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Liu SY, Erazo T, Jee J, Arfe A, Gupta A, Pike LRG, Santini FC, Daly B, Schoenfeld A, Eichholz J, Johnson K, Martinez A, Sui J, Riaz N, Chang J, Yang SR, Travis W, Arcila ME, Guo J, Gagne E, Garg K, Baehner F, Lee NY, Drilon A, Kris MG, Scher HI, Razavi P, Gomez DR, Jones DR, Rudin CM, Chandarlapaty S, Isbell JM, Li BT. Optimal systemic treatment and real-world clinical application of ctDNA in patients with metastatic HER2-mutant lung cancer. Eur J Cancer 2024; 210:114257. [PMID: 39151324 DOI: 10.1016/j.ejca.2024.114257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION No definitive answers currently exist regarding optimal first-line therapy for HER2-mutant NSCLC. Access to rapid tissue sequencing is a major barrier to precision drug development in the first-line setting. ctDNA analysis has the potential to overcome these obstacles and guide treatment. METHODS We retrospectively analyzed patients with metastatic HER2-mutant NSCLC who underwent prospective clinical ctDNA sequencing and received systemic therapy at Memorial Sloan Kettering Cancer Center (MSK) from January 2016 to September 2022. HER2 mutations were identified by next-generation sequencing through MSK-IMPACT, MSK-ACCESS or Resolution ctDx LungTM assay. Primary endpoints were time to the next treatment (TTNT) and overall survival (OS). RESULTS Sixty-three patients were included in the primary analysis. Chemoimmunotherapy (33/63, 52.4 %) was the predominant first-line treatment with a median TTNT of 5.1 months (95 %CI 4.1 - 6.1) whereas 55.0 % (22/40) of patients who received second-line T-DXd obtained a median TTNT of 9.2 m (95 % CI, 0-22.2). Plasma ctDNA was tested before first-line therapy in 40 patients with a median OS of 28.0 months (95 % CI 21-34), in whom 31 patients (78.0 %) had detectable ctDNA. HER2 mutations were detected on ctDNA with a median turnaround time of 13 days, occasionally co-occurred with EGFR and MET alterations and were tracked longitudinally correlating with treatment response. Patients with detectable baseline ctDNA had significantly shorter OS (hazard ratio (HR), 5.25; 95 % CI, 1.2-23.9; p = 0.019). CONCLUSION Chemoimmunotherapy remains a major treatment option for metastatic HER2-mutant NSCLC. ctDNA can rapidly detect HER2 and co-mutations, and it has the potential to guide and monitor optimal first-line therapy. As a negative prognostic biomarker, detectable ctDNA at baseline would need to be taken into account for patient selection in future studies.
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Affiliation(s)
- Si-Yang Liu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Chinese Thoracic Oncology Group, Guangzhou, China
| | - Tatiana Erazo
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin Jee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Arfe
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Avantika Gupta
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luke R G Pike
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fernando C Santini
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Bobby Daly
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Kaylie Johnson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jane Sui
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem Riaz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason Chang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Soo-Ryum Yang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Travis
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jiannan Guo
- Resolution Bioscience, Exact Sciences, Kirkland, WA, USA
| | - Eric Gagne
- Resolution Bioscience, Exact Sciences, Kirkland, WA, USA
| | - Kavita Garg
- Resolution Bioscience, Exact Sciences, Kirkland, WA, USA
| | | | - Nancy Y Lee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Mark G Kris
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Howard I Scher
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pedram Razavi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel R Gomez
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Charles M Rudin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Sarat Chandarlapaty
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - James M Isbell
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Bob T Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine, Cornell University, New York, NY, USA.
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Wang L, Wu Y, Ren Z, Chu X, Chen J, Liu L, Zhao J, Yu X, Xie M, Su C. A retrospective study of first-line therapy and subsequent pyrotinib treatment in advanced lung adenocarcinoma with HER2 mutations. Cancer Med 2024; 13:e7335. [PMID: 38923311 PMCID: PMC11194746 DOI: 10.1002/cam4.7335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVES HER2 is an infrequently mutated driver gene in non-small cell lung cancer (NSCLC). At present, there has been no comprehensive large-scale clinical study to establish the optimal first-line treatment strategy for advanced lung adenocarcinoma (LUAD) with HER2-Mutant. Besides that, the effectiveness and safety of pyrotinib, a pan-HER inhibitor, in the context of NSCLC are still undergoing investigation. MATERIALS AND METHODS In this study, we conducted a retrospective data collection of HER2-Mutated advanced LUAD who received first-line treatment and pyrotinib between May 2014 and June 2023. Patients treated with chemotherapy, chemotherapy + immune checkpoint inhibitors (ICIs), chemotherapy + bevacizumab and pyrotinib in first-line treatment. Furthermore, we collected data on the efficacy and safety of pyrotinib in these patients after disease progression. The main endpoint of the study was progression-free survival (PFS). RESULTS In the final analysis, 89 patients were included in the first-line cohort and 30 patients were included in the pyrotinib cohort. In the first-line treatment cohort, chemotherapy + ICIs, chemotherapy + bevacizumab, and pyrotinib exhibited notable survival benefits compared to chemotherapy (median PFS: 9.87 vs. 7.77 vs. 7.10 vs. 5.40 months, p-value < 0.05). Furthermore, patients with a first-line treatment PFS of less than 6 months may potentially benefit from subsequent treatment with pyrotinib (median PFS: 7.467 vs. 3.000, p-value = 0.0490). CONCLUSIONS In the first-line treatment of HER2-Mutant LUAD, regimens involving combinations like chemotherapy + ICIs, chemotherapy + bevacizumab, and pyrotinib may confer enhanced survival advantages compared to chemotherapy. Nevertheless, no significant distinctions were observed among these three treatment strategies, underscoring the imperative to identify biomarkers for the discerning selection of suitable therapeutic modalities. Moreover, patients with suboptimal response to first-line treatment may potentially derive more benefit from pyrotinib.
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Affiliation(s)
- Li Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer InstituteTongji University School of MedicineShanghaiPeople's Republic of China
| | - Yueran Wu
- Department of Chronic Disease Prevention and ControlJiujiang City Center for Disease Control and PreventionJiangxiChina
| | - Zhixuan Ren
- Department of Radiation OncologyHuadong Hospital Affiliated to Fudan UniversityShanghaiPeople's Republic of China
| | - Xiangling Chu
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer InstituteTongji University School of MedicineShanghaiPeople's Republic of China
| | - Jianing Chen
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer InstituteTongji University School of MedicineShanghaiPeople's Republic of China
| | - Li Liu
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer InstituteTongji University School of MedicineShanghaiPeople's Republic of China
| | - Jing Zhao
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer InstituteTongji University School of MedicineShanghaiPeople's Republic of China
| | - Xin Yu
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer InstituteTongji University School of MedicineShanghaiPeople's Republic of China
| | - Mengqing Xie
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer InstituteTongji University School of MedicineShanghaiPeople's Republic of China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer InstituteTongji University School of MedicineShanghaiPeople's Republic of China
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Zhang J, Han W, Guo J, Zhang C, Cao L, Peng L, Han X, Wang Z. Efficacy of immunotherapy in HER2-mutated non-small cell lung cancer: a single-arm meta-analysis. J Cancer Res Clin Oncol 2024; 150:42. [PMID: 38280966 PMCID: PMC10822003 DOI: 10.1007/s00432-023-05509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/13/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Non-small cell lung cancers (NSCLC) harboring Human Epidermal Growth Factor Receptor 2 (HER2) mutations represent a distinct subset with unique therapeutic challenges. Although immune checkpoint inhibitors (ICIs) have been transformative in lung cancer treatment, the efficacy of ICIs in HER2-mutated NSCLC remains to be established. METHODS We systematically searched for real-world studies investigating the use of ICIs in treating HER2-mutated NSCLC, sourced from the PubMed, Cochrane Library, and Embase databases. Outcomes including objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS) were extracted for further analysis. RESULTS Twelve studies involving 260 patients were enrolled in this meta-analysis. Pooled data revealed an ORR of 0.26 (95% CI 0.17-0.34), a DCR of 0.68 (95% CI 0.55-0.81), and a median PFS (mPFS) of 5.36 months (95% CI 3.50-7.21). Notably, in the subgroup receiving combined immune and chemotherapy, the ORR increased to 0.37 (95% CI 0.26-0.49), the DCR to 0.79 (95% CI 0.70-0.87), and the mPFS to 7.10 months (95% CI 5.21-8.99). CONCLUSIONS ICIs demonstrate promising anti-tumor activity and safety in patients with HER2-mutated NSCLC. Furthermore, the combined regimen of ICIs and chemotherapy may provide a significant therapeutic option for this patient population.
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Affiliation(s)
- Juguang Zhang
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Weizhong Han
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jun Guo
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Chufeng Zhang
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Lijun Cao
- Department of Oncology, Liaocheng Chiping District Hospital of Traditional Chinese Medicine, Liaocheng, Shandong, China
| | - Lixiu Peng
- Department of Internal Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiao Han
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
| | - Zhehai Wang
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Ruan M, Chang C, Sun J, Liu L, Wang L, Lei B, Yan H, Zhang H, Xie W, Wang Y. Exploring the correlation between HER2 alterations and 18F-FDG PET/CT metabolic parameters and their prognostic value in EGFR-negative non-small-cell lung cancer patients. J Cancer Res Clin Oncol 2023; 149:14493-14507. [PMID: 37572120 DOI: 10.1007/s00432-023-05218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Our study intended to explore the correlation between HER2 alterations and 18F-FDG PET/CT metabolic parameters and their prognostic value in EGFR-negative non-small-cell lung cancer (NSCLC) patients detected by next-generation sequencing (NGS). METHODS NGS assay was performed in 1737 NSCLC patients, a total of 88 HER2 alterations and 176 negative HER2 with EGFR-negative patients were randomly selected for this study. RESULTS When the HER2 status with EGFR-negative group was analyzed, multivariate analysis showed that smoking status, primary tumor SUVmax (pSUVmax) < 13.03 and stage were the independent deterministic factors of HER2 alterations. Multivariate cox regression analysis revealed that HER2 status, age, smoking status and stage were independent risk factors for overall survival (OS) in EGFR-negative NSCLC patients with different HER2 status. When the HER2 alterations group was separately analyzed, multivariate analysis demonstrated that low pSUVmax < 15.32 and histology were the independent deterministic factors of HER2 mutation. Multivariate cox regression analysis revealed that pSUVmax, smoking status, nodal involvement and treatment methods were independent risk factors for OS in EGFR-negative NSCLC patients with HER2 alterations. CONCLUSION The study revealed that low pSUVmax was associated with HER2 alterations in EGFR-negative NSCLC patients, moreover HER2 mutation and HER2 amplification exhibited distinct 18F-FDG metabolic and clinical characteristics. Furthermore, it explored the prognostic value of HER2 alterations and 18F-FDG PET/CT metabolic parameters of pSUVmax in EGFR-negative NSCLC patients.
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Affiliation(s)
- Maomei Ruan
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu, People's Republic of China
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Cheng Chang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Jianwen Sun
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Liu Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Lihua Wang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Hui Yan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - He Zhang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu, People's Republic of China.
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, People's Republic of China.
