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Macioch T, Krzakowski M, Gołębiewska K, Dobek M, Warchałowska N, Niewada M. Pembrolizumab monotherapy survival benefits in metastatic non-small-cell lung cancer: a systematic review of real-world data. Discov Oncol 2024; 15:303. [PMID: 39048812 PMCID: PMC11269554 DOI: 10.1007/s12672-024-01153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
The efficacy of pembrolizumab in the treatment-naïve non-small-cell lung cancer (NSCLC) patients was proved in the KEYNOTE-024 randomized trial. The aim of this systematic literature review was to identify and summarize the real world evidence (RWE) of overall survival (OS) in previously untreated patients with NSCLC receiving pembrolizumab monotherapy. A systematic search was conducted in PubMed (MEDLINE®) and EMBASE databases. Analyses were focused on survival data (median OS and survival rates at specific time points). To explore the population comparable with the KEYNOTE-024 study, we focused on studies enrolling at least 50% of patients at stage IV of cancer and ECOG performance status 0-2. A total of 41 RWE studies covering over 7600 advanced NSCLC patients naïve to systemic treatment were identified. Overall, survival outcomes reported in those studies vary considerably (median OS range: 3.0-34.6 months). Most RWE studies reported median OS shorter to that reported in KEYNOTE-024 (26.3 months), but about half of reported OS medians were in range of 95% confidence interval for OS as reported in KEYNOTE-024 trial (18.3-40.4 months). Patients with similar characteristics of stage and performance status to those of KEYNOTE-024 trial benefited the same with pembrolizumab monotherapy as their survival outcomes (18.9-22.8 months) were consistent with those reported in the clinical trial. RWE data showed substantially worse outcomes in patients with ECOG-PS 2+ compared to ECOG-PS 0-1 patients.
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Affiliation(s)
- Tomasz Macioch
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Żwirki i Wigury 81, 02-091, Warsaw, Poland
- HealthQuest Sp. z.o.o., Warsaw, Poland
| | - Maciej Krzakowski
- Department of Lung & Thoracic Tumours, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | | | | | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Żwirki i Wigury 81, 02-091, Warsaw, Poland.
- HealthQuest Sp. z.o.o., Warsaw, Poland.
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2
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Naratornsirakul D, Chewaskulyong B, Kongkarnka S, Oranratnachai S. Comparison of treatment outcome between first-line combination immunotherapy (anti-PD-L1 or anti-PD1) with or without chemotherapy and chemotherapy alone in advanced non-small cell lung cancer patients in tertiary care hospital. Cancer Med 2024; 13:e70007. [PMID: 39030820 PMCID: PMC11257996 DOI: 10.1002/cam4.70007] [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: 05/13/2024] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Despite promising outcomes of first-line immunotherapy with or without chemotherapy in advanced non-small cell lung cancer (NSCLC), limited accessibility due to reimbursement was remain the problem in low to middle income countries. This study aimed to evaluate real-world effectiveness of immunotherapy in patients with advanced NSCLC in Northern Thailand. METHOD A retrospective, single-centered cohort, was conducted. Patients with advanced NSCLC who underwent PD-L1 testing (excluding EGFR and ALK mutations) and were treated with immunotherapy or without chemotherapy or chemotherapy alone were included. The primary end point was progression-free survival (PFS). The secondary endpoints were overall survival (OS), objective response rate (ORR), and adverse events. RESULTS A total of 123 patients, of which 21 patients received immunotherapy-based regimen and 102 patients received chemotherapy alone. The median PFS was 11.9 months in immunotherapy-based group compared to 5.93 months in the chemotherapy group, with a. hazard ratio (HR) of 0.4 (95% confidence interval [CI], 0.23 to 0.68; p = 0.001). Similarly, the median OS was 26.68 months in the immunotherapy-based group and 11.21 months in the chemotherapy group, with HR of 0.42 (95% CI 0.22-0.8; p = 0.009). ORRs were significantly higher in the immunotherapy-based group, with 65% of patients showing a response compared to 32% in the chemotherapy group (p = 0.006). CONCLUSION The result of this real-world study in patients with advanced stage NSCLC indicate that first-line immunotherapy-based regimen was associated with significantly greater PFS, OS, and ORR with a safety profile consistent with pivotal studies.
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Affiliation(s)
- Danainut Naratornsirakul
- Division of Medical Oncology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Busyamas Chewaskulyong
- Division of Medical Oncology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Sarawut Kongkarnka
- Department of Pathology, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
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Wu X, Stabile LP, Burns TF. The Emerging Role of Immune Checkpoint Blockade for the Treatment of Lung Cancer Brain Metastases. Clin Lung Cancer 2024:S1525-7304(24)00124-4. [PMID: 38991863 DOI: 10.1016/j.cllc.2024.06.004] [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: 12/03/2023] [Revised: 04/15/2024] [Accepted: 06/06/2024] [Indexed: 07/13/2024]
Abstract
Lung cancer has the highest incidence of brain metastases (BM) among solid organ cancers. Traditionally whole brain radiation therapy has been utilized for non-small-cell lung cancer (NSCLC) BM treatment, although stereotactic radiosurgery has emerged as the superior treatment modality for most patients. Highly penetrant central nervous system (CNS) tyrosine kinase inhibitors have also shown significant CNS activity in patients harboring select oncogenic drivers. There is emerging evidence that patients without oncogene-driven tumors derive benefit from the use of immune checkpoint inhibitors (ICIs). The CNS activity of ICIs have not been well studied given exclusion of patients with active BM from landmark trials, due to concerns of inadequate CNS penetration and activity. However, studies have challenged the idea of an immune-privileged CNS, given the presence of functional lymphatic drainage within the CNS and destruction of the blood brain barrier by BM. An emerging understanding of the interactions between tumor and CNS immune cells in the BM tumor microenvironment also support a role for immunotherapy in BM treatment. In addition, posthoc analyses of major trials have shown improved intracranial response and survival benefit of regimens with ICIs over chemotherapy (CT) alone for patients with BM. Two prospective phase 2 trials evaluating pembrolizumab monotherapy and atezolizumab plus CT in patients with untreated NSCLC BM also demonstrated significant intracranial responses. This review describes the interplay between CNS immune cells and tumor cells, discusses current evidence for ICI CNS activity from retrospective and prospective studies, and speculates on future directions of investigation.
