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Chang AEB, Potter AL, Yang CFJ, Sequist LV. Early Detection and Interception of Lung Cancer. Hematol Oncol Clin North Am 2024; 38:755-770. [PMID: 38724286 DOI: 10.1016/j.hoc.2024.03.004] [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: 07/05/2024]
Abstract
Recent advances in lung cancer treatment have led to dramatic improvements in 5-year survival rates. And yet, lung cancer remains the leading cause of cancer-related mortality, in large part, because it is often diagnosed at an advanced stage, when cure is no longer possible. Lung cancer screening (LCS) is essential for intercepting the disease at an earlier stage. Unfortunately, LCS has been poorly adopted in the United States, with less than 5% of eligible patients being screened nationally. This article will describe the data supporting LCS, the obstacles to LCS implementation, and the promising opportunities that lie ahead.
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Affiliation(s)
- Allison E B Chang
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA; Department of Hematology/Oncology, Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chi-Fu Jeffrey Yang
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lecia V Sequist
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Ding L, Yuan X, Wang Y, Yang M, Wu P, Chen H, Yun Y, Shen Z, Ji D, Ma Y. Ensartinib in the treatment of anaplastic lymphoma kinase-positive locally advanced or metastatic patients with lung squamous or adenosquamous carcinoma: A real-world, retrospective study. Asia Pac J Clin Oncol 2024. [PMID: 38898784 DOI: 10.1111/ajco.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/13/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
AIM To report the efficacy and safety of ensartinib, an anaplastic lymphoma kinase (ALK) inhibitor, in treating patients with ALK-positive advanced lung squamous cell carcinoma (LUSC) or lung adenosquamous carcinoma (LASC) in China. METHODS This retrospective study analyzed data for 36 advanced-stage patients with ALK-positive LUSC (cohort A) and 13 patients with ALK-positive LASC (cohort B) between December 16, 2020 and December 16, 2021. All patients received once-daily ensartinib 225 mg. Outcome analysis included the demographic characteristics, tumor response, progression-free survival (PFS), and treatment-related adverse events (TRAE). RESULTS Among the 49 patients, the majority were under 65 years old (73.5%), non-smokers (85.7%), had an Eastern Cooperative Oncology Group Performance Status of 0-1 (77.6%), and were at stage IV (71.4%). All patients were included in the efficacy and safety analysis. Seven PFS events were reported in cohort A while no patients experienced PFS events in cohort B. The median PFS was not estimable for both cohorts. In cohort A, the objective response rate (ORR) was 63.9%, and the disease control rate (DCR) was 83.3%. In the cohort B, the ORR was 76.9% and the DCR was 100.0%. Rash was the only TRAE reported in the cohort A (8.3%) and cohort B (23.1%). No patients had grade 3 or higher TRAE. CONCLUSION Ensartinib has been tentatively proven favorable efficacy and tolerability in the treatment of patients with ALK-positive advanced LUSC or LASC in the real-world. However, confirmatory studies are still needed in larger sample sizes.
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Affiliation(s)
- Lieming Ding
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Xiaobin Yuan
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Yang Wang
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Min Yang
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Pengxiang Wu
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Hui Chen
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Yu Yun
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Zhilin Shen
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Dong Ji
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
| | - Yongbin Ma
- Department of Medicine, Betta Pharmaceuticals Co., Ltd, Hangzhou, China
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Real-World Management and Outcomes of Crizotinib-Treated ROS1-Rearranged NSCLC: A Retrospective Canadian Cohort. Curr Oncol 2022; 29:1967-1982. [PMID: 35323360 PMCID: PMC8947433 DOI: 10.3390/curroncol29030160] [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] [Received: 01/31/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
The use, safety and effectiveness of crizotinib as part of the management of ROS1-rearranged NSCLC patients in a real-world Canadian clinical cohort was the focus of this retrospective review. Twenty-one ROS1-rearranged patients with advanced/metastatic disease receiving crizotinib between 2014–2020 were identified; crizotinib demonstrated tolerability and effectiveness in this population where outcomes were similar to those described in other crizotinib-treated real-world cohorts, but lower than those of the PROFILE 1001 clinical trial population. Systemic anti-cancer therapy prior to crizotinib initiation occurred in half of the study cohort, with platin-pemetrexed and immune checkpoint inhibitors being most common. Platin-pemetrexed showed good effectiveness in this cohort, but despite high prevalence of upregulated PD-L1 expression, immune checkpoint inhibitors showed poor effectiveness in his cohort. Among all systemic therapies received, crizotinib showed the most effective disease control, although longer intervals between diagnosis and crizotinib initiation were more common among those showing a lack of clinical response to crizotinib, and patients with brain metastases at the time of crizotinib initiation also showed increased diagnosis to crizotinib initiation intervals and decreased clinical response to crizotinib. This study reveals crizotinib has clinical benefit, but timely identification of ROS1-rearrangements and initiation targeted therapies appears important to maximize outcome in this population.
