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Bortolot M, Cortiula F, Fasola G, De Ruysscher D, Naidoo J, Hendriks LEL. Treatment of unresectable stage III non-small cell lung cancer for patients who are under-represented in clinical trials. Cancer Treat Rev 2024; 129:102797. [PMID: 38972134 DOI: 10.1016/j.ctrv.2024.102797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024]
Abstract
Concurrent chemoradiotherapy (cCRT) followed by one year of consolidation durvalumab is the current standard-of-care for patients with unresectable stage III non-small cell lung cancer (NSCLC), of good functional status. However, cCRT and consolidation durvalumab may be challenging to administer for selected patient populations underrepresented or even excluded in clinical trials: older and/or frail patients; those with cardiovascular or respiratory comorbidities in which treatment-related adverse events may be higher, and patients with pre-existing autoimmune disorders for whom immunotherapy use is controversial. In this narrative review, we discuss the current evidence, challenges, ongoing clinical trials and potential future treatment scenarios in relevant subgroups of patients with locally advanced NSCLC, who are underrepresented in clinical trials.
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Affiliation(s)
- Martina Bortolot
- University of Udine, Department of Medicine (DAME), Udine, Italy; University Hospital of Udine, Department of Oncology, Udine, Italy
| | - Francesco Cortiula
- University Hospital of Udine, Department of Oncology, Udine, Italy; Department of Radiation Oncology (Maastro), Maastricht University Medical Centre (+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands.
| | - Gianpiero Fasola
- University Hospital of Udine, Department of Oncology, Udine, Italy
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre (+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - Jarushka Naidoo
- Beaumont Hospital and RCSI University of Health Sciences, Dublin, Ireland; Sidney Kimmel Comprehensive Cancer Centre at Johns Hopkins University, Baltimore, USA
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Centre (+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
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Liu Y, Yalavarthi S, Yang F, Abdul-Rashid Y, Tang S, Long Z, Qin Y, Wu K, Wang Z. Insights into treatment-specific prognostic somatic mutations in NSCLC from the AACR NSCLC GENIE BPC cohort analysis. BMC Pulm Med 2024; 24:309. [PMID: 38956553 PMCID: PMC11218090 DOI: 10.1186/s12890-024-03124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/23/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Treatment of non-small lung cancer (NSCLC) has evolved in recent years, benefiting from advances in immunotherapy and targeted therapy. However, limited biomarkers exist to assist clinicians and patients in selecting the most effective, personalized treatment strategies. Targeted next-generation sequencing-based genomic profiling has become routine in cancer treatment and generated crucial clinicogenomic data over the last decade. This has made the development of mutational biomarkers for drug response possible. METHODS To investigate the association between a patient's responses to a specific somatic mutation treatment, we analyzed the NSCLC GENIE BPC cohort, which includes 2,004 tumor samples from 1,846 patients. RESULTS We identified somatic mutation signatures associated with response to immunotherapy and chemotherapy, including carboplatin-, cisplatin-, pemetrexed- or docetaxel-based chemotherapy. The prediction power of the chemotherapy-associated signature was significantly affected by epidermal growth factor receptor (EGFR) mutation status. Therefore, we developed an EGFR wild-type-specific mutation signature for chemotherapy selection. CONCLUSION Our treatment-specific gene signatures will assist clinicians and patients in selecting from multiple treatment options.
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Affiliation(s)
- Yi Liu
- Department of Neurosurgery, the Third XiangYa Hospital of Central South University, Changsha, 410013, PR China
| | - Sindhu Yalavarthi
- Department of Nanoscience, The Joint School of Nanoscience and Nanoengineering, University of North Carolina Greensboro, Greensboro, NC, 27401, USA
| | - Fan Yang
- Department of Neurosurgery, the Third XiangYa Hospital of Central South University, Changsha, 410013, PR China
| | - Yusif Abdul-Rashid
- Department of Nanoscience, The Joint School of Nanoscience and Nanoengineering, University of North Carolina Greensboro, Greensboro, NC, 27401, USA
| | - Shenkun Tang
- Department of Neurosurgery, the Third XiangYa Hospital of Central South University, Changsha, 410013, PR China
| | - Zihe Long
- Department of Neurosurgery, the Third XiangYa Hospital of Central South University, Changsha, 410013, PR China
| | - Yongkai Qin
- Department of Neurosurgery, the Third XiangYa Hospital of Central South University, Changsha, 410013, PR China
| | - Kerui Wu
- Department of Nanoscience, The Joint School of Nanoscience and Nanoengineering, University of North Carolina Greensboro, Greensboro, NC, 27401, USA
| | - Zhifei Wang
- Department of Neurosurgery, the Third XiangYa Hospital of Central South University, Changsha, 410013, PR China.
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Riudavets M, Auclin E, Mosteiro M, Dempsey N, Majem M, Prelaj A, López-Castro R, Bosch-Barrera J, Pilotto S, Escalera E, Tagliamento M, Mosquera J, Zalcman G, Aboubakar Nana F, Ponce S, Albarrán-Artahona V, Dal Maso A, Spotti M, Mielgo X, Mussat E, Reyes R, Benítez JC, Lupinacci L, Duchemann B, De Giglio A, Blaquier JB, Audigier-Valette C, Scheffler M, Nadal E, Lopes G, Signorelli D, Garcia-Campelo R, Menis J, Bluthgen V, Campayo M, Recondo G, Besse B, Mezquita L, Planchard D. Association Between Lung Immune Prognostic Index and Durvalumab Consolidation Outcomes in Patients With Locally Advanced Non-Small-Cell Lung Cancer. Clin Lung Cancer 2024; 25:233-243.e8. [PMID: 38105153 DOI: 10.1016/j.cllc.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The LIPI, based on pretreatment derived neutrophils/[leukocytes-neutrophils] ratio (dNLR) and LDH, is associated with immune checkpoint inhibitors (ICI) outcomes in advanced non-small-cell lung cancer (NSCLC). We aimed to assess baseline LIPI correlation with durvalumab consolidation outcomes in the locally advanced setting. MATERIAL AND METHODS Multicentre retrospective study (330 patients) with stage III unresectable NSCLC treated with durvalumab after chemo-radiotherapy between April 2015 and December 2020; 65 patients treated with chemo-radiotherapy only. Baseline LIPI characterized 3 groups: good (dNLR≤3+LDH≤ULN), intermediate (dNLR>3/LDH>ULN) and poor (dNLR>3+LDH>ULN). Primary endpoint was overall survival (OS). RESULTS In the durvalumab cohort, median age was 67 years, 95% smokers, 98% with a performance status of 0-1; 60% had nonsquamous histology and 16% a PD-L1 expression <1%. Radiotherapy was delivered concurrently in 81%. LIPI was evaluable in 216 patients: 66% good, 31% intermediate, 3% poor. LIPI significantly correlated with median OS (median follow-up: 19 months): 18.1 months vs. 47.0 months vs. not reached in poor, intermediate and good LIPI groups, respectively (P = .03). A trend between objective response rate and LIPI groups was observed: 0% vs. 41% vs. 45%, respectively (P = .05). The pooled intermediate/poor LIPI group was associated with shorter OS (HR 1.97; P = .03) and higher risk of progressive disease (OR 2.68; P = .047). Survivals and response were not influenced in the control cohort. CONCLUSION Baseline LIPI correlated with outcomes in patients with locally advanced NSCLC treated with durvalumab consolidation, but not in those who only received chemo-radiotherapy, providing further evidence of its prognostic and potential predictive role of ICI benefit in NSCLC.
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Affiliation(s)
- Mariona Riudavets
- Medical Oncology Department, Gustave Roussy cancer campus, Villejuif, France
| | - Edouard Auclin
- Medical Oncology Department, Hôpital Européen Georges Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | - Miguel Mosteiro
- Medical Oncology Department, Institut Català d'Oncologia - ICO Hospitalet, Barcelona, Spain
| | - Naomi Dempsey
- Medical Oncology Department, Jackson Memorial Hospital, Miami, FL
| | - Margarita Majem
- Medical Oncology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Arsela Prelaj
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milan, Milano, Italy
| | - Rafael López-Castro
- Medical Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Joaquim Bosch-Barrera
- Medical Oncology Department, Catalan Institute of Oncology, Hospital Universitari Josep Trueta, Girona, Spain
| | - Sara Pilotto
- Medical Oncology Department, University and Hospital Trust of Verona, Verona, Italy
| | - Elena Escalera
- Medical Oncology Department, Hospital Clínico de Salamanca, Salamanca, Spain
| | - Marco Tagliamento
- Medical Oncology Department, Gustave Roussy cancer campus, Villejuif, France; Internal Medicine and Medical Specialties Department, University of Genova, Genova, Italy
| | - Joaquin Mosquera
- Medical Oncology Department, Hospital Universitario A Coruña, A Coruña, Spain
| | - Gérard Zalcman
- Université Paris Cité, Thoracic Oncology Department, CIC Inserm 1425, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - Santiago Ponce
- Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Víctor Albarrán-Artahona
- Medical Oncology Department, Department of Medicine, Hospital Clinic, Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alessandro Dal Maso
- Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Martina Spotti
- Medical Oncology Department, Hospital Alemán, Buenos Aires, Argentina
| | - Xabier Mielgo
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Elodie Mussat
- Medical Oncology Department, Hôpital Européen Georges Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | - Roxana Reyes
- Medical Oncology Department, Department of Medicine, Hospital Clinic, Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose-Carlos Benítez
- Medical Oncology Department, Gustave Roussy cancer campus, Villejuif, France; Medical Oncology Department, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Lorena Lupinacci
- Medical Oncology Department, Hospital Italiano, Buenos Aires, Argentina
| | - Boris Duchemann
- Medical Oncology Department, Hôpital Avicenne, Bobigny, France
| | - Andrea De Giglio
- Medical Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Juan Bautista Blaquier
- Medical Oncology Department, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | | | - Matthias Scheffler
- Internal Medicine I Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ernest Nadal
- Medical Oncology Department, Institut Català d'Oncologia - ICO Hospitalet, Barcelona, Spain
| | - Gilberto Lopes
- Medical Oncology Department, Jackson Memorial Hospital, Miami, FL
| | - Diego Signorelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milan, Milano, Italy; Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Jessica Menis
- Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Virginia Bluthgen
- Medical Oncology Department, Hospital Alemán, Buenos Aires, Argentina
| | - Marc Campayo
- Medical Oncology Department, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Gonzalo Recondo
- Medical Oncology Department, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Benjamin Besse
- Medical Oncology Department, Gustave Roussy cancer campus, Villejuif, France
| | - Laura Mezquita
- Medical Oncology Department, Department of Medicine, Hospital Clinic, Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - David Planchard
- Medical Oncology Department, Gustave Roussy cancer campus, Villejuif, France
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Cafaro A, Foca F, Nanni O, Chiumente M, Coppola M, Baldo P, Orzetti S, Enrico F, Ladisa V, Lerose R, Nardulli P, Maiolino P, Gradellini F, Gasbarro AR, Carrucciu G, Provasi R, Cappelletto PC, Pasqualini A, Vecchia S, Veraldi M, De Francesco AE, Crinò L, Delmonte A, Masini C. A real-world retrospective, observational study of first-line pembrolizumab plus chemotherapy for metastatic non-squamous non-small cell lung cancer with PD-L1 tumor proportion score < 50% (PEMBROREAL). Front Oncol 2024; 14:1351995. [PMID: 38601759 PMCID: PMC11004281 DOI: 10.3389/fonc.2024.1351995] [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: 12/07/2023] [Accepted: 03/05/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The phase III Keynote-189 trial established a first-line treatment combining pembrolizumab with pemetrexed and platinum as a standard treatment for patients with stage IV non-small cell lung cancer (NSCLC) without known EGFR and ALK driver mutations and independent of programmed cell death ligand 1 (PD-L1) expression. However, in Italy, eligibility for the National Health Service payment program is limited to patients with PD-L1 <50%. The PEMBROREAL study assesses the real-world effectiveness and safety of pembrolizumab in patients eligible for the National Health Service payment program. Methods PEMBROREAL is a retrospective, observational study on patients with NSCLC who started pembrolizumab combined with pemetrexed and platinum within the reimbursability time window, considered as December 2019 to December 2020. The primary endpoints were to assess progression-free survival (PFS) and overall survival (OS; using the Kaplan-Meier method), response to therapy, and tolerability. Results Until February 2022, 279 patients (median follow-up: 19.7 months) have been observed. The median PFS was 8.0 months (95% confidence interval: 6.5-9.2). OS was not reached, but we can estimate a 12- to 24-month survival rate for the combined treatment: 66.1% and 52.5%, respectively. PD-L1 expression and Eastern Cooperative Group (ECOG) Performance Status were both associated with PFS and OS. Overall, only 44.4% of patients reported an adverse event, whereas toxicity led to a 5.4% discontinuation rate. Conclusion The results of the PEMBROREAL study have shown that the combined treatment of pembrolizumab with pemetrexed and platinum is effective for metastatic non-squamous NSCLC, even for patients with PD-L1 levels below 50%, despite the differences in patient demographics and pathological features compared to the Keynote-189 study. The adverse events reported during the study were more typical of chemotherapy treatment rather than immunotherapy, and physicians were able to manage them easily.
