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Shao ZM, Cai L, Wang S, Hu X, Shen K, Wang H, Li H, Feng J, Liu Q, Cheng J, Wu X, Wang X, Li H, Luo T, Liu J, Amin K, Slimane K, Qiao Y, Liu Y, Tong Z. BOLERO-5: a phase II study of everolimus and exemestane combination in Chinese post-menopausal women with ER + /HER2- advanced breast cancer. Discov Oncol 2024; 15:237. [PMID: 38904918 PMCID: PMC11192707 DOI: 10.1007/s12672-024-01027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The global BOLERO-2 trial established the efficacy and safety of combination everolimus (EVE) and exemestane (EXE) in the treatment of estrogen receptor positive (ER +), HER2-, advanced breast cancer (ABC). BOLERO-5 investigated this combination in a Chinese population (NCT03312738). METHODS BOLERO-5 is a randomized, double-blind, multicenter, placebo controlled, phase II trial comparing EVE (10 mg/day) or placebo (PBO) in combination with EXE (25 mg/day). The primary endpoint was progression-free survival (PFS) per investigator assessment. Secondary endpoints included PFS per blinded independent review committee (BIRC), overall survival (OS), overall response rate (ORR), clinical benefit rate (CBR), pharmacokinetics, and safety. RESULTS A total of 159 patients were randomized to EVE + EXE (n = 80) or PBO + EXE (n = 79). By investigator assessment, treatment with EVE + EXE prolonged median PFS by 5.4 months (HR 0.52; 90% CI 0.38, 0.71), from 2.0 months (PBO + EXE; 90% CI 1.9, 3.6) to 7.4 months (EVE + EXE; 90% CI 5.5, 9.0). Similar results were observed following assessment by BIRC, with median PFS prolonged by 4.3 months. Treatment with EVE + EXE was also associated with improvements in ORR and CBR. No new safety signals were identified in BOLERO-5, with the incidence of adverse events in Chinese patients consistent with the safety profile of both drugs. CONCLUSION The efficacy and safety results of BOLERO-5 validate the findings from BOLERO-2, and further support the use of EVE + EXE in Chinese post-menopausal women with ER + , HER2- ABC. NCT03312738, registered 18 October 2017.
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Affiliation(s)
- Zhi-Ming Shao
- Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Li Cai
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Shusen Wang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xichun Hu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Kunwei Shen
- Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haibo Wang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | | | - Qiang Liu
- Second Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | | | - Xinhong Wu
- Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology and Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan, China
| | | | - Hongyuan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ting Luo
- West China Hospital, Sichuan University, Chengdu, China
| | - Jinping Liu
- Sichuan Provincial People's Hospital, Chengdu, China
| | | | | | - Yongping Qiao
- China Novartis Institutes for BioMedical Research, Beijing, China
| | - Yongmin Liu
- China Novartis Institutes for BioMedical Research, Beijing, China
| | - Zhongsheng Tong
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Shroff GS, Sheshadri A, Altan M, Truong MT, Erasmus LT, Vlahos I. Drug-induced Lung Disease in the Oncology Patient: From Cytotoxic Agents to Immunotherapy. Clin Chest Med 2024; 45:325-337. [PMID: 38816091 DOI: 10.1016/j.ccm.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Drug-induced lung disease is commonly encountered, especially in the oncology setting. Diagnosis is challenging because clinical and radiologic findings are nonspecific, often overlapping with other lung pathologies in these patients due to underlying neoplasia, infection, or other treatment effects such as radiotherapy. Furthermore, oncology patients often receive multiple antineoplastic agents concurrently, and virtually every agent has an association with lung injury. In this article, we will review a variety of antineoplastic agents that are associated with drug-induced injury and discuss incidence, their typical timing of onset, and imaging features.
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Affiliation(s)
- Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA.
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1462, Houston, TX 77030, USA
| | - Mehmet Altan
- Department of Thoracic Head & Neck Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0432, Houston, TX 77030, USA
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Lauren T Erasmus
- McGill University, 845 Sherbrooke Street West, Montreal, Quebec H3A 0G4, Canada
| | - Ioannis Vlahos
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1478, Houston, TX 77030, USA
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Ayuk F, Wagner-Drouet EM, Wolff D, von Huenerbein N, von Pein UM, Klyuchnikov E, von Harsdorf S, Koenecke C, Sayer H, Kröger N. Treatment of newly diagnosed moderate or severe chronic graft-versus-host disease with prednisone and everolimus (PredEver first): a prospective multicenter phase IIA study. Bone Marrow Transplant 2024:10.1038/s41409-024-02289-0. [PMID: 38698080 DOI: 10.1038/s41409-024-02289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
Although most patients with chronic graft-versus-host disease (cGVHD) show initial response to first-line therapy, long-term clinically meaningful success of first-line treatment remains rare. In a prospective multicentre phase II trial in 6 German centers, patients with newly diagnosed moderate or severe cGVHD received prednisone and everolimus for 12 months followed by a 1-year follow-up period. Primary endpoint was treatment success (TS) at 6 months defined as patient being alive, achieving PR or CR of cGVHD, having no relapse of underlying disease and requiring no secondary treatment for cGVHD. Of the 34 patients evaluable for efficacy, 19 (56%) had TS at 6 months with 22 and 52% of the patients in a CR and PR respectively. Overall 30 patients (88%) had a CR or PR as best response, nearly all responses (29/30) occurring within the first 6 weeks of treatment. The cumulative incidence of treatment failure at 1 year was 63%, corresponding to 37% TS. Predefined safety endpoint (thrombotic microangiopathy, pneumonitis, and avascular necrosis) were not observed in any patient. Addition of everolimus to prednisolone is well tolerated and may improve long-term treatment success. Larger studies are necessary to ascertain the possible role of everolimus in first-line treatment of cGVHD.
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Affiliation(s)
- Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Eva-Maria Wagner-Drouet
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center, Mainz, Germany
| | - Daniel Wolff
- Department of Internal Medicine III, Hematology and Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - Natascha von Huenerbein
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ute-Marie von Pein
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evgeny Klyuchnikov
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie von Harsdorf
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
- Department of Medicine, Diakonie Hospital, Stuttgart, Germany
| | - Christian Koenecke
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, MHH, Hanover, Germany
| | - Herbert Sayer
- Department of Internal Medicine II, University Medical Center Jena, Jena, Germany
- Department of Hematology, Oncology and Stem Cell Transplantation, Helios Klinikum Erfurt, University Campus of the Health and Medical University, Potsdam, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Qin Q, Nein E, Flaten A, Zhang T. Toxicity Management of Systemic Kidney Cancer Therapies. Hematol Oncol Clin North Am 2023; 37:993-1003. [PMID: 37353375 DOI: 10.1016/j.hoc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Systemic treatments for metastatic renal cell carcinoma have expanded to include antiangiogenic agents targeting either vascular endothelial growth factor receptor, immune checkpoint inhibitors against cytotoxic T-lymphocyte antigen 4, or programmed cell death 1 pathways, and combinations of these treatments. The hypoxia inducible factor-2 inhibitors are emerging, whereas mammalian target of rapamycin (inhibitors) role is fading. To sustain optimal efficacy of these agents, potential toxicities must be recognized early and clinically managed. Here, the authors discuss the adverse events attributable to these treatments and management strategies.
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Affiliation(s)
- Qian Qin
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8852, USA; Harold C. Simmons Comprehensive Cancer Center
| | - Ellen Nein
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8852, USA
| | - Andrea Flaten
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8852, USA; Harold C. Simmons Comprehensive Cancer Center
| | - Tian Zhang
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8852, USA; Harold C. Simmons Comprehensive Cancer Center.
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Lin AL, Geer EB, Lala N, Page-Wilson G, Magge R, Young RJ, Tabar V. The treatment of aggressive prolactinomas with everolimus. Pituitary 2023; 26:474-481. [PMID: 37428396 PMCID: PMC10765418 DOI: 10.1007/s11102-023-01340-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Aggressive prolactinomas are life-limiting tumors without a standard of care treatment option after the oral alkylator, temozolomide, fails to provide tumor control. METHODS We reviewed an institutional database of pituitary tumors for patients with aggressive prolactinomas who progressed following treatment with a dopamine receptor agonist, radiotherapy and temozolomide. Within this cohort, we identified four patients who were treated with everolimus and we report their response to this therapy. Treatment response was determined by a neuroradiologist, who manually performed volumetric assessment and determined treatment response by Response Assessments in Neuro-Oncology (RANO) criteria. RESULTS Three of four patients who were treated with everolimus had a biochemical response to therapy and all patients derived a clinically meaningful benefit based upon suppression of tumor growth. While the best overall response as assessed by RANO criteria was stable disease for the four patients, a minor regression in tumor size was appreciated in two of the four patients. CONCLUSION Everolimus is an active agent in the treatment of prolactinomas that warrants further investigation.
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Affiliation(s)
- Andrew L Lin
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA.
| | - Eliza B Geer
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nupur Lala
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | | | - Rajiv Magge
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Schmucki K, Hofmann P, Fehr T, Inci I, Kohler M, Schuurmans MM. Mammalian Target of Rapamycin Inhibitors and Kidney Function After Thoracic Transplantation: A Systematic Review and Recommendations for Management of Lung Transplant Recipients. Transplantation 2023; 107:53-73. [PMID: 36508646 PMCID: PMC9746343 DOI: 10.1097/tp.0000000000004336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) after lung transplantation is common and limits the survival of transplant recipients. The calcineurin inhibitors (CNI), cyclosporine A, and tacrolimus being the cornerstone of immunosuppression are key mediators of nephrotoxicity. The mammalian target of rapamycin (mTOR) inhibitors, sirolimus and everolimus, are increasingly used in combination with reduced CNI dosage after lung transplantation. METHODS This systematic review examined the efficacy and safety of mTOR inhibitors after lung transplantation and explored their effect on kidney function. RESULTS mTOR inhibitors are often introduced to preserve kidney function. Several clinical trials have demonstrated improved kidney function and efficacy of mTOR inhibitors. The potential for kidney function improvement and preservation increases with early initiation of mTOR inhibitors and low target levels for both mTOR inhibitors and CNI. No defined stage of CKD for mTOR inhibitor initiation exists, nor does severe CKD preclude the improvement of kidney function under mTOR inhibitors. Baseline proteinuria may negatively predict the preservation and improvement of kidney function. Discontinuation rates of mTOR inhibitors due to adverse effects increase with higher target levels. CONCLUSIONS More evidence is needed to define the optimal immunosuppressive regimen incorporating mTOR inhibitors after lung transplantation. Not only the indication criteria for the introduction of mTOR inhibitors are needed, but also the best timing, target levels, and possibly discontinuation criteria must be defined more clearly. Current evidence supports the notion of nephroprotective potential under certain conditions.
