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Doumat G, Daher D, Zerdan MB, Nasra N, Bahmad HF, Recine M, Poppiti R. Drug Repurposing in Non-Small Cell Lung Carcinoma: Old Solutions for New Problems. Curr Oncol 2023; 30:704-719. [PMID: 36661704 PMCID: PMC9858415 DOI: 10.3390/curroncol30010055] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Lung cancer is the second most common cancer and the leading cause of cancer-related deaths in 2022. The majority (80%) of lung cancer cases belong to the non-small cell lung carcinoma (NSCLC) subtype. Despite the increased screening efforts, the median five-year survival of metastatic NSCLC remains low at approximately 3%. Common treatment approaches for NSCLC include surgery, multimodal chemotherapy, and concurrent radio and chemotherapy. NSCLC exhibits high rates of resistance to treatment, driven by its heterogeneity and the plasticity of cancer stem cells (CSCs). Drug repurposing offers a faster and cheaper way to develop new antineoplastic purposes for existing drugs, to help overcome therapy resistance. The decrease in time and funds needed stems from the availability of the pharmacokinetic and pharmacodynamic profiles of the Food and Drug Administration (FDA)-approved drugs to be repurposed. This review provides a synopsis of the drug-repurposing approaches and mechanisms of action of potential candidate drugs used in treating NSCLC, including but not limited to antihypertensives, anti-hyperlipidemics, anti-inflammatory drugs, anti-diabetics, and anti-microbials.
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Affiliation(s)
- George Doumat
- Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Darine Daher
- Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Morgan Bou Zerdan
- Faculty of Medicine, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Nasri Nasra
- Faculty of Medicine, University of Aleppo, Aleppo 15310, Syria
| | - Hisham F. Bahmad
- The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Monica Recine
- The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Robert Poppiti
- The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
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Yu C, Jiang L, Yang D, Dong X, Yu R, Yu H. Anlotinib Hydrochloride and PD-1 Blockade as a Salvage Second-Line Treatment in Patients with Progress of Local Advanced Non-Small Cell Lung Cancer in Half a Year After Standard Treatment. Onco Targets Ther 2022; 15:1221-1228. [PMID: 36262804 PMCID: PMC9575589 DOI: 10.2147/ott.s380615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/01/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose As for local advanced non-small cell lung cancer (NSCLC), synchronous radiotherapy and chemotherapy is the standard treatment mode. But for patients with progress in half a year, which means the second-line chemotherapy effect is not ideal for them. We observed the efficacy and safety of anlotinib hydrochloride combined with PD-1 blockade as the second-line treatment for those patients in this trial. Patients and Methods From January 2018 to December 2019, 57 patients with the progress of local advanced NSCLC treated with anlotinib plus PD-1 blockade until disease progression or intolerance as a result of adverse events. Patients have been assessed using computed tomography prior to treatment and during follow-up every 2 months until disease progression or death. The primary endpoint was objective response rate (ORR). The secondary endpoints included overall survival (OS), progression-free survival (PFS) and safety. Survival curves were created using the Kaplan-Meier method. Results 57 patients were enrolled. The median age was 64 years, and 61.4% of the patients were men. The ORR was 50.9% with a median OS time of 14 months and the 1-year OS rates and PFS rates were 81.8% and 33.3%, respectively. The patients with squamous cell carcinoma, no brain or liver metastases had longer PFS than patients with liver metastasis. When the PFS was calculated from the time of second treatment, the median PFS was 9 months. Most adverse events (AEs) were grade 1-3, one drug-related death was noted. Conclusion The expected outcome of this study is that anlotinib combined with PD-1 blockade has tolerable toxicity and better ORR, OS than second-line chemotherapy. The results may indicate additional treatment options for patients with progress of local advance NSCLC in half a year after standard treatment.
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Affiliation(s)
- Chengqi Yu
- School of Basic Medical Science, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Leilei Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, People’s Republic of China
| | - Dan Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, People’s Republic of China
| | - Xin Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, People’s Republic of China
| | - Rong Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, People’s Republic of China
| | - Huiming Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, People’s Republic of China,Correspondence: Huiming Yu, Department of Radiation Oncology, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, Beijing, 100142, People’s Republic of China, Tel +86 13699249320, Fax +86 10-59300192, Email
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Zheng Q, Xu J, Gao Y, Liu M, Cheng L, Xiong L, Cheng J, Yuan M, OuYang G, Huang H, Wu J, Zhang J, Tian J. Past, present and future of living systematic review: a bibliometrics analysis. BMJ Glob Health 2022; 7:e009378. [PMID: 36220305 PMCID: PMC9558789 DOI: 10.1136/bmjgh-2022-009378] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In recent years, the concept of living systematic review (LSR) has attracted the attention of many scholars and institutions. A growing number of studies have been conducted based on LSR methodology, but their focus direction is unclear. The objective of this study was to provide a comprehensive review of existing LSR-related studies and to analyse their whole picture and future trends with bibliometrics. METHODS A comprehensive search strategy was used to construct a representative dataset of LSRs up to October 2021. GraphPad V.8.2.1 and Mindmaster Pro presented the basic information of the included studies and the timeline of LSR development, respectively. The author and country cooperation network, hotspot distribution clustering, historical citation network and future development trend prediction related to LSR were visualised by VOSviewer V.1.6.16 and R-Studio V.1.4. RESULTS A total of 213 studies were eventually included. The concept of LSR was first proposed in 2014, and the number of studies has proliferated since 2020. There was a closer collaboration between author teams and more frequent LSR research development and collaboration in Europe, North America and Australia. Numerous LSR studies have been published in high-impact journals. COVID-19 is the predominant disease of concern at this stage, and the rehabilitation of its patients and virological studies are possible directions of research in LSR for a long time to come. A review of existing studies found that more than half of the LSR series had not yet been updated and that the method needed to be more standardised in practice. CONCLUSION Although LSR has a relatively short history, it has received much attention and currently has a high overall acceptance. The LSR methodology was further practised in COVID-19, and we look forward to seeing it applied in more areas.
