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Xu Y, Zhang Y, Qiang H, Zhong H, Xu J, Zhong R. Impact of PD-L1 expression on the efficacy of first-line crizotinib in advanced ROS1-rearranged NSCLC. Lung Cancer 2024; 194:107892. [PMID: 39018704 DOI: 10.1016/j.lungcan.2024.107892] [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: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The predictive value of programmed death-ligand 1 (PD-L1) expression for the efficacy of tyrosine kinase inhibitors (TKIs) in patients with advanced ROS1-rearranged non-small cell lung cancer (NSCLC) remains underexplored. This study analyzed patients with advanced NSCLC harboring ROS1 rearrangements who received first-line crizotinib to evaluate the correlation between baseline PD-L1 expression and crizotinib efficacy. METHODS In this study, the clinical data from 371 patients diagnosed with ROS1-rearranged NSCLC at Shanghai Chest Hospital between November 2017 and December 2022 were reviewed. The patients were categorized into three groups according to the baseline PD-L1 expression: tumor proportion score (TPS) <1%, TPS 1 %-49 %, and TPS≥50 %. The objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS) following first-line crizotinib treatment were measured. RESULTS A total of 64 patients were included in the analysis, with 16 patients in the TPS<1% group, 22 in the TPS 1 %-49 % group, and 26 in the TPS≥50 % group. The overall DCR was 100 %, and the overall ORR was 76.5 %. The ORRs were 81.2 % (13/16) in the TPS<1% group, 63.6 % (14/22) in the TPS 1 %-49 % group, and 84.6 % (22/26) in the TPS≥50 % group (p = 0.218). The median PFS across all patients was 20.21 months (95 % CI: 15.71-24.71), with a median PFS of 28.96 months (95 % CI: 19.87-38.04) in the TPS<1% group, 17.56 months (95 % CI: 12.25-22.86) in the TPS 1 %-49 % group, and 25.85 months (95 % CI: 18.52-33.17) in the TPS≥50 % group (p = 0.100). The median PFS for patients with CD74 fusion was 18.23 months (95 % CI: 15.24-21.22), while those with non-CD74 fusion exhibited a PFS of 16.49 months (95 % CI: 9.75-23.23) (p = 0.359). CONCLUSION Patients with advanced ROS1-rearranged NSCLC were found to benefit from first-line crizotinib treatment, irrespective of baseline PD-L1 expression.
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Affiliation(s)
- Yingqi Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yidan Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiping Qiang
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Zhong
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianlin Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Runbo Zhong
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Berland L, Gabr Z, Chang M, Ilié M, Hofman V, Rignol G, Ghiringhelli F, Mograbi B, Rashidian M, Hofman P. Further knowledge and developments in resistance mechanisms to immune checkpoint inhibitors. Front Immunol 2024; 15:1384121. [PMID: 38903504 PMCID: PMC11188684 DOI: 10.3389/fimmu.2024.1384121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
The past decade has witnessed a revolution in cancer treatment, shifting from conventional drugs (chemotherapies) towards targeted molecular therapies and immune-based therapies, in particular immune-checkpoint inhibitors (ICIs). These immunotherapies release the host's immune system against the tumor and have shown unprecedented durable remission for patients with cancers that were thought incurable, such as metastatic melanoma, metastatic renal cell carcinoma (RCC), microsatellite instability (MSI) high colorectal cancer and late stages of non-small cell lung cancer (NSCLC). However, about 80% of the patients fail to respond to these immunotherapies and are therefore left with other less effective and potentially toxic treatments. Identifying and understanding the mechanisms that enable cancerous cells to adapt to and eventually overcome therapy can help circumvent resistance and improve treatment. In this review, we describe the recent discoveries on the onco-immunological processes which govern the tumor microenvironment and their impact on the resistance to PD-1/PD-L1 checkpoint blockade.
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Affiliation(s)
- Léa Berland
- Inserm U1081 Institute for Research on Cancer and Aging, Nice (IRCAN) Team 4, Université Côte d’Azur, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Nice, France
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Zeina Gabr
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, United States
- School of Life Science, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland
| | - Michelle Chang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Marius Ilié
- Inserm U1081 Institute for Research on Cancer and Aging, Nice (IRCAN) Team 4, Université Côte d’Azur, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Nice, France
- Laboratory of Clinical and Experimental Pathology, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Pasteur Hospital, Université Côte d’Azur, Nice, France
- Institut Hospitalo Universitaire (IHU) RespirERA, Nice, France
- Hospital-Integrated Biobank (BB-0033–00025), Pasteur Hospital, Nice, France
| | - Véronique Hofman
- Inserm U1081 Institute for Research on Cancer and Aging, Nice (IRCAN) Team 4, Université Côte d’Azur, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Nice, France
- Laboratory of Clinical and Experimental Pathology, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Pasteur Hospital, Université Côte d’Azur, Nice, France
- Institut Hospitalo Universitaire (IHU) RespirERA, Nice, France
- Hospital-Integrated Biobank (BB-0033–00025), Pasteur Hospital, Nice, France
| | - Guylène Rignol
- Inserm U1081 Institute for Research on Cancer and Aging, Nice (IRCAN) Team 4, Université Côte d’Azur, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Nice, France
- Laboratory of Clinical and Experimental Pathology, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Pasteur Hospital, Université Côte d’Azur, Nice, France
- Institut Hospitalo Universitaire (IHU) RespirERA, Nice, France
| | - François Ghiringhelli
- Institut Hospitalo Universitaire (IHU) RespirERA, Nice, France
- Department of Biology and Pathology of Tumors, Georges-Francois Leclerc Cancer Center-UNICANCER, Dijon, France
| | - Baharia Mograbi
- Inserm U1081 Institute for Research on Cancer and Aging, Nice (IRCAN) Team 4, Université Côte d’Azur, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Nice, France
- Institut Hospitalo Universitaire (IHU) RespirERA, Nice, France
| | - Mohamad Rashidian
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Paul Hofman
- Inserm U1081 Institute for Research on Cancer and Aging, Nice (IRCAN) Team 4, Université Côte d’Azur, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Nice, France
- Laboratory of Clinical and Experimental Pathology, Institut Hospitalo Universitaire (IHU) RespirERA, Federation Hospitalo Universitaire (FHU) OncoAge, Pasteur Hospital, Université Côte d’Azur, Nice, France
- Institut Hospitalo Universitaire (IHU) RespirERA, Nice, France
- Hospital-Integrated Biobank (BB-0033–00025), Pasteur Hospital, Nice, France
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Scott JA, Lennerz J, Johnson ML, Gordan LN, Dumanois RH, Quagliata L, Ritterhouse LL, Cappuzzo F, Wang B, Xue M, Vasudevan A, Varughese P, Vaidya V, Gart M, Dorrow N, Gierman HJ, Choksi RJ. Compromised Outcomes in Stage IV Non-Small-Cell Lung Cancer With Actionable Mutations Initially Treated Without Tyrosine Kinase Inhibitors: A Retrospective Analysis of Real-World Data. JCO Oncol Pract 2024; 20:145-153. [PMID: 37556776 PMCID: PMC10827288 DOI: 10.1200/op.22.00611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Identification and targeting of actionable oncogenic drivers (AODs) in advanced non-small-cell lung cancer (NSCLC) has dramatically improved outcomes. However, genomic testing uptake is variable and hampered by factors including slow turnaround time, frequently resulting in initial non-tyrosine kinase inhibitor (TKI) treatment. We investigate how this behavior affects outcomes. METHODS This retrospective analysis of real-world, deidentified data from the Integra Connect Database included adults with stage IV NSCLC newly diagnosed from January 1, 2018, to December 31, 2020, with mutations of EGFR, ALK, ROS1, BRAF, MET, RET, ERBB2, or NTRK. Outcomes were reported as time to next treatment or death (TTNT) and overall survival (OS). RESULTS Five hundred ten patients harboring AODs were identified and grouped as follows: group A (n = 379) were treated after the AOD was reported and served as the comparator. One hundred thirty-one patients treated before their AOD report were divided into group B (n = 47) who were initially started on chemotherapy and/or checkpoint inhibitor but switched to appropriate TKI within 35 days and group C (n = 84) who were also started empirically on non-TKI and did not switch within 35 days. Survival (OS) was significantly superior in group A compared with group C; TTNT was significantly superior in group A compared with groups B and C. CONCLUSION For patients harboring AODs in advanced NSCLC, initial treatment before receipt of genomic test results yields significantly inferior outcomes and should be avoided. Molecular profiling panels with rapid turnaround times are essential to optimize patient outcomes and should be standard of care.
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Affiliation(s)
| | - Jochen Lennerz
- Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | | | - Lucio N. Gordan
- Research Institute, Florida Cancer Specialists, Fort Myers, FL
| | | | | | | | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | | | - Mei Xue
- Integra Connect, West Palm Beach, FL
| | | | | | - Varun Vaidya
- Department of Pharmacy Practice, The University of Toledo, Toledo, OH
| | - Mike Gart
- Integra Connect, West Palm Beach, FL
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Zhou C, Solomon B, Loong HH, Park K, Pérol M, Arriola E, Novello S, Han B, Zhou J, Ardizzoni A, Mak MP, Santini FC, Elamin YY, Drilon A, Wolf J, Payakachat N, Uh MK, Rajakumar D, Han H, Puri T, Soldatenkova V, Lin AB, Lin BK, Goto K. First-Line Selpercatinib or Chemotherapy and Pembrolizumab in RET Fusion-Positive NSCLC. N Engl J Med 2023; 389:1839-1850. [PMID: 37870973 PMCID: PMC10698285 DOI: 10.1056/nejmoa2309457] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Selpercatinib, a highly selective potent and brain-penetrant RET inhibitor, was shown to have efficacy in patients with advanced RET fusion-positive non-small-cell lung cancer (NSCLC) in a nonrandomized phase 1-2 study. METHODS In a randomized phase 3 trial, we evaluated the efficacy and safety of first-line selpercatinib as compared with control treatment that consisted of platinum-based chemotherapy with or without pembrolizumab at the investigator's discretion. The primary end point was progression-free survival assessed by blinded independent central review in both the intention-to-treat-pembrolizumab population (i.e., patients whose physicians had planned to treat them with pembrolizumab in the event that they were assigned to the control group) and the overall intention-to-treat population. Crossover from the control group to the selpercatinib group was allowed if disease progression as assessed by blinded independent central review occurred during receipt of control treatment. RESULTS In total, 212 patients underwent randomization in the intention-to-treat-pembrolizumab population. At the time of the preplanned interim efficacy analysis, median progression-free survival was 24.8 months (95% confidence interval [CI], 16.9 to not estimable) with selpercatinib and 11.2 months (95% CI, 8.8 to 16.8) with control treatment (hazard ratio for progression or death, 0.46; 95% CI, 0.31 to 0.70; P<0.001). The percentage of patients with an objective response was 84% (95% CI, 76 to 90) with selpercatinib and 65% (95% CI, 54 to 75) with control treatment. The cause-specific hazard ratio for the time to progression affecting the central nervous system was 0.28 (95% CI, 0.12 to 0.68). Efficacy results in the overall intention-to-treat population (261 patients) were similar to those in the intention-to-treat-pembrolizumab population. The adverse events that occurred with selpercatinib and control treatment were consistent with those previously reported. CONCLUSIONS Treatment with selpercatinib led to significantly longer progression-free survival than platinum-based chemotherapy with or without pembrolizumab among patients with advanced RET fusion-positive NSCLC. (Funded by Eli Lilly and others; ClinicalTrials.gov number, NCT04194944.).
