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Zhao N, Wu ZP, Yang J, Feng WN, Yang SL, Luo Y, Ye J, Wang F, Zhang XW, Xiao Y, Wu LL, Gu WQ. Epidermal growth factor receptor inhibitors as adjuvant treatment for patients with resected non-small cell lung cancer harboring EGFR mutation: a meta-analysis of randomized controlled clinical trials. World J Surg Oncol 2023; 21:45. [PMID: 36782320 PMCID: PMC9926719 DOI: 10.1186/s12957-023-02925-x] [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: 05/08/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is still under investigation as adjuvant treatment for early-stage disease. Here, we performed a meta-analysis to evaluate the efficacy of adjuvant EGFR-TKI versus non-EGFR-TKI treatment in patients with completely resected non-small cell lung cancer (NSCLC) harboring EGFR mutation. METHODS Two investigators independently extracted data from databases. A meta-analysis was performed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The protocol was registered in PROSPERO (ID: CRD42022316481). The primary outcome was disease-free survival (DFS) in patients with EGFR mutation, measured as the hazard ratio (HR). Other outcomes (of subgroup analyses) included overall survival (OS) and DFS. RESULTS After the systematic screening, eight studies with a total of 3098 patients with stage IB-IIIA NSCLC were included. The results show that in patients with EGFR mutation, the DFS in the adjuvant EGFR-TKI group was significantly superior to that in the control group, with a HR of 0.47 (95% confidence interval [CI]: 0.30-0.74; P = 0.001). In subgroup analyses of DFS, the benefit was observed in the EGFR-TKI group versus the chemotherapy group (HR 0.50, 95% CI 0.30-0.84; P = 0.009), the EGFR-TKI combined with chemotherapy group versus the chemotherapy group (HR 0.37, 95% CI 0.16-0.85; P = 0.02), and in stage IIA-IIIA NSCLC (HR 0.45, 95% CI 0.27-0.74; P = 0.002). However, the benefit of DFS did not translate into improved OS in the whole population (HR 0.79, 95% CI 0.54-1.14; P = 0.20). CONCLUSION EGFR-TKIs prolonged DFS but not OS in patients with completely resected stage II-IIIA NSCLC harboring EGFR mutation. Longer follow-ups and new clinical trials that can result in changes in clinical practice are needed.
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Affiliation(s)
- Ning Zhao
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Zhuo-peng Wu
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Jie Yang
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Wei-neng Feng
- grid.452881.20000 0004 0604 5998Department of Head and Neck/Thoracic Medical Oncology, The First People’s Hospital of Foshan, Foshan, China
| | - Sheng-li Yang
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Ying Luo
- grid.452881.20000 0004 0604 5998Department of Traditional Chinese Medicine, The First People’s Hospital of Foshan, Foshan, China
| | - Jun Ye
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Fei Wang
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Xiao-wen Zhang
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Ye Xiao
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Ling-ling Wu
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
| | - Wei-quan Gu
- grid.452881.20000 0004 0604 5998Department of Thoracic Surgery, The First People’s Hospital of Foshan, Foshan, 528000 Guangdong China
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Aggarwal H, Ndirangu K, Winfree KB, Muehlenbein CE, Zhu E, Tongbram V, Thom H. A network meta-analysis of immunotherapy-based treatments for advanced nonsquamous non-small cell lung cancer. J Comp Eff Res 2023; 12:e220016. [PMID: 36621905 PMCID: PMC10288959 DOI: 10.2217/cer-2022-0016] [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: 01/27/2022] [Accepted: 09/29/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction: In the absence of head-to-head trials comparing immunotherapies for advanced nonsquamous non-small-cell lung cancer (NsqNSCLC), a network meta-analysis (NMA) was conducted to compare the relative efficacy of these treatments. Materials & methods: A systematic literature review of randomized controlled trials evaluating first-line-to-progression and second-line treatments for advanced NsqNSCLC informed Bayesian NMAs for overall survival (OS) and progression-free survival (PFS) end points. Results: Among first-line-to-progression treatments, pembrolizumab + pemetrexed + platinum showed the greatest OS benefit versus other regimens and a PFS benefit versus all but three regimens. Among second-line treatments, an OS benefit was seen for atezolizumab, nivolumab and pembrolizumab versus docetaxel. Conclusion: Pembrolizumab + pemetrexed + platinum showed the maximum OS benefit in the first-line setting. In the second-line setting, anti-PD-1/anti-PD-L1 monotherapies were better than docetaxel.
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Affiliation(s)
- Himani Aggarwal
- Eli Lilly & Company, 893 S Delaware Street Indianapolis, IN 46225, USA
| | | | | | | | - Emily Zhu
- Eli Lilly & Company, 893 S Delaware Street Indianapolis, IN 46225, USA
| | | | - Howard Thom
- Health Economics Bristol (HEB), Bristol Medical School, University of Bristol, 1-5 Whiteladies Road Clifton Bristol, BS8 1NU, United Kingdom
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Proctor T, Zimmermann S, Seide S, Kieser M. A comparison of methods for enriching network meta-analyses in the absence of individual patient data. Res Synth Methods 2022; 13:745-759. [PMID: 35521904 DOI: 10.1002/jrsm.1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/08/2022] [Accepted: 04/25/2022] [Indexed: 11/07/2022]
Abstract
During drug development, a biomarker is sometimes identified as separating a patient population into those with more and those with less benefit from evaluated treatments. Consequently, later studies might be targeted, while earlier ones are performed in mixed patient populations. This poses a challenge in evidence synthesis, especially if only aggregated data are available. Starting from this scenario, we investigate three commonly used network meta-analytic estimation methods, the naive estimation approach, the stand-alone analysis, and the network meta-regression. Additionally, we adapt and modify two methods which are used in evidence synthesis to combine randomized controlled trials with observational studies, the enrichment-through-weighting approach and the informative prior estimation. We evaluate all five methods in a simulation study with 32 scenarios using bias, RMSE, coverage, precision, and power. Additionally, we re-visit a clinical data set to exemplify and discuss the application. In the simulation study, none of the methods was observed to be clearly favorable over all investigated scenarios. However, the stand-alone analysis and the naive estimation performed comparably or worse than the other methods in all evaluated performance measures and simulation scenarios and are therefore not recommended. While substantial between-trial heterogeneity is challenging for all estimation approaches, the performance of the network meta-regression, the enriching-through weighting approach and the informative prior approach was dependent on the simulation scenario and the performance measure of interest. Furthermore, as these estimation methods are drawing slightly different assumptions, some of which require the presence of additional information for estimation, we recommend sensitivity-analyses wherever possible. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tanja Proctor
- Institute of Medical Biometry, University of Heidelberg
| | | | - Svenja Seide
- Institute of Medical Biometry, University of Heidelberg
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Efficacy and Safety of Pemetrexed and Gefitinib in the Treatment of Non-Small-Cell Lung Cancer: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021. [DOI: 10.1155/2021/5534823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Object. This study is aimed at evaluating the efficacy and safety of pemetrexed and gefitinib in the treatment of non-small-cell lung cancer (NSCLC). Methods. Databases, including PubMed, the Cochrane Library, Embase, CNKI, and Web of Science, were applied to search for randomized controlled trials (RCTs) about the use of pemetrexed and gefitinib in the second-line treatment of locally advanced and metastatic NSCLC from database foundation to April 2020. Meta-analysis was conducted using the RevMan 5.3 software. Primary outcomes included progression-free survival (PFS) and overall survival (OS), and secondary outcomes included objective response rate (ORR), disease control rate (DCR), and all grades of drug-related adverse events (AEs). Results. Totally, 14 RCTs and 1,334 patients were involved in the study. The results of meta-analysis showed that compared with pemetrexed, gefitinib was not superior in improving ORR (
), DCR (
), PFS (
), and OS (
). Subgroup analysis showed that in patients with mutant EGFR (
) and wild-type EGFR (
), both pemetrexed and gefitinib produced a similar effect on PFS. In terms of safety, the incidence of rash (
) and diarrhea (
) in the gefitinib group was significantly higher than those in the pemetrexed group, while the occurrence of neutropenia (
) and fatigue (
) was significantly lower. Conclusion. Gefitinib and pemetrexed showed similar efficacy and safety, regardless of the type of EGFR. Both gefitinib and pemetrexed can be used as conventional drugs for the second-line treatment of locally advanced and metastatic NSCLC.
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Zhao Y, Cheng B, Chen Z, Li J, Liang H, Chen Y, Zhu F, Li C, Xu K, Xiong S, Lu W, Chen Z, Zhong R, Zhao S, Xie Z, Liu J, Liang W, He J. Toxicity profile of epidermal growth factor receptor tyrosine kinase inhibitors for patients with lung cancer: A systematic review and network meta-analysis. Crit Rev Oncol Hematol 2021; 160:103305. [PMID: 33757838 DOI: 10.1016/j.critrevonc.2021.103305] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/24/2022] Open
Abstract
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are treatments commonly used for lung cancer. The toxicity profile including toxicity incidence, severity, and spectrum (involving various specific adverse events) of each EGFR-TKI are of particular clinical interest and importance. Data from phase II and III randomized controlled trials comparing treatments among EGFR-TKIs (osimertinib, dacomitinib, afatinib, erlotinib, gefitinib, and icotinib) and chemotherapy for lung cancer were synthesized with Bayesian network meta-analysis. The primary outcome was systemic all-grade and grade ≥3 adverse events. The secondary outcome was specific all-grade adverse events including those of the skin, gastrointestinal tract, lung, etc. 40 trials randomizing 13,352 patients were included. Generally greater toxicity for dacomitinib and afatinib, and safety for icotinib were suggested. Furthermore, we found individual EGFR-TKIs had different toxicity spectrums. These findings provide a compelling safety reference for the individualized use of EGFR-TKIs for patients with lung cancer.
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Affiliation(s)
- Yi Zhao
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Bo Cheng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zisheng Chen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China; Department of Respiratory Medicine, The Sixth Affliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan 511518, China
| | - Jianfu Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Ying Chen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Feng Zhu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Caichen Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Ke Xu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shan Xiong
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Weixiang Lu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhuxing Chen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Ran Zhong
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shen Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510050, China
| | - Zhanhong Xie
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China; Department of Medical Oncology, The First People's Hospital of Zhaoqing, Zhaoqing 526020, China.
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.
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Gong H, Li Y, Yuan Y, Li W, Zhang H, Zhang Z, Shi R, Liu M, Liu C, Chen C, Liu H, Chen J. EZH2 inhibitors reverse resistance to gefitinib in primary EGFR wild-type lung cancer cells. BMC Cancer 2020; 20:1189. [PMID: 33276757 PMCID: PMC7716470 DOI: 10.1186/s12885-020-07667-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer-related deaths worldwide. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. In traditional anti-cancer therapy, epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI) have been proven to be beneficial for patients with EGFR mutations. However, patients with EGFR wild-type NSCLC were usually not respond to EGFR-TKIs. Enhancer of zeste homolog 2 (EZH2) is a key molecular in the PRC2 complex and plays an important role in epigenetic regulation and is overexpressed in variant tumors. EZH2 inhibitors have been reported to sensitize variant tumor cells to anticancer drugs. This study aimed to investigate whether the EZH2 inhibitors, GSK343 and DZNep when combined with gefitinib can reverse EGFR-TKIs resistance in EGFR wild-type NSCLC cells. Methods The RNA-sequencing data of patients with NSCLC [502 patients with lung squamous cell carcinoma, including 49 paracancerous lung tissues and 513 patients with lung adenocarcinoma (LUAD), including 59 paracancerous lung tissues] from the Cancer Genome Atlas (TCGA), were analyzed for EZH2 expression. EZH2 expression was verified in 40 NSCLC tissue cancer samples and their corresponding paracancerous tissues from our institute (TJMUGH) via RT-PCR. A549 and H1299 cells treated with siRNA or EZH2 inhibitors were subjected to cell viability and apoptosis analyses as well to EGFR pathway proteins expression analyses via western blotting. Results EZH2 was upregulated in human NSCLC tissues and correlated with poor prognosis in patients with LUAD based on data from both TCGA and TJMUGH. Both GSK343 and DZNep sensitized EGFR wild-type LUAD cells (A549 and H1299) to gefitinib and suppressed cell viability and proliferation in vitro by downregulating the phosphorylation of EGFR and AKT and by inducing cell apoptosis. Co-administration of EZH2 inhibitors (GSK343 or DZNep) with gefitinib exerted a stronger inhibitory effect on tumor activity, cell proliferation and cell migration than single drug administration in vitro and in vivo. Conclusions These data suggest that the combination of EZH2 inhibitors with EGFR-TKIs may be an effective method for treating NSCLC-patients with EGFR-wild type, who do not want to undergo traditional treatment with chemotherapy.
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Affiliation(s)
- Hao Gong
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Yongwen Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, 300052, P.R. China
| | - Yin Yuan
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Weiting Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Hongbing Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Zihe Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Ruifeng Shi
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Minghui Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Chao Liu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Chen Chen
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, 300052, P.R. China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, 300052, P.R. China.
