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Papazyan T, Denis MG, Sagan C, Raimbourg J, Herbreteau G, Pons-Tostivint E. Impact of PD-L1 Expression on the Overall Survival of Caucasian Patients with Advanced EGFR-Mutant NSCLC Treated with Frontline Osimertinib. Target Oncol 2024:10.1007/s11523-024-01072-x. [PMID: 38825654 DOI: 10.1007/s11523-024-01072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The treatment of advanced non-small cell lung cancer (NSCLC) harboring an oncogenic epidermal growth factor receptor mutation (EGFRm) is currently based on osimertinib, a third-generation tyrosine kinase inhibitor (TKI). High Programmed death ligand 1 (PD-L1) expression ≥ 50% demonstrated to be a negative prognostic factor, mostly among Asian populations treated with 1st/2nd generation TKI. OBJECTIVE We investigated the impact of PD-L1 expression on the progression free survival (PFS) and overall survival (OS) within a cohort of patients receiving osimertinib as first-line treatment. METHODS Our bi-centre French retrospective study included all newly diagnosed patients with an advanced EGFRm (common and uncommon) NSCLC, between May 2018 and November 2022, treated with osimertinib. The primary endpoint was OS according to tumor proportion score PD-L1 expression (low/intermediate < 50% vs high ≥ 50%). Survival analyses were performed using Kaplan-Meier method and Cox model for adjusted multivariate analysis. RESULTS Of 96 patients, median age was 71 (IQR 62-76), 70 were women (72.9%), 81 had a performance status (PS) 0-1 (84.3%). Median follow-up was 22.6 months (95% CI 20.5-24.7). Twenty patients (20.8%) had high PD-L1 expression ≥ 50%. No significant differences in baseline characteristics were observed based on PD-L1 status. Patients with PD-L1 ≥ 50% had significant shorter PFS and OS than those with PD-L1 < 50%, respectively 9.3 vs 17.5 months (p = 0.044 months) and 14.3 vs 26.0 months (p = 0.025). Multivariable adjustment for baseline characteristics found that PS ≥ 2 (HR 2.79, 95% CI 1.12-6.93, p = 0.027), PD-L1 ≥ 50% (HR 2.61, 95% CI 1.31 to 5.22, p = 0.007) and uncommon EGFR mutation (HR 4.59, 95% CI 1.95-10.80, p = <0.001) were associated with a shorter OS. Brain metastases at diagnosis and age ≥ 65 were not, respectively HR 1.66 (95% CI 0.90-3.06, p = 0.11) and HR 0.95 (95% CI 0.50-1.80, p=0.9). CONCLUSIONS Our study found that PD-L1 expression ≥ 50% was associated with a shorter OS in EGFRm NSCLC patients treated with first line osimertinib. Further research is warranted to understand the underlying molecular and cellular mechanisms of this correlation.
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Affiliation(s)
- Thomas Papazyan
- Medical oncology, Centre Hospitalier Universitaire Nantes, Nantes University, Boulevard Professeur Jacques Monod, 44800, Saint Herblain, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Marc G Denis
- Department of Biochemistry, Centre Hospitalier Universitaire Nantes, Nantes University, 44000, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Christine Sagan
- Pathology Department, Centre Hospitalier Universitaire Nantes, Nantes University, 44000, Nantes, France
| | - Judith Raimbourg
- Department of Medical Oncology, Comprehensive Cancer Center, Institut de Cancérologie de L'Ouest, Saint-Herblain, France
| | - Guillaume Herbreteau
- Department of Biochemistry, Centre Hospitalier Universitaire Nantes, Nantes University, 44000, Nantes, France
| | - Elvire Pons-Tostivint
- Medical oncology, Centre Hospitalier Universitaire Nantes, Nantes University, Boulevard Professeur Jacques Monod, 44800, Saint Herblain, France.
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France.