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Affiliation(s)
- Caicun Zhou
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Benjamin Solomon
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Herbert H Loong
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Keunchil Park
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Maurice Pérol
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Edurne Arriola
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Silvia Novello
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Baohui Han
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Jianying Zhou
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Andrea Ardizzoni
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - M Perez Mak
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Fernando C Santini
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Yasir Y Elamin
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Alexander Drilon
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Jürgen Wolf
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Nalin Payakachat
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Minji K Uh
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Deborah Rajakumar
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Hongmei Han
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Tarun Puri
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Victoria Soldatenkova
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - A Bence Lin
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Boris K Lin
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
| | - Koichi Goto
- From Shanghai Pulmonary Hospital, Tongji University School of Medicine (C.Z.), and the Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University (B.H.), Shanghai, the Chinese University of Hong Kong, Hong Kong (H.H.L.), and the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (J.Z.) - all in China; Peter MacCallum Cancer Institute, Melbourne, VIC, Australia (B.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.P.); Centre Léon Bérard, Lyon, France (M.P.); Hospital del Mar, Barcelona (E.A.); the Department of Oncology, Azienda Ospedaliero-Universitaria San Luigi-Orbassano, University of Turin, Turin (S.N.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna (A.A.) - both in Italy; Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School and Instituto D'Or de Ensino e Pesquisa (M.P.M.), and the Oncology Center, Hospital Śırio Libanês (F.C.S.) - both in São Paulo; the University of Texas M.D. Anderson Cancer Center, Houston (Y.Y.E.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (A.D.); the Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany (J.W.); Loxo@Lilly (H.H.) and Eli Lilly (N.P., M.K.U., D.R., T.P., V.S., A.B.L., B.K.L.) - both in Indianapolis; and National Cancer Center Hospital East, Kashiwa, Japan (K.G.)
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Zeng H, Tang X, Tian X, Liu Y, Tian P. Poor response to sintilimab plus chemotherapy in a pulmonary epithelioid hemangioendothelioma patient: a case report. Immunotherapy 2023; 15:77-83. [PMID: 36695105 DOI: 10.2217/imt-2022-0073] [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: 01/26/2023] Open
Abstract
Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular tumor with no established treatment protocol. The authors report the case of a young woman diagnosed with PEH. DNA and RNA analysis by next-generation sequencing was performed on the tumor tissue. A novel germline PALB2 mutation and classical WWTR1-CAMTA1 fusion were identified. She experienced a poor response to sintilimab (a PD-1 inhibitor) plus platinum-based chemotherapy as the first-line treatment. PEH patients harboring a germline PALB2 mutation and WWTR1-CAMTA1 gene fusion may respond poorly to treatment with PD-1 inhibitors plus chemotherapy.
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Affiliation(s)
- Hao Zeng
- Department of Respiratory & Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaojun Tang
- Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xia Tian
- Department of Respiratory & Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yujie Liu
- Department of Respiratory & Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Panwen Tian
- Department of Respiratory & Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
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6
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Zhao L, Mei Q, Yu Y, Wang N, Zhang D, Liao D, Zuo J, Xie H, Jia Y, Kong F. Research Progress on RET Fusion in Non-Small-Cell Lung Cancer. Front Oncol 2022; 12:894214. [PMID: 35707347 PMCID: PMC9190697 DOI: 10.3389/fonc.2022.894214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Abstract
Great progress has been made in the treatment of driver gene-positive Non- Small Cell Lung Cancer (NSCLC) in recent years. RET fusion was seen in 0.7% to 2% of NSCLC and was associated with younger age and never-smoker status. The pralsetinib and selpercatinib for RET fusion NSCLC was recommended by the 2021 NSCLC treatment guidelines. This review outlines the research progress in the treatment of RET fusion NSCLC, identifies current challenges and describes proposals for improving the outlook for these patients.
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Affiliation(s)
- Lu Zhao
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qingyun Mei
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yongchao Yu
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Na Wang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Dou Zhang
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Dongying Liao
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jinhui Zuo
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hongxia Xie
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yingjie Jia
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Fanming Kong
- Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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7
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Tian T, Yu M, Yu Y, Wang K, Tian P, Luo Z, Ding Z, Wang Y, Gong Y, Zhu J, Zou B, Sio TT, Alves A, Liu Y, Huang M, Lu Y. Immune checkpoint inhibitor (ICI)-based treatment beyond progression with prior immunotherapy in patients with stage IV non-small cell lung cancer: a retrospective study. Transl Lung Cancer Res 2022; 11:1027-1037. [PMID: 35832458 PMCID: PMC9271428 DOI: 10.21037/tlcr-22-376] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/16/2022] [Indexed: 02/05/2023]
Abstract
Background Although immune checkpoint inhibitors (ICIs) provide unprecedented survival improvement for patients with advanced non-small cell lung cancer (NSCLC), disease progression inevitably occurs. After ICIs failure, limited data exist on whether ICI-based treatment beyond progression (TBP) may be beneficial to advanced NSCLC. This retrospective study aimed to evaluate the efficacy of this treatment approach in advanced NSCLC and identify potential beneficial factors. Methods Patients with stage IV NSCLC who received ICI-based treatment after the failure of prior PD-1/PD-L1 inhibitor treatments (monotherapy or combination therapy) between January 2016 and July 2020 were enrolled. Their clinical characteristics and treatment procedures were collected, and the follow-up would be performed. Results A total of 204 patients were included. All patients had disease progression after prior immunotherapy, with 49.5% (101/204) of patients presenting with new metastasis lesions and the rest 50.5% (103/204) of patients' progression on originate lesions. Within the entire cohort, the median progression-free survival (PFS) and median overall survival (OS) of ICI-based TBP with prior immunotherapy were 5.0 months (95% CI: 4.5-5.5 months) and 15.7 months (95% CI: 14.7-16.8 months), respectively. The objective response rate (ORR) and disease control rate (DCR) were 9.3% and 74.0%, respectively. According to the multivariate analysis, ICI-based combination therapy [PFS: hazard ratio (HR), 0.48, 95% confidence interval (CI): 0.28-0.84, P=0.011] (OS: HR, 0.44, 95% CI: 0.23-0.85, P=0.014), not having targetable gene alterations (PFS: HR, 0.56, 95% CI: 0.40-0.79, P=0.001) (OS: HR, 0.57, 95% CI: 0.37-0.87, P=0.009), and good response to prior immunotherapy (PFS: HR, 0.36, 95% CI: 0.24-0.53, P<0.0001) (OS: HR, 0.31, 95% CI: 0.19-0.52, P<0.0001) were independently associated with improved PFS and OS. Moreover, disease progression due to appearances of new metastasis (OS: HR, 0.56, 95% CI: 0.37-0.84, P=0.005) was only associated with better OS. Conclusions While the ORR in patients with advanced NSCLC receiving ICI-based TBP with prior immunotherapy was limited, the DCR was relatively high in our study which is encouraging. ICI-based treatment strategy may be a reasonable option for patients who progressed from prior immunotherapy. Further prospective studies on larger sample size are warranted.
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Affiliation(s)
- Tian Tian
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Min Yu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Yu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Panwen Tian
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ziyue Luo
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhenyu Ding
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Youling Gong
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Zhu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bingwen Zou
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Adelaide Alves
- Pulmonology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Yongmei Liu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Meijuan Huang
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - You Lu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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8
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Rowbotham SP, Goruganthu MUL, Arasada RR, Wang WZ, Carbone DP, Kim CF. Lung Cancer Stem Cells and Their Clinical Implications. Cold Spring Harb Perspect Med 2022; 12:a041270. [PMID: 34580078 PMCID: PMC9121890 DOI: 10.1101/cshperspect.a041270] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
It is now widely accepted that stem cells exist in various cancers, including lung cancer, which are referred to as cancer stem cells (CSCs). CSCs are defined in this context as the subset of tumor cells with the ability to form tumors in serial transplantation and cloning assays and form tumors at metastatic sites. Mouse models of lung cancer have shown that lung CSCs reside in niches that are essential for the maintenance of stemness, plasticity, enable antitumor immune evasion, and provide metastatic potential. Similar to normal lung stem cells, Notch, Wnt, and the Hedgehog signaling cascades have been recruited by the CSCs to regulate stemness and also provide therapy-driven resistance in lung cancer. Compounds targeting β-catenin and Sonic hedgehog (Shh) activity have shown promising anti-CSC activity in preclinical murine models of lung cancer. Understanding CSCs and their niches in lung cancer can answer fundamental questions pertaining to tumor maintenance and associated immune regulation and escape that appear important in the quest to develop novel lung cancer therapies and enhance sensitivity to currently approved chemo-, targeted-, and immune therapeutics.
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Affiliation(s)
- Samuel P Rowbotham
- Stem Cell Program, Boston Children's Hospital, Boston, Massachusetts 02115, USA
- Department of Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Mounika U L Goruganthu
- Molecular, Cellular, and Developmental Biology Program, The Ohio State University, Columbus, Ohio 43210, USA
| | - Rajeswara R Arasada
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Medical Center, Columbus, Ohio 43210, USA
| | - Walter Z Wang
- James Thoracic Oncology Center, The Ohio State University, Columbus, Ohio 43210, USA
| | - David P Carbone
- James Thoracic Oncology Center, The Ohio State University, Columbus, Ohio 43210, USA
| | - Carla F Kim
- Stem Cell Program, Boston Children's Hospital, Boston, Massachusetts 02115, USA
- Department of Genetics, Harvard Medical School, Boston, Massachusetts 02115, USA
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9
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Starzer AM, Preusser M, Berghoff AS. Immune escape mechanisms and therapeutic approaches in cancer: the cancer-immunity cycle. Ther Adv Med Oncol 2022; 14:17588359221096219. [PMID: 35510032 PMCID: PMC9058458 DOI: 10.1177/17588359221096219] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/04/2022] [Indexed: 12/31/2022] Open
Abstract
The introduction of immune checkpoint inhibitors has changed the therapeutic possibilities for various cancer types. However, despite the success in some entities, a significant fraction of patients does not respond to immune checkpoint inhibitors. A functioning cancer-immunity cycle is needed as the precondition for a clinically meaningful response to immune checkpoint inhibitors. It is assumed that only if each step of the cycle is activated and functioning properly, immune checkpoint inhibitors induce a meaningful immune response. However, an activated cancer-immunity cycle might not be present equally in each patient and cancer type. Ideally, treatment concepts should consider each single step of the cancer-immunity cycle and provide personalized treatment approaches, allowing the adaption to functioning and malfunctioning steps of the individual patient’s specific cancer-immunity cycle. In the following review, we provide an overview of the single steps of the cancer-immunity cycle as well as the impact of malfunctioning steps on the generation of an effective tumor-specific immune response.
