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Reck M, Popat S, Grohé C, Corral J, Novello S, Gottfried M, Brueckl W, Radonjic D, Kaiser R, Heymach J. Anti-angiogenic agents for NSCLC following first-line immunotherapy: Rationale, recent updates, and future perspectives. Lung Cancer 2023; 179:107173. [PMID: 36940614 DOI: 10.1016/j.lungcan.2023.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
The implementation of immune checkpoint inhibitors (ICIs), with or without chemotherapy, as first-line treatment for patients who do not have actionable mutations has proved to be a major paradigm shift in the management of advanced non-small cell lung cancer (NSCLC). However, the transition of ICIs, such as pembrolizumab and nivolumab, to a first-line setting has left an unmet need for effective second-line treatment options, which is an area of intense research. In 2020, we reviewed the biological and mechanistic rationale for anti-angiogenic agents in combination with, or following, immunotherapy with the aim of eliciting a so called 'angio-immunogenic' switch in the tumor microenvironment. Here, we review the latest clinical evidence of the benefits of incorporating anti-angiogenic agents into treatment regimens. While there is a paucity of prospective data, several recent observational studies indicate that the marketed anti-angiogenic drugs, nintedanib or ramucirumab, are effective in combination with docetaxel following immuno-chemotherapy. Addition of anti-angiogenics, like bevacizumab, have also demonstrated clinical benefit when combined with first-line immuno-chemotherapy regimens. Ongoing clinical trials are assessing these agents in combination with ICIs, with encouraging early results (e.g., ramucirumab plus pembrolizumab in LUNG-MAP S1800A). Also, several emerging anti-angiogenic agents combined with ICIs are currently being assessed in phase III trials following immunotherapy, including lenvatinib (LEAP-008), and sitravatinib (SAPPHIRE) It is hoped that these trials will help expand second-line treatment options in patients with NSCLC. Areas of focus in the future will include further molecular dissection of the mechanisms of resistance to immunotherapy and the various response-progression profiles to immunotherapy observed in the clinic and the monitoring of the dynamics of immunomodulation over the course of treatment. Improved understanding of these phenomena may help identify clinical biomarkers and inform the optimal use of anti-angiogenics in the treatment of individual patients.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL), LungenClinic, Großhansdorf, Germany.
| | - Sanjay Popat
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | | | - Jesus Corral
- Clínica Universidad de Navarra en Madrid, Madrid, Spain
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | | | - Wolfgang Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg Lung Cancer Center, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Dejan Radonjic
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Rolf Kaiser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany; Institute of Pharmacology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - John Heymach
- Department of Thoracic/Head and Neck Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Remon J, Lacas B, Herbst R, Reck M, Garon EB, Scagliotti GV, Ramlau R, Hanna N, Vansteenkiste J, Yoh K, Groen HJ, Heymach JV, Mandrekar SJ, Okamoto I, Neal JW, Heist RS, Planchard D, Pignon JP, Besse B, Besse B, Lacas B, Pignon J, Remon J, Berghmans T, Dahlberg S, Felip E, Berghmans T, Besse B, Dahlberg S, Felip E, Garon E, Groen HJ, Hanna N, Heist RS, Herbst R, Heymach JV, Lacas B, Adjei AA, Heist R, Mandrekar SJ, Neal JW, Okamoto I, Pignon JP, Ramlau R, Remon J, Reck M, Scagliotti GV, Vansteenkiste J, Yoh K. ANtiangiogenic Second-line Lung cancer Meta-Analysis on individual patient data in non-small cell lung cancer: ANSELMA. Eur J Cancer 2022; 166:112-125. [DOI: 10.1016/j.ejca.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022]
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Sun W, He G, Zhang M, Zhao Y, Yu H, Li Y, Wu W, Ji T. 99mTc-3PRGD 2 SPECT Predicts the Outcome of Endostar and Cisplatin Therapy in Xenograft Animals. Dose Response 2019; 17:1559325819882544. [PMID: 31673250 PMCID: PMC6804356 DOI: 10.1177/1559325819882544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/03/2019] [Accepted: 08/11/2019] [Indexed: 11/16/2022] Open
Abstract
Aims: Our study was designed to investigate the usefulness of 99mTc-3PRGD2 single-photon emission computed tomography (SPECT) for noninvasively monitoring the response of integrin αvβ3 expression to antiangiogenic treatment with endostar and cisplatin in xenograft animals. Methods: 99mTc-3PRGD2 SPECT imaging was performed at days 0, 7, 14, and 21. Tumors were harvested at all imaging time points for Western blotting and histopathological analysis. Result: In 99mTc-3PRGD2 SPECT imaging, the radioactivity accumulation of NaCl group rised gradually in the first half and dispersed on day 21 due to the necrosis of the tumor. While the radioactivity accumulation of treated groups gradually decreased throughout the course. The downtrend of tumor to nontumor ratio in endostar-treated group was more remarkable than cisplatin-treated group. The expression of intergrin αvβ3 of treated groups was lower than NaCl group from day 14. The expression of intergrin αvβ3 of endostar-treated group was significantly lower than cisplatin-treated group from baseline onward. Conclusion: It’s demonstrated that the 99mTc-3PRGD2 could noninvasively visualize and semiquantify tumor angiogenesis in the xenograft model and monitor the response to the antiangiogenic therapy of endostar and cisplatin effectively. It also can predict the outcome of endostar and cisplatin therapy in xenograft animals.