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Lasvergnas J, Fallet V, Duchemann B, Jouveshomme S, Cadranel J, Chouaïd C. PDL1-status predicts primary resistance of metastatic, EGFR-mutated non small cell lung cancers to EGFR tyrosine-kinase inhibitors. Respir Med Res 2023; 84:101018. [PMID: 37302160 DOI: 10.1016/j.resmer.2023.101018] [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: 01/06/2023] [Revised: 04/03/2023] [Accepted: 04/16/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND EGFR tyrosine-kinase inhibitors (TKIs) are the reference treatment for metastatic, EGFR-mutated, non-small-cell lung cancers (EGFRm NSCLCs). However, 16-20% of those tumors progress early (3-6 months) and factors predicting that resistance are unknown. This study was undertaken to examine PDL1 status as such a factor. METHODS This retrospective analysis included metastatic, EGFRm-NSCLC patients who received first-line 1st-, 2nd- or 3rd-generation EGFR TKIs with PDL1 expression determined in pretreatment biopsies. Kaplan-Meier estimations of probabilities of progression-free survival (PFS) and overall survival (OS) were compared with log-rank test, and logistic-regression analyses. RESULTS PDL1 status of the 145 included patients was ≥1% (47%), 1-49% (33%) or ≥50% (14%). For PDL1-positive vs PDL1-negative patients, respectively, median PFS lasted 8 (95% CI: 6-12) vs 12 (95% CI: 11-17) months (p = 0.008), with 18% vs. 8% (NS) of NSCLCs progressing at 3 months, and 47% vs. 18% (HR 0.25 [95% CI 0.10-0.566], p<0.001) at 6 months. Multivariate analysis retained 1st- or 2nd-generation EGFR TKI, brain metastases and albuminemia <35 g/L at diagnosis as significantly associated with shorter PFS, but not PDL1 status, which was independently associated with progression at 6 months (HR 3.76 [1.23-12.63], p = 0.02). PDL1-negative and PDL1-positive patients' OS lasted 27 (95% CI 24-39) and 22 (95% CI 19-41) months, respectively (NS). Multivariate analysis retained only brain metastases or albuminemia <35 g/L at diagnosis as being independently associated with OS. CONCLUSION PDL1 expression ≥1% seems to be associated with early progression during the first 6 months of first-line EGFR-TKI treatment of metastatic EGFRm NSCLCs, without impacting OS.
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Affiliation(s)
- Julie Lasvergnas
- Service de Pneumologie, Groupe Hospitalier Paris Saint-Joseph, 195 rue Raymond Losserand, 75014 Paris, France.
| | - Vincent Fallet
- Service de Pneumologie et Oncologie Thoracique, DMU APPROCHES, Hôpital Tenon, APHP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Boris Duchemann
- Service d'Oncologie Médicale et Thoracique, Université Paris Sorbonne Nord, APHP, Hôpital Avicenne, 125 rue de Stalingrad, 93000 Bobigny, France
| | - Stephane Jouveshomme
- Service de Pneumologie, Groupe Hospitalier Paris Saint-Joseph, 195 rue Raymond Losserand, 75014 Paris, France
| | - Jacques Cadranel
- Service de Pneumologie et Oncologie Thoracique, DMU APPROCHES, Hôpital Tenon, APHP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Christos Chouaïd
- Service de Pneumologie, CHI Créteil, 40 av. de Verdun, 94000 Créteil, France; Inserm U955, UPEC, IMRB, Créteil, France
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Lei S, Xu H, Li H, Yang Y, Xu F, Li J, Wang Z, Xing P, Hao X, Wang Y. Influence of PD-L1 expression on the efficacy of EGFR-TKIs in EGFR-mutant non-small cell lung cancer. Thorac Cancer 2023; 14:2327-2337. [PMID: 37407282 PMCID: PMC10447169 DOI: 10.1111/1759-7714.15021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Evidence on the influence of programmed death-ligand 1 (PD-L1) expression on the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in EGFR-mutant non-small cell lung cancer (NSCLC) patients is at variance. METHODS A single-center retrospective study was conducted to evaluate the influence of PD-L1 expression on the efficacy of EGFR-TKIs for NSCLC patients with EGFR mutation. Clinical information was retrieved from electronic medical records. The patients were divided into three subgroups according to PD-L1 expression level: PD-L1 < 1% (negative), PD-L1 1%-49% and PD-L1 ≥ 50%. The clinicopathological features, overall response rate (ORR), progression-free survival (PFS) and comutation information were collected and compared between the three subgroups. RESULTS A total of 117 patients were included. For PD-L1 < 1%, PD-L1 1%-49% and PD-L1 ≥ 50% group, there were 39 (33.3%), 51 (43.5%) and 27 (23.0%) patients respectively, and the ORR was 43.2%, 64.0%, and 51.9%, respectively (p = 0.162), and the median progression-free survival (mPFS) was 22.0 months (95% CI: 14.0-29.9 months), 15.4 months (95% CI: 8.9-21.8 months) and 13.0 months (95% CI: 10.6-15.3 months), respectively (log-rank, p = 0.01). The mPFS was negatively correlated with PD-L1 expression level (r = -0.264, p = 0.041) and PD-L1 expression was an independent risk factor for worse PFS of EGFR-TKIs in multivariate Cox regression. Patients with concurrent TP53 mutation had shorter PFS (p = 0.039) and the patients harboring both mutant TP53 and positive PD-L1 had the shortest PFS (p = 0.006). CONCLUSIONS The efficacy of EGFR-TKIs was influenced by the baseline PD-L1 expression. Higher PD-L1 expression was associated with shorter PFS. The combined indicators of TP53 and PD-L1 identified subgroups showing divergent benefits from EGFR-TKIs.