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Affiliation(s)
- Qingyong Zheng
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
| | - Jianguo Xu
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Ya Gao
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ming Liu
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Luying Cheng
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
- Zigong First People's Hospital, Zigong, Sichuan, China
| | - Lu Xiong
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jie Cheng
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, Gansu, China
| | - Mengyuan Yuan
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, Gansu, China
| | - Guoyuan OuYang
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, Gansu, China
| | - Hengyi Huang
- School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, Gansu, China
| | - Jiarui Wu
- Department of Clinical Chinese Pharmacy, Beijing University of Chinese Medicine, Beijing, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, China
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
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Kholod O, Basket W, Liu D, Mitchem J, Kaifi J, Dooley L, Shyu CR. Identification of Immuno-Targeted Combination Therapies Using Explanatory Subgroup Discovery for Cancer Patients with EGFR Wild-Type Gene. Cancers (Basel) 2022; 14:cancers14194759. [PMID: 36230688 PMCID: PMC9564073 DOI: 10.3390/cancers14194759] [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: 08/15/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Phenotypic and genotypic heterogeneity are characteristic features of cancer patients. To tackle patients’ heterogeneity, immune checkpoint inhibitors (ICIs) represent some the most promising therapeutic approaches. However, approximately 50% of cancer patients that are eligible for treatment with ICIs do not respond well, especially patients with no targetable mutations. Over the years, multiple patient stratification techniques have been developed to identify homogenous patient subgroups, although matching a patient subgroup to a treatment option that can improve patients’ health outcomes remains a challenging task. (2) Methods: We extended our Subgroup Discovery algorithm to identify patient subpopulations that could potentially benefit from immuno-targeted combination therapies in four cancer types: head and neck squamous carcinoma (HNSC), lung adenocarcinoma (LUAD), lung squamous carcinoma (LUSC), and skin cutaneous melanoma (SKCM). We employed the proportional odds model to identify significant drug targets and the corresponding compounds that increased the likelihood of stable disease versus progressive disease in cancer patients with the EGFR wild-type (WT) gene. (3) Results: Our pipeline identified six significant drug targets and thirteen specific compounds for cancer patients with the EGFR WT gene. Three out of six drug targets—FCGR2B, IGF1R, and KIT—substantially increased the odds of having stable disease versus progressive disease. Progression-free survival (PFS) of more than 6 months was a common feature among the investigated subgroups. (4) Conclusions: Our approach could help to better select responders for immuno-targeted combination therapies and improve health outcomes for cancer patients with no targetable mutations.
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Affiliation(s)
- Olha Kholod
- MU Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, USA
| | - William Basket
- MU Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, USA
| | - Danlu Liu
- Department of Electrical Engineering & Computer Science, University of Missouri, Columbia, MO 65212, USA
| | - Jonathan Mitchem
- MU Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, USA
- Department of Surgery, School of Medicine, University of Missouri, Columbia, MO 65212, USA
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO 65201, USA
| | - Jussuf Kaifi
- MU Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, USA
- Department of Surgery, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Laura Dooley
- Department of Otolaryngology, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Chi-Ren Shyu
- MU Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, USA
- Department of Electrical Engineering & Computer Science, University of Missouri, Columbia, MO 65212, USA
- Correspondence:
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Effectiveness and Cost-Effectiveness Profile of Second-Line Treatments with Nivolumab, Pembrolizumab and Atezolizumab in Patients with Advanced Non-Small Cell Lung Cancer. Pharmaceuticals (Basel) 2022; 15:ph15040489. [PMID: 35455486 PMCID: PMC9025730 DOI: 10.3390/ph15040489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 12/10/2022] Open
Abstract
No evidence is available on the head-to-head comparison of clinical outcomes of patients treated with immune checkpoint inhibitors (ICIs) for advanced non-small cell lung cancer (NSCLC) in a real-world setting. We aimed to compare the effectiveness and cost-effectiveness profile of nivolumab, pembrolizumab and atezolizumab. We used a population-based retrospective cohort study based on the healthcare utilization databases of the Lombardy Region, Italy. The study cohort included all patients with a diagnosis of lung cancer, who started a second-line treatment for advanced NSCLC with nivolumab, pembrolizumab or atezolizumab from 2015 to 30 June 2020. Overall survival and average cumulative healthcare costs were measured from the start of second-line treatment until 31 December 2020. The study cohort included 1607 patients who started a second-line treatment with ICIs, of which there were 1193 with nivolumab, 138 with pembrolizumab and 276 with atezolizumab. No differences were observed between treatment arms in terms of sex, age or comorbidities. Median OS was very similar between groups, being 8.9, 9.4 and 8.7 months, respectively, in patients treated with nivolumab, pembrolizumab and atezolizumab (p = 0.898). The adjusted hazard ratio of death of patients treated with pembrolizumab and atezolizumab, as compared to nivolumab, were 1.01 (95% CI: 0.81 to 1.25) and 1.03 (0.88 to 1.21), respectively. Healthcare cumulative costs measured in the first two years of follow-up were EUR 43,764, 46,233 and 34,116, on average, associated with nivolumab, pembrolizumab and atezolizumab, respectively. In our real-world study, atezolizumab was the ICI associated with the most favorable cost-effectiveness profile.
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6
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Yang Y, Zhang X, Gao Y, Dong Y, Wang D, Huang Y, Qu T, Fan B, Li Q, Zhang C, Cui X, Zhang B. Research progress in immunotherapy of NSCLC with EGFR sensitive mutations. Oncol Res 2022; 29:63-74. [PMID: 35236543 PMCID: PMC9110674 DOI: 10.3727/096504022x16462176651719] [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
Lung cancer is a malignant tumor with high incidence and mortality across the world. The use of immune checkpoint inhibitors for lung cancer has improved the prognosis of some lung cancer patients to a greater extent and provided a new direction for the clinical treatment of lung cancer. Immunotherapy still has limitations in terms of its appropriate population and adverse reactions. Particularly for non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation, there has been no major breakthrough in current immunotherapy. Whether immunotherapy can bring new benefits after drug resistance is induced by tyrosine kinase inhibitor-targeted therapy and whether the combination of immunotherapy with other treatments can improve the prognosis remain to be studied in depth. In this article, we provide a detailed review of the relevant characteristics of the tumor microenvironment of NSCLC with EGFR mutation and the current research on immunotherapy for NSCLC with EGFR mutation.
