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Zeng M, Verma V, Chen X, Li S, Sun Y, Liu G, Tian X, Zhang D, Li J, Liu Y, Liao X, Liu Y, Wang L, Wang X, Shi H, Li B, Xue B, Luo X. Stereotactic radiotherapy vs whole brain radiation therapy in EGFR mutated NSCLC: Results & reflections from the prematurely closed phase III HYBRID trial. Radiother Oncol 2024; 197:110334. [PMID: 38801945 DOI: 10.1016/j.radonc.2024.110334] [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: 11/22/2023] [Revised: 04/22/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND All known randomized trials of stereotactic radiotherapy (SRT) versus whole brain radiotherapy (WBRT) for brain metastases (BMs) comprise mixed histologies. The phase III HYBRID trial (NCT02882984) attempted to evaluate the non-inferiority of SRT vs. WBRT specifically for EGFR-mutated non-small cell lung cancer (EGFRm NSCLC) BMs. METHODS Inclusion criteria were ≤ 5 BMs (any size) from treatment-naïve EGFRm NSCLC. All patients started a first-generation tyrosine kinase inhibitor on the first day of WBRT (37.5 Gy/15 fractions) or SRT (25-40 Gy/5 fractions per tumor volume). The primary endpoint was 18-month intracranial progression-free survival (iPFS; intention-to-treat). RESULTS The trial commenced in June 2015 and was closed in April 2021 after screening 208 patients but enrolling 85 (n = 41 WBRT, n = 44 SRT; median follow-up 31 and 36 months, respectively). Respectively, 9.5 % vs. 10.2 % of patients experienced intracranial progression at 18 months, and the median iPFS was 21.4 vs. 22.3 months (p > 0.05 for all). The SRT arm experienced higher overall survival and cognitive preservation (p < 0.05 for all). The most notable reason for low enrollment was patients not wishing to risk neurocognitive decline from WBRT. CONCLUSIONS Although this phase III trial was underpowered, there was no evidence that SRT yielded outcome detriments compared to WBRT for EGFRm NSCLC BMs. Lessons from prematurely closed trials are valuable, as they often provide important experiential perspectives for investigators designing/executing future trials. In the current era, randomized trials involving WBRT without cognitive sparing measures may be at high risk of underaccrual; trial investigators are encouraged to carefully consider our experience when attempting to design such trials. However, trials of molecular-/biologically-stratified patients are highly recommended as the notion of "individualized medicine/oncology" continues to expand.
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Affiliation(s)
- Ming Zeng
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China.
| | - Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Xue Chen
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Simin Li
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Yongliang Sun
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Guotao Liu
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Xiaoman Tian
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Deng Zhang
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Jingqiu Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, 55 South Renmin Ave, Fourth Section, Chengdu, Sichuan Province, China
| | - Yi Liu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, 55 South Renmin Ave, Fourth Section, Chengdu, Sichuan Province, China
| | - Xingyu Liao
- Familial & Hereditary Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yingyi Liu
- Department of Oncology, 416 Hospital, North Fourth Section of the Second Ring Road, Chengdu, Sichuan Province, China
| | - Ling Wang
- Department of Oncology, Sichuan Friendship Hospital, No. 96, Shangshahepu Street, Jinjiang District, Chengdu, Sichuan Province, China
| | - Xiao Wang
- Department of Oncology, Sichuan Friendship Hospital, No. 96, Shangshahepu Street, Jinjiang District, Chengdu, Sichuan Province, China
| | - Huibing Shi
- Department of Oncology, Sichuan Friendship Hospital, No. 96, Shangshahepu Street, Jinjiang District, Chengdu, Sichuan Province, China
| | - Bin Li
- Cancer Center, Sichuan Taikang Hospital, Tianfu New Area, #881 Xiang He First Street, Chengdu, Sichuan Province, China
| | - Binyue Xue
- Department of Oncology, Sichuan Friendship Hospital, No. 96, Shangshahepu Street, Jinjiang District, Chengdu, Sichuan Province, China
| | - Xing Luo
- Department of Oncology, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China; Clinical Medical School, Chengdu Medical College, Chengdu, Sichuan Province, China
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Planchard D, Jänne PA, Cheng Y, Yang JCH, Yanagitani N, Kim SW, Sugawara S, Yu Y, Fan Y, Geater SL, Laktionov K, Lee CK, Valdiviezo N, Ahmed S, Maurel JM, Andrasina I, Goldman J, Ghiorghiu D, Rukazenkov Y, Todd A, Kobayashi K. Osimertinib with or without Chemotherapy in EGFR-Mutated Advanced NSCLC. N Engl J Med 2023; 389:1935-1948. [PMID: 37937763 DOI: 10.1056/nejmoa2306434] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Osimertinib is a third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) that is selective for EGFR-TKI-sensitizing and EGFR T790M resistance mutations. Evidence suggests that the addition of chemotherapy may extend the benefits of EGFR-TKI therapy. METHODS In this phase 3, international, open-label trial, we randomly assigned in a 1:1 ratio patients with EGFR-mutated (exon 19 deletion or L858R mutation) advanced non-small-cell lung cancer (NSCLC) who had not previously received treatment for advanced disease to receive osimertinib (80 mg once daily) with chemotherapy (pemetrexed [500 mg per square meter of body-surface area] plus either cisplatin [75 mg per square meter] or carboplatin [pharmacologically guided dose]) or to receive osimertinib monotherapy (80 mg once daily). The primary end point was investigator-assessed progression-free survival. Response and safety were also assessed. RESULTS A total of 557 patients underwent randomization. Investigator-assessed progression-free survival was significantly longer in the osimertinib-chemotherapy group than in the osimertinib group (hazard ratio for disease progression or death, 0.62; 95% confidence interval [CI], 0.49 to 0.79; P<0.001). At 24 months, 57% (95% CI, 50 to 63) of the patients in the osimertinib-chemotherapy group and 41% (95% CI, 35 to 47) of those in the osimertinib group were alive and progression-free. Progression-free survival as assessed according to blinded independent central review was consistent with the primary analysis (hazard ratio, 0.62; 95% CI, 0.48 to 0.80). An objective (complete or partial) response was observed in 83% of the patients in the osimertinib-chemotherapy group and in 76% of those in the osimertinib group; the median response duration was 24.0 months (95% CI, 20.9 to 27.8) and 15.3 months (95% CI, 12.7 to 19.4), respectively. The incidence of grade 3 or higher adverse events from any cause was higher with the combination than with monotherapy - a finding driven by known chemotherapy-related adverse events. The safety profile of osimertinib plus pemetrexed and a platinum-based agent was consistent with the established profiles of the individual agents. CONCLUSIONS First-line treatment with osimertinib-chemotherapy led to significantly longer progression-free survival than osimertinib monotherapy among patients with EGFR-mutated advanced NSCLC. (Funded by AstraZeneca; FLAURA2 ClinicalTrials.gov number, NCT04035486.).
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Affiliation(s)
- David Planchard
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Pasi A Jänne
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Ying Cheng
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - James C-H Yang
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Noriko Yanagitani
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Sang-We Kim
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Shunichi Sugawara
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Yan Yu
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Yun Fan
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Sarayut L Geater
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Konstantin Laktionov
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Chee K Lee
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Natalia Valdiviezo
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Samreen Ahmed
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Jean-Marc Maurel
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Igor Andrasina
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Jonathan Goldman
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Dana Ghiorghiu
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Yuri Rukazenkov
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Alex Todd
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
| | - Kunihiko Kobayashi
- From the Department of Medical Oncology, Institut Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers, Villejuif, and the Faculty of Medicine, Paris-Saclay University, Paris - both in France (D.P.); the Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston (P.A.J.); the Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun (Y.C.), the Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin (Y.Y.), and the Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou (Y.F.) - all in China; the Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei (J.C.-H.Y.); the Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (N.Y.), the Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai (S.S.), and the Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka (K.K.) - all in Japan; the Department of Oncology, Asan Medical Center, Seoul, South Korea (S.-W.K.); the Department of Internal Medicine, Prince of Songkla University, Songkhla, Thailand (S.L.G.); the Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.L.); the Department of Medical Oncology, Cancer Care Centre, St. George Hospital, Kogarah, NSW, Australia (C.K.L.); the Department of Oncology, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru (N.V.); the Department of Medical Oncology, University Hospitals of Leicester, Leicester (S.A.), and Oncology Research and Development (D.G., Y.R.) and Oncology Biometrics (A.T.), AstraZeneca, Cambridge - both in the United Kingdom; the Department of Clinical Oncology, Rondebosch Oncology Centre, Cape Town, South Africa (J.-M.M.); the Department of Radiotherapy and Oncology, Východoslovenský Onkologický Ústav, Košice, Slovakia (I.A.); and the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles (J.G.)