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Affiliation(s)
- Xiancheng Wu
- Department of Medicine, Division of Internal Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Laura P Stabile
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA; UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Timothy F Burns
- UPMC Hillman Cancer Center, Pittsburgh, PA; Department of Medicine, Division of Hematology-Oncology, University of Pittsburgh, Pittsburgh, PA.
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Cafaro A, Foca F, Nanni O, Chiumente M, Coppola M, Russi A, Svegliati E, Baldo P, Orzetti S, Enrico F, Foglio F, Pinnavaia D, Ladisa V, Lauria Pantano C, Lerose R, Nardulli P, Ferraiuolo S, Maiolino P, De Stasio I, Gradellini F, Gasbarro AR, Santeramo R, Carrucciu G, Provasi R, Cirino M, Cappelletto PC, Fonzi E, Pasqualini A, Vecchia S, Veraldi M, De Francesco AE, Crinò L, Delmonte A, Masini C. Real-World Safety and Outcome of First-Line Pembrolizumab Monotherapy for Metastatic NSCLC with PDL-1 Expression ≥ 50%: A National Italian Multicentric Cohort (" PEMBROREAL" Study). Cancers (Basel) 2024; 16:1802. [PMID: 38791882 PMCID: PMC11119961 DOI: 10.3390/cancers16101802] [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: 04/15/2024] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Results from the phase III Keynote-024 clinical trial established pembrolizumab monotherapy as the first-line standard of care for patients with metastatic NSCLC who have PD-L1 expression ≥ 50%, EGFR, and ALK wild-type tumors. However, given the differences between patients treated in routine clinical practice and those treated in a clinical trial, real-world data are needed to confirm the treatment benefit in standard practice. Given the lack of data on large cohorts of patients with long follow-ups, we designed an observational retrospective study of patients with metastatic NSCLC who were treated with pembrolizumab, starting from its reimbursement eligibility until December 2020. The primary endpoints were PFS and OS, determined using the Kaplan-Meier method. Response and safety were also evaluated. We followed 880 patients (median follow-up: 35.1 months) until February 2022. Median PFS and OS were 8.6 months (95% CI: 7.6-10.0) and 25.5 months (95% CI: 21.8-31.6), respectively. We also found that ECOG PS, PD-L1 expression, and habitual smoking were prognostic factors for PFS, while age, sex, ECOG PS, habitual smoking and histology had an impact on OS. Multivariable analysis confirms the prognostic role of PD-L1 for PFS and of ECOG for both PFS and OS. 39.9% of patients reported an adverse event, but only 6.3% of patients discontinued therapy due to toxicity. Our results suggest a long-term benefit of pembrolizumab in the first-line setting, as well as a safety profile consistent with the results of Keynote-024. Many collected variables appear to influence clinical outcome, but results from these exploratory unadjusted analyses should be interpreted with caution.
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Affiliation(s)
- Alessandro Cafaro
- Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (F.F.); (O.N.)
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (F.F.); (O.N.)
| | - Marco Chiumente
- Scientific Direction, Società Italiana di Farmacia Clinica e Terapia (SIFaCT), 10123 Turin, Italy;
| | - Marina Coppola
- Pharmacy Unit, IRCCS Istituto Oncologico Veneto (IOV), 35128 Padova, Italy; (M.C.); (A.R.); (E.S.)
| | - Alberto Russi
- Pharmacy Unit, IRCCS Istituto Oncologico Veneto (IOV), 35128 Padova, Italy; (M.C.); (A.R.); (E.S.)
| | - Elena Svegliati
- Pharmacy Unit, IRCCS Istituto Oncologico Veneto (IOV), 35128 Padova, Italy; (M.C.); (A.R.); (E.S.)
| | - Paolo Baldo
- Pharmacy Unit, CRO Aviano IRCCS, National Cancer Institute, 33081 Aviano, Italy; (P.B.); (S.O.)
| | - Sabrina Orzetti
- Pharmacy Unit, CRO Aviano IRCCS, National Cancer Institute, 33081 Aviano, Italy; (P.B.); (S.O.)
| | - Fiorenza Enrico
- Hospital Pharmacy, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (F.E.); (F.F.); (D.P.)
| | - Federico Foglio
- Hospital Pharmacy, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (F.E.); (F.F.); (D.P.)
| | - Davide Pinnavaia
- Hospital Pharmacy, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (F.E.); (F.F.); (D.P.)
| | - Vito Ladisa
- Hospital Pharmacy, IRCCS National Cancer Institute Foundation, 20133 Milan, Italy; (V.L.); (C.L.P.)
| | - Claudia Lauria Pantano
- Hospital Pharmacy, IRCCS National Cancer Institute Foundation, 20133 Milan, Italy; (V.L.); (C.L.P.)
| | - Rosa Lerose
- Hospital Pharmacy, IRCCS-CROB Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy;
| | - Patrizia Nardulli
- Pharmacy Unit, National Cancer Research Center Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (P.N.); (S.F.)
| | - Simona Ferraiuolo
- Pharmacy Unit, National Cancer Research Center Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (P.N.); (S.F.)
| | - Piera Maiolino
- Pharmacy Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”, IRCCS, 80131 Naples, Italy; (P.M.); (I.D.S.)
| | - Immacolata De Stasio
- Pharmacy Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”, IRCCS, 80131 Naples, Italy; (P.M.); (I.D.S.)
| | - Federica Gradellini
- Pharmacy Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Anna Rita Gasbarro
- Pharmacy Unit, University Hospital Policlinico, 70100 Bari, Italy; (A.R.G.); (R.S.)