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Yang Y, Yang G, Li W, Xu H, Hao X, Zhang S, Ai X, Lei S, Wang Y. Immunotherapy as a later-line option for HER2-altered advanced non-small-cell lung cancer: taxane might be a favorable partner. Future Oncol 2023; 19:2251-2261. [PMID: 37909261 DOI: 10.2217/fon-2022-0879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Aim: To assess the effectiveness of different types of taxanes, including nab-paclitaxel, paclitaxel and docetaxel, and further compare the effectiveness of taxane-based chemotherapy, taxane-based chemotherapy plus angiogenesis inhibitors or taxane-based chemotherapy plus immune checkpoint inhibitors in HER2-altered non-small-cell lung cancer in the second- or third-line setting. Materials & methods: A total of 52 patients were included in the study. Progression-free survival was compared between subgroups. Results: A clinically meaningful improvement in progression-free survival was observed among patients in the nab-paclitaxel group compared with the docetaxel group. Taxane-based chemotherapy plus immune checkpoint inhibitors achieved longer progression-free survival than taxane-based chemotherapy. There was no difference between taxane-based chemotherapy plus immune checkpoint inhibitors and taxane-based chemotherapy plus angiogenesis inhibitors. Conclusion: Nab-paclitaxel appears to be a reasonable alternative to docetaxel. Chemotherapy plus immune checkpoint inhibitors might yield more survival benefits than chemotherapy alone.
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Affiliation(s)
- Yaning Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Chaoyang District, Beijing, 100021, China
| | - Guangjian Yang
- Department of Respiratory Medicine, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, China
| | - Weihua Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Chaoyang District, Beijing, 100021, China
| | - Haiyan Xu
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Chaoyang District, Beijing, 100021, China
| | - Xuezhi Hao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Chaoyang District, Beijing, 100021, China
| | - Shuyang Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Chaoyang District, Beijing, 100021, China
| | - Xin Ai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Chaoyang District, Beijing, 100021, China
| | - Siyu Lei
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Chaoyang District, Beijing, 100021, China
| | - Yan Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Chaoyang District, Beijing, 100021, China
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Warrier A, George A, Thummar V, Mehta P. A Case Report on the Efficacy of Trastuzumab Emtansine in a Patient With Human Epidermal Growth Factor Receptor 2 Exon 20-Mutated Adenocarcinoma of the Lung. Cureus 2023; 15:e38271. [PMID: 37255898 PMCID: PMC10225718 DOI: 10.7759/cureus.38271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/01/2023] Open
Abstract
Lung cancer is the foremost reason for cancer-related mortality among men and women. The ultimate goal of patient supervision post-diagnosis for advanced cases is to improve survival and quality of life with minimal treatment-associated side effects. With advancements in genomic medicine and a better understanding of cell signaling pathways, many actionable gene mutations have been identified in lung carcinoma, which drastically improve survival outcomes. Mutations in human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor together are observed in nearly 1-3% of cases and act as an oncogenic driver. In the case of HER2-mutant lung cancers, there are limited approved agents, and the treatment represents a critical unmet medical need because of the poorer survival outcomes compared to patients with additional oncogenic drivers. The recent standard of care of treatment is chemotherapy, but reports suggest that compared with cytotoxic chemotherapy, patients receiving HER2-directed therapies have relatively longer median survival duration. Here, we report a case of HER2 exon 20-mutated metastatic lung adenocarcinoma patient who received trastuzumab emtansine in the third-line setting and achieved durable disease control.
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Affiliation(s)
| | - Anu George
- Medical Oncology, Aster Medcity, Kochi, IND
| | | | - Priya Mehta
- Medical Affairs, Zydus Lifesciences Limited, Ahmedabad, IND
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Waliany S, Wakelee H, Ramchandran K, Das M, Huang J, Myall N, Li C, Pagtama J, Tisch AH, Neal JW. Characterization of ERBB2 (HER2) Alterations in Metastatic Non-small Cell Lung Cancer and Comparison of Outcomes of Different Trastuzumab-based Regimens. Clin Lung Cancer 2022; 23:498-509. [PMID: 35753988 DOI: 10.1016/j.cllc.2022.05.015] [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: 02/25/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION About 3%-5% of mNSCLC have ERBB2 (HER2) alterations, but currently, there are no FDA-approved targeted therapies for this indication. We compared treatment response between trastuzumab-based and non-targeted regimens in ERBB2-mutant mNSCLC. METHODS This retrospective, single-institution study included patients with mNSCLC with ERBB2 alterations identified by next-generation sequencing. Best overall response was determined using Response Evaluation Criteria in Solid Tumors 1.1. RESULTS We identified 3 groups of patients: ERBB2-mutant/EGFR-wildtype mNSCLC (n = 33), ERBB2-amplified/EGFR-wildtype mNSCLC without concurrent ERBB2 mutations (n = 6), and ERBB2-altered/EGFR-mutant mNSCLC (n = 8). Observed mutations included A775_G776insYVMA (n = 23), Gly778_Pro780dup (n = 4), Ser310Phe (n = 3), and others (n = 5). Among the 33 with ERBB2-mutant/EGFR-wildtype mNSCLC, those with and without A775_G776insYVMA had significantly different median overall survival (OS) of 17.7 and 52.9 months, respectively (Cox regression multivariable HR: 5.03, 95% CI: 1.37-18.51, P = .02). In those with mNSCLC with A775_G776insYVMA, trastuzumab-based therapies were associated with greater OS (20.3 vs. 9.8 months; multivariable HR: 0.19, 95% CI: 0.04-0.87, P = .032). Objective response and disease control rates (median tumor size change) in the 33 patients with ERBB2-mutant/EGFR-wildtype mNSCLC were 40.0% and 80.0% (-35.8%), respectively, for patients treated with trastuzumab deruxtecan; 0% and 30.0% (-5.2%) for trastuzumab emtansine; and 7.1% and 50.0% (-13.0%) for trastuzumab/chemotherapy combinations. CONCLUSION In ERBB2-mutant/EGFR-wildtype mNSCLC, while most trastuzumab-based regimens had modest activity in this real-world analysis, trastuzumab deruxtecan had highest response rates and best tumor size reduction. Receipt of any trastuzumab-based regimen was associated with greater OS with A775_G776insYVMA. There remains an unmet need for approved targeted therapies for ERBB2-mutant/EGFR-wildtype NSCLC.
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Affiliation(s)
- Sarah Waliany
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Heather Wakelee
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA
| | - Kavitha Ramchandran
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA
| | - Millie Das
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA; Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
| | - Jane Huang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA
| | - Nathaniel Myall
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA
| | - Connie Li
- Stanford Cancer Institute, Stanford, CA
| | | | | | - Joel W Neal
- Department of Medicine, Stanford University School of Medicine, Stanford, CA; Division of Oncology, Stanford University School of Medicine, Stanford, CA; Stanford Cancer Institute, Stanford, CA.
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Son J, Jang J, Beyett TS, Eum Y, Haikala HM, Verano A, Lin M, Hatcher JM, Kwiatkowski NP, Eser PÖ, Poitras MJ, Wang S, Xu M, Gokhale PC, Cameron MD, Eck MJ, Gray NS, Jänne PA. A Novel HER2-Selective Kinase Inhibitor Is Effective in HER2 Mutant and Amplified Non-Small Cell Lung Cancer. Cancer Res 2022; 82:1633-1645. [PMID: 35149586 PMCID: PMC10428001 DOI: 10.1158/0008-5472.can-21-2693] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
In-frame insertions in exon 20 of HER2 are the most common HER2 mutations in patients with non-small cell lung cancer (NSCLC), a disease in which approved EGFR/HER2 tyrosine kinase inhibitors (TKI) display poor efficiency and undesirable side effects due to their strong inhibition of wild-type (WT) EGFR. Here, we report a HER2-selective covalent TKI, JBJ-08-178-01, that targets multiple HER2 activating mutations, including exon 20 insertions as well as amplification. JBJ-08-178-01 displayed strong selectivity toward HER2 mutants over WT EGFR compared with other EGFR/HER2 TKIs. Determination of the crystal structure of HER2 in complex with JBJ-08-178-01 suggests that an interaction between the inhibitor and Ser783 may be responsible for HER2 selectivity. The compound showed strong antitumoral activity in HER2-mutant or amplified cancers in vitro and in vivo. Treatment with JBJ-08-178-01 also led to a reduction in total HER2 by promoting proteasomal degradation of the receptor. Taken together, the dual activity of JBJ-08-178-01 as a selective inhibitor and destabilizer of HER2 represents a combination that may lead to better efficacy and tolerance in patients with NSCLC harboring HER2 genetic alterations or amplification. SIGNIFICANCE This study describes unique mechanisms of action of a new mutant-selective HER2 kinase inhibitor that reduces both kinase activity and protein levels of HER2 in lung cancer.
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Affiliation(s)
- Jieun Son
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jaebong Jang
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
| | - Tyler S. Beyett
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
| | - Yoonji Eum
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Heidi M. Haikala
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alyssa Verano
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
| | - Mika Lin
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - John M. Hatcher
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
| | - Nicholas P. Kwiatkowski
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
| | - Pinar Ö. Eser
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael J. Poitras
- Experimental Therapeutics Core, Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephen Wang
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Man Xu
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Prafulla C. Gokhale
- Experimental Therapeutics Core, Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael D. Cameron
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, Florida
| | - Michael J. Eck
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
| | - Nathanael S. Gray
- Chemical and Systems Biology, Chem-H, Stanford Cancer Institute, Stanford Medicine, Stanford University, Stanford, California
| | - Pasi A. Jänne
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
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9
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Yang G, Yang Y, Liu R, Li W, Xu H, Hao X, Li J, Xing P, Zhang S, Ai X, Xu F, Wang Y. First-line immunotherapy or angiogenesis inhibitor plus chemotherapy for HER2-altered NSCLC: a retrospective real-world POLISH study. Ther Adv Med Oncol 2022; 14:17588359221082339. [PMID: 35251321 PMCID: PMC8894956 DOI: 10.1177/17588359221082339] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background: There have been no comprehensive large-scale studies that have evaluated the benefits of chemotherapy-based regimens in addressing HER2-altered advanced non-small-cell lung cancer (NSCLC) in a first-line setting. Data on HER2 alteration subtypes and concomitant alterations are also limited. Accordingly, our retrospective, real-world POLISH study assesses the efficacy of first-line chemotherapy alone (C) as well as combinations with immune checkpoint inhibitors (C + I) or angiogenesis inhibitors (C + A) for HER2-altered NSCLC; molecular features are also reported. Methods: HER2-altered NSCLC patients who received a first-line treatment between November 2015 and September 2021 were screened. Patients treated with C, C + I, or C + A were included in our final efficacy analysis. Progression-free survival (PFS) was compared between the subgroups. A Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis was performed to evaluate concomitant alterations. Results: A total of 293 patients were screened, with an identification of HER2 amplification and 37 distinct HER2 mutations, and 210 cases treated with C, C + I, or C + A were ultimately included. C + A achieved longer PFS than C (5.63 vs 4.03 months, hazard ratio: 0.64, 95% confidence interval [CI]: 0.46–0.88, p = 0.006). C + I did not improve median PFS compared to C + A or C (both p > 0.05), despite the programmed cell death ligand-1 (PD-L1) expression or tumor mutational burden. KEGG analysis revealed that concomitant upregulation of PI3 K/AKT pathway signaling was common in HER2-altered NSCLC. Conclusion: Chemotherapy plus angiogenesis inhibitors may yield a greater survival benefit than chemotherapy alone in a first-line setting for HER2-altered NSCLC, whereas an immune-based combination therapy may not be superior to a sole chemotherapy regimen. Activation of PI3 K/AKT signaling may mediate immunosuppression in HER2-altered NSCLC.
