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Karadurmus N, Kaplan MA, Sendur MAN, Urun Y, Demirci U, Karaca SB, Goktas Aydin S, Aykan MB, Bilici A, Sezer A, Yilmaz U, Abali H, Yumuk PF, Degirmencioglu S, Demirkazik A, Paydas S, Mirili C, Turna H, Kargi A, Ozdogan M, Guven DC, Ozguroglu M, Kilickap S. Evaluation of the efficacy and safety of nivolumab in the second- or later-line treatment of patients with locally advanced/metastatic non-small cell lung cancer in Türkiye: a retrospective multicenter non-interventional registry study. Curr Med Res Opin 2024; 40:1171-1178. [PMID: 38809230 DOI: 10.1080/03007995.2024.2359026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/20/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of nivolumab in the second-line (2L) or later-line (LL) treatment of patients with locally advanced/metastatic non-small cell lung cancer (NSCLC) in real-life setting in Türkiye. METHODS This study was designed as a national, multi-center, retrospective study. The study population was evaluated in two groups for the line of nivolumab therapy: those receiving nivolumab in the 2L (Group 2L) and third-line (3L) or LL (Group 3L/LL). Efficacy was evaluated based on one-year overall survival (OS) and progression-free survival (PFS). Safety was evaluated based on treatment-related adverse events (AEs) and nivolumab discontinuation rate. RESULTS Of 244 patients, 52.9% were in Group 2L and 47.1% were in Group 3L/LL. Demographic and clinical characteristics did not differ between the groups. In Group 2L and Group 3L/LL, one-year OS and PFS rates were 60.8% and 61.4% (p = 0.592) and 31.2% and 21.3% (p = 0.078), respectively. The objective response rate (ORR) was 34.7% in Group 2L and 27.3% in Group 3L/LL (p = 0.262). The percentage of patients reporting at least one AE in Groups 2L and 3L/LL was 34.9% and 43.5%, respectively (p = 0.169). Fatigue was the most common (16.4%) treatment-related AE in each group. The groups were comparable regarding the AE frequency. Nivolumab was discontinued in 61 patients in Group 2L and 53 patients in Group 3L/LL, with the most common reason being disease progression (57.4% and 66.0%, respectively). CONCLUSION Nivolumab is safe and effective in the 2L or 3L/LL treatment of locally advanced/metastatic NSCLC and associated with acceptable AEs in real-life setting.
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Affiliation(s)
- Nuri Karadurmus
- Medical Oncology Department, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Türkiye
| | | | | | - Yuksel Urun
- Medical Oncology Division, Department of Internal Diseases, Ankara University Medical Faculty, Ankara, Türkiye
| | - Umut Demirci
- Medical Oncology Unit, Memorial Ankara Hospital, Ankara, Türkiye
| | | | - Sabin Goktas Aydin
- Medical Oncology Unit, Bagcilar Medipol Mega University Hospital, Istanbul, Türkiye
| | - Musa Baris Aykan
- Medical Oncology Department, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Türkiye
| | - Ahmet Bilici
- Medical Oncology Unit, Bagcilar Medipol Mega University Hospital, Istanbul, Türkiye
| | - Ahmet Sezer
- Medical Oncology Unit, Adana Dr. Turgut Noyan Application and Research Center, Baskent University, Adana, Türkiye
| | - Ulku Yilmaz
- Chest Diseases Unit, Ankara Ataturk Sanatory Education and Research Hospital, Ankara, Türkiye
| | - Huseyin Abali
- Medical Oncology Unit, Acibadem Adana Hospital, Adana, Türkiye
| | - Perran Fulden Yumuk
- Medical Oncology Unit, Marmara University Medical Faculty, Istanbul, Türkiye
| | - Serkan Degirmencioglu
- Department of Internal Diseases, Pamukkale University Medical Faculty, Denizli, Türkiye
| | - Ahmet Demirkazik
- Medical Oncology Division, Department of Internal Diseases, Ankara University Medical Faculty, Ankara, Türkiye
| | - Semra Paydas
- Department of Medical Oncology, Cukurova University Medical Faculty, Adana, Türkiye
| | - Cem Mirili
- Department of Medical Oncology, Cukurova University Medical Faculty, Adana, Türkiye
| | - Hande Turna
- Medical Oncology Division, Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Aysegul Kargi
- Medical Oncology Unit, Medstar Antalya Hospital Cancer Center, Antalya, Türkiye
| | - Mustafa Ozdogan
- Medical Oncology Unit, Medstar Antalya Hospital Cancer Center, Antalya, Türkiye
| | - Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Türkiye
| | - Mustafa Ozguroglu
- Medical Oncology Division, Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
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Freitas-Dias C, Gonçalves F, Martins F, Lemos I, Gonçalves LG, Serpa J. Interaction between NSCLC Cells, CD8 + T-Cells and Immune Checkpoint Inhibitors Potentiates Coagulation and Promotes Metabolic Remodeling-New Cues on CAT-VTE. Cells 2024; 13:305. [PMID: 38391918 PMCID: PMC10886748 DOI: 10.3390/cells13040305] [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: 01/03/2024] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Cancer-associated thrombosis (CAT) and venous thromboembolism (VTE) are frequent cancer-related complications associated with high mortality; thus, this urges the identification of predictive markers. Immune checkpoint inhibitors (ICIs) used in cancer immunotherapy allow T-cell activation against cancer cells. Retrospective studies showed increased VTE following ICI administration in some patients. Non-small cell lung cancer (NSCLC) patients are at high risk of thrombosis and thus, the adoption of immunotherapy, as a first-line treatment, seems to be associated with coagulation-fibrinolysis derangement. METHODS We pharmacologically modulated NSCLC cell lines in co-culture with CD8+ T-cells (TCD8+) and myeloid-derived suppressor cells (MDSCs), isolated from healthy blood donors. The effects of ICIs Nivolumab and Ipilimumab on NSCLC cell death were assessed by annexin V and propidium iodide (PI) flow cytometry analysis. The potential procoagulant properties were analyzed by in vitro clotting assays and enzyme-linked immunosorbent assays (ELISAs). The metabolic remodeling induced by the ICIs was explored by 1H nuclear magnetic resonance (NMR) spectroscopy. RESULTS Flow cytometry analysis showed that TCD8+ and ICIs increase cell death in H292 and PC-9 cells but not in A549 cells. Conditioned media from NSCLC cells exposed to TCD8+ and ICI induced in vitro platelet aggregation. In A549, Podoplanin (PDPN) levels increased with Nivolumab. In H292, ICIs increased PDPN levels in the absence of TCD8+. In PC-9, Ipilimumab decreased PDPN levels, this effect being rescued by TCD8+. MDSCs did not interfere with the effect of TCD8+ in the production of TF or PDPN in any NSCLC cell lines. The exometabolome showed a metabolic remodeling in NSCLC cells upon exposure to TCD8+ and ICIs. CONCLUSIONS This study provides some insights into the interplay of immune cells, ICIs and cancer cells influencing the coagulation status. ICIs are important promoters of coagulation, benefiting from TCD8+ mediation. The exometabolome analysis highlighted the relevance of acetate, pyruvate, glycine, glutamine, valine, leucine and isoleucine as biomarkers. Further investigation is needed to validate this finding in a cohort of NSCLC patients.
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Affiliation(s)
- Catarina Freitas-Dias
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; (C.F.-D.); (F.G.); (F.M.); (I.L.)
