151
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Characteristics and Outcome of ROS1-Positive Non–Small Cell Lung Cancer Patients in Routine Clinical Practice. J Thorac Oncol 2018; 13:1373-1382. [DOI: 10.1016/j.jtho.2018.05.026] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 10/14/2022]
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152
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Zhou S, Zuo L, He X, Pi J, Jin J, Shi Y. Efficacy and safety of rh-endostatin (Endostar) combined with pemetrexed/cisplatin followed by rh-endostatin plus pemetrexed maintenance in non-small cell lung cancer: A retrospective comparison with standard chemotherapy. Thorac Cancer 2018; 9:1354-1360. [PMID: 30152052 PMCID: PMC6209785 DOI: 10.1111/1759-7714.12827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/04/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022] Open
Abstract
Background Recombinant human endostatin (rh‐endostatin) plus standard chemotherapy in advanced non‐small cell lung cancer (NSCLC) patients has shown improved efficacy; however, it is unclear whether it is effective and safe when added to pemetrexed/cisplatin and used as maintenance therapy. Methods We retrospectively evaluated the data of untreated NSCLC patients administered rh‐endostatin plus pemetrexed/cisplatin or pemetrexed/cisplatin. The primary endpoint was progression‐free survival (PFS). Results Fifty‐six and 39 patients received rh‐endostatin plus pemetrexed/cisplatin and pemetrexed/cisplatin, and 34 and 29 underwent maintenance treatment, respectively. The median PFS was 10 months (95% confidence interval [CI] 5.85–14.15) in the rh‐endostatin and 8.2 months (4.04–12.36) in the chemotherapy group, but the difference was not statistically significant (P = 0.13). In patients administered maintenance treatment, rh‐endostatin plus pemetrexed was associated with prolonged PFS compared to single‐agent pemetrexed when PFS was calculated from first dosing (13.7 [9.41–17.99] vs. 8.2 [4.16–12.24]; P = 0.032); however, PFS did not differ between the groups (hazard ratio 0.618; 95% CI 0.368–1.038; P = 0.069) after adjusting for clinical factors. No difference was observed in the objective response rate between the groups (48.2% vs. 38.5%; P = 0.346), with the exception of men (62.1% vs. 33.3%; P = 0.032) or in the incidence of drug‐related or grade 3–4 adverse events. Conclusion In previously untreated, advanced‐stage NSCLC patients, first‐line treatment with pemetrexed/cisplatin plus rh‐endostatin did not prolong PFS or overall survival when compared to pemetrexed/cisplatin, but a trend of improved PFS was observed in patients administered maintenance rh‐endostatin plus pemetrexed.
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Affiliation(s)
- Shengyu Zhou
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lijie Zuo
- Department of Medical Oncology, Beijing Sanhuan Cancer Hospital, Beijing, China
| | - Xiaohui He
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinping Pi
- Department of Medical Oncology, Beijing Sanhuan Cancer Hospital, Beijing, China
| | - Jun Jin
- Department of Medical Oncology, Beijing Sanhuan Cancer Hospital, Beijing, China
| | - Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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153
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Mahmud F, Jeon OC, Alam F, Maharjan R, Choi JU, Park J, Lee S, Park JW, Lee DS, Byun Y. Oral pemetrexed facilitates low-dose metronomic therapy and enhances antitumor efficacy in lung cancer. J Control Release 2018; 284:160-170. [DOI: 10.1016/j.jconrel.2018.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/12/2018] [Indexed: 01/03/2023]
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154
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Carmichael JA, Wing-San Mak D, O'Brien M. A Review of Recent Advances in the Treatment of Elderly and Poor Performance NSCLC. Cancers (Basel) 2018; 10:E236. [PMID: 30021993 PMCID: PMC6070834 DOI: 10.3390/cancers10070236] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/20/2018] [Accepted: 06/30/2018] [Indexed: 12/31/2022] Open
Abstract
Until recently, chemotherapy has remained the mainstay of treatment for the majority of patients with advanced non-small cell lung cancer (NSCLC). Excellent responses have been observed with immune-checkpoint inhibitors, and targeted treatments for those tumours with actionable mutations, resulting in a paradigm shift in the treatment approach for these patients. Elderly patients and those with poor performance status (PS), such as Eastern Cooperative Oncology Group (ECOG) 2, have historically been excluded from clinical trials due to poor outcomes. There is therefore a lack of data to define the optimal treatment strategy for these patients. Due to improved tolerability of novel therapies, inclusion of these patients in clinical trials has increased, and sub-group analyses have identified many treatments demonstrating potential activity. Here, we summarise key recent advances in the treatment of NSCLC, specifically evaluating their efficacy and tolerability in these patient cohorts.
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Affiliation(s)
| | - Daisy Wing-San Mak
- Queen Elizabeth Hospital, 30 Gascoigne Road, Yau Ma Tei, Hong Kong, China.
| | - Mary O'Brien
- Lung Unit, Royal Marsden Hospital, Downs Rd, Sutton, Surrey SM2 5PT, UK.
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155
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Hsu CY, Chen CH, Hsu KN, Lu YH. A useful design utilizing the information fraction in a group sequential clinical trial with censored survival data. Biometrics 2018; 75:133-143. [PMID: 30004574 DOI: 10.1111/biom.12925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/01/2018] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
Abstract
Lan and DeMets (1983) proposed the alpha spending function for group sequential trials to permit the use of unspecified frequencies and timings of interim analyses in the trial design. Regarding a trial with censored time to endpoint, Lan and DeMets (1989) later defined information time at an interim analysis in a maximum duration trial. To compare two survival curves utilizing such a design, information times for group sequential logrank and Wilcoxon-type statistics have been developed by assuming that the survival time follows an exponential distribution or a Weibull distribution without considering the censoring distribution. To better address the practical concerns inherent in clinical trials with survival endpoints, we present a new approach to adequately design a group sequential trial using the Harrington-Fleming (1982) test based on our proposed information fractions by assuming the censoring distribution depends on the patient's accrual time according to various entry distributions and by extending the underlying survival distribution to the generalized gamma distribution. We also determine associated sample sizes, expected number of events and expected stopping time. Two phase III trials of non-small-cell lung cancer originally designed using fixed-sample tests are utilized to illustrate the potential advantages of using a group sequential design with the proposed approach. This enhanced method facilitates the design and analysis of group sequential clinical trials studying survival endpoints by increasing implemental flexibility.
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Affiliation(s)
- Chih-Yuan Hsu
- Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan, Republic of China
| | - Chen-Hsin Chen
- Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan, Republic of China.,Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei 10055, Taiwan, Republic of China
| | - Ken-Ning Hsu
- Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan, Republic of China
| | - Ya-Hung Lu
- Institute of Statistical Science, Academia Sinica, Taipei 11529, Taiwan, Republic of China
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156
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Indian consensus statement for treatment of advanced non small cell lung cancer: First line, maintenance, and second line. Indian J Cancer 2018; 54:89-103. [PMID: 29199671 DOI: 10.4103/ijc.ijc_136_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming complex with the identification of driver mutations and targeted therapies. The expert group of academic medical oncologists used data from published literature, practical experience to arrive at practical consensus recommendations to treat advanced NSCLC for use by the community oncologists.
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157
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Park CK, Oh IJ, Kim YC. What is Currently the Best for Adenocarcinoma without Driver Mutation? Tuberc Respir Dis (Seoul) 2018; 81:258-259. [PMID: 29926553 PMCID: PMC6030658 DOI: 10.4046/trd.2018.0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/20/2018] [Accepted: 05/09/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Cheol Kyu Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - In Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea.
| | - Young Chul Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.,Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea
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158
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Daaboul N, Nicholas G, Laurie SA. Algorithm for the treatment of advanced or metastatic squamous non-small-cell lung cancer: an evidence-based overview. ACTA ACUST UNITED AC 2018; 25:S77-S85. [PMID: 29910650 DOI: 10.3747/co.25.3792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The treatment of squamous non-small-cell lung cancer (nsclc) is evolving. In the past, the backbone of treatment was chemotherapy, with very few other options available. Fortunately, that situation is changing, especially with a better understanding of tumour biology. Various strategies have been tried to improve patient outcomes. The most notable advance must be immunotherapy, which has revolutionized the treatment paradigm for lung cancer in patients without a driver mutation. Immunotherapy is now the treatment of choice in patients who have progressed after chemotherapy and is replacing chemotherapy as upfront therapy in a selected population. Other strategies have also been tried, such as the addition of targeted therapy to chemotherapy. Targeted agents include ramucirumab, an inhibitor of vascular endothelial growth factor receptor 2, and necitumumab, a monoclonal antibody against epithelial growth factor receptor. Recently, advances in molecular profiling have also been applied to tumours of squamous histology, in which multiple genetic alterations, including mutations and amplifications, have been described. Research is actively seeking targetable mutations and testing various therapies in the hopes of further improving prognosis for patients with squamous nsclc. Here, we review the various advances in the treatment of squamous nsclc and present a proposed treatment algorithm based on current evidence.
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Affiliation(s)
- N Daaboul
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - G Nicholas
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - S A Laurie
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
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159
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Blumenthal DT, Gorlia T, Gilbert MR, Kim MM, Burt Nabors L, Mason WP, Hegi ME, Zhang P, Golfinopoulos V, Perry JR, Hyun Nam D, Erridge SC, Corn BW, Mirimanoff RO, Brown PD, Baumert BG, Mehta MP, van den Bent MJ, Reardon DA, Weller M, Stupp R. Is more better? The impact of extended adjuvant temozolomide in newly diagnosed glioblastoma: a secondary analysis of EORTC and NRG Oncology/RTOG. Neuro Oncol 2018; 19:1119-1126. [PMID: 28371907 DOI: 10.1093/neuonc/nox025] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Radiation with concurrent and adjuvant (6 cycles) temozolomide (TMZ) is the established standard of postsurgical care for newly diagnosed glioblastoma (GBM). This regimen has been adopted with variations, including extending TMZ beyond 6 cycles. The optimal duration of maintenance therapy remains controversial. Methods We performed pooled analysis of individual patient data from 4 randomized trials for newly diagnosed GBM. All patients who were progression free 28 days after cycle 6 were included. The decision to continue TMZ was per local practice and standards, and at the discretion of the treating physician. Patients were grouped into those treated with 6 cycles and those who continued beyond 6 cycles. Progression-free and overall survival were compared, adjusted by age, performance status, resection extent, and MGMT methylation. Results A total of 2214 GBM patients were included in the 4 trials. Of these, 624 qualified for analysis 291 continued maintenance TMZ until progression or up to 12 cycles, while 333 discontinued TMZ after 6 cycles. Adjusted for prognostic factors, treatment with more than 6 cycles of TMZ was associated with a somewhat improved progression-free survival (hazard ratio [HR] 0.80 [0.65-0.98], P = .03), in particular for patients with methylated MGMT (n = 342, HR 0.65 [0.50-0.85], P < .01). However, overall survival was not affected by the number of TMZ cycles (HR = 0.92 [0.71-1.19], P = .52), including the MGMT methylated subgroup (HR = 0.89 [0.63-1.26], P = .51). Conclusions Continuing TMZ beyond 6 cycles was not shown to increase overall survival for newly diagnosed GBM.