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Affiliation(s)
- Guangjian Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaning Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runze Liu
- Guangxi Medical University, Nanning, China
| | - Weihua Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuezhi Hao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junling Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Puyuan Xing
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuyang Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Ai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Street South, Chaoyang District, Beijing 100021, China
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10
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Wu R, Yuan B, Li C, Wang Z, Song Y, Liu H. A narrative review of advances in treatment and survival prognosis of HER2-positive malignant lung cancers. J Thorac Dis 2021; 13:3708-3720. [PMID: 34277062 PMCID: PMC8264687 DOI: 10.21037/jtd-20-3265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/14/2021] [Indexed: 12/15/2022]
Abstract
Human epidermal growth factor receptor 2 (HER2), as a receptor tyrosine kinase of EGF receptor family, whose mutation is often associated with even if less frequency but poor prognosis and shorter survival in pulmonary malignant tumor. HER2 status include mutation, overexpression, amplification and also some rare genotypes, detected by next generation sequencing (NGS), immunohistochemistry (IHC), and also fluorescence in situ hybridization (FISH). Different genotypes represent different therapeutic targets and indicate different clinical prognosis concluded by previous studies. Unfortunately, no standard guidelines for first-line treatment are widely recognized, and current therapeutic schedules include chemotherapy, radiotherapy, targeted therapy, and immunotherapy. Especially for patients with advanced metastasis, chemotherapy is based as a systemic therapy using studies of breast cancer or EGFR-positive lung adenocarcinoma as a template. Studies already explored treatment including EGFR tyrosine kinase inhibitors (TKIs) such as gefitinib and afatinib, and also trastuzumab and its conjugation like HER2-targeted antibody-drug conjugate trastuzumab emtansine (T-DM1) and conjugate trastuzumab deruxtecan (T-DXd). Also, he researches explored combination therapy with chemotherapy and TKIs or monoclonal antibodies. This review describes commonly used therapies for HER2-positive/HER2-overexpression patients and general relationship between genotypes of HER2, drug selection and final prognosis in order to provide suggestions for future diagnosis and treatment.
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Affiliation(s)
- Ranpu Wu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University of Medicine, Nanjing, China
| | - Bingxiao Yuan
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
| | - Chuling Li
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
| | - Zimu Wang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
| | - Hongbing Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southeast University of Medicine, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing Medical University, Nanjing, China
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11
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Zhao S, Xian X, Tian P, Li W, Wang K, Li Y. Efficacy of Combination Chemo-Immunotherapy as a First-Line Treatment for Advanced Non-Small-Cell Lung Cancer Patients With HER2 Alterations: A Case Series. Front Oncol 2021; 11:633522. [PMID: 33959501 PMCID: PMC8093620 DOI: 10.3389/fonc.2021.633522] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/26/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Although the treatment of non-small-cell lung cancer (NSCLC) patients with human epidermal growth factor receptor 2 (HER2) alterations has been studied for years, the overall response rate (ORR) of these patients is still unsatisfactory, and more therapeutic strategies are needed. Little is known about the combination of chemo- and immunotherapy in HER2-altered lung cancer treatment. Materials and Methods We report five cases of advanced NSCLC with HER2 insertion mutation or amplification treated with immunotherapy combined with chemotherapy as the first-line treatment. The HER2 alteration type, duration of treatment and survival were also analyzed. Results The five advanced NSCLC patients, three with HER2 mutations and two with HER2 amplifications, received chemo-immunotherapy as the first-line treatment. The average patient age was 54.6 years. Three patients were females, and two were males. Among all the patients, only one had a smoking history. The immunotherapies used were as follows: two patients were treated with sintilimab, and three patients were treated with pembrolizumab. Only one patient had squamous carcinoma, and she was also the only patient with a complete response (CR). The progression-free survival (PFS) ranged from 2-12 months, with a median PFS of 8.0 months. Conclusions Chemo-immunotherapy may be a promising first-line treatment option for NSCLC patients with HER2 alterations. Further clinical trials are required to confirm this therapeutic option.
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Affiliation(s)
- Shuang Zhao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xinghong Xian
- Clinical Medicine of West China Medical School/West China Hospital, Sichuan University, Chengdu, China
| | - Panwen Tian
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yalun Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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12
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De Toma A, Lo Russo G, Signorelli D, Pagani F, Randon G, Galli G, Prelaj A, Ferrara R, Proto C, Ganzinelli M, Zilembo N, de Braud F, Garassino MC. Uncommon targets in non-small cell lung cancer: Everyone wants a slice of cake. Crit Rev Oncol Hematol 2021; 160:103299. [PMID: 33722699 DOI: 10.1016/j.critrevonc.2021.103299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/14/2020] [Accepted: 03/10/2021] [Indexed: 01/15/2023] Open
Abstract
Target therapies completely changed the clinical approach in EGFR mutated and ALK rearranged non-small cell lung cancer, ensuring these patients exceptional outcomes with a better toxicity profile compared to conventional chemotherapy. In recent years, beyond EGFR and ALK alterations, new data are emerging about less common alterations, new drugs have been already approved and others agents have been recently investigated or are currently under investigation. In this review we will discuss some uncommon alterations in non-small cell lung cancer such as ROS1, BRAF, RET, HER2, NTRK, MET and other targets that are in an early evaluation phase. We will summarize the characteristics of patients harboring these alterations, the already approved or under investigation therapies and the related resistance mechanisms.
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Affiliation(s)
- Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Pagani
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Electronics, Information, and Bioengineering, Polytechnic University of Milan, Milan, Italy
| | - Roberto Ferrara
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicoletta Zilembo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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13
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Shan J, Ruan J, Tan Y, Yan L, Chen S, Du M, Wang L. Efficacy of Pyrotinib in a Heavily Pretreated Patient with Lung Adenocarcinoma Harboring HER2 Amplification and Exon 20 Insertions: A Case Report. Onco Targets Ther 2020; 13:9849-9856. [PMID: 33061462 PMCID: PMC7537839 DOI: 10.2147/ott.s271999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/05/2020] [Indexed: 12/28/2022] Open
Abstract
The clinical benefits of HER2 inhibitors in patients with non-small cell lung cancer (NSCLC) have been limited. There is a paucity of effective therapies in NSCLC after developing resistance to initial anti-HER2 therapy. Herein, we presented the clinical benefit of pyrotinib in a 53-year-old patient with advanced lung adenocarcinoma whose circulating tumor DNA (ctDNA) analysis of pleural effusion revealed the coexistence of HER2 exon 20 p.Y772_A775dup (mutation ratio: 38.86%) and HER2 amplification (copy number: 4.5) following failures of multiple therapies including afatinib and ado-trastuzumab emtansine (T-DM1). Notably, pyrotinib treatment induced rapid and marked improvement of clinical symptoms, and partial response was observed after 8 weeks. CtDNA monitoring during the treatment showed that the mutation ratio of HER2 decreased to 7.99%, and the amplification disappeared. The patient achieved a progression-free survival of 7.5 months after treatment with pyrotinib. Thus, pyrotinib may be a new treatment strategy for the subgroup of lung adenocarcinoma patients, with coexistence of HER2 exon 20 p.Y772_A775dup and HER2 amplification even after failures of multiple anti-HER2 therapies. It also indicated the value of capture-based next-generation sequencing to monitor and guide therapy.
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Affiliation(s)
- Jianzhen Shan
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jian Ruan
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yanbin Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Li Yan
- Department of Medicine, Burning Rock Biotech, Guangzhou, People's Republic of China
| | - Songan Chen
- Department of Medicine, Burning Rock Biotech, Guangzhou, People's Republic of China
| | - Miaoyan Du
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Lingjie Wang
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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14
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Shih JY, Inoue A, Cheng R, Varea R, Kim SW. Does Pemetrexed Work in Targetable, Nonsquamous Non-Small-Cell Lung Cancer? A Narrative Review. Cancers (Basel) 2020; 12:cancers12092658. [PMID: 32957736 PMCID: PMC7563381 DOI: 10.3390/cancers12092658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022] Open
Abstract
Simple Summary The chemotherapy agent pemetrexed is currently considered in combination with other therapies for the treatment of advanced nonsquamous non-small-cell lung cancer (NSCLC) in patients negative for gene mutations/rearrangements. The aim of this review was to highlight data from clinical studies with pemetrexed in patients with advanced nonsquamous NSCLC positive for gene mutations/rearrangements. The results of the review suggest that pemetrexed could be a treatment option in patients with advanced nonsquamous NSCLC positive for certain gene mutations/rearrangements. Abstract Pemetrexed is currently mainly considered for the treatment of advanced nonsquamous non-small-cell lung cancer (NSCLC) negative for gene mutations/rearrangements (wild-type disease (WTD)). This narrative review aimed to highlight the role of pemetrexed in the treatment of onco-driven nonsquamous advanced NSCLC by reviewing published clinical studies. For epidermal growth factor receptor (EGFR) mutations, patient survival following first-line pemetrexed–platinum was longer than for WTD. Later-line pemetrexed-based treatment after tyrosine kinase inhibitor (TKI) failure provided greater benefits than non-pemetrexed regimens. First- and later-line pemetrexed-based therapy also provided survival benefits in patients with anaplastic lymphoma kinase (ALK) or ROS proto-oncogene 1 (ROS1) rearrangements. In patients with rearranged during transfection (RET) proto-oncogene rearrangements, survival with pemetrexed was similar to that in ALK- and ROS1-positive patients and longer than that in patients with Kirsten rat sarcoma (KRAS) virus proto-oncogene mutations or WTD, although the available studies were limited. For Erb-b2 receptor tyrosine kinase 2 (ERRB2) mutations, first-line pemetrexed showed outcomes similar to those for EGFR and KRAS alterations. Data on pemetrexed in patients with KRAS mutations or MNNG HOS-transforming (MET) expression were limited. Pemetrexed could be an option for first- and second-line treatment for TKI failure in nonsquamous advanced NSCLC with select targetable driver mutations.
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Affiliation(s)
- Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, No. 7 Zhongshan South Road, Zhongzheng District, Taipei City 100, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University, 7 Chung-Shan S. Rd., Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456 (ext. 62905)
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan;
| | - Rebecca Cheng
- Eli Lilly and Company, Songshan District, Fuxing North Road 365, Taipei 105, Taiwan; (R.C.); (R.V.)
| | - Rocio Varea
- Eli Lilly and Company, Songshan District, Fuxing North Road 365, Taipei 105, Taiwan; (R.C.); (R.V.)
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea;
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15
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Jiao H, Zhao X, Han J, Zhang J, Wang J. Synthesis of a novel 99mTc labeled GE11 peptide for EGFR SPECT imaging. Int J Radiat Biol 2020; 96:1443-1451. [PMID: 32809887 DOI: 10.1080/09553002.2020.1811419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE This study investigated a novel SPECT agent for the noninvasive imaging of EGFR-overexpressing tumors. METHODS The EGFR-targeting peptide GE11 was synthesized with the introduction of four amino acids (GGGC) to its C-terminal to act as a strong chelator and radiolabeled using 99mTc. The radiochemical yield of the 99mTc-peptide-GE11 were evaluated using RP-HPLC. Cellular assays of the probe were performed on two NSCLC cell lines: A549 (high expression) and H23 (low expression). Biodistribution and SPECT imaging were performed in BALB/c nude mice bearing A549 and H23 NSCLC xenografts. RESULTS The 99mTc-peptide-GE11 was prepared at high efficiency with radiochemical yield of 98.40 ± 1.00 % and it showed favorable stability. The cellular uptake was significantly higher in A549 than in H23 at all time points (especially at 1 h, which was 10.34 ± 0.72 and 2.04 ± 0.18, respectively). A nearly 56% reduction in probe uptake was observed after pretreatment with excess unlabeled peptides. The performance of SPECT imaging and biodistribution demonstrated higher uptake of the 99mTc-peptide-GE11 in A549 xenograft than in H23 xenografts. CONCLUSION The new SPECT tracer 99mTc-peptide-GE11 showed EGFR specificity, favorable pharmacokinetics and great potential for EGFR-targeted imaging.