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Affiliation(s)
- Angelika M. Starzer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anna S. Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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10
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Murciano-Goroff YR, Pak T, Mondaca S, Flynn JR, Montecalvo J, Rekhtman N, Halpenny D, Plodkowski AJ, Wu SL, Kris MG, Paik PK, Riely GJ, Yu HA, Rudin CM, Hellmann MD, Land JD, Buie LW, Heller G, Lito P, Yaeger R, Drilon A, Liu D, Li BT, Offin M. Immune biomarkers and response to checkpoint inhibition of BRAF V600 and BRAF non-V600 altered lung cancers. Br J Cancer 2022; 126:889-898. [PMID: 34963703 PMCID: PMC8927094 DOI: 10.1038/s41416-021-01679-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While 2-4% of lung cancers possess alterations in BRAF, little is known about the immune responsiveness of these tumours. METHODS Clinical and genomic data were collected from 5945 patients with lung cancers whose tumours underwent next-generation sequencing between 2015 and 2018. Patients were followed through 2020. RESULTS In total, 127 patients with metastatic BRAF-altered lung cancers were identified: 29 tumours had Class I mutations, 59 had Class II/III alterations, and 39 had variants of unknown significance (VUS). Tumour mutation burden was higher in Class II/III than Class I-altered tumours (8.8 mutations/Mb versus 4.9, P < 0.001), but this difference was diminished when stratified by smoking status. The overall response rate to immune checkpoint inhibitors (ICI) was 9% in Class I-altered tumours and 26% in Class II/III (P = 0.25), with median time on treatment of 1.9 months in both groups. Among patients with Class I-III-altered tumours, 36-month HR for death in those who ever versus never received ICI was 1.82 (1.17-6.11). Nine patients were on ICI for >2 years (two with Class I mutations, two with Class II/III alterations, and five with VUS). CONCLUSIONS A subset of patients with BRAF-altered lung cancers achieved durable disease control on ICI. However, collectively no significant clinical benefit was seen.
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Affiliation(s)
| | - Terry Pak
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sebastian Mondaca
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica R Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph Montecalvo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Darragh Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephanie L Wu
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark G Kris
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul K Paik
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gregory J Riely
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Helena A Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles M Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew D Hellmann
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josiah D Land
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larry W Buie
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Glenn Heller
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Piro Lito
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dazhi Liu
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bob T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Offin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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11
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Lambert SL, Zhang C, Guo C, Turan T, Masica DL, Englert S, Fang Y, Sheridan J, McLaughlin RT, Tribouley C, Vosganian G, Afar D. Association of Baseline and Pharmacodynamic Biomarkers With Outcomes in Patients Treated With the PD-1 Inhibitor Budigalimab. J Immunother 2022; 45:167-179. [PMID: 35034046 PMCID: PMC8906246 DOI: 10.1097/cji.0000000000000408] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022]
Abstract
Budigalimab, a novel anti-PD-1 monoclonal antibody, demonstrated efficacy and biomarker pharmacodynamics in patients with head and neck squamous cell carcinoma (HNSCC) or non-small cell lung cancer (NSCLC) consistent with those reported by other PD-1 inhibitors. Herein are presented additional outcomes of biomarker analyses from the phase 1 study of budigalimab monotherapy in patients with HNSCC and NSCLC (NCT03000257). PD-1 inhibitor naive patients with advanced HNSCC (n=41) or NSCLC (n=40) received budigalimab intravenously at 250 mg every 2 weeks (Q2W) or 500 mg Q4W until progression. Archival tumor specimens were evaluated by immunohistochemistry for CD8 and tumor PD-1 ligand 1 (PD-L1) expression, RNA, and whole-exome sequencing. Serum and whole blood samples were acquired at baseline and at select on-treatment time points. As of October 2019, best overall response of 15% in HNSCC and 18% in NSCLC was observed in all treated patients; both cohorts reported responses in PD-L1+ and PD-L1- tumors. Treatment with budigalimab was associated with increases in multiple soluble biomarkers including interferon gamma-induced chemokines. Expanded overall T-cell counts, total CD8 T-cell counts, and percentages of CD8+CD45RA-CD62L- effector memory T cells were observed at cycle 1, day 15 in responders. Univariate analysis demonstrated an association between prolonged progression-free survival and higher tumor mutational burden/neoantigen load, smaller tumor size, lower platelet-lymphocyte ratios, lower CCL23, lower colony-stimulating factor 1, and lower interleukin-6 levels at baseline. The biomarker analysis presented herein identified additional early pharmacodynamic biomarkers associated with anti-PD-1 activity and improved clinical responses to budigalimab in patients with advanced HNSCC and NSCLC.
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Affiliation(s)
| | | | | | | | | | - Stefan Englert
- Data and Statistical Sciences, AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | - Yuni Fang
- Drug Metabolism, Pharmacokinetics, AbbVie Inc, Redwood City, CA
| | - James Sheridan
- Drug Metabolism, Pharmacokinetics, AbbVie Inc, Redwood City, CA
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12
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Berghmans T, Cadranel J, Grigoriu B. Editorial: New Advances in Non-small Cell Lung Cancer Management: Immune Modulation and Targeted Therapies. Front Med (Lausanne) 2021; 8:761078. [PMID: 34901075 PMCID: PMC8655242 DOI: 10.3389/fmed.2021.761078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/22/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Thierry Berghmans
- Clinic of Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Cadranel
- Assistance Publique Hôpitaux de Paris, Hôpital Tenon and Groupes de recherche clinique Theranoscan and Curamus Sorbonne Université, Paris, France
| | - Bogdan Grigoriu
- Service des Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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13
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Lee SW, Choi HY, Lee GW, Kim T, Cho HJ, Oh IJ, Song SY, Yang DH, Cho JH. CD8 + TILs in NSCLC differentiate into TEMRA via a bifurcated trajectory: deciphering immunogenicity of tumor antigens. J Immunother Cancer 2021; 9:jitc-2021-002709. [PMID: 34593620 PMCID: PMC8487216 DOI: 10.1136/jitc-2021-002709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 01/21/2023] Open
Abstract
Background CD8+ tumor-infiltrating lymphocytes (TILs) comprise phenotypically and functionally heterogeneous subpopulations. Of these, effector memory CD45RA re-expressing CD8+ T cells (Temra) have been discovered and characterized as the most terminally differentiated subset. However, their exact ontogeny and physiological importance in association with tumor progression remain poorly understood. Methods We analyzed primary tumors and peripheral blood samples from 26 patients with non-small cell lung cancer and analyzed their phenotypes and functional characteristics using flow cytometry, RNA-sequencing, and bioinformatics. Results We found that tumor-infiltrating Temra (tilTemra) cells largely differ from peripheral blood Temra (pTemra), with distinct transcriptomes and functional properties. Notably, although majority of the pTemra was CD27−CD28− double-negative (DN), a large fraction of tilTemra population was CD27+CD28+ double-positive (DP), a characteristic of early-stage, less differentiated effector cells. Trajectory analysis revealed that CD8+ TILs undergo a divergent sequence of events for differentiation into either DP or DN tilTemra. Such a differentiation toward DP tilTemra relied on persistent expression of CD27 and CD28 and was associated with weak T cell receptor engagement. Thus, a higher proportion of DP Temra was correlated with lower immunogenicity of tumor antigens and consequently lower accumulation of CD8+ TILs. Conclusions These data suggest a complex interplay between CD8+ T cells and tumors and define DP Temra as a unique subset of tumor-specific CD8+ TILs that are produced in patients with relatively low immunogenic cancer types, predicting immunogenicity of tumor antigens and CD8+ TIL counts, a reliable biomarker for successful cancer immunotherapy.
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Affiliation(s)
- Sung-Woo Lee
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongsangbukdo, Republic of Korea
| | - He Yun Choi
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun Hospital, Hwasunup, Jeollanamdo, Republic of Korea
| | - Gil-Woo Lee
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongsangbukdo, Republic of Korea
| | - Therasa Kim
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun Hospital, Hwasunup, Jeollanamdo, Republic of Korea
| | - Hyun-Ju Cho
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun Hospital, Hwasunup, Jeollanamdo, Republic of Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun Hospital, Hwasunup, Jeollanamdo, Republic of Korea
| | - Sang Yun Song
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School, Hwasun Hospital, Hwasunup, Jeollanamdo, Republic of Korea
| | - Deok Hwan Yang
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun Hospital, Hwasunup, Jeollanamdo, Republic of Korea
| | - Jae-Ho Cho
- Department of Microbiology and Immunology, Chonnam National University Medical School, Hwasunup, Jeollanamdo, Republic of Korea .,Medical Research Center for Combinatorial Tumor Immunotherapy, Chonnam National University Medical School, Hwasunup, Jeollanamdo, Republic of Korea.,Immunotherapy Innovation Center, Chonnam National University Medical School, Hwasunup, Jeollanamdo, Republic of Korea.,BioMedical Sciences Graduate Program, Chonnam National University Medical School, Hwasunup, Jeollanamdo, Republic of Korea
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14
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Sun S, Du W, Sun Q, Zhao X, Qin B, Shi D, Wan C, Wu Z. Driver gene alterations profiling of Chinese non-small cell lung cancer and the effects of co-occurring alterations on immunotherapy. Cancer Med 2021; 10:7360-7372. [PMID: 34599863 PMCID: PMC8525092 DOI: 10.1002/cam4.4178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Molecular testing for alterations in oncogenic driver genes and targeted therapies have become standard procedures for non-small cell lung cancer (NSCLC) patients. However, little evidence has shed light on the pattern of co-existence of driver genes in NSCLC, and whether they may have different tumor features affecting immunotherapy is still unclarified. METHODS Genomic alterations in 14 lung cancer-related genes were conducted in 3440 Chinese NSCLC patients using next-generation sequencing. Meanwhile, tumor mutational burden and immunotherapy dataset from the Memorial sloan kettering cancer center (MSKCC) and lung adenocarcinoma dataset from The Cancer Genome Atlas (TCGA) were utilized for analyzing the impact of the co-occurring alterations on patients' survival following immunotherapy. RESULTS In this cohort, 90.17% of patients had at least one somatic alteration in the 14 genes, including 51% of co-occurring alterations. TP53 and epidermal growth factor receptor (EGFR) were the most prevalent genes (54.74% and 53.55%, respectively), followed by KRAS, ERBB2, ALK, PIK3CA, ROS1, RET, MET, BRAF, KIT, FGFR1, PDGFRA, and NRAS. The prevalence of TP53, EGFR, and ERBB2 in our cohort were significantly higher than that from the TCGA database, whereas KRAS, BRAF, and PDGFRA were significantly lower than the latter. Furthermore, the patients who harbored multiple alterations (8.86%, 31/350) in eight driver genes survived longer and have a higher tumor mutation burden compared to the patients with a single alteration. Similar result was found between the patients with co-occurring alteration of EGFR and other driver genes and the patients with single EGFR alteration. Meanwhile, we found a distinct immune cell infiltration feature between patients with single and multiple driver gene alterations, as well as between patients with only EGFR alteration and co-occurring groups. CONCLUSION This study identified a unique driver gene feature and found patients harboring co-occurring alterations of EGFR and other driver genes may benefit from immunotherapy, which may provide more therapeutic selections for EGFR-mutated NSCLC patients and merit additional investigation.
