1
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Shen B, Wu D, Liu J, Yang Y. Efficacy of Adjuvant First-Generation TKIs versus Chemotherapy in Patients with Completely Resected EGFR-Mutant Non-Small Cell Lung Cancer: A Meta-Analysis. Cancer Invest 2024; 42:63-74. [PMID: 38224061 DOI: 10.1080/07357907.2024.2303311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND The use of adjuvant first-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs) in patients with resected EGFR-mutant non-small cell lung cancer (NSCLC) remains controversial. Therefore, we performed a systematic review with meta-analysis to investigate the overall survival (OS) in patients with resected NSCLC. METHODS Relevant studies were identified from the PubMed and EMBASE databases, and pooled hazard risks were obtained by random-effects models. RESULTS Three prospective phase III and one phase II randomized controlled trials were identified, including a total of 839 patients who had undergone resection of EGFR-sensitive mutation in our analysis, 429 of whom received adjuvant first-generation TKIs therapy. For all patients with complete resection, adjuvant first-generation TKIs therapy was associated with improved disease-free survival (DFS) [hazard ratio (HR): 0.50, 95% confidence interval (CI): 0.30-0. 82] but not OS (HR: 0.78, 95% CI: 0.48-1.27) compared with adjuvant chemotherapy. In addition, we reconstructed the OS curves of the ADJUVANT and IMPACT studies, and the pooled 3- and 5-year OS rates of stage II-III patients in the TKI group and chemotherapy group were 80% vs. 79% and 66% vs. 64%, respectively. We also reconstructed the DFS curves based on the ADJUVANT, IMPACT, and EVIDENCE studies, and the pooled 1-, 3- and 5-year DFS rates of stage II-III patients in the TKI group and chemotherapy group were 87% vs. 70%, 49% vs. 37% and 28% vs. 29%, respectively. CONCLUSIONS In patients with completely resected EGFR-mutant NSCLC, adjuvant first-generation TKIs may delay disease progression but still fail to improve long-term survival compared with conventional chemotherapy.
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Affiliation(s)
- Bin Shen
- Nursing Department, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Dongping Wu
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Jianjiang Liu
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Yang Yang
- Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
- Zhejiang Key Laboratory of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
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2
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Huang HM, Wei Y, Wang JJ, Ran FY, Wen Y, Chen QH, Zhang BF. Epidermal Growth Factor Receptor Mutation Status and the Impact on Clinical Outcomes in Patients with Non-Small Cell Lung Cancer. Balkan J Med Genet 2023; 25:29-36. [PMID: 37265968 PMCID: PMC10230834 DOI: 10.2478/bjmg-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Epidermal growth factor receptor (EGFR) mutation status differs according to ethnicity, gender, smoking history, and histology types. The present study aimed to evaluate EGFR mutation status in patients with non-small cell lung cancer (NSCLC) and further explore its association with clinical characteristics and prognosis in advanced NSCLC patients (Stage IIIB-IV). 238 NSCLC patients were enrolled in this study from October 2016 through December 2019. Patient characteristics and clinical data including age, gender, smoking history, histology types, tumor stage, survival status, and time were collected via electronic medical record system or telephone. 21 somatic mutations which spanned exons 18-21 of EGFR were detected using the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) method, followed by analysis of links to clinical characteristics, progression-free survival (PFS) and overall survival (OS). 103 patients were detected harboring EGFR mutations among the 238 cases tested (43.3%), and exons 19 and 21 were the highest mutation frequencies, with 20.6% and 19.3% respectively. The EGFR mutation rate was much higher in female versus male (57.4% vs 31.5%, p <0.001), in non-smokers compared to smokers (56.8% vs 25.9%, p <0.001), and in those with adenocarcinoma than other histology types (48.3% vs 3.7%, p <0.001). For patients in advanced stage, median PFS was 11 months in patients harboring EGFR mutations, versus 4 months in patients with wild type EGFR (p <0.001); median OS was 24 versus 12 months (p <0.001). Never smoking (p = 0.042) and adenocarcinoma (p = 0.007) were independent favorable factors for EGFR mutations. Our data strengthen the findings of high prevalence of EGFR mutations in Asian patients with NSCLC. Mutations are prevalent in those patients who are female, adenocarcinoma, and have never smoked. Moreover, advanced EGFR mutation-positive patients have better PFS and OS than those with wild type EGFR.
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Affiliation(s)
- HM Huang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, 442008, China
| | - Y Wei
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, 442008, China
| | - JJ Wang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, 442008, China
| | - FY Ran
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, 442008, China
| | - Y Wen
- School of Public Health, Xi’an Jiaotong University, Xi’an, 710003, China
| | - QH Chen
- Department of Pharmacy, Shenzhen Baoan Authentic TCM Therapy Hospital, Shenzhen, 518101, China
| | - BF Zhang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, 442008, China
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3
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Utility of ctDNA Liquid Biopsies from Cancer Patients: An Institutional Study of 285 ctDNA Samples. Cancers (Basel) 2022; 14:cancers14235859. [PMID: 36497340 PMCID: PMC9739663 DOI: 10.3390/cancers14235859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
Liquid biopsy has improved significantly over the last decade and is attracting attention as a tool that can complement tissue biopsy to evaluate the genetic landscape of solid tumors. In the present study, we evaluated the usefulness of liquid biopsy in daily oncology practice in different clinical contexts. We studied ctDNA and tissue biopsy to investigate EGFR, KRAS, NRAS, and BRAF mutations from 199 cancer patients between January 2016 and March 2021. The study included 114 male and 85 female patients with a median age of 68 years. A total of 122 cases were lung carcinoma, 53 were colorectal carcinoma, and 24 were melanoma. Liquid biopsy was positive for a potentially druggable driver mutation in 14 lung and colorectal carcinoma where tissue biopsy was not performed, and in two (3%) lung carcinoma patients whose tissue biopsy was negative. Liquid biopsy identified nine (45%) de novo EGFR-T790M mutations during TKI-treatment follow-up in lung carcinoma. BRAF-V600 mutation resurgence was detected in three (12.5%) melanoma patients during follow-up. Our results confirm the value of liquid biopsy in routine clinical oncologic practice for targeted therapy, diagnosis of resistance to treatment, and cancer follow-up.
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4
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Morfouace M, Novello S, Stevovic A, Dooms C, Janžič U, Berghmans T, Dziadziuszko R, Gorlia T, Felip E, Paz-Ares L, Mazieres J, O'Brien M, Bironzo P, Vansteenkiste J, Lacroix L, Dingemans AC, Golfinopoulos V, Besse B. Results of screening in early and advanced thoracic malignancies in the EORTC pan-European SPECTAlung platform. Sci Rep 2022; 12:8342. [PMID: 35585228 PMCID: PMC9117328 DOI: 10.1038/s41598-022-12056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Access to a comprehensive molecular alteration screening is patchy in Europe and quality of the molecular analysis varies. SPECTAlung was created in 2015 as a pan-European screening platform for patients with thoracic malignancies. Here we report the results of almost 4 years of prospective molecular screening of patients with thoracic malignancies, in terms of quality of the program and molecular alterations identified. Patients with thoracic malignancies at any stage of disease were recruited in SPECTAlung, from June 2015 to May 2019, in 7 different countries. Molecular tumour boards were organised monthly to discuss patients' molecular and clinical profile and possible biomarker-driven treatments, including clinical trial options. FFPE material was collected and analysed for 576 patients with diagnosis of pleural, lung, or thymic malignancies. Ultimately, 539 patients were eligible (93.6%) and 528 patients were assessable (91.7%). The turn-around time for report generation and molecular tumour board was 214 days (median). Targetable molecular alterations were observed in almost 20% of cases, but treatment adaptation was low (3% of patients). SPECTAlung showed the feasibility of a pan-European screening platform. One fifth of the patients had a targetable molecular alteration. Some operational issues were discovered and adapted to improve efficiency.
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Affiliation(s)
- M Morfouace
- EORTC HQ, Avenue E. Mounier 83/11, 1200, Brussels, Belgium.
