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Drilon A, Horan JC, Tangpeerachaikul A, Besse B, Ou SHI, Gadgeel SM, Camidge DR, van der Wekken AJ, Nguyen-Phuong L, Acker A, Keddy C, Nicholson KS, Yoda S, Mente S, Sun Y, Soglia JR, Kohl NE, Porter JR, Shair MD, Zhu V, Davare MA, Hata AN, Pelish HE, Lin JJ. NVL-520 Is a Selective, TRK-Sparing, and Brain-Penetrant Inhibitor of ROS1 Fusions and Secondary Resistance Mutations. Cancer Discov 2023; 13:598-615. [PMID: 36511802 PMCID: PMC9975673 DOI: 10.1158/2159-8290.cd-22-0968] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
SIGNIFICANCE The combined preclinical features of NVL-520 that include potent targeting of ROS1 and diverse ROS1 resistance mutations, high selectivity for ROS1 G2032R over TRK, and brain penetration mark the development of a distinct ROS1 TKI with the potential to surpass the limitations of earlier-generation TKIs for ROS1 fusion-positive patients. This article is highlighted in the In This Issue feature, p. 517.
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Affiliation(s)
- Alexander Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | | | | | | | | | | | - D. Ross Camidge
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, Colorado
| | | | - Linh Nguyen-Phuong
- Massachusetts General Hospital Cancer Center, Charlestown, Massachusetts
| | - Adam Acker
- Massachusetts General Hospital Cancer Center, Charlestown, Massachusetts
| | - Clare Keddy
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
- Papé Family Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon
| | - Katelyn S. Nicholson
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
- Papé Family Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon
| | - Satoshi Yoda
- Massachusetts General Hospital Cancer Center, Charlestown, Massachusetts
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scot Mente
- Nuvalent, Inc., Cambridge, Massachusetts
| | - Yuting Sun
- Nuvalent, Inc., Cambridge, Massachusetts
| | | | - Nancy E. Kohl
- Nuvalent, Inc., Cambridge, Massachusetts
- Kohl Consulting, Wellesley, Massachusetts
| | | | | | - Viola Zhu
- Nuvalent, Inc., Cambridge, Massachusetts
| | - Monika A. Davare
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
- Papé Family Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon
| | - Aaron N. Hata
- Massachusetts General Hospital Cancer Center, Charlestown, Massachusetts
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Henry E. Pelish
- Nuvalent, Inc., Cambridge, Massachusetts
- Corresponding Authors: Henry E. Pelish, Nuvalent, Inc., One Broadway, 14th Floor, Cambridge, MA 02142. Phone: 617-872-5700; E-mail: ; and Jessica J. Lin, 32 Fruit Street, Yawkey 7B, Boston, MA 02114. Phone: 617-724-1100; E-mail:
| | - Jessica J. Lin
- Massachusetts General Hospital Cancer Center, Charlestown, Massachusetts
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Corresponding Authors: Henry E. Pelish, Nuvalent, Inc., One Broadway, 14th Floor, Cambridge, MA 02142. Phone: 617-872-5700; E-mail: ; and Jessica J. Lin, 32 Fruit Street, Yawkey 7B, Boston, MA 02114. Phone: 617-724-1100; E-mail:
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Velthaus JL, Iglauer P, Simon R, Bokemeyer C, Bannas P, Beumer N, Imbusch CD, Goekkurt E, Loges S. Lorlatinib Induces Durable Disease Stabilization in a Pancreatic Cancer Patient with a ROS1 p.L1950F Mutation: Case Report. Oncol Res Treat 2021; 44:495-502. [PMID: 34320493 DOI: 10.1159/000517616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/04/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The prognosis of pancreatic cancer has improved only modestly in recent years. This is partly due to the lack of development in precision oncology including immune oncology in this entity. Rearrangements of the proto-oncogene tyrosine protein kinase ROS1 gene represent driver alterations found especially in lung cancer. Tyrosine kinase inhibitors (TKI) with activity against ROS1 including lorlatinib substantially improved the outcome of this patient population. Anecdotal evidence reports treatment of pancreatic cancer harboring ROS1 fusions with ROS1 TKI, but data concerning treatment of patients with ROS1 point mutations are lacking. CASE PRESENTATION This case describes a pancreatic cancer patient harboring a ROS1 point mutation that occurred without an underlying ROS1 rearrangement and thus not in the resistance situation. The heavily pretreated patient showed a strong decrease of the tumor biomarkers (CA19-9 and CEA) and radiologically a durable stable disease to the targeted treatment with lorlatinib, thereby achieving a progression-free survival of 12 months. CONCLUSION Our data are the first to show a clinical benefit from targeted treatment with ROS1 TKI in a cancer patient with a thus far undescribed ROS1 point mutation without a concomitant ROS1 rearrangement. Furthermore, they indicate that ROS1 could be an oncogenic driver in pancreatic cancer. This subgroup could be eligible for targeted treatments, which may contribute to the urgently needed improvement in patient outcome.
