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Tang S, Cong X, Zheng D, Chen C, Liu Z, Gao J, Zhang H, Zhang Y, Liu Z. Concurrent sintilimab with sequential chemoradiotherapy for unresectable, stage III non-small cell lung cancer: a retrospective study. Front Oncol 2023; 13:1129989. [PMID: 37152047 PMCID: PMC10157220 DOI: 10.3389/fonc.2023.1129989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Background Concurrent programmed death 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors with sequential chemoradiotherapy (SCRT) have been reported in only a limited number of studies involving patients with unresectable stage III non-small-cell lung cancer (NSCLC). A retrospective study was conducted to systematically analyze the efficacy and safety of the emerging therapy among Chinese patients. Materials and methods We included patients with unresectable, stage III NSCLC who received concurrent sintilimab with chemotherapy or chemotherapy alone for 3-6 cycles, followed by radical radiotherapy at the First Hospital of Jilin University from Dec 15, 2019, to Jul 15, 2022. The primary end point was the objective response rate (ORR). The secondary end points included progression-free survival (PFS), overall survival (OS), 12-month and 18-month PFS rates, the duration of response (DoR), and safety. Results The retrospective study involved 77 patients, of which 49 receiving concurrent sintilimab with SCRT were assigned to cohort A, and 28 receiving SCRT alone were assigned to cohort B. The ORR was significantly higher in cohort A (79.6%, 95% CI 65.7-89.8) than in cohort B (35.7%, 95% CI 18.6-55.9) (p<0.001). Median PFS was significantly longer in cohort A than in cohort B (NR [95% CI 21.4-NR] vs. 16.0 months [13.0-22.5]; HR 0.375, 95% CI 0.192-0.735; p=0.003). The PFS rates at 12 and 18 months were 84.8% (95% CI 75.0-95.9) and 71.3% (95% CI 58.7-86.7) in cohort A and 75.0% (95% CI 60.6-92.9) and 38.3% (95% CI 23.7-61.7) in cohort B, respectively. Grade 3 or 4 adverse events (AEs) were reported in 19 patients (38.8%) and seven patients (25.0%) in two cohorts, respectively. Grade 3 or 4 pneumonitis or immune-mediated pneumonitis, radiation pneumonitis, and pneumonia occurred in five (10.2%), four (8.2%), and two (4.1%) cohort A patients, and zero, two (7.1%), and two (7.1%) cohort B patients, respectively. Only cohort A reported AE leading to death in one (2.0%) patient (immune-mediated pneumonitis). Conclusion Concurrent sintilimab with SCRT resulted in a significantly better ORR and longer PFS than SCRT alone, with manageable safety profiles in Chinese patients with unresectable stage III NSCLC.
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Chang CH, Chang YC. Comparing the Therapeutic Efficacies of Lung Cancer: Network Meta-Analysis Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14324. [PMID: 36361201 PMCID: PMC9657796 DOI: 10.3390/ijerph192114324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In recent years, reduction of nuclear power generation and the use of coal-fired power for filling the power supply gap might have increased the risk of lung cancer. This study aims to explore the most effective treatment for different stages of lung cancer patients. METHODS We searched databases to investigate the treatment efficacy of lung cancer. The network meta-analysis was used to explore the top three effective therapeutic strategies among all collected treatment methodologies. RESULTS A total of 124 studies were collected from 115 articles with 171,757 participants in total. The results of network meta-analyses showed that the best top three treatments: (1) in response rate, for advanced lung cancer were Targeted + Targeted, Chemo + Immuno, and Targeted + Other Therapy with cumulative probabilities 82.9, 80.8, and 69.3%, respectively; for non-advanced lung cancer were Chemoradio + Targeted, Chemoradi + Immuno, and Chemoradio + Other Therapy with cumulative probabilities 69.0, 67.8, and 60.7%, respectively; (2) in disease-free control rate, for advanced lung cancer were Targeted + Others, Chemo + Immuno, and Targeted + Targeted Therapy with cumulative probabilities 93.4, 91.5, and 59.4%, respectively; for non-advanced lung cancer were Chemo + Surgery, Chemoradio + Targeted, and Surgery Therapy with cumulative probabilities 80.1, 71.5, and 43.1%, respectively. CONCLUSION The therapeutic strategies with the best effectiveness will be different depending on the stage of lung cancer patients.
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Affiliation(s)
- Chuan-Hsin Chang
- Research Center for Chinese Herbal Medicine, Graduate Institute of Healthy Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City 25137, Taiwan
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Consolidation Systemic Therapy in Locally Advanced, Inoperable Nonsmall Cell Lung Cancer-How to Identify Patients Which Can Benefit from It? Curr Oncol 2022; 29:8316-8329. [PMID: 36354716 PMCID: PMC9689287 DOI: 10.3390/curroncol29110656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Consolidation systemic therapy (ST) given after concurrent radiotherapy (RT) and ST (RT-ST) is frequently practiced in locally advanced inoperable nonsmall cell lung cancer (NSCLC). Little is known, however, about the fate of patients achieving different responses after concurrent phases of the treatment. METHODS we searched the English-language literature to identify full-length articles on phase II and Phase III clinical studies employing consolidation ST after initial concurrent RT-ST. We sought information about response evaluation after the concurrent phase and the outcome of these patient subgroups, the patterns of failure per response achieved after the concurrent phase as well as the outcome of these subgroups after the consolidation phase. RESULTS Eighty-seven articles have been initially identified, of which 20 studies were excluded for various reasons, leaving, therefore, a total of 67 studies for our analysis. Response evaluation after the concurrent phase was performed in 36 (54%) studies but in only 14 (21%) response data were provided, while in 34 (51%) studies patients underwent a consolidation phase regardless of the response. No study provided any outcome (survivals, patterns of failure) as per response achieved after the concurrent phase. CONCLUSIONS Information regarding the outcome of subgroups of patients achieving different responses after the concurrent phase and before the administration of the consolidation phase is still lacking. This may negatively affect the decision-making process as it remains unknown which patients may preferentially benefit from the consolidation of ST.
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Cost-effectiveness Analyses of Durvalumab Consolidation Therapy Versus no Consolidation Therapy After Chemoradiotherapy in Stage-III NSCLC. Lung Cancer 2022; 170:11-19. [DOI: 10.1016/j.lungcan.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 12/25/2022]
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Chen Y, Tian X, Fan K, Zheng Y, Tian N, Fan K. The Value of Artificial Intelligence Film Reading System Based on Deep Learning in the Diagnosis of Non-Small-Cell Lung Cancer and the Significance of Efficacy Monitoring: A Retrospective, Clinical, Nonrandomized, Controlled Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2864170. [PMID: 35360550 PMCID: PMC8964156 DOI: 10.1155/2022/2864170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/24/2022]
Abstract
Objective To explore the value of artificial intelligence (AI) film reading system based on deep learning in the diagnosis of non-small-cell lung cancer (NSCLC) and the significance of curative effect monitoring. Methods We retrospectively selected 104 suspected NSCLC cases from the self-built chest CT pulmonary nodule database in our hospital, and all of them were confirmed by pathological examination. The lung CT images of the selected patients were introduced into the AI reading system of pulmonary nodules, and the recording software automatically identified the nodules, and the results were compared with the results of the original image report. The nodules detected by the AI software and film readers were evaluated by two chest experts and recorded their size and characteristics. Comparison of calculation sensitivity, false positive rate evaluation of the NSCLC software, and physician's efficiency of nodule detection whether there was a significant difference between the two groups. Results The sensitivity, specificity, accuracy, positive predictive rate, and false positive rate of NSCLC diagnosed by radiologists were 72.94% (62/85), 92.06% (58/63), 81.08% (62+58/148), 92.53% (62/67), and 7.93% (5/63), respectively. The sensitivity, specificity, accuracy, positive prediction rate, and false positive rate of AI film reading system in the diagnosis of NSCLC were 94.12% (80/85), 77.77% (49/63), 87.161% (80 + 49/148), 85.11% (80/94), and 22.22% (14/63), respectively. Compared with radiologists, the sensitivity and false positive rate of artificial intelligence film reading system in the diagnosis of NSCLC were higher (P < 0.05). The sensitivity, specificity, accuracy, positive prediction rate, and negative prediction rate of artificial intelligence film reading system in evaluating the efficacy of patients with NSCLC were 87.50% (63/72), 69.23% (9/13), 84.70% (63 + 9)/85, 94.02% (63/67), and 50% (9/18), respectively. Conclusion The AI film reading system based on deep learning has higher sensitivity for the diagnosis of NSCLC than radiologists and can be used as an auxiliary detection tool for doctors to screen for NSCLC, but its false positive rate is relatively high. Attention should be paid to identification. Meanwhile, the AI film reading system based on deep learning also has a certain guiding significance for the diagnosis and treatment monitoring of NSCLC.
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Affiliation(s)
- Yunbing Chen
- Department of Computerized Tomography, Jincheng People's Hospital (Jincheng Hospital Affiliated to Changzhi Medical College), No. 456 Wenchang East Street, Jincheng, 048026 Shanxi, China
| | - Xin Tian
- Department of Computerized Tomography, Jincheng People's Hospital (Jincheng Hospital Affiliated to Changzhi Medical College), No. 456 Wenchang East Street, Jincheng, 048026 Shanxi, China
| | - Kai Fan
- Department of Computerized Tomography, Jincheng People's Hospital (Jincheng Hospital Affiliated to Changzhi Medical College), No. 456 Wenchang East Street, Jincheng, 048026 Shanxi, China
| | - Yanni Zheng
- Department of Computerized Tomography, Jincheng People's Hospital (Jincheng Hospital Affiliated to Changzhi Medical College), No. 456 Wenchang East Street, Jincheng, 048026 Shanxi, China
| | - Nannan Tian
- Department of Computerized Tomography, Jincheng People's Hospital (Jincheng Hospital Affiliated to Changzhi Medical College), No. 456 Wenchang East Street, Jincheng, 048026 Shanxi, China
| | - Ka Fan
- Department of Computerized Tomography, Jincheng People's Hospital (Jincheng Hospital Affiliated to Changzhi Medical College), No. 456 Wenchang East Street, Jincheng, 048026 Shanxi, China
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Mayahara H, Uehara K, Harada A, Kitatani K, Yabuuchi T, Miyazaki S, Ishihara T, Kawaguchi H, Kubota H, Okada H, Ninomaru T, Shindo C, Hata A. Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer. Radiat Oncol 2022; 17:7. [PMID: 35033139 PMCID: PMC8760798 DOI: 10.1186/s13014-021-01979-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background Concurrent chemoradiotherapy (CCRT) followed by durvalumab is the standard of care for unresectable locally-advanced non-small cell carcinoma (LA-NSCLC). However, a major concern about administration of durvalumab after CCRT is whether the incidence of symptomatic radiation pneumonitis (RP) may increase or not. In the present analysis, we report the initial results of CCRT followed by durvalumab in patients with LA-NSCLC in a real-world setting with focus on predicting factors for symptomatic RP. Methods Patients who were pathologically diagnosed as NSCLC and initiated treatment with CCRT followed by durvalumab between July 2018 to December 2019 were eligible for this study. Patients were included if they completed the planned CRT course and administered at least one course of durvalumab. We retrospectively investigated the preliminary survival outcome and incidence and predicting factors for symptomatic RP. Results Of the 67 patients who planned CCRT, 63 patients completed the entire CCRT course. Of these, 56 patients proceeded to consolidation with durvalumab. The median time to eternal discontinuation of durvalumab was 9.7 months. The cumulative proportion of the patients who exhibited symptomatic RP was 30, 40 and 44% at 3, 6 and 12 months, respectively. In multivariate analyses, pulmonary fibrosis score and lung V40 were significant predictive factors for symptomatic RP (p < 0.001, HR: 7.83, 95% CI: 3.38–18.13, and p = 0.034, HR: 3.17, 95% CI: 1.09–9.19, respectively). Conclusions Pulmonary fibrosis sore and lung V40 were significant predictive factors for symptomatic RP. We should be cautious about the administration of durvalumab for patients having subclinical pulmonary fibrosis. To our best knowledge, this is one of the first report showing the predictive value of high dose volumes to the lung in patients with LA-NSCLC who received CCRT followed by durvalumab. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01979-z.