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Affiliation(s)
- Deborah T Blumenthal
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Thierry Gorlia
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Mark R Gilbert
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Michelle M Kim
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - L Burt Nabors
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Warren P Mason
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Monika E Hegi
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Peixin Zhang
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Vassilis Golfinopoulos
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - James R Perry
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Do Hyun Nam
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Sara C Erridge
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Benjamin W Corn
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - René O Mirimanoff
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Paul D Brown
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Brigitta G Baumert
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Minesh P Mehta
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Martin J van den Bent
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - David A Reardon
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Michael Weller
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
| | - Roger Stupp
- Tel-Aviv Sourasky Medical Center, Tel-Aviv University; European Organization for Research and Treatment of Cancer, Brussels (EORTC); National Institutes of Health (M.R.M.); University of Alabama at Birmingham; Princess Margaret Cancer Centre, University of Toronto; Lausanne University Hospital; NRG Oncology Statistics and Data Management Center; Odette Cancer Centre and Sunnybrook Health Sciences Centre, University of Toronto; Samsung Medical Center, Sungkyunkwan University School of Medicine; Edinburgh Cancer Centre; Mayo Clinic; Robert-Janker Clinic at the University of Bonn Medical Centre, and MAASTRO clinic, GROW School for Oncology, Maastricht University Medical Centre; Miami Cancer Institute; Erasmus University Hospital; Dana-Farber Cancer Institute and Harvard Medical School; University of Zurich
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160
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Gandhi L, Rodríguez-Abreu D, Gadgeel S, Esteban E, Felip E, De Angelis F, Domine M, Clingan P, Hochmair MJ, Powell SF, Cheng SYS, Bischoff HG, Peled N, Grossi F, Jennens RR, Reck M, Hui R, Garon EB, Boyer M, Rubio-Viqueira B, Novello S, Kurata T, Gray JE, Vida J, Wei Z, Yang J, Raftopoulos H, Pietanza MC, Garassino MC. Pembrolizumab plus Chemotherapy in Metastatic Non-Small-Cell Lung Cancer. N Engl J Med 2018; 378:2078-2092. [PMID: 29658856 DOI: 10.1056/nejmoa1801005] [Citation(s) in RCA: 4214] [Impact Index Per Article: 702.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND First-line therapy for advanced non-small-cell lung cancer (NSCLC) that lacks targetable mutations is platinum-based chemotherapy. Among patients with a tumor proportion score for programmed death ligand 1 (PD-L1) of 50% or greater, pembrolizumab has replaced cytotoxic chemotherapy as the first-line treatment of choice. The addition of pembrolizumab to chemotherapy resulted in significantly higher rates of response and longer progression-free survival than chemotherapy alone in a phase 2 trial. METHODS In this double-blind, phase 3 trial, we randomly assigned (in a 2:1 ratio) 616 patients with metastatic nonsquamous NSCLC without sensitizing EGFR or ALK mutations who had received no previous treatment for metastatic disease to receive pemetrexed and a platinum-based drug plus either 200 mg of pembrolizumab or placebo every 3 weeks for 4 cycles, followed by pembrolizumab or placebo for up to a total of 35 cycles plus pemetrexed maintenance therapy. Crossover to pembrolizumab monotherapy was permitted among the patients in the placebo-combination group who had verified disease progression. The primary end points were overall survival and progression-free survival, as assessed by blinded, independent central radiologic review. RESULTS After a median follow-up of 10.5 months, the estimated rate of overall survival at 12 months was 69.2% (95% confidence interval [CI], 64.1 to 73.8) in the pembrolizumab-combination group versus 49.4% (95% CI, 42.1 to 56.2) in the placebo-combination group (hazard ratio for death, 0.49; 95% CI, 0.38 to 0.64; P<0.001). Improvement in overall survival was seen across all PD-L1 categories that were evaluated. Median progression-free survival was 8.8 months (95% CI, 7.6 to 9.2) in the pembrolizumab-combination group and 4.9 months (95% CI, 4.7 to 5.5) in the placebo-combination group (hazard ratio for disease progression or death, 0.52; 95% CI, 0.43 to 0.64; P<0.001). Adverse events of grade 3 or higher occurred in 67.2% of the patients in the pembrolizumab-combination group and in 65.8% of those in the placebo-combination group. CONCLUSIONS In patients with previously untreated metastatic nonsquamous NSCLC without EGFR or ALK mutations, the addition of pembrolizumab to standard chemotherapy of pemetrexed and a platinum-based drug resulted in significantly longer overall survival and progression-free survival than chemotherapy alone. (Funded by Merck; KEYNOTE-189 ClinicalTrials.gov number, NCT02578680 .).
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/secondary
- Disease-Free Survival
- Double-Blind Method
- Female
- Follow-Up Studies
- Humans
- Kaplan-Meier Estimate
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Male
- Middle Aged
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Affiliation(s)
- Leena Gandhi
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Delvys Rodríguez-Abreu
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Shirish Gadgeel
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Emilio Esteban
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Enriqueta Felip
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Flávia De Angelis
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Manuel Domine
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Philip Clingan
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Maximilian J Hochmair
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Steven F Powell
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Susanna Y-S Cheng
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Helge G Bischoff
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Nir Peled
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Francesco Grossi
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Ross R Jennens
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Martin Reck
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Rina Hui
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Edward B Garon
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Michael Boyer
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Belén Rubio-Viqueira
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Silvia Novello
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Takayasu Kurata
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Jhanelle E Gray
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - John Vida
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Ziwen Wei
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Jing Yang
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Harry Raftopoulos
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - M Catherine Pietanza
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
| | - Marina C Garassino
- From NYU Perlmutter Cancer Center, New York (L.G.); Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria (D.R.-A.), Hospital Universitario Central de Asturias, Oviedo (E.E.), Vall d'Hebron University, Vall d'Hebron Institute of Oncology, Barcelona (E.F.), and Fundación Jiménez Díaz (M.D.) and Hospital Universitario Quirón Madrid (B.R.-V.), Madrid - all in Spain; Karmanos Cancer Institute, Detroit (S.G.); Integrated Health and Social Services Centres, Montérégie Centre, Greenfield Park, QC (F.D.A.), and Sunnybrook Health Sciences Centre, Toronto (S.Y.-S.C.) - both in Canada; Southern Medical Day Care Centre, Wollongong, NSW (P.C.), Epworth Healthcare, Richmond, VIC (R.R.J.), Westmead Hospital and University of Sydney, Sydney (R.H.), and Chris O'Brien Lifehouse, Camperdown, NSW (M.B.) - all in Australia; Otto Wagner Hospital, Vienna (M.J.H.); Sanford Health, Sioux Falls, SD (S.F.P.); Thoraxklinik, Heidelberg (H.G.B.), and LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Davidoff Cancer Center, Tel Aviv University, Petah Tikva, Israel (N.P.); Ospedale Policlinico San Martino, Genoa (F.G.), University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano (S.N.), and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (M.C.G.) - all in Italy; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); Kansai Medical University Hospital, Osaka, Japan (T.K.); Moffitt Cancer Center, Tampa, FL (J.E.G.); and Merck, Kenilworth, NJ (J.V., Z.W., J.Y., H.R., M.C.P.)
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Nab-paclitaxel maintenance therapy following carboplatin + nab-paclitaxel combination therapy in chemotherapy naïve patients with advanced non-small cell lung cancer: multicenter, open-label, single-arm phase II trial. Invest New Drugs 2018; 36:903-910. [PMID: 29846848 DOI: 10.1007/s10637-018-0617-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
Background A global multicenter study demonstrated superiority of carboplatin + nab-paclitaxel (PTX) therapy compared to carboplatin + PTX in terms of response rate (RR) and non-inferiority in terms of progression free survival (PFS) and overall survival (OS) in untreated patients with stage IIIB/IV non-small cell lung cancer; no clinical findings have so far been reported on maintenance therapies with nab-PTX. The aim of this study was to determine the efficacy and safety of maintenance therapy with nab-PTX following carboplatin + nab-PTX combination therapy. Methods Carboplatin (AUC 6) was administered on Day 1; and nab-PTX 100 mg/m2 on Days 1, 8, and 15, and dosing was repeated in 4 courses of 4 weeks each. In patients with clinical response was observed at the end of the 4th course, nab-PTX maintenance therapy was repeated. Results Out of 39 patients included in the efficacy analysis, 19 (48.7%) patients completed the induction therapy and 15 (38.5%) were transitioned to maintenance therapy. The median PFS in the maintenance phase was 6.5 (90%CI 1.4-11.4) months. The median OS in 15 patients was 12.6 (95%CI: 7.4-not reached). Grade ≥ 3 toxicities observed in more than 5% of patients were neutropenia (55.0%), anemia (15.0%), and febrile neutropenia (5.0%), with no increase during the maintenance phase. Conclusions Although statistically significance was not demonstrated presumably due to a limited transition rate from induction to maintenance phase, nab-PTX was suggested to be a useful treatment option following the induction therapy with nab-PTX in patients with advanced NSCLC.
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The Role of Combination Maintenance with Pemetrexed and Bevacizumab for Advanced Stage Nonsquamous Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5839081. [PMID: 29998136 PMCID: PMC5994575 DOI: 10.1155/2018/5839081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/25/2018] [Accepted: 04/24/2018] [Indexed: 11/21/2022]
Abstract
Purpose To evaluate the effect of combination maintenance therapy of pemetrexed plus bevacizumab for patients with advanced non-small cell lung cancer. Methods We identified relevant studies by electronic search (Embase, PubMed, Cochrane, and Web of Science from 1 January 1960 to 29 October 2016) and manual search. The primary outcome of interest was progression-free survival (PFS) and secondary end point included overall survival (OS) and toxicities. The data was pooled for quantitative analysis and the final effect size was reported as hazard ratio (HR) for survival outcomes and relative risk (RR) for safety outcomes, both with a random-effects model. Results Three randomized controlled trials enrolling 1302 patients with advanced non-small cell lung cancer were included in this meta-analysis. An evident PFS improvement (HR = 0.73, 95% CI = 0.63–0.83, P < 0.01) was observed in patients with pemetrexed and bevacizumab combination maintenance therapy compared with single-agent maintenance therapy, yet it did not subsequently lead to a significant improvement in OS (HR = 0.97, 95% CI = 0.84–1.10, P = 0.66). Our analysis also showed statistically increased risks for provoking grade 3-4 adverse events in patients managed using pemetrexed plus bevacizumab combination (RR = 1.59, 95% CI = 1.07–2.36, P = 0.022). Conclusions Pemetrexed plus bevacizumab combination maintenance therapy leads to significant improvement in PFS but not in OS for patients with advanced non-small cell lung cancer, which also increases the risks of grade 3-4 adverse events. Yet, in view of the limitation of existing studies and this meta-analysis, current evidence is not adequate to support routine use of pemetrexed-bevacizumab maintenance.
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163
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Lin L, Zhao J, Hu J, Zou G, Huang F, Han J, He Y, Cao X. Current Smoking has a Detrimental Effect on Survival for Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) negative Advanced non-squamous Non-small Cell Lung Cancer (NSCLC) Patients Treated with Pemetrexed Continuation Maintenance. J Cancer 2018; 9:2140-2146. [PMID: 29937933 PMCID: PMC6010680 DOI: 10.7150/jca.24872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/13/2018] [Indexed: 12/20/2022] Open
Abstract
Objectives: The aim of this study is to investigate the predictive value of smoking history on treatment outcomes of pemetrexed continuation maintenance therapy in advanced non-squamous NSCLC patients without EGFR mutations and ALK rearrangements. Methods: 71 consecutive EGFR and ALK negative advanced non-squamous NSCLC patients who had received pemetrexed continuation maintenance therapy at least two cycles were retrospectively analyzed in our single center. The enrolled patients were categorized into two groups as never-/former light smokers and current smokers according to their smoking history. Results: In the 71 non-squamous NSCLC patients, 30 (42.3%) were never-/former light smokers and 41 (57.7%) were current smokers. The objective response rate (ORR) of never-/former light smokers was significantly higher than that of current smokers (26.7% vs. 7.3%, p = 0.026). Never-/former light smokers showed significantly longer progression free survival (PFS) (6.6 [95% CI 5.3-7.9] months vs. 5.1 [95% CI 3.5-6.7] months; HR: 0.557, 95% CI 0.339-0.915, p = 0.021) and overall survival (OS) (17.3 [95% CI 14.4-20.2] months vs. 15.7 [95% CI 12.0-19.4] months; HR: 0.578, 95% CI 0.338-0.986, p = 0.044) than current smokers. Multivariate analysis identified smoking history was an independent predictive factor for PFS and OS. Conclusions: Current smoking is an independent negative predictive factor of outcomes for pemetrexed continuation maintenance therapy in advanced non-squamous NSCLC patients without EGFR mutations and ALK rearrangements.
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Affiliation(s)
- Liping Lin
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Juanjuan Zhao
- School of Nursing, Sun Yat-sen University, Guangzhou, China, 510000
| | - Jiazhu Hu
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Guorong Zou
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Fuxi Huang
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Jianjun Han
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Yan He
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
| | - Xiaolong Cao
- Department of Oncology, Panyu Central Hospital, Guangzhou, China, 511400.,Cancer Institute of Panyu, Guangzhou, China, 511400
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Koba T, Minami S, Nishijima-Futami Y, Masuhiro K, Kimura H, Futami S, Yaga M, Mori M, Kagawa H, Uenami T, Kohmo S, Otsuka T, Yamamoto S, Komuta K, Kijima T. Phase II trial of induction chemotherapy of pemetrexed plus split-dose cisplatin followed by pemetrexed maintenance for untreated non-squamous non-small-cell lung cancer. Cancer Chemother Pharmacol 2018; 82:111-117. [PMID: 29728800 DOI: 10.1007/s00280-018-3598-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/01/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE We conducted a phase II trial to evaluate the efficacy and safety of induction chemotherapy of pemetrexed plus split-dose cisplatin followed by pemetrexed maintenance for advanced non-squamous non-small-cell lung cancer (NSCLC). METHODS Patients with advanced or recurrent untreated non-squamous NSCLC received split-dose cisplatin (40 mg/m2, days 1 and 8) plus pemetrexed (500 mg/m2, day 1) tri-weekly. After four cycles of induction, patients without disease progression received pemetrexed maintenance until disease progression or unacceptable toxicity. The primary endpoint was the 1-year survival rate. The secondary endpoints were progression-free survival (PFS), overall survival (OS), response in induction phase, and safety. RESULTS From February 2012 to September 2014, 53 assessable patients were enrolled in this study. Thirty-eight (71.7%) patients completed induction therapy, while 35 (66.0%) received maintenance therapy. The 1-year survival rate was 67.7%. The median PFS and OS were 5.3 and 18.6 months, respectively. The response rate and disease control rate (DCR) during the induction phase were 37.7 and 86.8%, respectively. Eight patients (15.1%) discontinued the therapy due to adverse events (AEs) during the induction phase, but both hematological and non-hematological AEs were infrequent. CONCLUSIONS Treatment with induction chemotherapy of pemetrexed plus split-dose cisplatin showed a promising 1-year survival rate, DCR, and transition rate into maintenance phase. This regimen is feasible and well-tolerated. A phase III study comparing this regimen with conventional tri-weekly regimen is warranted.