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Affiliation(s)
- Katja Schmucki
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Patrick Hofmann
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Macé M. Schuurmans
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Tseng SC, Lee HY, Nishino M. Imaging of Drug-Related Pneumonitis in Oncology. Semin Respir Crit Care Med 2022; 43:887-898. [PMID: 36307109 DOI: 10.1055/s-0042-1755569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Clinical applications of novel anticancer agents in the past few decades brought marked advances in cancer treatment, enabling remarkable efficacy and effectiveness; however, these novel agents are also associated with toxicities. Among various toxicities, drug-related pneumonitis is one of the major clinical challenges in the management of cancer patients. Imaging plays a key role in detection, diagnosis, and monitoring of drug-related pneumonitis during cancer treatment. In the current era of precision oncology, pneumonitis from molecular targeted therapy and immune-checkpoint inhibitors (ICI) has been recognized as an event of clinical significance. Additionally, further advances of therapeutic approaches in cancer have brought several emerging issues in diagnosis and monitoring of pneumonitis. This article will describe the computed tomography (CT) pattern-based approach for drug-related pneumonitis that has been utilized to describe the imaging manifestations of pneumonitis from novel cancer therapies. Then, we will discuss pneumonitis from representative agents of precision cancer therapy, including mammalian target of rapamycin inhibitors, epidermal growth factor receptor inhibitors, and ICI, focusing on the incidence, risk factors, and the spectrum of CT patterns. Finally, the article will address emerging challenges in the diagnosis and monitoring of pneumonitis, including pneumonitis from combination ICI and radiation therapy and from antibody conjugate therapy, as well as the overlapping imaging features of drug-related pneumonitis and coronavirus disease 2019 pneumonia. The review is designed to provide a practical overview of drug-related pneumonitis from cutting-edge cancer therapy with emphasis on the role of imaging.
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Affiliation(s)
- Shu-Chi Tseng
- Department of Radiology, Brigham and Women's Hospital and Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-Gu, Seoul, Korea
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
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Sato Y, Sumikawa H, Shibaki R, Morimoto T, Sakata Y, Oya Y, Tamiya M, Suzuki H, Matsumoto H, Yokoi T, Hashimoto K, Kobe H, Hino A, Inaba M, Tsukita Y, Ikeda H, Arai D, Maruyama H, Hara S, Tsumura S, Sakata S, Fujimoto D. Drug-Related Pneumonitis Induced by Osimertinib as First-Line Treatment for Epidermal Growth Factor Receptor Mutation-Positive Non-Small Cell Lung Cancer. Chest 2022; 162:1188-1198. [DOI: 10.1016/j.chest.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/17/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
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Gendarme S, Pastré J, Billaud EM, Gibault L, Guillemain R, Oudard S, Medioni J, Lillo-Lelouet A, Israël-Biet D. Pulmonary toxicity of mTOR inhibitors. Comparisons of two populations: Solid organ recipients and cancer patients. Therapie 2022; 78:267-278. [DOI: 10.1016/j.therap.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/14/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
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Pulmonary Lymphangitis Poses a Major Challenge for Radiologists in an Oncological Setting during the COVID-19 Pandemic. J Pers Med 2022; 12:jpm12040624. [PMID: 35455740 PMCID: PMC9024504 DOI: 10.3390/jpm12040624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/17/2022] Open
Abstract
Due to the increasing number of COVID-19-infected and vaccinated individuals, radiologists continue to see patients with COVID-19 pneumonitis and recall pneumonitis, which could result in additional workups and false-positive results. Moreover, cancer patients undergoing immunotherapy may show therapy-related pneumonitis during imaging management. This is otherwise known as immune checkpoint inhibitor-related pneumonitis. Following on from this background, radiologists should seek to know their patients’ COVID-19 infection and vaccination history. Knowing the imaging features related to COVID-19 infection and vaccination is critical to avoiding misleading results and alarmism in patients and clinicians.
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Busutti M, Cingolani A, Natali F, Mattiotti M, Grandinetti V, Baraldi O, Comai G, Candoli P, La Manna G. Everolimus-associated alveolar hemorrage relapse after drug discontinuation in a kidney transplant recipient. J Nephrol 2022; 35:1275-1278. [PMID: 35286598 PMCID: PMC8919162 DOI: 10.1007/s40620-022-01298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/26/2022] [Indexed: 11/01/2022]
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12
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Yamamoto K, Ioroi T, Shinomiya K, Yoshida A, Harada K, Fujisawa M, Omura T, Ikemi Y, Nakagawa S, Yonezawa A, Ogawa O, Matsubara K, Iwamoto T, Nishikawa K, Hayashi S, Tohara D, Murakami Y, Motoshima T, Jono H, Yano I. STAT3 polymorphism associates with mTOR inhibitor-induced interstitial lung disease in patients with renal cell carcinoma. Oncol Res 2022; 29:11-23. [PMID: 35016744 PMCID: PMC9110706 DOI: 10.3727/096504022x16418911579334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We evaluated the association of signal transducer and activator of transcription 3 (STAT3) polymorphisms with the incidence of mammalian target of rapamycin (mTOR) inhibitor-induced interstitial lung disease (ILD) in patients with renal cell carcinoma (RCC). We also used lung-derived cell lines to investigate the mechanisms of this association. Japanese patients with metastatic RCC who were treated with mTOR inhibitors were genotyped for the STAT3 polymorphism, rs4796793 (−1697C/G). We evaluated the association of the STAT3 genotype with the incidence of ILD and therapeutic outcome. In the 57 patients included in the primary analysis, the ILD rate within 140 days was significantly higher in patients with the GG genotype compared with those with other genotypes (77.8% vs. 23.1%, odds ratio = 11.67, 95% confidential interval = 3.06–44.46). There were no significant differences in progression-free survival or time-to-treatment failure between the patients with the GG genotype and those with other genotypes. An in vitro study demonstrated that some lung-derived cell lines carrying the GG genotype exhibited an increase in the expression of mesenchymal markers, such as fibronectin, N-cadherin, and vimentin, and decreases in E-cadherin, which is an epithelial marker associated with exposure to everolimus, although STAT3 expression and activity were not related to the genotype. In conclusion, the GG genotype of the STAT3 rs4796793 polymorphism increases the risk of mTOR inhibitor-induced ILD, supporting its use as a predictive marker for RCC.
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Pezzicoli G, Filoni E, Gernone A, Cosmai L, Rizzo M, Porta C. Playing the Devil's Advocate: Should We Give a Second Chance to mTOR Inhibition in Renal Clear Cell Carcinoma? - ie Strategies to Revert Resistance to mTOR Inhibitors. Cancer Manag Res 2021; 13:7623-7636. [PMID: 34675658 PMCID: PMC8500499 DOI: 10.2147/cmar.s267220] [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] [Received: 08/11/2021] [Accepted: 09/24/2021] [Indexed: 01/10/2023] Open
Abstract
In the last decade, the inhibition of the mechanistic target of Rapamycin (mTOR) in renal clear cell carcinoma (RCC) has disappointed the clinician's expectations. Many clinical trials highlighted the low efficacy and unmanageable safety profile of first-generation mTOR inhibitors (Rapalogs), thus limiting their use in the clinical practice only to those patients who already failed several therapy lines. In this review, we analyze the major resistance mechanisms that undermine the efficacy of this class of drugs. Moreover, we describe some of the possible strategies to overcome the mechanisms of resistance and their clinical experimentation, with particular focus on novel mTOR inhibitors and the combinations of mTOR inhibitors and other anti-cancer drugs.
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Affiliation(s)
- Gaetano Pezzicoli
- Department of Biomedical Sciences and Human Oncology, Post-Graduate School of Specialization in Medical Oncology, University of Bari 'A. Moro', Bari, Italy.,Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Elisabetta Filoni
- Department of Biomedical Sciences and Human Oncology, Post-Graduate School of Specialization in Medical Oncology, University of Bari 'A. Moro', Bari, Italy.,Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Angela Gernone
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Laura Cosmai
- Onconephrology Outpatient Clinic, Division of Nephrology and Dialysis, A.S.S.T. Fatebenefratelli-Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Mimma Rizzo
- Division of Translational Oncology, I.R.C.C.S. Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Camillo Porta
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy.,Chair of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy
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14
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Petrache I, de Boer E. Rapalogs Target the Endothelium to Set the Stage for Acute Lung Injury. Am J Respir Cell Mol Biol 2021; 65:576-577. [PMID: 34618662 PMCID: PMC8641797 DOI: 10.1165/rcmb.2021-0250ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Irina Petrache
- Department of Medicine National Jewish Health Denver, Colorado.,Department of Medicine University of Colorado Denver, Colorado
| | - Esther de Boer
- Department of Medicine University of Colorado Denver, Colorado
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Nakamura Y, Takimoto T, Kobayashi T, Tachibana K, Kasai T, Akira M, Arai T, Inoue Y. Drug-related pneumonitis with radiographic hypersensitivity pneumonitis pattern: Three case series. Respir Med Case Rep 2021; 34:101498. [PMID: 34471597 PMCID: PMC8390688 DOI: 10.1016/j.rmcr.2021.101498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/12/2021] [Accepted: 08/16/2021] [Indexed: 12/17/2022] Open
Abstract
Novel therapies have recently emerged for various diseases, and the management of drug-related pneumonitis (DRP) has become increasingly important. In particular, the hypersensitivity pneumonitis (HP) pattern of DRP has been increasingly recognized due to development of new therapeutic strategies, such as immunotherapy. However, literature describing detailed clinical cases is still lacking. Herein, we report three cases of DRP with typical HP radiographic pattern. These patients were treated with different drugs, namely nano albumin-bound (nab)-paclitaxel, everolimus, or nivolumab, but had common clinical features, including a good prognosis.
