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Pre-treatment Neutrophil-to-Lymphocyte Ratio significantly affects progression free survival in positive EGFR mutation advanced lung adenocarcinoma with EGFR-TKI treatment in Bali, Indonesia. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:63-71. [PMID: 36453446 DOI: 10.2478/rjim-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Indexed: 12/03/2022]
Abstract
Introduction: Today, recommendations about initial Response Evaluation Criteria in Solid Tumor (RECIST) and its frequency still vary, while early diagnosis of progression affects patient's prognosis and subsequent treatment options. Methods: This study aims to examine Progression Free Survival (PFS) of positive EGFR mutations advanced lung adenocarcinoma receiving Tyrosine Kinase Inhibitor (TKI) and factors that influence it. This was an observational study with retrospective cohort design conducted at Prof IGNG Ngoerah Hospital from January to December 2021. Sample was data from Epidermal Growth Factor Receptor (EGFR) positive mutation advanced lung adenocarcinoma patient who were treated with EGFR-TKI at Prof IGNG Ngoerah Hospital, Denpasar, Bali from January 2017 to February 2021. Total sample was 63. Results: Median PFS was 12 months (95% CI 10.28-13.71) and minimum PFS was 3 months. In univariate analysis, Hazard Ration (HR) of older age, smoker, distant metastasis, brain metastasis, increased Neutrophil-to-Lymphocyte Ration (NLR), and exon 21 mutation to shorter PFS was 0.99 (95% CI 0.95-1.02); 1.03 (95% CI 0.57-1.85); 1.45 (95% CI 0.85-2.49); 2.14 (95% CI 1.02-4.49); 1.08 (95% CI 1.03-1.13); and 1.21 (95% CI 0.67-2.18). Multivariate analysis showed only increased NLR affected PFS significantly with HR 1.06 (95% CI 1.007-1.13). Conclusion: Median PFS of EGFR positive mutation advanced lung adenocarcinoma patients who received TKI was 12 months and minimum value was 3 months. Increased age, smoking, distant metastases, brain metastases, and exon 21 mutations were not associated with PFS. NLR significantly affected PFS.
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Sakamoto S, Sato K, Takita Y, Izumiya Y, Kumagai N, Sudo K, Hasegawa Y, Yokota H, Akamine Y, Okuda Y, Asano M, Takeda M, Sano M, Miura M, Nakayama K. ABCG2 C421A polymorphisms affect exposure of the epidermal growth factor receptor inhibitor gefitinib. Invest New Drugs 2020; 38:1687-1695. [PMID: 32436059 DOI: 10.1007/s10637-020-00946-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/06/2020] [Indexed: 01/05/2023]
Abstract
ATP-binding castle protein G2 (ABCG2) is thought to inhibit the activities of certain gefitinib transporters, thereby affecting drug pharmacokinetics. The C421A polymorphism affects the function and expression of ABCG2 on the cell membrane. Previous studies have shown that proton-pump inhibitors (PPIs) inhibit gefitinib absorption, as well as the function of ABCG2. We evaluated the plasma concentrations of gefitinib in patients with and without the ABCG2 C421A polymorphism, who were or were not taking PPIs. In total, 61 patients with advanced epidermal-growth-factor-positive non-small-cell lung cancer were enrolled in this study. They were treated with gefitinib at a dose of 250 mg per day. Plasma gefitinib concentration and ABCG2 C421A status were determined after 2 weeks. The patients were divided into CC- and CA/AA genotype groups. We compared the trough and peak gefitinib levels and the area under the curve (AUC) values for 24-h gefitinib concentrations. We also compared these parameters among four groups distinguished according to the presence or absence of the polymorphism and PPI use. The mean trough gefitinib level and AUC value for 24-h gefitinib concentration were significantly lower in the CA/AA group compared to the CC group (mean trough level: 333.2 vs. 454.5 ng/mL, respectively, P = 0.021; AUC: 9949.9 vs. 13,085.4 ng・h/mL, respectively, P = 0.034). Among patients taking PPIs, the mean trough gefitinib level was significantly lower in the CA/AA group than the CC group (220.1 vs. 340.5 ng/mL, respectively, P = 0.033). The CA/AA-type of ABCG2 C421A polymorphism may be associated with lower gefitinib plasma concentrations.