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Affiliation(s)
- Honglei Jiao
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinming Zhao
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingya Han
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingmian Zhang
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianfang Wang
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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16
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Zhang X, Lv J, Wu Y, Qin N, Ma L, Li X, Nong J, Zhang H, Zhang Q, Yang X, Shi H, Wang J, Zhang S. HER2 Exon 20 Insertion Mutations in Lung Adenocarcinoma: Case Series and Response to Pyrotinib. Front Oncol 2020; 10:1162. [PMID: 32850330 PMCID: PMC7411254 DOI: 10.3389/fonc.2020.01162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
HER2 mutations have emerged as oncogenic driver gene mutations in non-small cell lung cancer (NSCLC), which have not been described in detail like other driver gene mutations. Here, 295 patients with advanced lung adenocarcinoma were retrospectively screened for HER2 mutations using next-generation sequencing (NGS), and the positive cases were validated by Sanger sequencing. We identified five cases with HER2 exon 20 insertions, representing 1.7% of 295 lung adenocarcinomas. Among them, four different subtypes of HER2 exon 20 insertions were identified, including a rare subtype G778_S779insCPG never reported before with a partial response (PR) to pyrotinib and progression-free survival (PFS) of 12.8 months. Our findings reveal that HER2 exon 20 insertion mutations were detected in a small subset of lung adenocarcinomas. Given the different drug sensitivities, determining the mutation subtype by next-generation sequencing at the time of diagnosis might make sense.
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Affiliation(s)
- Xinyong Zhang
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Jialin Lv
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yuhua Wu
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Na Qin
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Li Ma
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Xi Li
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Jingying Nong
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hui Zhang
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Quan Zhang
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Xinjie Yang
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Huibo Shi
- Organ Transplantation Research Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinghui Wang
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Shucai Zhang
- Department of Medical Oncology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
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17
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Zhou C, Li X, Wang Q, Gao G, Zhang Y, Chen J, Shu Y, Hu Y, Fan Y, Fang J, Chen G, Zhao J, He J, Wu F, Zou J, Zhu X, Lin X. Pyrotinib in HER2-Mutant Advanced Lung Adenocarcinoma After Platinum-Based Chemotherapy: A Multicenter, Open-Label, Single-Arm, Phase II Study. J Clin Oncol 2020; 38:2753-2761. [PMID: 32614698 DOI: 10.1200/jco.20.00297] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Targeted therapies against non-small-cell lung cancer (NSCLC) harboring HER2 mutations remain an unmet need. In this study, we assessed the efficacy and safety of pyrotinib in patients with HER2-mutant advanced NSCLC in a prospective, multicenter, open-label, single-arm, phase II study. PATIENTS AND METHODS Patients with stage IIIB or IV HER2-mutant lung adenocarcinoma who were previously treated with platinum-based chemotherapy were enrolled to receive pyrotinib at a dose of 400 mg/d for 21-day cycles. The primary end point was objective response rate per independent review committee (IRC). RESULTS Between October 20, 2016, and December 10, 2018, 60 patients received pyrotinib monotherapy. At baseline, 58 (96.7%) were stage IV, and 25 (41.7%) received at least 2 lines of prior chemotherapy. As of data cutoff on June 20, 2019, IRC-assessed objective response rate was 30.0% (95% CI, 18.8% to 43.2%). All subgroups of patients with different HER2 mutation types showed a favorable objective response rate. The objective response rates were similar between patients with and without brain metastases (25.0% v 31.3%). The median duration of response was 6.9 months (95% CI, 4.9 to 11.1 months). The median progression-free survival was 6.9 months (95% CI, 5.5 to 8.3 months) per IRC. The median overall survival was 14.4 months (95% CI, 12.3 to 21.3 months). Treatment-related adverse events of grade 3 or 4 occurred in 28.3% of patients, with the most common being diarrhea (20.0%; all grade 3). No treatment-related deaths were reported. CONCLUSION Pyrotinib showed promising antitumor activity and an acceptable safety profile in chemotherapy-treated patients with HER2-mutant NSCLC.
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Affiliation(s)
- Caicun Zhou
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xingya Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Guanghui Gao
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | | | - Jianhua Chen
- Cancer Hospital of Central South University, Changsha, China
| | - Yongqian Shu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | - Yun Fan
- Zhejiang Cancer Hospital, Hangzhou, China
| | - Jian Fang
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Jun Zhao
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianxing He
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fengying Wu
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Medicine Co, Ltd, Shanghai, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Medicine Co, Ltd, Shanghai, China
| | - Xiang Lin
- Jiangsu Hengrui Medicine Co, Ltd, Shanghai, China
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18
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Zhou N, Zhao J, Huang X, Shen H, Li W, Xu Z, Xia Y. The efficacy of afatinib in patients with HER2 mutant non-small cell lung cancer: a meta-analysis. Transl Cancer Res 2020; 9:3634-3642. [PMID: 35117726 PMCID: PMC8797916 DOI: 10.21037/tcr.2020.04.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Erb-b2 receptor tyrosine kinase 2 (ErbB2/HER2) mutation has been found in approximately 2-4% of non-small cell lung cancer (NSCLC) patients and has been identified as one of carcinogenic mutations. Afatinib, a member of irreversible HER family inhibitor, has been investigated by a number of literatures, yet whose therapeutic efficiency remains uncertain in NSCLC with HER2 mutation. To elucidate the clinical efficacy and safety of afatinib in treating HER2 mutant NSCLC, we integrated and reanalyzed the data from current available studies. METHODS We conducted a systematic literature search for published articles regarding afatinib treating HER2-mutant lung cancer. Eight studies met the inclusion and exclusion criteria. The main outcomes were the objective response rate (ORR) and disease control rate (DCR). RESULTS Ninety-five patients with HER2 mutations were identified from eight studies. The pooled ORR was 21% (95% CI: 11-34%) and the pooled DCR was 66% (95% CI: 57-76%). The patients harboring A775-G776ins YVMA mutation, the most common subtype of HER2 exon 20 mutation, derived greater clinical benefit. Most adverse events were grade 1-2, except a case of fatal acute renal injury, possibly related to afatinib. CONCLUSIONS Afatinib monotherapy demonstrated frustrating anti-tumor activity with tolerable toxicity in HER2 mutant NSCLC. Based on current available data, we do not recommend the regular application of afatinib in NSCLC with HER2 mutations unless the response heterogeneity with specific genomic variant of HER2 mutation was further clarified.
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Affiliation(s)
- Niya Zhou
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jie Zhao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xiu Huang
- Department of Respiratory and Critical Care Medicine, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China
| | - Hui Shen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.,Department of Respiratory and Critical Care Medicine, Huzhou Central Hospital, Huzhou 313000, China
| | - Wen Li
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhihao Xu
- Department of Respiratory and Critical Care Medicine, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China
| | - Yang Xia
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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19
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Russo A, Lopes AR, McCusker MG, Garrigues SG, Ricciardi GR, Arensmeyer KE, Scilla KA, Mehra R, Rolfo C. New Targets in Lung Cancer (Excluding EGFR, ALK, ROS1). Curr Oncol Rep 2020; 22:48. [PMID: 32296961 DOI: 10.1007/s11912-020-00909-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Over the last two decades, the identification of targetable oncogene drivers has revolutionized the therapeutic landscape of non-small cell lung cancer (NSCLC). The extraordinary progresses made in molecular biology prompted the identification of several rare molecularly defined subgroups. In this review, we will focus on the novel and emerging actionable oncogenic drivers in NSCLC. RECENT FINDINGS Recently, novel oncogene drivers emerged as promising therapeutic targets besides the well-established EGFR mutations, and ALK/ROS1 rearrangements, considerably expanding the list of potential exploitable genetic aberrations. However, the therapeutic algorithm in these patients is far less defined. The identification of uncommon oncogene drivers is reshaping the diagnostic and therapeutic approach to NSCLC. The introduction of novel highly selective inhibitors is expanding the use of targeted therapies to rare and ultra-rare subsets of patients, further increasing the therapeutic armamentarium of advanced NSCLC.
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Affiliation(s)
- Alessandro Russo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 S Greene Street Rm. N9E08, Baltimore, MD, 21201, USA.,Medical Oncology Unit, A.O. Papardo & Department of Human Pathology, University of Messina, Contrada Papardo, 98158, Messina, Italy
| | - Ana Rita Lopes
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 S Greene Street Rm. N9E08, Baltimore, MD, 21201, USA.,Portuguese Institute of Oncology (IPO), Porto, Portugal
| | - Michael G McCusker
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 S Greene Street Rm. N9E08, Baltimore, MD, 21201, USA
| | - Sandra Gimenez Garrigues
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 S Greene Street Rm. N9E08, Baltimore, MD, 21201, USA
| | - Giuseppina R Ricciardi
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology, University of Messina, Contrada Papardo, 98158, Messina, Italy
| | - Katherine E Arensmeyer
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 S Greene Street Rm. N9E08, Baltimore, MD, 21201, USA
| | - Katherine A Scilla
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 S Greene Street Rm. N9E08, Baltimore, MD, 21201, USA
| | - Ranee Mehra
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 S Greene Street Rm. N9E08, Baltimore, MD, 21201, USA
| | - Christian Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 S Greene Street Rm. N9E08, Baltimore, MD, 21201, USA.
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20
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Wang Y, Jiang T, Qin Z, Jiang J, Wang Q, Yang S, Rivard C, Gao G, Ng TL, Tu MM, Yu H, Ji H, Zhou C, Ren S, Zhang J, Bunn P, Doebele RC, Camidge DR, Hirsch FR. HER2 exon 20 insertions in non-small-cell lung cancer are sensitive to the irreversible pan-HER receptor tyrosine kinase inhibitor pyrotinib. Ann Oncol 2020; 30:447-455. [PMID: 30596880 DOI: 10.1093/annonc/mdy542] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Effective targeted therapy for non-small-cell lung cancer (NSCLC) patients with human epidermal growth factor receptor 2 (HER2) mutations remains an unmet need. This study investigated the antitumor effect of an irreversible pan-HER receptor tyrosine kinase inhibitor, pyrotinib. PATIENTS AND METHODS Using patient-derived organoids and xenografts established from an HER2-A775_G776YVMA-inserted advanced lung adenocarcinoma patient sample, we investigated the antitumor activity of pyrotinib. Preliminary safety and efficacy of pyrotinib in 15 HER2-mutant NSCLC patients in a phase II clinical trial are also presented. RESULTS Pyrotinib showed significant growth inhibition of organoids relative to afatinib in vitro (P = 0.0038). In the PDX model, pyrotinib showed a superior antitumor effect than afatinib (P = 0.0471) and T-DM1 (P = 0.0138). Mice treated with pyrotinib displayed significant tumor burden reduction (mean tumor volume, -52.2%). In contrast, afatinib (25.4%) and T-DM1 (10.9%) showed no obvious reduction. Moreover, pyrotinib showed a robust ability to inhibit pHER2, pERK and pAkt. In the phase II cohort of 15 patients with HER2-mutant NSCLC, pyrotinib 400 mg resulted in a objective response rate of 53.3% and a median progression-free survival of 6.4 months. CONCLUSION Pyrotinib showed activity against NSCLC with HER2 exon 20 mutations in both patient-derived organoids and a PDX model. In the clinical trial, pyrotinib showed promising efficacy. CLINICAL TRIAL REGISTRATION NCT02535507.
