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Shah AT, Blanchard I, Padda SK, Wakelee HA, Neal JW. Molecular Characteristics and Pretreatment Neutrophil-to-Lymphocyte Ratio as Predictors of Durable Clinical Benefit from Immune Checkpoint Inhibition in Non-Small Cell Lung Cancer. Clin Lung Cancer 2024:S1525-7304(24)00133-5. [PMID: 38987048 DOI: 10.1016/j.cllc.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/06/2024] [Accepted: 06/15/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Prior research in non-small cell lung cancer (NSCLC) has shown that tumors with specific driver mutations may be less likely to respond to immune checkpoint inhibitors (ICI). In this analysis, we evaluated the characteristics of patients with durable clinical benefit (DCB) to ICI compared to those with no durable clinical benefit (NDB), with emphasis on the role of molecular alterations in EGFR, ALK, and ROS1 and pretreatment neutrophil-to-lymphocyte ratio (NLR). METHODS We retrospectively collected clinical characteristics and outcomes for patients who initiated ICI monotherapy for advanced NSCLC at Stanford University between April 2015 and May 2018. Patients were classified as having DCB if time on ICI therapy was greater than or equal to 180 days, or NDB if less than 180 days. Outcomes included best radiographic benefit while on ICI and survival from time of ICI initiation. RESULTS Of 123 patients treated with ICI for NSCLC, 28 patients had DCB (23%), while 95 had NDB (77%). Median overall survival from initiation of ICI in the 33 patients with molecular alterations in EGFR (n = 31), ALK, or ROS1 and NLR of 5.9 or higher was 2.0 months, compared to 8.1 months in patients with these genomic alterations and NLR less than 5.9. Median overall survival in patients without alterations in EGFR, ALK, or ROS1 and NLR of 5.9 or higher was 4.3 months, compared to 12.1 months in patients with NLR less than 5.9 (P = .023). CONCLUSIONS Elevation in pretreatment NLR was associated with significantly lower overall median survival from initiation of ICI, particularly when in combination with NSCLC with alterations in EGFR, ALK, or ROS1. This finding could influence clinical practice as NLR is readily available through routine blood testing.
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Affiliation(s)
| | - Isabelle Blanchard
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA
| | - Sukhmani K Padda
- Department of Hematology/Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, PA
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA
| | - Joel W Neal
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA.
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Attieh F, Chartouni A, Boutros M, Mouawad A, Kourie HR. Tackling the immunotherapy conundrum: advances and challenges for operable non-small-cell lung cancer treatment. Immunotherapy 2023; 15:1415-1428. [PMID: 37671552 DOI: 10.2217/imt-2023-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Lung cancer is the most common cause of cancer-related deaths worldwide. Non-small-cell lung cancer (NSCLC) represents the majority of lung cancer cases, and its standard treatment is primarily surgery. Nonetheless, this type of cancer exhibits an important rate of tumor recurrence. Immune checkpoint inhibitors (ICIs) have demonstrated significant survival benefits in many cancers, especially in early-stage NSCLC. This review considers the latest CheckMate816, IMpower010 and KEYNOTE-091 trials that led to US FDA approvals. The new wave of resectable NSCLC trial results are also summarized. Finally, the latest challenges for these treatment modalities, such as the choice between neoadjuvant and adjuvant use, the accurate identification of biomarkers and the presence of driver mutations such as EGFR, are discussed.
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Affiliation(s)
- Fouad Attieh
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 11072180, Lebanon
| | - Antoine Chartouni
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 11072180, Lebanon
| | - Marc Boutros
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 11072180, Lebanon
| | - Antoine Mouawad
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 11072180, Lebanon
| | - Hampig Raphaël Kourie
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, 11072180, Lebanon
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Martin C, Enrico D. Current and novel therapeutic strategies for optimizing immunotherapy outcomes in advanced non-small cell lung cancer. Front Oncol 2022; 12:962947. [PMID: 36568253 PMCID: PMC9772042 DOI: 10.3389/fonc.2022.962947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
During the past decade, immunotherapy has dramatically improved the outcomes of patients with non-small cell lung cancer (NSCLC). The development of specific antibodies against the programmed death (PD1) receptor and its ligand PD-L1 (programmed death ligand-1) has demonstrated substantial efficacy in advanced NSCLC either in the first or in the second line. However, the success of immune checkpoint inhibitors (ICIs) as monotherapy did not reach all patients and long-term responders still represent a small subset of cases. Under these circumstances, different strategies have been and are being tested to optimize clinical outcomes. Here, we reviewed the current evidence and the more promising perspectives of ICI combination approaches, such as the addition of chemotherapy, antiangiogenic agents, other co-inhibitory or co-stimulatory checkpoints, and targeted therapies.
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Affiliation(s)
- Claudio Martin
- Department of Medical Oncology, Thoracic Oncology Section, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Department of Clinical Research, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
| | - Diego Enrico
- Department of Medical Oncology, Thoracic Oncology Section, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
- Department of Clinical Research, Alexander Fleming Cancer Institute, Buenos Aires, Argentina
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Safety and efficacy of pralsetinib in RET fusion-positive non-small cell lung cancer including as first-line therapy: update from the ARROW trial. Ann Oncol 2022; 33:1168-1178. [PMID: 35973665 DOI: 10.1016/j.annonc.2022.08.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND RET fusions are present in 1%-2% of non-small cell lung cancer (NSCLC). Pralsetinib, a highly potent, oral, central nervous system-penetrant, selective RET inhibitor, previously demonstrated clinical activity in patients with RET fusion-positive NSCLC in the phase I/II ARROW study, including among treatment-naïve patients. We report an updated analysis from the ARROW study. PATIENTS AND METHODS ARROW is a multi-cohort, open-label, phase I/II study. Eligible patients were ≥18 years of age with locally advanced or metastatic solid tumours and an Eastern Cooperative Oncology Group performance status 0-2 (later 0-1). Patients initiated pralsetinib at the recommended phase II dose of 400 mg once-daily (QD) until disease progression, intolerance, consent withdrawal, or investigator's decision. The co-primary endpoints (phase II) were overall response rate (ORR) by blinded independent central review and safety. RESULTS Between 17 March 2017 and 06 November 2020 (data cutoff), 281 patients with RET fusion-positive NSCLC were enrolled. The ORR was 72% (54/75; 95% CI, 60-82) for treatment-naïve patients and 59% (80/136; 95% CI, 50-67) for patients with prior platinum-based chemotherapy (enrolment cutoff for efficacy analysis: 22 May 2020); median duration of response was not reached for treatment-naïve patients and 22.3 months for prior platinum-based chemotherapy patients. Tumour shrinkage was observed in all treatment-naïve patients and in 97% of patients with prior platinum-based chemotherapy; median progression-free survival was 13.0 and 16.5 months, respectively. In patients with measurable intracranial metastases, the intracranial response rate was 70% (7/10; 95% CI, 35-93); all had received prior systemic treatment. In treatment-naïve patients with RET fusion-positive NSCLC who initiated pralsetinib by the data cutoff (n = 116), the most common Grade 3-4 treatment-related adverse events (TRAEs) were neutropenia (18%), hypertension (10%), increased blood creatine phosphokinase (9%), and lymphopenia (9%). Overall, 7% (20/281) discontinued due to TRAEs. CONCLUSIONS Pralsetinib treatment produced robust efficacy and was generally well tolerated in treatment-naïve patients with advanced RET fusion-positive NSCLC. Results from the confirmatory phase III AcceleRET Lung study (NCT04222972) of pralsetinib versus standard of care in the first-line setting are pending.