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof Lima Basto, 1099-023 Lisboa, Portugal
- Faculdade de Ciências, FCUL, Universidade de Lisboa, Campo Grande, 130, 1169-056 Lisboa, Portugal
| | - Filipe Gonçalves
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; (C.F.-D.); (F.G.); (F.M.); (I.L.)
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof Lima Basto, 1099-023 Lisboa, Portugal
| | - Filipa Martins
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; (C.F.-D.); (F.G.); (F.M.); (I.L.)
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof Lima Basto, 1099-023 Lisboa, Portugal
| | - Isabel Lemos
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; (C.F.-D.); (F.G.); (F.M.); (I.L.)
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof Lima Basto, 1099-023 Lisboa, Portugal
| | - Luís G. Gonçalves
- Instituto de Tecnologia Química e Biológica António Xavier (ITQB NOVA), Avenida da República (EAN), 2780-157 Oeiras, Portugal;
| | - Jacinta Serpa
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; (C.F.-D.); (F.G.); (F.M.); (I.L.)
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof Lima Basto, 1099-023 Lisboa, Portugal
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Luciani A, Ghidini A, Borgonovo K, Parati MC, Petrelli F. Outcome of non-small-cell lung cancer with driven mutations treated with anti-PD-(L)1 agents: A systematic review. TUMORI JOURNAL 2023; 109:442-449. [PMID: 36165425 DOI: 10.1177/03008916221122601] [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] [Indexed: 11/17/2022]
Abstract
Patients whose tumours harbour epidermal growth factor receptor (EGFR), and anaplastic lymphoma kinase (ALK) driver mutations can benefit most from treatment with tyrosine kinase inhibitors (TKIs). Most trials with immune checkpoint inhibitors (ICIs) included few patients whose tumour had oncogenic driver alterations. We therefore performed a meta-analysis of studies reporting the activity of ICIs in oncogene addicted NSCLC. A comprehensive search of MEDLINE, The Cochrane Library and EMBASE was conducted to identify relevant studies published up to 31 January 2021. The primary outcomes were median overall survival (OS); the secondary endpoints were progression-free survival and overall response rate (PFS and ORR). Overall, 46 studies were screened and selected for final analysis. The pooled ORR was 14.5% (95% CI 9.6-21.2%). The median pooled PFS in EGFR/ALK mutated cases was 3.9 months (95% CI 3-5.2 months). Median pooled OS was 10.7 months (95% CI 9.2-12.5 months). All registration trials in second line did not show any benefit of immunotherapy for the subgroup of patients with EGFR-mutated or ALK-rearranged tumours. The unsatisfied benefit of immunotherapy in oncogene-addicted tumours has been debated and is mainly due to the lower mutation burden of these neoplasms. Our data do not support the use of immunotherapy in the setting of oncogene actionable tumours. More data are needed to confirm or reject the benefit of the combination of TKIs with ICIs.
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Abler D, Courlet P, Dietz M, Gatta R, Girard P, Munafo A, Wicky A, Jreige M, Guidi M, Latifyan S, De Micheli R, Csajka C, Prior JO, Michielin O, Terranova N, Cuendet MA. Semiautomated Pipeline to Quantify Tumor Evolution From Real-World Positron Emission Tomography/Computed Tomography Imaging. JCO Clin Cancer Inform 2023; 7:e2200126. [PMID: 37146261 PMCID: PMC10281365 DOI: 10.1200/cci.22.00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/04/2022] [Accepted: 02/03/2023] [Indexed: 05/07/2023] Open
Abstract
PURPOSE A semiautomated pipeline for the collection and curation of free-text and imaging real-world data (RWD) was developed to quantify cancer treatment outcomes in large-scale retrospective real-world studies. The objectives of this article are to illustrate the challenges of RWD extraction, to demonstrate approaches for quality assurance, and to showcase the potential of RWD for precision oncology. METHODS We collected data from patients with advanced melanoma receiving immune checkpoint inhibitors at the Lausanne University Hospital. Cohort selection relied on semantically annotated electronic health records and was validated using process mining. The selected imaging examinations were segmented using an automatic commercial software prototype. A postprocessing algorithm enabled longitudinal lesion identification across imaging time points and consensus malignancy status prediction. Resulting data quality was evaluated against expert-annotated ground-truth and clinical outcomes obtained from radiology reports. RESULTS The cohort included 108 patients with melanoma and 465 imaging examinations (median, 3; range, 1-15 per patient). Process mining was used to assess clinical data quality and revealed the diversity of care pathways encountered in a real-world setting. Longitudinal postprocessing greatly improved the consistency of image-derived data compared with single time point segmentation results (classification precision increased from 53% to 86%). Image-derived progression-free survival resulting from postprocessing was comparable with the manually curated clinical reference (median survival of 286 v 336 days, P = .89). CONCLUSION We presented a general pipeline for the collection and curation of text- and image-based RWD, together with specific strategies to improve reliability. We showed that the resulting disease progression measures match reference clinical assessments at the cohort level, indicating that this strategy has the potential to unlock large amounts of actionable retrospective real-world evidence from clinical records.
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Affiliation(s)
- Daniel Abler
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Informatics, School of Management, University of Applied Sciences Western Switzerland (HES-SO), Sierre, Switzerland
| | - Perrine Courlet
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthieu Dietz
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- INSERM U1060, CarMeN Laboratory, University of Lyon, Lyon, France
| | - Roberto Gatta
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pascal Girard
- Translational Medicine, Merck Institute of Pharmacometrics, Lausanne, Switzerland, an Affiliate of Merck KGaA, Darmstadt, Germany
| | - Alain Munafo
- Translational Medicine, Merck Institute of Pharmacometrics, Lausanne, Switzerland, an Affiliate of Merck KGaA, Darmstadt, Germany
| | - Alexandre Wicky
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mario Jreige
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Monia Guidi
- Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sofiya Latifyan
- Service of Medical Oncology, Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rita De Micheli
- Service of Medical Oncology, Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chantal Csajka
- Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - John O. Prior
- Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Michielin
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nadia Terranova
- Translational Medicine, Merck Institute of Pharmacometrics, Lausanne, Switzerland, an Affiliate of Merck KGaA, Darmstadt, Germany
| | - Michel A. Cuendet
- Department of Oncology, Precision Oncology Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, University of Lausanne, Lausanne, Switzerland
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY
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Luján M, Lema M, Preciado B, Lema C, Egurrola J, Cardona A, González D, Mantilla W, Pino L, Rojas G, Gómez D, Munevar I, Manneh R, Manneh R, Lobatón J, Calle E, Borras M, Triana I, Londoño P, Aruachán S, Pineda M, Morán D. Real-world evidence of nivolumab for non-small-cell lung cancer in a developing country. J Investig Med 2023; 71:502-510. [PMID: 36760084 DOI: 10.1177/10815589221147897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Nivolumab is a human programmed death receptor-1 blocking antibody, used as treatment option in patients with advanced non-small-cell lung cancer (NSCLC). We assessed the nivolumab efficacy in terms of survival and response to treatment as second-line (2L) or third-line (3L) therapy in patients with advanced NSCLC. This is a multicentric observational study. Data of patients with advanced NSCLC who received nivolumab as 2L or 3L treatment were analyzed retrospectively. Information regarding patient demographics and clinical backgrounds, treatment patterns from diagnosis to post-nivolumab treatment, effectiveness, and safety of nivolumab treatment were collected. The outcomes evaluated were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) to treatment. OS and PFS were estimated with the Kaplan-Meier method and the differences were evaluated through the log-rank test. Data of 178 patients were included. The median follow-up was 26.8 months (interquartile range (IQR): 20.3-40.4). Nivolumab was commonly used as a 2L treatment (77.5%). The outcomes in this setting (2L) were as follows: ORR was 21.0%, and the median PFS and OS were 5.5 months (95% confidence interval (CI): 4.5-6.5) and 12.4 months (95% CI: 10.8-14.0), respectively. In 3L, the ORR with nivolumab was 15.0%, the median PFS and OS were 4.1 months (95% CI: 3.1-5.1) and 10.1 months (95% CI: 9.4-10.6), respectively. Three patients (1.7%) required discontinuation due to toxicity. Nivolumab effectiveness and safety in this scenario was consistent with that reported by previous trials and other real-world data.