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Mahajan A, B G, Wadhwa S, Agarwal U, Baid U, Talbar S, Janu AK, Patil V, Noronha V, Mummudi N, Tibdewal A, Agarwal JP, Yadav S, Kumar Kaushal R, Puranik A, Purandare N, Prabhash K. Deep learning based automated epidermal growth factor receptor and anaplastic lymphoma kinase status prediction of brain metastasis in non-small cell lung cancer. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:657-668. [PMID: 37745691 PMCID: PMC10511818 DOI: 10.37349/etat.2023.00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/13/2023] [Indexed: 09/26/2023] Open
Abstract
Aim The aim of this study was to investigate the feasibility of developing a deep learning (DL) algorithm for classifying brain metastases from non-small cell lung cancer (NSCLC) into epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement groups and to compare the accuracy with classification based on semantic features on imaging. Methods Data set of 117 patients was analysed from 2014 to 2018 out of which 33 patients were EGFR positive, 43 patients were ALK positive and 41 patients were negative for either mutation. Convolutional neural network (CNN) architecture efficient net was used to study the accuracy of classification using T1 weighted (T1W) magnetic resonance imaging (MRI) sequence, T2 weighted (T2W) MRI sequence, T1W post contrast (T1post) MRI sequence, fluid attenuated inversion recovery (FLAIR) MRI sequences. The dataset was divided into 80% training and 20% testing. The associations between mutation status and semantic features, specifically sex, smoking history, EGFR mutation and ALK rearrangement status, extracranial metastasis, performance status and imaging variables of brain metastasis were analysed using descriptive analysis [chi-square test (χ2)], univariate and multivariate logistic regression analysis assuming 95% confidence interval (CI). Results In this study of 117 patients, the analysis by semantic method showed 79.2% of the patients belonged to ALK positive were non-smokers as compared to double negative groups (P = 0.03). There was a 10-fold increase in ALK positivity as compared to EGFR positivity in ring enhancing lesions patients (P = 0.015) and there was also a 6.4-fold increase in ALK positivity as compared to double negative groups in meningeal involvement patients (P = 0.004). Using CNN Efficient Net DL model, the study achieved 76% accuracy in classifying ALK rearrangement and EGFR mutations without manual segmentation of metastatic lesions. Analysis of the manually segmented dataset resulted in improved accuracy of 89% through this model. Conclusions Both semantic features and DL model showed comparable accuracy in classifying EGFR mutation and ALK rearrangement. Both methods can be clinically used to predict mutation status while biopsy or genetic testing is undertaken.
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Affiliation(s)
- Abhishek Mahajan
- Clatterbridge Centre for Oncology NHS Foundation Trust, L7 8YA Liverpool, UK
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Gurukrishna B
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Shweta Wadhwa
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Baid
- Department of Electronics and Telecommunication Engineering, SGGS Institute of Engineering and Technology, Nanded 431606, Maharashtra, India
| | - Sanjay Talbar
- Department of Electronics and Telecommunication Engineering, SGGS Institute of Engineering and Technology, Nanded 431606, Maharashtra, India
| | - Amit Kumar Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - JP Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Subash Yadav
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
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Raman R, Ramamohan V, Rathore A, Jain D, Mohan A, Vashistha V. Prevalence of highly actionable mutations among Indian patients with advanced non-small cell lung cancer: A systematic review and meta-analysis. Asia Pac J Clin Oncol 2023; 19:158-171. [PMID: 35634796 DOI: 10.1111/ajco.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality in India. To clarify rates of actionable mutations, and thereby identify opportunities to improve the delivery of best available care for a large volume of patients, a comprehensive review of available data is warranted. METHODS Studies that reported prevalence of any actionable gene variant among adult Indian patients with advanced NSCLC were selected from three databases (PubMed, EMBASE, and Cochrane Library). Ranges in actionable variant prevalence were reported. Meta-analysis of proportions was completed among studies specifically evaluating mutational prevalence within ALK or EGFR. Sensitivity analyses were undertaken among populations sharing high heterogeneity. RESULTS Twenty-six studies were selected. Ranges in actionable mutational prevalence among NSCLC patients were as follows: ALK: 4.1-21.4%, BRAF: 1.5-3.5%, EGFR: 11.9-51.8%, HER2: 0-1.5%, KRAS: 4.5-6.4%, NTRK: 0-.7%, and ROS-1: 3.5-4.1%. Following sensitivity analysis, pooled ALK mutational prevalence rates were 8.3% (95% CIs: 6.6-10.4%) and 4.01% (95% CIs: 2.3-7.0) for adenocarcinoma and NSCLC patients, respectively. Pooled EGFR mutational prevalence rates were 28.7% (95% CIs: 23.5-34.6%) and 24.2% (95% CIs: 19.9-29.1%) for adenocarcinoma and NSCLC patients, respectively. CONCLUSIONS Nearly 40% of Indian patients with advanced adenocarcinoma and 30% with NSCLC share an actionable mutation in ALK or EGFR. Approximately one-half of adenocarcinoma patients have an actionable variant. Efforts should be directed toward efficiently identifying candidates for targeted agents and delivering such treatments.
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Affiliation(s)
- Ruchir Raman
- Centre of Excellence for Biopharmaceutical Technology, Indian Institute of Technology, Delhi, India.,Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - Varun Ramamohan
- Department of Mechanical Engineering, Indian Institute of Technology, Delhi, India
| | - Anurag Rathore
- Centre of Excellence for Biopharmaceutical Technology, Indian Institute of Technology, Delhi, India.,Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All Indian Institute of Medical Sciences, New Delhi, India
| | - Vishal Vashistha
- Department of Pulmonary, Critical Care and Sleep Medicine, All Indian Institute of Medical Sciences, New Delhi, India.,Section of Hematology and Oncology, Department of Medicine, New Mexico Veterans Affairs Medical Center, Albuquerque, New Mexico, USA.,University of New Mexico Cancer Center, Albuquerque, New Mexico, USA
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5
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Nayanar SK, Mohan A, Shenoy P, Saravanan M, Gopinath V, Deepak Roshan VG. Frequency of EGFR mutations in lung adenocarcinoma patients - A study from tertiary cancer center of South India. J Cancer Res Ther 2023; 19:S712-S718. [PMID: 38384044 DOI: 10.4103/jcrt.jcrt_653_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/31/2022] [Indexed: 02/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Epidermal growth factor receptor (EGFR) mutation analysis has become an important part of the initial workup of non-squamous non-small cell lung cancer (NS-NSCLC) patients. This study is attempted as South Indians population is comprised of ethnic groups with diverse genetic makeup and only very limited data on EGFR mutation is available from south India. A detailed understanding of EGFR mutation profile will help in better planning of treatment strategies and resource allocation. METHODS A retrospective analysis of EGFR mutation frequency in 350 patients diagnosed with adenocarcinoma of lung and its association with pathological characteristics was done. RESULTS Out of 350 cases of pulmonary adenocarcinoma, within an age group ranging from 30 to 86 years. EGFR mutations were identified in 34.8% (n = 122) cases, out of which 35.24% (n = 43) were in non-smoker females (P = 0.001). Of the 14 cases with resistant type of EGFR mutations, nine were in smoker males and the remaining five in non-smoker females. INTERPRETATION AND CONCLUSION Overall EGFR mutation frequency observed in our study was similar to other Indian studies. However, in our study, we observed that mutation in exon 21 was less frequent compared to other studies. A similar slightly increased frequency of rare mutations and double mutations were observed in our study. A detailed study of the molecular epidemiology of lung cancer and its association with different geographical zones of India is needed. This understanding will help in better planning of treatment strategies and resource allocation.
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Affiliation(s)
- Sangeetha K Nayanar
- Division of Oncopathology, Departmentof Clinical Lab Services and Translational Research, Kerala, India
| | - Anju Mohan
- Division of Oncopathology, Departmentof Clinical Lab Services and Translational Research, Kerala, India
| | - Praveen Shenoy
- Department of Clinical Hematology and Medical Oncology, Kerala, India
| | - M Saravanan
- Division of Microbiology, Department of Clinical Lab Services and Translational Research, Kerala, India
| | - Vipin Gopinath
- Division of Genetics and Cytogentics, Department of Clinical Lab Services and Translational Research, Malabar Cancer Centre, Moozhikkara P.O, Thalassery, Kerala, India
| | - V G Deepak Roshan
- Division of Genetics and Cytogentics, Department of Clinical Lab Services and Translational Research, Malabar Cancer Centre, Moozhikkara P.O, Thalassery, Kerala, India
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6
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Kaler AK, Patel K, Patil H, Tiwarekar Y, Kulkarni B, Hastak M, Athikari N, Rane S, Nikam A, Umarji S, Shaikh I, Goyle S, Mistry R. Mutational Analysis of EGFR Mutations in Non-Small Cell Lung Carcinoma-An Indian Perspective of 212 Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:758. [PMID: 36613084 PMCID: PMC9819110 DOI: 10.3390/ijerph20010758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Lung cancer is the world's leading cause of cancer-related deaths. Epidermal growth factor receptor (EGFR) is one of the critical oncogenes and plays a significant role in tumor proliferation and metastasis. Patients with sensitizing mutations in the EGFR gene have better clinical outcomes when treated with tyrosine kinase inhibitors (TKI). This study expands our knowledge of the spectrum of EGFR mutations among lung cancer patients in the Indian scenario. This is a retrospective descriptive study of all newly diagnosed patients with lung cancer in tertiary care hospital in India. All the samples were subjected to real-time PCR (q-PCR) analysis and confirmation of rare novel mutations was done using Sanger sequencing. Clinicopathological characteristics, mutational EGFR status, and location on the exon and metastatic sites were evaluated. An analysis of total 212 samples showed mutations in 38.67% of cases. Among these, five (5.9%) samples had mutations in exon 18, 41 (48.8%) samples had mutations in exon 19, 12 (14.28%) samples had mutations in exon 20, and 26 (30.95%) samples had mutations in exon 21. Eleven (13.41%) were found to be uncommon EGFR mutations. Additionally, six (21.4%) samples that had EGFR mutations were also positive for brain metastasis. Future testing on bigger panels will help to characterize the incidence of genetic mutations and to determine the appropriate targeted treatment choices for NSCLC patients.
