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Primdahl D, Cohen-Nowak A, Kumthekar P. Novel approaches to treatment of leptomeningeal metastases. Curr Opin Neurol 2023; 36:592-602. [PMID: 37865856 DOI: 10.1097/wco.0000000000001218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW The incidence of leptomeningeal metastases is increasing in the setting of improved survival from systemic cancers. In more recent years, our understanding of leptomeningeal metastasis pathogenesis, how to diagnose and treat has been evolving. RECENT FINDINGS Diagnosing leptomeningeal metastasis has been challenging due to the limitations of cytology and neuroimaging; However, newer techniques detecting circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA) have shown potential advantage with diagnosis, quantification and detection of oncogenic mutations. The use of small molecule inhibitors and immunotherapy has shown some promise in specific leptomeningeal metastasis subtypes. SUMMARY These new discoveries have improved clinical trials' ability to assess treatment response and thereby more optimally compare different treatments. Furthermore, they have helped the individual clinician better diagnose, monitor the disease and provide novel therapies.
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Affiliation(s)
- Ditte Primdahl
- Department of Neurology at The Feinberg School of Medicine at Northwestern University and The Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Adam Cohen-Nowak
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Priya Kumthekar
- Department of Neurology at The Feinberg School of Medicine at Northwestern University and The Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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Tsakonas G, Ekman S, Koulouris A, Adderley H, Ackermann CJ, Califano R. Safety and efficacy of immune checkpoint blockade in patients with advanced nonsmall cell lung cancer and brain metastasis. Int J Cancer 2023; 153:1556-1567. [PMID: 37334528 DOI: 10.1002/ijc.34628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/12/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
The presence of brain metastases (BM) is a negative prognostic factor for patients with advanced nonsmall cell lung cancer (NSCLC). Their incidence seems to be higher in patients with oncogene-driven tumours, especially those with EGFR-mutated or ALK-rearranged tumours. Although targeted treatments demonstrate significant efficacy regarding BM, they only apply to a minority of NSCLC patients. On the other hand, systemic therapies for nononcogenic-driven NSCLC with BM have shown limited clinical benefit. In recent years, immunotherapy alone or combined with chemotherapy has been adopted as a new standard of care in first-line therapy. This approach seems to be beneficial to patients with BM in terms of efficacy and toxicity. Combined immune checkpoint inhibition as well as the combination of immunotherapy and radiation therapy show promising results with significant, but overall acceptable toxicity. A pragmatic approach of allowing enrolment of patients with untreated or symptomatic BM in randomised trials evaluating immune checkpoint inhibitors strategies, possibly coupled with central nervous system-related endpoints may be needed to generate data to refine treatment for this patient population.
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Affiliation(s)
- Georgios Tsakonas
- Department of Oncology-Pathology, Karolinska Institutet/Thoracic Oncology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Simon Ekman
- Department of Oncology-Pathology, Karolinska Institutet/Thoracic Oncology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Koulouris
- Department of Oncology-Pathology, Karolinska Institutet/Thoracic Oncology Center, Karolinska University Hospital, Stockholm, Sweden
- Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Helen Adderley
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Department of Medical Oncology, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
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Nei T, Tamauchi S, Ikeda Y, Yoshikawa N, Niimi K, Kajiyama H. Niraparib as a therapeutic agent for the treatment of ovarian cancer meningeal dissemination with BRCA1 mutation. J Obstet Gynaecol Res 2023. [PMID: 37114359 DOI: 10.1111/jog.15663] [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: 01/17/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Abstract
This study analyzed a 63-year-old woman with hereditary BRCA1 mutation. She underwent interval debulking surgery after neoadjuvant chemotherapy for high-grade serous ovarian carcinoma (HGSOC). After 2 years of postoperative chemotherapy, she developed headache and dizziness, and a suspected metastatic cerebellar mass in left ovary was detected. Pathological analysis of the mass revealed HGSOC, which was removed surgically. Eight months and another 6 months after the surgery, local recurrence was noted; hence, she underwent CyberKnife treatment. After 3 months, cervical spinal cord metastasis was found, evidenced by left shoulder pain. Moreover, meningeal dissemination was present around the cauda equina. Chemotherapy treatment, including bevacizumab, was ineffective and increased lesions were observed. After CyberKnife treatment for the cervical spinal cord metastasis, niraparib was initiated for the meningeal dissemination. The cerebellar lesions and meningeal dissemination improved within 8 months of niraparib treatment. Although meningeal dissemination is challenging to treat, niraparib may be useful in BRCA-mutated HGSOC.
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Affiliation(s)
- Takashi Nei
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tamauchi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Wang Y, Li J, Liu T, Ge M, Ji X, Chu Z, Zhan Q, Liang X, Zhou X. Clinical Outcomes of Patients with Epidermal Growth Factor Receptor-Mutated Non-Small-Cell Lung Cancer with Leptomeningeal Metastasis in the Modern Target Therapy Era. World Neurosurg 2023; 170:e500-e509. [PMID: 36396052 DOI: 10.1016/j.wneu.2022.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Leptomeningeal metastasis (LM) is a severe complication in patients with non-small-cell lung cancer (NSCLC) and the optimal treatment strategy remains a challenge. This study aimed to investigate the treatment strategies and clinical outcomes in these patients. METHODS We retrospectively reviewed the data of 44 patients with epidermal growth factor receptor (EGFR)-mutated NSCLC with LM between 2014 and 2020 at our institute. The patient characteristics, treatment approaches, LM progression-free survival (LMPFS) and overall survival (OS) after the diagnosis of LM (OSLM) were analyzed. RESULTS The median OSLM was 16.0 months and the 3-year OS rate was 22.5%. The PFSLM in EGFR T790M-positive NSCLC patients with leptomeingeal disease was significantly improved by initiation of third-generation tyrosine kinase inhibitors (TKIs) compared with that of patients who were T790M negative (14.0 vs. 7.0 months; P = 0.030). A significantly higher LM disease control rate was shown in patients who received third-generation TKIs compared with previous generations of TKIs (90.1% vs. 60.0%; P = 0.024). Better Eastern Cooperative Oncology Group performance status, EGFR exon 19del, and clinical improvement of LM after therapy were independently associated with better OS. CONCLUSIONS The survival of patients with NSCLC with LM has improved in the target therapy era. Our study provided real-world clinical evidence that patients with EGFR-mutated NSCLC who developed LM from previous TKIs can be benefit from third-generation EGFR-TKIs, especially for patients with EGFR T790M-positive.
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Affiliation(s)
- Yu Wang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Li
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tao Liu
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengxi Ge
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Ji
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhaohui Chu
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiong Zhan
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaohua Liang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Xinli Zhou
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China.
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Abstract
Leptomeningeal metastases represent an aggressive stage of cancer with few durable treatment options. Improved understanding of cancer biology, neoplastic reliance on oncogenic driver mutations, and complex immune system interactions have resulted in an explosion in cancer-directed therapy in the last two decades to include small molecule inhibitors and immune checkpoint inhibitors. Most of these therapeutics are underexplored in patients with leptomeningeal metastases, limiting extrapolation of extracranial and even intracranial efficacy outcomes to the unique leptomeningeal space. Further confounding our interpretation of drug activity in the leptomeninges is an incomplete understanding of drug penetration through the blood-cerebrospinal fluid barrier of the choroid plexus. Nevertheless, a number of retrospective studies and promising prospective trials provide evidence of leptomeningeal activity of several small molecule and immune checkpoint inhibitors and underscore potential areas of further therapeutic development for patients harboring leptomeningeal disease.
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Affiliation(s)
- Jessica A Wilcox
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Adrienne A Boire
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Human Oncology and Pathogenesis Program, Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Billena C, Lobbous M, Cordova CA, Peereboom D, Torres-Trejo A, Chan T, Murphy E, Chao ST, Suh J, Yu JS. The role of targeted therapy and immune therapy in the management of non-small cell lung cancer brain metastases. Front Oncol 2023; 13:1110440. [PMID: 36910642 PMCID: PMC9997098 DOI: 10.3389/fonc.2023.1110440] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Brain metastases are a significant source of morbidity and mortality in patients with non-small cell lung cancer. Historically, surgery and radiation therapy have been essential to maintaining disease control within the central nervous system due to poorly penetrant conventional chemotherapy. With the advent of targeted therapy against actionable driver mutations, there is potential to control limited and asymptomatic intracranial disease and delay local therapy until progression. In this review paper, intracranial response rates and clinical outcomes to biological and immune therapies are summarized from the literature and appraised to assist clinical decision making and identify areas for further research. Future clinical trials ought to prioritize patient-centered quality of life and neurocognitive measures as major outcomes and specifically stratify patients based on mutational marker status, disease burden, and symptom acuity.
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Affiliation(s)
- Cole Billena
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Mina Lobbous
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Christine A Cordova
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - David Peereboom
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Alejandro Torres-Trejo
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Timothy Chan
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Erin Murphy
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - John Suh
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Jennifer S Yu
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, United States.,Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, OH, United States.,Center for Cancer Stem Cell Biology, Department of Cancer Biology, Cleveland Clinic Foundation, Cleveland, OH, United States
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Kanbour A, Salih F, Abualainin W, Abdelrazek M, Szabados L, Al-Bozom I, Omar NE. Leptomeningeal Metastatic L858R EGFR-mutant Lung Cancer: Prompt Response to Osimertinib in the Absence of T790M-mutation and Effective Subsequent Pulsed Erlotinib. Onco Targets Ther 2022; 15:659-667. [PMID: 35733652 PMCID: PMC9207126 DOI: 10.2147/ott.s336012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/30/2021] [Indexed: 12/04/2022] Open
Abstract
Leptomeningeal carcinomatosis (LMC) is a known sequel of metastatic lung cancer and its treatment is challenging. Nevertheless, treatment options for LMC due to metastatic epidermal growth factor receptor-mutant (EGFR-mutant) lung adenocarcinoma are expanding. We present a 52-year-old male patient with metastatic non-small-cell lung cancer (NSCLC). The patient was found to have L858R mutation in exon 21 of the EGFR gene. He was initially treated with erlotinib, followed by afatinib/cetuximab, followed by chemotherapy. Thereafter, his disease progressed to LMC. Although tissue biopsy did not show T790M-mutation, osimertinib (160 mg once daily) promptly induced clinical and radiological response that continued for five months. High dose pulsed erlotinib (1500 mg weekly) improved his quality of life and extended his survival for a further four months. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/hB2KtcuyWz4
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Affiliation(s)
- Aladdin Kanbour
- Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Faroug Salih
- Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Wafa Abualainin
- Solid Tumor Section, Molecular Genetics Laboratory, Diagnostic Genomic Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abdelrazek
- Clinical Imaging Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Lajos Szabados
- Clinical Imaging Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Issam Al-Bozom
- Precision Medicine Section, Anatomical Pathology Department, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Nabil E Omar
- Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Provenzano L, Cuccarini V, Platania M, Canziani L, Spagnoletti A, Doniselli FM, Eoli M, Prelaj A, Anghileri E. Carcinomatosis under control by osimertinib in EGFR and TP53 mutated lung adenocarcinoma. TUMORI JOURNAL 2021; 107:NP136-NP140. [PMID: 34727807 DOI: 10.1177/03008916211052330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Approximately 25%-30% of patients with non-small cell lung cancer (NSCLC) develop central nervous system (CNS) metastases during the course of the disease; this percentage is higher in patients with epidermal growth factor receptor (EGFR) mutations. Leptomeningeal metastases, infrequent in the advanced setting, have a particularly dismal prognosis. Osimertinib, a third-generation EGFR inhibitor, can provide effective and durable response in this setting. CASE DESCRIPTION We present a 62-year-old man with progressive vomiting, headache, short-term memory impairment, and left lower limb hyposthenia. Computed tomography (CT) showed bilateral lung nodules, multiple lymphadenopathies, liver and bone metastases, and CNS and leptomeningeal dissemination, including multiple parenchymal nodules located at supra- and infratentorial brain. Bone needle biopsy documented TTF1+ lung adenocarcinoma. Whole brain radiotherapy (WBRT) and symptomatic treatments were started. Next-generation sequencing reported deletion of exon 19 of EGFR and mutation 8 of TP53. Osimertinib 80 mg was promptly started and WBRT interrupted. Some days after the patient experienced repetitive seizures and neurologic worsening, antiepileptic drugs and dexamethasone were implemented, with gradual improvement. Radiologic evaluation, including brain MRI and thorax-abdominal CT, showed partial response on CNS as well as extracranial sites, which was sustained. CONCLUSIONS First-line treatment with osimertinib can be safe and effective in EGFR-mutated NSCLC even in presence of multiple negative predictive factors (poor Performance Status, diffuse leptomeningeal involvement, TP53 comutation), suggesting that deferring local treatments can be feasible in this setting, allowing the patient to maintain a good quality of life.
