1
|
Chhouri H, Alexandre D, Grumolato L. Mechanisms of Acquired Resistance and Tolerance to EGFR Targeted Therapy in Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:cancers15020504. [PMID: 36672453 PMCID: PMC9856371 DOI: 10.3390/cancers15020504] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 01/17/2023] Open
Abstract
Non-small cell lung cancers (NSCLC) harboring activating mutations of the epidermal growth factor receptor (EGFR) are treated with specific tyrosine kinase inhibitors (EGFR-TKIs) of this receptor, resulting in clinically responses that can generally last several months. Unfortunately, EGFR-targeted therapy also favors the emergence of drug tolerant or resistant cells, ultimately resulting in tumor relapse. Recently, cellular barcoding strategies have arisen as a powerful tool to investigate the clonal evolution of these subpopulations in response to anti-cancer drugs. In this review, we provide an overview of the currently available treatment options for NSCLC, focusing on EGFR targeted therapy, and discuss the common mechanisms of resistance to EGFR-TKIs. We also review the characteristics of drug-tolerant persister (DTP) cells and the mechanistic basis of drug tolerance in EGFR-mutant NSCLC. Lastly, we address how cellular barcoding can be applied to investigate the response and the behavior of DTP cells upon EGFR-TKI treatment.
Collapse
|
2
|
Grande E, Harvey RD, You B, Batlle JF, Galbraith H, Sarantopoulos J, Ramalingam SS, Mann H, So K, Johnson M, Vishwanathan K. Pharmacokinetic Study of Osimertinib in Cancer Patients with Mild or Moderate Hepatic Impairment. J Pharmacol Exp Ther 2019; 369:291-299. [PMID: 30872388 PMCID: PMC11046734 DOI: 10.1124/jpet.118.255919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/20/2019] [Indexed: 12/29/2022] Open
Abstract
Osimertinib, an epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI), undergoes significant hepatic elimination. In this phase 1 study, we assessed the effects of mild and moderate hepatic impairment on the pharmacokinetics (PK) of osimertinib in patients with malignant solid tumors. In part A, patients with normal hepatic function, mild hepatic impairment, and moderate hepatic impairment, according to the Child-Pugh classification, received a single 80 mg oral dose of osimertinib. Standard PK measures were assessed. In part B, patients could continue osimertinib treatment if deemed clinically appropriate. We compared these study results with a population PK analysis including other osimertinib clinical studies. Geometric mean osimertinib plasma concentrations were lower in patients with mild (n = 7) or moderate hepatic impairment (n = 5) versus normal hepatic function (n = 10): C max was reduced to 51% and 61%, respectively; area under the curve was reduced to 63% and 68%, respectively. PK results for the metabolites were similar. No apparent differences in the safety profile were found between patients with normal hepatic function and patients with mild or moderate hepatic impairment. Comparison of these study results with National Cancer Institute-Organ Dysfunction Working Group criteria from population PK analysis showed osimertinib exposure was not affected by hepatic impairment. No dose adjustment is required for osimertinib when treating patients with mild or moderate hepatic impairment. No apparent differences in the safety of osimertinib were found between patients with normal hepatic function and mild or moderate hepatic impairment.
Collapse
Affiliation(s)
- Enrique Grande
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - R Donald Harvey
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - Benoit You
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - Jaime Feliu Batlle
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - Hal Galbraith
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - John Sarantopoulos
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - Suresh S Ramalingam
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - Helen Mann
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - Karen So
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - Martin Johnson
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| | - Karthick Vishwanathan
- Medical Oncology Department, Ramón y Cajal Hospital, Madrid, Spain (E.G.); Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia (R.D.H., S.S.R.); Medical Oncology, Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon-1, Institute de Cancérologie des Hospices Civils de Lyon, Lyon, France (B.Y.); Medical Oncology Department, La Paz University Hospital, Autonoma University of Madrid (affiliated with CIBERONC-Instituto de Salud Carlos III), Madrid, Spain (J.F.B.); IQVIA, Kansas City, Missouri (H.G.); Institute for Drug Development, Mays Cancer Center at University of Texas, Health San Antonio, San Antonio, Texas (J.S.); Global Medicines Development, AstraZeneca, Cambridge, United Kingdom (H.M., K.S.); and Quantitative Clinical Pharmacology, Early Clinical Development IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom (M.J., K.V.)
