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Real-World Effectiveness of Immunotherapies in Pre-Treated, Advanced Non-Small Cell Lung Cancer Patients: A Systematic Literature Review. Lung Cancer 2022; 166:205-220. [DOI: 10.1016/j.lungcan.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 12/26/2022]
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2
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Which treatment after first line therapy in NSCLC patients without genetic alterations in the era of immunotherapy? Crit Rev Oncol Hematol 2021; 169:103538. [PMID: 34801700 DOI: 10.1016/j.critrevonc.2021.103538] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/23/2021] [Accepted: 11/15/2021] [Indexed: 12/30/2022] Open
Abstract
Cancer immunotherapy has produced an unprecedented durable response rate, thus shifting from traditional doublet chemotherapy to immunotherapy-based treatments with and without chemotherapy as the first line strategies for advanced non-small cell lung cancer patients without a molecular driver. However, the majority of patients do not benefit from the treatment or may relapse after a period of response. As few treatment options are available after failure of cancer immunotherapy, including the combination of chemotherapy and anti-angiogenic drugs, a better understanding of the mechanisms limiting cancer immunotherapy may be of help in the definition of the best second line. Whereas only retrospective data support an immunotherapy rechallenge approach, new combination strategies including immunotherapy and cell-signaling inhibitors or double immunotherapy represent the newest and most promising strategy to overcome primary or acquired resistance to first line immunotherapy.
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3
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Rzeniewicz K, Larkin J, Menzies AM, Turajlic S. Immunotherapy use outside clinical trial populations: never say never? Ann Oncol 2021; 32:866-880. [PMID: 33771665 PMCID: PMC9246438 DOI: 10.1016/j.annonc.2021.03.199] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Based on favourable outcomes in clinical trials, immune checkpoint inhibitors (ICIs), most notably programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibitors, are now widely used across multiple cancer types. However, due to their strict inclusion and exclusion criteria, clinical studies often do not address challenges presented by non-trial populations. DESIGN This review summarises available data on the efficacy and safety of ICIs in trial-ineligible patients, including those with autoimmune disease, chronic viral infections, organ transplants, organ dysfunction, poor performance status, and brain metastases, as well as the elderly, children, and those who are pregnant. In addition, we review data concerning other real-world challenges with ICIs, including timing of therapy switch, relationships to radiotherapy or surgery, re-treatment after an immune-related toxicity, vaccinations in patients on ICIs, and current experience around ICI and coronavirus disease-19. Where possible, we provide recommendations to aid the often-difficult decision-making process in those settings. CONCLUSIONS Data suggest that ICIs are often active and have an acceptable safety profile in the populations described above, with the exception of PD-1 inhibitors in solid organ transplant recipients. Decisions about whether to treat with ICIs should be personalised and require multidisciplinary input and careful counselling of patients with respect to potential risks and benefits. Clinical judgements need to be carefully weighed, considering factors such as underlying cancer type, feasibility of alternative treatment options, or activity in trial-eligible patients.
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Affiliation(s)
- K Rzeniewicz
- Warwick Medical School, University of Warwick, Warwick, UK; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
| | - J Larkin
- Renal and Skin Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - A M Menzies
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - S Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK; Renal and Skin Units, The Royal Marsden NHS Foundation Trust, London, UK.
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Guaitoli G, Barbieri F, Barbolini M, Molinaro E, Emidio KD, Borghi V, Dominici M, Bertolini F. Pembrolizumab rechallenge in squamous non-small-cell lung cancer and HIV-positivity: a case report. Immunotherapy 2020; 13:277-281. [PMID: 33249929 DOI: 10.2217/imt-2020-0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) changed management of non-small-cell lung cancer, but resistance usually develops. Today, at ICIs failure, chemotherapy is the treatment of choice, but the chance of immunotherapy rechallenge is appealing. Another challenging issue is whether it is safe to treat HIV-positive patients with ICIs: safety and efficacy of immunotherapy have been marginally considered in this subgroup. We report the case of a non-small-cell lung cancer patient treated by PD-1 inhibitors rechallenge despite his HIV-positivity, achieving good partial response with significant clinical benefit and without toxicities. Our experience underlines that HIV-positive patients can be treated similarly to HIV-negative individuals. HIV-positivity should be considered similar to other comorbidities, and not as a sufficient reason to preclude them the best available treatments.