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Affiliation(s)
- Leonardo Provenzano
- Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valeria Cuccarini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Platania
- Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Canziani
- Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Spagnoletti
- Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Fabio M Doniselli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marica Eoli
- Molecular Neuro-oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Arsela Prelaj
- Medical Oncology Department 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.,Department of Electronics, Information, and Bioengineering, Polytechnic University of Milan, Milano, Milan, Italy
| | - Elena Anghileri
- Molecular Neuro-oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Li H, Xie Y, Lin Y, Yu T, Yin Z. [Different Gene Mutation Spectrum of the Paired CSF and Plasma Samples in Lung Adenocarcinoma with Leptomeningeal Metastases: the Liquid Biopsy Based on Circulating Tumor DNA]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:646-654. [PMID: 32838487 PMCID: PMC7467992 DOI: 10.3779/j.issn.1009-3419.2020.102.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
背景与目的 软脑膜转移(leptomeningeal metastasis, LM)是晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)的一种严重并发症, 通常预后较差。对于驱动基因阳性的NSCLC患者, 表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitors, EGFR-TKIs)是治疗的首选, 但常伴随着无法解决的耐药问题。本研究旨在探讨NSCLC-LM患者的脑脊液(cerebrospinal fluid, CSF)和血液中不同的基因突变谱及突变丰度, 筛查相关耐药基因, 以期能精确指导个体化的治疗。 方法 采用二代基因测序(next generation sequencing, NGS)的液体活检技术, 检测、对比分析TKI耐药后NSCLC患者同期的外周血及脑脊液中的循环肿瘤DNA(circulating tumor DNA, ctDNA)。 结果 共纳入18例NSCLC伴有LM的患者, 基础突变中11例(61.11%)为EGFR, 6例(33.33%)为间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK), 1例(5.56%)为原癌基因酪氨酸蛋白激酶ROS(ROS proto-oncogene 1, receptor tyrosine kinase, ROS1), 伴随突变中肿瘤蛋白P53(tumor protein p53 gene, TP53)、间质-上皮细胞转化因子(mesenchymal-epithelial transition factor, MET)检出率相对较高。CSF样本的靶向基因突变检出率明显高于外周血(100.00% vs 66.67%, P=0.006), 且基础突变基因的CSF丰度均明显高于血浆样本(P < 0.001)。CSF样本检测出丰富的单核苷酸变异(single-nucleotide variations, SNV)和拷贝数变异(copy number variants, CNV), 数量均多于血液样本;且相较于只接受过单一TKI治疗的患者, 使用多种TKI后脑脊液和血液中会产生更多的SNV突变。 结论 NSCLC-LM患者CSF中的ctDNA, 相较于外周血, 能更加准确、全面地反映出LM的真实基因突变状态, 在指导用药、耐药监测、预后评估等方面具有广泛的应用前景, 可作为液体活检的优选。
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Affiliation(s)
- Huiying Li
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yu Xie
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yongjuan Lin
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Tingting Yu
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zhenyu Yin
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
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Tsakonas G, Martín-Bernabé A, Rounis K, Moreno-Ruiz P, Botling J, De Petris L, Ylipää A, Mezheyeuski A, Micke P, Östman A, Ekman S. High Density of NRF2 Expression in Malignant Cells Is Associated with Increased Risk of CNS Metastasis in Early-Stage NSCLC. Cancers (Basel) 2021; 13:cancers13133151. [PMID: 34202448 PMCID: PMC8268817 DOI: 10.3390/cancers13133151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 01/14/2023] Open
Abstract
Simple Summary We retrospectively analyzed 304 patients with surgically removed non-small cell lung cancer (NSCLC). Multiplex antibody staining of nuclear factor erythroid 2-related factor 2 (NRF2) and thioredoxin reductase 1 (TrxR1) was conducted and scored in cytokeratin-positive (CK+) cells within the whole-tissue core as well as the tumor and stromal compartments of each tissue microarray (TMA) core. A high density of NRF2+/CK+ cells in the whole-tissue core compartment was an independent prognostic factor, with an eightfold increase in odds regarding the risk of relapse in the central nervous system (CNS). This is the first study to report a tumor-cell-associated protein biomarker for CNS relapse in early-stage lung cancer and the first trial to report the correlation between NRF2 expression and risk of CNS relapse. The results of our study may have an impact on the follow-up strategy for early-stage NSCLC patients and eventually improve their prognosis. Abstract Nuclear factor erythroid 2-related factor 2 (NRF2) protein expression promotes cancer progression in non-small cell lung cancer (NSCLC). However, its role in the clinical setting has not been established. We retrospectively analyzed data from 304 patients with surgically removed NSCLC. Multiplex antibody staining of NRF2 and thioredoxin reductase 1 (TrxR1) was conducted and scored in cytokeratin-positive (CK+) cells within the whole-tissue core as well as the tumor and stromal compartments of each tissue microarray (TMA) core. A high density of NRF2+/CK+ cells in the whole-tissue core compartment was correlated with a higher risk of central nervous system (CNS) relapse OR = 7.36 (95% CI: 1.64–33.06). The multivariate analysis showed an OR = 8.00 (95% CI: 1.70–37.60) for CNS relapse in NRF2+/CK+ high-density cases. The density of TrxR1+/CK+ cells failed to show any statistically significant risk of relapse. The OS analyses for NRF2+/CK+ and TrxR1+/CK+ cell density failed to show any statistical significance. This is the first study to report a correlation between NRF2+/CK+ cell density and the risk of CNS relapse in early-stage NSCLC. The results of our study may impact the follow-up strategy for early-stage NSCLC patients and eventually improve their prognosis.
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Affiliation(s)
- Georgios Tsakonas
- Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Solna, 17164 Stockholm, Sweden; (K.R.); (L.D.P.); (S.E.)
- Department of Oncology–Pathology, Karolinska Institutet, 17164 Stockholm, Sweden; (A.M.-B.); (P.M.-R.); (A.Ö.)
- Correspondence: ; Tel.: +46-(0)762129941
| | - Alfonso Martín-Bernabé
- Department of Oncology–Pathology, Karolinska Institutet, 17164 Stockholm, Sweden; (A.M.-B.); (P.M.-R.); (A.Ö.)
| | - Konstantinos Rounis
- Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Solna, 17164 Stockholm, Sweden; (K.R.); (L.D.P.); (S.E.)
| | - Pablo Moreno-Ruiz
- Department of Oncology–Pathology, Karolinska Institutet, 17164 Stockholm, Sweden; (A.M.-B.); (P.M.-R.); (A.Ö.)
| | - Johan Botling
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden; (J.B.); (A.M.); (P.M.)
| | - Luigi De Petris
- Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Solna, 17164 Stockholm, Sweden; (K.R.); (L.D.P.); (S.E.)
- Department of Oncology–Pathology, Karolinska Institutet, 17164 Stockholm, Sweden; (A.M.-B.); (P.M.-R.); (A.Ö.)
| | - Antti Ylipää
- Genevia Technologies Oy, 33100 Tampere, Finland;
| | - Artur Mezheyeuski
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden; (J.B.); (A.M.); (P.M.)
| | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden; (J.B.); (A.M.); (P.M.)
| | - Arne Östman
- Department of Oncology–Pathology, Karolinska Institutet, 17164 Stockholm, Sweden; (A.M.-B.); (P.M.-R.); (A.Ö.)
| | - Simon Ekman
- Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Solna, 17164 Stockholm, Sweden; (K.R.); (L.D.P.); (S.E.)
- Department of Oncology–Pathology, Karolinska Institutet, 17164 Stockholm, Sweden; (A.M.-B.); (P.M.-R.); (A.Ö.)
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Biological Treatments of Neurofibromatosis Type 2 and Other Skull Base Disorders. Otolaryngol Clin North Am 2021; 54:789-801. [PMID: 34120747 DOI: 10.1016/j.otc.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies of genomic alterations that occur in skull base tumors have provided information regarding biological aberrations that are necessary for the growth and maintenance of these tumors. This has led to the development and initiation of clinical trials incorporating biological treatments for many skull base tumors. The exciting developments of molecularly targeted therapy for the treatment of skull base tumors may provide noninvasive therapeutic options for patients that can be used either alone or in combination with surgery and/or radiation therapy. Future analysis and continued scientific discovery of treatments for skull base tumors can lead to improved outcomes in patients.
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12
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Lu Z, Cai J, Zeng Z, Liu A. [Management of Drug Therapy for Leptomeningeal Metastasis of Sensitive Driver Gene Positive Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:710-718. [PMID: 32758347 PMCID: PMC7467993 DOI: 10.3779/j.issn.1009-3419.2020.102.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Leptomeningeal metastasis (LM) is one of the serious complications of advanced non-small cell lung cancer (NSCLC), although the incidence is not high, the clinical symptoms are severe and the prognosis is poor. LM is prone to occur in patients with positive driver gene than negative. At present, the treatment of LM mainly includes molecular targeted therapy, systemic chemotherapy, whole brain radiotherapy, intrathecal chemotherapy and immunotherapy. Although there are many treatments, the efficacy of LM is still unsatisfactory. This article reviews the drug therapy of sensitive driver gene positive NSCLC LM.