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Affiliation(s)
- Y Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - T Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Z Qin
- Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai
| | - J Jiang
- Department of Medical Affairs, Hengrui Pharmaceutical Company, Shanghai, China
| | - Q Wang
- Department of Medical Affairs, Hengrui Pharmaceutical Company, Shanghai, China
| | - S Yang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - C Rivard
- Departments of Medicine, Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora
| | - G Gao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - T L Ng
- Departments of Medicine, Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora
| | - M M Tu
- Department of Surgery (Urology), University of Colorado Anschutz Medical Campus, Aurora; University of Colorado Comprehensive Cancer Center, Aurora
| | - H Yu
- Departments of Medicine, Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora
| | - H Ji
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai; Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai
| | - C Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - S Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai; Departments of Medicine, Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora.
| | - J Zhang
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, USA
| | - P Bunn
- Departments of Medicine, Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora
| | - R C Doebele
- Departments of Medicine, Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora
| | - D R Camidge
- Departments of Medicine, Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora
| | - F R Hirsch
- Departments of Medicine, Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora
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21
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Xu F, Yang G, Xu H, Yang L, Qiu W, Wang Y. Treatment outcome and clinical characteristics of HER2 mutated advanced non-small cell lung cancer patients in China. Thorac Cancer 2020; 11:679-685. [PMID: 31975535 PMCID: PMC7049517 DOI: 10.1111/1759-7714.13317] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND HER2 mutation is found in 1%-2% of lung cancer patients. Studies comparing chemotherapy to HER2-TKIs are limited. This study aimed to investigate the molecular and clinical patterns of HER2 mutations in advanced non-small cell lung cancer (NSCLC), and compare the different outcomes between chemotherapy and HER2-TKIs. METHODS Advanced or recurrent non-small cell lung cancer patients with de novo HER2 mutations (N = 75) were included in this study. Molecular information, clinical features, and treatment outcomes were retrospectively collected from a web-based patient registry and hospital chart review. RESULTS Between October 2012 and December 2018, 65 patients with in-frame insertion mutations, eight with point mutations and two with gene amplification were found. The most common subtypes of insertion mutations were A775_G776insYVMA, G776delinsVC, and V777_G778insGSP. HER2 mutated patients were mostly young-aged, females, never or light smokers, with adenocarcinoma. Chemotherapy achieved better outcomes than HER2-TKIs (median PFS: 5.5 vs. 3.7 months in the first-line setting and 4.2 vs. 2.0 months in the second-line setting, P = 0.001 and 0.031, respectively). In particular for the most common subtype, YVMA insertions, PFS was significantly longer in chemotherapy than HER2-TKIs both in the first-line (6.0 vs. 2.6 months, P = 0.008) and the second-line (4.2 vs. 2.6 months P < 0.001). CONCLUSIONS HER2 mutated lung cancer patients were younger, mostly females, never or light smokers, with histologically diagnosed adenocarcinomas. Compared with afatinib, chemotherapy might bring more benefit to HER2 mutated advanced lung cancer patients, especially the most common type of HER2 exon 20 insertions, A775_G776insYVMA subtype. KEY POINTS Chemotherapy achieved better outcomes than afatinib for Chinese HER2 mutated advanced NSCLC patients, especially for the most common subtype, YVMA insertions.
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Affiliation(s)
- Fei Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangjian Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Yan Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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22
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Shin JW, Kim S, Ha S, Choi B, Kim S, Im SA, Yoon TY, Chung J. The HER2 S310F Mutant Can Form an Active Heterodimer with the EGFR, Which Can Be Inhibited by Cetuximab but Not by Trastuzumab as well as Pertuzumab. Biomolecules 2019; 9:E629. [PMID: 31635022 PMCID: PMC6843359 DOI: 10.3390/biom9100629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
G309 or S310 mutations on the HER2 extracellular domain II induce receptor activation. Clinically, S310F is most frequent among HER2 extracellular domain mutations and patients with the S310F mutation without HER2 amplification responded to trastuzumab with or without the pertuzumab combination. However, the ability of S310F mutant to form homodimers or heterodimers with wild-type HER2 and other HER receptors, or their reactivity to trastuzumab and pertuzumab treatments, has not been reported. We overexpressed S310F as well as G309A, G309E and S310Y HER2 mutants and tested their reactivity to trastuzumab and pertuzumab. All mutants reacted to trastuzumab, but S310F mutant did not react to pertuzumab along with S310Y or G309E mutants. Thereafter, we tested the effects of trastuzumab and pertuzumab on 5637 cell line expressing both wild-type HER2 and S310F mutant. The ligand-independent HER2 homodimerization blocking antibody, trastuzumab, did not inhibit the activation of the HER2 receptor, suggesting that the S310F HER2 mutant did not form homodimers or heterodimers with wild-type HER2. Because 5637 cells overexpressed the EGFR, the effects of cetuximab and gefitinib were determined, and both inhibited the activation of HER2 and significantly reduced cell growth. Because pertuzumab did not inhibit the phosphorylation of HER2 while it bound to wild-type HER2, EGFR-mediated phosphorylation is expected to occur on the S310F mutant. To confirm whether the S310F mutant HER2 retained its affinity to the EGFR, single molecule interaction analyses using TIRF microscopy were performed, which showed that S310F mutant successfully formed complexes with EGFR. In conclusion, HER2 S310F mutant can form an active heterodimer with the EGFR and it can be inhibited by cetuximab, but not by trastuzumab in combination with pertuzumab.
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Affiliation(s)
- Jung Won Shin
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul National University, Seoul 03080, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul 03080, Korea.
| | - Soohyun Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul 03080, Korea.
- Department of Cancer Biology, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Suji Ha
- Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul 03080, Korea.
- Department of Cancer Biology, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Byungsan Choi
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea.
| | - Seongyeong Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul 03080, Korea.
| | - Seock-Ah Im
- Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul 03080, Korea.
- Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Tae-Young Yoon
- Department of Biological Sciences, Seoul National University, Seoul 08826, Korea.
| | - Junho Chung
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul National University, Seoul 03080, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul 03080, Korea.
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23
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Oh DY, Bang YJ. HER2-targeted therapies - a role beyond breast cancer. Nat Rev Clin Oncol 2019; 17:33-48. [PMID: 31548601 DOI: 10.1038/s41571-019-0268-3] [Citation(s) in RCA: 538] [Impact Index Per Article: 107.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 12/13/2022]
Abstract
HER2 is an established therapeutic target in a large subset of women with breast cancer; a variety of agents including trastuzumab, pertuzumab, lapatinib, neratinib and trastuzumab emtansine (T-DM1) have been approved for the treatment of HER2-positive breast cancer. HER2 is also overexpressed in subsets of patients with other solid tumours. Notably, the addition of trastuzumab to first-line chemotherapy has improved the overall survival of patients with HER2-positive gastric cancer, and has become the standard-of-care treatment for this group of patients. However, trials involving pertuzumab, lapatinib and T-DM1 have failed to provide significant improvements in the outcomes of patients with HER2-positive gastric cancer. HER2-targeted therapies are also being tested in patients with other solid tumours harbouring HER2 overexpression, and/or amplifications or other mutations of the gene encoding HER2 (ERBB2), including biliary tract, colorectal, non-small-cell lung and bladder cancers. The experience with gastric cancer suggests that the successes observed in HER2-positive breast cancer might not be replicated in these other tumour types, owing to differences in the level of HER2 overexpression and other aspects of disease biology. In this Review, we describe the current role of HER2-targeted therapies beyond breast cancer and also highlight the potential of novel HER2-targeted agents that are currently in clinical development.
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Affiliation(s)
- Do-Youn Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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24
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Offin M, Feldman D, Ni A, Myers ML, Lai WV, Pentsova E, Boire A, Daras M, Jordan EJ, Solit DB, Arcila ME, Jones DR, Isbell JM, Beal K, Young RJ, Rudin CM, Riely GJ, Drilon A, Tabar V, DeAngelis LM, Yu HA, Kris MG, Li BT. Frequency and outcomes of brain metastases in patients with HER2-mutant lung cancers. Cancer 2019; 125:4380-4387. [PMID: 31469421 DOI: 10.1002/cncr.32461] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/13/2019] [Accepted: 06/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mutations in human epidermal growth factor receptor 2 (HER2; also known as ERBB2) are found in approximately 2% of lung adenocarcinomas. The frequency and clinical course of brain metastases in this oncogenic subset are ill defined. METHODS Baseline and subsequent development of brain metastases was evaluated in consecutive patients with HER2-mutant (n = 98), epidermal growth factor receptor (EGFR)-mutant (n = 200), and KRAS-mutant lung cancers (n = 200). RESULTS At metastatic diagnosis, the odds ratio (ORs) for brain metastases was similar for patients whose tumors harbored HER2 mutations (19%) in comparison with patients with KRAS mutations (24%; OR for HER2 vs KRAS, 0.7; P = .33) but lower compared to patients with EGFR mutations (31%; OR for HER2 vs EGFR, 0.5; P = .03). Patients with lung cancer and HER2 mutations developed more brain metastases on treatment than patients with KRAS mutations (28% vs 8%; hazard ratio [HR], 5.2; P < .001) and trended more than patients with EGFR mutations (28% vs 16%; HR, 1.7; P = .06). Patients with HER2 YVMA mutations also developed more brain metastases on treatment than patients with KRAS mutations (HR, 5.9; P < .001). The median overall survival (OS) was shorter for patients with HER2-mutant (1.6 years; P < .001) or KRAS-mutant lung cancers (1.1 years; P < .001) than patients with EGFR-mutant lung cancers (3.0 years). Brain metastases occurred in 47% of patients with HER2-mutant lung cancers, which imparted shorter OS (HR, 2.7; P < .001). CONCLUSIONS These data provide a framework for brain imaging surveillance in patients with HER2-mutant lung cancers and underpin the need to develop HER2-targeted agents with central nervous system activity.
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Affiliation(s)
- Michael Offin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Daniel Feldman
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ai Ni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mackenzie L Myers
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - W Victoria Lai
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Elena Pentsova
- Weill Cornell Medical College, New York, New York.,Neurology Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adrienne Boire
- Weill Cornell Medical College, New York, New York.,Neurology Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mariza Daras
- Weill Cornell Medical College, New York, New York.,Neurology Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emmet J Jordan
- Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - David B Solit
- Weill Cornell Medical College, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Marie-Josée & Henry R. Kravis Center for Molecular Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Weill Cornell Medical College, New York, New York.,Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James M Isbell
- Weill Cornell Medical College, New York, New York.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J Young
- Weill Cornell Medical College, New York, New York.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles M Rudin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Gregory J Riely
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Alexander Drilon
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Viviane Tabar
- Weill Cornell Medical College, New York, New York.,Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa M DeAngelis
- Weill Cornell Medical College, New York, New York.,Neurology Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helena A Yu
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Mark G Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Bob T Li
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
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Non-Small Cell Lung Cancer Patients Harboring HER2 Mutations: Clinical Characteristics and Management in a Real-Life Setting. Cohort HER2 EXPLORE GFPC 02-14. Adv Ther 2019; 36:2161-2166. [PMID: 31154630 PMCID: PMC6822870 DOI: 10.1007/s12325-019-01001-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Indexed: 02/05/2023]
Abstract
Background Mutation of human receptor tyrosine kinase epidermal growth factor receptor-2 (HER2) is a rare event, found in approximately 1% non-small cell lung cancers (NSCLC). The objective was to investigate the clinical characteristics and management of HER2-mutated NSCLCs in a real-life setting. Methods This multicenter study described NSCLCs harboring HER2 mutations diagnosed between January 2012 and December 2014, according their clinical characteristics, management, and outcomes: response rate (RR), progression-free survival (PFS), and overall survival (OS). Results Thirty patients were included: 66.7% women; median age 65.2 ± 12 years; never or former smokers 73.3%. Of the stage IV patients (n = 23), 86% received first-line platin doublet chemotherapy: RR 61.5% and PFS 6.7 (95% CI 5.9–9.5) months; 52.1% received a second-line therapy: RR 18.2% and PFS 4.9 (95% CI 2.5–11.9) months. Median OS of stage IV was 10.7 months and 2-year OS was 27.2% (95% CI 11.7–63.2). All patients with stage I–III NSCLCs were alive at 2 years. Conclusion The rarity of HER2-mutated NSCLCs requires specific studies.