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Abstract
This overview of the molecular pathology of lung cancer includes a review of the most salient molecular alterations of the genome, transcriptome, and the epigenome. The insights provided by the growing use of next-generation sequencing (NGS) in lung cancer will be discussed, and interrelated concepts such as intertumor heterogeneity, intratumor heterogeneity, tumor mutational burden, and the advent of liquid biopsy will be explored. Moreover, this work describes how the evolving field of molecular pathology refines the understanding of different histologic phenotypes of non-small-cell lung cancer (NSCLC) and the underlying biology of small-cell lung cancer. This review will provide an appreciation for how ongoing scientific findings and technologic advances in molecular pathology are crucial for development of biomarkers, therapeutic agents, clinical trials, and ultimately improved patient care.
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Affiliation(s)
- James J Saller
- Departments of Pathology and Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
| | - Theresa A Boyle
- Departments of Pathology and Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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Nadler E, Vasudevan A, Wang Y, Ogale S. Real-world patterns of biomarker testing and targeted therapy in de novo metastatic non-small cell lung cancer patients in the US oncology network. Cancer Treat Res Commun 2022; 31:100522. [PMID: 35189530 DOI: 10.1016/j.ctarc.2022.100522] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study investigated biomarker testing and biomarker-guided treatment among patients with metastatic NSCLC in a real-world setting. METHODS This retrospective study examined adult patients diagnosed with de novo mNSCLC between 01-Jan-2016 and 30-Sep-2019, with follow-up through 31-Dec-2019 using The US Oncology Network structured electronic health records data, with chart review for a subset. RESULTS Of 2257 patients, 76.3% had results for ≥1 driver mutation (DM) or programmed death ligand-1 (PD-L1) during the study observation period. The proportion with results for all 4 DM before 1L initiation increased from 2017 to 2019. Over 40% had results for anaplastic lymphoma kinase (ALK), epidermal growth factor receptor (EGFR), and c-ros oncogene 1 (ROS1) and 22% for B-Raf proto-oncogene (BRAF) before 1L initiation by structured data. In the chart review subset (n = 197), >70% had results for ALK, EGFR, or ROS1 with 44% for BRAF. Of the 42 ALK+ patients, 5 had results before 1L treatment and 3 received 1L ALK inhibitors. Similar, for the other biomarkers, not all who tested positive for a DM received 1L targeted therapy. The proportion of biomarker-positive patients receiving 1L targeted therapy was higher in chart review versus structured data. However, in both analyses, a substantial proportion did not have results for all 4 DM plus PD-L1 tests for appropriate biomarker-directed 1L treatment selection. CONCLUSIONS Despite increasing biomarker testing rates, reduced turnaround times, and availability of promising biomarker-based therapies, inadequate testing in the community oncology setting means that not all eligible patients are receiving the most effective therapies up front.
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Affiliation(s)
- Eric Nadler
- The US Oncology Network, 10101 Woodloch Forest Dr, The Woodlands, TX 77380, United States.
| | | | - Yunfei Wang
- Ontada, 6555 State Highway 161, Irving, TX 75039, United States.
| | - Sarika Ogale
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, United States.
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Phan C, Jespersen F, Weipert C, Li T, Yoneda KY. Interventional pulmonology use of cell-free DNA assay for metastatic non–small cell lung cancer: the UC Davis experience. Ther Adv Respir Dis 2022; 16:17534666221135324. [PMID: 36346075 PMCID: PMC9647290 DOI: 10.1177/17534666221135324] [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: 11/11/2022] Open
Abstract
Background: Interventional pulmonologists (IPs) are often the first specialist to see
patients with suspected metastatic non–small cell lung cancer (mNSCLC).