| | - Rossella Santeramo
- Pharmacy Unit, University Hospital Policlinico, 70100 Bari, Italy; (A.R.G.); (R.S.)
| | | | - Riccardo Provasi
- Department of Pharmacy, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (R.P.); (M.C.)
| | - Mario Cirino
- Department of Pharmacy, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (R.P.); (M.C.)
| | | | - Elisabetta Fonzi
- Pharmacy Unit, S.Chiara Hospital, 38122 Trento, Italy; (E.F.); (A.P.)
| | | | - Stefano Vecchia
- Pharmacy Unit, Hospital Guglielmo da Saliceto, 29121 Piacenza, Italy;
| | - Marianna Veraldi
- Protesic and Pharmaceutical Assistance Sector n. 3, Department of Health Protection and Health Service Calabria Region, 88100 Catanzaro, Italy;
| | | | - Lucio Crinò
- Thoracic Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (L.C.); (A.D.)
| | - Angelo Delmonte
- Thoracic Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (L.C.); (A.D.)
| | - Carla Masini
- Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
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Wagenius G, Vikström A, Berglund A, Salomonsson S, Bencina G, Hu X, Chirovsky D, Brunnström H. First-line Treatment Patterns and Outcomes in Advanced Non-Small Cell Lung Cancer in Sweden: A Population-based Real-world Study with Focus on Immunotherapy. Acta Oncol 2024; 63:198-205. [PMID: 38643377 PMCID: PMC11332554 DOI: 10.2340/1651-226x.2024.20309] [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: 10/10/2023] [Accepted: 03/08/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND PURPOSE The treatment landscape for patients with advanced non-small cell lung cancer (NSCLC) has evolved significantly since the introduction of immunotherapies. We here describe PD-L1 testing rates, treatment patterns, and real-world outcomes for PD-(L)1 inhibitors in Sweden. MATERIALS AND METHODS Data were obtained from the Swedish National Lung Cancer Registry for patients with advanced NSCLC and Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2 who initiated first-line -systemic treatment from 01 April 2017 to 30 June 2020. PD-L1 testing was available in the registry from 01 January 2018. Kaplan-Meier was used for overall survival (OS) by type treatment and histology. RESULTS A total of 2,204 patients with pathologically confirmed unresectable stage IIIB/C or IV NSCLC initiated first-line treatment, 1,807 (82%) with nonsquamous (NSQ) and 397 (18%) with SQ. Eighty-six per cent (NSQ) or 85% (SQ) had been tested for PD-L1 expression, a proportion that increased over time. The use of platinum-based therapy as first-line treatment decreased substantially over time while there was an upward trend for PD-(L)1-based therapy. Among patients with PS 0-1 initiating a first-line PD-(L)1 inhibitor monotherapy, the median OS was 18.6 and 13.3 months for NSQ and SQ NSCLC patients, respectively, while for the PD-(L)1 inhibitor and chemotherapy combination regimen, the median OS was 24.0 months for NSQ and not evaluable for SQ patients. INTERPRETATION The majority of advanced NSCLCs in Sweden were tested for PD-L1 expression. Real-world OS in patients with PS 0-1 receiving first-line PD-(L)1 inhibitor-based regimens was similar to what has been reported in pivotal clinical trials on PD-(L)1 inhibitors.
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Affiliation(s)
- Gunnar Wagenius
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Medical Unit Head and Neck, Lung, and Skin Tumors, Thoracic Oncology Center, Karolinska University Hospital, Stockholm, Sweden.
| | - Anders Vikström
- Department of Respiratory Medicine, Linköping University Hospital, Linköping, Sweden
| | | | - Stina Salomonsson
- MSD, Centre for Observational and Real-World Evidence, Stockholm, Sweden
| | - Goran Bencina
- MSD, Centre of Observational Real-World Evidence, Madrid, Spain
| | - Xiaohan Hu
- Merck & Co., Inc., Centre of Observational Real-World Evidence, Rahway, New Jersey, USA
| | - Dana Chirovsky
- Merck & Co., Inc., Centre of Observational Real-World Evidence, Rahway, New Jersey, USA
| | - Hans Brunnström
- Department of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Genetics, Pathology, and Molecular Diagnostics, Skåne University Hospital, Lund, Sweden
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Griesinger F, Sebastian M, Brueckl WM, Hummel HD, Jaeschke B, Kern J, Wesseler C, Jänicke M, Fleitz A, Zacharias S, Hipper A, Groth A, Weichert W, Dörfel S, Petersen V, Schröder J, Wilke J, Eberhardt WE, Thomas M. Checkpoint Inhibitor Monotherapy in Potentially Trial-Eligible or Trial-Ineligible Patients With Metastatic NSCLC in the German Prospective CRISP Registry Real-World Cohort (AIO-TRK-0315). JTO Clin Res Rep 2024; 5:100626. [PMID: 38586301 PMCID: PMC10995980 DOI: 10.1016/j.jtocrr.2023.100626] [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] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 04/09/2024] Open
Abstract
Introduction Patients with metastatic NSCLC (mNSCLC) treated with immune checkpoint inhibitors in clinical practice may often not meet the strict inclusion criteria of clinical trials. Our aim was to assess the trial eligibility of patients with mNSCLC treated with pembrolizumab monotherapy in real-world and to compare the outcome of "trial-ineligible" and "potentially trial-eligible" patients. Methods Data from the prospective, clinical research platform CRISP were used to compare patient characteristics, treatment, and outcome of patients with programmed cell death-ligand 1 tumor proportion score greater than or equal to 50% tumors treated with pembrolizumab monotherapy who are deemed either "potentially trial-eligible" or "trial-ineligible" according to inclusion and exclusion criteria of the registrational studies (KEYNOTE-024 and -042). Results Of 746 patients included, 343 patients (46.0%) were classified as "trial-ineligible" and had significantly worse outcomes compared with "potentially trial-eligible" patients (n = 403, 54.0%): median progression-free survival: 6.2 (95% confidence interval [CI]: 5.2-8.4) versus 10.3 (95% CI: 8.4-13.8) months, hazard ratio (trial-ineligible versus potentially trial-eligible) of 1.43 (95% CI: 1.19-1.72), p less than 0.001; median overall survival: 15.9 (95% CI: 11.4-20.3) versus 25.3 (95% CI: 19.8-30.4) months, hazard ratio of 1.36 (95% CI: 1.10-1.67), p equals 0.004. Conclusions Our data reveal that a considerable proportion of patients with mNSCLC are not eligible to participate in a clinical trial and were found to have worse outcomes than potentially trial-eligible patients, whose outcomes were comparable with those obtained from pivotal clinical trials. This is of substantial clinical relevance for physicians discussing outcomes to be expected with their patients and stresses the need for real-world effectiveness analyses.
