2201
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Hao Y, Zhou X, Li R, Song Z, Min Y. Advances of functional nanomaterials for cancer immunotherapeutic applications. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2019; 12:e1574. [PMID: 31566896 DOI: 10.1002/wnan.1574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/04/2019] [Accepted: 06/19/2019] [Indexed: 12/11/2022]
Abstract
Immunotherapy has made great progress by modulating the body's own immune system to fight against cancer cells. However, the low response rates of related drugs limit the development of immunotherapy strategies. Fortunately, the advantages of nanotechnology can just make up for this shortcoming. Nanocarriers of diverse systems are utilized to co-deliver antigens and adjuvants, combined with drugs for immunomodulatory, such as chemotherapy, radiotherapy, and photodynamic. Here we review recent studies on immunotherapy with biomimetic, organic, and inorganic nanomaterials. They are going to potentially overcome the drawbacks in cancer immunotherapy with delivering immunomodulatory drugs, delivering cancer vaccine, and monitoring the immune systems. This article is characterized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.
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Affiliation(s)
- Yuhao Hao
- CAS Key Lab of Soft Matter Chemistry, University of Science and Technology of China, Hefei, China.,Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Xingyu Zhou
- CAS Key Lab of Soft Matter Chemistry, University of Science and Technology of China, Hefei, China.,Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Rui Li
- CAS Key Lab of Soft Matter Chemistry, University of Science and Technology of China, Hefei, China.,Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Zechenxi Song
- CAS Key Lab of Soft Matter Chemistry, University of Science and Technology of China, Hefei, China.,Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Yuanzeng Min
- CAS Key Lab of Soft Matter Chemistry, University of Science and Technology of China, Hefei, China.,Department of Chemistry, University of Science and Technology of China, Hefei, China.,Hefei National Laboratory for Physical Science at the Microscale, University of Science and Technology of China, Hefei, China
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2202
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Passiglia F, Bironzo P, Scagliotti GV. First-line immune-chemotherapy combination: the right strategy to fight squamous non-small cell lung cancer? Transl Lung Cancer Res 2019; 8:546-549. [PMID: 31555529 DOI: 10.21037/tlcr.2019.04.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Francesco Passiglia
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Giorgio V Scagliotti
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Italy
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2203
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Tunger A, Sommer U, Wehner R, Kubasch AS, Grimm MO, Bachmann MP, Platzbecker U, Bornhäuser M, Baretton G, Schmitz M. The Evolving Landscape of Biomarkers for Anti-PD-1 or Anti-PD-L1 Therapy. J Clin Med 2019; 8:jcm8101534. [PMID: 31557787 PMCID: PMC6832659 DOI: 10.3390/jcm8101534] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
The administration of antibodies blocking the immune checkpoint molecules programmed cell death protein 1 (PD-1) or programmed cell death 1 ligand 1 (PD-L1) has evolved as a very promising treatment option for cancer patients. PD-1/PD-L1 inhibition has significantly enhanced expansion, cytokine secretion, and cytotoxic activity of CD4+ and CD8+ T lymphocytes, resulting in enhanced antitumor responses. Anti-PD-1 or anti-PD-L1 therapy has induced tumor regression and improved clinical outcome in patients with different tumor entities, including melanoma, non-small-cell lung cancer, and renal cell carcinoma. These findings led to the approval of various anti-PD-1 or anti-PD-L1 antibodies for the treatment of tumor patients. However, the majority of patients have failed to respond to this treatment modality. Comprehensive immune monitoring of clinical trials led to the identification of potential biomarkers distinguishing between responders and non-responders, the discovery of modes of treatment resistance, and the design of improved immunotherapeutic strategies. In this review article, we summarize the evolving landscape of biomarkers for anti-PD-1 or anti-PD-L1 therapy.
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Affiliation(s)
- Antje Tunger
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (A.T.); (R.W.); (M.P.B.); (M.B.); (G.B.)
- Institute of Immunology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ulrich Sommer
- Institute of Pathology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Rebekka Wehner
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (A.T.); (R.W.); (M.P.B.); (M.B.); (G.B.)
- Institute of Immunology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Anne Sophie Kubasch
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Liebigstraße 22, 04103 Leipzig, Germany (U.P.)
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, Lessingstraße 1, 07743 Jena, Germany;
| | - Michael Philipp Bachmann
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (A.T.); (R.W.); (M.P.B.); (M.B.); (G.B.)
- Department of Radioimmunology, Institute of Radiopharmaceutical Cancer Research, Helmholtz Center Dresden-Rossendorf, Bautzner Landstraße 400, 01328 Dresden, Germany
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Centre (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Centre for Regenerative Therapies Dresden, TU Dresden, Fetscherstraße 105, 01307 Dresden, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Liebigstraße 22, 04103 Leipzig, Germany (U.P.)
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Centre (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Martin Bornhäuser
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (A.T.); (R.W.); (M.P.B.); (M.B.); (G.B.)
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Centre (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Centre for Regenerative Therapies Dresden, TU Dresden, Fetscherstraße 105, 01307 Dresden, Germany
- Department of Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Gustavo Baretton
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (A.T.); (R.W.); (M.P.B.); (M.B.); (G.B.)
- Institute of Pathology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Centre (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Marc Schmitz
- National Center for Tumor Diseases (NCT), University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (A.T.); (R.W.); (M.P.B.); (M.B.); (G.B.)
- Institute of Immunology, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Centre (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Centre for Regenerative Therapies Dresden, TU Dresden, Fetscherstraße 105, 01307 Dresden, Germany
- Correspondence: ; Tel.: +49-351-458-6501
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2204
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Yang H, Liang SQ, Schmid RA, Peng RW. New Horizons in KRAS-Mutant Lung Cancer: Dawn After Darkness. Front Oncol 2019; 9:953. [PMID: 31612108 PMCID: PMC6773824 DOI: 10.3389/fonc.2019.00953] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022] Open
Abstract
In non-small cell lung cancer (NSCLC), the most frequent oncogenic mutation in western countries is KRAS, for which, however, there remains no clinically approved targeted therapies. Recent progress on high biological heterogeneity including diverse KRAS point mutations, varying dependence on mutant KRAS, wide spectrum of other co-occurring genetic alterations, as well as distinct cellular status across the epithelial-to-mesenchymal transition (EMT), has not only deepened our understanding about the pathobiology of KRAS-mutant NSCLC but also brought about unprecedented new hopes for precision treatment of patients. In this review, we provide an update on the most recent advances in KRAS-mutant lung cancer, with a focus on mechanistic insights into tumor heterogeneity, the potential clinic implications and new therapies on horizons tailored for KRAS-mutant lung cancer.
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Affiliation(s)
- Haitang Yang
- Department of General Thoracic Surgery, Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Shun-Qing Liang
- Department of General Thoracic Surgery, Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Ralph A. Schmid
- Department of General Thoracic Surgery, Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ren-Wang Peng
- Department of General Thoracic Surgery, Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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2205
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Tun AM, Thein KZ, Thein WL, Guevara E. Checkpoint inhibitors plus chemotherapy for first-line treatment of advanced non-small cell lung cancer: a systematic review and meta-analysis of randomized controlled trials. Future Sci OA 2019; 5:FSO421. [PMID: 31608159 PMCID: PMC6787520 DOI: 10.2144/fsoa-2019-0081] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: We conducted a meta-analysis to evaluate the efficacy and safety of upfront add-on immunotherapy for advanced non-small cell lung cancers (NSCLC). Methods: We performed a literature search on first-line chemotherapy ± immunotherapy in NSCLC. We utilized Revman version 5.3 to calculate the estimated pooled hazard ratio for overall survival (OS) and progression-free survival (PFS) and pooled risk ratio for objective response rate (ORR), all-grade and high-grade adverse events with 95% CI. Results: We analyzed 4322 patients. The pooled hazard ratios for OS, PFS and ORR were 0.74 (95% CI: 0.62–0.88; p = 0.0007), 0.62 (95% CI: 0.57–0.68; p = 0.00001) and 1.51 (95% CI: 1.3–1.74; p = 0.00001), respectively. The pooled risk ratios for all-grade and high-grade adverse events were 1.01 (95% CI: 0.99–1.03; p = 0.27) and 1.17 (95% CI: 1.07–1.28; p = 0.0006), respectively. Conclusion: Add-on immunotherapy significantly improves PFS, OS and ORR for the first-line treatment of advanced NSCLC with a reasonable safety profile. Lung cancer is the most frequent cancer and is the leading cause of cancer mortality worldwide – more than half of the patients presented at late-stage disease, which is associated with limited survival. To treat cancers, we use immune checkpoint inhibitors that release the brakes on the immune system; thus, the immune cells can kill cancer cells better. Multiple clinical trials have tested the role of immune checkpoint inhibitors combined with chemotherapy for lung cancer treatment. Based on these clinical trials, we conducted a systematic review that showed improvement in outcomes with combined chemotherapy and immunotherapy with acceptable adverse events.
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Affiliation(s)
- Aung Myint Tun
- Department of Medicine, Division of Hematology & Oncology, The Brooklyn Hospital Center, Brooklyn, NY 11201, USA
| | - Kyaw Zin Thein
- Department of Hematology & Oncology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | | | - Elizabeth Guevara
- Department of Medicine, Division of Hematology & Oncology, The Brooklyn Hospital Center, Brooklyn, NY 11201, USA
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2206
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The emerging role of epigenetic therapeutics in immuno-oncology. Nat Rev Clin Oncol 2019; 17:75-90. [PMID: 31548600 DOI: 10.1038/s41571-019-0266-5] [Citation(s) in RCA: 252] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 02/07/2023]
Abstract
The past decade has seen the emergence of immunotherapy as a prime approach to cancer treatment, revolutionizing the management of many types of cancer. Despite the promise of immunotherapy, most patients do not have a response or become resistant to treatment. Thus, identifying combinations that potentiate current immunotherapeutic approaches will be crucial. The combination of immune-checkpoint inhibition with epigenetic therapy is one such strategy that is being tested in clinical trials, encompassing a variety of cancer types. Studies have revealed key roles of epigenetic processes in regulating immune cell function and mediating antitumour immunity. These interactions make combined epigenetic therapy and immunotherapy an attractive approach to circumvent the limitations of immunotherapy alone. In this Review, we highlight the basic dynamic mechanisms underlying the synergy between immunotherapy and epigenetic therapies and detail current efforts to translate this knowledge into clinical benefit for patients.
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2207
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Hayashi H, Nakagawa K. Combination therapy with PD-1 or PD-L1 inhibitors for cancer. Int J Clin Oncol 2019; 25:818-830. [PMID: 31549270 DOI: 10.1007/s10147-019-01548-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
Immune checkpoint inhibitors (ICIs)-such as antibodies to programmed cell death-1 (PD-1), to its ligand PD-L1, or to cytotoxic T lymphocyte-associated protein-4 (CTLA-4)-are an evolving treatment option for several types of cancer, but only a limited number of patients benefit from such therapy. Preclinical studies have suggested that the combination of PD-1 or PD-L1 inhibitors with either cytotoxic chemotherapy or antibodies to CTLA-4 is a promising treatment strategy for advanced cancer. Indeed, combinations of cytotoxic chemotherapy and PD-1/PD-L1 inhibitors have been approved and are now used in clinical practice for the treatment of advanced non-small cell lung cancer and small cell lung cancer on the basis of positive results of large-scale clinical trials. In addition, the combination of antibodies to CTLA-4 (ipilimumab) and to PD-1 (nivolumab) has been found to confer a survival benefit in patients with melanoma or renal cell carcinoma. Several ongoing clinical trials are also investigating ICI combination therapy in comparison with standard therapy for other tumor types. The identification of patients likely to achieve a sufficient benefit from PD-1/PD-L1 inhibitor monotherapy remains a challenge; however, with the establishment of novel complementary biomarkers being needed. Preclinical and clinical investigations of immune-related adverse events of ICI combination therapy are also warranted to establish management strategies. In this review, we summarize the current landscape of combination therapy with PD-1/PD-L1 inhibitors plus either cytotoxic chemotherapy or CTLA-4 inhibitors to clarify the benefits of and outstanding clinical issues related to such treatment.