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Affiliation(s)
- Mauricio Luján
- Clínica de Oncología Astorga, Medellín, Colombia.,Universidad Pontificia Bolivariana, Medellín, Colombia.,Medicáncer, Medellín, Colombia
| | - Mauricio Lema
- Clínica de Oncología Astorga, Medellín, Colombia.,Clínica SOMA, Medellín, Colombia
| | | | - Camila Lema
- Clínica de Oncología Astorga, Medellín, Colombia
| | | | - Andrés Cardona
- Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC), Bogotá, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Diego González
- Instituto de Cancerología Las Américas-AUNA, Medellín, Colombia.,Universidad de Antioquia, Medellín, Colombia
| | | | - Luis Pino
- Fundación Santafé de Bogotá, Bogotá, Colombia
| | | | - Diego Gómez
- Instituto de Cáncer del Hospital Internacional de Colombia (HIC), Piedecuesta, Colombia
| | | | - Raimundo Manneh
- Sociedad de Oncología y Hematología del Cesar SAS (SOHEC), Valledupar, Colombia
| | - Ray Manneh
- Sociedad de Oncología y Hematología del Cesar SAS (SOHEC), Valledupar, Colombia
| | - José Lobatón
- Instituto Médico de Alta Tecnología (IMAT) Oncomédica S.A, Montería, Colombia
| | | | | | - Iván Triana
- Fundación Santafé de Bogotá, Bogotá, Colombia
| | | | - Sandra Aruachán
- Instituto Médico de Alta Tecnología (IMAT) Oncomédica S.A, Montería, Colombia
| | - Mateo Pineda
- Clínica de Oncología Astorga, Medellín, Colombia
| | - Diego Morán
- Clínica de Oncología Astorga, Medellín, Colombia
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Effectiveness of Nivolumab in Second-Line and Later in Patients with Advanced Non-Small Cell Lung Cancer in Real-Life Practice in France and Germany: Analysis of the ESME-AMLC and CRISP Cohorts. Cancers (Basel) 2022; 14:cancers14246148. [PMID: 36551632 PMCID: PMC9776880 DOI: 10.3390/cancers14246148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
This study reports characteristics and outcomes in patients with locally advanced or metastatic non-small cell lung cancer (aNSCLC) receiving nivolumab in second-line or later (2L+) in France and Germany between 2015 and 2020. Patients with aNSCLC (stage IIIB-C/IV) receiving nivolumab in 2L+ were included from the retrospective Epidemiological Strategy and Medical Economics of Advanced and Metastatic Lung Cancer cohort (ESME-AMLC, France; 2015-2019) and Clinical Research platform Into molecular testing, treatment and outcome of non-Small cell lung carcinoma Patients (CRISP, Germany; 2016-2020). Overall, 2262 ESME-AMLC and 522 CRISP patients were included. Median treatment duration (95% confidence intervals) was 2.8 months (2.5-3.2) in squamous and 2.5 months (2.3-2.8) in non-squamous/others patients in ESME-AMLC, and 2.3 months (1.4-3.1) and 2.3 months (2.0-2.8), respectively in CRISP. One-year and two-year overall survival (OS) were 47.2% and 26.7% in squamous and 50.8% and 32.8% in non-squamous/others patients in ESME-AMLC, and 43.1% and 20.9%, and 37.7% and 18.9%, respectively in CRISP. Poorer performance score and shorter time from start of previous line of therapy initiation were significantly associated with shorter treatment duration and OS. This study confirms, in real-world clinical databases, the efficacy of nivolumab previously observed in clinical trials.
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Kanabar SS, Tiwari A, Soran V, Balendran P, Price M, Turner AM. Impact of PD1 and PDL1 immunotherapy on non-small cell lung cancer outcomes: a systematic review. Thorax 2022; 77:1163-1174. [PMID: 35688624 DOI: 10.1136/thoraxjnl-2020-215614] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 05/11/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Despite comprising many cancer diagnoses, few treatments are suitable for patients with advanced non-small cell lung cancer (aNSCLC). Trials suggest blockade of programmed death 1 (PD1) or its ligand (PDL1) may be effective for these patients. However, this therapy's impact on outcomes other than survival, and outcomes of patients not in trials, remains largely unknown. Therefore, we compared the effectiveness of PD1 and PDL1 immunotherapy to chemotherapy and placebo across multiple clinical outcomes. METHODS Six databases were searched on 12-13 October 2019 for randomised controlled trials (RCTs) and observational studies investigating nivolumab, pembrolizumab, atezolizumab or durvalumab. Study selection was performed independently by two reviewers. Data for overall survival, progression-free survival, adverse effects (AEs) and quality of life (QoL) were descriptively and meta-analysed. Factors impacting treatment outcomes, including PDL1 expression, were explored. The similarity between RCT and observational data was assessed. RESULTS From 5423 search results, 139 full texts and abstracts were included. Immunotherapy was associated with a lower risk of death than both comparators. In RCTs, the incidence of treatment-related AEs was approximately 20% lower among patients using immunotherapy compared with chemotherapy. However, no other consistent benefits were observed. Progression-free survival results were inconsistent. Improvements to QoL varied according to the instrument used; however, QoL was not recorded widely. Survival results were similar between study designs; however, AEs incidence was lower in observational studies. DISCUSSION Among patients with aNSCLC, immunotherapy improved overall survival and incidence of treatment-related AEs compared with chemotherapy. Benefits to progression-free survival and QoL were less consistent. PROSPERO REGISTRATION NUMBER CRD42019153345.
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Affiliation(s)
- Shivani Setur Kanabar
- Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK .,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Abhinav Tiwari
- Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Vina Soran
- Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Prashanthan Balendran
- Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Ding T, Song Q, Xu Y, Liu Q. C-X-C Chemokine Receptor Type 4 (CXCR4) and Programmed Death-Ligand 1 (PD-L1) Expression are Prognostic Biomarkers for Papillary Thyroid Carcinoma. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chemokines and immunomodulatory factors involve in tumor development. Papillary thyroid carcinoma (PTC) is considered to start from dendritic cell infiltration and then produce immunomodulatory factors. In this study, CXCR4 and PD-L1 biomarkers were used to explore their prognostic
role in PTC survival. Confocal microscopy detected the transfection efficiency in tumor cells. 42 PTC patients and thyroiditis patients (control) were enrolled to measure the expressions of CXCR4 and PD-L1. Multi-factor analysis analyzed the effect of combined CXCR4 and PD-L1 expression on
ROC. The two groups had no differences in the baseline characteristics. CTXCR4 and PD-L1 level in PTC patients was significantly higher than control. CXCR4 was lowly expressed in thyroid cancer tissue and PD-L1 was highly expressed in serological samples. Compared with single measurement,
the combined detection of CXCR4 and PD-L1 showed more ROC area. In conclusion, reduced CXCR4 and increased PD-L1 level is found in thyroid cancer and their level might be used as predictive markers for PTC to improve the curative effect.