| | - S Novello
- Department of Oncology, University of Turin, AOU San Luigi, Orbassano (TO), Italy
| | - A Stevovic
- EORTC HQ, Avenue E. Mounier 83/11, 1200, Brussels, Belgium
| | - C Dooms
- Department of Respiratory Diseases and Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - U Janžič
- Department of Medical Oncology, University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik 36, Golnik, Slovenia
| | - T Berghmans
- Thoracic Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - R Dziadziuszko
- Department of Oncology and Radiotherapy, and Early Clinical Trials Unit, Medical University of Gdansk, Gdansk, Poland
| | - T Gorlia
- EORTC HQ, Avenue E. Mounier 83/11, 1200, Brussels, Belgium
| | - E Felip
- Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - L Paz-Ares
- Hospital Universitario 12 De Octubre, Madrid, Spain
| | - J Mazieres
- Service de Pneumologie, CHU de Toulouse, Université Paul Sabatier, Toulouse, France
| | - M O'Brien
- Lung Unit, Royal Marsden Hospital, Imperial College, London, UK
| | - P Bironzo
- Department of Oncology, University of Turin, AOU San Luigi, Orbassano (TO), Italy
| | - J Vansteenkiste
- Department of Respiratory Diseases and Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - L Lacroix
- Department of Medical Biology and Pathology, BMO Unit From AMMICa UMS3655/US23, Gustave Roussy, Villejuif, France
| | - A C Dingemans
- Department of Respiratory Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | | | - B Besse
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
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5
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Yang SC, Yeh YC, Chen YL, Chiu CH. Economic Analysis of Exclusionary EGFR Test Versus Up-Front NGS for Lung Adenocarcinoma in High EGFR Mutation Prevalence Areas. J Natl Compr Canc Netw 2022; 20:774-782.e4. [PMID: 35385830 DOI: 10.6004/jnccn.2021.7120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study sought to determine whether exclusionary EGFR mutation testing followed by next-generation sequencing (NGS) is a cost-efficient and timely strategy in areas with high prevalence rates of EGFR mutation. METHODS We developed a decision tree model to compare exclusionary EGFR testing followed by NGS and up-front NGS. Patients entered the model upon diagnosis of metastatic lung adenocarcinoma. Gene alterations with FDA-approved targeted therapies included EGFR, ALK, ROS1, BRAF, RET, MET, NTRK, and KRAS. Model outcomes were testing-related costs; time-to-test results; monetary loss, taking both costs and time into consideration; and percentage of patients who could be treated by FDA-approved therapies. Stacked 1-way and 3-way sensitivity analyses were performed. RESULTS Exclusionary EGFR testing incurred testing-related costs of US $1,387 per patient, a savings of US $1,091 compared with the costs of up-front NGS. The time-to-test results for exclusionary EGFR testing and up-front NGS were 13.0 and 13.6 days, respectively. Exclusionary EGFR testing resulted in a savings of US $1,116 in terms of net monetary loss, without a reduction of patients identified with FDA-approved therapies. The EGFR mutation rate and NGS cost had the greatest impact on minimizing monetary loss. Given that the tissue-based NGS turnaround time was shortened to 7 days, up-front NGS testing would become the best strategy if its price could be reduced to US $568 in Taiwan. CONCLUSIONS In areas with high prevalence rates of EGFR mutation, exclusionary EGFR testing followed by NGS, rather than up-front NGS, is currently a cost-efficient strategy for metastatic lung adenocarcinoma.
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Affiliation(s)
- Szu-Chun Yang
- 1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yi-Chen Yeh
- 2Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei.,3College of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yi-Lin Chen
- 4Molecular Diagnosis Laboratory, Department of Pathology, National Cheng Kung University Hospital, Tainan.,5Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan; and
| | - Chao-Hua Chiu
- 3College of Medicine, National Yang Ming Chiao Tung University, Taipei.,6Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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6
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Cardona AF, Ordóñez-Reyes C, Ruiz-Patiño A, Garcia-Robledo JE, Barron LZ, Recondo G, Rojas L, Corrales L, Martín C, Barrón F, Sotelo C, Rodríguez J, Ricaurte L, Rolfo C, Ávila J, Mayorga D, Archila P, Otero J, Mas L, Bermudez M, Gamez T, Carranza H, Vargas C, Rosell R, Arrieta O. EGFR Inhibitors Plus Bevacizumab are Superior Than EGFR Inhibitors Alone as First-Line Setting in Advanced NSCLC With EGFR Mutations and BIM Deletion Polymorphisms (BIM-CLICaP). JCO Precis Oncol 2021; 5:839-848. [DOI: 10.1200/po.20.00404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE BIM activation is essential for epidermal growth factor receptor ( EGFR)-tyrosine kinase inhibitor (TKI)–triggered apoptosis in EGFR-mutant non–small-cell lung cancer (NSCLC). A deletion in the intron two of the BIM gene results in generation of alternatively spliced isoforms that impairs their apoptotic response to TKIs, conferring the NSCLC cells intrinsic resistance to these medications. Patients with both alterations have poor clinical evolution. The current study aimed to investigate the clinical efficacy and tolerability of EGFR-TKIs plus bevacizumab (Bev) versus EGFR-TKIs alone as first-line treatment in advanced NSCLC patients with EGFR mutations and BIM deletions ( BIMdel). MATERIALS AND METHODS A retrospective analysis was conducted. BIMdel was detected using polymerase chain reaction analysis and direct sequencing of DNA. BIM protein expression was investigated by immunohistochemistry, and BIM mRNA levels by reverse transcriptase-polymerase chain reaction. Clinical characteristics, overall survival, progression-free survival (PFS), overall response rate (ORR), and treatment-related adverse events were compared between both groups. RESULTS Thirty-three patients were included; 15 received EGFR-TKIs, and 18 received EGFR-TKIs plus Bev. The median age was 63 years, with a majority of recruited female patients. All included individuals had an Eastern Cooperative Oncology Group performance score of 2 or less. The addition of Bev resulted in a significantly higher ORR (94.4% v 40%, P > .001). Median PFS was longer with the use of the combination therapy (11.12 v 7.87 months; P = .001). Median overall survival tended to be longer in the EGFR-TKIs plus Bev (30.9 v 25.4 months; P = .06) but failed to reach statistical significance. Response in terms of both partial and complete as well as overall favorably affected PFS. CONCLUSION EGFR-TKIs plus Bev conferred a significantly higher ORR and PFS in advanced NSCLC patients with EGFR mutation and BIMdel. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Andrés F. Cardona
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - Camila Ordóñez-Reyes
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - Alejandro Ruiz-Patiño
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | | | | | - Gonzalo Recondo
- Thoracic Oncology Section, Centro de Educación Médica e Investigaciones Clínicas—CEMIC, Buenos Aires, Argentina
| | - Leonardo Rojas
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
- Clinical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Luis Corrales
- Oncology Unit, Hospital San Juan de Dios/Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica
| | - Claudio Martín
- Medical Oncology Department, Thoracic Oncology Section, Instituto Fleming, Buenos Aires, Argentina
| | - Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, México
| | - Carolina Sotelo
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - July Rodríguez
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - Luisa Ricaurte
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
- Pathology Department, Mayo Clinic, Rochester, MN
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jenny Ávila
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
| | - Diana Mayorga
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
| | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - Jorge Otero
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - Luis Mas
- Thoracic Oncology Department, Instituto Nacional de Enfermedades Neoplásicas—INEN, Lima, Perú
| | - Maritza Bermudez
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - Tatiana Gamez
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - Hernán Carranza
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - Carlos Vargas
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G/ONCOLGroup), Universidad el Bosque, Bogotá, Colombia
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Barcelona, Spain
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, México City, México
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7
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Aguilar-Serra J, Gimeno-Ballester V, Pastor-Clerigues A, Milara J, Trigo-Vicente C, Cortijo J. Cost-effectiveness analysis of the first-line EGFR-TKIs in patients with advanced EGFR-mutated non-small-cell lung cancer. Expert Rev Pharmacoecon Outcomes Res 2021; 22:637-646. [PMID: 34602008 DOI: 10.1080/14737167.2022.1987220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the cost-effectiveness of first-line treatments, such as erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib, for patients diagnosed with stage IIIB/IV NSCLC harboring EGFR mutations. MATERIALS & METHODS A partitioned survival model was developed to estimate quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER) from the perspective of the Spanish National Health System. Two Bayesian NMAs were performed independently, by using the polynomial fraction method to fit Kaplan-Meier curves for overall survival and progression-free survival. Deterministic and probabilistic sensitivity analyses were performed to evaluate the uncertainty. RESULTS The ICER was calculated for the four first-line treatments by comparing them with gefitinib, and the ratios obtained were as follows: €166,416/QALY for osimertinib, €183,682/QALY for dacomitinib, €167,554/QALY for afatinib, €36,196/QALY for erlotinib. It was seen that patients who received osimertinib presented higher QALYs (0.49), followed by dacomitinib (0.33), afatinib (0.32), erlotinib (0.31), and gefitinib (0.28). CONCLUSIONS Gefitinib is the most cost-effective treatment. In terms of QALYs gained, Osimertinib was more effective than all other TKIs. Nevertheless, with a Spanish threshold of €24,000/QALY, the reduction in the acquisition cost of osimertinib will have to be greater than 70%, to obtain a cost-effectiveness alternative.
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Affiliation(s)
- J Aguilar-Serra
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - V Gimeno-Ballester
- Department of Pharmacy, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Pastor-Clerigues
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - J Milara
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain.,Department of Pharmacy, Research Foundation of General Hospital of Valencia, Valencia, Spain.,CIBERES, Health Institute Carlos III, Valencia, Spain
| | - C Trigo-Vicente
- Department of Pharmacy, C.r.p. Nuestra Señora Del Pilar, Zaragoza, Spain.,Department of Pharmacy, Universidad San Jorge, Zaragoza, Spain
| | - J Cortijo
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain.,CIBERES, Health Institute Carlos III, Valencia, Spain
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8
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Abstract
PURPOSE OF REVIEW Despite the significant advances in EGFR-mutant nonsmall cell lung cancer (NSCLC), some challenges remain. One of the permanent and inevitable issues is the emergence of acquired resistance. Therefore, blocking the activation of EGFR pathway and overcoming drug resistance with novel agents are still in high demand. Here, we review the development of novel drugs in EGFR-mutant, advanced NSCLC, including targeting EGFR exon 20 insertion (EGFR20ins), and novel role of epidermal growth factor receptor, tyrosine kinase inhibitor (EGFR-TKIs) in early-stage NSCLC. RECENT FINDINGS EGFR-TKIs as adjuvant therapy or neoadjuvant therapy in patients with early-stage NSCLC with EGFR-sensitizing mutations have shown promising efficacy. The resistance mechanisms of third-generation EGFR-TKIs can be divided into two types: EGFR dependent and EGFR independent. Several clinical trials have demonstrated that the addition of MET inhibitors to EGFR-TKIs was an effective option for patients who had acquired resistance to EGFR-TKIs caused by hepatocyte growth factor receptor gene (MET) amplification or overexpression. Novel compounds that selectively and potently inhibit EGFR20ins are being investigated in phase III studies. SUMMARY A better characterization and understanding of resistance mechanisms to first-line osimertinib and adjuvant osimertinib is helpful to guide further treatment.