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Subramanian J, Katta A, Masood A, Vudem DR, Kancha RK. Emergence of ERBB2 Mutation as a Biomarker and an Actionable Target in Solid Cancers. Oncologist 2019; 24:e1303-e1314. [PMID: 31292270 DOI: 10.1634/theoncologist.2018-0845] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 05/25/2019] [Indexed: 02/06/2023] Open
Abstract
The oncogenic role ERBB2 amplification is well established in breast and gastric cancers. This has led to the development of a well-known portfolio of monoclonal antibodies and kinase inhibitors targeting the ERBB2 kinase. More recently, activating mutations in the ERBB2 gene have been increasingly reported in multiple solid cancers and were shown to play an oncogenic role similar to that of ERBB2 amplification. Thus, ERBB2 mutations define a distinct molecular subtype of solid tumors and serve as actionable targets. However, efforts to target ERBB2 mutation has met with limited clinical success, possibly because of their low frequency, inadequate understanding of the biological activity of these mutations, and difficulty in separating the drivers from the passenger mutations. Given the current impetus to deliver molecularly targeted treatments for cancer, there is an important need to understand the therapeutic potential of ERBB2 mutations. Here we review the distribution of ERBB2 mutations in different tumor types, their potential as a novel biomarker that defines new subsets in many cancers, and current data on preclinical and clinical efforts to target these mutations. IMPLICATIONS FOR PRACTICE: A current trend in oncology is to identify novel genomic drivers of solid tumors and developing precision treatments that target them. ERBB2 amplification is an established therapeutic target in breast and gastric cancers, but efforts to translate this finding to other solid tumors with ERBB2 amplification have not been effective. Recently the focus has turned to targeting activating ERBB2 mutations. The year 2018 marked an important milestone in establishing ERBB2 mutation as an important actionable target in multiple cancer types. There have been several recent preclinical and clinical studies evaluating ERBB2 mutation as a therapeutic target with varying success. With increasing access to next-generation sequencing technologies in the clinic, oncologists are frequently identifying activating ERBB2 mutations in patients with cancer. There is a significant need both from the clinician and bench scientist perspectives to understand the current state of affairs for ERBB2 mutations.
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Affiliation(s)
- Janakiraman Subramanian
- Division of Oncology, Saint Luke's Cancer Institute, Kansas City, Missouri, USA
- Center for Precision Oncology, Saint Luke's Cancer Institute, Kansas City, Missouri, USA
| | - Archana Katta
- Molecular Medicine and Therapeutics Laboratory, Centre for Plant Molecular Biology, Osmania University, Hyderabad, India
| | - Ashiq Masood
- Division of Oncology, Saint Luke's Cancer Institute, Kansas City, Missouri, USA
- Center for Precision Oncology, Saint Luke's Cancer Institute, Kansas City, Missouri, USA
| | - Dashavantha Reddy Vudem
- Molecular Biology Laboratory, Centre for Plant Molecular Biology, Osmania University, Hyderabad, India
| | - Rama Krishna Kancha
- Molecular Medicine and Therapeutics Laboratory, Centre for Plant Molecular Biology, Osmania University, Hyderabad, India
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Li P, Li B, Shi Y, Zhang F, Shen S, Li X. [Association between the HER2 Gene Status and the Efficacy of First-line Pemetrexed Combined with Platinum Chemotherapy in Patients with Advanced Lung
Adenocarcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:137-142. [PMID: 30909992 PMCID: PMC6441116 DOI: 10.3779/j.issn.1009-3419.2019.03.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Human epidermal growth factor receptor 2 (HER2) is one of the driver genes of non-small cell lung cancer (NSCLC). Several studies have shown that the efficacy of pemetrexed in HER2-mutant NSCLC is controversial. The aim of this study is to investigate the efficacy of pemetrexed combined with platinum chemotherapy in patients with HER2-mutant and HER2 wild-type lung adenocarcinoma. METHODS The clinical data of 106 cases of EGFR, ALK, ROS-1, KRAS, BRAF, RET and MET-negative patients with advanced lung adenocarcinoma patients who diagnosed by histopathology in the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed. The relationships between HER2 gene status, clinical characteristics and response and progression-free survival (PFS) were analyzed. RESULTS All of the 106 patients' HER2 status were determined. HER2 mutations occurred in 32 cases (30.2%), no mutations in 74 cases (69.8%). HER2 mutations were common in young, non-smoking and female patients. All patients received first-line pemetrexed and platinum-based chemotherapy. The objective response rate (ORR) and disease control rate (DCR) of patients with HER2-mutant lung adenocarcinoma were significantly higher than those without HER2 mutations (40.6% vs 14.9%, χ²=8.464, P=0.004; 93.8% vs 68.9%, χ²=6.327, P=0.012), and the difference was statistically significant. According to univariate analysis, the PFS was significantly associated with the brain metastases, maintenance chemotherapy and HER2 gene status (P<0.05), but not with age, gender, smoking history, oligometastases, liver metastases and type of platinum (P>0.05). Cox multivariate analysis indicated that HER2 mutation was an independent positive prognostic factor of PFS (P=0.038). CONCLUSIONS HER2-mutant lung adenocarcinoma patients with first-line pemetrexed combined with platinum chemotherapy have greater clinical benefit than HER2 wild-type patients.
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Affiliation(s)
- Panhua Li
- Department of Medical Oncology, the First Affiliated Hospital of Zhengzhou University,
Zhengzhou 450052, China
| | - Banban Li
- Department of Medical Oncology, the First Affiliated Hospital of Zhengzhou University,
Zhengzhou 450052, China
| | - Yunshu Shi
- Department of Medical Oncology, the First Affiliated Hospital of Zhengzhou University,
Zhengzhou 450052, China
| | - Fengming Zhang
- Department of Medical Oncology, the First Affiliated Hospital of Zhengzhou University,
Zhengzhou 450052, China
| | - Shujing Shen
- Department of Tumor Radiotherapy, the First Affiliated Hospital of Zhengzhou University,
Zhengzhou 450052, China
| | - Xingya Li
- Department of Medical Oncology, the First Affiliated Hospital of Zhengzhou University,
Zhengzhou 450052, China
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28
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Lai WV, Lebas L, Barnes TA, Milia J, Ni A, Gautschi O, Peters S, Ferrara R, Plodkowski AJ, Kavanagh J, Sabari JK, Clarke SJ, Pavlakis N, Drilon A, Rudin CM, Arcila ME, Leighl NB, Shepherd FA, Kris MG, Mazières J, Li BT. Afatinib in patients with metastatic or recurrent HER2-mutant lung cancers: a retrospective international multicentre study. Eur J Cancer 2019; 109:28-35. [PMID: 30685684 DOI: 10.1016/j.ejca.2018.11.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION HER2 mutations occur in 1-3% of lung adenocarcinomas. With increasing use of next-generation sequencing at diagnosis, more patients with HER2-mutant tumours present for treatment. Few data are available to describe the clinical course and outcomes of these patients when treated with afatinib, a pan-HER inhibitor. METHODS We identified patients with metastatic or recurrent HER2-mutant lung adenocarcinomas treated with afatinib among seven institutions across Europe, Australia, and North America between 2009 and 2017. We determined the partial response rate to afatinib, types of HER2 mutations, duration of response, time on treatment, and survival. RESULTS We collected information on 27 patients with stage IV or recurrent HER2-mutant lung adenocarcinomas treated with afatinib. Of 23 patients evaluable for response, three partial responses were noted (13%, 95% confidence interval [CI] 4-33%). In addition, 57% of patients (13/23) had stable disease, and 30% (7/23) had progressive disease. We documented partial responses in patients with HER2 exon 20 insertions, including two with YVMA insertion and one with VAG insertion. Two patients with partial responses were previously treated with trastuzumab and pertuzumab. Median duration of response to afatinib was 6 months (range 5-10); median time on treatment was 3 months (range 1-30) and median overall survival from the date of diagnosis of metastatic or recurrent disease was 23 months (95% CI 18-53 months). CONCLUSIONS Afatinib is modestly active in patients with HER2-mutant lung adenocarcinomas, including responses after progression on prior HER2-targeted therapies. However, investigations into the biology of HER2-mutant lung adenocarcinomas and development of better HER2-directed therapies are warranted.
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Affiliation(s)
- W Victoria Lai
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Tristan A Barnes
- Princess Margaret Cancer Centre, Toronto, Canada(2); Northern Beaches Cancer Service, Manly NSW Australia(3)
| | - Julie Milia
- Toulouse University Hospital, Toulouse, France
| | - Ai Ni
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Kavanagh
- Toronto General Hospital, University Health Network and University of Toronto, Toronto, Canada
| | - Joshua K Sabari
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, New York, NY, USA(3)
| | - Stephen J Clarke
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Nick Pavlakis
- Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - Alexander Drilon
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles M Rudin
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Mark G Kris
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Bob T Li
- Department of Medicine, Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Ogoshi Y, Shien K, Yoshioka T, Torigoe H, Sato H, Sakaguchi M, Tomida S, Namba K, Kurihara E, Takahashi Y, Suzawa K, Yamamoto H, Soh J, Toyooka S. Anti-tumor effect of neratinib against lung cancer cells harboring HER2 oncogene alterations. Oncol Lett 2019; 17:2729-2736. [PMID: 30854046 PMCID: PMC6365915 DOI: 10.3892/ol.2019.9908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/31/2018] [Indexed: 11/12/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) is a member of the ErbB family of receptor tyrosine kinases. Numerous studies have reported the amplification and overexpression of HER2 in several types of cancer, including non-small cell lung cancer (NSCLC). However, the benefits of HER2-targeted therapy have not been fully established. In the present study, the anti-tumor effect of neratinib, an irreversible pan-HER tyrosine kinase inhibitor (TKI), against NSCLC cells harboring HER2 alterations was investigated. The sensitivity of normal bronchial epithelial cells (BEAS-2B) ectopically overexpressing wild-type or mutant HER2 to neratinib was assessed. Furthermore, the anti-tumor activity of neratinib in several NSCLC cell lines harboring HER2 alterations was determined in vitro and in vivo, and the association between their genetic alterations and sensitivity to neratinib treatment was investigated. BEAS-2B cells ectopically overexpressing wild-type HER2 or mutants (A775insYVMA, G776VC, G776LC, P780insGSP, V659E, G660D and S310F) exhibited constitutive autophosphorylation of HER2, as determined by western blotting. While these BEAS-2B cells were sensitive to neratinib, they were insensitive to erlotinib, a first-generation epidermal growth factor receptor-TKI. Neratinib also exerted anti-proliferative effects on HER2-altered (H2170, Calu-3 and H1781) NSCLC cell lines. Neratinib was also demonstrated to exert strong tumor growth inhibitory activity in mouse xenograft models using HER2-altered lung cancer cells. The results of the present study strongly suggest that neratinib has potential as a promising therapeutic option for the treatment of HER2-altered NSCLC.