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Affiliation(s)
- Hidetoshi Hayashi
- Department of Medical Oncology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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2208
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Liu X, Zhong D. [Research Progress of Immune Checkpoint Inhibitor Therapy for BRAF Mutation
in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:583-589. [PMID: 31526463 PMCID: PMC6754571 DOI: 10.3779/j.issn.1009-3419.2019.09.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
在非小细胞肺癌(non-small cell lung cancer, NSCLC)患者中,约2%-4%有BRAF基因突变,该型肿瘤恶性程度高、化疗有效率低、预后差。尽管BRAF抑制剂及MEK抑制剂联合治疗在BRAF V600E突变的晚期NSCLC患者中成效显著,已被写入美国国家综合癌症网络(National Comprehensive Cancer Network, NCCN)指南,但两药联合副作用发生率高,耐药之后尚无有效治疗策略,且针对非V600E突变患者仍缺乏靶向治疗方案。本文将针对BRAF突变型NSCLC免疫标志物表达情况以及免疫检查点抑制剂(immune checkpoint inhibitor, ICI)疗效相关研究做一综述,为延长患者生存提供更多选择方案。
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Affiliation(s)
- Xia Liu
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
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2209
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El-Osta HE, Mott FE, Burt BM, Wang DY, Sabichi AL. Predictors of benefits from frontline chemoimmunotherapy in stage IV non-small-cell lung cancer: a meta-analysis. Oncoimmunology 2019; 8:e1665974. [PMID: 31741764 DOI: 10.1080/2162402x.2019.1665974] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Immune checkpoint inhibitors (ICIs) have dramatically expanded the therapeutic landscape of non-small-cell lung cancer (NSCLC). In a previous study, gender, smoking history, and PD-L1 status were found to influence the efficacy of single-agent ICI in NSCLC. This meta-analysis evaluated the clinical and molecular factors that could predict a benefit from adding ICIs to first-line chemotherapy in metastatic NSCLC. Patients and Methods: The pooled hazard ratio (HR) of progression-free survival (PFS) and overall survival (OS) among the selected subgroups were analyzed using the random effects model. The correlation between PD-L1 expression and outcome was analyzed by meta-regression. Results: Seven phase III randomized controlled trials comparing chemo-immunotherapy (CIT) with chemotherapy in untreated stage 4 NSCLC were included. CIT evenly improved PFS irrespective of age, gender, histology, smoking history, and performance status. Among patients with baseline hepatic metastasis treated with Atezolizumab-containing CIT, PFS improvement was only detected with the addition of Bevacizumab. Whereas patients with EGFR/ALK-driven cancer exhibited greater PFS with the addition of ICI to a Bevacizumab (BEV)-based regimen, the derived benefit was no longer statistically significant among those treated with non-BEV-based regimens. Although the superior PFS conferred by CIT was noticeable across all PD-L1 expression subgroups, this benefit correlated with PD-L1 level and was more pronounced in the "PD-L1 high" cohort. Except for patients harboring EGFR/ALK aberrations or squamous histology, CIT consistently improved OS across the other selected subgroups. Conclusions: The survival advantage associated with first-line CIT in metastatic NSCLC was observed in different patient populations, including those for which single-agent ICI has marginal therapeutic benefit. Our findings support the role of chemotherapy with or without VEGF blockade as enhancers of ICI activity in NSCLC.
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Affiliation(s)
- Hazem E El-Osta
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Frank E Mott
- Thoracic-Head and Neck Medical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan M Burt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Y Wang
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Anita L Sabichi
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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2210
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Tachihara M, Kiriu T, Hata A, Hatakeyama Y, Nakata K, Nagano T, Yamamoto M, Kobayashi K, Ohnishi H, Katakami N, Nishimura Y. A multi-center, Phase II trial of nab-paclitaxel and gemcitabine in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy. Cancer Manag Res 2019; 11:7135-7140. [PMID: 31534366 PMCID: PMC6681155 DOI: 10.2147/cmar.s208224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
Background Nanoparticle albumin-bound paclitaxel (nab-PTX) plus gemcitabine (GEM) significantly improved overall survival in patients with metastatic pancreatic adenocarcinoma. Anti-tumor synergy between GEM and nab-PTX was recently demonstrated in a mouse model. We planned to assess the efficacy and safety of the combination of nab-PTX + GEM in patients with non-small-cell lung cancer (NSCLC) previously treated with platinum-based chemotherapy. Methods Patients with advanced NSCLC with progressive disease after platinum-based chemotherapy, an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1, and adequate kidney, liver and bone marrow function were eligible. Treatment consisted of nab-PTX (100 mg/m2) + GEM (1000 mg/m2) on days 1 and 8 of each 3-week cycle until progression disease or unacceptable toxicity occurred. The primary endpoint was progression-free survival (PFS). Results Of the 28 patients enrolled, all were evaluable for response and toxicity. The median age was 68 years (range 47–79), and 23 were male and 5 female. The histologic subtypes were: adenocarcinoma in 19 patients, and squamous cell carcinoma in 9 patients. Seventeen patients had ECOG PS 1 and 11 patients had PS 0. Twenty-four patients were second line and 4 patients were third line. The median number of cycles administered was 4 (range 1–10). The overall response rate was 17.9%. The disease control rate was 67.9%. The median progression-free survival was 3.1 months (95% confidence interval [CI] =1.6–4.1). Adverse events were generally tolerable except grade 3 interstitial pneumonia with in 4 patients (14.3%). Conclusion The efficacy of nab-PTX in combination with GEM in advanced second or third-line NSCLC patients was limited and the frequent occurrence of interstitial pneumonia was unacceptable.
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Affiliation(s)
- Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Tatsunori Kiriu
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Akito Hata
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan
| | - Yukihisa Hatakeyama
- Department of Respiratory Medicine, Akashi Medical Center, Akashi, Hyogo 674-0063, Japan
| | - Kyosuke Nakata
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Masatsugu Yamamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Kazuyuki Kobayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Hisashi Ohnishi
- Department of Respiratory Medicine, Akashi Medical Center, Akashi, Hyogo 674-0063, Japan
| | - Nobuyuki Katakami
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe, Hyogo 650-0047, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
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2211
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Bi J, Yang S, Li L, Dai Q, Borcherding N, Wagner BA, Buettner GR, Spitz DR, Leslie KK, Zhang J, Meng X. Metadherin enhances vulnerability of cancer cells to ferroptosis. Cell Death Dis 2019; 10:682. [PMID: 31527591 PMCID: PMC6746770 DOI: 10.1038/s41419-019-1897-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/29/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023]
Abstract
Ferroptosis is an iron-dependent, non-apoptotic form of regulated cell death driven by lipid hydroperoxides within biological membranes. Although therapy-resistant mesenchymal-high cancers are particularly vulnerable to ferroptosis inducers, especially phospholipid glutathione peroxidase 4 (GPx4) inhibitors, the underlying mechanism is yet to be deciphered. As such, the full application of GPx4 inhibitors in cancer therapy remains challenging. Here we demonstrate that metadherin (MTDH) confers a therapy-resistant mesenchymal-high cell state and enhanced sensitivity to inducers of ferroptosis. Mechanistically, MTDH inhibited GPx4, as well as the solute carrier family 3 member 2 (SLC3A2, a system Xc- heterodimerization partner), at both the messenger RNA and protein levels. Our metabolomic studies demonstrated that MTDH reduced intracellular cysteine, but increased glutamate levels, ultimately decreasing levels of glutathione and setting the stage for increased vulnerability to ferroptosis. Finally, we observed an enhanced antitumor effect when we combined various ferroptosis inducers both in vitro and in vivo; the level of MTDH correlated with the ferroptotic effect. We have demonstrated for the first time that MTDH enhances the vulnerability of cancer cells to ferroptosis and may serve as a therapeutic biomarker for future ferroptosis-centered cancer therapy.
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Affiliation(s)
- Jianling Bi
- Department of Obstetrics and Gynecology, Iowa City, IA, 52242, USA
| | - Shujie Yang
- Department of Pathology, Iowa City, IA, 52242, USA.,Holden Comprehensive Cancer Center, Iowa City, IA, 52242, USA
| | - Long Li
- Department of Obstetrics and Gynecology, Iowa City, IA, 52242, USA
| | - Qun Dai
- Department of Internal Medicine, Division of Hematology, Oncology and Blood & Marrow Transplantation, Iowa City, IA, 52242, USA.,Division of Medical Oncology, Department of Internal Medicine, University of Kansas Cancer Center, University of Kansas Medical Center, 2330 Shawnee Mission Pkwy #210, Westwood, KS, 66205, USA
| | - Nicholas Borcherding
- Holden Comprehensive Cancer Center, Iowa City, IA, 52242, USA.,Medical Science Training Program (MSTP), Iowa City, IA, 52242, USA
| | - Brett A Wagner
- Free Radical Radiation Biology, and Division of the Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Garry R Buettner
- Holden Comprehensive Cancer Center, Iowa City, IA, 52242, USA.,Free Radical Radiation Biology, and Division of the Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Douglas R Spitz
- Holden Comprehensive Cancer Center, Iowa City, IA, 52242, USA.,Free Radical Radiation Biology, and Division of the Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Kimberly K Leslie
- Department of Obstetrics and Gynecology, Iowa City, IA, 52242, USA.,Holden Comprehensive Cancer Center, Iowa City, IA, 52242, USA
| | - Jun Zhang
- Holden Comprehensive Cancer Center, Iowa City, IA, 52242, USA. .,Department of Internal Medicine, Division of Hematology, Oncology and Blood & Marrow Transplantation, Iowa City, IA, 52242, USA. .,Division of Medical Oncology, Department of Internal Medicine, University of Kansas Cancer Center, University of Kansas Medical Center, 2330 Shawnee Mission Pkwy #210, Westwood, KS, 66205, USA. .,Department of Cancer Biology, University of Kansas Cancer Center, University of Kansas Medical Center, 3005B Wahl Hall East, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Xiangbing Meng
- Department of Obstetrics and Gynecology, Iowa City, IA, 52242, USA. .,Department of Pathology, Iowa City, IA, 52242, USA. .,Holden Comprehensive Cancer Center, Iowa City, IA, 52242, USA.
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2212
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Nakanishi Y, Masuda T, Yamaguchi K, Sakamoto S, Horimasu Y, Mimae T, Nakashima T, Miyamoto S, Tsutani Y, Iwamoto H, Fujitaka K, Miyata Y, Hamada H, Okada M, Hattori N. Albumin-globulin ratio is a predictive biomarker of antitumor effect of anti-PD-1 antibody in patients with non-small cell lung cancer. Int J Clin Oncol 2019; 25:74-81. [PMID: 31531785 DOI: 10.1007/s10147-019-01539-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anti-programmed cell death receptor (PD)-1 antibody treatment results in better prognosis than standard chemotherapy in patients with non-small cell lung cancer (NSCLC), especially those with high PD-ligand 1 (PD-L1) expression. However, several studies have reported a lack of antitumor effect of PD-1 antibody, even in patients with high PD-L1 expression. Therefore, reliable predictors of treatment response are urgently needed. The albumin-globulin ratio (AGR) is associated with prognosis in several cancers. We aimed to determine whether AGR is a predictive biomarker of anti-PD-1 antibody response in patients with NSCLC. PATIENTS AND METHODS Seventy-four NSCLC patients treated with anti-PD-1 antibody were retrospectively enrolled. Patients with driver mutations were excluded. RESULTS The mean AGR was significantly higher in the disease control (DC) group than in the progressive disease (PD) group (p < 0.001). Receiver operating characteristic curve analysis revealed an AGR cutoff value for dividing patients into the DC or PD groups of 1.17. Multivariate logistic regression analysis showed that a high AGR (≥1.17, cutoff value) was an independent predictor of DC (p = 0.001). Progression-free survival (PFS) and overall survival (OS) were significantly longer in the high-AGR group than in the low-AGR group (p = 0.008, p = 0.002, respectively). Multivariate Cox regression analysis of PFS and OS showed that high AGR was an independent prognostic factor (p = 0.020, p < 0.001, respectively). CONCLUSION Pretreatment serum AGR may be a useful predictor for DC and prognostic factor of anti-PD-1 antibody in patients with NSCLC. The clinical utility of AGR still needs to be confirmed in a prospective analysis.