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Affiliation(s)
- Shengjie Sun
- Medical Oncology DepartmentThe Fifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Wenjuan Du
- Training Department of Medical Service DepartmentGeneral Hospital of People’s Liberation ArmyBeijingChina
| | - Qiong Sun
- Medical Oncology DepartmentThe Fifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xiao Zhao
- Medical Oncology DepartmentThe Fifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Boyu Qin
- Medical Oncology DepartmentThe Fifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Duozhi Shi
- Department of MedicineLifehealthcare Clinical LaboratoriesHangzhouChina
| | - Chong Wan
- Department of MedicineLifehealthcare Clinical LaboratoriesHangzhouChina
| | - Zhiyong Wu
- Medical Oncology DepartmentThe Fifth Medical Center of Chinese PLA General HospitalBeijingChina
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15
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Drilon A, Duruisseaux M, Han JY, Ito M, Falcon C, Yang SR, Murciano-Goroff YR, Chen H, Okada M, Molina MA, Wislez M, Brun P, Dupont C, Branden E, Rossi G, Schrock A, Ali S, Gounant V, Magne F, Blum TG, Schram AM, Monnet I, Shih JY, Sabari J, Pérol M, Zhu VW, Nagasaka M, Doebele R, Camidge DR, Arcila M, Ou SHI, Moro-Sibilot D, Rosell R, Muscarella LA, Liu SV, Cadranel J. Clinicopathologic Features and Response to Therapy of NRG1 Fusion-Driven Lung Cancers: The eNRGy1 Global Multicenter Registry. J Clin Oncol 2021; 39:2791-2802. [PMID: 34077268 PMCID: PMC8407651 DOI: 10.1200/jco.20.03307] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 04/16/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Although NRG1 fusions are oncogenic drivers across multiple tumor types including lung cancers, these are difficult to study because of their rarity. The global eNRGy1 registry was thus established to characterize NRG1 fusion-positive lung cancers in the largest and most diverse series to date. METHODS From June 2018 to February 2020, a consortium of 22 centers from nine countries in Europe, Asia, and the United States contributed data from patients with pathologically confirmed NRG1 fusion-positive lung cancers. Profiling included DNA-based and/or RNA-based next-generation sequencing and fluorescence in situ hybridization. Anonymized clinical, pathologic, molecular, and response (RECIST v1.1) data were centrally curated and analyzed. RESULTS Although the typified never smoking (57%), mucinous adenocarcinoma (57%), and nonmetastatic (71%) phenotype predominated in 110 patients with NRG1 fusion-positive lung cancer, further diversity, including in smoking history (43%) and histology (43% nonmucinous and 6% nonadenocarcinoma), was elucidated. RNA-based testing identified most fusions (74%). Molecularly, six (of 18) novel 5' partners, 20 unique epidermal growth factor domain-inclusive chimeric events, and heterogeneous 5'/3' breakpoints were found. Platinum-doublet and taxane-based (post-platinum-doublet) chemotherapy achieved low objective response rates (ORRs 13% and 14%, respectively) and modest progression-free survival medians (PFS 5.8 and 4.0 months, respectively). Consistent with a low programmed death ligand-1 expressing (28%) and low tumor mutational burden (median: 0.9 mutations/megabase) immunophenotype, the activity of chemoimmunotherapy and single-agent immunotherapy was poor (ORR 0%/PFS 3.3 months and ORR 20%/PFS 3.6 months, respectively). Afatinib achieved an ORR of 25%, not contingent on fusion type, and a 2.8-month median PFS. CONCLUSION NRG1 fusion-positive lung cancers were molecularly, pathologically, and clinically more heterogeneous than previously recognized. The activity of cytotoxic, immune, and targeted therapies was disappointing. Further research examining NRG1-rearranged tumor biology is needed to develop new therapeutic strategies.
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Affiliation(s)
- Alexander Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Michael Duruisseaux
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France
- Anticancer Antibodies Laboratory, Cancer Research Center of Lyon, Lyon, France
- Université Claude Bernard Lyon UMR INSERM 1052 CNRS 5286, Université de Lyon, Lyon, France
| | - Ji-Youn Han
- National Cancer Center, Korea, Goyang-si, South Korea
| | - Masaoki Ito
- Pangaea Oncology, Quiron-Dexeus University Institute, Barcelona, Spain
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Christina Falcon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Soo-Ryum Yang
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Haiquan Chen
- Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Institute of Thoracic Oncology, Fudan University, Shanghai, China
| | - Morihito Okada
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Miguel Angel Molina
- Pangaea Oncology, Laboratory of Molecular Biology, Quiron-Dexeus University Institute, Barcelona, Spain
| | - Marie Wislez
- Université de Paris, Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Paris, France
- Team Inflammation, Complement, and Cancer, and Oncology Thoracic Unit Pulmonology Department, AP-HP, Hôpital Cochin, Paris, France
| | - Philippe Brun
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Valence, France
| | - Clarisse Dupont
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France
| | - Eva Branden
- Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Giulio Rossi
- Local Health Authority of Romagna, Infermi Hospital, Rimini, Italy
- Local Health Authority of Romagna, St Maria delle Croci Hospital, Ravenna, Italy
| | | | - Siraj Ali
- Foundation Medicine Inc, Cambridge, MA
| | - Valérie Gounant
- Department of Pulmonology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Fanny Magne
- Hopital Nord Ouest Villefranche sur Saône, Gleizé, France
| | | | | | - Isabelle Monnet
- Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Jin-Yuan Shih
- National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Joshua Sabari
- New York University Langone Health Perlmutter Cancer Center, New York, NY
| | | | - Viola W. Zhu
- Chao Family Comprehensive Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of California, Irvine School of Medicine, Orange, CA
| | - Misako Nagasaka
- Karmanos Cancer Institute, Wayne State University, Detroit, MI
- Division of Neurology, Department of Internal Medicine, St Marianna University, Kawasaki, Japan
| | - Robert Doebele
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO
| | - D. Ross Camidge
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO
| | - Maria Arcila
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Sai-Hong Ignatius Ou
- Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, CA
| | - Denis Moro-Sibilot
- Clinique de Pneumologie, Pôle Médecine Aiguë Communautaire, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Rafael Rosell
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Lucia Anna Muscarella
- Laboratory of Oncology, Fondazione IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | - Stephen V. Liu
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Jacques Cadranel
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hopitaux de Paris, Tenon Hospital and GRC Theranoscan Sorbonne Université, Paris, France
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Simundza I, Krnic D, Juricic J, Benzon B, Simundza R, Stanicic IM, Capkun V, Vukojevic K, Glavina Durdov M. Expression of PD-L1 Is Associated with Inflammatory Microenvironment in Surgical Specimens of Non-Small Cell Lung Cancer. J Pers Med 2021; 11:jpm11080767. [PMID: 34442411 PMCID: PMC8398962 DOI: 10.3390/jpm11080767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to analyse the expression of PD-L1 in non-small cell lung cancer (NSCLC) and its correlation with immune microenvironment response (IMR), clinic-pathological parameters, and outcome. The sample included 76 male and 32 female patients who underwent surgical resection. The mean age of the males was 66 years, and that of the females was 64 years. Adenocarcinoma (ADC) was diagnosed in 68 (63%) cases, squamous cell carcinoma in 35 (32%) cases, and NSCLC (not otherwise specified) in 5 (5%) cases. Metastatic lymph nodes were found in 38 (36%) patients, 18 with N1 nodes and 20 with N2 nodes. PD-L1 expression was valuated as the percentage of positive cancer cells among all cancer cells. Gender, age, and histologic type were not associated with PD-L1 expression (all p > 0.05). The subtypes of ADC were associated with PD-L1 expression (p = 0.050). The papillary subtype was 4.3 times more common among PD-L1 negative than PD-L1 positive ADC; the solid subtype was 1.9 times more common among PD-L1 positive than PD-L1 negative ADC. IMR was predominantly strong in 19 cases, weak in 36, and absent in 53 cases. The median value of PD-L1 expression in cancer cells was positively correlated with IMR (p = 0.039). PD-L1 expression was not correlated with overall survival (p = 0.643). The patients with strong, inflammatory-like IMR had an average survival time that was 12 months longer than patients with absent/low IMR (LR = 2.8; p = 0.132). In conclusion, the papillary subtype was more commonly PD-L1 negative in comparison with other subtypes of ADC. Positive PD-L1 expression in tumour cells was connected with strong, inflammatory-like IMR. Patients with strong IMR tended to experience better outcomes. Further investigations are needed on larger-scale cohorts to elucidate the insights of this descriptive study.
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Affiliation(s)
- Ivan Simundza
- Department of Surgery, University Hospital of Split, 21000 Split, Croatia; (I.S.); (D.K.); (J.J.)
| | - Dragan Krnic
- Department of Surgery, University Hospital of Split, 21000 Split, Croatia; (I.S.); (D.K.); (J.J.)
| | - Josko Juricic
- Department of Surgery, University Hospital of Split, 21000 Split, Croatia; (I.S.); (D.K.); (J.J.)
| | - Benjamin Benzon
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, 21000 Split, Croatia; (B.B.); (V.C.)
| | - Rina Simundza
- Department of Gynaecology, University Hospital of Split, 21000 Split, Croatia;
| | - Ivan Mario Stanicic
- Department of Pathology, University Hospital of Split, 21000 Split, Croatia;
| | - Vesna Capkun
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, 21000 Split, Croatia; (B.B.); (V.C.)
| | - Katarina Vukojevic
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, 21000 Split, Croatia; (B.B.); (V.C.)
- Correspondence: (K.V.); (M.G.D.)
| | - Merica Glavina Durdov
- Department of Pathology, University Hospital of Split, 21000 Split, Croatia;
- Correspondence: (K.V.); (M.G.D.)
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Inhibitors Targeting CDK9 Show High Efficacy against Osimertinib and AMG510 Resistant Lung Adenocarcinoma Cells. Cancers (Basel) 2021; 13:cancers13153906. [PMID: 34359807 PMCID: PMC8345430 DOI: 10.3390/cancers13153906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Non-small cell lung cancer accounts for 80% of all lung cancer cases. While a subset of non-small cell lung cancer patients respond to immunotherapy, those who are treated with chemotherapy or targeted therapy develop resistance to the drugs. Thus, novel therapeutic strategies are needed to combat this disease. Here we show that inhibitors of the cyclin-dependent kinase 9 are highly effective in preventing the growth of a variety of lung cancer cell lines and lung cancer organoids with high potency. These inhibitors suppressed the expression of several genes like Sox2, Sox9, and Mcl1 that promote tumor growth, facilitating growth arrest. Since inhibitors of cyclin-dependent kinase 9 are undergoing clinical trials for hematological malignancies, our studies suggest that these inhibitors would be attractive candidates to combat non-small cell lung cancer. Abstract Non-small cell lung cancer has a 5-year survival rate of less than 12–15%, calling for the development of additional therapeutic strategies to combat this disease. Here we tested the efficacy of inhibiting cyclin-dependent kinase 9 (CDK9) on lung cancer cell lines with K-Ras and EGFR mutations and on lung cancer organoids. Three different CDK9 inhibitors reduced the viability and anchorage-independent growth of lung cancer cell lines at very low nanomolar to micromolar concentrations. CDK9 inhibition suppressed the expression of the anti-apoptotic protein, Mcl1, as well as the embryonic stem cell transcription factors, Sox2 and Sox9, which are pro-tumorigenic. In contrast, treatment with CDK9 inhibitors increased the levels of WT p53 and its downstream target p21 in K-Ras mutant cell lines. Furthermore, the CDK9 inhibitors could markedly reduce the viability of Osimertinib-resistant PC9 and AMG510-resistant H23 and H358 cells with comparable efficacy as the parental cells. CDK9 inhibitors could also significantly reduce the growth and viability of lung cancer organoids with high potency. Taken together, the data presented here strongly suggest that CDK9 inhibitors would be efficacious against K-Ras mutant and EGFR mutant NSCLCs, including those that develop resistance to targeted therapies.