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Affiliation(s)
- Alessandro Cafaro
- Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Marco Chiumente
- Scientific Direction, Società Italiana di Farmacia Clinica e Terapia (SIFaCT), Turin, Italy
| | - Marina Coppola
- Pharmacy Unit, IRCCS Istituto Oncologico Veneto (IOV), Padova, Italy
| | - Paolo Baldo
- Pharmacy Unit, CRO Aviano IRCCS, National Cancer Institute, Aviano, Italy
| | - Sabrina Orzetti
- Pharmacy Unit, CRO Aviano IRCCS, National Cancer Institute, Aviano, Italy
| | - Fiorenza Enrico
- Hospital Pharmacy, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Vito Ladisa
- Hospital Pharmacy, IRCCS National Cancer Institute Foundation, Milan, Italy
| | - Rosa Lerose
- Hospital Pharmacy, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| | - Patrizia Nardulli
- Pharmacy Unit, National Cancer Research Center Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Piera Maiolino
- Pharmacy Unit, Istituto Nazionale Tumori “Fondazione G. Pascale”, IRCCS, Naples, Italy
| | | | | | | | - Riccardo Provasi
- Pharmacy Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | | | - Stefano Vecchia
- Pharmacy Unit, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - Marianna Veraldi
- Protesic and Pharmaceutical Assistance sector n. 3, Department of Health Protection and Health Service Calabria Region, Catanzaro, Italy
| | | | - Lucio Crinò
- Thoracic Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Angelo Delmonte
- Thoracic Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Carla Masini
- Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
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Guo Z, Wei X, Tang C, Liang J. Non-tumor-related prognostic factors for immunotherapy-chemotherapy or immunotherapy alone as first-line in advanced non-small cell lung cancer (NSCLC). Clin Exp Med 2024; 24:52. [PMID: 38489142 PMCID: PMC10942875 DOI: 10.1007/s10238-024-01298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 03/17/2024]
Abstract
Besides programmed death ligand 1 (PD-L1) expression, rapid, cost-effective and validated scores or models are critical for the prognosis and prediction of patients received immune checkpoint inhibitors (ICIs). In this retrospective study, 182 patients with NSCLC receiving ICIs from 2015 to 2022 were divided 1:1 into a training cohort and a validation cohort. We identified a score established by three factors and analyzed the prognostic implications by Kaplan-Meier approach (Log rank test) and time-dependent receiver operating characteristic (ROC) analyses. A non-tumor-related score (NTRS) was established that could be used as a prognostic factor (HR 2.260, 95% CI 1.559-3.276, P < 0.001 in training cohort; HR 2.114, 95% CI 1.493-2.994, P < 0.001 in validation cohort) and had a high time-dependent ROC for overall survival (OS) (AUC 0.670-0.782 in training cohort; AUC 0.682-0.841 in validation cohort). PD-L1 (1-49%) and NTRS (score = 0, 1, 2, 3) combination significantly improved the assessment of patients' OS and progress-free survival (PFS), which was statistically different in training cohorts (P < 0.001 for OS, 0.012 for PFS) and validation cohorts (P = 0.01 for OS, < 0.001 for PFS). The NTRS provided a better assessment of durable clinical benefit (DCB) compared to PD-L1 expression (P = 0.009 vs. 0.232 in training cohort; P = 0.004 vs. 0.434 in validation cohort). NTRS may help improve prognosis stratification of patients receiving ICIs in first-line NSCLC and may be combined with tumor-related parameters.
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Affiliation(s)
- Ziwei Guo
- Department of Oncology, Peking University International Hospital, Beijing, 102206, China
| | - Xing Wei
- Department of Oncology, Peking University International Hospital, Beijing, 102206, China
| | - Chuanhao Tang
- Department of Oncology, Peking University International Hospital, Beijing, 102206, China.
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, Beijing, 102206, China.
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Jackson KM, Jones PC, Fluke LM, Fischer TD, Thompson JF, Cochran AJ, Stern SL, Faries MB, Hoon DSB, Foshag LJ. Smoking Status and Survival in Patients With Early-Stage Primary Cutaneous Melanoma. JAMA Netw Open 2024; 7:e2354751. [PMID: 38319662 PMCID: PMC10848058 DOI: 10.1001/jamanetworkopen.2023.54751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/21/2023] [Indexed: 02/07/2024] Open
Abstract
Importance While smoking is associated with a decreased incidence of cutaneous melanoma, the association of smoking with melanoma progression and death is not well defined. Objective To determine the association of smoking with survival in patients with early-stage primary cutaneous melanoma. Design, Setting, and Participants This cohort study performed a post hoc analysis of data derived from the randomized, multinational first and second Multicenter Selective Lymphadenectomy Trials (MSLT-I and MSLT-II). Participants were accrued for MSLT-I from January 20, 1994, to March 29, 2002; MSLT-II, from December 21, 2004, to March 31, 2014. Median follow-up was 110.0 (IQR, 53.4-120.0) months for MSLT-I and 67.6 (IQR, 25.8-110.2) months for MSLT-II. Patients aged 18 to 75 years with clinical stages I or II melanoma with a Breslow thickness of 1.00 mm or greater or Clark level IV to V and available standard prognostic and smoking data were included. Analyses were performed from October 4, 2022, to March 31, 2023. Exposure Current, former, and never smoking. Main Outcomes and Measures Melanoma-specific survival of patients with current, former, and never smoking status was assessed for the entire cohort and for nodal observation and among subgroups with sentinel lymph node biopsy (SLNB)-negative and SLNB-positive findings. Results Of 6279 included patients, 3635 (57.9%) were men, and mean (SD) age was 52.7 (13.4) years. The most common tumor location was an extremity (2743 [43.7%]), and mean (SD) Breslow thickness was 2.44 (2.06) mm. Smoking status included 1077 (17.2%) current, 1694 (27.0%) former, and 3508 (55.9%) never. Median follow-up was 78.4 (IQR, 30.5-119.6) months. Current smoking was associated with male sex, younger age, trunk site, thicker tumors, tumor ulceration, and SLNB positivity. Current smoking was associated with a greater risk of melanoma-associated death by multivariable analysis for the entire study (hazard ratio [HR], 1.48 [95% CI, 1.26-1.75]; P < .001). Former smoking was not. The increased risk of melanoma-specific mortality associated with current smoking was greatest for patients with SLNB-negative melanoma (HR, 1.85 [95% CI, 1.35-2.52]; P < .001), but also present for patients with SLNB-positive melanoma (HR, 1.29 [95% CI, 1.04-1.59]; P = .02) and nodal observation (HR, 1.68 [95% CI, 1.09-2.61]; P = .02). Smoking at least 20 cigarettes/d doubled the risk of death due to melanoma for patients with SLNB-negative disease (HR, 2.06 [95% CI, 1.36-3.13]; P < .001). Conclusions and Relevance The findings of this cohort study suggest that patients with clinical stage I and II melanoma who smoked had a significantly increased risk of death due to melanoma. Smoking status should be assessed at time of melanoma diagnosis and may be considered a risk factor for disease progression.
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Affiliation(s)
- Katherine M. Jackson
- Department of Surgical Oncology, Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, California
| | - Peter C. Jones
- Department of Surgical Oncology, Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, California
| | - Laura M. Fluke
- Department of Surgical Oncology, Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, California
| | - Trevan D. Fischer
- Department of Surgical Oncology, Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, California
| | | | - Alistair J. Cochran
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles
| | - Stacey L. Stern
- Translational Molecular Medicine and Biostatistics, Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, California
| | - Mark B. Faries
- The Angeles Clinic and Research Institute, Los Angeles, California
| | - Dave S. B. Hoon
- Translational Molecular Medicine and Biostatistics, Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, California
| | - Leland J. Foshag
- Department of Surgical Oncology, Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, California
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7
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Santoni M, Massari F, Myint ZW, Iacovelli R, Pichler M, Basso U, Kopecky J, Kucharz J, Buti S, Salfi A, Büttner T, De Giorgi U, Kanesvaran R, Fiala O, Grande E, Zucali PA, Fornarini G, Bourlon MT, Scagliarini S, Molina-Cerrillo J, Aurilio G, Matrana MR, Pichler R, Cattrini C, Büchler T, Seront E, Calabrò F, Pinto A, Berardi R, Zgura A, Mammone G, Ansari J, Atzori F, Chiari R, Zakopoulou R, Caffo O, Procopio G, Bassanelli M, Zampiva I, Messina C, Küronya Z, Mosca A, Bhuva D, Vau N, Incorvaia L, Rebuzzi SE, Roviello G, Zabalza IO, Rizzo A, Mollica V, Catalini I, Monteiro FSM, Montironi R, Battelli N, Rizzo M, Porta C. Clinico-Pathological Features Influencing the Prognostic Role of Body Mass Index in Patients With Advanced Renal Cell Carcinoma Treated by Immuno-Oncology Combinations (ARON-1). Clin Genitourin Cancer 2023; 21:e309-e319.e1. [PMID: 37062658 DOI: 10.1016/j.clgc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Obesity has been associated with improved response to immunotherapy in cancer patients. We investigated the role of body mass index (BMI) in patients from the ARON-1 study (NCT05287464) treated by dual immuno-oncology agents (IO+IO) or a combination of immuno-oncology drug and a tyrosine kinase inhibitors (TKI) as first-line therapy for metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS Medical records of patients with documented mRCC treated by immuno-oncology combinations were reviewed at 47 institutions from 16 countries. Patients were assessed for overall survival (OS), progression-free survival (OS), and overall clinical benefit (OCB), defined as the sum of the rate of partial/complete responses and stable disease. Univariate and multivariate analyses were used to explore the association of variables of interest with survival. RESULTS A total of 675 patients were included; BMI was >25 kg/m2 in 345 patients (51%) and was associated with improved OS (55.7 vs. 28.4 months, P < .001). The OCB of patients with BMI >25 kg/m2 versus those with BMI ≤25 kg/m2 was significantly higher only in patients with nonclear cell histology (81% vs. 65%, P = .011), and patients with liver metastases (76% vs. 58%, P = .007), Neutrophil to lymphocyte ratio >4 (77% vs 62%, P = .022) or treated by nivolumab plus ipilimumab (77% vs. 64%, P = .044). In the BMI ≤25 kg/m2 subgroup, significant differences were found between patients with NLR >4 versus ≤4 (62% vs. 82%, P = .002) and patients treated by IO+IO versus IO+TKIs combinations (64% vs. 83%, P = .002). CONCLUSION Our study suggests that the prognostic significance and the association of BMI with treatment outcome varies across clinico-pathological mRCC subgroups.