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Affiliation(s)
- Yudie Yang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Xia Zhang
- Department of Oncology, Dalian Fifth Peoples Hospital, Dalian, 116021, China
| | - Yajie Gao
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Yan Dong
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Di Wang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Yanping Huang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Tianhao Qu
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Buqun Fan
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Qizheng Li
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Chunxia Zhang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Xiaonan Cui
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Bin Zhang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
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Tang X, Trinquart L. Bayesian multivariate network meta-analysis model for the difference in restricted mean survival times. Stat Med 2021; 41:595-611. [PMID: 34883534 DOI: 10.1002/sim.9276] [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: 01/06/2021] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 11/08/2022]
Abstract
Network meta-analysis (NMA) is essential for clinical decision-making. NMA enables inference for all pair-wise comparisons between interventions available for the same indication, by using both direct evidence and indirect evidence. In randomized trials with time-to event outcome data, such as lung cancer data, conventional NMA methods rely on the hazard ratio and the proportional hazards assumption, and ignore the varying follow-up durations across trials. We introduce a novel multivariate NMA model for the difference in restricted mean survival times (RMST). Our model synthesizes all the available evidence from multiple time points simultaneously and borrows information across time points through within-study covariance and between-study covariance for the differences in RMST. We propose an estimator of the within-study covariance and we then assume it to be known. We estimate the model under the Bayesian framework. We evaluated our model by conducting a simulation study. Our multiple-time-point model yields lower mean squared error over the conventional single-time-point model at all time points, especially when the availability of evidence decreases. We illustrated the model on a network of randomized trials of second-line treatments of advanced non-small-cell lung cancer. Our multiple-time-point model yielded increased precision and detected evidence of benefit at earlier time points as compared to the single-time-point model. Our model has the advantage of providing clinically interpretable measures of treatment effects.
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Affiliation(s)
- Xiaoyu Tang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, USA
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Huang Q, Zheng Y, Gao Z, Yuan L, Sun Y, Chen H. Comparative Efficacy and Safety of PD-1/PD-L1 Inhibitors for Patients with Solid Tumors: A Systematic Review and Bayesian Network Meta-analysis. J Cancer 2021; 12:1133-1143. [PMID: 33442411 PMCID: PMC7797652 DOI: 10.7150/jca.49325] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/18/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose: The clinical use of immunotherapies targeting programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) is rapid expanding, but the equivalency of these inhibitors remains unclear. We aimed to comprehensively compare the efficacy and safety of PD-1/PD-L1 inhibitors with a systematic review and Bayesian network meta-analysis Methods: We searched PubMed, Web of Knowledge, related reviews and abstracts for randomized controlled trials of five PD-1/PD-L1 inhibitors for patients with solid tumors before November 30th, 2018. We estimated summary hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS), and odds ratios (ORs) for grade 3-5 treatment-related adverse events (TrAEs) using pairwise and network meta-analysis with random-effects. This study was registered with PROSPERO (#CRD42018116624). Results: Totally, 43 reports of 35 trials comprising 21261 patients were eligible for the analysis. Nivolumab, pembrolizumab, atezolizumab and durvalumab were more effective than control treatment, and no significant differences were identified in OS and PFS between any two inhibitors. Avelumab was associated with significantly inferior OS to nivolumab (HR 1.37, 95%CrI 1.05-1.78) and pembrolizumab (HR 1.33, 95%CrI 1.02-1.73), and with inferior PFS to nivolumab (HR 1.60, 95%CrI 1.03-2.51). Compared with placebo, nivolumab had increased risk of grade 3-5 TrAEs (OR 2.35, 95%CrI 1.35-4.17). Compared with standard-of-care, nivolumab (OR 0.39, 95%CrI 0.28-0.54), pembrolizumab (OR 0.43, 95%CrI 0.30-0.60), atezolizumab (OR 0.37, 95%CrI 0.21-0.64) and avelumab (OR 0.24, 95%CrI 0.12-0.48) significantly reduced grade 3-5 TrAEs. There were not significant differences in grade 3-5 TrAEs between any two inhibitors. Conclusion: This Bayesian network meta-analysis revealed that nivolumab, pembrolizumab, atezolizumab and durvalumab yielded equivalent survival, while avelumab was associated with unfavorable survival. PD-1/PD-L1 inhibitors were comparable in the risk of TrAEs, and safer than conventional therapies.
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Affiliation(s)
- Qingyuan Huang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuzhen Zheng
- Department of Thoracic Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.,Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhendong Gao
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lianxiong Yuan
- Office of Research Service, Third Affiliation Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yihua Sun
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Liang J, Li M, Sui Q, Hu Z, Bian Y, Huang Y, Zhan C, Jiang W, Wang Q, Tan L. Compare the efficacy and safety of programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) inhibitors for advanced non-small cell lung cancer: a Bayesian analysis. Transl Lung Cancer Res 2020; 9:1302-1323. [PMID: 32953506 PMCID: PMC7481633 DOI: 10.21037/tlcr-20-192] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Inhibitors of programmed cell death-1 (PD-1) and its ligand (PD-L1) have represented a novel approach for the management of advanced non-small cell lung cancer (NSCLC). In this study, we aimed to estimate five anti-PD-1/L1 agents (nivolumab, pembrolizumab, atezolizumab, durvalumab, and avelumab) using network meta-analyses (NMAs) and the Bayesian method to provide suggestions for advanced NSCLC treatments. Methods We searched PubMed, Web of Science, Embase, and the Wiley Online Library for eligible studies published up to March 2020. Both pairwise analyses and NMAs were conducted with clinical outcomes, including overall survival (OS), progression-free survival (PFS), objective response rate, and the incidences of adverse events. Results were presented in several patient populations according to treatment lines and PD-L1 status. Results Nineteen randomized clinical trials (RCTs) involving 11,456 patients were included in our study. PD-1/L1 inhibitors showed significant benefits over chemotherapies in OS regardless of tumor PD-L1 status [first-line settings: OS =0.85, 95% CI (0.77, 0.94), I2=37%; second- or further-line settings: OS =0.77, 95% CI (0.71, 0.84), I2=37%]. The combined regimen of pembrolizumab and chemotherapy stood out to be the most effective and safest for patients in the first-line settings. Pembrolizumab monotherapy was showed to be the best especially for patients with PD-L1 ≥50%. In the subsequent-line settings, nivolumab ranked the best in improving the survival of patients, and durvalumab had the greatest effect in tumor shrinkage. Atezolizumab, followed by nivolumab, ranked the safest in reducing adverse events, whereas durvalumab was showed with the largest side effects among the five inhibitors. Conclusions The combination of pembrolizumab with chemotherapy is suitable for advanced NSCLC patients who have not received any systematic treatments before, and pembrolizumab monotherapy should also be considered, especially for patients with highly-expressed PD-L1 (≥50%). Nivolumab is the best option for patients with advanced NSCLC whose tumors have progressed following chemotherapies or combined modalities of treatments including chemotherapy. However, our results need to be further validated in future head-to-head clinical trials.