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Affiliation(s)
- Taro Koba
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan
| | - Yu Nishijima-Futami
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kentaro Masuhiro
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Thoracic Malignancy, Osaka Habikino Medical Center, 3-7-1 Habikino, Habikino, 583-8588, Japan
| | - Hiromi Kimura
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan.,Department of Internal Medicine, Osaka Hospital Anti-Tuberculosis Association, 2276-1 Neyagawa-kouen, Neyagawa, Osaka, 572-0854, Japan
| | - Shinji Futami
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Moto Yaga
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan.,Department of Respiratory Medicine, NTT West Osaka Hospital, 2-6-40 Karasugatsuji, Tennoji-ku, Osaka, Osaka, 543-8922, Japan
| | - Masahide Mori
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Hiroyuki Kagawa
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Takeshi Uenami
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Satoshi Kohmo
- Department of General Internal Medicine, Nissay Hospital, 6-3-8 Itachibori, Nishi-ku, Osaka, Osaka, 550-0012, Japan
| | - Tomoyuki Otsuka
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.,Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan.,Department of Medical Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Oska, Osaka, 541-8567, Japan
| | - Suguru Yamamoto
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan
| | - Kiyoshi Komuta
- Department of Respiratory Medicine, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Osaka, 543-0035, Japan
| | - Takashi Kijima
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan. .,Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Deslypere G, Gullentops D, Wauters E, Vansteenkiste J. Immunotherapy in non-metastatic non-small cell lung cancer: Can the benefits of stage IV therapy be translated into earlier stages? Ther Adv Med Oncol 2018; 10:1758835918772810. [PMID: 29774061 PMCID: PMC5949924 DOI: 10.1177/1758835918772810] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/29/2018] [Indexed: 12/25/2022] Open
Abstract
Over the last decade, several steps forward in the treatment of patients with stage IV non-small cell lung cancer (NCSLC) were made. Examples are the use of pemetrexed, pemetrexed maintenance therapy, or bevacizumab for patients with nonsquamous NSCLC. A big leap forward was the use of tyrosine kinase inhibitors in patients selected on the basis of an activating oncogene, such as epidermal growth factor receptor (EGFR) activating mutations or anaplastic lymphoma kinase (ALK) translocations. However, all of these achievements could not be translated into survival benefits when studied in randomized controlled trials in patients with nonmetastatic NSCLC. Aside from chemotherapy and targeted therapy, immunotherapy has become the third pillar in the treatment armamentarium of advanced NSCLC. Antigen-specific immunotherapy (cancer vaccination) has been disappointing in large phase III clinical trials in stages I–III NSCLC. Based on the recent breakthroughs with immune checkpoint inhibitor immunotherapy in metastatic NSCLC, much hope currently rests on the use of this approach in patients with stage I–III NSCLC as well. Here we give a brief overview of how most new therapeutic approaches for advanced NSCLC failed in other stages, and then elaborate on the role of immunotherapy in patients with stage I–III NSCLC.
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Affiliation(s)
- Griet Deslypere
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - Dorothée Gullentops
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - Els Wauters
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - Johan Vansteenkiste
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
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166
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Middleton G, Gridelli C, De Marinis F, Pujol JL, Reck M, Ramlau R, Parente B, Pieters T, Visseren-Grul CM, San Antonio B, John WJ, Zimmermann AH, Chouaki N, Paz-Ares L. Evaluation of changes in renal function in PARAMOUNT: a phase III study of maintenance pemetrexed plus best supportive care versus placebo plus best supportive care after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. Curr Med Res Opin 2018; 34:865-871. [PMID: 29424248 DOI: 10.1080/03007995.2018.1439462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess the effect of long-term pemetrexed maintenance therapy on patients' renal function. METHODS In the PARAMOUNT phase III trial (NCT 00789373), pemetrexed was compared with placebo as maintenance treatment in advanced nonsquamous non-small-cell lung cancer patients who completed 4 cycles of pemetrexed plus cisplatin induction therapy. To evaluate changes in renal function during pemetrexed continuation maintenance treatment, we retrospectively analyzed changes in serum creatinine (sCr), treatment-emergent adverse events, dose delays and treatment discontinuations associated with impaired renal function. RESULTS Creatinine clearance ≥45 mL/min was required before the start of any cycle. Patients on pemetrexed maintenance had a significantly higher percentage maximum increase in sCr over baseline versus placebo for the range of ≥10% to ≥90% increase (p < .05). The risk of experiencing renal events leading to dose delays and discontinuations was higher with higher increases in sCr but reversible in most patients. sCr increases of ≥30% and ≥40% were associated with gender (female), age (<70 years) and longer exposure to pemetrexed compared with placebo. Sixteen (4%) pemetrexed patients and 1 (1%) placebo patient discontinued treatment due to drug-related renal events; 13/16 (81%) of those pemetrexed patients had sCr increases ≥30% and 7/13 (54%) had pre-existing conditions and/or were receiving nephrotoxic drugs. CONCLUSIONS The appearance of renal events leading to dose delays and/or treatment discontinuations was associated with sCr increase of at least 30%. However, it was difficult to identify patients at a higher risk of treatment discontinuation due to a drug-related renal event based only on changes in pre-maintenance laboratory values.
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Affiliation(s)
- Gary Middleton
- a University of Birmingham , Birmingham , United Kingdom
| | | | | | - Jean-Louis Pujol
- d Centre Hospitalier Régional Universitaire de Montpellier , Montpellier , France
| | - Martin Reck
- e Department of Thoracic Oncology , LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL) , Grosshansdorf , Germany
| | - Rodryg Ramlau
- f Poznan University of Medical Sciences , Poznan , Poland
| | | | - Thierry Pieters
- h Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | | | | | | | | | | | - Luis Paz-Ares
- m IBIS (University Hospital Virgen del Rocío, Seville University and CSIC), Seville & Doce de Octubre University Hospital , Madrid , Spain
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Effects of the Combination of Gliotoxin and Adriamycin on the Adriamycin-Resistant Non-Small-Cell Lung Cancer A549 Cell Line. Mar Drugs 2018; 16:md16040105. [PMID: 29584673 PMCID: PMC5923392 DOI: 10.3390/md16040105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/17/2018] [Accepted: 03/24/2018] [Indexed: 02/05/2023] Open
Abstract
Acquired drug resistance constitutes an enormous hurdle in cancer treatment, and the search for effective compounds against resistant cancer is still advancing. Marine organisms are a promising natural resource for the discovery and development of anticancer agents. In this study, we examined whether gliotoxin (GTX), a secondary metabolite isolated from marine-derived Aspergillus fumigatus, inhibits the growth of adriamycin (ADR)-resistant non-small-cell lung cancer (NSCLC) cell lines A549/ADR. We investigated the effects of GTX on A549/ADR cell viability with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and the induction of apoptosis in A549/ADR cells treated with GTX via fluorescence-activated cell sorting analysis, Hoechst staining, annexin V/propidium iodide staining, tetraethylbenzimidazolylcarbocyanine iodide (JC-1) staining, and western blotting. We found that GTX induced apoptosis in A549/ADR cells through the mitochondria-dependent pathway by disrupting mitochondrial membrane potential and activating p53, thereby increasing the expression levels of p21, p53 upregulated modulator of apoptosis (PUMA), Bax, cleaved poly (ADP-ribose) polymerase (PARP), and cleaved caspase-9. More importantly, we discovered that GTX works in conjunction with ADR to exert combinational effects on A549/ADR cells. In conclusion, our results suggest that GTX may have promising effects on ADR-resistant NSCLC cells by inducing mitochondria-dependent apoptosis and through the combined effects of sequential treatment with ADR.
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168
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Visser S, de Mol M, Cheung K, van Toor JJ, van Walree NC, Stricker BH, Den Oudsten BL, Aerts JGJV. Treatment Satisfaction of Patients With Advanced Non-Small-cell Lung Cancer Receiving Platinum-based Chemotherapy: Results From a Prospective Cohort Study (PERSONAL). Clin Lung Cancer 2018; 19:e503-e516. [PMID: 29705017 DOI: 10.1016/j.cllc.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/05/2018] [Accepted: 03/10/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In patients with advanced non-small-cell lung cancer, the treatment benefits and risks need to be constantly weighed. We explored patient-reported satisfaction with therapy (SWT) and assessed its value in addition to quality of life (QoL) and adverse events (AEs). PATIENTS AND METHODS In a prospective multicenter cohort study, patients with stage IIIB/IV non-small-cell lung cancer received platinum-pemetrexed chemotherapy. They completed the World Health Organization Quality of Life-BREF (WHOQoL-BREF) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) before and during chemotherapy. After the last cycle, patients reported on SWT, expectations of therapy, and feelings about side effects (FSE) using the Cancer Therapy Satisfaction Questionnaire. The explained variance (R2) of QoL after treatment by SWT was calculated. Using multivariable linear regression, we examined the association of SWT with patient- and treatment-related variables, FSE, and AEs. RESULTS Eighty-nine patients finished 4 cycles of chemotherapy, 65 of whom completed the Cancer Therapy Satisfaction Questionnaire. Fifty-six patients (86.2%) would probably or definitely decide to undergo the same treatment again, regardless of deterioration or improvement in QoL or a high or low frequency of AEs during chemotherapy. The explained variance of QoL by SWT was greatest for the EORTC QLQ C-30 global health status/QoL scale (R2 = 0.170). Patient age (β = 0.43; 95% confidence interval [CI], 0.05-0.82), FSE (β = 0.17; 95% CI, 0.06-0.29), and tumor response (β = 7.93; 95% CI (1.64 to 14.22)) were independently associated with SWT. CONCLUSION SWT could provide important supplementary information in addition to QoL assessments and treatment toxicities. Tumor response, older age, and FSE score were associated with better SWT. These insights could affect decision-making during palliative chemotherapy.
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Affiliation(s)
- Sabine Visser
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands
| | - Mark de Mol
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Kiki Cheung
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands
| | - Jermo J van Toor
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Nico C van Walree
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands.
| | - Brenda L Den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders, Tilburg University, Tilburg, The Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
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169
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Paik SS, Hwang IK, Park MJ, Lee SH. Pemetrexed Continuation Maintenance versus Conventional Platinum-Based Doublet Chemotherapy in EGFR-Negative Lung Adenocarcinoma: Retrospective Analysis. Tuberc Respir Dis (Seoul) 2018. [PMID: 29527843 PMCID: PMC5874144 DOI: 10.4046/trd.2017.0090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Although targeted therapy and immuno-oncology have shifted the treatment paradigm for lung cancer, platinum-based combination is still the standard of care for advanced non-small cell lung cancer (NSCLC). Pemetrexed continuation maintenance therapy has been approved and increasingly used for patients with nonsquamous NSCLC. However, the efficacy of this strategy has not been proven in patients without driving mutations. The objective of this study was to compare the clinical benefit of pemetrexed continuation maintenance to conventional platinum-based doublet in epidermal growth factor receptor (EGFR)-negative lung adenocarcinoma. Methods A total of 114 patients with EGFR-negative lung adenocarcinoma who were treated with platinum doublet were retrospectively enrolled. We compared the survival rates between patients received pemetrexed maintenance after four-cycled pemetrexed/cisplatin and those received at least four-cycled platinum doublet without maintenance chemotherapy as a first-line treatment. Results Forty-one patients received pemetrexed maintenance and 73 received conventional platinum doublet. Median progression-free survival (PFS), which was defined as the time from the day of response evaluation after four cycles of chemotherapy to disease progression or death, was significantly higher in the pemetrexed maintenance group compared to conventional group (5.8 months vs. 2.2 months, p<0.001). Median overall survival showed an increasing trend in the pemetrexed maintenance group (22.3 months vs. 16.1 months, p=0.098). Multivariate analyses showed that pemetrexed maintenance chemotherapy was associated with better PFS (hazard ratio, 0.73; 95% confidence interval, 0.15–0.87). Conclusion Compared to conventional platinum-based chemotherapy, premetrexed continuation maintenance treatment is associated with better clinical outcome for the patients with EGFR wild-type lung adenocarcinoma.