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Punekar SR, Shum E, Grello CM, Lau SC, Velcheti V. Immunotherapy in non-small cell lung cancer: Past, present, and future directions. Front Oncol 2022; 12:877594. [PMID: 35992832 PMCID: PMC9382405 DOI: 10.3389/fonc.2022.877594] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Many decades in the making, immunotherapy has demonstrated its ability to produce durable responses in several cancer types. In the last decade, immunotherapy has shown itself to be a viable therapeutic approach for non-small cell lung cancer (NSCLC). Several clinical trials have established the efficacy of immune checkpoint blockade (ICB), particularly in the form of anti-programmed death 1 (PD-1) antibodies, anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) antibodies and anti-programmed death 1 ligand (PD-L1) antibodies. Many trials have shown progression free survival (PFS) and overall survival (OS) benefit with either ICB alone or in combination with chemotherapy when compared to chemotherapy alone. The identification of biomarkers to predict response to immunotherapy continues to be evaluated. The future of immunotherapy in lung cancer continues to hold promise with the development of combination therapies, cytokine modulating therapies and cellular therapies. Lastly, we expect that innovative advances in technology, such as artificial intelligence (AI) and machine learning, will begin to play a role in the future care of patients with lung cancer.
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Real-World Management and Outcomes of Crizotinib-Treated ROS1-Rearranged NSCLC: A Retrospective Canadian Cohort. Curr Oncol 2022; 29:1967-1982. [PMID: 35323360 PMCID: PMC8947433 DOI: 10.3390/curroncol29030160] [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: 01/31/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
The use, safety and effectiveness of crizotinib as part of the management of ROS1-rearranged NSCLC patients in a real-world Canadian clinical cohort was the focus of this retrospective review. Twenty-one ROS1-rearranged patients with advanced/metastatic disease receiving crizotinib between 2014–2020 were identified; crizotinib demonstrated tolerability and effectiveness in this population where outcomes were similar to those described in other crizotinib-treated real-world cohorts, but lower than those of the PROFILE 1001 clinical trial population. Systemic anti-cancer therapy prior to crizotinib initiation occurred in half of the study cohort, with platin-pemetrexed and immune checkpoint inhibitors being most common. Platin-pemetrexed showed good effectiveness in this cohort, but despite high prevalence of upregulated PD-L1 expression, immune checkpoint inhibitors showed poor effectiveness in his cohort. Among all systemic therapies received, crizotinib showed the most effective disease control, although longer intervals between diagnosis and crizotinib initiation were more common among those showing a lack of clinical response to crizotinib, and patients with brain metastases at the time of crizotinib initiation also showed increased diagnosis to crizotinib initiation intervals and decreased clinical response to crizotinib. This study reveals crizotinib has clinical benefit, but timely identification of ROS1-rearrangements and initiation targeted therapies appears important to maximize outcome in this population.
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Sudmeier L, Tian S, Higgins KA. Multidisciplinary Management of Brain Metastases from Non-Small Cell Lung Cancer in the Era of Immunotherapy. Curr Treat Options Oncol 2021; 22:77. [PMID: 34213649 DOI: 10.1007/s11864-021-00871-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Brain metastases from non-small cell lung cancer often cause neurologic symptoms which lead to initial diagnosis or identification of recurrence. In other patients, they are identified on surveillance imaging or when a patient undergoing treatment develops neurological symptoms. Patients with symptomatic lesions should be started on dexamethasone and evaluated by a neurosurgeon as soon as possible. If feasible, surgery should be offered to decrease intracranial pressure, alleviate symptoms, and prevent irreversible neurological damage. Postoperative stereotactic radiosurgery (SRS) to the resection cavity and any additional brain metastases should follow within 4 weeks of surgery, as early as 2 weeks post-op. Tissue from surgery is used to confirm the diagnosis and test for targetable oncogenic driver mutations. Treatment response and surveillance for development of additional lesions is assessed with MRI of the brain 1 month after SRS and every 3 months thereafter. Patients who are not surgical candidates or who have small, asymptomatic brain metastases should proceed with SRS, the preferred treatment, or sometimes whole-brain radiation therapy (WBRT) if multifocal disease requires more extensive treatment, such as for leptomeningeal spread of disease. The number of brain metastases that warrants use of WBRT over SRS is controversial and a topic of ongoing investigation, and is discussed in this review. When possible, SRS is preferred over WBRT due to reduce morbidity and cognitive side effects. When patients are already on systemic therapy at time of brain metastases diagnosis, systemic therapy should continue, with radiation therapy occurring between cycles. Regarding systemic therapy for new diagnosis at time of brain metastases presentation, molecular testing will guide treatment choice, when available. If there is no neurosurgical intervention, biopsy of another site of disease may provide tissue for molecular testing. If there are no targetable oncogenic driver mutations, concurrent immune checkpoint blockade (ICB) and chemotherapy is preferable for patients who can tolerate it. Single-agent ICB is an alternative option for patients who cannot tolerate chemotherapy. Systemic therapy should start as soon as possible. In some patients with poor performance status, best supportive care may be the most appropriate choice. Treatment decisions should always incorporate patients' goals of care and in many cases should be discussed in a multidisciplinary setting.
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Affiliation(s)
- Lisa Sudmeier
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Road, Atlanta, GA, 30322, USA
| | - Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Road, Atlanta, GA, 30322, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Road, Atlanta, GA, 30322, USA.
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De Toma A, Lo Russo G, Signorelli D, Pagani F, Randon G, Galli G, Prelaj A, Ferrara R, Proto C, Ganzinelli M, Zilembo N, de Braud F, Garassino MC. Uncommon targets in non-small cell lung cancer: Everyone wants a slice of cake. Crit Rev Oncol Hematol 2021; 160:103299. [PMID: 33722699 DOI: 10.1016/j.critrevonc.2021.103299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/14/2020] [Accepted: 03/10/2021] [Indexed: 01/15/2023] Open
Abstract
Target therapies completely changed the clinical approach in EGFR mutated and ALK rearranged non-small cell lung cancer, ensuring these patients exceptional outcomes with a better toxicity profile compared to conventional chemotherapy. In recent years, beyond EGFR and ALK alterations, new data are emerging about less common alterations, new drugs have been already approved and others agents have been recently investigated or are currently under investigation. In this review we will discuss some uncommon alterations in non-small cell lung cancer such as ROS1, BRAF, RET, HER2, NTRK, MET and other targets that are in an early evaluation phase. We will summarize the characteristics of patients harboring these alterations, the already approved or under investigation therapies and the related resistance mechanisms.
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Affiliation(s)
- Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Pagani
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Electronics, Information, and Bioengineering, Polytechnic University of Milan, Milan, Italy
| | - Roberto Ferrara
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicoletta Zilembo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Real World Characterization of Advanced Non-Small Cell Lung Cancer in Never Smokers by Actionable Mutation Status. Clin Lung Cancer 2021; 22:260-267.e2. [PMID: 33678584 DOI: 10.1016/j.cllc.2021.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) in never-smokers (NS) is vastly different from those with a smoking history in terms of etiology, driver mutations, and immunotherapy responsiveness. This study compares the real-world overall survival (OS) of NSCLC patients by smoking history and mutation status. METHODS The study included 30,310 advanced or metastatic NSCLC patients in the Flatiron Health EHR-derived database who received biomarker testing results (EGFR, ALK, ROS1, and BRAF), and initiated therapy between 2011 and 2017, with follow up through June 2018. OS by smoking and driver mutation groups was summarized via Kaplan-Meier survival estimates, and compared in the context of a multivariate Cox proportional hazard model. RESULTS OS differed by smoking and driver-mutation categories (adjusted and stratified P< .001). The median OS for wild-type (WT) smoking patients was 9.6 months, for mutated (MT) smokers was 19.4 months (adjusted and stratified hazard ratio [HR] relative to WT smokers 0.65; 95% CI 0.60-0.71), for WT NS was 15.1 months (HR 0.78; 95% CI 0.73-0.83 relative to WT smokers), and for MT NS was 25.5 months (HR 0.52; 95% CI 0.48-0.58 relative to WT smokers). CONCLUSION NS with NSCLC survived longer than those with smoking history, in both groups of WT and mutation-positive patients. Findings highlight that in NSCLC patients, a history of never smoking may have similar effect on hazard of death as the presence of an actionable mutation. Taken together, differences in heredity, mutations, and biologic history suggest that NS lung cancer is a distinct clinical entity and must be managed accordingly.