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Affiliation(s)
- Amrit Kaur Kaler
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Khushi Patel
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Harshali Patil
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Yash Tiwarekar
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Bijal Kulkarni
- Department of Pathology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Meenal Hastak
- Department of Pathology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Nivetha Athikari
- Department of Pathology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Samrudhi Rane
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Ankita Nikam
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Smita Umarji
- Department of Molecular Pathology and Genomics, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Imran Shaikh
- Department of Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Sandeep Goyle
- Department of Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
| | - Rajesh Mistry
- Department of Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India
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7
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Hui C, Qu V, Wang JY, von Eyben R, Chang YC, Chiang PL, Liang CH, Lu JT, Li G, Hayden-Gephart M, Wakelee H, Neal J, Ramchandran K, Das M, Nagpal S, Soltys S, Myall N, Pollom E. Local control of brain metastases with osimertinib alone in patients with EGFR-mutant non-small cell lung cancer. J Neurooncol 2022; 160:233-240. [PMID: 36227422 DOI: 10.1007/s11060-022-04145-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/21/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Although osimertinib has excellent intracranial activity in metastatic non-small cell lung cancer (NSCLC) with exon 19 deletion or L858R EGFR alterations, measures of local control of brain metastases are less well-reported. We describe lesion-level outcomes of brain metastases treated with osimertinib alone. METHODS We retrospectively reviewed patients with EGFR-mutant NSCLC with untreated brain metastasis measuring ≥ 5 mm at the time of initiating osimertinib. Cumulative incidence of local recurrence in brain (LRiB) was calculated with death as a competing risk, and univariable and multivariable analyses were conducted to identify factors associated with LRiB. RESULTS We included 284 brain metastases from 37 patients. Median follow-up was 20.1 months. On initial MRI after starting osimertinib, patient-level response was complete response (CR) in 11 (15%), partial response (PR) in 33 (45%), stable disease (SD) in 18 (25%) and progressive disease (PD) in 11 (15%). The 1-year cumulative incidence of LRiB was 14% (95% CI 9.9-17.9) and was significantly different in patients with a CR (0%), PR (4%), and SD (11%; p = 0.02). Uncontrolled primary tumor (adjusted hazard ratio [aHR] 3.78, 95% CI 1.87-7.66; p < 0.001), increasing number of prior systemic therapies (aHR 2.12, 95% CI 1.49-3.04; p < 0.001), and higher ECOG score (aHR 7.8, 95% CI 1.99-31.81; p = 0.003) were associated with LRiB. CONCLUSIONS Although 1-year cumulative incidence of LRiB is < 4% with a CR or PR, 1-year cumulative incidence of LRiB is over 10% for patients with less than a PR to osimertinib on initial MRI. These patients should be followed closely for need for additional treatment such as stereotactic radiosurgery.
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Affiliation(s)
- Caressa Hui
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Vera Qu
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Jen-Yeu Wang
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | | | | | | | | | - Gordon Li
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | | | - Heather Wakelee
- Department of Medical Oncology, Stanford University, Palo Alto, CA, USA
| | - Joel Neal
- Department of Medical Oncology, Stanford University, Palo Alto, CA, USA
| | | | - Millie Das
- Department of Medical Oncology, Stanford University, Palo Alto, CA, USA
| | - Seema Nagpal
- Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Nathaniel Myall
- Department of Medical Oncology, Stanford University, Palo Alto, CA, USA. .,Department of Medical Oncology, Stanford University, 300 Pasteur Dr Rm JC007, Stanford, CA, 94305, USA.
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA. .,Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA.
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8
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Ahn SJ, Kwon H, Kim JW, Park G, Park M, Joo B, Suh SH, Chang YS, Lee JM. Hippocampal Metastasis Rate Based on Non-Small Lung Cancer TNM Stage and Molecular Markers. Front Oncol 2022; 12:781818. [PMID: 35619920 PMCID: PMC9127383 DOI: 10.3389/fonc.2022.781818] [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: 09/23/2021] [Accepted: 04/04/2022] [Indexed: 01/18/2023] Open
Abstract
Hippocampal-avoidance whole-brain radiation therapy (HA-WBRT) is justified because of low hippocampal brain metastases (BM) rate and its prevention of cognitive decline. However, we hypothesize that the risk of developing BM in the hippocampal-avoidance region (HAR) may differ depending on the lung-cancer stage and molecular status. We retrospectively reviewed 123 patients with non-small cell lung cancer (NSCLC) at the initial diagnosis of BM. The number of BMs within the HAR (5 mm expansion) was counted. The cohort was divided into patients with and without BMs in the HAR, and their clinical variables, TNM stage, and epidermal growth factor receptor (EGFR) status were compared. The most influential variable predicting BMs in the HAR was determined using multi-variable logistic regression, classification and regression tree (CART) analyses, and gradient boosting method (GBM). The feasibility of HAR expansion was tested using generalized estimating equation marginal model. Patients with BMs in the HAR were more frequently non-smokers, and more likely to have extra-cranial metastases and EGFR mutations (p<0.05). Multi-variable analysis revealed that extra-cranial metastases were independently associated with the presence of BM in the HAR (odds ratio=8.75, p=0.04). CART analysis and GBM revealed that the existence of extra-cranial metastasis was the most influential variable predicting BM occurrence in the HAR (variable importance: 23% and relative influence: 37.38). The estmated BM incidence of patients without extra-cranial metastases in th extended HAR (7.5-mm and 10-mm expansion) did not differ significantly from that in the conventional HAR. In conclusion, NSCLC patients with extra-cranial metastases were more likely to have BMs in the HAR than those without extra-cranial metastases.
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Affiliation(s)
- Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Hyeokjin Kwon
- Department of Electronic Engineering, Hanyang University, Seoul, South Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Goeun Park
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Yoon Soo Chang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
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9
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Du X, Bai H, Wang Z, Daun J, Liu Z, Xu J, Chang G, Zhu Y, Wang J. Establishment of prognostic nomograms for predicting the progression free survival of EGFR-sensitizing mutation, advanced lung cancer patients treated with EGFR-TKIs. Thorac Cancer 2022; 13:1289-1298. [PMID: 35347870 PMCID: PMC9058307 DOI: 10.1111/1759-7714.14380] [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: 01/04/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background There is a lack of clinically available predictive models for patients with epidermal growth factor receptor (EGFR) mutation positive, advanced non–small cell lung cancer (NSCLC) treated with EGFR‐tyrosine kinase inhibitors (TKIs). Methods The clinical data of patients at the Cancer Hospital, Chinese Academy of Medical Sciences between from January 2016 to January 2021 were retrospectively retrieved as training set. The patients from BENEFIT trial were for the validation cohort. The nomogram was built based on independent predictors identified by univariate and multivariate Cox regression analyses. The discrimination and calibration of the nomogram were evaluated by C‐index and calibration plots. Results A total of 502 patients with complete clinical data and follow‐up information were enrolled in this study. Five independent prognostic factors, including The Eastern Cooperative Oncology Group Performance Status scale (ECOG PS), EGFR mutation subtype, EGFR co‐mutation, liver metastasis and malignant pleural effusion (p < 0.05). The C‐indexes of the nomogram were 0.694 (95% confidence interval [CI], 0.663–0.725) for the training set and 0.653 (95% CI, 0.610–0.696) for the validation set. The calibration curves for the probabilities of 9‐, 12‐ and 18‐month progression‐free survival (PFS) revealed satisfactory consistency in both the internal and external validations. Additionally, the patients were divided into two groups according to risk (high‐risk, low‐risk), and significant differences in PFS were observed between the groups in the training and external validation cohorts (p < 0.001). Conclusions We constructed and validated a convenient nomogram that have the potential to become an accurate and reliable tool for patients with EGFR mutation positive, advanced NSCLC to individually predict their potential benefits from EGFR‐TKIs, and facilitate clinical decision‐making.
