1
|
Tóth LJ, Mokánszki A, Méhes G. The rapidly changing field of predictive biomarkers of non-small cell lung cancer. Pathol Oncol Res 2024; 30:1611733. [PMID: 38953007 PMCID: PMC11215025 DOI: 10.3389/pore.2024.1611733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024]
Abstract
Lung cancer is a leading cause of cancer-related death worldwide in both men and women, however mortality in the US and EU are recently declining in parallel with the gradual cut of smoking prevalence. Consequently, the relative frequency of adenocarcinoma increased while that of squamous and small cell carcinomas declined. During the last two decades a plethora of targeted drug therapies have appeared for the treatment of metastasizing non-small cell lung carcinomas (NSCLC). Personalized oncology aims to precisely match patients to treatments with the highest potential of success. Extensive research is done to introduce biomarkers which can predict the effectiveness of a specific targeted therapeutic approach. The EGFR signaling pathway includes several sufficient targets for the treatment of human cancers including NSCLC. Lung adenocarcinoma may harbor both activating and resistance mutations of the EGFR gene, and further, mutations of KRAS and BRAF oncogenes. Less frequent but targetable genetic alterations include ALK, ROS1, RET gene rearrangements, and various alterations of MET proto-oncogene. In addition, the importance of anti-tumor immunity and of tumor microenvironment has become evident recently. Accumulation of mutations generally trigger tumor specific immune defense, but immune protection may be upregulated as an aggressive feature. The blockade of immune checkpoints results in potential reactivation of tumor cell killing and induces significant tumor regression in various tumor types, such as lung carcinoma. Therapeutic responses to anti PD1-PD-L1 treatment may correlate with the expression of PD-L1 by tumor cells. Due to the wide range of diagnostic and predictive features in lung cancer a plenty of tests are required from a single small biopsy or cytology specimen, which is challenged by major issues of sample quantity and quality. Thus, the efficacy of biomarker testing should be warranted by standardized policy and optimal material usage. In this review we aim to discuss major targeted therapy-related biomarkers in NSCLC and testing possibilities comprehensively.
Collapse
Affiliation(s)
- László József Tóth
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | |
Collapse
|
2
|
Henschke C, Huber R, Jiang L, Yang D, Cavic M, Schmidt H, Kazerooni E, Zulueta JJ, Sales Dos Santos R, Ventura L. Perspective on Management of Low-Dose Computed Tomography Findings on Low-Dose Computed Tomography Examinations for Lung Cancer Screening. From the International Association for the Study of Lung Cancer Early Detection and Screening Committee. J Thorac Oncol 2024; 19:565-580. [PMID: 37979778 DOI: 10.1016/j.jtho.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
Lung cancer screening using low-dose computed tomography (LDCT) carefully implemented has been found to reduce deaths from lung cancer. Optimal management starts with selection of eligibility criteria, counseling of screenees, smoking cessation, selection of the regimen of screening which specifies the imaging protocol, and workup of LDCT findings. Coordination of clinical, radiologic, and interventional teams and ultimately treatment of diagnosed lung cancers under screening determine the benefit of LDCT screening. Ethical considerations of who should be eligible for LDCT screening programs are important to provide the benefit to as many people at risk of lung cancer as possible. Unanticipated diseases identified on LDCT may offer important benefits through early detection of leading global causes of death, such as cardiovascular diseases and chronic obstructive pulmonary disease, as the latter may result from conditions such as emphysema and bronchiectasis, which can be identified early on LDCT. This report identifies the key components of the regimen of LDCT screening for lung cancer which include the need for a management system to provide data for continuous updating of the regimen and provides quality assurance assessment of actual screenings. Multidisciplinary clinical management is needed to maximize the benefit of early detection, diagnosis, and treatment of lung cancer. Different regimens have been evolving throughout the world as the resources and needs may be different, for countries with limited resources. Sharing of results, further knowledge, and incorporation of technologic advances will continue to accelerate worldwide improvements in the diagnostic and treatment approaches.