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18
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First-in-human phase 1 study of budigalimab, an anti-PD-1 inhibitor, in patients with non-small cell lung cancer and head and neck squamous cell carcinoma. Cancer Immunol Immunother 2021; 71:417-431. [PMID: 34216247 PMCID: PMC8783908 DOI: 10.1007/s00262-021-02973-w] [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: 11/02/2020] [Accepted: 05/18/2021] [Indexed: 12/17/2022]
Abstract
Background Budigalimab is a humanized, recombinant immunoglobulin G1 monoclonal antibody targeting programmed cell death protein 1 (PD-1). We present the safety, efficacy, pharmacokinetic (PK), and pharmacodynamic data from patients enrolled in the head and neck squamous cell carcinoma (HNSCC) and non-small cell lung cancer (NSCLC) expansion cohorts of the phase 1 first-in-human study of budigalimab monotherapy (NCT03000257; registered 15 December 2016). Patients and methods Patients with recurrent/metastatic HNSCC or locally advanced/metastatic NSCLC naive to PD-1/PD-1-ligand inhibitors were enrolled; patients were not selected on the basis of oncogene driver mutations or PD-L1 status. Budigalimab was administered at 250 mg intravenously Q2W or 500 mg intravenously Q4W until disease progression/unacceptable toxicity. The primary endpoints were safety and PK; the secondary endpoint was efficacy. Exploratory endpoints included biomarker assessments. Results In total, 81 patients were enrolled (HNSCC: N = 41 [PD-L1 positive: n = 19]; NSCLC: N = 40 [PD-L1 positive: n = 16]); median treatment duration was 72 days (range, 1–617) and 71 days (range, 1–490) for the HNSCC and NSCLC cohorts, respectively. The most frequent grade ≥ 3 treatment-emergent adverse event was anemia (HNSCC: n = 9, 22%; NSCLC: n = 5, 13%). Both dosing regimens had comparable drug exposure and increased interferon gamma-induced chemokines, monokine induced by gamma interferon, and interferon-gamma-inducible protein 10. Objective response rates were 13% (90% CI, 5.1–24.5) in the HNSCC cohort and 19% (90% CI, 9.2–32.6) in the NSCLC cohort. Median progression-free survival was 3.6 months (95% CI, 1.7–4.7) and 1.9 months (95% CI, 1.7–3.7) in the HNSCC and NSCLC cohorts. Conclusions The safety, efficacy and biomarker profiles of budigalimab are similar to other PD-1 inhibitors. Development of budigalimab in combination with novel anticancer agents is ongoing. Supplementary Information The online version contains supplementary material available at 10.1007/s00262-021-02973-w.
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19
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Bhandari NR, Hess LM, Han Y, Zhu YE, Sireci AN. Efficacy of immune checkpoint inhibitor therapy in patients with RET fusion-positive non-small-cell lung cancer. Immunotherapy 2021; 13:893-904. [PMID: 34139897 DOI: 10.2217/imt-2021-0035] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To describe outcomes of patients with rearraned during transfection (RET) fusion-positive non-small-cell lung cancer (NSCLC) who received immune checkpoint inhibitor (ICI)-based treatments in the US. Patients & methods: Using de-identified Flatiron Health-Foundation Medicine NSCLC Clinico-Genomic and Guardant Health databases, treatment patterns and outcomes of 69 patients with advanced/metastatic RET fusion-positive NSCLC who received ICI-based treatment were described. Results: Median real-world progression-free survival and overall survival months were 4.2 (95% CI: 1.4-8.4) and 19.1 (6.9-not reached), respectively, among patients in Clinico-Genomic database (n = 17) receiving first-line ICI-based therapy. In the Guardant Health database, progression-free survival was unavailable, and the median overall survival was not reached (n = 29). Conclusion: Outcomes associated with ICI-based treatments in the first-line setting among patients with RET fusion-positive NSCLC are consistent with unselected populations reported in literature.
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Affiliation(s)
| | - Lisa M Hess
- Eli Lilly & Company, Indianapolis, IN 46225, USA
| | - Yimei Han
- Eli Lilly & Company, Indianapolis, IN 46225, USA
| | - Yajun E Zhu
- Eli Lilly & Company, Indianapolis, IN 46225, USA
| | - Anthony N Sireci
- Loxo Oncology, a wholly owned subsidiary of Eli Lilly & Company, Stamford, CT 06901, USA
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20
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Bozinovski S, Vannitamby A, Rangamuwa K, Aujla S, Wang H, Aloe C, Irving L, Leong TT, Steinfort DP. Integrating endobronchial ultrasound bronchoscopy with molecular testing of immunotherapy biomarkers in non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:2779-2787. [PMID: 34295677 PMCID: PMC8264344 DOI: 10.21037/tlcr-20-781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
Immunotherapy has transformed treatment of advanced non-small-cell lung cancer (NSCLC) patients leading to remarkable long-term survival benefit. However, only about 20% of advanced NSCLC patients typically respond to immune checkpoint inhibitors (ICIs) that target the PD-1/PD-L1 pathway. The only validated biomarker for ICI therapy is the PD-L1 immunohistochemistry (IHC) test, which is considered an imperfect assay due to several variables including availability and integrity of tumour tissue, variability in staining/scoring techniques and heterogeneity in PD-L1 protein expression within and across tumour biopsies. Herein, we discuss integrating minimally invasive EBUS bronchoscopy procedures with novel molecular approaches to improve accuracy and sensitivity of PD-L1 testing. EBUS guided bronchoscopy facilitates repeated sampling of tumour tissue to increase the probability of detecting PD-L1 positive tumours. Since intra-tumoural PD-L1 (CD274) copy number is reported to be less heterogeneous than PD-L1 protein detection, quantifying PD-L1 transcript levels may increase detection of PD-L1 positive tumours. PD-L1 transcript levels show excellent concordance with PD-L1 IHC scoring and multiplex digital droplet PCR (ddPCR) assays that quantify absolute PD-L1 transcript copy number have been developed. ddPCR can also be automated for high throughput detection of low abundant variants with excellent sensitivity and accuracy to improve the broader application of diagnostic cut-off values. Optimizing diagnostic workflows that integrate optimal EBUS bronchoscopy procedures with emerging molecular ICI biomarker assays may improve the selection criteria for ICI therapy benefit.
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Affiliation(s)
- Steven Bozinovski
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Amanda Vannitamby
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Kanishka Rangamuwa
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Savreet Aujla
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Hao Wang
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Christian Aloe
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Tracy T Leong
- Department of Respiratory Medicine, Austin Health, Heidelberg, Victoria, Australia.,The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
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21
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Tan AC, Chan J, Khasraw M. The role of immunotherapy in fusion-driven lung cancer. Expert Rev Anticancer Ther 2021; 21:461-464. [PMID: 33682589 DOI: 10.1080/14737140.2021.1899816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Aaron C Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Johan Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mustafa Khasraw
- Duke Center for Cancer Immunotherapy, Duke University, Durham, NC, USA
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22
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Current treatment and future challenges in ROS1- and ALK-rearranged advanced non-small cell lung cancer. Cancer Treat Rev 2021; 95:102178. [PMID: 33743408 DOI: 10.1016/j.ctrv.2021.102178] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
Non─small cell lung cancer (NSCLC) presents different druggable genetic abnormalities, including ROS1 and ALK rearrangements, which share relevant clinical features and therapeutic strategies. The homology between the tyrosine kinase domains of ROS1 and ALK defines unique subsets of patients highly sensitive to targeted tyrosine kinase inhibitors (TKIs). Genomic profiling in advanced NSCLC is standard, immunohistochemistry and fluorescence in situ hybridization being the main techniques used to detect genomic rearrangements. Personalized treatment with TKIs in ROS1- and ALK-positive NSCLC patients has dramatically improved patients' outcomes. Crizotinib has been the first-line standard of care treatment in ALK-rearranged NSCLC patients for a long time, while crizotinib still represents the best upfront therapeutic option in ROS1-positive NSCLC patients, followed by next-generation TKIs at the time of disease progression. However, the improved intracranial efficacy of next-generation TKIs has led to these drugs becoming first-line options, widening treatment opportunities for these patients. Since all patients will develop disease progression under TKI therapy, understanding the mechanisms of acquired resistance is crucial to define the optimal sequential therapeutic strategy. Despite the positive correlation between personalized treatment and patients' outcome, access to next-generation TKIs and genomic profiling at the time of disease progression are major challenges to achieving this goal. In this review, we present updated evidence on ROS1- and ALK-rearranged NSCLC regarding epidemiology and diagnostics, current therapies and the most suitable sequential treatment approaches, as well as mechanisms of acquired resistance and strategies to overcome them.
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Chen X, Gao A, Zhang F, Yang Z, Wang S, Fang Y, Li J, Wang J, Shi W, Wang L, Zheng Y, Sun Y. ILT4 inhibition prevents TAM- and dysfunctional T cell-mediated immunosuppression and enhances the efficacy of anti-PD-L1 therapy in NSCLC with EGFR activation. Theranostics 2021; 11:3392-3416. [PMID: 33537094 PMCID: PMC7847666 DOI: 10.7150/thno.52435] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022] Open
Abstract
Rationale: Immune checkpoint inhibitors (ICIs) against the PD-1/PD-L1 pathway showed limited success in non-small cell lung cancer (NSCLC) patients, especially in those with activating epidermal growth factor receptor (EGFR) mutations. Elucidation of the mechanisms underlying EGFR-mediated tumor immune escape and the development of effective immune therapeutics are urgently needed. Immunoglobulin-like transcript (ILT) 4, a crucial immunosuppressive molecule initially identified in myeloid cells, is enriched in solid tumor cells and promotes the malignant behavior of NSCLC. However, the upstream regulation of ILT4 overexpression and its function in tumor immunity of NSCLC with EGFR activation remains unclear. Methods: ILT4 expression and EGFR phosphorylation in human NSCLC tissues and cell lines were analyzed using immunohistochemistry (IHC), real-time PCR, Western blotting, immunofluorescence, and flow cytometry. The molecular signaling for EGFR-regulated ILT4 expression was investigated using mRNA microarray and The Cancer Genome Atlas (TCGA) database analyses and then confirmed by Western blotting. The regulation of tumor cell proliferation and apoptosis by ILT4 was examined by CCK8 proliferation and apoptosis assays. The impact of ILT4 and PD-L1 on tumor-associated macrophage (TAM) recruitment and polarization was evaluated using Transwell migration assay, flow cytometry, enzyme linked immunosorbent assay (ELISA) and real-time PCR, while their impact on T cell survival and cytotoxicity was analyzed by CFSE proliferation assay, apoptotic assay, flow cytometry, ELISA and cytolytic assay. Tumor immunotherapy models targeting at paired Ig-like receptor B (PIR-B, an ortholog of ILT4 in mouse)/ILT4 and/or PD-L1 were established in C57BL/6 mice inoculated with stable EGFR- overexpressing Lewis lung carcinoma (LLC) cells and in humanized NSG mice inoculated with EGFR mutant, gefitinib-resistant PC9 (PC9-GR) or EGFR-overexpressing wild type H1299 cells. PIR-B and ILT4 inhibition was implemented by infection of specific knockdown lentivirus and PD-L1 was blocked using human/mouse neutralizing antibodies. The tumor growth model was established in NSG mice injected with PIR-B-downregulated LLC cells to evaluate the effect of PIR-B on tumor proliferation. The frequencies and phenotypes of macrophages and T cells in mouse spleens and blood were detected by flow cytometry while those in tumor tissues were determined by IHC and immunofluorescence. Results: We found that ILT4 expression in tumor cells was positively correlated with EGFR phosphorylation in human NSCLC tissues. Using NSCLC cell lines, we demonstrated that ILT4 was upregulated by both tyrosine kinase mutation-induced and epidermal growth factor (EGF)-dependent EGFR activation and subsequent AKT/ERK1/2 phosphorylation. Overexpressed ILT4 in EGFR-activated tumor cells induced TAM recruitment and M2-like polarization, which impaired T cell function. ILT4 also directly inhibited T cell proliferation, cytotoxicity, and IFN-γ expression and secretion. In EGFR-activated cell lines in vitro and in wild-type EGFR-activated C57BL/6 and humanized NSG immunotherapy models in vivo, either ILT4 (PIR-B) or PD-L1 inhibition enhanced anti-tumor immunity and suppressed tumor progression by counteracting TAM- and dysfunctional T cell- induced immuno-suppressive TME; the combined inhibition of both molecules showed the most dramatic tumor retraction. Surprisingly, in EGFR mutant, TKI resistant humanized NSG immunotherapy model, ILT4 inhibition alone rather than in combination with a PD-L1 inhibitor suppressed tumor growth and immune evasion. Conclusions: ILT4 was induced by activation of EGFR-AKT and ERK1/2 signaling in NSCLC cells. Overexpressed ILT4 suppressed tumor immunity by recruiting M2-like TAMs and impairing T cell response, while ILT4 inhibition prevented immunosuppression and tumor promotion. Furthermore, ILT4 inhibition enhanced the efficacy of PD-L1 inhibitor in EGFR wild-type but not in EGFR mutant NSCLC. Our study identified novel mechanisms for EGFR-mediated tumor immune escape, and provided promising immunotherapeutic strategies for patients with EGFR-activated NSCLC.