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Affiliation(s)
- Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qihai Sui
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Eight-year Program Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengyang Hu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunyi Bian
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Boutron I, Créquit P, Williams H, Meerpohl J, Craig JC, Ravaud P. Future of evidence ecosystem series: 1. Introduction Evidence synthesis ecosystem needs dramatic change. J Clin Epidemiol 2020; 123:135-142. [DOI: 10.1016/j.jclinepi.2020.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
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11
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Wagner G, Stollenwerk HK, Klerings I, Pecherstorfer M, Gartlehner G, Singer J. Efficacy and safety of immune checkpoint inhibitors in patients with advanced non-small cell lung cancer (NSCLC): a systematic literature review. Oncoimmunology 2020; 9:1774314. [PMID: 32923134 PMCID: PMC7458604 DOI: 10.1080/2162402x.2020.1774314] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Therapeutic strategies with immune checkpoint inhibitors (ICIs) counteract the immunosuppressive effects of programmed cell death protein-1 (PD-1) and ligand-1 (PD-L1). ICI treatment has emerged in first- and second-line therapy of non-small cell lung cancer (NSCLC). As immunotherapeutic treatment with ICIs is a dynamic field where new drugs and combinations are constantly evaluated, we conducted an up-to-date systematic review on comparative efficacy and safety in patients with advanced NSCLC. Methods We searched PubMed up to February 2020 and Embase, CENTRAL, and clinical trial registries up to August 2018. Additionally, we checked reference lists. We dually screened titles, abstracts and, subsequently, full-texts for eligibility. Two reviewers assessed the risk of bias and graded the certainty of evidence following GRADE (Grading of Recommendations Assessment, Development and Evaluation). For second-line therapy, we performed random-effects meta-analyses. Due to considerable clinical heterogeneity, we reported first-line results narratively. Results Of 1497 references, we identified 22 relevant publications of 16 studies. For first-line therapy, a combination of an ICI with chemotherapy improved progression-free survival and overall survival compared to chemotherapy but increased the risk of serious adverse events. Single-agent pembrolizumab increased overall and progression-free survival in patients with PD-L1 expression of ≥50% and resulted in less TRAE than chemotherapy. Compared to placebo, maintenance therapy with durvalumab increased overall and progression-free survival at the downside of higher risk of TRAE. For second-line therapy, a random-effects meta-analysis yielded a statistically significantly improved overall survival (OS) and progression-free survival (PFS) for ICIs compared to docetaxel (HR 0.69; 95% CI: 0.63-0.75 for OS; HR 0.85; 95% CI: 0.77 - 0.93 for PFS; 6 studies, 3478 patients; median OS benefit in months: 2.4 to 4.2). In meta-analysis, risk of any treatment-related adverse events of any grade was lower for ICI than docetaxel as second-line therapy (RR 0.76, 95% CI: 0.73-0.79; 6 studies, 3763 patients). Conclusion In first-line therapy of patients with advanced NSCLC, ICI is effective when combined with chemotherapy not depending on PD-L1 expression, or as monotherapy in high PD-L1 expressing tumors. For second-line therapy, single-agent ICI improves efficacy and safety compared to docetaxel.
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Affiliation(s)
- Gernot Wagner
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | | | - Irma Klerings
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Martin Pecherstorfer
- Division of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital Krems, Krems, Austria
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria.,RTI International, Research Triangle Park, Durham, NC, USA
| | - Josef Singer
- Division of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital Krems, Krems, Austria
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Shulgin B, Kosinsky Y, Omelchenko A, Chu L, Mugundu G, Aksenov S, Pimentel R, DeYulia G, Kim G, Peskov K, Helmlinger G. Dose dependence of treatment-related adverse events for immune checkpoint inhibitor therapies: a model-based meta-analysis. Oncoimmunology 2020; 9:1748982. [PMID: 32934874 PMCID: PMC7466858 DOI: 10.1080/2162402x.2020.1748982] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Abstract
Programmed cell death-1 (PD-1) and/or cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) immune checkpoint inhibitor (ICI) treatments are associated with adverse events (AEs), which may be dependent on ICI dose. Applying a model-based meta-analysis to evaluate safety data from published clinical trials from 2005 to 2018, we analyzed the dose/exposure dependence of ICI treatment-related AE (trAE) and immune-mediated AE (imAE) rates. Unlike with PD-1 inhibitor monotherapy, CTLA-4 inhibitor monotherapy exhibited a dose/exposure dependence on most AE types evaluated. Furthermore, combination therapy with PD-1 inhibitor significantly strengthened the dependence of trAE and imAE rates on CTLA-4 inhibitor dose/exposure.
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Affiliation(s)
| | | | | | - Lulu Chu
- PK Sciences Modeling & Simulation, Novartis Institutes of BioMedical Research, Cambridge, MA, USA
| | - Ganesh Mugundu
- Clinical Pharmacology & Quantitative Pharmacology, R&D BioPharmaceuticals, AstraZeneca, Waltham, MA, USA
| | - Sergey Aksenov
- Clinical Pharmacology & Quantitative Pharmacology, R&D BioPharmaceuticals, AstraZeneca, Waltham, MA, USA
| | | | | | | | - Kirill Peskov
- M&S Decisions LLC, Moscow, Russia
- I.M.Sechenov first Moscow State Medical University of the Russian Ministry of Health, Moscow, Russia
| | - Gabriel Helmlinger
- Clinical Pharmacology & Toxicology, Obsidian Therapeutics, Cambridge, MA, USA
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13
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Retrospective observational cohort study on innovation in oncology and progress in survival: How far have we gotten in the two decades of treating patients with advanced non-small cell lung cancer as a single population? PLoS One 2020; 15:e0232669. [PMID: 32396541 PMCID: PMC7217468 DOI: 10.1371/journal.pone.0232669] [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: 06/20/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
We assessed the impact of new antineoplastic agents on the overall survival (OS) of advanced non-small cell lung cancer (aNSCLC) patients followed up until 2012. Multivariate regression models were run for OS (outcome) and four proxies for innovation (exposure): Index (InnovInd, for SEER-Research data 1973–2012) and three levels of aggregation of Mean Medication Vintage, i.e. Overall (MMVOverall), using data aggregated at the State Level (MMVState), and using patient-level data (MMVPatient) using data from the US captured in SEER-Medicare 1991–2012. We derived Hazard ratios (HR) from Royston-Parmar models and odds ratios (OR) from a logistic regression on 1-year OS. Including 164,704 patients (median age 72 years, 56.8% stage IV, 61.8% with no comorbidities, 37.8% with adenocarcinoma, 22.9% with squamous-cell, 6.1% were censored). One-year OS improved from 0.22 in 1973 to 0.39 in 2012, in correlation with InnovInd (r = 0.97). Ten new NSCLC drugs were approved and 28 more used off-label. Regression-models results indicate that therapeutic innovation only marginally reduced the risk of dying (HROverall = 0.98 [0.98–0.98], HRMMV-Patient = 0.98 [0.97–0.98], and HRMMV-State = 0.98 [0.98–0.98], and slightly improved 1-year survival (ORMMV-Overall = 1.05 95%CI [1.04–1.05]). These results were validated with data from the Swedish National Health Data registers. Until 2013, aNSCLC patients were treated undifferentiated and the introduction of innovative therapies had statistically significant, albeit modest, effects on survival. Most treatments used off-guidelines highlight the high unmet need; however new advancements in treatment may further improve survival.