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Affiliation(s)
- Zhiqin Lu
- Department of Oncology, The Second Affiliated of Nanchang University, Nanchang 330006, China
| | - Jing Cai
- Department of Oncology, The Second Affiliated of Nanchang University, Nanchang 330006, China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang 330006, China
| | - Zhimin Zeng
- Department of Oncology, The Second Affiliated of Nanchang University, Nanchang 330006, China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang 330006, China
| | - Anwen Liu
- Department of Oncology, The Second Affiliated of Nanchang University, Nanchang 330006, China.,Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang 330006, China
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13
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Hossain JA, Latif MA, Ystaas LAR, Ninzima S, Riecken K, Muller A, Azuaje F, Joseph JV, Talasila KM, Ghimire J, Fehse B, Bjerkvig R, Miletic H. Long-term treatment with valganciclovir improves lentiviral suicide gene therapy of glioblastoma. Neuro Oncol 2020; 21:890-900. [PMID: 30958558 DOI: 10.1093/neuonc/noz060] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Suicide gene therapy for malignant gliomas has shown encouraging results in the latest clinical trials. However, prodrug application was most often restricted to short-term treatment (14 days), especially when replication-defective vectors were used. We previously showed that a substantial fraction of herpes simplex virus thymidine kinase (HSV-TK) transduced tumor cells survive ganciclovir (GCV) treatment in an orthotopic glioblastoma (GBM) xenograft model. Here we analyzed whether these TK+ tumor cells are still sensitive to prodrug treatment and whether prolonged prodrug treatment can enhance treatment efficacy. METHODS Glioma cells positive for TK and green fluorescent protein (GFP) were sorted from xenograft tumors recurring after suicide gene therapy, and their sensitivity to GCV was tested in vitro. GBM xenografts were treated with HSV-TK/GCV, HSV-TK/valganciclovir (valGCV), or HSV-TK/valGCV + erlotinib. Tumor growth was analyzed by MRI, and survival as well as morphological and molecular changes were assessed. RESULTS TK-GFP+ tumor cells from recurrent xenograft tumors retained sensitivity to GCV in vitro. Importantly, a prolonged period (3 mo) of prodrug administration with valganciclovir (valGCV) resulted in a significant survival advantage compared with short-term (3 wk) application of GCV. Recurrent tumors from the treatment groups were more invasive and less angiogenic compared with primary tumors and showed significant upregulation of epidermal growth factor receptor (EGFR) expression. However, double treatment with the EGFR inhibitor erlotinib did not increase therapeutic efficacy. CONCLUSION Long-term treatment with valGCV should be considered as a replacement for short-term treatment with GCV in clinical trials of HSV-TK mediated suicide gene therapy.
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Affiliation(s)
- Jubayer A Hossain
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Md A Latif
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Lars A R Ystaas
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Sandra Ninzima
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Kristoffer Riecken
- Research Department Cell and Gene Therapy, Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany
| | - Arnaud Muller
- Bioinformatics Team, Center for Quantitative Biology, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Francisco Azuaje
- Bioinformatics Team, Center for Quantitative Biology, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Justin V Joseph
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | | | - Jiwan Ghimire
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Boris Fehse
- Research Department Cell and Gene Therapy, Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany
| | - Rolf Bjerkvig
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Norlux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Hrvoje Miletic
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
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14
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Xu H, Zhou L, Lu Y, Su X, Cheng P, Li D, Gao H, Li H, Yuan W, Zhang L, Zhang T. Dual Targeting of the Epidermal Growth Factor Receptor Using Combination of Nimotuzumab and Erlotinib in Advanced Non-Small-Cell Lung Cancer with Leptomeningeal Metastases: A Report of Three Cases. Onco Targets Ther 2020; 13:647-656. [PMID: 32021306 PMCID: PMC6982442 DOI: 10.2147/ott.s230399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/16/2019] [Indexed: 02/05/2023] Open
Abstract
Leptomeningeal metastases (LM) occur in 3-5% of patients with advanced non-small-cell lung cancer (NSCLC) and are associated with a dismal prognosis. We report three cases of NSCLC with LM who were treated with the combination of nimotuzumab and erlotinib. Magnetic Resonance Imaging (MRI) evaluation during follow-up showed significant improvement in cancer symptoms and decreased tumor size in all three patients. Grade 3 and 4 toxicities were rarely seen. Based on apparent efficacy of the regimen and fewer side effects, we suggest that nimotuzumab in combination with erlotinib may be a promising option for the treatment of NSCLC with LM.
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Affiliation(s)
- Hongyu Xu
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Lin Zhou
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - You Lu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xiaomei Su
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Peng Cheng
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Dong Li
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Hui Gao
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Hua Li
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Weiwei Yuan
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Ling Zhang
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, People's Republic of China
| | - Tao Zhang
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, People's Republic of China
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15
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Nishino M, Soejima K, Mitsudomi T. Brain metastases in oncogene-driven non-small cell lung cancer. Transl Lung Cancer Res 2019; 8:S298-S307. [PMID: 31857953 DOI: 10.21037/tlcr.2019.05.15] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Molecular targeted therapies have significantly improved the treatment outcome of patients with non-small cell lung cancer (NSCLC) harboring driver gene mutations such as receptor (EGFR) or anaplastic lymphoma kinase (ALK). However, the brain is a frequent site of recurrence, and it significantly deteriorates the prognosis of these patients. Treatment strategies include surgical resection, whole-brain radiation therapy, stereotactic radiotherapy, and drug therapy depending on patient condition. First-generation EGFR/ALK tyrosine kinase inhibitors (TKI) demonstrates only limited efficacy for intracranial lesions probably because of low penetration through the blood-brain barrier (BBB). However, newly developed TKIs with improved penetration such as osimertinib for EGFR and alectinib, ceritinib, brigatinib, or lorlatinib for ALK have demonstrated significant intracranial activity that should contribute to improved overall survival. Whole-brain radiation therapy used to be a standard of care that confers alleviation of symptom and modest survival benefit. However, it potentially causes neurological and cognitive deficits as a chronic toxicity. With the prolonged survival owing to newer generation drugs, this toxicity is becoming more relevant. Stereotactic radiotherapy is considered when there are three or fewer lesions, and the lesions are <3 cm as local control of tumor is excellent, and neurotoxicity is less. In this review, we discuss the various aspects of brain metastases occurring in NSCLC patients with driver gene mutations. We also propose a treatment algorithm for these patients.
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Affiliation(s)
- Makoto Nishino
- Division of Pulmonary Medicine, Department of Medicine, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Japan
| | - Kenzo Soejima
- Clinical and Translational Research Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Tetsuya Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, Japan
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16
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Nakao T, Okuda T, Fujita M, Kato A. A case of leptomeningeal metastases of human epidermal growth factor receptor 2-positive breast cancer that responded well to lapatinib plus capecitabine. Surg Neurol Int 2019; 10:131. [PMID: 31528467 PMCID: PMC6744731 DOI: 10.25259/sni-106-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/22/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Leptomeningeal metastases (LM) pose the most difficult form of cancer metastasis to treat and portend a poor prognosis. Standard treatment has yet to be established, and intrathecal chemotherapy and whole- brain radiotherapy are administered on an empirical basis. Case Description: We report on a 46-year-old woman with LM from human epidermal growth factor receptor 2 (HER2)-positive breast cancer. She was suffering from intractable headaches, severe nausea and vomiting, and cerebellar ataxia. Contrast-enhanced magnetic resonance imaging (MRI) revealed diffuse enhancement of the meninges, mainly in the posterior cranial fossa, and compression of the cerebellum by the profoundly thickened meninges. The first step in the treatment was decompression of the posterior cranial fossa to relieve intracranial hypertension. After surgery, her symptoms immediately improved. The second step was treatment with lapatinib at 1250 mg and capecitabine 1200 mg, which dramatically improved her symptoms and disappeared diffuse abnormal signal enhancement on MRI. Conclusion: We treated a patient with LM from primary HER2-positive breast cancer who responded well to lapatinib plus capecitabine.
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Affiliation(s)
- Takayuki Nakao
- Departments of Neurosurgery Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Takeshi Okuda
- Departments of Neurosurgery Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Mitsugu Fujita
- Departments of Microbiology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Amami Kato
- Departments of Neurosurgery Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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17
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Yoshida K, Kanda S, Shiraishi H, Goto K, Itahashi K, Goto Y, Horinouchi H, Fujiwara Y, Nokihara H, Yamamoto N, Ohe Y. Difference in central nerve system metastasis during gefitinib or erlotinib therapy in patients with EGFR-mutated non-small cell lung cancer: a retrospective study. J Thorac Dis 2019; 11:1347-1354. [PMID: 31179076 DOI: 10.21037/jtd.2019.03.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Central nervous system (CNS) metastasis is a poor prognostic factor in patients with advanced non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutation EGFR-mutant NSCLC and is associated with a deteriorated quality of life (QOL). Some clinical studies have suggested a possible difference in the incidence of CNS metastasis between EGFR-mutant NSCLC patients treated with gefitinib and erlotinib, both of which are classified as first-generation EGFR tyrosine kinase inhibitors (TKIs). However, the difference in the incidence of CNS metastasis between patients receiving these two drugs has not yet been sufficiently well investigated. We analyzed the frequency of occurrence/progression of CNS metastasis in EGFR-mutant NSCLC patients treated with erlotinib and gefitinib as the first-line treatment. Methods We analyzed the incidence of CNS metastasis, frequency of progression of CNS metastasis and the treatment outcomes in EGFR-mutant patients who received gefitinib or erlotinib as the first-line EGFR-TKI treatment. CNS progressive disease (PD) was defined as progression of CNS metastasis during EGFR-TKI treatment. We also evaluated the progression-free survival (PFS), CNS-PFS, and overall survival (OS) of the patients who received each of the two drugs. Results A total of 170 patients were enrolled in the study, of which 144 had received gefitinib, and 26 had received erlotinib. The frequency of CNS PD in the erlotinib group tended to be lower than that in the gefitinib group (11.5% vs. 29.9%, P=0.06). In patients with no existing CNS metastasis at the start of the EGFR-TKI treatments, the incidence of CNS PD was significantly lower in the erlotinib group than that in the gefitinib group (4.8% vs. 24.5%, P=0.04). A re-biopsy after failure of EGFR-TKI treatment was performed in 48 patients. The incidence of EGFR T790M tended to be higher among patients with CNS PD than in those without CNS PD, although the difference was not statistically significant (66.7% vs. 40.4%; P=0.23). Conclusions The incidence of progression of CNS metastasis during erlotinib treatment was lower than that during gefitinib treatment. In addition, the difference in the incidence in patients without existing CNS metastasis at the time of start of EGFR-TKI treatment was significantly lower in the patients treated with erlotinib than in those treated with gefitinib.
