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Zheng S, Chen R, Zhang L, Tan L, Li L, Long F, Wang T. Unraveling the future: Innovative design strategies and emerging challenges in HER2-targeted tyrosine kinase inhibitors for cancer therapy. Eur J Med Chem 2024; 276:116702. [PMID: 39059182 DOI: 10.1016/j.ejmech.2024.116702] [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: 06/14/2024] [Revised: 07/12/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
Human epidermal growth factor receptor 2 (HER2) is a transmembrane receptor-like protein with tyrosine kinase activity that plays a vital role in processes such as cell proliferation, differentiation, and angiogenesis. The degree of malignancy of different cancers, notably breast cancer, is strongly associated with HER2 amplification, overexpression, and mutation. Currently, widely used clinical HER2 tyrosine kinase inhibitors (TKIs), such as lapatinib and neratinib, have several drawbacks, including susceptibility to drug resistance caused by HER2 mutations and adverse effects from insufficient HER2 selectivity. To address these issues, it is essential to create innovative HER2 TKIs with enhanced safety, effectiveness against mutations, and high selectivity. Typically, SPH5030 has advanced to phase I clinical trials for its strong suppression of four HER2 mutations. This review discusses the latest research progress in HER2 TKIs, with a focus on the structural optimization process and structure-activity relationship analysis. In particular, this study highlights promising design strategies to address these challenges, providing insightful information and inspiration for future development in this field.
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Affiliation(s)
- Sixiang Zheng
- Department of Clinical Research, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Ruixian Chen
- Department of Breast Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lele Zhang
- Department of Respiratory and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lun Tan
- Department of Respiratory and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lintao Li
- Department of Radiotherapy, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China.
| | - Fangyi Long
- Laboratory Medicine Center, Sichuan Provincial Maternity and Child Health Care Hospital, Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu, 610032, China.
| | - Ting Wang
- Department of Clinical Research, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China.
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Liu HN, Zhu Y, Chi Y, Zhang Y, Li X, Wen W, Shan LS, Wang YT, Dai B. Synthetic routes and clinical application of Small-Molecule HER2 inhibitors for cancer therapy. Bioorg Chem 2024; 151:107653. [PMID: 39024803 DOI: 10.1016/j.bioorg.2024.107653] [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: 05/18/2024] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 07/20/2024]
Abstract
This comprehensive review undertakes a meticulous scrutiny of the synthesis and clinical applications pertaining to small-molecule tyrosine kinase inhibitors (TKIs) directed towards the human epidermal growth factor receptor 2 (HER2), a pivotal protagonist in the pathogenesis of cancer. Focused on compounds like lapatinib, neratinib, and tucatinib, the review delves into the intricate synthesis strategies, emphasizing the challenges associated with their structural complexity. The clinical utilization of HER2 TKIs underscores noteworthy strides in the therapeutic landscape for HER2-positive breast and gastric malignancies. Lapatinib, a dual HER2/ epidermal growth factor receptor (EGFR) inhibitor, has demonstrated efficacy in combination therapies, addressing the need for overcoming resistance mechanisms. Neratinib, an irreversible HER2 inhibitor, presents a promising avenue for patients with refractory tumors. Tucatinib, strategically engineered to traverse the blood-brain barrier, epitomizes a groundbreaking advancement in the management of metastatic HER2-positive breast cancer manifesting cerebral involvement. Despite their success, challenges such as resistance mechanisms and off-target effects persist, urging continuous research for the development of next-generation HER2 TKIs. This comprehensive review serves as a valuable resource for pharmaceutical scientists, offering insights into the synthetic intricacies and clinical impact of small-molecule TKIs targeting HER2.
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Affiliation(s)
- He-Nan Liu
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Zhu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Yuan Chi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yao Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xun Li
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wen Wen
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Liaoning Clinical Research Center for Laboratory Medicine, Shenyang, China
| | - Li-Shen Shan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Ya-Tao Wang
- Rega Institute for Medical Research, Medicinal Chemistry, KU Leuven, Herestraat 49-Box 1041, 3000 Leuven, Belgium.
| | - Bing Dai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
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Park S, Park S, Kim TM, Kim S, Koh J, Lim J, Yi K, Yi B, Ju YS, Kim M, Keam B, Kim JS, Jeon YK, Kim DW, Kim YT, Heo DS. Resistance mechanisms of EGFR tyrosine kinase inhibitors, in EGFR exon 20 insertion-mutant lung cancer. Eur J Cancer 2024; 208:114206. [PMID: 38981315 DOI: 10.1016/j.ejca.2024.114206] [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: 04/10/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Mobocertinib, an EGFR exon 20 insertion (Ex20ins)-specific tyrosine kinase inhibitor has been used for treatment of advanced/metastatic EGFR Ex20ins-mutant non-small cell lung cancer (NSCLC). However, resistance mechanisms to EGFR Ex20ins-specific inhibitors and the efficacy of subsequent amivantamab treatment is unknown. METHODS To investigate resistance mechanisms, tissue and cfDNA samples were collected before treatment initiation and upon development of resistance from NSCLC patients with EGFR Ex20ins mutations received mobocertinib, poziotinib, and amivantamab treatments. Genetic alterations were analyzed using whole-genome and targeted sequencing, and in vitro resistant cell lines were generated for validation. RESULTS EGFR amplification (n = 6, including 2 broad copy number gain) and EGFR secondary mutation (n = 3) were observed at the resistance of mobocertinib. One patient had both EGFR secondary mutation and high EGFR focal amplification. In vitro models harboring EGFR alterations were constructed to validate resistance mechanisms and identify overcoming strategies to resistance. Acquired EGFR-dependent alterations were found to mediate resistance to mobocertinib in patients and in vitro models. Furthermore, two of six patients who received sequential amivantamab followed by an EGFR tyrosine kinase inhibitor had MET amplification and showed partial response. CONCLUSIONS Our study revealed EGFR-dependent and -independent mechanisms of mobocertinib resistance in patients with advanced EGFR Ex20ins-mutant NSCLC.
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Affiliation(s)
- Siyeon Park
- Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Seongyeol Park
- Inocras Inc., San Diego, CA, USA; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Tae Min Kim
- Seoul National University Cancer Research Institute, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
| | - Soyeon Kim
- Seoul National University Cancer Research Institute, Seoul, South Korea; Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, South Korea
| | - Jaemoon Koh
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Joonoh Lim
- Inocras Inc., San Diego, CA, USA; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Kijong Yi
- Inocras Inc., San Diego, CA, USA; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Boram Yi
- Inocras Inc., San Diego, CA, USA
| | - Young Seok Ju
- Inocras Inc., San Diego, CA, USA; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Miso Kim
- Seoul National University Cancer Research Institute, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Bhumsuk Keam
- Seoul National University Cancer Research Institute, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jung Sun Kim
- Seoul National University Cancer Research Institute, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yoon Kyung Jeon
- Seoul National University Cancer Research Institute, Seoul, South Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong-Wan Kim
- Seoul National University Cancer Research Institute, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Tae Kim
- Seoul National University Cancer Research Institute, Seoul, South Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Dae Seog Heo
- Seoul National University Cancer Research Institute, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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Shi Y, Xu Y, Wang M. Current clinical practice and physicians' insights on Chinese patients with advanced non-small cell lung cancer habouring epidermal growth factor receptor 20 insertion mutation. BMC Cancer 2024; 24:1043. [PMID: 39179992 PMCID: PMC11342509 DOI: 10.1186/s12885-024-12797-3] [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: 09/11/2023] [Accepted: 08/12/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND The present study aimed to investigate physicians' perspectives on the diagnosis and treatment decisions for patients with non-small cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) exon 20 insertion (exon20ins) mutations in a real-world setting in China using an online questionnaire. METHODS This study was performed via the CAPTRA-Lung collaboration between December 9, 2022 and March 6, 2023. The questionnaire was distributed digitally to physicians around China and was comprised of three sections: basic characteristics of surveyed physicians, diagnosis and treatment status of NSCLC patients with the EGFR exon20ins-mutation, and physicians' perspectives on treatment options. Physicians who treat more than 10 patients with advanced NSCLC every month and who have treated patients with advanced EGFR exon20ins-mutant NSCLC in the past six months were involved in this study. RESULTS A total of 53,729 questionnaires were distributed and 390 valid ones were collected. The EGFR mutation test was performed in 80.9% and 59.9% of patients receiving first-line or second-line therapy and beyond (hereinafter "second-line")therapy, respectively. In terms of treatment options, chemotherapy plus antiangiogenic therapy was the most common treatment option (30.0% of patients in first-line settings; 25.0% of patients in second-line settings), and a certain proportion of patients received novel EGFR exon20ins-targeted agents (including tyrosine kinase inhibitors [TKIs] and bispecific antibodies) in first- or second-line settings, which accounted for 11.9% and 15.7% of all treated patients, respectively. Additionally, physicians reported the highest satisfaction score for the efficacy and safety of targeted agents. Most physicians believed that EGFR exon20ins-targeted TKIs represented the most promising treatment option (80.2% in first-line treatment and 73.3% in second-line treatment). Among several novel agents under study, sunvozertinib has received the highest recognition for efficacy and safety. CONCLUSIONS This study investigated the current diagnosis and treatment status and physicians' perspective, of patients with EGFR exon20ins-mutant NSCLC. The results highlight significant unmet clinical needs in this subgroup of patients. EGFR exon20ins-targeted TKIs were recognized as the most promising treatment regimen and may benefit more patients considering their awareness and acceptance of targeted therapy.
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Affiliation(s)
- Yuequan Shi
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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[Chinese Expert Consensus on the Standardized Diagnosis and Treatment of
Non‑small Cell Lung Cancer with EGFR Exon 20 Insertion Mutations (2024 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2024; 27:485-494. [PMID: 39147702 PMCID: PMC11331255 DOI: 10.3779/j.issn.1009-3419.2024.102.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Indexed: 08/17/2024]
Abstract
The standard clinical practice of managing the non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations was elaborated in Chinese expert consensus on non‑small cell lung cancer with EGFR exon 20 insertion mutations (2023 edition), and this rare subset has gradually attracted attention recently. With the deepening of treatment area exploration and the approval of new targeted drugs, there are more options for the diagnosis and treatment of EGFR ex20ins positive NSCLC patients. Therefore, based on the previous version of consensus, the expert panel has updated this consensus on the standardized clinical diagnosis and treatment of EGFR ex20ins mutation NSCLC through reference to literature and clinical data, and combined with the experts' own clinical experience. The updated recommendations includes disease congnition, testing methods, therapy and recent relevant clinical trials for NSCLC patients with EGFR ex20ins mutation, in order to provide better medication reference for clinical physicians.
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Girard N, Park K, Lee SH, Viteri S, Schioppa CA, Diels J, Oguz M, Rodrigues BH, Rahhali N, Sermon J, Ghilotti F, Li T, Thayu M, Knoblauch RE, Mahadevia P, Cho BC. A brief report on stable disease among amivantamab-treated patients with post-platinum epidermal growth factor receptor exon 20 insertion-mutated non-small cell lung cancer: A response-based analysis from the CHRYSALIS study. Cancer Treat Res Commun 2024; 40:100832. [PMID: 39033692 DOI: 10.1016/j.ctarc.2024.100832] [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: 03/04/2024] [Accepted: 07/04/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Amivantamab, an EGFR-MET bispecific antibody, is the first approved targeted therapy for patients with EGFR Ex20ins NSCLC after prior platinum-based chemotherapy-a population with historically poor outcomes before amivantamab approval. As antitumor activity in single-arm studies typically focuses on responders, the evaluation of outcomes in patients with stable disease (SD) as best response is of clinical interest. PATIENTS AND METHODS Among 114 patients with post-platinum EGFR Ex20ins NSCLC in CHRYSALIS (NCT02609776; data cutoff: March 30, 2021), response was assessed by blinded independent central review via RECIST v1.1. Patients alive and receiving therapy at 12 weeks were grouped by response at this landmark: partial or complete response (PR+), SD, or progressive disease (PD). Progression-free survival (PFS) and overall survival (OS) by response cohort were determined using the Kaplan-Meier method; hazard ratios (HRs) and 95% confidence intervals (CIs) between response cohorts were calculated using Cox proportional hazards regression. RESULTS Among patients alive and receiving therapy at 12 weeks (n=107), 42 (39%) had PR+, 52 (49%) had SD, and 13 (12%) had PD. Among patients with PR+ and SD, median PFS was 12.2 and 7.0 months, respectively. A corresponding improvement in OS was observed in patients achieving PR+ (median: not reached; HR vs PD=0.21 [95% CI: 0.08-0.54]) and SD (median: 23.0 months; HR vs PD=0.33 [95% CI: 0.14-0.77]), relative to those with PD (median: 14.0 months). CONCLUSION SD was observed in 49% of patients receiving amivantamab, with corresponding increases in OS that dramatically improved the prognoses of this patient population.
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Affiliation(s)
- Nicolas Girard
- Institut Curie, Institut du Thorax Curie-Montsouris, 42 Bd Jourdan, Paris 75014, France.