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Affiliation(s)
- Frank Griesinger
- Department of Hematology and Oncology, University Department Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Martin Sebastian
- Department of Medicine II, Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Germany; Frankfurt Cancer Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - Wolfgang M. Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Horst-Dieter Hummel
- Translational Oncology/Early Clinical Trial Unit (ECTU), Comprehensive Cancer Center Mainfranken and Bavarian Cancer Research Center (BZKF), University Hospital Würzburg, Würzburg, Germany
| | - Bastian Jaeschke
- HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, IM III: Hämatologie, Onkologie, Palliativmedizin, Interdisziplinäre Onkologische Ambulanz, Wiesbaden, Germany
| | - Jens Kern
- Klinikum Würzburg Mitte, Missioklinik, Medizinische Klinik – Schwerpunkt Pneumologie und Beatmungsmedizin, Würzburg, Germany
| | - Claas Wesseler
- Asklepios Tumorzentrum Hamburg, Klinikum Harburg, Lungenabteilung, Hamburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Annette Fleitz
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | | | - Wilko Weichert
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Volker Petersen
- Onkologische Schwerpunktpraxis Dr. med. Volker Petersen, Heidenheim a.d.B, Germany
| | - Jan Schröder
- Gemeinschaftspraxis für Hämatologie und internistische Onkologie, Mülheim a.d.R., Germany
| | - Jochen Wilke
- Schwerpunktpraxis Hämatologie & Internistische Onkologie, Fürth, Germany
| | - Wilfried E.E. Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg and Translational, Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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7
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Sereno M, Hernandez de Córdoba I, Gutiérrez-Gutiérrez G, Casado E. Brain metastases and lung cancer: molecular biology, natural history, prediction of response and efficacy of immunotherapy. Front Immunol 2024; 14:1297988. [PMID: 38283359 PMCID: PMC10811213 DOI: 10.3389/fimmu.2023.1297988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Brain metastases stemming from lung cancer represent a common and challenging complication that significantly impacts patients' overall health. The migration of these cancerous cells from lung lesions to the central nervous system is facilitated by diverse molecular changes and a specific environment that supports their affinity for neural tissues. The advent of immunotherapy and its varied combinations in non-small cell lung cancer has notably improved patient survival rates, even in cases involving brain metastases. These therapies exhibit enhanced penetration into the central nervous system compared to traditional chemotherapy. This review outlines the molecular mechanisms underlying the development of brain metastases in lung cancer and explores the efficacy of novel immunotherapy approaches and their combinations.
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Affiliation(s)
- Maria Sereno
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
- European University of Madrid, Madrid, Spain
- Fundación para la Innovación e Investigación Biomédica (FIIB) Hospital Universitario Infanta Sofía (HUIS) Hospital de Henares (HHEN), Madrid, Spain
- Instituto Madrileño Investigación Estudios Avanzados (IMDEA), Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI Universidad Autónoma de Madrid (UAM), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | | | - Gerardo Gutiérrez-Gutiérrez
- European University of Madrid, Madrid, Spain
- Fundación para la Innovación e Investigación Biomédica (FIIB) Hospital Universitario Infanta Sofía (HUIS) Hospital de Henares (HHEN), Madrid, Spain
- Neurology Department, Infanta Sofía University Hospital, Madrid, Spain
| | - Enrique Casado
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
- European University of Madrid, Madrid, Spain
- Fundación para la Innovación e Investigación Biomédica (FIIB) Hospital Universitario Infanta Sofía (HUIS) Hospital de Henares (HHEN), Madrid, Spain
- Instituto Madrileño Investigación Estudios Avanzados (IMDEA), Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI Universidad Autónoma de Madrid (UAM), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
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Bellur S, Khosla AA, Ozair A, Kotecha R, McDermott MW, Ahluwalia MS. Management of Brain Metastases: A Review of Novel Therapies. Semin Neurol 2023; 43:845-858. [PMID: 38011864 DOI: 10.1055/s-0043-1776782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Brain metastases (BMs) represent the most common intracranial tumors in adults, and most commonly originate from lung, followed by breast, melanoma, kidney, and colorectal cancer. Management of BM is individualized based on the size and number of brain metastases, the extent of extracranial disease, the primary tumor subtype, neurological symptoms, and prior lines of therapy. Until recently, treatment strategies were limited to local therapies, like surgical resection and radiotherapy, the latter in the form of whole-brain radiotherapy or stereotactic radiosurgery. The next generation of local strategies includes laser interstitial thermal therapy, magnetic hyperthermic therapy, post-resection brachytherapy, and focused ultrasound. New targeted therapies and immunotherapies with documented intracranial activity have transformed clinical outcomes. Novel systemic therapies with intracranial utility include new anaplastic lymphoma kinase inhibitors like brigatinib and ensartinib; selective "rearranged during transfection" inhibitors like selpercatinib and pralsetinib; B-raf proto-oncogene inhibitors like encorafenib and vemurafenib; Kirsten rat sarcoma viral oncogene inhibitors like sotorasib and adagrasib; ROS1 gene rearrangement (ROS1) inhibitors, anti-neurotrophic tyrosine receptor kinase agents like larotrectinib and entrectinib; anti-human epidermal growth factor receptor 2/epidermal growth factor receptor exon 20 agent like poziotinib; and antibody-drug conjugates like trastuzumab-emtansine and trastuzumab-deruxtecan. This review highlights the modern multidisciplinary management of BM, emphasizing the integration of systemic and local therapies.