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Affiliation(s)
- Si‐Yu Lei
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hai‐Yan Xu
- Department of Comprehensive OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hong‐Shuai Li
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ya‐Ning Yang
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Fei Xu
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jun‐Ling Li
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhi‐Jie Wang
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Pu‐Yuan Xing
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xue‐Zhi Hao
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yan Wang
- Department of Medical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Saw SPL, Ng WP, Zhou S, Lai GGY, Tan AC, Ang MK, Lim WT, Kanesvaran R, Ng QS, Jain A, Tan WL, Rajasekaran T, Chan JWK, Teh YL, Pang M, Yeo JC, Takano A, Ong BH, Tan EH, Tan SH, Skanderup AJ, Tan DSW. PD-L1 score as a prognostic biomarker in asian early-stage epidermal growth factor receptor-mutated lung cancer. Eur J Cancer 2023; 178:139-149. [PMID: 36436331 DOI: 10.1016/j.ejca.2022.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/09/2022] [Accepted: 10/15/2022] [Indexed: 12/24/2022]
Abstract
AIM To determine the prognostic value of programmed death-ligand 1 (PD-L1) score in early-stage epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC), contrasted against EGFR-wildtype NSCLC. METHODS Consecutive patients with Stage IA-IIIA NSCLC diagnosed 1st January 2010-31st December 2019 at National Cancer Centre Singapore with evaluable EGFR and PD-L1 status were included. Co-primary end-points were 2-year disease-free survival (DFS) and 5-year overall survival (OS) by Kaplan-Meier method. RESULTS 455 patients were included (267 EGFR-mutated, EGFR-M+; 188 EGFR-wildtype, wt). Median age at diagnosis was 65 years, 52.3% (238/455) of patients were males, 62.9% (286/455) of patients were never-smokers and 92.5% (421/455) of patients had R0 resection. Stage IA comprised 42.4% (193/455) of patients, Stage IB comprised 23.1% (105/455) of patients, Stage IIA comprised 10.8% of patients (49/455), Stage IIB comprised 5.1% of patients (23/455) and Stage IIIA comprised 18.7% (85/455) of patients. Among EGFR-M+, 45.3% (121/267) were Ex19del and 41.9% (112/267) were L858R. PD-L1 ≥1% among EGFR-M+ and EGFR-wt was 45.3% (121/267) and 54.8% (103/188) respectively (p = 0.047). At median follow-up of 47 months, 178 patients had relapsed. Among EGFR-M+, 2-year DFS comparing PD-L1 <1% and PD-L1 ≥1% was 78.1% and 67.6% (p = 0.007) while 5-year OS was 59.5% and 42.8% (p = 0.001), respectively. Controlling for age, gender, lymphovascular invasion, adjuvant therapy and resection margin status, PD-L1 ≥1% (hazard ratio, HR 2.18, 95% CI 1.04-4.54, p = 0.038), stage IIB (HR 7.78, 95% CI 1.72-35.27, p = 0.008) and stage IIIA (HR 4.45, 95% CI 1.44-13.80, p = 0.01) emerged as independent predictors of inferior OS on multivariable analysis. In exploratory analysis, genomic analysis of 81 EGFR-M+ tumours was performed. PD-L1 ≥1% tumours had significantly higher rates of TP53 mutations (36.1% versus 15.6%, p = 0.04), with predominantly missense mutations. CONCLUSION PD-L1 ≥1% is an independent predictor of worse OS among early-stage EGFR-mutated NSCLC and is associated with inferior DFS regardless of EGFR status. PD-L1 score as a risk stratification factor should be evaluated in prospective adjuvant studies among EGFR-mutated NSCLC.