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, the Republic of Korea
| | - Se-Hoon Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, the Republic of Korea
| | - Santiago Viteri
- Instituto Oncológico Dr Rosell, Hospital Universitario Dexeus, Grupo Quirónsalud, Carrer de Sabino Arana, 5, Barcelona 08028, Spain
| | | | - Joris Diels
- Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse B-2340, Belgium
| | - Mustafa Oguz
- Janssen-Cilag, 50-100 Holmers Farm Way, High Wycombe HP12 4EG, United Kingdom
| | | | - Nora Rahhali
- Janssen-Cilag, 1 rue Camille Desmoulins, Issy-les-Moulineaux 92130, France
| | - Jan Sermon
- Janssen-Cilag NV, Turnhoutseweg 30, Beerse B-2340, Belgium
| | - Francesca Ghilotti
- Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, Cologno Monzese 20093, Italy
| | - Tracy Li
- Janssen Research & Development, 1000 U.S. Route 202 South, Raritan, NJ 08869, United States
| | - Meena Thayu
- Janssen Research & Development, 1400 McKean Rd, Spring House, PA 19002, United States
| | - Roland E Knoblauch
- Janssen Research & Development, 1400 McKean Rd, Spring House, PA 19002, United States
| | - Parthiv Mahadevia
- Janssen Research & Development, 1000 U.S. Route 202 South, Raritan, NJ 08869, United States
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, the Republic of Korea
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Hicken EJ, Brown K, Dwulet NC, Gaudino JJ, Hansen EP, Hartley DP, Kowalski JP, Laird ER, Lazzara NC, Li B, Mou TC, Mutryn MF, Oko L, Pajk S, Pipal RW, Rosen RZ, Shelp R, Singh A, Wang J, Wise CE, Wong C, Wong JY. Discovery of Potent and Selective Covalent Inhibitors of HER2 WT and HER2 YVMA. J Med Chem 2024; 67:9759-9771. [PMID: 38820338 DOI: 10.1021/acs.jmedchem.4c00978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
HER2 overexpression and amplification have been identified as oncogenic drivers, and the development of therapies to treat tumors harboring these markers has received considerable attention. Activation of HER2 signaling and subsequent cell growth can also be induced by HER2 mutations, including the common YVMA insertion in exon 20 within the kinase domain. Enhertu is currently the only approved treatment for HER2 mutant tumors in NSCLC. TKIs tested in this space have suffered from off-target activity, primarily due to EGFRWT inhibition or attenuated activity against HER2 mutants. The goal of this work was to identify a TKI that would provide robust inhibition of oncogenic HER2WT and HER2 mutants while sparing EGFRWT activity. Herein, we describe the development of a potent, covalent inhibitor of HER2WT and the YVMA insertion mutant while providing oral bioavailability and avoiding the inhibition of EGFRWT.
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Affiliation(s)
- Erik J Hicken
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Karin Brown
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Natalie C Dwulet
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - John J Gaudino
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Erik P Hansen
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Dylan P Hartley
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - John P Kowalski
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Ellen R Laird
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Nicholas C Lazzara
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Bin Li
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Tung-Chung Mou
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Marie F Mutryn
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Lauren Oko
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Spencer Pajk
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Robert W Pipal
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Rachel Z Rosen
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Russell Shelp
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Anurag Singh
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Jing Wang
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Courtney E Wise
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Christina Wong
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
| | - Jim Y Wong
- Pfizer Boulder Research and Development, Boulder, Colorado 80301, United States
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Banda A, Impomeni O, Singh A, Baloch AR, Hu W, Jaijyan DK. Precision in Action: The Role of Clustered Regularly Interspaced Short Palindromic Repeats/Cas in Gene Therapies. Vaccines (Basel) 2024; 12:636. [PMID: 38932365 PMCID: PMC11209408 DOI: 10.3390/vaccines12060636] [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: 04/14/2024] [Revised: 05/21/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR)-associated enzyme-CAS holds great promise for treating many uncured human diseases and illnesses by precisely correcting harmful point mutations and disrupting disease-causing genes. The recent Food and Drug Association (FDA) approval of the first CRISPR-based gene therapy for sickle cell anemia marks the beginning of a new era in gene editing. However, delivering CRISPR specifically into diseased cells in vivo is a significant challenge and an area of intense research. The identification of new CRISPR/Cas variants, particularly ultra-compact CAS systems with robust gene editing activities, paves the way for the low-capacity delivery vectors to be used in gene therapies. CRISPR/Cas technology has evolved beyond editing DNA to cover a wide spectrum of functionalities, including RNA targeting, disease diagnosis, transcriptional/epigenetic regulation, chromatin imaging, high-throughput screening, and new disease modeling. CRISPR/Cas can be used to engineer B-cells to produce potent antibodies for more effective vaccines and enhance CAR T-cells for the more precise and efficient targeting of tumor cells. However, CRISPR/Cas technology has challenges, including off-target effects, toxicity, immune responses, and inadequate tissue-specific delivery. Overcoming these challenges necessitates the development of a more effective and specific CRISPR/Cas delivery system. This entails strategically utilizing specific gRNAs in conjunction with robust CRISPR/Cas variants to mitigate off-target effects. This review seeks to delve into the intricacies of the CRISPR/Cas mechanism, explore progress in gene therapies, evaluate gene delivery systems, highlight limitations, outline necessary precautions, and scrutinize the ethical considerations associated with its application.
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Affiliation(s)
- Amrutha Banda
- Department of Biology, The College of New Jersey, Ewing Township, NJ 08618, USA
| | - Olivia Impomeni
- Department of Biology, The College of New Jersey, Ewing Township, NJ 08618, USA
| | - Aparana Singh
- Department of Chemistry, National Institute of Technology Agartala, Agartala 799046, India;
| | - Abdul Rasheed Baloch
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA;
| | - Wenhui Hu
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA;
| | - Dabbu Kumar Jaijyan
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA;
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Behera M, Jiang R, Huang Z, Bunn B, Wynes MW, Switchenko J, Scagliotti GV, Belani CP, Ramalingam SS. Natural History and Real-World Treatment Outcomes for Patients With NSCLC Having EGFR Exon 20 Insertion Mutation: An International Association for the Study of Lung Cancer-American Society of Clinical Oncology CancerLinQ Study. JTO Clin Res Rep 2024; 5:100592. [PMID: 38827378 PMCID: PMC11143895 DOI: 10.1016/j.jtocrr.2023.100592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 06/04/2024] Open
Abstract
Introduction EGFR exon 20 insertion (ex20ins) mutations account for approximately 10% of EGFR mutations in lung adenocarcinoma. Patients with ex20ins mutation do not respond to standard EGFR tyrosine kinase inhibitor therapy. In this work, we analyzed the characteristics, treatment patterns, and outcomes in this subgroup of patients with NSCLC. Methods The American Society of Clinical Oncology CancerLinQ Discovery data set was queried to identify patients with initial diagnosis of NSCLC between the years 1995 and 2018 and with EGFR ex20ins mutations. Data were extracted on patient demographics, tumor characteristics, treatments, and outcomes, and compared using chi-square and analysis of variance. Kaplan-Meier curves were generated to compare overall survival with log-rank tests. All analyses were performed using Python 3.6 (Python Software Foundation). Results A total of 357 patients were eligible. Patient characteristics include a median age of 68 years comprising female sex of 54%, White race of 63%, and Black race of 9%. Approximately 62% of total patients had stage 4 disease, and 30% of all patients had brain metastasis. There were 54% of patients who were treated with chemotherapy and 15% with immune checkpoint inhibitors (ICIs). In patients with brain metastasis, 16% were treated with ICI, 18% with targeted therapy, and 59% with chemotherapy. The median survival of the entire group was 23.8 months. Among patients with stage 4 disease (n = 222): 51% were women, 64% were white, 37% had brain metastasis, 18% were treated with ICI, 14% had targeted therapy, and 60% were treated with chemotherapy. Stage 4 patients treated with targeted therapy had better survival compared with those who did not receive targeted therapy (20.6 versus 16.1 mo, p = 0.02). Univariate and multivariate analyses suggested favorable outcomes for patients treated with immunotherapy. Conclusions EGFR ex20ins mutation represents a unique subset of NSCLC; it is associated with a higher propensity for brain metastases and a relatively modest overall survival. Novel treatment approaches are urgently needed to improve patient outcomes.
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Affiliation(s)
- Madhusmita Behera
- Winship Cancer Institute, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
| | - Renjian Jiang
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Zhonglu Huang
- Winship Cancer Institute of Emory University, Atlanta, Georgia
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Xu Y, Jia L, Zhang L, Wang H, Jiang L, Feng X, Wei R, Yao Q, Ren M, Xue T, Li Y, Zhu X, Zhou X, Bai Q. Comprehensive analysis of next generation sequencing and ARMS-PCR for detecting EGFR exon 20 insertion (ex20ins) mutations in Chinese non-small cell lung cancer patients. Transl Lung Cancer Res 2024; 13:986-997. [PMID: 38854943 PMCID: PMC11157361 DOI: 10.21037/tlcr-23-848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/22/2024] [Indexed: 06/11/2024]
Abstract
Background Amivantamab (JNJ-372) and mobocertinib (TAK-788) have been reported to have favorable therapeutic effect for non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations. Thus, accurate detection of EGFR ex20ins mutations is crucial for subsequent individualized therapy. The aim of this study was to compare the two common methods of next generation sequencing (NGS) and amplification refractory mutation system polymerase chain reaction (ARMS-PCR) for detecting EGFR ex20ins mutations in Chinese NSCLC patients. Methods We retrospectively analyzed EGFR mutations, especially for ex20ins, in 3,606 NSCLC patients detected by NGS and 1,785 patients by ARMS. Results Among the 3,606 NGS patients, a total of 2,077 EGFR mutations and 95 EGFR ex20ins were identified, accounting for 57.6% and 2.6%, respectively. While 48.4% of EGFR mutations and 1.1% of ex20ins were detected in 1,785 ARMS patients, which were significantly lower than those of NGS (P<0.01). Thirty-four unique ex20ins variants were identified by NGS, and eight of them was reported for the first time. However, ARMS was designed to detect only several known EGFR ex20ins variants, and even did not include the most common variants in Chinese NSCLC patients. Conclusions NGS is more advantageous and strongly recommended for the detection of EGFR ex20ins mutations. Considering the fast and cost-effective ARMS detection method, it is suggested that the primers design should be updated according to the characteristics of EGFR ex20ins mutations in Chinese NSCLC patients.
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Affiliation(s)
- Yuyin Xu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Liqing Jia
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Ling Zhang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Haochen Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Lin Jiang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Xu Feng
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Ran Wei
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Qianlan Yao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Min Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Tian Xue
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Yuan Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Xiaoli Zhu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Xiaoyan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
| | - Qianming Bai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
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11
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Seo D, Lim JH. Targeted Therapies for EGFR Exon 20 Insertion Mutation in Non-Small-Cell Lung Cancer. Int J Mol Sci 2024; 25:5917. [PMID: 38892105 PMCID: PMC11172945 DOI: 10.3390/ijms25115917] [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: 05/02/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Non-small-cell lung cancer (NSCLC) frequently harbors mutations in the epidermal growth factor receptor (EGFR), with exon 20 insertions comprising 1-10% of these mutations. EGFR exon 20 insertions are less responsive to conventional tyrosine kinase inhibitors (TKIs), leading to the development of targeted agents. This review explores key therapeutic agents, such as Amivantamab, Mobocertinib, Poziotinib, Zipalertinib, and Sunvozertinib, which have shown promise in treating NSCLC with EGFR exon 20 insertions. Amivantamab, a bispecific antibody-targeting EGFR and c-MET, demonstrates significant efficacy, particularly when combined with chemotherapy. Mobocertinib, a TKI, selectively targets EGFR exon 20 mutations but faces limitations in efficacy. Poziotinib, another oral TKI, shows mixed results due to mutation-specific responses. Zipalertinib and Sunvozertinib have emerged as potent TKIs with promising clinical data. Despite these advances, challenges in overcoming resistance mutations and improving central nervous system penetration remain. Future research should focus on optimizing first-line combination therapies and enhancing diagnostic strategies for comprehensive mutation profiling.
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Affiliation(s)
- Donghyun Seo
- Department of Medicine, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Jun Hyeok Lim
- Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
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12
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Hu M, Zhong C, Wang J, Chen J, Zhou T. Current status and breakthroughs in treating advanced non-small cell lung cancer with EGFR exon 20 insertion mutations. Front Immunol 2024; 15:1399975. [PMID: 38774882 PMCID: PMC11106363 DOI: 10.3389/fimmu.2024.1399975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/23/2024] [Indexed: 05/24/2024] Open
Abstract
Recently, targeted therapy and immunotherapy have emerged as effective treatment options for non-small cell lung cancer (NSCLC). This progress has been facilitated by the rapid development of diagnostic and therapeutic technologies and the continuous research and development of new drugs, leading to a new era in precision medicine for NSCLC. This is a breakthrough for patients with common mutations in the human epidermal growth factor receptor (EGFR) gene in NSCLC. Consequently, the use of targeted drugs has significantly improved survival. Nevertheless, certain rare genetic mutations are referred to as EGFR exon 20 insertion (ex20ins) mutations, which differ in structure from conventional EGFR gene mutations, namely, exon 19 deletion mutations (19-Del) and exon 21 point mutations. Owing to their distinct structural characteristics, patients harboring these EGFR ex20ins mutations are unresponsive to traditional tyrosine kinase inhibitor (TKI) therapy. This particular group of patients did not fall within the scope of their applicability. However, the activating A763_Y764insFQEA mutation elicits a more pronounced response than mutations in the near and far regions of the C-helix immediately following it and should, therefore, be treated differently. Currently, there is a lack of effective treatments for EGFR ex20ins mutations NSCLC. The efficacy of chemotherapy has been relatively favorable, whereas the effectiveness of immunotherapy remains ambiguous owing to inadequate clinical data. In addition, the efficacy of the first- and second-generation targeted drugs remains limited. However, third-generation and novel targeted drugs have proven to be effective. Although novel EGFR-TKIs are expected to treat EGFR ex20ins mutations in patients with NSCLC, they face many challenges. The main focus of this review is on emerging therapies that target NSCLC with EGFR ex20ins and highlight major ongoing clinical trials while also providing an overview of the associated challenges and research advancements in this area.