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Affiliation(s)
- Shreyas Bellur
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | | | - Ahmad Ozair
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rupesh Kotecha
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Michael W McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida
| | - Manmeet S Ahluwalia
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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9
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Pelicon V, Cufer T, Knez L. Real-world outcomes of immunotherapy with or without chemotherapy in first-line treatment of advanced non-small cell lung cancer. Front Oncol 2023; 13:1182748. [PMID: 37404771 PMCID: PMC10316645 DOI: 10.3389/fonc.2023.1182748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
Background Immunotherapy alone (mono-IT) or combined with chemotherapy (chemo-IT) has recently become the cornerstone of first-line treatment for advanced non-small cell lung cancer (NSCLC) patients. Here, real-world outcomes of first-line mono-IT and chemo-IT of advanced NSCLC treated within routine clinical practice at a single academic center in the Central Eastern European (CEE) region are presented. Materials and methods A total of 176 consecutive patients with advanced NSCLC treated with mono-IT (118 patients) or chemo-IT (58 patients) were included. At the participating institution, all medical data relevant for providing oncology care are collected prospectively and in a standardized manner using purposely created pro-forms. Adverse events (AEs) were recorded and graded according to Common Terminology Criteria for Adverse Events (CTCAE). The Kaplan-Meier method was used to estimate median overall survival (mOS) and median duration of treatment (mDOT). Results The 118 patients in the mono-IT cohort had a median age of 64 years, most were male (59%), 20% had ECOG PS ≥2, and 14% had controlled CNS metastases at baseline. With a median follow-up time (mFU) of 24.1 months, the mOS was 19.4 months (95% CI, 11.1-27.6), and the mDOT was 5.0 months (95% CI, 3.5-6.5). The 1-year OS was 62%. The 58 patients in the chemo-IT cohort had a median age of 64 years, most were male (64%), 9% had ECOG PS ≥2, and 7% had controlled CNS metastases at baseline. With a mFU of 15.5 months, the mOS was 21.3 months (95% CI, 15.9-26.7), and the mDOT was 12.0 months (95% CI, 8.3-15.6). The 1-year OS was 75%. Adverse events of severe grade were recorded in 18% and 26% of patients, and immunotherapy discontinuation due to AEs occurred in 19% and 9% in the mono-IT and chemo-IT groups, respectively. No treatment-related deaths were recorded. Conclusion The results from the present real-world observational study from a CEE country suggest similar effectiveness and safety of first-line mono-IT and chemo-IT in patients with advanced NSCLC to those observed in randomized clinical trials. However, continuous follow-up will offer better insight into the magnitude of long-term benefits in routine clinical practice.
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Affiliation(s)
- Veronika Pelicon
- Department of Pharmacy, University Clinic Golnik, Golnik, Slovenia
| | - Tanja Cufer
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Lea Knez
- Department of Pharmacy, University Clinic Golnik, Golnik, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
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10
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Belaroussi Y, Bouteiller F, Bellera C, Pasquier D, Perol M, Debieuvre D, Filleron T, Girard N, Schott R, Mathoulin-Pélissier S, Martin AL, Cousin S. Survival outcomes of patients with metastatic non-small cell lung cancer receiving chemotherapy or immunotherapy as first-line in a real-life setting. Sci Rep 2023; 13:9584. [PMID: 37311845 DOI: 10.1038/s41598-023-36623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
Treatment of metastatic non-small cell lung cancer (mNSCLC) has been modified due to the development of immunotherapy. We assessed survival outcomes (overall [OS] and progression-free [rwPFS] survivals, time-to-next-treatment [TNT]) in mNSCLC patients after first-line immunotherapy and chemotherapy in real-life settings. Association between rwPFS and TNT, two candidate surrogate endpoints (SE), with OS was assessed. This retrospective multi-center study uses data from patients included in the Epidemio-Strategy Medico-Economic program with mNSCLC over 2015-2019. The impact of treatment on rwPFS/OS was evaluated with Cox models. Individual-level associations between SE and OS were estimated with an iterative multiple imputation approach and joint survival models. The population included 5294 patients (63 years median age). Median OS in immunotherapy group was 16.4 months (95%CI [14.1-NR]) and was higher than in chemotherapy group (11.6 months; 95%CI [11.0-12.2]). Improved OS was observed for the immunotherapy group after 3 months for subjects with performance status 0-1 (HR = 0.59; 95%CI [0.42-0.83], p < 0.01). The associations between rwPFS and TNT with OS were close ([Formula: see text]=0.57). Results emphasized a survival improvement with immunotherapy for patients in good health condition. There was moderate evidence of individual-level association between candidate SE and OS.
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Affiliation(s)
- Yaniss Belaroussi
- UMR 1219, Univ. Bordeaux, Bordeaux Population Health Research Center, Epicene Team, 33000, Bordeaux, France.