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Affiliation(s)
- Stephanie P L Saw
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore. https://twitter.com/stephanieplsaw
| | - Win Pin Ng
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Genome Institute of Singapore, 60 Biopolis St 138672, Singapore
| | - Siqin Zhou
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 11 Hospital Crescent 169610, Singapore
| | - Gillianne G Y Lai
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Aaron C Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Mei-Kim Ang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Wan-Teck Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Quan Sing Ng
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Amit Jain
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Wan Ling Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Tanujaa Rajasekaran
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Johan W K Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Yi Lin Teh
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Mengyuan Pang
- Genome Institute of Singapore, 60 Biopolis St 138672, Singapore
| | - Jia-Chi Yeo
- Genome Institute of Singapore, 60 Biopolis St 138672, Singapore
| | - Angela Takano
- Division of Pathology, Singapore General Hospital, 20 College Road Academia, Level 7 169856, Singapore
| | - Boon-Hean Ong
- Department of Cardiothoracic Surgery, National Heart Centre, Singapore, 5 Hospital Dr 169609, Singapore
| | - Eng-Huat Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore
| | - Sze Huey Tan
- Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore; Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, 11 Hospital Crescent 169610, Singapore
| | | | - Daniel S W Tan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore; Duke-NUS Medical School, National University of Singapore, 8 College Rd 169857, Singapore.
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Osimertinib and Bevacizumab Cotreatment for Untreated EGFR-Mutated NSCLC With Malignant Pleural or Pericardial Effusion (SPIRAL II): A Single-Arm, Open-Label, Phase 2 Clinical Trial. JTO Clin Res Rep 2022; 3:100424. [PMID: 36438852 PMCID: PMC9692038 DOI: 10.1016/j.jtocrr.2022.100424] [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: 08/15/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction First-line treatment of EGFR-mutated NSCLC with erlotinib plus antiangiogenic inhibitor exhibits promising results. However, the efficacy of this combination has not been fully investigated. Therefore, we evaluated the efficacy and safety of osimertinib plus bevacizumab in patients with EGFR-mutated NSCLC complicated with malignant pleural or pericardial effusion (MPE) for whom combination therapy may be particularly effective. Methods This single-arm, open-label, phase 2 study aimed to investigate the clinical benefits of the bevacizumab (15 mg/kg) and osimertinib (80 mg) combination in the first-line setting for advanced EGFR-mutated NSCLC with MPE. The primary end point of this study was 1-year progression-free survival (PFS). The secondary end points were objective response rate, PFS, overall survival, drainage-free survival without the need for thoracic or pericardial drainage, and safety. Results Between January 2019 and August 2020, a total of 31 patients with EGFR-mutated NSCLC were enrolled from Japan in the study. The median PFS was 8.5 months (95% confidence interval [CI]: 5.3–11.3), the 1-year PFS was 32.1% (80% CI: 21.4–43.3), and the objective response rate was 74.2% (95% CI: 56.8–86.3). The median overall survival was not reached. The median drainage-free survival was 18.4 months (95% CI: 10.3–not estimable). Anorexia was the most common grade 3 or higher adverse event (four patients, 12.9%), followed by fatigue and dyspnea (three patients, 9.7%). No treatment-related deaths were recorded. Conclusions Osimertinib and bevacizumab combination in patients with advanced EGFR-mutated NSCLC with MPE were safe but did not effectively increase PFS when compared with the inferred value from previous literature.