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Affiliation(s)
- Yu Nakanishi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kakuhiro Yamaguchi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinjiro Sakamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroshi Iwamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazunori Fujitaka
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Hamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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2213
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Teramoto K, Igarashi T, Kataoka Y, Ishida M, Hanaoka J, Sumimoto H, Daigo Y. Clinical significance of PD-L1-positive cancer-associated fibroblasts in pN0M0 non-small cell lung cancer. Lung Cancer 2019; 137:56-63. [PMID: 31546072 DOI: 10.1016/j.lungcan.2019.09.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/28/2019] [Accepted: 09/16/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cancer-associated fibroblasts (CAFs) are a dominant cell type in tumor stroma and support the generation of pro-tumorigenic microenvironment. CAFs have frequent opportunities to interact with immune cells infiltrating the tumor stroma, but the process remains to be determined. In this study, we focused on immune checkpoint mechanism. We also examined the induction of programmed cell death-ligand 1 (PD-L1) on CAFs by immune cell, and the clinical significance of PD-L1-expressed CAFs in non-small cell lung cancer (NSCLC). MATERIALS AND METHODS CAFs were isolated from human NSCLC tissues, and PD-L1 expression levels in CAFs were analyzed by real-time polymerase chain reaction and flow-cytometry. Following immunohistochemical analysis of PD-L1 in surgically resected pN0M0 NSCLC (n = 125, including 88 invasive adenocarcinomas and 37 squamous cell carcinomas), the correlation of PD-L1-positive CAFs with clinicopathological features was investigated. RESULTS PD-L1 mRNA and protein expression on CAFs was upregulated by exogenously supplemented interferon-gamma (IFN-γ) and downregulated through the depletion of IFN-γ. PD-L1 expression on CAFs was upregulated by co-culture with activated lymphocytes releasing IFN-γ. Immunohistochemistry revealed that PD-L1-positive CAFs were observed in 31 cases (24.8%). Postoperative relapse-free survival was significantly prolonged in patients with PD-L1-positive CAFs as compared with those with PD-L1-negative CAFs, with 5-year relapse-free probabilities of 84.5% and 66.3%, respectively (P = 0.031). Multivariate analysis revealed that PD-L1 expression on CAFs was an independent prognostic factor of longer relapse-free survival after surgery (hazard ratio: 3.225, P = 0.027). CONCLUSION PD-L1 expression on CAFs is reversibly regulated by environmental stimuli including IFN-γ from activated lymphocytes. In the non-metastatic NSCLC, PD-L1 expression on CAFs suggests the induction of anti-tumor immune responses, contributing to better prognosis after surgery.
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MESH Headings
- Adenocarcinoma of Lung/drug therapy
- Adenocarcinoma of Lung/immunology
- Adenocarcinoma of Lung/metabolism
- Adenocarcinoma of Lung/pathology
- Aged
- Aged, 80 and over
- Antiviral Agents/pharmacology
- B7-H1 Antigen/immunology
- B7-H1 Antigen/metabolism
- CD8-Positive T-Lymphocytes/drug effects
- CD8-Positive T-Lymphocytes/immunology
- Cancer-Associated Fibroblasts/drug effects
- Cancer-Associated Fibroblasts/immunology
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/metabolism
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/immunology
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Female
- Follow-Up Studies
- Humans
- Interferon-gamma/pharmacology
- Lung Neoplasms/drug therapy
- Lung Neoplasms/immunology
- Lung Neoplasms/metabolism
- Lung Neoplasms/pathology
- Lymphocytes, Tumor-Infiltrating/drug effects
- Lymphocytes, Tumor-Infiltrating/immunology
- Male
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Survival Rate
- Tumor Cells, Cultured
- Tumor Microenvironment/drug effects
- Tumor Microenvironment/immunology
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Affiliation(s)
- Koji Teramoto
- Department of Medical Oncology and Cancer Center, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan; Center for Advanced Medicine against Cancer, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan; Center for Antibody and Vaccine Therapy, Research Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.
| | - Tomoyuki Igarashi
- Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Yoko Kataoka
- Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Mitsuaki Ishida
- Department of Pathology and Laboratory Medicine, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Jun Hanaoka
- Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Hidetoshi Sumimoto
- Department of Medical Oncology and Cancer Center, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan; Center for Advanced Medicine against Cancer, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
| | - Yataro Daigo
- Department of Medical Oncology and Cancer Center, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan; Center for Advanced Medicine against Cancer, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan; Center for Antibody and Vaccine Therapy, Research Hospital, Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.
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2214
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Comparing three different anti-PD-L1 antibodies for immunohistochemical evaluation of small cell lung cancer. Lung Cancer 2019; 137:108-112. [PMID: 31568887 DOI: 10.1016/j.lungcan.2019.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/05/2019] [Accepted: 09/15/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Small cell lung cancer (SCLC), which accounts for approximately 15% of all lung cancer cases, has high initial sensitivity to chemotherapy. However, clinical outcomes have not improved in the past two decades. Therefore, novel biomarkers are needed to prolong survival in patients with advanced SCLC. MATERIAL AND METHODS In this retrospective study, we assessed 44 patients with SCLC who underwent first-line or adjuvant chemotherapy. We analyzed PD-L1 expression in SCLC tumors using three specific anti-PD-L1 antibody clones (28-8, 22C3, and SP263) and assessed their correlation with clinical profiles. RESULTS Each clone yielded PD-L1 positivity as follows: 10 cases with 28-8, eight cases with 22C3, and six cases with SP263. Eleven patients tested positive with at least one of the three anti-PD-L1 antibodies, and 33 patients tested negative with all anti-PD-L1 antibodies. Serum neuron-specific enolase levels at diagnosis were significantly higher in negative tumors than in positive tumors with the 28-8 clone (p = 0.036) and, similarly, tended to be higher in negative tumors with the 22C3 and SP263 clones. CONCLUSION These observations suggest that PD-L1 is detected in SCLC tumors at a similar rate and with similar clinical correlates when detected using any of these three anti-PD-L1 clones. Further large-scale investigations are warranted to reveal the roles of PD-L1 expression in patients with SCLC.
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2215
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Sears CR, Peikert T, Possick JD, Naidoo J, Nishino M, Patel SP, Camus P, Gaga M, Garon EB, Gould MK, Limper AH, Montgrain PR, Travis WD, Rivera MP. Knowledge Gaps and Research Priorities in Immune Checkpoint Inhibitor-related Pneumonitis. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2019; 200:e31-e43. [PMID: 31518182 PMCID: PMC6775885 DOI: 10.1164/rccm.201906-1202st] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rationale: Immune checkpoint inhibitors (ICIs) have revolutionized cancer care but are associated with unique adverse events, including potentially life-threatening pneumonitis. The diagnosis of ICI-pneumonitis is increasing; however, the biological mechanisms, clinical and radiologic features, and the diagnosis and management have not been well defined.Objectives: To summarize evidence, identify knowledge and research gaps, and prioritize topics and propose methods for future research on ICI-pneumonitis.Methods: A multidisciplinary group of international clinical researchers reviewed available data on ICI-pneumonitis to develop and refine research questions pertaining to ICI-pneumonitis.Results: This statement identifies gaps in knowledge and develops potential research questions to further expand knowledge regarding risk, biologic mechanisms, clinical and radiologic presentation, and management of ICI-pneumonitis.Conclusions: Gaps in knowledge of the basic biological mechanisms of ICI-pneumonitis, coupled with a precipitous increase in the use of ICIs alone or combined with other therapies, highlight the importance in triaging research priorities for ICI-pneumonitis.
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2216
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Nagasaka M, Abdallah N, Crosby M, Thummala N, Patel D, Wozniak AJ, Gadgeel S, Abrams J, Sukari A. A retrospective study evaluating the pretreatment tumor volume (PTV) in non-small cell lung cancer (NSCLC) as a predictor of response to program death-1 (PD-1) inhibitors. LUNG CANCER-TARGETS AND THERAPY 2019; 10:95-105. [PMID: 31572037 PMCID: PMC6750163 DOI: 10.2147/lctt.s219886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/27/2019] [Indexed: 12/26/2022]
Abstract
Introduction of hypothesis Little information is available regarding the imaging characteristics that assist in differentiating responders from non-responders. We hypothesized that patients with higher pretreatment tumor volume (PTV) would have lower response rates and shorter overall survival (OS). Methods Data from patients who received at least one dose of program death-1 (PD-1) inhibitors before August 31, 2016 were captured from our institution’s pharmacy database. The primary objective was to determine the association of PTV with best response, evaluated utilizing RECIST v1.1 criteria. Secondary objectives were estimation of progression-free survival (PFS) and OS. PTV was measured using the Philips Intellispace Multi-Modality Tumor Tracking application. Results 116 non-small cell lung cancer (NSCLC) patients were evaluated. 66% patients had adenocarcinoma, 28% had squamous cell carcinoma and 5% had poorly differentiated NSCLC. Median PTV was 53.7 cm3 (95% CI: 13.3–107.9). Only one individual had no metastases and the remainder had M1 disease; 38% M1a, 10% M1b, 51% M1c. Most (79%) were previously treated. There were no complete responses; among those followed for at least 6 weeks, 26% had a partial response, 39% stable disease and 34% PD; 4% had no recorded response. There were no strong associations of PTV with any of the demographic or clinical characteristics. There was no association between PTV and OS (HR 1.2, P=0.26) or PFS (HR 1.1, P=0.47). Liver metastasis was associated with shorter survival (HR=2.8, P=0.05). Conclusion PTV in NSCLC did not prove to be a predictor of response to PD-1 inhibitors but having liver metastasis was associated with significantly shorter survival.
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Affiliation(s)
- Misako Nagasaka
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.,Department of Advanced Medical Innovations, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Nadine Abdallah
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Marcus Crosby
- Department of Radiation Oncology, Gundersen Health System, La Crosse, WI, USA
| | - Nithin Thummala
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Dhaval Patel
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | | | - Shirish Gadgeel
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Judith Abrams
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Ammar Sukari
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
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2217
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Amino Y, Kitazono S, Uematsu S, Hasegawa T, Yoshizawa T, Uchibori K, Yanagitani N, Horiike A, Horai T, Kasahara K, Nishio M. Efficacy of anti-PD-1 therapy for recurrence after chemoradiotherapy in locally advanced NSC LC. Int J Clin Oncol 2019; 25:67-73. [PMID: 31506751 DOI: 10.1007/s10147-019-01537-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/28/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Chemoradiotherapy (CRT) is the standard treatment for locally advanced non-small cell lung cancer (NSCLC). Recently, anti-PD-1 antibody therapy became a key treatment for stage IV NSCLC as the combination of immune checkpoint inhibitors (ICIs) and platinum doublet chemotherapy. However, the efficacy and toxicity of anti-PD-1 therapy for recurrence after CRT in stage III NSCLC are not well examined. METHODS Patients who received anti-PD-1 therapy for recurrence after CRT were identified in our clinical database. The safety and efficacy of anti-PD-1 therapy were retrospectively analyzed. RESULTS From March 1, 2013 to April 30, 2018, there were 20 patients who received anti-PD-1 therapy for recurrence after CRT. The median duration from CRT to initial anti-PD-1 therapy was 9.3 months. 12 patients (60%) were alive and 7 patients (35%) were still receiving anti-PD-1 therapy at the data cutoff point (median follow-up, 13.5 months). The ORR for anti-PD-1 therapy was 45.0%. Median progression-free survival (PFS) and overall survival (OS) from initiation of anti-PD-1 therapy was 8.4 months and 26.2 months, respectively. PFS in patients who had a short interval from last CRT to initial anti-PD-1 therapy seemed to have better outcomes (duration from last CRT to initial anti-PD-1 therapy < 9.3 months vs. ≥ 9.3 months; median PFS, 17.0 months vs. 4.9 months). Grade 3 or 4 immune-related adverse events occurred in 5% of patients. Only grade 1 pneumonitis was observed. CONCLUSION The efficacy of anti-PD-1 therapy for recurrence after CRT in stage III NSCLC might better than in stage IV NSCLC. The duration from CRT to initial anti-PD-1 therapy might be related to efficacy.
