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Cui S, Wang N, Liang Y, Meng Y, Shu X, Kong F. Advances in clinical trials on perioperative immune checkpoint inhibitors for resectable non-small cell lung cancer: A comprehensive review. Int Immunopharmacol 2024; 141:112903. [PMID: 39146783 DOI: 10.1016/j.intimp.2024.112903] [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: 05/13/2024] [Revised: 07/12/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
The reduction in lung cancer mortality rates over the past decade can be partially ascribed to advancements in immunotherapy. Immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape for advanced non-small cell lung cancer (NSCLC) and have recently been evaluated in multiple clinical trials to confirm their safety and efficacy in the neoadjuvant, adjuvant and perioperative settings for patients with resectable NSCLC. The Food and Drug Administration (FDA) has granted approval for adjuvant atezolizumab following platinum-doublet chemotherapy, neoadjuvant nivolumab and platinum-doublet chemotherapy, adjuvant pembrolizumab after platinum-doublet chemotherapy, and neoadjuvant/adjuvant pembrolizumab for resectable NSCLC, with potential forthcoming approvals for additional agents or indications. Novel data, approvals, and emerging research findings are dramatically shifting the accepted standards of care over just a few years. Despite these advances, the optimal application of these treatments is not entirely straightforward. This article summarizes the biological rationale for immunotherapy and the important clinical trials regarding perioperative ICIs. We also further outline the controversies and future directions to better guide the individualized treatment of NSCLC patients.
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Affiliation(s)
- Siyuan Cui
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road No.88, Xiqing District, Tianjin 300381, China; Tianjin Cancer Institute of Traditional Chinese Medicine, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, China
| | - Na Wang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road No.88, Xiqing District, Tianjin 300381, China; Tianjin Cancer Institute of Traditional Chinese Medicine, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, China
| | - Yangyueying Liang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road No.88, Xiqing District, Tianjin 300381, China; Tianjin Cancer Institute of Traditional Chinese Medicine, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, China
| | - Yuan Meng
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road No.88, Xiqing District, Tianjin 300381, China; Tianjin Cancer Institute of Traditional Chinese Medicine, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, China
| | - Xinyi Shu
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road No.88, Xiqing District, Tianjin 300381, China; Tianjin Cancer Institute of Traditional Chinese Medicine, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, China
| | - Fanming Kong
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Changling Road No.88, Xiqing District, Tianjin 300381, China; Tianjin Cancer Institute of Traditional Chinese Medicine, China; National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, China.
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Gkika E, Dejonckheere CS, Sahlmann J, Barth SA, Schimek-Jasch T, Adebahr S, Hecht M, Miederer M, Brose A, Binder H, König J, Grosu AL, Nestle U, Rimner A. Impact of mediastinal tumor burden and lymphatic spread in locally advanced non-small-cell lung cancer: A secondary analysis of the multicenter randomized PET-Plan trial. Radiother Oncol 2024; 200:110521. [PMID: 39236984 DOI: 10.1016/j.radonc.2024.110521] [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: 06/05/2024] [Revised: 08/30/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE The aim of this secondary analysis of the prospective randomized phase 2 PET-Plan trial (ARO-2009-09; NCT00697333) was to evaluate the impact of mediastinal tumor burden and lymphatic spread in patients with locally advanced non-small-cell lung cancer (NSCLC). METHODS All patients treated per protocol (n = 172) were included. Patients received isotoxically dose-escalated chemoradiotherapy up to a total dose of 60-74 Gy in 30-37 fractions, aiming as high as possible while adhering to normal tissue constraints. Radiation treatment (RT) planning was based on an 18F-FDG PET/CT targeting all lymph node (LN) stations containing CT positive LNs (i.e. short axis diameter > 10 mm), even if PET-negative (arm A) or targeting only LN stations containing PET-positive nodes (arm B). LN stations were classified into echelon 1 (ipsilateral hilum), 2 (ipsilateral station 4 and 7), and 3 (rest of the mediastinum, contralateral hilum). The endpoints were overall survival (OS), progression-free survival (PFS), and freedom from local progression (FFLP). RESULTS The median follow-up time (95 % confidence interval [CI]) was 41.1 (33.8 - 50.4) months. Patients with a high absolute number of PET-positive LN stations had worse OS (hazard ratio [HR] = 1.09; 95 % CI 0.99 - 1.18; p = 0.05) and PFS (HR = 1.12; 95 % CI 1.04 - 1.20; p = 0.003), irrespective of treatment arm allocation. The prescribed RT dose to the LNs did not correlate with any of the endpoints when considering all patients. However, in patients in arm B (i.e., PET-based selective nodal irradiation), prescribed RT dose to each LN station correlated significantly with FFLP (HR=0.45; 95 % CI 0.24-0.85; p = 0.01). Furthermore, patients with involvement of echelon 3 LN stations had worse PFS (HR = 2.22; 95 % CI 1.16-4.28; p = 0.02), also irrespective of allocation. CONCLUSION Mediastinal tumor burden and lymphatic involvement patterns influence outcome in patients treated with definitive chemoradiotherapy for locally advanced NSCLC. Higher dose to LNs did not improve OS, but did improve FFLP in patients treated with PET-based dose-escalated RT.
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Affiliation(s)
- Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany; Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | | | - Jörg Sahlmann
- Institute of Medical Biometry and Statistics (IMBI), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simeon Ari Barth
- Department of Pediatrics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sonja Adebahr
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Hecht
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - Matthias Miederer
- Department of Translational Imaging in Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden: Faculty of Medicine and University Hospital Carl Gustav Carus, University of Technology Dresden (TUD), Dresden, Germany; German Cancer Research Center (DKFZ) Heidelberg, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Alexander Brose
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics (IMBI), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Hospital Mainz, Mainz, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - Andreas Rimner
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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3
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Rusch VW. Commentary: Real-world neoadjuvant immunochemotherapy for lung cancer: Additional data but still many questions. J Thorac Cardiovasc Surg 2024; 168:1259-1260. [PMID: 38492721 DOI: 10.1016/j.jtcvs.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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4
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Lee JM. Neoadjuvant, perioperative, or adjuvant immunotherapy in resectable non-small cell lung cancer: How do I choose? Importance of immune biomarkers and molecular testing. J Thorac Cardiovasc Surg 2024; 168:1281-1288. [PMID: 38649111 DOI: 10.1016/j.jtcvs.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Jay M Lee
- Thoracic Oncology Program, Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, Calif.
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5
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Sun X, Kang T, Liu B, Zhang Y, Huang G. A Meta-Analysis of Efficacy and Safety of Neoadjuvant Immunotherapy Plus Chemotherapy for Resectable Non-Small Cell Lung Cancer. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e70019. [PMID: 39359047 DOI: 10.1111/crj.70019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 09/11/2024] [Accepted: 09/17/2024] [Indexed: 10/04/2024]
Abstract
INTRODUCTION Neoadjuvant immunotherapy plus chemotherapy has ushered in a new era for surgical treatment for patients with NSCLC. This study aimed to examine the efficacy and safety of neoadjuvant immunotherapy plus chemotherapy in NSCLC. METHODS Eligible studies were identified from PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov, and conference meeting abstracts. The endpoints included major pathological response (MPR), complete pathological response (pCR), surgical resection rate, R0 resection, treatment-related adverse events (TRAEs), severe adverse events (SAEs), surgical complications, treatment discontinuation, surgical delay, and treatment-related death. Stata 18 software was used for statistical analysis, and p < 0.05 was considered statistically significant. Twenty-two studies including a total of 1108 patients were eligible for this study. RESULTS Among the patients who received neoadjuvant immunotherapy plus chemotherapy, the pooled MPR rate was 51% (95% CI [0.44-0.58]), and pCR rate was 34% (95% CI [0.28-0.40]). The pooled surgical resection rate was 85% (95% CI [0.81-0.89]), and the pooled R0 rate was 94% (95% CI [0.91-0.96]). The pooled rate of pathological tumor downstaging was 84% (95% CI [0.79-0.88]), and the pooled rate of pathological nodal downstaging was 38% (95% CI [0.23-0.57]). During the treatment of neoadjuvant immunotherapy plus chemotherapy with or without surgery, the pooled rate of TRAEs (any grade) was 84% (95% CI [0.73-0.91]), and the pooled rate of SAEs was 29% (95% CI [0.21-0.38]). Surgical complications pooled rate was 25% (95% CI [0.14-0.41]). The pooled rate of treatment discontinuation (11%, 95% CI [0.09-0.13]), surgical delay (3%, 95% CI [0.02-0.05]), and treatment-related death (2%, 95% CI [0.02-0.03]) were conducted. CONCLUSION Neoadjuvant immunotherapy plus chemotherapy provides a high pathological response, surgical resection rate, R0 resection rate, and pathological downstage rate and has a low risk of increasing the incidence of SAEs, surgical complications, treatment discontinuation, surgical delay, and treatment-related death. The validation of prospective and large sample studies is needed to confirm this conclusion.
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Affiliation(s)
- Xinru Sun
- Department of Interventional Oncology, Zibo Central Hospital, Zibo, Shandong Province, China
| | - Tianhua Kang
- Department of Interventional Oncology, Zibo Central Hospital, Zibo, Shandong Province, China
| | - Baodong Liu
- Department of Interventional Oncology, Zibo Central Hospital, Zibo, Shandong Province, China
| | - Yin Zhang
- Department of Interventional Oncology, Zibo Central Hospital, Zibo, Shandong Province, China
| | - Guangming Huang
- Department of Interventional Oncology, Zibo Central Hospital, Zibo, Shandong Province, China
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Li R, Liu X, Xu Y, Zhao J, Zhong W, Gao X, Chen M, Wang M. Remarkable pathological response to neoadjuvant tepotinib in lung adenocarcinoma with MET exon 14 skipping mutation: A case report. Thorac Cancer 2024. [PMID: 39343987 DOI: 10.1111/1759-7714.15459] [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: 06/20/2024] [Revised: 09/02/2024] [Accepted: 09/18/2024] [Indexed: 10/01/2024] Open
Abstract
Mesenchymal-epithelial transition (MET) exon 14 (METex14) skipping mutation is a rare (3%-4%) driver mutation in non-small cell lung cancer (NSCLC). Tepotinib, a selective MET inhibitor, has shown promise in treating METex14 skipping-mutated NSCLC. However, its feasibility for perioperative application remains unclear. This report describes a 60-year-old man with stage IIIA (cT2N2M0) lung adenocarcinoma harboring a METex14 skipping mutation. After initial treatment with savolitinib was discontinued due to grade 4 transaminitis, the patient was switched to tepotinib, resulting in significant tumor regression. Six months later, further shrinkage was observed, and surgery revealed remarkable pathological response with no residual tumor in lymph nodes (ypT2N0M0, IB). Postoperative tepotinib continued, with no relapse at 6-month follow-up. This case highlights the potential of tepotinib as neoadjuvant therapy for resectable METex14 skipping-mutated NSCLC, warranting further clinical trials.
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Affiliation(s)
- Rongzhen Li
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Liu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and 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 and Peking Union Medical College, Beijing, China
| | - Jing Zhao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhong
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoxing Gao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjiang Chen
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and 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 and Peking Union Medical College, Beijing, China
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Spicer JD, Garassino MC, Wakelee H, Liberman M, Kato T, Tsuboi M, Lee SH, Chen KN, Dooms C, Majem M, Eigendorff E, Martinengo GL, Bylicki O, Rodríguez-Abreu D, Chaft JE, Novello S, Yang J, Arunachalam A, Keller SM, Samkari A, Gao S. Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab compared with neoadjuvant chemotherapy alone in patients with early-stage non-small-cell lung cancer (KEYNOTE-671): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2024; 404:1240-1252. [PMID: 39288781 DOI: 10.1016/s0140-6736(24)01756-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND At the first interim analysis of the KEYNOTE-671 trial, adding perioperative pembrolizumab to neoadjuvant chemotherapy significantly improved event-free survival in participants with early-stage non-small-cell lung cancer (NSCLC). We report overall survival and health-related quality of life outcomes from the second interim analysis. METHODS KEYNOTE-671 was a global phase 3 trial done at 189 medical centres. Eligible participants (aged ≥18 years) with resectable stage II, IIIA, or IIIB (N2) NSCLC were randomly assigned (1:1) to four cycles of neoadjuvant pembrolizumab (200 mg administered intravenously every 3 weeks) plus cisplatin-based chemotherapy followed by surgery and 13 cycles of adjuvant pembrolizumab (200 mg administered intravenously every 3 weeks) or to four cycles of neoadjuvant placebo (administered intravenously every 3 weeks) plus cisplatin-based chemotherapy followed by surgery and 13 cycles of adjuvant placebo (administered intravenously every 3 weeks). Randomisation was done centrally using an interactive response technology system and was stratified by disease stage, PD-L1 expression, histology, and geographical region in blocks of four. Participants, investigators, and sponsor personnel were masked to treatment assignments; local pharmacists were unmasked to support treatment preparation. The dual primary endpoints were overall survival and event-free survival evaluated in the intention-to-treat population. This study is registered at ClinicalTrials.gov, NCT03425643, and is ongoing but closed to enrolment. FINDINGS Between May 11, 2018, and Dec 15, 2021, 797 participants were randomly assigned to the pembrolizumab group (n=397) or the placebo group (n=400). Median study follow-up at the second interim analysis was 36·6 months (IQR 27·6-47·8). 36-month overall survival estimates were 71% (95% CI 66-76) in the pembrolizumab group and 64% (58-69) in the placebo group (hazard ratio 0·72 [95% CI 0·56-0·93]; one-sided p=0·0052; threshold, one-sided p=0·0054). Median event-free survival was 47·2 months (95% CI 32·9 to not reached) in the pembrolizumab group and 18·3 months (14·8-22·1) in the placebo group (hazard ratio 0·59 [95% CI 0·48-0·72]). In the as-treated population, grade 3-5 treatment-related adverse events occurred in 179 (45%) of 396 participants in the pembrolizumab group and in 151 (38%) of 399 participants in the placebo group. Treatment-related adverse events led to death in four (1%) participants in the pembrolizumab group and three (1%) participants in the placebo group. INTERPRETATION The significant overall survival benefit of neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab compared with neoadjuvant chemotherapy alone coupled with a manageable safety profile support the use of perioperative pembrolizumab in patients with resectable, early-stage NSCLC. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co, Rahway, NJ, USA.