Collapse
Affiliation(s)
- Claudia Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Rudolf Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine, University of Munich - Campus Innenstadt, Ziemssenstrabe, Munich, Germany
| | - Long Jiang
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dawei Yang
- Department of Pulmonary Medicine and Critical Care, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Milena Cavic
- Department of Experimental Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Heidi Schmidt
- Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | - Ella Kazerooni
- Division of Cardiothoracic Radiology and Internal Medicine, University of Michigan Medical School, Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Javier J Zulueta
- Department of Medicine, Mount Sinai Morningside, New York, New York
| | - Ricardo Sales Dos Santos
- Department of Minimally Invasive Thoracic and Robotic Surgery, Albert Einstein Israeli Hospital, Sao Paulo, Brazil
| | - Luigi Ventura
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| |
Collapse
|
3
|
Real-World Testing Practices, Treatment Patterns and Clinical Outcomes in Patients from Central Eastern Europe with EGFR-Mutated Advanced Non-Small Cell Lung Cancer: A Retrospective Chart Review Study (REFLECT). Curr Oncol 2022; 29:5833-5845. [PMID: 36005198 PMCID: PMC9406426 DOI: 10.3390/curroncol29080460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
The targeted therapy with tyrosine kinase inhibitors (TKIs) against the epidermal growth factor receptor mutation (EGFRm) in advanced non-small cell lung cancer (NSCLC) changed the treatment paradigm. REFLECT study (NCT04031898) explored EGFR/T790M testing and treatment patterns in EGFRm NSCLC patients receiving first- or second-generation (1G/2G) EGFR TKIs as front-line (1L) in eight countries. Pooled data from Central Eastern Europe (CEE) countries from this study (Bulgaria, Poland, Romania, Slovenia) are presented here. This physician-led chart review study was conducted in patients with confirmed-EGFRm NSCLC initiating 1L 1G/2G EGFR TKIs between 2015–2018. The CEE cohort included 389 patients receiving 1L erlotinib (37%), afatinib (34%), and gefitinib (29%). Overall, 320 (82%) patients discontinued 1L, and 298 (77%) progression events were registered. Median progression free survival on 1L TKIs was 14.0 (95% CI: 12.6–15.6) months. Median overall survival from 1L start was 26.6 (95% CI: 24.1–29.0) months. Attrition rate between 1L and next line was 30%. Among patients with 1L progression, 200 (67%) were tested for T790M and 58% were positive. This first CEE analysis of treatments and outcomes in EGFRm NSCLC patients highlights the importance of using the most efficacious therapies currently available in 1L to reduce attrition and improve patient outcomes.
Collapse
|
4
|
Koleva-Kolarova R, Buchanan J, Vellekoop H, Huygens S, Versteegh M, Mölken MRV, Szilberhorn L, Zelei T, Nagy B, Wordsworth S, Tsiachristas A. Financing and Reimbursement Models for Personalised Medicine: A Systematic Review to Identify Current Models and Future Options. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:501-524. [PMID: 35368231 PMCID: PMC9206925 DOI: 10.1007/s40258-021-00714-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND The number of healthcare interventions described as 'personalised medicine' (PM) is increasing rapidly. As healthcare systems struggle to decide whether to fund PM innovations, it is unclear what models for financing and reimbursement are appropriate to apply in this context. OBJECTIVE To review financing and reimbursement models for PM, summarise their key characteristics, and describe whether they can influence the development and uptake of PM. METHODS A literature review was conducted in Medline, Embase, Web of Science, and Econlit to identify studies published in English between 2009 and 2021, and reviews published before 2009. Grey literature was identified through Google Scholar, Google and subject-specific webpages. Articles that described financing and reimbursement of PM, and financing of non-PM were included. Data were extracted and synthesised narratively to report on the models, as well as facilitators, incentives, barriers and disincentives that could influence PM development and uptake. RESULTS One hundred and fifty-three papers were included. Research and development of PM was financed through both public and private sources and reimbursed largely through traditional models such as single fees, Diagnosis-Related Groups, and bundled payments. Financial-based reimbursement, including rebates and price-volume agreements, was mainly applied to targeted therapies. Performance-based reimbursement was identified mainly for gene and targeted therapies, and some companion diagnostics. Gene therapy manufacturers offered outcome-based rebates for treatment failure for interventions including Luxturna®, Kymriah®, Yescarta®, Zynteglo®, Zolgensma® and Strimvelis®, and coverage with evidence development for Kymriah® and Yescarta®. Targeted testing with OncotypeDX® was granted value-based reimbursement through initial coverage with evidence development. The main barriers and disincentives to PM financing and reimbursement were the lack of strong links between stakeholders and the lack of demonstrable benefit and value of PM. CONCLUSIONS Public-private financing agreements and performance-based reimbursement models could help facilitate the development and uptake of PM interventions with proven clinical benefit.