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Affiliation(s)
- Hiroshi Mayahara
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan.
| | - Kazuyuki Uehara
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Aya Harada
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Keiji Kitatani
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Tomonori Yabuuchi
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Shuichirou Miyazaki
- Department of Radiation Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, 650-0046, Japan
| | - Takeaki Ishihara
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hiroki Kawaguchi
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hikaru Kubota
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, Japan
| | - Hideaki Okada
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
| | - Taira Ninomaru
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
| | - Chihiro Shindo
- Department of Diagnostic Radiology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
| | - Akito Hata
- Department of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer Center, 8-5-1, Minatojima-Nakamachi, Chuo-Ku, Kobe, Hyogo, Japan
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Wang J, Xiao L, Wang S, Pang Q, Wang J. Addition of Induction or Consolidation Chemotherapy in Definitive Concurrent Chemoradiotherapy Versus Concurrent Chemoradiotherapy Alone for Patients With Unresectable Esophageal Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:665231. [PMID: 34589418 PMCID: PMC8473880 DOI: 10.3389/fonc.2021.665231] [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: 06/27/2021] [Accepted: 08/23/2021] [Indexed: 01/23/2023] Open
Abstract
Background Concurrent chemoradiotherapy (CCRT) has become the standard of care in esophageal carcinoma patients who are not surgical candidates. The efficacy of induction chemotherapy (IC) or consolidation chemotherapy (CCT) for unresectable esophageal cancer (EC) treated with CCRT is unclear. We performed a systematic review and meta-analysis of published papers to evaluate the potential benefit of IC or CCT for patients with EC. Methods Eligible studies of IC followed by CCRT (IC-CCRT) vs. CCRT alone or CCRT followed by CCT (CCRT-CCT) vs. CCRT alone were retrieved through extensive searches of the PubMed, Science Direct, Embase, and Cochrane Library databases from the establishment of the database to July 31, 2021. Data such as 1-, 2-, 3-, and 5-year overall survival (OS), local recurrence rate (LRR), and distant metastasis rate (DMR) were collected for meta-analysis to evaluate the efficacy of IC/CCT. Results Four studies of IC-CCRT vs. CCRT including 836 EC patients and six studies of CCRT-CCT vs. CCRT including 1,339 patients with esophageal squamous cell carcinoma (ESCC) were finally identified in our analysis. Both IC-CCRT group [hazard ratio (HR) 0.446, 95% CI 0.286-0.693; p < 0.001] and CCRT-CCT group (HR 0.542, 95% CI 0.410-0.716; p < 0.001) exhibited statistically significant improvement in 1-year OS rate compared to that of CCRT, while the 2-year OS rate of IC-CCRT (HR 0.803, 95% CI 0.589-1.095; p = 0.166) or CCRT-CCT (HR 0.783, 95% CI 0.600-1.022; p = 0.072) was similar with that of CCRT. And the 3-year OS rate between IC-CCRT and CCRT was similar (HR 1.065, 95% CI 0.789-1.439; p = 0.680). However, comparing with CCRT alone, the CCRT-CCT group had lower DMR [odds ratio (OR) 1.562, 95% CI 1.090-2.240; p = 0.015] and higher 3-year OS rate (HR 0.786, 95% CI 0.625-0.987; p = 0.039). Besides, no differences were observed between the CCRT-CCT and CCRT groups in 5-year OS rate (HR 0.923, 95% CI 0.706-1.205; p = 0.555) and LRR (OR 0.899, 95% CI 0.686-1.179; p = 0.441). Conclusion The study revealed the short-time survival benefit of additional IC or CCT compared to CCRT alone for patients with unresectable EC, and CCRT followed by CCT could significantly reduce the risk of distant metastases.
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Affiliation(s)
- Jianing Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China
| | - Linlin Xiao
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China
| | - Shuai Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China
| | - Qingsong Pang
- Department of Radiation Oncology, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China
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Wang CC, Chiu LC, Ju JS, Lin YC, Fang YF, Yang CT, Hsu PC. Durvalumab as Consolidation Therapy in Post-Concurrent Chemoradiation (CCRT) in Unresectable Stage III Non-Small Cell Lung Cancer Patients: A Multicenter Observational Study. Vaccines (Basel) 2021; 9:vaccines9101122. [PMID: 34696229 PMCID: PMC8541274 DOI: 10.3390/vaccines9101122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The experience of using consolidation durvalumab in post-concurrent chemoradiation (CCRT) unresectable stage III non-small cell lung cancer (NSCLC) is rare in real-world clinical practice, and the factors associated with its efficacy are also unclear. We sought to analyze the efficacy of consolidation durvalumab and the factors associated with its efficacy using a multicenter observational study. Methods: The data for 61 patients with post-CCR unresectable stage III NSCLC receiving consolidation durvalumab at the Chang Gung Memorial Hospitals in Linkou, Keelung, Chiayi, and Kaohsiung from November 2017 to March 2020 were analyzed. (3) Results: The median post-CCRT progression-free survival (PFS) and time to metastatic disease or death (TMDD) for consolidation durvalumab were 14.0 months and 16.7 months, respectively. In multiple variant factors analysis, we found that an epidermal growth factor receptor (EGFR) mutation was an independently unfavorable predictive factor for consolidation durvalumab therapy regarding PFS. The median post-CCRT PFS was 6.50 months for EGFR-mutated patients and 33.63 months for EGFR wild-type and unknown patients (HR = 10.47; 95% CI, 4.55–24.07; p < 0.001). Conclusions: Consolidation durvalumab is effective and safe for post-CCRT unresectable stage III NSCLC in clinical practice, but EGFR mutation is an unfavorable factor for consolidation durvalumab. Thus, searching for a better consolidation therapy for EGFR-mutated patients is warranted.
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Affiliation(s)
- Chin-Chou Wang
- Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan;
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (L.-C.C.); (Y.-C.L.)
| | - Li-Chung Chiu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (L.-C.C.); (Y.-C.L.)
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (J.-S.J.); (Y.-F.F.); (C.-T.Y.)
- Department of Thoracic Medicine, New Taipei Municipal Tu Cheng Hospital, New Taipei City 23652, Taiwan
| | - Jia-Shiuan Ju
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (J.-S.J.); (Y.-F.F.); (C.-T.Y.)
| | - Yu-Ching Lin
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (L.-C.C.); (Y.-C.L.)
- Division of Thoracic Oncology, Department of Respiratory and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi City 61363, Taiwan
- Department of Respiratory Care, Chiayi Campus, Chang Gung University of Science and Technology, Chiayi City 33303, Taiwan
| | - Yueh-Fu Fang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (J.-S.J.); (Y.-F.F.); (C.-T.Y.)
| | - Cheng-Ta Yang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (J.-S.J.); (Y.-F.F.); (C.-T.Y.)
- Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33378, Taiwan
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Ping-Chih Hsu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan; (L.-C.C.); (Y.-C.L.)
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (J.-S.J.); (Y.-F.F.); (C.-T.Y.)
- Correspondence: ; Tel.: +886-3-3281200 (ext. 8468)
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Assessing the Influence of Subsequent Immunotherapy on Overall Survival in Patients with Unresectable Stage III Non-Small Cell Lung Cancer from the PACIFIC Study. Curr Ther Res Clin Exp 2021; 95:100640. [PMID: 34484473 PMCID: PMC8406163 DOI: 10.1016/j.curtheres.2021.100640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/17/2021] [Accepted: 07/24/2021] [Indexed: 12/25/2022] Open
Abstract
Background Historically, the standard of care for patients with unresectable, Stage III non-small cell lung cancer had been concurrent chemoradiotherapy. However, outcomes had been poor, with approximately 15% to 32% of patients alive at 5 years. In the placebo-controlled Phase III A PACIFIC trial, consolidation treatment with durvalumab after concurrent chemoradiotherapy significantly improved overall survival (OS) and progression-free survival in patients with unresectable, Stage III non-small cell lung cancer, establishing this regimen as a new standard of care in this setting. In the PACIFIC trial, crossover between treatment arms (durvalumab or placebo) was not permitted. However, after discontinuation from study treatment, patients from both arms of PACIFIC could switch to subsequent anticancer therapy, including durvalumab and other immunotherapies, which is known to influence standard intention-to-treat analysis of OS, potentially underestimating the effect of an experimental drug. Moreover, the introduction of immunotherapies has demonstrated marked improvements in the postprogression, metastatic non-small cell lung cancer setting. Objective To examine the influence of subsequent immunotherapy on OS in the PACIFIC trial. Methods Both a Rank Preserving Structural Failure Time Model (RPSFTM) and modified 2-stage method were used. RPSFTM assumes that a patient's survival time with no immunotherapy (counterfactual survival time) is equal to the observed time influenced by immunotherapy, multiplied by an acceleration factor, plus the time not influenced. The modified 2-stage method estimates the effect of immunotherapy by comparing postsubsequent-treatment-initiation survival times between patients with and without subsequent immunotherapy. In both models, OS was adjusted to reflect a hypothetical scenario in which no patients received subsequent immunotherapy. RPSFTM was also used for scenarios in which subsequent immunotherapy was received by increasing proportions of placebo patients but none of the durvalumab patients. Results In the intention-to-treat analysis (3-year follow-up), durvalumab improved OS versus placebo (stratified hazard ratio = 0.69; 95% CI, 0.55-0.86). Overall, 10% and 27% of durvalumab and placebo patients, respectively, received subsequent immunotherapy. With subsequent immunotherapy removed from both arms, estimated hazard ratio was 0.66 (95% CI, 0.53-0.84) with RPSFTM and 0.68 (95% CI, 0.54-0.85) with the modified 2-stage method. With subsequent immunotherapy removed from the durvalumab arm only (RPSFTM), estimated hazard ratio increased as the proportion of placebo patients receiving subsequent immunotherapy increased, up to 0.75 (95% CI, 0.60-0.94) maximum (assuming all placebo patients with subsequent treatment received immunotherapy). Conclusions Results were consistent with the intention-to-treat analysis, supporting the conclusion that durvalumab after chemoradiotherapy provides substantial OS benefit in patients with Stage III, unresectable non-small cell lung cancer. ClinicalTrials.gov identifier: NCT02125461 (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX).
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Evolution of systemic therapy for stages I-III non-metastatic non-small-cell lung cancer. Nat Rev Clin Oncol 2021. [PMID: 33911215 DOI: 10.1038/s41571-021-00501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The treatment goal for patients with early-stage lung cancer is cure. Multidisciplinary discussions of surgical resectability and medical operability determine the modality of definitive local treatment (surgery or radiotherapy) and the associated systemic therapies to further improve the likelihood of cure. Trial evidence supports cisplatin-based adjuvant therapy either after surgical resection or concurrently with radiotherapy. Consensus guidelines support neoadjuvant chemotherapy in lieu of adjuvant chemotherapy and carboplatin-based regimens for patients who are ineligible for cisplatin. The incorporation of newer agents, now standard for patients with stage IV lung cancer, into the curative therapy paradigm has lagged owing to inefficient trial designs, the lengthy follow-up needed to assess survival end points and a developmental focus on the advanced-stage disease setting. Surrogate end points, such as pathological response, are being studied and might shorten trial durations. In 2018, the anti-PD-L1 antibody durvalumab was approved for patients with stage III lung cancer after concurrent chemoradiotherapy. Since then, the study of targeted therapies and immunotherapies in patients with early-stage lung cancer has rapidly expanded. In this Review, we present the current considerations in the treatment of patients with early-stage lung cancer and explore the current and future state of clinical research to develop systemic therapies for non-metastatic lung cancer.
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Chaft JE, Rimner A, Weder W, Azzoli CG, Kris MG, Cascone T. Evolution of systemic therapy for stages I-III non-metastatic non-small-cell lung cancer. Nat Rev Clin Oncol 2021; 18:547-557. [PMID: 33911215 PMCID: PMC9447511 DOI: 10.1038/s41571-021-00501-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
The treatment goal for patients with early-stage lung cancer is cure. Multidisciplinary discussions of surgical resectability and medical operability determine the modality of definitive local treatment (surgery or radiotherapy) and the associated systemic therapies to further improve the likelihood of cure. Trial evidence supports cisplatin-based adjuvant therapy either after surgical resection or concurrently with radiotherapy. Consensus guidelines support neoadjuvant chemotherapy in lieu of adjuvant chemotherapy and carboplatin-based regimens for patients who are ineligible for cisplatin. The incorporation of newer agents, now standard for patients with stage IV lung cancer, into the curative therapy paradigm has lagged owing to inefficient trial designs, the lengthy follow-up needed to assess survival end points and a developmental focus on the advanced-stage disease setting. Surrogate end points, such as pathological response, are being studied and might shorten trial durations. In 2018, the anti-PD-L1 antibody durvalumab was approved for patients with stage III lung cancer after concurrent chemoradiotherapy. Since then, the study of targeted therapies and immunotherapies in patients with early-stage lung cancer has rapidly expanded. In this Review, we present the current considerations in the treatment of patients with early-stage lung cancer and explore the current and future state of clinical research to develop systemic therapies for non-metastatic lung cancer.
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Affiliation(s)
- Jamie E. Chaft
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY and Weill Cornell Medical College, New York, NY, USA,These authors contributed equally: Jamie E. Chaft, Andreas Rimner,
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA,These authors contributed equally: Jamie E. Chaft, Andreas Rimner
| | - Walter Weder
- Thoracic Surgery, Klinik Bethanien Zurich, Zurich, Switzerland
| | - Christopher G. Azzoli
- Division of Hematology/Oncology, Lifespan Cancer Institute, Brown University, Providence, RI, USA
| | - Mark G. Kris
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY and Weill Cornell Medical College, New York, NY, USA
| | - Tina Cascone
- Department of Thoracic/Head and Neck Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lin SH, Willers H, Krishnan S, Sarkaria JN, Baumann M, Lawrence TS. Moving Beyond the Standard of Care: Accelerate Testing of Radiation-Drug Combinations. Int J Radiat Oncol Biol Phys 2021; 111:1131-1139. [PMID: 34454045 DOI: 10.1016/j.ijrobp.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022]
Abstract
Radiation therapy is a major treatment modality used in > 60% of cancer patients as definitive local treatment for inoperable locoregionally confined tumors and as palliative therapy. Although cytotoxic chemotherapy enhances the effectiveness of treatment, the benefit over radiation therapy alone is modest. There is a need to enhance the effectiveness of local tumor control over what sequentially or concurrently administered cytotoxic chemotherapy provides. Although many biological pathways are known to enhance the effectiveness of radiation therapy, there is currently a paucity of drugs approved for use in combination. Several clinical trials have tested the effectiveness of combining targeted agents or immunotherapies with radiation therapy, but the results of these trials have been negative, likely stemming from the relative lack of preclinical evidence using appropriate experimental standardization or model systems. Accelerating the identification of agents tested in an appropriate clinical context and experimental systems or models would greatly enhance the potential to bring forward early testing of drugs that would not only be safe but also more effective. This article provides an overview of the opportunities and challenges of developing therapeutics to combine with radiation therapy, and some guidance toward preclinical and early clinical testing to improve the chance that advanced phase testing of drug-radiation combinations would be successful in the long term.
