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Uryu K, Imamura Y, Shimoyama R, Mase T, Fujimura Y, Hayashi M, Ohtaki M, Otani K, Hibino M, Horiuchi S, Fukui T, Fukai R, Chihara Y, Iwase A, Yamada N, Tamura Y, Harada H, Shinozaki N, Tsuya A, Fukuoka M, Minami H. Stepwise prolongation of overall survival from first to third generation EGFR-TKIs for EGFR mutation-positive non-small-cell lung cancer: the Tokushukai REAl-world Data project (TREAD 01). Jpn J Clin Oncol 2024; 54:319-328. [PMID: 37997468 DOI: 10.1093/jjco/hyad162] [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: 09/09/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE The introduction of new-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) has afforded promising overall survival outcomes in clinical trials for non-small-cell lung cancer. We aim to investigate the current adoption rate of these agents and the real-world impact on overall survival among institutions. METHODS In a nationwide retrospective cohort study of 46 Tokushukai Medical Group hospitals in Japan, we analyzed clinical data of consecutive patients with non-small-cell lung cancer receiving EGFR-TKIs between April 2010 and March 2020. Univariate and multivariate Cox regression analyses examined the associations between overall survival and patient/tumor-related factors and first-line EGFR-TKIs. RESULTS A total of 758 patients (58.5% females; median age, 73 years) were included. Of 40 patients diagnosed in 2010, 72.5% received gefitinib, whereas 81.3% of 107 patients diagnosed in 2019 received osimertinib as the first-line EGFR-TKI. With a median follow-up of 15.8 months, the median overall survival was 28.4 months (95% confidence interval, 15.3-31.0). In a multivariate Cox regression analysis, age, body mass index, disease status, EGFR mutational status and first-line epidermal growth factor receptor tyrosine kinase inhibitor were identified as significant prognostic factors after adjusting for background factors including study period, hospital volume and hospital type. The estimated 2-year overall survival rates for gefitinib, erlotinib, afatinib and osimertinib were 70.1% (95% confidence interval 59.7-82.4), 67.8% (95% confidence interval 55.3-83.2), 75.5% (95% confidence interval 64.7-88.0) and 90.8% (95% confidence interval 84.8-97.3), respectively. The median time to treatment failure of gefitinib, erlotinib, afatinib and osimertinib were 12.8, 8.8, 12.0 and 16.9 months or more, respectively. CONCLUSIONS Our real-world data revealed that the swift and widespread utilization of newer-generation EGFR-TKIs in patients with EGFR mutation-positive non-small-cell lung cancer, and that these newer-generation EGFR-TKIs can prolong overall survival regardless of hospital volume or type. Therefore, osimertinib could be a reasonable first choice treatment for these patients across various clinical practice settings.
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Affiliation(s)
- Kiyoaki Uryu
- Department of Medical Oncology, Yao Tokushukai General Hospital, Yao-shi, Osaka, Japan
| | - Yoshinori Imamura
- Department of Medical Oncology and Hematology, Kobe University Graduate School of Medicine, Kobe, Hyougo, Japan
| | - Rai Shimoyama
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Takahiro Mase
- Department of Breast Surgery, Ogaki Tokushukai Hospital, Ogaki-shi, Gifu, Japan
| | | | - Maki Hayashi
- Mirai Iryo Research Center Inc, Chiyoda-ku, Tokyo, Japan
| | - Megu Ohtaki
- deCult Co., Ltd., Hatsukaichi-shi, Hiroshima, Japan
| | - Keiko Otani
- deCult Co., Ltd., Hatsukaichi-shi, Hiroshima, Japan
| | - Makoto Hibino
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa-shi, Kanagawa, Japan
| | - Shigeto Horiuchi
- Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa-shi, Kanagawa, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ryuta Fukai
- Department of General Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yusuke Chihara
- Department of Respiratory Medicine, Uji Tokushukai Medical Center, Uji-shi, Kyoto, Japan
| | - Akihiko Iwase
- Department of Respiratory Medicine, Chibanishi General Hospital, Matsudo-shi, Chiba, Japan
| | - Noriko Yamada
- Department of General Thoracic Surgery, Chibanishi General Hospital, Matsudo-shi, Chiba, Japan
| | - Yukihiro Tamura
- Department of General Internal Medicine, Oosumi Kanoya Hospital, Kanoya-shi, Kagoshima, Japan
| | - Hiromasa Harada
- Department of Respiratory Medicine, Yao Tokushukai General Hospital, Yao-shi, Osaka, Japan
| | - Nobuaki Shinozaki
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
- General Incorporated Association Tokushukai, Chiyoda-ku, Tokyo, Japan
| | - Asuka Tsuya
- Department of Medical Oncology, Izumi City General Hospital, Izumi, Osaka, Japan
| | - Masahiro Fukuoka
- Department of Medical Oncology, Izumi City General Hospital, Izumi, Osaka, Japan