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Affiliation(s)
- Meng Hu
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Congying Zhong
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jiabing Wang
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - JinQin Chen
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Tao Zhou
- Department of Chinese and Western Medicine Oncology, Jiangxi Provincial People’s Hospital, Nanchang, China
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13
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Gou Q, Gou Q, Gan X, Xie Y. Novel therapeutic strategies for rare mutations in non-small cell lung cancer. Sci Rep 2024; 14:10317. [PMID: 38705930 PMCID: PMC11070427 DOI: 10.1038/s41598-024-61087-2] [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: 12/27/2023] [Accepted: 04/30/2024] [Indexed: 05/07/2024] Open
Abstract
Lung cancer is still the leading cause of cancer-related mortality. Over the past two decades, the management of non-small cell lung cancer (NSCLC) has undergone a significant revolution. Since the first identification of activating mutations in the epidermal growth factor receptor (EGFR) gene in 2004, several genetic aberrations, such as anaplastic lymphoma kinase rearrangements (ALK), neurotrophic tropomyosin receptor kinase (NTRK) and hepatocyte growth factor receptor (MET), have been found. With the development of gene sequencing technology, the development of targeted drugs for rare mutations, such as multikinase inhibitors, has provided new strategies for treating lung cancer patients with rare mutations. Patients who harbor this type of oncologic driver might acquire a greater survival benefit from the use of targeted therapy than from the use of chemotherapy and immunotherapy. To date, more new agents and regimens can achieve satisfactory results in patients with NSCLC. In this review, we focus on recent advances and highlight the new approval of molecular targeted therapy for NSCLC patients with rare oncologic drivers.
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Affiliation(s)
- Qitao Gou
- Department of Radiation Oncology and Department of Head & Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiheng Gou
- Department of Radiation Oncology and Department of Head & Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Xiaochuan Gan
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxin Xie
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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14
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Okahisa M, Udagawa H, Matsumoto S, Kato T, Yokouchi H, Furuya N, Kanemaru R, Toyozawa R, Nishiyama A, Ohashi K, Miyamoto S, Nishino K, Nakamura A, Iwama E, Niho S, Oi H, Sakai T, Shibata Y, Izumi H, Sugiyama E, Nosaki K, Umemura S, Zenke Y, Yoh K, Kah Mun Low G, Zhuo J, Goto K. Clinical outcomes in patients with non-small cell lung cancer harboring EGFR Exon20 in-frame insertions in the near-loop and far-loop: Results from LC-SCRUM-Asia. Lung Cancer 2024; 191:107798. [PMID: 38669727 DOI: 10.1016/j.lungcan.2024.107798] [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: 11/21/2023] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES In this study, we explored the clinical outcomes of non-small cell lung cancer (NSCLC) patients with EGFR Exon20 in-frame insertions (Exon20ins), and the impact of the location of Exon20ins on these clinical outcomes. MATERIALS AND METHODS The efficacies of current systemic therapies in NSCLC patients harboring Exon20ins were investigated using a large-scale clinico-genomic database of LC-SCRUM-Asia, and compared with that of amivantamab in the CHRYSALIS trial. RESULTS Of the 11,397 patients enrolled in LC-SCRUM-Asia, Exon20ins were detected in 189 patients (1.7 %). Treatment with classical EGFR tyrosine-kinase inhibitors (classical TKIs) was associated with a significantly shorter progression-free survival (PFS) in NSCLC patients with Exon20ins as compared with Exon19 deletions and L858R. Post platinum-based chemotherapy, classical TKIs and immune checkpoint inhibitors (ICIs) were associated with a shorter PFS than with docetaxel in patients with Exon20ins (HR [95 % CI]; TKIs vs docetaxel, 2.16 [1.35-3.46]; ICIs vs docetaxel, 1.49 [1.21-1.84]). Patients treated with amivantamab in the CHRYSALIS trial showed a risk reduction in PFS and overall survival as compared with LC-SCRUM-Asia patients treated with docetaxel, classical TKIs, or ICIs. Among the 189 patients, Exon20ins were classified as near-loop or far-loop insertions in 115 (61 %) and 56 (30 %) patients, respectively. Treatment with osimertinib was associated with a longer PFS in patients with Exon20ins in near-loop as compared with far-loop (median, 5.6 vs. 2.0 months; HR [95 % CI], 0.22 [0.07-0.64]). CONCLUSIONS After platinum-based chemotherapy, classical TKIs and ICIs are less effective in NSCLC patients with Exon20ins, and amivantamab may be a promising targeted therapy. There is a possibility that the location of Exon20ins has an impact on the efficacy of TKIs.
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Affiliation(s)
- Masanobu Okahisa
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan; Cancer Medicine, Cooperative Graduate School, The Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Hibiki Udagawa
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shingo Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroshi Yokouchi
- Department of Respiratory Medicine, Hokkaido Cancer Center, Sapporo, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ryota Kanemaru
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Akihiro Nishiyama
- Divisions of Medical Oncology, Kanazawa University Hospital, Kanazawa, Japan
| | - Kadoaki Ohashi
- Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Shingo Miyamoto
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Atsushi Nakamura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Eiji Iwama
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Seiji Niho
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Mibu, Japan
| | - Hajime Oi
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tetsuya Sakai
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuji Shibata
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroki Izumi
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Eri Sugiyama
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kaname Nosaki
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shigeki Umemura
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshitaka Zenke
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kiyotaka Yoh
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Grace Kah Mun Low
- Medical Affairs, Janssen Asia Pacific, a division of Johnson & Johnson International (Singapore) Pte. Ltd, Singapore
| | - Jianmin Zhuo
- Statistics and Decision Science, Janssen China Research & Development, China
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
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15
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Ravichandran A, Araque JC, Lawson JW. Predicting the functional state of protein kinases using interpretable graph neural networks from sequence and structural data. Proteins 2024; 92:623-636. [PMID: 38083830 DOI: 10.1002/prot.26641] [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: 02/26/2023] [Revised: 10/13/2023] [Accepted: 11/09/2023] [Indexed: 04/13/2024]
Abstract
Protein kinases are central to cellular activities and are actively pursued as drug targets for several conditions including cancer and autoimmune diseases. Despite the availability of a large structural database for kinases, methodologies to elucidate the structure-function relationship of these proteins (without manual intervention) are lacking. Such techniques are essential in structural biology and to accelerate drug discovery efforts. Here, we implement an interpretable graph neural network (GNN) framework for classifying the functionally active and inactive states of a large set of protein kinases by only using their tertiary structure and amino acid sequence. We show that the GNN models can classify kinase structures with high accuracy (>97%). We implement the Gradient-weighted Class Activation Mapping for graphs (Graph Grad-CAM) to automatically identify structurally important residues and residue-residue contacts of the kinases without any a priori input. We show that the motifs identified through the Graph Grad-CAM methodology are functionally critical, consistent with the existing kinase literature. Notably, the highly conserved DFG and HRD motifs of the well-known hydrophobic spine are identified by the interpretable framework in addition to some of the lesser known motifs. Further, using Grad-CAM maps as the vector embedding of the protein structures, we identify the subtle differences in the crystal structures among different sub-classes of kinases in the Protein Data Bank (PDB). Frameworks such as the one implemented here, for high-throughput identification of protein structure-function relationships are essential in designing targeted small molecules therapies as well as in engineering new proteins for novel applications.
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Affiliation(s)
- Ashwin Ravichandran
- KBR Inc., Intelligent Systems Division, NASA Ames Research Center, Moffett Field, California, USA
| | - Juan C Araque
- KBR Inc., Intelligent Systems Division, NASA Ames Research Center, Moffett Field, California, USA
| | - John W Lawson
- Intelligent Systems Division, NASA Ames Research Center, Moffett Field, California, USA
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16
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Zhang MS, Yeh YC, Huang HN, Lin LW, Huang YL, Wang LC, Yao LJ, Hung TC, Tseng YF, Lee YH, Liao WY, Shih JY, Hsieh MS. The association of EGFR amplification with aberrant exon 20 insertion report using the cobas EGFR Mutation Test v2. PLoS One 2024; 19:e0301120. [PMID: 38687753 PMCID: PMC11060574 DOI: 10.1371/journal.pone.0301120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/11/2024] [Indexed: 05/02/2024] Open
Abstract
Determining the exact type of epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutation in lung cancer has become important. We found that not all ex20ins mutations reported by cobas EGFR test v2 could be validated by Sanger sequencing even using surgical specimens with high tumor contents. This study aimed to validate the ex20ins results reported by the cobas test and to determine whether there were clinicopathological factors associated with aberrant cobas ex20ins report. In total, 123 cobas-reported cases with ex20ins were retrospectively collected and validated by Sanger sequencing and Idylla assay. Clinicopathological features between ex20ins cobas+/Sanger+ group (n = 71) and cobas+/Sanger- group (n = 52) were compared. The Idylla assay detected ex20ins in 82.6% of cobas+/Sanger+ cases but only in 4.9% of cobas+/Sanger- cases. The cobas+/Sanger- group was significantly associated with higher tumor contents, poorly differentiated patterns, tumor necrosis, and a lower internal control cycle threshold value reported by the Idylla which suggesting the presence of increased EGFR gene copy numbers. EGFR fluorescence in situ hybridization (FISH) revealed the majority of cobas+/Sanger- group had EGFR high copy number gain (16%) or amplification (76%) according to the Colorado criteria. Among cases reported to have concomitant classic EGFR and ex20ins mutations by the cobas, the classic EGFR mutations were all detected by Sanger sequencing and Idylla, while the ex20ins mutations were undetected by Sanger sequencing (0%) or rarely reported by Idylla assay (3%). FISH revealed high EGFR copy number gain (17.9%) and amplification (79.5%) in cases reported having concomitant classic EGFR and ex20ins mutations by the cobas. This study demonstrated an unusually high frequency of EGFR amplification in cases with aberrant cobas ex20ins report which could not be validated by Sanger sequencing or Idylla assay. Ex20ins reported by the cobas test should be validated using other methods especially those reported having concomitant ex20ins and classic EGFR mutations.
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Affiliation(s)
- Man-San Zhang
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsien-Neng Huang
- Department of Pathology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Long-Wei Lin
- Department of Pathology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Yen-Lin Huang
- Department of Pathology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Lei-Chi Wang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Lai-Jin Yao
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tze-Chun Hung
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Fen Tseng
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Yu Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Yuan Shih
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pathology, National Taiwan University Cancer Center, Taipei, Taiwan
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17
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Yang L, Li Y, Du Y, Guo Y, Guo Z, Liu B, Liu J, Liu Y, Niu H, Sun Y, Yan H, Yang Y, Yu S, Zhang Y, Zhang Y, Zheng K, Zheng N, Zhang X, Zhang Q, Hu L. Discovery of Novel 5,6-Dihydro-4 H-pyrido[2,3,4- de]quinazoline Irreversible Inhibitors Targeting Both Wild-Type and A775_G776insYVMA Mutated HER2 Kinases. J Med Chem 2024; 67:5662-5682. [PMID: 38518121 DOI: 10.1021/acs.jmedchem.3c02302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
HER2 mutations were seen in 4% of non-small-cell lung cancer (NSCLC) patients. Most of these mutations (90%) occur as an insertion mutation within the exon 20 frame, leading to the downstream activation of the PI3K-AKT and RAS/MAPK pathways. However, no targeted therapies have yet been approved worldwide. Here a novel series of highly potent HER2 inhibitors with a pyrido[2,3,4-de]quinazoline core were designed and developed. The derivatives with the pyrido[2,3,4-de]quinazoline core displayed superior efficacy of antiproliferation in BaF3 cells harboring HER2insYVMA mutation compared with afatinib and neratinib. Rat studies showed that 8a and 9a with the newly developed core have good pharmacokinetic properties with an oral bioavailability of 41.7 and 42.0%, respectively. Oral administration of 4a and 10e (30 mg/kg, QD) displayed significant antitumor efficacy in an in vivo xenograft model. We proposed promising strategies for the development of HER2insYVMA mutant inhibitors in this study.
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Affiliation(s)
- Leifu Yang
- . College of Chemistry and Life Science, Beijing University of Technology, Beijing 100124, China
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Yaxin Li
- . College of Chemistry and Life Science, Beijing University of Technology, Beijing 100124, China
| | - Yunling Du
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Yan Guo
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Zhenke Guo
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Baoxiu Liu
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Jianglin Liu
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Yanfei Liu
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Hongdan Niu
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Yueming Sun
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Henglin Yan
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Yajuan Yang
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Shannan Yu
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Yifan Zhang
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Yuan Zhang
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Kun Zheng
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Nanqiao Zheng
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Xiaoqing Zhang
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Qiang Zhang
- . . Beijing Scitech MQ Pharmaceuticals Ltd., Beijing 101320, China
| | - Liming Hu
- . College of Chemistry and Life Science, Beijing University of Technology, Beijing 100124, China
- . Beijing Key Laboratory of Environmental and Viral Oncology, Beijing 100124, China
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18
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Shi Q, Huang F, Wang Y, Liu H, Deng H, Chen YG. HER2 phosphorylation induced by TGF-β promotes mammary morphogenesis and breast cancer progression. J Cell Biol 2024; 223:e202307138. [PMID: 38407425 PMCID: PMC10896696 DOI: 10.1083/jcb.202307138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/15/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
Transforming growth factor β (TGF-β) and HER2 signaling collaborate to promote breast cancer progression. However, their molecular interplay is largely unclear. TGF-β can activate mitogen-activated protein kinase (MAPK) and AKT, but the underlying mechanism is not fully understood. In this study, we report that TGF-β enhances HER2 activation, leading to the activation of MAPK and AKT. This process depends on the TGF-β type I receptor TβRI kinase activity. TβRI phosphorylates HER2 at Ser779, promoting Y1248 phosphorylation and HER2 activation. Mice with HER2 S779A mutation display impaired mammary morphogenesis, reduced ductal elongation, and branching. Furthermore, wild-type HER2, but not S779A mutant, promotes TGF-β-induced epithelial-mesenchymal transition, cell migration, and lung metastasis of breast cells. Increased HER2 S779 phosphorylation is observed in human breast cancers and positively correlated with the activation of HER2, MAPK, and AKT. Our findings demonstrate the crucial role of TGF-β-induced S779 phosphorylation in HER2 activation, mammary gland development, and the pro-oncogenic function of TGF-β in breast cancer progression.