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Affiliation(s)
- Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Jacksonville, Jacksonville, Florida
| | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota
| | | | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Melillo G, Chand V, Yovine A, Gupta A, Massacesi C. Curative-Intent Treatment with Durvalumab in Early-Stage Cancers. Adv Ther 2021; 38:2759-2778. [PMID: 33881745 PMCID: PMC8190020 DOI: 10.1007/s12325-021-01675-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/16/2021] [Indexed: 12/25/2022]
Abstract
The introduction of immunotherapy has fundamentally transformed the treatment landscape in cancer, providing long-term survival benefit for patients with advanced disease across multiple tumor types, including non-small cell lung cancer (NSCLC). In the placebo-controlled phase 3 PACIFIC trial, the PD-L1 inhibitor durvalumab demonstrated significant improvements in progression-free survival and overall survival in patients with unresectable, stage III NSCLC who had not progressed after platinum-based chemoradiotherapy (CRT). These findings have led to the widespread acceptance of the 'PACIFIC regimen' (durvalumab after CRT) as the standard of care in this setting. Moreover, the PACIFIC trial is the first study to demonstrate a proven survival advantage with an immunotherapy in a curative-intent setting, thereby providing a strong rationale for further investigation of durvalumab in early-stage cancers. Herein, we describe the extensive clinical development program for durvalumab across multiple tumor types in curative-intent settings, outlining the scientific rationale(s) for its use and highlighting the innovative research (e.g., personalized cancer monitoring) advanced by these trials.
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Łazar-Poniatowska M, Bandura A, Dziadziuszko R, Jassem J. Concurrent chemoradiotherapy for stage III non-small-cell lung cancer: recent progress and future perspectives (a narrative review). Transl Lung Cancer Res 2021; 10:2018-2031. [PMID: 34012811 PMCID: PMC8107727 DOI: 10.21037/tlcr-20-704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Concurrent chemoradiotherapy (CHRT) remains the therapeutic standard for locally advanced inoperable non-small-cell lung cancer (NSCLC). The median overall survival (OS) with this approach is in the range of 20–30 months, with five-year survival of approximately 30%. These outcomes have recently been further improved by supplementing CHRT with maintenance durvalumab, a monoclonal anti-PD-L1 agent. The progress in treatment outcomes of locally advanced NSCLC before the era of immunotherapy has been achieved mainly by virtue of developments in diagnostics and radiotherapy techniques. Routine implementation of endoscopic and endobronchial ultrasonography for mediastinal lymph nodes assessment, positron emission tomography/computed tomography and magnetic resonance imaging of the brain allows for more accurate staging of NSCLC and for optimizing treatment strategy. Thorough staging and respiratory motion control allows for higher conformity of radiotherapy and reduction of radiotherapy related toxicity. Dose escalation with prolonged overall treatment time does not improve treatment outcomes of CHRT. In consequence, 60 Gy in 2 Gy fractions or equivalent biological dose remains the standard dose for definitive CHRT in locally advanced NSCLC. However, owing to increased toxicity of CHRT, this option may not be applicable in a proportion of elderly or frail patients. This article summarizes recent developments in curative CHRT for inoperable stage III NSCLC, and presents perspectives for further improvements of this strategy
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Affiliation(s)
| | - Artur Bandura
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Mehra R, Yong C, Seal B, van Keep M, Raad A, Zhang Y. Cost-Effectiveness of Durvalumab After Chemoradiotherapy in Unresectable Stage III NSCLC: A US Healthcare Perspective. J Natl Compr Canc Netw 2021; 19:153-162. [PMID: 33545688 DOI: 10.6004/jnccn.2020.7621] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Durvalumab was approved by the FDA in February 2018 for patients with unresectable stage III NSCLC that has not progressed after platinum-based concurrent chemoradiotherapy (cCRT), and this regimen is the current standard of care. The objective of this study was to examine the cost-effectiveness of durvalumab following cCRT versus cCRT alone in patients with locally advanced, unresectable stage III NSCLC. METHODS A 3-state semi-Markov model was used. Modeling was performed in a US healthcare setting from Medicare and commercial payer perspectives over a 30-year time horizon. Clinical efficacy (progression-free and post progression survival) and utility inputs were based on PACIFIC study data (ClinicalTrials.gov identifier: NCT02125461; data cutoff March 22, 2018). Overall survival extrapolation was validated using overall survival data from a later data cutoff (January 31, 2019). The main outcome was the incremental cost-effectiveness ratio (ICER) of durvalumab following cCRT versus cCRT alone, calculated as the difference in total costs between treatment strategies per quality-adjusted life-year (QALY) gained. RESULTS In the base-case analysis, durvalumab following cCRT was cost-effective versus cCRT alone from Medicare and commercial insurance perspectives, with ICERs of $55,285 and $61,111, respectively, per QALY gained. Durvalumab was thus considered cost-effective at the $100,000 willingness-to-pay (WTP) threshold. Sensitivity analyses revealed the model was particularly affected by variables associated with subsequent treatment, although no tested variable increased the ICER above the WTP threshold. Scenario analyses showed the model was most sensitive to assumptions regarding time horizon, treatment effect duration, choice of fitted progression-free survival curve, subsequent immunotherapy treatment duration, and use of a partitioned survival model structure. CONCLUSIONS In a US healthcare setting, durvalumab was cost-effective compared with cCRT alone, further supporting the adoption of durvalumab following cCRT as the new standard of care in patients with unresectable stage III NSCLC.
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Affiliation(s)
- Ranee Mehra
- 1University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | - Candice Yong
- 2AstraZeneca Pharmaceuticals LP, Gaithersburg, Maryland
| | - Brian Seal
- 2AstraZeneca Pharmaceuticals LP, Gaithersburg, Maryland
| | | | - Angie Raad
- 4BresMed Health Solutions, Sheffield, United Kingdom
| | - Yiduo Zhang
- 2AstraZeneca Pharmaceuticals LP, Gaithersburg, Maryland
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Watanabe K, Toi Y, Nakamura A, Chiba R, Akiyama M, Sakakibara-Konishi J, Tanaka H, Yoshimura N, Miyauchi E, Nakagawa T, Igusa R, Minemura H, Mori Y, Fujimoto K, Matsushita H, Takahashi F, Fukuhara T, Inoue A, Sugawara S, Maemondo M. Randomized phase II trial of uracil/tegafur and cisplatin versus pemetrexed and cisplatin with concurrent thoracic radiotherapy for locally advanced unresectable stage III non-squamous non-small cell lung cancer: NJLCG1001. Transl Lung Cancer Res 2021; 10:712-722. [PMID: 33718016 PMCID: PMC7947416 DOI: 10.21037/tlcr-20-721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The optimal regimen for concurrent chemoradiotherapy (CCRT) of locally advanced non-squamous non-small cell lung cancer (NSCLC) was not definitive. We conducted randomized phase II study, NJLCG0601, and chemoradiotherapy with uracil/tegafur (UFT) and cisplatin achieved promising efficacy without severe toxicities. Here, we evaluated between this regimen and pemetrexed plus cisplatin in chemoradiotherapy for stage III non-squamous NSCLC. Methods Patients with inoperable stage III non-squamous NSCLC were randomly assigned in a 1:1 ratio to UFT 400 mg/m2 on days 1–14 and 29–42, and cisplatin 80 mg/m2 on days 8 and 36 (UP), or cisplatin 75 mg/m2 and pemetrexed 500 mg/m2 on days 1, 22, and 43 (PP). Involved-field radiotherapy (IFRT) underwent from day 1 to a total dose of 66 Gy in 33 fractions. Consolidation chemotherapy after CCRT was prohibited for this study. The primary endpoint was defined as 2-year overall survival (OS). This trial was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000003948). Results From November 2010 to June 2017, 86 patients were entered from 11 institutions. Median follow-up was 54 months. Of the 85 eligible patients, the 2-year OS rate was 78.6% (95% CI, 62.8–88.3%) in UP and 85.5% (95% CI, 70.5–93.2%) in PP. Median PFS and OS was 12.3 and 64.2 months in UP, 26.2 months and not reached in PP, respectively. Grade 3/4 febrile neutropenia was more frequent in the UP group (14.0% vs. 2.0%). Conclusions Both UP and PP with IFRT achieved the expected 2-year OS. PP engendered more favorable OS and PFS compared to UP in terms.
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Affiliation(s)
- Kana Watanabe
- Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan
| | - Yukihiro Toi
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Atsushi Nakamura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Ryosuke Chiba
- Division of Pulmonary Medicine, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Masachika Akiyama
- Division of Pulmonary Medicine, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | | | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University, Hirosaki, Japan
| | - Naruo Yoshimura
- Department of Respiratory Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Taku Nakagawa
- Department of Thoracic Surgery, Omagari Kosei Medical Center, Daisen, Japan
| | - Ryotaro Igusa
- Department of Respiratory Medicine, Osaki Citizen Hospital, Osaki, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshiaki Mori
- Department of Respiratory Medicine, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Keisuke Fujimoto
- Department of Radiation Oncology, Miyagi Cancer Center, Natori, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Fumiaki Takahashi
- Department of Information Science, Iwate Medical University, Morioka, Japan
| | - Tatsuro Fukuhara
- Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Makoto Maemondo
- Division of Pulmonary Medicine, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
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Role of Consolidation Durvalumab in Patients With EGFR- and HER2-Mutant Unresectable Stage III NSCLC. J Thorac Oncol 2021; 16:868-872. [PMID: 33539970 DOI: 10.1016/j.jtho.2020.12.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Despite the recent advance of consolidation durvalumab in the treatment of unresectable stage III NSCLC, not every patient benefits from durvalumab and the predictive markers of response have been difficult to identify. METHODS We performed a retrospective analysis of patients with unresectable stage III NSCLC treated with consolidation durvalumab after definitive chemoradiation from January 2018 to March 2020. RESULTS A total of 36 patients with unresectable stage III NSCLC were treated with consolidation durvalumab. Of these patients, 14 had tumor mutations in the ERBB family including 11 EGFR and 3 ERBB2. The ERBB2/EGFR tumor mutation cohort was more likely to be nonsmokers; otherwise, the two groups were similar in age, sex, programmed death-ligand 1 expression, and type of previous chemotherapy regimen. Patients in the ERBB2/EGFR cohort had a significantly shorter disease-free survival compared with the EGFR or ERBB2 wild-type cohort (7.5 mo versus not reached, p = 0.04). CONCLUSIONS Consolidation durvalumab seems to be less efficacious in patients with ERBB2/EGFR-mutant tumors. Future work should seek to evaluate this in the prospective setting and provide insight into the optimal treatment of ERBB2/EGFR-mutant stage III NSCLC.
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Chen NB, Li QW, Zhu ZF, Wang YM, Cheng ZJ, Hui ZG, Guo SP, He HQ, Wang B, Huang XY, Li JB, Guo JY, Hu N, Ai XL, Zhou Y, Wang DQ, Liu FJ, Xie CM, Qiu B, Liu H. Developing and validating an integrated gross tumor volume (GTV)-TNM stratification system for supplementing unresectable locally advanced non-small cell lung cancer treated with concurrent chemoradiotherapy. Radiat Oncol 2020; 15:260. [PMID: 33168045 PMCID: PMC7653712 DOI: 10.1186/s13014-020-01704-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose The gross tumor volume (GTV) could be an independent prognostic factor for unresectable locally advanced non-small cell lung cancer (LANSCLC). We aimed to develop and validate a novel integrated GTV-TNM stratification system to supplement LANSCLC sub-staging in patients treated with concurrent chemoradiotherapy (CCRT).
Methods We performed a retrospective review of 340 patients with unresectable LANSCLC receiving definitive CCRT. All included patients were divided into two randomized cohorts. Then the Kaplan–Meier method and Cox regression were calculated to access the prognostic value of the integrated GTV-TNM stratification system, which was further validated by the area under the receiver operating characteristic curve (AUC) score and F1-score. Results The optimal outcome-based GTV cut-off values (70 and 180 cm3) of the modeling cohort were used to determine each patient’s integrated GTV-TNM stratum in the whole cohort. Our results indicated that a lower integrated GTV-TNM stratum could had better overall survival and progression-free survival (all P < 0.001), which was recognized as an independent prognostic factor. Also, its prognostic value was robust in both the modeling and validation cohorts. Furthermore, the prognostic validity of the integrated GTV-TNM stratification system was validated by significantly improved AUC score (0.636 vs. 0.570, P = 0.027) and F1-score (0.655 vs. 0.615, P < 0.001), compared with TNM stage. Conclusions We proposed a novel integrated GTV-TNM stratification system to supplement unresectable LANSCLC sub-staging due to its prognostic value independent of TNM stage and other clinical characteristics, suggesting that it could be considered in individual treatment decision-making process.
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Affiliation(s)
- Nai-Bin Chen
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Qi-Wen Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China.,Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zheng-Fei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Yi-Ming Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
| | - Zhangkai J Cheng
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Zhou-Guang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Su-Ping Guo
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Hao-Qiang He
- Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Bin Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Xiao-Yan Huang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Ji-Bin Li
- Clinical Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jin-Yu Guo
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Nan Hu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Xin-Lei Ai
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Yin Zhou
- Evidance Medical Technologies Inc., Ningbo, People's Republic of China
| | - Da-Quan Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Fang-Jie Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Chuan-Miao Xie
- Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Bo Qiu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China. .,Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Hui Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China. .,Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China.