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MESH Headings
- Humans
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Lung Neoplasms/drug therapy
- Lung Neoplasms/pathology
- Lung Neoplasms/mortality
- Male
- Female
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/mortality
- Middle Aged
- Neoadjuvant Therapy/methods
- Double-Blind Method
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chemotherapy, Adjuvant
- Cisplatin/administration & dosage
- Neoplasm Staging
- Quality of Life
- Antineoplastic Agents, Immunological/therapeutic use
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Adult
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Affiliation(s)
- Jonathan D Spicer
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
| | - Marina C Garassino
- Department of Medicine, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Heather Wakelee
- Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
| | - Moishe Liberman
- Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, QC, Canada
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Se-Hoon Lee
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Peking University, Beijing, China
| | - Christophe Dooms
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Margarita Majem
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ekkehard Eigendorff
- Clinic for Internal Oncology and Hematology, Zentralklinik Bad Berka, Bad Berka, Germany
| | | | | | - Delvys Rodríguez-Abreu
- Department of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jamie E Chaft
- Department of Oncology, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY, USA
| | - Silvia Novello
- Department of Oncology, University of Turin, A.O.U. San Luigi Gonzaga di Orbassano, Turin, Italy
| | - Jing Yang
- Biostatistics and Research Decision Sciences, Merck & Co, Rahway, NJ, USA
| | | | | | - Ayman Samkari
- Global Clinical Development, Merck & Co, Rahway, NJ, USA
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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8
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Presley CJ, Owen DH. Improved survival for patients with lung cancer treated with perioperative immunotherapy. Lancet 2024; 404:1176-1178. [PMID: 39288778 DOI: 10.1016/s0140-6736(24)01920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 09/09/2024] [Indexed: 09/19/2024]
Affiliation(s)
- Carolyn J Presley
- The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, Columbus, OH 43210, USA.
| | - Dwight H Owen
- The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, Columbus, OH 43210, USA
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Hendriks LEL, Remon J, Faivre-Finn C, Garassino MC, Heymach JV, Kerr KM, Tan DSW, Veronesi G, Reck M. Non-small-cell lung cancer. Nat Rev Dis Primers 2024; 10:71. [PMID: 39327441 DOI: 10.1038/s41572-024-00551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/28/2024]
Abstract
Non-small-cell lung cancer (NSCLC) is one of the most frequent cancer types and is responsible for the majority of cancer-related deaths worldwide. The management of NSCLC has improved considerably, especially in the past 10 years. The systematic screening of populations at risk with low-dose CT, the implementation of novel surgical and radiotherapeutic techniques and a deeper biological understanding of NSCLC that has led to innovative systemic treatment options have improved the prognosis of patients with NSCLC. In non-metastatic NSCLC, the combination of various perioperative strategies and adjuvant immunotherapy in locally advanced disease seem to enhance cure rates. In metastatic NSCLC, the implementation of novel drugs might prolong disease control together with preserving quality of life. The further development of predictive clinical and genetic markers will be essential for the next steps in individualized treatment concepts.
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Affiliation(s)
- Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jordi Remon
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, University of Manchester and The Christie NHS Foundation, Manchester, UK
| | - Marina C Garassino
- Thoracic Oncology Program, Section of Hematology Oncology, Department of Medicine, the University of Chicago, Chicago, IL, USA
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA
| | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary and Aberdeen University Medical School, Aberdeen, UK
| | - Daniel S W Tan
- National Cancer Centre Singapore, Duke-NUS Medical School, Singapore, Singapore
| | - Giulia Veronesi
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Martin Reck
- Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany.
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10
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Hu H, Zhu Q, Tang H, Zhang SC, Huang YZ, Wang YF, Xu ZY, Yang XW, Zheng JH, Guo CY. The risk of treatment-related toxicities with PD-1/PD-L1 inhibitors in patients with lung cancer. Int J Cancer 2024. [PMID: 39319530 DOI: 10.1002/ijc.35195] [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: 04/11/2024] [Revised: 08/19/2024] [Accepted: 09/04/2024] [Indexed: 09/26/2024]
Abstract
The risk of treatment-related toxicities with programmed cell death 1 and its ligand (PD-1/PD-L1) inhibitors in patients with lung cancer is unclear and inconclusive. PubMed, EMBASE, and the Cochrane Library databases were systematically searched without language restrictions from inception to May 31, 2024 to identify Phase 3 randomized controlled trials of lung cancer comparing PD-1/PD-L1 inhibitors versus placebo/best supportive care (alone or in combination with nontargeted chemotherapy) that had available data regarding treatment-related adverse events (TRAEs) or incidence and sample size. Random-effect models were employed to study the pooled relative risk (RR) and 95% confidence intervals (CIs). Finally, 36 trials, involving 19,693 participants, fulfilled the inclusion criteria. PD-1/PD-L1 inhibitors significantly augmented the likelihood of developing all-grade (RR, 1.03; 95% CI, 1.01-1.04, p < .01) and grade ≥3 TRAEs (RR, 1.16; 95% CI, 1.10 to 1.23, p < .01). PD-1/PD-L1 inhibitors substantially augmented the odds of developing treatment-related serious adverse events (SAEs) (RR, 1.48; 95% CI, 1.27-1.71, p < .01) and fatal adverse events (FAEs) (RR, 1.42; 95% CI, 1.11-1.82, p < .01). Subgroup analyses indicated that the RR of SAEs and FAEs were generally consistent, regardless of treatment type, tumor type, treatment setting, PD-1/PD-L1 inhibitors type and study design. The most common causes of FAEs were respiratory failure/insufficiency (33.3%), cardiac events (16.1%), and hematological disorders (10.1%). We demonstrated that PD-1/PD-L1 inhibitors were significantly correlated with higher possibility of developing treatment-related toxicities, especially SAEs and FAEs, compared with placebo/best supportive care controls.
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Affiliation(s)
- Hao Hu
- Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, China
| | - Qian Zhu
- Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hua Tang
- Department of Neurosurgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde, China
| | - Si-Cai Zhang
- Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yan-Ze Huang
- Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, China
| | - Ya-Fang Wang
- Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, China
| | - Zhi-Yong Xu
- Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, China
| | - Xiong-Wen Yang
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Ji-Hua Zheng
- Department of Radiation Therapy, General Hospital of Southern Theater Command, Guangzhou, China
- The First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Chang-Ying Guo
- Department of Thoracic Surgery, Jiangxi Cancer Hospital, Nanchang, China
- Department of Thoracic Surgery, Nanchang University, Nanchang, China
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11
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Wiesweg M, Küter C, Schnorbach J, Keyl J, Metzenmacher M, Cvetkovic J, Saalfeld FC, Glanemann F, Eberhardt W, Oezkan F, Theegarten D, Stenzinger A, Darwiche K, Koschel D, Herth F, Bölükbas S, Winter H, Weykamp F, Wermke M, Stuschke M, Plönes T, Thomas M, Schuler M, Christopoulos P. Oligometastatic non-small cell lung cancer: Impact of local and contemporary systemic treatment approaches on clinical outcome. Int J Cancer 2024. [PMID: 39319506 DOI: 10.1002/ijc.35199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/01/2024] [Accepted: 08/07/2024] [Indexed: 09/26/2024]
Abstract
Oligometastatic (OMD) non-small cell lung cancer (NSCLC) is a distinct but heterogeneous entity. Current guidelines recommend systemic therapy and consolidation with local ablative therapy (LAT). However, evidence regarding the optimal choice of multimodal treatment approaches is lacking, in particular with respect to the integration of immunotherapy. This real-world study identified 218 patients with OMD NSCLC (2004-2023, prespecified criteria: ≤5 metastases in ≤2 organ systems) from three major German comprehensive cancer centers. Most patients had one (72.5%) or two (17.4%) metastatic lesions in a single (89.9%) organ system. Overall survival (OS) was significantly longer with a single metastatic lesion (HR 0.54, p = .003), and female gender (HR 0.4, p < .001). Median OS of the full cohort was 27.8 months, with 29% survival at 5 years. Patients who had completed LAT to all NSCLC sites, typically excluding patients with early progression, had a median OS of 34.4 months (37.7% 5-year OS rate) with a median recurrence-free survival (RFS) of 10.9 months (13.3% at 5 years). In those patients, systemic treatment as part of first-line therapy was associated with doubling of RFS (12.3 vs. 6.4 months, p < .001). Despite limited follow-up of patients receiving chemo-immunotherapy (EU approval 2018/2019), RFS was greatly improved by adding checkpoint inhibitors to chemotherapy (HR 0.44, p = .008, 2-year RFS 51.4% vs. 15.1%). In conclusion, patients with OMD NSCLC benefitted from multimodality approaches integrating systemic therapy and local ablation of all cancer sites. A substantial proportion of patients achieved extended OS, suggesting a potential for cure that can be further augmented with the addition of immunotherapy.
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Affiliation(s)
- Marcel Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Claudia Küter
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Johannes Schnorbach
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Julius Keyl
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Jelena Cvetkovic
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Carl Saalfeld
- Clinic for Internal Medicine I, University Hospital, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Franziska Glanemann
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Wilfried Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Filiz Oezkan
- Department of Pulmonary Medicine, Section of Interventional Pneumology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases (NCT), NCT West, Essen, Germany
| | - Dirk Koschel
- Department of Pneumology, Fachkrankenhaus Coswig, Lung Center, Coswig and Division of Pneumology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Servet Bölükbas
- National Center for Tumor Diseases (NCT), NCT West, Essen, Germany
- Department of Thoracic Surgery and Endoscopy, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Hauke Winter
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Wermke
- Clinic for Internal Medicine I, University Hospital, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Stuschke
- National Center for Tumor Diseases (NCT), NCT West, Essen, Germany
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Till Plönes
- National Center for Tumor Diseases (NCT/UCC), Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Thoracic Surgery, Fachkrankenhaus Coswig, Lung Center, Coswig and Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
- National Center for Tumor Diseases (NCT), NCT West, Essen, Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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12
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Sposito M, Eccher S, Scaglione I, Avancini A, Rossi A, Pilotto S, Belluomini L. The frontier of neoadjuvant therapy in non-small cell lung cancer beyond PD-(L)1 agents. Expert Opin Biol Ther 2024:1-13. [PMID: 39311630 DOI: 10.1080/14712598.2024.2408292] [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: 06/18/2024] [Accepted: 09/20/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION While surgical resection is the cornerstone of treatment for resectable lung cancer, neoadjuvant/adjuvant chemotherapy has shown limited improvement in survival rates over the past decades. With the success of immune checkpoint inhibitors (ICIs) in advanced NSCLC, there is growing interest in their application in earlier stages of the disease. Recent approvals for neoadjuvant/adjuvant ICIs in stage II-IIIA NSCLC highlight this shift in treatment paradigms. AREAS COVERED In this review, we aim to explore available data regarding alternative agents beyond the PD-(L)1 inhibitors, such as monoclonal antibodies against CTLA4, LAG3, TIGIT, antiangiogenic drugs, and novel therapies (antibody drug conjugates, bispecific antibodies) in neoadjuvant/perioperative regimens. EXPERT OPINION Novel agents and combinations (with or without ICI or/and chemotherapy), guided by molecular profiling and immune phenotyping, showed promise in improving surgical and survival outcomes. Crucial is, also in early setting, to identifying biomarkers predictive of treatment efficacy in order to personalize neoadjuvant/perioperative treatment strategies.
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Affiliation(s)
- Marco Sposito
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and Verona University Hospital Trust, Verona, Italy
| | - Serena Eccher
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and Verona University Hospital Trust, Verona, Italy
| | - Ilaria Scaglione
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and Verona University Hospital Trust, Verona, Italy
| | - Alice Avancini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and Verona University Hospital Trust, Verona, Italy
| | - Antonio Rossi
- Oncology Centre of Excellence, Therapeutic Science & Strategy Unit, Milan, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and Verona University Hospital Trust, Verona, Italy
| | - Lorenzo Belluomini
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and Verona University Hospital Trust, Verona, Italy
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13
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Huang H, Li L, Tong L, Luo H, Luo H, Zhang Q. Perioperative PD-1/PD-L1 inhibitors for resectable non-small cell lung cancer: A meta-analysis based on randomized controlled trials. PLoS One 2024; 19:e0310808. [PMID: 39312569 PMCID: PMC11419369 DOI: 10.1371/journal.pone.0310808] [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: 07/01/2024] [Accepted: 09/04/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND PD-1/PD-L1 inhibitors (PI) have shown promising results in both neoadjuvant and adjuvant therapies for resectable non-small cell lung cancer (NSCLC). However, substantial evidence from large-scale studies is still lacking for their use in the perioperative setting (neoadjuvant plus adjuvant). This meta-analysis aims to evaluate the integration of perioperative PI (PPI) with neoadjuvant chemotherapy for resectable NSCLC. METHODS To identify appropriate randomized controlled trials (RCTs), we thoroughly explored six different databases. The primary endpoint was survival, while the secondary measures included pathological responses and adverse events (AEs). RESULTS Six RCTs involving 2941 patients were included. The PPI group significantly improved overall survival (OS) (hazard ratio [HR]: 0.62 [0.51, 0.77]), event-free survival (EFS) (HR: 0.57 [0.51, 0.64]), pathological complete response (risk ratio [RR]: 5.81 [4.47, 7.57]), and major pathological response (RR: 2.60 [1.77, 3.82]). Benefits in EFS were seen across all subgroups. OS rates at 12-48 months and EFS rates at 6-48 months were higher in the PPI cohort. Furthermore, the advantages in OS and EFS increased with prolonged survival times. The PPI group also exhibited higher rates of surgery and R0 resections. However, the PPI group experienced more grade 3-5 AEs, serious AEs, and treatment discontinuations due to AEs. CONCLUSIONS The integration of perioperative PI with neoadjuvant chemotherapy can significantly improve survival and pathological responses for resectable NSCLC. However, the increased incidence of grade 3-5 AEs must be carefully evaluated.