| | - Hironobu Minami
- Department of Medical Oncology and Hematology, Kobe University Graduate School of Medicine, Kobe, Hyougo, Japan
- Cancer Center, Kobe University Hospital, Kobe, Hyougo, Japan
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Cui K, Mei X, Cheng M. Increased interleukin-17A-producing γδT cells predict favorable survival in elderly patients with LUAD and LUSC. J Cancer Res Clin Oncol 2021; 147:3289-3298. [PMID: 34327570 DOI: 10.1007/s00432-021-03742-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Aging is closely related to the occurrence of many diseases, including cancer, and involves changes in the immune microenvironment. γδT cells are important components of resident lymphocytes in mucosal tissues. However, little is known about the effects that the aged lung has on γδT cells and their prognostic significance in non-small cell lung cancer. METHODS In the current study, the expression of γδTCR and IL-17A was measured by immunohistochemistry in paraffin-embedded lung tissues from 168 patients with adenocarcinoma (LUAD) and 144 patients with squamous cell carcinoma (LUSC). Furthermore, gene transcription patterns in LUAD and LUSC tumors and normal controls were extracted from TCGA and GTEx databases and were analyzed. RESULTS High frequency of γδT cells was observed in patients with LUAD and LUSC, whereas the levels of CD4 + T cells, CD8 + T cells and CD56 + cells were decreased. Elevated γδT cells in tumors were mainly IL-17A-releasing γδT17 cells, which were found to be enriched in aged patients. High γδT cell levels positively corelated with the overall survival (OS) of patients, especially the 5-year OS in the elderly. Further analysis of gene transcription patterns indicated that increased expression of LTBR, HES1, RORC, CCR6, IL1, and IL23A may contribute to the transformation of the tumor microenvironment in a manner conducive to γδT17 cell development and differentiation. Finally, gene analysis between different age groups revealed that the expression of CCR6 and IL7 in LUAD, as well as Hes1, IL7, and IL23A in LUSC, were remarkably higher in elderly (age ≥ 60 years) than in younger individuals (age < 60 years). CONCLUSION Our findings suggest that intrinsic alterations in the aging lung lead to γδT17 cell enrichment, which subsequently may exert anti-tumor effects in the elderly.
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Affiliation(s)
- Kele Cui
- Department of Clinical Laboratory, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China.,Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy, Hefei, 230001, China.,Cancer Immunotherapy Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
| | - Xinyu Mei
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
| | - Min Cheng
- Department of Geriatrics, Gerontology Institute of Anhui Province, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China. .,Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy, Hefei, 230001, China. .,Cancer Immunotherapy Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China.
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Hu M, Zhang T, Yang Y, Che N, Li J, Liu Z, Li B. Driver gene alterations in lung adenocarcinoma: Demographic features of 2544 Chinese cases. Int J Biol Markers 2020; 35:44-50. [PMID: 33063618 DOI: 10.1177/1724600820967015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND To understand the association between driver gene variations and age and gender in patients with lung adenocarcinoma, we investigated mutations of the three most important driver genes-epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) fusion genes and c-ros oncogene 1 (ROS1)-in this retrospective cohort study. METHODS Patients newly diagnosed with lung adenocarcinoma who received EGFR and ALK/ROS1 gene tests at our hospital from September 2014 to May 2019 were enrolled. EGFR mutations and ROS1 fusions were examined by ARMS-PCR and ALK fusions by Ventana-D5F3 IHC assay and ARMS-PCR. RESULTS Of 2544 eligible subjects, 2539 accomplished EGFR mutation tests. The prevalence of EGFR mutations was 62.1% in females, higher than that of 45.1% in males. In females, the EGFR mutation rate remained relatively stable at 60%-65% across the six age groups. Females showed an increased distribution of EGFR L858R and a decreased distribution of exon 19 deletion (19Del) by age. The incidence of ALK/ROS-1 rearrangements decreased significantly with age. CONCLUSIONS EGFR 19Del mutation is more prevalent in younger males and females, while L858R mutation is prevalent in older females. Both ALK and ROS1 rearrangements are more common in younger lung adenocarcinoma. The young lung adenocarcinoma population is a distinct group rich in targetable genomic alterations, and more research is needed to understand the mechanism.