Collapse
Affiliation(s)
| | - James Buchanan
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Heleen Vellekoop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Simone Huygens
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Matthijs Versteegh
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Maureen Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - László Szilberhorn
- Syreon Research Institute, Budapest, Hungary
- Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Tamás Zelei
- Syreon Research Institute, Budapest, Hungary
| | - Balázs Nagy
- Syreon Research Institute, Budapest, Hungary
| | - Sarah Wordsworth
- Health Economics Research Centre, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
| |
Collapse
|
5
|
Addeo A, Hochmair M, Janzic U, Dudnik E, Charpidou A, Płużański A, Ciuleanu T, Donev IS, Elbaz J, Aarøe J, Ott R, Peled N. Treatment patterns, testing practices, and outcomes in the pre-FLAURA era for patients with EGFR mutation-positive advanced NSCLC: a retrospective chart review (REFLECT). Ther Adv Med Oncol 2022; 13:17588359211059874. [PMID: 35173817 PMCID: PMC8842149 DOI: 10.1177/17588359211059874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: For epidermal growth factor receptor mutation-positive (EGFRm) non-small-cell
lung cancer (NSCLC), EGFR-tyrosine kinase inhibitors (EGFR-TKIs) are the
preferred first-line (1 L) treatment in the advanced setting. Osimertinib, a
third-generation EGFR-TKI, received full approval in 2017 for second-line (2
L) treatment of EGFR T790M-positive NSCLC. The REFLECT study characterizes
real-world treatment/testing patterns, attrition rates, and outcomes in
patients with EGFRm advanced NSCLC treated with 1 L first-/second-generation
(1G/2G) EGFR-TKIs before 1 L osimertinib approval. Methods: Retrospective chart review (NCT04031898) of European/Israeli adults with
EGFRm unresectable locally advanced/metastatic NSCLC, initiating 1 L 1G/2G
EGFR-TKIs 01/01/15–30/06/18 (index date). Results: In 896 patients (median follow-up of 21.5 months), the most frequently
initiated 1 L EGFR-TKI was afatinib (45%). Disease progression was reported
in 81%, including 10% (86/896) who died at 1 L. By the end of study, most
patients discontinued 1 L (85%), of whom 33% did not receive 2 L therapy.
From index, median 1 L real-world progression-free survival was 13.0 (95%
confidence interval (CI): 12.3–14.1) months; median overall survival (OS)
was 26.2 (95% CI: 23.6–28.4) months. 71% of patients with 1 L progression
were tested for T790M; 58% were positive. Of those with T790M, 95% received
osimertinib in 2 L or later. Central nervous system (CNS) metastases were
recorded in 22% at index, and 15% developed CNS metastases during treatment
(median time from index 13.5 months). Median OS was 19.4 months (95% CI:
17.1–22.1) in patients with CNS metastases at index, 24.8 months (95% CIs
not available) with CNS metastases diagnosed during treatment, and 30.3
months (95% CI: 27.1, 33.8) with no CNS metastases recorded. Conclusion: REFLECT is a large real-world study describing treatment patterns prior to 1
L osimertinib availability for EGFRm advanced NSCLC. Given the attrition
rates highlighted in the study and the impact of CNS progression on
outcomes, offering a 1 L EGFR-TKI with CNS penetration may improve patient
outcomes in this treatment setting.
Collapse
Affiliation(s)
- Alfredo Addeo
- Medical Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Brünner Strasse 68, A-1210 Vienna, Austria
| | - Urska Janzic
- Medical Oncology Department, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Elizabeth Dudnik
- Davidoff Cancer Center Rabin Medical Center, Clalit Health Services, Petah Tikva, Israel
| | - Andriani Charpidou
- Oncology Unit, 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Adam Płużański
- Department of Lung Cancer and Chest Tumors, The Maria Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tudor Ciuleanu
- Medical Oncology Department, Prof. Dr. Ion Chiricuta Oncology Institute and Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Judith Elbaz
- Oncology, AstraZeneca Israel, Hod Hasharon, Israel
| | | | - René Ott
- OBU Europe, AstraZeneca AG, Zug, Switzerland
| | - Nir Peled
- Soroka Cancer Center, Beer-Sheva, Israel
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Discussed the main approaches for lung control and point out differences among Central Europe and other countries. RECENT FINDINGS Three main approaches exist: smoking ban, early computed tomography screening and access to novel therapies; major differences exist between Central Europe and some other countries. SUMMARY A major effort will be needed from Central Europe countries in all three approaches; it will require strong involvement from the political authorities.
