Bayesian network secondary analysis. For PFS, erlotinib (Erlo)+bevacizumab (Bev) (HR 0.26, 95% CrI: 0.08-0.75 vs placebo), osimertinib (Osi) (HR 0.29, 0.11-0.70 vs placebo), and afatinib (Afa) were top-ranking individual treatments, while immunotherapy (IT)+anti-VEGFR (aVEGFR)+platinum-based therapy (Plat) (HR 0.42, 0.06-2.63 vs placebo), EGFR-TKI (ET)+aVEGFR (HR 0.35, 0.14-0.85 vs placebo), and ET+aVEGFR+Plat were top-ranking medication classes. For OS, Osi (HR 0.52, 0.10-2.00 vs placebo), cetuximab (Cet)+Bev+Plat (HR 0.51, 0.06-3.38 vs placebo), and cilengitide (Cil)+Cet+Plat were top-ranking individual treatments, while ET+aVEGFR+Plat, ET+Plat, and third-generation EGFR-TKI (3rd ET) were top-ranking medication classes. For PFS regarding the EGFR genomic aberration status, Erlo+Bev, Osi, and Afa were superior for exon 19 deletion status, whereas ET+Bev, Osi, and gefitinib (Gef)+pemetrexed (Peme) were excellent for exon 21 L858Arg mutation status. The results were consistent in terms of the ORR and DoR and remained robust across sensitivity analyses. However, Erlo + Bev had the most grade 3 or higher adverse events. Osi, Erlo+Bev, and Erlo+Bev+Plat are reasonably recommended to balance PFS and OS, but adverse events should be considered. IT+aVEGFR+Plat shows potential superiority, but more clinical evidence is needed.
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Affiliation(s)
- Xinmin Zeng
- Department of Thoracic Surgery, Nanchang First Hospital, Nanchang 330008, China
| | - Xuan Wan
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jun Xu
- Department of Oncology, Nanchang First Hospital, Nanchang 330008, China
| | - Hui Wang
- Department of Thoracic Surgery, Nanchang First Hospital, Nanchang 330008, China
| | - Hua Chen
- Department of Thoracic Surgery, Nanchang First Hospital, Nanchang 330008, China
| | - Qinghua Zeng
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Binghao Zhao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Hamid AB, Petreaca RC. Secondary Resistant Mutations to Small Molecule Inhibitors in Cancer Cells. Cancers (Basel) 2020; 12:cancers12040927. [PMID: 32283832 PMCID: PMC7226513 DOI: 10.3390/cancers12040927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 12/14/2022] Open
Abstract
Secondary resistant mutations in cancer cells arise in response to certain small molecule inhibitors. These mutations inevitably cause recurrence and often progression to a more aggressive form. Resistant mutations may manifest in various forms. For example, some mutations decrease or abrogate the affinity of the drug for the protein. Others restore the function of the enzyme even in the presence of the inhibitor. In some cases, resistance is acquired through activation of a parallel pathway which bypasses the function of the drug targeted pathway. The Catalogue of Somatic Mutations in Cancer (COSMIC) produced a compendium of resistant mutations to small molecule inhibitors reported in the literature. Here, we build on these data and provide a comprehensive review of resistant mutations in cancers. We also discuss mechanistic parallels of resistance.
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128
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Harrison PT, Vyse S, Huang PH. Rare epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer. Semin Cancer Biol 2020; 61:167-179. [PMID: 31562956 PMCID: PMC7083237 DOI: 10.1016/j.semcancer.2019.09.015] [Citation(s) in RCA: 277] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022]
Abstract
Epidermal growth factor receptor (EGFR) mutations are the second most common oncogenic driver event in non-small cell lung cancer (NSCLC). Classical activating mutations (exon 19 deletions and the L858R point mutation) comprise the vast majority of EGFR mutations and are well defined as strong predictors for good clinical response to EGFR tyrosine kinase inhibitors (EGFRi). However, low frequency mutations including point mutations, deletions, insertions and duplications occur within exons 18-25 of the EGFR gene in NSCLC and are associated with poorer responses to EGFRi. Despite an increased uptake of more sensitive detection methods to identify rare EGFR mutations in patients, our understanding of the biology of these rare EGFR mutations is poor compared to classical mutations. In particular, clinical data focused on these mutations is lacking due to their rarity and challenges in trial recruitment, resulting in an absence of effective treatment strategies for many low frequency EGFR mutations. In this review, we describe the structural and mechanistic features of rare EGFR mutations in NSCLC and discuss the preclinical and clinical evidence for EGFRi response for individual rare EGFR mutations. We also discuss EGFRi sensitivity for complex EGFR mutations, and conclude by offering a perspective on the outstanding questions and future steps required to make advances in the treatment of NSCLC patients that harbour rare EGFR mutations.
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Affiliation(s)
- Peter T Harrison
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Simon Vyse
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Paul H Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK.
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129
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Tien Y, Tsai CL, Hou WH, Chiang Y, Hsu FM, Tsai YC, Cheng JCH. Targeting human epidermal growth factor receptor 2 enhances radiosensitivity and reduces the metastatic potential of Lewis lung carcinoma cells. Radiat Oncol 2020; 15:58. [PMID: 32143669 PMCID: PMC7060577 DOI: 10.1186/s13014-020-01493-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/14/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sublethal radiation induces matrix metalloproteinase 9 (MMP-9)-mediated radioresistance in Lewis lung carcinoma (LLC) cells and their metastatic dissemination. We aim to determine if EGFR/HER2 activation associates with MMP-9-mediated radioresistance and invasiveness in irradiated LLC cells. METHODS LLC cells were treated with erlotinib or afatinib followed by sublethal radiation. After irradiation, we examined the phosphorylation of EGFR/HER2 and MMP-9 expression. Colony formation assay determined if the kinase inhibitors sensitize LLC cells to radiation. Matrigel-coated Boyden chamber assay assessed cellular invasiveness. Resulting tumors of wild-type LLC cells or HER2 knock-down mutant cells were irradiated to induce pulmonary metastases. RESULTS Afatinib more effectively sensitized LLC cells to radiation and decreased invasiveness by inhibiting phosphorylation of EGFR, HER2, Akt, ERK, and p38, and down-regulating MMP-9 when compared to erlotinib. Afatinib abolished radiation-induced lung metastases in vivo. Furthermore, LLC HER2 knock-down cells treated with radiation had growth inhibition. CONCLUSION Dual inhibition of radiation-activated EGFR and HER2 signaling by afatinib suppressed the proliferation and invasion of irradiated LLC cells. Increased radiosensitivity and decreased metastatic dissemination were observed by pharmacological or genetic HER2 inhibition in vivo. These findings indicate that HER2 plays a pivotal role in enhancing radioresistance and reducing metastatic potential of LLC cells.