Consequently, they are potentially ideally positioned to expedite the
identification of actionable molecular mutations by ordering blood-based
cell-free DNA (cfDNA), prior to or upon tissue diagnosis of mNSCLC. Methods: Retrospective review of cfDNA ordered by IP as part of a routine clinical
practice. Patients were categorized into two groups based on when cfDNA was
ordered by IP: (1) IP suspected mNSCLC prior to histologic confirmation or
(2) IP diagnosed mNSCLC based on histologic confirmation of NSCLC. Results: Twenty patients were identified. Twelve of 13 in group 1 were confirmed to
have mNSCLC by oncology and 1 had stage IIIA. Seven of 7 in group 2 were
confirmed to have mNSCLC by oncology. Fifteen of 20 also had next-generation
tissue molecular testing. Thirteen of 20 (65%) had targetable alterations.
Seven of 13 (54%) were identified on cfDNA and tissue, 5/13 (38%) on cfDNA
only, and 1/13 (8%) on tissue alone. Tissue results were available a medium
of 24 days after, and cfDNA results a medium of 4 days prior to, the
patients’ first oncology visit. Conclusions: IP appears to be able identify patients who have mNSCLC and for whom testing
for molecular mutations is appropriate even prior to tissue confirmation of
NSCLC. A strategy whereby IP employ blood-based cfDNA testing in suspected
and tissue confirmed mNSCLC could potentially provide medical oncologists
with more timely information on actionable mutations than tissue-based
testing first, potentially expediting patient treatment.
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Affiliation(s)
- Chinh Phan
- Division of Pulmonary, Critical Care and Sleep Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Forrest Jespersen
- Division of Pulmonary, Critical Care and Sleep Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | | | - Tianhong Li
- Division of Hematology/Oncology, Department of Internal Medicine, UC Davis School of Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
- Chinh Phan is also affiliated to Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Ken Y. Yoneda
- Division of Pulmonary, Critical Care and Sleep Medicine, UC Davis Medical Center, 4150 V Street, Suite 3400, Sacramento, CA 95817, USA
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Bernicker EH, Xiao Y, Croix DA, Yang B, Abraham A, Redpath S, Engstrom-Melnyk J, Shah R, Allen TC. Understanding Factors Associated With Anaplastic Lymphoma Kinase Testing Delays in Patients With Non-Small Cell Lung Cancer in a Large Real-World Oncology Database. Arch Pathol Lab Med 2021; 146:975-983. [PMID: 34752598 DOI: 10.5858/arpa.2021-0029-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— With multiple therapeutic options available for patients with advanced non-small cell lung cancer, the timely ordering and return of results to determine therapy are of critical importance. OBJECTIVE.— To assess factors impacting anaplastic lymphoma kinase (ALK) test ordering and time to result delivery. DESIGN.— A retrospective study using a de-identified electronic health record database was performed. Postdiagnosis ALK tests (n = 14 657) were analyzed from 14 197 patients with advanced non-small cell lung cancer diagnosed between January 2015 and May 2019. Time from non-small cell lung cancer diagnosis to ALK sample receipt in the laboratory was a surrogate for test order time. Test ordering was considered delayed if order time was more than 20 days. Turnaround time from sample received to test result was calculated and considered delayed if more than 10 days. Multivariable logistic regression was used to assess factors associated with order time and turnaround time delays. RESULTS.— Median ALK test order time was 15 days, and 36.4% (5342) of all 14 657 orders were delayed. Factors associated with delays were non-fluorescent in situ hybridization testing, send-out laboratories, testing prior to 2018, nonadenocarcinoma histology, and smoking history. Median turnaround time was 9 days, and 40.3% (5906) of all 14 657 test results were delayed. Non-fluorescent in situ hybridization testing, tissue sample, and orders combining ALK with other biomarkers were associated with delayed ALK result reporting. CONCLUSIONS.— This study provides a snapshot of real-world ALK test ordering and reporting time in US community practices. Multiple factors impacted both test ordering time and return of results, revealing opportunities for improvement. It is imperative that patients eligible for targeted therapy be identified in a timely fashion.