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Guo M, Li W, Li B, Zou B, Wang S, Fan B, Sun X, Wang L. Multiple Immune Features-Based Signature for Predicting Recurrence and Survival of Inoperable LA-NSCLC Patients. Front Oncol 2020; 10:571380. [PMID: 33154945 PMCID: PMC7591766 DOI: 10.3389/fonc.2020.571380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/21/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction The immune status of the tumor microenvironment is extremely complex. One single immune feature cannot reflect the integral immune status, and its prognostic value was limited. We postulated that the immune signature based on multiple immuno-features could markedly improve the prediction of post-chemoradiotherapeutic survival in inoperable locally advanced non-small-cell lung cancer (LA-NSCLC) patients. Methods In this study, 100 patients who were diagnosed as having inoperable LA-NSCLC between January 2005 and January 2016 were analyzed. A five immune features-based signature was then constructed using the nested repeat 10-fold cross validation with least absolute shrinkage and selection operator (LASSO) Cox regression model. Nomograms were then established for predicting prognosis. Results The immune signature combining five immuno-features was significantly associated with overall survival (OS) and progression-free survival (PFS) (P = 0.002 and P = 0.014, respectively) in patients with inoperable LA-NSCLC, and at a cutoff of −0.05 stratified patients into two groups with 5-year OS rates of 39.8 and 8.8%, and 2-year PFS rates of 22.2 and 5.5% for the high- and low-immune signature groups, respectively. Integrating immune signature, we proposed predictive nomograms that were better than the traditional TNM staging system in terms of discriminating ability (OS: 0.692 vs. 0.588; PFS: 0.672 vs. 0.586, respectively) or net weight classification (OS: 32.96%; PFS: 9.22%), suggesting that the immune signature plays a significant role in improving the prognostic value. Conclusion Multiple immune features-based immune signature could effectively predict recurrence and survival of inoperable LA-NSCLC patients and complemented the prognostic value of the TNM staging system.
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Affiliation(s)
- Meiying Guo
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, China
| | - Wanlong Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Butuo Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.,Key Laboratory of Cancer Prevention and Therapy, Department of Radiation Oncology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Bing Zou
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shijiang Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Bingjie Fan
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xindong Sun
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Linlin Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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20
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Hung HY, Tseng YH, Chao HS, Chiu CH, Hsu WH, Hsu HS, Wu YC, Chou TY, Chen CK, Lan KL, Chen YW, Wu YH, Chen YM. Multidisciplinary team discussion results in survival benefit for patients with stage III non-small-cell lung cancer. PLoS One 2020; 15:e0236503. [PMID: 33031375 PMCID: PMC7544080 DOI: 10.1371/journal.pone.0236503] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background The treatment for stage III non-small cell lung cancer (NSCLC) often involves multi-modality treatment. This retrospective study aimed to evaluate whether multidisciplinary team (MDT) discussion results in better patient survival. Materials and methods MDT discussion was optional before February 2016 and was actively encouraged by the MDT committee beginning February 2016. We reviewed the medical charts and computer records of patients with stage III NSCLC between January 2013 and December 2018. Results A total of 515 patients were included. The median survival of all the patients was 33.9 months (M). The median survival of patients who were treated after MDT discussion was 41.2 M and that of patients treated without MDT discussion was 25.7 M (p = 0.018). The median survival of patients treated before February 2016 was 25.7 M and that of patients treated after February 2016 was 33.9 M (p = 0.003). The median survival of patients with stage IIIA tumors and those with stage IIIB tumors was 39.4 M and 25.7 M, respectively (p = 0.141). Multivariate analysis showed that MDT or not (p<0.001), T staging (p = 0.009), performance status (p<0.001), and surgery (p = 0.016) to be significant prognostic factors. Conclusion The results of the study show that MDT discussion results in survival benefit in patients with stage III NSCLC. The MDT discussion, performance status, and if surgery was performed were independent prognostic factors for patients with stage III NSCLC.
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Affiliation(s)
- Hsiu-Ying Hung
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Han Tseng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Heng-Sheng Chao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wen-Hu Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Han-Shui Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Yu-Chung Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Teh-Ying Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Division of Molecular Pathology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chun-Ku Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Keng-Li Lan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wei Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Hung Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China (R.O.C)
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
- Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, R.O.C
- * E-mail:
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21
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Verma V, Lin SH. Optimizing current standard of care therapy for stage III non-small cell lung cancer. Transl Lung Cancer Res 2020; 9:2033-2039. [PMID: 33209623 PMCID: PMC7653132 DOI: 10.21037/tlcr-20-603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The management of stage III non-small cell lung cancer (NSCLC) remains complex and controversial, with a myriad of potentially feasible options. Given the diversity of non-surgical as well as surgical options, along with recent randomized data regarding adjuvant immunotherapy that has re-defined the standard of care for unresected stage III NSCLC cases, the goal of this narrative review was to provide a contemporary view at how management of these patients can be further optimized. Topics discussed include the following items: optimizing toxicity mitigation strategies (in order to avoid impaired receipt of subsequent therapies), the importance of multidisciplinary tumor boards (MTBs) and multidisciplinary clinics (MDCs), adhering to treatment approaches endorsed by national guidelines, prudently selecting patients for surgical intervention (as compared to non-operative approaches), coordination of multidisciplinary care so as to best preserve all potential therapeutic options, and addressing challenges regarding disparities in access to oncologic care. This review places particular emphasis for community and/or rural centers, which may not have the same level of resources and/or personnel as larger academic institutions. Taken together, these strategies are aimed towards the overarching goal of streamlining oncologic care for stage III NSCLC cases in light of the numerous approaches that currently exist for these patients.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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22
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Durm GA, Jabbour SK, Althouse SK, Liu Z, Sadiq AA, Zon RT, Jalal SI, Kloecker GH, Williamson MJ, Reckamp KL, Langdon RM, Kio EA, Gentzler RD, Adesunloye BA, Harb WA, Walling RV, Titzer ML, Hanna NH. A phase 2 trial of consolidation pembrolizumab following concurrent chemoradiation for patients with unresectable stage III non-small cell lung cancer: Hoosier Cancer Research Network LUN 14-179. Cancer 2020; 126:4353-4361. [PMID: 32697352 PMCID: PMC10865991 DOI: 10.1002/cncr.33083] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Five-year overall survival (OS) for patients with unresectable stage III non-small cell lung cancer (NSCLC) is poor. Until recently, a standard of care was concurrent chemoradiation alone. Patients with metastatic NSCLC treated with anti-programmed death 1 antibodies have demonstrated improved OS. This trial evaluated pembrolizumab as consolidation therapy after concurrent chemoradiation in patients with unresectable stage III disease. METHODS Patients with unresectable stage III NSCLC received concurrent chemoradiation with cisplatin and etoposide, cisplatin and pemetrexed, or carboplatin and paclitaxel and 59.4 to 66.6 Gy of radiation. Patients with nonprogression of disease were enrolled and received pembrolizumab (200 mg intravenously every 3 weeks for up to 12 months). The primary endpoint was the time to metastatic disease or death (TMDD). Secondary endpoints included progression-free survival (PFS) and OS. RESULTS The median follow-up for 93 patients (92 for efficacy) was 32.2 months (range, 1.2-46.6 months). The median TMDD was 30.7 months (95% confidence interval [CI], 18.7 months to not reached), which was significantly longer than the historical control of 12 months (P < .0001). The median PFS was 18.7 months (95% CI, 12.4-33.8 months), and the median OS was 35.8 months (95% CI, 24.2 months to not reached). The 1-, 2-, and 3-year OS estimates were 81.2%, 62.0%, and 48.5%, respectively. Forty patients (43.5%) completed 12 months of treatment (median number of cycles, 13.5). Symptomatic pneumonitis (grade 2 or higher) was noted in 16 patients (17.2%); these cases included 4 grade 3 events (4.3%), 1 grade 4 event (1.1%), and 1 grade 5 event (1.1%). CONCLUSIONS Consolidation pembrolizumab after concurrent chemoradiation improves TMDD, PFS, and OS in comparison with historical controls of chemoradiation alone. Rates of grade 3 to 5 pneumonitis were similar to those reported with chemoradiation alone.
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Affiliation(s)
- Greg A. Durm
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Salma K. Jabbour
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Ziyue Liu
- Department of Biostatistics, Indiana University, Indianapolis, Indiana
| | - Ahad A. Sadiq
- Fort Wayne Medical Oncology and Hematology, Fort Wayne, Indiana
| | - Robin T. Zon
- Michiana Hematology Oncology, South Bend, Indiana
| | - Shadia I. Jalal
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Goetz H. Kloecker
- James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
| | | | | | | | | | | | | | | | | | - Michael L. Titzer
- Oncology Hematology Associates of Southwest Indiana, Newburgh, Indiana
| | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
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23
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Akdeniz N, Küçüköner M, Kaplan MA, Urakçı Z, Karhan O, Sezgin Y, Bilen E, Ebinç S, Teke F, Laçin Ş, Alan Ö, Ercelep Ö, Işıkdoğan A, Yumuk PF. Comparison of three different chemotherapy regimens for concomitant chemoradiotherapy in locally advanced non-small cell lung cancer. Int J Clin Oncol 2020; 25:2015-2024. [PMID: 32797321 DOI: 10.1007/s10147-020-01767-x] [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] [Received: 12/06/2019] [Accepted: 08/07/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE The optimal chemotherapy regimen for concurrent chemoradiation in locally advanced non-small cell lung cancer (NSCLC) remains unclear. Cisplatin-etoposide regimen related toxicity is high, weekly regimens have been investigating. We aimed to compare the efficacy and safety of different concurrent chemotherapy regimens in the context. METHODS A total of 225 patients with locally advanced, unresectable stage III NSCLC were included. Patients who were treated with weekly docetaxel-platin (DP), paclitaxel-platin (PP) and standard dose etoposide-platin (EP) chemotherapy regimens were selected and divided into groups for the comparison of toxicity, response rate, progression free survival (PFS), and overall survival (OS) times. RESULTS There was a statistically significant difference between overall response rate of each treatment groups (DP: 96.1%, PP: 94% and EP: 76.7%, p < 0.001). The median PFS time of patients who were treated with DP, PP and EP was 16, 15 and 13.3 months, respectively (p = 0.435). The median OS time of patients treated with DP, PP and EP was 19.2, 29.7 and 28.3 months, respectively (p < 0.001). The rates of adverse events such as nausea, vomiting, neuropathy and anaphylaxis was similar. Grade 1-2 mucositis or esophagitis, anemia, pneumonitis were significantly higher in PP group than other groups. However, hematologic toxicities were higher in the EP group than other groups. CONCLUSIONS Compared to the weekly chemotherapy regimens with the standard dose, our study demonstrated similar PFS, but a prolonged OS with the EP regimen. The clinical response rate of weekly regimens was better than the full-dose regimen. Adverse events and toxicity rates were different and depended on the type of chemotherapy regimen used.
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Affiliation(s)
- Nadiye Akdeniz
- Department of Medical Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey.
| | - Mehmet Küçüköner
- Department of Medical Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Muhammet Ali Kaplan
- Department of Medical Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Zuhat Urakçı
- Department of Medical Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Oğur Karhan
- Department of Medical Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Yasin Sezgin
- Department of Medical Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Erkan Bilen
- Department of Medical Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Senar Ebinç
- Department of Medical Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Fatma Teke
- Department of Radiation Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Şahin Laçin
- Department of Medical Oncology, Gazi Yasargil Education and Training Hospital, Diyarbakir, Turkey
| | - Özkan Alan
- Department of Medical Oncology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Özlem Ercelep
- Department of Medical Oncology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Abdurrahman Işıkdoğan
- Department of Medical Oncology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Perran Fulden Yumuk
- Department of Medical Oncology, Marmara University Medical Faculty, Istanbul, Turkey
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24
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Horinouchi H, Atagi S, Oizumi S, Ohashi K, Kato T, Kozuki T, Seike M, Sone T, Sobue T, Tokito T, Harada H, Maeda T, Mio T, Shirosaka I, Hattori K, Shin E, Murakami H. Real-world outcomes of chemoradiotherapy for unresectable Stage III non-small cell lung cancer: The SOLUTION study. Cancer Med 2020; 9:6597-6608. [PMID: 32730697 PMCID: PMC7520333 DOI: 10.1002/cam4.3306] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023] Open
Abstract
There are limited real‐world data on the treatment practices, outcomes, and safety of chemoradiotherapy (CRT) alone in potential candidates for immune checkpoint inhibitors (ICI) for unresectable non‐small cell lung cancer (NSCLC). In this study, we analyzed the safety and efficacy of CRT in patients who underwent CRT and would satisfy the key eligibility criteria for maintenance therapy with durvalumab (eg, no progression after CRT) in real‐world settings (m‐sub) for unresectable Stage III NSCLC between 1 January 2013 and 31 December 2015 at 12 sites in Japan. The m‐sub comprised 214 patients with a median follow‐up of 31.6 months (range 1.9‐65.8 months). Median overall survival (OS) and progression‐free survival (PFS) from completing CRT were 36.4 months (95% confidence interval [CI] 28.1 months to not reached) and 9.5 months (95% CI 7.7‐11.7 months), respectively. Consolidation chemotherapy did not influence OS or PFS. Median PFS was 16.9 vs 9.1 months in patients with vs without epidermal growth factor receptor (EGFR) mutations, with PFS rates of ~20% at 3‐4 years. Pneumonitis was the most common adverse event (according to MedDRA version 21.0J), and about half of events were grade 1. Pneumonitis mostly occurred 10‐24 weeks after starting CRT, peaking at 18‐20 weeks. Esophagitis and dermatitis generally occurred from 0 to 4 weeks, peaking at 2‐4 weeks after starting CRT. Pericarditis was rare and occurred sporadically. In conclusion, the results of the m‐sub provide real‐world insight into the outcomes of CRT, and will be useful for future evaluations of ICI maintenance therapy after CRT.