| |
Collapse
|
3
|
Overcoming acquired resistance of gefitinib in lung cancer cells without T790M by AZD9291 or Twist1 knockdown in vitro and in vivo. Arch Toxicol 2019; 93:1555-1571. [PMID: 30993382 DOI: 10.1007/s00204-019-02453-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/09/2019] [Indexed: 12/14/2022]
Abstract
The T790M mutation is recognized as a typical mechanism of acquired resistance to first generation of epithermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) such as gefitinib in non-small cell lung cancer (NSCLC) patients who are commonly treated by third generation of EGFR-TKI AZD9291 (osimertinib). However, the therapeutic strategy for overcoming acquired resistance to EGFR-TKIs in NSCLC patients without T790M remains to be definitively determined. In the present study, gefitinib-resistant H1650 (H1650GR) or AZD9291-resistant H1975 (H1975AR) was generated by exposing NSCLC cell line H1650 or H1975 to progressively increased concentrations of gefitinib or AZD9291 over 11 months. The cytotoxic effects of gefitinib or AZD9291 in vitro were evaluated via the half maximal inhibitory concentrations (IC50s) determined by the MTT assay. IC50 of gefitinib in H1650GR (50.0 ± 3.0 µM) significantly increased compared with H1650 (31.0 ± 1.0 µM) (p < 0.05). Similarly, the IC50 of AZD9291 in H1975AR (10.3 ± 0.9 µM) significantly increased compared with H1975 (5.5 ± 0.6 µM) (p < 0.05). However, IC50 of AZD9291 on H1650GR (8.5 ± 0.5 µM) did not increase compared with H1650 (9.7 ± 0.7 µM). On the other hand, IC50 of AZD9291 on gefitinib-resistant A549 (A549GR established in our previous study) (12.7 ± 0.8 µM) was significantly increased compared with A549 (7.0 ± 1.0 µM) (p < 0.05). AZD9291 induced caspase 3/7 activation in A549, H1650, and H1650GR, but not in A549GR. Western blot analyses showed that p-Akt played a key role in determining the sensitivities of A549, A549GR, H1650, and H1650GR to gefitinib or AZD9291. Additionally, increased expression of Twist1 was observed in all cells with acquired EGFR-TKI resistance and knockdown of Twist1 by shRNA was found to significantly enhance the sensitivity of A549GR to gefitinib or AZD9291 via reversing epithelial-mesenchymal transition and downregulating p-Akt, but not of H1975AR to AZD9291. The enhanced cytotoxic effect of AZD9291 on A549GR by Twist1 knockdown in vitro was further validated by in vivo studies which showed that Twist1 knockdown could lead to significantly delayed tumor growth of A549GR xenograft with increased sensitivity to AZD9291 treatment in nude mice without any observed side toxic effects. In summary, our study demonstrated that the mechanisms of acquired resistance in different NSCLC cell lines treated by even the same EGFR-TKI might be quite different, which provide a rationale for adopting different therapeutic strategies for those NSCLC patients with acquired EGFR-TKI resistance based on different status of heterogeneous mutations.