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14
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Gallacher D, Auguste P, Royle P, Mistry H, Armoiry X. A Systematic Review of Economic Evaluations Assessing the Cost-Effectiveness of Licensed Drugs Used for Previously Treated Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) Negative Advanced/Metastatic Non-Small Cell Lung Cancer. Clin Drug Investig 2020; 39:1153-1174. [PMID: 31583605 DOI: 10.1007/s40261-019-00859-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is one of the most commonly diagnosed cancers. There are many published studies of cost-effectiveness analyses of licensed treatments, but no study has compared these studies or their approaches simultaneously. OBJECTIVE To investigate the methodology used in published economic analyses of licensed interventions for previously treated advanced/metastatic NSCLC in patients without anaplastic lymphoma kinase or epidermal growth factor receptor expression. METHODS A systematic review was performed, including a systematic search of key databases (e.g. MEDLINE, EMBASE, Web of Knowledge, Cost-effectiveness Registry) limited to the period from 01 January 2001 to 26 July 2019. Two reviewers independently screened, extracted data and quality appraised identified studies. The reporting quality of the studies was assessed by using the Consolidated Health Economic Evaluation Reporting Standards and the Philips' checklists. RESULTS Thirty-one published records met the inclusion criteria, which corresponded to 30 individual cost-effectiveness analyses. Analytical approaches included partitioned survival models (n = 14), state-transition models (n = 7) and retrospective analyses of new or published data (n = 8). Model structure was generally consistent, with pre-progression, post-progression and death health states used most commonly. Other characteristics varied more widely, including the perspective of analysis, discounting, time horizon, usually to align with the country that the analysis was set in. CONCLUSIONS There are a wide range of approaches in the modelling of treatments for advanced NSCLC; however, the model structures are consistent. There is variation in the exploration of sensitivity analyses, with considerable uncertainty remaining in most evaluations. Improved reporting is necessary to ensure transparency in future analyses.
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Affiliation(s)
- Daniel Gallacher
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Peter Auguste
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Pamela Royle
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Hema Mistry
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Xavier Armoiry
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Lyon School of Pharmacy (ISPB), Claude Bernard University Lyon 1, Lyon, 69008, France
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15
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Snyders K, Cho D, Hong JH, Lord S, Asher R, Marschner I, Lee CK. Benchmarking single-arm studies against historical controls from non-small cell lung cancer trials - an empirical analysis of bias. Acta Oncol 2020; 59:90-95. [PMID: 31608733 DOI: 10.1080/0284186x.2019.1674452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Recent trials of novel agents in 'rare' molecular subtypes of non-small cell lung cancer (NSCLC) have used single-arm trial designs and benchmarked outcomes against historical controls. We assessed the consistency of historical control outcomes using docetaxel data from published NSCLC randomized controlled trials (RCTs).Material and methods: Advanced NSCLC RCTs including a docetaxel monotherapy arm were included. Heterogeneity in tumor objective response rates (ORRs), progression-free survival (PFS) and overall survival (OS), and correlations between outcomes and year of trial commencement were assessed.Results: Among 63 trials (N = 10,633) conducted between 2000 and 2017, ORR ranged from 0% to 26% (I2 = 76.1%, pheterogeneity < .0001). Mean of the median PFS was 3.0 months (range: 1.4-6.4), 3-month PFS ranged from 25% to 85% (I2 = 86.0%, pheterogeneity < .0001). Mean of the median OS was 9.1 months (range: 4.7-22.9), 9-month OS ranged from 23% to 79% (I2 = 83.0%, pheterogeneity < .0001). Each later year of trial commencement was associated with 0.3% (p = .046), 0.5% (p = .11) and 0.9% (p = .001) improvement in ORR, 3-month PFS and 9-month OS rates, respectively.Conclusions: There was significant heterogeneity and an improving trend in docetaxel outcomes across trials conducted over 20 years. Benchmarking biomarker-targeted agents against historical controls may not be a valid approach to replace RCTs. Innovative study designs involving a concurrent control arm should be considered.
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Affiliation(s)
- Kelli Snyders
- Cancer Care Centre, St George Hospital, Kogarah, Australia
| | - Doah Cho
- National Health and Medical Research Council Clinical Trials Centre, Camperdown, Australia
| | - Jun Hee Hong
- Cancer Care Centre, St George Hospital, Kogarah, Australia
| | - Sally Lord
- National Health and Medical Research Council Clinical Trials Centre, Camperdown, Australia
- School of Medicine, The University of Norte Dame, Darlinghurst, Australia
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, Camperdown, Australia
| | - Ian Marschner
- National Health and Medical Research Council Clinical Trials Centre, Camperdown, Australia
- Department of Statistics, Macquarie University, Sydney, Australia
| | - Chee Khoon Lee
- Cancer Care Centre, St George Hospital, Kogarah, Australia
- National Health and Medical Research Council Clinical Trials Centre, Camperdown, Australia
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Abstract
Atezolizumab (TECENTRIQ™), an immune checkpoint inhibitor, is an immunoglobulin G1 monoclonal antibody that binds to programmed death ligand 1 (PD-L1) and blocks its interactions with programmed death 1 and B7.1 receptors. Atezolizumab is approved as monotherapy in several countries worldwide for the treatment of patients with advanced non-small cell lung cancer (NSCLC) who have previously received chemotherapy. Approval was based on its clinical benefit in this setting in the phase II POPLAR and phase III OAK trials. In these studies, atezolizumab significantly prolonged overall survival (OS) relative to docetaxel, regardless of PD-L1 status. Increasing PD-L1 expression was associated with OS improvements. Atezolizumab also demonstrated efficacy in the phase II FIR and BIRCH trials, as assessed by objective response rates (ORRs) in patients with tumours expressing PD-L1. Higher ORRs were seen in patients with high PD-L1 expression. Atezolizumab had an acceptable, manageable tolerability profile, with a low incidence of immune-related adverse events. Therefore, atezolizumab is a valuable treatment option for patients with advanced NSCLC that has progressed during or after chemotherapy.