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Affiliation(s)
- Seung Sook Paik
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | - In Kyoung Hwang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | - Myung Jae Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hyeun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
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170
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Jo J, Kim SH, Kim YJ, Lee J, Kim M, Keam B, Kim TM, Kim DW, Heo DS, Chung JH, Jeon YK, Lee JS. Efficacy of Pemetrexed-based Chemotherapy in Comparison to Non-Pemetrexed-based Chemotherapy in Advanced, ALK+ Non-Small Cell Lung Cancer. Yonsei Med J 2018; 59:202-210. [PMID: 29436187 PMCID: PMC5823821 DOI: 10.3349/ymj.2018.59.2.202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/26/2017] [Accepted: 12/31/2017] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Previous retrospective studies suggest that anaplastic lymphoma kinase (ALK) mutation-positive (ALK+) non-small cell lung cancer (NSCLC) patients are sensitive to pemetrexed. To determine its efficacy, we retrospectively evaluated clinical outcomes of pemetrexed-based chemotherapy in patients with ALK+ NSCLC. MATERIALS AND METHODS We identified 126 patients with advanced, ALK+ NSCLC who received first-line cytotoxic chemotherapy. We compared response, progression-free survival (PFS), and overall survival (OS) rates according to chemotherapy regimens. Furthermore, we evaluated intracranial time to tumor progression (TTP) and proportion of ALK+ cells as prognostic factors. RESULTS Forty-eight patients received pemetrexed-based chemotherapy, while 78 received other regimens as first-line treatment. The pemetrexed-based chemotherapy group showed superior overall response (44.7% vs. 14.3%, p<0.001) and disease control (85.1% vs. 62.3%, p=0.008) rates. The pemetrexed-based chemotherapy group also exhibited longer PFS (6.6 months vs. 3.8 months, p<0.001); OS rates were not significantly different. The lack of exposure to second-generation ALK inhibitors and intracranial metastasis on initial diagnosis were independent negative prognostic factors of OS. Intracranial TTP was similar between the treatment groups (32.7 months vs. 35.7 months, p=0.733). Patients who harbored a greater number of ALK+ tumor cells (≥70%) showed prolonged OS on univariate analysis (not reached vs. 44.8 months, p=0.041), but not on multivariate analysis (hazard ratio: 0.19, 95% confidence interval: 0.03-1.42; p=0.106). CONCLUSION Pemetrexed-based regimens may prolong PFS in patients with ALK+ NSCLC as a first-line treatment, but are not associated with prolonged OS. Exposure to second-generation ALK inhibitors may improve OS rates in patients with ALK+ NSCLC.
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Affiliation(s)
- Jaemin Jo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Juhyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jong Seok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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171
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Zhu Y, Xing P, Wang S, Ma D, Mu Y, Li X, Xu Z, Li J. Evaluation of calculating carboplatin dosage in carboplatin-pemetrexed therapy as the first-line therapy for Chinese patients with advanced lung adenocarcinoma. Thorac Cancer 2018; 9:400-407. [PMID: 29377581 PMCID: PMC5832477 DOI: 10.1111/1759-7714.12594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study aims to explore the application of actual carboplatin in carboplatin plus pemetrexed regimen as first-line treatment for advanced lung adenocarcinoma, and to determine the recommended dose of carboplatin for Chinese populations. METHODS From January 2014 to April 2016, 151 advanced lung adenocarcinoma patients who received carboplatin and pemetrexed (500 mg/m2 ) were included. The area under the curve (AUC) of carboplatin was back-calculated from actual dosages using the Calvert formula. According to the median of calculated AUC, patients were divided into AUC ≥4 and <4 groups. RESULTS The median of AUC was 4 (1.8-5.5). A total of 79 patients had an AUC ≥4 and 72 patients had an AUC <4. The mean relative dose intensities of pemetrexed were 100.4% for the AUC ≥4 group, and 101.4% for <4 group. Baseline characteristic variables were balanced between the two groups, except for Eastern Cooperative Oncology Group Performance score (P = 0.044). The overall response rate (ORR) and disease control rate (DCR) were 33.8% and 90.1%, respectively, 35.4% and 86.1% for the AUC ≥4 group, and 31.9% and 94.4% for the AUC <4 group. No significant difference was observed in ORR (P = 0.650) and DCR (P = 0.086) between the two groups. CONCLUSION Compared with an AUC of 5 or 6, the actual clinical application of AUC was generally insufficient for Chinese populations; fortunately, therapeutic efficacy remained equal. We found that AUC <4 was as adequate as AUC ≥4 in pemetrexed plus carboplatin regimen as first-line treatment for them.
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Affiliation(s)
- Yixiang Zhu
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Puyuan Xing
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shouzheng Wang
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Di Ma
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yuxin Mu
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xue Li
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ziyi Xu
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Junling Li
- National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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172
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Cost-effectiveness of gefitinib, icotinib, and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China. Oncotarget 2018; 8:9996-10006. [PMID: 28036283 PMCID: PMC5354787 DOI: 10.18632/oncotarget.14310] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022] Open
Abstract
Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR) are becoming the standard treatment option for patients with advanced non-small cell lung cancer (NSCLC) harboring an EGFR mutation, but the economic impact of this practice is unclear, especially in a health resource-limited setting. A decision-analytic model was developed to simulate 21-day patient transitions in a 10-year time horizon. The health and economic outcomes of four first-line strategies (pemetrexed plus cisplatin [PC] alone, PC followed by maintenance with pemetrexed, or initial treatment with gefitinib or icotinib) among patients harboring EGFR mutations were estimated and assessed via indirect comparisons. Costs in the Chinese setting were estimated. The primary outcome was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed. The icotinib strategy resulted in greater health benefits than the other three strategies in NSCLC patients harboring EGFR mutations. Relative to PC alone, PC followed by pemetrexed maintenance, gefitinib and icotinib resulted in ICERs of $104,657, $28,485 and $19,809 per quality-adjusted life-year gained, respectively. The cost of pemetrexed, the EGFR mutation prevalence and the utility of progression-free survival were factors that had a considerable impact on the model outcomes. When the icotinib Patient Assistance Program was available, the economic outcome of icotinib was more favorable. These results indicate that gene-guided therapy with icotinib might be a more cost-effective treatment option than traditional chemotherapy.
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173
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Román M, Baraibar I, López I, Nadal E, Rolfo C, Vicent S, Gil-Bazo I. KRAS oncogene in non-small cell lung cancer: clinical perspectives on the treatment of an old target. Mol Cancer 2018; 17:33. [PMID: 29455666 PMCID: PMC5817724 DOI: 10.1186/s12943-018-0789-x] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/01/2018] [Indexed: 12/14/2022] Open
Abstract
Lung neoplasms are the leading cause of death by cancer worldwide. Non-small cell lung cancer (NSCLC) constitutes more than 80% of all lung malignancies and the majority of patients present advanced disease at onset. However, in the last decade, multiple oncogenic driver alterations have been discovered and each of them represents a potential therapeutic target. Although KRAS mutations are the most frequently oncogene aberrations in lung adenocarcinoma patients, effective therapies targeting KRAS have yet to be developed. Moreover, the role of KRAS oncogene in NSCLC remains unclear and its predictive and prognostic impact remains controversial. The study of the underlying biology of KRAS in NSCLC patients could help to determine potential candidates to evaluate novel targeted agents and combinations that may allow a tailored treatment for these patients. The aim of this review is to update the current knowledge about KRAS-mutated lung adenocarcinoma, including a historical overview, the biology of the molecular pathways involved, the clinical relevance of KRAS mutations as a prognostic and predictive marker and the potential therapeutic approaches for a personalized treatment of KRAS-mutated NSCLC patients.
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Affiliation(s)
- Marta Román
- Department of Oncology, Clínica Universidad de Navarra, 31008, Pamplona, Spain.,Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Iosune Baraibar
- Department of Oncology, Clínica Universidad de Navarra, 31008, Pamplona, Spain.,Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Inés López
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain
| | - Ernest Nadal
- Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet del Llobregat, Barcelona, Spain
| | - Christian Rolfo
- Phase I-Early Clinical Phase I-Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital, Edegem, Belgium
| | - Silvestre Vicent
- Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain.,Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Ignacio Gil-Bazo
- Department of Oncology, Clínica Universidad de Navarra, 31008, Pamplona, Spain. .,Program of Solid Tumors and Biomarkers, Center for Applied Medical Research, Pamplona, Spain. .,Navarra Health Research Institute (IDISNA), Pamplona, Spain. .,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.
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174
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Long-term progression-free survival in an advanced lung adenocarcinoma patient harboring EZR-ROS1 rearrangement: a case report. BMC Pulm Med 2018; 18:13. [PMID: 29361925 PMCID: PMC5781300 DOI: 10.1186/s12890-018-0585-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/15/2018] [Indexed: 01/06/2023] Open
Abstract
Background Crizotinib is recommended as first-line therapy in ROS1-driven lung adenocarcinoma. However, the optimal first-line therapy for this subgroup of lung cancer is controversial according to the available clinical data. Case presentation Here, we describe a 57-year-old man who was diagnosed with stage IIIB lung adenocarcinoma and EGFR/KRAS/ALK-negative tumors. The patient received six cycles of pemetrexed plus cisplatin as first-line therapy and then pemetrexed as maintenance treatment, with a progression-free survival (PFS) of 42 months. The patient relapsed and underwent re-biopsy. EZR-ROS1 fusion mutation was detected by next-generation sequencing (NGS). The patient was prescribed crizotinib as second-line therapy and achieved a PFS of 6 months. After disease progression, lorlatinib was administered as third-line therapy, with a favorable response. Conclusions Prolonged PFS in patients receiving pemetrexed chemotherapy might be related to the EZR-ROS1 fusion mutation. Lorlatinib is an optimal choice in patients showing crizotinib resistance.
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175
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Iyengar P, Wardak Z, Gerber DE, Tumati V, Ahn C, Hughes RS, Dowell JE, Cheedella N, Nedzi L, Westover KD, Pulipparacharuvil S, Choy H, Timmerman RD. Consolidative Radiotherapy for Limited Metastatic Non-Small-Cell Lung Cancer: A Phase 2 Randomized Clinical Trial. JAMA Oncol 2018; 4:e173501. [PMID: 28973074 DOI: 10.1001/jamaoncol.2017.3501] [Citation(s) in RCA: 673] [Impact Index Per Article: 112.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Patterns-of-failure studies suggest that in metastatic non-small-cell lung cancer (NSCLC) sites of gross disease at presentation are the first to progress when treated with chemotherapy. This knowledge has led to increased adoption of local ablative radiation therapy in patients with stage IV NSCLC, though prospective randomized evidence is limited. Objective To determine if intervening with noninvasive stereotactic ablative radiotherapy (SAbR) prior to maintenance chemotherapy in patients with non-progressive limited metastatic NSCLC after induction therapy led to significant improvements in progression-free survival (PFS). Design, Setting, and Participants This is a single-institution randomized phase 2 study of maintenance chemotherapy alone vs SAbR followed by maintenance chemotherapy for patients with limited metastatic NSCLC (primary plus up to 5 metastatic sites) whose tumors did not possess EGFR-targetable or ALK-targetable mutations but did achieve a partial response or stable disease after induction chemotherapy. Interventions Maintenance chemotherapy or SAbR to all sites of gross disease (including SAbR or hypofractionated radiation to the primary) followed by maintenance chemotherapy. Main Outcomes and Measures The primary end point was PFS; secondary end points included toxic effects, local and distant tumor control, patterns of failure, and overall survival. Results A total of 29 patients (9 women and 20 men) were enrolled; 14 patients (median [range] age, 63.5 [51.0-78.0] years) were allocated to the SAbR-plus-maintenance chemotherapy arm, and 15 patients (median [range] age, 70.0 [51.0-79.0] years) were allocated to the maintenance chemotherapy-alone arm. The trial was stopped to accrual early after an interim analysis found a significant improvement in PFS in the SAbR-plus-maintenance chemotherapy arm of 9.7 months vs 3.5 months in the maintenance chemotherapy-alone arm (P = .01). Toxic effects were similar in both arms. There were no in-field failures with fewer overall recurrences in the SAbR arm while those patients receiving maintenance therapy alone had progression at existing sites of disease and distantly. Conclusions and Relevance Consolidative SAbR prior to maintenance chemotherapy appeared beneficial, nearly tripling PFS in patients with limited metastatic NSCLC compared with maintenance chemotherapy alone, with no difference in toxic effects. The irradiation prevented local failures in original disease, the most likely sites of first recurrence. Furthermore, PFS for patients with limited metastatic disease appeared similar to those patients with a greater metastatic burden, further arguing for the potential benefits of local therapy in limited metastatic settings. Trial Registration clinicaltrials.gov Identifier: NCT02045446.