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Affiliation(s)
- Yun Tien
- Division of Radiation Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan.,Department of Psychiatry, Taoyuan Psychiatric Center, Taoyuan city, Taiwan
| | - Chiao-Ling Tsai
- Division of Radiation Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan.,Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Hsien Hou
- Department of Radiation Oncology, City of Hope Medical Center, Duarte, CA, USA
| | - Yun Chiang
- Division of Radiation Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan.,Graduate Institutes of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Feng-Ming Hsu
- Division of Radiation Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan.,Graduate Institutes of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chieh Tsai
- Graduate Institutes of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jason Chia-Hsien Cheng
- Division of Radiation Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan. .,Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. .,Graduate Institutes of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
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130
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Manabe T, Yasuda H, Terai H, Kagiwada H, Hamamoto J, Ebisudani T, Kobayashi K, Masuzawa K, Ikemura S, Kawada I, Hayashi Y, Fukui K, Horimoto K, Fukunaga K, Soejima K. IGF2 Autocrine-Mediated IGF1R Activation Is a Clinically Relevant Mechanism of Osimertinib Resistance in Lung Cancer. Mol Cancer Res 2020; 18:549-559. [PMID: 31941753 DOI: 10.1158/1541-7786.mcr-19-0956] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/18/2019] [Accepted: 01/06/2020] [Indexed: 11/16/2022]
Abstract
EGFR-mutated lung cancer accounts for a significant proportion of lung cancer cases worldwide. For these cases, osimertinib, a third-generation EGFR tyrosine kinase inhibitor, is extensively used as a first-line or second-line treatment. However, lung cancer cells acquire resistance to osimertinib in 1 to 2 years. Thus, a thorough clarification of resistance mechanisms to osimertinib is highly anticipated. Recent next-generation sequencing (NGS) of lung cancer samples identified several genetically defined resistance mechanisms to osimertinib, such as EGFR C797S or MET amplification. However, nongenetically defined mechanisms are not well evaluated. For a thorough clarification of osimertinib resistance, both genetic and nongenetic mechanisms are essential. By using our comprehensive protein phosphorylation array, we detected IGF1R bypass pathway activation after EGFR abolishment. Both of our established lung cancer cells and patient-derived lung cancer cells demonstrated IGF2 autocrine-mediated IGF1R pathway activation as a mechanism of osimertinib resistance. Notably, this resistance mechanism was not detected by a previously performed NGS, highlighting the essential roles of living cancer cells for a thorough clarification of resistance mechanisms. Interestingly, the immunohistochemical analysis confirmed the increased IGF2 expression in lung cancer patients who were treated with osimertinib and met the established clinical definition of acquired resistance. The findings highlight the crucial roles of cell-autonomous ligand expression in osimertinib resistance. Here, we report for the first time the IGF2 autocrine-mediated IGF1R activation as a nongenetic mechanism of osimertinib resistance in lung cancer at a clinically relevant level. IMPLICATIONS: Using comprehensive protein phosphorylation array and patient-derived lung cancer cells, we found that IGF2 autocrine-mediated IGF1R pathway activation is a clinically relevant and common mechanism of acquired resistance to osimertinib.
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Affiliation(s)
- Tadashi Manabe
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan.
| | - Hideki Terai
- Division of Pulmonary Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Harumi Kagiwada
- Molecular Profiling Research Center for Drug Discovery (molprof), National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
| | - Junko Hamamoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Toshiki Ebisudani
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Keigo Kobayashi
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Keita Masuzawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | | | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Yuichiro Hayashi
- Department of Diagnostic Pathology, Keio University, School of Medicine, Tokyo, Japan
| | - Kazuhiko Fukui
- Molecular Profiling Research Center for Drug Discovery (molprof), National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
| | - Katsuhisa Horimoto
- Molecular Profiling Research Center for Drug Discovery (molprof), National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
| | - Kenzo Soejima
- Division of Pulmonary Medicine, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
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131
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Yang JCH, Schuler M, Popat S, Miura S, Heeke S, Park K, Märten A, Kim ES. Afatinib for the Treatment of NSCLC Harboring Uncommon EGFR Mutations: A Database of 693 Cases. J Thorac Oncol 2020; 15:803-815. [PMID: 31931137 DOI: 10.1016/j.jtho.2019.12.126] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Limited clinical data are available regarding the efficacy of EGFR tyrosine kinase inhibitors (EGFR TKIs) in patients with NSCLC harboring uncommon EGFR mutations. This pooled analysis assessed the activity of afatinib in 693 patients with tumors harboring uncommon EGFR mutations treated in randomized clinical trials, compassionate-use and expanded-access programs, phase IIIb trials, noninterventional trials, and case series or studies. METHODS Patients had uncommon EGFR mutations, which were categorized as follows: (1) T790M; (2) exon 20 insertions; (3) "major" uncommon mutations (G719X, L861Q, and S768I, with or without any other mutation except T790M or an exon 20 insertion); (4) compound mutations; and (5) other uncommon mutations. Key end points were overall response rate (ORR), duration of response, and time to treatment failure (TTF). RESULTS In EGFR TKI-naive patients (n = 315), afatinib demonstrated activity against major uncommon mutations (median TTF = 10.8 mo; 95% confidence interval [CI]: 8.1-16.6; ORR = 60.0%), compound mutations (median TTF = 14.7 mo; 95% CI: 6.8-18.5; ORR = 77.1%), other uncommon mutations (median TTF = 4.5 mo; 95% CI: 2.9-9.7; ORR = 65.2%), and some exon 20 insertions (median TTF = 4.2 mo; 95% CI: 2.8-5.3; ORR = 24.3%). The median duration of response for major uncommon mutations, compound mutations, other uncommon mutations, and some exon 20 insertions was 17.1, 16.6, 9.0, and 11.9 months, respectively. Activity of afatinib was also observed in EGFR TKI-pretreated patients (n = 378). A searchable database of these outcomes by individual genotype was generated. CONCLUSIONS Afatinib has clinical activity in NSCLC against major uncommon and compound EGFR mutations. It also has broad activity against other uncommon EGFR mutations and some exon 20 insertions. The data support the use of afatinib in these settings.