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Affiliation(s)
- Hai Huang
- Department of Oncology, Taihe People’s Hospital, Taihe, China
| | - Lianyun Li
- Department of Oncology, Taihe People’s Hospital, Taihe, China
| | - Ling Tong
- Department of Oncology, Taihe People’s Hospital, Taihe, China
| | - Houfu Luo
- Department of Oncology, Taihe People’s Hospital, Taihe, China
| | - Huijing Luo
- Department of Oncology, Taihe People’s Hospital, Taihe, China
| | - Qimin Zhang
- Department of Oncology, Taihe People’s Hospital, Taihe, China
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14
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Hu Y, Zhang Y, Shi F, Yang R, Yan J, Han T, Guan L. Reversal of T-cell exhaustion: Mechanisms and synergistic approaches. Int Immunopharmacol 2024; 138:112571. [PMID: 38941674 DOI: 10.1016/j.intimp.2024.112571] [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: 05/17/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
T cells suffer from long-term antigen stimulation and insufficient energy supply, leading to a decline in their effector functions, memory capabilities, and proliferative capacity, ultimately resulting in T cell exhaustion and an inability to perform normal immune functions in the tumor microenvironment. Therefore, exploring how to restore these exhausted T cells to a state with effector functions is of great significance. Exhausted T cells exhibit a spectrum of molecular alterations, such as heightened expression of inhibitory receptors, shifts in transcription factor profiles, and modifications across epigenetic, metabolic, and transcriptional landscapes. This review provides a comprehensive overview of various strategies to reverse T cell exhaustion, including immune checkpoint blockade, and explores the potential synergistic effects of combining multiple approaches to reverse T cell exhaustion. It offers new insights and methods for achieving more durable and effective reversal of T cell exhaustion.
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Affiliation(s)
- Yang Hu
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Yaqi Zhang
- Institutes of Health Central Plains, Xinxiang Medical University, Xinxiang 453003, China
| | - Fenfen Shi
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Ruihan Yang
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Jiayu Yan
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Tao Han
- Institutes of Health Central Plains, Xinxiang Medical University, Xinxiang 453003, China.
| | - Liping Guan
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China.
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15
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Li B, Gu Y, Zhao W, Li Z, Guo W, Lu X, Jiang J. The efficacy and safety of neoadjuvant immunochemotherapy in resectable stage I-III non-small cell lung cancer: a systematic review and network meta-analysis. Clin Transl Oncol 2024:10.1007/s12094-024-03704-0. [PMID: 39251495 DOI: 10.1007/s12094-024-03704-0] [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: 06/11/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Neoadjuvant immunochemotherapy (NICT) is a new treatment method for resectable non-small-cell lung cancer (NSCLC). Network meta-analysis assessed efficacy, safety, and optimal treatment. METHODS We searched for randomized controlled trials (RCTs) comparing NICT with neoadjuvant chemotherapy (NCT) in PubMed, Embase, Web of Science, Cochrane Library, and international conferences. Outcomes were surgical resection rate, pathological complete response(pCR),event-free survival (EFS), and Grade 3-5 treatment-related adverse events (TRAEs). RESULTS RCTs of 3,387 patients, six treatment combinations, and two modalities were included. Meta-analysis showed that NICT yielded higher pCR and EFS rates than NCT. The toripalimab-chemotherapy combination had the highest surgical resection rate (OR = 1.68, 95% CI: 1.05-2.73), pCR (OR = 38.84, 95% CI: 11.05-268.19) and EFS (HR = 0.40, 95% CI: 0.28-0.58).This regimen worked well for patients with low programmed death-ligand 1 (PD-L1) expression or squamous cell pathology. For high PD-L1 expression and patients with NSCLC, neoadjuvant nivolumab with chemotherapy had the most efficacy. The incidence of treatment-related adverse events increased with longer treatment cycles, with perioperative nivolumab combined with chemotherapy showing the worst safety profile (RR = 1.32, 95% CI: 1.00-1.76), while neoadjuvant nivolumab combined with chemotherapy alone had the best safety profile (RR = 0.91, 95% CI: 0.68-1.21). Indirect comparison showed no survival benefit for neoadjuvant-adjuvant immunotherapy (HR = 0.93, 95% CI: 0.65-1.35). In the indirect comparison between the two immune checkpoint inhibitors(ICIs), although there was no significant difference in EFS (HR = 0.81, 95% CI: 0.61-1.08), PD-1 inhibitors may still be the most effective treatment option. CONCLUSIONS NICT effectively and safely treats resectable NSCLC. The optimal treatment combination is typically toripalimab and chemotherapy. Treatment based on PD-L1 expression and pathological type is recommended.
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Affiliation(s)
- Bo Li
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Yujia Gu
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Weixing Zhao
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Zirui Li
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Wanjing Guo
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Xinxin Lu
- Department of Oncology, Graduate School of Qinghai University, Qinghai, China
| | - Jun Jiang
- Division III, Department of Medical Oncology, Affiliated Hospital of Qinghai University, Qinghai, China.
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16
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Zhang R, Zou C, Zeng L, Zhang Y. Perioperative immunotherapy in nonsmall cell lung cancer. Curr Opin Oncol 2024:00001622-990000000-00210. [PMID: 39246174 DOI: 10.1097/cco.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
PURPOSE OF REVIEW To evaluate and summarize the current clinical efficacy, safety, treatment patterns, and potential biomarkers, to guide future treatment strategies for nonsmall cell lung cancer (NSCLC), improve patient prognosis, and provide a scientific basis for personalized therapy. RECENT FINDINGS In recent years, the class of immune checkpoint inhibitors (ICIs), with programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors at the helm, has catalyzed groundbreaking advancements within the perioperative treatment milieu for NSCLC. With the positive results of several phase III clinical trials, perioperative immunotherapy has been confirmed to significantly reduce the risk of postoperative recurrence in resectable NSCLC, becoming the new standard for perioperative treatment of stages II to III NSCLC. With the advent of the perioperative immunotherapy era, clinical issues such as the selection of the treatment population, the choice of regimen, the duration of treatment, whether patients with pCR need further adjuvant therapy, and the comprehensive management of patients throughout the perioperative period have attracted widespread attention. SUMMARY The perioperative treatment of NSCLC has fully entered the era of immunotherapy. Multiple clinical studies have confirmed that perioperative immunotherapy can significantly improve the survival benefit of resectable stages II to III NSCLC, establishing a new standard for the perioperative treatment of stages II to III NSCLC.
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Affiliation(s)
- Renzhi Zhang
- Department of Medical Oncology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang
| | - Chun Zou
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Liang Zeng
- Department of Medical Oncology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yongchang Zhang
- Department of Medical Oncology, Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
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Reck M, Nadal E, Girard N, Filippi AR, Martin LW, Gay CM, Petersen C, Gale D, Emeribe UA, Georgoulia N, Perez IED, Spicer JD. MDT-BRIDGE: Neoadjuvant Durvalumab Plus Chemotherapy Followed by Either Surgery and Adjuvant Durvalumab or Chemoradiotherapy and Consolidation Durvalumab in Resectable or Borderline-resectable Stage IIB-IIIB NSCLC. Clin Lung Cancer 2024; 25:587-593.e3. [PMID: 39003185 DOI: 10.1016/j.cllc.2024.06.007] [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: 04/05/2024] [Revised: 05/29/2024] [Accepted: 06/15/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION In the AEGEAN trial, neoadjuvant durvalumab plus platinum-based chemotherapy (D+CT) followed by adjuvant durvalumab, versus neoadjuvant chemotherapy alone, significantly improved pathological complete response (pCR) rate and event-free survival (EFS) in patients with resectable NSCLC. In the PACIFIC trial, consolidation durvalumab significantly improved progression-free (PFS) and overall survival (OS) for patients with unresectable stage III NSCLC after chemoradiotherapy. Strong pathological and clinical outcomes with chemoimmunotherapy have generated interest in its use to enable patients with borderline-resectable NSCLC to undergo surgery. Additionally, for patients initially deemed resectable but who later become unresectable/inoperable during neoadjuvant treatment, consolidation immunotherapy after chemoradiotherapy should be explored. PATIENTS AND METHODS MDT-BRIDGE (NCT05925530) is a multicenter, phase II, non-randomized study in ∼140 patients with EGFR/ALK wild-type, stage IIB-IIIB (N2) NSCLC. Following baseline multidisciplinary team (MDT) assessment to determine resectable/borderline-resectable status, all patients receive 2 cycles of neoadjuvant D+CT every 3 weeks, followed by MDT reassessment of resectability. Patients deemed resectable receive 1-2 additional cycles of D+CT followed by surgery (Cohort 1). Patients deemed unresectable receive standard-of-care chemoradiotherapy (Cohort 2). Cohort 1 patients who become ineligible for surgery can enter Cohort 2. Following surgery or chemoradiotherapy, patients receive adjuvant or consolidation durvalumab for 1 year. The primary endpoint is resection rate in all patients. Additional endpoints include resection rates by baseline resectable/borderline-resectable status, resection outcomes, EFS/PFS, OS, pCR rate, circulating tumor DNA dynamics pre- and post-surgery (including correlation with clinical outcomes), and safety. CONCLUSION Enrollment began in February 2024; primary completion is anticipated in April 2026.
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Affiliation(s)
- Martin Reck
- Lung Clinic Großhansdorf, Airway Research Center North, German Center for Lung Research, Großhansdorf, Germany.
| | - Ernest Nadal
- Medical Oncology Department, Institut Català d'Oncologia - ICO Hospitalet, Barcelona, Spain
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France, and UVSQ, Paris Saclay, Versailles, France
| | - Andrea R Filippi
- Department of Oncology and Hemato-Oncology, University of Milan, and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Linda W Martin
- Department of Surgery, Division of Thoracic Surgery, University of Virginia, Charlottesville, VA
| | - Carl M Gay
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cordula Petersen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | - Jonathan D Spicer
- Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
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18
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Kneuertz PJ. Real-World Experience Favors a Neoadjuvant Strategy of Chemoimmunotherapy for Locoregionally Advanced NSCLC. Ann Thorac Surg 2024; 118:681-682. [PMID: 38508510 DOI: 10.1016/j.athoracsur.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Peter J Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Doan Hall N846, 410 West 10th Ave, Columbus, OH 43210.
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19
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Young RWC, Rodriguez GR, Kucera J, Carrera D, Antevil JL, Trachiotis GD. Molecular Markers, Immune Therapy, and Non-Small Cell Lung Cancer-State-of-the-Art Review for Surgeons. J Laparoendosc Adv Surg Tech A 2024; 34:786-797. [PMID: 38900703 DOI: 10.1089/lap.2024.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
Background: Lung cancer is a leading cause of cancer deaths in the United States. An increasing understanding of relevant non-small cell lung cancer (NSCLC) biomarkers has led to the recent development of molecular-targeted therapies and immune checkpoint inhibitors that have revolutionized treatment for patients with advanced and metastatic disease. The purpose of this review is to provide surgeons with a state-of-the-art understanding of the current medical and surgical treatment trends and their implications in the future of management of NSCLC. Materials and Methods: A systematic search of PubMed was conducted to identify English language articles published between January 2010 and March 2024 focusing on molecular markers, tumor targeting, and immunotherapy in the diagnosis and treatment of NSCLC. Case series, observational studies, randomized trials, guidelines, narrative reviews, systematic reviews, and meta-analyses were included. Results: There is now increasing data to suggest that molecular-targeted therapies and immune therapies have a role in the neoadjuvant setting. Advances in intraoperative imaging allow surgeons to perform increasingly parenchymal-sparing lung resections without compromising tumor margins. Liquid biopsies can noninvasively detect targetable mutations in cancer cells and DNA from a blood draw, potentially allowing for earlier diagnosis, personalized therapy, and long-term monitoring for disease recurrence. Conclusions: The management of NSCLC has advanced dramatically in recent years fueled by a growing understanding of the cancer biology of NSCLC. Advances in medical therapies, surgical techniques, and diagnostic and surveillance modalities continue to evolve but have already impacted current treatment strategies for NSCLC, which are encompassed in this review.
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Affiliation(s)
- Robert W C Young
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
| | - Gustavo R Rodriguez
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
| | - John Kucera
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Daniel Carrera
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
| | - Jared L Antevil
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Gregory D Trachiotis
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
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20
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Aredo JV, Wakelee HA. Top advances of the year: Perioperative therapy for lung cancer. Cancer 2024; 130:2897-2903. [PMID: 38717993 DOI: 10.1002/cncr.35357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Emerging data supporting the rise of perioperative immune checkpoint inhibitors (ICIs) as a standard of care in the treatment of early stage, surgically resectable non-small cell lung cancer (NSCLC) dominated the NSCLC news in 2023. Adjuvant pembrolizumab became the second adjuvant ICI to receive US Food and Drug Administration approval in early 2023 after the 2021 approval of adjuvant atezolizumab and the 2022 approval of neoadjuvant nivolumab with chemotherapy. Subsequently in 2023, multiple phase 3 trials examining perioperative ICIs were positive and demonstrated clinically meaningful outcomes by prolonging event-free survival, improving pathologic complete response rates, and trending toward improved overall survival in most. Perioperative pembrolizumab became the first ICI to attain US Food and Drug Administration approval in this setting through the KEYNOTE-671 trial (ClinicalTrials.gov identifier NCT03425643), which also demonstrated a definitive overall survival benefit in the entire study population. However, questions remain regarding patient selection for either approach and how we can optimize biomarkers to determine who needs adjuvant therapy after surgery.