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Affiliation(s)
- Yukihiro Nakamura
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Takayuki Takimoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
- Corresponding author.
| | - Takehiko Kobayashi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Kazunobu Tachibana
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Takahiko Kasai
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Masanobu Akira
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Toru Arai
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
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17
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Kleinloog D, Maas J, Lopez Matta J, Elzo Kraemer C. Favourable outcome after prolonged veno-venous extracorporeal membrane oxygenation (V-V ECMO) support for Pneumocystis jirovecii pneumonia in a renal transplant recipient. BMJ Case Rep 2021; 14:14/4/e240004. [PMID: 33795271 DOI: 10.1136/bcr-2020-240004] [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: 11/04/2022] Open
Abstract
A 27-year-old man, with a history of renal transplantation, presented with acute kidney failure and Pneumocystis jirovecii pneumonia. The patient developed severe acute respiratory failure and required support by veno-venous extracorporeal membrane oxygenation for a total of 59 days. During this period, the patient had extremely low tidal volumes using a lung protective ventilation strategy and intermittent prone positioning was used to optimise oxygenation. There was full recovery of pulmonary and partial recovery of renal function.
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Affiliation(s)
- Daniel Kleinloog
- Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacinta Maas
- Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jorge Lopez Matta
- Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Carlos Elzo Kraemer
- Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
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18
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Lanfranco J, Holt A, Montague A, Oza TH, Elballat M, Romero-Legro IH. Everolimus induced organizing pneumonia in a patient with tuberous sclerosis complex. Respir Med Case Rep 2021; 32:101347. [PMID: 33598397 PMCID: PMC7868714 DOI: 10.1016/j.rmcr.2021.101347] [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: 08/25/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022] Open
Abstract
Organizing pneumonia is characterized by a distinct histologic pattern in the lung interstitium and presents clinically as hypoxemia, fever, cough, and dyspnea that is not attributable to concurrent infection. Typical etiologies of this condition include inflammatory disease, malignancy, toxic inhalation, and an array of medications including the mTOR inhibitor everolimus. In this report, we describe the case of a female with tuberous sclerosis complex on everolimus therapy for renal angiomyolipomas who presented to the hospital with persistent cough, dyspnea, and fevers and bilateral lower lobe opacities on chest X-ray despite multiple courses of antibiotic therapy. Bronchoscopy was performed with transbronchial biopsies, and results demonstrated a lymphocytic predominance and pathologic findings of intraluminal plugs composed of fibroblasts and myofibroblasts consistent with organizing pneumonia. Everolimus therapy was discontinued and patient completed a steroid course with resolution of symptoms. To our knowledge, this is the first published case of organizing pneumonia secondary to everolimus in a patient with tuberous sclerosis complex.
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Affiliation(s)
| | - Andrew Holt
- University of Tennessee Health Science Center, USA
| | | | - Twisha H Oza
- University of Tennessee Health Science Center, USA
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19
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Johkoh T, Lee KS, Nishino M, Travis WD, Ryu JH, Lee HY, Ryerson CJ, Franquet T, Bankier AA, Brown KK, Goo JM, Kauczor HU, Lynch DA, Nicholson AG, Richeldi L, Schaefer-Prokop CM, Verschakelen J, Raoof S, Rubin GD, Powell C, Inoue Y, Hatabu H. Chest CT Diagnosis and Clinical Management of Drug-related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper from the Fleischner Society. Radiology 2021; 298:550-566. [PMID: 33434111 DOI: 10.1148/radiol.2021203427] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Use of molecular targeting agents and immune checkpoint inhibitors (ICIs) has increased the frequency and broadened the spectrum of lung toxicity, particularly in patients with cancer. The diagnosis of drug-related pneumonitis (DRP) is usually achieved by excluding other potential known causes. Awareness of the incidence and risk factors for DRP is becoming increasingly important. The severity of symptoms associated with DRP may range from mild or none to life-threatening with rapid progression to death. Imaging features of DRP should be assessed in consideration of the distribution of lung parenchymal abnormalities (radiologic pattern approach). The CT patterns reflect acute (diffuse alveolar damage) interstitial pneumonia and transient (simple pulmonary eosinophilia) lung abnormality, subacute interstitial disease (organizing pneumonia and hypersensitivity pneumonitis), and chronic interstitial disease (nonspecific interstitial pneumonia). A single drug can be associated with multiple radiologic patterns. Treatment of a patient suspected of having DRP generally consists of drug discontinuation, immunosuppressive therapy, or both, along with supportive measures eventually including supplemental oxygen and intensive care. In this position paper, the authors provide diagnostic criteria and management recommendations for DRP that should be of interest to radiologists, clinicians, clinical trialists, and trial sponsors, among others. This article is a simultaneous joint publication in Radiology and CHEST. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Takeshi Johkoh
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Kyung Soo Lee
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Mizuki Nishino
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - William D Travis
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Jay H Ryu
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Ho Yun Lee
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Christopher J Ryerson
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Tomás Franquet
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Alexander A Bankier
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Kevin K Brown
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Jin Mo Goo
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Hans-Ulrich Kauczor
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - David A Lynch
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Andrew G Nicholson
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Luca Richeldi
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Cornelia M Schaefer-Prokop
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Johny Verschakelen
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Suhail Raoof
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Geoffrey D Rubin
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Charles Powell
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Yoshikazu Inoue
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
| | - Hiroto Hatabu
- From the Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Radiology, Samsung Medical Center (K.S.L., H.Y.L.) and Department of Health Sciences and Technology, SAIHST (H.Y.L.), Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea; Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (M.N.); Department of Radiology (M.N.) and Center for Pulmonary Functional Imaging (H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn (J.H.R.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain (T.F.); Department of Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.A.B.); Departments of Medicine (K.K.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England (A.G.N.); Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy (L.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, University Hospitals Leuven, Leuven, Belgium (J.V.); Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY (S.R.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (C.P.); and Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan (Y.I.)
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20
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Johkoh T, Lee KS, Nishino M, Travis WD, Ryu JH, Lee HY, Ryerson CJ, Franquet T, Bankier AA, Brown KK, Goo JM, Kauczor HU, Lynch DA, Nicholson AG, Richeldi L, Schaefer-Prokop CM, Verschakelen J, Raoof S, Rubin GD, Powell C, Inoue Y, Hatabu H. Chest CT Diagnosis and Clinical Management of Drug-Related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper From the Fleischner Society. Chest 2021; 159:1107-1125. [PMID: 33450293 DOI: 10.1016/j.chest.2020.11.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022] Open
Abstract
Use of molecular targeting agents and immune checkpoint inhibitors (ICIs) has increased the frequency and broadened the spectrum of lung toxicity, particularly in patients with cancer. The diagnosis of drug-related pneumonitis (DRP) is usually achieved by excluding other potential known causes. Awareness of the incidence and risk factors for DRP is becoming increasingly important. The severity of symptoms associated with DRP may range from mild or none to life-threatening with rapid progression to death. Imaging features of DRP should be assessed in consideration of the distribution of lung parenchymal abnormalities (radiologic pattern approach). The CT patterns reflect acute (diffuse alveolar damage) interstitial pneumonia and transient (simple pulmonary eosinophilia) lung abnormality, subacute interstitial disease (organizing pneumonia and hypersensitivity pneumonitis), and chronic interstitial disease (nonspecific interstitial pneumonia). A single drug can be associated with multiple radiologic patterns. Treatment of a patient suspected of having DRP generally consists of drug discontinuation, immunosuppressive therapy, or both, along with supportive measures eventually including supplemental oxygen and intensive care. In this position paper, the authors provide diagnostic criteria and management recommendations for DRP that should be of interest to radiologists, clinicians, clinical trialists, and trial sponsors, among others.
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Affiliation(s)
- Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, SAIHST, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Mizuki Nishino
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Ho Yun Lee
- Department of Radiology, Samsung Medical Center, SAIHST, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Tomás Franquet
- Department of Radiology, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexander A Bankier
- Department of Radiology, University of Massachusetts Medical Center, Worcester, MA
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England
| | - Luca Richeldi
- Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Suhail Raoof
- Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health System, New York, NY
| | - Geoffrey D Rubin
- Department of Radiology, Duke University School of Medicine, Durham, NC
| | - Charles Powell
- Department of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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21
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Gong C, Xiao Q, Li Y, Gu Y, Zhang J, Wang L, Cao J, Tao Z, Zhao Y, Xie Y, Hu X, Wang B. Everolimus-Related Pneumonitis in Patients with Metastatic Breast Cancer: Incidence, Radiographic Patterns, and Relevance to Clinical Outcome. Oncologist 2020; 26:e580-e587. [PMID: 33191524 DOI: 10.1002/onco.13594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/22/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This study investigated the incidence, radiographic patterns, and relevance to clinical outcome of everolimus-related pneumonitis (ERP) in patients with metastatic breast cancer (MBC). MATERIALS AND METHODS Data of patients with MBC treated with everolimus who had baseline and at least one follow-up chest computed tomography (CT) were obtained from a medical electronic database system. An independent review of the CT scans of these patients was conducted by two radiologists (NCT03730428). Log-rank and Cox proportional hazard regression analyses were used for time-to-event analyses. RESULTS ERP was radiographically detected in 45 of 86 patients (52.3%). In more than 80% of these patients, ERP occurred during the first 4 months of everolimus treatment. Only 14 of the 45 patients with ERP were symptomatic (31.1%). Symptoms included cough, fever, and shortness of breath. Bilateral and lower distribution of the pneumonitis was most common. In most of the cases, ground-glass opacities and reticular opacities were noticed. Elderly patients were more likely to develop ERP. Patients with ERP had significantly longer progression-free survival (PFS; 6.8 vs. 4.1 months, p = .024) and overall survival (OS; 42.8 vs. 21.3 months, p = .016). ERP was a predictor of OS improvement confirmed by multivariate Cox analysis (hazard ratio, 0.49; 95% confidence interval, 0.25-0.97; p = .040). CONCLUSIONS ERP was noted in half of the patients with MBC treated with everolimus. Our data suggested that ERP was associated with improved prognosis and may be used as a biomarker for the efficacy of everolimus in MBC. Close monitoring, prompt diagnosis, and proper treatment for ERP are essential to maintain the quality of life of patients and achieve maximum treatment benefits. IMPLICATIONS FOR PRACTICE Everolimus-related pneumonitis (ERP) is one of the most worrying drug adverse events, especially in Asian patients. However, little has been known about the clinical and radiographic details of ERP in patients with metastatic breast cancers (MBCs) treated with everolimus. The present study investigated the clinical characteristics, radiographic patterns, and its correlation with treatment outcome in patients with MBC. ERP was identified in more than half of patients with MBC during everolimus therapy and was associated with improved outcome. Close monitoring and prompt diagnosis and appropriate treatment for ERP are critical for the preservation of patients' quality of life and achievement of maximal treatment benefits.