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Affiliation(s)
| | - Martin Schuler
- West German Cancer Center, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Sanjay Popat
- Lung Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Satoru Miura
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Simon Heeke
- Laboratory of Clinical and Experimental Pathology, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France
| | - Keunchil Park
- Division of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Angela Märten
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Edward S Kim
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
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132
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Ramalingam SS, Vansteenkiste J, Planchard D, Cho BC, Gray JE, Ohe Y, Zhou C, Reungwetwattana T, Cheng Y, Chewaskulyong B, Shah R, Cobo M, Lee KH, Cheema P, Tiseo M, John T, Lin MC, Imamura F, Kurata T, Todd A, Hodge R, Saggese M, Rukazenkov Y, Soria JC. Overall Survival with Osimertinib in Untreated, EGFR-Mutated Advanced NSCLC. N Engl J Med 2020; 382:41-50. [PMID: 31751012 DOI: 10.1056/nejmoa1913662] [Citation(s) in RCA: 1504] [Impact Index Per Article: 376.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Osimertinib is a third-generation, irreversible tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR-TKI) that selectively inhibits both EGFR-TKI-sensitizing and EGFR T790M resistance mutations. A phase 3 trial compared first-line osimertinib with other EGFR-TKIs in patients with EGFR mutation-positive advanced non-small-cell lung cancer (NSCLC). The trial showed longer progression-free survival with osimertinib than with the comparator EGFR-TKIs (hazard ratio for disease progression or death, 0.46). Data from the final analysis of overall survival have not been reported. METHODS In this trial, we randomly assigned 556 patients with previously untreated advanced NSCLC with an EGFR mutation (exon 19 deletion or L858R allele) in a 1:1 ratio to receive either osimertinib (80 mg once daily) or one of two other EGFR-TKIs (gefitinib at a dose of 250 mg once daily or erlotinib at a dose of 150 mg once daily, with patients receiving these drugs combined in a single comparator group). Overall survival was a secondary end point. RESULTS The median overall survival was 38.6 months (95% confidence interval [CI], 34.5 to 41.8) in the osimertinib group and 31.8 months (95% CI, 26.6 to 36.0) in the comparator group (hazard ratio for death, 0.80; 95.05% CI, 0.64 to 1.00; P = 0.046). At 3 years, 79 of 279 patients (28%) in the osimertinib group and 26 of 277 (9%) in the comparator group were continuing to receive a trial regimen; the median exposure was 20.7 months and 11.5 months, respectively. Adverse events of grade 3 or higher were reported in 42% of the patients in the osimertinib group and in 47% of those in the comparator group. CONCLUSIONS Among patients with previously untreated advanced NSCLC with an EGFR mutation, those who received osimertinib had longer overall survival than those who received a comparator EGFR-TKI. The safety profile for osimertinib was similar to that of the comparator EGFR-TKIs, despite a longer duration of exposure in the osimertinib group. (Funded by AstraZeneca; FLAURA ClinicalTrials.gov number, NCT02296125.).
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Affiliation(s)
- Suresh S Ramalingam
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Johan Vansteenkiste
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - David Planchard
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Byoung Chul Cho
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Jhanelle E Gray
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Yuichiro Ohe
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Caicun Zhou
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Thanyanan Reungwetwattana
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Ying Cheng
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Busyamas Chewaskulyong
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Riyaz Shah
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Manuel Cobo
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Ki Hyeong Lee
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Parneet Cheema
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Marcello Tiseo
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Thomas John
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Meng-Chih Lin
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Fumio Imamura
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Takayasu Kurata
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Alexander Todd
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Rachel Hodge
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Matilde Saggese
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Yuri Rukazenkov
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
| | - Jean-Charles Soria
- From Winship Cancer Institute, Emory University School of Medicine, Atlanta (S.S.R.); the Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospital KU Leuven, Leuven, Belgium (J.V.); the Thoracic Unit, Department of Medical Oncology, Institut Gustave Roussy, Villejuif (D.P., J.-C.S.), and University Paris Sud, Orsay (J.-C.S.) - both in France; the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.) - both in South Korea; the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka (T.K.) - all in Japan; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), and the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.) - both in Thailand; Kent Oncology Centre, Maidstone Hospital, and Tunbridge Wells NHS Trust, Maidstone (R.S.), and Late Oncology Statistics (A.T., R.H.) and Oncology Research and Development (M.S., Y.R.), AstraZeneca, Cambridge - both in the United Kingdom; Hospital Regional Universitario Málaga, Instituto de Investigación Biomédica de Málaga, Malaga, Spain (M.C.); William Osler Health System, University of Toronto, Toronto (P.C.); the Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy (M.T.); the Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia (T.J.); the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (M.-C.L.); and Early Oncology Research and Development, AstraZeneca, Gaithersburg, MD (J.-C.S.)
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Abstract
The discovery of activating mutations in the epidermal growth factor receptor (EGFR) gene and development of tyrosine kinase inhibitors (TKIs) of EGFR have achieved a paradigm shift in treatment strategy of non-small cell lung cancer (NSCLC). For advanced NSCLC harboring activating EGFR mutations, an EGFR-TKI is preferably prescribed as it provides a superior survival benefit over platinum-based chemotherapy. To further improve the therapeutic outcomes, more potent EGFR-TKIs through irreversible inhibition of tyrosine kinase have been developed. In a recent clinical trial, an irreversible EGFR-TKI (osimertinib) showed a superior survival benefit with lower toxicity profile. In addition, combination treatments such as an EGFR-TKI plus platinum-based chemotherapy may achieve a long-term survival. For earlier-stage resectable NSCLC with EGFR-mutations, several clinical trials to assess the efficacy of EGFR-TKIs in pre-operative induction setting and in postoperative adjuvant setting are now ongoing. Here we review and discuss the current status and future perspectives of treatment for EGFR-mutated NSCLC.