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France.
| | - Fanny Bouteiller
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France
| | - Carine Bellera
- UMR 1219, Univ. Bordeaux, Bordeaux Population Health Research Center, Epicene Team, 33000, Bordeaux, France
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France
| | - David Pasquier
- Radiotherapy Department, Centre Oscar Lambret, 59000, Lille, France
| | - Maurice Perol
- Medical Oncology Department, Centre Léon Bérard, 69373, Lyon, France
| | | | - Thomas Filleron
- Biostatistic and Health Data Science Unit, Institut Claudius Régaud IUTC-O, 31300, Toulouse, France
| | - Nicolas Girard
- Medical Oncology Department, Institut du Thorax Curie-Montsouris, 75014, Paris, France
| | - Roland Schott
- Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, 67200, Strasbourg, France
| | - Simone Mathoulin-Pélissier
- UMR 1219, Univ. Bordeaux, Bordeaux Population Health Research Center, Epicene Team, 33000, Bordeaux, France
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France
| | - Anne-Laure Martin
- Health Data and Partnership Department, Unicancer, 75654, Paris, France
| | - Sophie Cousin
- Early Phase Trials Unit, Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, 229 Cours de L'Argonne, 33000, Bordeaux, France
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11
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Rittberg R, Leung B, Shokoohi A, Pender A, Wong S, Al-Hashami Z, Wang Y, Ho C. Real-World Outcomes of Stage IV NSCLC with PD-L1 ≥ 50% Treated with First-Line Pembrolizumab: Uptake of Second-Line Systemic Therapy. Curr Oncol 2023; 30:5299-5308. [PMID: 37366885 DOI: 10.3390/curroncol30060402] [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: 04/02/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Platinum-based chemotherapy was compared to single-agent pembrolizumab in advanced non-small cell lung cancer (NSCLC) with PDL1 > 50% in KEYNOTE-024. In this trial, it was found that patients who received single-agent pembrolizumab had improved progression-free survival in addition to overall survival (OS). Based on KEYNOTE-024, only 53% of patients treated originally with pembrolizumab received second-line anticancer systemic therapy with an OS of 26.3 months. Based on these results, the objective of this study was to characterize real-world NSCLC patients who received second-line therapy after single-agent pembrolizumab. METHODS This was a retrospective cohort study considering stage IV NSCLC patients diagnosed with BC Cancer between 2018 and 2021 with PD-L1 ≥ 50% who received first-line single agent pembrolizumab. Patient demographics, cancer history, treatment administered, and survival were collected retrospectively. Descriptive statistics were produced. OS was calculated using Kaplan-Meier curves and compared using the log rank test. A multivariate model evaluated characteristics associated with the receipt of second-line therapy. RESULTS A total of 718 patients were diagnosed with Stage IV NSCLC and received at least one cycle of pembrolizumab. The median duration of treatment was 4.4 months, and the follow-up duration was 16.0 months. There were 567 (79%) patients who had disease progression, of whom 21% received second-line systemic therapy. Within the subset of patients with disease progression, the median duration of treatment was 3.0 months. It would be found that patients who received second-line therapy had better baseline ECOG performance status, were younger at diagnosis, and had a longer duration of pembrolizumab. Within the full population, the OS from the treatment initiation date was 14.0 months. OS was 5.6 months in patients who did not receive additional therapy after progression and 22.2 months in patients who received subsequent therapy. Baseline ECOG performance status was associated with improved OS in multivariate analysis. CONCLUSION Based on this real-world Canadian population, 21% of patients received second-line systemic therapy, despite second-line therapy being associated with prolonged survival. In this real-world population, we found that 60% fewer patients received second-line systemic therapy when compared to KEYNOTE-024. Although differences always exist when comparing a clinical and non-clinical trial population, our findings suggest undertreating stage IV NSCLC patients.
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Affiliation(s)
| | - Bonnie Leung
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Aria Shokoohi
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | | | - Selina Wong
- BC Cancer Victoria, Victoria, BC V8R 6V5, Canada
| | - Zamzam Al-Hashami
- Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat 123, Oman
| | - Ying Wang
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Cheryl Ho
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
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12
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Yang B, Wang B, Chen Y, Wan N, Xie F, Yang N, Lu L, Xiao W, Yuan J, Li J, Xie B, Ji B. Effectiveness and safety of pembrolizumab for patients with advanced non-small cell lung cancer in real-world studies and randomized controlled trials: A systematic review and meta-analysis. Front Oncol 2023; 13:1044327. [PMID: 36824127 PMCID: PMC9942927 DOI: 10.3389/fonc.2023.1044327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
Background Several randomized controlled trials (RCTs) have confirmed the favorable clinical benefit of pembrolizumab in advanced non-small cell lung cancer (NSCLC). However, considering the strict inclusion and exclusion criteria in clinical research, there are certain differences between patients in the real-world, it is unclear whether the findings of clinical trials are fully representative of the treatment efficacy in patients who will eventually use it. Therefore, to further comprehensively assess the efficacy and safety of pembrolizumab in NSCLC, we conducted a systematic review and meta-analysis based on the latest RCTs and real-world studies (RWSs). Methods We systematically searched PubMed, Embase, The Cochrane Library, The Web of Science, and clinical trials.gov as of December 2021. RCTs and RWSs of patients receiving pembrolizumab monotherapy or in combination with chemotherapy for advanced NSCLC were included. Results The meta-analysis ultimately included 11 RCTs and 26 RWSs with a total of 10,695 patients. The primary outcomes of this study were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), serious adverse events (SAEs), the incidence of severe pneumonia reactions, and drug-related mortality. Direct meta-analysis results showed that in RCTs, pembrolizumab in combination with chemotherapy was superior to chemotherapy in terms of OS (HR=0.60, 95%CI:0.50-0.73), PFS (HR=0.47, 95%CI:0.38-0.58) and ORR (OR=3.22, 95%CI:2.57-4.03); pembrolizumab monotherapy was superior to chemotherapy in terms of OS (HR=0.73, 95%CI:0.66-0.80) and ORR (OR=1.90, 95%CI:1.17-3.09), but comparable to chemotherapy in terms of PFS (HR=0.83, 95%CI:0.66-1.04). The ORR values in retrospective single-arm studies were 45% (40%-51%). Conclusion In RCTs, pembrolizumab monotherapy or in combination with chemotherapy is more effective and safer than chemotherapy for advanced NSCLC. In RWSs, ECOG PS 0-1 was shown to correlate with PFS and OS for patients with NSCLC.