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Herbst RS, Aisner DL, Sonett JR, Turk AT, Weintraub JL, Lindeman NI. Practical Considerations Relating to Routine Clinical Biomarker Testing for Non-small Cell Lung Cancer: Focus on Testing for RET Fusions. Front Med (Lausanne) 2021; 7:562480. [PMID: 33553195 PMCID: PMC7859651 DOI: 10.3389/fmed.2020.562480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022] Open
Abstract
For patients with advanced non–small cell lung cancer, genomic profiling of tumors to identify potentially targetable alterations and thereby inform treatment selection is now part of standard care. While molecular analyses are primarily focused on actionable biomarkers associated with regulatory agency-approved therapies, there are a number of emerging biomarkers linked to investigational agents in advanced stages of clinical development will become approved agents. A particularly timely example is the reported data and US Food and Drug Administration approval of highly specific small molecule inhibitors of the proto-oncogene tyrosine-protein kinase receptor RET indicate that testing for tumor RET gene fusions in patients with NSCLC has become clinically important. As the number of biomarkers to be tested in NSCLC grows, it becomes increasingly important to optimize and prioritize the use of biopsy tissue, in order to both continue to allow accurate histopathological diagnosis and also to support concurrent genomic profiling to identify perhaps relatively uncommon genetic events. In order to provide practical expert consensus guidance to optimize processes facilitating genomic testing in NSCLC and to overcome barriers to access and implementation, a multidisciplinary advisory board was held in New York, on January 30, 2019. The panel comprised physicians involved in sample procurement (interventional radiologists and a thoracic surgeon), surgical pathologists specializing in the lung, molecular pathologists, and thoracic oncologists. Particular consideration was given to the key barriers faced by these experts in establishing institutional genomic screening programs for NSCLC. Potential solutions have been devised in the form of consensus opinions that might be used to help resolve such issues.
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Affiliation(s)
- Roy S Herbst
- Section of Medical Oncology, Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, CT, United States
| | - Dara L Aisner
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Joshua R Sonett
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, United States
| | - Andrew T Turk
- Department of Pathology and Cell Biology, Columbia University, New York, NY, United States
| | - Joshua L Weintraub
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
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Alex F, Alfredo A. Promising predictors of checkpoint inhibitor response in NSCLC. Expert Rev Anticancer Ther 2020; 20:931-937. [PMID: 32870120 DOI: 10.1080/14737140.2020.1816173] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The development of immune-checkpoint inhibitors targeting the programmed death-1 (PD-1) and its ligand (PD-L1) axis has transformed the treatment paradigm in non-small-cell lung cancer, bringing about unprecedented 5-year survival rates. Despite this dramatic improvement, roughly 70% of patients do not derive durable benefit from these treatments, illustrating the need for predictive biomarkers. AREAS COVERED In this review, we will discuss what makes a successful biomarker and analyze the role and significance of currently available options, including PD-L1, oncogenic alterations and tumor mutation burden. We then discuss potential biomarkers on the horizon, including the microbiome, tumor infiltrating lymphocytes, neutrophil-to-lymphocyte ratio, gene signatures and the emerging field of multiomics. EXPERT OPINION To date, only PD-L1 is clinically validated as a positive predictor of response to immunotherapy, yet the need to refine patient selection has never been stronger, given the indication for checkpoint inhibitors alone or in combination in all non-oncogene driven non-small-cell lung cancer patients receiving front-line therapy. Prospective validation of the above-mentioned potential biomarkers, either alone or in combination, may help to elaborate improved predictive tools.
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Affiliation(s)
- Friedlaender Alex
- Department of Oncology, University Hospital Geneva , Geneva, Switzerland
| | - Addeo Alfredo
- Department of Oncology, University Hospital Geneva , Geneva, Switzerland
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12
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Marmarelis ME, Langer CJ. Treatment of Patients With Non–Small-Cell Lung Cancer Harboring Rare Oncogenic Mutations. Clin Lung Cancer 2020; 21:395-406. [DOI: 10.1016/j.cllc.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/23/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022]
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Frisone D, Friedlaender A, Malapelle U, Banna G, Addeo A. A BRAF new world. Crit Rev Oncol Hematol 2020; 152:103008. [PMID: 32485528 DOI: 10.1016/j.critrevonc.2020.103008] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/23/2020] [Indexed: 12/18/2022] Open
Abstract
BRAF is a rare targetable mutation in non-small-cell lung cancer (NSCLC). Emerging evidence underlines that, rather than a single point mutation, BRAF genes present with a wide array of mutations, essentially in lung adenocarcinoma. Different BRAF mutations have divergent clinical and therapeutic implications, with a particular distinction between V600E and non-V600E mutations. The latter are at least as frequent in NSCLC as V600E, but lack any proven targeted therapy. In this paper, we briefly review the current literature and provide an update of scientific knowledge about different types of BRAF mutations in NSCLC.
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Affiliation(s)
- Daniele Frisone
- IOSI - Oncology Institute of Southern Switzerland, Switzerland
| | | | - Umberto Malapelle
- Department of Public Health, University Federico II of Naples (Naples), Italy
| | - Giuseppe Banna
- Department of Oncology, United Lincolnshire Hospital Trust, UK
| | - Alfredo Addeo
- Department of Oncology, Geneva University Hospital, Switzerland.
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Progress on treatment of MET signaling pathway in non-small cell lung cancer. Int J Clin Oncol 2020; 25:1450-1458. [PMID: 32440811 DOI: 10.1007/s10147-020-01702-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/30/2020] [Indexed: 01/13/2023]
Abstract
MET activation includes gene mutation, amplification, and protein overexpression. Clinical evidence suggests that MET activation is both a primary oncogenic driver in lung cancer, and a secondary driver after acquired resistance to EGFR tyrosine kinase inhibitors (TKIs). Several small molecule TKIs have already shown to be effective in the MET pathway. However, the activation form and the diagnostic criteria of MET oncogene are still controversial, especially in patients resistant to EGFR TKIs or ALK TKIs. With the development of new MET inhibitors, a quantity of emerging trials has focused on the mechanism of acquired resistance to MET TKIs and therapeutic strategies after resistance.
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Abstract
PURPOSE OF REVIEW With the development of targeted therapies, the treatment strategy of patients with advanced or metastatic non-small cell lung cancer (NSCLC) has changed tremendously. In this review, we focus on the different aspects of the treatment of oncogene-driven NSCLC. RECENT FINDINGS Patients with an EGFR or ALK alteration show a better clinical outcome with tyrosine kinase inhibitor (TKI) treatment compared to chemotherapy.Patients with a ROS1 rearrangement or a BRAF V600E mutation show favorable clinical outcome with TKI treatment compared to chemotherapy, although randomized trials are not available.Patients on TKIs will eventually develop disease progression because of acquired resistance.The treatment with immunotherapy in EGFR and ALK-positive NSCLC patients did not improve overall survival over that of chemotherapy.Blood-based genetic analysis provides the opportunity to noninvasively screen patients for the presence of oncogenic drivers and to monitor resistance during TKI treatment. SUMMARY Targeted molecular therapies are now standard of care for patients with oncogene-driven NSCLC with a good clinical benefit and minimal toxicity. The role of immunotherapy in patients with molecular alterations is still unclear. Blood-based genotyping has gained interest in the diagnostic and resistance monitoring setting for patients with NSCLC.
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Guibert N, Pradines A, Favre G, Mazieres J. Current and future applications of liquid biopsy in nonsmall cell lung cancer from early to advanced stages. Eur Respir Rev 2020; 29:190052. [PMID: 32051167 PMCID: PMC9488537 DOI: 10.1183/16000617.0052-2019] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/11/2019] [Indexed: 01/10/2023] Open
Abstract
Liquid biopsy refers to the analysis of any tumour-derived material circulating in the blood or any other body fluid. This concept is particularly relevant in lung cancer as the tumour is often difficult to reach and may need an invasive and potentially harmful procedure. Moreover, the multitude of anticancer drugs and their sequential use underline the importance of conducting an iterative assessment of tumour biology. Liquid biopsies can noninvasively detect any targetable genomic alteration and guide corresponding targeted therapy, in addition to monitoring response to treatment and exploring the genetic changes at resistance, overcoming spatial and temporal heterogeneity.In this article, we review the available data in the field, which suggest the potential of liquid biopsy in the area of lung cancer, with a particular focus on cell-free DNA and circulating tumour cells. We discuss their respective applications in patient selection and monitoring through targeted therapy, as well as immune checkpoint inhibitors. The current data and future applications of liquid biopsy in the early stage setting are also investigated.Liquid biopsy has the potential to help manage nonsmall cell lung cancer throughout all stages of lung cancer: screening, minimal residual disease detection to guide adjuvant treatment, early detection of relapse, systemic treatment initiation and monitoring of response (targeted or immune therapy), and resistance genotyping.