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, P.R. China. .,Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, 300052, P.R. China.
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Brascia D, De Iaco G, Schiavone M, Panza T, Signore F, Geronimo A, Sampietro D, Montrone M, Galetta D, Marulli G. Resectable IIIA-N2 Non-Small-Cell Lung Cancer (NSCLC): In Search for the Proper Treatment. Cancers (Basel) 2020; 12:cancers12082050. [PMID: 32722386 PMCID: PMC7465235 DOI: 10.3390/cancers12082050] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 12/25/2022] Open
Abstract
Locally advanced non-small cell lung cancer accounts for one third of non-small cell lung cancer (NSCLC) at the time of initial diagnosis and presents with a wide range of clinical and pathological heterogeneity. To date, the combined multimodality approach involving both local and systemic control is the gold standard for these patients, since occult distant micrometastatic disease should always be suspected. With the rapid increase in treatment options, the need for an interdisciplinary discussion involving oncologists, surgeons, radiation oncologists and radiologists has become essential. Surgery should be recommended to patients with non-bulky, discrete, or single-level N2 involvement and be included in the multimodality treatment. Resectable stage IIIA patients have been the subject of a number of clinical trials and retrospective analysis, discussing the efficiency and survival benefits on patients treated with the available therapeutic approaches. However, most of them have some limitations due to their retrospective nature, lack of exact pretreatment staging, and the involvement of heterogeneous populations leading to the awareness that each patient should undergo a tailored therapy in light of the nature of his tumor, its extension and his performance status.
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Affiliation(s)
- Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Giulia De Iaco
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Marcella Schiavone
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Teodora Panza
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Francesca Signore
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Alessandro Geronimo
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Doroty Sampietro
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
| | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70121 Bari, Italy; (M.M.); (D.G.)
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, 70121 Bari, Italy; (D.B.); (G.D.I.); (M.S.); (T.P.); (F.S.); (A.G.); (D.S.)
- Correspondence: or
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Lu X, Li S, Chen W, Zheng D, Li Y, Li F. A meta-analysis of the safety and effectiveness of pemetrexed compared with gefitinib for pre-treated advanced or metastatic NSCLC. Medicine (Baltimore) 2020; 99:e21170. [PMID: 32702875 PMCID: PMC7373595 DOI: 10.1097/md.0000000000021170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The purpose of the current meta-analysis was to compare the oncological outcomes of pemetrexed versus gefitinib in pre-treated advanced or metastatic non-small cell lung cancer (NSCLC) patients. METHODS Search the online electronic databases on comparison the effectiveness and adverse effects of pemetrexed versus gefitinib in therapy outcomes of pre-treated NSCLC to September 2019. All studies analyzed the summary odds ratios (ORs) of the main outcomes, including survival efficacy and toxicity complications. RESULTS In all, 5 trials involving 676 subjects were included, with 332 receiving pemetrexed and 344 using gefitinib. The pooled analysis of overall survival (OS) (OR = 0.97, 95%CI = 0.77-1.21, P = .76) and progression-free survival (PFS) (OR = 1.17, 95%CI = 0.60-2.30, P = .65) showed that pemetrexed did not achieve benefit when compared with gefitinib. In the results of subgroup analysis among the EGFR mutation-positive patients, the comparison of gefitinib therapy versus pemetrexed did show PFS benefit 0.35 (95%CI 0.12-1.01; P = .05). In terms of grade 3 or 4 side effects, a similar toxicity profile of both pemetrexed and gefitinib was shown in the incidence rate of rash (P = .045), fatigue (P = .97), thrombocytopenia (P = .68) and anemia (P = .21) between the 2 groups. CONCLUSION Pemetrexed was not associated with survival benefit than gefitinib therapy among pre-treated NSCLC patients. While, gefitinib showed superior PFS efficacy than pemetrexed for patients with EGFR mutation-type. Future investigations are required to identify relevant biomarkers in selected patients that would most likely benefit from pemetrexed or gefitinib treatment in pre-treated advanced NSCLC patients.
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Affiliation(s)
| | - Shengshu Li
- Department of Pulmonary & Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya
| | - Weizong Chen
- Xinglong Red Cross Hospital of Wanninng, Wanning City, Hainan Province, China
| | - Dongyang Zheng
- Department of Pulmonary & Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya
| | - Yuzhu Li
- Department of Pulmonary & Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya
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9
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Wang H, Zhang Z, Liu F, Zhou M, Lv H. Pemetrexed versus Gefitinib as Second-line Treatment for Advanced Non-small Cell Lung Cancer: A Meta-analysis Based on Randomized Controlled Trials. Pteridines 2019. [DOI: 10.1515/pteridines-2019-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Objective To investigate the clinical efficacy and toxicity of Pemetrexed versus Gefitinib as second-line treatment for advanced non-small cell lung cancer (NSCLC).
Methods By systematically searching the electronic databases of Pubmed, CENTRAL, Cochrane, EMBASE, ASCO, and CBM, open published randomized clinical trials (RCTs) relevant to clinical efficacy and toxicity of Pemetrexed versus Gefitinib as second-line treatment of advanced NSCLC were included in the meta-analysis. Data of objective response rate (ORR) and drug related toxicity were extracted from the original publications and pooled by random or fixed effect method.
Results Fourteen clinical trials related to Pemetrexed versus Gefitinib as second-line treatment for advanced NSCLC fulfilled the inclusion criteria and were included in the meta-analysis. The pooled results show that the ORR (RR=0.81, 95% CI:0.56–1.16, p=0.25) and DCR (RR=1.11, 95% CI:0.94–1.31, p=0.24) were not statistical different for Pemetrexed versus Gefitinib as second-line treatment of advanced NSCLC. However, the pooled data demonstrated the risk of developing skin rash (RR=0.10, 95% CI:0.03–0.30, p=0.00) and diarrhea (RR=0.31, 95% CI:0.15–0.67, p=0.003) in patients with Pemetrexed was significantly lower than that of Gefitinib through random effect model analysis, but the incidence of neutropenia in Pemetrexed group was significantly higher than that of Gefitinib with statistical difference (RR=7.62, 95% CI:3.71–15.66, p=0.00).
Conclusion Pemetrexed was not inferior as second-line treatment for advanced NSCLC compared to Gefitinib for tumor response. However, Pemetrexed had higher incidence of neutropenia but lower risk of developing skin rash and diarrhea.
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Affiliation(s)
- Huiyu Wang
- Department of Pharmacy, Traditional Chinese Medicine Hospital of Lishui , Zhejiang Province, 323000 PR China
| | - Zunjing Zhang
- Department of Infection, Traditional Chinese Medicine Hospital of Lishui , Zhejiang Province, 323000 PR China
| | - Feng Liu
- Department of Pharmacy, Traditional Chinese Medicine Hospital of Lishui , Zhejiang Province, 323000 PR China
| | - Miaoying Zhou
- Department of Pharmacy , Longquan People’s Hospital , Zhejiang Province, 323700 PR China
| | - Handi Lv
- Department of Respiratory , Zhuji Affiliated Hospital of Shaoxing University , Zhejiang Province 311800 PR China
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10
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Proctor T, Jensen K, Kieser M. Integrated evaluation of targeted and non-targeted therapies in a network meta-analysis. Biom J 2019; 62:777-789. [PMID: 31544262 DOI: 10.1002/bimj.201800322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 08/13/2019] [Accepted: 08/28/2019] [Indexed: 11/11/2022]
Abstract
Individualized therapies for patients with biomarkers are moving more and more into the focus of research interest when developing new treatments. Hereby, the term individualized (or targeted) therapy denotes a treatment specifically developed for biomarker-positive patients. A network meta-analysis model for a binary endpoint combining the evidence for a targeted therapy from individual patient data with the evidence for a non-targeted therapy from aggregate data is presented and investigated. The biomarker status of the patients is either available at patient-level in individual patient data or at study-level in aggregate data. Both types of biomarker information have to be included. The evidence synthesis model follows a Bayesian approach and applies a meta-regression to the studies with aggregate data. In a simulation study, we address three treatment arms, one of them investigating a targeted therapy. The bias and the root-mean-square error of the treatment effect estimate for the subgroup of biomarker-positive patients based on studies with aggregate data are investigated. Thereby, the meta-regression approach is compared to approaches applying alternative solutions. The regression approach has a surprisingly small bias even in the presence of few studies. By contrast, the root-mean-square error is relatively greater. An illustrative example is provided demonstrating implementation of the presented network meta-analysis model in a clinical setting.
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Affiliation(s)
- Tanja Proctor
- Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, Heidelberg, Germany
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11
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Van Der Weijst L, Lievens Y, Schrauwen W, Surmont V. Health-Related Quality of Life in Advanced Non-small Cell Lung Cancer: A Methodological Appraisal Based on a Systematic Literature Review. Front Oncol 2019; 9:715. [PMID: 31456938 PMCID: PMC6699450 DOI: 10.3389/fonc.2019.00715] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background: The majority of lung cancer patients are diagnosed with advanced non-small cell lung cancer (NSCLC), the bulk of which receive palliative systemic treatment with the goal to provide effective symptom palliation and safeguard health-related quality of life (HRQoL). Advanced NSCLC trials with HRQoL endpoints face methodological constraints limiting interpretability. Objectives: We provide a comprehensive overview of recent clinical trials evaluating the impact of systemic therapies on HRQoL in advanced NSCLC, focusing on the methodological quality, with the ultimate goal to improve interpretation, comparison and reporting of HRQoL data. Methods: A systematic literature review was performed. Prospective studies published over the last decade evaluating the impact of systemic treatments on HRQoL in advanced NSCLC were included. Methodological quality of HRQoL reporting was assessed with the CONSORT-PRO extension. Results: Hundred-twelve manuscripts describing 85 trials met all criteria. No formal conclusion can be drawn regarding the impact on HRQoL of different treatments. We report an important variety in methodological quality in terms of definitions of HRQoL, missing data points, lack of standardization of analyzing and presenting HRQoL and no standard follow-up time. The quality of HRQoL data reporting varies substantially between studies but improves over time. Conclusion: This review shows that in the heterogeneous landscape of trials addressing HRQoL in advanced stage NSCLC. Methodology reporting remains generally poor. Adequate reporting of HRQoL outcome data is equally important to support clinical decision-making as to correctly inform health policy regarding direct approval and reimbursement of the new drugs and combinations that will come online.
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Affiliation(s)
| | - Yolande Lievens
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Wim Schrauwen
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Veerle Surmont
- Department of Thoracic Oncology, Ghent University Hospital, Ghent, Belgium
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12
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Zhao S, Zhang Z, Zhang Y, Hong S, Zhou T, Yang Y, Fang W, Zhao H, Zhang L. Progression-free survival and one-year milestone survival as surrogates for overall survival in previously treated advanced non-small cell lung cancer. Int J Cancer 2019; 144:2854-2866. [PMID: 30430561 DOI: 10.1002/ijc.31995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/06/2018] [Accepted: 11/06/2018] [Indexed: 12/24/2022]
Abstract
The advent of immunotherapy leads to greater availability of effective subsequent treatments and extended survival in previously treated advanced non-small cell lung cancer (NSCLC), complicating the evaluation of overall survival (OS) in second-line NSCLC trials. Here, we aimed to assess the surrogacy of progression-free survival (PFS) and milestone survival for OS in second-line NSCLC trials investigating chemotherapy, targeted therapy and immunotherapy, respectively. We systemically searched for active-controlled, second-line NSCLC trials. The milestone time point was set at one-year based on pre-analysis. A two-stage meta-analytic validation model was adopted to assess associations between surrogate endpoint (SE) and OS and associations between treatment effects on SE and OS. Treatment effects on SE and OS were expressed as PFS hazard ratios (HRPFS ), 1 yr-milestone ratio (Ratio1y-SUR ) and HROS . Subgroup analyses stratified by treatment types and trial publication years evaluated the surrogacy in different clinical contexts. The study included 50 trials with 22,804 patients. One-year survival strongly correlated with OS (R2 [95% confidence interval]: one-year survival -median OS = 0.707 [0.704-0.708]; Ratio1y-SUR -HROS = 0.829 [0.828-0.831]). No correlation was established between PFS and OS (median PFS-median OS = 0.100 [0.098-0.101]; HRPFS -HROS = 0.064 [0.059-0.069]), except in immunotherapy subgroup (HRPFS -HROS = 0.835 [0.791-0.918]). In subgroup analyses, surrogacy of one-year survival persisted in different clinical contexts, and the disassociation between PFS and OS persisted in recent trials. One-year milestone survival showed strong surrogacy for OS in second-line NSCLC trials. Although no association was identified between PFS and OS, the strong HRPFS -HROS correlation in immunotherapy trials indicates the potential of PFS as a SE in NSCLC trials involving immunotherapies.