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Affiliation(s)
- Beibei Yang
- Department of Clinical Pharmacy, Baoji Central Hospital, Baoji, Shaanxi, China
| | - Bing Wang
- Department of Clinical Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China,School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Yongbang Chen
- Department of Clinical Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China,College of Pharmacy, Jinan University, Guangzhou, China
| | - Ning Wan
- Department of Clinical Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China,School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China,Guangdong Branch Center, National Clinical Research Center for Geriatric Diseases (Chinese PLA General Hospital), Guangzhou, China,*Correspondence: Ning Wan, ; Bo Ji, ; Bo Xie,
| | - Fei Xie
- Department of Clinical Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China,Guangdong Branch Center, National Clinical Research Center for Geriatric Diseases (Chinese PLA General Hospital), Guangzhou, China
| | - Ning Yang
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Liqing Lu
- Department of Clinical Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China,Guangdong Branch Center, National Clinical Research Center for Geriatric Diseases (Chinese PLA General Hospital), Guangzhou, China
| | - Weibin Xiao
- Department of Clinical Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China,Guangdong Branch Center, National Clinical Research Center for Geriatric Diseases (Chinese PLA General Hospital), Guangzhou, China
| | - Jin Yuan
- Department of Clinical Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China,School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China,Guangdong Branch Center, National Clinical Research Center for Geriatric Diseases (Chinese PLA General Hospital), Guangzhou, China
| | - Jian Li
- Department of Clinical Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China,Guangdong Branch Center, National Clinical Research Center for Geriatric Diseases (Chinese PLA General Hospital), Guangzhou, China
| | - Bo Xie
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, China,*Correspondence: Ning Wan, ; Bo Ji, ; Bo Xie,
| | - Bo Ji
- Department of Clinical Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China,Guangdong Branch Center, National Clinical Research Center for Geriatric Diseases (Chinese PLA General Hospital), Guangzhou, China,*Correspondence: Ning Wan, ; Bo Ji, ; Bo Xie,
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13
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Brain metastases and immune checkpoint inhibitors in non-small cell lung cancer: a systematic review and meta-analysis. Cancer Immunol Immunother 2022; 71:3071-3085. [DOI: 10.1007/s00262-022-03224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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14
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Velcheti V, Hu X, Yang L, Pietanza MC, Burke T. Long-Term Real-World Outcomes of First-Line Pembrolizumab Monotherapy for Metastatic Non-Small Cell Lung Cancer With ≥50% Expression of Programmed Cell Death-Ligand 1. Front Oncol 2022; 12:834761. [PMID: 35402266 PMCID: PMC8990758 DOI: 10.3389/fonc.2022.834761] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Immune checkpoint inhibitors (ICIs) of programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) have been rapidly adopted in US clinical practice for first-line therapy of metastatic non-small cell lung cancer (NSCLC) since regulatory approval in October 2016, and a better understanding is needed of long-term outcomes of ICI therapy administered in real-world settings outside of clinical trials. Our aim was to describe long-term outcomes of first-line pembrolizumab monotherapy at US oncology practices for patients with metastatic NSCLC, PD-L1 expression ≥50%, and good performance status. Methods This retrospective two-cohort study used technology-enabled abstraction of deidentified electronic health records (EHR cohort) plus enhanced manual chart review (spotlight cohort) to study adult patients with stage IV NSCLC, PD-L1 expression ≥50%, no documented EGFR/ALK/ROS1 genomic aberration, and ECOG performance status 0-1 who initiated first-line pembrolizumab monotherapy from 1-November-2016 to 31-March-2020 (EHR cohort, with data cutoff 31-March-2021) or from 1-December-2016 to 30-November-2017 (spotlight cohort, with data cutoff 31-August-2020). Kaplan-Meier analysis was used to determine overall survival (OS; both cohorts) and, for the spotlight cohort, real-world progression-free survival (rwPFS) and real-world tumor response (rwTR). Results The EHR cohort included 566 patients (298 [53%] men); the spotlight cohort included 228 (105 [46%] men); median age in both cohorts was 71. Median follow-up from pembrolizumab initiation to data cutoff was 35.1 months (range, 12.0-52.7) and 38.4 months (range, 33.1-44.9) in EHR and spotlight cohorts, respectively. Median OS was 19.6 months (95% CI, 16.6-24.3) and 21.1 months (95% CI, 16.2-28.9), respectively; 3-year OS rates were 36.2% and 38.2% in EHR and spotlight cohorts, respectively. In the spotlight cohort, median rwPFS was 7.3 months (95% CI, 5.7-9.2); 88 patients (38.6%; 95% CI, 32.2-45.2) experienced rwTR of complete or partial response. For 151/228 patients (66%) who discontinued pembrolizumab, the most common reasons were disease progression (70 [46%]) and therapy-related adverse effects (35 [23%]). Conclusions Real-world outcomes remain consistent with outcomes observed in clinical trials, supporting long-term benefits of first-line pembrolizumab monotherapy for patients with metastatic NSCLC, PD-L1 expression ≥50%, and good performance status.
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Affiliation(s)
- Vamsidhar Velcheti
- Perlmutter Cancer Center, New York University, New York, NY, United States
| | - Xiaohan Hu
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, United States
| | - Lingfeng Yang
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, United States
| | | | - Thomas Burke
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, United States
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15
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Yang G, Xing L, Sun X. Navigate Towards the Immunotherapy Era: Value of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer Patients With Brain Metastases. Front Immunol 2022; 13:852811. [PMID: 35422812 PMCID: PMC9001915 DOI: 10.3389/fimmu.2022.852811] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
Brain metastases (BMs) in non-small-cell lung cancer (NSCLC) patients are associated with significant morbidity and poor prognosis. Immune checkpoint inhibitors (ICIs) have resulted in a paradigm shift in the management of advanced NSCLC. However, the value of ICIs in NSCLC patients with BMs remains unclear because patients with BMs are routinely excluded in numerous prospective trials on ICIs. Here, starting from the mechanisms of ICIs for BMs, we will reveal the value of ICIs by reviewing the efficacy and adverse effects of ICIs monotherapy as well as promising combination strategies, such as combinations with chemotherapy, radiotherapy, and anti-angiogenic drugs, etc. In addition, the methods of patient selection and response assessment will be summarized to assist clinical practice and further studies.