Collapse
|
4
|
Kiura K, Yoh K, Katakami N, Nogami N, Kasahara K, Takahashi T, Okamoto I, Cantarini M, Hodge R, Uchida H. Osimertinib in patients with epidermal growth factor receptor T790M advanced non-small cell lung cancer selected using cytology samples. Cancer Sci 2018; 109:1177-1184. [PMID: 29363250 PMCID: PMC5891183 DOI: 10.1111/cas.13511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 12/12/2022] Open
Abstract
Osimertinib is a potent, irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) selective for EGFR‑TKI sensitizing (EGFRm) and T790M resistance mutations. The primary objective of the cytology cohort in the AURA study was to investigate safety and efficacy of osimertinib in pretreated Japanese patients with EGFR T790M mutation‐positive non‐small cell lung cancer (NSCLC), with screening EGFR T790M mutation status determined from cytology samples. The cytology cohort was included in the Phase I dose expansion component of the AURA study. Patients were enrolled based on a positive result of T790M by using cytology samples, and received osimertinib 80 mg in tablet form once daily until disease progression or until clinical benefit was no longer observed at the discretion of the investigator. Primary endpoint for efficacy was objective response rate (ORR) by investigator assessment. Twenty‐eight Japanese patients were enrolled into the cytology cohort. At data cut‐off (February 1, 2016), 12 (43%) were on treatment. Investigator‐assessed ORR was 75% (95% confidence interval [CI] 55, 89) and median duration of response was 9.7 months (95% CI 3.8, not calculable [NC]). Median progression‐free survival was 8.3 months (95% CI 4.2, NC) and disease control rate was 96% (95% CI 82, 100). The most common all‐causality adverse events were paronychia (46%), dry skin (46%), diarrhea (36%) and rash (36%). Osimertinib provided clinical benefit with a manageable safety profile in patients with pretreated EGFR T790M mutation‐positive NSCLC whose screening EGFR T790M mutation‐positive status was determined from cytology samples. (ClinicalTrials.gov number NCT01802632).
Collapse
Affiliation(s)
- Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Kiyotaka Yoh
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Nobuyuki Katakami
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe, Japan
| | | | - Kazuo Kasahara
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | | | - Isamu Okamoto
- Graduate School of Medical Sciences, Research Institute for Diseases of the Chest, Kyushu University, Fukuoka, Japan
| | | | - Rachel Hodge
- Biostatistics and Informatics, AstraZeneca, Cambridge, UK
| | | |
Collapse
|
5
|
Zhong WZ, Zhou Q, Wu YL. The resistance mechanisms and treatment strategies for EGFR-mutant advanced non-small-cell lung cancer. Oncotarget 2017; 8:71358-71370. [PMID: 29050366 PMCID: PMC5642641 DOI: 10.18632/oncotarget.20311] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/06/2017] [Indexed: 12/24/2022] Open
Abstract
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) have been established as the standard therapy for EGFR-sensitizing mutant advanced non-small-cell lung cancer (NSCLC). However, patients ultimately develop resistance to these drugs. There are several mechanisms of both primary and secondary resistance to EGFR-TKIs. The primary resistance mechanisms include point mutations in exon 18, deletions or insertions in exon 19, insertions, duplications and point mutations in exon 20 and point mutation in exon 21 of EGFR gene. Secondary resistance to EGFR-TKIs is due to emergence of T790M mutation, activation of alternative signaling pathways, bypassing downstream signaling pathways and histological transformation. Strategies to overcome these intrinsic and acquired resistance mechanisms are complex. With the development of the precision medicine for advanced NSCLC, available systemic and local treatment options have expanded, requiring new clinical algorithms that take into account resistance mechanism. Though combination therapy is emerging as the standard of to overcome resistance mechanisms. Personalized treatment modalities based on molecular diagnosis and monitoring is essential for disease management. Emerging data from the ongoing clinical trials on combination therapy of third generation TKIs and antibodies in EGFR mutant NSCLC are promising for better survival outcomes.
Collapse
Affiliation(s)
- Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China
| |
Collapse
|
6
|
Karachaliou N, Sosa AE, Barron FB, Gonzalez Cao M, Santarpia M, Rosell R. Pharmacological management of relapsed/refractory NSCLC with chemical drugs. Expert Opin Pharmacother 2017; 18:295-304. [PMID: 28103738 DOI: 10.1080/14656566.2017.1285284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer death in both genders. In the early stages the disease is asymptomatic and most patients appear with metastasis at the time of the diagnosis. The discovery of key oncogenic events mainly in lung adenocarcinoma, like EGFR mutations or ALK rearrangements has changed the treatment landscape and has improved the prognosis of lung cancer patients. Inevitably, all patients initially treated with either chemotherapy or targeted therapies develop resistance and require a second-line therapeutic approach. Areas covered: In this review we are discussing the current treatment of relapsed or refractory lung cancer. We have thoroughly searched the literature (Pubmed) the last five years for studies or reviews published on the issue of second-line therapy in lung cancer using as key words, lung cancer, relapse, EGFR mutations, ALK rearrangements, chemotherapy and immunotherapy Expert opinion: The prognosis of lung cancer has been radically improved. Due to the recent development of checkpoint inhibitors, this also occurs for patients whose tumor's are not driven by a genetic alteration and who, until recently, derived only minimal benefit from chemotherapy.