Collapse
Affiliation(s)
- Jean A Klastersky
- Department of Medical Oncology, Institut Jules Bordet, Centre des Tumeurs de l'ULB, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
7
|
Ivanović M, Knez L, Herzog A, Kovačević M, Cufer T. Immunotherapy for Metastatic Non-Small Cell Lung Cancer: Real-World Data from an Academic Central and Eastern European Center. Oncologist 2021; 26:e2143-e2150. [PMID: 34288239 PMCID: PMC8649015 DOI: 10.1002/onco.13909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/01/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Immunotherapy with immune checkpoint inhibitors (ICIs) recently became the standard treatment for patients with advanced non-small cell lung cancer (NSCLC). Here, we present the first results of a real-world observational study on the effectiveness of ICI monotherapy in patients with advanced NSCLC treated at a single academic center in a Central and Eastern European (CEE) country. MATERIALS AND METHODS Overall, 66 consecutive patients with advanced NSCLC treated with ICIs in everyday clinical practice, either with first-line pembrolizumab (26 patients) or second-line atezolizumab, nivolumab, or pembrolizumab (40 patients), from August 2015 to November 2018, were included. All data were retrieved from a hospital lung cancer registry, in which the data is collected prospectively. RESULTS Included patients had a median age of 64 years, most were male (55%), 6% were in performance status ≥2, and 18% had controlled central nervous system metastases at baseline. In first-line, the median progression-free survival (mPFS) was 9.3 months, while the median overall survival (mOS) was not reached. The 1-year overall survival (OS) was 62%. In second-line, the mPFS and mOS were 3.5 months and 9.9 months, respectively, with a 1-year OS of 35%. In the overall population, adverse events of any grade were recorded in 79% of patients and of severe grade (3-4) in 12% of patients. CONCLUSION The first real-world outcomes of NSCLC immunotherapy from a CEE country suggest comparable effectiveness to those observed in clinical trials and other real-world series, mainly coming from North America and Western European countries. Further data to inform on the real-world effectiveness of immunotherapy worldwide are needed. IMPLICATIONS FOR PRACTICE Immunotherapy is a standard treatment of advanced non-small cell lung cancer (NSCLC). The real-world data on immunotherapy are still limited. This article presents the first data on the effectiveness of mono-immunotherapy with immune checkpoint inhibitors for patients with advanced NSCLC treated at a single academic center in a Central and Eastern European country. The survival rates and toxicity are comparable to those achieved in randomized clinical trials and other real-world series, coming mainly from North American and Western European countries. There is a pressing need to gather further data on the effectiveness of immunotherapy in everyday practice worldwide.
Collapse
Affiliation(s)
- Marija Ivanović
- Department of Oncology, University Medical Centre MariborMariborSlovenia
| | - Lea Knez
- University Clinic GolnikGolnikSlovenia
- Faculty of Pharmacy, University of LjubljanaLjubljanaSlovenia
| | - Ana Herzog
- Faculty of Computer and Information Science, University of LjubljanaLjubljanaSlovenia
- Psychiatric Hospital BegunjeBegunjeSlovenia
| | | | - Tanja Cufer
- University Clinic GolnikGolnikSlovenia
- Medical Faculty, University of LjubljanaLjubljanaSlovenia
| |
Collapse
|
8
|
Kiladze I, Mariamidze E, Jeremic B. Real-World Treatment Patterns of Lung Cancer in a Resource-Restricted Country: the Experience of Georgia. Health Serv Insights 2021; 14:11786329211055296. [PMID: 34776730 PMCID: PMC8573520 DOI: 10.1177/11786329211055296] [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: 05/29/2021] [Accepted: 09/30/2021] [Indexed: 12/24/2022] Open
Abstract