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Affiliation(s)
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.
| | - Zin W Myint
- Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Roberto Iacovelli
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Umberto Basso
- Oncology 3 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Jindrich Kopecky
- Department of Clinical Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jakub Kucharz
- Department of Uro-oncology, Maria Sklodowska-Curie National Research Institute of Oncology Warsaw, Warsaw, Poland
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma - Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessia Salfi
- Oncology Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Thomas Büttner
- Department of Urology, University Hospital Bonn (UKB), Bonn, Germany
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | | | - Ondřej Fiala
- Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
| | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano - Milan, Italy
| | | | - Maria T Bourlon
- Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sarah Scagliarini
- UOC di Oncologia, Azienda Ospedaliera di Rilievo Nazionale Cardarelli di Napoli, Naples, Italy
| | | | - Gaetano Aurilio
- Medical Oncology Division of Urogenital and Head and Neck Tumours, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marc R Matrana
- Department of Internal Medicine, Hematology/Oncology, Ochsner Medical Center, New Orleans, LA
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carlo Cattrini
- Department of Medical Oncology, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Tomas Büchler
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Emmanuel Seront
- Department of Medical Oncology, Centre Hospitalier de Jolimont, Belgium
| | - Fabio Calabrò
- Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Alvaro Pinto
- Medical Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti delle Marche, Ancona, Italy
| | - Anca Zgura
- Department of Oncology-Radiotherapy, Prof. Dr. Alexandru Trestioreanu Institute of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Giulia Mammone
- Department of Radiological, Oncological and Anatomo-Pathological Science, "Sapienza" University of Rome, Rome, Italy
| | - Jawaher Ansari
- Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Francesco Atzori
- Unità di Oncologia Medica, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Rita Chiari
- UOC Oncologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Italy
| | - Roubini Zakopoulou
- 2nd Propaedeutic Dept of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Orazio Caffo
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Giuseppe Procopio
- Dipartimento di Oncologia Medica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Oncologia Medica, Ospedale Maggiore di Cremona, Italy
| | - Maria Bassanelli
- Medical Oncology 1-IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ilaria Zampiva
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | | | - Zsófia Küronya
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Budapest, Hungary
| | | | - Dipen Bhuva
- Department of Medical Oncology, Army Hospital Research and Referral, New Delhi, India
| | - Nuno Vau
- Urologic Oncology, Champalimaud Clinical Center, Lisbon, Portugal
| | - Lorena Incorvaia
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Sara Elena Rebuzzi
- Ospedale San Paolo, Medical Oncology, Savona, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genoa, Genoa, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | | | - Alessandro Rizzo
- Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico "Don Tonino Bello", I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | | | - Fernando Sabino M Monteiro
- Latin American Cooperative Oncology Group - LACOG; Oncology and Hematology Department, Hospital Santa Lucia, Brasília, Federal District, Brazil
| | - Rodolfo Montironi
- Molecular Medicine and Cell Therapy Foundation, Polytechnic University of the Marche Region, Ancona, Italy
| | | | - Mimma Rizzo
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Camillo Porta
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy; Chair of Oncology, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
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8
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Nam JH, Yeo CD, Park CK, Kim SK, Kim JS, Kim YH, Kim JW, Kim SJ, Lee SH, Kang HS. Identification of predictive factors for early relapse in patients with unresectable stage III non-small cell lung cancer receiving consolidation durvalumab after concurrent chemoradiation therapy. Thorac Cancer 2023; 14:2657-2664. [PMID: 37519059 PMCID: PMC10493476 DOI: 10.1111/1759-7714.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Patients with locally advanced, unresectable, non-small cell lung cancer (NSCLC) receiving definitive concurrent chemoradiation therapy (CCRT) benefit from durvalumab consolidation therapy. However, predictive factors for early relapse during durvalumab maintenance have not yet been identified. METHODS The present study included the lung cancer cohort of the Catholic Medical Centers at the Catholic University of Korea from January 2018 to December 2021. A total of 51 NSCLC patients treated with durvalumab consolidation therapy after definitive CCRT were included in the analysis. Early relapse was defined as patients experiencing relapse within 6 months of starting initial durvalumab therapy. RESULTS Among the 51 patients, 15 (29.4%) relapsed during the study period. Median time from initial therapy of durvalumab to progression was 451.00 ± 220.87 days (95% confidence interval [CI]: 18.10-883.90) in overall patients. In multivariate analysis, younger age (adjusted odds ratio [aOR], 0.792; 95% CI: 0.642-0.977; p = 0.030), higher pack-years (aOR, 1.315; 95% CI: 1.058-1.635; p = 0.014), non-COPD (aOR, 0.004; 95% CI: 0.000-0.828; p = 0.004) and anemia (aOR, 234.30; 95% CI: 1.212-45280.24; p = 0.042), were independent predictive factors for early relapse during durvalumab consolidation therapy. CONCLUSION Younger age, higher number of pack-years, non-COPD, and anemia were independent predictive factors for early relapse during durvalumab consolidation therapy in patients with unresectable stage III NSCLC after definitive CCRT. Careful patient selection and clinical attention are needed for high-risk individuals.
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Affiliation(s)
- Jung Hyun Nam
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Chang Dong Yeo
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Chan Kwon Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Sung Kyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Vincent's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Yong Hyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Jin Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Seung Joon Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Hye Seon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
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9
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Kim KY, Lim JU, Kang HS, Kim JS, Kim SK, Kim SJ, Lee SH, Yeo CD. Smoking Status at Time of Diagnosis Affects the Efficacy of Anti-PD-1/L1 Therapy in Patients With Advanced NSCLC. In Vivo 2023; 37:2357-2364. [PMID: 37652510 PMCID: PMC10500490 DOI: 10.21873/invivo.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM Programmed death ligand-1 (PD-L1) expression is known to be a predictive biomarker for response to immunotherapy in non-small cell lung cancer (NSCLC). However, PD-L1 is not always a reliable predictive biomarker. In the present study, we aimed to compare responses to immunotherapy according to smoking status in NSCLC patients receiving immunotherapy in second line or further line treatment. PATIENTS AND METHODS The lung cancer registry database of the Catholic Medical Center, Seoul, Republic of Korea was used. Patients were eligible for this study if they were diagnosed with histologically confirmed NSCLC and received immune checkpoint inhibitors (ICIs) as second-line or further line therapy from January 2017 to December 2021. RESULTS Overall, 220 patients with NSCLC treated with ICIs were enrolled. There were 40 never smokers, 73 former smokers, and 107 current smokers. In multivariate analysis, smoking status, pathologic type, and PD-L1 expression were significant factors affecting PFS. Sex, ECOG performance status, pathologic type, and PD-L1 expression were significant factors affecting OS. CONCLUSION Smoking status at diagnosis of lung cancer could be a predictive biomarker for response to ICIs in patients with advanced NSCLC.
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Affiliation(s)
- Kyu Yean Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Uk Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Kyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Dong Yeo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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10
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Wang P, Sun S, Lam S, Lockwood WW. New insights into the biology and development of lung cancer in never smokers-implications for early detection and treatment. J Transl Med 2023; 21:585. [PMID: 37653450 PMCID: PMC10472682 DOI: 10.1186/s12967-023-04430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
Lung cancer is the leading cause of cancer deaths worldwide. Despite never smokers comprising between 10 and 25% of all cases, lung cancer in never smokers (LCNS) is relatively under characterized from an etiological and biological perspective. The application of multi-omics techniques on large patient cohorts has significantly advanced the current understanding of LCNS tumor biology. By synthesizing the findings of multi-omics studies on LCNS from a clinical perspective, we can directly translate knowledge regarding tumor biology into implications for patient care. Primarily focused on never smokers with lung adenocarcinoma, this review details the predominance of driver mutations, particularly in East Asian patients, as well as the frequency and importance of germline variants in LCNS. The mutational patterns present in LCNS tumors are thoroughly explored, highlighting the high abundance of the APOBEC signature. Moreover, this review recognizes the spectrum of immune profiles present in LCNS tumors and posits how it can be translated to treatment selection. The recurring and novel insights from multi-omics studies on LCNS tumor biology have a wide range of clinical implications. Risk factors such as exposure to outdoor air pollution, second hand smoke, and potentially diet have a genomic imprint in LCNS at varying degrees, and although they do not encompass all LCNS cases, they can be leveraged to stratify risk. Germline variants similarly contribute to a notable proportion of LCNS, which warrants detailed documentation of family history of lung cancer among never smokers and demonstrates value in developing testing for pathogenic variants in never smokers for early detection in the future. Molecular driver subtypes and specific co-mutations and mutational signatures have prognostic value in LCNS and can guide treatment selection. LCNS tumors with no known driver alterations tend to be stem-like and genes contributing to this state may serve as potential therapeutic targets. Overall, the comprehensive findings of multi-omics studies exert a wide influence on clinical management and future research directions in the realm of LCNS.
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Affiliation(s)
- Peiyao Wang
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, BC, Canada
- Interdisciplinary Oncology Program, University of British Columbia, Vancouver, BC, Canada
| | - Sophie Sun
- Department of Medical Oncology, British Columbia Cancer Agency Vancouver, Vancouver, BC, Canada
| | - Stephen Lam
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, BC, Canada
| | - William W Lockwood
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, BC, Canada.
- Interdisciplinary Oncology Program, University of British Columbia, Vancouver, BC, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
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11
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Kim SY, Gettinger S. First-Line Treatment of Driver-Negative Non-Small Cell Lung Cancer. Hematol Oncol Clin North Am 2023; 37:557-573. [PMID: 37150586 DOI: 10.1016/j.hoc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Immunotherapy-based regimens are an established standard of care for the first-line treatment of driver-negative (EGFR/ALK/ROS WT) advanced non-small cell lung cancer. With multiple immune-based regimens approved in the first-line setting, clinicians are faced in practice with a variety of treatment choices. This article summarizes the most up-to-date trial data on treatments for driver-negative advanced non-small cell lung cancer, including immunotherapy monotherapy, chemoimmunotherapy, and combination immunotherapy, providing a framework for clinicians based on PD-L1 and smoking status. A multibiomarker assay that may best predict immunotherapy response remains an active area of research.
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Affiliation(s)
- So Yeon Kim
- Section of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA.
| | - Scott Gettinger
- Section of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
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12
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Pîrlog CF, Costache R, Paroșanu AI, Slavu CO, Olaru M, Popa AM, Iaciu C, Niță I, Moțatu P, Cotan HT, Oprița AV, Costache D, Manolescu LSC, Nițipir C. Restricted Mean Survival Time-Can It Be a New Tool in Assessing the Survival of Non-Small Cell Lung Cancer Patients Treated with Immune Checkpoint Inhibitors? Diagnostics (Basel) 2023; 13:diagnostics13111892. [PMID: 37296744 DOI: 10.3390/diagnostics13111892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Lung cancer (LC) is the first and most lethal cancer in the world; identifying new methods to treat it, such as immune checkpoint inhibitors (ICIs), is needed. ICIs treatment is very effective, but it comes bundled with a series of immune-related adverse events (irAEs). Restricted mean survival time (RMST) is an alternative tool for assessing the patients' survival when the proportional hazard assumption (PH) fails. METHODS We included in this analytical cross-sectional observational survey patients with metastatic non-small-cell lung cancer (NSCLC), treated for at least 6 months with ICIs in the first- and second-line settings. Using RMST, we estimated the overall survival (OS) of patients by dividing them into two groups. A multivariate Cox regression analysis was performed to determine the impact of the prognostic factors on OS. RESULTS Seventy-nine patients were included (68.4% men, mean age 63.8), and 34/79 (43%) presented irAEs. The OS RMST of the entire group was 30.91 months, with a survival median of 22 months. Thirty-two out of seventy-nine (40.5%) died before we ended our study. The OS RMST and death percentage favored the patients who presented irAEs (long-rank test, p = 0.036). The OS RMST of patients with irAEs was 35.7 months, with a number of deaths of 12/34 (35.29%), while the OS RMST of the patients without irAEs was 17 months, with a number of deaths of 20/45 (44.44%). The OS RMST by the line of treatment favored the first line of treatment. In this group, the presence of irAEs significantly impacted the survival of these patients (p = 0.0083). Moreover, patients that experienced low-grade irAEs had a better OS RMST. This result has to be cautiously regarded because of the small number of patients stratified according to the grades of irAEs. The prognostic factors for the survival were: the presence of irAEs, Eastern Cooperative Oncology Group (ECOG) performance status and the number of organs affected by metastasis. The risk of dying was 2.13 times higher for patients without irAEs than for the patients who presented irAEs, (CI) 95% of 1.03 to 4.39. Moreover, by increasing the ECOG performance status by one point, the risk of death increased by 2.28 times, with a CI 95% of 1.46 to 3.58, while the involvement of more metastatic organs was associated with a 1.60 times increase in the death risk, with a CI 95% of 1.09 to 2.36. Age and the type of tumor were not predictive for this analysis. CONCLUSIONS The RMST is a new tool that helps researchers to better address the survival in studies with ICIs treatment where the PH fails, and the long-rank test is less efficient due to the existence of the long-term responses and delayed treatment effects. Patients with irAEs have a better prognosis than those without irAEs in the first-line settings. The ECOG performance status and the number of organs affected by metastasis must be considered when selecting patients for ICIs treatment.