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Affiliation(s)
- Qiaoni Shi
- The State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing, China
| | - Fei Huang
- The State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing, China
| | - Yalong Wang
- Guangzhou National Laboratory, Guangzhou, China
| | - Huidong Liu
- The State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing, China
| | - Haiteng Deng
- MOE Key Laboratory of Bioinformatics, School of Life Sciences, Tsinghua University, Beijing, China
| | - Ye-Guang Chen
- The State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing, China
- Guangzhou National Laboratory, Guangzhou, China
- School of Basic Medicine, Jiangxi Medical College, Nanchang University, Nanchang, China
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19
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Trinh JQ, Abughanimeh O. Current management of uncommon EGFR mutations in non-small cell lung cancer. Curr Probl Cancer 2024; 49:101064. [PMID: 38311523 DOI: 10.1016/j.currproblcancer.2024.101064] [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: 11/07/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
Epidermal growth factor receptor (EGFR) mutations are frequently implicated in non-small cell lung cancer (NSCLC). Though these typically involve exon 19 in-frame deletions or L858R mutations in exon 21, uncommon EGFR mutations comprise 10-15 % of all EGFR mutations. These most frequently include G719X mutations in exon 18, L861Q mutations in exon 21, S768I mutations in exon 20, and in-frame insertions and/or duplications in exon 20. It is crucial to understand these distinct variants and their specific responses to active treatment options to optimize care. In this review, we discuss these uncommon mutations in depth and dissect the current literature regarding their treatment outcomes and subsequent evidence-based management guidelines.
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Affiliation(s)
- Jonathan Q Trinh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States.
| | - Omar Abughanimeh
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, United States
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20
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Wang YT, Yang PC, Zhang JY, Sun JF. Synthetic Routes and Clinical Application of Representative Small-Molecule EGFR Inhibitors for Cancer Therapy. Molecules 2024; 29:1448. [PMID: 38611728 PMCID: PMC11012680 DOI: 10.3390/molecules29071448] [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: 12/07/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
The epidermal growth factor receptor (EGFR) plays a pivotal role in cancer therapeutics, with small-molecule EGFR inhibitors emerging as significant agents in combating this disease. This review explores the synthesis and clinical utilization of EGFR inhibitors, starting with the indispensable role of EGFR in oncogenesis and emphasizing the intricate molecular aspects of the EGFR-signaling pathway. It subsequently provides information on the structural characteristics of representative small-molecule EGFR inhibitors in the clinic. The synthetic methods and associated challenges pertaining to these compounds are thoroughly examined, along with innovative strategies to overcome these obstacles. Furthermore, the review discusses the clinical applications of FDA-approved EGFR inhibitors such as erlotinib, gefitinib, afatinib, and osimertinib across various cancer types and their corresponding clinical outcomes. Additionally, it addresses the emergence of resistance mechanisms and potential counterstrategies. Taken together, this review aims to provide valuable insights for researchers, clinicians, and pharmaceutical scientists interested in comprehending the current landscape of small-molecule EGFR inhibitors.
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Affiliation(s)
- Ya-Tao Wang
- First People’s Hospital of Shangqiu, Shangqiu 476100, China
| | - Peng-Cheng Yang
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji 133002, China;
| | - Jing-Yi Zhang
- College of Chemistry and Chemical Engineering, Zhengzhou Normal University, Zhengzhou 450044, China;
| | - Jin-Feng Sun
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, College of Pharmacy, Yanbian University, Yanji 133002, China;
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21
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Yue P, Zhang M, Feng Y, Gao Y, Sun C, Chen P. Cost-effectiveness analysis of amivantamab plus chemotherapy versus chemotherapy alone in NSCLC with EGFR Exon 20 insertions. Front Oncol 2024; 14:1368804. [PMID: 38585010 PMCID: PMC10995216 DOI: 10.3389/fonc.2024.1368804] [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] [Received: 01/11/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Objective Amivantamab plus chemotherapy has been proved to be an efficient treatment strategy for non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertions. The aim of this study was to conduct the cost-effectiveness analysis of amivantamab-chemotherapy compared with chemotherapy alone in NSCLC harboring EGFR exon 20 insertion mutations. Methods We constructed a Markov model based on the data derived from the PAPILLON trial. We evaluated the cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were used to evaluate the influence of different parameters on this model. Results Compared with chemotherapy alone, amivantamab combined with chemotherapy treatment gained an incremental effectiveness of 0.473 QALYs and an incremental cost of $361,950.952, which resulted in an ICER of $765,224/QALY. The ICER was much higher than the willingness-to-pay threshold of 15,0000/QALY. One-way sensitivity analysis revealed that amivantamab cost was the leading influential factor in the model. Conclusions Compared with chemotherapy alone, amivantamab plus chemotherapy is not a cost-effective first-line treatment choice for NSCLC patients with EGFR exon 20 insertions. The costly price of amivantamab is one of the major reasons for the high cost of this combined treatment strategy. Therefore, it is imperative to take into account the high cost of amivantamab in the subsequent clinical application and strive to attain a relative equilibrium between its significant clinical benefit and economic encumbrance.
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Affiliation(s)
- Ping Yue
- Department of Thoracic Oncology, Lung Cancer Diagnosis and Treatment Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Mengwei Zhang
- Department of Thoracic Oncology, Lung Cancer Diagnosis and Treatment Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Yuanying Feng
- Department of Thoracic Oncology, Lung Cancer Diagnosis and Treatment Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Yuan Gao
- Department of Thoracic Oncology, Lung Cancer Diagnosis and Treatment Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Chao Sun
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Chen
- Department of Thoracic Oncology, Lung Cancer Diagnosis and Treatment Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, National Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
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22
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Liu J, Xiang Y, Fang T, Zeng L, Sun A, Lin Y, Lu K. Advances in the Diagnosis and Treatment of Advanced Non-Small-Cell Lung Cancer With EGFR Exon 20 Insertion Mutation. Clin Lung Cancer 2024; 25:100-108. [PMID: 38172024 DOI: 10.1016/j.cllc.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
The discovery of epidermal growth factor receptor (EGFR) mutations has greatly changed the clinical outlook for patients with advanced non-small-cell lung cancer (NSCLC). Unlike the most common EGFR mutations, such as exon 19 deletion (del19) and exon 21 L858R point mutation, EGFR exon 20 insertion mutation (EGFR ex20ins) is a rare mutation of EGFR. Due to its structural specificity, it exhibits primary resistance to traditional epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), leading to poor overall survival prognosis for patients. In recent years, there has been continuous progress in the development of new drugs targeting EGFR ex20ins, bringing new hope for the treatment of this patient population. In this regard, we conducted a systematic review of the molecular characteristics, diagnostic advances, and treatment status of EGFR ex20ins. We summarized the latest data on relevant drug development and clinical research, aiming to provide reference for clinical diagnosis, treatment, and drug development.
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Affiliation(s)
- Jingwen Liu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Xiang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tingwen Fang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lulin Zeng
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ao Sun
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yixiang Lin
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kaihua Lu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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23
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Odintsov I, Sholl LM. Prognostic and predictive biomarkers in non-small cell lung carcinoma. Pathology 2024; 56:192-204. [PMID: 38199926 DOI: 10.1016/j.pathol.2023.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024]
Abstract
Lung cancer is the most common cause of cancer-related deaths globally, with the highest mortality rates among both men and women. Most lung cancers are diagnosed at late stages, necessitating systemic therapy. Modern clinical management of lung cancer relies heavily upon application of biomarkers, which guide the selection of systemic treatment. Here, we provide an overview of currently approved and emerging biomarkers of non-small cell lung cancer (NSCLC), including EGFR, ALK, ROS1, RET, NTRK1-3, KRAS, BRAF, MET, ERBB2/HER2, NRG1, PD-L1, TROP2, and CEACAM5. For practical purposes, we divide these biomarkers into genomic and protein markers, based on the tested substrate. We review the biology and epidemiology of the genomic and proteomic biomarkers, discuss optimal diagnostic assays for their detection, and highlight their contribution to the contemporary clinical management of NSCLC.
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Affiliation(s)
- Igor Odintsov
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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24
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Zhao R, Li J, Guo L, Xiang C, Chen S, Zhao J, Shao J, Zhu L, Ye M, Qin G, Chu T, Han Y. EGFR and ERBB2 Exon 20 Insertion Mutations in Chinese Non-small Cell Lung Cancer Patients: Pathological and Molecular Characterization, and First-Line Systemic Treatment Evaluation. Target Oncol 2024; 19:277-288. [PMID: 38416376 DOI: 10.1007/s11523-024-01042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Data from studies looking at both EGFR and ERBB2 exon 20 insertion mutations (-20ins) in the same cohort of patients with non-small cell lung cancer (NSCLC) are limited. OBJECTIVE The purpose of this study was to analyze EGFR/ERBB2-20ins in all-stage NSCLC patients to reveal their histological and molecular features, and to retrospectively evaluate the results of first-line real-world systemic treatments in patients with advanced-stage disease. PATIENTS AND METHODS We collected 13,920 formalin-fixed paraffin-embedded NSCLC specimens. Clinicopathological features were recorded and DNA-based next-generation sequencing was performed. First-line systemic treatment data were obtained via chart review. RESULTS In total, 414 (2.97%) EGFR-20ins cases and 666 (4.78%) ERBB2-20ins cases were identified. Both were more common in women, non-smokers, and patients with adenocarcinoma. The incidence of EGFR/ERBB2-20ins in adenocarcinoma is inversely proportional to the degree of invasion; 77 and 26 variants were detected in EGFR-20ins and ERBB2-20ins cases, respectively. The most common concurrently mutated genes were TP53 and RB1. In invasive adenocarcinoma, lepidic components were more common in EGFR/ERBB2-20ins-alone cases than in those with other concurrent mutated genes. In EGFR-/ERBB2-20ins patients, there was no significant difference in progression-free survival (PFS) or treatment response to first-line systemic treatments in this study. There was no significant difference in PFS or treatment response among patients with different EGFR/ERBB2-20ins variants and those with or without concurrent mutated genes. CONCLUSIONS EGFR/ERBB2-20ins is more common in early lung adenocarcinoma. EGFR-20ins had more variants. In both cohorts, the results for first-line systemic treatments showed no significant difference.
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Affiliation(s)
- Ruiying Zhao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Jiaqi Li
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Lianying Guo
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Chan Xiang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Shengnan Chen
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Jikai Zhao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Jinchen Shao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Min Ye
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Gang Qin
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China
| | - Tianqing Chu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China.
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No. 241, West Huai Hai Road, Xv Hui District, Shanghai, 200030, China.
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25
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Wang K, Du R, Myall NJ, Lewis WE, Uy N, Hong L, Skoulidis F, Byers LA, Tsao A, Cascone T, Pozadzides J, Tu J, Negrao MV, Gibbons DL, Park K, Rinsurongkawong W, Lee JJ, Gandara D, Behl D, Shu CA, Riess JW, Baik C, Wakelee HA, Vaporciyan AA, Heymach JV, Zhang J, Le X. Real-World Efficacy and Safety of Amivantamab for EGFR-Mutant NSCLC. J Thorac Oncol 2024; 19:500-506. [PMID: 38012986 DOI: 10.1016/j.jtho.2023.11.020] [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: 08/30/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Amivantamab-vmjw (amivantamab) is a bispecific EGFR/MET antibody approved for patients with advanced NSCLC with EGFR exon 20 insertion mutations, after prior therapy. Nevertheless, the benefits and safety of amivantamab in other EGFR-mutant lung cancer, with or without osimertinib, and with concurrent radiation therapy, are less known. METHODS We queried the MD Anderson Lung Cancer GEMINI, Fred Hutchinson Cancer Research Center, University of California Davis Comprehensive Cancer Center, and Stanford Cancer Center's database for patients with EGFR-mutant NSCLC treated with amivantamab, not on a clinical trial. The data analyzed included initial response, duration of treatment, and concomitant radiation safety in overall population and prespecified subgroups. RESULTS A total of 61 patients received amivantamab. Median age was 65 (31-81) years old; 72.1% were female; and 77% were patients with never smoking history. Median number of prior lines of therapies was four. On the basis of tumor's EGFR mutation, 39 patients were in the classical mutation cohort, 15 patients in the exon 20 cohort, and seven patients in the atypical cohort. There were 37 patients (58.7%) who received amivantamab concomitantly with osimertinib and 25 patients (39.1%) who received concomitant radiation. Furthermore, 54 patients were assessable for response in the overall population; 19 patients (45.2%) had clinical response and disease control rate (DCR) was 64.3%. In the classical mutation cohort of the 33 assessable patients, 12 (36.4%) had clinical response and DCR was 48.5%. In the atypical mutation cohort, six of the seven patients (85.7%) had clinical response and DCR was 100%. Of the 13 assessable patients in the exon 20 cohort, five patients (35.7%) had clinical response and DCR was 64.3%. Adverse events reported with amivantamab use were similar as previously described in product labeling. No additional toxicities were noted when amivantamab was given with radiation with or without osimertinib. CONCLUSIONS Our real-world multicenter analysis revealed that amivantamab is a potentially effective treatment option for patients with EGFR mutations outside of exon 20 insertion mutations. The combination of osimertinib with amivantamab is safe and feasible. Radiation therapy also seems safe when administered sequentially or concurrently with amivantamab.