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134
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Yuan M, Huang LL, Chen JH, Wu J, Xu Q. The emerging treatment landscape of targeted therapy in non-small-cell lung cancer. Signal Transduct Target Ther 2019; 4:61. [PMID: 31871778 PMCID: PMC6914774 DOI: 10.1038/s41392-019-0099-9] [Citation(s) in RCA: 394] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
Lung cancer is one of the most common cancer in the world. In 2018, there were over 2 million new cases of lung cancer and over 1.7 million deaths were attributed to lung cancer. Targeted therapy has emerged as an important mean of the disease management for patients with non-small-cell lung cancer (NSCLC). Herein, we review and analyze recent literature, discuss the targeting pathways and ongoing clinical trials in lung cancer. Chemotherapy is no longer the best available treatment for all patients. Therapeutic decisions should be guided by an understanding of the molecular features of patient's tumor tissues. The future gains will likely emerge from finding optimal ways of combining targeted therapy, immunotherapy, and chemotherapy.
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Affiliation(s)
- Min Yuan
- Department of Oncology, Dermatology Hospital, Tongji University School of Medicine, Shanghai, 200443 China
- Department of Oncology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072 China
| | - Li-Li Huang
- Department of Oncology, Dermatology Hospital, Tongji University School of Medicine, Shanghai, 200443 China
- Department of Oncology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072 China
| | - Jian-Hua Chen
- Department of Oncology, Dermatology Hospital, Tongji University School of Medicine, Shanghai, 200443 China
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Jie Wu
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Qing Xu
- Department of Oncology, Dermatology Hospital, Tongji University School of Medicine, Shanghai, 200443 China
- Department of Oncology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072 China
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135
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Zhang L, Zhang Z, Yu Z. Identification of a novel glycolysis-related gene signature for predicting metastasis and survival in patients with lung adenocarcinoma. J Transl Med 2019; 17:423. [PMID: 31847905 PMCID: PMC6916245 DOI: 10.1186/s12967-019-02173-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 12/06/2019] [Indexed: 12/18/2022] Open
Abstract
Background Lung cancer (LC) is one of the most lethal and most prevalent malignant tumors, and its incidence and mortality are increasing annually. Lung adenocarcinoma (LUAD) is the most common pathological type of lung cancer. Several biomarkers have been confirmed by data excavation to be related to metastasis, prognosis and survival. However, the moderate predictive effect of a single gene biomarker is not sufficient. Thus, we aimed to identify new gene signatures to better predict the possibility of LUAD. Methods Using an mRNA-mining approach, we performed mRNA expression profiling in large LUAD cohorts (n = 522) from The Cancer Genome Atlas (TCGA) database. Gene Set Enrichment Analysis (GSEA) was performed, and connections between genes and glycolysis were found in the Cox proportional regression model. Results We confirmed a set of nine genes (HMMR, B4GALT1, SLC16A3, ANGPTL4, EXT1, GPC1, RBCK1, SOD1, and AGRN) that were significantly associated with metastasis and overall survival (OS) in the test series. Based on this nine-gene signature, the patients in the test series could be divided into high-risk and low-risk groups. Additionally, multivariate Cox regression analysis revealed that the prognostic power of the nine-gene signature is independent of clinical factors. Conclusion Our study reveals a connection between the nine-gene signature and glycolysis. This research also provides novel insights into the mechanisms underlying glycolysis and offers a novel biomarker of a poor prognosis and metastasis for LUAD patients.
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Affiliation(s)
- Lei Zhang
- Department of Breast Surgery, The First Hospital Affiliated China Medical University, No. 155 Nanjing Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Zhe Zhang
- Department of Thoracic Surgery, The First Hospital Affiliated China Medical University, No. 155 Nanjing Street, Heping District, Shenyang, 110001, Liaoning, China
| | - Zhenglun Yu
- Department of Thoracic Surgery, The First Hospital Affiliated China Medical University, No. 155 Nanjing Street, Heping District, Shenyang, 110001, Liaoning, China.
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136
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Hoo WPY, Siak PY, In LLA. Overview of Current Immunotherapies Targeting Mutated KRAS Cancers. Curr Top Med Chem 2019; 19:2158-2175. [PMID: 31483231 DOI: 10.2174/1568026619666190904163524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 02/07/2023]
Abstract
The occurrence of somatic substitution mutations of the KRAS proto-oncogene is highly prevalent in certain cancer types, which often leads to constant activation of proliferative pathways and subsequent neoplastic transformation. It is often seen as a gateway mutation in carcinogenesis and has been commonly deemed as a predictive biomarker for poor prognosis and relapse when conventional chemotherapeutics are employed. Additionally, its mutational status also renders EGFR targeted therapies ineffective owing to its downstream location. Efforts to discover new approaches targeting this menacing culprit have been ongoing for years without much success, and with incidences of KRAS positive cancer patients being on the rise, researchers are now turning towards immunotherapies as the way forward. In this scoping review, recent immunotherapeutic developments and advances in both preclinical and clinical studies targeting K-ras directly or indirectly via its downstream signal transduction machinery will be discussed. Additionally, some of the challenges and limitations of various K-ras targeting immunotherapeutic approaches such as vaccines, adoptive T cell therapies, and checkpoint inhibitors against KRAS positive cancers will be deliberated.