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Affiliation(s)
- Nicolas Guibert
- Thoracic Oncology Dept, Hôpital Larrey, University Hospital of Toulouse, Toulouse, France
- Cancer Research Centre of Toulouse (CRCT), Inserm, University of Toulouse III - Paul Sabatier, National Scientific Research Centre (CNRS), Toulouse, France
- University of Toulouse III - Paul Sabatier, Toulouse, France
| | - Anne Pradines
- Cancer Research Centre of Toulouse (CRCT), Inserm, University of Toulouse III - Paul Sabatier, National Scientific Research Centre (CNRS), Toulouse, France
- Medical Laboratory, Claudius Regaud Institute, Toulouse University Cancer Institute (IUCT-O), Toulouse, France
| | - Gilles Favre
- Cancer Research Centre of Toulouse (CRCT), Inserm, University of Toulouse III - Paul Sabatier, National Scientific Research Centre (CNRS), Toulouse, France
- University of Toulouse III - Paul Sabatier, Toulouse, France
- Medical Laboratory, Claudius Regaud Institute, Toulouse University Cancer Institute (IUCT-O), Toulouse, France
| | - Julien Mazieres
- Thoracic Oncology Dept, Hôpital Larrey, University Hospital of Toulouse, Toulouse, France
- Cancer Research Centre of Toulouse (CRCT), Inserm, University of Toulouse III - Paul Sabatier, National Scientific Research Centre (CNRS), Toulouse, France
- University of Toulouse III - Paul Sabatier, Toulouse, France
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Roch B, Coffy A, Jean-Baptiste S, Palaysi E, Daures JP, Pujol JL, Bommart S. Cachexia - sarcopenia as a determinant of disease control rate and survival in non-small lung cancer patients receiving immune-checkpoint inhibitors. Lung Cancer 2020; 143:19-26. [PMID: 32200137 DOI: 10.1016/j.lungcan.2020.03.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The metabolic changes associated with cachexia - sarcopenia syndrome might down-regulate antitumor immunity. We hypothesized that this syndrome reduces efficiency of immune checkpoint inhibitors (ICPI) in non-small cell lung cancer (NSCLC). METHODS The records of 142 consecutive NSCLC patients receiving first- or second-line anti-Programmed cell death protein 1) ICPI were reviewed. Response evaluation according to Response Evaluation Criteria in Solid Tumors 1.1 was performed at the eighth week of immunotherapy. Pretreatment cachexia was defined as a body-weight loss of 5% or more in the previous 6 months. Sarcopenia was estimated with the third lumbar skeletal muscle mass index (mSMI) and was evaluated before immunotherapy and at the eighth week. A decrease by 5% or more of the mSMI was considered as an evolving sarcopenia. The endpoints were disease control rate (DCR), progression-free (PFS) and overall survival (OS).Logistic regression model and Cox model took into account others covariables known to influence ICPI efficiency, particularly Programmed Death -Ligand 1 tumor cell score, Eastern Cooperative Oncology Group performance status and common somatic mutational status. RESULTS In multivariate analysis, cachexia - sarcopenia syndrome reduced the probability of achieving a disease control and were associated with a shorter survival. Patients without cachexia had a better probability to achieve disease control in comparison with those who did not experience cachexia (59.9 % and 41.1 %, respectively; odds ratio 95 % (confidence interval [95 %CI]): 2.60 (1.03-6.58)). Patients with cachexia had a shorter OS when compared with those without cachexia (hazard ratios [HR] (95 %CI): 6.26 (2.23-17.57)). Patients with an evolving sarcopenia had a shorter PFS and OS, with HR (95 %CI): 2.45 (1.09-5.53) and 3.87 (1.60-9.34) respectively. CONCLUSION Cachexia - sarcopenia syndrome negatively influences patients' outcome during anti-PD-1 ICPI therapy.
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Affiliation(s)
- Benoît Roch
- Thoracic Oncology Unit, University Hospital of Montpellier, Arnaud de Villeneuve Hospital, 371 avenue Doyen Gaston Giraud, 34295, Montpellier, France; Cancerology Resarch Institute of Montpellier (IRCM), INSERM unit-U1194, 208 avenue des Apothicaires, 34298, Montpellier, France
| | - Amandine Coffy
- Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
| | - Sandy Jean-Baptiste
- Thoracic Oncology Unit, University Hospital of Montpellier, Arnaud de Villeneuve Hospital, 371 avenue Doyen Gaston Giraud, 34295, Montpellier, France
| | - Estelle Palaysi
- Department of Medical Imaging, University Hospital of Montpellier, Arnaud de Villeneuve Hospital, 371 avenue Doyen Gaston Giraud, 34295, Montpellier, France
| | - Jean-Pierre Daures
- Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
| | - Jean-Louis Pujol
- Thoracic Oncology Unit, University Hospital of Montpellier, Arnaud de Villeneuve Hospital, 371 avenue Doyen Gaston Giraud, 34295, Montpellier, France; Cancerology Resarch Institute of Montpellier (IRCM), INSERM unit-U1194, 208 avenue des Apothicaires, 34298, Montpellier, France.
| | - Sébastien Bommart
- Department of Medical Imaging, University Hospital of Montpellier, Arnaud de Villeneuve Hospital, 371 avenue Doyen Gaston Giraud, 34295, Montpellier, France; PhyMedExp University of Montpellier, INSERM U 1046, CNRS UMR, 9214, France
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Treatment of anaplastic lymphoma kinase-positive non-small cell lung cancer: update and perspectives. Curr Opin Oncol 2020; 31:8-12. [PMID: 30394941 DOI: 10.1097/cco.0000000000000494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We describe recent developments in the rapidly evolving field of anaplastic lymphoma kinase-targeting agents. RECENT FINDINGS Five targeted drugs are currently available in the clinic via regular approval or named patient programs, including crizotinib, ceritinib, alectinib, brigatinib and lorlatinib. Further drugs are tested in clinical trials. This review summarizes published data, together with drug-specific information on dosing and toxicity. Moreover, we discuss different clinical scenarios and potential treatment options in patients with tumor progression, based on current literature and our own experience. SUMMARY Patients with metastatic, anaplastic lymphoma kinase-rearranged nonsmall cell lung cancer should be managed by interdisciplinary expert teams. New drugs with enhanced brain activity are available, and some patients may benefit from local therapies.