Collapse
Affiliation(s)
- Niki Karachaliou
- a Instituto Oncológico Dr Rosell (IOR) , University Hospital Sagrat Cor , Barcelona , Spain
| | - Aaron E Sosa
- a Instituto Oncológico Dr Rosell (IOR) , University Hospital Sagrat Cor , Barcelona , Spain
| | | | - Maria Gonzalez Cao
- c Instituto Oncológico Dr Rosell (IOR) , Quirón-Dexeus University Institute , Barcelona , Spain
| | - Mariacarmela Santarpia
- d Medical Oncology Unit, Department of Human Pathology "G. Barresi" , University of Messina , Messina , Italy
| | - Rafael Rosell
- e Cancer Biology & Precision Medicine Program , Institut d'Investigació en Ciències Germans Trias i Pujol , Badalona , Spain.,f Institut Català d'Oncologia, Hospital Germans Trias i Pujol , Badalona , Spain
| |
Collapse
|
7
|
Goss G, Tsai CM, Shepherd FA, Bazhenova L, Lee JS, Chang GC, Crino L, Satouchi M, Chu Q, Hida T, Han JY, Juan O, Dunphy F, Nishio M, Kang JH, Majem M, Mann H, Cantarini M, Ghiorghiu S, Mitsudomi T. Osimertinib for pretreated EGFR Thr790Met-positive advanced non-small-cell lung cancer (AURA2): a multicentre, open-label, single-arm, phase 2 study. Lancet Oncol 2016; 17:1643-1652. [PMID: 27751847 DOI: 10.1016/s1470-2045(16)30508-3] [Citation(s) in RCA: 474] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Osimertinib (AZD9291) is an oral, potent, irreversible EGFR tyrosine-kinase inhibitor selective for EGFR tyrosine-kinase inhibitor sensitising mutations, and the EGFR Thr790Met resistance mutation. We assessed the efficacy and safety of osimertinib in patients with EGFR Thr790Met-positive non-small-cell lung cancer (NSCLC), who had progressed after previous therapy with an approved EGFR tyrosine-kinase inhibitor. METHODS In this phase 2, open-label, single-arm study (AURA2), patients aged at least 18 years with centrally confirmed EGFR Thr790Met-positive mutations, locally advanced or metastatic (stage IIIB/IV) NSCLC who progressed on previous EGFR tyrosine-kinase inhibitor therapy received osimertinib 80 mg orally once daily; treatment could continue beyond progression if the investigator observed a clinical benefit. Patients with asymptomatic, stable CNS metastases not requiring steroids were allowed to enrol. The primary endpoint was the proportion of patients achieving an objective response by blinded independent central review using Response Evaluation Criteria in Solid Tumors, version 1.1. Response endpoints were assessed in the evaluable for response analysis set (ie, all patients who received at least one dose of osimertinib and had measurable disease at baseline according to blinded independent central review). Other endpoints and safety were assessed in all patients receiving at least one osimertinib dose (full analysis set). The study is ongoing and patients are still receiving treatment. This study is registered with ClinicalTrials.gov, number NCT02094261. FINDINGS Between May 20, 2014, and Sept 12, 2014, 472 patients were screened, of whom 210 started osimertinib treatment between June 13, 2014, and Oct 27, 2014; 11 patients were excluded from the evaluable for response analysis set (n=199) due to absence of measurable disease at baseline by blinded independent central review. At data cutoff (Nov 1, 2015), 122 (58%) patients remained on treatment. The median duration of follow-up was 13·0 months (IQR 7·6-14·2). 