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17
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Almutairi AR, Alkhatib N, Martin J, Babiker HM, Garland LL, McBride A, Abraham I. Comparative efficacy and safety of immunotherapies targeting the PD-1/PD-L1 pathway for previously treated advanced non-small cell lung cancer: A Bayesian network meta-analysis. Crit Rev Oncol Hematol 2019; 142:16-25. [PMID: 31326706 DOI: 10.1016/j.critrevonc.2019.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Two PD-1 (pembrolizumab, nivolumab) and one PD-L1(atezolizumab) inhibitors are approved for previously treated advanced non-small cell lung cancer but have not been compared in head-to-head trials. METHOD A network meta-analysis was conducted to compare efficacy/safety of PD-1/PD-L1 inhibitors. RESULTS In five-trials (including long-term updates) with docetaxel as common comparator there were no differences in OS and PFS between PD-1/PD-L1 inhibitors. Pembrolizumab (odds ratio(OR) = 2.22, 95%CrI = 1.28-3.70) and nivolumab (OR = 1.92, 95%CrI = 1.15-3.23) had higher ORRs than atezolizumab and at PD-L1 expression ≥50% and ≥1%. Probabilistically, pembrolizumab ranked first in OS and ORR, and in OS sub-analyses for adenocarcinoma, EGFR-mutant, ECOG-score-1, male, and age <65 years. Nivolumab ranked first in PFS, and in OS sub-analyses for squamous-cell disease, EGFR-wild-type, and ECOG-score-0. Pembrolizumab and nivolumab ranked the best option for most of adverse events. CONCLUSION While pembrolizumab and nivolumab prevailed in rank in OS and ORR benefit, patient characteristics, safety and tolerance should be considered in treatment decision-making.
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Affiliation(s)
- Abdulaali R Almutairi
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Nimer Alkhatib
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Jennifer Martin
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Arizona Health Sciences Library, University Libraries, University of Arizona, Tucson, AZ, USA.
| | - Hani M Babiker
- Division of Hematology and Oncology, College of Medicine, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA.
| | - Linda L Garland
- Division of Hematology and Oncology, College of Medicine, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA.
| | - Ali McBride
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA.
| | - Ivo Abraham
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA; Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.
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Comparative Efficacy of Second- and Subsequent-line Treatments for Metastatic NSCLC: A Fractional Polynomials Network Meta-analysis of Cancer Immunotherapies. Clin Lung Cancer 2019; 20:451-460.e5. [PMID: 31375454 DOI: 10.1016/j.cllc.2019.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/05/2019] [Accepted: 06/10/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Extended onset of treatment effect and longer-term survival with anti-programmed death-ligand 1 (PD-L1)/programmed cell death protein 1 (PD-1) immunotherapies, atezolizumab, nivolumab, and pembrolizumab, have changed the landscape of second- or subsequent-line (2L+) treatments for adults with non-small-cell lung cancer (NSCLC). This systematic literature review included phase I to IV randomized, controlled trials of 2L+ NSCLC therapies from MEDLINE, Embase, and secondary sources. MATERIALS AND METHODS Studies of treatments approved in the European Union or United States had to be in English with ≥ 10 patients per arm. A fractional polynomials network meta-analysis (NMA) was conducted because traditional NMA of hazard ratios does not account for delayed onset of clinical effect or long-term survival observed in PD-L1/PD-1 inhibitor trials. Adjusted analyses accounted for treatment switching in the atezolizumab OAK trial. Expected survival time reflected area under the curve over the time horizon. Expected overall survival (OS) was ranked by median ranking with 95% credible intervals and by surface under the cumulative ranking curve. Of 25,115 screened records, 28 studies were included in the quantitative analyses of OS and progression-free survival. RESULTS PD-L1/PD-1 inhibitors had comparable expected 5-year OS; all performed better than other treatment options. In unadjusted analyses, surface under the cumulative ranking curve ranked nivolumab first (87.9%), followed by atezolizumab (85.8%) and pembrolizumab (82.8%). Analyses adjusted for patients switching from docetaxel to immunotherapy ranked atezolizumab first (89.6%), followed by nivolumab (86.5%) and pembrolizumab (81.9%). CONCLUSION This NMA applied an appropriate approach for indirect comparisons, including cancer immunotherapies, and supported robustness of PD-L1/PD-1 immunotherapies for 2L+ treatment of NSCLC.
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Connock M, Armoiry X, Tsertsvadze A, Melendez-Torres GJ, Royle P, Andronis L, Clarke A. Comparative survival benefit of currently licensed second or third line treatments for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) negative advanced or metastatic non-small cell lung cancer: a systematic review and secondary analysis of trials. BMC Cancer 2019; 19:392. [PMID: 31023244 PMCID: PMC6485098 DOI: 10.1186/s12885-019-5507-6] [Citation(s) in RCA: 5] [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: 01/26/2018] [Accepted: 03/21/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND A review of therapies for advanced cancers licenced by the EMA between 2009 and 2013 concluded that for more than half of these drugs there was little evidence of overall survival or quality of life benefit. Recent years have witnessed a growing number of licensed second-line pharmacotherapies for advanced/metastatic non-small cell lung cancer (NSCLC). With the aim of gauging patient survival benefit, we conducted a systematic review of randomised controlled trials (RCT) and compared survival outcomes from available licensed treatments for patients with advanced/metastatic NSCLC. METHODS RCTs of second/third line treatments in participants with advanced/metastatic NSCLC and negative/low expression of Anaplastic Lymphoma Kinase (ALK) and of Epidermal Growth Factor Receptor (EGFR) were included. We searched electronic databases (MEDLINE; EMBASE; Web of Science) from January, 2000 up to July, 2017. Two or more independent reviewers screened bibliographic records, extracted data, and assessed risk of bias of studies. Published Kaplan Meier plots for OS and PFS along with restricted-mean-survival methods and parametric modelling were used to estimate the survival outcomes as mean number of months of survival. Network meta-analysis was undertaken to rank interventions and to make indirect comparisons. RESULTS We included 11 RCTs with data for 7581 participants that compared nine different drugs. In studies of patients regardless of histology groups, targeted drugs (ramucirumab and nintedanib) yielded small overall survival gains of < 2.5 months over docetaxel, erlotinib provided no benefit, while immunotherapies (atezolizumab and pembrolizumab) delivered 5 to 6 months gain. Studies with patients stratified by histology confirmed the apparent superiority of immunotherapy (nivolumab and atezolizumab) over targeted treatments (ramucirumab, nintedanib, afatinib) providing between about 4 to 8 months OS gain over docetaxel. In network analysis immunotherapies consistently ranked higher than alternatives irrespective of population histology and outcome measure. CONCLUSION Our review indicates that nivolumab, pembrolizumab and atezolizumab provide superior survival benefits compared to other licensed drugs for late stage NSCLC. Patient gains from these immunotherapies are substantial compared to the expected average survival with chemotherapy (docetaxel) of < 1 year for people with squamous histology and about 1.25 year for those with non-squamous histology.