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Affiliation(s)
- Yusuke Ogoshi
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kazuhiko Shien
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Takahiro Yoshioka
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hidejiro Torigoe
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiroki Sato
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Masakiyo Sakaguchi
- Department of Cell Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Shuta Tomida
- Department of Biobank, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kei Namba
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Eisuke Kurihara
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yuta Takahashi
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Ken Suzawa
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiromasa Yamamoto
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Junichi Soh
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Shinichi Toyooka
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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30
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Shi Y, Wang M. Afatinib as first-line treatment for advanced lung adenocarcinoma patients harboring HER2 mutation: A case report and review of the literature. Thorac Cancer 2018; 9:1788-1794. [PMID: 30379401 PMCID: PMC6275816 DOI: 10.1111/1759-7714.12906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 12/19/2022] Open
Abstract
HER2 mutations are a rare group of driving genes that respond to HER2 targeted therapy, particularly afatinib. No more than 20 such cases have been reported, but afatinib was used after first-line chemotherapy. We present the case of a never-smoking female patient diagnosed with stage IV lung adenocarcinoma harboring a Her2 exon 20 inserted mutation who achieved a durable response (12 months) to first-line afatinib treatment. We review the literature concerning afatinib therapy in this rare cohort of mutated lung cancer patients.
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Affiliation(s)
- Yuequan Shi
- Department of Critical Care Medicine, the First Hospital Affiliated to China Medical University, Shenyang, China
| | - Mengzhao Wang
- Department of Respiratory Disease, Peking Union Medical College Hospital, Beijing, China
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31
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Remon J, Hendriks LE, Cabrera C, Reguart N, Besse B. Immunotherapy for oncogenic-driven advanced non-small cell lung cancers: Is the time ripe for a change? Cancer Treat Rev 2018; 71:47-58. [PMID: 30359792 DOI: 10.1016/j.ctrv.2018.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 12/12/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have been incorporated in the treatment strategy of advanced non-small cell lung cancer (NSCLC) in first- and second-line setting improving the prognosis of these patients. However, the treatment landscape has been also drastically overturned with the advent of targeted therapies in oncogenic-addicted advanced NSCLC patients. Despite ICIs represent an active and new treatment option for a wide range of advanced NSCLC patients, the efficacy and the optimal place of ICI in the treatment strategy algorithm of oncogenic-addicted tumors remains still controversial, as only a minority of trials with ICI enrol oncogenic-addicted NSCLC patients previously treated with standard therapy. Therefore, there are still several open questions about ICI in oncogenic-driven NSCLC, such as the efficacy and toxicities, which need to be addressed before considering treatment with ICI as a standard approach in this population. It is in this framework, we provide a thorough overview on this currently controversial topic.
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Affiliation(s)
- J Remon
- Centro Integral Oncología Clara Campal Bacelona, HM-Delfos, Medical Oncology Department, Barcelona, Spain.
| | - L E Hendriks
- Gustave Roussy, Cancer Medicine Department, Villejuif, France; Maastricht University Medical Center+, Pulmonary Diseases Department, GROW - School for Oncology and Developmental Biology, Maastricht, the Netherlands.
| | - C Cabrera
- Hospital Clínic i Provincial de Barcelona, Medical Oncology Department, Barcelona, Spain.
| | - N Reguart
- Hospital Clínic i Provincial de Barcelona, Medical Oncology Department, Barcelona, Spain.
| | - B Besse
- Gustave Roussy, Cancer Medicine Department, Villejuif, France; University Paris-Sud, Orsay, France.
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Jang J, Son J, Park E, Kosaka T, Saxon JA, De Clercq DJH, Choi HG, Tanizaki J, Eck MJ, Jänne PA, Gray NS. Discovery of a Highly Potent and Broadly Effective Epidermal Growth Factor Receptor and HER2 Exon 20 Insertion Mutant Inhibitor. Angew Chem Int Ed Engl 2018; 57:11629-11633. [PMID: 29978938 PMCID: PMC6118895 DOI: 10.1002/anie.201805187] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/26/2018] [Indexed: 12/11/2022]
Abstract
Exon 20 insertion (Ex20Ins) mutations are the third most prevalent epidermal growth factor receptor (EGFR) activating mutation and the most prevalent HER2 mutation in non-small cell lung cancer (NSCLC). Novel therapeutics for the patients with Ex20Ins mutations are urgently needed, due to their poor responses to the currently approved EGFR and HER2 inhibitors. Here we report the discovery of highly potent and broadly effective EGFR and HER2 Ex20Ins mutant inhibitors. The co-crystal structure of compound 1 b in complex with wild type EGFR clearly revealed an additional hydrophobic interaction of 4-fluorobenzene ring within a deep hydrophobic pocket, which has not been widely exploited in the development of EGFR and HER2 inhibitors. As compared with afatinib, compound 1 a exhibited superior inhibition of proliferation and signaling pathways in Ba/F3 cells harboring either EGFR or HER2 Ex20Ins mutations, and in the EGFR P772_H773insPNP patient-derived lung cancer cell line DFCI127. Our study identifies promising strategies for development of EGFR and HER2 Ex20Ins mutant inhibitors.
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Affiliation(s)
- Jaebong Jang
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, 02115, USA
| | - Jieun Son
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Eunyoung Park
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, 02115, USA
| | - Takayuki Kosaka
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Jamie A Saxon
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Dries J H De Clercq
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, 02115, USA
| | - Hwan Geun Choi
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, 02115, USA
| | - Junko Tanizaki
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Michael J Eck
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, 02115, USA
| | - Pasi A Jänne
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Nathanael S Gray
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, 02115, USA
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Sawan P, Plodkowski AJ, Li AE, Li BT, Drilon A, Capanu M, Ginsberg MS. CT features of HER2-mutant lung adenocarcinomas. Clin Imaging 2018; 51:279-283. [PMID: 29906786 PMCID: PMC7382989 DOI: 10.1016/j.clinimag.2018.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To describe the radiological phenotype of HER2-mutant lung cancers on CT at presentation. METHODS Eligible patients with lung adenocarcinomas with HER2 mutations were stage-matched with two control groups (EGFR- and KRAS-mutant groups). Evaluated CT features of the primary tumor included size, location, consistency, contour, presence of pleural tags and pleural retractions. Presence of pleural effusions, lung metastases, adenopathy, chest wall invasion, and were also recorded. Wilcoxon rank-sum and Fisher's exact tests were used to compare continuous and categorical features, respectively. RESULTS One hundred and fifty-four patients were identified: 50 (33%) harbored HER2 mutations, 56 (36%) harbored KRAS mutations, and 48 (31%) harbored EGFR mutations. Compared with KRAS, HER2 tumors presented as smaller lesions (2.3 cm versus 2.9 cm, p = 0.005 for length; 1.6 cm versus 2.1 cm, p = 0.002 for width) with the presence of pleural tags (74% vs. 52%, p = 0.03), pleural retractions (58% vs. 39%, p = 0.006), ipsilateral hilar (36% vs. 16%, p = 0.03) and scalene/supraclavicular N3 adenopathy (24% vs. 7%, p = 0.03). Compared with EGFR, pleural retractions were more prevalent among the HER2 tumors (58% vs. 37%, p = 0.05). CONCLUSIONS Lung adenocarcinomas with HER2 gene mutation exhibit an aggressive behavior manifesting by higher incidence of local invasion, compared to KRAS and EGFR mutant controls, and a nodal metastatic spread compared to KRAS-mutant control. This is the first radiogenomics study of HER2 mutations in lung cancer.
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Affiliation(s)
- Peter Sawan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Angela E Li
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Bob T Li
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Alexander Drilon
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Li BT, Shen R, Buonocore D, Olah ZT, Ni A, Ginsberg MS, Ulaner GA, Offin M, Feldman D, Hembrough T, Cecchi F, Schwartz S, Pavlakis N, Clarke S, Won HH, Brzostowski EB, Riely GJ, Solit DB, Hyman DM, Drilon A, Rudin CM, Berger MF, Baselga J, Scaltriti M, Arcila ME, Kris MG. Ado-Trastuzumab Emtansine for Patients With HER2-Mutant Lung Cancers: Results From a Phase II Basket Trial. J Clin Oncol 2018; 36:2532-2537. [PMID: 29989854 PMCID: PMC6366814 DOI: 10.1200/jco.2018.77.9777] [Citation(s) in RCA: 342] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose Human epidermal growth factor receptor 2 ( HER2, ERBB2)-activating mutations occur in 2% of lung cancers. We assessed the activity of ado-trastuzumab emtansine, a HER2-targeted antibody-drug conjugate, in a cohort of patients with HER2-mutant lung cancers as part of a phase II basket trial. Patients and Methods Patients received ado-trastuzumab emtansine at 3.6 mg/kg intravenously every 3 weeks until progression. The primary end point was overall response rate using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. A Simon two-stage optimal design was used. Other end points included progression-free survival and toxicity. HER2 testing was performed on tumor tissue by next generation sequencing, fluorescence in situ hybridization, immunohistochemistry, and protein mass spectrometry. Results We treated 18 patients with advanced HER2-mutant lung adenocarcinomas. The median number of prior systemic therapies was two (range, zero to four prior therapies). The partial response rate was 44% (95% CI, 22% to 69%), meeting the primary end point. Responses were seen in patients with HER2 exon 20 insertions and point mutations in the kinase, transmembrane, and extracellular domains. Concurrent HER2 amplification was observed in two patients. HER2 immunohistochemistry ranged from 0 to 2+ and did not predict response, and responders had low HER2 protein expression measured by mass spectrometry. The median progression-free survival was 5 months (95% CI, 3 to 9 months). Toxicities included grade 1 or 2 infusion reactions, thrombocytopenia, and elevated hepatic transaminases. No patient stopped therapy as a result of toxicity or died on study. Conclusion Ado-trastuzumab emtansine is an active agent in patients with HER2-mutant lung cancers. This is the first positive trial in this molecular subset of lung cancers. Further use and study of this agent are warranted.