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Affiliation(s)
- Sho Sakamoto
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Sato
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuri Takita
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuka Izumiya
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Naho Kumagai
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhisa Sudo
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yukiyasu Hasegawa
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hayato Yokota
- Department of Pharmacy, Akita University Hospital, Akita, Japan
| | - Yumiko Akamine
- Department of Pharmacy, Akita University Hospital, Akita, Japan
| | - Yuji Okuda
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Mariko Asano
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Masahide Takeda
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Masaaki Sano
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Masatomo Miura
- Department of Pharmacy, Akita University Hospital, Akita, Japan
| | - Katsutoshi Nakayama
- Department of Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan.
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Igawa S, Ono T, Kasajima M, Kusuhara S, Otani S, Fukui T, Yokoba M, Kubota M, Katagiri M, Mitsufuji H, Sasaki J, Naoki K. Real-world assessment of afatinib for patients with EGFR-positive non-small cell lung cancer. Invest New Drugs 2020; 38:1906-1914. [PMID: 32415486 DOI: 10.1007/s10637-020-00948-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 12/29/2022]
Abstract
Introduction Afatinib is used to treat patients with advanced non-small cell lung cancer (NSCLC) harboring common EGFR mutations; however, the clinicopathological factors that predict this drug's effectiveness in real-world settings remain unclear. We therefore evaluated the effectiveness of afatinib in such patients and assessed potential prognostic factors. Methods We retrospectively investigated patients with NSCLC who received first-line afatinib between July 2014 and August 2018. Variables (including sex, age, performance status, neutrophil-to-lymphocyte ratio, EGFR genotype, smoking status, clinical stage prior to treatment [stage IV vs.. postoperative recurrence], presence or absence of brain metastases, body surface area, any afatinib dose reductions, and afatinib starting dose [40 vs.. 20 or 30 mg]) were subjected to a Cox proportional hazards regression model to estimate progression-free survival (PFS). Results Forty-eight patients with a median age of 67 years were included; the objective response rate was 62.5% (30 patients). The median PFS was 14.1 months; the PFS periods were 11.8 and 15.9 months for patients receiving 40 mg versus 20-30 mg of afatinib (P = 0.41), respectively, and were 14.5 and 13.8 months for patients who required afatinib dose reduction and those who did not, respectively (P = 0.80). The PFS tended to be longer in patients without brain metastases (albeit not significantly). Ultimately, no significant predictive values for PFS were identified. Conclusions Afatinib is effective for patients with NSCLC harboring common EGFR mutations irrespective of their clinicopathological backgrounds. A direct comparison of afatinib and osimertinib in treatment-naïve patients is warranted to determine the optimal standard of care.
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Affiliation(s)
- Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Kanagawa, 252-0374, Sagamihara-City, Japan.