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Affiliation(s)
- Chengcheng Gong
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Qin Xiao
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yi Li
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Jian Zhang
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Leiping Wang
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Jun Cao
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Zhonghua Tao
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yannan Zhao
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yizhao Xie
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Xichun Hu
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Biyun Wang
- Departments of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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Waxing and waning pattern of mTOR inhibitor-associated pneumonitis in renal cell carcinoma patients: A retrospective observational study. Clin Imaging 2020; 71:29-33. [PMID: 33171363 DOI: 10.1016/j.clinimag.2020.10.052] [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: 03/04/2020] [Revised: 10/12/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE mTOR inhibitor-associated pneumonitis is common and often asymptomatic. We describe a waxing and waning pattern of pneumonitis observed on computed tomography (CT) scans of patients with renal cell carcinoma who were being treated with mTOR inhibitor molecular targeted therapy. MATERIALS AND METHODS In this HIPAA-compliant, IRB-approved retrospective single-institution study, 25 renal cell carcinoma patients were identified who received single-therapy temsirolimus or everolimus between January 2011 and June 2015 and who had chest CT scans available for review both before and after initiation of mTOR inhibitor treatment. A detailed review of the electronic medical record and serial chest CT examinations was performed. RESULTS Radiologic findings compatible with pneumonitis were identified in 13/25 (52%) patients on mTOR inhibitors in our study. Of the patients with CT findings of pneumonitis, 8/13 (62%) demonstrated a waxing and waning pattern; of whom 7 had clinical symptoms of pneumonitis. Of the 17 patients who received temsirolimus, 9/17 (53%) developed radiologic findings compatible with pneumonitis and 4/9 (44%) developed a waxing and waning pattern. Of the 8 patients who received everolimus, 4/8 (50%) had radiologic findings compatible with pneumonitis and 4/4 (100%) developed a waxing and waning pattern. CONCLUSION Waxing and waning is an unrecognized pattern of mTOR inhibitor-associated pneumonitis. Recognition of this pattern will promote clinical-radiologic concordance and may facilitate patient management.
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23
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Gomes ESR, Marques ML, Regateiro FS. Epidemiology and Risk Factors for Severe Delayed Drug Hypersensitivity Reactions. Curr Pharm Des 2020; 25:3799-3812. [PMID: 31694518 DOI: 10.2174/1381612825666191105115346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
Severe delayed drug hypersensitivity reactions comprise different clinical entities and can involve different immune-mediated mechanisms. Common examples are severe cutaneous adverse reactions and druginduced internal organ injuries. The incidence of such reactions is overall low but seems to be on the rise reaching numbers as high as 9 per million individuals-years in the case of SJS/TEN and DRESS. Such conditions carry an important associated morbidity, and mortality can attain 40% in SJS/TEN patients, making these hypersensitivity reactions important targets when implementing preventive measures. Several risk factors have been identified for reaction severity; some are transverse, such as older age and underlying chronic diseases. The recent advances in pharmacogenetics allowed the identification of specific populations with higher risk and permitted strategic avoidance of certain drugs being HLA-B*57:01 screening in patients initiating abacavir the best successful example. In this work, we reviewed the epidemiology of SCARs and liver/kidney/lung drug-induced immune-mediated reactions. We focus on particular aspects such as prevalence and incidence, drugs involved, mortality and risk factors.
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Affiliation(s)
- Eva S R Gomes
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitario do Porto, Porto, Portugal
| | - Maria L Marques
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitario do Porto, Porto, Portugal
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Reseach (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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24
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Afani L, Belbaraka R, Awada A. Tolérance de l’évérolimus en pratique clinique: étude retrospective. Pan Afr Med J 2020; 36:26. [PMID: 32774603 PMCID: PMC7388605 DOI: 10.11604/pamj.2020.36.26.16580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 04/05/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Leila Afani
- Department of Medical Oncology, CHU Mohamed VI, Marrakech, Morrocco
| | | | - Ahmad Awada
- Oncology Department, Jules Bordet Institute, Brussels, Belgium
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25
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Anaev EK. [Drug-induced interstitial lung disease: approaches to diagnostics and treatment]. TERAPEVT ARKH 2020; 92:84-91. [PMID: 32598798 DOI: 10.26442/00403660.2020.03.000399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 01/15/2023]
Abstract
Drug-induced interstitial lung disease (D-ILD) can be caused by various drugs, including antibiotics, amiodarone, antitumor, rheumatological and non-steroidal anti-inflammatory drugs. D-ILD includes hypersensitivity reactions, organizing and non-specific interstitial pneumonia, eosinophilic lung diseases, diffuse alveolar damage and alveolar hypoventilation. To exclude other causes of pulmonary diseases, an assessment of the medical history, physical data and examination results, which may include chest X-ray/multispiral computed tomography (MSCT), lung function tests, and bronchoscopy with bronchoalveolar lavage, are necessary. Diagnosis of D-ILD is difficult due to the heterogeneity of clinical, radiological and histological data. The X-ray pathological phenotype of D-ILD is different; a specific MSCT pattern has not been identified. Treatment includes drug withdrawal and, in some cases, glucocorticoid therapy, although there are no prospective studies on their effect on the outcome of the disease. This article provides various drugs that cause ILD, approaches to their diagnosis and treatment.
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Affiliation(s)
- E K Anaev
- Pirogov Russian National Research Medical University
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26
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McHugh DJ, Chudow J, DeNunzio M, Slovin SF, Danila DC, Morris MJ, Scher HI, Rathkopf DE. A Phase I Trial of IGF-1R Inhibitor Cixutumumab and mTOR Inhibitor Temsirolimus in Metastatic Castration-resistant Prostate Cancer. Clin Genitourin Cancer 2020; 18:171-178.e2. [PMID: 32057715 DOI: 10.1016/j.clgc.2019.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/07/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite frequent PTEN (phosphatase and tensin homologue) loss and Akt/mammalian target of rapamycin (mTOR) signaling in prostate cancer, the disease is insensitive to single-agent mTOR inhibition. Insulin-like growth factor-1 receptor inhibition might mitigate the feedback inhibition by Torc1 inhibitors, suppressing downstream Akt activation and, thus, potentiating the antitumor activity of mTOR inhibition. PATIENTS AND METHODS In the present phase I study, patients with metastatic castration-resistant prostate cancer received 6 mg/kg cixutumumab and 25 mg temsirolimus intravenously each week. The primary objective was safety and tolerability. Temsirolimus was decreased if ≥ 2 dose-limiting toxicities (DLTs) were observed in 6 patients. The correlative analyses included measurement of circulating tumor cells, [18F]-fluoro-2-deoxyglucose positron emission tomography, 16β-[18F]-fluoro-α-dihydrotestosterone positron emission tomography, and tumor biopsy. RESULTS A total of 16 patients were enrolled across 3 cohorts (1, -1, -2). Two DLTs (grade 3 oral mucositis) were observed in cohort 1 (temsirolimus, 25 mg), and 1 DLT (grade 3 lipase) in cohort -1 (temsirolimus, 20 mg). The most common adverse events included hyperglycemia (100%; 31% grade 3), oral mucositis (63%; 19% grade 3), and diarrhea (44%; 0 grade 3). Low-grade pneumonitis occurred in 7 of 11 patients (44%; 0 grade 3), prompting the opening of a 3-weekly cohort (temsirolimus, 20 mg/kg), without pneumonitis events. No patient had a >50% decline in prostate-specific antigen from baseline. The best radiographic response was stable disease, with median study duration of 22 weeks (range, 7-63 weeks). CONCLUSIONS Despite a strong scientific rationale for the combination, temsirolimus plus cixutumumab demonstrated limited antitumor activity and a greater than expected incidence of toxicity, including low-grade pneumonitis and hyperglycemia. Hence, the trial was stopped in favor of alternative androgen receptor/phosphatidylinositol 3-kinase-directed combinatorial therapies.
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Affiliation(s)
- Deaglan J McHugh
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Jay Chudow
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mia DeNunzio
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Susan F Slovin
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Daniel C Danila
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Michael J Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Dana E Rathkopf
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY.
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A Fatal Case of Life-Threatening Interstitial Pneumonitis Induced by Everolimus for Metastatic Renal Cell Carcinoma: A Comment about the Increased Risk of Interstitial Lung Disease in Japanese. Case Rep Urol 2019; 2019:2703871. [PMID: 30838154 PMCID: PMC6374873 DOI: 10.1155/2019/2703871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
We describe an 81-year-old woman with metastatic renal cell carcinoma who did not recover from life-threatening interstitial pneumonitis induced by everolimus therapy. She received everolimus due to disease progression after sunitinib, but 2 months after starting everolimus treatment, she visited the emergency department after developing a sudden fever and dyspnea. Chest CT revealed diffuse ground-glass opacities, thickening of the interlobular septa, and consolidation throughout both lung fields. The diagnosis was surmised to be everolimus-induced interstitial pneumonitis. Everolimus administration was stopped and 3 courses of steroid pulse therapy were administered, along with intensive care, but the patient died due to rapid respiratory failure.
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Refractory Metastatic Insulinoma Treated with Everolimus, Complicated by Cryptogenic Organizing Pneumonia. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2019; 7:125-132. [PMID: 31414042 PMCID: PMC6693857 DOI: 10.12691/ajmcr-7-7-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Insulinoma is a rare neuroendocrine pancreatic islet cell tumor of which the majority are benign and solitary. Its estimated incidence is 2 to 4 cases per 1 million person-years. We report the case of an 82-year-old female who presented with metastatic insulinoma to the liver and retroperitoneal lymph nodes. It was diagnosed based on positive Whipple's triad, elevated insulin, elevated C-peptide, and negative insulin auto-antibody. Her disease was initially managed with diazoxide 100 mg orally every 8 hours, octreotide LAR 30 mg intramuscularly every month, and sunitinib 12.5 mg orally three times a day. However, patient had recurrent symptoms and imaging consistent with worsened metastatic insulinoma; and thus, treatment was changed to everolimus 10 mg PO daily. Over the subsequent 10 months, the patient developed progressive shortness of breath and hypoxemia with and oxygen saturation (SpO2) of 89% on room air. Computerized tomography (CT) and lung biopsy were consistent with cryptogenic organizing pneumonia (COP) temporally associated with the initiation of everolimus. She was started on prednisone 1 mg/kg/day and within 48 hours, her symptoms and hypoxemia improved to SpO2 of 98-99% at room air and her repeat CT chest showed marked disease improvement. Given her good response with everolimus, it was continued in conjunction with the prednisone and to this day, patient has had a significant therapeutic response with normoglycemia and stable, well-controlled symptoms. This case is unique because to our knowledge, it is the first reported case of a patient with metastatic insulinoma complicated by the development of cryptogenic organizing pneumonia. It reaffirms the causal association between everolimus and cryptogenic organizing pneumonia that has been reported numerous times in literature. However, there has been no reported cases showing that the COP can be managed with prednisone concurrently with everolimus for the metastatic insulinoma without diminished clinical benefit. While pulmonary complications have been cited as reasons for discontinuation of everolimus therapy, our case report highlights the use of steroids as a viable therapeutic strategy that allows successful therapy with everolimus to be continued. In addition to presenting this case, we will also do a thorough review of the literature surrounding the available therapeutic options of metastatic insulinoma. This will include surgery, somatostatin analogs, antimicrobials, potassium channel activators, VEGF-A inhibitors, alkylating agents and mTOR inhibitors to provide a more in-depth picture of how we treat metastatic insulinoma.