Lung cancer (LC) is the most common malignancy responsible for 1.8 million of deaths worldwide. Lung and bronchus cancer represents 13% (n = 1217) of all new cancer cases in Georgia. In 2018, in Georgian males lung cancer age-standardized incidence rate was 35.7/per 100 000, less compared to regional countries as Turkey (70.6), Russia (48.2), Ukraine (41.7), and Armenia (58.5), but higher than in neighbor Azerbaijan (25.5). Incidence is higher compared to central and eastern Europe (27.3) and near similar to North America (34.5). Georgia is an Eastern European, middleincome country with 3.7 million residents and one of the highest numbers of active smokers in the European Region. The Georgian health care system is divided into a public and a private sector, with coverage of nearly 100% of the population. There is a national healthcare system as well as private insurance and all patients, irrespective of insurance (private or governmental) can choose the hospital for treatment by themselves all over the country. The Basic Package of the Universal Health Care Program includes the treatment of oncologic patients, specifically surgery, chemotherapy, hormone therapy and radiotherapy and investigations and medications related to these procedures. The program covers all types of laboratory and instrumental investigations related to planned treatment. Georgia lacks an LC screening program for smokers and partially because of this, the majority of patients with lung cancer present at an advanced stage. The National Centre for the Disease Control (NCDC) showed that almost 90% of LC patients in the country present with advanced stages (III-IV) with 60% of patients having stage IV disease at diagnosis . Lung cancer is generally diagnosed at an advanced stage. For non-small cell lung cancer (NSCLC), the proportion with metastatic disease (TNM stage IV) ranged from 46.8% to 61.2% in developed countries. In recent years, there have been several publications addressing specifics of LC worldwide, but none concerning Georgia. In light of the rapidly changing landscape in the diagnosis, staging, and treatment of LC, we thought to define the state of practice in Georgia by convening specialists who treat LC across 13 institutions in our country with the goal to describe differences in access and approaches to LC.
Collapse
Affiliation(s)
- Ivane Kiladze
- Department of Clinical Oncology, Caucasus Medical Centre, Tbilisi, Georgia
| | - Elene Mariamidze
- Department of Oncology and Hematology, Research Institute of Clinical Medicine after Academician F. Todua, Tbilisi, Georgia
| | | |
Collapse
|
9
|
The evolving landscape of biomarker testing for non-small cell lung cancer in Europe. Lung Cancer 2021; 154:161-175. [PMID: 33690091 DOI: 10.1016/j.lungcan.2021.02.026] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 12/31/2022]
Abstract
The discovery of oncogenic driver mutations rendering non-small cell lung cancer (NSCLC) targetable by small-molecule inhibitors, and the development of immunotherapies, have revolutionised NSCLC treatment. Today, instead of non-selective chemotherapies, all patients with advanced NSCLC eligible for treatment (and increasing numbers with earlier, less extensive disease) require fast and comprehensive screening of biomarkers for first-line patient selection for targeted therapy, chemotherapy, or immunotherapy (with or without chemotherapy). To avoid unnecessary re-biopsies, biomarker screening before first-line treatment should also include markers that are actionable from second-line onwards; PD-L1 expression testing is also mandatory before initiating treatment. Population differences exist in the frequency of oncogenic driver mutations: EGFR mutations are more frequent in Asia than Europe, whereas the converse is true for KRAS mutations. In addition to approved first-line therapies, a number of emerging therapies are being investigated in clinical trials. Guidelines for biomarker testing vary by country, with the number of actionable targets and the requirement for extensive molecular screening strategies expected to increase. To meet diagnostic demands, rapid screening technologies for single-driver mutations have been implemented. Improvements in DNA- and RNA-based next-generation sequencing technologies enable analysis of a group of genes in one assay; however, turnaround times remain relatively long. Consequently, rapid screening technologies are being implemented alongside next-generation sequencing. Further challenges in the evolving landscape of biomarker testing in NSCLC are actionable primary and secondary resistance mechanisms to targeted therapies. Therefore, comprehensive testing on re-biopsies, collected at the time of disease progression, in combination with testing of circulating tumour DNA may provide important information to guide second- or third-line therapies. Furthermore, longitudinal biomarker testing can provide insights into tumour evolution and heterogeneity during the course of the disease. We summarise best practice strategies for Europe in the changing landscape of biomarker testing at diagnosis and during treatment.