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Affiliation(s)
- Kazushi Yoshida
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shintaro Kanda
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hideaki Shiraishi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Keiko Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kota Itahashi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Nokihara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Yamamoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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18
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Xing P, Mu Y, Hao X, Wang Y, Li J. Data from real world to evaluate the efficacy of osimertinib in non-small cell lung cancer patients with central nervous system metastasis. Clin Transl Oncol 2019; 21:1424-1431. [DOI: 10.1007/s12094-019-02071-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/23/2019] [Indexed: 12/25/2022]
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19
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Lin YT, Chen JS, Liao WY, Ho CC, Hsu CL, Yang CY, Chen KY, Lee JH, Lin ZZ, Shih JY, Yang JCH, Yu CJ. Clinical outcomes and secondary epidermal growth factor receptor (EGFR) T790M mutation among first-line gefitinib, erlotinib and afatinib-treated non-small cell lung cancer patients with activating EGFR mutations. Int J Cancer 2019; 144:2887-2896. [PMID: 30485437 DOI: 10.1002/ijc.32025] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022]
Abstract
Gefitinib, erlotinib and afatinib are approved for first-line treatment of advanced non-small cell lung cancer (NSCLC) bearing an activating epidermal growth factor receptor (EGFR) mutation. However, the clinical outcomes among the three EGFR tyrosine kinase inhibitors (TKIs) are still controversial. We aimed to evaluate clinical outcomes and secondary EGFR T790M mutation among the three EGFR TKIs. From May 2014 to January 2016, a total of 301 patients received treatment with gefitinib, erlotinib or afatinib, for first-line treatment of advanced NSCLC with an activating EGFR mutation, based on their clinicians' choice. The median overall survival (OS) was 37.0 months. Although the baseline characteristics of patients were unequal, progression-free survival and OS did not differ among the 3 groups. Multivariate analysis found that gefitinib (adjusted odds ratio [aOR] 3.29, 95% confidence interval [CI], 1.15-9.46, p = 0.027), EGFR TKI treatment duration more than 13 months (aOR 3.16, 95% CI, 1.20-8.33, p = 0.020), male (aOR 3.25, 95% CI, 1.10-9.66, p = 0.034), initial liver metastasis (aOR 4.97, 95% CI 1.18-20.96, p = 0.029) and uncommon EGFR mutation (aOR 0.14, 95% CI, 0.02-0.97, compared to EGFR deletion 19, p = 0.047) were independent factors for secondary T790M mutation. In real-world practice, choosing first line EGFR TKI based on the patients' clinical characteristics yielded good clinical outcomes. First-line gefitinib, longer EGFR TKI treatment duration, male, initial liver metastasis and uncommon EGFR mutations may be independent factors for secondary EGFR T790M mutation.
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Affiliation(s)
- Yen-Ting Lin
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Yu Liao
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Lin Hsu
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Yao Yang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jih-Hsiang Lee
- Department of Oncology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Zhong-Zhe Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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20
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Yu M, Zhao Q, Li Y, Zhang S, Xu Y, Gong Y, Zhu J, Ding Z, Wang J, Peng F, Wang Y, Huang M, Ren L, Lu Y, Liu Y. Progression of Central Nervous System Metastases in Advanced Nonsmall Cell Lung Cancer Patients Effectively Treated with First-Generation Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor. Cancer Biother Radiopharm 2018; 33:421-426. [PMID: 31050549 DOI: 10.1089/cbr.2018.2493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Min Yu
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Zhao
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- The First People Hospital of Zigong, Chengdu, China
| | - Yanying Li
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Shuang Zhang
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Xu
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Youling Gong
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Zhu
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenyu Ding
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Wang
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Peng
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yongsheng Wang
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Meijuan Huang
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Li Ren
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - You Lu
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yongmei Liu
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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21
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Jiang Y, Zhang J, Huang J, Xu B, Li N, Cao L, Zhao M. Erlotinib versus gefitinib for brain metastases in Asian patients with exon 19 EGFR-mutant lung adenocarcinoma: a retrospective, multicenter study. BMC Pulm Med 2018; 18:171. [PMID: 30458751 PMCID: PMC6247515 DOI: 10.1186/s12890-018-0734-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/31/2018] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of this study was to compare clinical outcomes of Erlotinib versus Gefitinib in the treatment of Asian patients with exon 19 EGFR-mutant lung adenocarcinoma and newly diagnosed brain metastases. Methods Consecutive Asian patients with exon 19 EGFR-mutant lung adenocarcinoma and newly diagnosed brain metastases were identified and initially received peroral administration of 150 mg/d erlotinib or 250 mg/d gefitinib during 2009–2015. Overall survival (OS) was the primary endpoint. Progression-free survival (PFS) was the second endpoint. Results The cohort consisted of 227 Asian patients (erlotinib-treated cohort: n = 112, mean age = 58.5 years [SD: 20.13]; gefitinib-treated cohort: n = 115, mean age = 58.4 years [SD: 19.52]). In a multivariate analysis controlling for age, sex and time span of smoking history, significant difference was detected in the 36-month OS between erlotinib and gefitinib groups (58.3% vs. 49.1%, p = 0.012). There was also significant difference in the 36-month PFS between erlotinib and gefitinib groups (64% vs. 53%, p = 0.013). Conclusion For Asian patients with exon 19 EGFR-mutant lung adenocarcinoma and brain metastases, erlotinib was associated with a significantly longer OS and a more prolonged PFS and compared with gefitinib.
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Affiliation(s)
- Ye Jiang
- Department of Neurology, The Affiliated hospital of Hebei University, Yuhua East Road No. 212, Baoding, 071000, Hebei, China
| | - Jing Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Juanjuan Huang
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Gusao Road No. 16, Jianghan District, Wuhan, 430014, Hubei, China
| | - Bo Xu
- Department of Thoracic surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Ning Li
- Department of Neurology, The Affiliated hospital of Hebei University, Yuhua East Road No. 212, Baoding, 071000, Hebei, China
| | - Lei Cao
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Gusao Road No. 16, Jianghan District, Wuhan, 430014, Hubei, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai City, 201508, China.
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22
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Thomas CM, Lee CS. Penetrating the evidence of EGFR and ALK tyrosine kinase inhibitors for non-small cell lung cancer brain metastases. J Oncol Pharm Pract 2018; 25:623-637. [PMID: 30176786 DOI: 10.1177/1078155218796695] [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] [Indexed: 12/25/2022]
Abstract
The brain is a common metastatic site in lung cancer. Approximately one-third of patients will develop brain metastases during the course of their disease. Median overall survival has been reported between 3 and 14.8 months in patients with brain metastases compared to other metastatic sites. In addition, the lifetime incidence of brain metastases is increasing due to prolonged survival seen in non-small cell lung cancer (NSCLC) patients due to new systemic therapies and improved neuro-imaging techniques. Several targeted therapies-such as tyrosine kinase inhibitors targeting epidermal growth factor receptors and anaplastic lymphoma kinase-are active in NSCLC and have data to suggested possible effectiveness against brain metastases in these patients.
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Affiliation(s)
- Christan M Thomas
- 1 Hematology/Oncology, NewYork-Presbyterian Hospital, Columbia University, New York, USA
| | - Chung-Shien Lee
- 2 Department of Clinical Health Professions, College of Pharmacy and Health Sciences, St. John's University, New York, USA
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23
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Abstract
Leptomeningeal metastasis (LM) results from dissemination of cancer cells to both the leptomeninges (pia and arachnoid) and cerebrospinal fluid (CSF) compartment. Breast cancer, lung cancer, and melanoma are the most common solid tumors that cause LM. Recent approval of more active anticancer therapies has resulted in improvement in survival that is partly responsible for an increased incidence of LM. Neurologic deficits, once manifest, are mostly irreversible, and often have a significant impact on patient quality of life. LM-directed therapy is based on symptom palliation, circumscribed use of neurosurgery, limited field radiotherapy, intra-CSF and systemic therapies. Novel methods of detecting LM include detection of CSF circulating tumor cells and tumor cell-free DNA. A recent international guideline for a standardization of response assessment in LM may improve cross-trial comparisons as well as within-trial evaluation of treatment. An increasing number of retrospective studies suggest that molecular-targeted therapy, such as EGFR and ALK inhibitors in lung cancer, trastuzumab in HER2+ breast cancer, and BRAF inhibitors in melanoma, may be effective as part of the multidisciplinary management of LM. Prospective randomized trials with standardized response assessment are needed to further validate these preliminary findings.
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Kelly WJ, Shah NJ, Subramaniam DS. Management of Brain Metastases in Epidermal Growth Factor Receptor Mutant Non-Small-Cell Lung Cancer. Front Oncol 2018; 8:208. [PMID: 30018881 PMCID: PMC6037690 DOI: 10.3389/fonc.2018.00208] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/22/2018] [Indexed: 01/26/2023] Open
Abstract
Lung cancer remains a leading cause of mortality with 1.69 million deaths worldwide. Activating mutations in epidermal growth factor receptor (EGFR), predominantly exon 19 deletions and exon 21 L858R mutations, are known oncogenic drivers identified in 20-40% of non-small-cell lung cancers (NSCLC). 70% of EGFR-mutant NSCLC patients develop brain metastases (BM), compared to 38% in EGFR wild-type patients. First-generation tyrosine kinase inhibitors (TKIs), such as erlotinib and gefitinib have proven to be superior to chemotherapy in the front-line treatment of EGFR-mutant NSCLC, as has afatinib, a second-generation TKI. The most common acquired resistance mechanism is the development of a gatekeeper mutation in exon 20 T790M. Osimertinib has emerged as a third-generation EGFR TKI with proven activity in the front-line setting as well as in patients with a T790M acquired resistance mutation with remarkable CNS activity. As long-term survival outcomes in EGFR-mutant NSCLC continue to improve, the burden of BM becomes a greater challenge. Here, we review the literature related to the management of BM in EGFR-mutant NSCLC including the role of the three generations of EGFR TKIs, immunotherapy, and brain radiation.
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Affiliation(s)
| | | | - Deepa S. Subramaniam
- Division of Hematology-Oncology, Georgetown University, Washington, DC, United States
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25
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Hochmair M. Medical Treatment Options for Patients with Epidermal Growth Factor Receptor Mutation-Positive Non-Small Cell Lung Cancer Suffering from Brain Metastases and/or Leptomeningeal Disease. Target Oncol 2018; 13:269-285. [PMID: 29700687 PMCID: PMC6004273 DOI: 10.1007/s11523-018-0566-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Brain metastases and/or leptomeningeal disease (LMD) with associated central nervous system (CNS) metastases are known complications of advanced epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC). It is important, therefore, to assess the activity of EGFR tyrosine kinase inhibitors (TKIs) versus such CNS complications. This review explores the literature reporting the intracranial activity of EGFR TKIs, and finds that there is evidence for varying efficacy of the approved agents, erlotinib, gefitinib, afatinib, and osimertinib in patients with CNS metastases. Other EGFR TKIs in development, such as AZD3759, may have a future role as therapeutic options in this setting. Emerging evidence indicates that the second- and third-generation EGFR TKIs, afatinib and osimertinib, effectively penetrate the blood-brain barrier, and therefore represent viable treatment options for CNS lesions, and can reduce the risk of CNS progression. These agents should therefore be considered as first-line treatment options in patients with EGFR mutation-positive NSCLC who have brain metastases and/or LMD. While there are currently no prospective data comparing the intracranial efficacy of second- and third-generation EGFR TKIs in this setting, CNS activity and protection offered by different EGFR TKIs should be an additional consideration when making decisions about the optimal sequence of treatment with EGFR TKIs in order to maximize survival benefit in individual patients.
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Affiliation(s)
- Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
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26
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Khandekar MJ, Piotrowska Z, Willers H, Sequist LV. Role of Epidermal Growth Factor Receptor (EGFR) Inhibitors and Radiation in the Management of Brain Metastases from EGFR Mutant Lung Cancers. Oncologist 2018; 23:1054-1062. [PMID: 29703765 DOI: 10.1634/theoncologist.2017-0557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/06/2018] [Indexed: 12/19/2022] Open
Abstract
The growth of genotype-directed targeted therapies, such as inhibitors of the epidermal growth factor receptor (EGFR), has revolutionized treatment for some patients with oncogene-addicted lung cancer. However, as systemic control for these patients has improved, brain metastases remain an important source of morbidity and mortality. Traditional treatment for brain metastases has been radiotherapy, either whole-brain radiation or stereotactic radiosurgery. The growing availability of drugs that can cross the blood-brain barrier and have activity in the central nervous system (CNS) has led to many studies investigating whether targeted therapy can be used in combination with or in lieu of radiation. In this review, we summarize the key literature about the incidence and nature of EGFR-mutant brain metastases (EGFR BMs), the data about the activity of EGFR inhibitors in the CNS, and whether they can be used as front-line therapy for brain metastases. Although initial use of tyrosine kinase inhibitors for EGFR BMs can often be an effective treatment strategy, multidisciplinary evaluation is critical, and prospective studies are needed to clarify which patients may benefit from early radiotherapy. IMPLICATIONS FOR PRACTICE Management of brain metastases in epidermal growth factor receptor (EGFR) mutant lung cancer is a common clinical problem. The question of whether to start initial therapy with an EGFR inhibitor or radiotherapy (either whole-brain radiotherapy or stereotactic radiosurgery) is controversial. The development of novel EGFR inhibitors with enhanced central nervous system (CNS) penetration is an important advance in the treatment of CNS disease. Multidisciplinary evaluation and evaluation of extracranial disease status are critical to choosing the best treatment option for each patient.