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Affiliation(s)
- Wei Sun
- Institute of Pediatrics, First Hospital, Jilin University, Changchun, Jilin, China
| | - Guifu He
- Department of Nuclear Medicine, Jilin Provincial Tumor Hospital, Changchun, Jilin, China
| | - Mingming Zhang
- Department of Molecular Biology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, China
| | - Yi Zhao
- Department of Nuclear Medicine, Jilin Provincial Tumor Hospital, Changchun, Jilin, China
| | - Hongmei Yu
- Department of Blood Transfusion, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Yi Li
- State Key Laboratory of Inorganic Synthesis and Preparative Chemistry, College of Chemistry, Jilin University, Changchun, Jilin, China
| | - Wei Wu
- Department of Nuclear Medicine, Jilin Provincial Tumor Hospital, Changchun, Jilin, China
| | - Tiefeng Ji
- Department of Radiology, First Hospital, Jilin University, Changchun, Jilin, China
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Efficacy and safety of angiogenesis inhibitors in small-cell lung cancer. Oncotarget 2018; 8:1141-1155. [PMID: 27901478 PMCID: PMC5352042 DOI: 10.18632/oncotarget.13588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/09/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the efficacy and safety of angiogenesis inhibitors for small-cell lung cancer (SCLC). METHODS Totally, 16 controlled trials (1898 cases) involving angiogenesis inhibitors plus chemotherapy (ACT group) versus chemotherapy alone group (CT group) were identified from PubMed, EMBASE, Cochrane Library and Wanfang Data before March 2016. RESULTS Compared with CT group, ACT group obtained a significant benefit on objective response rate (ORR) (RR = 1.34; 95% CI = 1.19-1.51; P < 0.00001) and a trend of prolonging progression-free survival (PFS) (HR = 0.86; 95% CI = 0.73-1.01; P = 0.07) without improving overall survival (OS) (HR = 1.05; 95% CI = 0.94-1.17; P = 0.36). Remarkably, subgroup analysis showed that the antibodies targeting VEGF significantly prolonged PFS (HR = 0.76; 95% CI = 0.64-0.90; P = 0.001). With regard to toxicity, there was no significant difference in severe adverse events (AEs, Grade≥3) between two groups except that gastrointestinal symptom, hypertension, metabolic disorders, neurology and pain were higher in ACT group. CONCLUSION Compared with chemotherapy alone, antibodies targeting VEGF plus chemotherapy significantly improved ORR and prolonged PFS with an acceptable toxicity profile for patients with SCLC. Therefore, angiogenesis inhibitors, especially antibodies targeting VEGF, combining with chemotherapy may be a potential promising strategy in managing SCLC.