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Rothschild SI. KRAS and Immune Checkpoint Inhibitors-Serendipity Raising Expectations. J Thorac Oncol 2020; 14:951-954. [PMID: 31122556 DOI: 10.1016/j.jtho.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 10/26/2022]
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20
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Bylicki O, Guisier F, Monnet I, Doubre H, Gervais R, Janicot H, Perol M, Fournel P, Lamy R, Auliac JB, Chouaid C. Efficacy and safety of programmed cell-death-protein-1 and its ligand inhibitors in pretreated patients with epidermal growth-factor receptor-mutated or anaplastic lymphoma kinase-translocated lung adenocarcinoma. Medicine (Baltimore) 2020; 99:e18726. [PMID: 32011450 PMCID: PMC7220079 DOI: 10.1097/md.0000000000018726] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Immune-checkpoint inhibitor (ICI) efficacy in patients with non-small cell lung cancer (NSCLC) harboring molecular alterations remains poorly elucidated. This study was undertaken to determine ICI efficacy against epidermal growth-factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)/c-ros oncogene 1 (ROS1)-mutated NSCLC patients in the real-world setting.In this retrospective, multicenter study on adults with ICI-treated EGFR-mutated or ALK- or ROS1-translated NSCLCs, we analyzed clinical characteristics and outcomes: ICI-treatment duration, and progression-free survival (PFS), objective response rate, duration of response, and overall survival (OS) from immunotherapy initiation.Fifty-one NSCLC patients (mean age, 58.0 years) were included from 20 French centers: 61% were never-smokers and 59% were women. Among them, 82% had EGFR-activating mutations, 16% ALK translocations, or 2% ROS1 translocations. Before ICI therapy, patients had received a median of 3 treatment lines (including tyrosine-kinase inhibitor). The median PFS was 2.1 (95% confidence interval [CI], 1.5-3.2) months for the entire cohort, 2.2 (95% CI, 1.4-3.2) for EGFR-mutated patients, and 2.4 (95% CI, 2.1-not reached) months for ALK-translocated patients. The median OS was 14.7 (95% CI, 12.1-19.2) months for the entire population and 13.9 (95% CI, 8.8-20.0) and 19.2 (95% CI, 13.1-not reached) months for EGFR-mutated and ALK-translocated patients, respectively. Seven (13.7%) patients were treated with ICI for >9 months. Toxicities were reported in 22% (11/51), including 8% (4/51) grade ≥3.In this real-world setting, analysis of ICI PFS against EGFR-mutated or ALK-translocated NSCLC patients appeared close to that observed in pretreated unselected NSCLC patients. The more promising OS probably linked to post-ICI treatments. Large prospective studies on these patient subsets are needed.
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Affiliation(s)
- Olivier Bylicki
- Service de Pneumologie, Hôpital d’Instruction des Armées Percy, Clamart
| | - Florian Guisier
- Service de Pneumologie, Centre Hospitalier Universitaire de Rouen, Rouen
| | - Isabelle Monnet
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil
| | | | - Radj Gervais
- Département d’oncologie, Centre François Baclesse, Caen
| | - Henri Janicot
- Service de Pneumologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand
| | - Maurice Perol
- Service d’Oncologie Thoracique, Centre Léon Bérard, Lyon
| | - Pierre Fournel
- Département d’oncologie, Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez
| | - Régine Lamy
- Service de Pneumologie, Centre Hospitalier Bretagne Sud-Lorient, Lorient
| | - Jean-Bernard Auliac
- Service de Pneumologie, Centre Hospitalier F. Quesnay, Mantes-la-Jolie, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil
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21
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An Exceptional Responder to Nivolumab in Metastatic Non-Small-Cell Lung Cancer: A Case Report and Literature Review of Long-Term Survivors. Case Rep Oncol Med 2019; 2019:1816472. [PMID: 31885970 PMCID: PMC6915153 DOI: 10.1155/2019/1816472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background Exceptional responders to immune checkpoint inhibitors in metastatic non-small-cell lung cancer (NSCLC) are rare. Furthermore, the optimal duration of immunotherapy in patients who achieve complete remission and the benefit of rechallenge after recurrence remain unknown. Studying the clinical course of exceptional responders can help identify potential predictors of response to immunotherapy and further fine-tune our management algorithms in the absence of standard of care in challenging scenarios. Case Presentation We highlight the case of a 73-year-old Vietnam War Veteran with active tobacco dependence who achieved complete response with nivolumab for metastatic NSCLC after four prior lines of chemotherapy. Nivolumab was discontinued after 10 cycles due to immune-mediated hepatitis that resolved with steroids. He remained in complete remission for 14 months while off therapy. Then, his tumor recurred twice locally in the mediastinum and he again achieved complete and durable responses after each recurrence with radiotherapy. Due to recurrence in both lungs one year later, he was rechallenged with nivolumab and achieved partial response after two months of therapy. He continues to do well five and a half years since his initial diagnosis of de novo metastatic NSCLC. Conclusion Optimal management of exceptional responders to immune checkpoint inhibitors in metastatic NSCLC is largely unknown. Our case report adds to the limited data supporting the use of localized therapy for oligometastatic recurrences and rechallenge with immunotherapy for widespread disease in achieving disease control and long-term survival.
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22
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Liu WJ, Du Y, Wen R, Yang M, Xu J. Drug resistance to targeted therapeutic strategies in non-small cell lung cancer. Pharmacol Ther 2019; 206:107438. [PMID: 31715289 DOI: 10.1016/j.pharmthera.2019.107438] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
Rapidly developing molecular biology techniques have been employed to identify cancer driver genes in specimens from patients with non-small cell lung cancer (NSCLC). Inhibitors and antibodies that specifically target driver gene-mediated signaling pathways to suppress tumor growth and progression are expected to extend the survival time and further improve the quality of life of patients. However, the health of patients with advanced and metastatic NSCLC presents significant challenges due to treatment resistance, mediated by cancer driver gene alteration, epigenetic alteration, and tumor heterogeneity. In this review, we discuss two different resistance mechanisms in NSCLC targeted therapies, namely changes in the targeted oncogenes (on-target resistance) and changes in other related signaling pathways (off-target resistance) in tumor cells. We highlight the conventional mechanisms of drug resistance elicited by the complex heterogeneous microenvironment of NSCLC during targeted therapy, including mutations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), the receptor tyrosine kinase ROS proto-oncogene 1 (ROS1), and the serine/threonine-protein kinase BRAF (v-Raf murine sarcoma viral oncogene homolog B). We also discuss the mechanism of action of less common oncoproteins, as in-depth understanding of these molecular mechanisms is important for optimizing treatment strategies.
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Affiliation(s)
- Wen-Juan Liu
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, China
| | - Yue Du
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ru Wen
- Department of Medicine, Stanford University School of Medicine, California, USA
| | - Ming Yang
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, China.
| | - Jian Xu
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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23
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Al-Obeidi E, Li T, Kelly K. Durable Responses to Afatinib as First-line Therapy for HER2-mutated Metastatic Non-small-cell Lung Cancer. Clin Lung Cancer 2019; 21:e15-e20. [PMID: 31649001 DOI: 10.1016/j.cllc.2019.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/12/2019] [Accepted: 09/16/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Ebaa Al-Obeidi
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA
| | - Tianhong Li
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Karen Kelly
- University of California Davis Comprehensive Cancer Center, Sacramento, CA.
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24
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Santaniello A, Napolitano F, Servetto A, De Placido P, Silvestris N, Bianco C, Formisano L, Bianco R. Tumour Microenvironment and Immune Evasion in EGFR Addicted NSCLC: Hurdles and Possibilities. Cancers (Basel) 2019; 11:E1419. [PMID: 31554160 PMCID: PMC6826622 DOI: 10.3390/cancers11101419] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 12/23/2022] Open
Abstract
In the last few years, the treatment strategy in Non-Small Cell Lung Cancer (NSCLC) patients has been heavily modified by the introduction of the immune-checkpoint inhibitors. Anti-programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) therapy has improved both progression-free and the overall survival in almost all subgroups of patients, with or without PDL1 expression, with different degrees of responses. However, there are patients that are not benefitting from this treatment. A defined group of immune-checkpoint inhibitors non-responder tumours carry EGFR (epidermal growth factor receptor) mutations: nowadays, anti-PD-1/PD-L1 clinical trials often do not involve this type of patient and the use of immune-checkpoint inhibitors are under evaluation in this setting. Our review aims to elucidate the mechanisms underlying this resistance: we focused on evaluating the role of the tumour microenvironment, including infiltrating cells, cytokines, secreted factors, and angiogenesis, and its interaction with the tumour tissue. Finally, we analysed the possible role of immunotherapy in EGFR mutated tumours.
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Affiliation(s)
- Antonio Santaniello
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Alberto Servetto
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Nicola Silvestris
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, 70124 Bari, Italy.
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy.
| | - Cataldo Bianco
- Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy.