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Affiliation(s)
- Janna-Lisa Velthaus
- Department of Hematology, Oncology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Peter Iglauer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Hematology, Oncology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Niklas Beumer
- Division of Personalized Medical Oncology (A420), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Applied Bioinformatics (B330), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Charles D Imbusch
- Division of Applied Bioinformatics (B330), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eray Goekkurt
- Department of Hematology, Oncology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Hematology-Oncology Practice Hamburg (HOPE), Hamburg, Germany
| | - Sonja Loges
- Department of Hematology, Oncology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Personalized Medical Oncology (A420), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Personalized Oncology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Yue D, Qian J, Chen Z, Zhang B, Chen P, Zhang L, Li J, Zhang H, Wang C. Short-term response to immune-chemotherapy and immune features of a ceritinib-resistant patient with ROS1-rearranged lung adenocarcinoma. J Immunother Cancer 2021; 9:jitc-2020-001967. [PMID: 33558279 PMCID: PMC7871696 DOI: 10.1136/jitc-2020-001967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 12/12/2022] Open
Abstract
Patients with ROS1-rearranged non-small cell lung cancer (NSCLC) inevitably relapse after first-line targeted therapy with tyrosine kinase inhibitors. Efficacy of checkpoint inhibitor-based therapy on ROS1-positive NSCLC in second-line setting and change of immune factors during treatment are rarely studied. We report a ROS1-rearranged stage ⅢB lung adenocarcinoma patient who was resistant to ceritinib after developing a secondary ROS1 F2004L mutation. He received eight cycles of nivolumab plus chemotherapy and had an initial partial response, but brain metastases appeared in the seventh cycle. Lorlatinib was confirmed to have activity against CD74-ROS1 with F2004L in vitro, and was administered to this patient as the third-line therapy. The patient responded well to lorlatinib and had no relapse. We explored the tumor immune microenvironment (TIME) during immune-chemotherapy by multiplex immunohistochemistry, RNA sequencing, and multiplex plasma protein immunoassay. The results show that the TIME was active and plasma inflammatory factors were increased when the patient responded to immune-chemotherapy, while the plasma inhibitory checkpoint proteins, lymphocyte-activation gene 3, B and T lymphocyte attenuator, programmed cell death ligand 1 (PD-L1), and PD-1, were increased when the disease progressed. Moreover, the PD-L1 expression on tumor tissue was upregulated during treatment, predicting the limited benefit from immune-chemotherapy. This case report suggests that lorlatinib is a better choice than immune-chemotherapy in second-line setting for patients with similar genomic characteristics, and that monitoring the immune components during immunotherapy may help to predict disease response.
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Affiliation(s)
- Dongsheng Yue
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | | | - Zhipeng Chen
- Key Laboratory of Functional Protein Research of Guangdong, Higher Education Institutes and MOE Key Laboratory of Tumor Molecular Biology, Institute of Life and Health Engineering, Jinan University, Guangzhou, China
| | - Bin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Peng Chen
- Genecast Biotechnology Co., Ltd, Wuxi, China
| | - Lei Zhang
- Genecast Biotechnology Co., Ltd, Wuxi, China
| | - Jingjing Li
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Henghui Zhang
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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