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Angelicola S, Ruzzi F, Landuzzi L, Scalambra L, Gelsomino F, Ardizzoni A, Nanni P, Lollini PL, Palladini A. IFN-γ and CD38 in Hyperprogressive Cancer Development. Cancers (Basel) 2021; 13:309. [PMID: 33467713 PMCID: PMC7830527 DOI: 10.3390/cancers13020309] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/21/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) improve the survival of patients with multiple types of cancer. However, low response rates and atypical responses limit their success in clinical applications. The paradoxical acceleration of tumor growth after treatment, defined as hyperprogressive disease (HPD), is the most difficult problem facing clinicians and patients alike. The mechanisms that underlie hyperprogression (HP) are still unclear and controversial, although different factors are associated with the phenomenon. In this review, we propose two factors that have not yet been demonstrated to be directly associated with HP, but upon which it is important to focus attention. IFN-γ is a key cytokine in antitumor response and its levels increase during ICI therapy, whereas CD38 is an alternative immune checkpoint that is involved in immunosuppressive responses. As both factors are associated with resistance to ICI therapy, we have discussed their possible involvement in HPD with the conclusion that IFN-γ may contribute to HP onset through the activation of the inflammasome pathway, immunosuppressive enzyme IDO1 and activation-induced cell death (AICD) in effector T cells, while the role of CD38 in HP may be associated with the activation of adenosine receptors, hypoxia pathways and AICD-dependent T-cell depletion.
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Affiliation(s)
- Stefania Angelicola
- Laboratory of Immunology and Biology of Metastasis, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (S.A.); (F.R.); (L.S.); (A.P.)
| | - Francesca Ruzzi
- Laboratory of Immunology and Biology of Metastasis, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (S.A.); (F.R.); (L.S.); (A.P.)
| | - Lorena Landuzzi
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Laura Scalambra
- Laboratory of Immunology and Biology of Metastasis, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (S.A.); (F.R.); (L.S.); (A.P.)
| | - Francesco Gelsomino
- Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.G.); (A.A.)
| | - Andrea Ardizzoni
- Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.G.); (A.A.)
| | - Patrizia Nanni
- Laboratory of Immunology and Biology of Metastasis, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (S.A.); (F.R.); (L.S.); (A.P.)
| | - Pier-Luigi Lollini
- Laboratory of Immunology and Biology of Metastasis, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (S.A.); (F.R.); (L.S.); (A.P.)
| | - Arianna Palladini
- Laboratory of Immunology and Biology of Metastasis, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (S.A.); (F.R.); (L.S.); (A.P.)
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25
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Solomon BJ, Zhou CC, Drilon A, Park K, Wolf J, Elamin Y, Davis HM, Soldatenkova V, Sashegyi A, Lin AB, Lin BK, F Loong HH, Novello S, Arriola E, Pérol M, Goto K, Santini FC. Phase III study of selpercatinib versus chemotherapy ± pembrolizumab in untreated RET positive non-small-cell lung cancer. Future Oncol 2020; 17:763-773. [PMID: 33150799 DOI: 10.2217/fon-2020-0935] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Selpercatinib, a novel, highly selective and potent, inhibitor of RET, demonstrated clinically meaningful antitumor activity with manageable toxicity in heavily pretreated and treatment-naive RET fusion-positive non-small-cell lung cancer patients in a Phase I/II clinical trial. LIBRETTO-431 (NCT04194944) is a randomized, global, multicenter, open-label, Phase III trial, evaluating selpercatinib versus carboplatin or cisplatin and pemetrexed chemotherapy with or without pembrolizumab in treatment-naive patients with locally advanced/metastatic RET fusion-positive nonsquamous non-small-cell lung cancer. The primary end point is progression-free survival by independent review. Key secondary end points include overall survival, response rate, duration of response and progression-free survival. Clinical trial registration: NCT04194944 (ClinicalTrials.gov).
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Affiliation(s)
| | | | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center, Manhattan, NY 10065, USA
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jürgen Wolf
- Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - Yasir Elamin
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | | | | | | | - Boris K Lin
- Eli Lilly and Company, Indianapolis, IN 46225, USA
| | | | - Silvia Novello
- Department of Oncology, AOU San Luigi-Orbassano, University of Turin, Italy
| | | | | | - Koichi Goto
- National Cancer Center Hospital East, Chiba, Japan
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26
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Ding S, Wang R, Peng S, Luo X, Zhong L, Yang H, Ma Y, Chen S, Wang W. Targeted therapies for RET-fusion cancer: Dilemmas and breakthrough. Biomed Pharmacother 2020; 132:110901. [PMID: 33125973 DOI: 10.1016/j.biopha.2020.110901] [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: 07/04/2020] [Revised: 10/04/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022] Open
Abstract
Genomic profiling has revolutionized treatment options for patients with oncogene-driven cancers, such as epidermal growth factor receptor (EGFR) mutant carcinoma. Rearranged during transfection (RET) rearrangement, as one of the main activated oncogenes, has been well studied and found to be involved in the malignant behavior of carcinogenesis, resulting in acquired resistance to EGFR tyrosine kinase inhibitors and inducing an intrinsic resistance to immunotherapy. Thus, targeted therapies have been investigated against RET arrangement cancers, including several multi-kinase inhibitors and selective RET inhibitors. However, modest efficacy, a relatively high rate of toxicity, and poor effectiveness against brain metastasis are common limitations of multi-targeted novel molecular inhibitors. A promising prospect was shown recently in selective RET inhibitors in several ongoing clinical trials. In this review, we reviewed the concurrent dilemmas of targeted therapies against RET arrangement cancer from preclinical and clinical studies and proposed several clinical considerations for clinical practice prospectively.
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Affiliation(s)
- SiJie Ding
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Rong Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - ShunLi Peng
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Xiaoqing Luo
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - LongHui Zhong
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Hong Yang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China; Department of Oncology, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, PR China
| | - YueYun Ma
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - ShiYu Chen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Wei Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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27
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Ota T, Fukui T, Nakahara Y, Takeda T, Uchino J, Mouri T, Kudo K, Nakajima S, Suzumura T, Fukuoka M. Serum immune modulators during the first cycle of anti-PD-1 antibody therapy in non-small cell lung cancer: Perforin as a biomarker. Thorac Cancer 2020; 11:3223-3233. [PMID: 32915511 PMCID: PMC7606020 DOI: 10.1111/1759-7714.13650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background Currently used biomarkers for immunotherapy are inadequate because they are only based on tumor properties. In view of microenvironment changes by tumors, host immunity should be considered, which may result in identifying more accurate and easily detectable biomarkers for daily clinical practice. Here, we assessed serum immune‐modulating factor levels for the response to anti‐PD‐1 antibodies during the first cycle in non‐small cell lung cancer (NSCLC) patients. Methods Serum was collected from patients with advanced NSCLC treated with nivolumab or pembrolizumab at several time points during the first cycle. We applied the enzyme‐linked immunosorbent assays (ELISAs) and multiplex assays to measure the levels of immune modulators. Results A total of 40 patients treated with nivolumab and 26 patients treated with pembrolizumab were studied. By ELISA, serum perforin, but not granzyme B, was measured in all samples. By multiplex assay, 10 immune modulators, including granzyme B, were measured in some, but not all, samples. Serum baseline perforin levels were strongly associated with increased progression‐free survival (PFS) and overall survival (OS) times. Sequential changes in perforin levels during the first cycle were weakly associated with the clinical outcome. Conclusions Serum baseline perforin levels may be used to predict the prognosis of NSCLC patients treated with anti‐PD‐1 antibody therapy. Key points To identify a useful predictive marker for anti‐PD‐1 antibody therapy, using blood samples might be helpful. Serum baseline perforin levels were closely associated with prognosis with anti‐PD‐1 antibody therapy in non‐small cell lung cancer.
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Affiliation(s)
- Takayo Ota
- Department of Medical Oncology, Izumi City General Hospital, Osaka, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan.,Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takayuki Takeda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.,Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takako Mouri
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keita Kudo
- Department of Medical Oncology and Respiratory Medicine, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Saki Nakajima
- Department of Medical Oncology and Respiratory Medicine, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Tomohiro Suzumura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masahiro Fukuoka
- Department of Medical Oncology, Izumi City General Hospital, Osaka, Japan
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28
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Peng S, Ying AF, Tai BC, Soo RA. A meta-analysis on immune checkpoint inhibitor efficacy for advanced non-small cell lung cancer between East Asians versus non-East Asians. Transl Lung Cancer Res 2020; 9:1124-1137. [PMID: 32953491 PMCID: PMC7481594 DOI: 10.21037/tlcr-20-246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background We conducted a meta-analysis to assess the efficacy of immune checkpoint inhibitors (ICIs) (PD-1/L1 and CTLA-4 inhibitors) in first and subsequent lines in East Asians and non-East Asians. Methods We searched PubMed-MEDLINE, Embase and Scopus, from inception to 20 Sep 2019, and reviewed major conferences’ abstracts, for randomised controlled trials of ICI in advanced-stage NSCLC (Stage IIIB or IV) without EGFR mutation that reported hazard ratios (HRs) stratified by geographical region including the region “Asia” or “East Asia”. The primary outcome measures were overall survival (OS) and progression-free survival (PFS). The pooled HR and its 95% confidence interval (CI) for OS and PFS in East Asians and non-East Asians were calculated using a random effect model and the difference compared using an interaction test. Results A total of 5,465 patients from 7 randomised controlled trials involving CTLA-4 and/or PD-1/L1 inhibitors were included, with 1,740 (32%) East Asians and 3,725 (68%) non-East Asians. ICI was associated with an improvement in OS and PFS for both East Asian (OS HR, 0.74; 95% CI, 0.65–0.85; PFS HR, 0.56; 95% CI, 0.40–0.79) and non-East Asian patients (OS HR, 0.78; 95% CI, 0.72–0.85; PFS HR, 0.69; 95% CI, 0.56–0.85), with no significant difference between the two groups (Pinteraction=0.55 for OS; Pinteraction=0.33 for PFS). Subgroup analyses showed a statistically significant superior PFS (but not OS) for East Asians than non-East Asians in trials that used immune checkpoint inhibitor in the first-line treatment (Pinteraction=0.02). No significant regional difference was found in further subgroups of pure ICI and combination of ICI with chemotherapy. Conclusions There is no significant difference in response to ICI between East Asians and non-East Asians with advanced stage NSCLC, and the statistically significant subgroup difference in PFS in the first line use of ICI may not be clinically significant.