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Affiliation(s)
- Jacqueline V Aredo
- Department of Medicine, University of California, San Francisco, California, USA
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
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21
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Fuorivia V, Attili I, Corvaja C, Asnaghi R, Carnevale Schianca A, Trillo Aliaga P, Del Signore E, Spitaleri G, Passaro A, de Marinis F. Management of Non-Metastatic Non-Small Cell Lung Cancer (NSCLC) with Driver Gene Alterations: An Evolving Scenario. Curr Oncol 2024; 31:5121-5139. [PMID: 39330007 PMCID: PMC11431721 DOI: 10.3390/curroncol31090379] [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: 07/23/2024] [Revised: 08/21/2024] [Accepted: 08/28/2024] [Indexed: 09/28/2024] Open
Abstract
The ever-growing knowledge regarding NSCLC molecular biology has brought innovative therapies into clinical practice; however, the treatment situation in the non-metastatic setting is rapidly evolving. Indeed, immunotherapy-based perioperative treatments are currently considered the standard of care for patients with resectable NSCLC in the absence of EGFR mutations or ALK gene rearrangements. Recently, data have been presented on the use of tyrosine kinase inhibitors (TKIs) in the adjuvant and locally advanced setting for patients with NSCLC harboring such driver gene alterations. The aim of the current work is to review the available evidence on the use of targeted treatments in the non-metastatic setting, together with a summary of the ongoing trials designed for actionable gene alterations other than EGFR and ALK. To date, 3-year adjuvant osimertinib treatment has been demonstrated to improve DFS and OS and to reduce CNS recurrence in resected EGFR-mutated NSCLC in stage IB-IIIA (TNM 7th edition). The use of osimertinib after chemo-radiation in stage III unresectable EGFR-mutated NSCLC showed the relevant PFS improvement. In the ALK-positive setting, 2-year alectinib treatment was shown to clearly improve DFS compared to adjuvant standard chemotherapy in resected NSCLC with stage IB (≥4 cm)-IIIA (TNM 7th edition). Several trials are ongoing to establish the optimal adjuvant TKI treatment duration, as well as neoadjuvant TKI strategies in EGFR- and ALK-positive disease, and (neo)adjuvant targeted treatments in patients with actionable gene alterations other than EGFR or ALK. In conclusion, our review depicts how the current treatment scenario is expected to rapidly change in the context of non-metastatic NSCLC with actionable gene alterations, hence appropriate molecular testing from the early stages has become crucial to establish the most adequate approaches both in the perioperative and the locally advanced disease.
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Affiliation(s)
- Valeria Fuorivia
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ilaria Attili
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy (A.P.)
| | - Carla Corvaja
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy (A.P.)
| | - Riccardo Asnaghi
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | | | - Pamela Trillo Aliaga
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy (A.P.)
| | - Ester Del Signore
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy (A.P.)
| | - Gianluca Spitaleri
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy (A.P.)
| | - Antonio Passaro
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy (A.P.)
| | - Filippo de Marinis
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy (A.P.)
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22
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Boulanger MC, Schneider JL, Lin JJ. Advances and future directions in ROS1 fusion-positive lung cancer. Oncologist 2024:oyae205. [PMID: 39177972 DOI: 10.1093/oncolo/oyae205] [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: 04/27/2024] [Accepted: 07/11/2024] [Indexed: 08/24/2024] Open
Abstract
ROS1 gene fusions are an established oncogenic driver comprising 1%-2% of non-small cell lung cancer (NSCLC). Successful targeting of ROS1 fusion oncoprotein with oral small-molecule tyrosine kinase inhibitors (TKIs) has revolutionized the treatment landscape of metastatic ROS1 fusion-positive (ROS1+) NSCLC and transformed outcomes for patients. The preferred Food and Drug Administration-approved first-line therapies include crizotinib, entrectinib, and repotrectinib, and currently, selection amongst these options requires consideration of the systemic and CNS efficacy, tolerability, and access to therapy. Of note, resistance to ROS1 TKIs invariably develops, limiting the clinical benefit of these agents and leading to disease relapse. Progress in understanding the molecular mechanisms of resistance has enabled the development of numerous next-generation ROS1 TKIs, which achieve broader coverage of ROS1 resistance mutations and superior CNS penetration than first-generation TKIs, as well as other therapeutic strategies to address TKI resistance. The approach to subsequent therapy depends on the pace and pattern of progressive disease on the initial ROS1 TKI and, if known, the mechanisms of TKI resistance. Herein, we describe a practical approach for the selection of initial and subsequent therapies for metastatic ROS1+ NSCLC based on these clinical considerations. Additionally, we explore the evolving evidence for the optimal treatment of earlier-stage, non-metastatic ROS1+ NSCLC, while, in parallel, highlighting future research directions with the goal of continuing to build on the tremendous progress in the management of ROS1+ NSCLC and ultimately improving the longevity and well-being of people living with this disease.
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Affiliation(s)
- Mary C Boulanger
- Department of Medicine and Cancer Center, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Jaime L Schneider
- Department of Medicine and Cancer Center, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Jessica J Lin
- Department of Medicine and Cancer Center, Massachusetts General Hospital, Boston, MA 02114, United States
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23
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Reyes A, Muddasani R, Massarelli E. Overcoming Resistance to Checkpoint Inhibitors with Combination Strategies in the Treatment of Non-Small Cell Lung Cancer. Cancers (Basel) 2024; 16:2919. [PMID: 39199689 PMCID: PMC11353073 DOI: 10.3390/cancers16162919] [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: 07/03/2024] [Revised: 08/13/2024] [Accepted: 08/21/2024] [Indexed: 09/01/2024] Open
Abstract
Lung cancer continues to contribute to the highest percentage of cancer-related deaths worldwide. Advancements in the treatment of non-small cell lung cancer like immune checkpoint inhibitors have dramatically improved survival and long-term disease response, even in curative and perioperative settings. Unfortunately, resistance develops either as an initial response to treatment or more commonly as a progression after the initial response. Several modalities have been utilized to combat this. This review will focus on the various combination treatments with immune checkpoint inhibitors including the addition of chemotherapy, various immunotherapies, radiation, antibody-drug conjugates, bispecific antibodies, neoantigen vaccines, and tumor-infiltrating lymphocytes. We discuss the status of these agents when used in combination with immune checkpoint inhibitors with an emphasis on lung cancer. The early toxicity signals, tolerability, and feasibility of implementation are also reviewed. We conclude with a discussion of the next steps in treatment.
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Affiliation(s)
| | | | - Erminia Massarelli
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, CA 91010, USA; (A.R.); (R.M.)
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24
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Watanabe SI, Yotsukura M, Miyoshi T, Hattori A, Isaka T, Maniwa T, Isaka M, Yoshioka H, Endo M, Mimae T, Tsutani Y, Nakagawa K, Aokage K. Updated review of perioperative treatment for non-small-cell lung cancer in the new era of immune checkpoint inhibitors: past, present, and future. Jpn J Clin Oncol 2024:hyae106. [PMID: 39163130 DOI: 10.1093/jjco/hyae106] [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: 04/24/2024] [Accepted: 08/14/2024] [Indexed: 08/22/2024] Open
Abstract
The perioperative treatments for non-small cell lung cancer (NSCLC) should control both local and microscopic systemic disease, because the survival of patients with NSCLC who underwent surgical resection alone has been dismal except in stage IA patients. One way to improve surgical outcome is the administration of chemotherapy before or after the surgical procedure. During the last two decades, many clinical studies have focused on developing optimal adjuvant or neoadjuvant cisplatin-based chemotherapy regimens that can be combined with surgical treatment and/or radiotherapy. Based on the results of those clinical studies, multimodality therapy has been considered to be an appropriate treatment approach for locally advanced NSCLC patients. When nodal involvement is discovered postoperatively, adjuvant cisplatin-based chemotherapy has conferred an overall survival benefit. More recently, neoadjuvant and/or adjuvant use of immunotherapy adding to the cisplatin-based chemotherapy has been revealed to improve survival of the patients with locally advanced NSCLC in many large-scale clinical trials; although, optimal treatment strategies are still evolving.
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Affiliation(s)
- Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohiro Miyoshi
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Aritoshi Hattori
- Division of General Thoracic Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Tomohiro Maniwa
- Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Mitsuhiro Isaka
- Department of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yasuhiro Tsutani
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuo Nakagawa
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Keiju Aokage
- Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
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25
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Chu NQ, Tan KS, Dycoco J, Adusumilli PS, Bains MS, Bott MJ, Downey RJ, Gray KD, Huang J, Isbell JM, Molena D, Sihag S, Rocco G, Jones DR, Park BJ, Rusch VW. Determinants of successful minimally invasive surgery for resectable non-small cell lung cancer after neoadjuvant therapy. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00696-2. [PMID: 39168279 DOI: 10.1016/j.jtcvs.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/09/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Minimally invasive surgery (MIS) (video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery) for pulmonary resection is standard in early-stage non-small cell lung cancer because it is associated with better perioperative outcomes than thoracotomy. MIS for resection of more advanced non-small cell lung cancer (Stages IB-IIIB) treated with neoadjuvant therapy has been utilized. However, the determinants of success are not well defined. METHODS A single institution retrospective review of a prospectively maintained database was conducted, querying for patients with clinical Stage IB through IIIB non-small cell lung cancer who had resection after neoadjuvant systemic therapy without radiation from 2013 to 2022. Patients were grouped by surgical approach; that is, open versus MIS. Successful MIS was defined by no conversion, R0 resection, and no major (grade 3 or greater) morbidity. Analyses by intent-to-treat assessed outcomes by Wilcoxon rank-sum test and Fisher exact test. (Multivariable regression analysis identified variables that contributed to successful MIS resection.) RESULTS: Of 627 eligible patients, 360 (57%) had open and 267 (43%) had MIS procedures. Most patients (79.1%) received neoadjuvant platinum-based chemotherapy, and 21.9% were treated with immunotherapy or targeted therapy alone or combined with chemotherapy. Among MIS resections, 179 (67%) were performed by video-assisted thoracoscopic surgery and 88 (33%) by robot-assisted thoracoscopic surgery. The conversion rate was 16% (n = 43). Successful MIS resection was achieved in 77% of patients. Multivariable regression analysis showed that pretreatment clinical N stage was a significant determinant of success, but not pretreatment clinical T stage or type of neoadjuvant therapy. CONCLUSIONS Following neoadjuvant systemic therapy for clinical stage IB or IIIB non-small cell lung cancer, MIS resection can be successfully accomplished and should be considered in appropriate patients. Presence of pretreatment nodal disease is associated with higher odds of conversion, major morbidity, and incomplete resection.
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Affiliation(s)
- Ngoc-Quynh Chu
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joe Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine D Gray
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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26
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Zhou Y, Liu Z, Gong C, Zhang J, Zhao J, Zhang X, Liu X, Li B, Li R, Shi Z, Xie Y, Bao L. Targeting treatment resistance: unveiling the potential of RNA methylation regulators and TG-101,209 in pan-cancer neoadjuvant therapy. J Exp Clin Cancer Res 2024; 43:232. [PMID: 39160604 PMCID: PMC11331809 DOI: 10.1186/s13046-024-03111-x] [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: 01/15/2024] [Accepted: 06/27/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Tumor recurrence and mortality rates remain challenging in cancer patients despite comprehensive treatment. Neoadjuvant chemotherapy and immunotherapy aim to eliminate residual tumor cells, reducing the risk of recurrence. However, drug resistance during neoadjuvant therapy is a significant hurdle. Recent studies suggest a correlation between RNA methylation regulators (RMRs) and response to neoadjuvant therapy. METHODS Using a multi-center approach, we integrated advanced techniques such as single-cell transcriptomics, whole-genome sequencing, RNA sequencing, proteomics, machine learning, and in vivo/in vitro experiments. Analyzing pan-cancer cohorts, the association between neoadjuvant chemotherapy/immunotherapy effectiveness and RNA methylation using single-cell sequencing was investigated. Multi-omics analysis and machine learning algorithms identified genomic variations, transcriptional dysregulation, and prognostic relevance of RMRs, revealing distinct molecular subtypes guiding pan-cancer neoadjuvant therapy stratification. RESULTS Our analysis unveiled a strong link between neoadjuvant therapy efficacy and RNA methylation dynamics, supported by pan-cancer single-cell sequencing data. Integration of omics data and machine learning algorithms identified RMR genomic variations, transcriptional dysregulation, and prognostic implications in pan-cancer. High-RMR-expressing tumors displayed increased genomic alterations, an immunosuppressive microenvironment, poorer prognosis, and resistance to neoadjuvant therapy. Molecular investigations and in vivo/in vitro experiments have substantiated that the JAK inhibitor TG-101,209 exerts notable effects on the immune microenvironment of tumors, rendering high-RMR-expressing pan-cancer tumors, particularly in pancreatic cancer, more susceptible to chemotherapy and immunotherapy. CONCLUSIONS This study emphasizes the pivotal role of RMRs in pan-cancer neoadjuvant therapy, serving as predictive biomarkers for monitoring the tumor microenvironment, patient prognosis, and therapeutic response. Distinct molecular subtypes of RMRs aid individualized stratification in neoadjuvant therapy. Combining TG-101,209 adjuvant therapy presents a promising strategy to enhance the sensitivity of high-RMR-expressing tumors to chemotherapy and immunotherapy. However, further validation studies are necessary to fully understand the clinical utility of RNA methylation regulators and their impact on patient outcomes.
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Affiliation(s)
- Yaoyao Zhou
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin Medical University, Ministry of Education, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Ziyun Liu
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin Medical University, Ministry of Education, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute, Tianjin, 300060, China
| | - Cheng Gong
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin Medical University, Ministry of Education, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jie Zhang
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin Medical University, Ministry of Education, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jing Zhao
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xia Zhang
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiangyu Liu
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Bin Li
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Gastric Surgery, Key Laboratory of Digestive Cancer, Tianjin, China
| | - Rui Li
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zhenyu Shi
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China.
- Tianjin's Clinical Research Center for Cancer, Tianjin, China.
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.
| | - Yongjie Xie
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China.
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
| | - Li Bao
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China.
- Tianjin's Clinical Research Center for Cancer, Tianjin, China.
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
- Liver Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
- State Key Laboratory of Druggability Evaluation and Systematic Translational Medicine, Tianjin, China.