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Affiliation(s)
- Shen Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Zhonghan Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Yaxiong Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shaodong Hong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ting Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hongyun Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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13
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Vickers AD, Winfree KB, Cuyun Carter G, Kiiskinen U, Jen MH, Stull D, Kaye JA, Carbone DP. Relative efficacy of interventions in the treatment of second-line non-small cell lung cancer: a systematic review and network meta-analysis. BMC Cancer 2019; 19:353. [PMID: 30987609 PMCID: PMC6466705 DOI: 10.1186/s12885-019-5569-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/02/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Locally advanced or metastatic non-small cell lung cancer (NSCLC) that has progressed after first-line treatment has a poor prognosis. Recent randomized clinical trials (RCTs) have demonstrated survival benefits of alternative treatments to docetaxel. However, information is lacking on which patients benefit the most and what drug or regimen is optimal. We report a systematic review and network meta-analysis (NMA) of second-line treatments in all subgroup combinations determined by histology, programmed death ligand 1 (PD-L1) expression, and epidermal growth factor receptor (EGFR) mutation. METHODS MEDLINE, PubMed, EMBASE, Biosciences Information Service (using the Dialog Platform), Cochrane Library, and abstracts from scientific meetings were searched for RCTs published up to September 2015. Key outcomes were overall survival (OS) and progression-free survival (PFS). Bayesian hierarchical exchangeable NMAs were conducted to calculate mean survival times and relative differences for eight subgroups, using docetaxel as the reference comparator. For OS, the NMA was based on hazard ratios applied to a first-order fractional polynomial model fitted to the reference treatment. For PFS, a second-order fractional polynomial model was fitted to reconstructed patient-level data for the entire network of evidence. RESULTS The search identified 30 studies containing 17 different treatment regimens. Docetaxel plus ramucirumab was associated with a significant improvement in OS and PFS, relative to docetaxel, regardless of patient type. Docetaxel plus nintedanib showed similar efficacy to docetaxel plus ramucirumab in the nonsquamous populations. EGFR tyrosine kinase inhibitors (TKIs) erlotinib and gefitinib showed superior levels of efficacy in EGFR mutation-positive populations and the one PD-1 immunotherapy (nivolumab) studied showed superior efficacy in the populations exhibiting high PD-L1 expression. CONCLUSIONS In the absence of head-to-head comparisons, we performed a mixed-treatment analysis to synthesize evidence of the efficacy of each treatment. Benefits are optimized by targeting specific treatments to individual patients guided by histology, PD-L1 expression, and EGFR mutation status. SYSTEMATIC REVIEW REGISTRATION This review is registered in PROSPERO (registration number: CRD42014013780 available at www.crd.york.ac.uk/PROSPERO ).
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Affiliation(s)
- Adrian D Vickers
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK.
| | | | | | | | - Min-Hua Jen
- Eli Lilly and Company Limited, Windlesham, Surrey, UK
| | - Donald Stull
- RTI Health Solutions, Research Triangle Park, NC, USA
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14
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Peng Y, Li Q, Zhang J, Shen W, Zhang X, Sun C, Cui H. Update review of skin adverse events during treatment of lung cancer and colorectal carcinoma with epidermal growth receptor factor inhibitors. Biosci Trends 2018; 12:537-552. [PMID: 30555112 DOI: 10.5582/bst.2018.01246] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The past decades have witnessed a rapid increase in the use of molecularly targeted therapies. One class of agents includes the epidermal growth factor receptor inhibitors (EGFRIs), which afford patients longer progression-free survival (PFS) times, especially among non-small cell lung cancer (NSCLC) and metastatic colorectal carcinoma (mCRC). Certain adverse effects, particularly skin toxicity, are mainly manifested as rash, xerosis, pruritus, nails changes, hair changes and mucositis. Previous studies reported the adverse events occurred based on the cutaneous inflammation reaction. Treatment recommended glucocorticoids and antibiotics. It is suggested that skin toxicity is an important issue because it usually affects patients' quality of life (QoL) and still causes dose reduction or discontinuation of targeted therapies. For these reasons, more and more oncologists and dermatologists recognize the importance of recognition and management of skin toxicities with the expansion in availability of EGFRIs. In this review, we conducted a systematic review of recent data to examine the types and frequencies of dermatologic toxicities associated with anti-epidermal growth factor receptor (EGFR) therapies in NSCLC and mCRC. In addition, we would like to explore the management and treatment options currently used by clinicians based on the possible mechanism.
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Affiliation(s)
- Yanmei Peng
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Qiang Li
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Jingyi Zhang
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Wen Shen
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Xu Zhang
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Chenyao Sun
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital
| | - Huijuan Cui
- Department of Integrative Oncology, China-Japan Friendship Hospital
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15
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Liu Z, Ou W, Li N, Wang SY. Apatinib monotherapy for advanced non-small cell lung cancer after the failure of chemotherapy or other targeted therapy. Thorac Cancer 2018; 9:1285-1290. [PMID: 30126078 PMCID: PMC6166085 DOI: 10.1111/1759-7714.12836] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
Background Apatinib, a small‐molecule inhibitor of vascular endothelial growth factor receptor 2 (VEGFR‐2), has proven to be effective and safe for treating patients with advanced gastric cancer after second‐line chemotherapy failure. As VEGFR‐2 targeted therapy has made encouraging progress for the treatment of a broad range of malignancies, we explored the efficacy and safety of apatinib for the treatment of advanced non‐small cell lung cancer after the failure of chemotherapy or other targeted therapy. Methods We retrospectively analyzed the data of 34 patients (11 with squamous carcinoma and 23 with adenocarcinoma) who were treated with apatinib alone in a daily oral dose of 250 mg in the second‐line or third‐line setting from January 2016 to July 2017. The primary endpoint was progression‐free survival (PFS). Results EGFR mutation or amplification was detected in 15 patients. The median PFS of the whole group was four months (95% confidence interval 0.3–7.7). A partial response was observed in 2 patients (5.88%) and stable disease in 19 (55.88%). The disease control rate was 61.76%. Common side effects of apatinib were hypertension (n = 12), hand‐foot syndrome (n = 8), and proteinuria (n = 5), which accounted for 35.30%, 23.53%, and 14.71%, respectively, and no grade 3/4 adverse reactions occurred. Apatinib toxicity was controllable and tolerable. Conclusions Apatinib appears to be effective and safe for advanced non‐small cell lung cancer after the failure of chemotherapy or other targeted therapy.
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Affiliation(s)
- Zui Liu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Ou
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ning Li
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Si-Yu Wang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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16
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Carmichael JA, Wing-San Mak D, O'Brien M. A Review of Recent Advances in the Treatment of Elderly and Poor Performance NSCLC. Cancers (Basel) 2018; 10:E236. [PMID: 30021993 PMCID: PMC6070834 DOI: 10.3390/cancers10070236] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/20/2018] [Accepted: 06/30/2018] [Indexed: 12/31/2022] Open
Abstract
Until recently, chemotherapy has remained the mainstay of treatment for the majority of patients with advanced non-small cell lung cancer (NSCLC). Excellent responses have been observed with immune-checkpoint inhibitors, and targeted treatments for those tumours with actionable mutations, resulting in a paradigm shift in the treatment approach for these patients. Elderly patients and those with poor performance status (PS), such as Eastern Cooperative Oncology Group (ECOG) 2, have historically been excluded from clinical trials due to poor outcomes. There is therefore a lack of data to define the optimal treatment strategy for these patients. Due to improved tolerability of novel therapies, inclusion of these patients in clinical trials has increased, and sub-group analyses have identified many treatments demonstrating potential activity. Here, we summarise key recent advances in the treatment of NSCLC, specifically evaluating their efficacy and tolerability in these patient cohorts.
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Affiliation(s)
| | - Daisy Wing-San Mak
- Queen Elizabeth Hospital, 30 Gascoigne Road, Yau Ma Tei, Hong Kong, China.
| | - Mary O'Brien
- Lung Unit, Royal Marsden Hospital, Downs Rd, Sutton, Surrey SM2 5PT, UK.
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17
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Suh CH, Park HS, Kim KW, Pyo J, Hatabu H, Nishino M. Pneumonitis in advanced non-small-cell lung cancer patients treated with EGFR tyrosine kinase inhibitor: Meta-analysis of 153 cohorts with 15,713 patients: Meta-analysis of incidence and risk factors of EGFR-TKI pneumonitis in NSCLC. Lung Cancer 2018; 123:60-69. [PMID: 30089596 DOI: 10.1016/j.lungcan.2018.06.032] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Pneumonitis is a significant toxicity of EGFR tyrosine kinase inhibitors (EGFR-TKI) in non-small-cell lung cancer (NSCLC) patients. We studied the incidence of pneumonitis in clinical trials of EGFR-TKI published in 2003-2017, and performed subgroups analyses to identity predisposing factors. METHODS Ovid-MEDLINE and EMBASE search up to 4/17/17 using the keywords, "erlotinib", "gefitinib", "afatinib", "osimertinib", and "lung cancer", resulted in a total of 153 eligible trial cohorts with 15,713 advanced NSCLC patients treated with EGFR-TKI. The pooled incidence of all-grade, high-grade, and grade 5 pneumonitis was obtained. Subgroup analyses were performed with meta-regression using study-level covariates. RESULTS Among the patients without prior exposure to EGFR-TKI, the overall incidence was 1.12% (95% CI:0.79-1.58%) for all-grade, 0.61% (95% CI:0.40-0.93%) for high-grade, and 0.20% (95% CI:0.11-0.38%) for grade 5 pneumonitis. The incidence was significantly higher in Japanese studies compared to studies of non-Japan origin, for all-grade (4.77% vs. 0.55%, p < 0.001), high grade (2.49% vs. 0.37%, p < 0.001), and grade 5 pneumonitis (1.00% vs. 0.18%, p < 0.001). Multivariate analyses demonstrated higher odds of pneumonitis in Japanese studies for all-grade (odds ratio [OR]: 5.04; 95% CI:3.14-8.11, p < 0.001), high-grade (OR: 4.45; 95% CI:2.50-7.93, p < 0.001), and grade 5 pneumonitis (OR: 4.55; 95% CI:2.20-9.44, p < 0.001) compared to others, after adjusting for types of EGFR-TKI and lines of therapy. In patients with EGFR retreatment analyzed separately, the pooled incidence was 1.13% (95% CI:0.40-3.15%) for all-grade, 0.49% (95% CI:0.21-1.11%) for high-grade, and 0.16% (95% CI:0.04-0.65%) for grade 5 pneumonitis. CONCLUSIONS The overall incidence of EGFR-TKI pneumonitis was 1.12% in patients without prior exposure to EGFR-TKI, and 1.13% in EGFR-TKI retreatment group. The cohorts from Japan had significantly higher incidence of pneumonitis, providing insights for further mechanistic studies.
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea
| | - Hye Sun Park
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston MA, USA
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea
| | - Junhee Pyo
- WHO Collaborating Center for Pharmaceutical Policy and Regulation, Department of Pharmaceutical Science, Utrecht University, David de Wiedgebouw, Universiteitsweg 99 3584 CG Utrecht, Netherlands
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston MA, USA
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston MA, USA.
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18
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Wo H, He J, Zhao Y, Yu H, Chen F, Yi H. The Efficacy and Toxicity of Gefitinib in Treating Non-small Cell Lung Cancer: A Meta-analysis of 19 Randomized Clinical Trials. J Cancer 2018; 9:1455-1465. [PMID: 29721056 PMCID: PMC5929091 DOI: 10.7150/jca.23356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/05/2018] [Indexed: 01/22/2023] Open
Abstract
Background: This meta-analysis evaluated the efficacy and toxicity of gefitinib with other commonly used drugs in different treatment settings and epidermal growth factor receptor (EGFR) mutation status. Methods: Nineteen randomize clinical trials (RCTs) of 6,554 patients with NSCLC were pooled in this meta-analysis by random-effects or fixed-effects model, whichever is proper. Results: In first-line therapy, gefitinib showed higher odds than chemotherapy (OR = 2.19, 95% CI: 1.20-4.01), but less than other targeted therapies (OR = 0.58, 95% CI: 0.38-0.88). As non-first-line therapy, the overall survival (OS) and progression-free survival (PFS) were similar between gefitinib and controls (HR = 1.00, 95% CI: 0.93-1.08; HR = 0.91, 95% CI: 0.72-1.15), respectively. With the regard to toxicity, the incidences of dry skin, rash and pruritus were higher in gefitinib compared with controls, while gefitinib significantly reduced the incidence of hematologic toxicity. Conclusion: Gefitinib might be more efficient than chemotherapy, but less efficient than other targeted therapies in ORR, especially in EGFR mutation-positive patients. Gefitinib can decrease the odds of hematologic toxicity compared to controls. Future studies, especially those with EGFR mutation-positive patients, will be needed to confirm our findings.