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Affiliation(s)
- Ting Ding
- Department of Endocrinology, Huanggang Central Hospital, Huanggang City, Hubei Province, 438021, China
| | - Qian Song
- Department of Endocrinology, Huanggang Central Hospital, Huanggang City, Hubei Province, 438021, China
| | - Yanjun Xu
- Department of Special Inspection Section, The Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou City, Zhejiang Province, 310014, Chin
| | - Qiya Liu
- Department of General Medicine, Sha He Hospital of Chang Ping District in Beijing, Beijing, 100005, China
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Gärtner F, Aßmus J, Fløtten Ø, Ramnefjell MP, Aanerud M. Characteristics and survival of patients with non-small cell lung cancer treated with immune-checkpoint inhibitors in the real-world: experiences from Bergen, Norway. Acta Oncol 2022; 61:814-818. [PMID: 35481424 DOI: 10.1080/0284186x.2022.2068969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Fabian Gärtner
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Øystein Fløtten
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Maria Paula Ramnefjell
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Marianne Aanerud
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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10
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Real-World Analysis of Nivolumab and Atezolizumab Efficacy in Previously Treated Patients with Advanced Non-Small Cell Lung Cancer. Pharmaceuticals (Basel) 2022; 15:ph15050533. [PMID: 35631359 PMCID: PMC9147485 DOI: 10.3390/ph15050533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
Nivolumab (anti-PD-1 antibody) and atezolizumab (anti-PD-L1 antibody) have shown superior survival outcomes and improved adverse effects compared to standard chemotherapy in advanced non-small cell lung cancer (NSCLC) patients. However, the efficacy of both treatments has not been directly compared in clinical trials. This retrospective, single-centre study was performed from June 2015 to December 2020 and included a cohort of 158 previously treated patients with stage IV or recurrent NSCLC who received PD-1 (nivolumab) (n = 89) or PD-L1 (atezolizumab) (n = 69) inhibitors at the Virgen del Rocío Hospital in Seville. The objective response rate (ORR) was 22.5% in the nivolumab group and 14.5% in the atezolizumab group (p = 0.140). Multivariate analysis did not show significant differences between the two groups for PFS and OS (PFS hazard ratio (HR): 0.80, 95% confidence interval (CI): 0.55−1.17, p = 0.260; OS HR: 0.79, 95% CI: 0.52−1.21, p = 0.281). Adverse events of all grades occurred in 68 patients in the nivolumab group (76.4%) and in 34 patients in the atezolizumab group (49.3%) (p < 0.001). Atezolizumab and nivolumab did not show statistically significant differences in survival outcomes in patients with NSCLC, even when stratified by histological subtype (squamous versus nonsquamous). However, the safety analysis suggested a more favourable toxicity profile for atezolizumab.
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11
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Miao K, Zhang X, Wang H, Si X, Ni J, Zhong W, Zhao J, Xu Y, Chen M, Pan R, Wang M, Zhang L. Real-World Data of Different Immune Checkpoint Inhibitors for Non-Small Cell Lung Cancer in China. Front Oncol 2022; 12:859938. [PMID: 35392244 PMCID: PMC8982065 DOI: 10.3389/fonc.2022.859938] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/14/2022] [Indexed: 12/25/2022] Open
Abstract
Background Patients treated with immunotherapy in the real-world may have significantly different responses to those meeting inclusion criteria for random controlled clinical studies. There is a partial overlap in approved indications for the use of the different immune checkpoint inhibitors (ICIs) currently available. A comprehensive assessment of the efficacy, safety and economic effects of various ICIs is a problem that clinicians need to address. Methods Analyzed real-world data was collected from non-small cell lung cancer (NSCLC) patients who were treated with ICIs from hospitalized patients in the Lung Cancer Center of Peking Union Medical College Hospital between 2018 and 2021. The objectives were to evaluate the efficacy and safety of different ICIs for the treatment of NSCLC in China and to investigate the factors affecting their curative effects. Results Overall, 351 patients were included in the retrospective study. The median PFS for the NSCLC patient cohort treated with medication regimens that included ICIs was 9.5 months, with an ORR of 47.3%. There were no significant discrepancies in efficacy and safety between the different ICIs administered. Factors that had the greatest impact on the efficacy of ICIs were the disease stage, ECOG-PS scores and treatment lines. Gender, age, smoking history, PD-L1 TPS expression, history of targeted therapy and irAEs all had a degree of influence on patient prognosis. Conclusions The study reports the experience of real-world usage of ICIs for the treatment of NSCLC patients in China. The results were generally consistent with those of clinical trials, while the efficacy and safety of different ICIs exhibited no statistically significant differences. Therefore, physicians can make a comprehensive choice based on the indications and cost of different ICIs and the preferences of patients.
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Affiliation(s)
- Kang Miao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaotong Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hanping Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoyan Si
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei Zhong
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jing Zhao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yan Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Minjiang Chen
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ruili Pan
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Mengzhao Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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12
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Real-World Effectiveness of Immunotherapies in Pre-Treated, Advanced Non-Small Cell Lung Cancer Patients: A Systematic Literature Review. Lung Cancer 2022; 166:205-220. [DOI: 10.1016/j.lungcan.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 12/26/2022]
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13
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Pasello G, Lorenzi M, Calvetti L, Oliani C, Pavan A, Favaretto A, Palazzolo G, Giovanis P, Zustovich F, Bonetti A, Bernardi D, Mandarà M, Aprile G, Crivellaro G, Sinigaglia G, Tognazzo S, Morandi P, Bortolami A, Marino V, Bonanno L, Guarneri V, Conte P. OUP accepted manuscript. Oncologist 2022; 27:e484-e493. [PMID: 35429394 PMCID: PMC9177098 DOI: 10.1093/oncolo/oyac051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Giulia Pasello
- Corresponding author: Giulia Pasello, University of Padova DiSCOG and Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128 Padova, Italy. Tel: +390498215608; Fax: +390498215932;
| | - Martina Lorenzi
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, AULSS8 Berica, Vicenza, Italy
| | | | - Alberto Pavan
- Medical Oncology Department, ULSS 3 Serenissima, Sant’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Adolfo Favaretto
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca’Foncello Hospital, Treviso, Italy
| | - Giovanni Palazzolo
- Medical Oncology, AULSS 6 Euganea, Cittadella – Camposampiero Hospital, Camposampiero, Italy
| | - Petros Giovanis
- Department of Oncology, Unit of Oncology, Santa Maria del Prato Hospital, Azienda ULSS 1 Dolomiti, Feltre, Italy
| | - Fable Zustovich
- Clinical Oncology Department, AULSS 1 Dolomiti, San Martino Hospital, Belluno, Italy
| | - Andrea Bonetti
- Department of Oncology, AULSS 9 of the Veneto Region, Mater Salutis Hospital, Legnago, Italy
| | - Daniele Bernardi
- Medical Oncology, ULSS 4 “Veneto Orientale”, San Donà di Piave (VE), Italy
| | - Marta Mandarà
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, AULSS8 Berica, Vicenza, Italy
| | - Giovanna Crivellaro
- Rete Oncologica Veneta (ROV), Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | | | - Sandro Tognazzo
- Rete Oncologica Veneta (ROV), Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Paolo Morandi
- Medical Oncology Department, ULSS 3 Serenissima, Sant’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Alberto Bortolami
- Rete Oncologica Veneta (ROV), Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Valentina Marino
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca’Foncello Hospital, Treviso, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
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14
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Tran AN, Wang M, Hundt M, Chugh R, Ohm J, Grimshaw A, Ciarleglio M, Hung KW, Proctor DD, Price CC, Laine L, Al-Bawardy B. Immune Checkpoint Inhibitor-associated Diarrhea and Colitis: A Systematic Review and Meta-analysis of Observational Studies. J Immunother 2021; 44:325-334. [PMID: 34380976 DOI: 10.1097/cji.0000000000000383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have transformed the management of advanced malignancies but are associated with diarrhea and colitis. The objective of our systematic review and meta-analysis was to determine the incidence and outcomes of ICI-associated diarrhea and colitis. Bibliographic databases were searched through August 13, 2019, for observational studies of ICI therapy reporting the incidence and/or treatment of diarrhea or colitis. The primary outcome was ICI-associated diarrhea and colitis. Meta-analyses were performed with random-effects models. Twenty-five studies (N=12,661) were included. All studies had a high risk of bias in at least 1 domain. The overall incidence of diarrhea/colitis was 12.8% [95% confidence interval (CI), 8.8-18.2, I2=96.5]. The incidence was lower in patients treated with anti-programmed cell death 1/programmed death-ligand 1 (4.1%, 95% CI, 2.6-6.5) than in those treated with anti-cytotoxic T-cell lymphocyte-associated antigen 4 (20.1%, 95% CI, 15.9-25.1). The remission of diarrhea and/or colitis was higher in patients treated with corticosteroids plus biologics (88.4%, 95% CI, 79.4-93.8) than in those treated with corticosteroids alone (58.3%, 95% CI, 49.3-66.7, Q=18.7, P<0.001). ICI were permanently discontinued in 48.1% of patients (95% CI, 17.8-79.1). ICI were restarted after temporary interruption in 48.6% of patients (95% CI, 18.2-79.4) of whom 17.0% (95% CI, 6.4-30.0) experienced recurrence. Real-world incidence of ICI-associated diarrhea/colitis exceeds 10%. These events lead to permanent ICI discontinuation in just over 50% of patients, while <20% have recurrence of symptoms if ICI are resumed. Further studies are needed to identify patients who would benefit from early treatment with biologics as well as appropriate patients to resume ICI therapy.
