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Hellmann MD, Ciuleanu TE, Pluzanski A, Lee JS, Otterson GA, Audigier-Valette C, Minenza E, Linardou H, Burgers S, Salman P, Borghaei H, Ramalingam SS, Brahmer J, Reck M, O'Byrne KJ, Geese WJ, Green G, Chang H, Szustakowski J, Bhagavatheeswaran P, Healey D, Fu Y, Nathan F, Paz-Ares L. Nivolumab plus Ipilimumab in Lung Cancer with a High Tumor Mutational Burden. N Engl J Med 2018; 378:2093-2104. [PMID: 29658845 PMCID: PMC7193684 DOI: 10.1056/nejmoa1801946] [Citation(s) in RCA: 2240] [Impact Index Per Article: 373.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Nivolumab plus ipilimumab showed promising efficacy for the treatment of non-small-cell lung cancer (NSCLC) in a phase 1 trial, and tumor mutational burden has emerged as a potential biomarker of benefit. In this part of an open-label, multipart, phase 3 trial, we examined progression-free survival with nivolumab plus ipilimumab versus chemotherapy among patients with a high tumor mutational burden (≥10 mutations per megabase). METHODS We enrolled patients with stage IV or recurrent NSCLC that was not previously treated with chemotherapy. Those with a level of tumor programmed death ligand 1 (PD-L1) expression of at least 1% were randomly assigned, in a 1:1:1 ratio, to receive nivolumab plus ipilimumab, nivolumab monotherapy, or chemotherapy; those with a tumor PD-L1 expression level of less than 1% were randomly assigned, in a 1:1:1 ratio, to receive nivolumab plus ipilimumab, nivolumab plus chemotherapy, or chemotherapy. Tumor mutational burden was determined by the FoundationOne CDx assay. RESULTS Progression-free survival among patients with a high tumor mutational burden was significantly longer with nivolumab plus ipilimumab than with chemotherapy. The 1-year progression-free survival rate was 42.6% with nivolumab plus ipilimumab versus 13.2% with chemotherapy, and the median progression-free survival was 7.2 months (95% confidence interval [CI], 5.5 to 13.2) versus 5.5 months (95% CI, 4.4 to 5.8) (hazard ratio for disease progression or death, 0.58; 97.5% CI, 0.41 to 0.81; P<0.001). The objective response rate was 45.3% with nivolumab plus ipilimumab and 26.9% with chemotherapy. The benefit of nivolumab plus ipilimumab over chemotherapy was broadly consistent within subgroups, including patients with a PD-L1 expression level of at least 1% and those with a level of less than 1%. The rate of grade 3 or 4 treatment-related adverse events was 31.2% with nivolumab plus ipilimumab and 36.1% with chemotherapy. ical; CheckMate 227 ClinicalTrials.gov number, NCT02477826 .). CONCLUSIONS Progression-free survival was significantly longer with first-line nivolumab plus ipilimumab than with chemotherapy among patients with NSCLC and a high tumor mutational burden, irrespective of PD-L1 expression level. The results validate the benefit of nivolumab plus ipilimumab in NSCLC and the role of tumor mutational burden as a biomarker for patient selection. (Funded by Bristol-Myers Squibb and Ono Pharmaceut
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Affiliation(s)
- Matthew D Hellmann
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Tudor-Eliade Ciuleanu
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Adam Pluzanski
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Jong Seok Lee
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Gregory A Otterson
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Clarisse Audigier-Valette
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Elisa Minenza
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Helena Linardou
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Sjaak Burgers
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Pamela Salman
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Hossein Borghaei
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Suresh S Ramalingam
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Julie Brahmer
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Martin Reck
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Kenneth J O'Byrne
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - William J Geese
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - George Green
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Han Chang
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Joseph Szustakowski
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Prabhu Bhagavatheeswaran
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Diane Healey
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Yali Fu
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Faith Nathan
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
| | - Luis Paz-Ares
- From Memorial Sloan Kettering Cancer Center Hospital, New York (M.D.H.); Prof. Dr. Ion Chiricuta Institute of Oncology and Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania (T.-E.C.); Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie, Warsaw, Poland (A.P.); Seoul National University Bundang Hospital, Seoul, South Korea (J.S.L.); Ohio State University, Columbus (G.A.O.); Hôpital Sainte Musse, Toulon, France (C.A.-V.); Ospedale Santa Maria della Misericordia, Perugia, Italy (E.M.); First Department of Oncology, Metropolitan Hospital, Athens, Greece (H.L.); Antoni van Leeuwenhoek Ziekenhuis, Amsterdam (S.B.); Fundación Arturo López Pérez, Santiago, Chile (P.S.); Fox Chase Cancer Center, Philadelphia (H.B.); Winship Cancer Institute, Emory University, Atlanta (S.S.R.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (J.B.); LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany (M.R.); Princess Alexandra Hospital, Brisbane, QLD, Australia (K.J.O.); Bristol-Myers Squibb, Princeton, NJ (W.J.G., G.G., H.C., J.S., P.B., D.H., Y.F., F.N.); and Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Oncológicas, Universidad Complutense, and CiberOnc, Madrid (L.P.-A.)
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