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27
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Bertolaccini L, Casiraghi M, Bardoni C, Diotti C, Chiari M, Mazzella A, de Marinis F, Spaggiari L. Revamping Non-Small Cell Lung Cancer Treatments in Stages II and III: Preparing Healthcare for Cutting-Edge Immuno-Oncology Regimens. Cancers (Basel) 2024; 16:2842. [PMID: 39199613 PMCID: PMC11352981 DOI: 10.3390/cancers16162842] [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: 06/25/2024] [Revised: 07/28/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) poses a significant challenge in clinical oncology, necessitating continual refinement of treatment approaches in stages II and III. Recent advancements have highlighted the potential of neoadjuvant therapy in optimising patient outcomes. Biomarker testing guides neoadjuvant therapy decisions, including epidermal growth factor receptor (EGFR) mutation and programmed death-ligand 1 (PD-L1) expression testing. Neoadjuvant therapy aims to improve oncological outcomes by treating micrometastatic disease and assessing tumour response before surgery. Disease-free survival is a surrogate endpoint for overall survival in both neoadjuvant and adjuvant settings. Multidisciplinary collaboration is crucial for individualised treatment planning and optimising patient care. The management of NSCLC requires a comprehensive approach, integrating expertise across disciplines and tailoring treatment strategies to individual patient needs. Neoadjuvant therapy shows promise in improving long-term outcomes, with biomarker testing guiding treatment decisions. Challenges such as defining borderline resectability and differentiating pseudoprogression highlight the need for ongoing research and collaboration.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
- Department of Thoracic Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Claudia Bardoni
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Cristina Diotti
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Matteo Chiari
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Filippo de Marinis
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
- Department of Thoracic Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
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28
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Zhou B, Zhang F, Guo W, Wang S, Li N, Qiu B, Zhao L, Li J, Shao K, Xue Q, Lv F, Gao S. Five-year follow-up of neoadjuvant PD-1 inhibitor (sintilimab) in non-small cell lung cancer. J Immunother Cancer 2024; 12:e009355. [PMID: 39134344 PMCID: PMC11331958 DOI: 10.1136/jitc-2024-009355] [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] [Accepted: 07/24/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Neoadjuvant anti-programmed cell death protein-1 (PD-1) therapy exhibits potential in treating resectable non-small cell lung cancer (NSCLC). Previously, we have reported the 3-year clinical outcomes of this trial, implying the effectiveness and feasibility of neoadjuvant sintilimab monotherapy. However, the long-term prognosis of patients receiving neoadjuvant mono-immunotherapy has yet to be elucidated. METHODS For patients with stage IA-IIIB NSCLC, two doses of sintilimab (200 mg) were administered intravenously in the neoadjuvant setting. The 5-year event-free survival (EFS), disease-free survival (DFS), and overall survival (OS) were assessed in these updated results. The predictive role of specific biomarkers in neoadjuvant immunotherapy was also explored. RESULTS With a median follow-up of 61.0 months, 5-year DFS and OS rates of patients who underwent R0 resection were 65.7% and 80.4%, respectively. The 5-year DFS and OS rates of patients with positive programmed death-ligand 1 (PD-L1) expression were 71.9% and 90.9%, respectively. The presence of PD-L1 positivity (tumor proportion score ≥1%) showed a tendency toward the promising prognosis (OS, HR, 0.143; 95% CI: 0.027 to 0.743), especially for those who did not achieve pathological complete response (pCR). In addition, tumor mutation burden was positively correlated with a favorable prognosis. A total of 10 recurrences and 5 subsequent deaths were identified within the 5-year follow-up, with lung metastasis being the predominant. CONCLUSIONS These updated analyses were the first to unveil the 5-year survival benefits of neoadjuvant sintilimab monotherapy, implying the potential value of PD-1 inhibitors in neoadjuvant therapy.
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Affiliation(s)
- Bolun Zhou
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fan Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Guo
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shuhang Wang
- GCP center, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ning Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Key Laboratory of Minimally Invasive Therapy Research for Lung Cancer, Chinese Academy of Medical Sciences, Beijng, People's Republic of China
| | - Bin Qiu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Key Laboratory of Minimally Invasive Therapy Research for Lung Cancer, Chinese Academy of Medical Sciences, Beijng, People's Republic of China
| | - Liang Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Key Laboratory of Minimally Invasive Therapy Research for Lung Cancer, Chinese Academy of Medical Sciences, Beijng, People's Republic of China
| | - Kang Shao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Key Laboratory of Minimally Invasive Therapy Research for Lung Cancer, Chinese Academy of Medical Sciences, Beijng, People's Republic of China
| | - Fang Lv
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Key Laboratory of Minimally Invasive Therapy Research for Lung Cancer, Chinese Academy of Medical Sciences, Beijng, People's Republic of China
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Brazel D, Nagasaka M. Checkmate 77T: Perioperative chemoimmunotherapy outperforms in early-stage NSCLC. MED 2024; 5:852-855. [PMID: 39127033 DOI: 10.1016/j.medj.2024.06.012] [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: 06/21/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 08/12/2024]
Abstract
Approximately 1 in 4 patients with NSCLC present with resectable disease. Although surgery is potentially curative, 30%-50% of patients relapse. Studies have shown that neoadjuvant, adjuvant, and perioperative chemoimmunotherapy improve outcomes. The Checkmate 77T trial explored if perioperative platinum-based chemotherapy plus nivolumab, surgical resection, then adjuvant nivolumab further improved outcomes including EFS.1.
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Affiliation(s)
- Danielle Brazel
- Scripps Clinic/Scripps Green Hospital, Department of Hematology/Oncology, 10166 N Torrey Pines Road, La Jolla, CA 92037, USA
| | - Misako Nagasaka
- University of California Irvine School of Medicine, Chao Family Cancer Center, 101 The City Drive, Orange, CA 92868, USA; St. Marianna University School of Medicine, Kawasaki, Japan.
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Sorscher S. Perioperative Nivolumab in Resectable Lung Cancer. N Engl J Med 2024; 391:573. [PMID: 39115073 DOI: 10.1056/nejmc2407267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
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Lavaud P, Bortolot M, Zullo L, O’Reilly D, Naidoo J, Mountzios G, Mercier O, Hendriks LEL, Remon J. Early-Stage Non-Small Cell Lung Cancer: New Challenges with Immune Checkpoint Blockers and Targeted Therapies. Cancers (Basel) 2024; 16:2779. [PMID: 39199552 PMCID: PMC11353229 DOI: 10.3390/cancers16162779] [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: 07/19/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 09/01/2024] Open
Abstract
The recent advent of tyrosine kinase inhibitors (TKIs) and immune checkpoint blockers (ICBs) in early-stage non-small cell lung cancer (NSCLC) has dramatically modified treatment strategies by improving the prognosis in this setting. Osimertinib and alectinib, both TKIs, have shown significant improvements in outcomes for patients with resected EGFR- and ALK-positive NSCLC, respectively, changing the standard of care in these subgroups. More recently, the LAURA trial showed the efficacy of osimertinib after chemoradiotherapy in patients with unresectable stage III NSCLC harboring EGFR mutations. Numerous trials are still ongoing to investigate neoadjuvant/perioperative TKIs in several oncogene-driven NSCLC. In addition, several ICBs have been tested and approved as adjuvant (atezolizumab and pembrolizumab), neoadjuvant (nivolumab), and perioperative treatments (pembrolizumab) for patients with resectable early-stage NSCLC. Despite these advances, many challenges remain regarding the use of TKIs and ICBs in this setting, including the optimal duration of adjuvant TKI or induction ICB therapy, the role of minimal residual disease to identify patients at high-risk of disease relapse and to guide adjuvant treatment decisions, and the role of adjuvant chemotherapy in resected oncogene-driven NSCLC. Furthermore, potential predictive biomarkers for efficacy are needed to eventually intensify the entire perioperative strategies. This review aims to summarize and discuss the available evidence, the ongoing trials, and the challenges associated with TKI- and ICB-based approaches in early-stage NSCLC.
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Affiliation(s)
- Pernelle Lavaud
- Gustave Roussy, Department of Cancer Medicine, Paris-Saclay University, 114, rue Edouard Vaillant, 94805 Villejuif, France (L.Z.)
| | - Martina Bortolot
- Department of Respiratory Medicine, Maastricht University Medical Centre, GROW School for Oncology and Reproduction, 6229 ER Maastricht, The Netherlands
- Department of Medicine (DMED), University of Udine, 33100 Udine, Italy
| | - Lodovica Zullo
- Gustave Roussy, Department of Cancer Medicine, Paris-Saclay University, 114, rue Edouard Vaillant, 94805 Villejuif, France (L.Z.)
| | - David O’Reilly
- Medical Oncology, Beaumont Hospital, RCSI University of Health Sciences, D02 YN77 Dublin, Ireland
| | - Jarushka Naidoo
- Medical Oncology, Beaumont Hospital, RCSI University of Health Sciences, D02 YN77 Dublin, Ireland
| | - Giannis Mountzios
- Fourth Department of Medical Oncology and Clinical Trials Unit, Henry Dunant Hospital Center, 11526 Athens, Greece
| | - Olaf Mercier
- Department of Thoracic Surgery, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France;
| | - Lizza E. L. Hendriks
- Department of Respiratory Medicine, Maastricht University Medical Centre, GROW School for Oncology and Reproduction, 6229 ER Maastricht, The Netherlands
| | - Jordi Remon
- Gustave Roussy, Department of Cancer Medicine, Paris-Saclay University, 114, rue Edouard Vaillant, 94805 Villejuif, France (L.Z.)
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Chuang CH, Zhen YY, Ma JY, Lee TH, Hung HY, Wu CC, Wang PH, Huang CT, Huang MS, Hsiao M, Lee YR, Huang CYF, Chang YC, Yang CJ. CD47-mediated immune evasion in early-stage lung cancer progression. Biochem Biophys Res Commun 2024; 720:150066. [PMID: 38749193 DOI: 10.1016/j.bbrc.2024.150066] [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: 01/19/2024] [Revised: 04/27/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
Alveolar and interstitial macrophages play crucial roles in eradicating pathogens and transformed cells in the lungs. The immune checkpoint CD47, found on normal and malignant cells, interacts with the SIRPα ligand on macrophages, inhibiting phagocytosis, antigen presentation, and promoting immune evasion. In this study, we demonstrated that CD47 is not only a transmembrane protein, but that it is also highly concentrated in extracellular vesicles from lung cancer cell lines and patient plasma. Abundant CD47 was observed in the cytoplasm of lung cancer cells, aligning with our finding that it was packed into extracellular vesicles for physiological and pathological functions. In our clinical cohort, extracellular vesicle CD47 was significantly higher in the patients with early-stage lung cancer, emphasizing innate immunity inactivation in early tumor progression. To validate our hypothesis, we established an orthotopic xenograft model mimicking lung cancer development, which showed increased serum soluble CD47 and elevated IL-10/TNF-α ratio, indicating an immune-suppressive tumor microenvironment. CD47 expression led to reduced tumor-infiltrating macrophages during progression, while there was a post-xenograft increase in tumor-associated macrophages. In conclusion, CD47 is pivotal in early lung cancer progression, with soluble CD47 emerging as a key pathological effector.
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Affiliation(s)
- Cheng-Hao Chuang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Yi Zhen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Juei-Yang Ma
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Huang Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huei-Yang Hung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Hui Wang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Tang Huang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Shyan Huang
- Department of Internal Medicine, E-Da Cancer Hospital, School of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan
| | | | - Ying-Ray Lee
- Department of Microbiology and Immunology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Master of Science Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Tropical Medicine and Infectious Disease Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Ying F Huang
- Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Chan Chang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Jen Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Gupta R, Das CK, Nair SS, Pedraza-Bermeo AM, Zahalka AH, Kyprianou N, Bhardwaj N, Tewari AK. From foes to friends: rethinking the role of lymph nodes in prostate cancer. Nat Rev Urol 2024:10.1038/s41585-024-00912-9. [PMID: 39095580 DOI: 10.1038/s41585-024-00912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 08/04/2024]
Abstract
Clinically localized prostate cancer is often treated with radical prostatectomy combined with pelvic lymph node dissection. Data suggest that lymph node dissection does improve disease staging, but its therapeutic value has often been debated, with few studies showing that lymph node removal directly improves oncological outcomes; however, lymph nodes are an important first site of antigen recognition and immune system activation and the success of many currently used immunological therapies hinges on this dogma. Evidence, particularly in the preclinical setting, has demonstrated that the success of immune checkpoint inhibitors is dampened by the removal of tumour-draining lymph nodes. Thus, whether lymph nodes are truly 'foes' or whether they are actually 'friends' in oncological care is an important idea to discuss.
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Affiliation(s)
- Raghav Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chandan K Das
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sujit S Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ali H Zahalka
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natasha Kyprianou
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nina Bhardwaj
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Teng M, Yi C, Yang W, Zhang J, Yao W, Hu S, Qing Y, Ji S, Shen Z, Zhang P. Sleeve lobectomy versus pneumonectomy following neoadjuvant therapy in patients with non-small cell lung cancer. Eur J Cardiothorac Surg 2024; 66:ezae300. [PMID: 39120883 DOI: 10.1093/ejcts/ezae300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/19/2024] [Accepted: 08/08/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES Neoadjuvant therapy has gained widespread acceptance as the standard modality for locally advanced non-small cell lung cancer. However, the clinical benefit of sleeve lobectomy (SL) or pneumonectomy (PN) following neoadjuvant therapy remains controversial. METHODS The clinical and pathological characteristics of non-small cell lung cancer patients who underwent SL or PN after neoadjuvant therapy at a high-volume single centre between December 2019 and March 2023 were retrospectively collected. The SL group was matched 4:1 with the PN group by propensity score matching. The surgical outcomes were systematically collected and analysed. RESULTS During a 5-year study period, the majority of patients (175 of 215, 81.4%) underwent the SL procedure, while 40 patients (18.6%) underwent PN. Following propensity score matching, the SL group exhibited lower postoperative arrythmia (4.8% vs 26.9%, P < 0.001), lower 30-day mortality (1.0% vs 7.7%, P = 0.046) and a shorter length of postoperative hospital stay (6.0 days vs 10.0 days, P < 0.001), compared with the PN group. In addition, no significant difference was observed between the two groups in terms of disease-free survival or overall survival (P = 0.977 and P = 0.913, respectively). CONCLUSIONS SL stands as a safe and feasible option for patients with centrally located non-small-cell lung cancer who have undergone neoadjuvant therapy, in comparison to PN. This finding suggests that SL remains the preferable choice when feasible in the context of the widespread utilization of neoadjuvant therapy.
