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Lu S, Pan H, Wu L, Yao Y, He J, Wang Y, Wang X, Fang Y, Zhou Z, Wang X, Cai X, Yu Y, Ma Z, Min X, Yang Z, Cao L, Yang H, Shu Y, Zhuang W, Cang S, Fang J, Li K, Yu Z, Cui J, Zhang Y, Li M, Wen X, Zhang J, Li W, Shi J, Xu X, Zhong D, Wang T, Zhu J. Efficacy, safety and pharmacokinetics of Unecritinib (TQ-B3101) for patients with ROS1 positive advanced non-small cell lung cancer: a Phase I/II Trial. Signal Transduct Target Ther 2023; 8:249. [PMID: 37385995 PMCID: PMC10310851 DOI: 10.1038/s41392-023-01454-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/09/2023] [Accepted: 04/20/2023] [Indexed: 07/01/2023] Open
Abstract
This phase I/II trial characterized the tolerability, safety, and antitumor activities of unecritinib, a novel derivative of crizotinib and a multi-tyrosine kinase inhibitor targeting ROS1, ALK, and c-MET, in advanced tumors and ROS1 inhibitor-naive advanced or metastatic non-small cell lung cancer (NSCLC) harboring ROS1 rearrangements. Eligible patients received unecritinib 100, 200, and 300 mg QD, and 200, 250, 300, and 350 mg BID in a 3 + 3 design during dose escalation and 300 and 350 mg BID during expansion. Phase II trial patients received unecritinib 300 mg BID in continuous 28-day cycles until disease progression or unacceptable toxicity. The primary endpoint was the objective response rate (ORR) per independent review committee (IRC). Key secondary endpoints included intracranial ORR and safety. The ORR of 36 efficacy evaluable patients in the phase I trial was 63.9% (95% CI 46.2%, 79.2%). In the phase II trial, 111 eligible patients in the main study cohort received unecritinib. The ORR per IRC was 80.2% (95% CI 71.5%, 87.1%) and the median progression-free survival (PFS) per IRC was 16.5 months (95% CI 10.2, 27.0). Additionally, 46.9% of the patients who received recommended phase II dose of 300 mg BID experienced grade 3 or higher treatment-related adverse events. Treatment-related ocular disorders and neurotoxicity occurred in 28.1% and 34.4% of patients, respectively, but none was grade 3 or higher. Unecritinib is efficacious and safe for ROS1 inhibitor-naive patients with ROS1-positive advanced NSCLC, particularly patients with brain metastases at baseline, strongly supporting that unecritinib should become one of the standards of care for ROS1-positive NSCLC.ClinicalTrials.gov identifier: NCT03019276 and NCT03972189.
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Affiliation(s)
- Shun Lu
- Department of Medical Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China.
| | - Hongming Pan
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, 310016, Hangzhou, China.
| | - Lin Wu
- Department of Thoracic Medical Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University (Hunan Cancer Hospital), 410031, Changsha, China
| | - Yu Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xian, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China
| | - Yan Wang
- 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, 100021, Beijing, China
| | - Xiuwen Wang
- Department of Oncology, Qilu Hospital of Shandong University, 250012, Jinan, China
| | - Yong Fang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, 310016, Hangzhou, China
| | - Zhen Zhou
- Department of Medical Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 200030, Shanghai, China
| | - Xicheng Wang
- Department of Oncology, The First Affiliated Hospital/School of Clinical Medicine of Guangdong Pharmaceutical University, 510699, Guangzhou, China
| | - Xiuyu Cai
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060, Guangzhou, China
| | - Yan Yu
- Department of Respiratory Medicine, Harbin Medical University Cancer Hospital, 150081, Harbin, China
| | - Zhiyong Ma
- Department of Medical Oncology, Henan Tumor Hospital, 450003, Zhengzhou, China
| | - Xuhong Min
- Department of Oncology Radiotherapy, Anhui Chest Hospital, 230022, Hefei, China
| | - Zhixiong Yang
- Department of Cancer Center, Affiliated Hospital of Guangdong Medical University, 524000, Zhanjiang, China
| | - Lejie Cao
- Department of Respiratory Medicine, The First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 230031, Hefei, China
| | - Huaping Yang
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital Central South University, 410008, Changsha, China
| | - Yongqian Shu
- Department of Cancer Center, Jiangsu Province Hospital, 210029, Nanjing, China
| | - Wu Zhuang
- Department of Thoracic Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 350014, Fuzhou, China
| | - Shundong Cang
- Department of Medical Oncology, Henan Province People's Hospital, 450003, Zhengzhou, China
| | - Jian Fang
- Department of Thoracic Oncology, Peking University Cancer Hospital, 100142, Beijing, China
| | - Kai Li
- Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute and Hospital, 300060, Tianjin, China