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Affiliation(s)
| | | | | | | | | | - Alyssa Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven
| | | | | | | | - Christina C Price
- Section of Allergy and Immunology, Yale School of Medicine
- VA Connecticut Healthcare System, West Haven, CT
| | - Loren Laine
- Section of Digestive Diseases
- VA Connecticut Healthcare System, West Haven, CT
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15
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Geiger-Gritsch S, Olschewski H, Kocher F, Wurm R, Absenger G, Flicker M, Hermann A, Heininger P, Fiegl M, Zechmeister M, Endel F, Wild C, Pall G. Real-world experience with anti-PD-1/PD-L1 monotherapy in patients with non-small cell lung cancer : A retrospective Austrian multicenter study. Wien Klin Wochenschr 2021; 133:1122-1130. [PMID: 34528126 DOI: 10.1007/s00508-021-01940-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE As real-world data regarding immunotherapy for non-small cell lung cancer are lacking for Austria, we conducted a retrospective study in six hospitals to present data from real-world practice. METHODS Patients with metastatic non-small cell lung cancer were stratified into two groups, either patients with first-line pembrolizumab monotherapy (cohort 1) or patients with second-line nivolumab, pembrolizumab or atezolizumab monotherapy (cohort 2). Primary outcome measures were objective response rate and overall survival. A matched-pair analysis was performed to compare overall survival to patients from the Tyrolean Lung Cancer Project as a historical control group. RESULTS In total, 89 patients were identified, 42 patients in cohort 1 and 47 patients in cohort 2. The objective response rates were 43.3% and 31.4%, respectively. The median overall survival was 17.0 months (95% CI 11.7-21.5 months) in cohort 1 and 18.7 months (95% CI 9.5-23.4 months) in cohort 2. Treatment-related adverse events grades 3 and 4 were reported in 11.2% of patients. The matched-pair analysis showed a median overall survival of 15.2 months (95% CI 7.6-20.4 months) for first-line pembrolizumab monotherapy compared to 9.8 months (95% CI 7.8-11.6 months) for the historical control (p = 0.43). In cohort 2, a median overall survival of 20.3 months (95% CI 6.9-26.2 months) for second-line immunotherapy compared to 5.4 months (95% CI 3.2-11.7 months) for the historical control (p = 0.18) was shown. CONCLUSION The results are comparable with other real-world studies and, when matched to historical controls, support the improvement in outcomes made possible by these agents.
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Affiliation(s)
- Sabine Geiger-Gritsch
- HTA Austria-Austrian Institute for Health Technology Assessment GmbH, Garnisongasse 7/20, 1090, Vienna, Austria.
| | - Horst Olschewski
- Department of Internal Medicine, Division of Pulmonology, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Florian Kocher
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Robert Wurm
- Department of Internal Medicine, Division of Pulmonology, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Gudrun Absenger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Martin Flicker
- Department of Lung Diseases, Landeskrankenhaus Hochsteiermark, Vordernberger Straße 42, 8700, Leoben, Austria
| | - André Hermann
- Department of Internal Medicine, Division of Gastroenterology, Infectiology & Pneumology, Landeskrankenhaus Graz II West, Göstinger Straße 22, 8020, Graz, Austria
| | - Peter Heininger
- Medical Directorate, District Hospital Schwaz, Swarovskistraße 1-3, 6130, Schwaz, Austria
| | - Michael Fiegl
- Internal Medicine, Privatklinik Hochrum, Lärchenstraße 41, 6063, Rum, Austria
| | | | - Florian Endel
- Verein DEXHELPP, Neustiftgasse 57-59, 1070, Vienna, Austria
| | - Claudia Wild
- HTA Austria-Austrian Institute for Health Technology Assessment GmbH, Garnisongasse 7/20, 1090, Vienna, Austria
| | - Georg Pall
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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16
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Yamamoto N, Nakanishi Y, Gemma A, Nakagawa K, Sakamoto T, Akamatsu A, Ohe Y. Real-world safety of nivolumab in patients with non-small-cell lung cancer in Japan: Postmarketing surveillance. Cancer Sci 2021; 112:4692-4701. [PMID: 34431585 PMCID: PMC8586674 DOI: 10.1111/cas.15117] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 12/26/2022] Open
Abstract
Postmarketing surveillance of Japanese patients with unresectable, previously treated, advanced or recurrent non‐small‐cell lung cancer treated with nivolumab was undertaken during the conditional approval period. The study aim was to evaluate the occurrence of treatment‐related adverse events of nivolumab in the real world. Patients were registered between December 2015 and March 2016 at 536 sites. Nivolumab was given intravenously (3 mg/kg every 2 weeks); the observation period was 12 months after the first dose of nivolumab. Patients were evaluated for safety (n = 3601; 18.2% ≥75 years, 22.4% ECOG performance status ≥2) and effectiveness (n = 3570). The frequencies of any grade and grade 3 or higher treatment‐related adverse events were 47.1% and 15.9%, respectively. The most frequent treatment‐related adverse events (any grade) were interstitial lung disease (6.4%), hypothyroidism (5.7%), and diarrhea (4.4%). Treatment‐related adverse events of special interest (priority items) occurring at a frequency of 5% or more were adverse events related to interstitial lung disease, thyroid dysfunction, liver dysfunction, colitis/severe diarrhea, infusion reaction, and infusion reaction within 24 hours. Significant risk factors for these priority items were identified by competing risk analysis: interstitial lung disease (previous/comorbid interstitial lung disease, abnormal findings on chest imaging, and smoking history); liver dysfunction (previous/comorbid liver disease, smoking history, and metastasis); thyroid dysfunction (previous/comorbid thyroid disease and performance status); and colitis/severe diarrhea (treatment line 2 vs ≥3). The 12‐month survival rate was 40.7%. In conclusion, the safety profile of nivolumab in this postmarketing surveillance was similar to that in clinical trials, and no new safety signals were identified. The study was registered with the Japan Pharmaceutical Information Center (clinicaltrials.jp: Japic‐163271).