| | - Taihei Ono
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Kanagawa, 252-0374, Sagamihara-City, Japan
| | - Masashi Kasajima
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Kanagawa, 252-0374, Sagamihara-City, Japan
| | - Seiichiro Kusuhara
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Kanagawa, 252-0374, Sagamihara-City, Japan
| | - Sakiko Otani
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Kanagawa, 252-0374, Sagamihara-City, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Kanagawa, 252-0374, Sagamihara-City, Japan
| | - Masanori Yokoba
- School of Allied Health Sciences, Kitasato University, Kanagawa, 252-0373, Sagamihara-City, Japan
| | - Masaru Kubota
- School of Allied Health Sciences, Kitasato University, Kanagawa, 252-0373, Sagamihara-City, Japan
| | - Masato Katagiri
- School of Allied Health Sciences, Kitasato University, Kanagawa, 252-0373, Sagamihara-City, Japan
| | - Hisashi Mitsufuji
- Kitasato University School of Nursing, Kanagawa, Sagamihara-City, Japan
| | - Jiichiro Sasaki
- Kitasato University School of Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Sagamihara-City, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Kanagawa, 252-0374, Sagamihara-City, Japan
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Impact of neutrophil-to-lymphocyte ratio in patients with EGFR-mutant NSCLC treated with tyrosine kinase inhibitors. Invest New Drugs 2020; 38:885-893. [DOI: 10.1007/s10637-020-00919-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
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Igawa S, Ono T, Kasajima M, Ishihara M, Hiyoshi Y, Kusuhara S, Nishinarita N, Fukui T, Kubota M, Sasaki J, Hisashi M, Yokoba M, Katagiri M, Naoki K. Impact of EGFR genotype on the efficacy of osimertinib in EGFR tyrosine kinase inhibitor-resistant patients with non-small cell lung cancer: a prospective observational study. Cancer Manag Res 2019; 11:4883-4892. [PMID: 31213907 PMCID: PMC6549661 DOI: 10.2147/cmar.s207170] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose: A T790M of the epidermal growth factor receptor (EGFR) is the most frequently encountered mutation conferring acquired resistance to EGFR tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC). The aim of this study was to assess the differential clinical outcomes of osimertinib therapy in NSCLC patients with T790M according to the type of activating EGFR mutation, ie, exon 19 deletion or L858R point mutation. Patients and methods: A prospective observational cohort study was conducted to evaluate the efficacy and safety of osimertinib in patients with a major EGFR mutation and T790M-positive advanced NSCLC who had disease progression after first-line EGFR-TKI therapy. The efficacy of osimertinib was evaluated according to the type of EGFR mutation. Results: A total of 51 patients were included in this study. An objective response was obtained in 29 patients, indicating an objective response rate of 58.8%. The response rate was 69.7% in patients with exon 19 deletion and 38.9% in patients with L858R point mutation, indicating a statistically significant difference (P=0.033). The median progression-free survival (PFS) and overall survival (OS) of the entire patient population were 7.8 and 15.5 months, respectively. The median PFS in the exon 19 deletion and L858R point mutation groups was 8.0 months and 5.2 months, respectively, indicating a statistically significant difference (P=0.045). Median OS in the exon 19 deletion and L858R point mutation groups was significantly different at 19.8 months and 12.9 months, respectively (P=0.0015). Multivariate analysis identified the exon 19 deletion as a favorable independent predictor of PFS and OS. Conclusion: Investigators should consider the proportions of sensitive EGFR mutation types as a stratification factor in designing or reviewing clinical studies involving osimertinib.
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Affiliation(s)
- Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Taihei Ono
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Masashi Kasajima
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Mikiko Ishihara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Yasuhiro Hiyoshi
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Seiichiro Kusuhara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Noriko Nishinarita
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Masaru Kubota
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
| | - Mitsufuji Hisashi
- Kitasato University School of Nursing, Sagamihara-city, Kanagawa, Japan
| | - Masanori Yokoba
- School of Allied Health Sciences, Kitasato University, Sagamihara-city, Kanagawa 252-0373, Japan
| | - Masato Katagiri
- School of Allied Health Sciences, Kitasato University, Sagamihara-city, Kanagawa 252-0373, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara-city, Kanagawa, Japan
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Nicotine Induces Resistance to Erlotinib Therapy in Non-Small-Cell Lung Cancer Cells Treated with Serum from Human Patients. Cancers (Basel) 2019; 11:cancers11030282. [PMID: 30818860 PMCID: PMC6468898 DOI: 10.3390/cancers11030282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 12/20/2022] Open
Abstract
Previously, we reported that nicotine reduces erlotinib sensitivity in a xenograft model of PC9, an epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI)-sensitive non-small-cell lung cancer cell line. The present study examined whether smoking induces erlotinib resistance in vitro. We assessed resistance to EGFR-TKIs by treating cancer cell lines with erlotinib, afatinib, or osimertinib, and serum collected from smokers within 30 min of smoking and that from a non-smoker as a control. We also assessed erlotinib resistance by treating PC9 cells exposed to serum from a smoker or a non-smoker, or serum from an erlotinib user. Treatment of the cancer cell lines with serum from smokers induced significant erlotinib resistance, compared with the control (p < 0.05). Furthermore, serum samples with a high concentration of cotinine (a nicotine exposure indicator) demonstrated stronger erlotinib resistance than those with low concentrations. Similar to the observations with erlotinib treatment of cell lines, the analysis of serum from erlotinib users revealed that smokers demonstrated significantly reduced sensitivity to erlotinib (p < 0.001). In conclusion, our present results support the hypothesis that smoking contributes to resistance to erlotinib therapy in non-small-cell lung cancer.