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Affiliation(s)
- Eric H Bernicker
- From the Cancer Center, Houston Methodist Hospital, Houston, Texas (Bernicker)
| | - Yan Xiao
- Data Services, Roche Information Solutions, Pleasanton, California (Xiao, Yang, Shah).,Xiao is now at Digital Health, AstraZeneca R&D, Beijing, China
| | - Denise A Croix
- Medical and Scientific Affairs, Roche Diagnostics Corporation, Indianapolis, Indiana (Croix, Redpath, Engstrom-Melnyk)
| | - Baiyu Yang
- Data Services, Roche Information Solutions, Pleasanton, California (Xiao, Yang, Shah)
| | - Anup Abraham
- Evidence Strategy, Genesis Research, Hoboken, New Jersey (Abraham)
| | - Stella Redpath
- Medical and Scientific Affairs, Roche Diagnostics Corporation, Indianapolis, Indiana (Croix, Redpath, Engstrom-Melnyk)
| | - Julia Engstrom-Melnyk
- Medical and Scientific Affairs, Roche Diagnostics Corporation, Indianapolis, Indiana (Croix, Redpath, Engstrom-Melnyk).,Engstrom-Melnyk is now at Medical Diagnostics, AstraZeneca, Gaithersburg, Maryland
| | - Roma Shah
- Data Services, Roche Information Solutions, Pleasanton, California (Xiao, Yang, Shah)
| | - Timothy Craig Allen
- the Department of Pathology, University of Mississippi Medical Center, Jackson (Allen)
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Gray J, Thompson JC, Carpenter EL, Elkhouly E, Aggarwal C. Plasma Cell-Free DNA Genotyping: From an Emerging Concept to a Standard-of-Care Tool in Metastatic Non-Small Cell Lung Cancer. Oncologist 2021; 26:e1812-e1821. [PMID: 34216176 PMCID: PMC8488793 DOI: 10.1002/onco.13889] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
Plasma cell-free DNA (cfDNA) genotyping is an alternative to tissue genotyping, particularly when tissue specimens are insufficient or unavailable, and provides critical information that can be used to guide treatment decisions in managing patients with non-small cell lung cancer (NSCLC). In this article, we review the evolution of plasma cfDNA genotyping from an emerging concept, through development of analytical methods, to its clinical applications as a standard-of-care tool in NSCLC. The number of driver or resistance mutations recommended for testing in NSCLC continues to increase. Because of the expanding list of therapeutically relevant variants, comprehensive testing to investigate larger regions of multiple genes in a single run is often preferable and saves on time and cost, compared with performing serial single-gene assays. Recent advances in nucleic acid next-generation sequencing have led to a rapid expansion in cfDNA genotyping technologies. Analytic assays that have received regulatory approval are now routinely used as diagnostic companions in the setting of metastatic NSCLC. As the demand for plasma-based technologies increases, more regulatory approvals of cfDNA genotyping assays are expected in the future. Plasma cfDNA genotyping is currently aiding oncologists in the delivery of personalized care by facilitating matching of patients with targeted therapy and monitoring emergence of resistance to therapy in NSCLC. Further advances currently underway to increase assay sensitivity and specificity will potentially expand the use of plasma cfDNA genotyping in early cancer detection, monitoring response to therapy, detection of minimal residual disease, and measurement of tumor mutational burden in NSCLC. IMPLICATIONS FOR PRACTICE: Plasma cell-free DNA (cfDNA) genotyping offers an alternative to tissue genotyping, particularly when tissue specimens are insufficient or unavailable. Advances in cfDNA genotyping technologies have led to analytic assays that are now routinely used to aid oncologists in the delivery of personalized care by facilitating matching of patients with targeted therapy and monitoring emergence of resistance to therapy. Further advances underway to increase assay sensitivity and specificity will potentially expand the use of plasma cfDNA genotyping in early cancer detection, monitoring response to therapy, detection of minimal residual disease, and evaluation of tumor mutational burden in non-small cell lung cancer.
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Affiliation(s)
- Jhanelle Gray
- H. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Jeffrey C. Thompson
- Division of Hematology/Oncology, University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Erica L. Carpenter
- Division of Hematology/Oncology, University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | | | - Charu Aggarwal
- Division of Hematology/Oncology, University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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Filipska M, Rosell R. Mutated circulating tumor DNA as a liquid biopsy in lung cancer detection and treatment. Mol Oncol 2021; 15:1667-1682. [PMID: 33969622 PMCID: PMC8169447 DOI: 10.1002/1878-0261.12983] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022] Open
Abstract
Over the past decade, substantial developments have been made in the detection of circulating tumor DNA (ctDNA)-cell-free DNA (cfDNA) fragments released into the circulation from tumor cells and displaying the genetic alterations of those cells. As such, ctDNA detected in liquid biopsies serves as a powerful tool for cancer patient stratification, therapy guidance, detection of resistance, and relapse monitoring. In this Review, we describe lung cancer diagnosis and monitoring strategies using ctDNA detection technologies and compile recent evidence regarding lung cancer-related mutation detection in liquid biopsy. We focus not only on epidermal growth factor receptor (EGFR) alterations, but also on significant co-mutations that shed more light on novel ctDNA-based liquid biopsy applications. Finally, we discuss future perspectives of early-cancer detection and clonal hematopoiesis filtering strategies, with possible inclusion of microbiome-driven liquid biopsy.