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Affiliation(s)
- Melin J Khandekar
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Zofia Piotrowska
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lecia V Sequist
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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27
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Tan J, Li M, Zhong W, Hu C, Gu Q, Xie Y. Tyrosine kinase inhibitors show different anti-brain metastases efficacy in NSCLC: A direct comparative analysis of icotinib, gefitinib, and erlotinib in a nude mouse model. Oncotarget 2017; 8:98771-98781. [PMID: 29228726 PMCID: PMC5716766 DOI: 10.18632/oncotarget.21936] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/26/2017] [Indexed: 12/27/2022] Open
Abstract
Brain metastasis is an increasing problem in non-small cell lung cancer (NSCLC) patients. Tyrosine kinase inhibitors (TKIs), including gefitinib, erlotinib, and icotinib, are reported to be effective in patients with brain metastases. However, direct comparative studies of the pharmacokinetics and efficacy of these three drugs in treating brain metastases are lacking. In the present investigation, we found that gefitinib penetrated the blood-tumor barrier and was distributed to brain metastases more effectively than erlotinib or icotinib in a nude mouse model. The 1-h ratio of brain metastases to plasma concentration for gefitinib, erlotinib, and icotinib was 9.82±1.03%, 4.83±0.25%, and 2.62±0.21%, respectively. The 2-h ratio of brain metastases to plasma concentration for gefitinib, erlotinib, and icotinib was 15.11±2.00%, 5.73±1.31%, and 2.69±0.31%, respectively. Gefitinib exhibited the strongest antitumor activity (pgefitinib vs. erlotinib=0.005; pgefitinib vs. icotinib=0.002). Notably, erlotinib exhibited a better treatment efficacy than icotinib (p=0.037). Consistently, immunohistochemical data showed that TKIs differentially inhibit the proliferation of metastatical tumor cells. Gefitinib and erlotinib markedly inhibited the proliferation of tumor cells, while there were more ki-67-positive tumor cells in the icotinib group. Additionally, gefitinib inhibited the phosphorylation of EGFR better than the other drugs, whereas pEGFR expression levels in erlotinib groups were lower than levels in the icotinib group (pgefitinib vs. erlotinib=0.995; pgefitinib vs. icotinib=0.028; perlotinib vs. icotinib=0.042).Altogether, our findings suggest that gefitinib and erlotinib can inhibit the growth of PC-9-luc brain tumors. Gefitinib demonstrated better antitumor activity and penetration rate in brain metastases than erlotinib or icotinib.
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Affiliation(s)
- Jianlong Tan
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Wen Zhong
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Yali Xie
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
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28
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Goto Y, Tanai C, Yoh K, Hosomi Y, Sakai H, Kato T, Kaburagi T, Nishio M, Kim YH, Inoue A, Hasegawa Y, Isobe H, Tomizawa Y, Mori Y, Minato K, Yamada K, Ohashi Y, Kunitoh H. Continuing EGFR-TKI beyond radiological progression in patients with advanced or recurrent, EGFR mutation-positive non-small-cell lung cancer: an observational study. ESMO Open 2017; 2:e000214. [PMID: 29018574 PMCID: PMC5604715 DOI: 10.1136/esmoopen-2017-000214] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/20/2017] [Accepted: 07/16/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Some patients with advanced or recurrent, epidermal growth factor receptor (EGFR) mutation-positive (EGFR M+) non-small-cell lung cancer (NSCLC) continue to receive EGFR tyrosine kinase inhibitors (TKIs) beyond radiological progression. METHODS We analysed a cohort of 577 patients with EGFR M+ NSCLC, who had received a first-line EGFR-TKI. We classified patients according to clinical course and treatment patterns at Response Evaluation Criteria in Solid Tumors (RECIST) progressive disease (PD). We evaluated the period from RECIST PD to TKI discontinuation or clinical PD and also evaluated survival after RECIST PD and compared it between groups. RESULTS RECIST PD was documented in 451 cases, of which 283 (62.7%) were clinically stable. 186 (65.7%) discontinued and 97 (34.3%) continued the EGFR-TKI. In those who continued EGFR-TKI, median time between RECIST PD and clinical PD or TKI discontinuation was 5.1 months. Median survival after RECIST PD in patients who discontinued and continued EGFR-TKI after clinically stable RECIST PD was 14.6 and 15.3 months (p=0.5489), respectively. In multivariate analysis, continuing EGFR-TKI therapy, female gender, better performance status and exon 19 deletion subtype were likely positive predictive factors for survival after clinically stable RECIST PD. CONCLUSION Our study suggests that some patients could benefit from receiving an EGFR-TKI beyond radiological progression.
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Affiliation(s)
- Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Chiharu Tanai
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kiyotaka Yoh
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroshi Sakai
- Department of Thoracic Oncology, Saitama Cancer Center, Saitama, Japan
| | - Terufumi Kato
- Department of Respiratory Medicine, Kanagawa Cancer Center, Yokohama, Japan
| | - Takayuki Kaburagi
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Isobe
- Department of Medical Oncology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Yoshio Tomizawa
- Department of Respiratory Medicine, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Yoshiaki Mori
- Department of Respiratory Medicine, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Koichi Minato
- Department of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Kazuhiko Yamada
- Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
| | - Hideo Kunitoh
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
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29
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McGranahan T, Nagpal S. A Neuro-oncologist's Perspective on Management of Brain Metastases in Patients with EGFR Mutant Non-small Cell Lung Cancer. Curr Treat Options Oncol 2017; 18:22. [PMID: 28391420 PMCID: PMC5385200 DOI: 10.1007/s11864-017-0466-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of non-small cell lung cancer (NSCLC) with brain metastasis (BrM) has been revolutionized by identification of molecular subsets that have targetable oncogenes. Historically, survival for NSCLC with symptomatic BrM was weeks to months. Now, many patients are surviving years with limited data to guide treatment decisions. Tumors with activating mutations in epidermal growth factor receptor (EGFRact+) have a higher incidence of BrM, but a longer overall survival. The high response rate of both systemic and BrM EGFRact+ NSCLC to tyrosine kinase inhibitors (TKIs) has led to the rapid incorporation of new therapies but is outpacing evidence-based decisions for BrM in NSCLC. While whole brain radiation therapy (WBRT) was the foundation of management of BrM, extended survival raises concerns for the subacute and late effects radiotherapy. We favor the use of TKIs and delaying the use of WBRT when able. At inevitable disease progression, we consider alternative dosing schedules to increase CNS penetration (such as pulse dosing of erlotinib) or advance to next generation TKI if available. We utilize local control options of surgery or stereotactic radiosurgery (SRS) for symptomatic accessible lesions based on size and edema. At progression despite available TKIs, we use pemetrexed-based platinum doublet chemotherapy or immunotherapy if the tumor has high expression of PDL-1. We reserve the use of WBRT for patients with more than 10 BrM and progression despite TKI and conventional chemotherapy, if performance status is appropriate.
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Affiliation(s)
- Tresa McGranahan
- Department of Neurology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
| | - Seema Nagpal
- Department of Neurology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
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30
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Kashima J, Okuma Y, Miwa M, Hosomi Y. Retrospective analysis of survival in patients with leptomeningeal carcinomatosis from lung adenocarcinoma treated with erlotinib and gefitinib. Jpn J Clin Oncol 2017; 47:357-362. [PMID: 28064206 DOI: 10.1093/jjco/hyw206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
Abstract
Background Leptomeningeal carcinomatosis is a relatively rare metastatic form of non-small cell lung cancer, which can impact prognosis. There is an increasing need for selecting suitable epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors among those currently included in standard care for EGFR mutation-positive patients. We compared the efficacy of gefitinib and erlotinib in survival of patients with leptomeningeal carcinomatosis. Patients and methods The medical records of 269 patients who received tyrosine kinase inhibitors at a single center were retrospectively reviewed. Overall, 22 patients (8.2%) were treated with tyrosine kinase inhibitors for leptomeningeal carcinomatosis from non-small cell lung cancer with EGFR mutation between 2006 and 2016. Time to death from leptomeningeal carcinomatosis diagnosis was compared between the gefitinib and erlotinib groups. Results Gefitinib and erlotinib were administrated to 5 and 17 patients, respectively. Median progression-free survival was longer in the erlotinib group than in the gefitinib group (6.60 vs 2.12 months, P = 0.07). Overall survival was more than twice as long in the erlotinib arm compared with that in the gefitinib arm (7.20 vs 2.99 months, P = 0.32). Response in patients with exon 19 deletion was better than in those with exon 21 mutation (overall survival, 7.20 and 5.62 months, respectively, P = 0.12). Conclusions Erlotinib seemed more effective than gefitinib in prolonging survival in leptomeningeal carcinomatosis from EGFR mutation-positive non-small cell lung cancer and may be particularly beneficial in patients with EGFR exon 19 mutations, warranting further studies.
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Affiliation(s)
- Jumpei Kashima
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan.,Division of Oncology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
| | - Maki Miwa
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan
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31
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Kanai O, Kim YH, Nakatani K, Fujita K, Mio T. Nasogastric tube-administered alectinib achieved long-term survival in a crizotinib-refractory nonsmall cell lung cancer patient with a poor performance status. Clin Case Rep 2017; 5:927-930. [PMID: 28588841 PMCID: PMC5458002 DOI: 10.1002/ccr3.973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/08/2017] [Accepted: 03/22/2017] [Indexed: 11/07/2022] Open
Abstract
Alectinib shows remarkable efficacy against anaplastic lymphoma kinase (ALK)-positive nonsmall cell lung cancer (NSCLC), with minimal adverse effects. Therefore, alectinib may provide a survival benefit to ALK-positive NSCLC patients with a poor performance status. If the medication cannot be taken by mouth, the patient may be given alectinib through a nasogastric tube.