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9
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Khaddour K, Jonna S, Deneka A, Patel JD, Abazeed ME, Golemis E, Borghaei H, Boumber Y. Targeting the Epidermal Growth Factor Receptor in EGFR-Mutated Lung Cancer: Current and Emerging Therapies. Cancers (Basel) 2021; 13:3164. [PMID: 34202748 PMCID: PMC8267708 DOI: 10.3390/cancers13133164] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 02/07/2023] Open
Abstract
Epidermal growth factor receptor-targeting tyrosine kinase inhibitors (EGFR TKIs) are the standard of care for patients with EGFR-mutated metastatic lung cancer. While EGFR TKIs have initially high response rates, inherent and acquired resistance constitute a major challenge to the longitudinal treatment. Ongoing work is aimed at understanding the molecular basis of these resistance mechanisms, with exciting new studies evaluating novel agents and combination therapies to improve control of tumors with all forms of EGFR mutation. In this review, we first provide a discussion of EGFR-mutated lung cancer and the efficacy of available EGFR TKIs in the clinical setting against both common and rare EGFR mutations. Second, we discuss common resistance mechanisms that lead to therapy failure during treatment with EGFR TKIs. Third, we review novel approaches aimed at improving outcomes and overcoming resistance to EGFR TKIs. Finally, we highlight recent breakthroughs in the use of EGFR TKIs in non-metastatic EGFR-mutated lung cancer.
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Affiliation(s)
- Karam Khaddour
- Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Sushma Jonna
- Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Alexander Deneka
- Fox Chase Cancer Center, Program in Molecular Therapeutics, Philadelphia, PA 19111, USA; (A.D.); (E.G.)
| | - Jyoti D. Patel
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Mohamed E. Abazeed
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Erica Golemis
- Fox Chase Cancer Center, Program in Molecular Therapeutics, Philadelphia, PA 19111, USA; (A.D.); (E.G.)
| | - Hossein Borghaei
- Fox Chase Cancer Center, Department of Hematology and Oncology, Philadelphia, PA 19111, USA;
| | - Yanis Boumber
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Russia
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10
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Aguilar-Serra J, Gimeno-Ballester V, Pastor-Clerigues A, Milara J, Marti-Bonmati E, Trigo-Vicente C, Cortijo J. Dacomitinib in first-line treatment of advanced EGFR-mutated non-small-cell lung cancer: a cost-effectiveness analysis. J Comp Eff Res 2021; 10:325-335. [PMID: 33635095 DOI: 10.2217/cer-2020-0233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: To assess the cost-effectiveness of first-line treatment with dacomitinib compared with gefitinib in patients newly diagnosed with advanced NSCLC EGFR-positive in the context of Spain. Materials & methods: A partitioned survival model was developed including costs, utilities and disutilities to estimate quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio when treating with dacomitinib versus gefitinib. Results: Dacomitinib presented higher QALYs (0.51) compared with gefitinib (0.45). Dacomitinib costs were €33,061 in comparison with €26,692 for gefitinib arm. An incremental cost-effectiveness ratio of €111,048 was obtained for dacomitinib. Conclusion: Dacomitinib was more effective in terms of QALYs gained than gefitinib. However, to obtain a cost-effectiveness alternative, a discount greater than 25% in dacomitinib acquisition cost is required.
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Affiliation(s)
| | | | - Alfonso Pastor-Clerigues
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - Javier Milara
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain.,Department of Pharmacology, Research Foundation of General Hospital of Valencia, Valencia, Spain.,CIBER (ES), Respiratory Research, Health Institute Carlos III, Valencia, Spain
| | - Ezequiel Marti-Bonmati
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - Cristina Trigo-Vicente
- Department of Pharmacy, C.R.P. Nuestra Señora del Pilar, Zaragoza, Spain.,Department of Pharmacology, Universidad San Jorge, Zaragoza, Spain
| | - Julio Cortijo
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Spain.,Department of Pharmacy, University General Hospital Consortium, Valencia, Spain.,CIBER (ES), Respiratory Research, Health Institute Carlos III, Valencia, Spain
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11
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Rennert G, Gottfried M, Rennert HS, Lejbkowicz F, Frank M, Cohen I, Kelt S, Agbarya A, Dudnik E, Dudnik J, Katznelson R, Mishali M, Maimon Rabinovich N, Nechushtan H, Onn A, Keren Rosenberg S, Wollner M, Zer A, Bar J, Gronich N. Long term follow-up of EGFR mutated NSCLC cases. Transl Oncol 2020; 14:100934. [PMID: 33186889 PMCID: PMC7658494 DOI: 10.1016/j.tranon.2020.100934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 01/30/2023] Open
Abstract
PURPOSE A substantial fraction of all non-small cell lung cancers(NSCLC) carry a mutation in the EGFR gene for which an effective treatment with anti-tyrosine kinases(TKIs) is available. We studied the long term survival of these patients following the introduction of TKIs. EXPERIMENTAL DESIGN All consecutive cases of NSCLC newly diagnosed with advanced disease were referred for free tumor EGFR mutation testing at Clalit's national personalized medicine laboratory. Mutations and deletions in target codons 18-21 of EGFR were sought using RT-PCR and fragment analysis. Comprehensive EMRs were used to collect full data on treatments and clinical status. RESULTS A cohort of 3,062 advanced NSCLC cases, included 481(15.7%) somatic EGFR mutation carriers (17.5% of all adenocarcinomas, 26.7% of females with adenocarcinomas). TKIs treatment to EGFR mutation carriers was provided to 85% of all eligible. After a median follow up period of 15.9 months for EGFR mutated cases the hazard ratio for overall survival of EGFR-mutated NSCLC treated with TKIs was 0.55(0.49-0.63, p<0.0001) when compared with EGFR wild-type(WT) tumors under usual care. After adjusting for age, sex, ethnicity, smoking history and tumor histology, all of which had an independently significant effect on survival, the HR for TKI-treated, EGFR-mutated tumors, was 0.63 (0.55-0.71, p<0.0001). Treating EGFR-WT cases with TKIs yielded a high HR=1.32 (1.19-1.48). CONCLUSIONS TKIs given to EGFR mutated advanced NSCLC demonstrated a substantial survival benefit for at least five years. Squamous histology, smoking, male sex and Arab ethnicity were associated with higher NSCLC mortality hazard. Treating non-EGFR-mutated NSCLC with TKIs seems detrimental. Statement of Significance: • TKIs given to EGFR mutated advanced NSCLC demonstrated a substantial survival benefit for at least five years but not much longer. • Treating non-EGFR-mutated NSCLC with TKIs seems detrimental and should probably be avoided. • Squamous histology of non-small cell lung cancer, smoking history, male sex and Arab ethnicity were associated with altogether higher NSCLC mortality hazard.
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Affiliation(s)
- Gad Rennert
- Clalit Health Services National Cancer Control Center and Personalized Medicine Program, Israel; Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Office of Chief Physician, Clalit Health Services Headquarters, Tel Aviv, Israel.
| | - Maya Gottfried
- Lung Cancer Unit, Meir Medical Center, 4428164 Kfar Saba, Israel
| | - Hedy S Rennert
- Clalit Health Services National Cancer Control Center and Personalized Medicine Program, Israel; Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Flavio Lejbkowicz
- Clalit Health Services National Cancer Control Center and Personalized Medicine Program, Israel; Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Meira Frank
- Clalit Health Services National Cancer Control Center and Personalized Medicine Program, Israel; Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ilana Cohen
- Clalit Health Services National Cancer Control Center and Personalized Medicine Program, Israel; Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shiri Kelt
- Clalit Health Services National Cancer Control Center and Personalized Medicine Program, Israel; Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abed Agbarya
- Oncology Unit, Bene Zion Medical Center, Haifa, Israel
| | - Elizabeta Dudnik
- Thoracic Cancer Unit, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Julia Dudnik
- Department of Oncology, Soroka University Medical Center (SUMC) and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Rivka Katznelson
- Institute of Oncology, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Moshe Mishali
- Lung Cancer Unit, Meir Medical Center, 4428164 Kfar Saba, Israel
| | | | - Hovav Nechushtan
- Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Amir Onn
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Mariana Wollner
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Alona Zer
- Thoracic Cancer Unit, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Jair Bar
- Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Naomi Gronich
- Clalit Health Services National Cancer Control Center and Personalized Medicine Program, Israel; Department of Community Medicine and Epidemiology, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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12
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Centeno C, Serra Mitja P, Avila M, Carcereny E, Muñoz-Mármol AM, Moran T, Castellà E, Sanz-Santos J, García-Olivè I, Ramirez Serrano JL, Rosell Gratacos A, Andreo García F. Molecular analysis in cytological samples obtained by endobronchial or oesophageal ultrasound guided needle aspiration in non-small cell lung cancer. Pulmonology 2020; 28:28-33. [PMID: 32507497 DOI: 10.1016/j.pulmoe.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Cytological samples obtained by endobronchial ultrasound (EBUS) are capital for diagnosis, staging and molecular profile in non-small cell lung carcinoma (NSCLC). OBJECTIVE To assess the success rate of complete, partial and individual of molecular analysis in samples obtained by EBUS-guided transbronchial needle aspiration (TBNA) and/or by oesophageal ultrasound-guided fine needle aspiration with an echobronchoscope (EUS-B-FNA) in patients with NSCLC. METHODS Prospective study including 90 patients with non-squamous NSCLC, or non-smoking squamous. Cytological samples were classified into two groups. Group 1: PEN membrane slide and/or cell blocks for the determination of mutations of EGFR, KRAS, ERBB2 and BRAF. Group 2: silane coated slides or cell blocks for rearrangements of ALK, ROS1 and MET amplification. RESULTS The success rate was 78.6% for 4 molecular alterations (EGFR, KRAS, ALK and ROS1), and 44% for 7 determinations. The individual success rate for EGFR was 97%, KRAS 96.3%, ALK 85%, ROS1 82.3%, ERBB2 71.4%, BRAF 67.7% and MET 81.1%. There were no significant differences (p=0.489) in the number of molecular analyses (1-3 vs. 4) in group 1, depending on the types of samples (cell block vs. PEN membrane slide vs. cell block and PEN membrane slide). CONCLUSIONS In patients with NSCLC, the cytological material obtained by ultrasound-guided needle aspiration is sufficient for individual and partial molecular analysis in the vast majority of cases. Membrane slides such as cell blocks are valid samples for molecular analysis.