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Teranishi S, Sugimoto C, Nagaoka S, Nagayama H, Segawa W, Miyasaka A, Hiro S, Kajita Y, Maeda C, Kobayashi N, Yamamoto M, Kudo M, Kaneko T. Retrospective analysis of independent predictors of progression‐free survival in patients with
EGFR
mutation‐positive
advanced non‐small cell lung cancer receiving first‐line osimertinib. Thorac Cancer 2022; 13:2741-2750. [PMID: 36082812 PMCID: PMC9527177 DOI: 10.1111/1759-7714.14608] [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: 06/14/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background Clinically measurable factors affecting the progression‐free survival (PFS) of patients receiving osimertinib as first‐line therapy for epidermal growth factor receptor (EGFR) mutation‐positive advanced non‐small cell lung cancer (NSCLC) have not yet been established. Methods We retrospectively reviewed the medical records of 61 patients treated with osimertinib as primary therapy for EGFR mutation‐positive advanced NSCLC at Yokohama City University Medical Center between August 2018 and March 2022. Our objective was to identify the independent predictors of PFS. Results The median age of participants was 74 years. Overall, 73.8% had good (0–1) Eastern Cooperative Oncology Group performance status (PS), and 98.4% had histology of adenocarcinoma. The EGFR mutation was exon19 deletion in 52.5% and exon21 L858R in 44.3% of patients. Programmed death‐ligand 1 tumor proportion score >50% was observed in 21.3% and liver metastasis in 9.9% of patients. Median PFS was 19.5 months (95% confidence interval [CI]: 10.6–31.6), and overall survival was not reached. The objective response rate was 68.9%, and disease control rate was 93.4%. Multivariate analysis showed that poor PS (2–4) negatively impacted PFS (hazard ratio, 3.79; 95% CI: 1.46–9.87; p = 0.006). Median PFS in the good PS and poor PS groups was 20.4 months (95% CI: 12.4‐not evaluable) and 7.2 months (95% CI: 7.2–19.5), respectively. Interstitial lung disease of all grades and grade 3 was observed as an adverse event in 6.6 and 4.9% of patients, respectively. Conclusion Poor PS was associated with poor prognosis in patients with EGFR mutation‐positive advanced NSCLC treated with osimertinib as first‐line therapy.
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Affiliation(s)
- Shuhei Teranishi
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Chihiro Sugimoto
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Satoshi Nagaoka
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Hirokazu Nagayama
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Wataru Segawa
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Atsushi Miyasaka
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Shuntaro Hiro
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Yukihito Kajita
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Chihiro Maeda
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Nobuaki Kobayashi
- Department of Pulmonology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Masaki Yamamoto
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Makoto Kudo
- Respiratory Disease Center Yokohama City University Medical Center Yokohama Japan
| | - Takeshi Kaneko
- Department of Pulmonology Yokohama City University Graduate School of Medicine Yokohama Japan
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7
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PD-L1 strong expressions affect the clinical outcomes of osimertinib in treatment naïve advanced EGFR-mutant non-small cell lung cancer patients. Sci Rep 2022; 12:9753. [PMID: 35697720 PMCID: PMC9192769 DOI: 10.1038/s41598-022-13102-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/20/2022] [Indexed: 12/14/2022] Open
Abstract
The impact of strong Programmed Death-ligand 1 (PD-L1) expression on the clinical outcomes of osimertinib in treatment naïve advanced Epidermal Growth Factor Receptor (EGFR)-mutant Non-small Cell Lung Cancer (NSCLC) patients remains uncertain. We enrolled advanced NSCLC patients who harbored sensitizing EGFR mutation and were treated first-line with osimertinib between 2017 and 2021. The PD-L1 expression level was also tested. A total of 85 patients were included. The objective response rate to osimertinib was 78.9%, with the disease control rate being 90.8%. Median Progression-free Survival (PFS) was 22.1 months, while median Overall Survival (OS) was not reached (NR). Patients with the exon 19 deletion experienced better PFS than those with the exon 21 L858R mutation (NR vs 12.4 months, aHR 0.24 (95% CI, 0.10 to 0.57); p = 0.001). Seventy-one of these 85 patients had reported on their PD-L1 expression. Patients with a PD-L1 < 50% experienced longer PFS than patients with a PD-L1 ≧50% (26.5 vs 9.7 months, aHR 0.19 (95% CI, 0.06 to 0.67); p = 0.009). Additionally, patients with a PD-L1 < 50% experienced better OS than those with a PD-L1 ≧50% (NR vs 25.4 months, aHR 0.09 (95% CI, 0.01 to 0.70); p = 0.021). Strong expressions of PD-L1 in treatment naïve advanced EGFR-mutant NSCLC patients were associated with poor prognoses in those undergoing treatment with osimertinib as first-line therapy.