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Affiliation(s)
- Kaiwen Wang
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robyn Du
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Whitney E Lewis
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Natalie Uy
- University of Washington Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lingzhi Hong
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ferdinandos Skoulidis
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lauren A Byers
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anne Tsao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jenny Pozadzides
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Janet Tu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marcelo V Negrao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Don L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Keunchil Park
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Waree Rinsurongkawong
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Gandara
- University of California, Davis Comprehensive Cancer Center, Sacramento, California
| | - Deepti Behl
- Sutter Medical Center, Sacramento, California
| | - Catherine A Shu
- Columbia University Irving Medical Center, New York, New York
| | - Jonathan W Riess
- University of California, Davis Comprehensive Cancer Center, Sacramento, California
| | - Christina Baik
- University of Washington Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Ara A Vaporciyan
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiuning Le
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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26
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Friedlaender A, Perol M, Banna GL, Parikh K, Addeo A. Oncogenic alterations in advanced NSCLC: a molecular super-highway. Biomark Res 2024; 12:24. [PMID: 38347643 PMCID: PMC10863183 DOI: 10.1186/s40364-024-00566-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
Lung cancer ranks among the most common cancers world-wide and is the first cancer-related cause of death. The classification of lung cancer has evolved tremendously over the past two decades. Today, non-small cell lung cancer (NSCLC), particularly lung adenocarcinoma, comprises a multitude of molecular oncogenic subsets that change both the prognosis and management of disease.Since the first targeted oncogenic alteration identified in 2004, with the epidermal growth factor receptor (EGFR), there has been unprecedented progress in identifying and targeting new molecular alterations. Almost two decades of experience have allowed scientists to elucidate the biological function of oncogenic drivers and understand and often overcome the molecular basis of acquired resistance mechanisms. Today, targetable molecular alterations are identified in approximately 60% of lung adenocarcinoma patients in Western populations and 80% among Asian populations. Oncogenic drivers are largely enriched among non-smokers, east Asians, and younger patients, though each alteration has its own patient phenotype.The current landscape of druggable molecular targets includes EGFR, anaplastic lymphoma kinase (ALK), v-raf murine sarcoma viral oncogene homolog B (BRAF), ROS proto-oncogene 1 (ROS1), Kirstin rat sarcoma virus (KRAS), human epidermal receptor 2 (HER2), c-MET proto-oncogene (MET), neurotrophic receptor tyrosine kinase (NTRK), rearranged during transfection (RET), neuregulin 1 (NRG1). In addition to these known targets, others including Phosphoinositide 3-kinases (PI3K) and fibroblast growth factor receptor (FGFR) have garnered significant attention and are the subject of numerous ongoing trials.In this era of personalized, precision medicine, it is of paramount importance to identify known or potential oncogenic drivers in each patient. The development of targeted therapy is mirrored by diagnostic progress. Next generation sequencing offers high-throughput, speed and breadth to identify molecular alterations in entire genomes or targeted regions of DNA or RNA. It is the basis for the identification of the majority of current druggable alterations and offers a unique window into novel alterations, and de novo and acquired resistance mechanisms.In this review, we discuss the diagnostic approach in advanced NSCLC, focusing on current oncogenic driver alterations, through their pathophysiology, management, and future perspectives. We also explore the shortcomings and hurdles encountered in this rapidly evolving field.
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Affiliation(s)
- Alex Friedlaender
- Clinique Générale Beaulieu, Geneva, Switzerland
- Oncology Department, University Hospital Geneva, Rue Gentil Perret 4. 1205, Geneva, Switzerland
| | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Giuseppe Luigi Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | | | - Alfredo Addeo
- Oncology Department, University Hospital Geneva, Rue Gentil Perret 4. 1205, Geneva, Switzerland.
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27
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Vaishnavi A, Kinsey CG, McMahon M. Preclinical Modeling of Pathway-Targeted Therapy of Human Lung Cancer in the Mouse. Cold Spring Harb Perspect Med 2024; 14:a041385. [PMID: 37788883 PMCID: PMC10760064 DOI: 10.1101/cshperspect.a041385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Animal models, particularly genetically engineered mouse models (GEMMs), continue to have a transformative impact on our understanding of the initiation and progression of hematological malignancies and solid tumors. Furthermore, GEMMs have been employed in the design and optimization of potent anticancer therapies. Increasingly, drug responses are assessed in mouse models either prior, or in parallel, to the implementation of precision medical oncology, in which groups of patients with genetically stratified cancers are treated with drugs that target the relevant oncoprotein such that mechanisms of drug sensitivity or resistance may be identified. Subsequently, this has led to the design and preclinical testing of combination therapies designed to forestall the onset of drug resistance. Indeed, mouse models of human lung cancer represent a paradigm for how a wide variety of GEMMs, driven by a variety of oncogenic drivers, have been generated to study initiation, progression, and maintenance of this disease as well as response to drugs. These studies have now expanded beyond targeted therapy to include immunotherapy. We highlight key aspects of the relationship between mouse models and the evolution of therapeutic approaches, including oncogene-targeted therapies, immunotherapies, acquired drug resistance, and ways in which successful antitumor strategies improve on efficiently translating preclinical approaches into successful antitumor strategies in patients.
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Affiliation(s)
- Aria Vaishnavi
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84112, USA
| | - Conan G Kinsey
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84112, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah 84112, USA
| | - Martin McMahon
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84112, USA
- Department of Dermatology, University of Utah, Salt Lake City, Utah 84112, USA
- Department of Oncological Sciences, University of Utah, Salt Lake City, Utah 84112, USA
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Chen T, Wen J, Li Y, Deng J, Zhong Y, Hou L, She Y, Xie D, Chen C. Prognostic outcomes and recurrence patterns in resected stage I lung adenocarcinoma harbouring atypical epidermal growth factor receptor mutations. Eur J Cardiothorac Surg 2024; 65:ezad388. [PMID: 38001033 DOI: 10.1093/ejcts/ezad388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES Limited data exist on the characteristics of atypical epidermal growth factor receptor (EGFR) mutations in early-stage lung cancer. Our goal was to elucidate the associations with outcomes and recurrence patterns in resected stage I lung adenocarcinoma harbouring atypical EGFR mutations. METHODS Eligible patients between 2014 and 2019 were retrospectively identified and grouped into exon20 insertion mutations and major atypical mutations, which included G719X, L861Q and S768I. Disease-free survival (DFS) was evaluated in the entire cohort and stratified by radiologic characteristics. Recurrence patterns were investigated and compared between groups. A competing risk model was used to estimate the cumulative incidence of recurrence. RESULTS A total of 710 patients were finally included. Among them, 289 (40.7%) patients had exon 20 insertion mutations and 421 (59.3%) patients had major atypical mutations. There was no significant difference regarding DFS (P = 0.142) between groups in the entire cohort. The interaction between mutation subtype and the presence of ground-glass opacities was significant (hazard ratio 2.00, 95% confidence interval 1.59-2.51, P < 0.001), indicating DFS between exon 20 insertion mutations and major atypical mutations may be different among subsolid and solid tumours. Survival analysis consistently revealed no significant difference in subsolid tumours (P = 0.680), but favourable DFS of exon 20 insertion mutations in solid tumours (P = 0.037). Furthermore, patients with exon 20 insertion mutations had a lower risk of developing bone metastases did those with radiologic solid tumours (Gray's test, P = 0.012). CONCLUSIONS Exon 20 insertion mutations were correlated with favourable DFS and lower incidence of bone metastases in radiologic solid lung adenocarcinomas harbouring atypical EGFR mutations.
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Affiliation(s)
- Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jialiang Wen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingze Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Likun Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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He X, Hou L, Bai J, Sun C, Wang D, An G. Trastuzumab deruxtecan (DS8201) for advanced non-small cell lung cancer with HER2 exon 20 insertion mutation: a case report. Anticancer Drugs 2024; 35:101-108. [PMID: 37615532 PMCID: PMC10720853 DOI: 10.1097/cad.0000000000001535] [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: 07/13/2023] [Revised: 07/13/2023] [Indexed: 08/25/2023]
Abstract
An antibody-drug conjugate (ADC) of human epidermal growth factor receptor-2 (HER2) provides effective treatment for patients with HER2-positive non-small cell lung cancer (NSCLC). Exon 20 insertion mutations are the most common among HER2 mutations. This mutant subtype is highly drug-resistant, and patients receiving conventional treatment often have a poor prognosis. Trastuzumab deruxtecan (T-DXd), a novel anti-HER2 ADC, has emerged as a novel treatment option for HER2-positive (mutated, expressed, amplified, alternated) NSCLC, based on several studies and reported results. Herein, we report a case of stage IV NSCLC with HER2 exon 20 mutation in a 52-year-old male patient whose tumor recurred after radical resection of pulmonary carcinoma, who could not tolerate chemotherapy, and presented with bone metastasis. After treatment with T-DXd, the tumor significantly regressed and bone metastasis improved, maintaining a state of no progression for 21 months. This case report evidences the use of T-DXd in the treatment of NSCLC with HER2 exon 20 insertion mutation.
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Affiliation(s)
- Xincheng He
- Department of Clinical Oncology, Shaanxi Provincial People’s Hospital, Xi’an
| | - Lei Hou
- Department of Clinical Oncology, Shaanxi Provincial People’s Hospital, Xi’an
| | - Jun Bai
- Department of Clinical Oncology, Shaanxi Provincial People’s Hospital, Xi’an
| | - Chao Sun
- Department of Clinical Oncology, Shaanxi Provincial People’s Hospital, Xi’an
| | - Dongjie Wang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Gaili An
- Department of Clinical Oncology, Shaanxi Provincial People’s Hospital, Xi’an
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Wang H, Xu Y, Lin J, Huang Y. Evaluating the Clinical Characteristics and Prognosis of Advanced Non-Small Cell Lung Cancer with Exon 20 Insertions. Cancer Control 2024; 31:10732748241262190. [PMID: 38857163 PMCID: PMC11165965 DOI: 10.1177/10732748241262190] [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: 12/06/2023] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Epidermal growth factor receptor exon 20 insertion (EGFR ex20ins), an uncommon mutation in non-small cell lung cancer (NSCLC), can induce poor patient response to EGFR tyrosine kinase inhibitors (EGFR-TKI). However, the clinical features and prognosis of patients with EGFR ex20ins are not clearly understood. This study investigated the clinical characteristics and prognosis of advanced NSCLC patients with EGFR ex20ins. METHODS Advanced NSCLC patients treated at Fujian Cancer Hospital were consecutively recruited from June 1, 2014 to December 20, 2021 and retrospectively examined. EGFR ex20ins was identified by polymerase chain reaction (PCR) or next-generation sequencing (NGS). The clinical characteristics, treatment methods, and patient outcomes were retrieved from the hospital database. The progression-free survival (PFS) and overall survival (OS) were assessed by Kaplan-Meier analysis. RESULTS Fourteen mutation subtypes of EGFR ex20ins were identified in the 24 enrolled patients, with EGFR ex20ins mutation more prevalent in non-smoking women. A763_Y764insFQEA and A767_V769dup (12.5% for both) were the most common mutation subtypes. Notably, no significant differences in PFS and OS were found between the first-line targeted therapy group [PFS: 257 days, 95% confidence interval (CI): 116-397 days; OS: not reached] and chemotherapy-based combination therapy group (PFS: 182 days, 95% CI: 156-207 days; OS: 998 days, 95% CI: 674-1321 days). TP53 mutation was the commonest concomitant mutation (62%), followed by EGFR amplification (25%). Chemotherapy combined with immunotherapy improved the prognosis of patients with high PD-L1 expression. CONCLUSION For NSCLC patients with EGFR ex20ins, limited therapeutic benefits can be gleaned from either EGFR-TKIs or chemotherapy-based combination therapy.
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Affiliation(s)
- Haibo Wang
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yiquan Xu
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jinlan Lin
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yunjian Huang
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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Wang HY, Ho CC, Lin YT, Liao WY, Chen CY, Shih JY, Yu CJ. Comprehensive Genomic Analysis of Patients With Non-Small-Cell Lung Cancer Using Blood-Based Circulating Tumor DNA Assay: Findings From the BFAST Database of a Single Center in Taiwan. JCO Precis Oncol 2024; 8:e2300314. [PMID: 38190582 DOI: 10.1200/po.23.00314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE The Blood First Assay Screening Trial (BFAST) is a prospective study using next-generation sequencing (NGS) of circulating tumor DNA (ctDNA) in treatment-naïve advanced/metastatic non-small-cell lung cancer (NSCLC). We compared liquid biopsy to tissue testing and analyzed genomic alterations in Taiwanese patients with NSCLC using the BFAST database. MATERIALS AND METHODS A total of 269 patients underwent FoundationOne Liquid Companion Diagnostic (F1LCDx) assay at the National Taiwan University Hospital, of whom 264 underwent tissue-based genetic testing also. We analyzed the actionable mutations and the concordance between tissue-based genetic testing, which was limited to EGFR, ALK, ROS1, and BRAF, in a real-life clinical setting and blood-based NGS in the clinical trial. Additionally, we analyzed the co-occurring genomic alterations from the blood-based ctDNA assay. RESULTS A total of 76.2% patients showed actionable mutations. Standard tissue testing did not detect known driver alterations in about 22.7% of the patients (sensitivity, 70.24%). Liquid NGS detected additional mutations (RET, KRAS, MET, and ErbB2) in 14% of the patients, which went undetected by the standard-of-care testing. The complementary use of ctDNA NGS increased the detection rate by 42%. The F1LCDx assay had a sensitivity of 83.41%. Lower tumor and metastasis stages predicted nondetected blood-based NGS ctDNA results. Common co-occurring mutations in the blood-based NGS ctDNA assay were TP53, DNMT3A, TET2, PIK3CA, CTNNB1, and RB1. Among the patients with EGFR-mutated NSCLC, TET2 co-occurring alterations correlated with shorter progression-free survival of EGFR tyrosine kinase inhibitor treatment. CONCLUSION NGS ctDNA analysis in comprehensive genetic testing improves actionable mutation identification, vital for treating Asian NSCLC cases with high actionable mutation rates. Lower stages correlated with undetected blood-based NGS ctDNA assay results.