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Affiliation(s)
- Hongmei Wo
- Department of Health Economics, School of Health Policy and Management, Nanjing Medical University, Nanjing, 211166, China
| | - Jing He
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Hao Yu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Feng Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Honggang Yi
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
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Sun L, Xiong Z, Han C. [Research Advances of Pan-negative Type of Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018. [PMID: 29526181 PMCID: PMC5973015 DOI: 10.3779/j.issn.1009-3419.2018.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
近年来随着对肿瘤驱动基因的不断探索和分子检测技术的快速发展,在非小细胞肺癌(non-small cell lung cancer, NSCLC)领域,一系列的驱动基因如EGFR、KRAS、BRAF、PIK3CA、ALK和ROS-1等相继被发现,并逐渐研发出相应的针对特定驱动基因变异的靶向治疗药物,使NSCLC患者的生存得到极大改善。尽管如此,仍有部分NSCLC患者未能检测到任何已知驱动基因变异,称之为pan-negative型NSCLC。本文就pan-negative型NSCLC的概念、临床病理和流行病学特点以及治疗预后等作一综述。
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Affiliation(s)
- Li Sun
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - Zhicheng Xiong
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - Chengbo Han
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, China
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Itchins M, Clarke S, Pavlakis N. Do EGFR tyrosine kinase inhibitors (TKIs) still have a role in EGFR wild-type pre-treated advanced non-small cell lung cancer (NSCLC)?-the shifting paradigm of therapeutics. Transl Lung Cancer Res 2018. [PMID: 29531903 DOI: 10.21037/tlcr.2018.01.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Malinda Itchins
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, St Leonards, NSW, Australia.,Northern Clinical School, University of Sydney, NSW, Australia.,Northern Cancer Institute, St Leonards, NSW, Australia
| | - Stephen Clarke
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, St Leonards, NSW, Australia.,Northern Clinical School, University of Sydney, NSW, Australia.,Northern Cancer Institute, St Leonards, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Nick Pavlakis
- Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, St Leonards, NSW, Australia.,Northern Clinical School, University of Sydney, NSW, Australia.,Northern Cancer Institute, St Leonards, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
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21
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Abstract
BACKGROUND The role of gefitinib for the treatment of advanced non-small cell lung cancer (NSCLC) is evolving. We undertook a systematic review to evaluate the available evidence from all randomised trials. OBJECTIVES To determine the effectiveness and safety of gefitinib as first-line, second-line or maintenance treatment for advanced NSCLC. SEARCH METHODS We performed searches in CENTRAL, MEDLINE and Embase from inception to 17 February 2017. We handsearched relevant conference proceedings, clinical trial registries and references lists of retrieved articles. SELECTION CRITERIA We included trials assessing gefitinib, alone or in combination with other treatment, compared to placebo or other treatments in the first- or successive-line treatment of patients with NSCLC, excluding compassionate use. DATA COLLECTION AND ANALYSIS We used the standard Cochrane methodology. Two authors independently assessed the search results to select those with sound methodological quality. We carried out all analyses on an intention-to-treat basis. We recorded the following outcome data: overall survival, progression-free survival, toxicity, tumour response and quality of life. We also collected data for the following subgroups: Asian ethnicity and positive epidermal growth factor receptor (EGFR) mutation. MAIN RESULTS We included 35 eligible randomised controlled trials (RCTs), which examined 12,089 patients.General populationGefitinib did not statistically improve overall survival when compared with placebo or chemotherapy in either first- or second-line settings. Second-line gefitinib prolonged time to treatment failure (TTF) (hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.75 to 0.90, P < 0.0001) when compared with placebo. Maintenance gefitinib improved progression-free survival (HR 0.70, 95% CI 0.53 to 0.91, P = 0.007) after first-line therapy.Studies in patients of Asian ethnicity or that conducted subgroup analysesSecond-line gefitinib prolonged overall survival over placebo (HR 0.66, 95% CI 0.48 to 0.91, P = 0.01). In the first-line setting, progression-free survival was improved with gefitinib over chemotherapy alone (HR 0.65, 95% CI 0.43 to 0.98, P = 0.04, moderate quality of evidence). Gefitinib given in combination with a chemotherapy regimen improved progression-free survival versus either gefitinib alone or chemotherapy alone (HR 0.69, 95% CI 0.49 to 0.96, P = 0.03; HR 0.69, 95% CI 0.62 to 0.77, P < 0.00001, respectively). In the second-line setting, progression-free survival was superior in patients given gefitinib over placebo or chemotherapy (HR 0.69, 95% CI 0.52 to 0.91, P = 0.009; HR 0.71, 95% CI 0.57 to 0.88, P = 0.002; moderate quality of evidence, respectively). Combining gefitinib with chemotherapy in the second-line setting was superior to gefitinib alone (HR 0.65, 95% CI 0.43 to 0.97, P = 0.04). As maintenance therapy, gefitinib improved progression-free survival when compared with placebo (HR 0.42, 95% CI 0.33 to 0.54, P < 0.00001).Patients with EGFR mutation-positive tumoursStudies in patients with EGFR mutation-positive tumours showed an improvement in progression-free survival in favour of gefitinib over first-line and second-line chemotherapy (HR 0.47, 95% CI 0.36 to 0.61, P < 0.00001; HR 0.24, 95% CI 0.12 to 0.47, P < 0.0001, respectively). Gefitinib as maintenance therapy following chemotherapy improved overall and progression-free survival (HR 0.39, 95% CI 0.15 to 0.98, P = 0.05; HR 0.17, 95% CI 0.07 to 0.41, P < 0.0001, respectively) in one phase III study when compared to placebo.Toxicities from gefitinib included skin rash, diarrhoea and liver transaminase derangements. Toxicities from chemotherapy included anaemia, neutropenia and neurotoxicity.In terms of quality of life, gefitinib improved Functional Assessment of Cancer Therapy-Lung (FACT-L) (standardised mean difference (SMD) 10.50, 95% CI 9.55 to 11.45, P < 0.000001), lung cancer subscale (SMD 3.63, 95% CI 3.08 to 4.19, P < 0.00001) and Trial Outcome Index (SMD 9.87, 95% CI 1.26 to 18.48, P < 0.00001) scores when compared with chemotherapy. AUTHORS' CONCLUSIONS This systematic review shows that gefitinib, when compared with standard first- or second-line chemotherapy or maintenance therapy, probably has a beneficial effect on progression-free survival and quality of life in selected patient populations, particularly those with tumours bearing sensitising EGFR mutations.Patients with EGFR mutations lived longer when given maintenance gefitinib than those given placebo.One study conducted subgroup analysis and showed that gefitinib improved overall survival over placebo in the second-line setting in patients of Asian ethnicity. All other studies did not detect any benefit on overall survival. The data analysed in this review were very heterogenous. We were limited in the amount of data that could be pooled, largely due to variations in study design. The risk of bias in most studies was moderate, with some studies not adequately addressing potential selection, attrition and reporting bias. This heterogeneity may have an impact on the applicability of the resultsCombining gefitinib with chemotherapy appears to be superior in improving progression-free survival to either gefitinib or chemotherapy alone, however further data and phase III studies in these settings are required.Gefitinib has a favourable toxicity profile when compared with current chemotherapy regimens. Although there is no improvement in overall survival, gefitinib compares favourably with cytotoxic chemotherapy in patients with EGFR mutations with a prolongation of progression-free survival and a lesser side effect profile.
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Affiliation(s)
- Esther HA Sim
- GenesisCare Radiation Oncology1 Medical PlaceUrraweenQueenslandAustralia4655
| | - Ian A Yang
- The University of QueenslandUQ Thoracic Research Centre, School of MedicineBrisbaneAustralia
- The Prince Charles HospitalDepartment of Thoracic MedicineBrisbaneAustralia
| | | | - Rayleen V Bowman
- The Prince Charles HospitalDepartment of Thoracic MedicineBrisbaneAustralia
| | - Kwun M Fong
- The Prince Charles HospitalDepartment of Thoracic MedicineBrisbaneAustralia
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22
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Bronte G, Franchina T, Alù M, Sortino G, Celesia C, Passiglia F, Savio G, Laudani A, Russo A, Picone A, Rizzo S, De Tursi M, Gambale E, Bazan V, Natoli C, Blasi L, Adamo V, Russo A. The comparison of outcomes from tyrosine kinase inhibitor monotherapy in second- or third-line for advanced non-small-cell lung cancer patients with wild-type or unknown EGFR status. Oncotarget 2017; 7:35803-35812. [PMID: 26993607 PMCID: PMC5094963 DOI: 10.18632/oncotarget.8130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/28/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Second-line treatment for advanced non-small-cell lung cancer (NSCLC) patients includes monotherapy with a third-generation cytotoxic drug (CT) or a tyrosine kinase inhibitor (TKI). These options are the actual standard for EGFR wild-type (WT) status, as patients with EGFR mutations achieve greater benefit by the use of TKI in first-line treatment. Some clinical trials and meta-analyses investigated the comparison between CT and TKI in second-line, but data are conflicting. METHODS We designed a retrospective trial to gather information about TKI sensitivity in comparison with CT. We selected from clinical records patients treated with at least 1 line of CT and at least 1 line of TKI. We collected data about age, sex, performance status, comorbidity, smoking status, histotype, metastatic sites, EGFR status, treatment schedule, better response and time-to-progression (TTP) for each line of treatment and overall survival (OS). RESULTS 93 patients met selection criteria. Mean age 66,7 (range: 46-84). M/F ratio is 3:1. 39 EGFR-WT and 54 EGFR-UK. All patients received erlotinib or gefitinib as second-line treatment or erlotinib as third-line treatment. No TTP differences were observed for both second-line (HR:0,91; p = 0,6333) and third-line (HR:1.1; p = 0,6951) treatment (TKI vs CT). A trend of a benefit in OS in favor of 3rd-line TKI (HR:0,68; p = 0,11). CONCLUSIONS This study explores the role of TKIs in EGFR non-mutated NSCLC patients. OS analysis highlights a trend to a benefit in patients who received TKI in third-line, even if this result is statistically non-significant. Further analysis are needed to find an explanation for this observation.
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Affiliation(s)
- Giuseppe Bronte
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Tindara Franchina
- Medical Oncology Unit-AOOR Papardo-Piemonte, Messina and Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Giovanni Sortino
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Claudia Celesia
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Passiglia
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | | | - Agata Laudani
- Medical Oncology Unit, A.R.N.A.S. Civico, Palermo, Italy
| | - Alessandro Russo
- Medical Oncology Unit-AOOR Papardo-Piemonte, Messina and Department of Human Pathology, University of Messina, Messina, Italy
| | - Antonio Picone
- Medical Oncology Unit-AOOR Papardo-Piemonte, Messina and Department of Human Pathology, University of Messina, Messina, Italy
| | - Sergio Rizzo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy
| | - Elisabetta Gambale
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy
| | - Viviana Bazan
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio", Chieti, Italy
| | - Livio Blasi
- Medical Oncology Unit, A.R.N.A.S. Civico, Palermo, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit-AOOR Papardo-Piemonte, Messina and Department of Human Pathology, University of Messina, Messina, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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23
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Response to Tyrosine Kinase Inhibitors in Lung Adenocarcinoma with the Rare Epidermal Growth Factor Receptor Mutation S768I: a Retrospective Analysis and Literature Review. Target Oncol 2017; 12:81-88. [PMID: 27538584 DOI: 10.1007/s11523-016-0455-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The rare epidermal growth factor receptor (EGFR) mutation S768I has only been reported sporadically in patients with lung adenocarcinoma (AC). OBJECTIVE This study aimed to investigate the prevalence of the S768I mutation in Chinese patients with lung AC and to retrospectively analyze the response of S768I mutants to tyrosine kinase inhibitors (TKIs). PATIENTS AND METHODS A total of 6698 tissue specimens of lung AC were collected from the Department of Pathology of Shanghai Cancer Center of Fudan University between 2013 and 2015 and screened for EGFR mutations. Previously reported cases were combined with our data to evaluate the response of the S768I mutants to TKIs. RESULTS Thirty-five patients (0.52 %, 35/6698) harbored the S768I mutation, including 8 (22.9 %) with just the S768I mutation and 27 (77.1 %) with compound mutations of S768I and other EGFR mutations (including G719X and L858R). The median progression-free survival (PFS) of the 8 cases with available PFS data was 5.0 months (95 % confidential interval: 0.4-9.6 months). We combined our cases with the sporadic cases from 14 previous reports (total 49 cases) to assess the response to TKIs and found that the objective response rate was 40.0 %, 74.9 %, and 60.0 % for S768I-only mutants, S768I+G719X mutants, and S768I+L858R mutants, respectively. CONCLUSIONS S786I mutation is rare in lung AC and is frequently accompanied by G719X, L858R, or other EGFR mutations. Patients harboring only the S768I mutation appear to be more sensitive to TKIs than those with the wild-type EGFR. The S768I mutation may increase the sensitivity of G719X to TKIs but not the sensitivity of L858R to TKIs.