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Affiliation(s)
- Xinyang Du
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hua Bai
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhijie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchun Daun
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Liu
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiachen Xu
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Geyun Chang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yixiang Zhu
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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10
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Peled N, Kian W, Inbar E, Goldstein IM, Zemel M, Rotem O, Rozenblum AB, Nechushtan H, Dudnik E, Levin D, Zer A, Keren-Rosenberg S, Yust-Katz S, Fuchs V, Remilah AA, Shelef I, Roisman LC. Osimertinib in advanced EGFR-mutant lung adenocarcinoma with asymptomatic brain metastases: an open-label, 3-arm, phase II pilot study. Neurooncol Adv 2022; 4:vdab188. [PMID: 35156036 PMCID: PMC8826702 DOI: 10.1093/noajnl/vdab188] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Osimertinib is selective for both epidermal growth factor receptor (EGFR)-tyrosine-kinase inhibitor (TKI) sensitizing and Thr790Met mutations. While intracranial activity of osimertinib is documented in larger trials, a prospective study focusing exclusively on patients with asymptomatic brain metastases has not been reported. Methods In this nonrandomized, phase II, open-label, 3-arm prospective proof-of-concept pilot study, 48 patients with metastatic EGFR-mutant lung adenocarcinoma (LUAD) received osimertinib 80 mg daily. Patients were either treatment naive (arm A = 20) or previously treated with an EGFR-TKI and Thr790Met positive (arm B = 18) or negative (arm C = 10). In cases of isolated intracranial progression, osimertinib dose was escalated (160 mg). The primary endpoints were intracranial objective response rate (iORR) and intracranial disease control rate (iDCR). The secondary endpoint was intracranial progression-free survival (iPFS). This study is registered at Clinicaltrials.gov, NCT02736513. Results The iORRs were 84.2%, 66.7%, and 50% and the iDCRs were 94.7%, 94.4%, and 80% in arms A, B, and C, respectively. The median iPFS was 11.8 months (95% CI 7.7 to NA), 7.6 months (95% CI 5.3 to NA), and 6.3 months (95% CI 3.9 to NA) in arms A, B, and C, respectively. Following dose escalation, pooled iORR was 54% (arm A = 5, arm B = 4, arm C = 2). Adverse events were similar to those in previously published literature. Conclusion Osimertinib demonstrated high efficacy on brain metastases. All trial arms displayed a significant decrease in the number and diameter of target lesions. These findings indicate that osimertinib is effective for Thr790Met-positive and -negative LUAD patients with asymptomatic brain metastases. Therefore, osimertinib should be considered a viable option for EGFR-mutant patients with brain involvement regardless of their Thr790Met mutation status.
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Affiliation(s)
- Nir Peled
- Department of Oncology, The Institute of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Waleed Kian
- Department of Oncology, The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Edna Inbar
- Department of Diagnostic Imaging, Rabin Medical Center, Davidoff Cancer Center, Petach Tikva, Israel
| | - Iris M Goldstein
- Department of Oncology, The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Melanie Zemel
- Department of Oncology, The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ofer Rotem
- Department of Oncology, Rabin Medical Center, Davidoff Cancer Center, Petach Tikva, Israel
| | - Anna B Rozenblum
- Department of Oncology, Rabin Medical Center, Davidoff Cancer Center, Petach Tikva, Israel
| | - Hovav Nechushtan
- Department of oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Elizabeth Dudnik
- Department of Oncology, Rabin Medical Center, Davidoff Cancer Center, Petach Tikva, Israel
| | - Daniel Levin
- Department of Diagnostic Imaging, The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Alona Zer
- Department of Oncology, Rabin Medical Center, Davidoff Cancer Center, Petach Tikva, Israel
| | | | - Shlomit Yust-Katz
- Department of Oncology, Rabin Medical Center, Davidoff Cancer Center, Petach Tikva, Israel
| | - Vered Fuchs
- Department of Oncology, The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Areen A Remilah
- Department of Oncology, The Institute of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ilan Shelef
- Department of Diagnostic Imaging, Diagnostic Imaging Institute, Soroka University Medical Center, Be'er-Sheba, Israel
| | - Laila C Roisman
- Department of Oncology, The Institute of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.,Department of Oncology, The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University of the Negev, Be'er Sheva, Israel
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11
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Mohan A, Garg A, Iyer H, Jindal V, Vashistha V, Ali A, Jain D, Tiwari P, Mittal S, Madan K, Hadda V, Guleria R, Sati H. Prognostic factors for treatment response and survival outcomes after first-line management of Stage 4 non-small cell lung cancer: A real-world Indian perspective. Lung India 2022; 39:102-109. [PMID: 35259791 PMCID: PMC9053916 DOI: 10.4103/lungindia.lungindia_408_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Indian data on treatment outcomes and survival in advanced non-small cell lung cancer (NSCLC) remain scarce. Materials and Methods: A retrospective review of 537 advanced NSCLC patients treated at a tertiary care facility in North India from January 2008 to March 2018 was done to assess treatment response and survival in terms of objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). Results: Median age of enrolled patients was 60 years (range: 26–89 years). The majority were males (78.2%) and smokers (66.5%). Adenocarcinoma (51.2%) was the most common pathological type. Most patients had good performance status (PS) (the Eastern Cooperative Oncology Group [ECOG] 0 or 1 in 55.7%) and received conventional chemotherapy (86.6%). ORR and DCR after 3–4 months of first-line treatment were 55.2% and 71.75%, respectively (n = 223). Never smokers had better ORR as well as DCR compared to chronic smokers whereas treatment with tyrosine kinase inhibitors achieved significantly better ORR, and patients with good PS had better DCR compared to those with poor PS. Median PFS (n = 455) was 7.0 months (95% confidence interval [CI]: 3.7–14.0) and median OS was 11.7 months (95% CI: 5.5–29.9 months). Good PS and nonsmoking status were independent predictors of better PFS on multivariate analysis. For OS, good PS, nonsmoking behavior, and treatment with epidermal growth factor receptor inhibitors were independent predictors. Conclusion: In advanced NSCLC, never-smokers, and patients with good baseline ECOG have favorable treatment and survival outcomes. Treatment with targeted therapy results in better ORR and OS but did not affect PFS.
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12
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Naresh G, Malik PS, Khurana S, Pushpam D, Sharma V, Yadav M, Jain D, Pathy S. Assessment of Brain Metastasis at Diagnosis in Non-Small-Cell Lung Cancer: A Prospective Observational Study From North India. JCO Glob Oncol 2021; 7:593-601. [PMID: 33891479 PMCID: PMC8162524 DOI: 10.1200/go.20.00629] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The incidence of symptomatic brain metastasis at diagnosis in non–small-cell lung cancer (NSCLC) is 5%-10%, and up to 40% develop during the disease course. There is a paucity of data supporting the role of brain imaging at diagnosis in asymptomatic cases particularly from resource-constraint settings. Here, we present our experience of mandatory baseline brain imaging with contrast-enhanced computed tomography (CECT) scans of all patients with NSCLC. MATERIALS AND METHODS This was a prospective observation study of patients with NSCLC with mandatory baseline brain CECT and a CNS examination. All histology proven patients with NSCLC diagnosed between January 2018 and October 2019 were included irrespective of stage. RESULTS A total of 496 patients were enrolled. The median age was 57 years (range, 23-84) with majority being males (75%) and smokers (66%). The prevalence of epidermal growth factor receptor mutations and anaplastic lymphoma kinase fusions was 33.4% and 12%, respectively. Brain imaging leads to upstaging in 7% cases. The prevalence of brain metastases was 21% (n = 104), with half being asymptomatic (51%). Factors associated with higher proportion of brain metastasis were young age (≤ 40 years), adenocarcinoma histology, poor Eastern Cooperative Oncology Group performance status (3 and 4), and high neutrophil-lymphocyte ratio (NLR) (> 2.5). After a median follow-up of 10.8 months (95% CI, 7.33 to 12.73), the median overall survival was 7.46 versus 12.76 months (hazard ratio 0.67; 95% CI, 0.46 to 0.96; P = .03) in patients with and without brain metastases, respectively. On multivariate analyses, high NLR and molecular graded prognostic assessment affected the overall survival significantly. CONCLUSION In our study, 21% of patients had brain metastasis at diagnosis detected with a mandatory baseline brain imaging with CECT. NLR and molecular graded prognostic assessment are significant predictors of survival in patients with brain metastasis.