| | - Zhuang Yu
- Department of Oncology, The Affiliated Hospital of Qingdao University, 266000, Qingdao, China
| | - Jiuwei Cui
- Department of Oncology, The First Hospital of Jilin University, 130061, Changchun, China
| | - Yang Zhang
- Department of Medical Oncology, The Second Hospital of Dalian Medical University, 116023, Dalian, China
| | - Man Li
- Department of Medical Oncology, The Second Hospital of Dalian Medical University, 116023, Dalian, China
| | - Xinxuan Wen
- Department of Oncology, Xiangyang No. 1 People's Hospital, 441011, Xiangyang, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, 130041, Changchun, China
| | - Weidong Li
- Department of Medical Oncology, Affiliated Cancer Hospital and Institute of Guangdong Medical University, 510095, Guangzhou, China
| | - Jianhua Shi
- Department of Oncology, Linyi Cancer Hospital, 276002, Linyi, China
| | - Xingxiang Xu
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, 225001, Yangzhou, China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, 300052, Tianjin, China
| | - Tao Wang
- Biostatistics Department of Clinical Center of Research Institute, Chia Tai Tianqing Pharmaceutical Group Co., Ltd., 222000, Nanjing, China
| | - Jiajia Zhu
- Biostatistics Department of Clinical Center of Research Institute, Chia Tai Tianqing Pharmaceutical Group Co., Ltd., 222000, Nanjing, China
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Tao H, Liu Z, Mu J, Gai F, Huang Z, Shi L. Concomitant novel ALK-SSH2, EML4-ALK and ARID2-ALK, EML4-ALK double-fusion variants and confer sensitivity to crizotinib in two lung adenocarcinoma patients, respectively. Diagn Pathol 2022; 17:27. [PMID: 35144623 PMCID: PMC8832643 DOI: 10.1186/s13000-022-01212-9] [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: 10/21/2021] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Anaplastic lymphoma kinase (ALK) gene rearrangements, have been identified in approximately 2-7% of patients with lung adenocarcinoma (LUAD). However, co-occurrence of double ALK fusions in one patient was rare. Herein, we reported two Chinese female LUAD patients with confirmed double ALK fusion variants by next generation sequencing. Case presentation Case 1, a 38-year-old female was diagnosed as peripheral LUAD in left upper lobe with synchronous multiple intrapulmonary metastases (pT2N0M1b, stage IVa). And case 2, a 58-year-old female had left lower lobe primary LUAD and synchronous multiple lung metastases (pT4N2M1b, stage IVa). In both patients, tumor cells displayed strong expression of ALK protein. Genetic profiling by next generation sequencing showed both patients concurrently harbored two types of ALK rearrangements. Case 1 had an unreported ALK-SSH2/EML4-ALK double fusions, and case 2 had an another novel ARID2-ALK/EML4‐ALK double fusions. Both of these patients responded to ALK inhibitor crizotinib. Conclusions Our study reported two novel ALK fusion partners never reported, which expands the knowledge of ALK fusion spectrum and provides insight into therapeutic options for patients with double ALK fusions.
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Affiliation(s)
- Hong Tao
- Department of Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Zhe Liu
- Department of Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Jing Mu
- Department of Pathology, Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Thoracic Tumor Research Institute, Beijing Tuberculosis, Beijing, China
| | - Fei Gai
- Department of Medical Business, Amoy Diagnostics Co., Ltd, Xiamen, China
| | - Zhan Huang
- Department of Medical Business, Amoy Diagnostics Co., Ltd, Xiamen, China
| | - Liang Shi
- Department of Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
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Chelala E, Hoyek S, Arej N, Kattan J, Kourie HR, Baakliny J, Antoun J. Ocular and orbital side effects of ALK inhibitors: a review article. Future Oncol 2019; 15:1939-1945. [PMID: 31140869 DOI: 10.2217/fon-2018-0608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
ALK inhibitors are a new group of tyrosine kinase inhibitors, highly efficient in the treatment of non-small-cell lung carcinoma. However, these targeted therapies can induce various adverse effects, including ocular toxicity. To date, few articles reporting ophthalmological side effects of ALK inhibitors have been published. In this review, we aim to describe the different side effects and to collect information regarding the causes behind the discrepancy between the reported rates of visual disorders. Frequent ocular side effects of ALK inhibitors included flashes, post-flashbulb effect, stripes, photopsia, accommodation disorder, presbyopia, reduced visual acuity and blurred vision. Optic neuropathy, vitreous floaters, diplopia, cataract and macular edema were also reported.