Collapse
|
10
|
Thunnissen E, Weynand B, Udovicic-Gagula D, Brcic L, Szolkowska M, Hofman P, Smojver-Ježek S, Anttila S, Calabrese F, Kern I, Skov B, Perner S, Dale VG, Eri Z, Haragan A, Leonte D, Carvallo L, Prince SS, Nicholson S, Sansano I, Ryska A. Lung cancer biomarker testing: perspective from Europe. Transl Lung Cancer Res 2020; 9:887-897. [PMID: 32676354 PMCID: PMC7354119 DOI: 10.21037/tlcr.2020.04.07] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A questionnaire on biomarker testing previously used in central European countries was extended and distributed in Western and Central European countries to the pathologists participating at the Pulmonary Pathology Society meeting 26-28 June 2019 in Dubrovnik, Croatia. Each country was represented by one responder. For recent biomarkers the availability and reimbursement of diagnoses of molecular alterations in non-small cell lung carcinoma varies widely between different, also western European, countries. Reimbursement of such assessments varies widely between unavailability and payments by the health care system or even pharmaceutical companies. The support for testing from alternative sources, such as the pharmaceutical industry, is no doubt partly compensating for the lack of public health system support, but it is not a viable or long-term solution. Ideally, a structured access to testing and reimbursement should be the aim in order to provide patients with appropriate therapeutic options. As biomarker enabled therapies deliver a 50% better probability of outcome success, improved and unbiased reimbursement remains a major challenge for the future.
Collapse
Affiliation(s)
- Erik Thunnissen
- Department of Pathology, AmsterdamUMC, Location VU Medical Center, Amsterdam, The Netherlands
| | | | - Dalma Udovicic-Gagula
- Clinical Center University of Sarajevo, Department of Pathology and Cytology, Sarajevo, Bosnia and Herzegovina
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Malgorzata Szolkowska
- National Tuberculosis and Lung Diseases Research Institute, Department of Pathology, Warsaw, Poland
| | - Paul Hofman
- Nice University Hospital, FHU OncoAge, Laboratory of Clinical and Experimental Pathology, Nice, France
| | - Silvana Smojver-Ježek
- Clinical Unit for Pulmonary Cytology, Department of Pathology and Cytology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sisko Anttila
- Department of Pathology, HUSLAB, Helsinki and Uusimaa Health Care District, Helsinki, Finland
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Izidor Kern
- Laboratory for cytology and pathology, University Clinic Golnik, Golnik, Slovenia
| | - Birgit Skov
- Department of Pathology, University Hospital, Copenhagen Ø, Denmark
| | - Sven Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany;,Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Vibeke G. Dale
- Department of Pathology, St. Olavs Hospital, Trondheim, Norway
| | - Zivka Eri
- Institute for pulmonary diseases of Vojvodina, Department for Pathology, put dr Goldmana 4, Sremska Kamenica, Serbia
| | - Alex Haragan
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, England
| | - Diana Leonte
- National Institute of Pneumology, Pathology Department, Bucharest, Romania
| | - Lina Carvallo
- Institute of Anatomical and Molecular Pathology, Faculty of Medicine – University of Coimbra, Coimbra, Portugal
| | - Spasenja Savic Prince
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Siobhan Nicholson
- Department of Histopathology, St. James’s Hospital, Dublin 8, Ireland
| | - Irene Sansano
- Pathology Department, Passeig de la Vall d’Hebron 119-129, Barcelona, Spain
| | - Ales Ryska
- The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, Hradec Kralove, Czech Republic
| |
Collapse
|
11
|
Brisudova A, Skarda J. Gene rearrangement detection by next-generation sequencing in patients with non-small cell lung carcinoma. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:127-132. [PMID: 32284620 DOI: 10.5507/bp.2020.015] [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: 11/11/2019] [Accepted: 03/19/2020] [Indexed: 11/23/2022] Open
Abstract
Non-small cell lung carcinoma (NSCLC) is the leading cause of cancer-related deaths worldwide. Various molecular markers in NSCLC patients have been developed, including gene rearrangements, currently used in therapeutic strategies. With increasing number of these molecular biomarkers of NSCLC, there is a demand for highly efficient methods for detecting mutations and translocations in treatable targets. Those currently available U.S. Food and Drug Administration (FDA) approved approaches, for example imunohistochemisty (IHC) and fluorescence in situ hybridization (FISH), are inadequate, due to sufficient quantity of material and long time duration. Next-generation massive parallel sequencing (NGS), with the ability to perform and capture data from millions of sequencing reactions simultaneously could resolve the problem. Thanks to gradual NGS introduction into clinical laboratories, screening time should be considerably shorter, which is very important for patients with advanced NSCLC. Moreover, only a minimum sample input is needed for achieving adequate results. NGS was compared to the current detection methods of ALK, ROS1, c-RET and c-MET rearrangements in NSCLC and a significant match, between IHC, FISH and NGS results, was found. Recent available researches have been carried out on a small numbers of patients. Verifying these results on larger patients cohort is important. This review sumarizes the literature on this subject and compares current possibilities of predictive gene rearrangements detection in patients with NSCLC.