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Affiliation(s)
- Gundu Naresh
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Khurana
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Sharma
- Department of Medical Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Yadav
- Department of Radiodiagnosis, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushmita Pathy
- Department of Radiation Oncology, Dr B.R.A.I.R.C.H., All India Institute of Medical Sciences, New Delhi, India
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Chen C, Wu Y, Liu BL, Wang HW, Ma JH, Zhou JY. Whole-Brain Radiotherapy Can Improve the Survival of Patients with Multiple Brain Metastases from Non-Small Cell Lung Cancer Treated by Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors. Cancer Manag Res 2020; 12:11333-11340. [PMID: 33192093 PMCID: PMC7654538 DOI: 10.2147/cmar.s279096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To observe whether whole-brain radiotherapy (WBRT) can bring survival benefits to patients with multiple brain metastases (BM) from non-small cell lung cancer (NSCLC) treated by epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) and determine the best time for WBRT intervention. Methods A retrospective analysis was performed on 148 patients diagnosed with EGFR gene-mutated NSCLC. All patients had multiple BM and received EGFR-TKI targeted therapy, which was performed to observe whether WBRT can bring survival benefits, and whether the choice of WBRT timing affects the survival of patients. Results Among the 148 patients with NSCLC treated with EGFR-TKI, 76 received WBRT; 72 were without WBRT. WBRT can reduce the intracranial progression rate in the patients (19.7% vs 33.3%, P=0.040), thus improving the intracranial progression-free survival (iPFS) (median iPFS: 11.9 months versus 10.2 months, P=0.039) and overall survival (OS) (median OS: 21.0 months versus 16.7 months, P=0.043). Multivariate analysis showed that WBRT (HR=0.606; 95% CI: 0.403-0.912, P=0.016) and the low Eastern Cooperative Oncology Group performance status (HR=1.884; 95% CI: 1.120-3.170, P=0.017) are independent prognostic factors in all patients. Further subgroup analysis showed that the choice of WBRT time had no effect on patient survival. Conclusion WBRT can improve the survival of patients with multiple BM from NSCLC receiving EGFR-TKI targeted therapy and is an independent prognostic factor. The choice of RT time has no effect on patient survival.
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Affiliation(s)
- Cheng Chen
- Department of Radiotherapy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China.,Department of Radiotherapy, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | - Yan Wu
- Department of Radiotherapy, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | - Bao Ling Liu
- Department of Radiotherapy, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | - Hong Wei Wang
- Department of Radiotherapy, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | - Jian Hua Ma
- Department of Radiotherapy, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, People's Republic of China
| | - Ju Ying Zhou
- Department of Radiotherapy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
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14
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Ouyang W, Yu J, Zhou Y, Xu Y, Li J, Gong J, Zhang J, Xie C. Metachronous Brain Metastasis in patients with EGFR-mutant NSCLC indicates a worse prognosis. J Cancer 2020; 11:7283-7290. [PMID: 33193892 PMCID: PMC7646168 DOI: 10.7150/jca.46462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose: NSCLC patients with EGFR mutation were associated with high incidence of brain metastasis (BM). BM could be grouped by the time of occurrence, including synchronous BM at initial diagnosis and metachronous BM during disease course. The primary aim of the study was to investigate the survival of patients with metachronous BM. Methods: A total of 99 EGFR-mutant advanced NSCLC patients in our institute between 2012 and 2018 were grouped into synchronous BM and metachronous BM. Comparisons of OS were performed based on BM status. The independent prognostic factors of OS were investigated, and extracranial and intracranial PFS were further analyzed. Results: Patients with metachronous BM (mOS: 22.1 months) had poorer outcomes than synchronous BM (mOS: 30.3 months) (P=0.016). Moreover, multivariate analysis indicated that BM status (P=0.015), local therapy for BM (P=0.013) and subsequent treatment of Osimertinib (P=0.008) impact significantly on OS. Significantly, the proportion of local therapy for BM had no difference between patients with synchronous and metachronous BM. And patients with metachronous BM harbored a more favorable prognostic factor (higher proportion of subsequent Osimertinib treatment), but also harbored a poorer prognostic factor (metachronous BM), which confirmed BM status was the most significant prognostic factor of OS. At last, results of extracranial and intracranial PFS indicated that patients with metachronous BM tended to have a higher risk of intracranial disease progression. Conclusions: Patients developing metachronous BM during EGFR-TKIs treatment have worse outcomes than synchronous BM. Our findings suggested that the patients with metachronous BM should receive more aggressive treatments.
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Affiliation(s)
- Wen Ouyang
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jing Yu
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yan Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yu Xu
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jie Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jun Gong
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Junhong Zhang
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Clinical Cancer Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China
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15
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Park CK, Cho HJ, Choi YD, Oh IJ, Kim YC. A Phase II Trial of Osimertinib as the First-Line Treatment of Non-Small Cell Lung Cancer Harboring Activating EGFR Mutations in Circulating Tumor DNA: LiquidLung-O-Cohort 1. Cancer Res Treat 2020; 53:93-103. [PMID: 32972042 PMCID: PMC7812005 DOI: 10.4143/crt.2020.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/17/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Osimertinib is a potent, irreversible third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor for both EGFR-activating and T790M resistant mutation. The treatment efficacy of osimertinib was assessed in previously untreated patients with metastatic non–small cell lung carcinoma (NSCLC) harboring activating EGFR mutations in circulating tumor DNA (ctDNA) as well as tumor DNA. Materials and Methods Patients with activating EGFR mutations in their tumor DNA underwent screening with ctDNA analysis using Mutyper and Cobas v2 assays. Enrolled subjects received osimertinib 80 mg, once daily. Primary endpoint was objective response rate (ORR) and secondary endpoints were ctDNA test sensitivity, progression-free survival (PFS), duration of response (DoR), and safety. Results Among 39 screened patients, 29 were ctDNA positive for activating EGFR mutations and 19 were enrolled (ex19del, n=11; L858R/L861Q, n=7; G719A, n=1). Median age was 70 and most patients had brain metastases (15/19, 79%). ctDNA test sensitivity for activating EGFR mutations was 74% using both methods and 62% (Mutyper) or 64% (Cobas v2) for individual methods. ORR was 68% (13/19), median PFS was 11.1 months (95% confidence interval [CI], 0.0 to 26.7), and median DoR was 17.6 months (95% CI, 3.5 to 31.7). ORR and median PFS were significantly superior with ex19del (91%; 21.9 months; 95% CI, 5.5 to 38.3) than with L858R/L861Q (43%; 5.1 months; 95% CI, 2.3 to 7.9). One patient discontinued the drug because of drug-related interstitial pneumonitis. Conclusion Osimertinib had favorable efficacy in the first-line treatment of metastatic NSCLC harboring activating EGFR mutations in ctDNA as well as tumor DNA.
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Affiliation(s)
- Cheol-Kyu Park
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyun-Ju Cho
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
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16
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Ouyang W, Yu J, Zhou Y, Hu J, Huang Z, Zhang J, Xie C. Risk factors of metachronous brain metastasis in patients with EGFR-mutated advanced non-small cell lung cancer. BMC Cancer 2020; 20:699. [PMID: 32723319 PMCID: PMC7390194 DOI: 10.1186/s12885-020-07202-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 07/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background NSCLC patients with EGFR mutation were at a higher incidence of developing brain metastasis (BM). Patients with BM are associated with high mortality. Reducing BM incidence becomes increasingly significant for NSCLC patients to achieve prolonged survival. The aim of the study was to explore the possible risk factors of developing metachronous BM during EGFR-TKIs treatment, and to identify the potential candidates for prophylactic cranial irradiation (PCI) or the first-line Osimertinib treatment. Methods A total of 157 consecutive EGFR-mutated advanced NSCLC patients without BM at initial diagnosis in our institution from 2012 and 2018 were retrospectively reviewed. Comparisons of OS were performed based on BM status. The cumulative incidence of metachronous BM was calculated by the Kaplan-Meier method, and the independent risk factors of metachronous BM were investigated by multivariate analysis. Results Patients developing metachronous BM had worse survival (mOS: 22.1 months) than patients not-developing BM (mOS: 44.8 months). Moreover, the multivariate analysis indicated that age ≤ 49 years (P = 0.035), number of extracranial metastases (P = 0.013), and malignant pleural effusion (P = 0.002) were independent risk factors of metachronous BM. Furthermore, the 1-year actuarial incidence of developing metachronous BM in patients with no risk factor (n = 101), 1 risk factor (n = 46), and 2 risk factors (n = 10) were 7.01, 14.61, and 43.75%, respectively (P < 0.001). Conclusions Patients developing metachronous BM during EGFR-TKIs treatment have worse outcomes. Our results suggested that EGFR-mutated advanced NSCLC patients with ≥1 risk factors were candidates for PCI or the first-line Osimertinib treatment.