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Affiliation(s)
- Guanqun Yang
- Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ligang Xing
- Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaorong Sun
- Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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16
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Galán RJ, Prado-Mel E, Pérez-Moreno MA, Caballano-Infantes E, Flores Moreno S. Influence of Performance Status on the Effectiveness of Pembrolizumab Monotherapy in First-Line for Advanced Non-Small-Cell Lung Cancer: Results in a Real-World Population. BIOLOGY 2021; 10:biology10090890. [PMID: 34571767 PMCID: PMC8472602 DOI: 10.3390/biology10090890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022]
Abstract
The KEYNOTE-024 clinical trial showed promising results for pembrolizumab in the first-line of treatment of advanced non-small-cell lung cancer (NSCLC). However, the profile of patients in real-world practice differs from those included in this clinical trial. Here, an observational single-center retrospective study was performed through a comparative analysis of clinical outcomes after pembrolizumab therapy according to the Eastern Cooperative Oncology Group Stage Performance Status (ECOG PS). Moreover, univariate and multivariate analyses were carried out to detect prognostic factors. In our cohort, 63.7% of patients had an ECOG PS of 0-1. Regarding response rate, 31.8% of patients had a partial response (PR), 19.3% had stable disease (SD) and 23.9% had progression disease. On the other hand, patients with ECOG PS ≥ 2 showed a significantly lower rate of PR and SD to pembrolizumab than patients with a PS of 0-1. The rate of response, median overall survival (OS) and progression-free survival (PFS) were significantly higher in patients with ECOG PS 0-1 than in those with ECOG PS ≥ 2. In the current study, we found ECOG PS as the only independent predictor of OS and PFS. Due to the ECOG PS scale being a subjective parameter, other tools are needed to identify treatment effectiveness to each patient.
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Affiliation(s)
- Rocío Jiménez Galán
- Clinical Unit of Pharmacy, University Hospital Virgen del Rocio, Avenue Manuel Siurot, 41013 Seville, Spain; (E.P.-M.); (M.A.P.-M.); (E.C.-I.); (S.F.M.)
- Correspondence: ; Tel.: +34-955-012-061
| | - Elena Prado-Mel
- Clinical Unit of Pharmacy, University Hospital Virgen del Rocio, Avenue Manuel Siurot, 41013 Seville, Spain; (E.P.-M.); (M.A.P.-M.); (E.C.-I.); (S.F.M.)
| | - María Antonia Pérez-Moreno
- Clinical Unit of Pharmacy, University Hospital Virgen del Rocio, Avenue Manuel Siurot, 41013 Seville, Spain; (E.P.-M.); (M.A.P.-M.); (E.C.-I.); (S.F.M.)
| | - Estefanía Caballano-Infantes
- Clinical Unit of Pharmacy, University Hospital Virgen del Rocio, Avenue Manuel Siurot, 41013 Seville, Spain; (E.P.-M.); (M.A.P.-M.); (E.C.-I.); (S.F.M.)
- Andalusian Public Foundation for Health Research Management of Seville (FISEVI), 41013 Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
| | - Sandra Flores Moreno
- Clinical Unit of Pharmacy, University Hospital Virgen del Rocio, Avenue Manuel Siurot, 41013 Seville, Spain; (E.P.-M.); (M.A.P.-M.); (E.C.-I.); (S.F.M.)
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17
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Wang Z, Ren Z, Li R, Ge J, Zhang G, Xin Y, Qu Y. Multi-Omics Integrative Bioinformatics Analyses Reveal Long Non-coding RNA Modulates Genomic Integrity via Competing Endogenous RNA Mechanism and Serves as Novel Biomarkers for Overall Survival in Lung Adenocarcinoma. Front Cell Dev Biol 2021; 9:691540. [PMID: 34368141 PMCID: PMC8339593 DOI: 10.3389/fcell.2021.691540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Long non-coding RNA (lncRNA) plays a crucial role in modulating genome instability, immune characteristics, and cancer progression, within which genome instability was identified as a critical regulator in tumorigenesis and tumor progression. However, the existing accounts fail to detail the regulatory role of genome instability in lung adenocarcinoma (LUAD). We explored the clinical value of genome instability-related lncRNA in LUAD with multi-omics bioinformatics analysis. We extracted the key genome instability-related and LUAD-related gene modules using weighted gene co-expression network analysis (WGCNA) and established a competing endogenous RNA (ceRNA) network using four lncRNAs (LINC01224, LINC00346, TRPM2-AS, and CASC9) and seven target mRNAs (CCNF, PKMYT1, GCH1, TK1, PSAT1, ADAM33, and DDX11). We found that LINC01224 is primarily located in the cytoplasm and that LINC00346 and TRPM2-AS are primarily located in the nucleus (CASC9 unknown). We found that all 11 genes were positively related to tumor mutational burden and involve drug resistance, cancer stemness, and tumor microenvironment infiltration. Additionally, an eight-lncRNA genome instability-related lncRNA signature was established and validated, predicting the overall survival and immunotherapy outcomes in LUAD. To conclude, we discovered that sponging microRNA, genome instability-related lncRNA functions as ceRNA, modulating genomic integrity. This research provides clinical references for LUAD immunotherapy and prognosis and interprets a potential genome instability-related ceRNA regulatory network in which LINC01224-miR-485-5p/miR-29c-3p-CCNF-RRM2 and LINC01224-miR485-5p-PKMYT1-CDK1 axes were the most promising pathways. However, the potential mechanisms underlying our findings still need biological validation through in vitro and in vivo experiments.
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Affiliation(s)
- Zhonglin Wang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,School of Physical Science, University of California, Irvine, Irvine, CA, United States
| | - Ziyuan Ren
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Rui Li
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Junpeng Ge
- Department of Biology Engineering, Shandong Jianzhu University, Jinan, China
| | - Guoming Zhang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yaodong Xin
- School of Statistics and Management, Shanghai University of Finance and Economics, Shanghai, China
| | - Yiqing Qu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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