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Affiliation(s)
- Cristina-Florina Pîrlog
- Department of Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Raluca Costache
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andreea Ioana Paroșanu
- Department of Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Cristina Orlov Slavu
- Department of Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Mihaela Olaru
- Department of Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Ana Maria Popa
- Department of Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Cristian Iaciu
- Department of Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Irina Niță
- Department of Medical Oncology, Monza Oncology Hospital, 013821 Bucharest, Romania
| | - Pompilia Moțatu
- Department of Medical Oncology, Municipal Hospital Ploiesti, 100409 Ploiesti, Romania
| | - Horia Teodor Cotan
- Department of Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Alexandru Vlad Oprița
- Department of Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology, "Saint Nicholas" Hospital Pitești, 110124 Pitesti, Romania
| | - Daniel Costache
- Third Department, Discipline Dermatology II, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Loredana Sabina Cornelia Manolescu
- Department of Microbiology, Parasitology and Virology, Faculty of Midwifery and Nursing, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Virology, Institute of Virology "Stefan S. Nicolau", 030304 Bucharest, Romania
| | - Cornelia Nițipir
- Department of Oncology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Medical Oncology, Elias Emergency University Hospital, 011461 Bucharest, Romania
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13
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Arora R, Haynes L, Kumar M, McNeil R, Ashkani J, Nakoneshny SC, Matthews TW, Chandarana S, Hart RD, Jones SJM, Dort JC, Itani D, Chanda A, Bose P. NCBP2 and TFRC are novel prognostic biomarkers in oral squamous cell carcinoma. Cancer Gene Ther 2023; 30:752-765. [PMID: 36635327 DOI: 10.1038/s41417-022-00578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 01/13/2023]
Abstract
There are few prognostic biomarkers and targeted therapeutics currently in use for the clinical management of oral squamous cell carcinoma (OSCC) and patient outcomes remain poor in this disease. A majority of mutations in OSCC are loss-of-function events in tumour suppressor genes that are refractory to conventional modes of targeting. Interestingly, the chromosomal segment 3q22-3q29 is amplified in many epithelial cancers, including OSCC. We hypothesized that some of the 468 genes located on 3q22-3q29 might be drivers of oral carcinogenesis and could be exploited as potential prognostic biomarkers and therapeutic targets. Our integrative analysis of copy number variation (CNV), gene expression and clinical data from The Cancer Genome Atlas (TCGA), identified two candidate genes: NCBP2, TFRC, whose expression positively correlates with worse overall survival (OS) in HPV-negative OSCC patients. Expression of NCBP2 and TFRC is significantly higher in tumour cells compared to most normal human tissues. High NCBP2 and TFRC protein abundance is associated with worse overall, disease-specific survival, and progression-free interval in an in-house cohort of HPV-negative OSCC patients. Finally, due to a lack of evidence for the role of NCBP2 in carcinogenesis, we tested if modulating NCBP2 levels in human OSCC cell lines affected their carcinogenic behaviour. We found that NCBP2 depletion reduced OSCC cell proliferation, migration, and invasion. Differential expression analysis revealed the upregulation of several tumour-promoting genes in patients with high NCBP2 expression. We thus propose both NCBP2 and TFRC as novel prognostic and potentially therapeutic biomarkers for HPV-negative OSCC.
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Affiliation(s)
- Rahul Arora
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Logan Haynes
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mehul Kumar
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Reid McNeil
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jahanshah Ashkani
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Steven C Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - T Wayne Matthews
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shamir Chandarana
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Robert D Hart
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Joseph C Dort
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, T2N 4N1, AB, Canada
| | - Doha Itani
- Department of Anatomic and Molecular Pathology, Dalhousie University, Saint John, NB, Canada
| | - Ayan Chanda
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Pinaki Bose
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, T2N 4N1, AB, Canada.
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14
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Di Federico A, De Giglio A, Gelsomino F, Sperandi F, Melotti B, Ardizzoni A. Predictors of survival to immunotherapy and chemoimmunotherapy in non-small cell lung cancer: A meta-analysis. J Natl Cancer Inst 2023; 115:29-42. [PMID: 36322815 DOI: 10.1093/jnci/djac205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Many patients with non-small cell lung cancer (NSCLC) derive poor benefit from immunotherapy (IO). For some of them, adding chemotherapy (CT) can improve the outcomes, but the reliability of programmed death-ligand 1 (PD-L1) expression as the only biomarker to distinguish these patients is unsatisfactory. We sought to detect clinicopathological and molecular predictive factors of survival that might be added to PD-L1 expression in the selection of patients who should receive IO alone or chemoimmunotherapy (CIT). METHODS We conducted a systematic search of randomized controlled clinical trials investigating IO, alone or with CT, vs CT alone in treatment-naïve advanced NSCLC patients. Meta-analyses and meta-regression analyses were performed to investigate IO alone vs CT, CIT vs CT, and IO alone vs CIT. RESULTS A total of 14 367 patients with advanced NSCLC across 25 randomized controlled clinical trials were included. Squamous histology, male sex, current and former smoker status, PD-L1 expression of 50% or more, and high tumor mutational burden (TMB) correlated with improved survival with IO alone compared with CT. Conversely, female sex, no smoking history, negative PD-L1 expression, and low TMB correlated with unsatisfactory outcomes with IO alone vs CT but not with CIT vs CT. CIT improved survival vs IO alone in female patients, never smokers, those having a PD-L1 expression of 1% or more (but not with a PD-L1 of ≥ 50%) or a low TMB and in patients with central nervous system metastasis. CONCLUSIONS These findings suggest some clinicopathological and molecular features that, added to PD-L1 expression, could help in the selection of the most appropriate first-line IO-based treatment for advanced NSCLC patients.
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Affiliation(s)
- Alessandro Di Federico
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Andrea De Giglio
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Francesco Gelsomino
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Francesca Sperandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Barbara Melotti
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Ardizzoni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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15
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Chellappan S. Smoking Cessation after Cancer Diagnosis and Enhanced Therapy Response: Mechanisms and Significance. Curr Oncol 2022; 29:9956-9969. [PMID: 36547196 PMCID: PMC9776692 DOI: 10.3390/curroncol29120782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The adverse effects of smoking on human health have been recognized for several decades, especially in the context of cancer. The ability of tobacco smoke components, including tobacco-specific carcinogens and additive compounds such as nicotine, to initiate or promote tumor growth have been described in hundreds of studies. These investigations have revealed the tumor-promoting activities of nicotine and other tobacco smoke components and have also recognized the ability of these agents to suppress the efficacy of cancer therapy; it is now clear that smoking can reduce the efficacy of most of the widely used therapeutic modalities, including immunotherapy, radiation therapy, and chemotherapy. Several studies examined if continued smoking after cancer diagnosis affected therapy response; it was found that while never smokers or non-smokers had the best response to therapy, those who quit smoking at the time of diagnosis had higher overall survival and reduced side-effects than those who continued to smoke. These studies also revealed the multiple mechanisms via which smoking enhances the growth and survival of tumors while suppressing therapy-induced cell death. In conclusion, smoking cessation during the course of cancer therapy markedly increases the chances of survival and the quality of life.
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Affiliation(s)
- Srikumar Chellappan
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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16
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Kim YA, Hodzic E, Amgalan B, Saslafsky A, Wojtowicz D, Przytycka TM. Mutational Signatures as Sensors of Environmental Exposures: Analysis of Smoking-Induced Lung Tissue Remodeling. Biomolecules 2022; 12:biom12101384. [PMID: 36291592 PMCID: PMC9599238 DOI: 10.3390/biom12101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Smoking is a widely recognized risk factor in the emergence of cancers and other lung diseases. Studies of non-cancer lung diseases typically investigate the role that smoking has in chronic changes in lungs that might predispose patients to the diseases, whereas most cancer studies focus on the mutagenic properties of smoking. Large-scale cancer analysis efforts have collected expression data from both tumor and control lung tissues, and studies have used control samples to estimate the impact of smoking on gene expression. However, such analyses may be confounded by tumor-related micro-environments as well as patient-specific exposure to smoking. Thus, in this paper, we explore the utilization of mutational signatures to study environment-induced changes of gene expression in control lung tissues from lung adenocarcinoma samples. We show that a joint computational analysis of mutational signatures derived from sequenced tumor samples, and the gene expression obtained from control samples, can shed light on the combined impact that smoking and tumor-related micro-environments have on gene expression and cell-type composition in non-neoplastic (control) lung tissue. The results obtained through such analysis are both supported by experimental studies, including studies utilizing single-cell technology, and also suggest additional novel insights. We argue that the study provides a proof of principle of the utility of mutational signatures to be used as sensors of environmental exposures not only in the context of the mutational landscape of cancer, but also as a reference for changes in non-cancer lung tissues. It also provides an example of how a database collected with the purpose of understanding cancer can provide valuable information for studies not directly related to the disease.
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17
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Tobacco Use and Response to Immune Checkpoint Inhibitor Therapy in Non-Small Cell Lung Cancer. Curr Oncol 2022; 29:6260-6276. [PMID: 36135061 PMCID: PMC9498279 DOI: 10.3390/curroncol29090492] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Tobacco is a known risk factor for lung cancer, and continued tobacco use is associated with poorer outcomes across multiple lung cancer treatment modalities including surgery, chemotherapy and radiation therapy. Less is known about the association of tobacco use and outcomes with immune checkpoint inhibitors (ICIs), which are becoming an important part of the treatment landscape in lung cancer, both in metastatic and curative settings. We reviewed the literature on the association of tobacco and tumor biology as it relates to immunotherapy. We also reviewed the association of tobacco use on outcomes among phase III randomized clinical trials involving ICIs in non-small cell lung cancer (NSCLC). We identified that patients with a smoking history may have a greater benefit with ICI treatment compared to never smokers in both treatment-naïve (HR 0.82, 95% CI 0.69–0.97, vs. HR 1.06, 95% CI 0.81–1.38) and pre-treated (HR 0.79, 95% CI 0.70–0.90 vs. 1.03, 95% CI 0.74–1.43) settings. In trials where smoking status was further defined, ex-smokers appear to demonstrate greater benefit with ICI therapy compared to current smokers (HR 0.78, 95% CI 0.59–1.01 vs. 0.91, 95% CI 0.72–1.14). We conclude by offering our perspective on future directions in this area of research, including implementation of standardized collection and analysis of tobacco use in clinical trials involving ICI therapy in lung cancer and other disease sites, and also evaluating how tobacco may affect toxicities related to ICI therapy. Based on our review, we believe that a patient’s history of tobacco smoking does have a role to play in guiding treatment decision making in patients with lung cancer.