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Affiliation(s)
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medicine, Kyushu University, Fukuoka, Japan.,Kitakyushu City Hospital Organization, Kitakyushu, Japan
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17
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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 DOI: 10.1002/onco.13909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [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.
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Affiliation(s)
- Marija Ivanović
- Department of Oncology, University Medical Centre Maribor, Maribor, Slovenia
| | - Lea Knez
- University Clinic Golnik, Golnik, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Herzog
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia.,Psychiatric Hospital Begunje, Begunje, Slovenia
| | | | - Tanja Cufer
- University Clinic Golnik, Golnik, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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18
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Hsu JC, Nguyen PA, Chen YT, Yang SC, Lin CC, Yang YH, Lin YC, Hsia TC, Hsieh HC, Wu JS, Chang CP, Feng YH, Lin PC, Hsu PC, Tzeng HE, Chien SC, Chang WC, Chang CC, Yang HC, Lee CM, Lu CY. The Effectiveness and Safety of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer Patients With Stage III/IV: A Multicenter Study. Front Oncol 2021; 11:671127. [PMID: 34307141 PMCID: PMC8293991 DOI: 10.3389/fonc.2021.671127] [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: 02/23/2021] [Accepted: 06/22/2021] [Indexed: 12/09/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have been approved to treat patients with various cancer types, including lung cancer, in many countries. This study aims to investigate the effectiveness and safety of ICIs under different treatment conditions of non-small cell lung cancer patients. A population-based retrospective cohort study was conducted using the electronic health records of three medical centers in Taiwan. From January 01, 2016, to November 30, 2018, a total of 91 ICIs and 300 traditional chemotherapy users who had undergone stage III and IV lung cancer treatment were included in the study. We performed the randomized matched pair design by selecting a Chemotherapy subject for each ICI patient in the sample population. All subjects were monitored from the date of taking ICIs or chemotherapy drugs until the event of death, loss to follow-up, or were occurred with any defined adverse events. Kaplan-Meier estimators and cox proportional hazard regression models were used to compute the overall survival, efficacy, and safety of the ICIs group. The median overall survival (OS) in the ICI and Chemo groups after matching was 11.2 months and 10.5 months, respectively. However, the results showed no significant OS differences between ICIs and chemo groups for both before and after matching (HR,1.30; 95%CI, 0.68-2.46; p=0.428 before matching and HR,0.96; 95CI%, 0.64-1.44; p=0.838 after matching). We observed that with the higher amount of PD-L1, the length of the patients’ overall survival was (positive vs. negative PD-L1, HR,0.21; 95%CI, 0.05-0.80; p=0.022). The incidences of serious adverse drug events above grade 3 in the ICIs and traditional chemo groups were 12.7% and 21.5%, respectively. We also found that the number of AEs was less in ICIs than in the Chemo group, and the AEs that occurred after treatments were observed earlier in the ICIs compared to the Chemo group. ICIs drugs were observed to be safer than traditional chemotherapy as they had a lower risk of serious adverse drug events. It is necessary to pay attention to immune-related side effects and provide appropriate treatment. Furthermore, the patient’s physical status and PD-L1 test can be used to evaluate the clinical effectiveness of ICIs.
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Affiliation(s)
- Jason C Hsu
- International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Phung-Anh Nguyen
- International Center for Health Information Technology, College of Medical Science & Technology, Taipei Medical University, Taipei, Taiwan.,Department of Healthcare Information & Management, Ming Chuan University, Taoyuan, Taiwan
| | - Yen-Tzu Chen
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hsin Yang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yu-Chao Lin
- Department of Respiratory Therapy, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Hsia
- Department of Respiratory Therapy, China Medical University Hospital, Taichung, Taiwan
| | - Hsing-Chun Hsieh
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jia-Syuan Wu
- Department of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chi-Pei Chang
- Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yin-Hsun Feng
- Division of Hematology and Oncology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Peng-Chan Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Chih Hsu
- Division of Thoracic Medicine, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huey-En Tzeng
- Division of Hematology and Oncology, Department of Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shu-Chen Chien
- Department of Clinical Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chiao Chang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chih-Cheng Chang
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Chia Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science & Technology, Taipei Medical University, Taipei, Taiwan
| | - Chueh Ming Lee
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
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19
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Sudmeier L, Tian S, Higgins KA. Multidisciplinary Management of Brain Metastases from Non-Small Cell Lung Cancer in the Era of Immunotherapy. Curr Treat Options Oncol 2021; 22:77. [PMID: 34213649 DOI: 10.1007/s11864-021-00871-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT Brain metastases from non-small cell lung cancer often cause neurologic symptoms which lead to initial diagnosis or identification of recurrence. In other patients, they are identified on surveillance imaging or when a patient undergoing treatment develops neurological symptoms. Patients with symptomatic lesions should be started on dexamethasone and evaluated by a neurosurgeon as soon as possible. If feasible, surgery should be offered to decrease intracranial pressure, alleviate symptoms, and prevent irreversible neurological damage. Postoperative stereotactic radiosurgery (SRS) to the resection cavity and any additional brain metastases should follow within 4 weeks of surgery, as early as 2 weeks post-op. Tissue from surgery is used to confirm the diagnosis and test for targetable oncogenic driver mutations. Treatment response and surveillance for development of additional lesions is assessed with MRI of the brain 1 month after SRS and every 3 months thereafter. Patients who are not surgical candidates or who have small, asymptomatic brain metastases should proceed with SRS, the preferred treatment, or sometimes whole-brain radiation therapy (WBRT) if multifocal disease requires more extensive treatment, such as for leptomeningeal spread of disease. The number of brain metastases that warrants use of WBRT over SRS is controversial and a topic of ongoing investigation, and is discussed in this review. When possible, SRS is preferred over WBRT due to reduce morbidity and cognitive side effects. When patients are already on systemic therapy at time of brain metastases diagnosis, systemic therapy should continue, with radiation therapy occurring between cycles. Regarding systemic therapy for new diagnosis at time of brain metastases presentation, molecular testing will guide treatment choice, when available. If there is no neurosurgical intervention, biopsy of another site of disease may provide tissue for molecular testing. If there are no targetable oncogenic driver mutations, concurrent immune checkpoint blockade (ICB) and chemotherapy is preferable for patients who can tolerate it. Single-agent ICB is an alternative option for patients who cannot tolerate chemotherapy. Systemic therapy should start as soon as possible. In some patients with poor performance status, best supportive care may be the most appropriate choice. Treatment decisions should always incorporate patients' goals of care and in many cases should be discussed in a multidisciplinary setting.
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Affiliation(s)
- Lisa Sudmeier
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Road, Atlanta, GA, 30322, USA
| | - Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Road, Atlanta, GA, 30322, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Road, Atlanta, GA, 30322, USA.
