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Ang YLE, Zhao X, Reungwetwattana T, Cho BC, Liao BC, Yeung R, Loong HH, Kim DW, Yang JCH, Lim SM, Ahn MJ, Lee SH, Suwatanapongched T, Kongchauy K, Ou Q, Yu R, Tai BC, Goh BC, Mok TSK, Soo RA. A Phase II Study of Osimertinib in Patients with Advanced-Stage Non-Small Cell Lung Cancer following Prior Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor (EGFR TKI) Therapy with EGFR and T790M Mutations Detected in Plasma Circulating Tumour DNA (PLASMA Study). Cancers (Basel) 2023; 15:4999. [PMID: 37894366 PMCID: PMC10605750 DOI: 10.3390/cancers15204999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 10/29/2023] Open
Abstract
Epidermal growth factor receptor (EGFR) T790M mutations drive resistance in 50% of patients with advanced non-small cell lung cancer (NSCLC) who progress on first/second generation (1G/2G) EGFR tyrosine kinase inhibitors (TKIs) and are sensitive to Osimertinib. Tissue sampling is the gold-standard modality of T790M testing, but it is invasive. We evaluated the efficacy of Osimertinib in patients with EGFR mutant NSCLC and T790M in circulating tumour DNA (ctDNA). PLASMA is a prospective, open-label, multicentre single-arm Phase II study. Patients with advanced NSCLC harbouring sensitizing EGFR and T790M mutations in plasma at progression from ≥one 1G/2G TKI were treated with 80 mg of Osimertinib daily until progression. The primary endpoint was the objective response rate (ORR); the secondary endpoints included progression-free survival (PFS), overall survival (OS), disease control rate (DCR) and toxicities. Plasma next-generation sequencing was performed to determine Osimertinib resistance mechanisms and assess serial ctDNA. A total of 110 patients from eight centres in five countries were enrolled from 2017 to 2019. The median follow-up duration was 2.64 (IQR 2.44-3.12) years. The ORR was 50.9% (95% CI 41.2-60.6) and the DCR was 84.5% (95% CI 76.4-90.7). Median PFS was 7.4 (95% CI 6.0-9.3) months; median OS was 1.63 (95% CI 1.35-2.16) years. Of all of the patients, 76% had treatment-related adverse events (TRAEs), most commonly paronychia (22.7%); 11% experienced ≥ Grade 3 TRAEs. The ctDNA baseline load and dynamics were prognostic. Osimertinib is active in NSCLC harbouring sensitizing EGFR and T790M mutations in ctDNA testing post 1G/2G TKIs.
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Affiliation(s)
- Yvonne L. E. Ang
- Department of Haematology-Oncology, National University Cancer Institute, Singapore 119074, Singapore
| | - Xiaotian Zhao
- Geneseeq Research Institute, Geneseeq Technology Inc., Nanjing 210032, China
| | - Thanyanan Reungwetwattana
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Byoung-Chul Cho
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Bin-Chi Liao
- Department of Oncology, National Taiwan University Hospital, Taipei 100229, Taiwan
- National Taiwan University Cancer Center, Taipei 100229, Taiwan
| | - Rebecca Yeung
- Clinical Oncology Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Herbert H. Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Central Ave, Hong Kong
| | - Dong-Wan Kim
- Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, Taipei 100229, Taiwan
- National Taiwan University Cancer Center, Taipei 100229, Taiwan
| | - Sun Min Lim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Myung-Ju Ahn
- Division of Haematology-Oncology, Samsung Medical Center, Seoul 06351, Republic of Korea; (M.-J.A.); (S.-H.L.)
| | - Se-Hoon Lee
- Division of Haematology-Oncology, Samsung Medical Center, Seoul 06351, Republic of Korea; (M.-J.A.); (S.-H.L.)
| | - Thitiporn Suwatanapongched
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Kanchaporn Kongchauy
- Clinical Research Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Qiuxiang Ou
- Geneseeq Research Institute, Geneseeq Technology Inc., Nanjing 210032, China
| | - Ruoying Yu
- Geneseeq Research Institute, Geneseeq Technology Inc., Nanjing 210032, China
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Boon Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore 119074, Singapore
| | - Tony S. K. Mok
- Department of Clinical Oncology, The Chinese University of Hong Kong, Central Ave, Hong Kong
| | - Ross A. Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore 119074, Singapore
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Patkulkar P, Subbalakshmi AR, Jolly MK, Sinharay S. Mapping Spatiotemporal Heterogeneity in Tumor Profiles by Integrating High-Throughput Imaging and Omics Analysis. ACS OMEGA 2023; 8:6126-6138. [PMID: 36844580 PMCID: PMC9948167 DOI: 10.1021/acsomega.2c06659] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/05/2023] [Indexed: 05/14/2023]
Abstract
Intratumoral heterogeneity associates with more aggressive disease progression and worse patient outcomes. Understanding the reasons enabling the emergence of such heterogeneity remains incomplete, which restricts our ability to manage it from a therapeutic perspective. Technological advancements such as high-throughput molecular imaging, single-cell omics, and spatial transcriptomics allow recording of patterns of spatiotemporal heterogeneity in a longitudinal manner, thus offering insights into the multiscale dynamics of its evolution. Here, we review the latest technological trends and biological insights from molecular diagnostics as well as spatial transcriptomics, both of which have witnessed burgeoning growth in the recent past in terms of mapping heterogeneity within tumor cell types as well as the stromal constitution. We also discuss ongoing challenges, indicating possible ways to integrate insights across these methods to have a systems-level spatiotemporal map of heterogeneity in each tumor and a more systematic investigation of the implications of heterogeneity for patient outcomes.