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Wang S, Wang Y, Huang Z, Wei H, Wang X, Shen R, Lan W, Zhong G, Lin J. Stattic sensitizes osteosarcoma cells to epidermal growth factor receptor inhibitors via blocking the interleukin 6-induced STAT3 pathway. Acta Biochim Biophys Sin (Shanghai) 2021; 53:1670-1680. [PMID: 34693451 DOI: 10.1093/abbs/gmab146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 11/14/2022] Open
Abstract
Osteosarcoma (OS), the most common malignant bone tumor with high metastatic potential, frequently affects children and adolescents. Epidermal growth factor receptor (EGFR)-targeted tyrosine kinase inhibitors exhibit encouraging anti-tumor activity for patients with solid tumors, whereas their effects on OS remain controversial. In the present study, we aimed to elucidate the anti-tumor activity of gefitinib for OS, as well as to explore the underlying mechanisms. Gefitinib inhibits cell viability, tumor growth, cell migration, and invasion and promotes cell apoptosis and G1 cycle arrest in OS at a relatively high concentration via suppressing the PI3K/Akt and ERK pathways. However, gefitinib treatment results in the feedback activation of signal transducer and activator of transcription 3 (STAT3) induced by interleukin 6 (IL-6) secretion. Combined treatment with gefitinib and stattic, an inhibitor for STAT3 phosphorylation, engenders more evident inhibitory effects on cell proliferation, migration, and invasion and promotive effects on cell apoptosis and G1 phase arrest in OS, compared with the single exposure to gefitinib or stattic. Western blot analysis demonstrates that stattic treatment in gefitinib-treated OS abrogates the IL-6-induced STAT3 activation and subsequently further restrains the activities of EGFR, Akt, and ERK pathways in tumor cells. This study confirms that the EGFR inhibitor of gefitinib has moderate anti-tumor effects on OS through IL-6 secretion-mediated STAT3 activation. Additional administration of stattic in EGFR-targeted therapies may contribute to improve the efficacy for OS.
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Affiliation(s)
- Shenglin Wang
- Department of Orthopedics, Fujian Institute of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Yunqing Wang
- Department of Orthopedics, Fujian Institute of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Zhen Huang
- Department of Orthopedics, Fujian Institute of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Hongxiang Wei
- Department of Orthopedics, Fujian Institute of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Xinwen Wang
- Department of Orthopedics, The People's Hospital of Jiangmen City, Jiangmen 529051, China
| | - Rongkai Shen
- Department of Orthopedics, Fujian Institute of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Wenbin Lan
- Department of Orthopedics, Fujian Institute of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Guangxian Zhong
- Department of Orthopedics, Fujian Institute of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Jianhua Lin
- Department of Orthopedics, Fujian Institute of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
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9
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Hellyer JA, White MN, Gardner RM, Cunanan K, Padda SK, Das M, Ramchandran K, Neal JW, Wakelee HA. Impact of Tumor Suppressor Gene Co-Mutations on Differential Response to EGFR TKI Therapy in EGFR L858R and Exon 19 Deletion Lung Cancer. Clin Lung Cancer 2021; 23:264-272. [PMID: 34838441 DOI: 10.1016/j.cllc.2021.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND In most studies, patients with EGFR L858R mutant non-small cell lung cancer (NSCLC) have a shorter duration of response to EGFR tyrosine kinase inhibitor (TKI) therapy than do patients with EGFR exon 19 deletion NSCLC. The role that co-mutations play in this observation is unknown. METHODS We performed a single-institution retrospective analysis of patients with EGFR-mutant NSCLC (exon 19 deletion or L858R mutation) who received frontline EGFR TKI for metastatic disease between 2014 and 2019, and who had STAMP next-generation sequencing (NGS), a 130-gene platform. Time to treatment failure (TTF) and overall survival were calculated using Cox models adjusted for age, race, and brain metastases. Co-mutations in key tumor suppressor genes (TP53, RB1, KEAP1, CDKN2A, or CTNNB1) were identified and their effects on outcomes were evaluated. Analyses were stratified according to receipt of osimertinib versus nonosimertinib as frontline EGFR TKI. RESULTS Of 137 patients, 72 (57%) had EGFR exon 19 deletions and 65 (43%) had EGFR L858R mutations. Median TTF and OS on frontline TKI was shorter for the L858R cohort versus the exon 19 deletion cohort in univariate analysis. In adjusted models, this difference persisted for TTF but was no longer significant for OS. The difference in TTF in L858R mutant tumors was driven by the presence of co-mutations in key tumor suppressor genes. CONCLUSION Patients with metastatic NSCLC with mutations in EGFR L858R had shorter TTF on frontline TKI compared to patients with EGFR exon 19 deletions. Co-mutations in tumor suppressor genes may play an important role in the differential response to TKI therapy.