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Respiratory Tract Diseases That May Be Mistaken for Infection. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7119916 DOI: 10.1007/978-1-4939-9034-4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Skeoch S, Weatherley N, Swift AJ, Oldroyd A, Johns C, Hayton C, Giollo A, Wild JM, Waterton JC, Buch M, Linton K, Bruce IN, Leonard C, Bianchi S, Chaudhuri N. Drug-Induced Interstitial Lung Disease: A Systematic Review. J Clin Med 2018; 7:jcm7100356. [PMID: 30326612 PMCID: PMC6209877 DOI: 10.3390/jcm7100356] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023] Open
Abstract
Background: Drug-induced interstitial lung disease (DIILD) occurs as a result of numerous agents, but the risk often only becomes apparent after the marketing authorisation of such agents. Methods: In this PRISMA-compliant systematic review, we aimed to evaluate and synthesise the current literature on DIILD. Results: Following a quality assessment, 156 full-text papers describing more than 6000 DIILD cases were included in the review. However, the majority of the papers were of low or very low quality in relation to the review question (78%). Thus, it was not possible to perform a meta-analysis, and descriptive review was undertaken instead. DIILD incidence rates varied between 4.1 and 12.4 cases/million/year. DIILD accounted for 3–5% of prevalent ILD cases. Cancer drugs, followed by rheumatology drugs, amiodarone and antibiotics, were the most common causes of DIILD. The radiopathological phenotype of DIILD varied between and within agents, and no typical radiological pattern specific to DIILD was identified. Mortality rates of over 50% were reported in some studies. Severity at presentation was the most reliable predictor of mortality. Glucocorticoids (GCs) were commonly used to treat DIILD, but no prospective studies examined their effect on outcome. Conclusions: Overall high-quality evidence in DIILD is lacking, and the current review will inform larger prospective studies to investigate the diagnosis and management of DIILD.
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Affiliation(s)
- Sarah Skeoch
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 1RL, UK.
| | - Nicholas Weatherley
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK.
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK.
| | - Alexander Oldroyd
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
| | - Christopher Johns
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK.
| | - Conal Hayton
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK.
| | - Alessandro Giollo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds LS2 9JT, UK.
- Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy.
| | - James M Wild
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK.
| | - John C Waterton
- Bioxydyn Limited, Rutherford House, Manchester Science Park, Manchester M15 6SZ, UK.
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
| | - Maya Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds LS2 9JT, UK.
| | - Kim Linton
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
- The Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK.
| | - Colm Leonard
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK.
| | - Stephen Bianchi
- Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK.
| | - Nazia Chaudhuri
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK.
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Dejust S, Morland D, Bruna-Muraille C, Eymard JC, Yazbek G, Savoye AM, Papathanassiou D. Everolimus-induced pulmonary toxicity: Findings on 18F-FDG PET/CT imaging. Medicine (Baltimore) 2018; 97:e12518. [PMID: 30290608 PMCID: PMC6200531 DOI: 10.1097/md.0000000000012518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The everolimus-exemestane combination is indicated in advanced breast cancer treatment and usually well tolerated. The objective of the study was to determine the frequency of everolimus lung side effects and investigate their imaging characteristics on positron emission tomography with 18F-fluoro-deoxy-glucose combined with computerized tomography (F-FDG PET/CT).Our single-center retrospective descriptive study systematically included all patients with metastatic breast cancer treated by this combination (n = 29 representing 57 F-FDG PET/CT). Number of segments involved was quantified. Maximum standardized uptake value (SUVmax), average standardized uptake value (SUVmean), metabolic target volume (MTV), and total lesion glycolysis (TLG) were measured. Severe pneumopathy was studied by subgroup analysis.Pleuroparenchymal anomalies rate detected on F-FDG PET/CT was 62%. Alveolar-interstitial lesions were mainly observed (89%) and affected 2.8 segments (0.5-11.5) with a median of 2 segments. S7 and S10 were the most involved segments with SUVmax 3.9 (1.3-8.8) and SUVmean 2.2 (0.7-4.9). Statistically significant difference (P = .02) was found with number of segment involved to characterize severe pneumopathy (average of 6.3 segments [2.5-11.5] vs 1.9 segments [0.5-8] for interstitial lung disease) but not with SUVmax, SUVmean, MTV, TLG (P = .14, 0.22, 0.22, and 0.17, respectively).The F-FDG PET/CT could highlight pulmonary everolimus side effects, with a typical imaging pattern: alveolar-interstitial opacities associated with moderate uptake, more or less extensive, mainly affecting the lower lobes. Rarely, a pseudotumoral aspect may be detected, corresponding to a pitfall. MTV or TLG showed a tendency to differentiate severe pneumopathy vs interstitial lung disease but no statistically significant differences was observed contrarily to the number of segments involved. Further studies are necessary to determine if the F-FDG PET/CT could early predict adverse effects of mTOR inhibitors.
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Affiliation(s)
| | - David Morland
- Department of Nuclear Medicine, Jean Godinot Institut
- Laboratory of Biophysics, University of Reims
| | | | | | | | | | - Dimitri Papathanassiou
- Department of Nuclear Medicine, Jean Godinot Institut
- Laboratory of Biophysics, University of Reims
- Research Center in Information and Communication Sciences and Technologies, EA 3804, University of Reims, Reims, France
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Lertjanyakun V, Chaiyakunapruk N, Kunisawa S, Imanaka Y. Cost-Effectiveness of Second-Line Endocrine Therapies in Postmenopausal Women with Hormone Receptor-positive and Human Epidermal Growth Factor Receptor 2-negative Metastatic Breast Cancer in Japan. PHARMACOECONOMICS 2018; 36:1113-1124. [PMID: 29707743 DOI: 10.1007/s40273-018-0660-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Exemestane (EXE), exemestane + everolimus (EXE + EVE), toremifene (TOR), and fulvestrant (FUL) are second-line endocrine therapies for postmenopausal hormone receptor-positive (HR +)/human epidermal growth factor receptor 2-negative (HER2 -) metastatic breast cancer (mBC) in Japan. Although the efficacy of these therapies has been shown in recent studies, cost-effectiveness has not yet been determined in Japan. OBJECTIVE This study aimed to examine the cost-effectiveness of second-line endocrine therapies for the treatment of postmenopausal women with HR + and HER2 - mBC. METHODS A Markov model was developed to analyze the cost-effectiveness of the therapies over a 15-year time horizon from a public healthcare payer's perspective. The efficacy and utility parameters were determined via a systematic search of the literature. Direct medical care costs were used. A discount rate of 2% was applied for costs and outcomes. Subgroup analysis was performed for non-visceral metastasis. A series of sensitivity analyses, including probabilistic sensitivity analysis (PSA) and threshold analysis were performed. RESULTS Base-case analyses estimated incremental cost-effectiveness ratios (ICERs) of 3 million and 6 million Japanese yen (JPY)/quality-adjusted life year (QALY) gained for TOR and FUL 500 mg relative to EXE, respectively. FUL 250 mg and EXE + EVE were dominated. The overall survival (OS) highly influenced the ICER. With a willingness-to-pay (WTP) threshold of 5 million JPY/QALY, the probability of TOR being cost-effective was the highest. Subgroup analysis in non-visceral metastasis revealed 0.4 and 10% reduction in ICER from the base-case results of FUL5 500 mg versus EXE and TOR versus EXE, respectively, while threshold analysis indicated EVE and FUL prices should be reduced 73 and 30%, respectively. CONCLUSION As a second-line therapy for postmenopausal women with HR +/HER2 - mBC, TOR may be cost-effective relative to other alternatives and seems to be the most favorable choice, based on a WTP threshold of 5 million JPY/QALY. FUL 250 mg is expected to be as costly and effective as EXE. The cost-effectiveness of EXE + EVE and FUL 500 mg could be improved by a large price reduction. However, the results are highly sensitive to the hazard ratio of OS. Policy makers should carefully interpret and utilize these findings.
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Affiliation(s)
- Verin Lertjanyakun
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin-Madison, Wisconsin, USA
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Abstract
OBJECTIVE Renal cell carcinoma (RCC) has a propensity to metastasize to the chest, with the lungs being the most common distant metastatic site. The histologic subtype of RCC has implications for prognosis. CONCLUSION Significant advances have been made in the management of metastatic RCC, both in systemic and locoregional therapies. The aim of this article is to review appearances of intrathoracic metastases from RCC and to discuss treatment considerations.
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Almeida F, Amorim S, Sarmento A, Santos L. Life-Threatening Everolimus-Associated Pneumonitis: A Case Report and a Review of the Literature. Transplant Proc 2018; 50:933-938. [PMID: 29588066 DOI: 10.1016/j.transproceed.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/04/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Noninfective pneumonitis is a class-related effect within mammalian target of rapamycin (mTOR) inhibitors, including everolimus, and can occasionally be severe. CASE REPORT A 62-year-old man, medicated with everolimus due to a heart transplantation 17 years previously and with chronic kidney disease, was admitted to the intensive care unit (ICU) with acute respiratory failure, cardiovascular shock, and impaired renal function requiring dialysis. Computed tomography (CT) scan revealed right upper lobe consolidation. Extensive microbiological workup, autoimmune testing, and cytology were negative and echocardiography showed preserved heart function. Everolimus levels were normal (5.7-6.1 ng/mL) and the drug was suspended at day 9. The patient was difficult to ventilate and responded poorly to broad-spectrum antibiotic and antifungal therapy. On day 25, CT scan and bronchoscopy revealed left-sided alveolar hemorrhage, and corticosteroid pulses were performed. The patient gradually improved. After discharge and 6 months of follow-up, clinical recovery was complete and chest imaging substantially improved. DISCUSSION Pneumonitis occurs in up to 4.3% of transplant recipients using everolimus for immunosuppression. Despite usually presenting as a mild and self-limited disease, severe cases have been described. Alveolar hemorrhage can occur and is associated with poor outcome. Everolimus levels do not seem to accurately predict toxicity. Corticosteroid therapy has been used with success in severe disease. We review the pathophysiological, clinical, and management-related aspects of this entity with emphasis on its potential severity. CONCLUSION Our case was a rare occurrence of severe life-threatening pulmonary disease related to everolimus. Awareness of the potential severity of this entity is important for the management of patients using mTOR inhibitors.