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Affiliation(s)
- Martin Connock
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill road, CV47AL Coventry, England
| | - Xavier Armoiry
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill road, CV47AL Coventry, England
- School of Pharmacy (ISPB) / UMR CNRS 5510 MATEIS / Lyon University Hospitals, Edouard Herriot hospital, Pharmacy Department, University of Lyon, 8 avenue Rockefeller, 69008 Lyon, France
| | - Alexander Tsertsvadze
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill road, CV47AL Coventry, England
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Pamela Royle
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill road, CV47AL Coventry, England
| | - Lazaros Andronis
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill road, CV47AL Coventry, England
| | - Aileen Clarke
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill road, CV47AL Coventry, England
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Germonpré P, Van den Wyngaert T. Second-line erlotinib after failure of pemetrexed-containing chemotherapy in advanced non-small cell lung cancer (NSCLC): Real-world effectiveness, safety and tolerability. PLoS One 2019; 14:e0215135. [PMID: 30973926 PMCID: PMC6459587 DOI: 10.1371/journal.pone.0215135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/27/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Little data is available on patients with advanced non-squamous NSCLC treated with erlotinib specifically after failure of first-line pemetrexed-containing chemotherapy. We assessed the effectiveness, safety and tolerability of erlotinib in a real-world setting. METHODS Prospective single-arm, open-label, multicenter, non-interventional study of erlotinib (150mg daily) in inoperable stage III/IV NSCLC after progression on first-line pemetrexed-containing chemotherapy without EGFR-mutation selection. Patients were followed according to routine practice and response assessment was performed using RECIST 1.1. The primary end point was progression-free survival (PFS). Secondary end points included best confirmed overall response rate (ORR), disease control rate (DCR), and overall survival (OS). Adverse events were recorded. An independent dataset was used to validate the results. RESULTS In all, 59 patients were screened, 57 enrolled, and 54 (36 men; median age 65 years) included in the per-protocol analysis. Median PFS was 1.8 (95% CI 1.4-2.6) months, with 11% (95% CI 5-21%) alive and progression-free at 6 months. The ORR was 0.0% (97.5% CI 0.0-6.8%) and the DCR 34.6% (95% CI 21.9-49.0%). Median overall survival was 5.8 (95% CI 3.3-8.6) months with 28% (95% CI 17-42%) alive at one year. Rash occurred in 60.7% (95% CI 46.7-73.5%), with severe rash in 12.5% (95% CI 5.1-24.1%). Any grade diarrhea was observed in 42.8% (95% CI 29.7-56.8%), with grade 3 occurring in 7.1% (95% CI 1.9-17.2%). Erlotinib was stopped in 21.0% (95% CI 11.3-33.9%) of patients due to adverse events, which were treatment related in 7%. CONCLUSION Second-line erlotinib after pemetrexed treatment results in similar real-world outcomes as reported after non-pemetrexed containing first-line therapy. However, the overall duration of response in unselected patients remains limited and other effective treatments have in the meantime been introduced. No new safety signals were detected.
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Affiliation(s)
- Paul Germonpré
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Pneumology, AZ Maria Middelares, Ghent, Belgium
| | - Tim Van den Wyngaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- * E-mail:
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Paglialunga L, Ricciardi S, D'Arcangelo M. New options on the horizon for nononcogene addicted non-small-cell lung cancer. Future Oncol 2018; 14:19-28. [PMID: 29989449 DOI: 10.2217/fon-2018-0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The treatment of non-small-cell lung cancer (NSCLC) has historically been based on platinum doublets- and taxan-based chemotherapy in the first- and second-line therapy, respectively. Although new agents have emerged for patients with driver mutations, treatment options for nononcogene addicted NSCLC have not changed for years. However, the last 5 years have seen the approval and introduction of new biological agents, such as immune checkpoint inhibitors and antiangiogenic drugs. The aim of this review is to give readers an update on the news in the treatment of nononcogene addicted NSCLC. As more and more therapeutic options are now available, we will delineate a potential therapeutic algorithm for the optimization of daily life treatment choice of NSCLC patients.
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Affiliation(s)
| | - Serena Ricciardi
- San Camillo Forlanini Hospital, Pneumological Oncology Unit, Rome, Italy
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Wu Y, Lin L, Shen Y, Wu H. Comparison between PD-1/PD-L1 inhibitors (nivolumab, pembrolizumab, and atezolizumab) in pretreated NSCLC patients: Evidence from a Bayesian network model. Int J Cancer 2018; 143:3038-3040. [DOI: 10.1002/ijc.31733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/20/2018] [Accepted: 06/21/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Yingcheng Wu
- Department of Medical Informatics, School of Medicine; Ministry of Education Cooperative Research Center on Evidence-Based Medicine Nantong University Division; Nantong University; Jiangsu 226001 China
| | - Lifeng Lin
- Department of Statistics; Florida State University; Tallahassee FL 32306
| | - Yanting Shen
- Department of Medical Informatics, School of Medicine; Ministry of Education Cooperative Research Center on Evidence-Based Medicine Nantong University Division; Nantong University; Jiangsu 226001 China
| | - Huiqun Wu
- Department of Medical Informatics, School of Medicine; Ministry of Education Cooperative Research Center on Evidence-Based Medicine Nantong University Division; Nantong University; Jiangsu 226001 China
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Tan SH, Abrams KR, Bujkiewicz S. Bayesian Multiparameter Evidence Synthesis to Inform Decision Making: A Case Study in Metastatic Hormone-Refractory Prostate Cancer. Med Decis Making 2018; 38:834-848. [PMID: 30102868 PMCID: PMC6156771 DOI: 10.1177/0272989x18788537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In health technology assessment, decisions are based on complex cost-effectiveness models that require numerous input parameters. When not all relevant estimates are available, the model may have to be simplified. Multiparameter evidence synthesis combines data from diverse sources of evidence, which results in obtaining estimates required in clinical decision making that otherwise may not be available. We demonstrate how bivariate meta-analysis can be used to predict an unreported estimate of a treatment effect enabling implementation of a multistate Markov model, which otherwise needs to be simplified. To illustrate this, we used an example of cost-effectiveness analysis for docetaxel in combination with prednisolone in metastatic hormone-refractory prostate cancer. Bivariate meta-analysis was used to model jointly available data on treatment effects on overall survival and progression-free survival (PFS) to predict the unreported effect on PFS in a study evaluating docetaxel with prednisolone. The predicted treatment effect on PFS enabled implementation of a 3-state Markov model comprising stable disease, progressive disease, and dead states, while lack of the estimate restricted the model to a 2-state model (with alive and dead states). The 2-state and 3-state models were compared by calculating the incremental cost-effectiveness ratio (which was much lower in the 3-state model: £22,148 per quality-adjusted life year gained compared to £30,026 obtained from the 2-state model) and the expected value of perfect information (which increased with the 3-state model). The 3-state model has the advantage of distinguishing surviving patients who progressed from those who did not progress. Hence, the use of advanced meta-analytic techniques allowed obtaining relevant parameter estimates to populate a model describing disease pathway in more detail while helping to prevent valuable clinical data from being discarded.