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Affiliation(s)
- Meixin Teng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Thoracic Surgery, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Chengxiang Yi
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Weiguang Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jing Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wangchao Yao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shiqi Hu
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yang Qing
- Department of Thoracic Surgery, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Shuyu Ji
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ziyun Shen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Central Laboratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Thoracic Surgery, Shihezi University School of Medicine, Shihezi, Xinjiang, China
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Leong TL, Steinfort DP. Contemporary Concise Review 2023: Advances in lung cancer and interventional pulmonology. Respirology 2024; 29:665-673. [PMID: 38960450 DOI: 10.1111/resp.14789] [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: 06/02/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
Eligibility criteria for lung cancer screening increasingly need to consider family history of lung cancer, as well as age and smoking status. Lung cancer screening will reveal a multitude of incidental findings, of variable clinical significance, and with a need for clear pathways of management. Pulmonary nodule sampling is enhanced by intra-procedural imaging and cutting-edge robotic technology. Systematic thoracic lymph node sampling has implications for treatment efficacy. Bronchoscopic ablative techniques are feasible for peripheral lung cancers. Bronchoscopic sampling continues to have a high yield for lung cancer molecular characterization. Immunotherapy indications have expanded to include early stage and resectable lung cancer.
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Affiliation(s)
- Tracy L Leong
- Department of Respiratory Medicine, Austin Health, Heidelberg, Victoria, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Daniel P Steinfort
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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D'Amours MF, Wu FTH, Theisen-Lauk O, Chan EK, McGuire A, Ho C. Surgically resectable nonsmall cell lung cancer: a contemporary approach. Eur Respir J 2024; 64:2400332. [PMID: 38843914 DOI: 10.1183/13993003.00332-2024] [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: 02/15/2024] [Accepted: 05/28/2024] [Indexed: 07/28/2024]
Abstract
New treatment paradigms for resectable nonsmall cell lung cancer (NSCLC), with an emphasis on personalised care and a multidisciplinary approach, have significantly improved patient outcomes. The incorporation of immune checkpoint inhibitors into neoadjuvant, perioperative and adjuvant treatment algorithms is reshaping the standard of care for resectable NSCLC. Adjuvant targeted therapy trials have also paved the way for a much-needed personalised approach for patients with actionable genomic alterations. Innovative surgical techniques and judicious use of postoperative radiotherapy may mitigate the toxicity associated with a multimodality approach. Amid the many new treatment options, questions remain about the best approach to consider for each patient. Measurement of minimal residual disease and achievement of pathological complete response are emerging biomarkers of interest to help further refine treatment selection. This review summarises the current management of resectable NSCLC, focusing on ongoing and recent advances in surgical approaches, the role of postoperative radiotherapy and the rapidly changing field of systemic therapies.
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Affiliation(s)
| | - Florence T H Wu
- Department of Medical Oncology, BC Cancer Agency Vancouver, Vancouver, BC, Canada
| | - Olivia Theisen-Lauk
- Department of Thoracic Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Elisa K Chan
- Department of Radiation Oncology, BC Cancer Agency Vancouver, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Anna McGuire
- University of British Columbia, Vancouver, BC, Canada
- Department of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Cheryl Ho
- Department of Medical Oncology, BC Cancer Agency Vancouver, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
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37
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Le UT, Ohm B, Schmid S. [Perioperative Immunotherapy for Resectable Non-Small Cell Lung Cancer: Current Evidence and New Standard of Care]. Zentralbl Chir 2024; 149:S35-S44. [PMID: 39137760 DOI: 10.1055/a-2353-6336] [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: 08/15/2024]
Abstract
Immunotherapy has drastically changed the treatment of lung cancer not only in systemic disease but also in the perioperative setting in locally advanced non-small cell lung cancer. In particular, the neoadjuvant and perioperative therapy regimes of the CheckMate 816 and KEYNOTE-671 studies as well as the adjuvant therapy according to the IMPower010 and the PEARLS/KEYNOTE-091 protocols have already been approved by the European Medicines Agency (EMA) for the treatment of selected cases. Other therapy protocols and combination therapies with varying drug classes and therapy modalities are currently being examined for their effectiveness and tolerance. The new treatment landscape creates new opportunities but also challenges for the treating disciplines. This article will focus on the current evidence for perioperative immunotherapy for resectable lung cancer and the resulting therapy standards, especially with regard to patient selection for both neoadjuvant and adjuvant immunotherapy, as well as current research efforts.
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Affiliation(s)
- Uyen-Thao Le
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Birte Ohm
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Severin Schmid
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Allaf ME, Kim SE, Master V, McDermott DF, Harshman LC, Cole SM, Drake CG, Signoretti S, Akgul M, Baniak N, Li-Ning E, Palmer MB, Emamekhoo H, Adra N, Kaimakliotis H, Ged Y, Pierorazio PM, Abel EJ, Bilen MA, Ogan K, Moon HH, Ramaswamy KA, Singer EA, Mayer TM, Lohrey J, Margulis V, Gills J, Delacroix SE, Waples MJ, James AC, Wang P, Choueiri T, Michaelson MD, Kapoor A, Heng DY, Shuch B, Leibovich BC, Lara PN, Manola J, Maskens D, Battle D, Uzzo R, Bratslavsky G, Haas NB, Carducci MA. Perioperative nivolumab versus observation in patients with renal cell carcinoma undergoing nephrectomy (PROSPER ECOG-ACRIN EA8143): an open-label, randomised, phase 3 study. Lancet Oncol 2024; 25:1038-1052. [PMID: 38942046 PMCID: PMC11323681 DOI: 10.1016/s1470-2045(24)00211-0] [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: 01/15/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The standard of care for patients with intermediate-to-high risk renal cell carcinoma is partial or radical nephrectomy followed by surveillance. We aimed to investigate use of nivolumab before nephrectomy followed by adjuvant nivolumab in patients with high-risk renal cell carcinoma to determine recurrence-free survival compared with surgery only. METHODS In this open-label, randomised, phase 3 trial (PROSPER EA8143), patients were recruited from 183 community and academic sites across the USA and Canada. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0-1, with previously untreated clinical stage T2 or greater or Tany N+ renal cell carcinoma of clear cell or non-clear cell histology planned for partial or radical nephrectomy. Selected patients with oligometastatic disease, who were disease free at other disease sites within 12 weeks of surgery, were eligible for inclusion. We randomly assigned (1:1) patients using permuted blocks (block size of 4) within stratum (clinical TNM stage) to either nivolumab plus surgery, or surgery only followed by surveillance. In the nivolumab group, nivolumab 480 mg was administered before surgery, followed by nine adjuvant doses. The primary endpoint was investigator-reviewed recurrence-free survival in patients with renal cell carcinoma assessed in all randomly assigned patients regardless of histology. Safety was assessed in all randomly assigned patients who started the assigned protocol treatment. This trial is registered with ClinicalTrials.gov, NCT03055013, and is closed to accrual. FINDINGS Between Feb 2, 2017, and June 2, 2021, 819 patients were randomly assigned to nivolumab plus surgery (404 [49%]) or surgery only (415 [51%]). 366 (91%) of 404 patients assigned to nivolumab plus surgery and 387 (93%) of 415 patients assigned to surgery only group started treatment. Median age was 61 years (IQR 53-69), 248 (30%) of 819 patients were female, 571 (70%) were male, 672 (88%) were White, and 77 (10%) were Hispanic or Latino. The Data and Safety Monitoring Committee stopped the trial at a planned interim analysis (March 25, 2022) because of futility. Median follow-up was 30·4 months (IQR 21·5-42·4) in the nivolumab group and 30·1 months (21·9-41·8) in the surgery only group. 381 (94%) of 404 patients in the nivolumab plus surgery group and 399 (96%) of 415 in the surgery only group had renal cell carcinoma and were included in the recurrence-free survival analysis. As of data cutoff (May 24, 2023), recurrence-free survival was not significantly different between nivolumab (125 [33%] of 381 had recurrence-free survival events) versus surgery only (133 [33%] of 399; hazard ratio 0·94 [95% CI 0·74-1·21]; one-sided p=0·32). The most common treatment-related grade 3-4 adverse events were elevated lipase (17 [5%] of 366 patients in the nivolumab plus surgery group vs none in the surgery only group), anaemia (seven [2%] vs nine [2%]), increased alanine aminotransferase (ten [3%] vs one [<1%]), abdominal pain (four [1%] vs six [2%]), and increased serum amylase (nine [2%] vs none). 177 (48%) patients in the nivolumab plus surgery group and 93 (24%) in the surgery only group had grade 3-5 adverse events due to any cause, the most common of which were anaemia (23 [6%] vs 19 [5%]), hypertension (27 [7%] vs nine [2%]), and elevated lipase (18 [5%] vs six [2%]). 48 (12%) of 404 patients in the nivolumab group and 40 (10%) of 415 in the surgery only group died, of which eight (2%) and three (1%), respectively, were determined to be treatment-related. INTERPRETATION Perioperative nivolumab before nephrectomy followed by adjuvant nivolumab did not improve recurrence-free survival versus surgery only followed by surveillance in patients with high-risk renal cell carcinoma. FUNDING US National Institutes of Health National Cancer Institute and Bristol Myers Squibb.
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Affiliation(s)
- Mohamad E Allaf
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Se-Eun Kim
- Department of Data Science, Dana-Farber Cancer Institute/ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Viraj Master
- Department of Urology, Emory University, Altanta, GA, USA
| | - David F McDermott
- Division of Medical Oncology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Lauren C Harshman
- Department of Internal Medicine, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Suzanne M Cole
- Department of Internal Medicine, UT Southwestern/Simmons Cancer Center-Dallas, Dallas, TX, USA
| | | | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mahmut Akgul
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Nicholas Baniak
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Elsa Li-Ning
- Department of Translational Molecular Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew B Palmer
- Department of Pathology and Laboratory Medcine, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA, USA
| | - Hamid Emamekhoo
- Department of Medicine, Wisconsin Institute for Medical Research, Madison, WI, USA
| | - Nabil Adra
- Department of Hematology/Oncology, Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Hristos Kaimakliotis
- Department of Urology, Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Yasser Ged
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- Division of Urology, Department of Surgery, Penn Presbyterian Medical Center, Penn Medicine, Philadelphia, PA, USA
| | - E Jason Abel
- Department of Urology, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University/Winship Cancer Institute, Atlanta, GA, USA
| | - Kenneth Ogan
- Department of Urology, Emory University/Winship Cancer Institute, Atlanta, GA, USA
| | - Helen H Moon
- Department of Research and Evaluation, Kaiser Permanente, Riverside, CA, USA
| | - Krishna A Ramaswamy
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Eric A Singer
- Department of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Tina M Mayer
- Deparment of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jay Lohrey
- Department of Internal Medicine, UT Southwestern/Simmons Cancer Center-Dallas, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, UT Southwestern/Simmons Cancer Center-Dallas, Dallas, TX, USA
| | - Jessie Gills
- Department of Urology, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Scott E Delacroix
- Department of Urology, Louisiana Cancer Research Center, New Orleans, LA, USA
| | - Mark J Waples
- Department of Urology, Aurora Urology, Milwaukee, WI, USA
| | - Andrew C James
- Department of Urology, University of Kentucky/Markey Cancer Center, Lexington, KY, USA
| | - Peng Wang
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Toni Choueiri
- Department of Medical Oncology, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - M Dror Michaelson
- Department of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Anil Kapoor
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Daniel Y Heng
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Brian Shuch
- Department of Urology, UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | - Primo N Lara
- Division Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Judith Manola
- Department of Data Science, Dana-Farber Cancer Institute/ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Deborah Maskens
- International Kidney Cancer Coalition, Amsterdam NL, Guelph, ON, Canada
| | - Dena Battle
- Kidney Cancer Research Alliance, Alexandria, VA, USA
| | - Robert Uzzo
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Gennady Bratslavsky
- Department of Urology, SUNY Upstate Medical Center-Community Campus, Syracuse, NY, USA
| | - Naomi B Haas
- Department of Medicine, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA, USA; Perelman Center for Advanced Medicine, Philadelphia, PA, USA.
| | - Michael A Carducci
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Li R, Xu Y, Zhao J, Zhang L, Zhong W, Gao X, Liu X, Chen M, Wang M. Comparison of radiotherapy versus surgical resection following neoadjuvant chemoimmunotherapy in potentially resectable stage III non-small-cell lung cancer: A propensity score matching analysis. Lung Cancer 2024; 194:107884. [PMID: 38991281 DOI: 10.1016/j.lungcan.2024.107884] [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: 06/01/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Neoadjuvant chemoimmunotherapy followed by surgery is recommended for resectable non-small-cell lung cancer (NSCLC). However, a considerable proportion of patients do not undergo surgery and opt for alternative treatments such as radiotherapy. The efficacy of radiotherapy in this context remains unclear. METHODS This retrospective study analyzed data from patients with stage III NSCLC who received neoadjuvant chemoimmunotherapy followed by either surgery or radiotherapy. Propensity score matching (PSM) was used to balance the heterogeneity between the groups. Efficacy outcomes, safety profiles, and disease recurrence patterns were assessed. RESULTS In total, 175 patients were included; 50 underwent radiotherapy, and 125 underwent surgery. Prior to matching, radiotherapy was inferior to surgery in terms of progression-free survival (PFS; Hazard ratio [HR], 2.23; P = 0.008). Following a 1:1 PSM adjustment, each group consisted of 40 patients. The median PFS was 30.8 months in the radiotherapy group and not reached in the surgery group (HR, 1.46; P = 0.390). The 12- and 24-month PFS rates were 90.4 % and 69.0 % for the radiotherapy group compared to 94.1 % and 73.9 % for the surgery group, respectively. Subgroup analyses after PSM showed that patients with stage IIIA disease tend to benefit more from surgery than those with stage IIIB disease (HR, 3.00; P = 0.074). Grade 3-4 treatment-related adverse events (TRAEs) occurred in 62.5 % of patients in the radiotherapy group and 55.0 % in the surgery group, with no grade 5 TRAEs reported. The incidence of grade 3-4 treatment-related pneumonitis or pneumonia was 7.5 % and 2.5 % in the radiotherapy and surgery groups, respectively. CONCLUSION Radiotherapy may be a viable alternative to surgery in patients with resectable NSCLC who do not undergo surgical resection after initial neoadjuvant chemoimmunotherapy, offering comparable efficacy and a manageable safety profile. Larger prospective studies are needed to validate these findings and optimize the treatment strategies for this patient population.