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Affiliation(s)
- F Almeida
- Infectious Diseases Department, Centro Hospitalar de São João, Porto, Portugal.
| | - S Amorim
- Cardiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - A Sarmento
- Infectious Diseases Department, Centro Hospitalar de São João, Alameda Professor Hernani Monteiro, Porto, Portugal; i3S, Instituto de Inovação e Investigação em Saúde, Grupo de I&D em Nefrologia e Doenças Infeciosas, Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - L Santos
- Infectious Diseases Department, Centro Hospitalar de São João, Porto, Portugal
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Alvarez RH, Bechara RI, Naughton MJ, Adachi JA, Reuben JM. Emerging Perspectives on mTOR Inhibitor-Associated Pneumonitis in Breast Cancer. Oncologist 2018; 23:660-669. [PMID: 29487226 DOI: 10.1634/theoncologist.2017-0343] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/03/2018] [Indexed: 01/14/2023] Open
Abstract
Substantial improvements in the early detection and treatment of breast cancer have led to improvements in survival, but breast cancer remains a significant cause of morbidity and mortality in women. In 2012, the mammalian target of rapamycin (mTOR) inhibitor everolimus was approved by the U.S. Food and Drug Administration for the treatment of advanced breast cancer in patients resistant to endocrine therapy. Although everolimus is generally well tolerated, mTOR inhibitor-associated pneumonitis is one of the most common adverse drug events leading to treatment discontinuation. To date, the underlying pathophysiology of this toxicity is unclear, and this uncertainty may hinder the optimization of management strategies. However, experiences from breast cancer and renal cell carcinoma clinical trials indicate that mTOR inhibitor-associated pneumonitis can be effectively managed by early detection, accurate diagnosis, and prompt intervention that generally involves everolimus dose reductions, interruptions, or discontinuation. Management can be achieved by a multidisciplinary approach that involves the collaborative efforts of nurses, oncologists, radiologists, infectious disease specialists, pulmonologists, clinical pharmacists, and pathologists. Comprehensive education must be provided to all health care professionals involved in managing patients receiving everolimus therapy. Although general recommendations on the management of mTOR inhibitor-associated pneumonitis have been published, there is a lack of consensus on the optimal management of this potentially serious complication. This article provides an overview of mTOR inhibitor-associated pneumonitis, with a focus on the detection, accurate diagnosis, and optimal management of this class-related complication of mTOR inhibitor therapy. IMPLICATIONS FOR PRACTICE This article summarizes the pathogenesis, clinical presentation, incidence, detection, and optimal management of everolimus-related noninfectious pneumonitis in breast cancer. In particular, this article provides a detailed overview of the important aspects of the detection, accurate diagnosis, and appropriate management of mammalian target of rapamycin inhibitor-associated pneumonitis. In addition, this article emphasizes that effective management of this adverse drug event in patients with breast cancer will require a multidisciplinary approach and collaboration among various health care professionals.
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Affiliation(s)
| | | | - Michael J Naughton
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Javier A Adachi
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James M Reuben
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Edwards SJ, Wakefield V, Cain P, Karner C, Kew K, Bacelar M, Masento N, Salih F. Axitinib, cabozantinib, everolimus, nivolumab, sunitinib and best supportive care in previously treated renal cell carcinoma: a systematic review and economic evaluation. Health Technol Assess 2018; 22:1-278. [PMID: 29393024 PMCID: PMC5817410 DOI: 10.3310/hta22060] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Several therapies have recently been approved for use in the NHS for pretreated advanced or metastatic renal cell carcinoma (amRCC), but there is a lack of comparative evidence to guide decisions between them. OBJECTIVE To evaluate the clinical effectiveness and cost-effectiveness of axitinib (Inlyta®, Pfizer Inc., NY, USA), cabozantinib (Cabometyx®, Ipsen, Slough, UK), everolimus (Afinitor®, Novartis, Basel, Switzerland), nivolumab (Opdivo®, Bristol-Myers Squibb, NY, USA), sunitinib (Sutent®, Pfizer, Inc., NY, USA) and best supportive care (BSC) for people with amRCC who were previously treated with vascular endothelial growth factor (VEGF)-targeted therapy. DATA SOURCES A systematic review and mixed-treatment comparison (MTC) of randomised controlled trials (RCTs) and non-RCTs. Primary outcomes were overall survival (OS) and progression-free survival (PFS). Secondary outcomes were objective response rates (ORRs), adverse events (AEs) and health-related quality of life (HRQoL). MEDLINE, EMBASE and The Cochrane Library were searched from inception to January and June 2016 for RCTs and non-RCTs, respectively. Two reviewers abstracted data and performed critical appraisals. REVIEW METHODS A fixed-effects MTC was conducted for OS, PFS [hazard ratios (HRs)] and ORR (odds ratios), and all were presented with 95% credible intervals (CrIs). The RCT data formed the primary analyses, with non-RCTs and studies rated as being at a high risk of bias included in sensitivity analyses (SAs). HRQoL and AE data were summarised narratively. A partitioned survival model with health states for pre progression, post progression and death was developed to perform a cost-utility analysis. Survival curves were fitted to the PFS and OS results from the MTC. A systematic review of HRQoL was undertaken to identify sources of health state utility values. RESULTS Four RCTs (n = 2618) and eight non-RCTs (n = 1526) were included. The results show that cabozantinib has longer PFS than everolimus (HR 0.51, 95% CrI 0.41 to 0.63) and both treatments are better than BSC. Both cabozantinib (HR 0.66, 95% CrI 0.53 to 0.82) and nivolumab (HR 0.73, 95% CrI 0.60 to 0.89) have longer OS than everolimus. SAs were consistent with the primary analyses. The economic analysis, using drug list prices, shows that everolimus may be more cost-effective than BSC with an incremental cost-effectiveness ratio (ICER) of £45,000 per quality-adjusted life-year (QALY), as it is likely to be considered an end-of-life treatment. Cabozantinib has an ICER of £126,000 per QALY compared with everolimus and is unlikely to be cost-effective. Nivolumab was dominated by cabozantinib (i.e. more costly and less effective) and axitinib was dominated by everolimus. LIMITATIONS Treatment comparisons were limited by the small number of RCTs. However, the key limitation of the analysis is the absence of the drug prices paid by the NHS, which was a limitation that could not be avoided owing to the confidentiality of discounts given to the NHS. CONCLUSIONS The RCT evidence suggests that cabozantinib is likely to be the most effective for PFS and OS, closely followed by nivolumab. All treatments appear to delay disease progression and prolong survival compared with BSC, although the results are heterogeneous. The economic analysis shows that at list price everolimus could be recommended as the other drugs are much more expensive with insufficient incremental benefit. The applicability of these findings to the NHS is somewhat limited because existing confidential patient access schemes could not be used in the analysis. Future work using the discounted prices at which these drugs are provided to the NHS would better inform estimates of their relative cost-effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42016042384. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Parrot A, Gibelin A, Issoufaly T, Voiriot G, Djibré M, Naccache J, Cadranel J, Fartoukh M. Toxicité pulmonaire des médicaments : ce que le réanimateur doit connaître ? MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Komatsu H, Izumi N, Tsukioka T, Toda M, Hara K, Miyamoto H, Nishiyama N. Elevation of Serum Carcinoembryonic Antigen Concentration Caused by Everolimus-Induced Lung Injury: A Case Report. Ann Thorac Cardiovasc Surg 2017; 24:151-153. [PMID: 29249770 PMCID: PMC6033529 DOI: 10.5761/atcs.cr.17-00092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 66-year-old woman underwent right nephrectomy for treatment of renal cell carcinoma (RCC). Two years later, she underwent wedge resection of the right lung for treatment of metastatic RCC and primary adenocarcinoma of the lung. She began oral sorafenib for the remaining nodules of the left lung, which were suspected to be metastatic RCC. Two years later, the sorafenib was changed to everolimus because of slight enlargement of the left pulmonary nodules. The carcinoembryonic antigen (CEA) concentration then increased to 25.7 ng/mL, and chest computed tomography (CT) revealed ground-glass opacities (GGO) in the bilateral lungs. Everolimus-induced lung injury was suspected, and she discontinued the everolimus. Two months later, the serum CEA concentration decreased to almost within the reference range at 5.9 ng/mL, and the GGO disappeared on chest CT. In conclusion, we encountered a patient who developed an elevated serum CEA concentration caused by everolimus-induced lung injury.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Nobuhiro Izumi
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Takuma Tsukioka
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Michihito Toda
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Kantaro Hara
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Hikaru Miyamoto
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
| | - Noritoshi Nishiyama
- Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan
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Nitawaki T, Sakata Y, Kawamura K, Ichikado K. Case report: continued treatment with alectinib is possible for patients with lung adenocarcinoma with drug-induced interstitial lung disease. BMC Pulm Med 2017; 17:173. [PMID: 29207989 PMCID: PMC5718064 DOI: 10.1186/s12890-017-0519-y] [Citation(s) in RCA: 7] [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: 07/03/2017] [Accepted: 11/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alectinib, a second-generation anaplastic lymphoma kinase (ALK) inhibitor, is a key drug for ALK rearranged lung adenocarcinoma. Interstitial lung disease (ILD) is an important adverse effect of alectinib, which generally requires termination of treatment. However, we treated two patients with drug-induced ILD who continued to receive alectinib. CASE PRESENTATION Patient 1 was a 57-year-old male with an ALK-rearranged Stage IV lung adenocarcinoma who was administered alectinib as first-line therapy. Computed tomography (CT) detected asymptomatic ground-glass opacity (GGO) on day 33 of treatment. Alectinib therapy was therefore discontinued for 7 days and then restarted. GGO disappeared, and the progression of ILD ceased. Patient 2 was a 64-year-old woman with an ALK-positive lung adenocarcinoma who was administered alectinib as third-line therapy. One year later, CT detected GGO; and she had a slight, nonproductive cough. Alectinib therapy was continued in the absence of other symptoms, and GGO slightly diminished after 7 days. Two months later, CT detected increased GGO, and alectinib therapy was continued. GGO diminished again after 7 days. The patient has taken alectinib for more than 2 years without progression of ILD. CONCLUSIONS Certain patients with alectinib-induced ILD Grade 2 or less may continue alectinib therapy if they are closely managed.