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18
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de Alencar VTL, Figueiredo AB, Corassa M, Gollob KJ, Cordeiro de Lima VC. Lung cancer in never smokers: Tumor immunology and challenges for immunotherapy. Front Immunol 2022; 13:984349. [PMID: 36091058 PMCID: PMC9448988 DOI: 10.3389/fimmu.2022.984349] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 12/16/2022] Open
Abstract
Lung cancer is the second most common and the most lethal malignancy worldwide. It is estimated that lung cancer in never smokers (LCINS) accounts for 10-25% of cases, and its incidence is increasing according to recent data, although the reasons remain unclear. If considered alone, LCINS is the 7th most common cause of cancer death. These tumors occur more commonly in younger patients and females. LCINS tend to have a better prognosis, possibly due to a higher chance of bearing an actionable driver mutation, making them amenable to targeted therapy. Notwithstanding, these tumors respond poorly to immune checkpoint inhibitors (ICI). There are several putative explanations for the poor response to immunotherapy: low immunogenicity due to low tumor mutation burden and hence low MANA (mutation-associated neo-antigen) load, constitutive PD-L1 expression in response to driver mutated protein signaling, high expression of immunosuppressive factors by tumors cells (like CD39 and TGF-beta), non-permissive immune TME (tumor microenvironment), abnormal metabolism of amino acids and glucose, and impaired TLS (Tertiary Lymphoid Structures) organization. Finally, there is an increasing concern of offering ICI as first line therapy to these patients owing to several reports of severe toxicity when TKIs (tyrosine kinase inhibitors) are administered sequentially after ICI. Understanding the biology behind the immune response against these tumors is crucial to the development of better therapeutic strategies.
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Affiliation(s)
- Viviane Teixeira L. de Alencar
- Medical Oncology Department, Grupo Carinho de Clínicas Oncológicas, São José dos Campos, Brazil
- *Correspondence: Viviane Teixeira L. de Alencar,
| | - Amanda B. Figueiredo
- Translational Immuno-oncology Laboratory, Albert Einstein Research and Education Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Center for Research in Immuno-oncology (CRIO), Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Corassa
- Medical Oncology Department, A C Camargo Cancer Center, São Paulo, Brazil
| | - Kenneth J. Gollob
- Translational Immuno-oncology Laboratory, Albert Einstein Research and Education Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Center for Research in Immuno-oncology (CRIO), Hospital Israelita Albert Einstein, São Paulo, Brazil
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19
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Caini S, Del Riccio M, Vettori V, Scotti V, Martinoli C, Raimondi S, Cammarata G, Palli D, Banini M, Masala G, Gandini S. Quitting Smoking At or Around Diagnosis Improves the Overall Survival of Lung Cancer Patients: A Systematic Review and Meta-Analysis. J Thorac Oncol 2022; 17:623-636. [PMID: 34995798 DOI: 10.1016/j.jtho.2021.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Lung cancer (LC) remains a disease with poor prognosis despite recent advances in treatments. Here, we aimed at summarizing the current scientific evidence on whether quitting smoking at or around diagnosis has a beneficial effect on the survival of LC patients. METHODS We searched MEDLINE and EMBASE for articles published until 31st October, 2021, that quantified the impact on LC patients' survival of quitting smoking at or around diagnosis or during treatment. Study-specific data were pooled into summary relative risk (SRR) and corresponding 95% confidence intervals (CI) using random effect meta-analysis models. RESULTS Twenty-one articles published between 1980 and 2021 were included, which encompassed a total of over 10,000 LC patients. There was substantial variability across studies in terms of design, patients' characteristics, treatments received, criteria used to define smoking status (quitters or continued), and duration of follow-up. Quitting smoking at or around diagnosis was significantly associated with improved overall survival (SRR 0.71, 95% CI 0.64-0.80), consistently among patients with non-small cell LC (SRR 0.77, 95% CI 0.66-0.90, n studies = 8), small cell LC (SRR 0.75, 95% CI 0.57-0.99, n studies = 4), or LC of both or unspecified histological type (SRR 0.81, 95% CI 0.68-0.96, n studies = 6). CONCLUSIONS Quitting smoking at or around diagnosis is associated with a beneficial effect on the survival of LC patients. Treating physicians should educate LC patients about the benefits of quitting smoking even after diagnosis and provide them with the necessary smoking cessation support.
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Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Marco Del Riccio
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Virginia Vettori
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Department of Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Martinoli
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulio Cammarata
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Marco Banini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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20
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Velcheti V, Hu X, Yang L, Pietanza MC, Burke T. Long-Term Real-World Outcomes of First-Line Pembrolizumab Monotherapy for Metastatic Non-Small Cell Lung Cancer With ≥50% Expression of Programmed Cell Death-Ligand 1. Front Oncol 2022; 12:834761. [PMID: 35402266 PMCID: PMC8990758 DOI: 10.3389/fonc.2022.834761] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Immune checkpoint inhibitors (ICIs) of programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) have been rapidly adopted in US clinical practice for first-line therapy of metastatic non-small cell lung cancer (NSCLC) since regulatory approval in October 2016, and a better understanding is needed of long-term outcomes of ICI therapy administered in real-world settings outside of clinical trials. Our aim was to describe long-term outcomes of first-line pembrolizumab monotherapy at US oncology practices for patients with metastatic NSCLC, PD-L1 expression ≥50%, and good performance status. Methods This retrospective two-cohort study used technology-enabled abstraction of deidentified electronic health records (EHR cohort) plus enhanced manual chart review (spotlight cohort) to study adult patients with stage IV NSCLC, PD-L1 expression ≥50%, no documented EGFR/ALK/ROS1 genomic aberration, and ECOG performance status 0-1 who initiated first-line pembrolizumab monotherapy from 1-November-2016 to 31-March-2020 (EHR cohort, with data cutoff 31-March-2021) or from 1-December-2016 to 30-November-2017 (spotlight cohort, with data cutoff 31-August-2020). Kaplan-Meier analysis was used to determine overall survival (OS; both cohorts) and, for the spotlight cohort, real-world progression-free survival (rwPFS) and real-world tumor response (rwTR). Results The EHR cohort included 566 patients (298 [53%] men); the spotlight cohort included 228 (105 [46%] men); median age in both cohorts was 71. Median follow-up from pembrolizumab initiation to data cutoff was 35.1 months (range, 12.0-52.7) and 38.4 months (range, 33.1-44.9) in EHR and spotlight cohorts, respectively. Median OS was 19.6 months (95% CI, 16.6-24.3) and 21.1 months (95% CI, 16.2-28.9), respectively; 3-year OS rates were 36.2% and 38.2% in EHR and spotlight cohorts, respectively. In the spotlight cohort, median rwPFS was 7.3 months (95% CI, 5.7-9.2); 88 patients (38.6%; 95% CI, 32.2-45.2) experienced rwTR of complete or partial response. For 151/228 patients (66%) who discontinued pembrolizumab, the most common reasons were disease progression (70 [46%]) and therapy-related adverse effects (35 [23%]). Conclusions Real-world outcomes remain consistent with outcomes observed in clinical trials, supporting long-term benefits of first-line pembrolizumab monotherapy for patients with metastatic NSCLC, PD-L1 expression ≥50%, and good performance status.
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Affiliation(s)
- Vamsidhar Velcheti
- Perlmutter Cancer Center, New York University, New York, NY, United States
| | - Xiaohan Hu
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, United States
| | - Lingfeng Yang
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, United States
| | | | - Thomas Burke
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, United States
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21
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Gupta A, Zhang D, Braithwaite D, Karanth SD, Tailor TD, Clarke JM, Akinyemiju T. Racial Differences in Survival Among Advanced-stage Non-small-Cell Lung Cancer Patients Who Received Immunotherapy: An Analysis of the US National Cancer Database (NCDB). J Immunother 2022; 45:132-137. [PMID: 34747372 DOI: 10.1097/cji.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
Lung cancer is the most common cause of cancer death among men and women in the United States, with significant racial disparities in survival. It is unclear whether these disparities persist upon equal utilization of immunotherapy. The purpose of this study was to evaluate the association between race and all-cause mortality among non-small-cell lung cancer (NSCLC) patients who received immunotherapy. We obtained data from the 2016 National Cancer Database on patients diagnosed with advanced-stage (III-IV) NSCLC from 2015 to 2016. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) by race/ethnicity. A total of 2940 patients were included. Non-Hispanic (NH)-Black patients had a lower risk of death relative to NH-White patients (HR: 0.85; 95% CI: 0.73, 0.98) after adjusting for sociodemographic, clinical, and treatment factors. Formal tests of interaction evaluating race with Charlson-Deyo comorbidity score and race with area-level median income were nonsignificant. However, in stratified analyses, NH-Black versus NH-White patients had a lower risk of death in models adjusted for sociodemographic factors among those with at least 1 comorbidity (HR: 0.75; 95% CI: 0.57, 0.97), and those living in regions within the 2 lowest quartiles of median income (HR: 0.82; 95% CI: 0.68, 0.99). Among advanced-stage NSCLC patients who received immunotherapy, NH-Black patients experienced higher survival compared with NH-White patients. We urge the implementation of policies and interventions that seek to equalize access to care as a means of addressing differences in overall NSCLC survival by race.
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22
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Kim J, Ha H, Park J, Cho J, Lim JH, Lee MH. Association of Smoking Status with Efficacy of First-line Immune Checkpoint Inhibitors in Advanced Non-small Cell Lung Cancers: A Systematic Review and Meta-analysis. J Cancer 2022; 13:364-372. [PMID: 35069886 PMCID: PMC8771515 DOI: 10.7150/jca.65374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Although smoking status has potential as a biomarker for immune checkpoint blockade in advanced non-small cell lung cancer (NSCLC), its clinical significance remains obscure. This meta-analysis aims to assess the impact of the smoking status on the efficacy of first-line immunotherapy and to find better treatment in never-smoker and ever-smoker patients. Methods: We searched the MEDLINE, EMBASE, and Cochrane database for trials comparing immunotherapy with conventional chemotherapy as front-line treatment for advanced NSCLC. Random-effects models were used to pool estimates of hazard ratios (HRs) for overall survival with 95% confidence intervals (CIs). Predefined subgroup analysis was performed to investigate the difference in the efficacy between the single checkpoint blockade and checkpoint inhibitor plus chemotherapy combination in the never-smokers and current/former smokers. Results: Twelve trials involving 6,446 patients were included in the analysis. A statistically significant overall survival benefit over conventional chemotherapy was found for both checkpoint inhibitor monotherapy (HR, 0.71; 95% CI, 0.59-0.85) and checkpoint inhibitor plus chemotherapy (HR, 0.75; 95% CI, 0.63-0.90) in the current/former smoker group. There was no subgroup difference between monotherapy and combination treatment (p=0.67). However, there was an inconsistent survival outcome in the never-smoker group; checkpoint blockade monotherapy did not show significantly better efficacy than chemotherapy alone (HR, 1.05; 95% CI, 0.81-1.37), but combination treatment showed an overall survival benefit (HR, 0.64; 95% CI, 0.43-0.94). A significant subgroup difference existed between monotherapy and combination therapy (p=0.04). Similarly, there was a significant difference in efficacy of monotherapy between the current/former smoker and never-smoker group (p=0.01), but the efficacy of the combination treatment was comparable between the two groups (p=0.45). Conclusion: Smoking status, which is easily available information, could be used as a guide in clinical practice to choose better treatment in the front-line setting for advanced NSCLC patients.
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Affiliation(s)
- Jinchul Kim
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Hyerim Ha
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Jisun Park
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Jinhyun Cho
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Joo Han Lim
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Moon Hee Lee
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
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23
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Immunotherapy in Patients with Advanced Non-Small Cell Lung Cancer Lacking Driver Mutations and Future Perspectives. Cancers (Basel) 2021; 14:cancers14010122. [PMID: 35008287 PMCID: PMC8749892 DOI: 10.3390/cancers14010122] [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] [Received: 11/03/2021] [Revised: 12/11/2021] [Accepted: 12/22/2021] [Indexed: 12/20/2022] Open
Abstract
From a complete literature review, we were able to present in this paper what is most current in the treatment with immunotherapy for advanced non-small cell lung cancer (NSCLC). Especially the use of immunotherapy, particularly inhibitors of PD-1 (programmed cell death protein 1), PDL-1 (programmed cell death protein ligand 1), and CTLA-4 (cytotoxic T-lymphocyte antigen 4). Since 2015, these drugs have transformed the treatment of advanced NSCLC lacking driver mutations, evolving from second-line therapy to first-line, with excellent results. The arrival of new checkpoint inhibitors such as cemiplimab and the use of checkpoint inhibitors earlier in the therapy of advanced and metastatic cancers has been making the future prospects for treating NSCLC lacking driver mutations more favorable and optimistic. In addition, for those patients who have low PDL-1 positivity tumors, the combination of cytotoxic chemotherapy, VEGF inhibitor, and immunotherapy have shown an important improvement in global survival and progression free survival regardless the PDL-1 status. We also explored the effectiveness of adding radiotherapy to immunotherapy and the most current results about this combination. One concern that cannot be overlooked is the safety profile of immune checkpoint inhibitors (ICI) and the most common toxicities are described throughout this paper as well as tumor resistance to ICI.