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Affiliation(s)
- Martyna Filipska
- Germans Trias i Pujol Research Institute and HospitalBadalonaSpain
- Autonomous University of BarcelonaCerdanyola del VallesSpain
| | - Rafael Rosell
- Germans Trias i Pujol Research Institute and HospitalBadalonaSpain
- Autonomous University of BarcelonaCerdanyola del VallesSpain
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Waterhouse DM, Tseng WY, Espirito JL, Robert NJ. Understanding Contemporary Molecular Biomarker Testing Rates and Trends for Metastatic NSCLC Among Community Oncologists. Clin Lung Cancer 2021; 22:e901-e910. [PMID: 34187757 DOI: 10.1016/j.cllc.2021.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Although guidelines recommend testing for actionable biomarkers for patients with advanced or metastatic non-small cell lung cancer (NSCLC), testing rates have varied. This study aimed to assess molecular testing patterns in a large network of US community-based oncology practices. METHODS This retrospective observational study examined adult patients with newly diagnosed stage IV NSCLC with ≥ 2 visits in The US Oncology Network from July 1, 2016 to September 30, 2019. Testing patterns were examined using electronic health record structured fields and chart review. Structured data were analyzed for the overall study population (cohort A), and structured and unstructured data were analyzed for a select cohort of 300 patients (cohort B). RESULTS In cohort A (n = 3337), programmed death ligand 1 (37%) was the most frequently tested biomarker documented in structured data, followed by epidermal growth factor receptor (36%), anaplastic lymphoma kinase (35%), ROS1 (20%), and BRAF (16%). According to unstructured data in cohort B (n = 300), epidermal growth factor receptor (80%) was the most frequently tested biomarker, followed by anaplastic lymphoma kinase (79%), programmed death ligand 1 (72%), ROS1 (71%), and BRAF (56%). The proportion of tests ordered prior to first-line (1L) treatment increased from 2016 to 2018 for all biomarkers, as did the proportion of test results available prior to 1L treatment. However, some of the test results became available after 1L or later lines of treatment were in progress. CONCLUSION Our study found increased testing rates over time and decreases in testing turnaround times. However, rates of testing for all biomarkers still need to improve, as does completion of testing prior to initiation of therapy.
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Yatabe Y, Yoshiki Y, Matsumura K, Togo K, Kikkawa H, Iadeluca L, Li B, Nishio K. Real-World Evidence of Diagnostic Testing for Driver Oncogene Mutations in Lung Cancer in Japan. JTO Clin Res Rep 2021; 2:100136. [PMID: 34589999 PMCID: PMC8474388 DOI: 10.1016/j.jtocrr.2020.100136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Diagnostic testing is important in determining appropriate treatment for individuals with lung cancer. In 2018, testing of five biomarkers (EGFR, ALK, ROS1, BRAF, programmed cell death-ligand 1 [PD-L1]) was approved in Japan. Information is lacking regarding real-world testing patterns. METHODS This descriptive, retrospective observational study used the Japan Medical Data Vision Co., Ltd. (MDV), database (June 2017-November 2018) and covered data for EGFR, ALK, ROS1, and PD-L1; records on BRAF testing were not yet available. Adults diagnosed with having lung cancer (International Classification of Diseases-10 C34) with record of any biomarker test ordered were included. RESULTS Of 8323 patients with any biomarker test, 83.2% were tested for EGFR, 55.3% for ALK, 32.2% ROS1, and 77.2% PD-L1. Combinations of EGFR with other biomarkers accounted for approximately 80% of the testing patterns; 1427 patients (17.1%) had combination testing ordered for EGFR/ALK/ROS1/PD-L1, but some biomarker combinations were tested in less than 1% of the cases. Median time from first testing order to treatment order was 22 (range: 2-525) days overall and increased with number of testing instances: 21 (2-509) days for patients with one, 28 (3-525) days for patients with two, and 30 (9-502) days for patients with three. A 7-day pattern of peaks was observed in the test order date and time to treatment. CONCLUSIONS This real-world evidence revealed variations in diagnostic testing patterns, which could affect time to treatment in Japan. Variations are likely influenced by individual biomarker prioritization considering limited tissue samples in clinical practice.