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24
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Wu D, Duan C, Wu F, Chen L, Chen S. Which treatment is preferred for advanced non-small-cell lung cancer with wild-type epidermal growth factor receptor in second-line therapy? A meta-analysis comparing immune checkpoint inhibitor, tyrosine kinase inhibitor and chemotherapy. Oncotarget 2017; 8:66491-66503. [PMID: 29029530 PMCID: PMC5630430 DOI: 10.18632/oncotarget.20281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 07/26/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The recommendations regarding the optimum treatment for advanced non-small-cell lung cancer (NSCLC) patients with wild-type (WT) epidermal growth factor receptor (EGFR) tumors remain unclear. This meta-analysis was conducted to assess the efficacy among programmed death-ligand 1 (PD-L1)/programmed death-1 (PD-1) antibody, EGFR-tyrosine kinase inhibitors (TKI) and chemotherapy in second-and third-line therapy. PATIENTS AND METHODS Randomized trials investigating two of the three treatments were searched and included. Multiple treatments comparison and pairwise comparison were performed to assess overall survival (OS) and progression-free survival (PFS), expressed as hazard ratios (HRs). The effect of prespecified study-level characteristics was assessed by subgroup analysis and meta-regression. RESULTS 12 randomized trials accruing 3341 advanced patients with WT EGFR tumors were analyzed. PD-1/PD-L1 antibody was associated with significantly longer OS and PFS than chemotherapy (OS: HR 0.67, 95% CrI 0.60-0.75; PFS: HR 0.83, 95% CrI 0.73-0.95) and TKI (OS: HR 0.59, 95% CrI 0.50-0.70; PFS: HR 0.75, 95% CrI 0.66-0.84) , while chemotherapy was associated with significantly longer OS (HR 0.88, 95% CrI 0.77-0.99) and PFS (HR 0.75, 95% CrI 0.66-0.84) than TKI. CONCLUSIONS For advanced NSCLC patients with WT-EGFR tumors in second- or third-line therapy, PD-1/PD-L1 antibody appeared to be the most efficacious treatment, which was followed by chemotherapy. EGFR-TKI was worse than chemotherapy.
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Affiliation(s)
- Di Wu
- Central Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Fenfang Wu
- Central Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Liyong Chen
- Guangdong Province Key Laboratory for Medical Molecular Diagnostics, China-America Cancer Research Institute, Dongguan Scientific Research Center, Guangdong Medical University, Dongguan, China
| | - Size Chen
- Central Laboratory, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
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25
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Luo D, Ma J, Zhang J, Zhao Y. [Molecular Imaging in vivo Detection of EGFR Mutations in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017. [PMID: 28641700 PMCID: PMC5973363 DOI: 10.3779/j.issn.1009-3419.2017.06.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
靶向药物表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitor, EGFR-TKI)改变了非小细胞肺癌的治疗格局,研究表明只有EGFR敏感突变人群能从中获益。EGFR突变检测的主流方法是针对EGFR的DNA序列进行分析,标本可以是手术或穿刺获取的肺癌组织、胸水肿瘤细胞、循环肿瘤细胞、外周血游离DNA,其最大的缺点是无法分析EGFR突变的异质性。针对EGFR在蛋白质水平进行突变检测分析的技术尚不成熟,但随着分子影像学的发展,基于正电子发射型计算机断层显像(positron emission computed tomography, PET)-计算机断层扫描(computed tomography, CT)的靶向EGFR分子探针的研发,使得在体检测肺癌组织的EGFR突变状态成为了可能,而且可以检测EGFR突变的异质性。本文综述了目前靶向EGFR突变的分子探针的研究结果及进展。
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Affiliation(s)
- Danjing Luo
- Department of Oncology, The Second Xiangya Hospital, Center South University, Changsha 410011, China
| | - Jin'an Ma
- Department of Oncology, The Second Xiangya Hospital, Center South University, Changsha 410011, China
| | - Jinming Zhang
- Department of Nuclear Medicine, The PLA General Hospital, Beijing 100853, China
| | - Yanzhong Zhao
- The Medical Experimental Center, the Third Xiangya Hospital,
Central South University, Changsha 410013, China
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Popat S, Mellemgaard A, Reck M, Hastedt C, Griebsch I. Nintedanib plus docetaxel as second-line therapy in patients with non-small-cell lung cancer of adenocarcinoma histology: a network meta-analysis vs new therapeutic options. Future Oncol 2017; 13:1159-1171. [PMID: 28326832 DOI: 10.2217/fon-2016-0493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PATIENTS & METHODS We provide an update to a network meta-analysis evaluating the relative efficacy of nintedanib + docetaxel versus other second-line agents in adenocarcinoma histology non-small-cell lung cancer. RESULTS Overall similarity of nintedanib + docetaxel versus ramucirumab + docetaxel, and versus nivolumab. Comparing nintedanib + docetaxel with nivolumab, hazards ratio (HR) of overall survival and progression-free survival (PFS) pointed in opposite directions (overall survival: HR: 1.20 [95% credible interval: 0.92-1.58]; PFS: HR: 0.91 [0.68-1.21]). Exploratory subgroup analysis indicated superiority of nivolumab in high PD-L1 expression level subgroups; results were more favorable for nintedanib in all subgroups with low (<1%, <5%, <10%) PD-L1 expression levels - in particular, with regard to PFS. CONCLUSION Results demonstrated similar efficacy of nintedanib + docetaxel compared with the new therapeutic options ramucirumab + docetaxel and nivolumab, with potential differences in subgroups according to PD-L1 expression level.
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Affiliation(s)
- Sanjay Popat
- Department of Medicine (Lung), Royal Marsden Hospital, London, UK
| | | | - Martin Reck
- Department of Thoracic Oncology, LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
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Second-Line Treatment of Non-Small Cell Lung Cancer: New Developments for Tumours Not Harbouring Targetable Oncogenic Driver Mutations. Drugs 2017; 76:1321-36. [PMID: 27557830 DOI: 10.1007/s40265-016-0628-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Platinum-based doublet chemotherapy with or without bevacizumab is the standard of care for the initial management of advanced and metastatic non-small cell lung cancer (NSCLC) without a targetable molecular abnormality. However, the majority of patients with NSCLC will ultimately develop resistance to initial platinum-based chemotherapy, and many remain candidates for subsequent lines of therapy. Randomised trials over the past 10-15 years have established pemetrexed (non-squamous histology), docetaxel, erlotinib and gefitinib as approved second-line agents in NSCLC without targetable driver mutations or rearrangements. Trials comparing these agents with other chemotherapy, evaluating the addition of an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) to chemotherapy or the addition of another targeted agent to erlotinib or gefitinib have all failed to demonstrate an improvement in overall survival for patients with NSCLC. In contrast, recent data comparing therapy with novel monoclonal antibodies against programmed cell death 1 (PD-1) or PD ligand (PD-L1) pathway versus standard chemotherapy following platinum failure have demonstrated significant improvements in overall survival. Therapy with nivolumab or pembrolizumab would now be considered standard second-line therapy in patients without contraindication to immune checkpoint inhibitors. Atezolizumab also appears promising in this setting.
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Zhou Q, Chen XY, Yang ZM, Wu YL. The changing landscape of clinical trial and approval processes in China. Nat Rev Clin Oncol 2017; 14:577-583. [DOI: 10.1038/nrclinonc.2017.10] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Köhler J. Second-Line Treatment of NSCLC-The Pan-ErbB Inhibitor Afatinib in Times of Shifting Paradigms. Front Med (Lausanne) 2017; 4:9. [PMID: 28243590 PMCID: PMC5303897 DOI: 10.3389/fmed.2017.00009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/20/2017] [Indexed: 12/22/2022] Open
Abstract
In contrast to the established role of epidermal growth factor receptor (EGFR) inhibitors for the first-line treatment of patients with non-small cell lung cancer (NSCLC) harboring activating EGFR mutations, the role of EGFR blockade and of EGFR molecular testing in the second-line treatment remains less clear. The irreversible pan-ErbB family inhibitor afatinib (Gi(l)otrif®) was recently FDA- and EMA-approved for the second-line treatment of NSCLC with squamous cell histology irrespective of the EGFR mutational status (LUX-Lung 8). Contrariwise, results from the TAILOR and DELTA trials among retrospective biomarker analyses show the predictive value of the EGFR mutational status for efficacy of reversible EGFR inhibitors also as a second-line therapy. This mini review critically summarizes the current role of EGFR-targeting strategies in the second-line treatment of NSCLC with special respect to afatinib in light of emerging T790M-specific EGFR and immune check point inhibitors. The review also emphasizes the urgent need for reliable biomarkers to guide therapeutic decision-making and outlines prospective changes to the second-line landscape with some of the current second-line treatment concepts likely to be moved to the first-line.
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Affiliation(s)
- Jens Köhler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; West German Cancer Center Essen, Department of Medical Oncology, Division of Thoracic Oncology, University Hospital Essen, Essen, North-Rhine Westphalia, Germany
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30
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The Efficacy of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors for Molecularly Selected Patients with Non-Small Cell Lung Cancer: A Meta-Analysis of 30 Randomized Controlled Trials. Target Oncol 2016. [PMID: 26206590 DOI: 10.1007/s11523-015-0376-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the efficacy of first-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in molecularly selected patients with advanced non-small cell lung cancer (NSCLC), we performed this pooled analysis. METHOD Randomized trials of EGFR-TKIs as treatment for advanced NSCLC were included for this meta-analysis. We used published hazard ratios (HRs), if available, or derived treatment estimates from other survival data. Pooled estimates of treatment efficacy of EGFR-TKIs in the selected patients by EGFR-mutation status were calculated. RESULTS Out of 2134 retrieved articles, 30 randomized controlled trials (RCTs) enrolling more than 4053 patients with wild-type EGFR tumors and 1592 patients with mutant EGFR tumors were identified. For EGFR mutant patients, EGFR-TKIs treatment improved progression-free survival (PFS) compared with chemotherapy: the summary HRs were 0.41 (p < 0.00001) for the first-line setting and 0.46 (p = 0.02) for second/third-line setting, respectively. Also, the same superior trend was found with TKIs maintenance over placebo (HR = 0.14, p < 0.00001) and with TKIs combined with chemotherapy over chemotherapy (HR = 0.49, p = .002) in both the first-line and maintenance therapy settings. For EGFR wild-type patients, EGFR-TKIs have fared worse than chemotherapy in the first-line setting (HR = 1.65, p = .03) and in the second/third-line setting (HR = 1.27, p = .005). However, EGFR-TKIs maintenance still produced a reduction of 19 % in the risk of progression over placebo (HR = 0.81, p = .02). Furthermore, EGFR-TKIs added to chemotherapy as first-line treatment resulted in an improvement of PFS over chemotherapy alone in such wild-type EGFR patients (HR = 0.82, p = .03). In overall survival (OS) analysis, only EGFR-TKIs single agent was inferior to chemotherapy in EGFR wild-type patients (HR = 1.13, p = .02). No statistically significant difference in terms of OS was observed in any other subgroup analysis. CONCLUSIONS For EGFR mutant patients, EGFR-TKIs therapy produced a prominent PFS benefit in all settings. Among EGFR wild-type patients, EGFR-TKIs were inferior to chemotherapy both for first-line treatment and for second/third-line treatment. However, EGFR-TKIs maintenance and addition of EGFR-TKIs to chemotherapy could provide additive benefit over chemotherapy alone in such EGFR wild-type patients.