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Affiliation(s)
- Puneeth Iyengar
- Departments of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Zabi Wardak
- Departments of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - David E Gerber
- Department of Internal Medicine (Hematology-Oncology), Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Vasu Tumati
- Departments of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Chul Ahn
- Department of Clinical Sciences, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Randall S Hughes
- Department of Internal Medicine (Hematology-Oncology), Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Jonathan E Dowell
- Department of Internal Medicine (Hematology-Oncology), Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Naga Cheedella
- Department of Internal Medicine (Hematology-Oncology), Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Lucien Nedzi
- Departments of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Kenneth D Westover
- Departments of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Suprabha Pulipparacharuvil
- Departments of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Hak Choy
- Departments of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
| | - Robert D Timmerman
- Departments of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas
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Cortellini A, Gambale E, Cannita K, Brocco D, Parisi A, Napoleoni L, Masedu F, Irtelli L, De Tursi M, Natoli C, Ficorella C. Multicentric retrospective analysis of platinum-pemetrexed regimens as first-line therapy in non-squamous non-small cell lung cancer patients: A "snapshot" from clinical practice. Thorac Cancer 2017; 9:241-252. [PMID: 29388383 PMCID: PMC5792744 DOI: 10.1111/1759-7714.12570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/04/2017] [Accepted: 11/04/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The major challenge for treating non-squamous (non-Sq) non-small cell lung cancer (NSCLC) patients without actionable biomarkers is the actual selection of proper treatment, weighing expected clinical outcomes and safety profile. METHODS Consecutive non-Sq NSCLC patients were treated with platinum-pemetrexed (PP) doublets in clinical practice. Subgroup analyses were conducted in patients treated with standard (s)PP and modified (m)PP doublets (because of age, performance status, and/or comorbidities) and in patients treated with cisplatin-based and carboplatin-based PP doublets. Activity, efficacy, safety, and toxicities were evaluated. RESULTS From November 2009 to April 2017, 111 patients were treated: 87 (78.4%) with sPP and 24 (21.6%) with mPP; 76 (68.5%) with cisplatin-based and 35 (31.5%) with carboplatin-based regimens. The objective response rate (ORR), median progression-free survival (PFS), and median overall survival (OS) were 49.0%, 7, and 13 months in the entire patient population, respectively. We found no significant differences in ORR, median PFS, and median OS between sPP and mPP. Cisplatin-based PP showed higher ORR (53.7%) versus carboplatin-based PP (38.7%) and longer PFS (7 vs. 6 months; P = 0.028) and OS (18 vs. 11 months; P = 0.006). We confirm that carboplatin has a better toxicity profile than cisplatin. The received dose-intensities were ~80% of standard full doses. CONCLUSIONS Accurate management allowed us to treat the majority of advanced non-Sq NSCLC patients with PP combination therapy without significant differences in ORR, median PFS, and median OS. Even considering the selection bias, our data seems to confirm the greater effectiveness of cisplatin-based over carboplatin-based regimens.
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Affiliation(s)
- Alessio Cortellini
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Katia Cannita
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Davide Brocco
- Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy
| | - Alessandro Parisi
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luca Napoleoni
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luciana Irtelli
- Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy
| | - Michele De Tursi
- Department of Medical and Oral and Sciences and Biotechnologies, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Clara Natoli
- Department of Medical and Oral and Sciences and Biotechnologies and CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Corrado Ficorella
- Medical Oncology Unit, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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177
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Hingmire SS, Sambhus MB, Kelkar DS, Joshi SW, Narsinghpura KS. First-line therapy outcomes in patients with advanced stage nonsmall cell lung cancer treated at nongovernment tertiary care centrer in India: Experience from a real world practice. Indian J Cancer 2017; 54:182-186. [PMID: 29199686 DOI: 10.4103/0019-509x.219594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Reports on first line or subsequent treatment and their outcomes for patients with advanced nonsmall cell lung cancer (NSCLC) in India are scarce. The present study is an attempt to understand real world practice scenario of first-line therapy and outcome in advanced stage NSCLC patients. METHODS Observational study was conducted at a nongovernment tertiary cancer care center. Totally 83 patients with newly diagnosed advanced NSCLC who were evaluated for further treatment from 2008 onward were included in the study. RESULTS Best supportive care was the only treatment received in 11/83 patients. Sixty-three patients received platinum-based doublet chemotherapy and nine received epidermal growth factor receptor tyrosine kinase inhibitor (TKI) as first-line therapy. Pemetrexed and platinum was the most common first-line chemotherapy (56%) regimen used. First-line chemotherapy had to be discontinued in these eight patients due to Grade III/IV toxicity. Disease control rate with the first-line chemotherapy was 70% (partial response 38%, stable disease 32%). Median overall survival (OS) was 17 months with OS at 1 and 2 years was 52% and 29.5%, respectively. CONCLUSION First-line platinum-based chemotherapy is feasible and does achieve disease control in the majority of patients with advanced NSCLC. Strategies of selection of therapy based on histology and the presence of driver mutations, use of small molecule TKI, maintenance therapy and multiple lines of therapies are being increasingly implemented in clinical practice and thus improving survival of Indian patients of NSCLC.
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Affiliation(s)
- S S Hingmire
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - M B Sambhus
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - D S Kelkar
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - S W Joshi
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - K S Narsinghpura
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
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178
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Ho C, Siegfried J, Remo K, Laskin J. Adherence to surveillance guidelines in resected NSCLC: Physician compliance and impact on outcomes. Lung Cancer 2017; 112:176-180. [PMID: 29191592 DOI: 10.1016/j.lungcan.2017.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Resected NSCLC guidelines have varying recommendations on appropriate post-operative surveillance. There is general consensus that patients require follow-up with clinic visits and/or CT scans every 6 months for the first 2 years. This study evaluated compliance with surveillance guidelines and the impact on outcomes. METHODS The BC Cancer Agency (BCCA) provides cancer control for 4.6 million individuals. Inclusion criteria included referred patients from 2005 to 2010, resected stage Ib/II NSCLC, minimum 2 years follow-up at the BCCA, no prior cancer within 5 years. Retrospective chart review collected baseline parameters, follow up visits, CT imaging, recurrence and death. RESULTS 479 were referred and 263 were eligible. Baseline characteristics: median age 68, male 52%, current/former/never smoker 38/52/10%, stage Ib/II 51/49%, squamous/non 30%/70%. Adherence to visits and/or CT scans every 6 months in 2 years: clinic visits 77%, CT scans 35%, visit and/or CT 80%. Recurrence rate was 46% at 2 years. Surveillance below vs per/above guidelines; metastatic recurrence 57% vs 79% (p=0.28), curative intent treatment at recurrence 14% vs 9% (p=0.50), palliative systemic treatment given 14% vs 34% (p=0.42), DFS 66.6m vs 37.6m (p<0.001), OS 76.5m vs 37.7m (p<0.001). CONCLUSIONS Compliance with follow up recommendations for resected NSCLC was 80%. Guideline conformity did not increase the rate of curative treatment at recurrence nor did it increase the proportion of patients treated with palliative chemotherapy. Better adjuvant treatment and surveillance options are needed for resected NSCLC.
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Affiliation(s)
- Cheryl Ho
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
| | - Jennifer Siegfried
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Karen Remo
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Janessa Laskin
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
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179
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Zhang L, Gao S, He J. The role of maintenance therapy in the treatment of elderly non-small-cell lung cancer patients: a meta-analysis of randomized controlled trials. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:3435-3440. [PMID: 29238168 PMCID: PMC5716332 DOI: 10.2147/dddt.s145025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose Maintenance therapy is an effective treatment strategy for advanced non-small-cell lung cancer (NSCLC). We aim to investigate whether age would affect the efficacy of maintenance therapy in the treatment of advanced NSCLC. Materials and methods Relevant trials were identified by searching electronic databases and conference meetings. Prospective randomized controlled trials assessing maintenance therapy in elderly patients with advanced NSCLC were included. Outcomes of interest included overall survival (OS) and progression-free survival (PFS) in elderly patients with advanced NSCLC. Results A total of 2,724 patients from 5 randomized controlled trials were included for analysis, with 897 patients aged ≥65 years and 1,577 patients aged <65 years. Single-agent maintenance therapy in elderly patients significantly improved PFS (hazard ratio [HR] 0.65, 95% CI: 0.43–0.98, p=0.04) and OS (HR 0.81, 95% CI: 0.68–0.97, p=0.024) when compared with placebo. In addition, doublet maintenance therapy significantly improved PFS (HR 0.81, 95% CI: 0.68–0.97, p=0.024) in comparison with single-agent maintenance therapy. However, doublet maintenance did not improve OS in comparison with single-agent maintenance therapy (HR 1.05, 95% CI: 0.60–1.83, p=0.86). Conclusions The findings of this study suggest that single-agent maintenance therapy in elderly patients with advanced NSCLC offers an improved PFS and OS when compared with placebo. Further trials are recommended to clearly investigate the efficacy of combination maintenance therapy for advanced NSCLC in this setting.
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Affiliation(s)
- Liangze Zhang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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180
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Phase IB Trial of the Anti-Cancer Stem Cell DLL4-Binding Agent Demcizumab with Pemetrexed and Carboplatin as First-Line Treatment of Metastatic Non-Squamous NSCLC. Target Oncol 2017; 13:89-98. [DOI: 10.1007/s11523-017-0543-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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181
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Mascaux C, Tomasini P, Greillier L, Barlesi F. Personalised medicine for nonsmall cell lung cancer. Eur Respir Rev 2017; 26:26/146/170066. [PMID: 29141962 DOI: 10.1183/16000617.0066-2017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022] Open
Abstract
After years of standard care prescribed to cancer patients without any selection except the primary site and histology of the tumour, the era of precision medicine has revolutionised cancer care. Personalised medicine refers to the selection of patients for specific treatment based on the presence of specific biomarkers which indicate sensitivity to corresponding targeted therapies and/or lower toxicity risk, such that patients will have the greatest chance of deriving benefit from the treatments. Here, we review personalised medicine for nonsmall cell lung cancer.
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Affiliation(s)
- Céline Mascaux
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Dept, Marseille, France .,Aix Marseille University, Inserm U911 CRO2, Marseille, France
| | - Pascale Tomasini
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Dept, Marseille, France.,Aix Marseille University, Inserm U911 CRO2, Marseille, France
| | - Laurent Greillier
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Dept, Marseille, France.,Aix Marseille University, Inserm U911 CRO2, Marseille, France
| | - Fabrice Barlesi
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Dept, Marseille, France.,Aix Marseille University, Inserm U911 CRO2, Marseille, France
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182
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Miyahara T, Sueoka-Aragane N, Iwanaga K, Ureshino N, Komiya K, Nakamura T, Nakashima C, Abe T, Matsunaga H, Kimura S. Severity and predictive factors of adverse events in pemetrexed-containing chemotherapy for non-small cell lung cancer. Med Oncol 2017; 34:195. [PMID: 29124473 DOI: 10.1007/s12032-017-1053-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
Abstract
Pemetrexed is a key anticancer agent for treatment of advanced non-small cell lung cancer (NSCLC). Pemetrexed is generally well tolerated, but individual-patient differences exist in severity of adverse events. Our study aimed to characterize the adverse events of pemetrexed that result in discontinuation of chemotherapy and to identify risk factors associated with those adverse events. We retrospectively studied the incidence of adverse events in 257 patients with NSCLC who received pemetrexed (P) with or without bevacizumab (B) and/or carboplatin (C): P, PB, CP, or CPB. Patients whose chemotherapy was discontinued were divided into two groups according to adverse events and disease progression. Grade 2/3 nausea, fatigue with P and PB, and rash with CP and CPB occurred more frequent in the adverse events group than in the disease progression group. Multivariate analysis indicated that grade 2/3 nausea [odds ratio (OR) 9.94; 95% confidence interval (CI) 1.46-67.37; p = 0.01] and fatigue (OR 10.62; CI 1.60-70.20; p = 0.01) with P or PB, and rash (OR 6.12; CI 1.34-27.88; p = 0.01) with CP or CPB, were independent risk factors for discontinuation of chemotherapy. Administration of dexamethasone at doses less than 4 mg after the day of pemetrexed administration was associated with nausea following P or PB (OR 11.08; 95% CI 1.02-119.95; p = 0.04). Grade 2/3 nausea and fatigue with P or PB, and rash with CP or CPB, were associated with discontinuation of chemotherapy.
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Affiliation(s)
- Tsuyoshi Miyahara
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan.,Department of Pharmacy, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan.
| | - Kentaro Iwanaga
- Division of Respiratory Medicine, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Norio Ureshino
- Division of Medical Oncology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kazutoshi Komiya
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Tomomi Nakamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Chiho Nakashima
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Tomonori Abe
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Hisashi Matsunaga
- Department of Pharmacy, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
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Efficacy and Safety of Necitumumab Continuation Therapy in the Phase III SQUIRE Study of Patients With Stage IV Squamous Non-Small-Cell Lung Cancer. Clin Lung Cancer 2017; 19:130-138.e2. [PMID: 29158123 DOI: 10.1016/j.cllc.2017.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/04/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In a retrospective analysis of the SQUamous NSCLC treatment with the Inhibitor of EGF REceptor (SQUIRE) study, we investigated the efficacy and safety of single-agent necitumumab continuation therapy in patients with stage IV squamous non-small-cell lung cancer and in a subpopulation of patients with epidermal growth factor receptor (EGFR)-expressing tumors. PATIENTS AND METHODS Patients were randomized 1:1 for ≤ 6 cycles of gemcitabine and cisplatin either with or without necitumumab. Patients who received necitumumab continued receiving single-agent necitumumab until progressive disease (necitumumab continuation). Tissue collection was mandatory in SQUIRE. EGFR protein expression was assessed using immunohistochemistry in a central lab. In this subgroup analysis we compared patients treated with necitumumab monotherapy after completion of ≥ 4 cycles of chemotherapy with those in the chemotherapy arm who were progression-free and did not discontinue because of adverse events (AEs) after completion of ≥ 4 cycles of chemotherapy (gemcitabine-cisplatin nonprogressors). The same analysis was done for the subgroup of EGFR-expressing patients (EGFR > 0). RESULTS Baseline characteristics and chemotherapy exposure were well balanced between the necitumumab continuation (n = 261) and gemcitabine-cisplatin nonprogressor (n = 215) arms and in the EGFR-expressing population. Median overall survival (OS) from randomization in the necitumumab with gemcitabine-cisplatin versus gemcitabine-cisplatin nonprogressor arm was 15.9 versus 15.0 months (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.69-1.05) and median progression-free survival (PFS) from randomization was 7.4 versus 6.9 months (HR, 0.86; 95% CI, 0.70-1.06). OS and PFS benefits were similar when assessed from the postinduction period and in EGFR-expressing patients. No new safety findings emerged. CONCLUSION There was a consistent treatment effect in favor of necitumumab continuation versus that in gemcitabine-cisplatin nonprogressors, with no unexpected increases in AEs in intention-to-treat as well as EGFR-expressing populations.