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24
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Nair VS, Eaton K, McGarry Houghton A. A case series of morbid COPD exacerbations during immune checkpoint inhibitor therapy in cancer patients. Respir Med Case Rep 2021; 34:101541. [PMID: 34760616 PMCID: PMC8566897 DOI: 10.1016/j.rmcr.2021.101541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/09/2022] Open
Abstract
Background Immune checkpoint inhibitor therapy is rapidly becoming front line adjuvant or primary therapy in a number of solid cancer types. Since many of these cancers are a result of tobacco smoking, a large number of these patients will have underlying comorbid conditions attributed to smoking such as Chronic Obstructive Pulmonary Disease (COPD). The effect of immune checkpoint inhibitor therapy on COPD is not well documented, and COPD exacerbations are not currently considered a pulmonary associated immune checkpoint inhibitor toxicity in current guidelines. Case presentation We describe and summarize here a series of patients with prolonged and severe COPD exacerbations upon the initiation of immune checkpoint inhibitor therapy for cancers of the skin and lung without radiographic evidence of pneumonitis. Conclusions COPD exacerbation from immune checkpoint inhibitor is not reported in the literature and is associated with prolonged and severe episodes without radiographic evidence of pneumonitis. Awareness of this potential morbid toxicity and research efforts to understand its etiology are required.
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Affiliation(s)
- Viswam S Nair
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave, Seattle, WA, 98109, USA.,Division of Pulmonary, Critical Care & Sleep Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Keith Eaton
- Thoracic, Head & Neck Medical Oncology, Seattle Cancer Care Alliance, 1354 Aloha St, Seattle, WA, 98109, USA.,Division of Medical Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - A McGarry Houghton
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave, Seattle, WA, 98109, USA.,Division of Pulmonary, Critical Care & Sleep Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
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25
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Grosjean HAI, Dolter S, Meyers DE, Ding PQ, Stukalin I, Goutam S, Kong S, Chu Q, Heng DYC, Bebb DG, Morris DG, Cheung WY, Pabani A. Effectiveness and Safety of First-Line Pembrolizumab in Older Adults with PD-L1 Positive Non-Small Cell Lung Cancer: A Retrospective Cohort Study of the Alberta Immunotherapy Database. Curr Oncol 2021; 28:4213-4222. [PMID: 34677275 PMCID: PMC8534423 DOI: 10.3390/curroncol28050357] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022] Open
Abstract
The emergence of immunotherapy revolutionized the treatment of non-small-cell-lung cancer (NSCLC), with multiple landmark clinical trials establishing the efficacy of these agents. However, many patients who receive immunotherapy in clinical practice would be considered clinical trial ineligible. One such population that is often under-represented in clinical trials is older adults. In the current study, we evaluated clinical and safety outcomes in this population. Overall, older adults (>70 years of age) and younger adults had comparable clinical outcomes with an equivalent objective response rate (ORR), time to treatment failure (TTF), and median overall survival (p = 0.67, p = 0.98, and p = 0.91, respectively). Furthermore, the safety outcomes were equivalent between the cohorts with similar rates of immune-related adverse events (irAEs), irAE-related hospitalizations, and all-cause hospitalization (p = 0.99, p = 0.63, and p = 0.74, respectively). While older age was not found to impact overall survival, multivariant analysis revealed that a poor Eastern Cooperative Oncology Group (ECOG) status, low body-mass-index (BMI), and poor/intermediate lung immune prognostic index (LIPI) were all associated with worse survival. In conclusion, age does not impact the efficacy or safety of pembrolizumab in NSCLC, and therefore advanced age should not be a deterrent for treating these patients with pembrolizumab. Physicians and care providers can thus focus on other factors that may influence therapeutic outcomes.
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Affiliation(s)
- Heidi A. I. Grosjean
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Samantha Dolter
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Daniel E. Meyers
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Philip Q. Ding
- Oncology Outcomes, Calgary, AB T2N4N2, Canada;
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G2R3, Canada;
| | - Igor Stukalin
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Siddhartha Goutam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G2R3, Canada;
- Cross Cancer Institute, Edmonton, AB T6G1Z2, Canada;
| | - Shiying Kong
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Quincy Chu
- Cross Cancer Institute, Edmonton, AB T6G1Z2, Canada;
| | - Daniel Y. C. Heng
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - D. Gwyn Bebb
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Don G. Morris
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Winson Y. Cheung
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Aliyah Pabani
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
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Zeng H, Huang WW, Liu YJ, Huang Q, Zhao SM, Li YL, Tian PW, Li WM. Development and Validation of a Nomogram for Predicting Prognosis to Immune Checkpoint Inhibitors Plus Chemotherapy in Patients With Non-Small Cell Lung Cancer. Front Oncol 2021; 11:685047. [PMID: 34458139 PMCID: PMC8397581 DOI: 10.3389/fonc.2021.685047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) plus chemotherapy improved the prognosis of patients with non-small cell lung cancer (NSCLC); however, reliable prognostic biomarkers are lacking. We explored factors associated with prognosis and developed a predictive model. Methods We retrospectively analyzed 130 consecutive stage IIIA–IVB NSCLC patients treated with ICIs combined with chemotherapy. Cox univariate and multivariate proportional hazards regression analyses were used to identify prognostic factors associated with progression-free survival (PFS). A nomogram was developed based on key factors in the training cohort (n = 86) and evaluated in the validation cohort (n = 44). According to the nomogram-based total point scores, we divided patients into low- and high-risk groups. Results In the training cohort, bone metastases (p = 0.017) and an increased derived neutrophil-to-lymphocyte ratio (p = 0.018) were significantly associated with poor PFS, while smoking (p = 0.007) and programmed death-ligand 1 (PD-L1) ≥50% (p = 0.001) were associated with improved PFS. A nomogram based on these factors was developed to predict PFS at 3, 6, and 12 months. The C-index of the nomogram to predict PFS was 0.725 (95% CI: 0.711–0.739) in the training cohort and 0.688 (95% CI: 0.665–0.711) in the validation cohort. The area under the curve (AUC) exhibited an acceptable discriminative ability, and calibration curves demonstrated a consistency between the actual results and predictions. In the training cohort, the median PFS (mPFS) was 12.3 and 5.7 months in the low- and high-risk groups, respectively (p < 0.001). In the validation cohort, the mPFS was 12.6 and 6.2 months in the low- and high-risk groups, respectively (p = 0.021). Conclusions A predictive nomogram was developed to help clinicians assess prognosis early for advanced NSCLC patients who received ICI plus chemotherapy.
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Affiliation(s)
- Hao Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Wei-Wei Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yu-Jie Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Qin Huang
- Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, China
| | - Sheng-Min Zhao
- Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ya-Lun Li
- Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, China
| | - Pan-Wen Tian
- Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Min Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Huang L, Han H, Zhou L, Chen X, Xu Q, Xie J, Zhan P, Chen S, Lv T, Song Y. Evaluation of the Lung Immune Prognostic Index in Non-Small Cell Lung Cancer Patients Treated With Systemic Therapy: A Retrospective Study and Meta-Analysis. Front Oncol 2021; 11:670230. [PMID: 34249708 PMCID: PMC8264771 DOI: 10.3389/fonc.2021.670230] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022] Open
Abstract
The lung immune prognostic index (LIPI) has been shown to be an important prognostic marker for various tumors. However, the prognostic value of LIPI among non-small cell lung cancer (NSCLC) patients treated with systemic therapy remains controversial. We aimed to evaluate survival status according to LIPI among NSCLC patients receiving different forms of systemic therapy at our institution. We also performed a meta-analysis of articles from PubMed and Embase to illustrate this question. For our cohort, we found that good LIPI was associated with better overall survival (OS) among 91 patients on immunotherapy, 329 patients on targeted therapy, and 570 patients on chemotherapy. For the meta-analysis, a total of eight studies with 8,721 patients were included. Pooled results showed that a higher LIPI (those with 1 or 2 factors) was associated with poor overall progression-free survival (PFS) (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.45−1.71) and OS (HR, 2.01; 95% CI, 1.75−2.31). Subgroup analyses showed that a higher LIPI was related to poor survival among patients prescribed different systemic therapies: immunotherapy (OS HR, 2.50; 95% CI, 1.99–3.13; PFS HR, 1.77; 95% CI, 1.56–2.01), chemotherapy (OS HR, 1.58; 95% CI, 1.34–1.86; PFS HR, 1.38; 95% CI, 1.23–1.55), and targeted therapy (OS HR; 2.15, 95% CI, 1.57–2.96; PFS HR, 1.60; 95% CI, 1.25–2.06). The study shows that the LIPI is a clinically significant prognostic factor for NSCLC patients receiving systemic therapy.
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Affiliation(s)
- Litang Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University, Sch Med, Nanjing, China
| | - Hedong Han
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Li Zhou
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xi Chen
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qiuli Xu
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jingyuan Xie
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ping Zhan
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Si Chen
- Department of Ophthalmology, Affiliated Jinling Hospital, School of Medicine, Southeast University, Sch Med, Nanjing, China
| | - Tangfeng Lv
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University, Sch Med, Nanjing, China.,Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Affiliated Jinling Hospital, School of Medicine, Southeast University, Sch Med, Nanjing, China
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Lenci E, Marcantognini G, Cognigni V, Lupi A, Rinaldi S, Cantini L, Fiordoliva I, Carloni AL, Rocchi M, Zuccatosta L, Gasparini S, Berardi R. Tumor burden as possible biomarker of outcome in advanced NSCLC patients treated with immunotherapy: a single center, retrospective, real-world analysis. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2021; 2:227-239. [PMID: 36046436 PMCID: PMC9400786 DOI: 10.37349/etat.2021.00043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
Aim: The role of tumor burden (TB) for patients with non-small cell lung cancer (NSCLC) receiving immunotherapy is still unknown. The aim of this analysis was to analyze the prognostic value of TB in a real-world sample of advanced NSCLC patients. Methods: Sixty-five consecutive patients with advanced NSCLC treated with immunotherapy as first or second line therapy were retrospectively analyzed between August 2015 and February 2018. TB was recorded at baseline considering sites and number of metastases, thoracic vs. extrathoracic disease, measurable disease (MD) vs. not-MD (NMD) and evaluating dimensional aspects as maximum lesion diameter (cut-off = 6.3 cm), sum of the 5 major lesions diameters (cut-off = 14.3 cm), and number of sites of metastases (cut-off > 4). All cut-offs were calculated by receiver operating characteristic curves. Median overall survival (OS) was estimated using Kaplan-Meier method. A Cox regression model was carried out for univariate and multivariate analyses. Results: Median age was 70 years and most patients (86.2%) had a good performance status (PS-Eastern Cooperative Oncology Group < 2). No significant difference in OS was noted between subgroups of patients according to TB. Bone metastases (BM) had a negative prognostic impact [median OS (mOS), 13.8 vs. 70.0 months, P = 0.0009; median progression free survival in the second line (mPFS2) 2.97 vs. 8.63 months; P = 0.0037]. Patients with NMD had a poorer prognosis (mOS, 15.9 months vs. not reached, P < 0.0001; mPFS2 3.8 vs. 12.2 months; P = 0.0199). Patients with disease limited to the thorax had a better prognosis compared to patients with involvement of extrathoracic sites (mOS, 70 vs. 17.3 months; P = 0.0136). Having more than 4 metastatic sites resulted as a negative prognostic factor (mOS, 15.9 vs. 25.2 months; P = 0.0106). At multivariate analysis, BM, NMD, extrathoracic disease and number of sites of metastases > 4 were negative prognostic factors (P < 0.0001). Conclusions: This study underlines the negative prognostic impact of specific metastatic sites, presence of NMD and extrathoracic disease in advanced NSCLC patients treated with immunotherapy. However, TB does not appear to affect the outcome of these patients.