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Affiliation(s)
- Winfrey Pui Yee Hoo
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, 56000, Kuala Lumpur, Malaysia
| | - Pui Yan Siak
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, 56000, Kuala Lumpur, Malaysia
| | - Lionel L A In
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, 56000, Kuala Lumpur, Malaysia
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137
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A Third Shot at EGFR: New Opportunities in Cancer Therapy. Trends Pharmacol Sci 2019; 40:941-955. [DOI: 10.1016/j.tips.2019.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023]
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138
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Xie J, Wang X, Ge H, Peng F, Zheng N, Wang Q, Tao L. Cx32 mediates norepinephrine-promoted EGFR-TKI resistance in a gap junction-independent manner in non-small-cell lung cancer. J Cell Physiol 2019; 234:23146-23159. [PMID: 31152452 DOI: 10.1002/jcp.28881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 01/10/2023]
Abstract
The second-generation EGFR-TKI Afatinib is an irreversible ErbB family blocker used to treat patients with non-small-cell lung cancer (NSCLC). Unfortunately, resistance to this drug develops over time, and patients are always under great psychological pressure. A previous study showed that chronic stress hormones participate in EGFR-TKI resistance via β2 -AR signaling via an IL-6 dependent mechanism. Our study further explores a novel potential underlying mechanism. In the present study, we show that the stress hormone norepinephrine (NE) promotes Afatinib resistance by upregulating Cx32 expression. Furthermore, we, for the first time, find that Cx32 is a target gene for transcription factor CREB and NE enhances Cx32 mRNA expression by activation of CREB. We also demonstrate that Cx32 promotes Afatinib resistance by decreasing the degradation of EGFR-TKI resistance-associated proteins (MET, IGF-1R) and by increasing their transcription levels. Together, these results reveal that the stress hormone NE accelerates Afatinib resistance by increasing the expression of Cx32, which augments MET and IGF-1R levels in cancer cells and provides a promising therapeutic strategy against EGFR-TKI Afatinib resistance in NSCLC.
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Affiliation(s)
- Jie Xie
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Xiyan Wang
- Tumor Research Institute, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, Xinjiang, China
| | - Hui Ge
- Tumor Research Institute, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, Xinjiang, China
| | - Fuhua Peng
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Ningze Zheng
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Qin Wang
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Liang Tao
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
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139
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Alafate W, Wang M, Zuo J, Wu W, Sun L, Liu C, Xie W, Wang J. Targeting Aurora kinase B attenuates chemoresistance in glioblastoma via a synergistic manner with temozolomide. Pathol Res Pract 2019; 215:152617. [DOI: 10.1016/j.prp.2019.152617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/15/2019] [Accepted: 08/23/2019] [Indexed: 02/01/2023]
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140
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Nanoformulations of small molecule protein tyrosine kinases inhibitors potentiate targeted cancer therapy. Int J Pharm 2019; 573:118785. [PMID: 31678384 DOI: 10.1016/j.ijpharm.2019.118785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/05/2019] [Accepted: 10/10/2019] [Indexed: 01/08/2023]
Abstract
Protein tyrosine kinases (PTKs) are closely related to tumor development and usually participate in apoptosis, DNA repair, and cell proliferation by activating signaling pathways. Therefore, PTKs have become the most promising targets for cancer therapy. In recent years, a large number of studies on the mechanism of tyrosine kinase activation have indicated that tyrosine kinase inhibitors (TKIs) have important clinical significance and application prospects as targeted anticancer drugs because they can effectively block certain cellular signaling pathways, inhibit tumor metastases and reduce tumor proliferation. Although the increasing emergence of anticancer drug resistance limits the clinical application of TKIs, emerging nanotechnology has made it possible to solve this problem. In this work, the state-of-art of small molecule protein tyrosine kinase inhibitors and the applications of drug delivery systems for TKIs are reviewed, and the potentials and challenges for future research of small molecule TKIs are addressed.
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141
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Mu Y, Xing P, Hao X, Wang Y, Li J. Real-World Data Of Osimertinib In Patients With Pretreated Non-Small Cell Lung Cancer: A Retrospective Study. Cancer Manag Res 2019; 11:9243-9251. [PMID: 31802944 PMCID: PMC6826191 DOI: 10.2147/cmar.s221434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/10/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose Osimertinib is an oral, irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) targeted for both EGFR sensitizing mutations and T790M resistance mutation in patients with non-small-cell lung cancer (NSCLC). We assessed efficacy and safety of osimertinib in patients with pretreated NSCLC in a real-world setting. Patients and methods Ninety-four patients with advanced NSCLC who received osimertinib after progression of prior EGFR-TKIs or chemotherapy treatments were retrospectively collected. Results In patients evaluable for response analysis (n = 91), overall objective response rate (ORR) was 47.3%, and disease control rate (DCR) was 90.1%. Median duration of response (DoR) in responding patients was 12.5 months (95% confidence interval [CI], 10.7 to 14.3). Median progression-free survival (PFS) was 8.5 months (95% CI, 7.4 to 9.6) in 2nd line group, 9.1 months (95% CI, 6.6 to 11.6) in ≥3rd line group, and 8.6 months (95% CI, 7.2 to 10.0) in overall population. For subgroup analysis, DCR and median PFS were 91.9% and 8.6 months (95% CI, 7.2 to 10.0) in patients with detectable T790M mutation, respectively, while 80.0% and 3.2 months (95% CI, 0.5 to 5.9) for those without. Median PFS was significantly longer for T790M-positive patients co-occurring with exon19del than with L858R (17.9 months vs 7.3 months; P<0.001). Among 45 patients with metastases to the central nervous system (CNS), median systemic PFS was 8.8 months (95% CI, 6.9 to 10.7), while intracranial time to progression (iTTP) was not reached. Safety profile was acceptable, no adverse events (AEs) related deaths was observed. Conclusion Osimertinib was highly active in patients with pretreated advanced NSCLC who harbored EGFR T790M mutation, with manageable side-effects.
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Affiliation(s)
- Yuxin Mu
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Puyuan Xing
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xuezhi Hao
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Wang
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Junling Li
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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142
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Solassol I, Pinguet F, Quantin X. FDA- and EMA-Approved Tyrosine Kinase Inhibitors in Advanced EGFR-Mutated Non-Small Cell Lung Cancer: Safety, Tolerability, Plasma Concentration Monitoring, and Management. Biomolecules 2019; 9:biom9110668. [PMID: 31671561 PMCID: PMC6921037 DOI: 10.3390/biom9110668] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 12/31/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) is the most common form of primary lung cancer. The discovery of several oncogenic driver mutations in patients with NSCLC has allowed the development of personalized treatments based on these specific molecular alterations, in particular in the tyrosine kinase (TK) domain of the epidermal growth factor receptor (EGFR) gene. Gefitinib, erlotinib, afatinib, and osimertinib are TK inhibitors (TKIs) that specifically target EGFR and are currently approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) as first line treatment for sensitive EGFR-mutant patients. However, these four drugs are associated with severe adverse events (AEs) that can significantly impact patient health-related quality of life and patient monitoring. EGFR-TKIs are commonly used together with other types of medication that can substantially interact. Here, we review approaches used for the management of TKI-AEs in patients with advanced NSCLC to promote the benefits of treatments and minimize the risk of TKI treatment discontinuation. We also consider potential TKI–drug interactions and discuss the usefulness of plasma concentration monitoring TKIs based on chromatographic and mass spectrometry approaches to guide clinical decision-making. Adjusting the most appropriate therapeutic strategies and drug doses may improve the performance therapy and prognosis of patients with advanced EGFR-mutated NSCLC.