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Affiliation(s)
- Mingming Hu
- Oncology Department, Beijing Chest Hospital of Capital Medical University, Beijing, China
| | - Tongmei Zhang
- Oncology Department, Beijing Chest Hospital of Capital Medical University, Beijing, China
| | - Yuan Yang
- Oncology Department, Beijing Chest Hospital of Capital Medical University, Beijing, China
| | - Nanying Che
- Pathology Department, Beijing Chest Hospital of Capital Medical University, Beijing, China
| | - Jie Li
- Oncology Department, Beijing Chest Hospital of Capital Medical University, Beijing, China
| | - Zichen Liu
- Pathology Department, Beijing Chest Hospital of Capital Medical University, Beijing, China
| | - Baolan Li
- Oncology Department, Beijing Chest Hospital of Capital Medical University, Beijing, China
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Lee SY, Hong YK, Ji W, Lee JC, Choi CM. Active Treatment Improves Overall Survival in Extremely Older Non-Small Cell Lung Cancer Patients: A Multicenter Retrospective Cohort Study. Cancer Res Treat 2020; 53:104-111. [PMID: 33017882 PMCID: PMC7811996 DOI: 10.4143/crt.2020.894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/04/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE As the aging of society progresses, the proportion of extremely older lung cancer patients has also increased; However, studies of these patients with non-small cell lung cancer are limited. Therefore, we investigated the initial treatment modalities and survival outcomes for patients aged 80 years or over. Materials and Methods We included a multicenter retrospective cohort from the Korean Association for Lung Cancer Registry, which surveys 10% of the newly diagnosed lung cancer patients across 52 hospitals in Korea. We analyzed and compared the 2014-2016 data of the non-small cell lung cancer patients aged ≥ 80 years and those aged < 80 years. RESULTS Of the 6,576 patients reviewed, 780 patients were aged ≥ 80 years, and 5,796 patients were aged < 80 years. In the patients aged ≥ 80 years, surgery and radiation therapy resulted in longer patient survival among those with a resectable tumor (stage I-II) than the best supportive care (median survival, not reached [surgery] vs. 32.2 months [radiation therapy] vs. 11.43 months [best supportive care]). The duration of survival in patients with advanced-stage (IV) lung cancers was higher after chemotherapy than after the best supportive care (median survival, 8.63 months vs. 2.5 months). Patients with stage IV adenocarcinoma who received targeted therapy had better survival than those who did not (median survival, 9.0 months vs. 4.3 months). CONCLUSION Even in extremely older patients, active treatments, such as surgery, radiation therapy, and chemotherapy, can result in better survival outcomes than the best supportive care.
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Affiliation(s)
- Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Ki Hong
- Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Cheng M, Chen Y, Huang D, Chen W, Xu W, Chen Y, Shen G, Xu T, Shen G, Tian Z, Hu S. Intrinsically altered lung-resident γδT cells control lung melanoma by producing interleukin-17A in the elderly. Aging Cell 2020; 19:e13099. [PMID: 31903715 PMCID: PMC6996947 DOI: 10.1111/acel.13099] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/28/2019] [Accepted: 12/07/2019] [Indexed: 01/12/2023] Open
Abstract
Cancer is an age‐associated disease, potentially related to the altered immune system of elderly individuals. However, cancer has gradually decreased incidence in the eldest globally such as the most common lung cancer, the mechanisms of which remain to be elucidated. In this study, it was found that the number of lung‐resident γδT cells was significantly increased with altered gene expression in aged mice (20–24 months) versus young mice (10–16 weeks). Aged lung Vγ4+ and Vγ6+ γδT cells predominantly produced interleukin‐17A (IL‐17A), resulting in increased levels in the serum and lungs. Moreover, the aged mice exhibited smaller tumors and reduced numbers of tumor foci in the lungs after challenge with intravenous injection of B16/F10 melanoma cells compared with the young mice. Aged lung Vγ4+ and Vγ6+ γδT cells were highly cytotoxic to B16/F10 melanoma cells with higher expression levels of CD103. The markedly longer survival of the challenged aged mice was dependent on γδT17 cells, since neutralization of IL‐17A or depletion of indicated γδT cells significantly shortened the survival time. Consistently, supplementation of IL‐17A significantly enhanced the survival time of young mice with lung melanoma. Furthermore, the anti‐tumor activity of aged lung γδT17 cells was not affected by alterations in the load and composition of commensal microbiota, as demonstrated through co‐housing of the aged and young mice. Intrinsically altered lung γδT17 cells underlying age‐dependent changes control lung melanoma, which will help to better understand the lung cancer progression in the elderly and the potential use of γδT17 cells in anti‐tumor immunotherapy.