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20
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Thuillier P, Joly C, Alavi Z, Crouzeix G, Descourt R, Quere G, Kerlan V, Roudaut N. Thyroid dysfunction induced by immune checkpoint inhibitors is associated with a better progression-free survival and overall survival in non-small cell lung cancer: an original cohort study. Cancer Immunol Immunother 2021; 70:2023-2033. [PMID: 33423089 PMCID: PMC10991310 DOI: 10.1007/s00262-020-02802-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this study was to investigate the association between the onset of TD and treatment efficacy in NSCLC patients who initiated anti-PD-1 blockade (Nivolumab®) and to assess the impact of TD severity and subtype on nivolumab efficacy. MATERIALS AND METHODS This study was performed at a referral oncology center between July 20, 2015 and June 30, 2018. Patients with histologically confirmed stage IIIB/IV NSCLC in progression after one or two lines of treatment and who initiated Nivolumab were included. Thyroid function (TSH ± fT4, fT3) was monitored and patients were classified according to TD status [TD(+) versus TD(-)], severity [moderate thyroid dysfunction: TSH level between 0.1 and 0.4 or 4.0 and 10 mIU/L and severe thyroid dysfunction: TSH ≤ 0.1 or ≥ 10mUI/L) and subtype (isolated hypothyroidism, isolated hyperthyroidism and hyperthyroidism then hypothyroidism)]. Clinical endpoints were overall survival (OS) and progression-free survival (PFS). RESULTS Among 194 eligible patients, 134 patients (median age, 63 yo; 70.1% male) were included. Forty (29.9%) patients were classified in TD(+) and had a longer OS of 29.8 months (95% CI 18.8-NR) versus 8.1 months (95% CI 5.5-11.5) in TD(-) group (p < 0.001). PFS was also longer (8.7 months (95% CI 5.3-15.1) in TD(+) versus 1.7 months (95% CI 1.6-1.9) in TD(-) group (p < 0.001). In Cox proportional hazards analysis, TD remained an independent predictive factor of OS/PFS. Severity and subtype of TD were not correlated with OS/PFS. CONCLUSIONS This study suggested that TD induced by Nivolumab appears to be an independent predictive factor of survival, irrespective of TD severity and subtype.
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Affiliation(s)
- Philippe Thuillier
- Department of Endocrinology, University Hospital of Brest, Boulevard Tanguy Prigent, 29609, Brest Cedex, France.
- EA GETBO 3878, University Hospital of Brest, Brest Cedex, France.
| | - Claire Joly
- Department of Endocrinology, University Hospital of Brest, Boulevard Tanguy Prigent, 29609, Brest Cedex, France
- EA GETBO 3878, University Hospital of Brest, Brest Cedex, France
| | - Zarrin Alavi
- Inserm CIC 1412, University Hospital of Brest, Brest Cedex, France
| | - Geneviève Crouzeix
- Department of Endocrinology, University Hospital of Brest, Boulevard Tanguy Prigent, 29609, Brest Cedex, France
- EA GETBO 3878, University Hospital of Brest, Brest Cedex, France
| | - Renaud Descourt
- Department of Oncology, University Hospital of Brest, Brest Cedex, France
| | - Gilles Quere
- Department of Oncology, University Hospital of Brest, Brest Cedex, France
| | - Véronique Kerlan
- Department of Endocrinology, University Hospital of Brest, Boulevard Tanguy Prigent, 29609, Brest Cedex, France
- EA GETBO 3878, University Hospital of Brest, Brest Cedex, France
| | - Nathalie Roudaut
- Department of Endocrinology, University Hospital of Brest, Boulevard Tanguy Prigent, 29609, Brest Cedex, France
- EA GETBO 3878, University Hospital of Brest, Brest Cedex, France
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21
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Abbas MN, Klevansky M, Koczwara B, Roy AC, Sukumaran S, Vatandoust S, Karapetis CS. Real-world experience of nivolumab in the treatment of poor performance status patients with advanced non-small cell lung cancer. Cancer Rep (Hoboken) 2021; 5:e1487. [PMID: 34196124 PMCID: PMC8955060 DOI: 10.1002/cnr2.1487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nivolumab improves disease control and survival in advanced NSCLC in patients with good performance status (PS), but there is limited data on its efficacy in patients with poor PS. Aim Primary objective of the study was to evaluate the efficacy and safety of nivolumab and examine the influence of PS on outcomes. Methods and Results Retrospective analysis of patients treated with single‐agent nivolumab for advanced NSCLC at a single institution was performed. Sixty‐six patients treated with nivolumab were identified (33 male) with a median age of 68.5 years. Fifty‐six (85%) patients were current or former smokers and 17 (26%) had brain metastasis. All patients had received prior chemotherapy, 39 (59%) patients received one and 27 (41%) had ≥2 prior lines of therapy. Median overall survival (OS) was 7.1 months (95%CI 3.61–11.3) in the overall study population. OS of patients with PS ≥2 at the start of treatment was 3.04 months (95%CI 1.64–7.36) as compared to 10.23 months (95%CI 7.06–18.9) with PS ≤1. The overall response rate was 7% (four patients had a partial response), 23 (40%) patients had stable disease; the overall disease control rate (partial response and stable disease) was 47%. Twenty‐six (40%) patients had PS ≥2 at the start of treatment and 2 (8%) of these patients developed a partial response, 4 (15%) had stable disease; the overall disease control rate was 23%. Fourteen (58%) patients with PS ≥2 had disease progression at the time of first disease response evaluation. In the overall population, 20% of patients experienced grade ≥3 treatment‐related adverse events (TRAEs), most commonly pneumonitis, hepatitis, and colitis. Fourteen TRAEs led to treatment discontinuation, 9 (23%) adverse events (AEs) in patients with PS ≤1 and 5 (19%) with PS ≥2. Fourteen (21%) patients died within 30 days of the last nivolumab treatment. Conclusion There was no significant difference in toxicity leading to treatment discontinuation between the poor and good PS groups, but survival was shorter with poorer PS. PS appears to be an important prognostic factor and remains a relevant discriminator in the selection of treatment with immunotherapy for lung cancer.
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Affiliation(s)
- M Nazim Abbas
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Myron Klevansky
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amitesh Chandra Roy
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Shawgi Sukumaran
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sina Vatandoust
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Christos Stelios Karapetis
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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22
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Guaitoli G, Tiseo M, Di Maio M, Friboulet L, Facchinetti F. Immune checkpoint inhibitors in oncogene-addicted non-small cell lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2021; 10:2890-2916. [PMID: 34295687 PMCID: PMC8264334 DOI: 10.21037/tlcr-20-941] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022]
Abstract
Background Treatment of oncogene-addicted non-small cell lung cancer (NSCLC) has been changed by the advent of tyrosine kinase inhibitors (TKIs). Albeit great benefits are achieved with target therapies, resistance invariably occurs and recourse to alternative treatments is unavoidable. Immune checkpoint inhibitors (ICIs) role and the best setting of immunotherapy administration in oncogene-driven NSCLC are matter of debate. Methods We performed a systematic literature review through PubMed, in order to gather all the available information regarding ICI activity and efficacy in oncogene-addicted NSCLC, from both prospective trials and retrospective series. A meta-analysis of objective response rate in different molecular subgroups was provided. Combinatorial strategies including ICIs and related toxicities were also recorded. Results Eighty-seven studies were included in the qualitative analysis. EGFR mutation may be a biomarker of poor response to single-agent ICIs (7% of EGFR-mutant NSCLC patients achieved disease response in prospective trials), while encouraging results have been shown with combination strategies. KRAS-mutated disease (response rate, RR, 22%) has different clinical and pathological characteristics, and the co-existence of additional mutations (e.g., STK11 or TP53) influence tumor microenvironment and response to immunotherapy. Other molecular alterations have been marginally considered prospectively, and data from clinical practice are variegated, given poor effectiveness of ICIs in ALK-rearranged disease (RR 9.5%, pooling the data of retrospective studies) or some encouraging results in BRAF-(RR 25%, retrospective data) or MET-driven one (with estimations conditioned by the presence of both exon 14 skipping mutations and gene amplification in reported series). Conclusions In oncogene-addicted NSCLC (with the exception of KRAS-mutated), ICIs are usually administered at the failure of other treatment options, but administering single-agent immunotherapy in later disease phases may limit its efficacy. With the progressive administration of TKIs and ICIs in early-stage disease, molecular characterization will become fundamental in this setting.