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Affiliation(s)
- Tatsuya Nitawaki
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto, 861-4193 Japan
| | - Yoshihiko Sakata
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto, 861-4193 Japan
| | - Kodai Kawamura
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto, 861-4193 Japan
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto, 861-4193 Japan
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Evaluation of the clinical characteristics of everolimus-induced lung injury and determination of associated risk factors. Respir Med 2017; 134:6-11. [PMID: 29413509 DOI: 10.1016/j.rmed.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Everolimus (ERL), a mammalian target of rapamycin (mTOR) inhibitor, has been used for the management of several advanced cancers. ERL frequently causes lung injury, although the clinical and radiographic features have not been clarified. The aim of this study was to assess the clinical features of ERL-induced lung injury and determine the associated risk factors. METHODS This single-center, retrospective study included 45 patients (29 men, 16 women; age, 12-78 years) who had received ERL at our hospital between August 2010 and March 2016. Drug-induced lung injury (DILI) was diagnosed using the Japanese Respiratory Society criteria. We obtained information regarding the clinical course, symptoms, clinical findings, blood test findings, and chest computed tomography findings from the patients' medical records. Risk factors for DILI onset were investigated using the Wilcoxon rank sum test. RESULTS Fifteen patients (33%) were diagnosed with DILI. The median time from ERL administration to DILI onset was 64 days. High Serum Krebs von den Lungen-6 (KL-6) levels and a low estimated glomerular filtration rate (eGFR) before ERL administration were found to be significant risk factors for DILI. KL-6 and lactate dehydrogenase (LDH) were significantly elevated at the onset of DILI. All 15 patients recovered; 11 were without steroids. CONCLUSIONS Our results suggest that patients with high KL-6 levels and a low eGFR at baseline are at increased risk of ERL-induced lung injury. In addition, KL-6 and LDH may be useful biomarkers of ERL-induced lung injury.
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Budinger GRS, Kohanski RA, Gan W, Kobor MS, Amaral LA, Armanios M, Kelsey KT, Pardo A, Tuder R, Macian F, Chandel N, Vaughan D, Rojas M, Mora AL, Kovacs E, Duncan SR, Finkel T, Choi A, Eickelberg O, Chen D, Agusti A, Selman M, Balch WE, Busse P, Lin A, Morimoto R, Sznajder JI, Thannickal VJ. The Intersection of Aging Biology and the Pathobiology of Lung Diseases: A Joint NHLBI/NIA Workshop. J Gerontol A Biol Sci Med Sci 2017; 72:1492-1500. [PMID: 28498894 PMCID: PMC5861849 DOI: 10.1093/gerona/glx090] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/10/2017] [Indexed: 12/31/2022] Open
Abstract
Death from chronic lung disease is increasing and chronic obstructive pulmonary disease has become the third leading cause of death in the United States in the past decade. Both chronic and acute lung diseases disproportionately affect elderly individuals, making it likely that these diseases will become more frequent and severe as the worldwide population ages. Chronic lung diseases are associated with substantial morbidity, frequently resulting in exercise limiting dyspnea, immobilization, and isolation. Therefore, effective strategies to prevent or treat lung disease are likely to increase healthspan as well as life span. This review summarizes the findings of a joint workshop sponsored by the NIA and NHLBI that brought together investigators focused on aging and lung biology. These investigators encouraged the use of genetic systems and aged animals in the study of lung disease and the development of integrative systems-based platforms that can dynamically incorporate data sets that describe the genomics, transcriptomics, epigenomics, metabolomics, and proteomics of the aging lung in health and disease. Further research was recommended to integrate benchmark biological hallmarks of aging in the lung with the pathobiology of acute and chronic lung diseases with divergent pathologies for which advanced age is the most important risk factor.
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Affiliation(s)
- GR Scott Budinger
- Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Ronald A Kohanski
- Division of Aging Biology, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | - Weiniu Gan
- Division of Lung Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael S Kobor
- Center for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Luis A Amaral
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, Illinois
| | - Mary Armanios
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karl T Kelsey
- Departments of Epidemiology, Laboratory Medicine & Pathology, Brown University, Providence, Rhode Island
| | - Annie Pardo
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, México
| | - Rubin Tuder
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado
| | - Fernando Macian
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York
| | - Navdeep Chandel
- Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Douglas Vaughan
- Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Mauricio Rojas
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ana L Mora
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Kovacs
- Department of Surgery, University of Colorado at Denver Health Sciences Center, Denver, Colorado
| | | | - Toren Finkel
- Center for Molecular Medicine, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Augustine Choi
- Weill Cornell Medical College, Division of Pulmonary and Critical Care Medicine, Weill Department of Medicine, New York, New York
| | - Oliver Eickelberg
- Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus
| | - Danica Chen
- Program in Metabolic Biology, Nutritional Sciences & Toxicology, University of California, Berkeley, California
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Spain
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, México
| | - William E Balch
- Department of Chemical Physiology, Department of Cell and Molecular Biology, The Skaggs Institute of Chemical Biology, The Scripps Research Institute, La Jolla, California
| | - Paula Busse
- Division of Clinical Immunology, Department of Medicine, Mount Sinai School of Medicine, New York, New York
| | - Anning Lin
- Ben May Department for Cancer Research, University of Chicago, Chicago, Illinois
| | - Richard Morimoto
- Department of Molecular Biosciences, Rice Institute for Biomedical Research, Northwestern University, Evanston, Illinois
| | - Jacob I Sznajder
- Feinberg School of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
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Penttilä P, Donskov F, Rautiola J, Peltola K, Laukka M, Bono P. Everolimus-induced pneumonitis associates with favourable outcome in patients with metastatic renal cell carcinoma. Eur J Cancer 2017; 81:9-16. [DOI: 10.1016/j.ejca.2017.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/26/2017] [Accepted: 05/01/2017] [Indexed: 01/13/2023]
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Lolli C, Gallà V, Schepisi G, Barone D, Burgio SL, Maugeri A, Vertogen B, Amadori D, De Giorgi U. A Phase II Study of Everolimus Plus Oral Prednisone in Patients with Metastatic Renal Cell Cancer. Oncologist 2017; 22:784-e74. [PMID: 28546463 PMCID: PMC5507652 DOI: 10.1634/theoncologist.2017-0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/04/2017] [Indexed: 01/05/2023] Open
Abstract
Lessons Learned. The combination of everolimus and low‐dose prednisone administered daily was hypothesized to prevent noninfectious pneumonitis (NIP) and mucositis, two common adverse events related to everolimus. Although mucositis was detected in only one case, all‐grade NIP occurred in four of eight cases (50%), and this was considered enough to stop accrual of the study. These data suggest the need for careful monitoring of patients receiving everolimus who are treated with corticosteroids.
Background. Everolimus is standard of care in the treatment of patients affected by metastatic renal cell carcinoma (mRCC) that has progressed after at least one previous line of treatment. Stomatitis and noninfectious pneumonitis (NIP) are common adverse events (AEs) in patients treated with everolimus. Prednisone could reduce the incidence of stomatitis, and it is commonly used to treat NIP. We hypothesized that low doses of prednisone could reduce the incidence and/or the severity of everolimus‐induced NIP and stomatitis. Methods. We have conducted an open‐label, single‐arm, phase II trial of prednisone 5 mg b.i.d. added to everolimus 10 mg/day in patients with mRCC. We planned to evaluate the safety, tolerability, and activity of this combination in mRCC patients. We aimed to reduce incidence of drug discontinuations due to stomatitis or NIP from 25% to 10%. Results. Three (38%) of the first eight patients enrolled experienced grade ≥2 pneumonitis and stopped treatment. Grade 1 stomatitis occurred in only one patient (13%). Five of eight patients experienced disease progression at the 2‐month evaluation. Two patients (25%) were reported free of disease progression at 1 year of treatment. Conclusion. The incidence of NIP in these patients was considered too high for completing accrual of this study. These results may be of interest for investigating the pathogenesis of NIP and suggest that patients should be carefully followed if treated with chronic corticosteroids while receiving everolimus.
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Affiliation(s)
- Cristian Lolli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Gallà
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Schepisi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Domenico Barone
- Radiology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Salvatore Luca Burgio
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonio Maugeri
- Oncology Pharmacy Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Bernadette Vertogen
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Everolimus-Induced Systemic Serositis After Simultaneous Liver and Kidney Transplantation: A Case Report. Transplant Proc 2017; 49:181-184. [PMID: 28104132 DOI: 10.1016/j.transproceed.2016.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/16/2016] [Indexed: 11/20/2022]
Abstract
Although everolimus, a mammalian target of rapamycin inhibitor, has been used as a potent immunosuppressive agent in organ transplantation, data regarding its adverse effect profile compared with that of sirolimus in clinical circumstances are limited. A 50-year-old man who underwent simultaneous liver and kidney transplantation 14 months previously was admitted with large pleural effusion, pericardial effusion, and ascites. Laboratory findings and cultures for possible infectious causes were all negative. Pericardial window surgery with drainage of the pericardial fluid was performed on day 3. Pleural and pericardial biopsy revealed non-specific inflammation without evidence of malignant cells. Everolimus was discontinued and replaced by mycophenolate mofetil on day 4. Significant clinical improvement was observed after discontinuation of everolimus, and follow-up echocardiography and chest radiography showed no recurrence of the pericardial or pleural effusion after discharge.