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Affiliation(s)
- Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | | | | | | | | | - Kazuto Nishio
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka, Japan
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Veluswamy R, Mack PC, Houldsworth J, Elkhouly E, Hirsch FR. KRAS G12C-Mutant Non-Small Cell Lung Cancer: Biology, Developmental Therapeutics, and Molecular Testing. J Mol Diagn 2021; 23:507-520. [PMID: 33618059 DOI: 10.1016/j.jmoldx.2021.02.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023] Open
Abstract
Mutation in the gene that encodes Kirsten rat sarcoma viral oncogene homolog (KRAS) is the most common oncogenic driver in advanced non-small cell lung cancer, occurring in approximately 30% of lung adenocarcinomas. Over 80% of oncogenic KRAS mutations occur at codon 12, where the glycine residue is substituted by different amino acids, leading to genomic heterogeneity of KRas-mutant tumors. The KRAS glycine-to-cysteine mutation (G12C) composes approximately 44% of KRAS mutations in non-small cell lung cancer, with mutant KRasG12C present in approximately 13% of all patients with lung adenocarcinoma. Mutant KRas has been an oncogenic target for decades, but no viable therapeutic agents were developed until recently. However, advances in KRas molecular modeling have led to the development and clinical testing of agents that directly inhibit mutant KRasG12C. These agents include sotorasib (AMG-510), adagrasib (MRTX-849), and JNJ-74699157. In addition to testing for known actionable oncogenic driver alterations in EGFR, ALK, ROS1, BRAF, MET exon 14 skipping, RET, and NTRK and for the expression of programmed cell-death protein ligand 1, pathologists, medical oncologists, and community practitioners will need to incorporate routine testing for emerging biomarkers such as MET amplification, ERBB2 (alias HER2), and KRAS mutations, particularly KRAS G12C, considering the promising development of direct inhibitors of KRasG12C protein.
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Affiliation(s)
| | - Philip C Mack
- Icahn School of Medicine, The Mount Sinai Hospital, New York, New York
| | - Jane Houldsworth
- Icahn School of Medicine, The Mount Sinai Hospital, New York, New York
| | | | - Fred R Hirsch
- Icahn School of Medicine, The Mount Sinai Hospital, New York, New York.
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Herbst RS, Aisner DL, Sonett JR, Turk AT, Weintraub JL, Lindeman NI. Practical Considerations Relating to Routine Clinical Biomarker Testing for Non-small Cell Lung Cancer: Focus on Testing for RET Fusions. Front Med (Lausanne) 2021; 7:562480. [PMID: 33553195 PMCID: PMC7859651 DOI: 10.3389/fmed.2020.562480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022] Open
Abstract
For patients with advanced non–small cell lung cancer, genomic profiling of tumors to identify potentially targetable alterations and thereby inform treatment selection is now part of standard care. While molecular analyses are primarily focused on actionable biomarkers associated with regulatory agency-approved therapies, there are a number of emerging biomarkers linked to investigational agents in advanced stages of clinical development will become approved agents. A particularly timely example is the reported data and US Food and Drug Administration approval of highly specific small molecule inhibitors of the proto-oncogene tyrosine-protein kinase receptor RET indicate that testing for tumor RET gene fusions in patients with NSCLC has become clinically important. As the number of biomarkers to be tested in NSCLC grows, it becomes increasingly important to optimize and prioritize the use of biopsy tissue, in order to both continue to allow accurate histopathological diagnosis and also to support concurrent genomic profiling to identify perhaps relatively uncommon genetic events. In order to provide practical expert consensus guidance to optimize processes facilitating genomic testing in NSCLC and to overcome barriers to access and implementation, a multidisciplinary advisory board was held in New York, on January 30, 2019. The panel comprised physicians involved in sample procurement (interventional radiologists and a thoracic surgeon), surgical pathologists specializing in the lung, molecular pathologists, and thoracic oncologists. Particular consideration was given to the key barriers faced by these experts in establishing institutional genomic screening programs for NSCLC. Potential solutions have been devised in the form of consensus opinions that might be used to help resolve such issues.