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Affiliation(s)
- Min Cheng
- Gerontology Institute of Anhui Province The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy Hefei China
- Cancer Immunotherapy Center The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
| | - Yongyan Chen
- Institute of Immunology and The CAS Key Laboratory of Innate Immunity and Chronic Disease School of Life Science and Medical Center University of Science and Technology of China Hefei China
| | - Dake Huang
- Comprehensive Laboratory School of Basic Medical Sciences Anhui Medical University Hefei China
| | - Wen Chen
- Gerontology Institute of Anhui Province The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy Hefei China
- Cancer Immunotherapy Center The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
| | - Weiping Xu
- Gerontology Institute of Anhui Province The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy Hefei China
| | - Yin Chen
- Gerontology Institute of Anhui Province The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy Hefei China
| | - Guodong Shen
- Gerontology Institute of Anhui Province The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy Hefei China
| | - Tingjuan Xu
- Gerontology Institute of Anhui Province The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy Hefei China
| | - Gan Shen
- Gerontology Institute of Anhui Province The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy Hefei China
| | - Zhigang Tian
- Cancer Immunotherapy Center The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
- Institute of Immunology and The CAS Key Laboratory of Innate Immunity and Chronic Disease School of Life Science and Medical Center University of Science and Technology of China Hefei China
| | - Shilian Hu
- Gerontology Institute of Anhui Province The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) Hefei China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy Hefei China
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A Comprehensive Meta-Analysis of Association between EGFR Mutation Status and Brain Metastases in NSCLC. Pathol Oncol Res 2019; 25:791-799. [PMID: 30761450 DOI: 10.1007/s12253-019-00598-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/15/2019] [Indexed: 02/07/2023]
Abstract
Non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation have different clinicopathological characteristics compared with EGFR wild type NSCLC. A growing number of studies focused on the relevance between EGFR mutation status and brain metastases (BM) in NSCLC, but it remains controversial. Therefore, this study performed a comprehensive meta-analysis to untangle this issue. Several electronic databases including Pubmed, Embase, Web of science and Cochrane database were thoroughly searched. The odds ratio (OR) with 95% confidence interval (95%CI) was pooled to evaluate the relevance. Meta-regression analysis and subgroup analysis were conducted according to the heterogeneity. A total of 26 studies were identified finally in this meta-analysis. The overall OR was 1.58 (95%CI: 1.36-1.84), which indicated that EGFR mutation had a positive association with BM of NSCLC. The subgroup analysis resulted from eleven studies with lung adenocarcinoma revealed a higher possibility of BM in NSCLC with EGFR mutation compared with EGFR wild (p < 0.05). There was no significant difference in the risk of BM between NSCLC EGFR exon 19 mutation and exon 21 point mutation (p = 0.23). This meta-analysis suggests that EGFR mutation can be a risk factor for BM in NSCLC.