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Shi Y, Sun Y, Yu J, Ding C, Wang Z, Wang C, Wang D, Wang C, Wang Z, Wang M, Zhi X, Lu Y, Feng J, Liu Y, Liu X, Liu W, Wu G, Li X, Li K, Li E, Li W, Chen G, Chen Z, Yu P, Wu N, Wu M, Xiao W, Zhang L, Zhang Y, Zhang S, Yang S, Song X, Lin D, Luo R, Shan L, Zhou C, Zhou Z, Zhao Q, Hu C, Hu Y, Guo Q, Chang J, Huang C, Zeng X, Han B, Han X, Jia B, Han Y, Huang Y. China experts consensus on the diagnosis and treatment of advanced stage primary lung cancer (2016 version). Asia Pac J Clin Oncol 2016; 13:87-103. [PMID: 28134505 DOI: 10.1111/ajco.12608] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/12/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Yan Sun
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Jinming Yu
- Shandong Province Cancer Hospital, Ji'nan, China
| | - Cuimin Ding
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Changli Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Dong Wang
- Daping Hospital, The Third Military Medical University, Chongqing, China
| | - Cunde Wang
- Yunnan Province Cancer Hospital, Kunming, China
| | | | | | - Xiuyi Zhi
- Beijing Xuanwu Hospital, Capital Medical University, China
| | - You Lu
- West China Hospital of Sichuan University, Chengdu, China
| | | | - Yunpeng Liu
- The First Hospital of China Medical University, Shenyang, China
| | - Xiaoqing Liu
- The 307th Hospital of Chinese People's Liberation Army, China
| | - Wei Liu
- Beijing Cancer Hospital, China
| | - Gang Wu
- Huazhong University of Science and Technology Union Hospital, Wuhan, China
| | - Xiaomei Li
- Chinese People's Liberation Army General Hospital, China
| | - Kai Li
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Enxiao Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Li
- The First Hospital of Jilin University, Changchun, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhengtang Chen
- Xinqiao Hospital of The Third Military Medical University, Chongqing, China
| | - Ping Yu
- Sichuan Cancer Hospital, Chengdu, China
| | - Ning Wu
- Department of Imaging Diagnostic, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Milu Wu
- Qinghai University Affiliated Hospital, Xining, China
| | - Wenhua Xiao
- The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, China
| | - Li Zhang
- Peking Union Medical College Hospital, China
| | | | - Shucai Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Shujun Yang
- Henan Province Cancer Hospital, Zhengzhou, China
| | - Xia Song
- Shanxi Province Cancer Hospital, Taiyuan, China
| | | | - Rongcheng Luo
- Nanfang Hospital, Nanfang Medical University, Guangzhou, China
| | - Li Shan
- Cancer Hospital of Xinjiang Medical University, Urumqi, China
| | - Caicun Zhou
- Shanghai Pulmonary Hospital, Tongji University, China
| | - Zongmei Zhou
- Department of Imaging Diagnostic, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Qiong Zhao
- The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chengping Hu
- Xiangya Hospital, Central South University, Changsha, China
| | - Yi Hu
- Chinese People's Liberation Army General Hospital, China
| | - Qisen Guo
- Shandong Province Cancer Hospital, Ji'nan, China
| | | | | | - Xuan Zeng
- Peking Union Medical College Hospital, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai Jiaotong University, China
| | - Xiaohong Han
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Bo Jia
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Ying Han
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Yu Huang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
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Xu J, Ding G, Zhang X, Jin B, Lou Y, Zhang Y, Wang H, Wu D, Han B. The EGFR tyrosine kinase inhibitors as second-line therapy for EGFR wild-type non-small-cell lung cancer: a real-world study in People's Republic of China. Onco Targets Ther 2016; 9:6479-6484. [PMID: 27799795 PMCID: PMC5079695 DOI: 10.2147/ott.s119341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction Clinical evidence comparing chemotherapy and tyrosine kinase inhibitors (TKIs) as second-line therapy for epidermal growth factor receptor (EGFR) wild-type non-small-cell lung cancer (NSCLC) are conflicting. Methods We retrospectively reviewed stage IV EGFR wild-type NSCLC patients who relapsed on first-line chemotherapy at the Shanghai Chest Hospital to compare the efficacy of TKIs and chemotherapy as second-line therapy among different clinical subgroups. Results The progression-free survival (PFS) and overall survival for patients receiving chemotherapy as second-line therapy for NSCLC were longer than patients who received TKIs. The hazard ratios (HRs) were 0.40 (P<0.001) and 0.50 (P<0.001), respectively. Subgroup analyses showed that second-line TKI therapy resulted in inferior PFS among smokers (HR =0.24, P<0.001), males (HR =0.33, P<0.001), females (HR =0.54, P=0.004), and patients with adenocarcinoma (HR =0.48, P<0.001) and nonadenocarcinoma histology (HR =0.20, P<0.001). Among never-smokers, the PFS in cohorts receiving second-line chemotherapy or TKIs was not significantly different (HR =0.70, P=0.08). Conclusion These results suggest that EGFR TKI therapy was inferior compared to chemotherapy in EGFR wild-type NSCLC patients who relapsed from first-line chemotherapy; however, among never-smokers, these two treatment strategies were comparable.
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Affiliation(s)
- Jianlin Xu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Guozheng Ding
- Department of Pulmonary, Anqing Municipal Hospital, Anhui, People's Republic of China
| | - Xueyan Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Bo Jin
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yuqing Lou
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yanwei Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Huiming Wang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Dan Wu
- Central laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Baohui Han
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Lin L, Zhao J, Hu J, Huang F, Han J, He Y, Cao X. Comparison of the efficacy and tolerability of gefitinib with pemetrexed maintenance after first-line platinum-based doublet chemotherapy in advanced lung adenocarcinoma: single-center experience. Onco Targets Ther 2016; 9:6305-6314. [PMID: 27789961 PMCID: PMC5072510 DOI: 10.2147/ott.s113374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose Both gefitinib and pemetrexed maintenance were effective therapies for advanced lung adenocarcinoma, but which is better is unclear. For patients with advanced lung adenocarcinoma, we have no idea whether we should choose gefitinib or pemetrexed maintenance in clinical practice. Here, we assessed the efficacy and tolerability of gefitinib versus pemetrexed maintenance in these patients. Patients and methods A total of 101 patients were identified and divided into gefitinib (n=53) or pemetrexed (n=48) maintenance. Epidermal growth factor receptor (EGFR) status of tumors was analyzed in 67 patients. Disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were compared between the two groups. Results The results showed that DCR (79.2% vs 75%, P=0.642) was similar between gefitinib and pemetrexed groups. The PFS of gefitinib was significantly longer than that of pemetrexed (8 months vs 5.4 months, hazard ratio [HR]: 0.520, 95% confidence interval [CI]: 0.341–0.791, P=0.002); however, the OS was similar (19.9 months vs 18.8 months, HR: 1.006, 95% CI: 0.664–1.525, P=0.977). In EGFR mutation-positive patients, PFS was significantly longer in gefitinib (12 months vs 5.4 months; HR: 0.158, 95% CI: 0.074–0.333, P<0.001), whereas in EGFR wild-type subgroup gefitinib had a significantly shorter PFS than that by pemetrexed (2.5 months vs 5 months; HR: 2.822, 95% CI: 1.137–7.005, P=0.025). Cox multivariate regression analysis of PFS for overall population showed that smoking status (P=0.001) and maintenance regimens (P=0.013) were independent prognostic factors for PFS. Both gefitinib and pemetrexed were well tolerated. Conclusion Gefitinib compared with pemetrexed as maintenance therapy had a significantly longer PFS and a similar OS with good tolerability in patients with advanced lung adenocarcinoma. Moreover, for EGFR mutation-positive patients, gefitinib maintenance had a significantly longer PFS; however, pemetrexed maintenance was considered more effective for EGFR wild-type patients.
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Affiliation(s)
- Liping Lin
- Department of Oncology, Panyu Central Hospital; Cancer Institute of Panyu
| | - Juanjuan Zhao
- School of Nursing, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jiazhu Hu
- Department of Oncology, Panyu Central Hospital; Cancer Institute of Panyu
| | - Fuxi Huang
- Department of Oncology, Panyu Central Hospital; Cancer Institute of Panyu
| | - Jianjun Han
- Department of Oncology, Panyu Central Hospital; Cancer Institute of Panyu
| | - Yan He
- Department of Oncology, Panyu Central Hospital; Cancer Institute of Panyu
| | - Xiaolong Cao
- Department of Oncology, Panyu Central Hospital; Cancer Institute of Panyu
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Shi Y, Sun Y, Yu J, Ding C, Wang Z, Wang C, Wang D, Wang C, Wang Z, Wang M, Zhi X, Lu Y, Feng J, Liu Y, Liu X, Liu W, Wu G, Li X, Li K, Li E, Li W, Chen G, Chen Z, Yu P, Wu N, Wu M, Xiao W, Zhang L, Zhang Y, Zhang S, Yang S, Song X, Lin D, Luo R, Shan L, Zhou C, Zhou Z, Zhao Q, Hu C, Hu Y, Guo Q, Chang J, Huang C, Zeng X, Han B, Han X, Jia B, Han Y, Huang Y. [China Experts Consensus on the Diagnosis and Treatment of Advanced Stage Primary Lung Cancer (2016 Version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:1-15. [PMID: 26805732 PMCID: PMC5999802 DOI: 10.3779/j.issn.1009-3419.2016.01.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yuankai Shi
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Yan Sun
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Jinming Yu
- Shandong Province Cancer Hospital, Ji'nan 250117, China
| | - Cuimin Ding
- The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Ziping Wang
- Beijing Cancer Hospital, Beijing 100142, China
| | - Changli Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin 300070, China
| | - Dong Wang
- Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Cunde Wang
- Yunnan Province Cancer Hospital, Kunming 650118, China
| | | | - Mengzhao Wang
- Peking Union Medical College Hospital, Beijing 100730, China
| | - Xiuyi Zhi
- Beijing Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - You Lu
- West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jifeng Feng
- Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Yunpeng Liu
- The First Hospital of China Medical University, Shenyang 110001, China
| | - Xiaoqing Liu
- The 307th Hospital of Chinese People's Liberation Army, Beijing 100071, China
| | - Wei Liu
- Beijing Cancer Hospital, Beijing 100142, China
| | - Gang Wu
- Huazhong University of Science and Technology Union Hospital, Wuhan 430022, China
| | - Xiaomei Li
- Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Kai Li
- Tianjin Medical University Cancer Institute & Hospital, Tianjin 300070, China
| | - Enxiao Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Wei Li
- The First Hospital of Jilin University, Changchun 130021, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Zhengtang Chen
- Xinqiao Hospital of The Third Military Medical University, Chongqing 400037, China
| | - Ping Yu
- Sichuan Cancer Hospital, Chengdu 610047, China
| | - Ning Wu
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Milu Wu
- Qinghai University Affiliated Hospital, Xining 810000, China
| | - Wenhua Xiao
- The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing 100048, China
| | - Li Zhang
- Peking Union Medical College Hospital, Beijing 100730, China
| | - Yiping Zhang
- Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Shucai Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Shujun Yang
- Henan Province Cancer Hospital, Zhengzhou 450008, China
| | - Xia Song
- Shanxi Province Cancer Hospital, Taiyuan 030013, China
| | - Dongmei Lin
- Beijing Cancer Hospital, Beijing 100142, China
| | - Rongcheng Luo
- Nanfang Hospital, Nanfang Medical University, Guangzhou 510515, China
| | - Li Shan
- Cancer Hospital of Xinjiang Medical University, Urumqi 830000, China
| | - Caicun Zhou
- Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Zongmei Zhou
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Qiong Zhao
- The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
| | - Chengping Hu
- Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Hu
- Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Qisen Guo
- Shandong Province Cancer Hospital, Ji'nan 250117, China
| | - Jianhua Chang
- Cancer Hospital, Fudan Universitay, Shanghai 200032, China
| | - Cheng Huang
- Fujian Cancer Hospital, Fuzhou 350014, China
| | - Xuan Zeng
- Peking Union Medical College Hospital, Beijing 100730, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Xiaohong Han
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Bo Jia
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Ying Han
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Yu Huang
- Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
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Neumair P, Joos L, Warschkow R, Dutly A, Ess S, Hitz F, Früh M, Brutsche M, Baty F, Krähenbühl S, Cerny T, Joerger M. Erlotinib has comparable clinical efficacy to chemotherapy in pretreated patients with advanced non-small cell lung cancer (NSCLC): A propensity-adjusted, outcomes research-based study. Lung Cancer 2016; 100:38-44. [PMID: 27597279 DOI: 10.1016/j.lungcan.2016.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Controversy exists about the integration of erlotinib in patients with EGFR wildtype, advanced NSCLC. MATERIALS AND METHODS We included patients with advanced NSCLC receiving at least two lines of palliative systemic treatment between January 2005 and December 2014 and not harbouring targetable driver mutations. Primary study endpoint was overall survival (OS), secondary endpoint progression-free survival (PFS). We used Kaplan-Meier statistics, multivariate Cox regression and Propensity score or Inverse Probability Weights (IPW) matching to compare clinical outcome between patients receiving erlotinib in second or further line and those receiving chemotherapy only. The study had a power of 90% to detect a survival superiority of 30%. RESULTS From a total of 827 patients, we excluded 171 patients with potentially curative treatment, 189 receiving treatment outside of our institute, 206 receiving no or only one line of systemic treatment, 6 with ALK translocations and 28 with EGFR mutations. From 227 patients in the final efficacy analysis, 125 patients received erlotinib in second (89 patients), third (28) or further-line (8), and 102 patients received chemotherapy only. Women and never smokers were significantly overrepresented in the erlotinib group. Both OS (hazard ratio (HR)=1.14, 95% CI 0.80-1.63, P=0.448) and PFS (HR=1.20, 95% CI 0.95-1.52, P=0.119) were similar in the erlotinib compared to the chemotherapy group using IPW-adjusted Cox regression analysis treating the use of erlotinib as a time-dependent covariate starting from second-line treatment and stratified for ECOG performance status and treatment line. ECOG performance status was the most powerful covariate to select patients for erlotinib treatment. CONCLUSION The present study suggests erlotinib to have similar clinical efficacy compared to chemotherapy in patients with pretreated advanced NSCLC and no known molecular targetable alterations.