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Kim IA, Lee JS, Kim HJ, Kim WS, Lee KY. Cumulative smoking dose affects the clinical outcomes of EGFR-mutated lung adenocarcinoma patients treated with EGFR-TKIs: a retrospective study. BMC Cancer 2018; 18:768. [PMID: 30055587 PMCID: PMC6064083 DOI: 10.1186/s12885-018-4691-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/24/2018] [Indexed: 02/04/2023] Open
Abstract
Background Although lung adenocarcinoma with activating epidermal growth factor receptor (EGFR) mutations is common in never smokers, one-third of the patients are ever-smokers. We aimed to investigate the effect of cumulative smoking dose(CSD) on clinical outcomes, including progression-free survival (PFS) and overall survival (OS), in patients with EGFR-mutated lung adenocarcinoma receiving EGFR-tyrosine kinase inhibitors (TKIs). Methods We retrospectively analyzed 142 patients with EGFR-mutation positive advanced or recurrent lung adenocarcinoma who were administered gefitinib, erlotinib, afatinib, and osimertinib. These patients were classified based on their CSD as never smokers, light smokers (≤10 pack-years [PYs]), moderate smokers (11–30 PYs), and heavy smokers (> 30 PYs). PFS and OS were analyzed according to smoking subgroups via Kaplan-Meier curves. Results Among the 142 patients, 91 (64.1%), 12 (8.5%), 22 (15.5%), and 17 (12%) were never, light, moderate, and heavy smokers, respectively. CSD was inversely associated with median PFS in a statistically significant dose-dependent manner (11.8 months (mo), 11.0 mo, 7.4 mo, and 3.9 mo; p < 0.001). Statistically significant negative association was observed between CSD and median OS (33.6 mo, 26.3 mo, 20 mo, and 8.9 mo; p < 0.001). In the multivariate analysis adjusted for age, sex, performance status, stage, and timing of EGFR-TKIs, CSD was an independent predictive factor for disease progression (hazard ratio [HR], 4.00; 95% confidence interval [CI], 1.95–8.23; p = 0.012) and OS (HR, 3.9; 95% CI, 1.84–8.28; p < 0.001). Conclusion CSD is an important predictive and prognostic factor in patients with EGFR-mutated lung adenocarcinoma, and associated smoking-related gene signatures might affect the outcomes. Electronic supplementary material The online version of this article (10.1186/s12885-018-4691-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- In Ae Kim
- Lung Cancer Center, Konkuk University Medical Center, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea.,Department of Pulmonary Medicine, Konkuk University School of Medicine, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea
| | - Jong Sik Lee
- Lung Cancer Center, Konkuk University Medical Center, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea
| | - Hee Joung Kim
- Lung Cancer Center, Konkuk University Medical Center, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea.,Department of Pulmonary Medicine, Konkuk University School of Medicine, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea
| | - Wan Seop Kim
- Lung Cancer Center, Konkuk University Medical Center, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea.,Department of Pathology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kye Young Lee
- Lung Cancer Center, Konkuk University Medical Center, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea. .,Department of Pulmonary Medicine, Konkuk University School of Medicine, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea.