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Affiliation(s)
- C Centeno
- Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Spain.
| | - P Serra Mitja
- Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Spain
| | - M Avila
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - E Carcereny
- Oncology Department, Badalona Applied Research Group in Oncology (B-ARGO), Institut Catala d' Oncologia, Barcelona, Spain
| | - A M Muñoz-Mármol
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - T Moran
- Oncology Department, Badalona Applied Research Group in Oncology (B-ARGO), Institut Catala d' Oncologia, Barcelona, Spain
| | - E Castellà
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - J Sanz-Santos
- Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - I García-Olivè
- Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - J L Ramirez Serrano
- Oncology Department, Badalona Applied Research Group in Oncology (B-ARGO), Institut Catala d' Oncologia, Barcelona, Spain
| | - A Rosell Gratacos
- Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Spain; CIBERES, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - F Andreo García
- Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Spain; CIBERES, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
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13
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Jazieh AR, Bounedjar A, Al Dayel F, Fahem S, Tfayli A, Rasul K, Jaafar H, Jaloudi M, Al Fayea T, Al Maghrabi HQ, Bamefleh H, Al Kattan K, Larbaoui B, Filali T, Al Husaini H, Ali Y. The Study of Druggable Targets in Nonsquamous Non-Small-Cell Lung Cancer in the Middle East and North Africa. ACTA ACUST UNITED AC 2020. [DOI: 10.4103/jipo.jipo_22_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
Background: Druggable molecular targets are very important in the management of non-small-cell lung cancer (NSCLC). The purpose of our study is to determine the pattern of testing and mutation prevalence in the Middle East and North Africa population. Patients and Methods: Data of consecutive patients with nonsquamous NSCLC were collected from 10 centers in five countries; Saudi Arabia, UAE, Qatar, Lebanon, and Algeria. Statistical analysis was performed to delineate the prevalence of druggable targets and other relevant information. Results: Five hundred and sixty-six patients were included in the study. Majority were males (78.1%) with a median age of 61 years (22–89), 50% were current or ex-smokers and 370 patients (65.4%) were Stage IV. The epidermal growth factor receptor (EGFR) testing was performed on 164 patients of all stages. EGFR mutation was detected in 30 out of 96 patients (31.3%) with metastatic disease and in 12 out of 68 patients (17.6%) with Stage I to III. Female sex (39.5% vs. 22% males, P = 0.032), Stage IV (31.2% vs. 17.6% in Stage I to III, P = 0.049), and positive immunohistochemical-TTF1 (31.4% vs. 8.7% negative, P = 0.026) were predictors of mutation on univariate analysis. The multivariate analysis showed that patients with stage IV have three times higher positivity than lower stages (odds ratio = 3.495, P = 0.036). Anaplastic lymphoma kinase fusion was present in seven out of 89 patients (7.8%) of all stages, and only three out of 52 patients (5.8%) with metastatic disease. The reasons for not performing the tests in all of the 370 patients with metastatic disease were: physicians do not know where and how to send the test (62.3%), lack of funding to perform the test (11.1%), insufficient tissue (10.1%), and other reasons (16.6%). Conclusions: Only a small fraction of patients with NSCLC are tested for druggable targets and the prevalence of EGFR mutation is prevalence higher than the Western population. Overcoming the challenges of testing requires systematic plans to address education and resource allocation.
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Affiliation(s)
- Abdul Rahman Jazieh
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
| | - Adda Bounedjar
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- BLIDA 1 University, CHU BLIDA, Algeria
| | - Fouad Al Dayel
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | - Shamayel Fahem
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | - Arafat Tfayli
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- The American University of Beirut, Lebanon
| | - Kakil Rasul
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- Weill Cornell Medical College/Hamad Medical Corporation, Qatar
| | - Hassan Jaafar
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- Tawam Hospital, UAE
| | - Mohammad Jaloudi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- Tawam Hospital, UAE
| | - Turki Al Fayea
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- Princess Noorah Oncology Center, King Abdulaziz Medical City
| | - Hatim Q Al Maghrabi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, KSA
| | - Hanaa Bamefleh
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
| | - Khaled Al Kattan
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | - Blaha Larbaoui
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- Anti Cancer Center, Oran, Algeria
| | - Taha Filali
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- Centre Hospitalo Universitaire Ben Badis de Constantine, Constantine, Algeria
| | - Hamed Al Husaini
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
- King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | - Yosra Ali
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA
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14
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Vincenten JPL, van Essen HF, Lissenberg-Witte BI, Bulkmans NWJ, Krijgsman O, Sie D, Eijk PP, Smit EF, Ylstra B, Thunnissen E. Clonality analysis of pulmonary tumors by genome-wide copy number profiling. PLoS One 2019; 14:e0223827. [PMID: 31618260 PMCID: PMC6795528 DOI: 10.1371/journal.pone.0223827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/30/2019] [Indexed: 01/15/2023] Open
Abstract
Multiple tumors in patients are frequently diagnosed, either synchronous or metachronous. The distinction between a second primary and a metastasis is important for treatment. Chromosomal DNA copy number aberrations (CNA) patterns are highly unique to specific tumors. The aim of this study was to assess genome-wide CNA-patterns as method to identify clonally related tumors in a prospective cohort of patients with synchronous or metachronous tumors, with at least one intrapulmonary tumor. In total, 139 tumor pairs from 90 patients were examined: 35 synchronous and 104 metachronous pairs. Results of CNA were compared to histological type, clinicopathological methods (Martini-Melamed-classification (MM) and ACCP-2013-criteria), and, if available, EGFR- and KRAS-mutation analysis. CNA-results were clonal in 74 pairs (53%), non-clonal in 33 pairs (24%), and inconclusive in 32 pairs (23%). Histological similarity was found in 130 pairs (94%). Concordance between histology and conclusive CNA-results was 69% (74 of 107 pairs: 72 clonal and two non-clonal). In 31 of 103 pairs with similar histology, genetics revealed non-clonality. In two out of four pairs with non-matching histology, genetics revealed clonality. The subgroups of synchronous and metachronous pairs showed similar outcome for the comparison of histological versus CNA-results. MM-classification and ACCP-2013-criteria, applicable on 34 pairs, and CNA-results were concordant in 50% and 62% respectively. Concordance between mutation matching and conclusive CNA-results was 89% (8 of 9 pairs: six clonal and two non-clonal). Interestingly, in one patient both tumors had the same KRAS mutation, but the CNA result was non-clonal. In conclusion, although some concordance between histological comparison and CNA profiling is present, arguments exist to prefer extensive molecular testing to determine whether a second tumor is a metastasis or a second primary.