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Affiliation(s)
- Sze Huey Tan
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, Leicester, UK (SHT, KRA, SB).,Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore (SHT)
| | - Keith R Abrams
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, Leicester, UK (SHT, KRA, SB)
| | - Sylwia Bujkiewicz
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, Leicester, UK (SHT, KRA, SB)
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Armoiry X, Tsertsvadze A, Connock M, Royle P, Melendez-Torres GJ, Souquet PJ, Clarke A. Comparative efficacy and safety of licensed treatments for previously treated non-small cell lung cancer: A systematic review and network meta-analysis. PLoS One 2018; 13:e0199575. [PMID: 30044785 PMCID: PMC6059384 DOI: 10.1371/journal.pone.0199575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/08/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This systematic review with network meta-analysis compared the efficacy and safety of currently licensed second-line treatments in patients with late stage non-small cell lung cancer (NSCLC). METHODS Randomised controlled trials (RCTs) of participants with advanced/metastatic NSCLC receiving second/third line treatments were screened. We searched electronic databases (MEDLINE; EMBASE; Web of Science) from January, 2000 to July, 2017. Two reviewers screened bibliographic records, extracted data, and assessed risk of bias of included studies. The outcomes were overall survival (OS), progression-free survival (PFS), and drug-related grade 3-5 adverse-events (AEs). We pooled study-specific hazard ratios (HR; for OS and PFS) and risk ratios (RR; for AEs) using conventional and network-meta-analyses, and ranked interventions by the surface under the cumulative ranking curve. FINDINGS We included 11 RCTs (7,581 participants) comparing nine drugs. All drugs except for erlotinib significantly improved OS compared to docetaxel. Nivolumab was the highest ranking drug followed by atezolizumab and pembrolizumab. There was no significant difference in OS across these three drugs (HR = 0.98, 95% CI 0.79, 1.21 for nivolumab vs atezolizumab; HR = 0.98, 95% CI 0.77, 1.25 for nivolumab vs pembrolizumab). For PFS, ramucirumab + docetaxel and nivolumab were the drugs with the highest ranking. All interventions except ramucirumab + docetaxel had a reduced risk for severe drug-related AEs vs. docetaxel. Of the drugs with the highest ranking on AEs, nivolumab was significantly safer compared to atezolizumab (RR = 0.55, 95% CI 0.38, 0.79) or pembrolizumab (RR = 0.52, 95% CI 0.34, 0.81). IMPLICATIONS Nivolumab, pembrolizumab and atezolizumab exhibited superior benefit/risk balance compared to other licensed drugs used late stage NSCLC. Our results indicate that the use of immunotherapies in people diagnosed with non-specific late stage NSCLC should be promoted. The use of docetaxel may now be judged irrelevant as a comparator intervention for approval of new drugs for second line treatment of NSCLC. STUDY REGISTRATION NUMBER PROSPERO CRD42017065928.
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Affiliation(s)
- Xavier Armoiry
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
| | - Alexander Tsertsvadze
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Canada
| | - Martin Connock
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
| | - Pamela Royle
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
| | - G. J. Melendez-Torres
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
| | - Pierre-Jean Souquet
- Hospices Civils de Lyon, Groupement hospitalier Sud, Service de Pneumologie oncologique, Pierre-Bénite, France
| | - Aileen Clarke
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
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Sun L, Xiong Z, Han C. [Research Advances of Pan-negative Type of Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018. [PMID: 29526181 PMCID: PMC5973015 DOI: 10.3779/j.issn.1009-3419.2018.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
近年来随着对肿瘤驱动基因的不断探索和分子检测技术的快速发展,在非小细胞肺癌(non-small cell lung cancer, NSCLC)领域,一系列的驱动基因如EGFR、KRAS、BRAF、PIK3CA、ALK和ROS-1等相继被发现,并逐渐研发出相应的针对特定驱动基因变异的靶向治疗药物,使NSCLC患者的生存得到极大改善。尽管如此,仍有部分NSCLC患者未能检测到任何已知驱动基因变异,称之为pan-negative型NSCLC。本文就pan-negative型NSCLC的概念、临床病理和流行病学特点以及治疗预后等作一综述。
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Affiliation(s)
- Li Sun
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - Zhicheng Xiong
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - Chengbo Han
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang 110022, China
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Morabito A. Second-line treatment for advanced NSCLC without actionable mutations: is immunotherapy the 'panacea' for all patients? BMC Med 2018; 16:24. [PMID: 29448944 PMCID: PMC5815183 DOI: 10.1186/s12916-018-1011-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/22/2018] [Indexed: 12/12/2022] Open
Abstract
The therapeutic approach for the second-line treatment of patients with advanced non-small cell lung cancer (NSCLC) without actionable mutations has been revolutionized by the recent approval of new effective drugs with various mechanisms of action, including nintedanib, ramucirumab, nivolumab, pembrolizumab, atezolizumab, and afatinib. The recent network meta-analysis of Créquit et al. (BMC Medicine, 15:193, 2017) compared the effectiveness and tolerability of the second-line treatments for advanced NSCLC with wild-type or unknown status for EGFR. The authors found that immunotherapy might be more efficacious than the currently recommended treatments. However, their meta-analysis does not take into account the role of predictive biomarkers - this is indeed a crucial point in the decision-making process considering that only a fraction of advanced NSCLC patients might derive a long-term benefit from second-line immunotherapy. The identification of molecular biomarkers that can predict a response to immune checkpoints, angiogenesis, and EGFR inhibitors remains an important goal of clinical research in order to maximize the benefit of these agents and to aid clinicians in the decision-making process.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0954-x.
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Affiliation(s)
- Alessandro Morabito
- The Medical Oncology Unit, Thoracic-Pulmonary Department, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS, Via Mariano Semola, 80131, Naples, Italy.
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