140 (70%; 95% CI 64-77) of 199 patients achieved an objective response by blinded independent central review: confirmed complete responses were achieved in six (3%) patients and partial responses were achieved in 134 (67%) patients. The most common all-causality grade 3 and 4 adverse events were pulmonary embolism (seven [3%]), prolonged electrocardiogram QT (five [2%]), decreased neutrophil count (four [2%]), anaemia, dyspnoea, hyponatraemia, increased alanine aminotransferase, and thrombocytopenia (three [1%] each). Serious adverse events were reported in 52 (25%) patients, of which 11 (5%) were investigator assessed as possibly treatment-related to osimertinib. Seven deaths were due to adverse events; these were pneumonia (n=2), pneumonia aspiration (n=1), rectal haemorrhage (n=1), dyspnoea (n=1), failure to thrive (n=1), and interstitial lung disease (n=1). The only fatal event assessed as possibly treatment-related by the investigator was due to interstitial lung disease. INTERPRETATION Osimertinib showed clinical activity with manageable side-effects in patients with EGFR Thr790Met-positive NSCLC. Therefore, osimertinib could be a suitable treatment for patients with EGFR Thr790Met-positive disease who have progressed on an EGFR tyrosine-kinase inhibitor. FUNDING AstraZeneca.
Collapse
Affiliation(s)
- Glenwood Goss
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
| | - Chun-Ming Tsai
- Department of Chest Medicine, Taipei-Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Jong Seok Lee
- Seoul National University, Bundang Hospital, Seongnam, South Korea
| | - Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, National Yang-Ming University, Taipei, Taiwan
| | - Lucio Crino
- Perugia University Medical School, Perugia, Italy
| | | | - Quincy Chu
- University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Ji-Youn Han
- National Cancer Center, Goyang-si, Republic of Korea
| | - Oscar Juan
- La Fe University Hospital, Valencia, Spain
| | | | - Makoto Nishio
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
8
|
Ortiz-Cuaran S, Scheffler M, Plenker D, Dahmen L, Scheel AH, Fernandez-Cuesta L, Meder L, Lovly CM, Persigehl T, Merkelbach-Bruse S, Bos M, Michels S, Fischer R, Albus K, König K, Schildhaus HU, Fassunke J, Ihle MA, Pasternack H, Heydt C, Becker C, Altmüller J, Ji H, Müller C, Florin A, Heuckmann JM, Nuernberg P, Ansén S, Heukamp LC, Berg J, Pao W, Peifer M, Buettner R, Wolf J, Thomas RK, Sos ML. Heterogeneous Mechanisms of Primary and Acquired Resistance to Third-Generation EGFR Inhibitors. Clin Cancer Res 2016; 22:4837-4847. [PMID: 27252416 DOI: 10.1158/1078-0432.ccr-15-1915] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 05/21/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify novel mechanisms of resistance to third-generation EGFR inhibitors in patients with lung adenocarcinoma that progressed under therapy with either AZD9291 or rociletinib (CO-1686). EXPERIMENTAL DESIGN We analyzed tumor biopsies from seven patients obtained before, during, and/or after treatment with AZD9291 or rociletinib (CO-1686). Targeted sequencing and FISH analyses were performed, and the relevance of candidate genes was functionally assessed in in vitro models. RESULTS We found recurrent amplification of either MET or ERBB2 in tumors that were resistant or developed resistance to third-generation EGFR inhibitors and show that ERBB2 and MET activation can confer resistance to these compounds. Furthermore, we identified a KRASG12S mutation in a patient with acquired resistance to AZD9291 as a potential driver of acquired resistance. Finally, we show that dual inhibition of EGFR/MEK might be a viable strategy to overcome resistance in EGFR-mutant cells expressing mutant KRAS CONCLUSIONS: Our data suggest that heterogeneous mechanisms of resistance can drive primary and acquired resistance to third-generation EGFR inhibitors and provide a rationale for potential combination strategies. Clin Cancer Res; 22(19); 4837-47. ©2016 AACR.