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Affiliation(s)
- Osamu Kanai
- Division of Respiratory Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Young Hak Kim
- Department of Respiratory Medicine Graduate School of Medicine Kyoto University Kyoto Japan
| | - Koichi Nakatani
- Division of Respiratory Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kohei Fujita
- Division of Respiratory Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Tadashi Mio
- Division of Respiratory Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
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32
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Sakai H, Hayashi H, Iwasa T, Hasegawa Y, Takeda M, Nakagawa K. Successful osimertinib treatment for leptomeningeal carcinomatosis from lung adenocarcinoma with the T790M mutation of EGFR. ESMO Open 2017; 2:e000104. [PMID: 28848674 PMCID: PMC5559906 DOI: 10.1136/esmoopen-2016-000104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 11/12/2022] Open
Abstract
Osimertinib is a third-generation tyrosine kinase inhibitor (TKI) of the epidermal growth factor receptor (EGFR) that has been approved for the treatment of metastatic non-small cell lung cancer (NSCLC) positive for the secondary T790M mutation of EGFR. In a preclinical study, it also showed efficacy against leptomeningeal carcinomatosis (LMC) derived from NSCLC resistant to first-generation and second-generation EGFR-TKIs. We now report the case of a patient aged 70 years with symptomatic LMC derived from NSCLC with the T790M mutation of EGFR who showed a clinical and radiographic response to osimertinib.
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Affiliation(s)
- Hitomi Sakai
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama,Japan
| | - Hidetoshi Hayashi
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama,Japan.
| | - Tsutomu Iwasa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama,Japan
| | | | - Masayuki Takeda
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama,Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama,Japan
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Tsakonas G, De Petris L, Ekman S. Management of brain metastasized non-small cell lung cancer (NSCLC) – From local treatment to new systemic therapies. Cancer Treat Rev 2017; 54:122-131. [DOI: 10.1016/j.ctrv.2017.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/31/2017] [Accepted: 02/07/2017] [Indexed: 01/24/2023]
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How J, Mann J, Laczniak AN, Baggstrom MQ. Pulsatile Erlotinib in EGFR-Positive Non-Small-Cell Lung Cancer Patients With Leptomeningeal and Brain Metastases: Review of the Literature. Clin Lung Cancer 2017; 18:354-363. [PMID: 28245967 DOI: 10.1016/j.cllc.2017.01.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/24/2017] [Accepted: 01/31/2017] [Indexed: 02/08/2023]
Abstract
Patients with epidermal growth factor receptor (EGFR)-positive (EGFR+) non-small-cell lung cancer (NSCLC) show improved response rates when treated with tyrosine kinase inhibitors (TKIs) such as erlotinib. However, standard daily dosing of erlotinib often does not reach therapeutic concentrations within the cerebrospinal fluid (CSF), resulting in progression of central nervous system (CNS) disease. Intermittent, high-dose administration of erlotinib reaches therapeutic concentrations within the CSF and is well tolerated in patients. Experience with "pulsatile" dosing, however, is limited. We review the literature on the pharmacology and clinical outcomes of pulsatile erlotinib in the treatment of EGFR+ NSCLC with brain and leptomeningeal metastases, and include available data on the use of next-generation TKIs in CNS progression. We also provide our institution's experience with patients treated with pulsatile erlotinib for CNS metastasis, and propose clinical criteria for its use. Pulsatile erlotinib is a reasonable alternative in EGFR+ patients with new or worsening CNS disease, without evidence of systemic progression, and without confirmed T790M resistance mutations within the CNS.
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Affiliation(s)
- Joan How
- Barnes-Jewish Hospital, St Louis, MO
| | - Janelle Mann
- Mallinckrodt Institute of Radiology at Washington University, St Louis, MO
| | - Andrew N Laczniak
- Division of Pharmacology, Washington University School of Medicine, St Louis, MO
| | - Maria Q Baggstrom
- Division of Oncology, Washington University School of Medicine, St Louis, MO.
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35
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Takagaki M, Kinoshita M, Nishino K, Nakano M, Adachi H, Ueno M, Kitamura M, Fujimoto Y, Tashiro K, Tomita Y, Imamura F, Yoshimine T. Downregulation of EGFR in a metastatic brain lesion of EGFR-mutated non-small cell lung cancer using a tyrosine kinase inhibitor: A case report. Oncol Lett 2017; 13:2085-2088. [PMID: 28454365 PMCID: PMC5403179 DOI: 10.3892/ol.2017.5677] [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: 05/22/2016] [Accepted: 11/25/2016] [Indexed: 12/17/2022] Open
Abstract
Brain metastasis is a common complication in patients with cancer, with lung cancer being the most frequent origin of brain metastases. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have begun to serve a pivotal role in lung cancer treatment and have been reported to demonstrate anticancer activity against brain metastases by penetrating the blood-brain barrier. The present study reports, to the best of our knowledge, the first case of EGFR-mutated non-small cell lung cancer (NSCLC) brain metastasis that was surgically resected while the lesion was responding to the EGFR-TKI erlotinib. The results of the present study demonstrated that EGFR-mutated NSCLC cells were able to evade the cytotoxic effect of EGFR-TKI by downregulating EGFR expression, without exhibiting the T790M EGFR mutation.
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Affiliation(s)
- Masatoshi Takagaki
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Masakazu Nakano
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto 606-8507, Japan
| | - Hiroko Adachi
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto 606-8507, Japan
| | - Morio Ueno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 606-8507, Japan
| | - Masanori Kitamura
- Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Yasunori Fujimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Kei Tashiro
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto 606-8507, Japan
| | - Yasuhiko Tomita
- Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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36
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Koba T, Kijima T, Takimoto T, Hirata H, Naito Y, Hamaguchi M, Otsuka T, Kuroyama M, Nagatomo I, Takeda Y, Kida H, Kumanogoh A. Rapid intracranial response to osimertinib, without radiotherapy, in nonsmall cell lung cancer patients harboring the EGFR T790M mutation: Two Case Reports. Medicine (Baltimore) 2017; 96:e6087. [PMID: 28178168 PMCID: PMC5313025 DOI: 10.1097/md.0000000000006087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Most of nonsmall cell lung cancer (NSCLC) patients harboring epidermal growth factor receptor (EGFR) activating mutations eventually acquire resistance to the first EGFR-tyrosine kinase inhibitors (TKIs) therapy after varying periods of treatment. Of note, approximately one-third of those patients develop brain metastases, which deteriorate their quality of life and survival. The effect of systemic chemotherapy on brain metastases after acquisition of EGFR-TKI resistance is limited, and thus far, whole-brain radiation therapy, which may cause the harmful effect on neurocognitive functions, has been the only established therapeutic option for especially symptomatic brain metastases. Osimertinib is a third-generation oral, potent, and irreversible EGFR-TKI. It can bind to EGFRs with high affinity even when the EGFR T790M mutation exists in addition to the sensitizing mutations. Its clinical efficacy for NSCLC patients harboring the T790M mutation has already been shown; however, the evidence of osimertinib on brain metastases has not been documented well, especially in terms of the appropriate timing for treatment and its response evaluation. PATIENT CONCERNS, DIAGNOSES, AND INTERVENTIONS We experienced 2 NSCLC patients with the EGFR T790M mutation; a 67-year-old woman with symptomatic multiple brain metastases administered osimertinib as seventh-line chemotherapy, and a 76-year old man with an asymptomatic single brain metastasis administered osimertinib as fifth-line chemotherapy. OUTCOMES These patients showed great response to osimertinib within 2 weeks without radiation therapy. LESSONS These are the first reports to reveal the rapid response of the brain metastases to osimertinib within 2 weeks. These cases suggest the possibility that preemptive administration of osimertinib may help patients to postpone or avoid radiation exposures. In addition, rapid reassessment of the effect of osimertinib on brain metastases could prevent patients from being too late to receive essential radiotherapy.
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Affiliation(s)
- Taro Koba
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Takashi Kijima
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
- Department of Immunopathology, Immunology Frontier Research Center, Osaka University, Japan
| | - Takayuki Takimoto
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Haruhiko Hirata
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Yujiro Naito
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Masanari Hamaguchi
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Tomoyuki Otsuka
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Muneyoshi Kuroyama
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Izumi Nagatomo
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Yoshito Takeda
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Hiroshi Kida
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine
- Department of Immunopathology, Immunology Frontier Research Center, Osaka University, Japan
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Thomas KH, Ramirez RA. Leptomeningeal Disease and the Evolving Role of Molecular Targeted Therapy and Immunotherapy. Ochsner J 2017; 17:362-378. [PMID: 29230121 PMCID: PMC5718449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Leptomeningeal disease (LMD) is a complication that results from solid tumor metastasis. Prognosis is extremely poor. As therapeutic options for solid tumors improve, the rate of LMD continues to increase. Until recently, treatment has been limited to radiation therapy, intrathecal chemotherapy, and systemic chemotherapy, with an overall survival of 2-3 months. Targeted molecular therapy and immunotherapies are promising new options for increasing overall survival and clinical improvement; however, optimal clinical management remains unknown. METHODS In this review, we discuss targeted molecular therapy and immunotherapy treatment options for LMD resulting from primary lung, breast, and melanoma tumors. In addition, we summarize dosing strategies, overall survival, clinical outcomes, and novel approaches to treatment. RESULTS Our review indicates a deficiency in the current literature. Presently, intrathecal trastuzumab administration may be an effective option for patients with HER2-positive breast cancer. BRAF inhibitors and cytotoxic T lymphocyte-associated antigen-4 targets have shown promising results in LMD resulting from melanoma. Finally, tyrosine kinase inhibitors may increase overall survival in epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer. Pulsatile drug administration or dual therapy may be beneficial for patients who progress to LMD while being treated with EGFR targets for their primary malignancy. CONCLUSION Targeted molecular therapy and immunotherapy in LMD may provide favorable treatment options. Current literature is lacking in safety, efficacy, and overall response rates from the use of targeted therapy. Research is needed to draw significant conclusions about the most appropriate therapy for patients with LMD.
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Affiliation(s)
- Katharine Hall Thomas
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Robert A. Ramirez
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
- Department of Hematology and Oncology, Ochsner Clinic Foundation, New Orleans, LA
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Chamberlain MC, Baik CS, Gadi VK, Bhatia S, Chow LQM. Systemic therapy of brain metastases: non-small cell lung cancer, breast cancer, and melanoma. Neuro Oncol 2017; 19:i1-i24. [PMID: 28031389 PMCID: PMC5193029 DOI: 10.1093/neuonc/now197] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Brain metastases (BM) occur frequently in many cancers, particularly non-small cell lung cancer (NSCLC), breast cancer, and melanoma. The development of BM is associated with poor prognosis and has an adverse impact on survival and quality of life. Commonly used therapies for BM such as surgery or radiotherapy are associated with only modest benefits. However, recent advances in systemic therapy of many cancers have generated considerable interest in exploration of those therapies for treatment of intracranial metastases.This review discusses the epidemiology of BM from the aforementioned primary tumors and the challenges of using systemic therapies for metastatic disease located within the central nervous system. Cumulative data from several retrospective and small prospective studies suggest that molecularly targeted systemic therapies may be an effective option for the treatment of BM from NSCLC, breast cancer, and melanoma, either as monotherapy or in conjunction with other therapies. Larger prospective studies are warranted to further characterize the efficacy and safety profiles of these targeted agents for the treatment of BM.