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Affiliation(s)
- Siyu Peng
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Ariel Fangting Ying
- Health Services and System Research, Duke-NUS Medical School, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ross Andrew Soo
- Department of Haematology-Oncology, National University Cancer Institute Singapore, National University Health System, Singapore, Singapore.,Cancer Science Institute, Singapore, Singapore
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29
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Efficacy of anti-PD-1 antibodies in NSCLC patients with an EGFR mutation and high PD-L1 expression. J Cancer Res Clin Oncol 2020; 147:245-251. [PMID: 32705363 PMCID: PMC7810613 DOI: 10.1007/s00432-020-03329-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/18/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Several studies have demonstrated that non-small cell lung cancer patients (NSCLCs) harboring epidermal growth factor receptor (EGFR) mutations have poor clinical outcomes in response to treatment with programmed death-1 (PD-1) inhibitors. However, it remains unclear whether EGFR-mutated NSCLCs with a high programmed death-ligand-1 (PD-L1) expression (tumor proportion score ≥ 50%) respond to PD-1 inhibitors. METHODS We retrospectively investigated the NSCLCs who had received PD-1 inhibitors between January 2016 and December 2018 to assess the efficacy of PD-1 inhibitors in patients with an EGFR mutation and high PD-L1 expression. RESULTS There were 153 patients with a high PD-L1 expression level, and the median progression-free survival (mPFS) was 5.3 months [95% confidence interval (CI) 1.3-12.4 months] in the patients with EGFR mutations (n = 17) and 8.3 months (95% CI 6.0-11.7 months) in those with wild-type EGFR (n = 136; hazard ratio (HR) 1.62; 95% CI 0.83-2.87). Among the 110 patients in the low PD-L1 expression group, the mPFS was 1.6 months (95% CI 1.3-5.9 months) in the patients with EGFR mutations (n = 18) and 3.8 months (95% CI 2.5-5.9 months) in those with wild-type EGFR (n = 92; HR 2.59; 95% CI 1.48-4.31). The HR for PFS in the group with EGFR mutations and high PD-L1 expression was 0.97 (95% CI 0.56-1.59) compared to the group with wild-type EGFR and low PD-L1 expression. CONCLUSIONS PD-1 inhibitors can serve as one of the treatment options for NSCLCs with an EGFR mutation and high PD-L1 expression.
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30
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Passarelli A, Aieta M, Sgambato A, Gridelli C. Targeting Immunometabolism Mediated by CD73 Pathway in EGFR-Mutated Non-small Cell Lung Cancer: A New Hope for Overcoming Immune Resistance. Front Immunol 2020; 11:1479. [PMID: 32760402 PMCID: PMC7371983 DOI: 10.3389/fimmu.2020.01479] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022] Open
Abstract
Despite the relevant antitumor efficacy of immunotherapy in advanced non-small cell lung cancer (NSCLC), the results in patients whose cancer harbors activating epidermal growth factor receptor (EGFR) mutations are disappointing. The biological mechanisms underlying immune escape and both unresponsiveness and resistance to immunotherapy in EGFR-mutant NSCLC patients have been partially investigated. To this regard, lung cancer immune escape largely involves high amounts of adenosine within the tumor milieu with broad immunosuppressive effects. Indeed, besides immune checkpoint receptors and their ligands, other mechanisms inducing immunosuppression and including adenosine produced by ecto-nucleotidases CD39 and CD73 contribute to lung tumorigenesis and progression. Here, we review the clinical results of immune checkpoint inhibitors in EGFR-mutant NSCLC, focusing on the dynamic immune composition of EGFR-mutant tumor microenvironment. The adenosine pathway-mediated dysregulation of energy metabolism in tumor microenvironment is suggested as a potential mechanism involved in the immune escape process. Finally, we report the strong rationale for planning strategies of combination therapy with immune checkpoints blockade and adenosine signaling inhibition to overcome immune escape and immunotherapy resistance in EGFR-mutated NSCLC.
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Affiliation(s)
- Anna Passarelli
- Unit of Medical Oncology, Department of Onco-Hematology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Rionero in Vulture, Italy
| | - Michele Aieta
- Unit of Medical Oncology, Department of Onco-Hematology, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Rionero in Vulture, Italy
| | - Alessandro Sgambato
- Laboratory of Pre-clinical and Translational Research, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Rionero in Vulture, Italy
| | - Cesare Gridelli
- Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy
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31
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Sehgal K, Piper-Vallillo AJ, Viray H, Khan AM, Rangachari D, Costa DB. Cases of ROS1-rearranged lung cancer: when to use crizotinib, entrectinib, lorlatinib, and beyond? ACTA ACUST UNITED AC 2020; 3. [PMID: 32776005 PMCID: PMC7410006 DOI: 10.21037/pcm-2020-potb-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
ROS1-rearranged (also known as ROS1 fusion-positive) non-small-cell lung cancer is an uncommon but distinct molecular subgroup seen in approximately 1–2% of cases. Oncogene addiction due to constitutive ROS1 tyrosine kinase activation has allowed development of molecularly targeted therapies with remarkable anti-tumor activity. Both crizotinib and entrectinib, multitargeted tyrosine kinase inhibitors (TKIs) have now received approval by the FDA for treatment of patients with advanced ROS1-rearranged lung cancers; however, the clinical efficacy and safety of these drugs have been derived from expansion cohorts of single-arm phase I or basket clinical trials with relatively small populations of this clinically and molecularly distinct subgroup. Both drugs lead to high objective response rates (approximately 70–80%) and have manageable side effects, although only entrectinib has potent intracranial efficacy. Lorlatinib is an oral brain-penetrant ALK/ROS1 TKI with activity in both TKI-naïve and some crizotinib-resistant settings (albeit with limited potency against the crizotinib/entrectinib-resistant ROS1-G2032R mutation). We describe cases of advanced ROS1-rearranged lung cancer receiving crizotinib, entrectinib, and/or lorlatinib in first and later line treatment settings to dissect the current state of evidence supporting management decisions for these patients. The next generation ROS1 TKIs (repotrectinib and DS-6051b), owing to their broad activity against kinase mutations including ROS1-G2032R in preclinical studies, hold promise to transform the current treatment paradigm and permit even further gains with regards to long-term outcomes in this subset of patients.
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Affiliation(s)
- Kartik Sehgal
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrew J Piper-Vallillo
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hollis Viray
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Adeel M Khan
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Deepa Rangachari
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel B Costa
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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32
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Darrason M, Chatelain E, Ranchon F, Gervaise C, Duruisseaux M, Couraud S. Do systemic treatments delivered after Nivolumab result in better outcomes? A bicentric case-control study. Respir Med Res 2020; 77:100-105. [PMID: 32512522 DOI: 10.1016/j.resmer.2020.02.001] [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: 08/19/2019] [Revised: 01/08/2020] [Accepted: 02/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) are now widely used at different stages of non-small cell lung cancers (NSCLC). Some clinical studies suggest that chemotherapy and immunotherapy have synergic activities, raising the question of the best therapeutic sequence. We studied the effect of chemotherapy in advanced NSCLC when administered after immunotherapy by nivolumab. METHODS We performed a bicentric, retrospective, case-control study in two French hospitals. Patients with NSCLC treated with chemotherapy after nivolumab between January 2015 and January 2016 were included. Each case was matched on age and number of previous lines to one lung cancer patient who had not received nivolumab. Each CT-scanner has been reviewed and the objective response to chemotherapy was assessed for each patient according to the RECIST 1.1 criteria. RESULTS Thirty-one patients with advanced NSCL who had at least received one cycle of chemotherapy after progression under nivolumab in the inclusion period were matched to 31 controls. The median age for cases was 59 yo and the predominant tumoral histology was adenocarcinoma (77%). The progression free survival (PFS) was 2.95 months in the studied group vs 2.69 months (P=0.18) in the control group. At best response, disease control (DC=partial response and stable disease) was better in the case group than in the control group (58% vs 39%, P=0.127). Cases were about five times more likely to get objective response to best evaluation than controls (OR=5.043 [95% CI: 0.975-26.086]; P=0.054). The overall survival (OS) was 7.3 months in the case group and 3.3 months in the control group (P=0.074). Patients who have been treated with targeted therapy instead of chemotherapy and patients with squamous lung cancer had worst PFS and OS. CONCLUSION In advanced NSCLC, the chemotherapy progression free survival does not seem higher when administered after nivolumab. However, when administered post-nivolumab, traditional chemotherapy has 5 times more chances to achieve objective response and seems to improve overall survival of cases. Pooled analysis with other similar studies might be interesting for a next step.
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Affiliation(s)
- M Darrason
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, institut de cancérologie des hospices civils de Lyon, hôpital Lyon Sud, Pierre-Bénite, France
| | - E Chatelain
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, institut de cancérologie des hospices civils de Lyon, hôpital Lyon Sud, Pierre-Bénite, France
| | - F Ranchon
- Service de pharmacie, institut de cancérologie des hospices civils de Lyon, hôpital Lyon Sud, Pierre-Bénite, France
| | - C Gervaise
- Service de pharmacie, institut de cancérologie des hospices civils de Lyon, hôpital Lyon Sud, Pierre-Bénite, France
| | - M Duruisseaux
- Service de pneumologie, groupe hospitalier Est, hospices civils de Lyon, Bron, France
| | - S Couraud
- EMR 3738 ciblage thérapeutique en oncologie, faculté de médecine Lyon Sud Charles-Mérieux, université de Lyon, Oullins, France.
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33
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Lu C, Dong XR, Zhao J, Zhang XC, Chen HJ, Zhou Q, Tu HY, Ai XH, Chen XF, An GL, Bai J, Shan JL, Wang YN, Yang SY, Liu X, Zhuang W, Wu HT, Zhu B, Xia XF, Chen RR, Gu DJ, Xu HM, Wu YL, Yang JJ. Association of genetic and immuno-characteristics with clinical outcomes in patients with RET-rearranged non-small cell lung cancer: a retrospective multicenter study. J Hematol Oncol 2020; 13:37. [PMID: 32295619 PMCID: PMC7160902 DOI: 10.1186/s13045-020-00866-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/27/2020] [Indexed: 01/05/2023] Open
Abstract
Background Rearranged during transfection (RET) has been proven to be a tumorigenic target in non-small cell lung cancers (NSCLCs). In RET-rearranged NSCLCs, molecular features and their impact on prognosis were not well illustrated, and the activity of mainstay therapeutics has not currently been well compared. Methods Patients diagnosed with NSCLCs with RET rearrangements were analyzed for concomitant mutations, tumor mutation burden (TMB), PD-L1 expression, T cell receptor repertoire and clinical outcomes with chemotherapy, immune checkpoint inhibitors (ICIs), and multikinase inhibitors (MKIs). Results Among 129 patients with RET-rearranged NSCLC who were analyzed, 41.1% (53/129) had co-occurring genetic alterations by next-generation sequencing, and concomitant TP53 mutation appeared most frequently (20/53, 37.7%). Patients with concurrent TP53 mutation (n = 15) had shorter overall survival than those without (n = 30; median, 18.4 months [95% CI, 8.6–39.1] vs 24.8 months [95% CI, 11.7–52.8]; P < 0.05). Patients with lower peripheral blood TCR diversity (n = 5) had superior overall survival compared with those with higher diversity (n = 6; median, 18.4 months [95% CI, 16.9–19.9] vs 4.8 months [95% CI, 4.5–5.3]; P = 0.035). An association with overall survival was not observed for PD-L1 expression nor for tumor mutation burden level. Median progression-free survival was not significantly different across chemotherapy, ICIs, and MKIs (median, 3.5 vs 2.5 vs 3.8 months). For patients treated with ICIs, the disease control rate was 60% (6/10) and the objective response rate was 20% (2/10). Conclusions RET-rearranged lung cancers can be heterogeneous in terms of concomitant genetic alterations. Patients with concurrent TP53 mutation or high peripheral blood TCR repertoire diversity have relatively inferior overall survival in this series. Outcomes with traditional systemic therapies in general are suboptimal.