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Lepidic, Papillary Components and EGFR Mutations are Frequent in Patients With Lung Adenocarcinoma Who are Over 75 Years Old. Appl Immunohistochem Mol Morphol 2018; 27:667-671. [PMID: 30095461 DOI: 10.1097/pai.0000000000000678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Treatment for lung adenocarcinoma frequently diverges from standard treatment in older patients. Clinical, pathologic, and molecular characteristics of lung cancer in patients over 75 years old have not been fully described. The aim of our work was to describe the rate of EGFR, KRAS, BRAF, and HER2 mutations, and ALK rearrangement and pathologic characteristics in patients with lung adenocarcinoma over 75, compared with patients below 75 years old. This is a retrospective study from 2 cohorts: a histopathologic cohort of all consecutively resected lung adenocarcinoma in our institution for patients over 75 (n=54, from 2006 to 2017) compared with patients below 75 years old (n=148, from 2014 to 2017) and a molecular cohort of all stage IIIb or IV lung adenocarcinoma from 2009 to 2017 (n=1611). Papillary and lepidic components were more frequently found in patients over 75 years old (P=0.046 and 0.0078, respectively). The rate of current smokers was lower in older patients (P<0.0001). EGFR mutations were more frequent in patients over 75 than in younger patients: 17% versus 8.1% (P<0.0001). The mutually exclusive KRAS mutation was more frequent in patients below 75 years old than in older patients: 25.8% versus 12.8% (P<0.0001). There was no difference for the proportion of the 2 most frequent EGFR mutations (exon 19 deletion and L858R mutation) (P=0.85) or KRAS-mutated codon (P=0.22) between tumors in younger or older patients. There was no statistically significant difference for the presence of BRAF, HER2 mutations, and ALK rearrangement (P=0.44, 0.71, and 1, respectively). Our work highlights the fact that EGFR mutations are more frequent in patients over 75 years old in our population. We can hypothesize that this difference might be mainly caused by the less frequent occurrence of tobacco-smoking-related lung cancers in the elderly and the presence of a lepidic or papillary component in this age group.
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Wu M, Pan X, Xu Y, Wu S, Wu X, Chen B. Methodological comparison of the allele refractory mutation system and direct sequencing for detecting EGFR mutations in NSCLC, and the association of EGFR mutations with patient characteristics. Oncol Lett 2018; 16:1087-1094. [PMID: 30061936 DOI: 10.3892/ol.2018.8775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 11/02/2017] [Indexed: 12/30/2022] Open
Abstract
Gefitinib is effective for patients with non-small cell lung cancer (NSCLC) with a mutation in the epidermal growth factor receptor (EGFR) gene, which makes the detection of EGFR mutations a critical step prior to determining a treatment schedule. Therefore, the present study determined the EGFR mutation status in patients with NSCLC using an allele refractory mutation system (ARMS) and analyzed the detection ratio for different specimen types. A total of 1,596 NSCLS samples were collected and EGFR gene mutations were detected on exons 18-21 using ARMS and direct sequencing. The concordance of two methods reached 89.21%, with a total mutation rate of 45.55% (727/1,596), in which the mutation rate in lung adenocarcinoma samples was markedly increased compared with squamous cell carcinoma (51.77 vs. 8.68%). In patients with lung adenocarcinoma, EGFR mutations were more frequent in female patients than male patients (65.53 vs. 39.80%, P<0.01); there was no observable difference depending on age. Similar results were obtained for squamous cell carcinoma. In the present study, certain rare mutations were also identified; these may be subjects for further study. The impact of different sample types on the consistency between the methods was determined to be insignificant. ARMS is a more applicable approach for large-scale clinical detection than direct sequencing, and we hypothesize that ARMS may replace direct sequencing if the drawbacks of ARMS, including its narrow detection range, can be amended.
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Affiliation(s)
- Minmin Wu
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiaodong Pan
- Department of Transplantation Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yaya Xu
- Department of Transplantation Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Siying Wu
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiuling Wu
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Bicheng Chen
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Pan X, Lv T, Zhang F, Fan H, Liu H, Song Y. Frequent genomic alterations and better prognosis among young patients with non-small-cell lung cancer aged 40 years or younger. Clin Transl Oncol 2018; 20:1168-1174. [PMID: 29460035 DOI: 10.1007/s12094-018-1838-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/22/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND The subgroup of young patients with non-small-cell lung cancer (NSCLC) is poorly understood. We retrospectively studied the clinical characteristics, gene mutations, and outcomes of patients with NSCLC (aged ≤ 40 years). RESULTS Of the 7494 patients with lung cancer diagnosed from February 2001 to October 2016, 252 aged ≤ 40 years showed NSCLC. We divided their cases into non-squamous cell carcinoma and squamous cell carcinoma groups according to their histology results. Of the 252 young NSCLC patients, 173 (69%) patients had stage IIIB or IV, and 196 (78%) had never smoked. The four most common metastases were intrapulmonary lesions, pleura, bone, and brain. Among patients with adenocarcinoma, 29 (40%, n = 73) harbored epidermal growth factor receptor (EGFR) mutations, 25 (34%, n = 74) harbored anaplastic lymphoma kinase (ALK) translations, and 1 (14%, n = 7) harbored ROS proto-oncogene 1 receptor tyrosine kinase (ROS1) translations. The median progression-free survival (PFS) and overall survival (OS) were 3.3 and 27.6 months for patients receiving chemotherapy (n = 65), and 12.1 and 33.6 months for patients receiving EGFR tyrosine kinase inhibitors (TKIs) (n = 13), respectively. Patients receiving crizotinib had a median PFS time of 21.9 months (n = 8). CONCLUSIONS Young patients are associated with an increased likelihood of gene mutations and can receive a better prognosis when patients harboring gene mutations are treated with EGFR-TKIs or ALK inhibitors.