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Affiliation(s)
- Wen Ouyang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Jing Yu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Yan Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Jing Hu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Zhao Huang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China
| | - Junhong Zhang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. .,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China. .,Hubei Clinical Cancer Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China. .,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, China. .,Hubei Clinical Cancer Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
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17
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Bai Q, Li L, Chen F, Zhu J, Cao L, Yang Y, Zhong F. Suppression of Circular RNA Hsa_circ_0109320 Attenuates Non-Small Cell Lung Cancer Progression via MiR-595/E2F7 Axis. Med Sci Monit 2020; 26:e921200. [PMID: 32508344 PMCID: PMC7297023 DOI: 10.12659/msm.921200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Circular RNAs (circRNAs) are frequently aberrantly expressed in non-small cell lung cancer (NSCLC) and are considered to exert a pivotal role in the occurrence and development of NSCLC via targeting and negatively regulating microRNAs (miRNAs). We aimed to investigate the role of hsa_circ_0109320 in the proliferation, invasion and apoptosis of NSCLC, and explore its underlying molecular mechanism. Material/Methods Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis was performed to determine the circ_0109320 and miR-595 expression in tissues or cells. Western blot analysis was conducted to examine the cleaved caspase-3, Bax, Bcl-2, and E2F7 protein expression. Transwell detection was used to evaluate the invasion level of NSCLC cell lines. Results The results of present study indicated that circ_0109320 expression in NSCLC patients was upregulated significantly in tumor tissues compared with tissues adjacent to carcinoma. Upregulated circ_0109320 level was significantly associated with TNM stages as well as lymph node metastasis of NSCLC. Moreover, downregulation of circ_0109320 attenuated proliferation and invasion while promoting apoptosis in NSCLC cells. We further confirmed that circ_0109320 could sponge miR-595 to upregulate E2F7 expression. Silencing of miR-595 or overexpression of E2F2 could partially reversed the inhibitory role of circ_0109320 knockdown in NSCLC cells. These data provided evidence that the suppression of circ_0109320 attenuates NSCLC cell proliferation and invasion and enhances apoptosis through the miR-595/E2F7 pathway. Conclusions Circ_0109320/miR-595/E2F2 axis may exert a pivotal role in the pathological mechanism of NSCLC progression, and it has potential application in the future treatment of NSCLC.
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Affiliation(s)
- Qiaohong Bai
- Department of Respiratory, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China (mainland)
| | - Li Li
- Department of Respiratory, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Futao Chen
- Department of Respiratory, The Second Hospital of LianYunGang, Lianyungang, Jiangsu, China (mainland)
| | - Jiang Zhu
- Department of Respiratory, The Second Hospital of LianYunGang, Lianyungang, Jiangsu, China (mainland)
| | - Lifeng Cao
- Department of Respiratory, The Second Hospital of LianYunGang, Lianyungang, Jiangsu, China (mainland)
| | - Yang Yang
- Department of Respiratory, The Second Hospital of LianYunGang, Lianyungang, Jiangsu, China (mainland)
| | - Fukuan Zhong
- Department of Respiratory, The Second Hospital of LianYunGang, Lianyungang, Jiangsu, China (mainland)
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18
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Nadler E, Espirito JL, Pavilack M, Baidoo B, Fernandes A. Real-world disease burden and outcomes of brain metastases in EGFR mutation-positive non-small-cell lung cancer. Future Oncol 2020; 16:1575-1584. [PMID: 32495656 DOI: 10.2217/fon-2020-0280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: To evaluate the real-world impact of brain metastases (BM) among patients with EGFR mutation-positive (EGFRm) metastatic non-small-cell lung cancer (NSCLC). Materials & methods: This retrospective, observational matched cohort electronic health record study assessed adults with EGFRm metastatic NSCLC with/without BM. Results: Among 402 patients split equally between both cohorts (±BM), the majority were Caucasian (69%), female (65%) and with adenocarcinoma (92%). Overall symptom burden and ancillary support service use were higher and median overall survival from metastatic diagnosis was significantly shorter in BM patients (11.9 vs 16 months; p = 0.017). Conclusion: BM in EGFRm NSCLC patients can negatively impact clinical outcomes. New targeted therapies that can penetrate the blood-brain barrier should be considered for treating these patients.
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19
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Garg A, Batra U, Choudhary P, Jain D, Khurana S, Malik PS, Muthu V, Prasad KT, Singh N, Suri T, Mohan A. Clinical predictors of response to EGFR-tyrosine kinase inhibitors in EGFR-mutated non-small cell lung cancer: A real-world multicentric cohort analysis from India. Curr Probl Cancer 2020; 44:100570. [PMID: 32498966 DOI: 10.1016/j.currproblcancer.2020.100570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The development of various targeted therapies against Epidermal Growth Factor Receptor (EGFR) has been a major step in therapeutic advancements in lung cancer. However, the response to tyrosine kinase inhibitors (TKI) therapy in a real-world setting has not been well elucidated. METHODS As part of a retrospective analysis, patients with EGFR mutated non-small cell lung cancer at 4 tertiary care Institutions in North India between December 2007 and August 2018 were evaluated. The overall response rate, disease control rate, progression-free survival (PFS) and factors affecting PFS were analyzed. RESULTS A total of 483 patients were included, including 52.4% males, with mean (±SD) age of 56.7 (±12.4) years. Majority (63.8%) had good performance status (Eastern Cooperative Oncology Group 0 or 1) and 77.4% were nonsmokers. Among the EGFR mutations, exon 19 deletion was the most common mutation detected (68.1%), followed by L858R mutation in exon 21 (26.9%). Extra-thoracic metastasis was present in 69.5% patients and majority of them had ≤ 2 metastatic sites (85.1%). TKIs were used as the first-line therapy in 64.8% patients, and gefitinib was the most frequently used TKI (67.3%), followed by erlotinib (26.7%). The overall response rate and disease control rate were 65.9% and 90.7% respectively. The median PFS was 9.3 months and brain was the exclusive site of progression in 18.0% patients. On univariate analysis, the factors that significantly affected PFS were, the number of metastatic sites and the type of EGFR mutation. On multivariate analysis, the number of metastatic sites was the only factor that affected the PFS [HR (95% CI): 2.5 (1.7-3.6); Pvalue <0.001]. Skin toxicity was the most common adverse event (32.3%), followed by involvement of the gastro-intestinal tract (22.5%). CONCLUSION In this one of the largest multicentric Indian study of treatment outcomes in EGFR-mutated non-small cell lung cancer in a real-world setting, we found that increased tumor burden (number of metastatic sites > 2) was the only significant factor associated with a worse PFS.
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Affiliation(s)
- Avneet Garg
- Department of Pulmonary Medicine, Adesh Institute of Medical Sciences and Research, Bhatinda, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, India
| | - Priyanshu Choudhary
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Khurana
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Valliappan Muthu
- Department Of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K T Prasad
- Department Of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department Of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tejas Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
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A Comprehensive Meta-Analysis of Association between EGFR Mutation Status and Brain Metastases in NSCLC. Pathol Oncol Res 2019; 25:791-799. [PMID: 30761450 DOI: 10.1007/s12253-019-00598-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/15/2019] [Indexed: 02/07/2023]
Abstract
Non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation have different clinicopathological characteristics compared with EGFR wild type NSCLC. A growing number of studies focused on the relevance between EGFR mutation status and brain metastases (BM) in NSCLC, but it remains controversial. Therefore, this study performed a comprehensive meta-analysis to untangle this issue. Several electronic databases including Pubmed, Embase, Web of science and Cochrane database were thoroughly searched. The odds ratio (OR) with 95% confidence interval (95%CI) was pooled to evaluate the relevance. Meta-regression analysis and subgroup analysis were conducted according to the heterogeneity. A total of 26 studies were identified finally in this meta-analysis. The overall OR was 1.58 (95%CI: 1.36-1.84), which indicated that EGFR mutation had a positive association with BM of NSCLC. The subgroup analysis resulted from eleven studies with lung adenocarcinoma revealed a higher possibility of BM in NSCLC with EGFR mutation compared with EGFR wild (p < 0.05). There was no significant difference in the risk of BM between NSCLC EGFR exon 19 mutation and exon 21 point mutation (p = 0.23). This meta-analysis suggests that EGFR mutation can be a risk factor for BM in NSCLC.
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Chen P, Chen F, Lei J, Zhou B. Curative effectiveness and safety of osimertinib in the treatment for non-small-cell lung cancer: a meta-analysis of the experimental evidence. Onco Targets Ther 2018; 11:9033-9047. [PMID: 30588016 PMCID: PMC6296202 DOI: 10.2147/ott.s182077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Osimertinib is an EGFR-TKI that is selective for both EGFR-TKI-sensitizing and T790M resistance mutations in patients with non-small-cell lung cancer (NSCLC). The purpose of this study was conducting a meta-analysis to evaluate the clinical efficacy and safety of osimertinib in the treatment for NSCLC. Methods Using “osimertinib” as a keyword combined with “non-small-cell lung cancer” and “randomized controlled trial” as medical subject headings, the following electronic databases were searched: PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure. After data extraction and quality assessment of the included randomized controlled trials, the RevMan 5.3 software and R meta package were applied for meta-analysis of objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and safety. Results Ten studies met our criteria and were included in the meta-analysis, with a total of 3,260 participants. The meta-analysis showed that osimertinib therapy was superior to the control therapy alone in ORR (combined RR=1.53, 95% CI: 0.87–2.71, P=0.14), DCR (combined RR=1.07, 95% CI: 0.79–1.44, P=0.66), PFS (combined RR=0.32, 95% CI: 0.24–0.44, P<0.00001), and OS (combined RR=0.57, 95% CI: 0.47–0.70, P<0.00001). In addition, osimertinib led to some toxicities, and the overall prevalence of all-grade diarrhea was 40% (95% CI: 33–47), paronychia 26% (95% CI: 20–33), rash 40% (95% CI: 34–47), dry skin 28% (95% CI: 23–33), and stomatitis 15% (95% CI: 9–23). Conclusion Our study showed that osimertinib demonstrated a significant improvement in the ORR, DCR, PFS, and OS with tolerable adverse effects for NSCLC patients. However, because of some clear limitations (heterogeneity and publication bias), these results should be interpreted with caution.