Collapse
Affiliation(s)
- Sandra Ortiz-Cuaran
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany
| | - Dennis Plenker
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany. Molecular Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Llona Dahmen
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Andreas H Scheel
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Lynnette Fernandez-Cuesta
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany. Genetic Cancer Susceptibility Group, Section of Genetics, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Lydia Meder
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | | | | | - Sabine Merkelbach-Bruse
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Marc Bos
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Sebastian Michels
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany
| | - Rieke Fischer
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany
| | - Kerstin Albus
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | | | | | - Jana Fassunke
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Michaela A Ihle
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Helen Pasternack
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany. Pathology of the University Hospital of Luebeck and Leibniz Research Center Borstel, Lübeck and Borstel, Germany
| | - Carina Heydt
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Christian Becker
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Hongbin Ji
- Key Laboratory of Systems Biology, CAS Center for Excellence in Molecular Cell Science, Innovation Center for Cell Signaling Network, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Science, Shanghai, China. School of Life Science and Technology, Shanghai Tech University, Shanghai, China
| | - Christian Müller
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Alexandra Florin
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | | | - Peter Nuernberg
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Sascha Ansén
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany
| | - Lukas C Heukamp
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany. NEO New Oncology AG, Cologne, Germany
| | - Johannes Berg
- Institute for Theoretical Physics. University of Cologne, Cologne, Germany
| | - William Pao
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Martin Peifer
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany. Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Reinhard Buettner
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany.
| | - Jürgen Wolf
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany.
| | - Roman K Thomas
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany. Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany.
| | - Martin L Sos
- Molecular Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany.
| |
Collapse
|
9
|
Solimando DA, Waddell JA. Drug Monographs: Daratumumab and Osimertinib. Hosp Pharm 2016; 51:288-92. [PMID: 27303075 PMCID: PMC4896330 DOI: 10.1310/hpj5104-288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, e-mail: waddfour@charter.net.
Collapse
|
10
|
Zhou C, Yao LD. Strategies to Improve Outcomes of Patients with EGFR-Mutant Non–Small Cell Lung Cancer: Review of the Literature. J Thorac Oncol 2016; 11:174-86. [DOI: 10.1016/j.jtho.2015.10.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 01/29/2023]
|
11
|
Takemura Y, Takayama K. [The Cutting-edge of Medicine; Clinico-pathogenetic background and approach for early detection of lung cancer]. ACTA ACUST UNITED AC 2016; 105:105-11. [PMID: 27266050 DOI: 10.2169/naika.105.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
12
|
|
13
|
Remon J, Planchard D. AZD9291 in EGFR-mutant advanced non-small-cell lung cancer patients. Future Oncol 2015; 11:3069-81. [DOI: 10.2217/fon.15.250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) patients whose tumors have an EGFR-activating mutation develop acquired resistance after a median of 9–11 months from the beginning of treatment with erlotinib, gefitinib and afatinib. T790M mutation is the cause of this resistance in approximately 60% of cases. AZD9291 is an oral, irreversible, mutant-selective EGF receptor (EGFR) tyrosine kinase inhibitor (TKI) developed to have potency against EGFR mutations, including T790M mutation, while sparing wild-type EGFR. A Phase I trial of AZD9291 in EGFR-mutant NSCLC patients, demonstrated high activity, essentially among T790M-mutant tumors, with a manageable tolerability profile. Ongoing Phase III trials are evaluating AZD9291 in EGFR-mutant patients as first-line treatment compared with erlotinib and gefitinib; and as second-line treatment compared with chemotherapy after progression on EGFR TKI in T790M-mutant tumors. Better identification of T790M-mutant tumors post EGFR TKI relapse and mechanisms of resistance to AZD9291 are the future challenges. This article reviews the emerging data regarding AZD9291 in the treatment of patients with advanced NSCLC.
Collapse
Affiliation(s)
- Jordi Remon
- Gustave Roussy, Medical Oncology Department, Villejuif, France
| | - David Planchard
- Gustave Roussy, Medical Oncology Department, Villejuif, France
| |
Collapse
|