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Affiliation(s)
- Hsin-Yi Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu City, Yunlin County, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, Zhongzheng District, Taipei City, Taiwan
| | - Yen-Ting Lin
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medicine, National Taiwan University Cancer Centre, Da'an District, Taipei City, Taiwan
| | - Wei-Yu Liao
- Department of Internal Medicine, National Taiwan University Hospital, Zhongzheng District, Taipei City, Taiwan
| | - Chung-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu City, Yunlin County, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, Zhongzheng District, Taipei City, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Zhongzheng District, Taipei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, North District, Hsinchu City, Taiwan
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Udagawa H, Nilsson MB, Robichaux JP, He J, Poteete A, Jiang H, Heeke S, Elamin YY, Shibata Y, Matsumoto S, Yoh K, Okazaki S, Masuko T, Odintsov I, Somwar R, Ladanyi M, Goto K, Heymach JV. HER4 and EGFR Activate Cell Signaling in NRG1 Fusion-Driven Cancers: Implications for HER2-HER3-specific Versus Pan-HER Targeting Strategies. J Thorac Oncol 2024; 19:106-118. [PMID: 37678511 PMCID: PMC11161205 DOI: 10.1016/j.jtho.2023.08.034] [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: 05/12/2023] [Revised: 08/20/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION NRG1 gene fusions are clinically actionable alterations identified in NSCLC and other tumors. Previous studies have reported that NRG1 fusions signal through HER2 and HER3 but, thus far, strategies targeting HER3 specifically or HER2-HER3 signaling have exhibited modest activity in patients with NSCLC bearing NRG1 fusions. Although NRG1 fusion proteins can bind HER4 in addition to HER3, the contribution of HER4 and other HER family members in NRG1 fusion-positive cancers is not fully understood. METHODS We investigated the role of HER4 and EGFR-HER3 signaling in NRG1 fusion-positive cancers using Ba/F3 models engineered to express various HER family members in combination with NRG1 fusions and in vitro and in vivo models of NRG1 fusion-positive cancer. RESULTS We determined that NRG1 fusions can stimulate downstream signaling and tumor cell growth through HER4, independent of other HER family members. Moreover, EGFR-HER3 signaling is also activated in cells expressing NRG1 fusions, and inhibition of these receptors is also necessary to effectively inhibit tumor cell growth. We observed that cetuximab, an anti-EGFR antibody, in combination with anti-HER2 antibodies, trastuzumab and pertuzumab, yielded a synergistic effect. Furthermore, pan-HER tyrosine kinase inhibitors were more effective than tyrosine kinase inhibitors with greater specificity for EGFR, EGFR-HER2, or HER2-HER4, although the relative degree of dependence on EGFR or HER4 signaling varied between different NRG1 fusion-positive cancers. CONCLUSIONS Our findings indicate that pan-HER inhibition including HER4 and EGFR blockade is more effective than selectively targeting HER3 or HER2-HER3 in NRG1 fusion-positive cancers.
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Affiliation(s)
- Hibiki Udagawa
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Monique B Nilsson
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jacqulyne P Robichaux
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Junqin He
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alissa Poteete
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hong Jiang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simon Heeke
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yasir Y Elamin
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yuji Shibata
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Shingo Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kiyotaka Yoh
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Shogo Okazaki
- Department of Microbiology and Immunology, Nihon University School of Dentistry, Tokyo, Japan
| | - Takashi Masuko
- Cell Biology Laboratory, School of Pharmacy, Kindai University, Osaka, Japan
| | - Igor Odintsov
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Romel Somwar
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc Ladanyi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Han H, Zhang X, Liu X, Zhao J, Zhang J, Zhang J, Zhu H, Jiao S, Tang H. First report of furmonertinib as a first-line treatment in advanced lung adenocarcinoma patients harboring EGFR exon 20 insertion mutations after the kinase domain αC-helix: Two case reports and a literature review. Medicine (Baltimore) 2023; 102:e36667. [PMID: 38206746 PMCID: PMC10754557 DOI: 10.1097/md.0000000000036667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/23/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE Many studies have shown that first- and second-generation epidermal growth factor receptor tyrosine kinase inhibitors are less effective in patients with epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations. The efficacy of third-generation epidermal growth factor receptor tyrosine kinase inhibitors is still under investigation. Although new targeted tyrosine kinase inhibitors and monoclonal antibody-based agents have made significant advances in the treatment of epidermal growth factor receptor exon 20 insertion (EGFR ex20ins) mutation, the efficacy of these novel agents is not quite satisfactory. Platinum- and pemetrexed-based chemotherapy remains the standard first-line treatment for patients harboring EGFR ex20ins mutation. PATIENT CONCERNS We report for the first time 2 Chinese patients diagnosed with advanced lung adenocarcinoma with EGFR ex20ins mutations after analysis of the αC-helix sequence by next-generation sequencing. Both patients were treated with furmonertinib as the first-line therapy. INTERVENTIONS The first case included a 38-year-old female who had an EGFR ex20ins mutation (p.S768_D770dupSVD). After 1 month of treatment with furmonertinib, her symptoms of pain and cough were significantly alleviated. She achieved a partial response according to response evaluation criteria in solid tumors.[1] The final progression-free survival was 8.13 months. The second case included a 40-year-old male who had an EGFR ex20ins mutation (p.N771_P772insVal). He had a good response to furmonertinib and exhibited stable disease according to response evaluation criteria in solid tumors with a progression-free survival of 10.90 months. OUTCOMES Both patients experienced significant improvement in symptoms and prolonged survival after furmonertinib was used as first-line treatment. Side effects were limited but manageable. CONCLUSION The present study indicates that furmonertinib may be a first-line treatment option for patients with non-small cell lung cancer harboring EGFR ex20ins mutation.
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Affiliation(s)
- Huan Han
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Xiao Zhang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Xiao Liu
- Department of Radiotherapy, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Jiuzhou Zhao
- Department of Pathology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Jianbo Zhang
- Department of Pathology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Jianwei Zhang
- Department of Medical Iconography, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Hui Zhu
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Shuyue Jiao
- Department of Respiratory Medicine, Luohe Central Hospital, Luohe, China
| | - Hong Tang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
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Choi DH, Jung HA, Park S, Sun JM, Ahn JS, Ahn MJ, Lee SH. Effectiveness and safety of amivantamab in EGFR exon 20 insertion (E20I) mutations in non-small cell lung cancer (NSCLC). Transl Lung Cancer Res 2023; 12:2448-2459. [PMID: 38205202 PMCID: PMC10775014 DOI: 10.21037/tlcr-23-643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
Background In non-small cell lung cancer (NSCLC), the epidermal growth factor receptor (EGFR) mutation is a representative oncogenic driver mutation. Only about 12% of EGFR mutation patients have the exon 20 insertion mutation, which is the third most frequent mutation among EGFR mutation NSCLC. Amivantamab, an EGFR and MET proto-oncogene, receptor tyrosine kinase (MET) bispecific antibody, was approved for NSCLC patients with the EGFR exon 20 insertion (E20I) mutation. In this study, we described the real-world, single-center efficacy and safety data of amivantamab in E20I mutation patients. Methods This study included metastatic NSCLC patients with EGFR E20I mutations. From January 2018 to June 2022, patients with EGFR E20I mutations who were treated with amivantamab were analyzed at Samsung Medical Center as part of the clinical trial or the early access program (EAP). We collected the patients' characteristics [age, sex, smoking history, location of mutation, sites of metastasis, programmed death-ligand 1 (PD-L1) expression status, etc.] and analyzed progression-free survival (PFS) and overall survival (OS) stratified by PD-L1 expression status, co-mutation such as tumor protein p53 (TP53), and metastasis sites. Results A total of 42 patients were analyzed, of which 16 patients were enrolled in the phase 1 study, and 26 patients received amivantamab through EAP. There were 14 (33%) patients with partial remission, 18 (43%) patients with stable disease, and 10 (24%) patients with disease progression. The objective response rate (ORR) was 33%, and the disease control rate (DCR) was 76%. PFS was analyzed by dividing the near and far loop for 31 patients whose mutation location was known. The two groups had no statistically significant difference in PFS [median (range): 11.8 (2.3-21.3) vs. 11.3 (3.4-19.2) months, P=0.69]. For 29 patients with TP53 mutation data, there was no significant difference in PFS between the two groups [median (range): 5.9 (0-18.0) vs. 12.6 (6.9-18.3) months, P=0.11]. When analyzing PFS in 37 patients with PD-L1 expression data, PD-L1 (+) patients showed a poor prognosis [median (range): 11.3 (5.0-17.6) vs. 19.5 (5.3-33.7) months, P=0.04; hazard ratio (HR), 0.44; 95% confidence interval (CI): 0.20-0.98]. Conclusions The efficacy of amivantamab was confirmed for the real-world population for EGFR E20I-mutated NSCLC. PD-L1 status could be a poor predictive factor, which should be further validated.
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Affiliation(s)
- Dae-Ho Choi
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sehhoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Hashimoto Y, Maeda K, Shimomura O, Miyazaki Y, Hashimoto S, Moriyama A, Oda T, Kusuhara H. Evaluation of the risk of diarrhea induced by epidermal growth factor receptor tyrosine kinase inhibitors with cultured intestinal stem cells originated from crypts in humans and monkeys. Toxicol In Vitro 2023; 93:105691. [PMID: 37660997 DOI: 10.1016/j.tiv.2023.105691] [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: 04/11/2023] [Revised: 07/13/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
Severe diarrhea is a common side effect of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). We aimed to evaluate the risk of EGFR-TKI-induced diarrhea using spheroids of human and monkey crypt-derived intestinal stem cells. Intestinal spheroids exhibited higher toxic susceptibility to EGFR-TKIs than Caco-2 cells. As concentration of EGFR-TKIs increased, cellular ATP first decreased relative to the control condition, followed by an increase in LDH release, in contrast with their simultaneous changes with traditional cytotoxic anticancer drugs. The toxic sensitivity of spheroids to various EGFR-TKIs corresponded to clinical diarrhea incidence. Afatinib, a second-generation EGFR-TKI, exhibited higher toxic sensitivity compared with the first-generation ones, corresponding to the clinical evidence that afatinib-induced diarrhea is almost inevitable and severe. By contrast, the third-generation osimertinib, which reduces the risk of diarrhea, showed mitigated cytotoxicity compared with afatinib. For irreversible EGFR-TKIs, the decreased ATP level persisted or its recovery was delayed even after drug removal compared with reversible ones. Furthermore, the highest drug accumulation in spheroids (TKIspheroids) and inhibition potency against EGFR (TKIspheroids/Ki) were observed for afatinib. This system would be useful for predicting the risk of EGFR-TKI-induced diarrhea; moreover, on-target cytotoxicity against intestinal stem cells might contribute to clinically observed diarrhea.
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Affiliation(s)
- Yoshiki Hashimoto
- Laboratory of Molecular Pharmacokinetics, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Kazuya Maeda
- Laboratory of Molecular Pharmacokinetics, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan; Laboratory of Pharmaceutics, School of Pharmacy, Kitasato University, Tokyo, Japan.
| | - Osamu Shimomura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshihiro Miyazaki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shinji Hashimoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akiko Moriyama
- Pathology Department, Drug Safety Research Laboratories, Shin Nippon Biomedical Laboratories, Ltd., Kagoshima, Japan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroyuki Kusuhara
- Laboratory of Molecular Pharmacokinetics, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.
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Kim TM, Girard N, Low GKM, Zhuo J, Yu DY, Yang Y, Murota M, Lim CTK, Kleinman NJ, Cho BC. Amivantamab compared with real-world therapies in patients with advanced non-small cell lung cancer EGFR Exon 20 insertion mutations after platinum-based chemotherapy. Acta Oncol 2023; 62:1689-1697. [PMID: 37938161 DOI: 10.1080/0284186x.2023.2254479] [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: 01/25/2023] [Accepted: 08/04/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND In the single-arm CHRYSALIS trial, advanced non-small cell lung cancer patients harboring epidermal growth factor receptor (EGFR) exon 20 insertion (Exon 20ins) showed durable responses to amivantamab, an EGFR-MET bispecific antibody targeting tumors with EGFR Exon 20ins. This study compared the effectiveness of amivantamab to real-world systemic anti-cancer therapies in Japan. PATIENTS AND METHODS External control patients were selected by applying CHRYSALIS eligibility to Japanese patients from LC-SCRUM-Asia. External control patients were included for every qualifying line of therapy after platinum-based chemotherapy. Propensity score weighting was applied to external control patients to adjust for differences in baseline characteristics. Outcomes were compared between external control patients, and all and Asian-only CHRYSALIS patients using weighted Cox proportional hazards regression models for progression-free survival (PFS), time to next therapy (TTNT), and overall survival (OS), and generalized estimating equations with repeated measurements for overall response rate (ORR). RESULTS One hundred fifteen CHRYSALIS and 94 external control patients were identified. Compared to external control patients, amivantamab-treated patients had significantly longer OS (median OS 19.88 vs 14.09 months, HR [95% CI] 0.59 [0.40-0.88]), PFS (median PFS 6.74 vs 4.73 months, HR 0.59 [0.45-0.78]), TTNT (median TTNT 12.16 vs 5.09 months, HR 0.39 [0.29-0.53]), and significantly higher ORR (41.7% vs 14.1%). Analyses of amivantamab-treated Asian patients (n = 61) showed similar clinical benefits. CONCLUSION In the absence of clinical evidence from randomized clinical trials, this study reflects the benefit of amivantamab after platinum-based chemotherapy for advanced non-small cell lung cancer patients harboring EGFR Exon 20ins, compared to current real-world therapies.