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Affiliation(s)
- P Neumair
- Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland
| | - L Joos
- Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland; University of Basel, Basel, Switzerland
| | - R Warschkow
- Department of Surgery, Cantonal Hospital, St. Gallen, Switzerland
| | - A Dutly
- Department of Thoracic Surgery, Cantonal Hospital, St. Gallen, Switzerland
| | - S Ess
- Cancer Registry St. Gallen-Appenzell, St. Gallen, Switzerland
| | - F Hitz
- Department of Medical Oncology, Cantonal Hospital, St. Gallen, Switzerland
| | - M Früh
- Department of Medical Oncology, Cantonal Hospital, St. Gallen, Switzerland
| | - M Brutsche
- Department of Pneumology, Cantonal Hospital, St. Gallen, Switzerland
| | - F Baty
- Department of Pneumology, Cantonal Hospital, St. Gallen, Switzerland
| | - S Krähenbühl
- Department of Clinical Pharmacology and Toxicology, University Hospital, Basel, Switzerland
| | - T Cerny
- Department of Medical Oncology, Cantonal Hospital, St. Gallen, Switzerland
| | - M Joerger
- Department of Medical Oncology, Cantonal Hospital, St. Gallen, Switzerland.
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Syn NLX, Yong WP, Goh BC, Lee SC. Evolving landscape of tumor molecular profiling for personalized cancer therapy: a comprehensive review. Expert Opin Drug Metab Toxicol 2016; 12:911-22. [PMID: 27249175 DOI: 10.1080/17425255.2016.1196187] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Tumour molecular profiling has been at the crossroads of large-scale integrative genomic studies and major clinical trials over the past 5 years and has provided roadmaps for better disease stratification and therapeutic management. AREAS COVERED We review the landscape of precision oncology trials in Asia, Europe and the United States, and emerging insights gained from recently reported studies such as the SHIVA and CUSTOM trials. Changes in the molecular portraits of human cancers and the immune contexture of the tumor microenvironment during treatment may predict the course of tumor progression, including the development of treatment resistance. 'Liquid biopsy' approaches that harness circulating tumor cells, cell-free DNA and exosomes may provide a non-invasive means of monitoring the parent tumor in real-time. Several molecular signatures are being evaluated as biomarkers for emerging immunologic approaches, such as the mismatch-repair deficiency status and nonsynonymous mutation burden in anti-PD-1 immune checkpoint blockade. Finally, we review the current actionability and future clinical impact of multigene panel and next-generation sequencing (NGS)-based profiling. EXPERT OPINION In the future, molecular profiling may help to fulfill unmet needs for predictive biomarkers in novel immunotherapeutic approaches, while ongoing precision trials are laying the foundations for clinical uptake of NGS testing.
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Affiliation(s)
- Nicholas Li-Xun Syn
- a Department of Haematology-Oncology , National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Wei-Peng Yong
- a Department of Haematology-Oncology , National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Boon-Cher Goh
- a Department of Haematology-Oncology , National University Cancer Institute, National University Health System , Singapore , Singapore
| | - Soo-Chin Lee
- a Department of Haematology-Oncology , National University Cancer Institute, National University Health System , Singapore , Singapore
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Tomasini P, Barlesi F, Mascaux C, Greillier L. Pemetrexed for advanced stage nonsquamous non-small cell lung cancer: latest evidence about its extended use and outcomes. Ther Adv Med Oncol 2016; 8:198-208. [PMID: 27239238 DOI: 10.1177/1758834016644155] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is still the leading cause of cancer-related death, and the treatment of advanced NSCLC relies on systemic treatments. During the last decade, pemetrexed, an antifolate agent, gradually became a key component of the treatment for patients with advanced nonsquamous NSCLC. It has indeed been shown to be efficient for first-line, maintenance and second- or third-line treatment in this subgroup of NSCLC. Moreover, it is usually well tolerated, with few grade 3 and 4 toxicities. Several studies have tried to identify predictive biomarkers of pemetrexed efficacy. Due to pemetrexed's mechanism of action, thymidilate synthase expression predictive value was investigated but could not be demonstrated. Currently, more than 400 trials of pemetrexed for the treatment of nonsquamous NSCLC are ongoing.
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Affiliation(s)
- Pascale Tomasini
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
| | - Fabrice Barlesi
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
| | - Celine Mascaux
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
| | - Laurent Greillier
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Multidisciplinary Oncology & Therapeutic Innovations, Marseille, France
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Ragazzi M, Tamagnini I, Bisagni A, Cavazza A, Pagano M, Baldi L, Boni C, Cantile F, Barbieri F, Nicoli D, Sartori G, de Biase D, Gardini G, Rossi G. Diamond: immunohistochemistry versus sequencing in EGFR analysis of lung adenocarcinomas. J Clin Pathol 2016; 69:440-7. [PMID: 26553934 DOI: 10.1136/jclinpath-2015-203348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/18/2015] [Indexed: 02/05/2023]
Abstract
AIMS Identification of epidermal growth factor receptor (EGFR) mutations in lung adenocarcinomas is the single most important predictor of clinical response and outcome using EGFR tyrosine kinase inhibitors (TKIs). EGFR E746-A750del and L858R mutations are the most common gene alterations, also predicting the best clinical response to TKIs. We evaluated the accuracy of EGFR mutation-specific antibodies in a large cohort of lung adenocarcinomas, with different molecular settings and types of tissue samples. METHODS 300 lung adenocarcinomas diagnosed on cytology (48 cell blocks), biopsy (157 cases) and surgical resections (95 cases) were selected. All cases were investigated for EGFR by sequencing and two mutation-specific antibodies (clone 6B6 for E746-A750del; clone 43B2 for L858R) were tested using an automated immunostainer. Discordant results were investigated by next-generation sequencing (NGS). RESULTS Overall sensitivity and specificity of mutant-specific antibodies were 58.6% and 98.0%, respectively, and they increased up to 84% and 100% if only tumours harbouring E746-A750del were considered. In 13 discordant cases, NGS confirmed immunohistochemistry results in eight samples. CONCLUSIONS The EGFR mutation-specific antibodies have a fair/good sensitivity and good/high specificity in identifying classic mutations, but they cannot replace molecular tests. The antibodies work equally well on biopsies and cell blocks, possibly permitting a rapid screening in cases with poor material.
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Affiliation(s)
- Moira Ragazzi
- Department of Oncology and Advanced Technologies, Operative Unit of Pathology, Azienda S Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Ione Tamagnini
- Department of Oncology and Advanced Technologies, Operative Unit of Pathology, Azienda S Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Alessandra Bisagni
- Department of Oncology and Advanced Technologies, Operative Unit of Pathology, Azienda S Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Alberto Cavazza
- Department of Oncology and Advanced Technologies, Operative Unit of Pathology, Azienda S Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Maria Pagano
- Department of Oncology and Advanced Technologies, Operative Unit of Oncology, Azienda S. Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Licia Baldi
- Department of Oncology and Advanced Technologies, Operative Unit of Oncology, Azienda S. Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Corrado Boni
- Department of Oncology and Advanced Technologies, Operative Unit of Oncology, Azienda S. Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Flavia Cantile
- Department of Oncology and Hematology, Division of Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Fausto Barbieri
- Department of Oncology and Hematology, Division of Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Davide Nicoli
- Department of Oncology and Advanced Technologies, Operative Unit of Molecular Biology, Azienda S. Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Giuliana Sartori
- Department of Oncology and Advanced Technologies, Cervical Screening Unit, Azienda S. Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Dario de Biase
- Department of Medicine (DIMES), Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Giorgio Gardini
- Department of Oncology and Advanced Technologies, Operative Unit of Pathology, Azienda S Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Giulio Rossi
- Integrated Department of Diagnostic Laboratories, Section of Pathologic Anatomy, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
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Mitsuoka S, Kawaguchi T, Kubo A, Isa SI, Asai K, Uji M, Watanabe T, Sawa K, Yoshimoto N, Oka T, Nakai T, Suzumura T, Tanaka H, Matsuura K, Kimura T, Yoshimura N, Kudoh S, Hirata K. Epidermal growth factor receptor tyrosine kinase inhibitors in previously treated advanced non-small-cell lung cancer with wild-type EGFR. Expert Opin Pharmacother 2016; 17:193-203. [PMID: 26781399 DOI: 10.1517/14656566.2016.1109635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION While epidermal growth factor receptor (EGFR) - tyrosine kinase inhibitors (TKIs) lead to longer progression-free survival (PFS) when compared with conventional chemotherapy in non-small-cell lung cancer (NSCLC) harboring activating EGFR mutations, the role of EGFR-TKI remains unclear in EGFR-wild-type (WT) NSCLC. AREAS COVERED This article reviews selected data from randomized trials regarding the use of TKIs in EGFR-WT NSCLC. Nine randomized phase III trials have compared EGFR-TKI with chemotherapy in NSCLC patients in a second or later line setting. Two of these trials, TAILOR and DELTA, which were designed to investigate treatment benefits according to EGFR genotype, demonstrated that docetaxel chemotherapy displayed significantly better in progression-free survival (PFS) when compared with the EGFR-TKI erlotinib. Biomarkers to predict clinical benefits of the drug against EGFR WT tumor, and the efficacy of combination regimens using erlotinib or single-use afatinib against tumors are also covered in this article. EXPERT OPINION Considering the modest benefits of erlotinib for EGFR-WT tumors, future studies are warranted, including the exploration of useful biomarkers and new treatment strategies for EGFT-TKI use, as well as the development of more sensitive EGFR mutation tests.
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Affiliation(s)
- Shigeki Mitsuoka
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tomoya Kawaguchi
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Akihito Kubo
- b Department of Respiratory Medicine , Aichi Medical University School of Medicine , Aichi , Japan
| | - Shun-ichi Isa
- c Clinical Research Center , National Hospital Organization Kinki-chuo Chest Medical Center , Osaka , Japan
| | - Kazuhisa Asai
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Masato Uji
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tetsuya Watanabe
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Kenji Sawa
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Naoki Yoshimoto
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Takako Oka
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Toshiyuki Nakai
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tomohiro Suzumura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Hidenori Tanaka
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Kuniomi Matsuura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tatsuo Kimura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Naruo Yoshimura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Shinzoh Kudoh
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Kazuto Hirata
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
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Cytostatic Agents—Tyrosine Kinase Inhibitors Utilized in the Treatment of Solid Malignancies. SIDE EFFECTS OF DRUGS ANNUAL 2016. [DOI: 10.1016/bs.seda.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
Herein, we have reviewed and analysed recent literature, published in 2013 and early 2014, in the context of pre-existing data. Considered target therapies were tyrosine kinase inhibitors of active epidermal growth factor receptor mutations (e.g. erlotinib, gefinitib and afatinib), anaplastic lymphoma kinase rearrangements (e.g. crizotinib) or angiogenesis (drugs under development), or monoclonal antibodies against vascular endothelial growth factor (e.g. bevacizumab) or epidermal growth factor receptors (e.g. cetuximab). The therapeutic project has to consider tyrosine kinase inhibitors in the case of nonsmall cell lung cancer with active epidermal growth factor receptor mutations or anaplastic lymphoma kinase rearrangement. However, these drugs should not be used in the absence of the targeted genetic abnormalities. Targeted therapies are modifying the therapeutic approach in NSCLC with specific oncogenic mutationshttp://ow.ly/HeVMZ
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Affiliation(s)
- Jean-Paul Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Oncologie Thoracique, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Berghmans
- Service des Soins Intensifs et Urgences Oncologiques & Oncologie Thoracique, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques & Oncologie Thoracique, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
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Zhong WZ, Su J, Xu FP, Zhai HR, Zhang XC, Yang XN, Chen ZY, Chen ZH, Li W, Dong S, Zhou Q, Yang JJ, Liu YH, Wu YL. Rare discrepancies in a driver gene alteration within histologically heterogeneous primary lung cancers. Lung Cancer 2015; 90:205-11. [PMID: 26391021 DOI: 10.1016/j.lungcan.2015.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Most lung adenocarcinomas consist of mixtures of histological subtypes harboring different frequencies of driver gene mutations. However, little is known about intratumoral heterogeneity(ITH) within histologically heterogeneous primary lung cancers. Investigating key driver genes in respective morphological pattern is crucial to personalized treatment. METHODS Morphologically different areas within the same surgically resected adenocarcinomas were extracted from tissues to analyze gene status in each growth pattern. Driver genes, epidermal growth factor receptor (EGFR), KRAS and EML4-ALK, were assessed by assays with different sensitivities. RESULTS Seventy-nine consecutive eligible patients harboring a driver gene (EGFR=65; KRAS=10; EML4-ALK=4) were enrolled. For EGFR mutations, ITH occurred in 13.3% (8/60) by direct sequencing (DS) and 1.7% (1/60) by amplification refractory mutation system (ARMS) (P=0.016) among adenocarcinomas, but consistent within five adeno-squamous cell carcinomas by both methods. ITH among KRAS mutations were detected in 20% (2/10) by DS, whereas consistent (10/10) by high resolution melting. No discrepancies in EML4-ALK rearrangements existed according to fluorescence in situ hybridization. CONCLUSION Rare ITHs of EGFR/KRAS/EML4-ALK alterations within histologically heterogeneous primary lung adenocarcinomas existed by methods with higher sensitivity. Discrepancies might be due to abundance of mutant tumor cells and detection assays.