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Affiliation(s)
- Julien P. L. Vincenten
- Amsterdam UMC, location VUmc, Department of Pulmonary Diseases, Amsterdam, The Netherlands
- Albert Schweitzer Hospital, Department of Pulmonary Diseases, Dordrecht, The Netherlands
| | - Hendrik F. van Essen
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | | | | | - Oscar Krijgsman
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Molecular Oncology & Immunology, Amsterdam, The Netherlands
| | - Daoud Sie
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | - Paul P. Eijk
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | - Egbert F. Smit
- Amsterdam UMC, location VUmc, Department of Pulmonary Diseases, Amsterdam, The Netherlands
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Thoracic Oncology, Amsterdam, The Netherlands
| | - Bauke Ylstra
- Amsterdam UMC, location VUmc, Tumor Genome Analysis Core, Cancer Center Amsterdam, The Netherlands
| | - Erik Thunnissen
- Amsterdam UMC, location VUmc, Department of Pathology, Amsterdam, The Netherlands
- * E-mail:
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Du W, Wo Y, Lu T, Wang Y, Jiao W. [A Review of EGFR-TKIs Therapy of Non-small Cell Lung Cancer
with Uncommon EGFR Mutations]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:590-599. [PMID: 31526464 PMCID: PMC6754574 DOI: 10.3779/j.issn.1009-3419.2019.09.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
肺癌是目前最常见的癌症,也是导致癌症死亡的首要原因。非小细胞肺癌(non-small cell lung cancer, NSCLC)占85%以上,且高达50%的亚洲NSCLC患者携带表皮生长因子受体(epidermal growth factor receptor, EGFR)基因突变。研究证明,伴有EGFR突变的NSCLC患者接受表皮生长因子受体-酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitors, EGFR-TKIs)治疗能获得更好的生存结果。然而,因为EGFR罕见突变相对治疗效果较差,会对研究结果带来负面影响,所以大部分研究EGFR-TKIs疗效的临床试验都不包含罕见突变患者,另外EGFR罕见突变本身就少见,就导致临床试验中这部分患者数量较少。由于EGFR罕见突变样本量少且具有高度异质性,EGFR-TKIs对EGFR罕见突变患者的疗效仍然不清楚。本文就EGFR罕见突变与EGFR-TKIs的疗效关系进行综述,为携带EGFR罕见突变的NSCLC患者合理选择治疗方式提供指导和建议。
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Affiliation(s)
- Wenxing Du
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Yang Wo
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Tong Lu
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Yuanyong Wang
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
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16
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Aguilar-Serra J, Gimeno-Ballester V, Pastor-Clerigues A, Milara J, Marti-Bonmati E, Trigo-Vicente C, Alós-Almiñana M, Cortijo J. Osimertinib in first-line treatment of advanced EGFR-mutated non-small-cell lung cancer: a cost–effectiveness analysis. J Comp Eff Res 2019; 8:853-863. [DOI: 10.2217/cer-2019-0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: Osimertinib improves progression-free survival in first-line EGFR mutation–positive non-small-cell lung cancer. Materials & methods: A Markov cohort model including costs, utilities and disutilities, was conducted to estimate quality-adjusted life-year (QALY) and incremental cost–effectiveness ratio when treating with osimertinib versus standard first-line tyrosine kinase inhibitors (TKIs). Results: Osimertinib presented higher QALYs (0.61) compared with standard EGFR–TKIs (0.42). Osimertinib costs were €83,258.99, in comparison with €29,209.45 for the standard EGFR–TKIs. An incremental cost–effectiveness ratio of €273,895.36/QALY was obtained for osimertinib. Conclusion: Osimertinib was more effective in terms of QALYs gained than comparators (erlotinib–gefitinib). However, to obtain a cost–effectiveness alternative, a discount greater than 60% in osimertinib acquisition cost is required.
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Affiliation(s)
| | | | - Alfonso Pastor-Clerigues
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Spain
- Research Foundation of General Hospital of Valencia, Valencia, Spain
- Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - Javier Milara
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Spain
- CIBERES, Health Institute Carlos III, Valencia, Spain
- Department of Pharmacy, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario Valencia
| | - Ezequiel Marti-Bonmati
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Spain
- Research Foundation of General Hospital of Valencia, Valencia, Spain
- Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
| | - Cristina Trigo-Vicente
- Department of Pharmacy, C.R.P. Nuestra Señora del Pilar, Zaragoza, Spain
- Universidad San Jorge, Zaragoza, Spain
| | - Manuel Alós-Almiñana
- Department of Pharmacy, Biomedical Research Institute INCLIVA, Hospital Clínico Universitario Valencia
| | - Julio Cortijo
- Department of Pharmacology, Faculty of Medicine, University of Valencia, Spain
- Research Foundation of General Hospital of Valencia, Valencia, Spain
- Department of Pharmacy, University General Hospital Consortium, Valencia, Spain
- CIBERES, Health Institute Carlos III, Valencia, Spain
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Soria-Comes T, Palomar-Abril V, Ureste MM, Guerola MT, Maiques ICM. Real-World Data of the Correlation between EGFR Determination by Liquid Biopsy in Non-squamous Non-small Cell Lung Cancer (NSCLC) and the EGFR Profile in Tumor Biopsy. Pathol Oncol Res 2019; 26:845-851. [PMID: 30847713 DOI: 10.1007/s12253-019-00628-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/28/2019] [Indexed: 12/22/2022]
Abstract
EGFR-mutated non-small cell lung cancer (NSCLC) has significant improved outcomes when treated with EGFR-tyrosine kinase inhibitors (TKI). Thus, EGFR-mutational status should be assessed at diagnosis and in the course of treatment with TKI. However, tissue samples are not always evaluable, and molecular profiling has been increasingly performed in cell-free tumor DNA (ctDNA) from blood samples. Our objective is to evaluate the reliability of ctDNA profiling in plasma samples in a real-world setting. We retrospectively analyzed the patients diagnosed with non-squamous NSCLC from May 2016 to December 2017 at Hospital Universitario Doctor Peset who had been tested for EGFR mutations in tissue and plasma samples. Both samples were sent to an external laboratory to perform the analysis by the cobas® EGFR assay. Percentage of agreement and concordance were calculated by kappa statistic. Of 102 patients reviewed, 89 were eligible. The overall EGFR mutation frequency was 18.6% for the evaluable tissue samples and 19.6% for evaluable plasma samples. Mutation status concordance between matched samples was 87.4%. Cohen's kappa index (κ) = 0.6 (sensitivity 70.6%, specificity 91.7%, positive predictive value 66.7%, negative predictive value 93%). When concordance was stablished only in stage IV tumors κ = 0.7, suggesting a higher agreement in advanced disease. This real-world data suggest that plasma is a feasible sample for ctDNA EGFR mutation assessment. Results of ctDNA molecular profiling are reliable when using a validated technique such as the cobas® EGFR assay, especially in patients that cannot undergo a tissue biopsy.
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Affiliation(s)
- Teresa Soria-Comes
- Department of Medical Oncology, Hospital Universitario Doctor Peset, 46017, Comunitat Valenciana, Valencia, Spain.
| | | | - María Martín Ureste
- Department of Medical Oncology, Hospital Universitario Doctor Peset, 46017, Comunitat Valenciana, Valencia, Spain
| | - Mónica Tallón Guerola
- Department of Medical Oncology, Hospital Universitario Doctor Peset, Comunitat Valenciana, Valencia, Spain
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Li H, Wang C, Wang Z, Hu Y, Zhang G, Zhang M, Zheng X, Zhang X, Yang J, Ma Z, Wang H. Efficacy and long-term survival of advanced lung adenocarcinoma patients with uncommon EGFR mutations treated with 1st generation EGFR-TKIs compared with chemotherapy as first-line therapy. Lung Cancer 2019; 130:42-49. [PMID: 30885350 DOI: 10.1016/j.lungcan.2019.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/23/2019] [Accepted: 02/01/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aims to understand the effects and long-term survival of 1st generation epithelial growth factor receptor tyrosine kinase inhibitors(EGFR-TKI)or platinum-based chemotherapy as first-line therapy in advanced lung adenocarcinoma patients with uncommon EGFR mutations. PATIENTS AND METHODS Specimens from 4276 advanced (IIIB/IV) patients were diagnosed with lung adenocarcinoma and underwent EGFR gene detection at the Affiliated Cancer Hospital of Zhengzhou University. The clinic characteristics, survival outcomes data, treatment outcomes and data of subsequent therapies after first-line treatment were collected of patients with uncommon EGFR mutations. The results were compared with common EGFR mutations. RESULTS For patients with uncommon EGFR mutations, EGFR-TKIs or platinum-based chemotherapy as first-line therapy, showed no difference in objective response rate (ORR 33% vs 27.1% P = 0.499) and disease control rate (DCR 76.5% vs 87.5%, P = 0.194). EGFR-TKIs showed a superior progression-free survival than chemotherapy (median PFS, 7.2 vs 4.9 mt, HR = 0.604; P = 0.0088). Interestingly, compared with chemotherapy, we found that overall survival (median OS, 14.3 vs 20.7 mts, HR = 1.759; P = 0.0336) was significantly worse in patients with EGFR-TKIs. Multivariate analysis showed that extra metastases (HR = 2.240, P = 0.001) and smoking history (HR = 2.048, P = 0.013) were independent prognostic factors for OS in lung adenocarcinoma patients with EGFR uncommon mutations. CONCLUSIONS Compared with chemotherapy, use of the 1st generation of EGFR-TKIs as first-line therapy can improve the short-term efficacy of patients with EGFR uncommon mutations advanced lung adenocarcinoma, but platinum-based chemotherapy showed a longer overall survival.
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Affiliation(s)
- Haixia Li
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Chenyu Wang
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Ziqi Wang
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Yabo Hu
- Department of Biological Immunology, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Guowei Zhang
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Mina Zhang
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Xuanxuan Zheng
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Xiaojuan Zhang
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Jinbo Yang
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Zhiyong Ma
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University, China
| | - Huijuan Wang
- Department of Respiratory Medicine, Affiliated Cancer Hospital of Zhengzhou University, China.