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Affiliation(s)
- Marc C Chamberlain
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
| | - Christina S Baik
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
| | - Vijayakrishna K Gadi
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
| | - Shailender Bhatia
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
| | - Laura Q M Chow
- Seattle Cancer Center Alliance, Seattle, Washington (M.C.C., C.S.B., V.K.G., S.B., L.Q.M.C.); Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (C.S.B., V.K.G., L.Q.M.C.); Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington (M.C.C.); Division of Medical Oncology, University of Washington, Seattle, Washington (C.S.B., V.K.G., S.B., L.Q.M.C)
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Kawaguchi Y, Hanaoka J, Hayashi H, Mizusaki N, Iihara H, Itoh Y, Sugiyama T. Clinical Efficacy of Afatinib Treatment for a Patient with Leptomeningeal Carcinomatosis. Chemotherapy 2016; 62:147-150. [PMID: 28030859 DOI: 10.1159/000454727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
Abstract
Leptomeningeal metastases occur in 1% of patients with non-small-cell lung cancer. There have been several reports on the treatment of leptomeningeal metastases with afatinib. Our patient was a 41-year-old woman who had never smoked and was diagnosed with stage IV adenocarcinoma of the lung with an epidermal growth factor receptor (EGFR) mutation. She was treated with afatinib for the recurrence of leptomeningeal metastases. After the treatment with afatinib was initiated, the neurological symptoms dramatically regressed, and she achieved progression-free survival for 7 months. The concentration of afatinib in the cerebrospinal fluid (CSF) ranged from 0.05 to 0.14 ng/mL, and the penetration rate of afatinib from the plasma to the CSF ranged from 0.28 to 0.40%. This concentration might be sufficient to achieve a clinical effect for leptomeningeal carcinomatosis. Therefore, afatinib administered at the usual doses may be an effective treatment for leptomeningeal carcinomatosis of EGFR-mutated or EGFR-tyrosine kinase inhibitor-sensitive lung adenocarcinoma.
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Affiliation(s)
- Yo Kawaguchi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu City, Japan
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40
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Proto C, Imbimbo M, Gallucci R, Brissa A, Signorelli D, Vitali M, Macerelli M, Corrao G, Ganzinelli M, Greco FG, Garassino MC, Lo Russo G. Epidermal growth factor receptor tyrosine kinase inhibitors for the treatment of central nervous system metastases from non-small cell lung cancer: the present and the future. Transl Lung Cancer Res 2016; 5:563-578. [PMID: 28149752 DOI: 10.21037/tlcr.2016.10.16] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lung cancer is one of the major causes of cancer related mortality worldwide. Brain metastases (BM) complicate clinical evolution of non-small cell lung cancer (NSCLC) in approximately 25-40% of cases, adversely influencing quality of life (QoL) and overall survival (OS). Systemic therapy remains the standard strategy for metastatic disease. Nevertheless, the blood-brain barrier (BBB) makes central nervous system (CNS) a sanctuary site. To date, the combination of chemotherapy with whole brain radiation therapy (WBRT), surgery and/or stereotactic radiosurgery (SRS) represents the most used treatment for patients (pts) with intracranial involvement. However, due to their clinical conditions, many pts are not able to undergo local treatments. Targeted therapies directed against epidermal growth factor receptor (EGFR), such as gefitinib, erlotinib and afatinib, achieved important improvements in EGFR mutated NSCLC with favorable toxicity profile. Although their role is not well defined, the reported objective response rate (ORR) and the good tolerance make EGFR-tyrosine kinase inhibitors (TKIs) an interesting valid alternative for NSCLC pts with BM, especially for those harboring EGFR mutations. Furthermore, new-generation TKIs, such as osimertinib and rociletinib, have already shown important activity on intracranial disease and several trials are still ongoing to evaluate their efficacy. In this review we want to highlight literature data about the use and the effectiveness of EGFR-TKIs in pts with BM from NSCLC.
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Affiliation(s)
- Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Martina Imbimbo
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Rosaria Gallucci
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Angela Brissa
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Milena Vitali
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Marianna Macerelli
- Department of Medical Oncology, University-Hospital of Santa Maria delle Grazie, Udine, Italy
| | - Giulia Corrao
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
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Yap TA, Macklin-Doherty A, Popat S. Continuing EGFR inhibition beyond progression in advanced non-small cell lung cancer. Eur J Cancer 2016; 70:12-21. [PMID: 27866095 DOI: 10.1016/j.ejca.2016.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/29/2016] [Accepted: 10/18/2016] [Indexed: 01/31/2023]
Abstract
The majority of patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) respond to first-line EGFR tyrosine kinase inhibitors (TKIs), but nearly all inevitably acquire resistance and develop disease progression. Conventional practice would be to switch treatments to second-line therapy. However, continuing TKIs beyond progression is becoming increasingly commonplace in patients with indolent, small volume asymptomatic growth, who may potentially continue to derive ongoing clinical benefit and to avoid a 'withdrawal tumour flare'. Nevertheless, there are limitations to our current criteria for assessing disease response, which are based on radiological assessments without considering symptomatic benefit, or the complex molecular and clinical heterogeneity of tumour growth and drug response patterns. In this article, we review the rationale for continuing EGFR inhibitors in patients with EGFR mutant NSCLC beyond disease progression and discuss strategies that have been pursued in the context of molecularly and clinically heterogeneous populations of tumour growth depending on the different clinical scenarios encountered. We discuss the management of systemic disease progression, including continuing EGFR TKIs alone, introducing a drug holiday, or combining TKIs with chemotherapy or other molecularly targeted agents. We also focus on approaches in managing patients with indolent, small volume asymptomatic growth (non-CNS oligometastatic disease progression) and those with oligometastatic EGFR mutant NSCLC with involvement of the central nervous system. We envision future precision medicine strategies through the use of next generation sequencing strategies of serial tumour rebiopsies and circulating plasma DNA to individualise the management for such patients during disease progression.
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Affiliation(s)
- Timothy A Yap
- Department of Medicine, Royal Marsden Hospital, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | | | - Sanjay Popat
- Department of Medicine, Royal Marsden Hospital, London, UK; Section of Genomic Medicine, National Heart and Lung Institute, Imperial College, London, UK.
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EGFR mutation status of paired cerebrospinal fluid and plasma samples in EGFR mutant non-small cell lung cancer with leptomeningeal metastases. Cancer Chemother Pharmacol 2016; 78:1305-1310. [PMID: 27770237 DOI: 10.1007/s00280-016-3155-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Central nervous system (CNS) is the prevalent site for metastases in epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI)-relapsed NSCLC patients. To understand the EGFR mutation status in paired cerebrospinal fluid (CSF) and plasma samples after EGFR-TKI treatment failure might be useful to guide the treatment of intra- and extracranial tumors in those patients. METHODS Paired CSF and plasma samples were collected from seven NSCLC patients with CNS metastases after EGFR-TKI failure. EGFR mutations were tested by amplification refractory mutation system (ARMS) and droplet digital PCR (ddPCR) methods. Gefitinib concentrations were evaluated by high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS). RESULTS EGFR mutations were detected in all seven CSF samples, including three of E19-Del, three of L858R and one of E19-Del&T790M by both methods. On the other hand, majority of the matched plasma samples (5/7) were negative for EGFR mutations by both methods. The other two plasma samples were positive for E19-Del&T790M by ddPCR, and one of them had undetectable T790M by ARMS. Gefitinib concentration in CSF was much lower than that in plasma (mean CSF/plasma ratio: 1.8 %). CONCLUSIONS After EGFR-TKI failure, majority of the NSCLC patients with CNS metastases remained positive detection of EGFR sensitive mutations in CSF, but much less detection in the matched plasma. Significantly low exposure of gefitinib in CSF might explain the intracranial protection of the EGFR sensitive mutation positive tumor cells.
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Survival of patients with brain metastases from non-small cell lung cancer harboring EGFR mutations treated with epidermal growth factor receptor tyrosine kinase inhibitors. Med Oncol 2016; 33:129. [PMID: 27757781 DOI: 10.1007/s12032-016-0843-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
Brain metastases (BM) is one of the most crucial distant metastases in patients with non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. There is no consensus about which EGFR tyrosine kinase inhibitor (TKI) is most effective against BM in such patients. Here, we compared prognoses of patients with EGFR-TKI naïve EGFR-positive BM treated with erlotinib or gefitinib after BM diagnosis. Of 269 patients with NSCLC treated with EGFR-TKIs at a single institution, we reviewed medical records of 205 patients with documented EGFR mutations. Eleven patients were administered erlotinib, and 52 patients were administered gefitinib as the first-line EGFR-TKI treatment after diagnosis. We used propensity score matching to balance patient backgrounds between groups, and the log-rank test to compare survival curves. Patients with BM at the induction of chemotherapy had a poorer prognosis than those without BM [median overall survival (OS) 18.5 vs. 28.0 months]. Meanwhile, there was no significant difference in OS between those with or without BM at the initiation of EGFR-TKI treatment (20.3 vs. 23.8 months). Median OS of patients treated with erlotinib was not significantly longer than that of patients treated with gefitinib (25.0 vs. 18.1 months). The presence of BM at the initiation of EGFR-TKI treatment had no apparent effect on survival. Erlotinib was deemed more effective than gefitinib in preventing intracranial lesions and prolonging survival; however, prospective studies are needed to confirm these results.
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44
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Yufen X, Binbin S, Wenyu C, Jialiang L, Xinmei Y. The role of EGFR-TKI for leptomeningeal metastases from non-small cell lung cancer. SPRINGERPLUS 2016; 5:1244. [PMID: 27536527 PMCID: PMC4972805 DOI: 10.1186/s40064-016-2873-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 07/19/2016] [Indexed: 02/07/2023]
Abstract
Leptomeningeal metastasis (LM) is a terminal event in the development of non-small cell lung cancer (NSCLC). It has a poor prognosis with median survival of 1.9 months if untreated. The improvement of OS in NSCLC patients relatively increases incidence of LM. While current therapeutic options for LM are limited. Epidermal growth factor receptor-tyrosine kinase inhibitors are a class of small molecules and show dramatic response in epidermal growth factor receptor mutated patients. It also has a distinct therapeutic potential against brain metastases. Although there are some studies on EGFR-TKIs and brain metastases, the role of EGFR-TKIs on LM are not fully clarified. In this review, we will summarize current evidences concerning the use and discuss the role of EGFR-TKIs on LM.
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Affiliation(s)
- Xu Yufen
- School of Medicine, Jiaxing University, Jiaxing, 314000 Zhejiang People's Republic of China.,Department of Oncology, The First Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314000 Zhejiang People's Republic of China
| | - Song Binbin
- School of Medicine, Jiaxing University, Jiaxing, 314000 Zhejiang People's Republic of China.,Department of Oncology, The First Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314000 Zhejiang People's Republic of China
| | - Chen Wenyu
- School of Medicine, Jiaxing University, Jiaxing, 314000 Zhejiang People's Republic of China.,Department of Oncology, The First Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314000 Zhejiang People's Republic of China
| | - Liu Jialiang
- School of Medicine, Jiaxing University, Jiaxing, 314000 Zhejiang People's Republic of China.,Department of Oncology, The First Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314000 Zhejiang People's Republic of China
| | - Yang Xinmei
- School of Medicine, Jiaxing University, Jiaxing, 314000 Zhejiang People's Republic of China.,Department of Oncology, The First Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314000 Zhejiang People's Republic of China
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Pentsova EI, Shah RH, Tang J, Boire A, You D, Briggs S, Omuro A, Lin X, Fleisher M, Grommes C, Panageas KS, Meng F, Selcuklu SD, Ogilvie S, Distefano N, Shagabayeva L, Rosenblum M, DeAngelis LM, Viale A, Mellinghoff IK, Berger MF. Evaluating Cancer of the Central Nervous System Through Next-Generation Sequencing of Cerebrospinal Fluid. J Clin Oncol 2016; 34:2404-15. [PMID: 27161972 PMCID: PMC4981784 DOI: 10.1200/jco.2016.66.6487] [Citation(s) in RCA: 281] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Cancer spread to the central nervous system (CNS) often is diagnosed late and is unresponsive to therapy. Mechanisms of tumor dissemination and evolution within the CNS are largely unknown because of limited access to tumor tissue. MATERIALS AND METHODS We sequenced 341 cancer-associated genes in cell-free DNA from cerebrospinal fluid (CSF) obtained through routine lumbar puncture in 53 patients with suspected or known CNS involvement by cancer. RESULTS We detected high-confidence somatic alterations in 63% (20 of 32) of patients with CNS metastases of solid tumors, 50% (six of 12) of patients with primary brain tumors, and 0% (zero of nine) of patients without CNS involvement by cancer. Several patients with tumor progression in the CNS during therapy with inhibitors of oncogenic kinases harbored mutations in the kinase target or kinase bypass pathways. In patients with glioma, the most common malignant primary brain tumor in adults, examination of cell-free DNA uncovered patterns of tumor evolution, including temozolomide-associated mutations. CONCLUSION The study shows that CSF harbors clinically relevant genomic alterations in patients with CNS cancers and should be considered for liquid biopsies to monitor tumor evolution in the CNS.