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Affiliation(s)
- Yoshiaki Amino
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan.
| | - Satoru Kitazono
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Shinya Uematsu
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Tsukasa Hasegawa
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Takahiro Yoshizawa
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Ken Uchibori
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Noriko Yanagitani
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Atsushi Horiike
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Takeshi Horai
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
| | - Kazuo Kasahara
- Hematology/Respiratory Medicine, Kanazawa University Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa, Ishikawa, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan
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2218
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Chemoimmunotherapy for stage IV non-small-cell lung cancer. Lancet Oncol 2019; 20:e466. [PMID: 31486365 DOI: 10.1016/s1470-2045(19)30498-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/21/2022]
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2219
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Si Z, Zhang S, Yang X, Ding N, Xiang M, Zhu Q, Mao Y, Lv Y, Yu L, Shang H, Xie J, Tian Y. The Association Between the Incidence Risk of Peripheral Neuropathy and PD-1/PD-L1 Inhibitors in the Treatment for Solid Tumor Patients: A Systematic Review and Meta-Analysis. Front Oncol 2019; 9:866. [PMID: 31552184 PMCID: PMC6736994 DOI: 10.3389/fonc.2019.00866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/21/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose: We conducted this study to determine the relationship between PD-1/PD-L1 inhibitors and the incidence risk of peripheral neuropathy in patients with solid tumors. Method: The process of the meta-analysis was performed by us according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Incidence of all-grade and grade 3-5 treatment-related peripheral neuropathy in patients with solid tumors were taken into account. Results: After screening and eligibility assessment, a total of 17 clinical trials involving 10,500 patients were selected for the final meta-analysis. The incidence risk of peripheral neuropathy for all grade was significantly lower in the PD-1/PD-L1 inhibitor group than that of the control group, either monotherapy (OR = 0.08, 95%CI:[0.03, 0.19]) or chemotherapy (OR = 0.05, 95%CI:[0.03, 0.11]). Similar incidence trend could also be seen for the incidence risk of grade 3-5 peripheral neuropathy. When PD-1/PD-L1 inhibitors were used in combination with chemotherapy, the incidence risk of peripheral neuropathy was higher than in the control chemotherapy group, whether it was all-grade (OR = 1.22, 95%CI:[1.00, 1.49]) or grade 3-5 degree (OR = 1.74, 95%CI:[1.03, 2.92]). Conclusion: Compared with chemotherapy, incidence risk of peripheral neuropathy related to PD-1/PD-L1 inhibitor was significantly lower than that of the chemotherapy group, while PD-1/PD-L1 inhibitor increased the incidence risk of peripheral neuropathy when it was combined with chemotherapy.
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Affiliation(s)
- Zhihua Si
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Jinan, China
| | - Shuisheng Zhang
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Xiaowei Yang
- Department of Hepatobiliary Intervention, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Nan Ding
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Division of Etiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Meiyi Xiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Division of Etiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Qingshan Zhu
- Department of Radiotherapy Oncology, Anyang Tumor Hospital, Anyang, China
| | - Yantao Mao
- Department of Oncology, Yantaishan Hospital, Yantai, China
| | - Yajuan Lv
- Department of Radiotherapy Oncology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Jinan, China
| | - Lili Yu
- Department of Radiotherapy Oncology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Jinan, China
| | - Heli Shang
- Department of Radiotherapy Oncology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Jinan, China
| | - Jian Xie
- Department of Radiotherapy Oncology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Jinan, China
| | - Yuan Tian
- Department of Radiotherapy Oncology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Jinan, China
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2220
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Criss SD, Mooradian MJ, Watson TR, Gainor JF, Reynolds KL, Kong CY. Cost-effectiveness of Atezolizumab Combination Therapy for First-Line Treatment of Metastatic Nonsquamous Non-Small Cell Lung Cancer in the United States. JAMA Netw Open 2019; 2:e1911952. [PMID: 31553470 PMCID: PMC6764123 DOI: 10.1001/jamanetworkopen.2019.11952] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Immune checkpoint inhibitor combination therapy has recently become the standard of care for first-line treatment of metastatic nonsquamous non-small cell lung cancer. The implications of these first-line treatments are considerable, given the potential population of patients eligible to receive them and their high cost. OBJECTIVE To evaluate the cost-effectiveness of adding atezolizumab to bevacizumab, carboplatin, and paclitaxel as a first-line treatment strategy for patients with metastatic nonsquamous non-small cell lung cancer in the United States. DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, a primary microsimulation model was developed to assess atezolizumab combination vs bevacizumab, carboplatin, and paclitaxel alone in the first line (base case 1). A secondary model was developed to assess these treatments along with pembrolizumab combination and platinum doublet chemotherapy (base case 2). Treatment strategies and other simulated conditions were based on those from the IMpower150 and KEYNOTE-189 clinical trials. The study perspective was the US health care sector. One million patients with metastatic nonsquamous non-small cell lung cancer were simulated for each treatment group. This study was performed from February 2019 through May 2019. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratios were compared with a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY). RESULTS In base case 1, in which 1 million patients were simulated, treating with bevacizumab, carboplatin, and paclitaxel in the first line was associated with a mean cost of $112 551 (95% CI, $112 450-$112 653) and a mean survival of 1.48 QALYs (95% CI, 1.47-1.48 QALYs) per patient. Atezolizumab plus bevacizumab, carboplatin, and paclitaxel was associated with a mean cost of $244 166 (95% CI, $243 864-$244 468) and a mean survival of 2.13 QALYs (95% CI, 2.12-2.13 QALYs) per patient, for an estimated incremental cost-effectiveness ratio of $201 676 per QALY (95% CI, $198 105-$205 355 per QALY). In base case 2, in which 1 million patients were simulated, pembrolizumab combination therapy was associated with a mean cost of $226 282 (95% CI, $226 007-$226 557) and a mean survival of 2.45 QALYs (95% CI, 2.44-2.46 QALYs) per patient. Pembrolizumab combination dominated atezolizumab plus bevacizumab, carboplatin, and paclitaxel, leading to an incremental cost-effectiveness ratio of $116 698 per QALY (95% CI, $115 088-$118 342 per QALY) between pembrolizumab combination and bevacizumab, carboplatin, and paclitaxel. Atezolizumab combination was not cost-effective at a willingness-to-pay threshold of $100 000 per QALY. CONCLUSIONS AND RELEVANCE In this simulated model economic analysis, atezolizumab combination was not cost-effective compared with bevacizumab, carboplatin, and paclitaxel and provided suboptimal incremental benefit compared with cost vs pembrolizumab combination for first-line treatment. Although atezolizumab combination therapy provides clinical benefits, price reductions may be necessary for this treatment strategy to become cost-effective.
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MESH Headings
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/economics
- Antineoplastic Combined Chemotherapy Protocols
- Bevacizumab/economics
- Bevacizumab/therapeutic use
- Carboplatin/economics
- Carboplatin/therapeutic use
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/economics
- Carcinoma, Non-Small-Cell Lung/pathology
- Cost-Benefit Analysis
- Humans
- Lung Neoplasms/drug therapy
- Lung Neoplasms/economics
- Lung Neoplasms/pathology
- Models, Economic
- Paclitaxel/economics
- Paclitaxel/therapeutic use
- Patient Simulation
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
- Steven D. Criss
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Meghan J. Mooradian
- Massachusetts General Hospital Cancer Center, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Tina R. Watson
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Justin F. Gainor
- Massachusetts General Hospital Cancer Center, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Kerry L. Reynolds
- Massachusetts General Hospital Cancer Center, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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2221
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Immunotherapy in Metastatic Castration-Resistant Prostate Cancer: Past and Future Strategies for Optimization. Curr Urol Rep 2019; 20:64. [PMID: 31482315 DOI: 10.1007/s11934-019-0931-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW To date, prostate cancer has been poorly responsive to immunotherapy. In the current review, we summarize and discuss the current literature on the use of vaccine therapy and checkpoint inhibitor immunotherapy in metastatic castration-resistant prostate cancer (mCRPC). RECENT FINDINGS Sipuleucel-T currently remains the only FDA-approved immunotherapeutic agent for prostate cancer. Single-agent phase 3 vaccine trials with GVAX and PROSTVAC have failed to demonstrate survival benefit to date. Clinical trials using combination approaches, including combination PROSTVAC along with a neoantigen vaccine and checkpoint inhibitor immunotherapy, are ongoing. Checkpoint inhibitor monotherapy clinical trials have demonstrated limited efficacy in advanced prostate cancer, and combination approaches and molecular patient selection are currently under investigation. The optimal use of vaccine therapy and checkpoint inhibitor immunotherapy in metastatic castration-resistant prostate cancer remains to be determined. Ongoing clinical trials will continue to inform future clinical practice.
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2222
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Tone M, Izumo T, Awano N, Kuse N, Inomata M, Jo T, Yoshimura H, Minami J, Takada K, Miyamoto S, Kunitoh H. High mortality and poor treatment efficacy of immune checkpoint inhibitors in patients with severe grade checkpoint inhibitor pneumonitis in non-small cell lung cancer. Thorac Cancer 2019; 10:2006-2012. [PMID: 31482678 PMCID: PMC6775002 DOI: 10.1111/1759-7714.13187] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background The treatment efficacy of immune checkpoint inhibitor (ICI) and clinical outcomes in patients with non‐small cell lung cancer (NSCLC) who develop severe grade checkpoint inhibitor pneumonitis (CIP) are unclear. Here, we report on the treatment efficacy of ICI and prognosis in NSCLC patients with severe grade CIP. Methods In this retrospective cohort study, CIP severity, CIP‐related mortality, and ICI efficacy in 71 patients with advanced NSCLC treated with ICIs were evaluated. Data was obtained from the patients’ medical charts. Results All grade and severe grade CIP were observed in 22 and 11 patients, respectively. The CIP‐related mortality rate was 22.7% (N = 5). An Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) score of ≥2 and pre‐existing interstitial lung disease (ILD) were significantly associated with the development of severe grade CIP (P = 0.001 and P = 0.035, respectively). The median progression‐free survival (PFS) and overall survival (OS) were significantly shorter in patients with severe grade CIP than in those without severe grade CIP (PFS 1.0 month, 95% confidence interval [CI] 0.5–2.0 vs. 3.5 months, 95% CI 2.0–5.0 months, P = 0.003; OS 3.0 months, 95% CI 0.5–13 vs. 12.7 months, 95% CI 8.0–21.0 months, P = 0.011). Conclusion CIP is a serious complication with a poor prognosis associated with high mortality. The efficacy of ICI is significantly worse in patients with severe grade CIP than in those without severe grade CIP. Whether ICIs should be administered to patients with CIP risk factors, such as an ECOG PS score of ≥2 or pre‐existing ILD, should be carefully assessed.
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Affiliation(s)
- Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naoyuki Kuse
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tatsunori Jo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hanako Yoshimura
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Jonsu Minami
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kohei Takada
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shingo Miyamoto
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hideo Kunitoh
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
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2223
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Cohen AY, Kian W, Roisman LC, Levitas D, Peled N, Dudnik Y. Are we facing a cure in lung cancer?-KEYNOTE-001 insights. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S215. [PMID: 31656794 DOI: 10.21037/atm.2019.08.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Aharon Y Cohen
- Oncology Division, The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
| | - Waleed Kian
- Oncology Division, The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
| | - Laila C Roisman
- Oncology Division, The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
| | - Dina Levitas
- Oncology Division, The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
| | - Nir Peled
- Oncology Division, The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
| | - Yulia Dudnik
- Oncology Division, The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
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2224
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Morgensztern D. KEYNOTE-042 and the role for single agent pembrolizumab in patients with PD-L1 tumor proportion score 1-49. J Thorac Dis 2019; 11:S1963-S1965. [PMID: 31632798 DOI: 10.21037/jtd.2019.07.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Daniel Morgensztern
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
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2225
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Molecular basis and rationale for combining immune checkpoint inhibitors with chemotherapy in non-small cell lung cancer. Drug Resist Updat 2019; 46:100644. [PMID: 31585395 DOI: 10.1016/j.drup.2019.100644] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022]
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2226
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Rassy E, Mezquita L, Remon J, Besse B. Non-small-cell lung cancer: what are the benefits and challenges of treating it with immune checkpoint inhibitors? Immunotherapy 2019; 11:1149-1160. [DOI: 10.2217/imt-2019-0071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape of advanced non-small-cell lung cancer (NSCLC). It has improved the overall survival in the first- and second-line setting with manageable adverse events. Multiple challenges still impede the success of ICI in the whole population of NSCLC namely the lack of reliable predictive biomarkers, the scarcity of data regarding the optimal treatment duration with ICI and possibility of rechallenge with ICI as well as the efficacy of ICI in special subgroups of patients such as those with oncogenic addicted tumors or patients with brain metastases. In this framework, we review the benefits and challenges of ICI in NSCLC, in monotherapy and in combinations, in the advanced setting.