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Fountzilas E, Levva S, Mountzios G, Polychronidou G, Maniadakis N, Kotoula V, Fountzilas G. Treating EGFR-Mutated Oncogene-Addicted Advanced Non-Small-Cell Lung Cancer in the Era of Economic Crisis in Greece: Challenges and Opportunities. J Glob Oncol 2018; 4:1-12. [PMID: 30260753 PMCID: PMC6223495 DOI: 10.1200/jgo.18.00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Because of the profound financial crisis that commenced in Greece in 2010, severe cuts in health care spending and other restriction measures led to significant delays in the reimbursement of novel antineoplastic agents. In 2011, the Hellenic Society of Medical Oncology initiated a program of early access to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors for the treatment of patients with advanced, EGFR-mutant non-small-cell lung cancer (NSCLC). We evaluated treatment patterns and clinical outcomes in patients with EGFR-mutant or wild-type disease treated at a large center in Greece throughout the period of financial crisis. PATIENTS AND METHODS From 2011 through 2015, 252 patients with newly diagnosed advanced NSCLC were treated at the Department of Medical Oncology of the Papageorgiou Hospital, a tertiary cancer center in northern Greece. We retrospectively reviewed patient medical records to obtain clinicopathologic characteristics, EGFR mutation status, and follow-up data. The primary end point was time to treatment failure. RESULTS Of the 198 evaluable patients, 25 (12%) had EGFR mutations. All patients with EGFR mutations except one received treatment with an EGFR tyrosine kinase inhibitor. Median times to treatment failure for patients with EGFR-mutant and wild-type disease were 15.8 and 7.1 months, respectively (hazard ratio, 0.58; 95% CI, 0.35 to 0.95; P = .031). There was no difference in overall survival between the two groups ( P = .293). No deviation from treatment guidelines or discontinuation of treatment regimens occurred because of logistic reasons or drug shortages. CONCLUSION Despite restrictions in the reimbursement policy and accompanying controls in the use of high-cost medicines, the national program enabled treatment of patients with EGFR-mutant NSCLC according to established guidelines. Therefore, the clinical outcomes of such patients treated in Greece during the economic crisis were in accordance with international standards.
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Affiliation(s)
- Elena Fountzilas
- Elena Fountzilas, MD Anderson Cancer Center, The University of Texas, Houston, TX; Sofia Levva and Genovefa Polychronidou, Papageorgiou Hospital; Sofia Levva, Genovefa Polychronidou, and Vassiliki Kotoula, School of Health Sciences, Aristotle University of Thessaloniki; Vassiliki Kotoula and George Fountzilas, Hellenic Foundation for Cancer Research; George Fountzilas, Aristotle University of Thessaloniki, Thessaloniki; Giannis Mountzios, Henry Dunant Hospital Center; and Nikos Maniadakis, National School οf Public Health, Athens, Greece
| | - Sofia Levva
- Elena Fountzilas, MD Anderson Cancer Center, The University of Texas, Houston, TX; Sofia Levva and Genovefa Polychronidou, Papageorgiou Hospital; Sofia Levva, Genovefa Polychronidou, and Vassiliki Kotoula, School of Health Sciences, Aristotle University of Thessaloniki; Vassiliki Kotoula and George Fountzilas, Hellenic Foundation for Cancer Research; George Fountzilas, Aristotle University of Thessaloniki, Thessaloniki; Giannis Mountzios, Henry Dunant Hospital Center; and Nikos Maniadakis, National School οf Public Health, Athens, Greece
| | - Giannis Mountzios
- Elena Fountzilas, MD Anderson Cancer Center, The University of Texas, Houston, TX; Sofia Levva and Genovefa Polychronidou, Papageorgiou Hospital; Sofia Levva, Genovefa Polychronidou, and Vassiliki Kotoula, School of Health Sciences, Aristotle University of Thessaloniki; Vassiliki Kotoula and George Fountzilas, Hellenic Foundation for Cancer Research; George Fountzilas, Aristotle University of Thessaloniki, Thessaloniki; Giannis Mountzios, Henry Dunant Hospital Center; and Nikos Maniadakis, National School οf Public Health, Athens, Greece
| | - Genovefa Polychronidou
- Elena Fountzilas, MD Anderson Cancer Center, The University of Texas, Houston, TX; Sofia Levva and Genovefa Polychronidou, Papageorgiou Hospital; Sofia Levva, Genovefa Polychronidou, and Vassiliki Kotoula, School of Health Sciences, Aristotle University of Thessaloniki; Vassiliki Kotoula and George Fountzilas, Hellenic Foundation for Cancer Research; George Fountzilas, Aristotle University of Thessaloniki, Thessaloniki; Giannis Mountzios, Henry Dunant Hospital Center; and Nikos Maniadakis, National School οf Public Health, Athens, Greece
| | - Nikos Maniadakis
- Elena Fountzilas, MD Anderson Cancer Center, The University of Texas, Houston, TX; Sofia Levva and Genovefa Polychronidou, Papageorgiou Hospital; Sofia Levva, Genovefa Polychronidou, and Vassiliki Kotoula, School of Health Sciences, Aristotle University of Thessaloniki; Vassiliki Kotoula and George Fountzilas, Hellenic Foundation for Cancer Research; George Fountzilas, Aristotle University of Thessaloniki, Thessaloniki; Giannis Mountzios, Henry Dunant Hospital Center; and Nikos Maniadakis, National School οf Public Health, Athens, Greece
| | - Vassiliki Kotoula
- Elena Fountzilas, MD Anderson Cancer Center, The University of Texas, Houston, TX; Sofia Levva and Genovefa Polychronidou, Papageorgiou Hospital; Sofia Levva, Genovefa Polychronidou, and Vassiliki Kotoula, School of Health Sciences, Aristotle University of Thessaloniki; Vassiliki Kotoula and George Fountzilas, Hellenic Foundation for Cancer Research; George Fountzilas, Aristotle University of Thessaloniki, Thessaloniki; Giannis Mountzios, Henry Dunant Hospital Center; and Nikos Maniadakis, National School οf Public Health, Athens, Greece
| | - George Fountzilas
- Elena Fountzilas, MD Anderson Cancer Center, The University of Texas, Houston, TX; Sofia Levva and Genovefa Polychronidou, Papageorgiou Hospital; Sofia Levva, Genovefa Polychronidou, and Vassiliki Kotoula, School of Health Sciences, Aristotle University of Thessaloniki; Vassiliki Kotoula and George Fountzilas, Hellenic Foundation for Cancer Research; George Fountzilas, Aristotle University of Thessaloniki, Thessaloniki; Giannis Mountzios, Henry Dunant Hospital Center; and Nikos Maniadakis, National School οf Public Health, Athens, Greece
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20
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Donner I, Katainen R, Sipilä LJ, Aavikko M, Pukkala E, Aaltonen LA. Germline mutations in young non-smoking women with lung adenocarcinoma. Lung Cancer 2018; 122:76-82. [DOI: 10.1016/j.lungcan.2018.05.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023]
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21
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Erlotinib in routine clinical practice for first-line maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC). J Cancer Res Clin Oncol 2018; 144:1375-1383. [PMID: 29687154 DOI: 10.1007/s00432-018-2649-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The controlled phase III trial SATURN demonstrated that maintenance therapy with erlotinib after the first-line platinum-based chemotherapy prolonged progression-free survival (PFS) and overall survival (OS) of non-small cell lung cancer (NSCLC) patients with advanced, non-progressive disease. We conducted the non-interventional study SATURN NIS to investigate the effectiveness and tolerability of erlotinib maintenance in daily clinical practice. METHODS This single-arm NIS screened 290 patients with locally advanced or metastatic NSCLC (stage IIIB or IV) and stable disease after standard platinum-based first-line chemotherapy in 95 institutions across Germany. Erlotinib was dosed and administered corresponding to the terms of the marketing authorization at the time of recruitment. The main effectiveness endpoint was subjects' OS at 1 year. Subgroup analyses of survival estimates of OS and PFS were performed. RESULTS 272 patients were eligible for analysis (median age 66 years, 37.1% females, 99.6% Caucasian, median ECOG performance status 1, 61.8% adenocarcinoma, 96.3% of patients with stable disease). Maintenance therapy with erlotinib resulted in median OS comparable to that of the SATURN phase III trial 10.4 months [95% CI: (8.8; 12.5) vs. 11.9 months]. The 1-year survival rate was 45.6% [95% CI: (37.5%; 53.6%)]. No new safety signals were observed. As expected, patients with epidermal growth factor receptor (EGFR) mutations derived a greater benefit concerning OS and PFS than EGFR-wild-type patients. Moreover, a significant association of OS and PFS and the smoking status was observed. CONCLUSIONS The results of this non-interventional study support the current clinical practice of erlotinib switch maintenance in EGFR-mutation-positive patients.