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
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Rassy E, Mezquita L, Remon J, Besse B. Non-small-cell lung cancer: what are the benefits and challenges of treating it with immune checkpoint inhibitors? Immunotherapy 2019; 11:1149-1160. [DOI: 10.2217/imt-2019-0071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape of advanced non-small-cell lung cancer (NSCLC). It has improved the overall survival in the first- and second-line setting with manageable adverse events. Multiple challenges still impede the success of ICI in the whole population of NSCLC namely the lack of reliable predictive biomarkers, the scarcity of data regarding the optimal treatment duration with ICI and possibility of rechallenge with ICI as well as the efficacy of ICI in special subgroups of patients such as those with oncogenic addicted tumors or patients with brain metastases. In this framework, we review the benefits and challenges of ICI in NSCLC, in monotherapy and in combinations, in the advanced setting.
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Affiliation(s)
- Elie Rassy
- Department of Cancer Medicine, Gustave Roussy Institute, F-94805 Villejuif, France
- Department of Medical Oncology, Faculty of Medicine, Saint Joseph University, Lebanon
| | - Laura Mezquita
- Department of Cancer Medicine, Gustave Roussy Institute, F-94805 Villejuif, France
| | - Jordi Remon
- Centroi Integral Oncología Clara Campal Barcelona – HM Delfos, Barcelona, Spain
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy Institute, F-94805 Villejuif, France
- Université Paris Sud, Université Paris-Saclay, F-94270 Le Kremlin-Bicêtre, France
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26
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Low JL, Walsh RJ, Ang Y, Chan G, Soo RA. The evolving immuno-oncology landscape in advanced lung cancer: first-line treatment of non-small cell lung cancer. Ther Adv Med Oncol 2019; 11:1758835919870360. [PMID: 31497071 PMCID: PMC6716180 DOI: 10.1177/1758835919870360] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/26/2019] [Indexed: 12/22/2022] Open
Abstract
Lung cancer is the most common cancer and leading cause of cancer death. While
targeted therapies have redefined treatment options for non-small cell lung
carcinoma (NSCLC) with genetic aberrations such as epidermal growth factor and
anaplastic lymphoma kinase, many patients do not harbour these oncogenic
drivers. Cancer immunology has enabled the development of immune modulators that
has dramatically altered the therapeutic landscape of advanced NSCLC. The
success of immune-checkpoint inhibitors in pretreated NSCLC has led to the
conduct of multiple studies exploring their role in the first-line setting. This
article provides an overview of the evolving landscape of immune-checkpoint
inhibitors with a focus on the programmed cell-death 1 (PD-1; pembrolizumab,
nivolumab) and programmed cell-death ligand 1 (PD-L1; atezolizumab, durvalumab,
avelumab) immune-checkpoint inhibitors as single agent or in combination with
either chemotherapy or with another immune-checkpoint inhibitor in the treatment
of NSCLC, the challenges faced, as well as future perspectives.
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Affiliation(s)
- Jia Li Low
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Robert J Walsh
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Yvonne Ang
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Gloria Chan
- Department of Haematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore 119228, Singapore
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Hastings K, Yu HA, Wei W, Sanchez-Vega F, DeVeaux M, Choi J, Rizvi H, Lisberg A, Truini A, Lydon CA, Liu Z, Henick BS, Wurtz A, Cai G, Plodkowski AJ, Long NM, Halpenny DF, Killam J, Oliva I, Schultz N, Riely GJ, Arcila ME, Ladanyi M, Zelterman D, Herbst RS, Goldberg SB, Awad MM, Garon EB, Gettinger S, Hellmann MD, Politi K. EGFR mutation subtypes and response to immune checkpoint blockade treatment in non-small-cell lung cancer. Ann Oncol 2019; 30:1311-1320. [PMID: 31086949 PMCID: PMC6683857 DOI: 10.1093/annonc/mdz141] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although EGFR mutant tumors exhibit low response rates to immune checkpoint blockade overall, some EGFR mutant tumors do respond to these therapies; however, there is a lack of understanding of the characteristics of EGFR mutant lung tumors responsive to immune checkpoint blockade. PATIENTS AND METHODS We retrospectively analyzed de-identified clinical and molecular data on 171 cases of EGFR mutant lung tumors treated with immune checkpoint inhibitors from the Yale Cancer Center, Memorial Sloan Kettering Cancer Center, University of California Los Angeles, and Dana Farber Cancer Institute. A separate cohort of 383 EGFR mutant lung cancer cases with sequencing data available from the Yale Cancer Center, Memorial Sloan Kettering Cancer Center, and The Cancer Genome Atlas was compiled to assess the relationship between tumor mutation burden and specific EGFR alterations. RESULTS Compared with 212 EGFR wild-type lung cancers, outcomes with programmed cell death 1 or programmed death-ligand 1 (PD-(L)1) blockade were worse in patients with lung tumors harboring alterations in exon 19 of EGFR (EGFRΔ19) but similar for EGFRL858R lung tumors. EGFRT790M status and PD-L1 expression did not impact response or survival outcomes to immune checkpoint blockade. PD-L1 expression was similar across EGFR alleles. Lung tumors with EGFRΔ19 alterations harbored a lower tumor mutation burden compared with EGFRL858R lung tumors despite similar smoking history. CONCLUSIONS EGFR mutant tumors have generally low response to immune checkpoint inhibitors, but outcomes vary by allele. Understanding the heterogeneity of EGFR mutant tumors may be informative for establishing the benefits and uses of PD-(L)1 therapies for patients with this disease.
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MESH Headings
- Aged
- Alleles
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/immunology
- B7-H1 Antigen/metabolism
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/mortality
- Drug Resistance, Neoplasm/genetics
- ErbB Receptors/antagonists & inhibitors
- ErbB Receptors/genetics
- ErbB Receptors/metabolism
- Female
- Genetic Heterogeneity
- Humans
- Lung/immunology
- Lung/pathology
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/immunology
- Lung Neoplasms/mortality
- Male
- Middle Aged
- Mutation
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/immunology
- Programmed Cell Death 1 Receptor/metabolism
- Progression-Free Survival
- Retrospective Studies
- Tobacco Smoking/adverse effects
- Tobacco Smoking/epidemiology
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Affiliation(s)
| | - H A Yu
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York
| | - W Wei
- Yale School of Public Health, New Haven
| | - F Sanchez-Vega
- Human Oncology and Pathogenesis Program; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering, New York
| | - M DeVeaux
- Yale School of Public Health, New Haven
| | - J Choi
- Department of Genetics, Yale School of Medicine, New Haven
| | - H Rizvi
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York
| | - A Lisberg
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | | | - C A Lydon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - Z Liu
- Department of Pathology, Yale School of Medicine, New Haven
| | - B S Henick
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York; Department of Medicine, Columbia University Medical Center, New York
| | - A Wurtz
- Yale Cancer Center, New Haven
| | - G Cai
- Department of Pathology, Yale School of Medicine, New Haven
| | - A J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York
| | - N M Long
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York
| | - D F Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York
| | - J Killam
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven
| | - I Oliva
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven
| | - N Schultz
- Human Oncology and Pathogenesis Program; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering, New York; Department of Epidemiology and Biostatistics
| | - G J Riely
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York
| | - M E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - M Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | | | - R S Herbst
- Yale Cancer Center, New Haven; Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, USA
| | - S B Goldberg
- Yale Cancer Center, New Haven; Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, USA
| | - M M Awad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - E B Garon
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - S Gettinger
- Yale Cancer Center, New Haven; Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, USA
| | - M D Hellmann
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York.
| | - K Politi
- Yale Cancer Center, New Haven; Department of Pathology, Yale School of Medicine, New Haven; Department of Medicine (Section of Medical Oncology), Yale School of Medicine, New Haven, USA.