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Affiliation(s)
| | - Shinji Atagi
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Satoshi Oizumi
- National Hospital Organization Hokkaido Cancer Center, Hokkaido, Japan
| | | | - Tomohiro Kato
- National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Toshiyuki Kozuki
- National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | | | | | - Tomotaka Sobue
- Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | | | - Tadashi Maeda
- National Hospital Organization Yamaguchi-Ube Medical Center, Yamaguchi, Japan
| | - Tadashi Mio
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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25
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Cotarla I, Boron ML, Cullen SL, Spinner DS, Faulkner EC, Carroll MC, Shah S, Yagui-Beltran A. Treatment Decision Drivers in Stage III Non-Small-Cell Lung Cancer: Outcomes of a Web-Based Survey of Oncologists in the United States. JCO Oncol Pract 2020; 16:e1232-e1242. [PMID: 32552457 DOI: 10.1200/jop.19.00781] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE We conducted a cross-sectional survey of practicing medical oncologists in the United States to obtain insight into physician and patient treatment decision making in stage III non-small-cell lung cancer (NSCLC). METHODS A convenience sample of 150 oncologists completed a 38-question Web-based survey in January 2019. RESULTS Surveyed oncologists (82% community based) had an average of 15 years of clinical experience and had treated an average of 20 patients newly diagnosed with stage III NSCLC in the previous 6 months. Oncologists reported presenting 55% of their patients with stage III NSCLC to tumor boards. For patients with new unresectable stage III NSCLC seen in the previous 6 months, concurrent chemoradiation therapy (cCRT) was reported as the initial treatment in an average of 48% of patients. The most frequent reason for delays in starting the initial chosen treatment was insurance preauthorization processes (reported by 65% of oncologists). A total of 55% of all patients with unresectable stage III NSCLC who received cCRT went on to receive consolidation immunotherapy; for patients who received consolidation chemotherapy after cCRT, the rate of immunotherapy was lower (42%). Biomarker test results were given as the reason for oncologists not recommending immunotherapy after cCRT in approximately a quarter of cases. The 112 oncologists with eligible patients who declined immunotherapy reported previous treatment fatigue as the reason in 34% of patients and insurance challenges in 19% of patients. CONCLUSION Oncologists reported notable deviations from treatment guidelines for stage III NSCLC. Our findings highlight important opportunities to improve decision making and the coordination of care in stage III NSCLC.
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26
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Zhang AD, Su XH, Shi GF, Han C, Wang L, Liu H, Zhang J, Zhang RH. Survival Comparision of Three-dimensional Radiotherapy Alone vs. Chemoradiotherapy for Esophageal Squamous Cell Carcinoma. Arch Med Res 2020; 51:419-428. [PMID: 32418649 DOI: 10.1016/j.arcmed.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare the survival of esophageal squamous cell carcinoma (ESCC) patients who received chemoradiotherapy (CRT) or radiotherapy (RT) alone. METHODS A total of 753 well-matched patients were enrolled. A total of 299 patients were treated with CRT, and 454 patients were treated with RT alone. Propensity score matching (PSM) was performed with the R project. The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used to assess differences in survival. RESULTS The response rate was 99.0% with CRT and 98.3% with RT alone (p = 0.651). The 1-, 3-, 5- and 10 year overall survival (OS) rates were as follows: 72.2, 40.1, 30.7 and 13.9% with CRT, 68.1, 35.2%, 23.3 and 12.5% with RT alone (p = 0.033); 73.4, 40.1, 31.0 and 16.1% with concurrent chemoradiotherapy (CCRT); and 68.1, 35.2, 23.3 and 12.5% with RT alone (p = 0.028). There was no significant difference in OS between the CCRT group and the sequential chemoradiotherapy (SCRT) group (p = 0.527). Consolidation chemotherapy (CCT) after CCRT led to a significant increase in the OS rate compared with no CCT after CCRT (p = 0.003). Compared with the OS of patients who received 1∼2 cycles of CCT, the OS of patients who received 3∼4 cycles of CCT was significantly improved (p = 0.011). Acute toxic effects were more severe in the CRT, but no significant differences in late reactions. CRT exhibited more appetite loss and fatigue symptoms than RT alone, and dysphagia of CRT relief more obviously. The CRT group had a significantly lower rate of local control failure than the RT alone group (p = 0.019). CONCLUSIONS For patients with ESCC, CRT led to a significantly improved OS compared to RT alone, and this trend was more obvious with CCRT. CCT after CCRT prolonged OS, especially in patients who received at least 2 cycles of CCT. CRT can reduce the deaths due to local control failure compared to RT alone.
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Affiliation(s)
- An-Du Zhang
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei, China
| | - Xiao-Hua Su
- Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Gao-Feng Shi
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei, China.
| | - Chun Han
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei, China
| | - Lan Wang
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei, China
| | - Hui Liu
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei, China
| | - Jun Zhang
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei, China
| | - Ruo-Hui Zhang
- Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei, China
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27
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Chu CH, Chiu TH, Wang CC, Chang WC, Huang ACC, Liu CY, Wang CL, Ko HW, Chung FT, Hsu PC, Guo YK, Kuo CHS, Yang CT. Consolidation treatment of durvalumab after chemoradiation in real-world patients with stage III unresectable non-small cell lung cancer. Thorac Cancer 2020; 11:1541-1549. [PMID: 32281272 PMCID: PMC7262925 DOI: 10.1111/1759-7714.13426] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 12/25/2022] Open
Abstract
Background Treatment for stage III non‐small cell lung cancer (NSCLC) of unresectable disease mainly involves concurrent chemoradiation (CRT). Post‐CRT consolidation treatment with durvalumab is a major therapeutic advance that provides survival benefit in this group of patients. However, the performance of this treatment strategy remains to be studied in a real‐world setting. Methods A total of 31 patients who had disease control post‐CRT were included in the durvalumab early access program (EAP) as an intent‐to‐treat cohort and retrospectively reviewed for post‐CRT progression‐free survival (PFS) and time to metastatic disease or death (TMDD). The neutrophil‐to‐lymphocyte ratio (NLR) at the initiation of durvalumab was analyzed in 29 patients. Results The median time from the completion of concurrent CRT to the initiation of durvalumb was 2.8 months. The objective response was 25.8% and the 12 month PFS and TMDD‐free rate were 56.4% and 66.9%, respectively. The low NLR patients showed a significantly longer post‐CRT PFS (not reach vs. 12.0 months [95% CI: 5.5–not estimable]; P = 0.040; the hazard ratio for disease progression or death, 0.23 [95% CI: 0.05–1.00]; P = 0.048) and the 12 month post‐CRT PFS rate (82.5 vs. 42.6%). The post‐CRT TMDD (not reach vs. 12.6 months, [95% CI: 10.8–not estimable]; P = 0.010; the hazard ratio for distant metastasis or death, 0.11 [95% CI: 0.01–0.88]; P = 0.037) and 12 month post‐CRT TMDD‐free rate (90.9 vs. 57.1%) were also significantly higher in the low NLR patients. Conclusions Durvalumab consolidation treatment in real‐world patients showed substantial efficacy and the correlation with the NLR level warrants further investigation.
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Affiliation(s)
- Chia-Hsun Chu
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Tzu-Hsuan Chiu
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Chen Chang
- Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan.,Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Allen Chung-Cheng Huang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Chien-Ying Liu
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Chih-Liang Wang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Ho-Wen Ko
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Fu-Tsai Chung
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Ping-Chih Hsu
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
| | - Yi-Ke Guo
- Data Science Institute, Department of Computing, Imperial College London, London, UK
| | - Chih-Hsi S Kuo
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan.,Data Science Institute, Department of Computing, Imperial College London, London, UK
| | - Cheng-Ta Yang
- Division of Thoracic Oncology, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan City, Taiwan.,Thoracic Oncology Unit, Chang Gung Memorial Hospital Cancer Center, Taoyuan City, Taiwan
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Fukui T, Hosotani S, Soda I, Ozawa T, Kusuhara S, Kakegawa MI, Kasajima M, Hiyoshi Y, Igawa S, Yokoba M, Mitsufuji H, Kubota M, Katagiri M, Sasaki J, Ishiyama H, Naoki K. Current status and progress of concurrent chemoradiotherapy in patients with locally advanced non-small cell lung cancer prior to the approval of durvalumab. Thorac Cancer 2020; 11:1005-1014. [PMID: 32057187 PMCID: PMC7113036 DOI: 10.1111/1759-7714.13357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 12/25/2022] Open
Abstract
Background The standard treatment for patients with unresectable locally advanced (LA) non‐small cell lung cancer (NSCLC) is chemoradiotherapy (CRT). Consolidation therapy with durvalumab after CRT demonstrated survival benefits and was approved in Japan in July 2018. The use of immune checkpoint inhibitors (ICIs) is entering routine oncological practice, and here we investigate the feasibility of concurrent CRT for LA‐NSCLC patients based on the PACIFIC criteria. Methods We performed a retrospective study to evaluate the feasibility and efficacy of concurrent CRT prior to the approval of durvalumab. We assessed consecutive patients with LA‐NSCLC treated with CRT between January 2012 and June 2018. Results We analyzed a total of 108 consecutive patients who received radical thoracic radiotherapy and concurrent platinum‐based chemotherapy. Of those patients, 105 (97%) completed the planned radiotherapy. Radiation pneumonitis was observed in 93 patients (85%), with a median of 130 days (range: 41–317 days) from the initiation of radiation to the onset of the complication. Among the patients, 74 (69%) were considered eligible for consolidation therapy with durvalumab. The overall response rate was 64%, and the two‐year survival rate was 63%. Patients who received an ICI after relapse were associated with significantly better survival than those who did not receive an ICI (two‐year survival rate: 87% vs. 41%, respectively; P = 0.001). Conclusions Prior to the approval of durvalumab, the clinical application of ICIs improved the outcome of patients with relapsed NSCLC after CRT for LA‐NSCLC. The management of radiation pneumonitis remains a challenge following the approval of durvalumab.
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Affiliation(s)
- Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shinji Hosotani
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Itaru Soda
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takahiro Ozawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Seiichiro Kusuhara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Mikiko I Kakegawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masashi Kasajima
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yasuhiro Hiyoshi
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masanori Yokoba
- Department of Medical Laboratory, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Hisashi Mitsufuji
- Fundamental Nursing, Kitasato University School of Nursing, Kanagawa, Japan
| | - Masaru Kubota
- Department of Medical Laboratory, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Masato Katagiri
- Department of Medical Laboratory, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with locally-advanced unresectable non-small-cell lung cancer: a KSMO-ESMO initiative endorsed by CSCO, ISMPO, JSMO, MOS, SSO and TOS. Ann Oncol 2019; 31:191-201. [PMID: 31959336 DOI: 10.1016/j.annonc.2019.10.026] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/28/2019] [Indexed: 02/06/2023] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of early and locally-advanced non-small-cell lung cancer (NSCLC) was published in 2017, and covered the diagnosis, staging, management and treatment of both early stage I and II disease and locally-advanced stage III disease. At the ESMO Asia Meeting in November 2018, it was decided by both the ESMO and the Korean Society of Medical Oncology (KSMO) to convene a special face-to-face guidelines meeting in 2019 in Seoul. The aim was to adapt the ESMO 2017 guidelines to take into account potential differences related to ethnicity, cancer biology and standard practices associated with the treatment of locally-advanced, unresectable NSCLC in Asian patients. These guidelines represent the consensus opinions reached by those experts in the treatment of patients with lung cancer who represented the oncology societies of Korea (KSMO), China (CSCO), India (ISMPO), Japan (JSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence, and it was independent of both local current treatment practices and the treatment availability and reimbursement situations in the individual participating Asian countries.
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Cordeiro de Lima VC, Baldotto CS, Barrios CH, Sobrinho EM, Zukin M, Mathias C, Zaffaroni F, Nery RC, Madeira G, Amadio AV, Coelho JC, Geib G, Simões MF, Castro G. Stage III Non-Small-Cell Lung Cancer Treated With Concurrent Chemoradiation Followed or Not by Consolidation Chemotherapy: A Survival Analysis From a Brazilian Multicentric Cohort. J Glob Oncol 2019; 4:1-11. [PMID: 30241276 PMCID: PMC6223524 DOI: 10.1200/jgo.17.00214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Of newly diagnosed patients with non–small-cell lung cancer (NSCLC), stage III accounts for 30%. Most patients are treated with concurrent chemoradiation therapy, but the addition of consolidation chemotherapy (CC) is debatable. We examined the effect of CC in Brazilian patients with stage III NSCLC treated in routine clinical practice. Methods We retrospectively collected data for patients from five different Brazilian cancer institutions who had stage III NSCLC and who were treated with chemoradiation therapy followed or not by CC. Eligible patients were age 18 years or older and must have been treated with cisplatin-carboplatin plus etoposide, paclitaxel, or vinorelbine, concurrently with thoracic radiation therapy (RT). Patients treated with surgery or neoadjuvant chemotherapy were excluded. The primary end point was overall survival (OS). Associations between CC and clinical variables and demographics were evaluated by using Pearson’s χ2 test. Survival curves were calculated by using the Kaplan-Meier method and were compared using the log-rank test. Univariable and multivariable analysis used a Cox proportional hazards model. Results We collected data from 165 patients. Median age was 60 years. Most patients were male (69.1%), white (77.9%), current or former smokers (93.3%), and had stage IIIB disease (52.7%). Adenocarcinoma was the most common histology (47.9%). Weight loss of more than 5% was observed in 39.1% and Eastern Cooperative Oncology Group performance status of 2 was observed in 14.6%. The only variable associated with CC was T stage (P = .022). We observed no statistically significant difference in OS between patients treated or not with CC (P = .128). A total delivered RT dose ≥ 61 Gy was the only variable independently associated with improved survival (P = .012). Conclusion Brazilian patients with locally advanced NSCLC who were treated with standard treatment achieved OS similar to that reported in randomized trials. CC did not improve OS in patients with stage III NSCLC after concurrent chemoradiation therapy. An RT dose of less than 61 Gy had a negative effect on OS.