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Affiliation(s)
- Edoardo Lenci
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Giulia Marcantognini
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Valeria Cognigni
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Alessio Lupi
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Silvia Rinaldi
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Luca Cantini
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Ilaria Fiordoliva
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Anna Lisa Carloni
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | - Marco Rocchi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Lina Zuccatosta
- Operative Unit of Pneumology, Ospedali Riuniti University Hospital, 60126 Ancona, Italy
| | - Stefano Gasparini
- Operative Unit of Pneumology, Ospedali Riuniti University Hospital, 60126 Ancona, Italy
| | - Rossana Berardi
- Clinical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, 60126 Ancona, Italy
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Buti S, Bersanelli M, Perrone F, Bracarda S, Di Maio M, Giusti R, Nigro O, Cortinovis DL, Aerts JGJV, Guaitoli G, Barbieri F, Ferrara MG, Bria E, Grossi F, Bareggi C, Berardi R, Torniai M, Cantini L, Sforza V, Genova C, Chiari R, Rocco D, Della Gravara L, Gori S, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Citarella F, Russano M, Mazzoni F, Garassino MC, De Toma A, Signorelli D, Gelibter A, Siringo M, Follador A, Bisonni R, Tuzi A, Minuti G, Landi L, Ricciardi S, Migliorino MR, Tabbò F, Olmetto E, Metro G, Adamo V, Russo A, Spinelli GP, Banna GL, Addeo A, Friedlaender A, Cannita K, Porzio G, Ficorella C, Carmisciano L, Pinato DJ, Mazzaschi G, Tiseo M, Cortellini A. Predictive ability of a drug-based score in patients with advanced non-small-cell lung cancer receiving first-line immunotherapy. Eur J Cancer 2021; 150:224-231. [PMID: 33934059 DOI: 10.1016/j.ejca.2021.03.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND We previously demonstrated the cumulative poor prognostic role of concomitant medications on the clinical outcome of patients with advanced cancer treated with immune checkpoint inhibitors, creating and validating a drug-based prognostic score to be calculated before immunotherapy initiation in patients with advanced solid tumours. This 'drug score' was calculated assigning score 1 for each between proton-pump inhibitor and antibiotic administration until a month before cancer therapy initiation and score 2 in case of corticosteroid intake. The good risk group included patients with score 0, intermediate risk with score 1-2 and poor risk with score 3-4. METHODS Aiming at validating the prognostic and putative predictive ability depending on the anticancer therapy, we performed the present comparative analysis in two cohorts of advanced non-small-cell lung cancer (NSCLC), respectively, receiving first-line pembrolizumab or chemotherapy through a random case-control matching and through a pooled multivariable analysis including the interaction between the computed score and the therapeutic modality (pembrolizumab vs chemotherapy). RESULTS Nine hundred fifty and 595 patients were included in the pembrolizumab and chemotherapy cohorts, respectively. After the case-control random matching, 589 patients from the pembrolizumab cohort and 589 from the chemotherapy cohort were paired, with no statistically significant differences between the characteristics of the matched subjects. Among the pembrolizumab-treated group, good, intermediate and poor risk evaluable patients achieved an objective response rate (ORR) of 50.0%, 37.7% and 23.4%, respectively, (p < 0.0001), whereas among the chemotherapy-treated group, patients achieved an ORR of 37.0%, 40.0% and 32.4%, respectively (p = 0.4346). The median progression-free survival (PFS) of good, intermediate and poor risk groups was 13.9 months, 6.3 months and 2.8 months, respectively, within the pembrolizumab cohort (p < 0.0001), and 6.2 months, 6.2 months and 4.3 months, respectively, within the chemotherapy cohort (p = 0.0280). Among the pembrolizumab-treated patients, the median overall survival (OS) for good, intermediate and poor risk patients was 31.4 months, 14.5 months and 5.8 months, respectively, (p < 0.0001), whereas among the chemotherapy-treated patients, it was 18.3 months, 16.8 months and 10.6 months, respectively (p = 0.0003). A similar trend was reported considering the two entire populations. At the pooled analysis, the interaction term between the score and the therapeutic modality was statistically significant with respect to ORR (p = 0.0052), PFS (p = 0.0003) and OS (p < 0.0001), confirming the significantly different effect of the score within the two cohorts. CONCLUSION Our 'drug score' showed a predictive ability with respect to ORR in the immunotherapy cohort only, suggesting it might be a useful tool for identifying patients unlikely to benefit from first-line single-agent pembrolizumab. In addition, the prognostic stratification in terms of PFS and OS was significantly more pronounced among the pembrolizumab-treated patients.
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Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sergio Bracarda
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin and Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | | | - Olga Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | | | - Joachim G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Giorgia Guaitoli
- Dipartimeto di Oncologia Ed Ematologia, AOU Policlinico Modena, Modena, Italy
| | - Fausto Barbieri
- Dipartimeto di Oncologia Ed Ematologia, AOU Policlinico Modena, Modena, Italy
| | - Miriam G Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Francesco Grossi
- Division of Medical Oncology, University of Insubria, Varese, Italy
| | - Claudia Bareggi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Napoli, Italy
| | - Carlo Genova
- Lung Cancer Unit IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Monaldi Hospital, Naples, Italy
| | | | - Stefania Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, VR, Italy
| | - Michele De Tursi
- Dipartimento di Terapie Innovative in Medicina e Odontoiatria, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | | | | | | | | | | | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Francesca Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Marina C Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Siringo
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Follador
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | | | | | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, St. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Fabrizio Tabbò
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, (TO), Italy
| | - Emanuela Olmetto
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, (TO), Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria Della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Vincenzo Adamo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - Alessandro Russo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - Gian P Spinelli
- UOC Territorial Oncology of Aprilia, AUSL Latina, University of Rome Sapienza, Aprilia, Italy
| | | | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | | | - Corrado Ficorella
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - David J Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK; Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessio Cortellini
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
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Cortellini A, Di Maio M, Nigro O, Leonetti A, Cortinovis DL, Aerts JG, Guaitoli G, Barbieri F, Giusti R, Ferrara MG, Bria E, D'Argento E, Grossi F, Rijavec E, Guida A, Berardi R, Torniai M, Sforza V, Genova C, Mazzoni F, Garassino MC, De Toma A, Signorelli D, Gelibter A, Siringo M, Marchetti P, Macerelli M, Rastelli F, Chiari R, Rocco D, Della Gravara L, Inno A, Michele DT, Grassadonia A, Di Marino P, Mansueto G, Zoratto F, Filetti M, Santini D, Citarella F, Russano M, Cantini L, Tuzi A, Bordi P, Minuti G, Landi L, Ricciardi S, Migliorino MR, Passiglia F, Bironzo P, Metro G, Adamo V, Russo A, Spinelli GP, Banna GL, Friedlaender A, Addeo A, Cannita K, Ficorella C, Porzio G, Pinato DJ. Differential influence of antibiotic therapy and other medications on oncological outcomes of patients with non-small cell lung cancer treated with first-line pembrolizumab versus cytotoxic chemotherapy. J Immunother Cancer 2021; 9:e002421. [PMID: 33827906 PMCID: PMC8031700 DOI: 10.1136/jitc-2021-002421] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Some concomitant medications including antibiotics (ATB) have been reproducibly associated with worse survival following immune checkpoint inhibitors (ICIs) in unselected patients with non-small cell lung cancer (NSCLC) (according to programmed death-ligand 1 (PD-L1) expression and treatment line). Whether such relationship is causative or associative is matter of debate. METHODS We present the outcomes analysis according to concomitant baseline medications (prior to ICI initiation) with putative immune-modulatory effects in a large cohort of patients with metastatic NSCLC with a PD-L1 expression ≥50%, receiving first-line pembrolizumab monotherapy. We also evaluated a control cohort of patients with metastatic NSCLC treated with first-line chemotherapy. The interaction between key medications and therapeutic modality (pembrolizumab vs chemotherapy) was validated in pooled multivariable analyses. RESULTS 950 and 595 patients were included in the pembrolizumab and chemotherapy cohorts, respectively. Corticosteroid and proton pump inhibitor (PPI) therapy but not ATB therapy was associated with poorer performance status at baseline in both the cohorts. No association with clinical outcomes was found according to baseline statin, aspirin, β-blocker and metformin within the pembrolizumab cohort. On the multivariable analysis, ATB emerged as a strong predictor of worse overall survival (OS) (HR=1.42 (95% CI 1.13 to 1.79); p=0.0024), and progression free survival (PFS) (HR=1.29 (95% CI 1.04 to 1.59); p=0.0192) in the pembrolizumab but not in the chemotherapy cohort. Corticosteroids were associated with shorter PFS (HR=1.69 (95% CI 1.42 to 2.03); p<0.0001), and OS (HR=1.93 (95% CI 1.59 to 2.35); p<0.0001) following pembrolizumab, and shorter PFS (HR=1.30 (95% CI 1.08 to 1.56), p=0.0046) and OS (HR=1.58 (95% CI 1.29 to 1.94), p<0.0001), following chemotherapy. PPIs were associated with worse OS (HR=1.49 (95% CI 1.26 to 1.77); p<0.0001) with pembrolizumab and shorter OS (HR=1.12 (95% CI 1.02 to 1.24), p=0.0139), with chemotherapy. At the pooled analysis, there was a statistically significant interaction with treatment (pembrolizumab vs chemotherapy) for corticosteroids (p=0.0020) and PPIs (p=0.0460) with respect to OS, for corticosteroids (p<0.0001), ATB (p=0.0290), and PPIs (p=0.0487) with respect to PFS, and only corticosteroids (p=0.0033) with respect to objective response rate. CONCLUSION In this study, we validate the significant negative impact of ATB on pembrolizumab monotherapy but not chemotherapy outcomes in NSCLC, producing further evidence about their underlying immune-modulatory effect. Even though the magnitude of the impact of corticosteroids and PPIs is significantly different across the cohorts, their effects might be driven by adverse disease features.