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Affiliation(s)
- Elie Rassy
- Department of Cancer Medicine, Gustave Roussy Institute, F-94805 Villejuif, France
- Department of Medical Oncology, Faculty of Medicine, Saint Joseph University, Lebanon
| | - Laura Mezquita
- Department of Cancer Medicine, Gustave Roussy Institute, F-94805 Villejuif, France
| | - Jordi Remon
- Centroi Integral Oncología Clara Campal Barcelona – HM Delfos, Barcelona, Spain
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy Institute, F-94805 Villejuif, France
- Université Paris Sud, Université Paris-Saclay, F-94270 Le Kremlin-Bicêtre, France
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2227
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Gao G, Qiao M, Liu H, Jiang T, Zhou F, Li X, Zhao C, Chen X, Su C, Ren S, Zhou C. Impact of clinicopathological features on the efficacy of immune checkpoint inhibitors plus conventional treatment in patients with advanced lung cancer. J Thorac Dis 2019; 11:3794-3807. [PMID: 31656652 DOI: 10.21037/jtd.2019.09.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background To investigate the impact of different immune checkpoint inhibitors (ICI), programmed-death ligand 1 (PD-L1) expression and clinical characteristics on clinical outcome of ICI plus conventional treatment in advanced lung cancer patients. Methods Randomized clinical trials that compared combination therapy versus control group were screened in PubMed, EMBASE, Web of Science, Cochrane Library and included. The pooled hazard ratio (HR) with a 95% confidence interval (95% CI) were used to estimate associations. Cochrane Collaboration tool was used for quality assessment. Results Thirteen clinical trials were included (n=9,241). The pooled results indicated that combination strategy based on ICI significantly improved PFS (HR =0.66, P<0.001) and OS (HR =0.77, P<0.001) in overall population. Greatest PFS improvement was seen in group of PD-1 based combination (HR =0.54, P<0.001), followed by PD-L1 based (HR =0.66, P<0.001) and CTLA-4 based combination (HR =0.86, P=0.002) (interaction: P<0.001).The improvement in PFS did proportionally differ by PD-L1 expression (interaction: P<0.001). OS HRs favored combination in patients with negative or strong positive group of PD-L1 expression not in the group of weak positive group (HR =0.77, P=0.12). Subgroup analysis demonstrated that OS benefit could be observed in male (HR =0.82, P=0.03), current or former smokers (HR =0.74, P=0.04), non-squamous (HR =0.71, P<0.001) and patients without driver mutations (HR =0.73, P<0.001). OS benefit rather than PFS benefit was appeared in patients with liver metastasis treated with ICI-based combination (HR =0.74, P=0.005). Conclusions ICI plus conventional treatment could significantly improve PFS and OS in overall advanced lung cancer patients. PD-1-based combination leads to the greatest improvement in both PFS and OS. More data are warranted to address the association of PD-L1 staining intensity with OS improvement. Male, current or former smokers, non-squamous and patients without driver mutations do benefit from ICI-based combination.
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Affiliation(s)
- Guanghui Gao
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou 213000, China.,Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Meng Qiao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Hongcheng Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Tao Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Fei Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Chao Zhao
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Xiaoxia Chen
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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2228
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Ohba T, Takamori S, Toyozawa R, Nosaki K, Umeyama Y, Haratake N, Miura N, Yamaguchi M, Taguchi K, Seto T, Shimokawa M, Takenoyama M. Prognostic impact of the Controlling Nutritional Status score in patients with non-small cell lung cancer treated with pembrolizumab. J Thorac Dis 2019; 11:3757-3768. [PMID: 31656648 DOI: 10.21037/jtd.2019.09.29] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Pembrolizumab, an anti-programmed cell death-1 (PD-1) monoclonal antibody, has been shown to yield a durable response and significant survival benefit in some non-small cell lung cancer (NSCLC) patients. Recent studies have shown that the Controlling Nutritional Status (CONUT) score, a novel nutritional index, can be useful for predicting the prognosis in some malignancies. However, its usefulness in predicting the clinical outcome of immune-checkpoint inhibitor (ICI) treatment in patients with NSCLC has not been clarified. The aim of this study was to investigate the clinical significance of the CONUT score in NSCLC patients treated with pembrolizumab. Methods We conducted a retrospective analysis of the clinical data of 32 patients with advanced NSCLC who received pembrolizumab monotherapy. A cut-off CONUT score of 2 was used to categorize patients into low and high CONUT groups. We evaluated the relation between the clinicopathological factors including CONUT score and neutrophil-to-lymphocyte ratio (NLR) and the prognosis. Results Twenty-two patients were classified into the low CONUT score group, while 10 were classified into the high CONUT score group. In the univariate and multivariate analyses, the number of prior treatments and the CONUT score were found to independently predict progression-free survival (PFS) (P<0.05), while the CONUT score as well as NLR was an independent prognostic factor for overall survival (P<0.05). In addition, in patients who received pembrolizumab as a first-line treatment, a high CONUT score was associated with a significantly worse PFS and overall survival in comparison to a low CONUT score. Conclusions The CONUT score has potential application as a predictor of the therapeutic effect and the prognosis of NSCLC patients treated with pembrolizumab. Our findings suggest that in addition to the programmed cell death ligand 1 expression level, the CONUT may also be a useful indicator for selecting NSCLC patients who may benefit from ICI treatment.
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Affiliation(s)
- Taro Ohba
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Shinkichi Takamori
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kaname Nosaki
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yasuhiro Umeyama
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Naoki Haratake
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Naoko Miura
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Masafumi Yamaguchi
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kenichi Taguchi
- Department of Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Mitsuhiro Takenoyama
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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2229
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Muniz TP, de Jesus VHF, Sousa VAR, Barbosa MVDR, de Lima VCC. A modified recursive partitioning analysis for predicting overall survival in patients with non-small cell lung cancer and central nervous system metastases. J Thorac Dis 2019; 11:3909-3919. [PMID: 31656665 DOI: 10.21037/jtd.2019.08.115] [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] [Indexed: 12/21/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) is a major cause of brain metastases. Nonetheless, patients with central nervous system (CNS) spread are poorly represented in clinical trials. We sought to evaluate the overall survival (OS) of patients with NSCLC and CNS metastases. Methods Patients with NSCLC and CNS metastases treated at A. C. Camargo Cancer Center from January 2007 to December 2017 were selected. The primary endpoint was OS following the diagnosis of CNS metastasis. The Kaplan-Meier method was applied to calculate OS. Prognostic factors were assessed by the Cox Proportional Hazards model. As an exploratory analysis, a survival tree was generated based upon the two most statistically significant variables in the multivariate model and one additional clinically meaningful variable. Results In total, 311 patients were included. Median OS was 10.3 months (95% CI, 8.7-13.1 months). ECOG performance status 2-4 (HR 2.12; 95% CI, 1.40-3.20; P<0.01) and the absence of a driver mutation (HR 3.30; 95% CI, 1.85-5.90; P<0.01) were strongly associated with worse OS. A Modified Recursive Partitioning Analysis (mRPA) was developed based on the curves generated by the survival tree. mRPA stratified our cohort in four subgroups with significantly different OS (3.1 to 43 months) and it outperformed both RPA and GPA in predicting OS in our population. Conclusions OS in our cohort was better than previously reported. However, prognosis is widely variable and is mostly dictated by performance status and the presence of a driver mutation.
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2230
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Molife C, Hess LM, Cui ZL, Li XI, Beyrer J, Mahoui M, Oton AB. Sequential therapy with ramucirumab and/or checkpoint inhibitors for non-small-cell lung cancer in routine practice. Future Oncol 2019; 15:2915-2931. [PMID: 30793926 DOI: 10.2217/fon-2018-0876] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: To describe treatment patterns and outcomes for advanced/metastatic non-small-cell lung cancer (aNSCLC) treated with single-agent or combination ramucirumab (ramucirumab-based) and/or immune checkpoint inhibitor (ICI-based) therapy. Materials & methods: Retrospective study of aNSCLC patients (n = 4054) identified in the Flatiron Health database, who received at least two treatment lines including ramucirumab- and/or ICI-based regimens between December 2014 and May 2017. Results: Median overall survival (95% CI) from aNSCLC diagnosis was 29.3 (25.5-33.0) months for patients receiving sequential ramucirumab- and ICI-based therapy (n = 245), 15.1 (12.6-18.2) months for patients receiving sequences including ramucirumab- without ICI-based therapy (n = 112), and 23.1 (21.9-24.2) months for patients receiving ICI-based therapy without ramucirumab-based therapy in sequence (n = 3697). Conclusion: Results provide real-world survival estimates for aNSCLC treated with sequences including ramucirumab- and/or ICI-based therapies.
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Affiliation(s)
- Cliff Molife
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Lisa M Hess
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Zhanglin Lin Cui
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Xiaohong Ivy Li
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Julie Beyrer
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Malika Mahoui
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Ana B Oton
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
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2231
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Bauml JM, Mick R, Ciunci C, Aggarwal C, Davis C, Evans T, Deshpande C, Miller L, Patel P, Alley E, Knepley C, Mutale F, Cohen RB, Langer CJ. Pembrolizumab After Completion of Locally Ablative Therapy for Oligometastatic Non-Small Cell Lung Cancer: A Phase 2 Trial. JAMA Oncol 2019; 5:1283-1290. [PMID: 31294762 DOI: 10.1001/jamaoncol.2019.1449] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Patients with oligometastatic non-small cell lung cancer (NSCLC) may benefit from locally ablative therapy (LAT) such as surgery or stereotactic radiotherapy. Prior studies were conducted before the advent of immunotherapy, and a strong biological rationale for the use of immunotherapy exists in a minimal residual disease state. Objective To evaluate whether the addition of pembrolizumab after LAT improves outcomes for patients with oligometastatic NSCLC. Design, Setting, and Participants This single-arm phase 2 trial of pembrolizumab therapy was performed from February 1, 2015, through September 30, 2017, at an academic referral cancer center. The 51 eligible patients enrolled had oligometastatic NSCLC (≤4 metastatic sites) and had completed LAT to all known sites of disease. Data were analyzed from February 1, 2015, to August 23, 2018. Interventions Within 4 to 12 weeks of completing LAT, patients began intravenous pembrolizumab therapy, 200 mg every 21 days, for 8 cycles, with provision to continue to 16 cycles in the absence of progressive disease or untoward toxic effects. Main Outcomes and Measures The 2 primary efficacy end points were progression-free survival (PFS) from the start of LAT (PFS-L), which preceded enrollment in the trial, and PFS from the start of pembrolizumab therapy (PFS-P). The study was powered for comparison with historical data on the first efficacy end point. Secondary outcomes included overall survival, safety, and quality of life as measured by the Functional Assessment of Cancer Therapy-Lung instrument. Results Of 51 patients enrolled, 45 (24 men [53%]; median age, 64 years [range, 46-82 years]) received pembrolizumab. At the time of analysis, 24 patients had progressive disease or had died. Median PFS-L was 19.1 months (95% CI, 9.4-28.7 months), significantly greater than the historical median of 6.6 months (P = .005). Median PFS-P was 18.7 months (95% CI, 10.1-27.1 months). Eleven patients died. Overall mean (SE) survival rate at 12 months was 90.9% (4.3%); at 24 months, 77.5% (6.7%). Neither programmed death ligand 1 expression nor CD8 T-cell tumor infiltration was associated with PFS-L. Pembrolizumab after LAT yielded no new safety signals and no reduction in quality of life. Conclusions and Relevance Pembrolizumab after LAT for oligometastatic NSCLC appears to improve PFS with no reduction in quality of life. Trial Registration ClinicalTrials.gov identifier: NCT02316002.