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Affiliation(s)
- Vladmir C Cordeiro de Lima
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Clarissa S Baldotto
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Carlos H Barrios
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Eldsamira M Sobrinho
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Mauro Zukin
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Clarissa Mathias
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Facundo Zaffaroni
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Rodrigo C Nery
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Gabriel Madeira
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Alex V Amadio
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Juliano C Coelho
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Guilherme Geib
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Maria Fernanda Simões
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Gilberto Castro
- Vladmir C. Cordeiro de Lima and Rodrigo C. Nery, AC Camargo Cancer Center; Clarissa S. Baldotto, Mauro Zukin, and Gabriel Madeira, Instituto Nacional de Câncer, Rio de Janeiro; Carlos H. Barrios and Facundo Zaffaroni, Latin American Cooperative Oncology Group; Juliano C. Coelho and Guilherme Geib, Hospital de Clínicas de Porto Alegre, Porto Alegre; Eldsamira M. Sobrinho, Clarissa Mathias, and Maria Fernanda Simões, Núcleo de Oncologia da Bahia, Salvador, and Alex V. Amadio and Gilberto Castro Jr, Instituto de Câncer do Estado de São Paulo, São Paulo, Brazil
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Hui R, Özgüroğlu M, Villegas A, Daniel D, Vicente D, Murakami S, Yokoi T, Chiappori A, Lee KH, de Wit M, Cho BC, Gray JE, Rydén A, Viviers L, Poole L, Zhang Y, Dennis PA, Antonia SJ. Patient-reported outcomes with durvalumab after chemoradiotherapy in stage III, unresectable non-small-cell lung cancer (PACIFIC): a randomised, controlled, phase 3 study. Lancet Oncol 2019; 20:1670-1680. [PMID: 31601496 DOI: 10.1016/s1470-2045(19)30519-4] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the ongoing, phase 3 PACIFIC trial, durvalumab improved the primary endpoints of progression-free survival and overall survival compared with that for placebo, with similar safety, in patients with unresectable, stage III non-small-cell lung cancer. In this analysis, we aimed to evaluate one of the secondary endpoints, patient-reported outcomes (PROs). METHODS PACIFIC is an ongoing, international, multicentre, double-blind, randomised, controlled, phase 3 trial. Eligible patients were aged at least 18 years, had a WHO performance status of 0 or 1, with histologically or cytologically documented stage III, unresectable non-small-cell lung cancer, for which they had received at least two cycles of platinum-based chemoradiotherapy, with no disease progression after this treatment. We randomly assigned patients (2:1) using an interactive voice response system and a blocked design (block size=3) stratified by age, sex, and smoking history to receive 10 mg/kg intravenous durvalumab or matching placebo 1-42 days after concurrent chemoradiotherapy, then every 2 weeks up to 12 months. The primary endpoints of progression-free survival and overall survival have been reported previously. PROs were a prespecified secondary outcome. We assessed PRO symptoms, functioning, and global health status or quality of life in the intention-to-treat population with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) version 3 and its lung cancer module, the Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) at the time of random allocation to groups, at weeks 4 and 8, every 8 weeks until week 48, and then every 12 weeks until progression. Changes from baseline to 12 month in key symptoms were analysed with mixed model for repeated measures (MMRM) and time-to-event analyses. A 10-point or greater change from baseline (deterioration or improvement) was deemed clinically relevant. This study is registered with ClinicalTrials.gov, NCT02125461, and EudraCT, 2014-000336-42. FINDINGS Between May 9, 2014, and April 22, 2016, 476 patients were assigned to receive durvalumab, and 237 patients were assigned to receive placebo. As of March 22, 2018, the median follow-up was 25·2 months (IQR 14·1-29·5). More than 79% of patients given durvalumab and more than 82% of patients given placebo completed questionnaires up to week 48. Between baseline and 12 months, the prespecified longitudinal PROs of interest, cough (MMRM-adjusted mean change 1·8 [95% CI 0·06 to 3·54] in the durvalumab group vs 0·7 [-1·91 to 3·30] in the placebo group), dyspnoea (3·1 [1·75 to 4·36] vs 1·4 [-0·51 to 3·34]), chest pain (-3·1 [-4·57 to -1·60] vs -3·5 [-5·68 to -1·29]), fatigue (-3·0 [-4·53 to -1·50] vs -5·2 [-7·45 to -2·98]), appetite loss (-5·8 [-7·28 to -4·36] vs -7·0 [-9·17 to -4·87]), physical functioning (0·1 [-1·10 to 1·28] vs 2·0 [0·22 to 3·73]), and global health status or quality of life (2·6 [1·21 to 3·94] vs 1·8 [-0·25 to 3·81]) remained stable with both treatments, with no clinically relevant changes from baseline. The between-group differences in changes from baseline to 12 months in cough (difference in adjusted mean changes 1·1, 95% CI -1·89 to 4·11), dyspnoea (1·6, -0·58 to 3·87), chest pain (0·4, -2·13 to 2·93), fatigue (2·2, -0·38 to 4·78), appetite loss (1·2, -1·27 to 3·67), physical functioning (-1·9, -3·91 to 0·15), or global health status or quality of life (0·8, -1·55 to 3·14) were not clinically relevant. Generally, there were no clinically important between-group differences in time to deterioration of prespecified key PRO endpoints. INTERPRETATION Our findings suggest that a clinical benefit with durvalumab can be attained without compromising PROs. This result is of note because the previous standard of care was observation alone, with no presumed detriment to PROs. FUNDING AstraZeneca.
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Affiliation(s)
- Rina Hui
- Department of Medical Oncology, Westmead Hospital and the University of Sydney, Sydney, NSW, Australia.
| | - Mustafa Özgüroğlu
- Division of Medical Oncology, Department of Internal Medicine, Cerrahpaşa School of Medicine, Istanbul University Cerrahpaşa, Istanbul, Turkey
| | | | - Davey Daniel
- Sarah Cannon Research Institute, Nashville and Tennessee Oncology, Chattanooga, TN, USA
| | - David Vicente
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Shuji Murakami
- Department of Thoracic Oncology, Kanagawa Cancer Centre, Kanagawa, Japan
| | - Takashi Yokoi
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata, Japan
| | - Alberto Chiappori
- Thoracic Oncology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ki Hyeong Lee
- Department of Internal Medicine, College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Maike de Wit
- Department of Internal Medicine-Hematology, Oncology and Palliative Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Byoung Chul Cho
- Department of Internal Medicine, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, South Korea
| | - Jhanelle E Gray
- Thoracic Oncology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | | | | | - Scott J Antonia
- Thoracic Oncology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Ying M, Liu J, Zhou W, Weng K, Long B, Wang Y. The Role of Additional Chemotherapy in Combination with Concurrent Chemoradiotherapy for Locally Advanced Inoperable Non-Small Cell Lung Cancer, a Systematic Review and Meta-Analysis of 12 Randomized Trials. Cancer Invest 2019; 37:376-386. [PMID: 31474153 DOI: 10.1080/07357907.2019.1656730] [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: 01/23/2023]
Abstract
This meta-analysis aims to evaluate the effectiveness of chemotherapy before (I-CRT) or after (CRT-C) chemoradiotherapy (CRT) for inoperable locally advanced non-small cell lung cancer (LA-NSCLC). According to the object response rate (ORR) and disease control rate (DCR), there were no differences among I-CRT, CRT, and CRT-C treatments. I-CRT did not have significant survival benefits compared with CRT alone. Similar results comparing CRT-C with CRT were observed. Furthermore, I-CRT was not associated with improved survival compared to CRT-C with respect to OS and PFS. Our meta-analysis suggests the effects of additional chemotherapy added to CRT were limited for unselected LA-NSCLC.
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Affiliation(s)
- Min Ying
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital , Chongqing Province , People's Republic of China
| | - Jinkun Liu
- Chongqing Key Laboratory of Traditional Chinese Medicine to Prevent and Treat Autoimmune Diseases, Chongqing Hospital of Traditional Chinese Medicine , Chongqing Province , People's Republic of China.,College Pharmacy, Chengdu University of Traditional Chinese Medicine , Sichuan Province , People's Republic of China
| | - Wei Zhou
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital , Chongqing Province , People's Republic of China
| | - Kegui Weng
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital , Chongqing Province , People's Republic of China
| | - Bin Long
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital , Chongqing Province , People's Republic of China
| | - Ying Wang
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital , Chongqing Province , People's Republic of China
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Hsu PC, Chang JWC, Wang CC, Wu CT, Lin YC, Wang CL, Lin TY, Li SH, Wu YC, Kuo SCH, Yang CT, Liu CY, Chen CH. Oral vinorelbine plus cisplatin with concomitant radiotherapy as induction therapy for stage III non-small cell lung cancer: Results of a single-arm prospective cohort study. Thorac Cancer 2019; 10:1683-1691. [PMID: 31276309 PMCID: PMC6669803 DOI: 10.1111/1759-7714.13125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/20/2022] Open
Abstract
Background Concurrent chemoradiotherapy (CCRT) is an optimal recommended treatment for stage III non‐small cell lung cancer (NSCLC). Herein, we aimed to investigate the efficacy and safety of oral vinorelbine plus cisplatin with concomitant radiotherapy for stage III NSCLC. Methods This prospective, open‐label, single‐arm, observational cohort study was performed between January 2010 and September 2016. Patients were treated with two cycles of chemotherapy with 60 mg/m2 intravenous cisplatin on day 1 and 50 mg/m2 oral vinorelbine on days 1, 8, and 15; radiotherapy was administered concurrently from day 1 when chemotherapy was initiated. A total dose of 66–70 Gy radiotherapy was delivered in daily fractions of 2 Gy for 6.5–7 consecutive weeks. The tumor response was assessed after completing concomitant treatment. Results A total of 58 patients were enrolled and analyzed; 31 patients had stage IIIA NSCLC and 27 had stage IIIB NSCLC. After induction CCRT, 31 patients achieved an objective response (complete response in one and partial response in 30; the response rate was 53.4%). The median progression‐free survival was 6.73 months (95% confidence interval [CI], 5.42–7.91), duration of response was 12.30 months (95% CI, 5.59–19.01), and overall survival was 24.83 months (95% CI, 19.26–30.21). No treatment‐related mortality was observed, and neutropenia was the most common grade 3 and 4 treatment‐related toxicity (11 patients; 18.9%). Conclusions CCRT with the weekly regimen of oral vinorelbine plus triweekly cisplatin was effective and safe for stage III NSCLC.
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Affiliation(s)
- Ping-Chih Hsu
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - John Wen-Chang Chang
- Department of Oncology, Chang Gung Memorial Hospital Linkou branch, Taoyuan City, Taiwan
| | - Chun-Chieh Wang
- Division of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chen-Te Wu
- Department of Radiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Yu-Ching Lin
- Division of Thoracic Oncology, Department of Respiratory and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi county, Taiwan.,Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi county, Taiwan
| | - Chih-Liang Wang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Tin-Yu Lin
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Shih-Hong Li
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Yi-Chen Wu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Scott Chih-Hsi Kuo
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Cheng-Ta Yang
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan.,Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chien-Ying Liu
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chih-Hung Chen
- Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Gill HS, Ramalingam SS. A new standard of care for patients with surgically unresectable stage III non-small cell lung cancer. Cancer 2019; 125:2148-2153. [PMID: 30825394 DOI: 10.1002/cncr.31996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Harpaul S Gill
- Department of Hematology and Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Hematology and Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia
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35
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Multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer. Clin Transl Oncol 2019; 22:21-36. [PMID: 31172444 DOI: 10.1007/s12094-019-02134-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/11/2019] [Indexed: 12/17/2022]
Abstract
Stage III non-small cell lung cancer (NSCLC) is a very heterogeneous disease that encompasses patients with resected, potentially resectable and unresectable tumours. To improve the prognostic capacity of the TNM classification, it has been agreed to divide stage III into sub-stages IIIA, IIIB and IIIC that have very different 5-year survival rates (36, 26 and 13%, respectively). Currently, it is considered that both staging and optimal treatment of stage III NSCLC requires the joint work of a multidisciplinary team of expert physicians within the tumour committee. To improve the care of patients with stage III NSCLC, different scientific societies involved in the diagnosis and treatment of this disease have agreed to issue a series of recommendations that can contribute to homogenise the management of this disease, and ultimately to improve patient care.