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Affiliation(s)
- X Pan
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - T Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - F Zhang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - H Fan
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - H Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
| | - Y Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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Clay R, Kipp BR, Jenkins S, Karwoski RA, Maldonado F, Rajagopalan S, Voss JS, Bartholmai BJ, Aubry MC, Peikert T. Computer-Aided Nodule Assessment and Risk Yield (CANARY) may facilitate non-invasive prediction of EGFR mutation status in lung adenocarcinomas. Sci Rep 2017; 7:17620. [PMID: 29247171 PMCID: PMC5732170 DOI: 10.1038/s41598-017-17659-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/24/2017] [Indexed: 12/19/2022] Open
Abstract
Computer-Aided Nodule Assessment and Risk Yield (CANARY) is quantitative imaging analysis software that predicts the histopathological classification and post-treatment disease-free survival of patients with adenocarcinoma of the lung. CANARY characterizes nodules by the distribution of nine color-coded texture-based exemplars. We hypothesize that quantitative computed tomography (CT) analysis of the tumor and tumor-free surrounding lung facilitates non-invasive identification of clinically-relevant mutations in lung adenocarcinoma. Comprehensive analysis of targetable mutations (50-gene-panel) and CANARY analysis of the preoperative (≤3 months) high resolution CT (HRCT) was performed for 118 pulmonary nodules of the adenocarcinoma spectrum surgically resected between 2006–2010. Logistic regression with stepwise variable selection was used to determine predictors of mutations. We identified 140 mutations in 106 of 118 nodules. TP53 (n = 48), KRAS (n = 47) and EGFR (n = 15) were the most prevalent. The combination of Y (Yellow) and G (Green) exemplars, fibrosis within the surrounding lung and smoking status were the best discriminators for an EGFR mutation (AUC 0.77 and 0.87, respectively). None of the EGFR mutants expressing TP53 (n = 5) had a good prognosis based on CANARY features. No quantitative features were significantly associated with KRAS mutations. Our exploratory analysis indicates that quantitative CT analysis of a nodule and surrounding lung may noninvasively predict the presence of EGFR mutations in pulmonary nodules of the adenocarcinoma spectrum.
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Affiliation(s)
- Ryan Clay
- Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin R Kipp
- Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sarah Jenkins
- Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN, USA
| | - Ron A Karwoski
- Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, USA
| | - Fabien Maldonado
- Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University, Nashville, TN, USA
| | | | - Jesse S Voss
- Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Tobias Peikert
- Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
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11
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Corrales-Rodríguez L, Arrieta O, Mas L, Báez-Saldaña R, Castillo-Fernández O, Blais N, Martín C, Juárez M, Khanna P, Ramos-Esquivel A, Bacon L, Rojas L, Wills B, Oblitas G, Pérez MA, Cuello M, Cardona AF. An international epidemiological analysis of young patients with non-small cell lung cancer (AduJov-CLICaP). Lung Cancer 2017; 113:30-36. [PMID: 29110845 DOI: 10.1016/j.lungcan.2017.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND A proportion of patients with NSCLC is diagnosed at 40 years or younger. These patients tend to be never-smokers, usually present with stage IV adenocarcinoma, and have somatic genomic alterations. Few studies have documented and analyzed epidemiological characteristics of this population. MATERIALS AND METHODS We performed an international epidemiological analysis of 389 young patients with NSCLC. Data was collected from centers participating in the Latin American Consortium for Lung Cancer Research (AduJov-CLICaP). Patients were identified and data was retrospectively collected from different Latin American countries and Canada (Argentina=6, Canada=19, Colombia=29, Costa Rica=9, Mexico=219, Nicaragua=2, Panama=19, Perú=76 and Venezuela=10). The period of study was from 2012 to 2017. Inclusion criteria were: age 40 years or less and a histologically