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Affiliation(s)
- Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nicolas Girard
- Institut Curie, Institute du Thorax Curie-Montsouris, Paris, France
| | - Grace Kah Mun Low
- Medical Affairs, Janssen Asia Pacific Medical Affairs, a division of Johnson & Johnson International (Singapore) Pte. Ltd
| | - Jianmin Zhuo
- Statistics and Decision Science, Janssen China Research & Development, China
| | - Dae Young Yu
- Real World Evidence, Janssen Asia Pacific, Republic of Korea
| | - Yishen Yang
- Statistics and Decision Science, Janssen China Research & Development, China
| | - Maiko Murota
- Global Development, Medical Affair Operations, Janssen Research & Development, Tokyo, Japan
| | | | - Nora J Kleinman
- Real World Solutions, IQVIA Hong Kong, Kwai Fong, Hong Kong, P.R. China
| | - Byoung Chul Cho
- Department of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
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Zhou C, Tang KJ, Cho BC, Liu B, Paz-Ares L, Cheng S, Kitazono S, Thiagarajan M, Goldman JW, Sabari JK, Sanborn RE, Mansfield AS, Hung JY, Boyer M, Popat S, Mourão Dias J, Felip E, Majem M, Gumus M, Kim SW, Ono A, Xie J, Bhattacharya A, Agrawal T, Shreeve SM, Knoblauch RE, Park K, Girard N. Amivantamab plus Chemotherapy in NSCLC with EGFR Exon 20 Insertions. N Engl J Med 2023; 389:2039-2051. [PMID: 37870976 DOI: 10.1056/nejmoa2306441] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Amivantamab has been approved for the treatment of patients with advanced non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertions who have had disease progression during or after platinum-based chemotherapy. Phase 1 data showed the safety and antitumor activity of amivantamab plus carboplatin-pemetrexed (chemotherapy). Additional data on this combination therapy are needed. METHODS In this phase 3, international, randomized trial, we assigned in a 1:1 ratio patients with advanced NSCLC with EGFR exon 20 insertions who had not received previous systemic therapy to receive intravenous amivantamab plus chemotherapy (amivantamab-chemotherapy) or chemotherapy alone. The primary outcome was progression-free survival according to blinded independent central review. Patients in the chemotherapy group who had disease progression were allowed to cross over to receive amivantamab monotherapy. RESULTS A total of 308 patients underwent randomization (153 to receive amivantamab-chemotherapy and 155 to receive chemotherapy alone). Progression-free survival was significantly longer in the amivantamab-chemotherapy group than in the chemotherapy group (median, 11.4 months and 6.7 months, respectively; hazard ratio for disease progression or death, 0.40; 95% confidence interval [CI], 0.30 to 0.53; P<0.001). At 18 months, progression-free survival was reported in 31% of the patients in the amivantamab-chemotherapy group and in 3% in the chemotherapy group; a complete or partial response at data cutoff was reported in 73% and 47%, respectively (rate ratio, 1.50; 95% CI, 1.32 to 1.68; P<0.001). In the interim overall survival analysis (33% maturity), the hazard ratio for death for amivantamab-chemotherapy as compared with chemotherapy was 0.67 (95% CI, 0.42 to 1.09; P = 0.11). The predominant adverse events associated with amivantamab-chemotherapy were reversible hematologic and EGFR-related toxic effects; 7% of patients discontinued amivantamab owing to adverse reactions. CONCLUSIONS The use of amivantamab-chemotherapy resulted in superior efficacy as compared with chemotherapy alone as first-line treatment of patients with advanced NSCLC with EGFR exon 20 insertions. (Funded by Janssen Research and Development; PAPILLON ClinicalTrials.gov number, NCT04538664.).
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Affiliation(s)
- Caicun Zhou
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Ke-Jing Tang
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Byoung Chul Cho
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Baogang Liu
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Luis Paz-Ares
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Susanna Cheng
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Satoru Kitazono
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Muthukkumaran Thiagarajan
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Jonathan W Goldman
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Joshua K Sabari
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Rachel E Sanborn
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Aaron S Mansfield
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Jen-Yu Hung
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Michael Boyer
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Sanjay Popat
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Josiane Mourão Dias
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Enriqueta Felip
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Margarita Majem
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Mahmut Gumus
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Sang-We Kim
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Akira Ono
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - John Xie
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Archan Bhattacharya
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Trishala Agrawal
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - S Martin Shreeve
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Roland E Knoblauch
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Keunchil Park
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
| | - Nicolas Girard
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai (C.Z.), the Division of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (K.-J.T.), and Harbin Medical University Cancer Hospital, Harbin (B.L.) - all in China; the Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine (B.C.C.), Asan Medical Center, University of Ulsan College of Medicine (S. Kim), and Samsung Medical Center, Sungkyunkwan University School of Medicine (K.P.) - all in Seoul, South Korea; Hospital Universitario 12 de Octubre, Madrid (L.P.-A.), and Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (E.F.) and Hospital de la Santa Creu I Sant Pau (M.M.), Barcelona - all in Spain; Sunnybrook Odette Cancer Centre, Toronto (S.C.); Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (S. Kitazono), and Shizuoka Cancer Center, Shizuoka (A.O.) - both in Japan; General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.T.); David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.), and Janssen Research and Development, San Diego (S.M.S.) - both in California; NYU Langone Health, New York (J.K.S.); Earle A. Chiles Research Institute, Providence Cancer Institute of Oregon, Portland (R.E.S.); Mayo Clinic, Rochester, MN (A.S.M.); the Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (J.-Y.H.); Chris O'Brien Lifehouse, Camperdown, NSW, Australia (M.B.); Royal Marsden Hospital NHS Foundation Trust and the Institute of Cancer Research, London (S.P.), and Janssen Research and Development, High Wycombe (A.B.) - both in the United Kingdom; Barretos Cancer Hospital, Barretos, Brazil (J.M.D.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); Janssen Research and Development, Raritan, NJ (J.X.); Janssen Research and Development, Spring House, PA (T.A., R.E.K.); and Institut Curie, Institut du Thorax Curie-Montsouris, Paris, and Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Versailles - both in France (N.G.)
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Pan B, Liang J, Shi H, Rao K, Guo W, Zhan C. Epidemiological characteristics and therapeutic advances of EGFR exon 20 insertion mutations in non-small cell lung cancer. Thorac Cancer 2023; 14:3247-3258. [PMID: 37795778 PMCID: PMC10665789 DOI: 10.1111/1759-7714.15127] [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: 08/15/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
The third most prevalent type of epidermal growth factor receptor (EGFR) mutation, EGFR exon 20 insertions (EGFRex20ins), involves 2%-12% of all cases of EGFR-positive non-small cell lung cancer (NSCLC). Approximately 90% of the mutations occur within the loop structure region, and the most frequently reported subtypes are A767_V769dup and S768_D770dup, which together account for almost 50% of instances. Apart from the unique subtype of A763_Y764insFQEA, NSCLCs with EGFRex20ins are resistant to approved EGFR tyrosine kinase inhibitors (TKIs) and are also insensitive to chemotherapy or immunotherapy. A new modality of treatment for NSCLC patients with EGFRx20ins has been established with the approval of mobocertinib and amivantamab. There are also numerous novel targeted treatments for NSCLC with EGFRex20ins in development, which are anticipated to improve this patient population's survival even further. This review provides a reference for the clinical management of these patients by summarizing the most recent epidemiological, and clinicopathological characteristics, diagnostic techniques, and therapeutic advances of EGFRex20ins in NSCLC.
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Affiliation(s)
- Binyang Pan
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Haochun Shi
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Kungeng Rao
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Weigang Guo
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Department of Thoracic Surgery and UrologyShigatse People's HospitalShigatseChina
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
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Zwierenga F, van Veggel BAMH, van den Berg A, Groen HJM, Zhang L, Groves MR, Kok K, Smit EF, Hiltermann TJN, de Langen AJ, van der Wekken AJ. A comprehensive overview of the heterogeneity of EGFR exon 20 variants in NSCLC and (pre)clinical activity to currently available treatments. Cancer Treat Rev 2023; 120:102628. [PMID: 37797348 DOI: 10.1016/j.ctrv.2023.102628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
Activating EGFR mutations are commonly observed in non-small cell lung cancer (NSCLC). About 4-10 % of all activating epidermal growth factor receptor (EGFR) mutations are heterogenous in-frame deletion and/or insertion mutations clustering within exon 20 (EGFRex20+). NSCLC patients with EGFRex20+ mutations are treated as a single disease entity, irrespective of the type and location of the mutation. Here, we provide a comprehensive assessment of the literature reporting both in vitro and clinical drug sensitivity across different EGFRex20+ mutations. The activating A763_Y764insFQEA mutation has a better tumor response in comparison with mutations in the near- and far regions directly following the C-helix and should therefore be treated differently. For other EGFRex20+ mutations marked differences in treatment responses have been reported indicating the need for a classification beyond the exon-based classification. A further classification can be achieved using a structure-function modeling approach and experimental data using patient-derived cell lines. The detailed overview of TKI responses for each EGFRex20+ mutation can assist treating physicians to select the most optimal drug for individual NSCLC patients.
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Affiliation(s)
- Fenneke Zwierenga
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Bianca A M H van Veggel
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anke van den Berg
- Department of Pathology and Molecular Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry J M Groen
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lili Zhang
- Structural Biology in Drug Design, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Matthew R Groves
- Structural Biology in Drug Design, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - K Kok
- Department of Genetics, University of Groningen, University Medical Center Groningen, The Netherlands
| | - E F Smit
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Jeroen N Hiltermann
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrianus J de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anthonie J van der Wekken
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bai Q, Wang J, Zhou X. EGFR exon20 insertion mutations in non-small cell lung cancer: Clinical implications and recent advances in targeted therapies. Cancer Treat Rev 2023; 120:102605. [PMID: 37703723 DOI: 10.1016/j.ctrv.2023.102605] [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: 04/27/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 09/15/2023]
Abstract
The advent of targeted therapies for oncogenic mutations has led to a major paradigm shift in the management of non-small cell lung cancer (NSCLC). Molecular targets, such as epidermal growth factor receptor (EGFR)-activating mutations in the region of exons 18 through 21 are the most common oncogenic driver in NSCLC. Classical activating mutations, such as in-frame deletions in exon 19 and point mutations in exon 21 (L858R), are strong predictors for good clinical response to the approved EGFR-tyrosine kinase inhibitors (EGFR-TKIs). However, low frequency mutations occurring within exon 20 (ex20ins) have poorer responses to first/second generation EGFR-TKIs. Moreover, patients with NSCLC harboring EGFR ex20ins are known to have poorer prognosis than those with other EGFR-TKI sensitive mutations, leading to unmet clinical need of novel specific therapeutic options. Rapid changes in molecular diagnostics identifying specific causes have hastened the translation of diagnostic recommendations into clinical practice. Emergence of treatment strategies targeting EGFR ex20ins, such as newer EGFR-TKIs with increased specificity and novel approaches using bispecific monoclonal antibodies, may hold promising therapeutic options in the near future. In this review, we describe the structural, molecular characteristics, and detection strategies of EGFR ex20ins mutations and summarize the latest clinical data on approved treatments and emerging therapies for patients with NSCLC harboring EGFR ex20ins mutations. Further, we will discuss the response heterogeneity of ex20ins mutations to new drugs and acquired drug resistance mechanisms.
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Affiliation(s)
- Qianming Bai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Institute of Pathology, Fudan University, Shanghai, China
| | - Jialei Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Xiaoyan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Institute of Pathology, Fudan University, Shanghai, China.
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Jiang W, Sha M, Chen C. Successful Salvage Therapy With a High Dose of Furmonertinib in a Case of Lung Adenocarcinoma Harboring EGFR Exon 20 Insertion. Am J Ther 2023; 30:e570-e572. [PMID: 35482932 DOI: 10.1097/mjt.0000000000001504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Weizhen Jiang
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, China
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Kalra R, Lim B, Ellis MJ, Kavuri SM. The uncharted role of HER2 mutant alleles in breast cancer. Oncotarget 2023; 14:904-907. [PMID: 37921670 PMCID: PMC10624202 DOI: 10.18632/oncotarget.28489] [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: 07/12/2023] [Indexed: 11/04/2023] Open
Abstract
Somatic HER2 mutations are a novel class of therapeutic targets across different cancer types. Treatment with the tyrosine kinase inhibitor (TKI) neratinib as a single agent continues to be evaluated in HER2-mutant metastatic disease. However, responses are heterogeneous, with frequent early progression. Herein, we discuss the under-explored effects of individual HER2 mutant alleles on therapeutic response, a role for HER2 mutation in metastatic propensity, and differences in patient outcomes in ER+ invasive lobular carcinoma (ILC) versus invasive ductal carcinoma (IDC). The preclinical efficacy of additional agents is also discussed, particularly the pan-HER inhibitor poziotinib.
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Affiliation(s)
| | | | | | - Shyam M. Kavuri
- Correspondence to:Shyam M. Kavuri, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA email
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Ilesanmi A, Dairo G, Salimat S, Bodun DS, Awoyale B, Balogun TA. Identification of bioactive compounds from Vaccinium vitis-idaea L. (Lingonberry) as inhibitors for treating KRAS-associated cancer: a computational approach. In Silico Pharmacol 2023; 11:32. [PMID: 37915613 PMCID: PMC10616029 DOI: 10.1007/s40203-023-00165-1] [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: 07/29/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
Lung cancer is the cancer of the lung's epithelial cells typically characterized by difficulty breathing, chest pain, blood-stained coughs, headache, and weight loss. If left unmanaged, lung cancer can spread to other body parts. While several treatment methods exist for managing lung cancer, exploring natural plant sources for developing therapeutics offers great potential in complementing other treatment approaches. In this study, we evaluated the bioactive compounds in Vaccinium vitis-idaea for treating KRAS-associated lung cancer types. In this study, we concentrated on inhibiting the mutated Kirsten rat sarcoma viral oncogene homolog (KRAS) by targeting an associated protein (Phosphodiesterase 6δ) to which KRAS form complexes. We evaluated bioactive compounds from Lingonberry (Vaccinium vitis-idaea L.), adopting computational approaches such as molecular docking, molecular dynamics simulation, molecular mechanics/generalized Born surface area (MM/GBSA) calculations, and pharmacokinetics analysis. A total of 26 out of 39 bioactive compounds of Vaccinium vitis-idaea L. had a higher binding affinity to the target receptor than an approved drug, Sotorasib. Also, further analyses of all lead/top compounds in this study identified (+)-Catechin (Cianidanol), Arbutin, Resveratrol, and Sinapic acid, to be potential drug candidates that could be pursued. In sum, Arbutin, (+)-Catechin, and Sinapic acid are predicted to be the top compound of Vaccinium vitis-idaea L. because of their pharmacokinetic properties and drug-likeness attributes. Also, their stability to the target receptor makes them a potential drug candidate that could be explored for treating KRAS mutation-associated lung cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s40203-023-00165-1.