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36
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Guo M, Li W, Li B, Zou B, Wang S, Meng X, Sun X, Yu J, Wang L. Prognostic value of delta inflammatory biomarker-based nomograms in patients with inoperable locally advanced NSCLC. Int Immunopharmacol 2019; 72:395-401. [PMID: 31030095 DOI: 10.1016/j.intimp.2019.04.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Inflammation plays critical roles in tumor growth and progression, and can be adversely affected by chemotherapy and radiotherapy. However, there have been few studies on the prognostic value of delta (Δ) inflammatory biomarkers before and after chemoradiotherapy in patients with locally advanced non-small cell lung cancer (LA-NSCLC). METHODS In this study, pre/post-treatment and Δ inflammatory biomarkers of 370 patients who were diagnosed as having inoperable LA-NSCLC in Shandong Cancer Hospital between January 2005 and January 2016 were analyzed. Nomograms were then established for predicting prognosis. RESULTS Median overall survival (OS) and progression free survival (PFS) for all patients were 28.1 (range 1.9-129.0) months and 11.1 (range 1.7-58.7) months, respectively. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) significantly increased and the lymphocyte-to-monocyte ratio (LMR) significantly decreased during the concurrent chemoradiotherapy course (P < 0.001, P < 0.001, and P < 0.001, respectively). Multivariate analysis revealed that pre-LMR, ΔNLR, and minimum absolute lymphocyte counts were independent predictors of OS (P = 0.027, P = 0.012, and P = 0.015, respectively) and post-LMR, post-NLR, and ΔNLR were independent predictors of PFS (P = 0.014, P = 0.001, and P = 0.036, respectively). Nomograms for OS and PFS were established by combining all significant inflammatory markers and clinicopathological characteristics. The concordance indexes for OS and PFS were 0.709 and 0.688, respectively. CONCLUSION Post-treatment and Δ inflammatory biomarkers may have more prognostic significance than baseline measurements of inflammatory biomarkers in LA-NSCLC patients. The proposed nomograms based on the dynamic inflammatory biomarkers and clinicopathological factors may be practical and widely available for evaluating the prognosis of patients with inoperable LA-NSCLC.
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Affiliation(s)
- Meiying Guo
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China
| | - Wanlong Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China; Shandong Academy of Medical Sciences, Jinan 250001, China
| | - Butuo Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China; Department of Radiation Oncology and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300270, China
| | - Bing Zou
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China; Shandong Academy of Medical Sciences, Jinan 250001, China
| | - Shijiang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China; Shandong Academy of Medical Sciences, Jinan 250001, China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China; Shandong Academy of Medical Sciences, Jinan 250001, China
| | - Xindong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China; Shandong Academy of Medical Sciences, Jinan 250001, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China; Shandong Academy of Medical Sciences, Jinan 250001, China.
| | - Linlin Wang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China; Shandong Academy of Medical Sciences, Jinan 250001, China.
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37
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Cheema PK, Rothenstein J, Melosky B, Brade A, Hirsh V. Perspectives on treatment advances for stage III locally advanced unresectable non-small-cell lung cancer. Curr Oncol 2019; 26:37-42. [PMID: 30853796 PMCID: PMC6380636 DOI: 10.3747/co.25.4096] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
For more than a decade, there has been no improvement in outcomes for patients with unresectable locally advanced (la) non-small-cell lung cancer (nsclc). The standard treatment in that setting is definitive concurrent chemotherapy and radiation (ccrt). Although the intent of treatment is curative, most patients rapidly progress, and their prognosis is poor, with a 5-year overall survival (os) rate in the 15%-25% range. Those patients therefore represent a critical unmet need, warranting expedited approval of, and access to, new treatments that can improve outcomes. The pacific trial, which evaluated durvalumab consolidation therapy after ccrt in unresectable la nsclc, demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (pfs) and a significant improvement in os. Durvalumab thus fills a critical unmet need in the setting of unresectable la nsclc and provides a new option for patients treated with curative intent. Here, we review the treatment of unresectable la nsclc, with a focus on the effect of the clinical data for durvalumab.
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Affiliation(s)
- P K Cheema
- William Osler Health System, Brampton/Toronto, and University of Toronto, Toronto, ON
| | - J Rothenstein
- R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, and Queen's University, Kingston, ON
| | - B Melosky
- BC Cancer-Vancouver and University of British Columbia, Vancouver, BC
| | - A Brade
- Peel Regional Cancer Centre, Mississauga, and University of Toronto, Toronto, ON
| | - V Hirsh
- Royal Victoria Hospital and McGill University, Montreal, QC
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38
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Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, Kurata T, Chiappori A, Lee KH, de Wit M, Cho BC, Bourhaba M, Quantin X, Tokito T, Mekhail T, Planchard D, Kim YC, Karapetis CS, Hiret S, Ostoros G, Kubota K, Gray JE, Paz-Ares L, de Castro Carpeño J, Faivre-Finn C, Reck M, Vansteenkiste J, Spigel DR, Wadsworth C, Melillo G, Taboada M, Dennis PA, Özgüroğlu M. Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC. N Engl J Med 2018; 379:2342-2350. [PMID: 30280658 DOI: 10.1056/nejmoa1809697] [Citation(s) in RCA: 1839] [Impact Index Per Article: 306.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND An earlier analysis in this phase 3 trial showed that durvalumab significantly prolonged progression-free survival, as compared with placebo, among patients with stage III, unresectable non-small-cell lung cancer (NSCLC) who did not have disease progression after concurrent chemoradiotherapy. Here we report the results for the second primary end point of overall survival. METHODS We randomly assigned patients, in a 2:1 ratio, to receive durvalumab intravenously, at a dose of 10 mg per kilogram of body weight, or matching placebo every 2 weeks for up to 12 months. Randomization occurred 1 to 42 days after the patients had received chemoradiotherapy and was stratified according to age, sex, and smoking history. The primary end points were progression-free survival (as assessed by blinded independent central review) and overall survival. Secondary end points included the time to death or distant metastasis, the time to second progression, and safety. RESULTS Of the 713 patients who underwent randomization, 709 received the assigned intervention (473 patients received durvalumab and 236 received placebo). As of March 22, 2018, the median follow-up was 25.2 months. The 24-month overall survival rate was 66.3% (95% confidence interval [CI], 61.7 to 70.4) in the durvalumab group, as compared with 55.6% (95% CI, 48.9 to 61.8) in the placebo group (two-sided P=0.005). Durvalumab significantly prolonged overall survival, as compared with placebo (stratified hazard ratio for death, 0.68; 99.73% CI, 0.47 to 0.997; P=0.0025). Updated analyses regarding progression-free survival were similar to those previously reported, with a median duration of 17.2 months in the durvalumab group and 5.6 months in the placebo group (stratified hazard ratio for disease progression or death, 0.51; 95% CI, 0.41 to 0.63). The median time to death or distant metastasis was 28.3 months in the durvalumab group and 16.2 months in the placebo group (stratified hazard ratio, 0.53; 95% CI, 0.41 to 0.68). A total of 30.5% of the patients in the durvalumab group and 26.1% of those in the placebo group had grade 3 or 4 adverse events of any cause; 15.4% and 9.8% of the patients, respectively, discontinued the trial regimen because of adverse events. CONCLUSIONS Durvalumab therapy resulted in significantly longer overall survival than placebo. No new safety signals were identified. (Funded by AstraZeneca; PACIFIC ClinicalTrials.gov number, NCT02125461 .).
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Affiliation(s)
- Scott J Antonia
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Augusto Villegas
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Davey Daniel
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - David Vicente
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Shuji Murakami
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Rina Hui
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Takayasu Kurata
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Alberto Chiappori
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Ki H Lee
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Maike de Wit
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Byoung C Cho
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Maryam Bourhaba
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Xavier Quantin
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Takaaki Tokito
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Tarek Mekhail
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - David Planchard
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Young-Chul Kim
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Christos S Karapetis
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Sandrine Hiret
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Gyula Ostoros
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Kaoru Kubota
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Jhanelle E Gray
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Luis Paz-Ares
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Javier de Castro Carpeño
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Corinne Faivre-Finn
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Martin Reck
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Johan Vansteenkiste
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - David R Spigel
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Catherine Wadsworth
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Giovanni Melillo
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Maria Taboada
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Phillip A Dennis
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Mustafa Özgüroğlu
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), Florida Cancer Specialists, Fleming Island (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga (D.D.), and Sarah Cannon Research Institute, Nashville (D.D., D.R.S.) - both in Tennessee; Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.K.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Adelaide, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukoelln, Berlin (M.W.), and the Lung Clinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf (M.R.) - both in Germany; Centre Hospitalier Universitaire de Liège, Liège (M.B.), and University Hospitals KU Leuven, Leuven (J.V.) - both in Belgium; Centre Hospitalier Universitaire de Montpellier and Institut du Cancer de Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); the University of Manchester and the Christie NHS Foundation Trust, Manchester (C.F.-F.), AstraZeneca, Alderley Park (C.W.), and AstraZeneca, Cambridge (M.T.) - all in the United Kingdom; AstraZeneca, Gaithersburg, MD (G.M., P.A.D.); and Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
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Arulananda S, Mitchell P. Elderly patients with stage III NSCLC survive longer when chemotherapy is added to radiotherapy-fortune favours the bold. Transl Lung Cancer Res 2018; 7:S388-S392. [PMID: 30705864 DOI: 10.21037/tlcr.2018.08.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Surein Arulananda
- Cancer Immuno-Biology Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Australia.,School of Cancer Medicine, La Trobe University, Heidelberg, Australia.,Department of Medical Oncology, Austin Health, Heidelberg, Australia
| | - Paul Mitchell
- Cancer Immuno-Biology Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Australia.,Department of Medical Oncology, Austin Health, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia
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Badiyan SN, Roach MC, Chuong MD, Rice SR, Onyeuku NE, Remick J, Chilukuri S, Glass E, Mohindra P, Simone CB. Combining immunotherapy with radiation therapy in thoracic oncology. J Thorac Dis 2018; 10:S2492-S2507. [PMID: 30206494 PMCID: PMC6123189 DOI: 10.21037/jtd.2018.05.73] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 12/13/2022]
Abstract
Thoracic malignancies comprise some of the most common and deadly cancers. Immunotherapies have been proven to improve survival outcomes for patients with advanced non-small cell lung cancer (NSCLC) and show great potential for patients with other thoracic malignancies. Radiation therapy (RT), an established and effective treatment for thoracic cancers, has acted synergistically with immunotherapies in preclinical studies. Ongoing clinical trials are exploring the clinical benefits of combining RT with immunotherapies and the optimal manner in which to deliver these complementary treatments.
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Affiliation(s)
| | | | - Michael D. Chuong
- Miami Cancer Institute at Baptist Health South Florida, Miami, FL, USA
| | | | | | - Jill Remick
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Erica Glass
- University of Maryland School of Medicine, Baltimore, MD, USA
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Skrzypski M, Jassem J. Consolidation systemic treatment after radiochemotherapy for unresectable stage III non-small cell lung cancer. Cancer Treat Rev 2018; 66:114-121. [DOI: 10.1016/j.ctrv.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/02/2018] [Indexed: 12/22/2022]
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Chiramel J, Tay R, Califano R. Durvalumab after chemo-radiotherapy in stage III non-small cell lung cancer. J Thorac Dis 2018; 10:S991-S994. [PMID: 29850180 DOI: 10.21037/jtd.2018.04.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Jaseela Chiramel
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Rebecca Tay
- 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 Hospital NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
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Zhang TW, Rodrigues GB, Louie AV, Palma D, Dar AR, Dingle B, Kocha W, Sanatani M, Yaremko B, Yu E, Younus J, Vincent MD. Phase I study of concurrent and consolidation cisplatin and docetaxel chemotherapy with thoracic radiotherapy in non-small cell lung cancer. CURRENT ONCOLOGY (TORONTO, ONT.) 2018; 25:22-31. [PMID: 29507480 DOI: 10.347/co.25.3657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background We designed a phase i study of concurrent chemoradiotherapy (ccrt) with docetaxel (D) and cisplatin (C), followed by consolidation dc, for unresectable stage iii non-small cell lung cancer (nsclc). Methods Patients with histologically proven and unresectable stage iii nsclc were eligible. During ccrt, C was given every 3 weeks (75 mg/m2) and D given weekly. The starting dose of D was 20 mg/m2, escalated in cohorts of 3 to define the maximum tolerated dose (mtd). Radiotherapy was prescribed to a dose of 60 Gy in 30 fractions. This was followed by 2 cycles of consolidation dc, which were dose escalated if ccrt was tolerated. Results Twenty-six patients were enrolled, with 1 excluded following evidence of metastatic disease. Nineteen patients completed both phases of treatment. There were 7 grade 3 events during ccrt (5 esophagitis, 2 nausea), and 8 grade 3 events during consolidation (2 neutropenia, 2 leukopenia, 1 esophagitis, 2 nausea, and 1 pneumonitis). Three patients had grade 4 neutropenia. No patients died due to toxicities. The mtd of concurrent weekly D was 20 mg/m2. Consolidation D and C were each dose escalated to 75 mg/m2 in 8 patients. The median overall survival (os) and progression-free survival (pfs) of all patients were 33.6 months and 17.2 months, respectively, with median follow-up of 26.6 months (range 0.43-110.8). Conclusions The use of docetaxel 20 mg/m2 weekly and cisplatin 75 mg/m2 every 3 weeks concurrent with thoracic radiotherapy, followed by consolidation docetaxel and cisplatin, both given at 75 mg/m2 every 3 weeks, appears to be safe in this phase i trial.