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Affiliation(s)
- Peng Chen
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China,
| | - Fuchao Chen
- Department of Pharmacy, Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei 442008, People's Republic of China
| | - Jiexin Lei
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Benhong Zhou
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China,
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An N, Jing W, Wang H, Li J, Liu Y, Yu J, Zhu H. Risk factors for brain metastases in patients with non-small-cell lung cancer. Cancer Med 2018; 7:6357-6364. [PMID: 30411543 PMCID: PMC6308070 DOI: 10.1002/cam4.1865] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022] Open
Abstract
Brain metastases (BM) are severe incidents in patients with non-small-cell lung cancer (NSCLC). The controversial value of prophylactic cranial irradiation (PCI) in NSCLC in terms of survival benefit prompted us to explore the possible risk factors for BM in NSCLC and identify the potential population most likely to benefit from PCI. Risk factors for brain metastases in NSCLC are reviewed in this article. Identifying patients with a higher risk of BM could possibly increase the benefit of PCI while reducing the discomfort and risks caused by unnecessary invasive procedures in the NSCLC patient population. Future studies might focus on finding a solid basis for the prediction of the occurrence of brain metastases and for the therapeutic decision on the use of PCI.
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Affiliation(s)
- Ning An
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong UniversityJinanChina
| | - Wang Jing
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
| | - Haoyi Wang
- Department of HematologyQilu Hospital, Shandong UniversityJinanChina
| | - Ji Li
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
| | - Yang Liu
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
| | - Jinming Yu
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
| | - Hui Zhu
- Department of Radiation OncologyShandong Cancer Hospital and Institute, Shandong Academy of Medical SciencesJinanChina
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Joo JW, Hong MH, Shim HS. Clinical characteristics of T790M-positive lung adenocarcinoma after resistance to epidermal growth factor receptor-tyrosine kinase inhibitors with an emphasis on brain metastasis and survival. Lung Cancer 2018; 121:12-17. [PMID: 29858020 DOI: 10.1016/j.lungcan.2018.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We aimed to investigate the clinical characteristics of lung adenocarcinomas with acquired EGFR T790M mutation focusing on brain metastasis and survival. MATERIALS AND METHODS Our study included patients who had lung adenocarcinoma harboring EGFR mutation at 1st biopsy and then underwent 2nd biopsy after resistance to first- or second-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs). Statistical analyses were performed to examine the associations between clinicopathologic features of lung adenocarcinoma and presence of acquired T790M mutation. RESULTS A total of 111 patients were identified. Of these, 58 patients (52.3%) had acquired T790M mutations. Osimertinib was used in 29 patients (26.1%) after resistance to first- or second-generation TKIs. The T790M mutation was more frequently found in patients with exon 19 deletion than in those with L858R mutations (p = .026) and in patients who had longer treatment duration with EGFR-TKI (p = .0398). Multivariate analysis revealed that exon 19 deletion (p = .003) were independently associated with T790M mutation. Patients with acquired T790M mutation showed a longer progression-free survival. In addition, patients who had T790M mutation or who received osimertinib treatment had a longer overall and post-progression survival than patients who did not. Brain metastasis-free survival was also longer in the T790M-positive group or osimertinib-treated group among patients who had no brain metastasis at the time of diagnosis. Osimertinib treatment was independently associated with longer overall, post-progression, and brain metastasis-free survival. CONCLUSION The status of acquired T790M mutation was correlated with exon 19 deletion and longer progression-free survival to first- or second-generation EGFR-TKIs. A third-generation EGFR-TKI, osimertinib, was strongly associated with brain metastasis-free survival as well as other survival indicators in patients with EGFR-mutant lung adenocarcinoma.
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Affiliation(s)
- Jin Woo Joo
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Hee Hong
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Sup Shim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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24
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Ahluwalia MS, Becker K, Levy BP. Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors for Central Nervous System Metastases from Non-Small Cell Lung Cancer. Oncologist 2018; 23:1199-1209. [PMID: 29650684 DOI: 10.1634/theoncologist.2017-0572] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/22/2018] [Indexed: 12/14/2022] Open
Abstract
Central nervous system (CNS) metastases are a common complication in patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC), resulting in a poor prognosis and limited treatment options. Treatment of CNS metastases requires a multidisciplinary approach, and the optimal treatment options and sequence of therapies are yet to be established. Many systemic therapies have poor efficacy in the CNS due to the challenges of crossing the blood-brain barrier (BBB), creating a major unmet need for the development of agents with good BBB-penetrating biopharmaceutical properties. Although the CNS penetration of first- and second-generation EGFR tyrosine kinase inhibitors (TKIs) is generally low, EGFR-TKI treatment has been shown to delay time to CNS progression in patients with CNS metastases from EGFR-mutated disease. However, a major challenge with EGFR-TKI treatment for patients with NSCLC is the development of acquired resistance, which occurs in most patients treated with a first-line EGFR-TKI. Novel EGFR-TKIs, such as osimertinib, have been specifically designed to address the challenges of acquired resistance and poor BBB permeability and have demonstrated efficacy in the CNS. A rational, iterative drug development process to design agents that could penetrate the BBB could prevent morbidity and mortality associated with CNS disease progression. To ensure a consistent approach to evaluating CNS efficacy, special consideration also needs to be given to clinical trial endpoints. IMPLICATIONS FOR PRACTICE Historically, treatment options for patients who develop central nervous system (CNS) metastases have been limited and associated with poor outcomes. The development of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) has improved outcomes for patients with EGFR-mutated disease, and emerging data have demonstrated the ability of these drugs to cross the blood-brain barrier and elicit significant intracranial responses. Recent studies have indicated a role for next-generation EGFR-TKIs, such as osimertinib, in the treatment of CNS metastases. In the context of an evolving treatment paradigm, treatment should be individualized to the patient and requires a multidisciplinary approach.
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Affiliation(s)
| | - Kevin Becker
- Maimonides Medical Center, Brooklyn, New York, USA
| | - Benjamin P Levy
- Johns Hopkins University School of Medicine, Washington DC, USA
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25
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Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, Dechaphunkul A, Imamura F, Nogami N, Kurata T, Okamoto I, Zhou C, Cho BC, Cheng Y, Cho EK, Voon PJ, Planchard D, Su WC, Gray JE, Lee SM, Hodge R, Marotti M, Rukazenkov Y, Ramalingam SS. Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. N Engl J Med 2018; 378:113-125. [PMID: 29151359 DOI: 10.1056/nejmoa1713137] [Citation(s) in RCA: 3072] [Impact Index Per Article: 512.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Osimertinib is an oral, third-generation, irreversible epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that selectively inhibits both EGFR-TKI-sensitizing and EGFR T790M resistance mutations. We compared osimertinib with standard EGFR-TKIs in patients with previously untreated, EGFR mutation-positive advanced non-small-cell lung cancer (NSCLC). METHODS In this double-blind, phase 3 trial, we randomly assigned 556 patients with previously untreated, EGFR mutation-positive (exon 19 deletion or L858R) advanced NSCLC in a 1:1 ratio to receive either osimertinib (at a dose of 80 mg once daily) or a standard EGFR-TKI (gefitinib at a dose of 250 mg once daily or erlotinib at a dose of 150 mg once daily). The primary end point was investigator-assessed progression-free survival. RESULTS The median progression-free survival was significantly longer with osimertinib than with standard EGFR-TKIs (18.9 months vs. 10.2 months; hazard ratio for disease progression or death, 0.46; 95% confidence interval [CI], 0.37 to 0.57; P<0.001). The objective response rate was similar in the two groups: 80% with osimertinib and 76% with standard EGFR-TKIs (odds ratio, 1.27; 95% CI, 0.85 to 1.90; P=0.24). The median duration of response was 17.2 months (95% CI, 13.8 to 22.0) with osimertinib versus 8.5 months (95% CI, 7.3 to 9.8) with standard EGFR-TKIs. Data on overall survival were immature at the interim analysis (25% maturity). The survival rate at 18 months was 83% (95% CI, 78 to 87) with osimertinib and 71% (95% CI, 65 to 76) with standard EGFR-TKIs (hazard ratio for death, 0.63; 95% CI, 0.45 to 0.88; P=0.007 [nonsignificant in the interim analysis]). Adverse events of grade 3 or higher were less frequent with osimertinib than with standard EGFR-TKIs (34% vs. 45%). CONCLUSIONS Osimertinib showed efficacy superior to that of standard EGFR-TKIs in the first-line treatment of EGFR mutation-positive advanced NSCLC, with a similar safety profile and lower rates of serious adverse events. (Funded by AstraZeneca; FLAURA ClinicalTrials.gov number, NCT02296125 .).