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Comparing and contrasting predictive biomarkers for immunotherapy and targeted therapy of NSCLC. Nat Rev Clin Oncol 2019; 16:341-355. [PMID: 30718843 DOI: 10.1038/s41571-019-0173-9] [Citation(s) in RCA: 323] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The era of personalized medicine for advanced-stage non-small-cell lung cancer (NSCLC) began when biomarker-based evidence of molecular pathway and/or oncogene addiction of the tumour became mandatory for the allocation of specific targeted therapies. More recently, the immunotherapy revolution, specifically, the development of immune-checkpoint inhibitors (ICIs), has dramatically altered the NSCLC treatment landscape. Herein, we compare and contrast the clinical development of immunotherapy and oncogene-directed therapy for NSCLC, focusing on the role of predictive biomarkers. Immunotherapy biomarkers are fundamentally different from oncogene biomarkers in that they are continuous rather than categorical (binary), spatially and temporally variable and reliant on multiple complex interactions rather than a single, dominant determinant. The performance of predictive biomarkers for ICIs might be improved by combining different markers to reduce the assumptive risks associated with each one. Novel combinations with chemotherapy and ICIs complicate biomarker discovery but do not decrease the value of the markers identified. Perfectly predictive biomarkers of benefit from immunotherapy are unlikely to be identified, although exclusionary biomarkers of minimal benefit or an unacceptable risk of toxicity might be feasible. The clinical adoption and applicability of such biomarkers might vary depending on line of treatment, the available therapeutic alternatives and health economic considerations.
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29
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Berghoff AS, Bellosillo B, Caux C, de Langen A, Mazieres J, Normanno N, Preusser M, Provencio M, Rojo F, Wolf J, Zielinski CC. Immune checkpoint inhibitor treatment in patients with oncogene- addicted non-small cell lung cancer (NSCLC): summary of a multidisciplinary round-table discussion. ESMO Open 2019; 4:e000498. [PMID: 31297240 PMCID: PMC6586213 DOI: 10.1136/esmoopen-2019-000498] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/22/2019] [Accepted: 03/29/2019] [Indexed: 12/18/2022] Open
Abstract
The introduction of targeted treatments and more recently immune checkpoint inhibitors (ICI) to the treatment of metastatic non-small cell lung cancer (NSCLC) has dramatically changed the prognosis of selected patients. For patients with oncogene-addicted metastatic NSCLC harbouring an epidermal growth factor receptor (EGFR) or v-Raf murine sarcoma viral oncogene homologue B1 (BRAF) mutation or an anaplastic lymphoma kinase (ALK) or ROS proto-oncogene 1, receptor tyrosine kinase (ROS1) gene alteration (translocation, fusion, amplification) mutation-specific tyrosine kinase inhibitors (TKI) are already first-line standard treatment, while targeted treatment for other driver mutations affecting MET, RET, human epidermal growth factor receptor (HER) 2, tropomyosin receptor kinases (TRK) 1-3 and others are currently under investigation. The role of ICI in these patient subgroups is currently under debate. This article summarises a round-table discussion organised by ESMO Open in Vienna in July 2018. It reviews current clinical data on ICI treatment in patients with metastatic oncogene-addicted NSCLC and discusses molecular diagnostic assessment, potential biomarkers and radiological methods for response evaluation of ICI treatment. The round-table panel concluded ICI should only be considered in patients with oncogene-addicted NSCLC after exhaustion of effective targeted therapies and in some cases possibly after all other therapies including chemotherapies. More clinical trials on combination therapies and biomarkers for ICI therapy based on the specific differing characteristics of oncogene-addicted NSCLC need to be conducted.
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Affiliation(s)
- Anna S Berghoff
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Christophe Caux
- Centre de Recherche en Cancerologie de Lyon, Lyon, Rhône-Alpes, France
| | - Adrianus de Langen
- Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, Noord-Holland, Netherlands
| | - Julien Mazieres
- Service de Pneumologie, Toulouse University Hospital, Toulouse, France
| | - Nicola Normanno
- Istituto Nazionale Tumouri 'Fondazione G. Pascale'-IRCCS, Naples, Italy
| | - Matthias Preusser
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Mariano Provencio
- Department of Medical Oncology, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain
| | - Federico Rojo
- Pathology Department, Jiminez Dias University Hospital, Madrid, Spain
| | - Jurgen Wolf
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology, Uniklinik Koln, Koln, Nordrhein-Westfalen, Germany
| | - Christoph C Zielinski
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Central European Cancer Center, Vienna, Austria
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Mhanna L, Guibert N, Milia J, Mazieres J. When to Consider Immune Checkpoint Inhibitors in Oncogene-Driven Non-Small Cell Lung Cancer? Curr Treat Options Oncol 2019; 20:60. [PMID: 31172347 PMCID: PMC6554237 DOI: 10.1007/s11864-019-0652-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OPINION STATEMENT Targeted therapies and more recently immune checkpoint inhibitors (ICI) have transformed the treatment landscape of advanced NSCLC. Clinical trials investigating immune checkpoint inhibitors (ICI) have usually excluded patients with oncogenic drivers, so that the outcome of these agents in this population is poorly known. In patients with oncogenic addiction, targeted therapy remains clearly the best option, and the place of immunotherapy in this population has not been clearly defined yet.Based on available data, we suggest that (i) immunotherapy single agent should be proposed only after exhaustion of more validated treatments, (ii) combinations of immunotherapy with targeted therapies are of interest provided that we can manage toxicity and find the best sequence, (iii) a combination of immunotherapy with chemotherapy may be appealing in patients pretreated with targeted agents. The best way to opt in for the best strategy will depend upon the identification of adequate biomarkers. New basic and clinical research is awaited in this field.
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Affiliation(s)
- Laurent Mhanna
- Pulmonology Department, Toulouse University Hospital, Université Paul Sabatier, Toulouse, France
| | - Nicolas Guibert
- Pulmonology Department, Toulouse University Hospital, Université Paul Sabatier, Toulouse, France
| | - Julie Milia
- Pulmonology Department, Toulouse University Hospital, Université Paul Sabatier, Toulouse, France
| | - Julien Mazieres
- Pulmonology Department, Toulouse University Hospital, Université Paul Sabatier, Toulouse, France.
- Thoracic Oncology Department, Hopital LARREY, CHU Toulouse, Chemin de Pouvourville, 31059, Toulouse, France.
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31
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Searching for a chemoimmunotherapy signal in patients with non-small-cell lung cancer and EGFR mutations. THE LANCET RESPIRATORY MEDICINE 2019; 7:366-367. [PMID: 30922877 DOI: 10.1016/s2213-2600(19)30112-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Hendriks LEL, Henon C, Auclin E, Mezquita L, Ferrara R, Audigier-Valette C, Mazieres J, Lefebvre C, Rabeau A, Le Moulec S, Cousin S, Duchemann B, le Pechoux C, Botticella A, Ammari S, Gazzah A, Caramella C, Adam J, Lechapt E, Planchard D, De Ruysscher D, Dingemans AM, Besse B. Outcome of Patients with Non-Small Cell Lung Cancer and Brain Metastases Treated with Checkpoint Inhibitors. J Thorac Oncol 2019; 14:1244-1254. [PMID: 30780002 DOI: 10.1016/j.jtho.2019.02.009] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Although frequent in NSCLC, patients with brain metastases (BMs) are often excluded from immune checkpoint inhibitor (ICI) trials. We evaluated BM outcome in a less-selected NSCLC cohort. METHODS Data from consecutive patients with advanced ICI-treated NSCLC were collected. Active BMs were defined as new and/or growing lesions without any subsequent local treatment before the start of ICI treatment. Objective response rate (ORR), progression-free survival, and overall survival (OS) were evaluated. Multivariate analyses were performed by using a Cox proportional hazards model and logistic regression. RESULTS A total of 1025 patients were included; the median follow-up time from start of ICI treatment was 15.8 months. Of these patients, 255 (24.9%) had BMs (39.2% active, 14.3% symptomatic, and 27.4% being treated with steroids). Disease-specific Graded Prognostic Assessment (ds-GPA) score was known for 94.5% of patients (35.7% with a score of 0-1, 58.5% with a score of 1.5-2.5, and 5.8% with a score of 3). The ORRs with BM versus without BM were similar: 20.6% (with BM) versus 22.7% (without BM) (p = 0.484). The intracranial ORR (active BM with follow-up brain imaging [n = 73]) was 27.3%. The median progression-free survival times were 1.7 (95% confidence interval [CI]: 1.5-2.1) and 2.1 (95% CI: 1.9-2.5) months, respectively (p = 0.009). Of the patients with BMs, 12.7% had a dissociated cranial-extracranial response and two (0.8%) had brain pseudoprogression. Brain progression occurred more in active BM than in stable BM (54.2% versus 30% [p < 0.001]). The median OS times were 8.6 months (95% CI: 6.8-12.0) with BM and 11.4 months (95% CI: 8.6-13.8) months with no BM (p = 0.035). In the BM subgroup multivariate analysis, corticosteroid use (hazard ratio [HR] = 2.37) was associated with poorer OS, whereas stable BMs (HR = 0.62) and higher ds-GPA classification (HR = 0.48-0.52) were associated with improved OS. CONCLUSION In multivariate analysis BMs are not associated with a poorer survival in patients with ICI-treated NSCLC. Stable patients with BM without baseline corticosteroids and a good ds-GPA classification have the best prognosis.