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Affiliation(s)
- Alessio Cortellini
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Massimo Di Maio
- Department of Oncology and Medical Oncology, University of Turin and AO Ordine Mauriziano, Turin, Italy
| | - Olga Nigro
- Medical Oncology, ASST dei Sette Laghi, Varese, Italy
| | | | | | - Joachim Gjv Aerts
- Department of Pulmonary Disease, Erasmus Medical Center, Rotterdam, Netherlands
| | - Giorgia Guaitoli
- Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, Modena, Italy
| | - Fausto Barbieri
- Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, Modena, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Roma, Italy
| | - Miriam G Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
- Department of Translational Medicine and Surgery, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
- Department of Translational Medicine and Surgery, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - Ettore D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Francesco Grossi
- Division of Medical Oncology, University of Insubria, Varese, Italy
| | - Erika Rijavec
- Medical Oncology, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Guida
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, National Cancer Institute IRCCS Pascale Foundation, Napoli, Italy
| | - Carlo Genova
- Lung Cancer Unit, IRCCS Ospedal Policlinico San Martino, Genova, Italy
| | - Francesca Mazzoni
- Department of Medical Oncology, Careggi University Hospital, Firenze, Toscana, Italy
| | | | - Alessandro De Toma
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Signorelli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | - Marco Siringo
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy
| | - Marianna Macerelli
- Medical Oncology, University Hospital Santa Maria della Misericordia, Udine, Italy
| | | | - Rita Chiari
- Medical Oncology, Ospedali riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Padova, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Ospedali dei Colli Monaldi Cotugno CTO, Napoli, Italy
| | | | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - De Tursi Michele
- Dipartimento di Terapie Innovative in Medicina ed Odontoiatria, Universitá G. D'Annunzio, Chieti-Pescara, Italy
| | - Antonino Grassadonia
- Dipartimento di Terapie Innovative in Medicina ed Odontoiatria, Universitá G. D'Annunzio, Chieti-Pescara, Italy
| | | | - Giovanni Mansueto
- Medical Oncology, Azienda Sanitaria Locale Frosinone, Frosinone, Italy
| | | | - Marco Filetti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Roma, Italy
| | | | | | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Roma, Italy
| | - Luca Cantini
- Department of Pulmonary Disease, Erasmus Medical Center, Rotterdam, Netherlands
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Paola Bordi
- Medical Oncology, University Hospital of Parma, Parma, Italy
| | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, San Camillo Forlanini Hospital, Roma, Italy
| | | | - Francesco Passiglia
- Department of Oncology, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, San Luigi Hospital, Orbassano, Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Vincenzo Adamo
- Medical Oncology and Department of Human Pathology, Azienda Ospedaliera Papardo and Università degli Studi di Messina, Messina, Italy
| | - Alessandro Russo
- Medical Oncology and Department of Human Pathology, Azienda Ospedaliera Papardo and Università degli Studi di Messina, Messina, Italy
| | - Gian Paolo Spinelli
- UOC Territorial Oncology of Aprilia, AUSL Latina, Sapienza University of Rome, Aprilia, Italy
| | - Giuseppe L Banna
- Medical Oncology, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneve, Switzerland
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneve, Switzerland
| | - Katia Cannita
- Medical Oncology, San Salvatore Hospital, L'Aquila, Italy
| | - Corrado Ficorella
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
- Medical Oncology, San Salvatore Hospital, L'Aquila, Italy
| | | | - David J Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Translational Medicine, Universitá del Piemonte Orientale "A. Avogadro", Novara, Italy
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Post-progression outcomes of NSCLC patients with PD-L1 expression ≥ 50% receiving first-line single-agent pembrolizumab in a large multicentre real-world study. Eur J Cancer 2021; 148:24-35. [PMID: 33721704 DOI: 10.1016/j.ejca.2021.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment sequencing with first-line immunotherapy, followed by second-line chemotherapy, is still a viable option for NSCLC patients with PD-L1 expression ≥50%. METHODS We evaluated post-progression treatment pathways in a large real-world cohort of metastatic NSCLC patients with PD-L1 expression ≥ 50% treated with first-line pembrolizumab monotherapy. RESULTS Overall, 974 patients were included. With a median follow-up of 22.7 months (95%CI: 21.6-38.2), the median overall survival (OS) of the entire population was 15.8 months (95%CI: 13.5-17.5; 548 events). At the data cutoff, among the 678 patients who experienced disease progression, 379 (55.9%) had not received any further treatment, and 359 patients (52.9%) had died. Patients who did not receive post-progression therapies were older (p = 0.0011), with a worse ECOG-PS (p < 0.0001) and were on corticosteroids prior to pembrolizumab (p = 0.0024). At disease progression, 198 patients (29.2%) received a switched approach and 101 (14.9%) received pembrolizumab ByPD either alone (64 [9.4%]) or in combination with local ablative treatments (37 [5.5%]) (LATs). After a random-case control matching according to ECOG-PS, CNS metastases, bone metastases, and (previous) best response to pembrolizumab, patients receiving pembrolizumab ByPD plus LATs were confirmed to have a significantly longer post-progression OS compared to patients receiving pembrolizumab ByPD alone 13.9 months versus 7.8 months (p = 0.0179) 241 patients (35.5%) among the 678 who had experienced PD, received a second-line systemic treatment (regardless of previous treatment beyond PD). As compared to first-line treatment commencement, patients' features at the moment of second-line initiation showed a significantly higher proportion of patients aged under 70 years (p = 0.0244), with a poorer ECOG-PS (p < 0.0001) and having CNS (p = 0.0001), bone (p = 0.0266) and liver metastases (p = 0.0148). CONCLUSIONS In the real-world scenario NSCLC patients with PD-L1 expression ≥50% treated with first-line single-agent pembrolizumab achieve worse outcomes as compared to the Keynote-024 trial. Poor post-progression outcomes are major determinants of the global results that should be considered when counselling patients for first-line treatment choices.
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Lenci E, Cantini L, Pecci F, Cognigni V, Agostinelli V, Mentrasti G, Lupi A, Ranallo N, Paoloni F, Rinaldi S, Nicolardi L, Caglio A, Aerts S, Cortellini A, Ficorella C, Chiari R, Di Maio M, Dingemans AMC, Aerts JGJV, Berardi R. The Gustave Roussy Immune (GRIm)-Score Variation Is an Early-on-Treatment Biomarker of Outcome in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients Treated with First-Line Pembrolizumab. J Clin Med 2021; 10:jcm10051005. [PMID: 33801320 PMCID: PMC7958321 DOI: 10.3390/jcm10051005] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The Gustave Roussy Immune (GRIm)-Score takes into account neutrophil-to-lymphocyte ratio (NLR), serum albumin concentration and lactate dehydrogenase (LDH) and its prognostic value has been investigated in patients treated with immune check-point inhibitors (ICIs). To further assess the prognostic and predictive value of baseline GRIm-Score (GRImT0) in advanced non-small cell lung cancer (aNSCLC) patients, we separately investigated two cohorts of patients treated with first-line pembrolizumab or chemotherapy. We also investigated whether GRIm-Score at 45 days since treatment initiation (GRImT1) and GRIm-Score difference between the two timepoints may better predict clinical outcomes (GRImΔ = GRImT0 − GRImT1). Methods: We retrospectively evaluated 222 aNSCLC patients: 135 treated with pembrolizumab and 87 treated with chemotherapy as the first-line regimen. NLR, serum albumin and LDH concentrations were assessed at T0 and at T1. According to the GRIm-Score, patients were assigned 1 point if they had NLR > 6, LDH > upper limit normal or albumin < 3.5 g/dL. Patients with a GRIm-Score < 2 were considered as having a low Score. Results: In both cohorts, no difference in terms of overall survival (OS) between patients with low and high GRImT0 was found. Otherwise, median OS and progression free survival (PFS) of the low GRImT1 group were significantly longer than those of the high GRImT1 group in pembrolizumab-treated patients, but not in the CHT cohort (pembrolizumab cohort: low vs. high; median OS not reached vs. 9.2 months, p = 0.004; median PFS 10.8 vs. 2.3 months, p = 0.002). Patients receiving pembrolizumab with stable/positive GRImΔ had better OS (median OS not reached vs. 12.0 months, p < 0.001), PFS (median PFS 20.6 vs. 2.6 months, p < 0.001) and objective response rate (58.2% vs. 7.6%, p = 0.003) compared to patients with negative GRImΔ. Conclusion: Our data shown that GRImT1 and GRImΔ are more reliable peripheral blood biomarkers of outcome compared to GRImT0 in aNSCLC patients treated with pembrolizumab and might represent useful biomarkers to drive clinical decisions in this setting.
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Affiliation(s)
- Edoardo Lenci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Luca Cantini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Federica Pecci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Valeria Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Veronica Agostinelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Giulia Mentrasti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Alessio Lupi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Nicoletta Ranallo
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Francesco Paoloni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Silvia Rinaldi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
| | - Linda Nicolardi
- Medical Oncology, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy; (L.N.); (R.C.)
| | - Andrea Caglio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, 10128 Torino, Italy; (A.C.); (M.D.M.)
| | - Sophie Aerts
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Alessio Cortellini
- Medical Oncology, St Salvatore Hospital, 67100 L’Aquila, Italy; (A.C.); (C.F.)
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology, St Salvatore Hospital, 67100 L’Aquila, Italy; (A.C.); (C.F.)
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud, 35043 Monselice, Italy; (L.N.); (R.C.)
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, 10128 Torino, Italy; (A.C.); (M.D.M.)
| | - Anne-Marie C. Dingemans
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Joachim G. J. V. Aerts
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.A.); (A.-M.C.D.); (J.G.J.V.A.)
- Erasmus MC Cancer Institute, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Ancona, 60126 Ancona, Italy; (E.L.); (L.C.); (F.P.); (V.C.); (V.A.); (G.M.); (A.L.); (N.R.); (F.P.); (S.R.)
- Correspondence: ; Tel.: +39-071-596-4169
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Cortellini A, De Giglio A, Cannita K, Cortinovis DL, Cornelissen R, Baldessari C, Giusti R, D'Argento E, Grossi F, Santoni M, Catino A, Berardi R, Sforza V, Rossi G, Antonuzzo L, Di Noia V, Signorelli D, Gelibter A, Occhipinti MA, Follador A, Rastelli F, Chiari R, Gravara LD, Inno A, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Montrone M, Citarella F, Pensieri MV, Russano M, Cantini L, Nigro O, Leonetti A, Bordi P, Minuti G, Landi L, De Toma A, Donisi C, Ricciardi S, Migliorino MR, Napoli VM, Leone G, Metro G, Banna GL, Friedlaender A, Addeo A, Ficorella C, Porzio G. Smoking status during first-line immunotherapy and chemotherapy in NSCLC patients: A case-control matched analysis from a large multicenter study. Thorac Cancer 2021; 12:880-889. [PMID: 33527756 PMCID: PMC7952794 DOI: 10.1111/1759-7714.13852] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/11/2022] Open
Abstract
Background Improved outcome in tobacco smoking patients with non‐small cell lung cancer (NSCLC) following immunotherapy has previously been reported. However, little is known regarding this association during first‐line immunotherapy in patients with high PD‐L1 expression. In this study we compared clinical outcomes according to the smoking status of two large multicenter cohorts. Methods We compared clinical outcomes according to the smoking status (never smokers vs. current/former smokers) of two retrospective multicenter cohorts of metastatic NSCLC patients, treated with first‐line pembrolizumab and platinum‐based chemotherapy. Results A total of 962 NSCLC patients with PD‐L1 expression ≥50% who received first‐line pembrolizumab and 462 NSCLC patients who received first‐line platinum‐based chemotherapy were included in the study. Never smokers were confirmed to have a significantly higher risk of disease progression (hazard ratio [HR] = 1.49 [95% CI: 1.15–1.92], p = 0.0022) and death (HR = 1.38 [95% CI: 1.02–1.87], p = 0.0348) within the pembrolizumab cohort. On the contrary, a nonsignificant trend towards a reduced risk of disease progression (HR = 0.74 [95% CI: 0.52–1.05], p = 0.1003) and death (HR = 0.67 [95% CI: 0.45–1.01], p = 0.0593) were reported for never smokers within the chemotherapy cohort. After a random case–control matching, 424 patients from both cohorts were paired. Within the matched pembrolizumab cohort, never smokers had a significantly shorter progression‐free survival (PFS) (HR = 1.68 [95% CI: 1.17–2.40], p = 0.0045) and a nonsignificant trend towards a shortened overall survival (OS) (HR = 1.32 [95% CI: 0.84–2.07], p = 0.2205). On the contrary, never smokers had a significantly longer PFS (HR = 0.68 [95% CI: 0.49–0.95], p = 0.0255) and OS (HR = 0.66 [95% CI: 0.45–0.97], p = 0,0356) compared to current/former smoker patients within the matched chemotherapy cohort. On pooled multivariable analysis, the interaction term between smoking status and treatment modality was concordantly statistically significant with respect to ORR (p = 0.0074), PFS (p = 0.0001) and OS (p = 0.0020), confirming the significantly different impact of smoking status across the two cohorts. Conclusions Among metastatic NSCLC patients with PD‐L1 expression ≥50% receiving first‐line pembrolizumab, current/former smokers experienced improved PFS and OS. On the contrary, worse outcomes were reported among current/former smokers receiving first‐line chemotherapy.
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Affiliation(s)
- Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea De Giglio
- Division of Medical Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | | | - Robin Cornelissen
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cinzia Baldessari
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | | | - Ettore D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Annamaria Catino
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Naples, Italy
| | - Giovanni Rossi
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lorenzo Antonuzzo
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Vincenzo Di Noia
- Unità di Oncologia medica e Terapia Biomolecolare, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Foggia, Foggia, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Alessandro Follador
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | | | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Italy
| | | | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Michele De Tursi
- Department of Medical, Oral & Biotechnological Sciences, University G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | | | | | | | | | - Michele Montrone
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Maria Vittoria Pensieri
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, The Netherlands.,Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Olga Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | | | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Lorenza Landi
- Division of Medical Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Clelia Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, St. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Valerio Maria Napoli
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Giuseppe L Banna
- Oncology Department, Queen Alexandra University Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Corrado Ficorella
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
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