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184
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Abstract
Malignant pleural mesothelioma (MPM) is a highly aggressive and generally incurable cancer. Current anti-MPM chemotherapy-based treatments are only marginally effective, and long-term survival remains an unmet goal. Nonetheless, in selected cases, personalized surgery-based multimodality treatments (MMT) have been shown to significantly extend survival. The design of MMT and selection of patients are challenging, and optimal results require accurate presurgical diagnosis, staging, and risk stratification. Further, meticulous surgical techniques and advanced radiation protocols must be applied. We review key principles and evolving concepts in the care of MPM patients with a focus on the expanding role of MMT in MPM.
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Affiliation(s)
- Ori Wald
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem 91120, Israel
| | - David J Sugarbaker
- Division of General Thoracic Surgery, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.,Lung Institute, Baylor College of Medicine, Houston, Texas 77030, USA;
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185
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Furrukh M, Kumar S, Zahid KF, Al-Shamly HS, Al-Jabri ZA, Burney IA, Al-Moundhri MS. Trends and Outcomes of Non-Small-Cell Lung Cancer in Omani Patients: Experience at a university hospital. Sultan Qaboos Univ Med J 2017; 17:e301-e308. [PMID: 29062552 DOI: 10.18295/squmj.2017.17.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/27/2017] [Accepted: 04/20/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The incidence of lung cancer in Oman has shown a gradual but definitive increase since 2002. This study aimed to evaluate the demographic and epidemiological characteristics and survival outcomes of patients with non-small-cell lung cancer (NSCLC) at a university hospital in Oman. METHODS This study was conducted from January to June 2016. A retrospective analysis was performed of consecutive patients diagnosed with NSCLC presenting to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman, between March 2000 and December 2015. Clinical features at presentation and prognostic and predictive markers were reviewed. Kaplan-Meir estimates were used to determine relapse-free survival, progression-free survival (PFS) and overall survival (OS). RESULTS A total of 104 patients presented to SQUH during the study period. The median age at diagnosis was 64 years. Overall, 62 patients (59.6%) had adenocarcinomas. Only 12 patients (11.5%) presented in the early stages (I or II) of the disease and the majority of patients had an Eastern Cooperative Oncology Group performance status of 1 (27.9%) or 2 (26.0%). The prevalence of epidermal growth factor receptor mutations was 27.9%. The median PFS for patients with advanced disease (stages III or IV) was five months and the median OS for all patients was seven months. After five years, 50.0%, 60.0%, 10.0% and 8.0% of patients with disease stages I, II, III and IV, respectively, were alive. CONCLUSION Patients with NSCLC in Oman were found to present at an advanced stage. However, patient outcomes were similar to those reported in the USA.
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Affiliation(s)
- Muhammad Furrukh
- Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | - Shiyam Kumar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khawaja F Zahid
- The Queen's Centre for Oncology & Haematology, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Hanan S Al-Shamly
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Zainab A Al-Jabri
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ikram A Burney
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mansour S Al-Moundhri
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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186
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Shi YK, Wang L, Han BH, Li W, Yu P, Liu YP, Ding CM, Song X, Ma ZY, Ren XL, Feng JF, Zhang HL, Chen GY, Han XH, Wu N, Yao C, Song Y, Zhang SC, Song W, Liu XQ, Zhao SJ, Lin YC, Ye XQ, Li K, Shu YQ, Ding LM, Tan FL, Sun Y. First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label, randomized study. Ann Oncol 2017; 28:2443-2450. [PMID: 28945850 DOI: 10.1093/annonc/mdx359] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Icotinib has been previously shown to be non-inferior to gefitinib in non-selected advanced non-small-cell lung cancer patients when given as second- or further-line treatment. In this open-label, randomized, phase 3 CONVINCE trial, we assessed the efficacy and safety of first-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance in lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutation. PATIENTS AND METHODS Eligible participants were adults with stage IIIB/IV lung adenocarcinoma and exon 19/21 EGFR mutations. Participants were randomly allocated (1 : 1) to receive oral icotinib or 3-week cycle of cisplatin plus pemetrexed for up to four cycles; non-progressive patients after four cycles were maintained with pemetrexed until disease progression or intolerable toxicity. The primary end point was progression-free survival (PFS) assessed by independent response evaluation committee. Other end points included overall survival (OS) and safety. RESULTS Between January 2013 and August 2014, 296 patients were randomized, and 285 patients were treated (148 to icotinib, 137 to chemotherapy). Independent response evaluation committee-assessed PFS was significantly longer in the icotinib group (11.2 versus 7.9 months; hazard ratio, 0.61, 95% confidence interval 0.43-0.87; P = 0.006). No significant difference for OS was observed between treatments in the overall population or in EGFR-mutated subgroups (exon 19 Del/21 L858R). The most common grade 3 or 4 adverse events (AEs) in the icotinib group were rash (14.8%) and diarrhea (7.4%), compared with nausea (45.9%), vomiting (29.2%), and neutropenia (10.9%) in the chemotherapy group. AEs (79.1% versus 94.2%; P < 0.001) and treatment-related AEs (54.1% versus 90.5%; P < 0.001) were significantly fewer in the icotinib group than in the chemotherapy group. CONCLUSIONS First-line icotinib significantly improves PFS of advanced lung adenocarcinoma patients with EGFR mutation with a tolerable and manageable safety profile. Icotinib should be considered as a first-line treatment for this patient population.
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Affiliation(s)
- Y K Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing.
| | - L Wang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - B H Han
- Department of Pulmonology, Shanghai Chest Hospital, Shanghai
| | - W Li
- Department of Oncology, The First Hospital Affiliated to Jilin University, Changchun
| | - P Yu
- Department of Lung Cancer Medical Oncology, Sichuan Cancer Hospital, Chengdu
| | - Y P Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang
| | - C M Ding
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang
| | - X Song
- Department of Respiratory Medicine, Shanxi Provincial Tumor Hospital, Taiyuan
| | - Z Y Ma
- Department of Oncology, Henan Cancer Hospital, Zhengzhou
| | - X L Ren
- Department of Respiratory Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an
| | - J F Feng
- Department of Oncology, Jiangsu Cancer Hospital, Nanjing
| | - H L Zhang
- Department of Oncology, Tangdu Hospital, The Fourth Military Medical University, Xi'an
| | - G Y Chen
- Department of Medical Oncology, The Affiliated Tumor Hospital of Harbin Medical University, Harbin
| | - X H Han
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - N Wu
- Department of Imaging Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - C Yao
- Department of Biostatistics, Peking University Clinical Research Institute, Beijing
| | - Y Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing
| | - S C Zhang
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing
| | - W Song
- Department of Radiology, Peking Union Medical College Hospital, Beijing
| | - X Q Liu
- Department of Pulmonary Oncology, The 307th Hospital of Chinese People's Liberation Army, Beijing
| | - S J Zhao
- Department of Imaging Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Y C Lin
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou
| | - X Q Ye
- Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang
| | - K Li
- Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin
| | - Y Q Shu
- Department of Oncology, Jiangsu Provincial Hospital, Nanjing
| | - L M Ding
- Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - F L Tan
- Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Y Sun
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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187
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Zhao X, Yu H, Zhao J, Wu X, Sun S, Luo Z, Wang H, Qiao J, Chang J, Wang J. Efficacy and safety of first-line pemetrexed plus carboplatin followed by single-agent pemetrexed maintenance in elderly Chinese patients with non-squamous non-small-cell lung cancer. Oncotarget 2017; 8:86384-86394. [PMID: 29156802 PMCID: PMC5689692 DOI: 10.18632/oncotarget.21186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/26/2017] [Indexed: 11/25/2022] Open
Abstract
Chemotherapy with pemetrexed plus carboplatin followed by pemetrexed maintenance therapy is a first-line regimen for patients with advanced non-squamous non-small-cell lung cancer. This phase II clinical study investigated the efficacy and safety of this regimen in older patients (aged ≥65 years) with advanced non-squamous non-small-cell lung cancer. All patients received 4 courses of induction therapy with pemetrexed (500 mg/m2) combined with carboplatin once every 3 weeks. If patients had stable disease or achieved a complete or partial tumor response after 4 courses of pemetrexed + carboplatin therapy, maintenance treatment with pemetrexed monotherapy was administered until either disease progression or intolerable toxicity occurred. The primary endpoint was progression-free survival, while secondary endpoints were the objective response rate, overall survival, and tolerability. A total of 105 elderly patients (median age, 71 years) with advanced lung adenocarcinoma were enrolled in the trial. The ORR with induction therapy was 36.2% and the disease control rate was 70.5%. Sixty-two patients (59.0%) subsequently received pemetrexed maintenance therapy. The median progression-free survival for all patients was 8.23 months (95% CI 5.85-10.62 months) and the median overall survival was 22.6 months (95% CI 20.09-25.11 months). Grade 3 or greater toxicities included neutropenia (15.3%), thrombocytopenia (9.5%), anemia (8.6%), leukopenia (4.8%), nausea (1.0%), vomiting (1.0%), and fatigue (1.0%). No treatment-related deaths occurred. These results indicate that pemetrexed combined with carboplatin therapy maintained by single-agent pemetrexed treatment of elderly patients with advanced non-squamous non-small-cell lung cancer was effective and tolerable. ClinicalTrials.gov identifier: NCT01860508.
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Affiliation(s)
- Xinmin Zhao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hui Yu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jing Zhao
- Department of Medical Oncology, Shanghai Pulmonary Hospital Affiliated to Tongji University, Tongji University Medical School Cancer Institute, Shanghai 200433, China
| | - Xianghua Wu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Si Sun
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhiguo Luo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Huijie Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jie Qiao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jianhua Chang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jialei Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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188
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Langer CJ, Paz-Ares LG, Wozniak AJ, Gridelli C, de Marinis F, Pujol JL, San Antonio B, Chen J, Liu J, Oton AB, Visseren-Grul C, Scagliotti GV. Safety Analyses of Pemetrexed-cisplatin and Pemetrexed Maintenance Therapies in Patients With Advanced Non-squamous NSCLC: Retrospective Analyses From 2 Phase III Studies. Clin Lung Cancer 2017; 18:489-496. [DOI: 10.1016/j.cllc.2017.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
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189
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Battisti NML, Sehovic M, Extermann M. Assessment of the External Validity of the National Comprehensive Cancer Network and European Society for Medical Oncology Guidelines for Non–Small-Cell Lung Cancer in a Population of Patients Aged 80 Years and Older. Clin Lung Cancer 2017; 18:460-471. [DOI: 10.1016/j.cllc.2017.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 12/25/2022]
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190
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Wang Q, Wang Q, Wang SF, Jiao LJ, Zhang RX, Zhong Y, Zhang J, Xu L. Oral Chinese herbal medicine as maintenance treatment after chemotherapy for advanced non-small-cell lung cancer: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2017; 24:e269-e276. [PMID: 28874897 DOI: 10.3747/co.24.3561] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The concept of maintenance therapy in cancer treatment is currently under debate because of modest survival benefits, added toxicity, economic considerations, and quality-of-life concerns. Traditional Chinese Medicine (tcm) is widely used in China for cancer patients, offering the advantages of low toxicity and enhancement of quality of life. However, no systematic reviews or meta-analyses have assessed the role of tcm as maintenance treatment for non-small-cell lung carcinoma. METHODS We searched the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, PubMed, embase, and the Cochrane Library databases for all eligible studies. The endpoints were overall survival (os), progression-free survival (pfs), the 1-year and 2-year survival rates, and performance status. Our meta-analysis used a fixed-effects model and a random-effects model for heterogeneity in the Stata software application (version 11.0: StataCorp LP, College Station, TX, U.S.A.), with the results expressed as hazard ratios (hrs) or risk ratios (rrs), with their corresponding 95% confidence intervals (95% cis). RESULTS Sixteen randomized studies representing 1150 patients met the inclusion criteria. Compared with best supportive care, observation, or placebo, tcm as maintenance treatment was associated with a significant increase in os (hr: 0.49; 95% ci: 0.35 to 0.68; p < 0.001), pfs (hr: 0.66; 95% ci: 0.51 to 0.84; p = 0.001), and 2-year survival rate (rr: 0.63; 95% ci: 0.44 to 0.92, p = 0.017), and a significant improvement in performance status (rr: 0.68; 95% ci: 0.61 to 0.75; p < 0.001). CONCLUSIONS For patients who show non-progression-including stable disease, partial response, or complete response-after first-line chemotherapy, including those with poor quality of life, oral Chinese herbal medicine can be considered an efficient and safe maintenance therapy strategy.