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Affiliation(s)
- Joshua M Bauml
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Rosemarie Mick
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Christine Ciunci
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Charu Aggarwal
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Christiana Davis
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Tracey Evans
- Division of Hematology/Oncology, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Charuhas Deshpande
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Linda Miller
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Pooja Patel
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Evan Alley
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Christina Knepley
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Faith Mutale
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Roger B Cohen
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Corey J Langer
- Abramson Cancer Center, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
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2232
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Abdel Karim N, Kelly K. Role of Targeted Therapy and Immune Checkpoint Blockers in Advanced Non-Small Cell Lung Cancer: A Review. Oncologist 2019; 24:1270-1284. [PMID: 30914465 PMCID: PMC6738296 DOI: 10.1634/theoncologist.2018-0112] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 01/17/2019] [Indexed: 12/18/2022] Open
Abstract
Advanced non-small cell lung cancer (NSCLC) is a complex disease comprising molecularly distinct tumor types, each with a unique biology that is becoming increasingly better characterized. The aim of this review is to present an optimized treatment schema and the accompanying diagnostic testing approach for patients with advanced NSCLC. There are a number of therapies currently approved for patients with advanced NSCLC, including agents that target particular oncogenic drivers, as well as immune checkpoint blockers (ICBs) that elicit an antitumor response. Identification of genetic alterations (e.g., epidermal growth factor receptor, anaplastic lymphoma kinase, reactive oxygen species proto-oncogene 1, B-Raf proto-oncogene) or programmed cell death ligand-1 expression levels in NSCLC requires diligent molecular testing at initial diagnosis and, in some cases, at disease progression to ensure the most efficacious treatment is delivered. Accurate molecular diagnostic testing, along with the careful selection of currently approved targeted agents, ICBs, or systemic chemotherapy, provides therapy that is personalized according to patients' needs to achieve the best possible outcome. Enrollment in clinical trials that further the development of tailored therapies is highly recommended at all stages of treatment. IMPLICATIONS FOR PRACTICE: Targeted therapies and immune checkpoint blockers provide effective and tailored options for patients with non-small cell lung cancer. Careful molecular analysis of tumor samples is necessary to identify the genetic alterations that are present, to ensure that each patient receives the most efficacious treatment for their specific tumor type. Personalized therapy provides each patient with the best probability for prolonged survival. Enrolling patients in clinical trials should be the first consideration before making each treatment decision.
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Affiliation(s)
| | - Karen Kelly
- University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
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2233
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Kim YJ, Keam B, Ock CY, Song S, Kim M, Kim SH, Kim KH, Kim JS, Kim TM, Kim DW, Lee JS, Heo DS. A phase II study of pembrolizumab and paclitaxel in patients with relapsed or refractory small-cell lung cancer. Lung Cancer 2019; 136:122-128. [PMID: 31494530 DOI: 10.1016/j.lungcan.2019.08.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with etoposide/platinum-refractory extensive disease (ED) small-cell lung cancer (SCLC) have a dismal prognosis. We aimed to evaluate the efficacy and safety of pembrolizumab and paclitaxel combination therapy in these patients. METHODS In this multi-center, phase II study, ED-SCLC patients who showed progression after etoposide/platinum chemotherapy received paclitaxel 175 mg/m2 every 3 weeks for up to six cycles. Pembrolizumab 200 mg was added from the second cycle and continued until disease progression or unacceptable toxicity. The primary endpoint was the objective response rate (ORR) and the secondary endpoints were progression-free survival (PFS), overall survival (OS), safety, and biomarker analyses including programmed death-ligand 1 (PD-L1) expression, next-generation sequencing, and flow cytometric analysis of peripheral blood cells. RESULTS Of the 26 patients enrolled, the confirmed ORR was 23.1% (95%CI: 6.9%-39.3%); complete response: 3.9%, confirmed partial response [PR]: 19.2%, stable disease: 57.7%, progressive disease: 7.7%, and not evaluable: 11.5%. Including 4 cases of unconfirmed PRs, 38.5% of patients were responding and the disease control rate was 80.7%. The median PFS and OS were 5.0 months (95% CI: 2.7-6.7) and 9.1 months (95% CI: 6.5-15.0), respectively. The grade 3 or 4 adverse events observed included febrile neutropenia (7.7%), neutropenia (7.7%), asthenia (7.7%), hyponatremia (7.7%), and type I diabetes (7.7%). Targeted gene sequencing identified no specific genetic alterations correlated with the treatment, except for theMET copy number gain (PFS 10.5 versus 3.4 months, p = 0.019). CONCLUSIONS Pembrolizumab and paclitaxel combination therapy showed a moderate activity with acceptable toxicity in patients with refractory ED-SCLC.
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Affiliation(s)
- Yu-Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sanghoon Song
- Theragen Etex Bioinstitute, NGS Genome Division, Suwon, Republic of Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Hwan Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Jong Seok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
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2234
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Costantini A, Takam Kamga P, Dumenil C, Chinet T, Emile JF, Giroux Leprieur E. Plasma Biomarkers and Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer: New Tools for Better Patient Selection? Cancers (Basel) 2019; 11:cancers11091269. [PMID: 31470546 PMCID: PMC6769436 DOI: 10.3390/cancers11091269] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for patients with non-small cell lung cancer (NSCLC). Although some patients can experience important response rates and improved survival, many others do not benefit from ICIs developing hyper-progressive disease or immune-related adverse events. This underlines the need to select biomarkers for ICIs use in order to better select patients. There is currently no universally validated robust biomarker for daily use of ICIs. Programmed death-ligand 1 (PD-L1) or tumor mutational burden (TMB) are sometimes used but still have several limitations. Plasma biomarkers are a promising approach in ICI treatment. This review will describe the development of novel plasma biomarkers such as soluble proteins, circulating tumor DNA (ctDNA), blood TMB, and blood microbiome in NSCLC patients treated with ICIs and their potential use in predicting response and toxicity.
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Affiliation(s)
- Adrien Costantini
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Paul Takam Kamga
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
- Department of Pathology, APHP-Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France.
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France.
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2235
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Low JL, Walsh RJ, Ang Y, Chan G, Soo RA. The evolving immuno-oncology landscape in advanced lung cancer: first-line treatment of non-small cell lung cancer. Ther Adv Med Oncol 2019; 11:1758835919870360. [PMID: 31497071 PMCID: PMC6716180 DOI: 10.1177/1758835919870360] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/26/2019] [Indexed: 12/22/2022] Open
Abstract
Lung cancer is the most common cancer and leading cause of cancer death. While
targeted therapies have redefined treatment options for non-small cell lung
carcinoma (NSCLC) with genetic aberrations such as epidermal growth factor and
anaplastic lymphoma kinase, many patients do not harbour these oncogenic
drivers. Cancer immunology has enabled the development of immune modulators that
has dramatically altered the therapeutic landscape of advanced NSCLC. The
success of immune-checkpoint inhibitors in pretreated NSCLC has led to the
conduct of multiple studies exploring their role in the first-line setting. This
article provides an overview of the evolving landscape of immune-checkpoint
inhibitors with a focus on the programmed cell-death 1 (PD-1; pembrolizumab,
nivolumab) and programmed cell-death ligand 1 (PD-L1; atezolizumab, durvalumab,
avelumab) immune-checkpoint inhibitors as single agent or in combination with
either chemotherapy or with another immune-checkpoint inhibitor in the treatment
of NSCLC, the challenges faced, as well as future perspectives.
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Affiliation(s)
- Jia Li Low
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Robert J Walsh
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Yvonne Ang
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Gloria Chan
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore 119228, Singapore
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2236
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Abstract
IMPORTANCE Non-small cell lung cancer remains the leading cause of cancer death in the United States. Until the last decade, the 5-year overall survival rate for patients with metastatic non-small cell lung cancer was less than 5%. Improved understanding of the biology of lung cancer has resulted in the development of new biomarker-targeted therapies and led to improvements in overall survival for patients with advanced or metastatic disease. OBSERVATIONS Systemic therapy for metastatic non-small cell lung cancer is selected according to the presence of specific biomarkers. Therefore, all patients with metastatic non-small cell lung cancer should undergo molecular testing for relevant mutations and expression of the protein PD-L1 (programmed death ligand 1). Molecular alterations that predict response to treatment (eg, EGFR mutations, ALK rearrangements, ROS1 rearrangements, and BRAF V600E mutations) are present in approximately 30% of patients with non-small cell lung cancer. Targeted therapy for these alterations improves progression-free survival compared with cytotoxic chemotherapy. For example, somatic activating mutations in the EGFR gene are present in approximately 20% of patients with advanced non-small cell lung cancer. Tyrosine kinase inhibitors such as gefitinib, erlotinib, and afatinib improve progression-free survival in patients with susceptible EGFR mutations. In patients with overexpression of ALK protein, the response rate was significantly better with crizotinib (a tyrosine kinase inhibitor) than with the combination of pemetrexed and either cisplatin or carboplatin (platinum-based chemotherapy) (74% vs 45%, respectively; P < .001) and progression-free survival (median, 10.9 months vs 7.0 months; P < .001). Subsequent generations of tyrosine kinase inhibitors have improved these agents. For patients without biomarkers indicating susceptibility to specific targeted treatments, immune checkpoint inhibitor-containing regimens either as monotherapy or in combination with chemotherapy are superior vs chemotherapy alone. These advances in biomarker-directed therapy have led to improvements in overall survival. For example, the 5-year overall survival rate currently exceeds 25% among patients whose tumors have high PD-L1 expression (tumor proportion score of ≥50%) and 40% among patients with ALK-positive tumors. CONCLUSIONS AND RELEVANCE Improved understanding of the biology and molecular subtypes of non-small cell lung cancer have led to more biomarker-directed therapies for patients with metastatic disease. These biomarker-directed therapies and newer empirical treatment regimens have improved overall survival for patients with metastatic non-small cell lung cancer.
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Affiliation(s)
- Kathryn C Arbour
- Thoracic Oncology Service, Division of Solid Tumor, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Gregory J Riely
- Thoracic Oncology Service, Division of Solid Tumor, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
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2237
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Validation of prognostic impact of number of extrathoracic metastases according to the eighth TNM classification: a single-institution retrospective study in Japan. Int J Clin Oncol 2019; 24:1549-1557. [DOI: 10.1007/s10147-019-01525-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
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2238
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Qiu Z, Chen Z, Zhang C, Zhong W. Achievements and futures of immune checkpoint inhibitors in non-small cell lung cancer. Exp Hematol Oncol 2019; 8:19. [PMID: 31463163 PMCID: PMC6706908 DOI: 10.1186/s40164-019-0143-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/14/2019] [Indexed: 12/26/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) has been threatening human health for years. Cytotoxicity-based chemotherapy seems to reach plateau in NSCLC treatment. Immunotherapy with immune checkpoint inhibitors (ICIs) against programmed cell death 1 (PD-1/L1) axis are to provide long-term survival benefits for wild-type advanced NSCLC patients with acceptable adverse effects. Though beneficiary population is limited from monotherapy, combination strategies are expanding indicators. Retrospective evidences suggested ICIs are also potentially useful for brain metastasis. Furthermore, the combination of ICIs and surgery are to prolong progression free survival time for local advanced patients. Additionally, novel agents targeting in immune checkpoints other than PD-1/L1 demonstrated potential values in anticancer immunity. Herein, we summarize the novel therapies of checkpoint inhibitors in NSCLC treatment and some other potential immunotherapy to provide a conspectus for novel immunotherapy in NSCLC and perspective for the future in anti-cancer treatment.
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Affiliation(s)
- Zhenbin Qiu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 Guangdong China
| | - Zihao Chen
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 Guangdong China
| | - Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 Guangdong China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, 510080 Guangdong China
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2239
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Liang H, Wang M. Prospect of immunotherapy combined with anti-angiogenic agents in patients with advanced non-small cell lung cancer. Cancer Manag Res 2019; 11:7707-7719. [PMID: 31616186 PMCID: PMC6699593 DOI: 10.2147/cmar.s212238] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/24/2019] [Indexed: 12/26/2022] Open
Abstract
In the latest years, some drugs have been approved by European Medicines Agency (EMA) and/or the US Food and Drug Administration (FDA) for the treatment of patients with advanced non-small cell lung cancer (NSCLC), particularly for the treatment of those who have no targeted gene mutations or who have progressed on previously targeted therapy or platinum-containing dual-agent chemotherapy. In general, these drugs fall into two categories: anti-angiogenic agents and immune checkpoint inhibitors (ICIs). Anti-angiogenic agents currently approved by the FDA and/or EMA for advanced NSCLC treatment include bevacizumab, nintedanib, and ramucirumab. Anlotinib has been approved in advanced NSCLC by Chinese Food and Drug Administration (CFDA). These anti-angiogenic agents can induce anti-angiogenesis by targeting vascular endothelial growth factor (VEGF)/VEGF2 or inhibiting multiple small molecules involved in angiogenic and proliferative pathways such as platelet-derived growth factor receptors (PDGFRs) and fibroblast growth factor receptors (FGFRs). Although these drugs show significant therapeutic efficacy, most patients inevitably experience disease progression resulting in death. ICIs approved by the FDA and/or EMA for advanced NSCLC treatment include nivolumab, pembrolizumab, and atezolizumab. These ICIs can significantly improve efficacy compared with standard chemotherapy by targeting programmed cell death protein 1 (PD-1) receptor or PD-2 receptor with longer response duration and acceptable toxicity. However, the response rate of ICIs is suboptimal, and only a few patients ultimately benefit from immunotherapy. So current efforts have focused on exploring new potential combinatorial strategies with synergistic antitumor activity. Here, we summarized the theoretical basis, current clinical data, and potential future perspective of immunotherapy combined with anti-angiogenic agents for advanced NSCLC.