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Affiliation(s)
- Giorgia Guaitoli
- Department of Oncology & Hematology, Modena University Hospital, University of Modena & Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Fausto Barbieri
- Department of Oncology & Hematology, Modena University Hospital, Via del Pozzo 71, 41124 Modena, Italy
| | - Monica Barbolini
- Department of Oncology & Hematology, Modena University Hospital, Via del Pozzo 71, 41124 Modena, Italy
| | - Eleonora Molinaro
- Department of Oncology & Hematology, Modena University Hospital, University of Modena & Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Katia Di Emidio
- Department of Oncology & Hematology, Modena University Hospital, Via del Pozzo 71, 41124 Modena, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, Modena University Hospital, University of Modena & Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Massimo Dominici
- Department of Oncology & Hematology, Modena University Hospital, University of Modena & Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Federica Bertolini
- Department of Oncology & Hematology, Modena University Hospital, Via del Pozzo 71, 41124 Modena, Italy
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Sheth S, Gao C, Mueller N, Angra N, Gupta A, Germa C, Martinez P, Soria JC. Durvalumab activity in previously treated patients who stopped durvalumab without disease progression. J Immunother Cancer 2020; 8:e000650. [PMID: 32847985 PMCID: PMC7451272 DOI: 10.1136/jitc-2020-000650] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Limited data exist on potential clinical benefit with anti-programmed cell death ligand-1 (PD-L1) retreatment in patients who stop initial therapy for reasons other than disease progression or toxicity and develop disease progression while off treatment. PATIENTS AND METHODS NCT01693562 was a phase I/II study evaluating durvalumab monotherapy in advanced solid tumors. Patients benefiting from treatment were taken off durvalumab at 1 year per protocol and prospectively followed. At disease progression, they were eligible for durvalumab retreatment. Outcomes evaluated during retreatment included best overall response (BOR2), duration of response (DoR2), disease control rate (DCR2), and progression-free survival (PFS2). RESULTS Of 980 patients enrolled and treated with durvalumab 10 mg/kg every 2 weeks (Q2W) in the dose-expansion cohorts, 168 completed 1 year of initial durvalumab treatment with confirmed BOR1 of complete response in 20 (11.9%), partial response (PR) in 84 (50%), stable disease (SD) in 52 (31%), and disease progression in 12 (7.1%). All 168 patients stopped treatment and were eligible for retreatment at progression; 70 patients (41.7%) representing 14 primary tumor types were retreated and response evaluable. Confirmed BOR2 was PR in 8 patients (11.4%), SD in 42 (60.0%), disease progression in 16 (22.9%), and unevaluable in 4 (5.7%). Median DoR2 was 16.5 months. DCR2 ≥24 weeks (DCR2 24) was 47.1%. PFS2 rate at 12 months was 34.2%, and median PFS2 was 5.9 months. Median overall survival (OS2) was 23.8 months. Response rates, DCR2 24, and median DoR2 were generally greater in patients with high PD-L1 expression than those with low/negative expression. No new safety signals were observed during retreatment. CONCLUSION Retreatment restored antitumor activity, resulting in high rates of durable disease control with an acceptable safety profile. This evidence supports retreatment of patients who stop anti-PD-L1 therapy for reasons other than progression or toxicity, and supports further investigation.