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Affiliation(s)
- Roy S Herbst
- Section of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, CT, United States
| | - Dara L Aisner
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Joshua R Sonett
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, United States
| | - Andrew T Turk
- Department of Pathology and Cell Biology, Columbia University, New York, NY, United States
| | - Joshua L Weintraub
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
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14
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Griesinger F, Eberhardt W, Nusch A, Reiser M, Zahn MO, Maintz C, Bernhardt C, Losem C, Stenzinger A, Heukamp LC, Büttner R, Marschner N, Jänicke M, Fleitz A, Spring L, Sahlmann J, Karatas A, Hipper A, Weichert W, Heilmann M, Sadjadian P, Gleiber W, Grah C, Waller CF, Reck M, Rittmeyer A, Christopoulos P, Sebastian M, Thomas M. Biomarker testing in non-small cell lung cancer in routine care: Analysis of the first 3,717 patients in the German prospective, observational, nation-wide CRISP Registry (AIO-TRK-0315). Lung Cancer 2020; 152:174-184. [PMID: 33358484 DOI: 10.1016/j.lungcan.2020.10.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES An increasing number of treatment-determining biomarkers has been identified in non-small cell lung cancer (NSCLC) and molecular testing is recommended to enable optimal individualized treatment. However, data on implementation of these recommendations in the "real-world" setting are scarce. This study presents comprehensive details on the frequency, methodology and results of biomarker testing of advanced NSCLC in Germany. PATIENTS AND METHODS This analysis included 3,717 patients with advanced NSCLC (2,921 non-squamous; 796 squamous), recruited into the CRISP registry at start of systemic therapy by 150 German sites between December 2015 and June 2019. Evaluated were the molecular biomarkers EGFR, ALK, ROS1, BRAF, KRAS, MET, TP53, RET, HER2, as well as expression of PD-L1. RESULTS In total, 90.5 % of the patients were tested for biomarkers. Testing rates were 92.2 % (non-squamous), 70.7 % (squamous) and increased from 83.2 % in 2015/16 to 94.2% in 2019. Overall testing rates for EGFR, ALK, ROS1, and BRAF were 72.5 %, 74.5 %, 66.1 %, and 53.0 %, respectively (non-squamous). Testing rates for PD-L1 expression were 64.5 % (non-squamous), and 58.5 % (squamous). The most common testing methods were immunohistochemistry (68.5 % non-squamous, 58.3 % squamous), and next-generation sequencing (38.7 % non-squamous, 14.4 % squamous). Reasons for not testing were insufficient tumor material or lack of guideline recommendations (squamous). No alteration was found in 37.8 % (non-squamous), and 57.9 % (squamous), respectively. Most common alterations in non-squamous tumors (all patients/all patients tested for the respective biomarker): KRAS (17.3 %/39.2 %), TP53 (14.1 %/51.4 %), and EGFR (11.0 %/15.1 %); in squamous tumors: TP53 (7.0 %/69.1 %), MET (1.5 %/11.1 %), and EGFR (1.1 %/4.4 %). Median PFS (non-squamous) was 8.7 months (95 % CI 7.4-10.4) with druggable EGFR mutation, and 8.0 months (95 % CI 3.9-9.2) with druggable ALK alterations. CONCLUSION Testing rates in Germany are high nationwide and acceptable in international comparison, but still leave out a significant portion of patients, who could potentially benefit. Thus, specific measures are needed to increase implementation.
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Affiliation(s)
- Frank Griesinger
- Pius-Hospital Oldenburg, Universitätsklinik für Innere Medizin, Oldenburg, Germany.