confirmed NSCLC. Clinical data was obtained, and EGFR mutation status and EML4-ALK translocation were collected. RESULTS NSCLC patients aged 40 years or less accounted for approximately 4% of the total NSCLC population. Female patients accounted for 54.5%, while median age was of 37 years. Adenocarcinoma accounted for 86.1% (n=335/389), 72.5% (n=282/389; unknown=5) of patients were non-smokers, and 90.3% (n=351/389) had stage IV disease. Site of metastasis was obtained from 260/351 (unknown=91) stage IV patients (lung metastasis=40.0%, CNS metastasis=35.7%, and bone metastasis=31.5%). OS for the total population was 17.3 months (95%CI=13.9-20.7). OS for EGFRm(+)=31.4months (95%CI=11.6-51.3), EGFRm(-)=14.5months (95%CI=11.0-17.9) (p=0.005). OS for alk(+)=9.8months (95%CI=3.1-16.5) and alk(-)=5.6months (95%CI=3.9-7.3) (p=0.315). CONCLUSIONS Patients aged 40 years or less account for a small but important proportion of NSCLC cases. Younger patients may have different characteristics compared to the older population. EGFRm and EML4-alk translocation frequency is higher than that of the general population.
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Affiliation(s)
- Luis Corrales-Rodríguez
- Medical Oncology, Hospital San Juan de Dios, San José, Costa Rica; Centro de Investigación y Manejo del Cancer - CIMCA, San José, Costa Rica.
| | - Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), México City, Mexico
| | - Luis Mas
- Clinical Oncology Department, Instituto Nacional de Enfermedades Neoplásicas - INEN, Lima, Peru
| | | | | | | | - Claudio Martín
- Medical Oncology Department, Thoracic Oncology Unit, Instituto Fleming, Buenos Aires, Argentina
| | - Melissa Juárez
- Medical Oncology, Hospital San Juan de Dios, San José, Costa Rica; Centro de Investigación y Manejo del Cancer - CIMCA, San José, Costa Rica
| | - Priyanka Khanna
- Centro de Investigación y Manejo del Cancer - CIMCA, San José, Costa Rica
| | | | - Ludwing Bacon
- Oncology Department, Hospital Roberto Calderón, Managua, Nicaragua
| | - Leonardo Rojas
- Clinical Oncology Department, Centro Javeriano de Oncología, Hospital San Ignacio, Bogotá, Colombia; Internal Medicine Department, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Beatriz Wills
- Internal Medicine Department, Johns Hopkins University, Baltimore, United States
| | | | | | | | - Andrés Felipe Cardona
- Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia; Internal Medicine Department, Universidad el Bosque - Fundación Santa Fe de Bogotá, Bogotá, Colombia
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12
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Chang YP, Chen YM, Lai CH, Lin CY, Fang WF, Huang CH, Li SH, Chen HC, Wang CC, Lin MC. The impact of de novo liver metastasis on clinical outcome in patients with advanced non-small-cell lung cancer. PLoS One 2017; 12:e0178676. [PMID: 28591157 PMCID: PMC5462397 DOI: 10.1371/journal.pone.0178676] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/17/2017] [Indexed: 01/09/2023] Open
Abstract
Liver metastasis has been found to affect outcome in prostate cancer and colorectal cancer, but its role in lung cancer is unclear. The current study aimed to evaluate the impact of de novo liver metastasis (DLM) on stage IV non-small cell lung cancer (NSCLC) outcomes and to examine whether tyrosine kinase inhibitors (TKI) reverse poor prognosis in patients with DLM and epidermal growth factor receptor (EGFR)-mutant NSCLC. Among 1392 newly diagnosed NSCLC patients, 490 patients with stage IV disease treated between November 2010 and March 2014 at Kaohsiung Chang Gung Memorial Hospital were included. Patients were divided into two groups according to DLM status. There were 75 patients in the DLM group and 415 patients in the non-DLM group. The DLM group included more patients with bone metastasis, fewer patients with a lymphocyte-to-monocyte ratio (LMR) > 3.1, and fewer patients with pleural metastasis. In the DLM group, Eastern Cooperative Oncology Group performance status 3–4 and LMR ≦3.1 were associated with poor outcome. In patients without DLM, overall survival (OS) was longer in patients with EGFR-mutant NSCLC than in those without (20.2 vs. 7.3 months, p < 0.001). Among DLM patients, OS was similar between the EGFR-mutant and wild-type EGFR tumor subgroups (11.9 vs. 7.7 months, p = 0.155). We found that DLM was a significant poor prognostic factor in the EGFR-mutant patients treated with EGFR-TKIs, whereas DLM did not affect the prognosis of EGFR-wild-type patients.