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Rehman M, Kim C, Reuss JE, Kiedrowski LA, Garg RJ, Liu SV. Divergent RET- and BRAF-Mediated Resistance to Osimertinib in EGFR-Mutant NSCLC: A Case Report. JCO Precis Oncol 2022; 5:939-942. [PMID: 34994624 DOI: 10.1200/po.21.00083] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Muneeb Rehman
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Chul Kim
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Joshua E Reuss
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | | | | | - Stephen V Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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Fu Y, Wang A, Zhou J, Feng W, Shi M, Xu X, Zhao H, Cai L, Feng J, Lv X, Zhang X, Xu W, Zhang Z, Ma G, Wang J, Zhou T, Zhao D, Fang H, Liu Z, Huang JA. Advanced NSCLC Patients With EGFR T790M Harboring TP53 R273C or KRAS G12V Cannot Benefit From Osimertinib Based on a Clinical Multicentre Study by Tissue and Liquid Biopsy. Front Oncol 2021; 11:621992. [PMID: 33718183 PMCID: PMC7943858 DOI: 10.3389/fonc.2021.621992] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background Non-small cell lung cancer (NSCLC) patients treated with first-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) almost always acquire resistance, and the development of novel techniques analyzing circulating tumor DNA (ctDNA) have made it possible for liquid biopsy to detect genetic alterations from limited amount of DNA with less invasiveness. While a large amount of patients with EGFR exon 21 p.Thr790 Met (T790M) benefited from osimertinib treatment, acquired resistance to osimertinb has subsequently become a growing challenge. Methods We performed tissue and liquid rebiopsy on 50 patients with EGFR-mutant NSCLC who acquired resistance to first-generation EGFR-TKIs. Plasma samples underwent droplet digital PCR (ddPCR) and next-generation sequencing (NGS) examinations. Corresponding tissue samples underwent NGS and Cobas® EGFR Mutation Test v2 (Cobas) examinations. Results Of the 50 patients evaluated, the mutation detection rates of liquid biopsy group and tissue biopsy group demonstrated no significant differences (41/48, 85.4% vs. 44/48, 91.7%; OR=0.53, 95% CI=0.15 to 1.95). Overall concordance, defined as the proportion of patients for whom at least one identical genomic alteration was identified in both tissue and plasma, was 78.3% (36/46, 95% CI=0.39 to 2.69). Moreover, our results showed that almost half of the patients (46%, 23/50) resistant to first-generation EGFR-TKI harbored p.Thr790 Met (T790M) mutation. 82.6% (19/23) of the T790M positive patients were analyzed by liquid biopsy and 60.9% (14/23) by tumor tissue sequencing. Meanwhile, a wide range of uncommon mutations was detected, and novel mechanisms of osimertinib resistance were discovered. In addition, 16.7% (2/12) of the T790M positive patients with either TP53 R237C or KRAS G12V failed to benefit from the subsequent osimertinib treatment. Conclusion Our results emphasized that liquid biopsy is applicable to analyze the drug resistance mechanisms of NSCLC patients treated with EGFR-TKIs. Moreover, we discovered two uncommon mutations, TP53 R273C and KRAS G12V, which attenuates the effectiveness of osimertinib.
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Affiliation(s)
- Yulong Fu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.,Suzhou Key Laboratory for Respiratory Diseases, Suzhou, China
| | - Anqi Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.,Suzhou Key Laboratory for Respiratory Diseases, Suzhou, China
| | - Jieqi Zhou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.,Suzhou Key Laboratory for Respiratory Diseases, Suzhou, China
| | - Wei Feng
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Minhua Shi
- Department of Respiratory Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Xu
- Department of Respiratory Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Hongqing Zhao
- Department of Respirology, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, China
| | - Liming Cai
- Department of Respiratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jian Feng
- Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Xuedong Lv
- Department of Respiratory Medicine, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaodong Zhang
- Department of Medical Oncology, Nantong Tumor Hospital, Nantong, China
| | - Wenjing Xu
- Departments of Respiratory Medicine, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhengrong Zhang
- Department of Respiratory Medicine, First People's Hospital of Yangzhou City, Yangzhou, China
| | - Guoer Ma
- Department of Respiratory Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jian Wang
- Department of Respiratory Medicine, Zhenjiang First People's Hospital, Zhenjiang, China
| | - Tong Zhou
- Department of Oncology, Changzhou Cancer Hospital Affiliated to Soochow University, Changzhou, China
| | - Dahai Zhao
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Haohui Fang
- Department of Respiratory Medicine, Anhui Chest Hospital, Hefei, China
| | - Zeyi Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.,Suzhou Key Laboratory for Respiratory Diseases, Suzhou, China.,Institute of Respiratory Diseases, Soochow University, Suzhou, China
| | - Jian-An Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.,Suzhou Key Laboratory for Respiratory Diseases, Suzhou, China.,Institute of Respiratory Diseases, Soochow University, Suzhou, China
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