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Affiliation(s)
- Hongge Liang
- Lung Cancer Center, Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Mengzhao Wang
- Lung Cancer Center, Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
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2240
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Bylicki O, Barazzutti H, Paleiron N, Margery J, Assié JB, Chouaïd C. First-Line Treatment of Non-Small-Cell Lung Cancer (NSCLC) with Immune Checkpoint Inhibitors. BioDrugs 2019; 33:159-171. [PMID: 30825132 DOI: 10.1007/s40259-019-00339-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Treatment of advanced-stage or metastatic non-small-cell lung cancers (NSCLCs) without EGFR mutations or ALK rearrangements, which can now be treated with molecularly targeted therapies, had been based on cytotoxic chemotherapy for a long time. Immune checkpoint inhibitors (ICIs), notably antibodies directed against programmed cell-death protein-1 (PD-1) and its ligand (PD-L1) have transformed therapeutic standards in thoracic oncology. These ICIs are now the reference second-line treatment and numerous phase III trials have examined their efficacy in treatment-naïve patients. First-line pembrolizumab monotherapy was validated for patients with ≥ 50% of tumor cells expressing PD-L1; pembrolizumab, atezolizumab, and nivolumab have obtained good outcomes in combination with chemotherapy or another immunotherapy. However, in this context, other phase III trials yielded negative findings for nivolumab alone (CheckMate-026) or in combination (MYSTIC trial). Biomarkers, such as PD-L1 and the tumor mutation burden (TMB), enable better selection of patients who should benefit the most from first-line ICI use.
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Affiliation(s)
- Olivier Bylicki
- Service de Pneumologie, Hôpital d'Instruction des Armées Percy, 106, avenue Henri-Barbusse, 92140, Clamart Cedex, France.
| | - Helene Barazzutti
- Department of Respiratory Diseases, Hôpital d'Instruction des Armées Saint-Anne, Toulon, France
| | - Nicolas Paleiron
- Department of Respiratory Diseases, Hôpital d'Instruction des Armées Saint-Anne, Toulon, France
| | - Jacques Margery
- Service de Pneumologie, Hôpital d'Instruction des Armées Percy, 106, avenue Henri-Barbusse, 92140, Clamart Cedex, France
| | - Jean-Baptiste Assié
- Service de Pneumologie, Centre Hospitalier Intercommunal Creteil, 40 avenue de Verdun, 94010, Creteil, France
| | - Christos Chouaïd
- Service de Pneumologie, Centre Hospitalier Intercommunal Creteil, 40 avenue de Verdun, 94010, Creteil, France.
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2241
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Pretreatment prognostic nutritional index as a novel biomarker in non-small cell lung cancer patients treated with immune checkpoint inhibitors. Lung Cancer 2019; 136:45-51. [PMID: 31437663 DOI: 10.1016/j.lungcan.2019.08.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Immune checkpoint inhibitors (ICIs) have been established as a novel strategy for non-small cell lung cancer (NSCLC) therapy. However, a definitive biomarker that can predict response to ICI therapy remains unestablished. The prognostic nutritional index (PNI) is used to assess immune-nutritional conditions and is a prognostic factor in patients with various malignancies; however, its usefulness as a biomarker of response to ICI therapy and survival outcomes in NSCLC patients is unknown. Thus, we retrospectively analyzed the clinicopathological features of advanced-stage or recurrent NSCLC patients treated with ICI therapy to identify predictors of response to ICI therapy and investigate the effects of pretreatment PNI levels on survival after ICI therapy. MATERIALS AND METHODS We selected 102 consecutive NSCLC patients who were treated with ICI therapy from November 2015 to February 2019. We measured their pretreatment PNI levels and performed univariate and multivariate Cox regression analyses of progression-free survival (PFS) or overall survival (OS) after ICI therapy. RESULTS Pretreatment PNI levels were significantly associated with response to ICI therapy (objective response rate:P = 0.0131; disease control rate: P = 0.0002), PFS (P = 0.0013), and OS (P = 0.0053). In univariate and multivariate analyses of the associations between PNI, C-reactive protein (CRP) or neutrophil-lymphocyte ratio (NLR) and PFS or OS, NLR and PNI, but not CRP, are independent prognostic factors for PFS (NLR: relative risk [RR]=1.655, 95% confidence interval [CI]: 1.012-2.743, P = 0.0449, PNI: RR=1.704, 95% CI: 1.039-2.828, P = 0.0346). Only PNI showed a trend towards being an independent prognostic factor for OS (RR=1.606, 95% CI: 0.952-2.745, P = 0.0761). CONCLUSION The pretreatment PNI has the potential to be a simple and novel predictive biomarker of ICI response in NSCLC patients and might help to identify patients who will obtain a survival benefit from ICI therapy.
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2242
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Souquet PJ, Couraud S. Immune checkpoint inhibitors: a game changer for metastatic non-small-cell lung cancer. Lancet Oncol 2019; 20:1334-1335. [PMID: 31422027 DOI: 10.1016/s1470-2045(19)30508-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Pierre-Jean Souquet
- Service de Cancérologie Thoracique, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon, Lyon 69002, France; Intergroupe Francophone de Cancérologie Thoracique, Paris, France.
| | - Sébastien Couraud
- Service de Cancérologie Thoracique, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon, Lyon 69002, France; EMR 3738 Ciblage Thérapeutique en oncologie, Faculté de médecine Lyon Sud, Université Lyon, Lyon, France
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2243
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Morgensztern D, Karaseva N, Felip E, Delgado I, Burdaeva O, Dómine M, Lara P, Paik PK, Lassen U, Orlov S, Trigo J, Shomova M, Baker-Neblett K, Vasquez J, Wang X, Yan L, Mitrica I, DeYoung MP, Garrido P. An open-label phase IB study to evaluate GSK3052230 in combination with paclitaxel and carboplatin, or docetaxel, in FGFR1-amplified non-small cell lung cancer. Lung Cancer 2019; 136:74-79. [PMID: 31446228 DOI: 10.1016/j.lungcan.2019.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/11/2019] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES GSK3052230 (FP-1039) is a soluble fusion protein that acts as ligand trap sequestering fibroblast growth factors (FGFs) involved in tumor growth and angiogenesis, while sparing the hormonal FGFs. Because of this selectivity, the molecule is predicted to avoid toxicities associated with small molecule inhibitors of FGFR, including hyperphosphatemia and retinal, nail, and skin toxicities. Herein we report the results of a phase 1b study where GSK3052330 was administered with standard of care chemotherapy in FGFR1-amplified squamous non-small cell lung cancer (sqNSCLC) patients. METHODS AND METHODS Eligible patients with stage IV or recurrent metastatic sqNSCLC harboring FGFR1 gene amplification received escalating doses of GSK3052230 in combination with paclitaxel and carboplatin at the starting doses 200 mg/m2 and AUC of 6, respectively, in the first line setting (Arm A) or docetaxel 75 mg/m2 in second line (Arm B). The primary endpoints of the study were safety and tolerability, to identify a maximum tolerated dose (MTD), and to assess overall response rate (ORR) based on investigator assessment. RESULTS Twenty-nine patients were enrolled into the study, including 20 patients on Arm A and 9 patients on Arm B. There were no dose limiting toxicities in either Arm and the MTD was not reached. The most common adverse events (AEs) were compatible with the chemotherapy backbone used in each Arm, including neutropenia, alopecia, nausea, arthralgia, asthenia, diarrhea and peripheral neuropathy. The overall response rate and median progression-free survival were 47% and 5.5 months, respectively, for Arm A and 0% and 4.6 months, respectively, for Arm B. CONCLUSION GSK3052230 is a novel FGFR pathway inhibitor, which is well tolerated in combination with chemotherapy. Importantly, AEs associated with small molecule inhibitors of FGFR were not observed, as predicted by the unique mechanism of action of this drug.
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Affiliation(s)
| | - Nina Karaseva
- St. Petersburg City Oncology Dispensary, St. Petersburg, Russian Federation
| | - Enriqueta Felip
- Servicio de Oncologia, Hospital General Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Olga Burdaeva
- Arkhangelsk Regional Oncology Dispensary, Arkhangelsk, Russian Federation
| | | | - Primo Lara
- University of California, Davis Medical Center, Sacramento, CA, USA
| | - Paul K Paik
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ulrik Lassen
- Department of Oncology Rigshospitalet, Copenhagen, Denmark
| | - Sergey Orlov
- First Pavlov State Medical University, St. Petersburg, Russian Federation
| | - José Trigo
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Marina Shomova
- Regional Clinical Oncology Dispensary, Ryazan, Russian Federation
| | | | | | | | - Li Yan
- GlaxoSmithKline, Inc., Collegeville, PA, USA
| | | | | | - Pilar Garrido
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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2244
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Gray JE, Saltos A, Tanvetyanon T, Haura EB, Creelan B, Antonia SJ, Shafique M, Zheng H, Dai W, Saller JJ, Chen Z, Tchekmedyian N, Goas K, Thapa R, Boyle TA, Chen DT, Beg AA. Phase I/Ib Study of Pembrolizumab Plus Vorinostat in Advanced/Metastatic Non-Small Cell Lung Cancer. Clin Cancer Res 2019; 25:6623-6632. [PMID: 31409616 DOI: 10.1158/1078-0432.ccr-19-1305] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/20/2019] [Accepted: 08/06/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Histone deacetylase inhibitors (HDACi) enhance tumor immunogenicity through several mechanisms and may improve response to immune checkpoint inhibitors (ICIs). In a phase I/Ib trial, we tested the oral HDACi vorinostat combined with the programmed cell death protein 1 inhibitor pembrolizumab in advanced/metastatic non-small cell lung cancer. PATIENTS AND METHODS Patients received intravenous pembrolizumab (200 mg every 3 weeks) plus oral vorinostat (200 or 400 mg/day). Primary endpoint was safety/tolerability. Secondary endpoints included response rate, progression-free survival, disease control rate (DCR), and overall survival. Tumor gene expression changes, T-cell density, and myeloid cell levels were studied in serial tissue specimens. RESULTS Thirty-three patients were treated (13 in phase I, 20 in phase Ib). In phase I, both ICI-naïve and ICI-pretreated patients were enrolled to determine dose-limiting toxicities (DLT). No DLTs were observed, and the recommended phase I dose was pembrolizumab 200 mg and vorinostat 400 mg. Any-grade adverse events were mainly fatigue (33%) and nausea/vomiting (27%). Of six ICI-naïve and 24 ICI-pretreated patients evaluable for response, four (13%) had partial response [two confirmed, one unconfirmed with subsequent prolonged stable disease (SD), one unconfirmed with subsequent progressive disease (PD)], 16 (53%) had SD, and 10 (33%) had PD for a DCR of 67%. In the ICI-pretreated cohort, three patients (one confirmed, two unconfirmed) had partial response and 10 had SD. Pretreatment CD8+ T-cell presence in tumor stromal regions was associated with treatment benefit. CONCLUSIONS Pembrolizumab plus vorinostat was well tolerated and demonstrated preliminary antitumor activity despite progression on prior ICI treatment.