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Affiliation(s)
- T W Zhang
- Department of Oncology, London Regional Cancer Program, London, ON
| | - G B Rodrigues
- Department of Oncology, London Regional Cancer Program, London, ON
| | - A V Louie
- Department of Oncology, London Regional Cancer Program, London, ON
| | - D Palma
- Department of Oncology, London Regional Cancer Program, London, ON
| | - A R Dar
- Department of Oncology, London Regional Cancer Program, London, ON
| | - B Dingle
- Department of Oncology, London Regional Cancer Program, London, ON
| | - W Kocha
- Department of Oncology, London Regional Cancer Program, London, ON
| | - M Sanatani
- Department of Oncology, London Regional Cancer Program, London, ON
| | - B Yaremko
- Department of Oncology, London Regional Cancer Program, London, ON
| | - E Yu
- Department of Oncology, London Regional Cancer Program, London, ON
| | - J Younus
- Department of Oncology, London Regional Cancer Program, London, ON
| | - M D Vincent
- Department of Oncology, London Regional Cancer Program, London, ON
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Long-term survival of locally advanced stage III non-small cell lung cancer patients treated with chemoradiotherapy and perspectives for the treatment with immunotherapy. Radiol Oncol 2018; 52:281-288. [PMID: 30210037 PMCID: PMC6137367 DOI: 10.2478/raon-2018-0009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022] Open
Abstract
Background Standard treatment for patients with inoperable locally advanced non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy (CCRT). Five-year overall survival rates range between 15 and 25%, while long term survival data are rarely reported. Patients and methods A total of 102 patients with stage III NSCLC treated between September 2005 and November 2010 with induction chemotherapy and CCRT were included in this long term survival analysis. All patients were tested for PD-L1 status and expression of PD-L1 was correlated with overall survival (OS), progression free survival (PFS) and toxicities. Results The median OS of all patients was 24.8 months (95% CI 18.7 to 31.0) with 10 year-survival rate of 11.2%. The median OS of patients with PD-L1 expression was 12.1 months (95% CI 0.1 to 26.2), while in patients with negative or unknown PD-L1 status was significantly longer, 25.2 months (95% CI 18.9 to 31.6), p = 0.005. The median PFS of all patients was 16.4 months (95% CI 13.0 to 19.9). PFS of patients with PD-L1 expression was 10.1 months (95% CI 0.1 to 20.4) and in patients with negative or unknown PD-L1 status was 17.9 months (95% CI 14.2 to 21.7), p = 0.003. Conclusions 10-year overall survival of stage III NSCLC patients after CCRT is 11.2%. PFS and OS differ with regard to PD-L1 status and are significantly shorter for patients with PD-L1 expression. New treatment with check-point inhibitors combined with RT therefore seems reasonable strategy to improve these results.
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A phase III randomised study comparing concomitant radiochemotherapy with cisplatin and docetaxel as induction versus consolidation treatment in patients with locally advanced unresectable non-small cell lung cancer. Lung Cancer 2018; 117:32-37. [PMID: 29496253 DOI: 10.1016/j.lungcan.2017.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess if induction radiochemotherapy followed by consolidation chemotherapy (arm A) will improve survival in comparison with the same chemotherapy given as induction followed by consolidation concurrent radiochemotherapy (arm B) in patients with unresectable non-metastatic non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Chemotherapy consisted in a combination of cisplatin with docetaxel, with one initial course for each patient, two courses in single modality therapy and weekly administration during chest irradiation (66 Gy). RESULTS A total of 125 patients were randomised before early closure of the study because of poor accrual and an unplanned blind interim analysis which suggested that the continuation of the study would have been futile. Mature survival results showed no significant difference between both modalities with median survival times, respectively in arms A and B, of 19.6 months and 18.3 months, two years survival rates of 44% and 44% and five years survival rates of 23% and 26%. Toxicity was acceptable. CONCLUSIONS Our randomised study did not demonstrate survival difference between induction concurrent radiochemotherapy followed by consolidation chemotherapy and induction chemotherapy followed by consolidation concurrent radiochemotherapy.
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Taira T, Yoh K, Nagase S, Kubota K, Ohmatsu H, Niho S, Onozawa M, Akimoto T, Ohe Y, Goto K. Long-term results of S-1 plus cisplatin with concurrent thoracic radiotherapy for locally advanced non-small-cell lung cancer. Cancer Chemother Pharmacol 2018; 81:565-572. [DOI: 10.1007/s00280-018-3530-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
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Carter CA, Zeman K, Day RM, Richard P, Oronsky A, Oronsky N, Lybeck M, Scicinski J, Oronsky B. Addressing the elephant in the room, therapeutic resistance in non-small cell lung cancer, with epigenetic therapies. Oncotarget 2018; 7:40781-40791. [PMID: 27007055 PMCID: PMC5130044 DOI: 10.18632/oncotarget.8205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/07/2016] [Indexed: 12/15/2022] Open
Abstract
Like Chinese boxes nesting inside each other, the classification of non-small cell lung cancer (NSCLC) is subdivided into smaller and smaller subtypes on the basis of histological and molecular attributes. The latter characterizes NSCLC by its molecular alterations and the identification of inhibitors that target these cancer-specific "driver" mutations. Despite the initial promise of precision-guided therapies to inhibit a finer and finer array of molecular subcategories, despite even the curative potential of immunotherapeutic checkpoint blockade, in particular, casualties still abound and true clinical success stories are few and far between; the ever-present, if sometimes unmentioned, "elephant in the room", is the acquisition of resistance, which, sooner or later, rears its ugly head to undermine treatment success and shorten survival. Emerging data suggests that epigenetic therapies are able to reprogram the aberrant tumor-associated epigenome and 'tame the beast of resistance', thereby prolonging survival. This article reviews the role of epigenetic dysregulation in NSCLC, explores PFS2 as a possible surrogate endpoint, briefly mentions possible biomarkers and highlights combinatorial treatment epigenetic strategies to "prime" tumors and reverse resistance.
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Affiliation(s)
- Corey A Carter
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Karen Zeman
- National Naval Medical Center, Bethesda, MD, USA
| | - Regina M Day
- Uniformed Services University of The Health Sciences, Bethesda, MD, USA
| | - Patrick Richard
- Uniformed Services University of The Health Sciences, Bethesda, MD, USA
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Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, Yokoi T, Chiappori A, Lee KH, de Wit M, Cho BC, Bourhaba M, Quantin X, Tokito T, Mekhail T, Planchard D, Kim YC, Karapetis CS, Hiret S, Ostoros G, Kubota K, Gray JE, Paz-Ares L, de Castro Carpeño J, Wadsworth C, Melillo G, Jiang H, Huang Y, Dennis PA, Özgüroğlu M. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med 2017; 377:1919-1929. [PMID: 28885881 DOI: 10.1056/nejmoa1709937] [Citation(s) in RCA: 2811] [Impact Index Per Article: 401.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Most patients with locally advanced, unresectable, non-small-cell lung cancer (NSCLC) have disease progression despite definitive chemoradiotherapy (chemotherapy plus concurrent radiation therapy). This phase 3 study compared the anti-programmed death ligand 1 antibody durvalumab as consolidation therapy with placebo in patients with stage III NSCLC who did not have disease progression after two or more cycles of platinum-based chemoradiotherapy. METHODS We randomly assigned patients, in a 2:1 ratio, to receive durvalumab (at a dose of 10 mg per kilogram of body weight intravenously) or placebo every 2 weeks for up to 12 months. The study drug was administered 1 to 42 days after the patients had received chemoradiotherapy. The coprimary end points were progression-free survival (as assessed by means of blinded independent central review) and overall survival (unplanned for the interim analysis). Secondary end points included 12-month and 18-month progression-free survival rates, the objective response rate, the duration of response, the time to death or distant metastasis, and safety. RESULTS Of 713 patients who underwent randomization, 709 received consolidation therapy (473 received durvalumab and 236 received placebo). The median progression-free survival from randomization was 16.8 months (95% confidence interval [CI], 13.0 to 18.1) with durvalumab versus 5.6 months (95% CI, 4.6 to 7.8) with placebo (stratified hazard ratio for disease progression or death, 0.52; 95% CI, 0.42 to 0.65; P<0.001); the 12-month progression-free survival rate was 55.9% versus 35.3%, and the 18-month progression-free survival rate was 44.2% versus 27.0%. The response rate was higher with durvalumab than with placebo (28.4% vs. 16.0%; P<0.001), and the median duration of response was longer (72.8% vs. 46.8% of the patients had an ongoing response at 18 months). The median time to death or distant metastasis was longer with durvalumab than with placebo (23.2 months vs. 14.6 months; P<0.001). Grade 3 or 4 adverse events occurred in 29.9% of the patients who received durvalumab and 26.1% of those who received placebo; the most common adverse event of grade 3 or 4 was pneumonia (4.4% and 3.8%, respectively). A total of 15.4% of patients in the durvalumab group and 9.8% of those in the placebo group discontinued the study drug because of adverse events. CONCLUSIONS Progression-free survival was significantly longer with durvalumab than with placebo. The secondary end points also favored durvalumab, and safety was similar between the groups. (Funded by AstraZeneca; PACIFIC ClinicalTrials.gov number, NCT02125461 .).
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Affiliation(s)
- Scott J Antonia
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Augusto Villegas
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Davey Daniel
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - David Vicente
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Shuji Murakami
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Rina Hui
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Takashi Yokoi
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Alberto Chiappori
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Ki H Lee
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Maike de Wit
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Byoung C Cho
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Maryam Bourhaba
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Xavier Quantin
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Takaaki Tokito
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Tarek Mekhail
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - David Planchard
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Young-Chul Kim
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Christos S Karapetis
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Sandrine Hiret
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Gyula Ostoros
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Kaoru Kubota
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Jhanelle E Gray
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Luis Paz-Ares
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Javier de Castro Carpeño
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Catherine Wadsworth
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Giovanni Melillo
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Haiyi Jiang
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Yifan Huang
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Phillip A Dennis
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
| | - Mustafa Özgüroğlu
- From the H. Lee Moffitt Cancer Center and Research Institute, Tampa (S.J.A., A.C., J.E.G.), Cancer Specialists of North Florida, Jacksonville (A.V.), and Florida Hospital Cancer Institute, Orlando (T.M.) - all in Florida; Tennessee Oncology, Chattanooga, and Sarah Cannon Research Institute, Nashville - both in Tennessee (D.D.); Hospital Universitario Virgen Macarena, Seville (D.V.), and Hospital Universitario 12 de Octubre, Centro de Investigación Biomédica en Red de Cáncer, Universidad Complutense and the Spanish National Cancer Research Center (L.P.-A.), and Hospital Universitario La Paz (J.C.C.), Madrid - all in Spain; Kanagawa Cancer Center, Yokohama (S.M.), Kansai Medical University Hospital, Hirakata (T.Y.), Kurume University Hospital, Kurume (T.T.), and Nippon Medical School Hospital, Tokyo (K.K.) - all in Japan; Westmead Hospital and the University of Sydney, Sydney (R.H.), and Flinders University and Flinders Medical Centre, Bedford Park, SA (C.S.K.) - all in Australia; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju (K.H.L.), Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju (Y.-C.K.) - all in South Korea; Vivantes Klinikum Neukölln, Berlin (M.W.); Centre Hospitalier Universitaire de Liège, Liège, Belgium (M.B.); Centre Hospitalier Universitaire Montpellier and Cancer Institute of Montpellier Val d'Aurelle, Montpellier (X.Q.), Institut Gustave Roussy, Villejuif (D.P.), and Institut de Cancérologie de l'Ouest-Site René Gauducheau, Saint Herblain (S.H.) - all in France; National Koranyi Institute of Pulmonology, Budapest, Hungary (G.O.); AstraZeneca, Alderley Park, United Kingdom (C.W.); AstraZeneca, Gaithersburg, MD (G.M., H.J., Y.H., P.A.D.); and Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey (M.Ö.)
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Tabchi S, Kassouf E, Rassy EE, Kourie HR, Martin J, Campeau MP, Tehfe M, Blais N. Management of stage III non-small cell lung cancer. Semin Oncol 2017; 44:163-177. [PMID: 29248128 DOI: 10.1053/j.seminoncol.2017.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 10/13/2017] [Indexed: 12/25/2022]
Abstract
Optimal management of patients with locally advanced non-small cell lung cancer remains challenging in the context of this heterogeneous disease. Despite aggressive therapeutic approaches, survival benefits are still unsatisfactory for what might be viewed as a localized malignancy. A combined modality approach offers patients superior outcomes, especially because technological advances and refined surgical procedures now provide better results with fewer complications. Nevertheless, several features of therapy remain controversial and lack formal prospective data. Traditional cytotoxic chemoradiation therapy may have reached a plateau and future perspectives opting to integrate molecularly targeted agents and immunotherapy might be the way to improve outcomes in this disease subset.
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Affiliation(s)
- Samer Tabchi
- Medical Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Elie Kassouf
- Medical Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Elie El Rassy
- Hotel Dieu de France University Hospital, Faculty of Medicine Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Oncology Department, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Jocelyne Martin
- Department of Thoracic surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Campeau
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Mustapha Tehfe
- Medical Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Normand Blais
- Medical Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
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50
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Santana-Davila R, Martins R. Treatment of Stage IIIA Non-Small-Cell Lung Cancer: A Concise Review for the Practicing Oncologist. J Oncol Pract 2017; 12:601-6. [PMID: 27407154 DOI: 10.1200/jop.2016.013052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Stage IIIA non-small-cell lung cancer occurs in a heterogenous group of patients for whom the best treatment is multimodality therapy with chemotherapy, radiation, and surgery in a select group of individuals. This clinical review intends to answer the most common questions that clinicians face in the decision about the best management in this group.
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