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Affiliation(s)
- Jessica A Hellyer
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Maya N White
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Rebecca M Gardner
- Quantitative Sciences Unit, Stanford School of Medicine, Stanford, CA
| | - Kristen Cunanan
- Quantitative Sciences Unit, Stanford School of Medicine, Stanford, CA
| | - Sukhmani K Padda
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Millie Das
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA
| | - Kavitha Ramchandran
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Joel W Neal
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Heather A Wakelee
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA.
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10
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Sahu SS, Cavallaro S, Hååg P, Nagy Á, Karlström AE, Lewensohn R, Viktorsson K, Linnros J, Dev A. Exploiting Electrostatic Interaction for Highly Sensitive Detection of Tumor-Derived Extracellular Vesicles by an Electrokinetic Sensor. ACS APPLIED MATERIALS & INTERFACES 2021; 13:42513-42521. [PMID: 34473477 PMCID: PMC8447189 DOI: 10.1021/acsami.1c13192] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We present an approach to improve the detection sensitivity of a streaming current-based biosensor for membrane protein profiling of small extracellular vesicles (sEVs). The experimental approach, supported by theoretical investigation, exploits electrostatic charge contrast between the sensor surface and target analytes to enhance the detection sensitivity. We first demonstrate the feasibility of the approach using different chemical functionalization schemes to modulate the zeta potential of the sensor surface in a range -16.0 to -32.8 mV. Thereafter, we examine the sensitivity of the sensor surface across this range of zeta potential to determine the optimal functionalization scheme. The limit of detection (LOD) varied by 2 orders of magnitude across this range, reaching a value of 4.9 × 106 particles/mL for the best performing surface for CD9. We then used the optimized surface to profile CD9, EGFR, and PD-L1 surface proteins of sEVs derived from non-small cell lung cancer (NSCLC) cell-line H1975, before and after treatment with EGFR tyrosine kinase inhibitors, as well as sEVs derived from pleural effusion fluid of NSCLC adenocarcinoma patients. Our results show the feasibility to monitor CD9, EGFR, and PD-L1 expression on the sEV surface, illustrating a good prospect of the method for clinical application.
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Affiliation(s)
- Siddharth Sourabh Sahu
- Department
of Electrical Engineering, The Ångström Laboratory, Uppsala University, 75121 Uppsala, Sweden
| | - Sara Cavallaro
- Department
of Applied Physics, School of Engineering Sciences, KTH Royal Institute of Technology, 10691 Stockholm, Sweden
| | - Petra Hååg
- Department
of Oncology-Pathology, Karolinska Institutet, 17164 Stockholm, Sweden
| | - Ábel Nagy
- Department
of Protein Science, School of Chemistry, Biotechnology, and Health
(CBH), KTH Royal Institute of Technology, 10691 Stockholm, Sweden
| | - Amelie Eriksson Karlström
- Department
of Protein Science, School of Chemistry, Biotechnology, and Health
(CBH), KTH Royal Institute of Technology, 10691 Stockholm, Sweden
| | - Rolf Lewensohn
- Department
of Oncology-Pathology, Karolinska Institutet, 17164 Stockholm, Sweden
- Theme
Cancer, Patient Area Head and Neck, Lung, and Skin, Karolinska University Hospital, 17164 Solna, Sweden
| | - Kristina Viktorsson
- Department
of Oncology-Pathology, Karolinska Institutet, 17164 Stockholm, Sweden
| | - Jan Linnros
- Department
of Applied Physics, School of Engineering Sciences, KTH Royal Institute of Technology, 10691 Stockholm, Sweden
| | - Apurba Dev
- Department
of Electrical Engineering, The Ångström Laboratory, Uppsala University, 75121 Uppsala, Sweden
- Department
of Applied Physics, School of Engineering Sciences, KTH Royal Institute of Technology, 10691 Stockholm, Sweden
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