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Takashima Y, Sakakibara-Konishi J, Hatanaka Y, Hatanaka KC, Ohhara Y, Oizumi S, Hida Y, Kaga K, Kinoshita I, Dosaka-Akita H, Matsuno Y, Nishimura M. Clinicopathologic Features and Immune Microenvironment of Non–Small-cell Lung Cancer With Primary Resistance to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors. Clin Lung Cancer 2018; 19:352-359.e1. [DOI: 10.1016/j.cllc.2018.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/02/2018] [Accepted: 02/12/2018] [Indexed: 11/25/2022]
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9
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Zhang P, Nie X, Bie Z, Li L. Impact of heavy smoking on the benefits from first-line EGFR-TKI therapy in patients with advanced lung adenocarcinoma. Medicine (Baltimore) 2018; 97:e0006. [PMID: 29489642 PMCID: PMC5851738 DOI: 10.1097/md.0000000000010006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Smoking is a risk factor for nonsmall cell lung carcinoma (NSCLC) and is associated with a lower response to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI). The purpose of this study is to examine the impact of the smoking status on the benefits from first-line EGFR-TKI in NSCLC patients with EGFR mutation.This was a retrospective study of 159 patients with advanced NSCLC treated at the Beijing Hospital between January 2011 and December 2016. The follow-up was censored on December 2017. EGFR mutation status, smoking (nonsmoker vs <30 packs/year (light smoker) vs ≥30 packs/year (heavy smoker)), treatment, treatment response, and progression-free survival (PFS) were collected from the charts.Median follow-up was 10.0 (1.0-36.6) months. Response rate was lower in heavy smokers compared with nonheavy smokers (19.0% vs 71.7%, P < .001). There was no difference in PFS between nonsmokers (median, 10.5 months) and light smoker (median, 11.0 months), and these 2 groups were pooled together. PFS was longer in nonheavy smokers compared with heavy-smokers (median, 10.7 vs 6.0 months, P < .001). Smoking ≥ 30 packs/year (HR = 2.48, 95% CI: 1.55-3.98, P < .001) was associated with PFS.In patients with advanced NSCLC, the benefits and PFS of EGFR-TKI were better for nonheavy smokers than for heavy smokers.
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Affiliation(s)
| | | | - Zhixin Bie
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Beijing, China
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10
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Vestergaard HH, Christensen MR, Lassen UN. A systematic review of targeted agents for non-small cell lung cancer. Acta Oncol 2018; 57:176-186. [PMID: 29172833 DOI: 10.1080/0284186x.2017.1404634] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND advanced-stage non-small cell lung cancer (NSCLC) is characterized by having limited treatment options and thus a poor prognosis. However, new treatment options, in the form of targeted agents (TA), have emerged during recent years. This systematic review aims to provide an overview of the accessible literature in PubMed evaluating TA used on NSCLC patients, and the resulting survival outcomes. METHOD this systematic literature review was conducted by reviewing all relevant literature in PubMed. Six separate searches were performed: Three searches where controlled entry terms were used and three free text searches. Furthermore, other relevant publications were included manually. A total of seventy-two studies met the search criteria and were thus further analyzed and evaluated. RESULTS In the included studies, various TAs and their effect on different molecular targets have been evaluated. Clinical responses vary considerably among the different genetic aberrations. The majority of studies evaluated TA for epidermal growth factor receptor (EGFR) mutations and TA for echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) rearrangements. Studies regarding the use of TA for Rat sarcoma (RAS), rapidly accelerated fibrosarcoma (RAF), ROS proto-oncogene 1 (ROS1) rearrangement, Receptor tyrosine-protein kinase erbB-2 (ERBB2), Phosphatidylinositol 3-kinase (PIK3CA)/v-akt murine thymoma viral oncogene homolog; protein kinase B(AKT)/Phosphatase and tensin homolog deleted on chromosome 10(PTEN), The mammalian target of rapamycin (mTOR), and Mesenchymal-epithelial transition factor (MET) were included as well. In general, studies comparing treatment outcomes in EGFR-mutated patients and EML4-ALK (ALK) rearranged patients after use of either TA or standard chemotherapy, present significant better results after TA. CONCLUSIONS This systematic review provides an overview of available literature in PubMed regarding NSCLC and TA. Included studies point toward that TA appears to be a promising therapeutic tool in treating NSCLC patients and use of TA is expected to result in improved treatment outcomes.
