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Cho KM, Keam B, Kim TM, Lee SH, Kim DW, Heo DS. Clinical efficacy of erlotinib, a salvage treatment for non-small cell lung cancer patients following gefitinib failure. Korean J Intern Med 2015; 30:891-8. [PMID: 26552465 PMCID: PMC4642019 DOI: 10.3904/kjim.2015.30.6.891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 09/29/2014] [Accepted: 12/05/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS The purpose of this study was to identify predictive factors for erlotinib treatment in non-small cell lung cancer (NSCLC) patients following gefitinib failure. METHODS Forty-five patients with NSCLC who were treated with erlotinib following gefitinib failure at Seoul National University Hospital between August 2005 and November 2011 were enrolled. Epidermal growth factor receptor (EGFR) mutation status, pathologic findings and other clinical factors, including response to tyrosine kinase inhibitors (TKIs) and progression-free survival (PFS), were evaluated. RESULTS Of the 45 patients, 40 patients (88.8%) had adenocarcinoma. The following EGFR mutations were observed: five patients with a deletion of exon 19, six patients with an L858R mutation, three patients with wild-type EGFR, and 31 patients with unknown mutations. The response rate of erlotinib was 4.4%, and stable disease was 42.2%. The median PFS for erlotinib was 2.6 months (95% confidence interval, 1.4 to 3.7). Patients with a PFS ≥ 4 months during previous gefitinib treatment had a significantly longer PFS with erlotinib (3.3 months vs. 1.6 months, respectively; p < 0.01) than patients with PFS < 4 months with gefitinib. According to multivariate analyses, PFS ≥ 4 months for previous gefitinib treatment was significantly associated with prolonged PFS with erlotinib (p = 0.04). However, the response rate of gefitinib and treatment sequence were not associated with prolonged PFS with erlotinib (p = 0.28 and p = 0.67, respectively). CONCLUSIONS Following rechallenge with the EGFR TKI erlotinib following gefitinib failure, patients who showed prolonged PFS with gefitinib benefit from erlotinib. However, further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Kyoung Min Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Bhumsuk Keam, M.D. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno- gu, Seoul 03080, Korea Tel: +82-2-2072-7215 Fax: +82-2-762-9662 E-mail:
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Leong SM, Tan KML, Chua HW, Tan D, Fareda D, Osmany S, Li MH, Tucker S, Koay ESC. Sampling circulating tumor cells for clinical benefits: how frequent? J Hematol Oncol 2015; 8:75. [PMID: 26108208 PMCID: PMC4488127 DOI: 10.1186/s13045-015-0174-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/15/2015] [Indexed: 11/21/2022] Open
Abstract
Circulating tumor cells (CTCs) are cells shed from tumors or metastatic sites and are a potential biomarker for cancer diagnosis, management, and prognostication. The majority of current studies use single or infrequent CTC sampling points. This strategy assumes that changes in CTC number, as well as phenotypic and molecular characteristics, are gradual with time. In reality, little is known today about the actual kinetics of CTC dissemination and phenotypic and molecular changes in the blood of cancer patients. Herein, we show, using clinical case studies and hypothetical simulation models, how sub-optimal CTC sampling may result in misleading observations with clinical consequences, by missing out on significant CTC spikes that occur in between sampling times. Initial studies using highly frequent CTC sampling are necessary to understand the dynamics of CTC dissemination and phenotypic and molecular changes in the blood of cancer patients. Such an improved understanding will enable an optimal, study-specific sampling frequency to be assigned to individual research studies and clinical trials and better inform practical clinical decisions on cancer management strategies for patient benefits.
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Affiliation(s)
- Sai Mun Leong
- Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Karen M L Tan
- Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Hui Wen Chua
- Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Doreen Tan
- Tucker Medical, Novena Specialist Center, 8 Sinaran Drive #04-03, Singapore, 307470, Singapore
| | - Delly Fareda
- Tucker Medical, Novena Specialist Center, 8 Sinaran Drive #04-03, Singapore, 307470, Singapore
| | - Saabry Osmany
- Radlink PET and Cardiac Imaging Center, 290 Orchard Road, #08-06 Paragon Medical, Singapore, 238859, Singapore
| | - Mo-Huang Li
- CellSievo Private Limited Singapore, Block 289A, Bukit Batok St. 25, #15-218, Singapore, 650289, Singapore
| | - Steven Tucker
- Tucker Medical, Novena Specialist Center, 8 Sinaran Drive #04-03, Singapore, 307470, Singapore
| | - Evelyn S C Koay
- Department of Laboratory Medicine, National University Hospital, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.,Department of Pathology, National University of Singapore, Level 3 NUH Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
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Schuler M, Fischer JR, Grohé C, Gütz S, Thomas M, Kimmich M, Schneider CP, Laack E, Märten A. Experience with afatinib in patients with non-small cell lung cancer progressing after clinical benefit from gefitinib and erlotinib. Oncologist 2014; 19:1100-9. [PMID: 25232040 DOI: 10.1634/theoncologist.2014-0103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Afatinib, an irreversible ErbB family blocker, demonstrated superiority to chemotherapy as first-line treatment in patients with EGFR-mutated non-small cell lung cancer (NSCLC). Afatinib is also active in patients progressing on EGFR tyrosine kinase inhibitors (EGFR-TKIs). We report the results of a large cohort of NSCLC patients receiving afatinib within a compassionate-use program (CUP). PATIENTS AND METHODS Patients with advanced NSCLC progressing after one line or more of chemotherapy and one line or more of EGFR-TKI treatment with either an EGFR mutation or documented clinical benefit were enrolled. Data collection was not monitored or verified by central review. The intention of this CUP was to provide controlled preregistration access to afatinib for patients with life-threatening diseases and no other treatment option. RESULTS From May 2010 to October 2013, 573 patients (65% female; median age: 64 years [range: 28-89 years]) were enrolled, with strong participation of community oncologists. Comorbidities were allowed, including second malignancies in 11% of patients. EGFR mutation status was available in 391 patients (72%), and 83% tested mutation positive. Median time to treatment failure (TTF) of 541 patients treated with afatinib was 3.7 months (range: 0.0 to >29.0 months). Median TTF was 4.0 and 2.7 months in patients with adenocarcinomas and squamous cell carcinomas, respectively, and 4.6 months in patients with EGFR-mutated NSCLC. Adverse events were generally manageable. CONCLUSION Afatinib was able to be given in a real-world setting to heavily pretreated patients with EGFR-mutated or EGFR-TKI-sensitive NSCLC. Acknowledging the constraints of data collection in a CUP, afatinib appears to be safe and to confer some clinical benefit in this population.
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Affiliation(s)
- Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Jürgen R Fischer
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Christian Grohé
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Sylvia Gütz
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Michael Thomas
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Martin Kimmich
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Claus-Peter Schneider
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Eckart Laack
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Angela Märten
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
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