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Affiliation(s)
- Rongzhen Li
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jing Zhao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li Zhang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Zhong
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaoxing Gao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaoyan Liu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Minjiang Chen
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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40
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Eichhorn M, Eichhorn F, Griffo R, Klotz L, Winter H. [Anatomical Lung Resection Following Neoadjuvant Chemoimmunotherapy: Technical Aspects and Case Reports]. Zentralbl Chir 2024; 149:S26-S34. [PMID: 39137759 DOI: 10.1055/a-2348-0818] [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: 08/15/2024]
Abstract
Since the approval of neoadjuvant chemo-immunotherapy in Europe, treatment options for resectable stage II-III NSCLC have also significantly improved in clinical routine. Surgical excision of the tumour by anatomic lung resection still remains the most essential component of multimodal therapy. However, with the increasing use of the new treatment concepts in clinical routine, questions also arise regarding safety, adverse events and technical resectability following neoadjuvant chemo-immunotherapy. This review summarises the current data on perioperative safety following neoadjuvant chemo-immunotherapy and discusses aspects of surgical technique, the extent of resection and intraoperative challenges illustrated by clinical case reports.
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Affiliation(s)
- Martin Eichhorn
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - Florian Eichhorn
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - Raffaella Griffo
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Laura Klotz
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - Hauke Winter
- Chirurgische Abteilung, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRCH) Heidelberg, Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
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41
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Hsu R, Arter ZL, Poei D, Benjamin DJ. A narrative review on perioperative systemic therapy in non-small cell lung cancer. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2024; 5:931-954. [PMID: 39280253 PMCID: PMC11390295 DOI: 10.37349/etat.2024.00256] [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: 03/28/2024] [Accepted: 06/11/2024] [Indexed: 09/18/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) that is operable still carries a high risk of recurrence, approaching 50% of all operable cases despite adding adjuvant chemotherapy. However, the utilization of immunotherapy and targeted therapy moving beyond the metastatic NSCLC setting and into early-stage perioperative management has generated tremendous enthusiasm and has been practice-changing. Adjuvant atezolizumab in NSCLC first demonstrated a clinical benefit with an immune checkpoint inhibitor. Then, with studies studying a significant benefit in major pathologic response in surgical patients treated preoperatively with immunotherapy compared to only chemotherapy, neoadjuvant nivolumab and chemotherapy were evaluated and showed significant event-free survival benefit leading to subsequent studies evaluating perioperative immunotherapy and chemotherapy. Meanwhile, with regards to targeted therapies, adjuvant osimertinib in EGFR-mutated NSCLC and adjuvant alectinib in ALK-rearranged NSCLC have both received regulatory approvals following demonstrated clinical benefit in clinical trials. With rapidly evolving changes in the field, new combinations such as multiple immunotherapy agents and antibody-drug conjugates in development, perioperative NSCLC management has quickly become complicated with different pathways to perioperative treatment. Furthermore, circulating tumor DNA and studies looking at better tools to prognosticate immunotherapy response will help with decision-making regarding which patients should receive immunotherapy and if so, either only pre-operatively or both pre- and post-operatively. In this review, we look at the evolution of systemic therapy in the perioperative setting from adjuvant chemotherapy to adjuvant immunotherapy to perioperative immunotherapy and look at perioperative targeted therapy while looking ahead to future considerations.
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Affiliation(s)
- Robert Hsu
- Division of Medical Oncology, University of Southern California Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Zhaohui Liao Arter
- Department of Medicine, Division of Hematology-Oncology, University of California Irvine School of Medicine, Orange, CA 92697, USA
| | - Darin Poei
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
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Linares Díaz J, Edwards J, Deleu AL, Giaj-Levra N, Prisciandaro E, Roch B, Paesmans M, Berghmans T, Brandão M. What Does N2 Lymph Node Involvement Mean for Patients with Non-Small Cell Lung Cancer (NSCLC)?-A Review of Implications for Diagnosis and Treatment. Cancers (Basel) 2024; 16:2673. [PMID: 39123401 PMCID: PMC11311523 DOI: 10.3390/cancers16152673] [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: 06/17/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Patients with stage III NSCLC with N2 lymph node involvement carry a complex and diverse disease entity. Challenges persist in the areas of diagnosis, staging, multimodal management, and the determination of surgical indications and resectability criteria. Therefore, this review focuses on the latest updates in N2 disease staging and its prognostic and treatment implications. Emphasis is placed on the importance of accurate staging using imaging modalities such as [18F]FDG-PET/CT as well as minimally invasive mediastinal staging endoscopic techniques. The evolving role of surgery in the management of N2 disease is also explored. The benefits of neoadjuvant and adjuvant treatments have been demonstrated, along with the efficacy of a combined multimodal approach with chemo-immunotherapy in the perioperative setting, reigniting the debate of N2 disease subsets and optimal treatment options. Furthermore, this review addresses the controversies surrounding surgical approaches in upfront "borderline" resectable stage III NSCLC as well as the benefits of combined chemoradiotherapy with consolidation immunotherapy for patients with unresectable tumors. In conclusion, personalized diagnostic and treatment approaches tailored to individual patient characteristics, resource availability, and institutional expertise are essential for optimizing outcomes in patients with stage III-N2 NSCLC.
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Affiliation(s)
- Julio Linares Díaz
- Medical Oncology Department, Hospital La Fe, Avinguda de Fernando Abril Martorell 106, 46006 Valencia, Spain;
- Thoracic Oncology Functional Unit, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Rue Meylemeersch 90, 1070 Brussels, Belgium;
| | - John Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield S5 5AU, UK;
| | - Anne-Leen Deleu
- Nuclear Medicine Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Rue Meylemeersch 90, 1070 Brussels, Belgium;
| | - Niccolo Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy;
| | - Elena Prisciandaro
- Department of Thoracic Surgery, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium;
| | - Benoit Roch
- Thoracic Oncology Unit, Department of Respiratory Diseases, University of Montpellier, CHU Montpellier, F-34295 Montpellier, France;
- Montpellier Cancer Research Institute, University of Montpellier, ICM, INSERM, F-34298 Montpellier, France
| | - Marianne Paesmans
- Statistics Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Rue Meylemeersch 90, 1070 Brussels, Belgium;
| | - Thierry Berghmans
- Thoracic Oncology Functional Unit, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Rue Meylemeersch 90, 1070 Brussels, Belgium;
| | - Mariana Brandão
- Thoracic Oncology Functional Unit, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Rue Meylemeersch 90, 1070 Brussels, Belgium;
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Avancini A, Giannarielli D, Belluomini L, Schena F, Milella M, Pilotto S. Physical Exercise During Neoadjuvant Treatments for Non-Small Cell Lung Cancer: The Time is Coming. Clin Lung Cancer 2024:S1525-7304(24)00153-0. [PMID: 39127606 DOI: 10.1016/j.cllc.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/10/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Alice Avancini
- Department of Engineering for Innovation Medicine (DIMI), Section of Innovation Biomedicine - Oncology Area, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy; Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy.
| | - Diana Giannarielli
- Department of Epidemiology & Biostatistic, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Lorenzo Belluomini
- Department of Engineering for Innovation Medicine (DIMI), Section of Innovation Biomedicine - Oncology Area, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Milella
- Department of Engineering for Innovation Medicine (DIMI), Section of Innovation Biomedicine - Oncology Area, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
| | - Sara Pilotto
- Department of Engineering for Innovation Medicine (DIMI), Section of Innovation Biomedicine - Oncology Area, University of Verona and University and Hospital Trust (AOUI) of Verona, Verona, Italy
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44
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Pozzessere C, Mazini B, Omoumi P, Jreige M, Noirez L, Digklia A, Fasquelle F, Sempoux C, Dromain C. Immune-Related Adverse Events Induced by Immune Checkpoint Inhibitors and CAR-T Cell Therapy: A Comprehensive Imaging-Based Review. Cancers (Basel) 2024; 16:2585. [PMID: 39061225 PMCID: PMC11274393 DOI: 10.3390/cancers16142585] [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: 05/07/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Immunotherapy has revolutionized oncology care, improving patient outcomes in several cancers. However, these therapies are also associated with typical immune-related adverse events due to the enhanced inflammatory and immune response. These toxicities can arise at any time during treatment but are more frequent within the first few months. Any organ and tissue can be affected, ranging from mild to life-threatening. While some manifestations are common and more often mild, such as dermatitis and colitis, others are rarer and more severe, such as myocarditis. Management depends on the severity, with treatment being held for >grade 2 toxicities. Steroids are used in more severe cases, and immunosuppressive treatment may be considered for non-responsive toxicities, along with specific organ support. A multidisciplinary approach is mandatory for prompt identification and management. The diagnosis is primarily of exclusion. It often relies on imaging features, and, when possible, cytologic and/or pathological analyses are performed for confirmation. In case of clinical suspicion, imaging is required to assess the presence, extent, and features of abnormalities and to evoke and rule out differential diagnoses. This imaging-based review illustrates the diverse system-specific toxicities associated with immune checkpoint inhibitors and chimeric antigen receptor T-cells with a multidisciplinary perspective. Clinical characteristics, imaging features, cytological and histological patterns, as well as the management approach, are presented with insights into radiological tips to distinguish these toxicities from the most important differential diagnoses and mimickers-including tumor progression, pseudoprogression, inflammation, and infection-to guide imaging and clinical specialists in the pathway of diagnosing immune-related adverse events.
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Affiliation(s)
- Chiara Pozzessere
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland
| | - Bianca Mazini
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland
| | - Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland
| | - Leslie Noirez
- Department of Pulmonology, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland
| | - François Fasquelle
- Department of Pathology, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland
| | - Christine Sempoux
- Department of Pathology, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland
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45
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Hochmair M, Terbuch A, Lang D, Trockenbacher C, Augustin F, Ghanim B, Maurer D, Taghizadeh H, Kamhuber C, Wurm R, Lindenmann J, Braz P, Bundalo T, Begic M, Bauer J, Reimann P, Müser N, Huemer F, Schlintl V, Bianconi D, Baumgartner B, Schenk P, Rauter M, Hötzenecker K. Real-World Treatment Patterns and Timeliness of Clinical Care Pathway for Non-Small Cell Lung Cancer Patients in Austria: The PRATER Retrospective Study. Cancers (Basel) 2024; 16:2586. [PMID: 39061224 PMCID: PMC11275022 DOI: 10.3390/cancers16142586] [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: 06/11/2024] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
This was a retrospective study of the profile and initial treatments of adults diagnosed with early-stage (ES) non-small cell lung cancer (NSCLC) during January 2018-December 2021 at 16 leading hospital institutions in Austria, excluding patients enrolled in clinical trials. In total, 319 patients were enrolled at a planned ~1:1:1 ratio across StI:II:III. Most tested biomarkers were programmed death ligand 1 (PD-L1; 58% expressing), Kirsten rat sarcoma virus (KRAS; 22% positive), and epidermal growth factor receptor (EGFR; 18% positive). Of 115/98/106 StI/II/III patients, 82%/85%/36% underwent surgery, followed by systemic therapy in 9%/45%/47% of those [mostly chemotherapy (ChT)]. Unresected treated StIII patients received ChT + radiotherapy [43%; followed by immune checkpoint inhibitors (ICIs) in 39% of those], ICI ± ChT (35%), and ChT-alone/radiotherapy-alone (22%). Treatment was initiated a median (interquartile range) of 24 (7-39) days after histological confirmation, and 55 (38-81) days after first medical visit. Based on exploratory analyses of all patients newly diagnosed with any stage NSCLC during 2018-2021 at 14 of the sites (N = 7846), 22%/10%/25%/43% had StI/II/III/IV. The total number was not significantly different between pre-COVID-19 (2018-2019) and study-specific COVID-19 (2020-2021) periods, while StI proportion increased (21% vs. 23%; p = 0.012). Small differences were noted in treatments. In conclusion, treatments were aligned with guideline recommendations at a time which preceded the era of ICIs and targeted therapies in the (neo)adjuvant setting.