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Joly F, Eymard JC, Albiges L, Nguyen T, Guillot A, Rolland F, Spaeth D, Laguerre B, Lebret T, Kelkouli N, Slimane K, Ravaud A. A prospective observational study on the evaluation of everolimus-related adverse events in metastatic renal cell carcinoma after first-line anti-vascular endothelial growth factor therapy: the AFINITE study in France. Support Care Cancer 2017; 25:2055-2062. [DOI: 10.1007/s00520-017-3594-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/23/2017] [Indexed: 11/29/2022]
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González-Larriba JL, Maroto P, Durán I, Lambea J, Flores L, Castellano D. The role of mTOR inhibition as second-line therapy in metastatic renal carcinoma: clinical evidence and current challenges. Expert Rev Anticancer Ther 2017; 17:217-226. [PMID: 28105863 DOI: 10.1080/14737140.2017.1273774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Sequential treatment with targeted agents is the standard of care for patients with metastatic renal cell carcinoma (mRCC). Although first-line therapy with tyrosine kinase inhibitors (TKIs) is recommended for most patients, eventually all patients become resistant to them. Therefore, optimal selection of second-line therapy is crucial. Areas covered: We have reviewed the recent literature through pubmed search and recent congress presentations to briefly describe the clinical evidence for mTOR inhibition as a valid strategy in the treatment of mRCC after progression during anti-VEGFR therapy. In addition, we outline the management of adverse events associated with these agents, highlighting the importance of switching to an alternative mechanism of action to overcome resistance to TKI and to decrease cumulative toxicity associated with sequential treatments of the same type. Expert commentary: The choice of subsequent therapy after progression to first-line is not clear. Although the new drugs cabozantinib and nivolumab have shown to be superior that everolimus, still it is unknown which patients may benefit from these therapies in second-line, so treatment should be personalized to each patient and should consider approaches with different mechanisms of action.
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Affiliation(s)
| | - Pablo Maroto
- b Servicio de Oncología Médica , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Ignacio Durán
- c Sección de Oncología Médica, Hospital Universitario Virgen del Rocío , Sevilla , Spain.,d Laboratorio de Terapias Avanzadas y Biomarcadores en Oncología , Instituto de Biomedicina de Sevilla , Sevilla , Spain
| | - Julio Lambea
- e Servicio de Oncología Médica , Hospital Clínico Universitario Lozano Blesa , Zaragoza , Spain
| | | | - Daniel Castellano
- g Servicio de Oncología Médica , Hospital 12 de Octubre , Madrid , Spain
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47
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Recent Advances in Mammalian Target of Rapamycin Inhibitor Use in Heart and Lung Transplantation. Transplantation 2016; 100:2558-2568. [DOI: 10.1097/tp.0000000000001432] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Naidoo J, Wang X, Woo KM, Iyriboz T, Halpenny D, Cunningham J, Chaft JE, Segal NH, Callahan MK, Lesokhin AM, Rosenberg J, Voss MH, Rudin CM, Rizvi H, Hou X, Rodriguez K, Albano M, Gordon RA, Leduc C, Rekhtman N, Harris B, Menzies AM, Guminski AD, Carlino MS, Kong BY, Wolchok JD, Postow MA, Long GV, Hellmann MD. Pneumonitis in Patients Treated With Anti-Programmed Death-1/Programmed Death Ligand 1 Therapy. J Clin Oncol 2016; 35:709-717. [PMID: 27646942 DOI: 10.1200/jco.2016.68.2005] [Citation(s) in RCA: 731] [Impact Index Per Article: 91.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Pneumonitis is an uncommon but potentially fatal toxicity of anti-programmed death-1 (PD-1)/programmed death ligand 1 (PD-L1) monoclonal antibodies (mAbs). Clinical, radiologic, and pathologic features are poorly described. Methods Patients who received anti-PD-1/PD-L1 monotherapy or in combination with anti-cytotoxic T-cell lymphocyte-4 mAb were identified at two institutions (Memorial Sloan Kettering Cancer Center: advanced solid cancers, 2009 to 2014, and Melanoma Institute of Australia: melanomas only, 2013 to 2015). Pneumonitis was diagnosed by the treating investigator; cases with confirmed malignant lung infiltration or infection were excluded. Clinical, radiologic, and pathologic features of pneumonitis were collected. Associations among pneumonitis incidence, therapy received, and underlying malignancy were examined with Fisher's exact test as were associations between pneumonitis features and outcomes. Results Of 915 patients who received anti-PD-1/PD-L1 mAbs, pneumonitis developed in 43 (5%; 95% CI, 3% to 6%; Memorial Sloan Kettering Cancer Center, 27 of 578 [5%]; Melanoma Institute of Australia, 16 of 337 [5%]). Time to onset of pneumonitis ranged from 9 days to 19.2 months. The incidence of pneumonitis was higher with combination immunotherapy versus monotherapy (19 of 199 [10%] v 24 of 716 [3%]; P < .01). Incidence was similar in patients with melanoma and non-small-cell lung cancer (overall, 26 of 532 [5%] v nine of 209 [4%]; monotherapy, 15 of 417 v five of 152 [ P = 1.0]; combination, 11 of 115 v four of 57 [ P = .78]). Seventy-two percent (31 of 43) of cases were grade 1 to 2, and 86% (37 of 43) improved/resolved with drug holding/immunosuppression. Five patients worsened clinically and died during the course of pneumonitis treatment; proximal cause of death was pneumonitis (n = 1), infection related to immunosuppression (n = 3), or progressive cancer (n = 1). Radiologic and pathologic features of pneumonitis were diverse. Conclusion Pneumonitis associated with anti-PD-1/PD-L1 mAbs is a toxicity of variable onset and clinical, radiologic, and pathologic appearances. It is more common when anti-PD-1/PD-L1 mAbs are combined with anti-cytotoxic T-cell lymphocyte-4 mAb. Most events are low grade and improve/resolve with drug holding/immunosuppression. Rarely, pneumonitis worsens despite immunosuppression, and may result in infection and/or death.
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Affiliation(s)
- Jarushka Naidoo
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Xuan Wang
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Kaitlin M Woo
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Tunc Iyriboz
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Darragh Halpenny
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Jane Cunningham
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Jamie E Chaft
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Neil H Segal
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Margaret K Callahan
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Alexander M Lesokhin
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Jonathan Rosenberg
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Martin H Voss
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Charles M Rudin
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Hira Rizvi
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Xue Hou
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Katherine Rodriguez
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Melanie Albano
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Ruth-Ann Gordon
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Charles Leduc
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Natasha Rekhtman
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Bianca Harris
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Alexander M Menzies
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Alexander D Guminski
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Matteo S Carlino
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Benjamin Y Kong
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Jedd D Wolchok
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Michael A Postow
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Georgina V Long
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
| | - Matthew D Hellmann
- Jarushka Naidoo, Kaitlin M. Woo, Tunc Iyriboz, Darragh Halpenny, Jane Cunningham, Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Hira Rizvi, Xue Hou, Katherine Rodriguez, Melanie Albano, Ruth-Ann Gordon, Charles Leduc, Natasha Rekhtman, Bianca Harris, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Memorial Sloan Kettering Cancer Center; Jamie E. Chaft, Neil H. Segal, Margaret K. Callahan, Alexander M. Lesokhin, Jonathan Rosenberg, Martin H. Voss, Charles M. Rudin, Jedd D. Wolchok, Michael A. Postow, and Matthew D. Hellmann, Weill Cornell Medical College, New York, NY; Jarushka Naidoo, Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD; Xuan Wang, Peking University Cancer Hospital and Institute, Beijing; Xue Hou, Sun Yat-sen University Cancer Center, Guangdong Province, People's Republic of China; Xuan Wang, Matteo S. Carlino, Benjamin Y. Kong, and Georgina V. Long, The University of Sydney; Alexander M. Menzies and Alexander D. Guminski, Royal North Shore and Mater Hospital; and Matteo S. Carlino and Benjamin Y. Kong, Westmead and Blacktown Hospitals, Sydney, Australia
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Creel PA. Optimizing patient adherence to targeted therapies in renal cell carcinoma. Clin J Oncol Nurs 2016; 18:694-700. [PMID: 25427704 DOI: 10.1188/14.cjon.694-700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current standard of care for treating metastatic renal cell carcinoma is sequential therapy with vascular endothelial growth factor-targeted agents (i.e., axitinib, bevacizumab, pazopanib, sorafenib, and sunitinib) and mammalian target of rapamycin inhibitors (i.e., everolimus and temsirolimus). To maximize adherence to and persistence with targeted therapy, which should help improve clinical benefit, a clear understanding of the tolerability profiles of these agents and implementation of early, appropriately aggressive adverse event (AE) prevention and management strategies are key. Active and aggressive AE management should improve the quality of life of patients during the course of their treatment. Nurses are in a unique position to educate patients on the potential AEs they may experience and their prevention and management. This article reviews the safety and tolerability of currently available targeted therapies recommended for use in the second-line treatment setting, as well as their management in the context of maximizing clinical outcomes and patient quality of life.
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Buti S, Leonetti A, Dallatomasina A, Bersanelli M. Everolimus in the management of metastatic renal cell carcinoma: an evidence-based review of its place in therapy. CORE EVIDENCE 2016; 11:23-36. [PMID: 27621699 PMCID: PMC5012611 DOI: 10.2147/ce.s98687] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults, and its pathogenesis is strictly related to altered cellular response to hypoxia, in which mTOR signaling pathway is implicated. Everolimus, an mTOR serine/threonine kinase inhibitor, represents a therapeutic option for the treatment of advanced RCC. Aim The objective of this article is to review the evidence for the treatment of metastatic RCC with everolimus. Evidence review Everolimus was approved for second- and third-line therapy in patients with advanced RCC according to the results of a Phase III pivotal trial that demonstrated a benefit in median progression-free survival of ~2 months compared to placebo after failure of previous lines of therapy, of which at least one was an anti-VEGFR tyrosine kinase inhibitor (TKI). The role of this drug in first-line setting has been investigated in Phase II trials, with no significant clinical benefit, even in combination with bevacizumab. Everolimus activity in non-clear cell RCC is supported by two randomized Phase II trials that confirmed the benefit in second-line setting but not in first line. Recently, two randomized Phase III trials (METEOR and CheckMate 025) demonstrated the inferiority of everolimus in second-line setting compared to the TKI cabozantinib and to the immune checkpoint inhibitor nivolumab, respectively. Moreover, a recent Phase II study demonstrated a significant benefit for the second-line combination treatment with everolimus plus lenvatinib (a novel TKI) in terms of progression-free survival and overall survival compared to the single-agent everolimus. Basing on preclinical data, the main downstream effectors of mTOR cascade, S6RP and its phosphorylated form, could be good predictive biomarkers of response to everolimus. The safety profile of the drug is favorable, with a good cost-effectiveness compared to second-line sorafenib or axitinib, and no significant impact on the quality of life of treated patients has been found. Conclusion Everolimus still represents a current standard of treatment for RCC progressive to previous treatment lines with VEGFR-TKI. The evidence about two new molecules, cabozantinib and nivolumab, successfully tested head-to-head with everolimus in recently published Phase III trials, will determine the shift of everolimus to the third-line setting and subsequent lines of treatment.
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Affiliation(s)
| | | | - Alice Dallatomasina
- Division of Experimental Oncology, San Raffaele Scientific Institute, Milan, Italy
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