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Affiliation(s)
- Isabelle Solassol
- Unité de Recherche Translationnelle, Institut du Cancer de Montpellier (ICM), 34000 Montpellier, France.
- Département de Pharmacie, Institut du Cancer de Montpellier (ICM), 34000 Montpellier, France.
| | - Frédéric Pinguet
- Département de Pharmacie, Institut du Cancer de Montpellier (ICM), 34000 Montpellier, France.
| | - Xavier Quantin
- Service d'Oncologie Médicale, Institut du Cancer de Montpellier (ICM), IRCM, INSERM, Univ. Montpellier, 34000 Montpellier, France.
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Vansteenkiste J, Wauters E. Tyrosine kinase inhibition of EGFR: a successful history of targeted therapy for NSCLC since 20 years. Ann Oncol 2019; 29:i1-i2. [PMID: 29462258 DOI: 10.1093/annonc/mdx724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Vansteenkiste
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - E Wauters
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Leuven, Belgium
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Hsu WH, Yang JCH, Mok TS, Loong HH. Overview of current systemic management of EGFR-mutant NSCLC. Ann Oncol 2019; 29:i3-i9. [PMID: 29462253 DOI: 10.1093/annonc/mdx702] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Front-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) therapy is the standard of care for lung cancer patients with sensitising EGFR mutations (exon 19 deletion or L858R mutation). Several phase III studies have demonstrated the superiority of gefitinib, erlotinib (first generation of TKIs) or afatinib (second generation) to chemotherapy in progression-free survival and response rates. Drug-related toxicities, such as diarrhoea, acneiform skin rash, mucositis, and paronychia, are frequently encountered in patients who receive EGFR TKIs. Other rare side-effects, such as hepatic impairment and interstitial lung disease, should be identified early and managed carefully. Patients with uncommon EGFR mutations, such as G719X, S768I, and L861Q, may require special selection of EGFR TKIs. The combination of erlotinib plus bevacizumab has been accepted in certain parts of the world as an alternative front-line treatment. This review article summarizes the studies leading to the establishment of EGFR TKIs in EGFR-mutant lung cancer patients. The side-effect profiles of the current EGFR TKIs in these large trials are listed, and the management of uncommon EGFR mutations is discussed. Finally, the potential role of combination front-line treatment is discussed.
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Affiliation(s)
- W-H Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - J C-H Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - T S Mok
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - H H Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
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Lategahn J, Keul M, Klövekorn P, Tumbrink HL, Niggenaber J, Müller MP, Hodson L, Flaßhoff M, Hardick J, Grabe T, Engel J, Schultz-Fademrecht C, Baumann M, Ketzer J, Mühlenberg T, Hiller W, Günther G, Unger A, Müller H, Heimsoeth A, Golz C, Blank-Landeshammer B, Kollipara L, Zahedi RP, Strohmann C, Hengstler JG, van Otterlo WAL, Bauer S, Rauh D. Inhibition of osimertinib-resistant epidermal growth factor receptor EGFR-T790M/C797S. Chem Sci 2019; 10:10789-10801. [PMID: 31857889 PMCID: PMC6886544 DOI: 10.1039/c9sc03445e] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/03/2019] [Indexed: 11/21/2022] Open
Abstract
We present inhibitors of drug resistant mutants of EGFR including T790M and C797S. In addition, we present the first X-ray crystal structures of covalent inhibitors in complex with C797S-mutated EGFR to gain insight into their binding mode.
Precision medicine has revolutionized the treatment of patients in EGFR driven non-small cell lung cancer (NSCLC). Targeted drugs show high response rates in genetically defined subsets of cancer patients and markedly increase their progression-free survival as compared to conventional chemotherapy. However, recurrent acquired drug resistance limits the success of targeted drugs in long-term treatment and requires the constant development of novel efficient inhibitors of drug resistant cancer subtypes. Herein, we present covalent inhibitors of the drug resistant gatekeeper mutant EGFR-L858R/T790M based on the pyrrolopyrimidine scaffold. Biochemical and cellular characterization, as well as kinase selectivity profiling and western blot analysis, substantiate our approach. Moreover, the developed compounds possess high activity against multi drug resistant EGFR-L858R/T790M/C797S in biochemical assays due to their highly reversible binding character, that was revealed by characterization of the binding kinetics. In addition, we present the first X-ray crystal structures of covalent inhibitors in complex with C797S-mutated EGFR which provide detailed insight into their binding mode.