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Affiliation(s)
- Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Angelika Terbuch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - David Lang
- Department of Pulmonology, Johannes Kepler University Linz, Kepler University Hospital, 4829 Linz, Austria
| | | | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Bahil Ghanim
- Department of General and Thoracic Surgery, University Hospital Krems, 3500 Krems an der Donau, Austria
| | - Dominik Maurer
- Department of Pulmonology, Ordensklinikum Elisabethinen Linz, 4020 Linz, Austria
| | - Hossein Taghizadeh
- Division of Oncology, Department of Internal Medicine I, University Hospital St. Pölten, 3100 St. Pölten, Austria
| | - Christoph Kamhuber
- Department of Oncology, Kardinal Schwarzenberg Klinikum, 5620 Schwarzach, Austria
| | - Robert Wurm
- Department of Pulmonology, Medical University Graz, 8036 Graz, Austria
| | - Jörg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Petra Braz
- Department of Pulmonology, Landesklinikum Hochegg, 2840 Hochegg, Austria (P.S.)
| | - Tatjana Bundalo
- Department of Pulmonology, Landesklinikum Hochegg, 2840 Hochegg, Austria (P.S.)
| | - Merjem Begic
- Department of Thoracic Surgery, Medical University of Vienna, 8036 Vienna, Austria
| | - Johanna Bauer
- Department of Thoracic Surgery, Medical University of Vienna, 8036 Vienna, Austria
| | - Patrick Reimann
- Department of Oncology, Landeskrankenhaus Feldkirch, 6800 Feldkirch, Austria
| | - Nino Müser
- Department of Medicine II with Pneumology, Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, 1160 Vienna, Austria
| | - Florian Huemer
- Division of Pulmonology, Klinik Penzing, 1140 Vienna, Austria
| | - Verena Schlintl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | | | | | - Peter Schenk
- Department of Pulmonology, Landesklinikum Hochegg, 2840 Hochegg, Austria (P.S.)
| | - Markus Rauter
- Department of Pulmonology, Klinikum Klagenfurt Am Woerthersee, 9020 Klagenfurt, Austria
| | - Konrad Hötzenecker
- Department of Thoracic Surgery, Medical University of Vienna, 8036 Vienna, Austria
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Zhou Q, Pan Y, Yang X, Zhao Y, Han G, Pang Q, Zhang Z, Wang Q, Yao J, Wang H, Yang W, Liu B, Chen Q, Du X, Cai K, Li B, Huang Y, Li X, Song L, Shi W, Wu YL. Neoadjuvant SHR-1701 with or without chemotherapy in unresectable stage III non-small-cell lung cancer: A proof-of-concept, phase 2 trial. Cancer Cell 2024; 42:1258-1267.e2. [PMID: 38906157 DOI: 10.1016/j.ccell.2024.05.024] [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: 01/07/2024] [Revised: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 06/23/2024]
Abstract
We conducted a proof-of-concept, phase 2 trial to assess neoadjuvant SHR-1701 with or without chemotherapy, followed by surgery or radiotherapy, and then consolidation SHR-1701 in unresectable stage III non-small-cell lung cancer (NSCLC). In the primary cohort of patients receiving neoadjuvant combination therapy (n = 97), both primary endpoints were met, with a post-induction objective response rate of 58% (95% confidence interval [CI] 47-68) and an 18-month event-free survival (EFS) rate of 56.6% (95% CI 45.2-66.5). Overall, 27 (25%) patients underwent surgery; all achieved R0 resection. Among them, 12 (44%) major pathological responses and seven (26%) pathological complete responses were recorded. The 18-month EFS rate was 74.1% (95% CI 53.2-86.7) in surgical patients and 57.3% (43.0-69.3) in radiotherapy-treated patients. Neoadjuvant SHR-1701 with chemotherapy, followed by surgery or radiotherapy, showed promising efficacy with a tolerable safety profile in unresectable stage III NSCLC. Surgical conversion was feasible in a notable proportion of patients and associated with better survival outcomes.
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Affiliation(s)
- Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China
| | - Yi Pan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China
| | - Xuening Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China
| | - Yanqiu Zhao
- Department of Respiratory Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Guang Han
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, China
| | - Qingsong Pang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Zhenfa Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Qifeng Wang
- Radiotherapy Center, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Jun Yao
- Department of Medical Oncology, The First Affiliated Hospital of Henan University of Science & Technology, Luoyang 471000, China
| | - Hui Wang
- Department of Chest Radiotherapy, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410000, China
| | - Weihua Yang
- Department of Respiratory Medicine, Shanxi Provincial Cancer Hospital, Taiyuan 030013, China
| | - Baogang Liu
- First Ward of Respiratory Medicine, Harbin Medical University Cancer Hospital, Harbin 150000, China
| | - Qixun Chen
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou 310022, China
| | - Xianghui Du
- Department of Thoracic Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou 310022, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Baosheng Li
- Department of Thoracic Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250017, China
| | - Yunchao Huang
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650000, China
| | - Xiao Li
- Jiangsu Hengrui Pharmaceuticals, Co., Ltd, Shanghai 201203, China
| | - Li Song
- Jiangsu Hengrui Pharmaceuticals, Co., Ltd, Shanghai 201203, China
| | - Wei Shi
- Jiangsu Hengrui Pharmaceuticals, Co., Ltd, Shanghai 201203, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China.
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Chang AEB, Piper-Vallillo AJ, Mak RH, Lanuti M, Muzikansky A, Rotow J, Jänne PA, Mino-Kenudson M, Swanson S, Wright CD, Kozono D, Marcoux P, Piotrowska Z, Sequist LV, Willers H. The ASCENT Trial: a phase 2 study of induction and consolidation afatinib and chemoradiation with or without surgery in stage III EGFR-mutant NSCLC. Oncologist 2024; 29:609-618. [PMID: 38761385 PMCID: PMC11224994 DOI: 10.1093/oncolo/oyae107] [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: 04/18/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The role of tyrosine kinase inhibitors (TKIs) in early-stage and metastatic oncogene-driven non-small cell lung cancer (NSCLC) is established, but it remains unknown how best to integrate TKIs with concurrent chemoradiotherapy (cCRT) in locally advanced disease. The phase 2 ASCENT trial assessed the efficacy and safety of afatinib and cCRT with or without surgery in locally advanced epidermal growth factor receptor (EGFR)-mutant NSCLC. PATIENTS AND METHODS Adults ≥18 years with histologically confirmed stage III (AJCC 7th edition) NSCLC with activating EGFR mutations were enrolled at Mass General and Dana-Farber/Brigham Cancer Centers, Boston, Massachusetts. Patients received induction afatinib 40 mg daily for 2 months, then cisplatin 75 mg/m2 and pemetrexed 500 mg/m2 IV every 3 weeks during RT (definitive or neoadjuvant dosing). Patients with resectable disease underwent surgery. All patients were offered consolidation afatinib for 2 years. The primary endpoint was the objective response rate (ORR) to induction TKI. Secondary endpoints were safety, conversion to operability, progression-free survival (PFS), and overall survival (OS). Analyses were performed on the intention-to-treat population. RESULTS Nineteen patients (median age 56 years; 74% female) were enrolled. ORR to induction afatinib was 63%. Seventeen patients received cCRT; 2/9 previously unresectable became resectable. Ten underwent surgery; 6 had a major or complete pathological response. Thirteen received consolidation afatinib. With a median follow-up of 5.0 years, median PFS and OS were 2.6 (95% CI, 1.4-3.1) and 5.8 years (2.9-NR), respectively. Sixteen recurred or died; 6 recurrences were isolated to CNS. The median time to progression after stopping consolidation TKI was 2.9 months (95% CI, 1.1-7.2). Four developed grade 2 pneumonitis. There were no treatment-related deaths. CONCLUSION We explored the efficacy of combining TKI with cCRT in oncogene-driven NSCLC. Induction TKI did not compromise subsequent receipt of multimodality therapy. PFS was promising, but the prevalence of CNS-only recurrences and rapid progression after TKI discontinuation speak to unmet needs in measuring and eradicating micrometastatic disease.
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Affiliation(s)
- Allison E B Chang
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Andrew J Piper-Vallillo
- Department of Medicine, Division of Hematology/Oncology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
| | - Raymond H Mak
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA 02215, United States
| | - Michael Lanuti
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Alona Muzikansky
- Massachusetts General Hospital Biostatistics Center, Boston, MA 02114, United States
| | - Julia Rotow
- Lowe Center for Thoracic Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02115, United States
| | - Pasi A Jänne
- Lowe Center for Thoracic Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02115, United States
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Scott Swanson
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Cameron D Wright
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - David Kozono
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA 02215, United States
| | - Paul Marcoux
- Lowe Center for Thoracic Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02115, United States
| | - Zofia Piotrowska
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Lecia V Sequist
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
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Wu Y, Yu G, Jin K, Qian J. Advancing non-small cell lung cancer treatment: the power of combination immunotherapies. Front Immunol 2024; 15:1349502. [PMID: 39015563 PMCID: PMC11250065 DOI: 10.3389/fimmu.2024.1349502] [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: 12/04/2023] [Accepted: 06/10/2024] [Indexed: 07/18/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) remains an unsolved challenge in oncology, signifying a substantial global health burden. While considerable progress has been made in recent years through the emergence of immunotherapy modalities, such as immune checkpoint inhibitors (ICIs), monotherapies often yield limited clinical outcomes. The rationale behind combining various immunotherapeutic or other anticancer agents, the mechanistic underpinnings, and the clinical evidence supporting their utilization is crucial in NSCLC therapy. Regarding the synergistic potential of combination immunotherapies, this study aims to provide insights to help the landscape of NSCLC treatment and improve clinical outcomes. In addition, this review article discusses the challenges and considerations of combination regimens, including toxicity management and patient selection.
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Affiliation(s)
- Yuanlin Wu
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Guangmao Yu
- Department of Thoracic Surgery, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Ketao Jin
- Department of Gastrointestinal, Colorectal and Anal Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| | - Jun Qian
- Department of Colorectal Surgery, Xinchang People’s Hospital, Affiliated Xinchang Hospital, Wenzhou Medical University, Xinchang, Zhejiang, China
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49
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Hines JB, Cameron RB, Esposito A, Kim L, Porcu L, Nuccio A, Viscardi G, Ferrara R, Veronesi G, Forde PM, Taube J, Vokes E, Bestvina CM, Dolezal JM, Sacco M, Monteforte M, Cascone T, Garassino MC, Torri V. Evaluation of Major Pathologic Response and Pathologic Complete Response as Surrogate End Points for Survival in Randomized Controlled Trials of Neoadjuvant Immune Checkpoint Blockade in Resectable in NSCLC. J Thorac Oncol 2024; 19:1108-1116. [PMID: 38461929 DOI: 10.1016/j.jtho.2024.03.010] [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: 10/13/2023] [Revised: 02/05/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Controversy remains as to whether pathologic complete response (pCR) and major pathologic response (MPR) represent surrogate end points for event-free survival (EFS) and overall survival (OS) in neoadjuvant trials for resectable NSCLC. METHODS A search of PubMed and archives of international conference abstracts was performed from June 2017 through October 31, 2023. Studies incorporating a neoadjuvant arm with immune checkpoint blockade alone or in combination with chemotherapy were included. Those not providing information regarding pCR, MPR, EFS, or OS were excluded. For trial-level surrogacy, log ORs for pCR and MPR and log hazard ratios for EFS and OS were analyzed using a linear regression model weighted by sample size. The regression coefficient and R2 with 95% confidence interval were calculated by the bootstrapping approach. RESULTS Seven randomized clinical trials were identified for a total of 2385 patients. At the patient level, the R2 of pCR and MPR with 2-year EFS were 0.82 (0.66-0.94) and 0.81 (0.63-0.93), respectively. The OR of 2-year EFS rates by response status was 0.12 (0.07-0.19) and 0.11 (0.05-0.22), respectively. For the 2-year OS, the R2 of pCR and MPR were 0.55 (0.09-0.98) and 0.52 (0.10-0.96), respectively. At the trial level, the R2 for the association of OR for response and HR for EFS was 0.58 (0.00-0.97) and 0.61 (0.00-0.97), respectively. CONCLUSIONS Our analyses reveal a robust correlation between pCR and MPR with 2-year EFS but not OS. Trial-level surrogacy was moderate but imprecise. More mature follow-up and data to assess the impact of study crossover are needed.
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Affiliation(s)
- Jacobi B Hines
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Robert B Cameron
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.
| | - Alessandra Esposito
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Leeseul Kim
- Department of Medicine, Ascension Saint Francis Hospital, Chicago, Illinois
| | - Luca Porcu
- Cancer Research United Kingdom, Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Antonio Nuccio
- Department of Medical Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Viscardi
- Department of Pneumology and Oncology, Azienda Ospedaliera di Rilievo Nazionale (AORN) Ospedali dei Colli, Naples, Italy
| | - Roberto Ferrara
- Department of Medical Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Veronesi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy; Department of Thoracic Surgery, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Patrick M Forde
- Department of Oncology, Division of Upper Aerodigestive Malignancies, Bloomberg-Kimmel Institute for Cancer Immunotherapy, John Hopkins Kimmel Cancer Center, Baltimore, Maryland
| | - Janis Taube
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Everett Vokes
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Christine M Bestvina
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - James M Dolezal
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Matteo Sacco
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Marta Monteforte
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas, Monroe Dunaway (MD) Anderson Cancer Center, Houston, Texas
| | - Marina C Garassino
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Valter Torri
- Department of Clinical Oncology, "Mario Negri" Institute for Pharmacological Research- IRCCS, Milan, Italy
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50
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Cuppens K, Du Pont B, Knegjens J, Maes B, Baas P. Immune checkpoint inhibition in early-stage non-small cell lung cancer. Lung Cancer 2024; 193:107855. [PMID: 38896941 DOI: 10.1016/j.lungcan.2024.107855] [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: 04/29/2024] [Revised: 06/06/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
The introduction of immune checkpoint inhibitors significantly advanced outcomes in both metastatic and locally advanced non-small cell lung cancer. Despite these advancements, the 5-year survival rate remains suboptimal. Even in early-stage disease a significant portion of patients relapse and die from metastatic progression. The integration of immunotherapy in the management of early-stage NSCLC demonstrated promising results, supported by a plethora of positive clinical trials conducted in recent years. Nonetheless, numerous questions persist. In this manuscript we comprehensively review the currently available data on adjuvant, neoadjuvant, and perioperative treatment strategies. We also address the challenges inherent to these approaches from different stakeholders' perspective.
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Affiliation(s)
- Kristof Cuppens
- Department of Pulmonology and Thoracic Oncology and Jessa & Science, Jessa Hospital Hasselt, Belgium; Faculty of Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium; Department of Thoracic Oncology, The Netherlands Cancer Institute and Leiden University Medical Center, Amsterdam, the Netherlands.
| | - Bert Du Pont
- Department of Thoracic and Vascular Surgery, Jessa Hospital Hasselt, Belgium
| | - Joost Knegjens
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Brigitte Maes
- Faculty of Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium; Laboratory for Molecular Diagnostics, Department of Laboratory Medicine, Jessa Hospital Hasselt, Belgium
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute and Leiden University Medical Center, Amsterdam, the Netherlands
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