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Affiliation(s)
- Elias Chelala
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Sandra Hoyek
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Nicolas Arej
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Joseph Kattan
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | | | | | - Joelle Antoun
- Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
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Zheng SY, Shen W, Peng YM, Cui HJ, Duan H, Qiu YQ, Li Q, Zhang JY, Sun CY, Zhang X. Treatment of severe rash caused by crizotinib with both traditional Chinese medicine and Western medicine: Two case reports and literature review. Medicine (Baltimore) 2018; 97:e13088. [PMID: 30508887 PMCID: PMC6283193 DOI: 10.1097/md.0000000000013088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/11/2018] [Indexed: 11/06/2022] Open
Abstract
RATIONALE Lung adenocarcinoma is the most common pathologic pattern of lung cancer. During the past decades, a number of targeted agents have been explored to treat advanced lung adenocarcinoma. Recently, Crizotinib, the antagonist of anaplastic lymphoma kinase (ALK), has been widely used in ALK-rearranged lung cancer treatment. Crizotinib is generally well tolerated while its most frequent adverse events include visual disorders, gastrointestinal disturbances, cardiac and endocrine abnormalities. Rash caused by crizotinib is rarely seen, and there are few case reports of severe rash caused by crizotinib. PATIENT CONCERNS AND DIAGNOSES Here we report cases of an 81-year-old man and a 66-year-old woman with ALK-rearranged advanced lung adenocarcinoma. When patients came to our department, they both had crizotinib-induced severe rash. INTERVENTIONS Crizotinib was initiated as the 1st-line treatment without other therapies. We treated severe rash with traditional Chinese medicine (TCM) therapy called Zhiyang Pingfu liquid along with Western medicine. Zhiyang Pingfu liquid consists of Scutellaria baicalensis 20 g, Portulaca oleracea 30 g, Cortex Dictamni 30 g, Sophora flavescens 30 g, and other substances. Western medicine includes Minocycline hydrochloride tablets and Aprepitant capsules. OUTCOMES Both patients achieved a partial response when treated with crizotinib, and suffered from severe rash. With Zhiyang Pingfu liquid and Western medicine, their rash gradually disappeared with no sign of cancer progression. Also the male patient did not relieve after taking only antibiotics (standard therapy) and anti-allergic medicine. LESSONS Despite the dramatic benefit of crizotinib for patients with ALK rearrangement, crizotinib-induced severe rash needs to be dealt with caution. This is the 1st case in which TCM and Western medicine are used to successfully treat crizotinib-induced severe rash. The mechanism of crizotinib-induced rash deserves further attention in future research.
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Affiliation(s)
| | - Wen Shen
- Beijing University of Chinese Medicine
| | | | - Hui-Juan Cui
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Hua Duan
- Beijing University of Chinese Medicine
| | | | - Qiang Li
- Beijing University of Chinese Medicine
| | | | | | - Xu Zhang
- Beijing University of Chinese Medicine
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Jiao Q, Bi L, Ren Y, Song S, Wang Q, Wang YS. Advances in studies of tyrosine kinase inhibitors and their acquired resistance. Mol Cancer 2018; 17:36. [PMID: 29455664 PMCID: PMC5817861 DOI: 10.1186/s12943-018-0801-5] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/01/2018] [Indexed: 12/19/2022] Open
Abstract
Protein tyrosine kinase (PTK) is one of the major signaling enzymes in the process of cell signal transduction, which catalyzes the transfer of ATP-γ-phosphate to the tyrosine residues of the substrate protein, making it phosphorylation, regulating cell growth, differentiation, death and a series of physiological and biochemical processes. Abnormal expression of PTK usually leads to cell proliferation disorders, and is closely related to tumor invasion, metastasis and tumor angiogenesis. At present, a variety of PTKs have been used as targets in the screening of anti-tumor drugs. Tyrosine kinase inhibitors (TKIs) compete with ATP for the ATP binding site of PTK and reduce tyrosine kinase phosphorylation, thereby inhibiting cancer cell proliferation. TKI has made great progress in the treatment of cancer, but the attendant acquired acquired resistance is still inevitable, restricting the treatment of cancer. In this paper, we summarize the role of PTK in cancer, TKI treatment of tumor pathways and TKI acquired resistance mechanisms, which provide some reference for further research on TKI treatment of tumors.
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Affiliation(s)
- Qinlian Jiao
- International Biotechnology R&D Center, Shandong University School of Ocean, 180 Wenhua Xi Road, Weihai, Shandong, 264209, China
| | - Lei Bi
- School of Preclinical Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, Jiangsu, 210023, China
| | - Yidan Ren
- International Biotechnology R&D Center, Shandong University School of Ocean, 180 Wenhua Xi Road, Weihai, Shandong, 264209, China
| | - Shuliang Song
- International Biotechnology R&D Center, Shandong University School of Ocean, 180 Wenhua Xi Road, Weihai, Shandong, 264209, China
| | - Qin Wang
- Department of Anesthesiology, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China.
| | - Yun-Shan Wang
- International Biotechnology R&D Center, Shandong University School of Ocean, 180 Wenhua Xi Road, Weihai, Shandong, 264209, China.
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