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Affiliation(s)
- Jhanelle E Gray
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - Andreas Saltos
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tawee Tanvetyanon
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Eric B Haura
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ben Creelan
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Scott J Antonia
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michael Shafique
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hong Zheng
- Department of Immunology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Wenjie Dai
- Department of Immunology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - James J Saller
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Anatomic Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zhihua Chen
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Kristen Goas
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ram Thapa
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Theresa A Boyle
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Anatomic Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Dung-Tsa Chen
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Amer A Beg
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida. .,Department of Immunology, Moffitt Cancer Center and Research Institute, Tampa, Florida
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2245
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Gijtenbeek RGP, de Jong K, Venmans BJW, van Vollenhoven FHM, Ten Brinke A, Van der Wekken AJ, van Geffen WH. Best first-line therapy for patients with advanced non-small cell lung cancer, performance status 2 without a targetable mutation or with an unknown mutation status. Hippokratia 2019. [DOI: 10.1002/14651858.cd013382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rolof GP Gijtenbeek
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
| | - Kim de Jong
- Medical Center Leeuwarden; Department of Epidemiology; Henri Dunantweg 2 Leeuwarden Friesland Netherlands
| | - Ben JW Venmans
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
| | - Femke HM van Vollenhoven
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
| | - Anneke Ten Brinke
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
| | - Anthonie J Van der Wekken
- University of Groningen, University Medical Center Groningen; Department of Pulmonary Diseases; Hanzeplein 1 Groningen Netherlands
| | - Wouter H van Geffen
- Medical Center Leeuwarden; Department of Pulmonary Diseases; Henri Dunantweg 2 Leeuwarden Netherlands
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2246
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Cisplatin increases PD-L1 expression and optimizes immune check-point blockade in non-small cell lung cancer. Cancer Lett 2019; 464:5-14. [PMID: 31404614 DOI: 10.1016/j.canlet.2019.08.005] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022]
Abstract
The number of clinical protocols testing combined therapies including immune check-point inhibitors and platinum salts is currently increasing in lung cancer treatment, however preclinical studies and rationale are often lacking. Here, we evaluated the impact of cisplatin treatment on PD-L1 expression analyzing the clinicopathological characteristics of patients who received cisplatin-based neoadjuvant chemotherapy followed by surgery and showed that cisplatin-based induction treatment significantly increased PD-L1 staining in both tumor and immune cells from the microenvironment. Twenty-two patients exhibited positive PD-L1 staining variation after neoadjuvant chemotherapy; including 9 (23.1%) patients switching from <50% to ≥50% of stained tumor-cells. We also confirmed the up-regulation of PD-L1 by cisplatin, at both RNA and protein levels, in nude and immunocompetent mice bearing tumors grafted with A549, LNM-R, or LLC1 lung cancer cell lines. The combined administration of anti-PD-L1 antibodies (3 mg/kg) and cisplatin (1 mg/kg) to mice harboring lung carcinoma significantly reduced tumor growth compared to single agent treatments and controls. Overall, these results suggest that cisplatin treatment could synergize with PD-1/PD-L1 blockade to increase the clinical response, in particular through early and sustainable enhancement of PD-L1 expression.
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2247
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Tamiya M, Tamiya A, Hosoya K, Taniguchi Y, Yokoyama T, Fukuda Y, Hirano K, Matsumoto H, Kominami R, Suzuki H, Hirashima T, Uchida J, Morita M, Kanazu M, Sawa N, Kinoshita Y, Hara S, Kumagai T, Fujimoto D. Efficacy and safety of pembrolizumab as first-line therapy in advanced non-small cell lung cancer with at least 50% PD-L1 positivity: a multicenter retrospective cohort study (HOPE-001). Invest New Drugs 2019; 37:1266-1273. [PMID: 31392549 DOI: 10.1007/s10637-019-00843-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 12/19/2022]
Abstract
Objectives As first line therapy, pembrolizumab provides longer progression free survival (PFS) and overall survival (OS) than platinum doublets in programmed death ligand 1 (PD-L1)-positive non-small cell lung cancer (NSCLC) with tumor propensity scores (TPS) ≥50%. However, clinical trials do not represent real-world patients. Materials and Methods This multicenter retrospective study conducted across 11 medical centers in Japan analyzed clinical data from patients receiving first-line pembrolizumab for NSCLC between February 1, 2017 and April 30, 2018. The efficacy, safety, and suitability of pembrolizumab monotherapy were evaluated. Results The median age of the 213 enrolled patients was 71 (range: 39-91) years. Among them, 176 (82.6%) were male, 20 (9.4%) were never smokers (median Brinkman index: 900), 172 (80.8%) had an ECOG PS of 0-1, 55 (25.8%) had squamous-cell carcinoma (SQ). PD-L1 TPS were 50-74%, 75-89%, and 90-100% in 97 (45.5%), 47 (22.1%), and 69 (32.4%) patients, respectively. Adverse events (AEs) of grades ≥3 were observed in 39 (18.3%) patients. Pneumonitis was the most common severe AE, occurring in 10 patients (4.7%) including 1 with grade 4 toxicity; no severe AE-related deaths occurred. The overall response rate, median PFS, and median OS was 51.2%, 8.3 months, and 17.8 months, respectively. On multivariate analysis, ECOG PS (0-1 vs. ≥2: HR: 1.69, 95.0% CI: 1.05-2.72; p = 0.03138), CRP/Alb (<0.3 vs. ≥0.3: HR: 1.92, 95.0% CI: 1.28-2.87; p = 0.00153), steroid usage (not usage vs. usage: HR: 2.94, 95.0% CI: 1.45-5.95; p = 0.00267), and PD-L1 TPS (50-89% vs. 90-100%: HR: 0.65, 95.0% CI: 0.43-1.00; p = 0.04984) were significantly and independently correlated with PFS of pembrolizumab. Conclusion The results confirm the efficacy and safety of pembrolizumab in real-world patients. Poor PS and steroid usage at the time of commencing pembrolizumab treatment indicate poor outcomes. First-line pembrolizumab particularly benefits patients with PD-L1 TPS ≥90% or low inflammatory states (CRP/ALB<0.3).
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Affiliation(s)
- Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka City, Osaka, 541-8567, Japan.
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180, Nagasone-cho, Kita-ku, Sakai City, Osaka, 591-8555, Japan
| | - Kazutaka Hosoya
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180, Nagasone-cho, Kita-ku, Sakai City, Osaka, 591-8555, Japan
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki City, Okayama, 710-8602, Japan
| | - Yasushi Fukuda
- Department of Respiratory Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki City, Okayama, 710-8602, Japan
| | - Katsuya Hirano
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashi-Naniwa-Cho, Amagasaki City, Hyogo, 660-8550, Japan
| | - Hirotaka Matsumoto
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashi-Naniwa-Cho, Amagasaki City, Hyogo, 660-8550, Japan
| | - Ryota Kominami
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, 68, Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Habikino Medical Center, 3-7-1, Habikino, Habikino City, Osaka, 583-8588, Japan
| | - Junji Uchida
- Department of Respiratory Medicine, Osaka General Medical Center, 3-1-56, Bandai-Higashi, Sumiyoshi-ku, Osaka City, Osaka, 558-8558, Japan
| | - Mitsunori Morita
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, 2-4, Ichiban-cho, Nagata-ku, Kobe City, Hyogo, 653-0013, Japan
| | - Masaki Kanazu
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1, Toneyama, Toyonaka City, Osaka, 560-0045, Japan
| | - Nobuhiko Sawa
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1, Toneyama, Toyonaka City, Osaka, 560-0045, Japan
| | - Yoshinori Kinoshita
- Department of Respiratory Medicine, Itami City Hospital, 1-100, Koyaike, Itami City, Hyogo, 664-8540, Japan
| | - Satoshi Hara
- Department of Respiratory Medicine, Itami City Hospital, 1-100, Koyaike, Itami City, Hyogo, 664-8540, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka City, Osaka, 541-8567, Japan
| | - Daichi Fujimoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
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2248
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Park H, Sholl LM, Hatabu H, Awad MM, Nishino M. Imaging of Precision Therapy for Lung Cancer: Current State of the Art. Radiology 2019; 293:15-29. [PMID: 31385753 DOI: 10.1148/radiol.2019190173] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Advances in characterization of molecular and genomic abnormalities specific to lung cancer have made precision therapy the current standard of care for lung cancer treatment. This article will provide a cutting-edge review of imaging of lung cancer in the current era of precision medicine. The focus of the article includes (a) an update on the recent advances in precision therapy for non-small cell lung cancer and their implications on imaging; (b) molecular and genomic biomarkers and pitfalls of image interpretations for lung cancer precision therapy; and (c) review of the current approaches and future directions of precision imaging for lung cancer, emphasizing emerging observations in longitudinal tumor kinetics, radiomics, and molecular and functional imaging. The article is designed to help radiologists to remain up to date in the rapidly evolving world of lung cancer therapy and serve as key members of multidisciplinary teams caring for these patients.
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Affiliation(s)
- Hyesun Park
- From the Departments of Imaging (H.P., M.N.) and Medical Oncology (M.M.A.), Dana-Farber Cancer Institute, and Departments of Radiology (H.P., H.H., M.N.), Pathology (L.M.S.), and Medicine (M.M.A.), Brigham and Women's Hospital, 450 Brookline Ave, Boston, MA 02215
| | - Lynette M Sholl
- From the Departments of Imaging (H.P., M.N.) and Medical Oncology (M.M.A.), Dana-Farber Cancer Institute, and Departments of Radiology (H.P., H.H., M.N.), Pathology (L.M.S.), and Medicine (M.M.A.), Brigham and Women's Hospital, 450 Brookline Ave, Boston, MA 02215
| | - Hiroto Hatabu
- From the Departments of Imaging (H.P., M.N.) and Medical Oncology (M.M.A.), Dana-Farber Cancer Institute, and Departments of Radiology (H.P., H.H., M.N.), Pathology (L.M.S.), and Medicine (M.M.A.), Brigham and Women's Hospital, 450 Brookline Ave, Boston, MA 02215
| | - Mark M Awad
- From the Departments of Imaging (H.P., M.N.) and Medical Oncology (M.M.A.), Dana-Farber Cancer Institute, and Departments of Radiology (H.P., H.H., M.N.), Pathology (L.M.S.), and Medicine (M.M.A.), Brigham and Women's Hospital, 450 Brookline Ave, Boston, MA 02215
| | - Mizuki Nishino
- From the Departments of Imaging (H.P., M.N.) and Medical Oncology (M.M.A.), Dana-Farber Cancer Institute, and Departments of Radiology (H.P., H.H., M.N.), Pathology (L.M.S.), and Medicine (M.M.A.), Brigham and Women's Hospital, 450 Brookline Ave, Boston, MA 02215
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2249
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Abstract
Adrenocortical carcinoma (ACC) is a rare, aggressive, and frequently deadly cancer. Up to 75% of all patients will eventually develop metastatic disease, and our current medical therapies for ACC provide limited - if any - survival benefit. These statistics highlight a crucial need for novel approaches. Recent studies performing comprehensive molecular profiling on ACC have illuminated that ACC is comprised of three clinically distinct molecular subtypes, bearing differential regulation of cell cycle, epigenetics, Wnt/β-catenin signaling, PKA signaling, steroidogenesis and immune cell biology. Furthermore, these studies have spurred the development of molecular subtype-based biomarkers, contextualized outcomes of recent clinical trials, and advanced our understanding of the underlying biology of adrenocortical homeostasis and cancer. In this review, we describe these findings and their implications for new strategies to apply targeted therapies to ACC.
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2250
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Lee VHF, Mok TSK, Goto Y, Hsue VCC, Yang L, Jiang Y, Leung DKC, Lau KS, Tse PY. Differences Between the East and the West in Managing Advanced-Stage Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2019; 32:e1-e9. [PMID: 31375307 DOI: 10.1016/j.clon.2019.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/02/2019] [Accepted: 07/16/2019] [Indexed: 11/27/2022]
Abstract
Lung cancer is a common cancer associated with high mortality rates worldwide. Unfortunately, it usually presents at a late stage, precluding the chance of curative therapy. The discovery of oncogenic driver mutations in patients with non-small cell lung cancer over the past 20 years has led to new molecular targeted therapies that have dramatically improved treatment efficacy and quality of life. New generations of therapy that target the drug-resistant mutations have also quickly evolved, benefiting patients who are refractory or intolerant to first-line targeted therapy. Eastern patients, from Southeast Asia, Japan and China, are known to have a higher incidence of epidermal growth factor receptor mutation. Therefore, compared with the West, more patients would benefit from these recent advances. In contrast, survival of patients without driver mutations has benefited from advances in novel therapeutics, including the immune checkpoint inhibitors. The current review aims to highlight the recent developments in the management of advanced-stage non-small cell lung cancer and to compare the differences in clinical practice between Eastern and Western countries.
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Affiliation(s)
- V H F Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - T S K Mok
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Y Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - V C C Hsue
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - L Yang
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Y Jiang
- Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - D K C Leung
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - K S Lau
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - P Y Tse
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
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