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Affiliation(s)
- Elena I Pentsova
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Ronak H Shah
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Jiabin Tang
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Adrienne Boire
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Daoqi You
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Samuel Briggs
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Antonio Omuro
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Xuling Lin
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Martin Fleisher
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Christian Grommes
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Katherine S Panageas
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Fanli Meng
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - S Duygu Selcuklu
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Shahiba Ogilvie
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Natalie Distefano
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Larisa Shagabayeva
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Marc Rosenblum
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Lisa M DeAngelis
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Agnes Viale
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
| | - Ingo K Mellinghoff
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY.
| | - Michael F Berger
- Elena I. Pentsova, Ronak H. Shah, Jiabin Tang, Adrienne Boire, Daoqi You, Samuel Briggs, Antonio Omuro, Xuling Lin, Martin Fleisher, Christian Grommes, Katherine S. Panageas, Fanli Meng, S. Duygu Selcuklu, Shahiba Ogilvie, Natalie Distefano, Larisa Shagabayeva, Marc Rosenblum, Lisa M. DeAngelis, Agnes Viale, Ingo K. Mellinghoff, and Michael F. Berger, Memorial Sloan Kettering Cancer Center; Ingo K. Mellinghoff, Weill-Cornell Graduate School of Biomedical Sciences; and Michael F. Berger, Weill-Cornell Medical College, New York, NY
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Califano R, Romanidou O, Mountzios G, Landi L, Cappuzzo F, Blackhall F. Management of NSCLC Disease Progression After First-Line EGFR Tyrosine Kinase Inhibitors: What Are the Issues and Potential Therapies? Drugs 2016; 76:831-40. [PMID: 27129321 DOI: 10.1007/s40265-016-0578-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) represent the standard of care for advanced non-small cell lung cancer (NSCLC) patients whose tumor harbors an activating EGFR mutation. The vast majority of patients will experience disease control with an EGFR-TKI but inevitably all patients will progress, often within a year of treatment. There is no current standard of care for this scenario but, in clinical practice, most of the patients will be offered platinum-based doublet chemotherapy. In some situations, continuation of the EGFR-TKI beyond radiological progression, with or without use of local treatments in case of oligo-progressive disease, represents a reasonable therapeutic option. The aim of this review is to describe the different treatment strategies that have been developed to tackle progression on EGFR-TKIs, including specific clinical scenarios and novel agents designed to tackle the common T790M resistance mutation.
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Affiliation(s)
- Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.
- Department of Medical Oncology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
| | - Ourania Romanidou
- Medical Oncology Unit, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Giannis Mountzios
- Department of Medical Oncology, University of Athens School of Medicine, Athens, Greece
| | - Lorenza Landi
- Istituto Toscano Tumori, Ospedale Civile di Livorno,, Leghorn, Italy
| | - Federico Cappuzzo
- Istituto Toscano Tumori, Ospedale Civile di Livorno,, Leghorn, Italy
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
- University of Manchester, Manchester, UK
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47
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Couñago F, Rodríguez A, Calvo P, Luna J, Monroy JL, Taboada B, Díaz V, Rodríguez de Dios N. Targeted therapy combined with radiotherapy in non-small-cell lung cancer: a review of the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society). Clin Transl Oncol 2016; 19:31-43. [PMID: 27106020 DOI: 10.1007/s12094-016-1512-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/09/2016] [Indexed: 02/06/2023]
Abstract
In recent years, major advances in our understanding of the molecular biology of lung cancer, together with significant improvements in radiotherapy technologies, have revolutionized the treatment of non-small cell lung cancer (NSCLC). This has led to the development of new therapies that target molecular mutations specific to each tumor type, acting on the cell surface antigens or intracellular signaling pathways, or directly affecting cell survival. At the same time, ablative dose radiotherapy can be delivered safely in the context of metastatic disease. In this article, the GOECP/SEOR (Oncological Group for Study of Lung Cancer/Spanish Society of Radiation Oncology) reviews the role of new targeted therapies used in combination with radiotherapy in patients with locally advanced (stage III) NSCLC and in patients with advanced, metastatic (stage IV) NSCLC.
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Affiliation(s)
- F Couñago
- Department of Radiation Oncology, Hospital Universitario Quirón, Calle Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - A Rodríguez
- Department of Radiation Oncology, Hospital Ruber Internacional, Calle de la Masó, 38, 28034, Madrid, Spain
| | - P Calvo
- Department of Radiation Oncology, Hospital Universitario Santiago de Compostela, Travesía de Choupana, s/n, 15706, Santiago de Compostela, Spain
| | - J Luna
- Department of Radiation Oncology, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain
| | - J L Monroy
- Department of Radiation Oncology, Hospital Universitario La Ribera, Carretera de Corbera, km 1, 46600, Alzira, Valencia, Spain
| | - B Taboada
- Department of Radiation Oncology, Hospital Universitario Santiago de Compostela, Travesía de Choupana, s/n, 15706, Santiago de Compostela, Spain
| | - V Díaz
- Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cádiz, Spain
| | - N Rodríguez de Dios
- Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, Barcelona, Spain. .,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,Universitat Pompeu Fabra, San josé de la Montaña 12, 08024, Barcelona, Spain.
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48
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He Y, Sun W, Wang Y, Ren S, Li X, Li J, Rivard CJ, Zhou C, Hirsch FR. Comparison of erlotinib and pemetrexed as second-/third-line treatment for lung adenocarcinoma patients with asymptomatic brain metastases. Onco Targets Ther 2016; 9:2409-14. [PMID: 27143936 PMCID: PMC4844452 DOI: 10.2147/ott.s102236] [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: 11/23/2022] Open
Abstract
Objective Brain metastases occur in one-third of all non-small-cell lung cancer patients. Due to restrictive transport at the blood–brain barrier, many drugs provide poor control of metastases in the brain. The aim of this study was to compare erlotinib with pemetrexed as second-/third-line treatment in patients with lung adenocarcinoma with asymptomatic brain metastases. Methods From January 2012 to June 2014, all lung adenocarcinoma patients with asymptomatic brain metastases who received treatment with erlotinib or pemetrexed as second-/third-line treatment were retrospectively reviewed. Chi-square and log-rank tests were used to perform statistical analysis. Results The study enrolled 99 patients, of which 44 were positive for EGFR mutation. Median progression-free survival (PFS) in months was not significantly different between the erlotinib- and pemetrexed-treated groups (4.2 vs 3.4 months; 95% confidence interval [CI]: 2.01–6.40 vs 2.80–5.00, respectively; P=0.635). Median PFS was found to be significantly longer in EGFR mutation–positive patients in the erlotinib-treated group (8.0 months; 95% CI 5.85–10.15) compared to the pemetrexed group (3.9 months; 95% CI: 1.25–6.55; P=0.032). The most common treatment-related side effect was mild-to-moderate rash and the most common drug-related side effects in the pemetrexed-group were vomiting and nausea. Conclusion Erlotinib and pemetrexed may be used as second-/third-line treatment in lung adenocarcinoma patients with asymptomatic brain metastases, and detection of EGFR mutation status is very important in these patients. EGFR mutation–positive lung adenocarcinoma patients with asymptomatic brain metastases showed longer PFS when treated with erlotinib as opposed to pemetrexed.
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Affiliation(s)
- Yayi He
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Wenwen Sun
- Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yan Wang
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Shengxiang Ren
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jiayu Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Christopher J Rivard
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Fred R Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO, USA
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Sasaki S, Yoshioka Y, Ko R, Katsura Y, Namba Y, Shukuya T, Kido K, Iwakami S, Tominaga S, Takahashi K. Diagnostic significance of cerebrospinal fluid EGFR mutation analysis for leptomeningeal metastasis in non-small-cell lung cancer patients harboring an active EGFR mutation following gefitinib therapy failure. Respir Investig 2016; 54:14-19. [PMID: 26718140 DOI: 10.1016/j.resinv.2015.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/11/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been successfully used to treat patients with non-small cell lung cancer (NSCLC) harboring EGFR mutations. However, despite an initial excellent response, recurrence within one or two years is common. Diagnosis and treatment of leptomeningeal metastasis (LM), a form of NSCLC recurrence, remains particularly difficult. Here, we analyzed the EGFR mutation status of cerebrospinal fluid (CSF) directly using real-time polymerase chain reaction (PCR) and evaluated the efficacy of therapy with erlotinib, an EGFR TKI. PATIENTS AND METHODS Seven NSCLC patients harboring activating EGFR mutations who had developed LM during or after therapy with gefitinib, an EGFR TKI, were retrospectively analyzed. CSF was obtained and subjected to cytological examination and EGFR mutation analysis, including detection of the resistance-associated T790M mutation, using real-time PCR. RESULTS In all seven cases, the EGFR mutation detected in the CSF was the same as that detected in the primary tumor (sensitivity, 100%). Conversely, cytology results were positive in only two patients (sensitivity, 28.6%). No additional T790M mutations were detected. Erlotinib was efficacious in all cases, and improved performance status was achieved for five of the seven patients. The effect of erlotinib treatment was temporary, however, with time to treatment failure (TTF) ranging from 29 to 278 days (median, 65 days) and the interval between commencement of erlotinib treatment and death ranging from 45 to 347 days (median, 168 days). CONCLUSIONS Analysis of EGFR mutations in CSF using a highly sensitive real-time PCR assay is a potentially powerful diagnostic method for LM.
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Affiliation(s)
- Shinichi Sasaki
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan.
| | - Yasuko Yoshioka
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan
| | - Ryo Ko
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yoko Katsura
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yukiko Namba
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Takehito Shukuya
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Kenji Kido
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Shinichiro Iwakami
- Department of Respiratory Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Shigeru Tominaga
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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50
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Lee JS, Lee KA, Lee KH, Moon SY, Kim IA, Jeon SJ, Min JK, Kim HJ, Lee KY. Efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors for patient with leptomeningeal metastasis of epidermal growth factor receptor mutant non-small cell lung cancer. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jong Sik Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Ann Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kang Hoon Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Young Moon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - In Ae Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Jin Jeon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Ki Min
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hee Joung Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kye Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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