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Affiliation(s)
- Wen-zhao Zhong
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jian Su
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Fang-ping Xu
- Department of Pathology and Laboratory Medicine, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hao-ran Zhai
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xu-chao Zhang
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xue-ning Yang
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zhi-yong Chen
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zhi-hong Chen
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei Li
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Song Dong
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Qing Zhou
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jin-ji Yang
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yan-hui Liu
- Department of Pathology and Laboratory Medicine, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yi-long Wu
- Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
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Targeted therapies for patients with advanced NSCLC harboring wild-type EGFR: what's new and what's enough. CHINESE JOURNAL OF CANCER 2015; 34:310-9. [PMID: 26187152 PMCID: PMC4593374 DOI: 10.1186/s40880-015-0036-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/25/2015] [Indexed: 01/05/2023]
Abstract
Historically, non-small cell lung cancer (NSCLC) is divided into squamous and nonsquamous subtypes based on histologic features. With a growing number of oncogenic drivers being identified in squamous and nonsquamous NSCLC, this malignancy has been recently divided into several distinct subtypes according to the specific molecular alterations. This new paradigm has substantially highlighted the treatment of advanced NSCLC, shifting it from standard chemotherapy according to specific histologic subtypes to targeted therapy according to specific oncogenic drivers. The application of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in NSCLC patients harboring activating EGFR mutations has been a representative model of precise medicine in the treatment of NSCLC. As the role of EGFR-TKIs in routine management of patients with advanced NSCLC has been well established, this review provides an overview of alternative targeted therapy in the treatment of NSCLC, including EGFR-TKIs for patients with wild-type EGFR NSCLC, as well as other targeted agents either clinical available or in early- to late-stage development.
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Yang JJ, Wu YL. Insight into early-phase trials for lung cancer in the United States. CHINESE JOURNAL OF CANCER 2015; 34:288-94. [PMID: 26162603 PMCID: PMC4593356 DOI: 10.1186/s40880-015-0027-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/15/2015] [Indexed: 01/28/2023]
Abstract
Introduction Few data have been published comparing early-phase trials for lung cancer between China and the United States (US). This study was to investigate the differences of phase 1 trials for lung cancer between these two countries. Methods In 2014, a cross-sectional survey was conducted to compare phase 1 trials for lung cancer between the Guangdong Lung Cancer Institute (GLCI), the University of Wisconsin Carbone Cancer Center (UWCCC), and the University of Texas MD Anderson Cancer Center (MDACC). Results We found that the GLCI had a lower percentage of phase 1 lung cancer trials than the MDACC in December 2014 (23.8% [5/21] vs. 59.8% [28/47], P = 0.006) and the UWCCC in September 2014 (16.7% [3/18] vs. 34.8% [8/23], P = 0.345). Descriptive analyses were performed for early-phase trials conducted by the Cancer Therapy Evaluation Program at the National Cancer Institute (CTEP/NCI), the MDACC, and the Chinese Thoracic Oncology Group (CTONG). There were 149 ongoing early-phase trials in the Department of Investigational Cancer Therapeutics (Phase 1 program) at the MDACC in October 2014. In contrast, no phase 1 trials had been initiated by the CTONG since its establishment in 2007. Conclusions These data suggest that a significantly higher percentage of phase 1 trials for lung cancer were conducted in the US than in China. Early-phase oncology trials with robust preclinical data had a higher chance of being approved by the Investigational Drug Branch at the CTEP/NCI. Given the importance of early-phase oncology trials in developing innovative cancer medicines, such studies should be highly encouraged and strategically funded in China.
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Affiliation(s)
- Jin-Ji Yang
- Guangdong Lung Cancer Institute (GLCI), Guangdong General Hospital (GGH), Guangdong Academy of Medical Sciences (GAMS), Guangzhou, Guangdong, 510080, P.R. China.
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute (GLCI), Guangdong General Hospital (GGH), Guangdong Academy of Medical Sciences (GAMS), Guangzhou, Guangdong, 510080, P.R. China.
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A phase II study of icotinib and whole-brain radiotherapy in Chinese patients with brain metastases from non-small cell lung cancer. Cancer Chemother Pharmacol 2015; 76:517-23. [PMID: 26148750 DOI: 10.1007/s00280-015-2760-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 04/24/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE Icotinib is a new first-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors. A phase II study was conducted to evaluate the efficacy and safety of icotinib in combination with whole-brain radiotherapy (WBRT) in Chinese NSCLC patients with brain metastases (BMs); the cerebrospinal fluid (CSF)/plasma concentrations of icotinib were also investigated. METHODS Eligible patients had BMs from NSCLC, regardless of the EGFR status. Icotinib was administered at 125 mg orally 3 times/day until tumor progression or unacceptable toxicity, concurrently with WBRT (3.0 Gy per day, 5 days per week, to 30 Gy). CSF and plasma samples were collected simultaneously from 10 patients. Icotinib concentrations in the CSF and plasma were measured by high-performance liquid chromatography coupled with tandem mass spectrometry. RESULTS Twenty patients were enrolled. The median follow-up time was 20.0 months. The overall response rate was 80.0%. The median progression-free survival time was 7.0 months (95% CI 1.2-13.2 months), and the median survival time (MST) was 14.6 months (95% CI 12.5-16.7 months). Of the 18 patients with known EGFR status, the MST was 22.0 months for those with an EGFR mutation and was 7.5 months for those with wild-type EGFR (P = 0.0001). The CSF concentration and penetration rate of icotinib were 11.6 ± 9.1 ng/mL and 1.4 ± 1.1%, respectively. No patient experienced ≥grade 4 toxicity. CONCLUSIONS Icotinib was well tolerated in combination with WBRT and showed efficacy in patients with BMs from NSCLC. This clinical benefit was related to the presence of activating EGFR mutations.
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Zhong W, Yang X, Yan H, Zhang X, Su J, Chen Z, Liao R, Nie Q, Dong S, Zhou Q, Yang J, Tu H, Wu YL. Phase II study of biomarker-guided neoadjuvant treatment strategy for IIIA-N2 non-small cell lung cancer based on epidermal growth factor receptor mutation status. J Hematol Oncol 2015; 8:54. [PMID: 25981169 PMCID: PMC4455050 DOI: 10.1186/s13045-015-0151-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/07/2015] [Indexed: 12/25/2022] Open
Abstract
Background Neoadjuvant erlotinib and customized adjuvant therapy are appealing but controversial. The purpose of this study was to evaluate the role of biomarker-guided neoadjuvant treatment strategy in patients with IIIA-N2 non-small cell lung cancer (NSCLC) stratified by epidermal growth factor receptor (EGFR) mutation status. Findings Patients with resectable histologically documented stage IIIA-N2 NSCLC were assigned to a neoadjuvant erlotinib arm or a gemcitabine/carboplatin (GC) arm based on EGFR mutation status. The primary endpoint was response rate (RR). Secondary endpoints were progression-free survival (PFS) and overall survival (OS). Twenty-four patients with IIIA-N2 NSCLC were enrolled in the trial from January 2008 until May 2011. The overall response rate was 41.7 % and the PFS and OS were 7.9 and 23.2 months, respectively, in overall population. The RR was 58.3 % (7/12) for the erlotinib arm with mutant EGFR and 25.0 % (3/12) for the GC arm with wild type EGFR (P = 0.18). Median PFS was 6.9 months versus 9.0 months, respectively (P = 0.071). Median OS was 14.5 months for the erlotinib arm and 28.1 months for the GC arm (P = 0.201). No unexpected toxicities were observed. Conclusions The primary endpoint was met and biomarker-guided neoadjuvant treatment strategy in patients with IIIA-N2 NSCLC is feasible. Erlotinib alone in neoadjuvant setting of EGFR mutant population showed an improved response but without survival benefits. Trial registration ClinicalTrials.gov NCT00600587 https://www.clinicaltrials.gov/ct2/show/NCT00600587?term=NCT00600587&rank=1 Electronic supplementary material The online version of this article (doi:10.1186/s13045-015-0151-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Xuening Yang
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Honghong Yan
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Xuchao Zhang
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Jian Su
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Zhihong Chen
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Riqiang Liao
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Qiang Nie
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Song Dong
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Jinji Yang
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Haiyan Tu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People's Republic of China.
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Carpentier O, Selvaggi L, Jégu J, Purohit A, Prim N, Velten M, Quoix E. Modern Treatments in Advanced Non-Small-Cell Lung Cancer: Temporal Trends and Effect on Survival. A French Population-Based Study. Clin Lung Cancer 2015; 16:496-506. [PMID: 26071190 DOI: 10.1016/j.cllc.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/28/2015] [Accepted: 05/05/2015] [Indexed: 12/12/2022]
Abstract
UNLABELLED Extrapolation of clinical trials results to the general population is always challenging. We analysed 1047 patients diagnosed with an advanced stage disease between 1998 and 2005 in a french administrative department and found a good spread of modern chemotherapy since 1998 and targeted therapy since 2002. Moreover, the outcomes in patients treated according to guidelines are very proximal from those obtained in clinical trials. BACKGROUND Management of metastatic non-small-cell lung cancer has considerably evolved during the past 2 decades. In this study we aimed to assess how treatments have spread at a population-based level and their effect on survival. PATIENTS AND METHODS Medical records of patients diagnosed from 1998 to 2005 in the French department of Bas-Rhin were checked to collect data on patient characteristics and treatments received. Multivariate analysis of survival was performed using pretherapeutic and therapeutic factors including targeted therapies received as third-line treatment. RESULTS We included 1047 patients with stage IIIB to IV non-small-cell lung cancer. The proportion of patients who underwent chemotherapy increased from 373/471 (79.2%) to 491/576 (85.2%) over the 1998 to 2001 and 2002 to 2005 periods, and there was an increased use of third-generation drugs associated with platin. Third-line treatment was gefitinib or erlotinib in 73/155 (47.1%) of the cases among patients diagnosed from 2002 to 2005. Compared with older agents, targeted therapy administered as third-line treatment was associated with a longer survival but there was no significant difference in survival with recent chemotherapy agents in multivariate analyses (hazard ratio, 0.773; 95% confidence interval, 0.445-1.343). CONCLUSION Results of our study showed a good spread of modern chemotherapy and targeted therapy use at a population-based level. However, even if the general outcomes were improved along the years, the results observed in real clinical practice were slightly different from those reported in clinical trials.
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Affiliation(s)
- Olivier Carpentier
- Laboratoire d'épidémiologie et de santé publique, EA3430, Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Lucia Selvaggi
- Service de pneumologie, Nouvel Hôpital Civil, Strasbourg, France
| | - Jérémie Jégu
- Laboratoire d'épidémiologie et de santé publique, EA3430, Faculté de Médecine, Université de Strasbourg, Strasbourg, France; Service de santé publique, Nouvel Hôpital Civil, Strasbourg, France
| | - Ashok Purohit
- Service de pneumologie, Nouvel Hôpital Civil, Strasbourg, France
| | - Nathalie Prim
- Service de pneumologie, Nouvel Hôpital Civil, Strasbourg, France
| | - Michel Velten
- Laboratoire d'épidémiologie et de santé publique, EA3430, Faculté de Médecine, Université de Strasbourg, Strasbourg, France; Service de santé publique, Nouvel Hôpital Civil, Strasbourg, France
| | - Elisabeth Quoix
- Service de pneumologie, Nouvel Hôpital Civil, Strasbourg, France.
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Garassino MC, Broggini M. Chemotherapy versus tyrosine kinase inhibitor in EGFR unselected population advanced non-small cell lung cancer still matter of debate?-An update incorporating the DELTA trial data. J Thorac Dis 2015; 7:224-6. [PMID: 25922695 DOI: 10.3978/j.issn.2072-1439.2015.01.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/25/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Marina C Garassino
- 1 Thoracic Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy ; 2 Laboratory of Molecular Pharmacology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Massimo Broggini
- 1 Thoracic Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy ; 2 Laboratory of Molecular Pharmacology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
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Ke EE, Zhou Q, Wu YL. Emerging paradigms in targeted treatments for Asian patients with NSCLC. Expert Opin Pharmacother 2015; 16:1167-76. [DOI: 10.1517/14656566.2015.1040391] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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史 钟, 范 云. [Optimal therapeutic strategy for non-small cell lung cancer with mutated epidermal growth factor receptor]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:110-6. [PMID: 25676406 PMCID: PMC5999843 DOI: 10.3779/j.issn.1009-3419.2015.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/22/2014] [Indexed: 11/25/2022]
Abstract
Although epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have been widely used in non-small cell lung cancer (NSCLC) patients, it is still controversial about how to combine EGFR-TKI with chemotherapy and other targeted drugs. We have made a summary on the current therapeutic models of EGFR-TKI combined with chemotherapy/bevacizumab in this review and aimed to find the optimal therapeutic strategy for NSCLC patients with EGFR mutation.
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Affiliation(s)
- 钟 史
- />310022 杭州,浙江省肿瘤医院化疗中心Department of Medical Oncology, Zhejiang Provincial Cancer Hospital, Hangzhou 310027, China
| | - 云 范
- />310022 杭州,浙江省肿瘤医院化疗中心Department of Medical Oncology, Zhejiang Provincial Cancer Hospital, Hangzhou 310027, China
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