Collapse
Affiliation(s)
- Aneta Brisudova
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jozef Skarda
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| |
Collapse
|
12
|
Cufer T, Ciuleanu TE, Berzinec P, Galffy G, Jakopovic M, Jassem J, Jovanovic D, Mihaylova Z, Ostoros G, Thallinger C, Zemanova M, Zielinski C. Access to Novel Drugs for Non-Small Cell Lung Cancer in Central and Southeastern Europe: A Central European Cooperative Oncology Group Analysis. Oncologist 2019; 25:e598-e601. [PMID: 32162818 PMCID: PMC7066717 DOI: 10.1634/theoncologist.2019-0523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background Treatment of non‐small cell lung cancer (NSCLC) improved substantially in the last decades. Novel targeted and immune‐oncologic drugs were introduced into routine treatment. Despite accelerated development and subsequent drug registrations by the European Medicinal Agency (EMA), novel drugs for NSCLC are poorly accessible in Central and Eastern European (CEE) countries. Material and Methods The Central European Cooperative Oncology Group conducted a survey among experts from 10 CEE countries to provide an overview on the availability of novel drugs for NSCLC and time from registration to reimbursement decision in their countries. Results Although first‐generation epidermal growth factor receptor tyrosine kinase inhibitors were reimbursed and available in all countries, for other registered therapies—even for ALK inhibitors and checkpoint inhibitors in first‐line—there were apparent gaps in availability and/or reimbursement. There was a trend for better availability of drugs with longer time from EMA marketing authorization. Substantial differences in access to novel drugs among CEE countries were observed. In general, the availability of drugs is not in accordance with the Magnitude of Clinical Benefit Scale (MCBS), as defined by the European Society for Medical Oncology (ESMO). Time spans between drug registrations and national decisions on reimbursement vary greatly, from less than 3 months in one country to more than 1 year in the majority of countries. Conclusion The access to novel drugs for NSCLC in CEE countries is suboptimal. To enable access to the most effective compounds within the shortest possible time, reimbursement decisions should be faster and ESMO MCBS should be incorporated into decision making. Access to novel therapies is a factor contributing to disparities in cancer care. Limited drug availability is a challenge in Central and Eastern European countries, where financial and organizational shortages exist. This article reports a survey that investigated access to novel anti‐cancer drugs for non‐small cell lung cancer.
Collapse
Affiliation(s)
- Tanja Cufer
- Medical Faculty Ljubljana, University Clinic GolnikLjubljanaSlovenia
| | - Tudor E. Ciuleanu
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuta" Institute of OncologyCluj‐NapocaRomania
| | - Peter Berzinec
- Department of Oncology, Hospital of St Zoerardus ZoborNitraSlovakia
| | - Gabriela Galffy
- Department of Chest Surgery, Pest County Pulmonology HospitalTörökbálintHungary
| | - Marko Jakopovic
- Department for Respiratory Disease Jordanovic, University Hospital Centre ZagrebZagrebCroatia
| | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of GdanskGdanskPoland
| | - Dragana Jovanovic
- Department of Palliative Medicine, University Hospital of Pulmonology, Clinical Center of SerbiaBelgradeSerbia
| | | | - Gyula Ostoros
- Department of Pulmunology, National Koranyi Institute of PulmunologyBudapestHungary
| | - Christiane Thallinger
- Department of Medicine I, Medical University of Vienna – General HospitalViennaAustria and Central European Cooperative Oncology Group (CECOG)
| | - Milada Zemanova
- Department of Oncology, University HospitalPragueCzech Republic
| | - Christoph Zielinski
- Vienna Cancer Center, Medical University of Vienna – General HospitalViennaAustria and Central European Cooperative Oncology Group (CECOG)
| |
Collapse
|
13
|
Zwitter M, Čufer T, Vrankar M, Kern I, Štupnik T, Rozman A, Koprivnikar H, Zadnik V. Lung Cancer in Slovenia. J Thorac Oncol 2019; 14:1327-1331. [DOI: 10.1016/j.jtho.2019.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 01/26/2023]
|