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Affiliation(s)
- Jonas Lategahn
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Marina Keul
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Philip Klövekorn
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Hannah L Tumbrink
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Janina Niggenaber
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Matthias P Müller
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Luke Hodson
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Department of Chemistry and Polymer Science , Stellenbosch University , Private Bag X1 , Matieland 7602 , South Africa
| | - Maren Flaßhoff
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Julia Hardick
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Tobias Grabe
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
| | - Julian Engel
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | | | - Matthias Baumann
- Lead Discovery Center GmbH , Otto-Hahn-Strasse 15 , 44227 Dortmund , Germany
| | - Julia Ketzer
- Department of Medical Oncology , Sarcoma Center , West German Cancer Center , University Duisburg-Essen , Medical School , Hufelandstrasse 55 , 45122 Essen , Germany.,German Cancer Consortium (DKTK) , 69120, Heidelberg , Germany
| | - Thomas Mühlenberg
- Department of Medical Oncology , Sarcoma Center , West German Cancer Center , University Duisburg-Essen , Medical School , Hufelandstrasse 55 , 45122 Essen , Germany.,German Cancer Consortium (DKTK) , 69120, Heidelberg , Germany
| | - Wolf Hiller
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Georgia Günther
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) , TU Dortmund University , Ardeystrasse 67 , 44139 Dortmund , Germany
| | - Anke Unger
- Lead Discovery Center GmbH , Otto-Hahn-Strasse 15 , 44227 Dortmund , Germany
| | - Heiko Müller
- Lead Discovery Center GmbH , Otto-Hahn-Strasse 15 , 44227 Dortmund , Germany
| | - Alena Heimsoeth
- Molecular Pathology , Institute of Pathology , University Hospital of Cologne , Kerpener Strasse 62 , 50937 Cologne , Germany.,Department of Translational Genomics , Center of Integrated Oncology Cologne-Bonn , Medical Faculty , University of Cologne , Weyertal 115b , 50931 Cologne , Germany
| | - Christopher Golz
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Bernhard Blank-Landeshammer
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V. , Otto-Hahn-Strasse 6b , 44227 Dortmund , Germany
| | - Laxmikanth Kollipara
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V. , Otto-Hahn-Strasse 6b , 44227 Dortmund , Germany
| | - René P Zahedi
- Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V. , Otto-Hahn-Strasse 6b , 44227 Dortmund , Germany.,Segal Cancer Proteomics Centre , Lady Davis Institute , Jewish General Hospital , McGill University , 3755 Côte Ste-Catherine Road , Montreal , Quebec H3T 1E2 , Canada
| | - Carsten Strohmann
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080
| | - Jan G Hengstler
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) , TU Dortmund University , Ardeystrasse 67 , 44139 Dortmund , Germany
| | - Willem A L van Otterlo
- Department of Chemistry and Polymer Science , Stellenbosch University , Private Bag X1 , Matieland 7602 , South Africa
| | - Sebastian Bauer
- Department of Medical Oncology , Sarcoma Center , West German Cancer Center , University Duisburg-Essen , Medical School , Hufelandstrasse 55 , 45122 Essen , Germany.,German Cancer Consortium (DKTK) , 69120, Heidelberg , Germany
| | - Daniel Rauh
- Faculty of Chemistry and Chemical Biology , TU Dortmund University , Otto-Hahn-Strasse 4a , 44227 Dortmund , Germany . ; www.twitter.com/DDHDortmund ; Tel: +49-231-755-7080.,Drug Discovery Hub Dortmund (DDHD), Zentrum für Integrierte Wirkstoffforschung (ZIW) , 44227 Dortmund , Germany
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Dercle L, Connors DE, Tang Y, Adam SJ, Gönen M, Hilden P, Karovic S, Maitland M, Moskowitz CS, Kelloff G, Zhao B, Oxnard GR, Schwartz LH. Vol-PACT: A Foundation for the NIH Public-Private Partnership That Supports Sharing of Clinical Trial Data for the Development of Improved Imaging Biomarkers in Oncology. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652552 DOI: 10.1200/cci.17.00137] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To develop a public-private partnership to study the feasibility of a new approach in collecting and analyzing clinically annotated imaging data from landmark phase III trials in advanced solid tumors. PATIENTS AND METHODS The collection of clinical trials fulfilled the following inclusion criteria: completed randomized trials of > 300 patients, highly measurable solid tumors (non-small-cell lung cancer, colorectal cancer, renal cell cancer, and melanoma), and required sponsor and institutional review board sign-offs. The new approach in analyzing computed tomography scans was to transfer to an academic image analysis laboratory, draw contours semi-automatically by using in-house-developed algorithms integrated into the open source imaging platform Weasis, and perform serial volumetric measurement. RESULTS The median duration of contracting with five sponsors was 12 months. Ten trials in 7,085 patients that covered 12 treatment regimens across 20 trial arms were collected. To date, four trials in 3,954 patients were analyzed. Source imaging data were transferred to the academic core from 97% of trial patients (n = 3,837). Tumor imaging measurements were extracted from 82% of transferred computed tomography scans (n = 3,162). Causes of extraction failure were nonmeasurable disease (n = 392), single imaging time point (n = 224), and secondary captured images (n = 59). Overall, clinically annotated imaging data were extracted in 79% of patients (n = 3,055), and the primary trial end point analysis in each trial remained representative of each original trial end point. CONCLUSION The sharing and analysis of source imaging data from large randomized trials is feasible and offer a rich and reusable, but largely untapped, resource for future research on novel trial-level response and progression imaging metrics.
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Affiliation(s)
- Laurent Dercle
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Dana E Connors
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Ying Tang
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Stacey J Adam
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Mithat Gönen
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Patrick Hilden
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Sanja Karovic
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Michael Maitland
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Chaya S Moskowitz
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Gary Kelloff
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Binsheng Zhao
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Geoffrey R Oxnard
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Lawrence H Schwartz
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Gelatti ACZ, Drilon A, Santini FC. Optimizing the sequencing of tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC). Lung Cancer 2019; 137:113-122. [PMID: 31568888 DOI: 10.1016/j.lungcan.2019.09.017] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 12/18/2022]
Abstract
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for 80-85% of cases. Epidermal growth factor receptor (EGFR) mutations are observed in approximately 40% and 20% of patients with NSCLC in Asian and non-Asian populations, respectively. First-generation (gefitinib, erlotinib) and second-generation (afatinib, dacomitinib) EGFR-tyrosine kinase inhibitors (TKIs) have been standard-of-care (SoC) first-line treatment for patients with sensitizing EGFR mutation positive advanced NSCLC following Phase III trials versus platinum-based doublet chemotherapy. However, most patients treated with first-line first- or second-generation EGFR-TKIs develop resistance. Osimertinib, a third-generation, central nervous system active EGFR-TKI which potently and selectively inhibits both EGFR-TKI sensitizing (EGFRm) and the most common EGFR T790 M resistance mutations, has shown superior efficacy versus first-generation EGFR-TKIs (gefitinib / erlotinib). Osimertinib is now a treatment option for patients with advanced NSCLC harboring EGFRm in the first-line setting, and treatment of choice for patients with T790 M positive NSCLC following disease progression on first-line EGFR-TKIs. The second-generation EGFR-TKI dacomitinib has also recently been approved for the first-line treatment of EGFRm positive metastatic NSCLC. There remains a need to determine appropriate sequencing of EGFR-TKIs in this setting, including EGFR-TKIs as monotherapy or in combination with other TKIs / signaling pathway inhibitors. This review considers the evolving role of sequencing treatments to maximize benefits for patients with EGFRm positive advanced NSCLC.