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Affiliation(s)
- Q Wang
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine.,Department of Oncology, Shanghai Hospital of Integrated Traditional Chinese Medicine and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine
| | - Q Wang
- Department of Oncology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, and
| | - S F Wang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R.C.; and
| | - L J Jiao
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine
| | - R X Zhang
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, MD, U.S.A
| | - Y Zhong
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, MD, U.S.A
| | - J Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, P.R.C.; and
| | - L Xu
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine
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191
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Shen L, Niu X, Jian H, Xu Y, Yu Y, Lu S. Assessment of interfering factors and clinical risk associated with discontinuation of pemetrexed maintenance therapy in advanced non-squamous non-small cell lung cancer. Lung Cancer 2017; 111:43-50. [PMID: 28838396 DOI: 10.1016/j.lungcan.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/04/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pemetrexed continuation maintenance therapy after induction with platinum-based chemotherapy is a standard treatment option for non-squamous non-small cell lung cancer (NSCLC) patients. However, discontinuation of maintenance therapy is still a challenge in clinical practice. We aimed to investigate interfering factors and clinical risk associated with discontinuation of pemetrexed maintenance therapy (PMT). MATERIALS AND METHODS Data of patients with locally advanced or metastatic non-squamous NSCLC who received PMT between December 2011 and October 2015 were retrospectively analyzed. Patients' characteristics, performance status (PS), response and toxicity evaluation were collected. The reasons for PMT discontinuation were summarized. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier method and Cox proportional hazard model. RESULTS Of the 220 patients included for final analysis, 132 patients (60.0%) continued PMT until disease progression. The patients over 60 years old (p=0.021), the patients with PS 2 at the initiation of PMT (p=0.005) and the patients experienced grade 3/4 toxicity during PMT (p<0.001) had a higher discontinuation rate. The reasons for PMT discontinuation were the regarding toxicity (39.8%), high intensity of hospital visit (17.0%), treatment cost (13.6%), patients' preference (26.1%) and failure of pain control (3.4%). In univariate analysis, PS 0-1 at the initiation of PMT (5.6 versus 4.3 months, p=0.022) and PMT continuation (5.6 versus 4.3 months, p<0.001) were associated with improved PFS. And PMT continuation was associated with improved OS (19.2 versus 16.8 months, p=0.003) along with actionable mutations and PS 0-1 at the initiation of PMT. In multivariate analysis, PMT continuation (hazard ratio: 1.486; 95% CI: 1.050-2.104; p=0.025) was an independent prognostic factor regarding OS benefit assessed by Cox proportional hazard model. CONCLUSION Discontinuation of PMT is common in clinical practice. The survival benefit suggests that fit patients should be encouraged to continue PMT until disease progression.
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Affiliation(s)
- Lan Shen
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Xiaomin Niu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Hong Jian
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Yunhua Xu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Yongfeng Yu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Shun Lu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China.
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192
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Sztankay M, Giesinger JM, Zabernigg A, Krempler E, Pall G, Hilbe W, Burghuber O, Hochmair M, Rumpold G, Doering S, Holzner B. Clinical decision-making and health-related quality of life during first-line and maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC): findings from a real-world setting. BMC Cancer 2017; 17:565. [PMID: 28835219 PMCID: PMC5569463 DOI: 10.1186/s12885-017-3543-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022] Open
Abstract
Background Maintenance therapy (MT) with pemetrexed has been shown to improve overall and progression-free survival of patients with non-squamous non-small cell lung cancer (NSCLC), without impairing patients’ health-related quality of life (HRQOL) substantially. Comprehensive data on HRQOL under real-life conditions are necessary to enable informed decision-making. This study aims to (1) assess HRQOL during first-line chemotherapy and subsequent MT and (2) record patients’ and physicians’ reasons leading to clinical decisions on MT. Methods Patients treated for NSCLC at three Austrian medical centres were included. HRQOL was assessed at every chemotherapy cycle using the EORTC QLQ-C30/+LC13 questionnaire. Semi-structured interviews were conducted before MT initiation and at the time of discontinuation to evaluate patients’ and physicians’ reasons for treatment decisions. Longitudinal QOL analysis was based on linear mixed models. Results Sixty-one (73%) out of 84 patients were considered for MT. Thirty-six patients (43%) received MT and 29 (35%) discontinued therapy. Decisions on MT initiation (in 20 cases by the physician vs 4 by the patient) and discontinuation (19 vs 10) were mainly voiced by the physician. Treatment toxicity of first-line chemotherapy was the main reason for rejection of MT in patients with stable disease and was more often indicated by patients than clinicians. HRQOL data were collected from 83 patients at 422 assessment time points and indicated significantly lower symptom severity during MT compared with first-line therapy for nausea and vomiting (p = 0.006), sleep disturbances (p < 0.001), appetite loss (p = 0.043), constipation (p = 0.017) and chest pain (p = 0.022), and a deterioration in emotional functioning (p = 0.023) and cognitive functioning (p = 0.044) during MT. Conclusions Our results indicate that HRQOL and symptom burden improve between first-line treatment to MT in some respects, although some late toxicity persists. Discrepancies between patients’ and physicians’ perception of reasons for rejecting MT were evident. Thus, the integration of patient-reported outcomes, such as HRQOL, is required to enable shared decision-making and personalised healthcare based on mutual understanding of treatment objectives.
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Affiliation(s)
- Monika Sztankay
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria. .,Leopold-Franzens-University of Innsbruck, Innsbruck, Austria.
| | - Johannes Maria Giesinger
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - August Zabernigg
- Department of Internal Medicine, Kufstein County Hospital, Kufstein, Austria
| | - Elisabeth Krempler
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Pall
- Waldburg-Zeil Akutkliniken GmbH & Co. KG, Wangen, Germany
| | - Wolfgang Hilbe
- Department of Internal Medicine I (Haematology and Oncology), Wilhelminenspital Wien, Vienna, Austria
| | - Otto Burghuber
- Respiratory Oncology Unit, Department of Respiratory and Critical Care Medicine, Otto-Wagner-Spital, Vienna, Austria
| | - Maximilian Hochmair
- Respiratory Oncology Unit, Department of Respiratory and Critical Care Medicine, Otto-Wagner-Spital, Vienna, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
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193
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Taipale K, Winfree KB, Boye M, Basson M, Sleilaty G, Eaton J, Evans R, Chouaid C. A cost-effectiveness analysis of first-line induction and maintenance treatment sequences in patients with advanced nonsquamous non-small-cell lung cancer in France. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:505-518. [PMID: 28860832 PMCID: PMC5566359 DOI: 10.2147/ceor.s128371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Comparative effectiveness and cost-effectiveness data for induction–maintenance (I–M) sequences for the treatment of patients with nonsquamous non-small-cell lung cancer (nsqNSCLC) are limited because of a lack of direct evidence. This analysis aimed to compare the cost-effectiveness of I–M pemetrexed with those of other I–M regimens used for the treatment of patients with advanced nsqNSCLC in the French health-care setting. Materials and methods A previously developed global partitioned survival model was adapted to the France-only setting by restricting treatment sequences to include 12 I–M regimens most relevant to France, and incorporating French costs and resource-use data. Following a systematic literature review, network meta-analyses were performed to obtain hazard ratios for progression-free survival (PFS) and overall survival (OS) relative to gemcitabine + cisplatin (induction sequences) or best supportive care (BSC) (maintenance sequences). Modeled health-care benefits were expressed as life-years (LYs) and quality-adjusted LYs (QALYs) (estimated using French EuroQol five-dimension questionnaire tariffs). The study was conducted from the payer perspective (National Health Insurance). Cost- and benefit-model inputs were discounted at an annual rate of 4%. Results Base-case results showed pemetrexed + cisplatin induction followed by (→) pemetrexed maintenance had the longest mean OS and PFS and highest LYs and QALYs. Costs ranged from €12,762 for paclitaxel + carboplatin → BSC to €35,617 for pemetrexed + cisplatin → pemetrexed (2015 values). Gemcitabine + cisplatin → BSC, pemetrexed + cisplatin → BSC, and pemetrexed + cisplatin → pemetrexed were associated with fully incremental cost-effectiveness ratios (ICERs) of €16,593, €80,656, and €102,179, respectively, per QALY gained versus paclitaxel + carboplatin → BSC. All other treatment sequences were either dominated (ie, another sequence had lower costs and better/equivalent outcomes) or extendedly dominated (ie, the comparator had a higher ICER than a more effective comparator) in the model. Sensitivity analyses showed the model to be relatively insensitive to plausible changes in the main assumptions, with none increasing or decreasing the ICER by more than ~€20,000 per QALY gained. Conclusion In the absence of direct comparative trial evidence, this cost-effectiveness analysis indicated that of a large number of I–M sequences used for the treatment of patients with nsqNSCLC in France, pemetrexed + cisplatin → pemetrexed achieved the best clinical outcomes (0.28 incremental QALYs gained) versus paclitaxel + carboplatin → BSC.
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Affiliation(s)
- Kaisa Taipale
- Global Patient Outcomes and Real World Evidence International, Oy Eli Lilly Finland AB, Helsinki, Finland
| | - Katherine B Winfree
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Mark Boye
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Mickael Basson
- Corporate Affairs, Lilly France, Neuilly-sur-Seine, France
| | - Ghassan Sleilaty
- Bio-Medicines Medical Affairs, Lilly France, Neuilly-sur-Seine, France
| | - James Eaton
- ICON Health Economics and Epidemiology, ICON Plc, Milton Park, UK
| | - Rachel Evans
- ICON Health Economics and Epidemiology, ICON Plc, Milton Park, UK
| | - Christos Chouaid
- Thoracic Oncology, Service de Pneumologie, Centre Hospitalier Intercommunal Créteil, Créteil, France
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194
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Lievense LA, Sterman DH, Cornelissen R, Aerts JG. Checkpoint Blockade in Lung Cancer and Mesothelioma. Am J Respir Crit Care Med 2017; 196:274-282. [PMID: 28252315 DOI: 10.1164/rccm.201608-1755ci] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In the last decade, immunotherapy has emerged as a new treatment modality in cancer. The most success has been achieved with the class of checkpoint inhibitors (CPIs), antibodies that unleash the antitumor immune response. After the success in melanoma, numerous clinical trials are being conducted investigating CPIs in lung cancer and mesothelioma. The programmed death protein (PD) 1-PD ligand 1/2 pathway and cytotoxic T lymphocyte-associated protein 4 are currently the most studied immunotherapeutic targets in these malignancies. In non-small cell lung cancer, anti-PD-1 antibodies have become part of the approved treatment arsenal. In small cell lung cancer and mesothelioma, the efficacy of checkpoint inhibition has not yet been proven. In this Concise Clinical Review, an overview of the landmark clinical trials investigating checkpoint blockade in lung cancer and mesothelioma is provided. Because response rates are around 20% in the majority of clinical trials, there is much room for improvement. Predictive biomarkers are therefore essential to fully develop the potential of CPIs. To increase efficacy, multiple clinical trials investigating the combination of cytotoxic T lymphocyte-associated protein 4 inhibitors and PD-1/PD ligand 1 blockade in lung cancer and mesothelioma are being conducted. Given the potential benefit of immunotherapy, implementation of current and new knowledge in trial designs and interpretation of results is essential for moving forward.
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Affiliation(s)
- Lysanne A Lievense
- 1 Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands.,2 Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands; and
| | - Daniel H Sterman
- 3 Division of Pulmonary, Critical Care, and Sleep Medicine, New York University (NYU) School of Medicine/NYU Langone Medical Center, New York, New York
| | - Robin Cornelissen
- 1 Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Joachim G Aerts
- 1 Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands.,2 Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands; and
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195
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Zhang P, Bao Z, Xu L, Zhou J, Lu G, Yao Y, Liu R, Gao Q, Shen Y, Zhou J. PD-L1 expression indicates favorable prognosis for advanced lung adenocarcinoma patients treated with pemetrexed. Oncotarget 2017; 8:66293-66304. [PMID: 29029512 PMCID: PMC5630412 DOI: 10.18632/oncotarget.19973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/24/2017] [Indexed: 02/07/2023] Open
Abstract
Conventional chemotherapy for lung cancer exerts anti-tumor effects through cytotoxicity, and through immunologic regulation by reducing specific T cell subsets and inducing the expression of programmed death ligand 1 (PD-L1) on tumor cells. Even though pemetrexed has shown huge potential in combination with other targeted or immune therapies, there is still little information about the values of specific immune checkpoint markers for advanced lung adenocarcinoma treated with pemetrexed. In the present study, a total of 56 patients with advanced lung adenocarcinoma, who received pemetrexed-based chemotherapy, were included retrospectively. Immunohistochemistry was performed to assess PD-L1, programmed death 1 (PD-1), thymidylate synthase, and tumor infiltrating lymphocytes (TILs). In this cohort, the positive expression of PD-L1 and PD-1 were 26.8% and 33.9% respectively. PD-L1, PD-1, and thymidylate synthase expression were not significantly associated with any clinical features, while the expression of both PD-L1 and PD-1 were correlated with Ki-67 expression. Furthermore, the expression of PD-1 was significantly correlated with TILs. The progression-free survival (PFS) in patients with PD-L1+ specimens was significantly longer compared to PD-L1- specimens. Moreover, PD-L1 expression was an independent protective factor for PFS, and the smoking status was an independent risk factor. PD-L1 expression was significantly associated with better prognosis for patients with pemetrexed-based treatment. Our findings suggested that PD-L1 expression might be a favorable prognostic biomarker for pemetrexed-based regimen, which is a rationale for combining immunotherapy with chemotherapy for lung cancer.