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22
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Comparison of plasma ctDNA and tissue/cytology-based techniques for the detection of EGFR mutation status in advanced NSCLC: Spanish data subset from ASSESS. Clin Transl Oncol 2018; 20:1261-1267. [PMID: 29623586 PMCID: PMC6153859 DOI: 10.1007/s12094-018-1855-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/02/2018] [Indexed: 11/25/2022]
Abstract
Purpose The analysis of epidermal growth factor receptor (EGFR) mutations in many patients with advanced non-small-cell lung cancer (aNSCLC) has provided the opportunity for successful treatment with specific, targeted EGFR tyrosine kinase inhibitors. However, this therapeutic decision may be challenging when insufficient tumor tissue is available for EGFR mutation testing. Therefore, blood surrogate samples for EGFR mutation analysis have been suggested. Methods Data were collected from the Spanish cohort of patients in the large, non-interventional, diagnostic ASSESS study (NCT01785888) evaluating the utility of circulating free tumor-derived DNA from plasma for EGFR mutation testing. The incidence of EGFR mutation in Spain and the level of concordance between matched tissue/cytology and plasma samples were evaluated. Results In a cohort of 154 eligible patients, EGFR mutations were identified in 15.1 and 11.0% of tumor and plasma samples, respectively. The most commonly used EGFR mutation testing method for the tumor tissue samples was the QIAGEN Therascreen® EGFR RGQ PCR kit (52.1%). Fragment Length Analysis + PNA LNA Clamp was used for the plasma samples. The concordance rate for EGFR mutation status between the tissue/cytology and plasma samples was 88.8%; the sensitivity was 45.5%, and the specificity was 96.7%. Conclusions The high concordance between the different DNA sources for EGFR mutation testing supports the use of plasma samples when tumor tissue is unavailable. Electronic supplementary material The online version of this article (10.1007/s12094-018-1855-y) contains supplementary material, which is available to authorized users.
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23
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Deng H, Liu J, Duan X, Liu Y. The relationship between EGFR mutation status and clinic-pathologic features in pulmonary adenocarcinoma. Pathol Res Pract 2018; 214:450-454. [PMID: 29496311 DOI: 10.1016/j.prp.2017.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 08/18/2017] [Accepted: 09/09/2017] [Indexed: 01/02/2023]
Abstract
To detect the relationship of the epidermal growth factor receptor (EGFR) mutation status and the clinicopathologic features. Six hundred thirty-three patients with pathologically confirmed lung adenocarcinoma who underwent lung cancer resection surgery at the Fourth Hospital of Hebei Medical University between April 2012 and April 2015 were selected for the study. The 32 types of mutations in exons 18-21 of the EGFR gene were detected. The total EGFR mutation rate among patients with lung adenocarcinoma was 56.9%. The mutation rates were 71.2% among females and 42.8% among males (P < 0.05). Among patients with TNM stage I, II, III, and IV disease, the EGFR mutation rates were significant differences (P < 0.05). Concerning different subtypes of lung adenocarcinoma, the EGFR mutation rates were differences, and these differences were statistically significant (P < 0.05). Cox multivariate regression model analysis considering EGFR mutation status revealed that differences in TNM stage (P < 0.01), smoker status, and tumor size were statistically significant predictors. Patients with minimally invasive and lepidic adenocarcinomas were categorized as low-risk group with high EGFR mutation rate; Patients with micro-papillary and solid adenocarcinomas were categorized as high-risk with lower EGFR mutation rate, so there are different mechanisms in different types of adenocarcinomas.
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Affiliation(s)
- Huiyan Deng
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China
| | - Junying Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China
| | - Xiaojin Duan
- Department of Medical Record Management, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China
| | - Yueping Liu
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050011, China.
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24
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González-Larriba JL, Lázaro-Quintela M, Cobo M, Dómine M, Majem M, García-Campelo R. Clinical management of epidermal growth factor receptor mutation-positive non-small cell lung cancer patients after progression on previous epidermal growth factor receptor tyrosine kinase inhibitors: the necessity of repeated molecular analysis. Transl Lung Cancer Res 2017; 6:S21-S34. [PMID: 29299405 PMCID: PMC5750154 DOI: 10.21037/tlcr.2017.10.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
Abstract
One of the most important advances in the treatment of non-small cell lung cancer (NSCLC) has been the identification of molecular alterations vulnerable to targeted inhibition, such as mutations in the epidermal growth factor receptor (EGFR) gene. EGFR tyrosine kinase inhibitors (EGFR-TKIs) are targeted agents used to treat EGFR mutation-positive advanced NSCLC showing significant improvements in terms of response rate (RR) and progression-free survival (PFS) compared to conventional chemotherapy. However, all patients eventually develop resistance to first-line EGFR-TKIs. The most common mechanism of acquired resistance is the secondary acquisition of a single missense mutation within exon 20 in the EGFR gene, known as the T790M mutation (49-60%). New agents targeting the T790M mutation have undergone clinical development, and among these, osimertinib has shown significant activity in relapsing EGFR mutation positive patients harbouring the T790M mutation. Although precision medicine is a reality for NSCLC, obtaining relevant tissue for repeated molecular analysis from these patients remains a challenge. In this article, a group of experts from the Spanish Society of Medical Oncology (SEOM) and the Spanish Lung Cancer Group (GECP) evaluated the role of rebiopsy and the potential application of plasma-testing methodologies in advanced EGFR mutation patients progressing after EGFR-TKI.
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Affiliation(s)
| | | | - Manuel Cobo
- Department of Medical Oncology, Málaga University Hospital, General and Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Manuel Dómine
- Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Margarita Majem
- Department of Medical Oncology, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
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25
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Faehling M, Schwenk B, Kramberg S, Eckert R, Volckmar AL, Stenzinger A, Sträter J. Oncogenic driver mutations, treatment, and EGFR-TKI resistance in a Caucasian population with non-small cell lung cancer: survival in clinical practice. Oncotarget 2017; 8:77897-77914. [PMID: 29100434 PMCID: PMC5652823 DOI: 10.18632/oncotarget.20857] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/06/2017] [Indexed: 12/24/2022] Open
Abstract
Introduction Oncogenic driver mutations activating EGFR, ALK, or BRAF in NSCLC predict sensitivity to specific tyrosine-kinase inhibitors (TKIs). We provide data on prevalence, treatment and survival of driver-mutation positive NSCLC in a predominantly Caucasian population in routine clinical practice. Patients and Methods NSCLC patients diagnosed from 2006-2015 with an EGFR-test result were included (n=265). Testing for EGFR, ALK, or BRAF was performed if specific TKI therapy was considered. Case-control analyses of overall survival (OS) comparing driver-mutation positive and negative patients were performed. Results 44 sensitizing EGFR mutations (17%), 8 ALK translocations (7%, n=111) and 3 BRAF mutations (8%, n=39) were detected in adenocarcinoma or adenosquamous carcinoma. We did not find mutations in tumors without an adenocarcinoma-component. More than 90% of inoperable driver-mutation positive patients received TKI-therapy. Case-control analysis revealed improved OS of driver-mutation positive patients (39.6 vs. 19.4 months, HR 0.51). OS was improved in stage IV patients but not in stage I-III patients. OS of EGFR-TKI treated patients was similar for 1st and 2nd-line EGFR-TKI treatment. Patients not treated with EGFR-TKI had no benefit in OS. Re-biopsies obtained at progression revealed an EGFR-T790M mutation in 73% (n=11). These patients responded to the 3rd-generation EGFR-TKI osimertinib. Discussion Testing guided by predictive clinical parameters resulted in twice as high rates of mutation-positive patients than expected, and TKI treatment resulted in a strong long-term OS advantage. Conclusion Testing for driver mutations is feasible in routine clinical practice, and identifies patients who benefit from TKI-therapy. OS compares favorably with OS in clinical studies.
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Affiliation(s)
- Martin Faehling
- Department of Cardiology and Pneumology, Hospital Esslingen, Esslingen, Germany
| | - Birgit Schwenk
- Department of Cardiology and Pneumology, Hospital Esslingen, Esslingen, Germany
| | - Sebastian Kramberg
- Department of Cardiology and Pneumology, Hospital Esslingen, Esslingen, Germany
| | - Robert Eckert
- Outpatient Cancer Treatment Clinic Esslingen, Esslingen, Germany
| | - Anna-Lena Volckmar
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Jörn Sträter
- Institute of Pathology Esslingen, Esslingen, Germany
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26
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Matsumura Y, Owada Y, Inoue T, Watanabe Y, Yamaura T, Fukuhara M, Muto S, Okabe N, Hasegawa T, Hoshino M, Osugi J, Higuchi M, Suzuki H. Epidermal growth factor receptor mutation status is strongly associated with smoking status in patients undergoing surgical resection for lung adenocarcinoma. Interact Cardiovasc Thorac Surg 2017; 25:690-695. [DOI: 10.1093/icvts/ivx207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/29/2017] [Indexed: 12/25/2022] Open
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27
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Efficacy of tyrosine kinase inhibitors in EGFR-mutant lung cancer women in a real-world setting: the WORLD07 database. Clin Transl Oncol 2017; 19:1537-1542. [DOI: 10.1007/s12094-017-1700-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/02/2017] [Indexed: 01/26/2023]
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28
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Haghgoo SM, Khosravi A, Mortaz E, Pourabdollah-Toutkaboni M, Seifi S, Sabour S, Allameh A. Prognostic value of rare and complex mutations in EGFR and serum levels of soluble EGFR and its ligands in non-small cell lung carcinoma patients. Clin Biochem 2016; 50:293-300. [PMID: 27923629 DOI: 10.1016/j.clinbiochem.2016.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/27/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND A number of complex and rare mutations in epidermal growth factor receptor (EGFR) gene have been identified and the clinical implication of serum EGFR ligands has also been reported. However, the prognostic significance of these mutations and also the serum EGFR and its ligands in Non-Small Cell Lung Carcinoma (NSCLC) has remained a challenging issue. This study is aimed at finding the prognostic importance of EGFR rare mutations and serum EGFR, amphiregulin (AR), and TGF-α (Transforming Growth Factor-alpha) in NSCLC. MATERIALS AND METHOD NSCLC patients (n=98) with mean age of 59±10.5 were enrolled (M/F: 75/23). DNA was extracted from formalin fixed paraffin embedded tissues. Exons 19 and 21 were amplified using polymerase chain reaction followed by direct sequencing for identification of mutations. Serum EGFR, AR, and TGF-α were measured by ELISA. RESULTS EGFR mutation rate in patients was 37% (exon 19 deletions: 72.2%, exon 21 substitutions: 27.8%). The E872K in exon 21 mutation-positive cases was the most frequent rare mutation detected (90%; 9/10 samples). A significant relationship was found between EGFR exon 21mutations and serum EGFR and TGF-α (P<0.05). Increased serum AR (>3pg/ml) and TGF-α (>10.5pg/ml) were associated with shorter overall survival (P<0.05). CONCLUSIONS The data clearly show that elevation of serum TGF-α and AR are associated with poor prognosis of NSCLC. In addition to the close relationship between EGFR mutations and serum EGFR, serum TGF-α changes was associated with the gene mutations. These findings could be implicated in clinical decision making related to EGFR-TKIs.