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Affiliation(s)
- Ayooluwa Ilesanmi
- Department of Sciences and Mathematics, Mississippi University for Women, Columbus, USA
| | - Gbenga Dairo
- Department of Biological Sciences, Western Illinois University, Macomb, IL USA
| | - Sofela Salimat
- Department of Chemistry, University of Lagos, Lagos, Nigeria
| | - Damilola S. Bodun
- Department of Biochemistry, Adekunle Ajasin University, Akungba-Akoko, Nigeria
| | - Bibiire Awoyale
- Department of Chemistry, University of Ilorin, Ilorin, Nigeria
| | - Toheeb A. Balogun
- Department of Biochemistry, Adekunle Ajasin University, Akungba-Akoko, Nigeria
- Department of Biological Sciences, University of California, San Diego, La Jolla, USA
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Brazel D, Nagasaka M. The development of amivantamab for the treatment of non-small cell lung cancer. Respir Res 2023; 24:256. [PMID: 37880647 PMCID: PMC10601226 DOI: 10.1186/s12931-023-02558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) patients with sensitizing oncogenic driver mutations benefit from targeted therapies. Tyrosine kinase inhibitors are highly effective against classic sensitizing epidermal growth factor receptor (EGFR) mutations, such as exon 19 deletions and exon 21 L858R point mutations. Conversely, EGFR exon 20 insertions (exon20ins) are resistant to the traditional EGFR tyrosine kinase inhibitors (TKIs). In May 2021, the US Federal Drug Administration (FDA) provided accelerated approval to amivantamab (Rybrevant) in adults with locally advanced or metastatic NSCLC with EGFR exon20ins after treatment with platinum-based chemotherapy. Amivantamab was the first EGFR/MET bispecific antibody to be approved specifically for EGFR exon20ins where there was an unmet need. Furthermore, amivantamab is being evaluated in additional settings such as post osimertinib in sensitizing EGFR mutations as well as in MET altered NSCLC. Here we discuss amivantamab in regard to its mechanism of action, preclinical and clinical data, and clinical impact for patients with EGFR exon20ins NSCLC and beyond.
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Affiliation(s)
| | - Misako Nagasaka
- University of California Irvine Department of Medicine, Orange, CA, USA.
- Chao Family Comprehensive Cancer Center, Orange, CA, USA.
- St. Marianna University School of Medicine, Kawasaki, Japan.
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Attili I, Corvaja C, Spitaleri G, Del Signore E, Trillo Aliaga P, Passaro A, de Marinis F. New Generations of Tyrosine Kinase Inhibitors in Treating NSCLC with Oncogene Addiction: Strengths and Limitations. Cancers (Basel) 2023; 15:5079. [PMID: 37894445 PMCID: PMC10605462 DOI: 10.3390/cancers15205079] [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: 09/29/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Tyrosine kinase inhibitors (TKIs) revolutionized the treatment of patients with advanced or metastatic non-small cell lung cancer (NSCLC) harboring most driver gene alterations. Starting from the first generation, research rapidly moved to the development of newer, more selective generations of TKIs, obtaining improved results in terms of disease control and survival. However, the use of novel generations of TKIs is not without limitations. We reviewed the main results obtained, as well as the ongoing clinical trials with TKIs in oncogene-addicted NSCLC, together with the biology underlying their potential strengths and limitations. Across driver gene alterations, novel generations of TKIs allowed delayed resistance, prolonged survival, and improved brain penetration compared to previous generations, although with different toxicity profiles, that generally moved their use from further lines to the front-line treatment. However, the anticipated positioning of novel generation TKIs leads to abolishing the possibility of TKI treatment sequencing and any role of previous generations. In addition, under the selective pressure of such more potent drugs, resistant clones emerge harboring more complex and hard-to-target resistance mechanisms. Deeper knowledge of tumor biology and drug properties will help identify new strategies, including combinatorial treatments, to continue improving results in patients with oncogene-addicted NSCLC.
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Affiliation(s)
- Ilaria Attili
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via G. Ripamonti 435, 20141 Milan, Italy
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Xia X, Gong C, Zhang Y, Xiong H. The History and Development of HER2 Inhibitors. Pharmaceuticals (Basel) 2023; 16:1450. [PMID: 37895921 PMCID: PMC10610116 DOI: 10.3390/ph16101450] [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: 08/28/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
HER2 is highly expressed in a variety of malignant tumors and affects the prognosis of patients, making it a highly sensitive target for cancer therapy. Since the approval of the first HER2 inhibitor, trastuzumab, in 1998, HER2-targeted drugs have rapidly evolved. Currently, targeting HER2 drugs mainly include monoclonal antibodies (mAbs), tyrosine kinase inhibitors (TKIs), and antibody-drug conjugates (ADCs). This article reviews the development of HER2 inhibitors for various tumors over the past 20 years.
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Affiliation(s)
- Xiaohui Xia
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chen Gong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yinan Zhang
- School of Chemical Science and Engineering, Tongji University, Shanghai 200092, China
| | - Huihua Xiong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Marín A, Al Mamun A, Patel H, Akamatsu H, Ye D, Sudhan DR, Eli L, Marcelain K, Brown BP, Meiler J, Arteaga CL, Hanker AB. Acquired Secondary HER2 Mutations Enhance HER2/MAPK Signaling and Promote Resistance to HER2 Kinase Inhibition in Breast Cancer. Cancer Res 2023; 83:3145-3158. [PMID: 37404061 PMCID: PMC10530374 DOI: 10.1158/0008-5472.can-22-3617] [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: 11/17/2022] [Revised: 05/23/2023] [Accepted: 06/30/2023] [Indexed: 07/06/2023]
Abstract
HER2 mutations drive the growth of a subset of breast cancers and are targeted with HER2 tyrosine kinase inhibitors (TKI) such as neratinib. However, acquired resistance is common and limits the durability of clinical responses. Most HER2-mutant breast cancers progressing on neratinib-based therapy acquire secondary mutations in HER2. It is unknown whether these secondary HER2 mutations, other than the HER2T798I gatekeeper mutation, are causal to neratinib resistance. Herein, we show that secondary acquired HER2T862A and HER2L755S mutations promote resistance to HER2 TKIs via enhanced HER2 activation and impaired neratinib binding. While cells expressing each acquired HER2 mutation alone were sensitive to neratinib, expression of acquired double mutations enhanced HER2 signaling and reduced neratinib sensitivity. Computational structural modeling suggested that secondary HER2 mutations stabilize the HER2 active state and reduce neratinib binding affinity. Cells expressing double HER2 mutations exhibited resistance to most HER2 TKIs but retained sensitivity to mobocertinib and poziotinib. Double-mutant cells showed enhanced MEK/ERK signaling, which was blocked by combined inhibition of HER2 and MEK. Together, these findings reveal the driver function of secondary HER2 mutations in resistance to HER2 inhibition and provide a potential treatment strategy to overcome acquired resistance to HER2 TKIs in HER2-mutant breast cancer. SIGNIFICANCE HER2-mutant breast cancers acquire secondary HER2 mutations that drive resistance to HER2 tyrosine kinase inhibitors, which can be overcome by combined inhibition of HER2 and MEK.
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Affiliation(s)
- Arnaldo Marín
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas, TX 75390, USA
- Doctoral Program in Medical Sciences, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
- Department of Basic and Clinical Oncology, Faculty of Medicine, University of Chile, Santiago 838045, Chile
- These authors contributed equally: Arnaldo Marin, Abdullah Al Mamun
| | - Abdullah Al Mamun
- Department of Chemistry and Center for Structural Biology, Vanderbilt University, Nashville, TN 37240, USA
- These authors contributed equally: Arnaldo Marin, Abdullah Al Mamun
| | - Hima Patel
- Department of Basic and Clinical Oncology, Faculty of Medicine, University of Chile, Santiago 838045, Chile
| | - Hiroaki Akamatsu
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas, TX 75390, USA
- Current Address: Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Dan Ye
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas, TX 75390, USA
| | - Dhivya R. Sudhan
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas, TX 75390, USA
| | - Lisa Eli
- Puma Biotechnology, Inc., Los Angeles, CA 90024, USA
| | - Katherine Marcelain
- Department of Basic and Clinical Oncology, Faculty of Medicine, University of Chile, Santiago 838045, Chile
| | - Benjamin P. Brown
- Department of Chemistry and Center for Structural Biology, Vanderbilt University, Nashville, TN 37240, USA
| | - Jens Meiler
- Department of Chemistry and Center for Structural Biology, Vanderbilt University, Nashville, TN 37240, USA
- Institute for Drug Discovery, Leipzig University Medical School, Leipzig, 04103, Germany
| | - Carlos L. Arteaga
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas, TX 75390, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Ariella B. Hanker
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas, TX 75390, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
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Chen H, Hu S, Patterson AV, Smaill JB, Ding K, Lu X. Structural Mechanism and Inhibitors Targeting EGFR Exon 20 Insertion (Ex20ins) Mutations. J Med Chem 2023; 66:11656-11671. [PMID: 37669428 DOI: 10.1021/acs.jmedchem.3c00875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Epidermal growth factor receptor (EGFR) targeted therapy is one of the most important and effective strategies to combat EGFR mutant nonsmall-cell lung cancer (NSCLC). However, a substantial number of patients bearing EGFR exon 20 insertion (Ex20ins) mutations respond poorly to common EGFR targeted therapies. This clinical need remained unmet until recently, when the EGFR Ex20ins mutation inhibitor mobocertinib was approved by the FDA. Despite this progress, the structural mechanisms of EGFR Ex20ins mutation resistance and characterization of inhibitor binding modes have not been systematically summarized. Herein, we analyze the structural mechanisms for ligand binding and resistance and summarize recent developments for the reported inhibitors of EGFR Ex20ins mutations. Furthermore, this Perspective aims to provide insights for the design of the next generation of EGFR Ex20ins inhibitors.
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Affiliation(s)
- Hao Chen
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Discovery of Chinese Ministry of Education (MOE), School of Pharmacy, Jinan University, 855 Xingye Avenue, Guangzhou 510632, China
| | - Shiliang Hu
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Discovery of Chinese Ministry of Education (MOE), School of Pharmacy, Jinan University, 855 Xingye Avenue, Guangzhou 510632, China
| | - Adam V Patterson
- Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Jeff B Smaill
- Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Ke Ding
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Discovery of Chinese Ministry of Education (MOE), School of Pharmacy, Jinan University, 855 Xingye Avenue, Guangzhou 510632, China
- State Key Laboratory of Bioorganic and Nature Product Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai 200032, China
| | - Xiaoyun Lu
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Discovery of Chinese Ministry of Education (MOE), School of Pharmacy, Jinan University, 855 Xingye Avenue, Guangzhou 510632, China
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McLaughlin J, Berkman J, Nana-Sinkam P. Targeted therapies in non-small cell lung cancer: present and future. Fac Rev 2023; 12:22. [PMID: 37675274 PMCID: PMC10477963 DOI: 10.12703/r/12-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Lung cancer is the leading cause of malignancy-related death in the United States and the second most common cancer diagnosis worldwide. In the last two decades, lung cancer treatment has evolved to include advances in the development of mutation-based targeting, immunotherapy, radiation therapy, and minimally invasive surgical techniques. The discovery of lung cancer as a molecularly heterogeneous disease has driven investigation into the development of targeted therapies resulting in improved patient outcomes. Despite these advances, there remain opportunities, through further investigation of mechanisms of resistance, to develop novel therapeutics that better direct the personalization of lung cancer therapy. In this review, we highlight developments in the evolution of targeted therapies in non-small cell lung cancer, as well as future directions shaped by emerging patterns of resistance.
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Affiliation(s)
- Jessica McLaughlin
- Department of Internal Medicine, Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298
| | - Jonathan Berkman
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University Health System, Richmond, VA 23298
| | - Patrick Nana-Sinkam
- Department of Internal Medicine, Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298
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50
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Yang LL, Luo XZ, Xie LL, Lei XZ, Zhu J. The treatment of patients with non-small cell lung cancer carrying uncommon EGFR mutations, HER2 mutations, or brain metastases: a systematic review of pre-clinical and clinical findings for dacomitinib. Transl Cancer Res 2023; 12:2197-2211. [PMID: 37701115 PMCID: PMC10493789 DOI: 10.21037/tcr-23-95] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/21/2023] [Indexed: 09/14/2023]
Abstract
Background Accumulating evidence has shown that dacomitinib has potential activities for patients with non-small cell lung cancer (NSCLC) harboring uncommon epidermal growth factor receptor (EGFR) mutations, human epidermal growth factor receptor 2 (HER2) mutations, or central nervous system (CNS) metastases. Methods This study aimed to give a systematic review on its potential applications in the above settings by searching MEDLINE/PubMed, Embase, Cochrane Library, American Society of Clinical Oncology.org, European Society for Medical Oncology.org, and ClinicalTrials.gov. Results The literature search yielded 649 publications in total. According to our findings, dacomitinib exhibited promising efficacy in patients with major uncommon EGFR mutations (including G719X, S768I, and L861Q). Both EGFR exon 20 insertional mutation (Ex20ins) and HER2 Ex20ins demonstrated significant internal heterogeneity in response to dacomitinib, among which specific subtypes (including EGFR D770delinsGY, A763_Y764insFQEA, and HER2 M774delinsWLV) were highly sensitive. Other uncommon EGFR mutations including 18del and L747P have also been shown responsive to dacomitinib. Interestingly, limited studies suggested dacomitinib application on certain first or third generation tyrosine kinase inhibitors (TKIs)' resistant secondary mutations. Last but not least, both pre-clinical and clinical data indicated that dacomitinib has an encouraging intracranial tumor control ability, regardless of uncommon mutations. Conclusions Dacomitinib demonstrated good disease control on patients with NSCLC harboring major uncommon EGFR mutations and specific EGFR or HER2 mutation subtypes, and selective clinical application of dacomitinib is considerable in this setting, especially for those with intracranial metastases.
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Affiliation(s)
- Li-Li Yang
- Department of Medical Oncology, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao-Zhen Luo
- Department of Medical Oncology, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu, China
| | - Ling-Ling Xie
- Department of Medical Oncology, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao-Zhen Lei
- Department of Medical Oncology, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu, China
| | - Jiang Zhu
- Department of Medical Oncology, West China Hospital of Sichuan University, Chengdu, China
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