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Affiliation(s)
- Chang Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Rong Dong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department I of Thoracic Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xu-Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hua-Jun Chen
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hai-Yan Tu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xing-Hao Ai
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Feng Chen
- Oncology Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gai-Li An
- Department of Clinical Oncology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Jun Bai
- Department of Clinical Oncology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Jin-Lu Shan
- Daping Hospital, Army medical center of PLA, Chongqing, China
| | - Yi-Na Wang
- Department of Oncology, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Shuan-Ying Yang
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiang Liu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Wu Zhuang
- Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Hui-Ta Wu
- Department of Oncology, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | | | | | - De-Jian Gu
- Geneplus-Beijing Institute, Beijing, China
| | - Hua-Min Xu
- Geneplus-Beijing Institute, Beijing, China
| | - Yi-Long Wu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China. .,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Jin-Ji Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China. .,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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Systemic therapies for intrahepatic cholangiocarcinoma. J Hepatol 2020; 72:353-363. [PMID: 31954497 DOI: 10.1016/j.jhep.2019.10.009] [Citation(s) in RCA: 223] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 02/08/2023]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a highly lethal hepatobiliary neoplasm whose incidence is increasing. Largely neglected for decades as a rare malignancy and frequently misdiagnosed as carcinoma of unknown primary, considerable clinical and investigative attention has recently been focused on iCCA worldwide. The established standard of care includes first-line (gemcitabine and cisplatin), second-line (FOLFOX) and adjuvant (capecitabine) systemic chemotherapy. Compared to hepatocellular carcinoma, iCCA is genetically distinct with several targetable genetic aberrations identified to date. Indeed, FGFR2 and NTRK fusions, and IDH1 and BRAF targetable mutations have been comprehensively characterised and clinical data is emerging on targeting these oncogenic drivers pharmacologically. Also, the role of immunotherapy has been examined and is an area of intense investigation. Herein, in a timely and topical manner, we will review these advances and highlight future directions of research.
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Domagala-Kulawik J. New Frontiers for Molecular Pathology. Front Med (Lausanne) 2019; 6:284. [PMID: 31867335 PMCID: PMC6904313 DOI: 10.3389/fmed.2019.00284] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Lung cancer remains a serious oncological problem worldwide. The delayed diagnosis and a prevalence of advanced stages in up to 70% of cases at recognition are still observed. Thanks to targeted therapies and immunotherapy a significant progress in achieving prolonged survival in some lung cancer patients is reported. A precise histopathological diagnosis, especially the recognition of adenocarcinoma, and a progress in the methods of clinical staging underlie the proper qualification of patients for a tailored therapy. The deep molecular characteristics of lung cancer in liquid biopsy, for example blood, bronchoalveolar lavage fluid (BALF), cell suspension from needle aspirates, are currently available. The molecular characteristic has recently been extended with molecular aberrations of BRAF, KRAS, MET, ERBB2, RET, NTRK next to the well-known EGFR mutations and ALK, ROS-1 relocation. The present paper discusses the usefulness of adequate pathological methods and molecular testing for the identification of a broad spectrum of predictive biomarkers for a molecular-directed lung cancer therapy. Immunotherapy with immune checkpoint inhibitors (ICIs) is approved in the first line therapy of advanced non-small-cell lung cancer. To date only PD-L1 expression on tumor cells has been found to be a marker of response to ICIs. The efficacy of ICIs as well as the susceptibility to immune-related adverse events are highly individual, so immune biomarkers are widely investigated. The candidates for predictive factors for ICIs immunotherapy include cancer cell antigenicity, presence of regulatory/suppressory molecules on cancer cells, cancer stem cells or on exosomes, and, on the other hand, an immune status of the patient. Cancers with high immune infiltration in the tumor milieu, referred to as “hot” tumors, seem to ensure a better response to ICIs than the “cold” ones. BALF analysis may replace cancer tissue examination, which is of limited access in advanced stages, for the recognition of the nature of immune response in the tumor environment. Tumor mutational burden (TMB) was shown to correlate with a good response to ICIs, especially when combined with other anticancer therapies. The present paper demonstrates the results of recent studies on lung cancer characteristics which bring us closer to the definition of useful prognostic/predictive factors.
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Affiliation(s)
- Joanna Domagala-Kulawik
- Department of Internal Medicine, Pulmonary Diseases and Allergy Medical University of Warsaw, Warsaw, Poland
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Liu WJ, Du Y, Wen R, Yang M, Xu J. Drug resistance to targeted therapeutic strategies in non-small cell lung cancer. Pharmacol Ther 2019; 206:107438. [PMID: 31715289 DOI: 10.1016/j.pharmthera.2019.107438] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
Rapidly developing molecular biology techniques have been employed to identify cancer driver genes in specimens from patients with non-small cell lung cancer (NSCLC). Inhibitors and antibodies that specifically target driver gene-mediated signaling pathways to suppress tumor growth and progression are expected to extend the survival time and further improve the quality of life of patients. However, the health of patients with advanced and metastatic NSCLC presents significant challenges due to treatment resistance, mediated by cancer driver gene alteration, epigenetic alteration, and tumor heterogeneity. In this review, we discuss two different resistance mechanisms in NSCLC targeted therapies, namely changes in the targeted oncogenes (on-target resistance) and changes in other related signaling pathways (off-target resistance) in tumor cells. We highlight the conventional mechanisms of drug resistance elicited by the complex heterogeneous microenvironment of NSCLC during targeted therapy, including mutations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), the receptor tyrosine kinase ROS proto-oncogene 1 (ROS1), and the serine/threonine-protein kinase BRAF (v-Raf murine sarcoma viral oncogene homolog B). We also discuss the mechanism of action of less common oncoproteins, as in-depth understanding of these molecular mechanisms is important for optimizing treatment strategies.
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Affiliation(s)
- Wen-Juan Liu
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, China
| | - Yue Du
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ru Wen
- Department of Medicine, Stanford University School of Medicine, California, USA
| | - Ming Yang
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, China.
| | - Jian Xu
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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Bianco A, Perrotta F, Barra G, Malapelle U, Rocco D, De Palma R. Prognostic Factors and Biomarkers of Responses to Immune Checkpoint Inhibitors in Lung Cancer. Int J Mol Sci 2019; 20:E4931. [PMID: 31590386 PMCID: PMC6801651 DOI: 10.3390/ijms20194931] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022] Open
Abstract
Manipulation of the immune response is a game changer in lung cancer treatment, revolutionizing management. PD1 and CTLA4 are dynamically expressed on different T cell subsets that can either disrupt or sustain tumor growth. Monoclonal antibodies (MoAbs) against PD1/PDL1 and CTLA4 have shown that inhibitory signals can be impaired, blocking T cell activation and function. MoAbs, used as both single-agents or in combination with standard therapy for the treatment of advanced non-small cell lung cancer (NSCLC), have exhibited advantages in terms of overall survival and response rate; nivolumab, pembrolizumab, atezolizumab and more recently, durvalumab, have already been approved for lung cancer treatment and more compounds are in the pipeline. A better understanding of signaling elicited by these antibodies on T cell subsets, as well as identification of biological determinants of sensitivity, resistance and correlates of efficacy, will help to define the mechanisms of antitumor responses. In addition, the relevance of T regulatory cells (Treg) involved in immune responses in cancer is attracting increasing interest. A major challenge for future research is to understand why a durable response to immune checkpoint inhibitors (ICIs) occurs only in subsets of patients and the mechanisms of resistance after an initial response. This review will explore current understanding and future direction of research on ICI treatment in lung cancer and the impact of tumor immune microenvironment n influencing clinical responses.
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Affiliation(s)
- Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L Vanvitelli", 80131 Naples, Italy.
- Department of Pneumology and Oncology, A.O. dei Colli, Hosp. V Monaldi, 80131 Naples, Italy.
| | - Fabio Perrotta
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy.
| | - Giusi Barra
- Department of Precision Medicine, University of Campania "L Vanvitelli", 80131 Naples, Italy.
| | - Umberto Malapelle
- Department of Public Health, University of Naples "Federico II", 80131 Naples, Italy.
| | - Danilo Rocco
- Department of Pneumology and Oncology, A.O. dei Colli, Hosp. V Monaldi, 80131 Naples, Italy.
| | - Raffaele De Palma
- Department of Precision Medicine, University of Campania "L Vanvitelli", 80131 Naples, Italy.
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Immune Checkpoints as Promising Targets for the Treatment of Idiopathic Pulmonary Fibrosis? J Clin Med 2019; 8:jcm8101547. [PMID: 31561518 PMCID: PMC6833050 DOI: 10.3390/jcm8101547] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 12/21/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a rare, progressive and fatal lung disease which affects approximately 5 million persons worldwide. Although pirfenidone and/or nintedanib treatment improves patients’ wellbeing, the prognosis of IPF remains poor with 5-year mortality rates still ranging from 70 to 80%. The promise of the anti-cancer agent nintedanib in IPF, in combination with the recent notion that IPF shares several pathogenic pathways with cancer, raised hope that immune checkpoint inhibitors, the novel revolutionary anticancer agents, could also be the eagerly awaited ground-breaking and unconventional novel treatment modality limiting IPF-related morbidity/mortality. In the current review, we analyse the available literature on immune checkpoint proteins in IPF to explore whether immune checkpoint inhibition may be as promising in IPF as it is in cancer. We conclude that despite several promising papers showing that inhibiting specific immune checkpoint proteins limits pulmonary fibrosis, overall the data seem to argue against a general role of immune checkpoint inhibition in IPF and suggest that only PD-1/PD-L1 inhibition may be beneficial.
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Wang Y, Li Y, Chen P, Xu W, Wu Y, Che G. Prognostic value of the pretreatment systemic immune-inflammation index (SII) in patients with non-small cell lung cancer: a meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:433. [PMID: 31700869 DOI: 10.21037/atm.2019.08.116] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The objective of this study is to explore the association between the pretreatment systemic immune-inflammation index (SII) and prognosis in non-small cell lung cancer (NSCLC) patients. Methods A systemic literature search of PubMed, EMBASE, the Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP and SinoMed databases was performed from January 1, 1966 to April 15, 2019, to identify potential studies that assessed the prognostic role of the pretreatment SII in NSCLC. The hazard ratio (HR) and 95% confidence interval (CI) were combined to evaluate the correlation of the pretreatment SII with overall survival (OS), disease-free survival (DFS), progression-free survival (PFS) and cancer-specific survival (CSS) in NSCLC patients. Results A total of 9 studies involving 2,441 patients were eventually included. An elevated pretreatment SII indicated significantly poorer OS (HR =1.88, 95% CI: 1.50-2.36; P<0.001) with high heterogeneity (I2=60.6%, P=0.019), DFS/PFS (HR =2.50, 95% CI: 1.20-5.20; P=0.014) with high heterogeneity (I2=58.2%, P=0.092) and CSS (HR =1.852, 95% CI: 1.185-2.915; P=0.007). Subgroup analyses further verified the above results. In addition, compared with the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR), the SII showed a much higher prognostic value in NSCLC. Conclusions The pretreatment SII may serve as a useful prognostic indicator in NSCLC and contribute to prognosis evaluation and treatment strategy formulation. However, more well-designed studies are warranted to verify our findings.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yina Li
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Pingrun Chen
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Wenying Xu
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Yanming Wu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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