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Affiliation(s)
- Jean-Charles Soria
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Yuichiro Ohe
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Johan Vansteenkiste
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Thanyanan Reungwetwattana
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Busyamas Chewaskulyong
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Ki Hyeong Lee
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Arunee Dechaphunkul
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Fumio Imamura
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Naoyuki Nogami
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Takayasu Kurata
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Isamu Okamoto
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Caicun Zhou
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Byoung Chul Cho
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Ying Cheng
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Eun Kyung Cho
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Pei Jye Voon
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - David Planchard
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Wu-Chou Su
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Jhanelle E Gray
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Siow-Ming Lee
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Rachel Hodge
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Marcelo Marotti
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Yuri Rukazenkov
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
| | - Suresh S Ramalingam
- From Gustave Roussy Cancer Campus and University Paris-Sud, Orsay, France (J.-C.S., D.P.); the Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo (Y.O.), the Department of Thoracic Oncology, Osaka International Cancer Institute (F.I.), and the Department of Thoracic Oncology, Kansai Medical University Hospital (T.K.), Osaka, the Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama (N.N.), and the Research Institute for Diseases of the Chest, Graduate School of Medical Science, Kyushu University, Fukuoka (I.O.) - all in Japan; the Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium (J.V.); Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok (T.R.), the Oncology Unit, Department of Medicine, Chiang Mai University, Chiang Mai (B.C.), and the Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai (A.D.) - all in Thailand; the Division of Medical Oncology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju (K.H.L.), the Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and the Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon (E.K.C.) - all in South Korea; Pulmonary Hospital of Tongji University, Shanghai (C.Z.), and Jilin Provincial Cancer Hospital, Changchun (Y.C.) - both in China; Hospital Umum Sarawak, Kuching, Malaysia (P.J.V.); National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.E.G.); the Department of Oncology, University College London Hospitals Biomedical Research Centre, and the Cancer Research UK Lung Cancer Centre of Excellence, London (S.-M.L.), and AstraZeneca, Cambridge (R.H., M.M., Y.R.) - all in the United Kingdom; and Emory University School of Medicine, Winship Cancer Institute, Atlanta (S.S.R.)
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Identifying candidates for gamma knife radiosurgery among elderly patients with brain metastases. J Neurooncol 2018; 137:559-565. [PMID: 29327172 DOI: 10.1007/s11060-018-2745-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/03/2018] [Indexed: 01/17/2023]
Abstract
We investigated the outcomes of gamma knife radiosurgery (GKRS) for elderly patients (≥ 65 years) with brain metastases, and identified survival-associated factors. We retrospectively analyzed data from 115 patients treated with GKRS for 1-15 brain metastases. The median patient age was 72 years; most primary tumors were pulmonary (n = 83). The mean lesion volume was 2.1 ± 4.8 mL. A mean dose of 19.3 Gy was delivered to the mean 63.9% isodose line. The median overall survival (OS) was 5.3 months (95% confidence interval [CI] 3.5-7.1). During follow-up (median, 5.1 months), 91 patients died of primary cancer progression while 1 died of unknown causes. The 6- and 12-month local control rates were 94.9 and 88.1%, respectively. On multivariate analysis, female sex (p = 0.005, hazard ratio [HR] 0.533, 95% CI 0.343-0.827) and a controlled primary tumor (p < 0.001, HR 0.328, 95% CI 0.180-0.596) were significantly favorable prognostic factors. Of non-small cell lung cancer patients with EGFR mutations, 76.5% were women (p = 0.005). The median OS of EGFR-mutant and EGFR-wildtype patients were 19.1 and 4.7 months, respectively (p = 0.080). Brain metastases < 3 mL showed better local control rates after GKRS (p = 0.005). GKRS produces favorable outcomes in women with brain metastases who are ≥ 65 years and have controlled primary tumors. Such patients are therefore suitable candidates for GKRS.
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Li L, Luo S, Lin H, Yang H, Chen H, Liao Z, Lin W, Zheng W, Xie X. Correlation between EGFR mutation status and the incidence of brain metastases in patients with non-small cell lung cancer. J Thorac Dis 2017; 9:2510-2520. [PMID: 28932557 DOI: 10.21037/jtd.2017.07.57] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death worldwide. Numerous studies have been performed to investigate the correlation between epidermal growth factor receptor (EGFR) mutation status and the incidence of brain metastases (BMs) in patients with non-small cell lung cancer (NSCLC), however, the outcomes were inconsistent. Thus, we performed this study to establish the role of EGFR mutation status in BMs. METHODS Electronic databases PubMed, Embase, Cochrane Library, CBM, WanFang, CNKI were searched to identify relevant trials. The primary endpoint was the incidence of BMs in EGFR mutations or wild type NSCLC and the secondary endpoint was overall survival calculated from the BMs emerging (BMOS). RESULTS Twenty-two studies incorporating 8,152 participants were eligible. EGFR mutations group possessed a significantly higher risk of BMs (OR =1.99; 95% CI, 1.59-2.48; P=0.000) than EGFR wild type group. In the stratified analysis, compared with EGFR wild type group, EGFR mutations group had a significant higher incidence (OR =2.01; 95% CI, 1.56-2.59; P=0.000) of subsequent BMs while only a trend of increasing the incidence of initial BMs (OR =1.38; 95% CI, 0.98-1.94; P=0.066). Moreover, exon 19 deletion had a trend of increasing the incidence of BMs than exon 21 mutation (OR =1.44; 95% CI, 0.77-2.68; P=0.252). Compared with EGFR wild type group, EGFR mutations group possessed a prolonged overall BMOS (HR =0.68; 95% CI, 0.47-0.98; P=0.038) and a longer BMOS in initial BMs (HR =0.50; 95% CI, 0.31-0.80; P=0.004) but no significant difference in NSCLC with subsequent BMs (HR =0.95; 95% CI, 0.42-2.15; P=0.901). CONCLUSIONS Patients with EGFR mutations were more susceptible to develop into BMs than those with EGFR wild type, especially during the course of disease.
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Affiliation(s)
- Lina Li
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Shuimei Luo
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Heng Lin
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China.,Department of Oncology, Fuzhou Pulmonary Hospital, Fuzhou 350008, China
| | - Haitao Yang
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Huijuan Chen
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Ziyuan Liao
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Wanzun Lin
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Weili Zheng
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Xianhe Xie
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
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McIntyre A, Ganti AK. Lung cancer-A global perspective. J Surg Oncol 2017; 115:550-554. [PMID: 28418583 DOI: 10.1002/jso.24532] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/04/2016] [Indexed: 12/17/2022]
Abstract
Lung cancer is the leading cause of cancer deaths worldwide. While tobacco exposure is responsible for the majority of lung cancers, the incidence of lung cancer in never smokers, especially Asian women, is increasing. There is a global variation in lung cancer biology with EGFR mutations being more common in Asian patients, while Kras mutation is more common in Caucasians. This review will focus on the global variations in lung cancer and its treatment.
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Affiliation(s)
| | - Apar Kishor Ganti
- Department of Internal Medicine, VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
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Murali AN, Radhakrishnan V, Ganesan TS, Rajendranath R, Ganesan P, Selvaluxmy G, Swaminathan R, Sundersingh S, Krishnamurthy A, Sagar TG. Outcomes in Lung Cancer: 9-Year Experience From a Tertiary Cancer Center in India. J Glob Oncol 2017; 3:459-468. [PMID: 29094084 PMCID: PMC5646892 DOI: 10.1200/jgo.2016.006676] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Lung cancer is the most common cause of cancer mortality in the world. There are limited studies on survival outcomes of lung cancer in developing countries such as India. This study analyzed the outcomes of patients with lung cancer who underwent treatment at Cancer Institute (WIA), Chennai, India, between 2006 and 2015 to determine survival outcomes and identify prognostic factors. Patients and Methods In all, 678 patients with lung cancer underwent treatment. Median age was 58 years, and 91% of patients had non–small-cell lung cancer (NSCLC). Testing for epidermal growth factor receptor mutation was performed in 132 of 347 patients and 61 (46%) were positive. Results Median progression-free survival was 6.9 months and overall survival (OS) was 7.6 months for patients with NSCLC. Median progression-free survival was 6 months and OS was 7.2 months for patients with small-cell lung cancer. On multivariable analysis, the factors found to be significantly associated with inferior OS in NSCLC included nonadenocarcinoma histology, performance status more than 2, and stage. In small-cell lung cancer, younger age and earlier stage at presentation showed significantly better survival. Conclusion Our study highlights the challenges faced in treating lung cancer in India. Although median survival in advanced-stage lung cancer is still poor, strategies such as personalized medicine and use of second-line and maintenance chemotherapy may significantly improve the survival in patients with advanced-stage lung cancer in developing countries.
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