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Affiliation(s)
- Yu-Ping Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Mu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hao Lai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Yu Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung Institute of Technology, Chiayi, Taiwan
| | - Cherng-Hua Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chen Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung Institute of Technology, Chiayi, Taiwan
- * E-mail:
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung Institute of Technology, Chiayi, Taiwan
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13
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Bigot F, Boudou-Rouquette P, Arrondeau J, Thomas-Schoemann A, Tlemsani C, Chapron J, Huillard O, Cessot A, Vidal M, Alexandre J, Blanchet B, Goldwasser F. Erlotinib pharmacokinetics: a critical parameter influencing acute toxicity in elderly patients over 75 years-old. Invest New Drugs 2016; 35:242-246. [PMID: 27796680 DOI: 10.1007/s10637-016-0400-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/20/2016] [Indexed: 12/11/2022]
Abstract
Background Older non-small cell lung cancer (NSCLC) patients under erlotinib are reported to experience more acute toxicity. We hypothesized that modifications in erlotinib pharmacokinetics might explain this observation. Methods A monocentric prospective clinico-pharmacological study included stage IIIb/IV NSCLC consecutive pts. treated with erlotinib. The plasma concentration of erlotinib (Ce) was measured at steady state on day 15. We studied the relationship between age > 75 years, and Ce, using the Mann-Whitney U test and with the occurrence of acute toxicity, using a Fisher's test. Results A total of 53 pts. were analyzed. Median age was 68 years (31-83), 56 % were female. All pts. > 75 years experienced toxicity: all grade acute adverse events were 1.6 fold more frequent (100 % vs 61 %; OR 95 % CI [1.9-INF]; p = 0.003). At day 15, Ce increased with age. Over 75 years old, the mean Ce was 1.5 fold higher: 2091 ng/mL (95 % CI [1476; 2706]) vs 1359 (95 % CI [1029; 1689]; p = 0.024). In pts. over 80 years old, the mean Ce was doubled: 2729 (95 % CI [1961; 3497]) vs 1358 ng/mL (95 % CI [1070; 1646]; p = 0.0019). Reduced lean body mass over 75 years (median 36.6 kg versus 49.1 kg) might account for these differences. Finally, the risk of early erlotinib discontinuation was increased by 11 in older pts. (33 % vs 3 % OR 17.2; 95 % CI [1.7; 892.5] p = .005). Conclusion The risk of overexposure to erlotinib increases with age. Reduced lean body mass may explain erlotinib pharmacokinetics and excessive acute toxicity in the elderly.
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Affiliation(s)
- Frederic Bigot
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France
| | - Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France.
| | - Jennifer Arrondeau
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France
| | - Audrey Thomas-Schoemann
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France.,UF Pharmacocinétique et pharmacochimie, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Paris, France.,UMR 8638 CNRS, Faculty of Pharmacy of Paris, Université Paris Descartes, SPC, Paris, France
| | - Camille Tlemsani
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France
| | - Jeanne Chapron
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France.,Department of Pneumology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Olivier Huillard
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France
| | - Anatole Cessot
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France
| | - Michel Vidal
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France.,UF Pharmacocinétique et pharmacochimie, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Paris, France.,UMR 8638 CNRS, Faculty of Pharmacy of Paris, Université Paris Descartes, SPC, Paris, France
| | - Jerome Alexandre
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France
| | - Benoit Blanchet
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France.,UF Pharmacocinétique et pharmacochimie, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Francois Goldwasser
- Department of Medical Oncology, Cochin - Port Royal Hospital, AP-HP, Paris Descartes University, Sorbonne Paris Cité 123, Boulevard de Port-Royal, 75014, Paris, France
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