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Affiliation(s)
- Seyyed Mortaza Haghgoo
- Department of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Adnan Khosravi
- Department of Oncology, Chronic Respiratory Diseases Research Center and National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mortaz
- Department of Immunology, Chronic Respiratory Diseases Research Center and National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Mihan Pourabdollah-Toutkaboni
- Department of Pathology, Chronic Respiratory Diseases Research Center and National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sharareh Seifi
- Department of Oncology, Chronic Respiratory Diseases Research Center and National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Sabour
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolamir Allameh
- Department of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Vidal ÓJ. [Afatinib as first-line therapy in mutation-positive EGFR. Results by type of mutation]. Med Clin (Barc) 2016; 146 Suppl 1:12-8. [PMID: 27426243 DOI: 10.1016/s0025-7753(16)30258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The discovery of endothelial growth factor receptor (EGFR) mutations has laid the foundations for personalized medicine in non-small cell lung carcinoma (NSCLC). In phase III trials, the first-generation tyrosine kinase inhibitors (TKI), gefitinib and erlotinib, demonstrated greater efficacy compared with chemotherapy in patients with EGFR mutations, achieving progression-free survival of 8-13.5 months. Afatinib, a second-generation irreversible pan-ErbB inhibitor, is the first TKI that has shown a benefit in overall survival (OS) compared with chemotherapy in EGFR mutation-positive NSCLC when used as first-line treatment. Exon 19 deletion (Del19) and the single-point substitution mutation (L858R) in exon 21, called activating mutations due to their ability to confer sensitivity to TKI, represent approximately 90% of the EGFR mutations in NSCLC. Distinct sensitivity to TKI has been observed depending on the type of mutation, with greater progression-free survival in patients with the Del19 mutation. The analysis of OS in the LUX-Lung 3 and LUX-Lung 6 trials showed a statistically significant increase in survival in afatinib-treated patients with the Del 19 mutation, but no significant increase in that of patients with the L858R mutation. Direct comparison of afatinib and gefitinib as first-line therapy (LUX-Lung 7 trial) showed a statistically-significant increase in progression-free survival (hazard ratio: 0.73; 95% confidence interval, 0.57-0.95; p=0.0165) with afatinib. In the analysis by type of mutation, this benefit was observed for both the Del19 and the L858R mutations.
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Affiliation(s)
- Óscar Juan Vidal
- Servicio de Oncología Médica, Hospital Universitari i Politècnic La Fe, Valencia, España.
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Vázquez S, Casal J, Afonso Afonso FJ, Fírvida JL, Santomé L, Barón F, Lázaro M, Pena C, Amenedo M, Abdulkader I, González-Arenas C, Fachal L, Vega A. EGFR testing and clinical management of advanced NSCLC: a Galician Lung Cancer Group study (GGCP 048-10). Cancer Manag Res 2016; 8:11-20. [PMID: 26893581 PMCID: PMC4745839 DOI: 10.2147/cmar.s85173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR) gene in non-small-cell lung cancer (NSCLC) patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. Patients and methods All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens) and serum samples. Results Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6%) had EGFR mutations (84% sensitizing mutations). EGFR mutation was found in serum in 14 (8.1%) patients (of 174 evaluable). Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52%, respectively. All but two patients received gefitinib. Median progression-free survival and overall survival were 10 (95% confidence interval: 4.8–15.3) months and 17.8 (95% confidence interval: 13.9–21.6) months, respectively, in patients carrying sensitizing mutations. Conclusion The incidence of EGFR mutations in Galicia is consistent with previous data in Spain. Our results also support the feasibility of EGFR testing to guide treatment decision making using tumor tissue or cytology samples, or serum samples if tumor specimens are unavailable. These findings also confirm that first-line gefitinib is an active treatment option in Caucasians with EGFR mutation-positive NSCLC.
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Affiliation(s)
- Sergio Vázquez
- Medical Oncology Department, Lucus Augusti University Hospital, Lugo, Spain
| | - Joaquín Casal
- Medical Oncology Department, University Hospital Complex of Vigo, Pontevedra, Spain
| | | | - José Luis Fírvida
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Lucía Santomé
- Medical Oncology Department Povisa Hospital, Vigo, Spain
| | - Francisco Barón
- Medical Oncology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Martín Lázaro
- Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Carolina Pena
- Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Margarita Amenedo
- Medical Oncology Department, Oncology Center of Galicia, A Coruña, Spain
| | - Ihab Abdulkader
- Anatomical Pathology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Laura Fachal
- Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain
| | - Ana Vega
- Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain
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David M, Lamas-Pinheiro R, Henriques-Coelho T. Prenatal and Postnatal Management of Congenital Pulmonary Airway Malformation. Neonatology 2016; 110:101-15. [PMID: 27070354 DOI: 10.1159/000440894] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/06/2015] [Indexed: 11/19/2022]
Abstract
Congenital pulmonary airway malformation (CPAM) is one of the most common lung lesions detected prenatally. Despite the research efforts made in the past few years, controversy and lack of clarity in the literature still exist regarding nomenclature, classification, pathogenesis and the management of CPAM. Therefore, it is of greatest importance to delineate the natural history of CPAMs and to create a consensus to guide the management and follow-up of these lesions. This review will focus on classification systems, highlighting the most recent advancements in pathogenesis, and current practice in the prenatal diagnosis of CPAM. Strategies of prenatal management and postnatal management will be reviewed. Long-term follow-up, including lung cancer risk, is discussed and an outcome perspective is presented.
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Affiliation(s)
- Mafalda David
- Pediatric Surgery Department, Centro Hospitalar Sx00E3;o Jox00E3;o, Porto, Portugal
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The Frequency of Rare EGFR Mutations Is Higher than that of Classical Ones. J Thorac Oncol 2016; 11:e17. [DOI: 10.1016/j.jtho.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 11/24/2022]
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Naderi S, Ghorra C, Haddad F, Kourie HR, Rassy M, El Karak F, Ghosn M, Abadjian G, Kattan J. EGFR mutation status in Middle Eastern patients with non-squamous non-small cell lung carcinoma: A single institution experience. Cancer Epidemiol 2015; 39:1099-102. [PMID: 26362141 DOI: 10.1016/j.canep.2015.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/01/2015] [Accepted: 08/27/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) represents an important molecular target in the treatment of lung adenocarcinomas; many anti-EGFR therapies are approved as first line and second-line treatment in patients having metastatic lung adenocarcinomas. The occurrence of this mutation varies in terms of race; it is around 10% in Caucasians and can reach 30% in Asians. Its prevalence in our Middle Eastern region is not well known. METHODS Patients diagnosed with non-squamous non-small cell lung carcinomas between March 2013 and March 2015 were included. This study was conducted at Hôtel-Dieu de France University Hospital, a tertiary medical center in Lebanon. EFGR mutations were analyzed using real time PCR technique on the Rotor-Gene Q using Scorpions and ARMS technologies. The following data was collected: the patients' characteristics (age, gender, smoking status, stage), the samples' characteristics (histology subtype, TTF-1 and Napsin A immunostainings, the site and the adequacy and the type of the sample), and the mutational EGFR status (presence and type of mutation). These variables were analyzed using SPSS 20. RESULTS 201 patients were included. The mean age was 65.2 years [31-87]; 40.2% were females. 78.1% of the included patients were smokers or ex-smokers. 12.9% of patients had a localized disease, 17.4% a locally advanced disease and 69.7% a metastatic disease. Adenocarcinoma was the main histologic subtype found in 90.5% of patients, followed by large cell carcinoma (3.5%), adenosquamous carcinoma (3.0%) and non-small cell carcinoma not otherwise specified (3.0%). 11.9% of patients had an EGFR mutation: 48% of them presented a deletion on exon 19, 40.0% a L858R mutation on exon 21, 4.0% a G719X mutation in exon 18, 4.0% an insertion in exon 20, and 4% a T790M mutation in exon 20. The presence of an EGFR mutation was significantly associated with the female gender (two-third) (p<0.05) and the non-smoking status (two-third) (p<0.05). CONCLUSIONS The prevalence of EGFR mutation (11.9%) detected in our Lebanese population is similar to that observed in the Caucasian population. This mutation is also significantly more frequent in females and non-smokers.
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Affiliation(s)
- Samah Naderi
- Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fady Haddad
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marc Rassy
- Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Fadi El Karak
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marwan Ghosn
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gérard Abadjian
- Pathology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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