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Westover D, Zugazagoitia J, Cho BC, Lovly CM, Paz-Ares L. Mechanisms of acquired resistance to first- and second-generation EGFR tyrosine kinase inhibitors. Ann Oncol 2018; 29:i10-i19. [PMID: 29462254 PMCID: PMC6454547 DOI: 10.1093/annonc/mdx703] [Citation(s) in RCA: 447] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients with non-small-cell lung cancer (NSCLC) whose tumours harbour activating mutations within the epidermal growth factor receptor (EGFR) frequently derive significant clinical and radiographic benefits from treatment with EGFR tyrosine kinase inhibitors (TKIs). As such, prospective identification of EGFR mutations is now the standard of care worldwide. However, acquired therapeutic resistance to these agents invariably develops. Over the past 10 years, great strides have been made in defining the molecular mechanisms of EGFR TKI resistance in an effort to design rational strategies to overcome this acquired drug resistance. Approximately 60% of patients with acquired resistance to the EGFR TKIs (erlotinib, gefitinib, and afatinib) develop a new mutation within the drug target. This mutation-T790M-has been shown to alter drug binding and enzymatic activity of the mutant EGF receptor. Less common mechanisms of acquired resistance include MET amplification, ERBB2 amplification, transformation to small-cell lung cancer, and others. Here, we present a condensed overview of the literature on EGFR-mutant NSCLC, paying particular attention to mechanisms of drug resistance, recent clinical trial results, and novel strategies for identifying and confronting drug resistance, while also striving to identify gaps in current knowledge. These advances are rapidly altering the treatment landscape for EGFR-mutant NSCLC, expanding the armamentarium of available therapies to maximize patient benefit.
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Affiliation(s)
- D Westover
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - J Zugazagoitia
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid
- Instituto de Investigación i + 12, Madrid
- Lung Cancer Group, Clinical Research Program, CNIO, Madrid
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
| | - B C Cho
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - C M Lovly
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA
- Department of Cancer Biology
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, USA
| | - L Paz-Ares
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid
- Instituto de Investigación i + 12, Madrid
- Lung Cancer Group, Clinical Research Program, CNIO, Madrid
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
- Complutense University, Madrid, Spain
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12
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Zhang L, Li J, Hu J, Li D, Wang X, Zhang R, Zhang H, Shi M, Chen H. Cigarette smoke extract induces EGFR-TKI resistance via promoting EGFR signaling pathway and ROS generation in NSCLC cell lines. Lung Cancer 2017; 109:109-116. [PMID: 28577939 DOI: 10.1016/j.lungcan.2017.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/10/2017] [Accepted: 05/10/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Epithelial growth factor receptor (EGFR) somatic-mutated non-small cell lung cancer (NSCLC) patients with smoking history always show a poor response to EGFR tyrosine kinase inhibitors (EGFR-TKIs). The aim of the study is to explore the molecular mechanism of EGFR-TKI resistance induced by cigarette smoke extract and investigate the novel anti-resistance strategies. METHODS The effect of cigarette smoke extract (CSE) on gefitinib sensitivity, EGFR signaling, apoptosis and reactive oxygen species (ROS) levels were detected in vitro by MTT assays, western blot, flow cytometry and laser scanning confocal microscope, respectively. RESULTS MTT assays presented that CSE claimed antagonistic effect on gefitinib sensitivity via the up-regulated half maximal inhibitory concentration (IC50) values, western blot showed that CSE instigated EGFR, AKT phosphorylation, while N-Acetyl-l-Cysteine (NAC) could alleviate gefitinib resistance and abort the aberrant phosphorylation in both PC-9 and A549 cells. Confocal microscope and flow cytometry displayed that ROS generation increased after CSE exposure in NSCLC cells and this change could be inhibited by NAC. CONCLUSION Cigarette smoke extract induces EGFR-TKI resistance via promoting EGFR signaling and ROS generation in NSCLC cell lines which could be suppressed by NAC. Alternatively, combined NAC with EGFR-TKIs to treat EGFR mutated NSCLC patients with smoking history may be a potential choice in clinical setting.
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Affiliation(s)
- Lu Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jun Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jing Hu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dandan Li
- Department of Respiratory Medicine, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Xiaohui Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Rui Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hui Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Meng Shi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hong Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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