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Affiliation(s)
- Siddharth Sheth
- Division of Medical Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Development Oncology, Oncology Research and Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - Chen Gao
- Biometrics Oncology, Oncology Research and Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - Nancy Mueller
- Clinical Development Oncology, Oncology Research and Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - Natasha Angra
- Clinical Development Oncology, Oncology Research and Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - Ashok Gupta
- Clinical Development Oncology, Oncology Research and Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - Caroline Germa
- Clinical Development Oncology, Oncology Research and Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - Pablo Martinez
- Clinical Development Oncology, Oncology Research and Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - Jean-Charles Soria
- Oncology Research and Development, AstraZeneca, Gaithersburg, Maryland, USA
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Gullapalli S, Remon J, Hendriks LEL, Lopes G. Update on Targeted Therapies for Advanced Non-Small Cell Lung Cancer: Durvalumab in Context. Onco Targets Ther 2020; 13:6885-6896. [PMID: 32764980 PMCID: PMC7369644 DOI: 10.2147/ott.s259308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have transformed the therapeutic strategy and prognosis of advanced non-small cell lung cancer (NSCLC) patients. Nowadays, ICIs as monotherapy or in combination with chemotherapy are the standard of care treatment in advanced NSCLC, and in stage III, durvalumab (a programmed death ligand 1 inhibitor) is the unique drug approved as consolidation treatment after chemo-radiotherapy. This article reviews the pharmacological properties, clinical activity and safety of durvalumab as monotherapy or in combination with chemotherapy or other ICIs in the therapeutic strategy of NSCLC patients.
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Affiliation(s)
- Sneha Gullapalli
- Division of Pulmonary and Critical Care, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Jordi Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Delfos, HM Hospitales, Barcelona, Spain
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Gilberto Lopes
- Divisions of Hematology and Medical Oncology, Departments of Medicine, Miller School of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA
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7
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Basse C, Swalduz A, Levra MG, Girard N, Remon J, Moro-Sibilot D. [Immunotherapy of metastatic non-small cell lung cancer from first line to resistance and its management]. Bull Cancer 2020; 107:779-791. [PMID: 32532420 DOI: 10.1016/j.bulcan.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 01/22/2023]
Abstract
Immunotherapy alone or in combination with chemotherapy is now an integral part of the treatment of metastatic NSCLC. This treatment is transforming the management of these cancers, with 20-30% of patients achieving long survival. However, disease progression under treatment is still the rule for the majority of patients, raising problems both in understanding its mechanisms and in subsequent appropriate management. This study examines current therapeutic options and proposes solutions to circumvent resistance to immunotherapy. The mechanisms of resistance to these treatments is also analysed.
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MESH Headings
- Anaplastic Lymphoma Kinase/genetics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/therapy
- Clinical Trials, Phase III as Topic
- Combined Modality Therapy/methods
- Disease Progression
- Drug Resistance, Neoplasm/physiology
- Genes, erbB-1
- Humans
- Immunotherapy/methods
- Immunotherapy, Adoptive/methods
- Lung Neoplasms/genetics
- Lung Neoplasms/mortality
- Lung Neoplasms/therapy
- Mutation
- Receptors, Chimeric Antigen/therapeutic use
- Translocation, Genetic
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Affiliation(s)
- Clémence Basse
- Institut du thorax Curie Montsouris, institut Curie, Paris, France
| | - Aurelie Swalduz
- Centre Léon-Bérard, département d'oncologie médicale, Lyon, France
| | - Matteo Giaj Levra
- CHU de Grenoble-Alpes, oncologie thoracique SHUPP, CS10217 cedex, 38043 Grenoble, France; Hospital HM Delfos, HM Hospitales, Centro Integral Oncológico Clara-Campal (HM-CIOCC), Department of Medical Oncology, Barcelona, Espagne; Université Grenoble-Alpes, Institute for Advanced Biosciences, Inserm U1209 CNRS UMR5309, Grenoble, France
| | - Nicolas Girard
- Institut du thorax Curie Montsouris, institut Curie, Paris, France
| | - Jordi Remon
- Hospital HM Delfos, HM Hospitales, Centro Integral Oncológico Clara-Campal (HM-CIOCC), Department of Medical Oncology, Barcelona, Espagne
| | - Denis Moro-Sibilot
- CHU de Grenoble-Alpes, oncologie thoracique SHUPP, CS10217 cedex, 38043 Grenoble, France.
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8
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Metro G, Signorelli D. Immune checkpoints inhibitors rechallenge in non-small-cell lung cancer: different scenarios with different solutions? Lung Cancer Manag 2020; 8:LMT18. [PMID: 31983926 PMCID: PMC6978724 DOI: 10.2217/lmt-2019-0012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 01/29/2023] Open
Affiliation(s)
- Giulio Metro
- Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Diego Signorelli
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy
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