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Affiliation(s)
- Pei Zhang
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhang Bao
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liming Xu
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianya Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Guohua Lu
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yinan Yao
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Rong Liu
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qiqi Gao
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yihong Shen
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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196
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Niki M, Yokoi T, Kurata T, Nomura S. New prognostic biomarkers and therapeutic effect of bevacizumab for patients with non-small-cell lung cancer. LUNG CANCER (AUCKLAND, N.Z.) 2017; 8:91-99. [PMID: 28814907 PMCID: PMC5546813 DOI: 10.2147/lctt.s138887] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several biomarkers have emerged as potential prognostic and predictive markers for non-small-cell lung cancer (NSCLC). Successful inhibition of angiogenesis with the antivascular endothelial growth factor antibody, bevacizumab, has improved the efficacy seen with standard cytotoxic therapy of NSCLC. However, despite such enhanced treatment strategies, the prognosis for patients with advanced NSCLC remains poor. PATIENTS AND METHODS We assessed potential biomarkers in 161 NSCLC patients and 42 control patients. Enzyme-linked immunosorbent assay methods were used to evaluate three biomarkers: platelet-derived microparticle (PDMP), high-mobility group box-1 (HMGB1), and plasminogen activator inhibitor-1 (PAI-1). We studied the effects of bevacizumab on the expression of these markers. We also analyzed the relationship of the newly designed risk factor (NDRF) to overall survival and disease-free survival. The NDRF classification of patients was determined from the levels of PDMP, HMGB1, and PAI-1. To determine the individual prognostic power of PDMP, HMGB1, and PAI-1, we evaluated associations between their levels and patient outcomes by Kaplan-Meier survival analysis in a derivation cohort. RESULTS PDMP, HMGB1, and PAI-1 levels were higher in NSCLC patients compared with control patients. Notably, the difference in PDMP levels exhibited the strongest statistical significance (p<0.001). Multivariate analysis showed that HMGB1 and PAI-1 levels were significantly correlated with PDMP levels. Patients who received standard chemotherapy with bevacizumab exhibited significantly reduced levels of all three markers compared with patients who received standard chemotherapy. NDRF3 status (high levels of all three markers) was significantly correlated with a poor prognosis (p<0.05 for overall survival and disease-free survival). CONCLUSION Our results demonstrate that abnormal levels of PDMP, HMGB1, and PAI-1 are related to each other in NSCLC. Moreover, our findings suggest that the vascular complications associated with these markers may contribute to a poor prognosis for NSCLC patients.
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Affiliation(s)
- Maiko Niki
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takashi Yokoi
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takayasu Kurata
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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197
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Singh N, Aggarwal AN, Kaur J, Behera D. Association of Graded Folic Acid Supplementation and Total Plasma Homocysteine Levels With Hematological Toxicity During First-line Treatment of Nonsquamous NSCLC Patients With Pemetrexed-based Chemotherapy. Am J Clin Oncol 2017; 40:75-82. [PMID: 25089530 DOI: 10.1097/coc.0000000000000111] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pemetrexed is the preferred treatment of nonsquamous non-small cell lung cancer (ns-NSCLC). Folic acid supplementation (FAS) (350 to 1000 μg daily PO) is recommended to minimize hematological toxicity (HTox). Elevated total plasma homocysteine (tpHcy) predicts increased risk of HTox with pemetrexed in absence of FAS. The current study aimed to assess prevalence of elevated tpHcy levels at baseline and after pemetrexed treatment. Association of graded tpHcy levels/FAS with toxicity was also assessed. MATERIALS AND METHODS Retrospective analysis of all ns-NSCLC patients undergoing first-line treatment with pemetrexed-containing platinum doublet over 3½ years was carried out. All eligible patients received pemetrexed (500 mg/m) and cisplatin (65 mg/m) each on D1 of a 3-week cycle. FAS was 400 μg for tpHcy< upper limit of normal (ULN), 700 μg for tpHcy 1 to 2 ULN, and 1000 μg for tpHcy>2 ULN. All patients also received oral ferrous sulphate and injectable vitamin B12. Exact 95% confidence intervals (CI) were calculated for comparison with previously published studies. RESULTS 75.7% of 111 patients had stage IV disease. Prevalence of tpHcy levels <ULN, 1 to 2 ULN and >2 ULN were 47.8%, 41.4%, and 10.8% pretreatment and 78.9%, 21.1%, and 0% posttreatment, respectively (P<0.0001). Incidence of any grade and grade 3/4 HTox was 87.4% and 17.1% (anemia), 53.2% and 7.2% (leukopenia), 36.9% and 10.8% (neutropenia), and 39.6% and 7.2% (thrombocytopenia), respectively. HTox, non-HTox, and radiologic responses did not differ among patient groups based upon baseline tpHcy levels or upon graded baseline FAS. Incidence of grade 3/4 anemia was higher in current (17.1%; 95% CI, 11.3%-25.2%) as compared with previous studies. CONCLUSIONS Prevalence of elevated tpHcy levels posttreatment as compared with baseline was reduced significantly with FAS. Among ns-NSCLC patients treated with pemetrexed and with FAS of 400 to 1000 μg daily, HTox was not associated with either baseline tpHcy levels or with graded baseline FAS.
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Affiliation(s)
- Navneet Singh
- Departments of *Pulmonary Medicine †Biochemistry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Cobo M, Gutiérrez V, Villatoro R, Trigo JM, Ramos I, López O, Ruiz M, Godoy A, López I, Arroyo M. Spotlight on ramucirumab in the treatment of nonsmall cell lung cancer: design, development, and clinical activity. LUNG CANCER-TARGETS AND THERAPY 2017; 8:57-66. [PMID: 28744168 PMCID: PMC5513829 DOI: 10.2147/lctt.s118996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The vascular endothelial growth factor (VEGF) and receptor is a therapeutic target because of the importance of this pathway in carcinogenesis. This pathway regulates and promotes angiogenesis as well as increases endothelial cell proliferation, permeability, and cancer survival. Ramucirumab is a new fully human monoclonal antibody that targets the VEGF receptor-2, an important key receptor implicated in angiogenesis. Ramucirumab has been approved for the treatment of second-line advanced or metastatic non-small cell lung cancer (NSCLC) in combination with the chemotherapy agent docetaxel. This was based on the result of the randomized trial REVEL of 1,253 patients with metastatic NSCLC previously treated with a platinum-based combination therapy. The authors observed a significant improvement in overall survival (OS) with an acceptable toxicities profile. In this study, patients were randomized to receive ramucirumab plus docetaxel or placebo with docetaxel. The combination of docetaxel and ramucirumab showed an improved OS (hazard ratio [HR]: 0.86; 95% CI: 0.75, 0.98). Median OS was 10.5 months in the ramucirumab arm versus 9.1 months in the placebo arm. Regarding side effects, the toxicity described on the ramucirumab arm were principally diarrhea, fatigue, and neutropenia. The most common (5%) adverse reactions of grade 3 and 4 in the ramucirumab arm were fatigue, neutropenia, febrile neutropenia, leukopenia, and hypertension. Adding ramucirumab to docetaxel improves QoL of patients, and does not impair symptoms or functioning. There are currently several trials in progress evaluating the effects of ramucirumab in combination with other drugs in patients with advanced NSCLC.
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Affiliation(s)
- Manuel Cobo
- Medical Oncology Department, Hospital Universitario Málaga Regional y Virgen de la Victoria, IBIMA
| | - Vanesa Gutiérrez
- Medical Oncology Department, Hospital Universitario Málaga Regional y Virgen de la Victoria, IBIMA
| | - Rosa Villatoro
- Medical Oncology Department, Hospital Costa del Sol, Marbella, IBIMA
| | - Jose Manuel Trigo
- Medical Oncology Department, Hospital Universitario Málaga Regional y Virgen de la Victoria, IBIMA
| | - Inmaculada Ramos
- Medical Oncology Department, Hospital Universitario Málaga Regional y Virgen de la Victoria, IBIMA
| | - Omar López
- Medical Oncology Department, Hospital Universitario Málaga Regional y Virgen de la Victoria, IBIMA
| | - María Ruiz
- Medical Oncology Department, Hospital Universitario Málaga Regional y Virgen de la Victoria, IBIMA
| | - Ana Godoy
- Medical Oncology Department, Hospital Universitario Málaga Regional y Virgen de la Victoria, IBIMA
| | - Irene López
- Medical Oncology Department, Hospital Universitario Málaga Regional y Virgen de la Victoria, IBIMA
| | - Macarena Arroyo
- Pneumology Department, Hospital Universitario Málaga Regional, IBIMA, Málaga, Spain
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199
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Otsubo K, Nosaki K, Imamura CK, Ogata H, Fujita A, Sakata S, Hirai F, Toyokawa G, Iwama E, Harada T, Seto T, Takenoyama M, Ozeki T, Mushiroda T, Inada M, Kishimoto J, Tsuchihashi K, Suina K, Nagano O, Saya H, Nakanishi Y, Okamoto I. Phase I study of salazosulfapyridine in combination with cisplatin and pemetrexed for advanced non-small-cell lung cancer. Cancer Sci 2017; 108:1843-1849. [PMID: 28667792 PMCID: PMC5581516 DOI: 10.1111/cas.13309] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/20/2017] [Accepted: 06/27/2017] [Indexed: 12/23/2022] Open
Abstract
Spliced variant isoforms of CD44 (CD44v) are a marker of cancer stem cells in solid tumors. They stabilize the xCT subunit of the transporter system xc(–) and thereby promote synthesis of the antioxidant glutathione. Salazosulfapyridine (SASP) is an inhibitor of xCT and suppresses the proliferation of CD44v‐positive cancer cells. Chemotherapy‐naïve patients with advanced non‐squamous non‐small‐cell lung cancer were enrolled in a dose‐escalation study (standard 3 + 3 design) of SASP in combination with cisplatin and pemetrexed. The primary end‐point was the percentage of patients who experience dose‐limiting toxicity. Fifteen patients were enrolled in the study. Dose‐limiting toxicity was observed in one of six patients at a SASP dose of 1.5 g/day (elevation of aspartate and alanine aminotransferase levels, each of grade 3), two of five patients at 3 g/day (hypotension or pneumonitis, each of grade 3), and two of three patients at 4.5 g/day (anorexia of grade 3). The maximum tolerated dose was thus 3 g/day, and the recommended dose was 1.5 g/day. The overall response rate was 26.7% and median progression‐free survival was 11.7 months, much longer than that for cisplatin–pemetrexed alone in previous studies. Exposure to SASP varied markedly among individuals according to ABCG2 and NAT2 genotypes. The serum concentration of free CD44v protein was increased after the first cycle of treatment, possibly reflecting death of cancer stem cells. Salazosulfapyridine was thus given safely in combination with cisplatin–pemetrexed, with the addition of SASP tending to prolong progression‐free survival. This trial is registered in the UMIN Clinical Trials Registry as UMIN000017854.
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Affiliation(s)
- Kohei Otsubo
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kaname Nosaki
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Chiyo K Imamura
- Department of Clinical Pharmacokinetics and Pharmacodynamics, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Ogata
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akitaka Fujita
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinya Sakata
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumihiko Hirai
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Gouji Toyokawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Eiji Iwama
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taishi Harada
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | | | - Takeshi Ozeki
- Laboratory for Pharmacogenomics, RIKEN Center for Integrative Medical Sciences, Yokohama City, Japan
| | - Taisei Mushiroda
- Laboratory for Pharmacogenomics, RIKEN Center for Integrative Medical Sciences, Yokohama City, Japan
| | - Mieko Inada
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Kenji Tsuchihashi
- Division of Gene Regulation, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Suina
- Division of Gene Regulation, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Osamu Nagano
- Division of Gene Regulation, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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200
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The value of physical performance measurements alongside assessment of sarcopenia in predicting receipt and completion of planned treatment in non-small cell lung cancer: an observational exploratory study. Support Care Cancer 2017; 26:119-127. [DOI: 10.1007/s00520-017-3821-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/03/2017] [Indexed: 12/19/2022]
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