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Affiliation(s)
- Lizza E L Hendriks
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Institut d'Oncologie Thoracique, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Clemence Henon
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Institut d'Oncologie Thoracique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Edouard Auclin
- Gastrointestinal and Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - Laura Mezquita
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Institut d'Oncologie Thoracique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Roberto Ferrara
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Institut d'Oncologie Thoracique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Julien Mazieres
- Department of Pulmonary Diseases, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Corentin Lefebvre
- Department of Pulmonary Diseases, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Audrey Rabeau
- Department of Pulmonary Diseases, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Sophie Cousin
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Boris Duchemann
- Department of Pulmonary Diseases, Hopital Avicenne, Paris, France
| | - Cecile le Pechoux
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Angela Botticella
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Samy Ammari
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, IR4M, CNRS, Université Paris-Sud, Université Paris-Saclay, Orsay, France
| | - Anas Gazzah
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Institut d'Oncologie Thoracique, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Department of Drug Development, Gustave Roussy Cancer Campus, Villejuif, France
| | - Caroline Caramella
- Department of Radiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Julien Adam
- Department of Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Emmanuèle Lechapt
- Department of Pathology, Centre Hospitalier Sainte Anne, Paris, France
| | - David Planchard
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Institut d'Oncologie Thoracique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Dirk De Ruysscher
- Department of Radiation Oncology, MAASTRO Clinic, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Anne-Marie Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Benjamin Besse
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Institut d'Oncologie Thoracique, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Paris-Sud University, Orsay, France
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Baba K, Tanaka H, Sakamoto H, Shiratori T, Tsuchiya J, Ishioka Y, Itoga M, Taima K, Tasaka S. Efficacy of pembrolizumab for patients with both high PD-L1 expression and an MET exon 14 skipping mutation: A case report. Thorac Cancer 2019; 10:369-372. [PMID: 30600919 PMCID: PMC6360217 DOI: 10.1111/1759-7714.12939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 12/23/2022] Open
Abstract
Pembrolizumab has become the standard first-line treatment for non-small cell lung cancer (NSCLC) patients with high PD-L1expression. MET exon 14 skipping is a rare mutation typically found in older, female, and non-smoking patients with NSCLC. Herein, we report the case of a 71-year-old non-smoking woman who was diagnosed with NSCLC in the left lung. EGFR mutation and ALK fusion were not detected. Because the biopsy specimen showed high PD-L1 expression with a tumor proportion score of 95%, pembrolizumab was introduced as first-line therapy, but resulted in no clinical benefit. The patient was subsequently administered chemotherapy with carboplatin and pemetrexed, leading to remarkable tumor shrinkage. A next-generation sequencing panel analysis revealed a MET exon 14 skipping mutation. Thus, pembrolizumab might not be effective for NSCLC patients with MET exon 14 skipping mutations, even if PD-L1 expression is high.
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Affiliation(s)
- Keisuke Baba
- Department of Respiratory MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Hisashi Tanaka
- Department of Respiratory MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Hiroaki Sakamoto
- Department of Respiratory MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Toshihiro Shiratori
- Department of Respiratory MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Junichiro Tsuchiya
- Department of Respiratory MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yoshiko Ishioka
- Department of Respiratory MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Masamichi Itoga
- Department of Respiratory MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Kageaki Taima
- Department of Respiratory MedicineHirosaki University Graduate School of MedicineHirosakiJapan
| | - Sadatomo Tasaka
- Department of Respiratory MedicineHirosaki University Graduate School of MedicineHirosakiJapan
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Gamerith G, Kocher F, Rudzki J, Pircher A. ASCO 2018 NSCLC highlights-combination therapy is key. MEMO 2018; 11:266-271. [PMID: 30595752 PMCID: PMC6280781 DOI: 10.1007/s12254-018-0444-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/02/2018] [Indexed: 01/27/2023]
Abstract
Non-small cell lung cancer (NSCLC) treatment was booming at this year's ASCO 2018 meeting as several well-performed phase III trials with practice-changing potential were presented. Thereby immune checkpoint blockade (ICB) consolidated its major role in the treatment of NSCLC patients without genetic alterations and extended its use by showing impressive data on ICB combination therapies (mainly combined with chemotherapy). Furthermore the role of predictive biomarkers for ICB therapy (Programmed death-ligand 1 [PD-L1] expression, tumor mutational burden [TMB] testing and others) have been further developed and blood-based tests were presented with promising data revealing the potential of this minimally invasive method for treatment monitoring and guidance in the future. Nevertheless the best biomarker is still elusive and future research is ongoing and might be a multimodal approach combining different modalities. No major studies concerning new genetic alterations or innovative targets were presented and the focus in genetic driven NSCLC was the evaluation of combinational approaches (e.g. in epidermal growth factor receptor [EGFR] mutation positve patients, EGFR tyrosine kinase inhibitor [TKI] plus anti-angiogenic agent or chemotherapy backbone). The presented results showed some benefit for the combinational approach; however toxicity might be an issue and further validation is necessary. Summarizing, ASCO 2018 showed that combinational approaches will be the future standard treatment in NSCLC and that biomarker identification is more heterogeneous and complex than anticipated, but presented next generation techniques may pave the way to a more personalized cancer therapy.
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Affiliation(s)
- Gabriele Gamerith
- Department of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Florian Kocher
- Department of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Jakob Rudzki
- Department of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Andreas Pircher
- Department of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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Remon J, Hendriks LE, Cabrera C, Reguart N, Besse B. Immunotherapy for oncogenic-driven advanced non-small cell lung cancers: Is the time ripe for a change? Cancer Treat Rev 2018; 71:47-58. [PMID: 30359792 DOI: 10.1016/j.ctrv.2018.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 12/12/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have been incorporated in the treatment strategy of advanced non-small cell lung cancer (NSCLC) in first- and second-line setting improving the prognosis of these patients. However, the treatment landscape has been also drastically overturned with the advent of targeted therapies in oncogenic-addicted advanced NSCLC patients. Despite ICIs represent an active and new treatment option for a wide range of advanced NSCLC patients, the efficacy and the optimal place of ICI in the treatment strategy algorithm of oncogenic-addicted tumors remains still controversial, as only a minority of trials with ICI enrol oncogenic-addicted NSCLC patients previously treated with standard therapy. Therefore, there are still several open questions about ICI in oncogenic-driven NSCLC, such as the efficacy and toxicities, which need to be addressed before considering treatment with ICI as a standard approach in this population. It is in this framework, we provide a thorough overview on this currently controversial topic.
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Affiliation(s)
- J Remon
- Centro Integral Oncología Clara Campal Bacelona, HM-Delfos, Medical Oncology Department, Barcelona, Spain.
| | - L E Hendriks
- Gustave Roussy, Cancer Medicine Department, Villejuif, France; Maastricht University Medical Center+, Pulmonary Diseases Department, GROW - School for Oncology and Developmental Biology, Maastricht, the Netherlands.
| | - C Cabrera
- Hospital Clínic i Provincial de Barcelona, Medical Oncology Department, Barcelona, Spain.
| | - N Reguart
- Hospital Clínic i Provincial de Barcelona, Medical Oncology Department, Barcelona, Spain.
| | - B Besse
- Gustave Roussy, Cancer Medicine Department, Villejuif, France; University Paris-Sud, Orsay, France.
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