| | - Wilfried Eberhardt
- Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätszentrum Essen, Germany
| | - Arnd Nusch
- Praxis für Hämatologie und internistische Onkologie, Ratingen, Germany
| | - Marcel Reiser
- PIOH - Praxis internistische Onkologie und Hämatologie, Köln, Germany
| | | | | | | | - Christoph Losem
- MVZ für Onkologie und Hämatologie im Rhein-Kreis, Neuss, Germany
| | | | - Lukas C Heukamp
- Hämatopathologie Hamburg, Hamburg, Germany; Lungen Netzwerk NOWEL.org, Oldenburg, Germany
| | - Reinhard Büttner
- Institut für Pathologie des Universitätsklinikums Köln, Köln, Germany
| | - Norbert Marschner
- Praxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Annette Fleitz
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Lisa Spring
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | | | - Wilko Weichert
- Institut für Pathologie, Technische Universität München und German Cancer Consortium (DKTK), partner site Munich, München, Germany
| | | | - Parvis Sadjadian
- Universitätsklinik für Hämatologie, Onkologie, Hämostaseologie und Palliativmedizin, Johannes Wesling Klinikum, Universitätsklinikum der Ruhr Universität Bochum, Minden, Germany
| | - Wolfgang Gleiber
- Universitätsklinikum Frankfurt, Medizinische Klinik I, Schwerpunkt Pneumologie/Allergologie, Frankfurt, Germany
| | - Christian Grah
- MVZ Havelhöhe am Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Cornelius F Waller
- Medizinische Klinik I, Hämatologie, Onkologie und Stammzelltransplantation; Fakultät für Medizin, Universitätsklinikum Freiburg, Germany
| | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | | | - Petros Christopoulos
- Onkologie der Thoraxtumore, Thoraxklinik Heidelberg gGmbH, German Center for Lung Research (DZL), Germany
| | - Martin Sebastian
- Medizinische Klinik II, Hämatologie/Onkologie, Universitätsklinikum Frankfurt, Germany
| | - Michael Thomas
- Onkologie der Thoraxtumore, Thoraxklinik Heidelberg gGmbH, German Center for Lung Research (DZL), Germany
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15
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Madison R, Schrock AB, Castellanos E, Gregg JP, Snider J, Ali SM, Miller VA, Singal G, Alexander BM, Venstrom JM, Chung JH. Retrospective analysis of real-world data to determine clinical outcomes of patients with advanced non-small cell lung cancer following cell-free circulating tumor DNA genomic profiling. Lung Cancer 2020; 148:69-78. [PMID: 32823229 DOI: 10.1016/j.lungcan.2020.07.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/12/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Liquid biopsy and comprehensive genomic profiling (CGP) of circulating tumor DNA (ctDNA) are increasingly used for detection of targetable genomic alterations (GA) in non-small cell lung cancer (NSCLC). To examine the clinical outcomes for patients following CGP using liquid biopsy versus tissue biopsy, receipt of matched targeted therapy post-CGP and associated outcomes were evaluated in the real-world setting. METHODS 6491 patients with NSCLC and liquid biopsy (N = 937 tests) and/or tissue (N = 5582 tests) CGP were included in a de-identified commercial clinico-genomic database. Targetable GAs included National Comprehensive Cancer Network NSCLC guideline biomarkers. Clinical characteristics, real-world progression, and real-world response (rwR) were obtained via technology-enabled abstraction of clinician notes and radiology/pathology reports. RESULTS At the time of liquid biopsy CGP, 53% (496/937) of patients were documented to have received ≥1 line of prior therapy (tissue CGP: 13%, 735/5582). 90% (832/928) of liquid biopsy cases had evidence of ctDNA. A targetable GA was detected in 20% (188/937) of liquid biopsy and 22% (1215/5582) of tissue CGP cases. Use of matched targeted therapy overall was similar post-liquid biopsy or post-tissue CGP but varied considerably across emerging (25%, 79/317) versus standard of care (SOC) (74%, 475/640) GA. Real-world-progression free survival for patients receiving SOC first line matched targeted therapy administered following liquid biopsy (n = 33) and tissue (n = 229) CGP were similar (13.8 vs 10.6 months; aHR = 0.68 [0.36-1.26]). Among patients evaluated for rwR, overall response rate (partial/complete response) to matched targeted therapy post-liquid biopsy CGP was 75% (39/52) versus 66% post-tissue CGP (254/385, P = 0.51). CONCLUSION Retrospective analysis of real-world clinico-genomic data demonstrated that clinical outcomes on matched targeted therapy were similar following liquid biopsy and tissue CGP in NSCLC, which suggests routine clinical use of liquid biopsy CGP can reliably guide therapy selection.
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16
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Challenges in the Diagnosis of NTRK Fusion-Positive Cancers. J Thorac Oncol 2020; 15:e108-e110. [PMID: 32593446 DOI: 10.1016/j.jtho.2019.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 12/25/2022]
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17
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VanderLaan PA. Non–small cell lung cancer predictive biomarker testing via immunocytochemistry: Ways of future past? Cancer Cytopathol 2019; 127:278-280. [DOI: 10.1002/cncy.22138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Paul A. VanderLaan
- Department of Pathology Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts
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