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Affiliation(s)
- Bob T. Li
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Ronglai Shen
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Darren Buonocore
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Zachary T. Olah
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Ai Ni
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Michelle S. Ginsberg
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Gary A. Ulaner
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Michael Offin
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Daniel Feldman
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Todd Hembrough
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Fabiola Cecchi
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Sarit Schwartz
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Nick Pavlakis
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Stephen Clarke
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Helen H. Won
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Edyta B. Brzostowski
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Gregory J. Riely
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - David B. Solit
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - David M. Hyman
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Alexander Drilon
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Charles M. Rudin
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Michael F. Berger
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - José Baselga
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Maurizio Scaltriti
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Maria E. Arcila
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
| | - Mark G. Kris
- Bob T. Li, Ronglai Shen, Darren Buonocore, Zachary T. Olah, Ai Ni, Michelle S. Ginsberg, Gary A. Ulaner, Michael Offin, Daniel Feldman, Helen H. Won, Edyta B. Brzostowski, Gregory J. Riely, David B. Solit, David M. Hyman, Alexander Drilon, Charles M. Rudin, Michael F. Berger, José Baselga, Maurizio Scaltriti, Maria E. Arcila, and Mark G. Kris, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY; Bob T. Li, Nick Pavlakis, and Stephen Clarke, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; and Todd Hembrough, Fabiola Cecchi, and Sarit Schwartz, NantOmics, Rockville, MD
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Jang J, Son J, Park E, Kosaka T, Saxon JA, De Clercq DJH, Choi HG, Tanizaki J, Eck MJ, Jänne PA, Gray NS. Discovery of a Highly Potent and Broadly Effective Epidermal Growth Factor Receptor and HER2 Exon 20 Insertion Mutant Inhibitor. Angew Chem Int Ed Engl 2018. [DOI: 10.1002/ange.201805187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jaebong Jang
- Department of Cancer Biology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Biological Chemistry and Molecular Pharmacology; Harvard Medical School; Boston MA 02115 USA
| | - Jieun Son
- Lowe Center for Thoracic Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medicine; Harvard Medical School; Boston MA 02115 USA
| | - Eunyoung Park
- Department of Cancer Biology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Biological Chemistry and Molecular Pharmacology; Harvard Medical School; Boston MA 02115 USA
| | - Takayuki Kosaka
- Lowe Center for Thoracic Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medicine; Harvard Medical School; Boston MA 02115 USA
| | - Jamie A. Saxon
- Lowe Center for Thoracic Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medicine; Harvard Medical School; Boston MA 02115 USA
| | - Dries J. H. De Clercq
- Department of Cancer Biology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Biological Chemistry and Molecular Pharmacology; Harvard Medical School; Boston MA 02115 USA
| | - Hwan Geun Choi
- Department of Cancer Biology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Biological Chemistry and Molecular Pharmacology; Harvard Medical School; Boston MA 02115 USA
| | - Junko Tanizaki
- Lowe Center for Thoracic Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medicine; Harvard Medical School; Boston MA 02115 USA
| | - Michael J. Eck
- Department of Cancer Biology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Biological Chemistry and Molecular Pharmacology; Harvard Medical School; Boston MA 02115 USA
| | - Pasi A. Jänne
- Lowe Center for Thoracic Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medical Oncology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Medicine; Harvard Medical School; Boston MA 02115 USA
| | - Nathanael S. Gray
- Department of Cancer Biology; Dana-Farber Cancer Institute; Boston MA 02215 USA
- Department of Biological Chemistry and Molecular Pharmacology; Harvard Medical School; Boston MA 02115 USA
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Zhou F, Zhou C. Lung cancer in never smokers-the East Asian experience. Transl Lung Cancer Res 2018; 7:450-463. [PMID: 30225210 PMCID: PMC6131183 DOI: 10.21037/tlcr.2018.05.14] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
Approximately one third of all lung cancer patients in East Asia are never-smokers. Furthermore, the proportion of lung cancer in never smokers (LCINS) has been increasing over time. Never-smokers are more often diagnosed with adenocarcinoma in East Asia, a subtype largely defined by oncogenic drivers. In this subgroup of patients, as high as 90% of patients have been found to harbor well-known oncogenic mutations and can be successfully managed with targeted therapies inhibiting specific oncogenic mutant kinases. EGFR tyrosine kinase inhibitor (EGFR-TKI) treatment has been the most important targeted therapy in lung adenocarcinoma from East Asian never-smokers as approximately 70% of these patients have the opportunity to receive EGFR-TKI treatment. Lung squamous cell carcinoma (SQCC) and small cell lung cancer (SCLC) are two common histologic types of smoking-related non-small cell lung cancer (NSCLC). The proportion of never-smokers with SQCC and SCLC in East Asian patients seems to be higher than that in Caucasian patients. Recent studies also suggest that lung SQCC and SCLC in never-smokers may be distinct subtypes. Therefore, better understanding of the biologic characteristics of these subtypes of patients may provide new insights for the treatment. In this review, we will provide an overview of East Asian experience in the treatment of advanced, never-smoking lung cancer, focusing on etiologic factors in the development of LCINS, targeted therapy for never-smokers with adenocarcinoma, distinct characteristics of never-smokers with lung SQCC and SCLC, and the role of immunotherapy in never-smokers with NSCLC.
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Affiliation(s)
- Fei Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Personalized medicine in non-small cell lung cancer: a review from a pharmacogenomics perspective. Acta Pharm Sin B 2018; 8:530-538. [PMID: 30109178 PMCID: PMC6089847 DOI: 10.1016/j.apsb.2018.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/01/2018] [Accepted: 04/12/2018] [Indexed: 02/07/2023] Open
Abstract
Non-small cell lung cancer is a prevalent and rapidly-expanding challenge to modern medicine. While generalized medicine with traditional chemotherapy yielded comparatively poor response rates and treatment results, the cornerstone of personalized medicine using genetic profiling to direct treatment has exalted the successes seen in the field and raised the standard for patient treatment in lung and other cancers. Here, we discuss the current state and advances in the field of personalized medicine for lung cancer, reviewing several of the mutation-targeting strategies that are approved for clinical use and how they are guided by patient genetic information. These classes include inhibitors of tyrosine kinase (TKI), anaplastic lymphoma kinase (ALK), and monoclonal antibodies. Selecting from these treatment plans and determining the optimal dosage requires in-depth genetic guidance with consideration towards not only the underlying target genes but also other factors such as individual metabolic capability and presence of resistance-conferring mutations both directly on the target gene and along its cascade(s). Finally, we provide our viewpoints on the future of personalized medicine in lung cancer, including target-based drug combination, mutation-guided drug design and the necessity for data of population genetics, to provide rough guidance on treating patients who are unable to get genetic testing.
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Wang Y, Zhang S, Wu F, Zhao J, Li X, Zhao C, Ren S, Zhou C. Outcomes of Pemetrexed-based chemotherapies in HER2-mutant lung cancers. BMC Cancer 2018; 18:326. [PMID: 29587667 PMCID: PMC5869778 DOI: 10.1186/s12885-018-4277-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 03/21/2018] [Indexed: 12/31/2022] Open
Abstract
Background HER2 mutation has been found to be an oncogenic driver gene in non-small cell lung cancers(NSCLC) and HER2-directed therapies have shown promising results in this unique population, while little is known about its association with outcomes of chemotherapy. The aim of this study was to investigate the efficacy of first line chemotherapy in patients with advanced HER2-mutant lung adenocarcinomas. Methods Patients with advanced NSCLC(N = 1714) initially underwent testing for EGFR, KRAS, BRAF mutations and ALK, ROS1 rearrangements, and negative cases were then assessed for HER2 mutations using the method of amplification refractory mutation system(ARMS). The efficacy of first line pemetrexed-based chemotherapy was investigated in patients with HER2-mutant and those with EGFR-mutant, ALK/ROS1-rearranged and KRAS-mutant advanced adenocarcinomas. Results HER2 mutations were detected in 29 of 572(5.1%) specimens from a selected population of EGFR/KRAS/BRAF/ALK/ROS1 negative patients. All of them are adenocarcinomas. Among patients with HER2-mutant lung cancers, 25 received pemetrexed-based first line chemotherapy. The objective response rate(ORR) was 36.0%. Their median progression free survival(PFS) was 5.1 months, which was similar with that of KRAS-mutant group (n = 40,5.0 months, p = 0.971), numerically shorter than that of EGFR-mutant group(n = 74, 6.5 months, p = 0.247) and statistically significantly shorter than that of ALK/ROS1-rearranged group (n = 39,9.2 months, p = 0.004). Furthermore, HER2 variants subgroup analysis showed that PFS was inferior in A775_G776insYVMA group compared with other variants (4.2 vs 7.2 months, p = 0.085). Conclusions Patients with advanced HER2-mutant lung adenocarcinomas showed an inferior outcome of first line pemetrexed-based chemotherapy compared to those with ALK/ROS1 rearrangements, which strengthen the need for effective HER2-targeted drugs in clinical practice. Electronic supplementary material The online version of this article (10.1186/s12885-018-4277-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yan Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Tongji University Medical School Cancer Institute, No. 507 Zheng Min Road, Shanghai, 200433, People's Republic of China
| | - Shijia Zhang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Tongji University Medical School Cancer Institute, No. 507 Zheng Min Road, Shanghai, 200433, People's Republic of China.,Department of Respiratory Medicine, Huaihe Hospital, Henan University, Kaifeng, People's Republic of China
| | - Fengying Wu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Tongji University Medical School Cancer Institute, No. 507 Zheng Min Road, Shanghai, 200433, People's Republic of China
| | - Jing Zhao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Tongji University Medical School Cancer Institute, No. 507 Zheng Min Road, Shanghai, 200433, People's Republic of China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chao Zhao
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Tongji University Medical School Cancer Institute, No. 507 Zheng Min Road, Shanghai, 200433, People's Republic of China.
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Tongji University Medical School Cancer Institute, No. 507 Zheng Min Road, Shanghai, 200433, People's Republic of China
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HER2 Transmembrane Domain Mutations: Rare New Target for Non-Small Cell Lung Cancer Therapy. J Thorac Oncol 2018; 12:422-424. [PMID: 28215721 DOI: 10.1016/j.jtho.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 11/20/2022]
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Gow CH, Chang HT, Lim CK, Liu CY, Chen JS, Shih JY. Comparable clinical outcomes in patients with HER2-mutant and EGFR-mutant lung adenocarcinomas. Genes Chromosomes Cancer 2017; 56:373-381. [PMID: 28063177 DOI: 10.1002/gcc.22442] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
HER2 is a major proliferative driver in lung cancer. HER2 gene aberrations impact the prognosis of lung adenocarcinoma (ADC). A one-step reverse transcription-polymerase chain reaction was performed using RNA samples from 888 Asian lung cancer patients to detect HER2, EGFR, KRAS, ALK, and ROS1 mutations. The demographic data and treatment outcomes of HER2 mutation-positive lung ADC patients were analyzed and compared to those with HER2 mutation-negative tumors. HER2 mutation was identified in 40 (4.5%) lung ADC patients. HER2 mutations tended to occur in male patients with advanced-stage disease and never-smokers. A775_G776insYVMA (n = 22, 55%) was the most prevalent HER2 mutation, followed by P780_Y781insGSP (n = 4, 10%). For patients diagnosed with stage-IIIB/IV disease, HER2-mutant patients showed clinical outcomes comparable to EGFR-mutant patients (P = 0.721, log-rank test) and a better overall survival (OS) compared to patients lacking driver mutations in the investigated genes (P = 0.033, Breslow test). Specifically, lung ADC patients with stage-IV HER2-mutant tumors treated with chemotherapy or targeted agents, even without afatinib or anti-HER2 targeted therapy, showed similar clinical outcomes to lung ADC patients harboring EGFR exon 19 deletion or L858R mutations (P = 0.870). In addition, multivariate analysis indicated that HER2 mutation status was not a major risk factor for diminished OS in stage-IV lung cancer. In conclusion, lung ADC harboring HER2 mutations showed distinct characteristics from other driver mutations, including increased chemosensitivity with in advanced stage disease.
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Affiliation(s)
- Chien-Hung Gow
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Healthcare Information and Management, Ming-Chuan University, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hou-Tai Chang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chor-Kuan Lim
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chao-Yu Liu
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.,Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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张 权, 张 树. [Research Progress of Targeted Therapy for Anaplastic Lymphoma Kinase and Other Rare Driver Genes in Advanced Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:66-72. [PMID: 28103976 PMCID: PMC5973289 DOI: 10.3779/j.issn.1009-3419.2017.01.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 11/11/2016] [Accepted: 11/12/2016] [Indexed: 11/05/2022]
Abstract
Targeted therapy was one of the major treatments in advanced non-small cell lung cancer (NSCLC) with positive driver genes. This area of research progresses day by day, with novel target discoveries, novel drug development, and use of novel combination treatments. Researchers have also undergone deep investigation about the molecular mechanisms underlying inherent or acquired resistance to these targeted therapies. This review aimed to summarize the advanced developments of targeted therapy for anaplastic lymphoma kinase (ALK) and other rare driver genes in NSCLC.
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Affiliation(s)
- 权 张
- />101149 北京,首都医科大学附属北京胸科医院肿瘤内科Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
| | - 树才 张
- />101149 北京,首都医科大学附属北京胸科医院肿瘤内科Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China
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