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Affiliation(s)
- Ana C Z Gelatti
- Grupo Oncoclínicas, Porto Alegre, Brazil; Grupo Brasileiro de Oncologia Torácica (GBOT), Brazil.
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
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148
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Abstract
The article discusses the basic properties of fluorine atom that have made it so useful in drug development. It presents several examples of therapeutically useful drugs acting against many life-threatening diseases along with the mechanism as to how fluorine influences the drug activity. It has been pointed out that fluorine, due to its ability to increase the lipophilicity of the molecule, greatly affects the hydrophobic interaction between the drug molecule and the receptor. Because of its small size, it hardly produces any steric effect, rather due to electronic properties enters into electrostatic and hydrogen-bond interactions. Thus, it greatly affects the drug-receptor interaction and leads to increase the activity of the drugs.
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Affiliation(s)
- Satya Prakash Gupta
- Department of Pharmaceutical Technology, Meerut Institute of Engineering and Technology, Meerut 250005, India
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149
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Lin A, Wei T, Meng H, Luo P, Zhang J. Role of the dynamic tumor microenvironment in controversies regarding immune checkpoint inhibitors for the treatment of non-small cell lung cancer (NSCLC) with EGFR mutations. Mol Cancer 2019; 18:139. [PMID: 31526368 PMCID: PMC6745797 DOI: 10.1186/s12943-019-1062-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022] Open
Abstract
Immunotherapy has been incorporated into the first- and second-line treatment strategies for non-small cell lung cancer (NSCLC), profoundly ushering in a new treatment landscape. However, both adaptive signaling and oncogenic (epidermal growth factor receptor (EGFR)-driven) signaling may induce PD-L1 upregulation in NSCLC. Nevertheless, the superiority of immune checkpoint inhibitors (ICIs) in advanced EGFR-mutant NSCLC is only moderate. ICIs appear to be well tolerated, but clinical activity for some advanced EGFR-mutant NSCLC patients has only been observed in a small proportion of trials. Hence, there are still several open questions about PD-L1 axis inhibitors in patients with NSCLC whose tumors harbor EGFR mutations, such as the effect of EGFR tyrosine kinase inhibitors (TKIs) or EGFR mutations in the tumor microenvironment (TME). Finding the answers to these questions requires ongoing trials and preclinical studies to identify the mechanisms explaining this possible increased susceptibility and to identify prognostic molecular and clinical markers that may predict benefits with PD-1 axis inhibition in this specific NSCLC subpopulation. The presence of multiple mechanisms, including dynamic immune TME profiles, changes in PD-L1 expression and low tumor mutational burdens, may explain the conflicting data regarding the correlation between PD-L1 axis inhibitors and EGFR mutation status. We conducted a review of this currently controversial topic in an attempt to aid in the decision-making process.
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Affiliation(s)
- Anqi Lin
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, China
| | - Ting Wei
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, China
| | - Hui Meng
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, China
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, China.
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, Guangdong, China.
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150
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Thongprasert S, Geater SL, Clement D, Abdelaziz A, Reyes-Igama J, Jovanovic D, Alexandru A, Schenker M, Sriuranpong V, Serwatowski P, Suresh S, Cseh A, Gaafar R. Afatinib in locally advanced/metastatic NSCLC harboring common EGFR mutations, after chemotherapy: a Phase IV study. Lung Cancer Manag 2019; 8:LMT15. [PMID: 31807143 PMCID: PMC6891940 DOI: 10.2217/lmt-2019-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim The current study evaluated the efficacy and tolerability of second-line afatinib in patients with EGFR mutation-positive (EGFRm+) non-small-cell lung cancer (NSCLC) following chemotherapy. Patients & methods In this open-label, single-arm Phase IV study, patients with EGFRm+ (Del19/L858R) NSCLC who had progressed following platinum-based chemotherapy received afatinib (starting dose 40 mg/day). The primary end point was confirmed objective response. Results 60 patients received afatinib for a median duration of 11.5 months. 50% of patients had a confirmed objective response, of median duration 13.8 months. Median progression-free survival was 10.9 months. The most common treatment-related adverse events were diarrhea (72%), rash (28%) and paronychia (23%). Conclusion Our data support the use of afatinib (40 mg/day) as an effective and well-tolerated second-line treatment in EGFRm+ NSCLC.
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Affiliation(s)
- Sumitra Thongprasert
- Medical Oncology Unit, Wattanosoth Hospital & Bangkok Hospital Chiang Mai (BDMS), Chiang Mai 50000, Thailand
| | - Sarayut L Geater
- Department of Internal Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla 90110, Thailand
| | - Dana Clement
- Medical Oncology Department, Regional Oncology Institute of Iasi, Iasi 700483, Romania
| | - Amr Abdelaziz
- Clinical Oncology Department, Alexandria Clinical Research Centre, Alexandria University, Alexandria 21131, Egypt
| | - Jasmin Reyes-Igama
- Department of Internal Medicine, Hematology & Oncology, Baguio General Hospital & Medical Center, Baguio City, 2600 Benguet, Philippines
| | - Dragana Jovanovic
- Clinic for Pulmonology, Clinical Center Serbia, Belgrade 11000, Serbia
| | - Aurelia Alexandru
- Medical Oncology II Department, Oncology Institute of Bucharest, Bucharest 022328, Romania
| | | | - Virote Sriuranpong
- Department of Medicine, Faculty of Medicine, Chulalongkorn University & The King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Piotr Serwatowski
- Department of Clinical Oncology & Chemotherapy, Specialist Hospital, Szczecin-Zdunowo 70-891, Poland
| | - Sheethal Suresh
- Oncology Department, Boehringer Ingelheim Pharmaceuticals, Inc., Singapore 199555, Republic of Singapore
| | - Agnieszka Cseh
- Medical Department, Boehringer Ingelheim RCV GmbH & Co. KG, Vienna 1120, Austria
| | - Rabab Gaafar
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
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