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Chen B, Zhang W, Ji B, Ma Q, Li D, Gao S. Integrin αVβ 3-targeted SPECT/CT for the assessment of Bevacizumab therapy in orthotopic lung cancer xenografts. Oncol Lett 2018. [PMID: 29541186 PMCID: PMC5835916 DOI: 10.3892/ol.2018.7901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The present study aimed to determine the utility of 99mTc-3PRGD2 single photon emission computed tomography (SPECT)/computed tomography (CT) for the non-invasive monitoring of the response of integrin αvβ3 expression to anti-angiogenic treatment with bevacizumab. Bevacizumab or vehicle therapy was performed in athymic nu/nu mice bearing A549 lung tumors (moderately high integrin αvβ3 expression) or PC-3 prostate tumors (low integrin αvβ3 expression) at a dose of 1 mg twice a week. The average tumor volume was 180±90 mm3 the day prior to baseline SPECT/CT. Longitudinal 99mTc-3PRGD2 SPECT/CT imaging was performed at baseline (-1 day) and at days 5 and 15. Tumors were harvested at all imaging time points for histopathological analysis with hematoxylin and eosin (H&E) and immunohistochemistry staining. Results revealed a significant difference in tumor volume between vehicle- and bevacizumab-treated groups at 5 and 15 days following the start of treatment in the A549 lung model (P<0.05). At 5 days after the start of therapy, the percent injected dose per gram of tissue (%ID/g) and tumor-to-muscle ratio for bevacizumab-treated A549 declined persistently (P<0.05). However, for the vehicle-treated A549 model, the %ID and %ID/g value increased 5 days after the start of treatment (P<0.05). For the PC-3 model, slow-growing tumors and low tumor uptake was observed throughout the study. Alterations in tumor vasculature were confirmed by histopathological H&E analysis and immunohistochemistry. In conclusion, longitudinal imaging using 99mTc-3PRGD2 SPECT/CT may be a useful tool for monitoring the anti-angiogenic effect of bevacizumab therapy.
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Affiliation(s)
- Bin Chen
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Erdao, Changchun 130033, P.R. China
| | - Wenqi Zhang
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Erdao, Changchun 130033, P.R. China
| | - Bin Ji
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Erdao, Changchun 130033, P.R. China
| | - Qingjie Ma
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Erdao, Changchun 130033, P.R. China
| | - Dandan Li
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Erdao, Changchun 130033, P.R. China
| | - Shi Gao
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Erdao, Changchun 130033, P.R. China
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Raphael J, Chan K, Karim S, Kerbel R, Lam H, Santos KD, Saluja R, Verma S. Antiangiogenic Therapy in Advanced Non-small-cell Lung Cancer: A Meta-analysis of Phase III Randomized Trials. Clin Lung Cancer 2017; 18:345-353.e5. [PMID: 28188101 DOI: 10.1016/j.cllc.2017.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 12/26/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022]
Abstract
We conducted a meta-analysis to evaluate the efficacy of adding any antiangiogenic therapy (AT) to the standard of care in advanced non-small-cell lung cancer (NSCLC). The electronic databases Ovid PubMed, Cochrane Central Register of Controlled Trials, and Embase were searched to identify eligible trials. We included all phase III randomized trials with any line and type of treatment, histology. and AT dose. Pooled hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS), and pooled odds ratio (OR) for overall response rates (RR) were calculated. We divided the population into 2 subgroups based on the bevacizumab dose. Data of 19,098 patients from 25 phase III trials were analyzed. Compared with the standard of care, the addition of AT did not prolong OS (HR 0.98; 95% confidence interval [CI], 0.96-1.00; P = .1 and HR 0.97; 95% CI, 0.94-1.00; P = .06 for groups 1 and 2, respectively). However, there was a significant improvement in PFS with the addition of AT (HR 0.85; 95% CI, 0.79-0.91; P < .00001 and HR 0.81; 95% CI, 0.75-0.88; P < .00001 for groups 1 and 2, respectively) and overall RR (OR 1.61; 95% CI, 1.30-2.01; P < .0001 and OR 1.72; 95% CI, 1.39-2.14; P < .00001 for groups 1 and 2, respectively). This is the first meta-analysis including only all phase III trials with AT in NSCLC showing no significant effect on OS and an improvement in PFS and RR only. The role of AT in advanced NSCLC is still questionable; strong validated biomarkers are eagerly needed to predict which subgroup might benefit the most from such therapy.
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Affiliation(s)
- Jacques Raphael
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
| | - Kelvin Chan
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Safiya Karim
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Robert Kerbel
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Henry Lam
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Keemo Delos Santos
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Ronak Saluja
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Sunil Verma
- Medical Oncology Division, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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From 2000 to 2016: Which Second-Line Treatment in Advanced Non-Small Cell Lung Cancer? Curr Treat Options Oncol 2016; 17:59. [DOI: 10.1007/s11864-016-0437-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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