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Affiliation(s)
- Giorgia Guaitoli
- Division of Medical Oncology, University Hospital of Modena, Modena, Italy.,Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin at Ordine Mauriziano Hospital, Torino, Italy
| | - Luc Friboulet
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Francesco Facchinetti
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
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23
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Debieuvre D, Juergens RA, Asselain B, Audigier-Valette C, Auliac JB, Barlesi F, Benoit N, Bombaron P, Butts CA, Dixmier A, Gröschel A, Gutz S, Labbé C, Moro-Sibilot D, Pérol M, Raspaud C, Schumann C, Juarez-Garcia A, Lakhdari K, Pettersson F, Penrod JR, Reynaud D, Waldenberger D, Allan V, Sebastian M. Two-year survival with nivolumab in previously treated advanced non-small-cell lung cancer: A real-world pooled analysis of patients from France, Germany, and Canada. Lung Cancer 2021; 157:40-47. [PMID: 33980420 DOI: 10.1016/j.lungcan.2021.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Immune checkpoint inhibitors have become the standard of care for metastatic non-small-cell lung cancer (NSCLC) progressing during or after platinum-based chemotherapy. Real-world clinical practice tends to represent more diverse patient characteristics than randomized clinical trials. We sought to evaluate overall survival (OS) outcomes in the total study population and in key subsets of patients who received nivolumab for previously treated advanced NSCLC in real-world settings in France, Germany, or Canada. MATERIALS AND METHODS Data were pooled from two prospective observational cohort studies, EVIDENS and ENLARGE, and a retrospective registry in Canada. Patients included in this analysis were aged ≥18 years, had stage IIIB/IV NSCLC, and received nivolumab after at least one prior line of systemic therapy. OS was estimated in the pooled population and in various subgroups using the Kaplan-Meier method. Timing of data collection varied across cohorts (2015-2019). RESULTS Of the 2585 patients included in this analyses, 1235 (47.8 %) were treated in France, 881 (34.1 %) in Germany, and 469 (18.1 %) in Canada. Median OS for the total study population was 11.3 months (95 % CI: 10.5-12.2); this was similar across France, Germany, and Canada. The OS rate was 49 % at 1 year and 28 % at 2 years for the total study population. In univariable Cox analyses, the presence of epidermal growth factor receptor mutations in nonsquamous disease, liver, or bone metastases were associated with significantly shorter OS, whereas tumor programmed death ligand 1 expression and Eastern Cooperative Oncology Group performance status 0-1 were associated with significantly prolonged OS. Similar OS was noted across subgroups of age and prior lines of therapy. CONCLUSION OS rates in patients receiving nivolumab for previously treated advanced NSCLC in real-world clinical practice closely mirrored those in phase 3 studies, suggesting similar effectiveness of nivolumab in clinical trials and clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Sylvia Gutz
- Ev. Diakonissenkrankenhaus, Leipzig, Germany
| | - Catherine Labbé
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada
| | - Denis Moro-Sibilot
- Thoracic Oncology Unit, SHUPP, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | | | | | - Christian Schumann
- Klinikverbund Allgäu, Klinik für Pneumologie, Thoraxonkologie, Schlaf- und Beatmungsmedizin, Kempten Und Immenstadt, Germany
| | | | | | | | | | | | | | | | - Martin Sebastian
- University Hospital, Goethe-University Frankfurt, Department of Hematology and Medical Oncology, Frankfurt, Germany.
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24
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Kocak MZ. Comment on 'Impact of performance status on non-small cell lung cancer patients with a PD-L1 tumour proportion score ≥50% treated with front-line pembrolizumab'. Acta Oncol 2021; 60:564-565. [PMID: 33612057 DOI: 10.1080/0284186x.2021.1889028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Mehmet Zahid Kocak
- Medical Oncology Department, Necmettin Erbakan University, Meram, Konya, Turkey
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25
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Epaillard N, Benitez JC, Gorria T, Fabre E, Riudavets M, Reyes R, Planchard D, Oudard S, Viñolas N, Reguart N, Besse B, Mezquita L, Auclin E. Pleural effusion is a negative prognostic factor for immunotherapy in patients with non-small cell lung cancer (NSCLC): The pluie study. Lung Cancer 2021; 155:114-119. [PMID: 33798900 DOI: 10.1016/j.lungcan.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pleural effusion (PE) is a common metastatic site of NSCLC, associated with poor outcomes. As very few data are available about immune checkpoint inhibitors (ICI) and PE, we aimed to assess the clinical outcome of PE in NSCLC treated with ICI. METHOD Multicenter international retrospective study of patients with metastatic NSCLC treated with ICI, between 2012 and 2019. Stratification according to the presence of PE at ICI baseline or appearance under ICI treatment (PE group) versus no history of PE (non-PE group). Primary endpoints were overall survival (OS) and early death rate (EDR, OS ≤ 3 months). RESULTS A total of 538 patients were included: 196 in the PE group and 342 in the non-PE group. In the PE group, median age was 64, 31.6 % were female, 77.6 % had non-squamous histology, PD-L1 was ≥50 % in 38.6 % of cases (95 missing). PE was more likely associated with >2 metastatic sites (70.4 % vs. 50 %) and worse performance status (PS ≥ 2, 30.8 % vs 23.1 %). Globally, the overall median OS was 9.7 months [95 %CI: 8.1-11.8]; 6.3 [95 % CI: 4.0-8.6] in PE vs. 11.4 [95 %CI: 9.7-13.8] in the non-PE respectively, P = 0.002. Overall the EDR was 31.4 %; higher in the PE group (38.3 % vs. 27.5 %; OR 1.63, 95 %CI: 1.13-2.37, P = 0.01). In the PE PD-L1≥50 % group, EDR was 33.3 %. In multivariate analysis, after adjustment on PS, liver/intracranial/bone metastasis, ICI line and dNLR, PE remained an independent prognostic factor for OS [HR: 1.38, 95 %CI: 1.09-1.74, P = 0.007]. In the PE group, PE appeared under ICI for 31 patients (16.4 %). We observed lower EDR in this group compared to patients whom PE was already present (29.0 % vs 40.5 %, P = 0.2). CONCLUSION PE is associated with worse immunotherapy outcomes in NSCLC treated with ICI, including in patients with ≥50 % PD-L1 tumors. Thus, in these patients, combination strategies should be explored.
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Affiliation(s)
- Nicolas Epaillard
- Medical and Thoracic Oncology Department, Hôpital Européen Georges Pompidou AP-HP, Université de Paris, France
| | | | - Teresa Gorria
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain
| | - Elizabeth Fabre
- Medical and Thoracic Oncology Department, Hôpital Européen Georges Pompidou AP-HP, Université de Paris, France
| | - Mariona Riudavets
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Roxana Reyes
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain
| | - David Planchard
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Stéphane Oudard
- Medical and Thoracic Oncology Department, Hôpital Européen Georges Pompidou AP-HP, Université de Paris, France
| | - Nuria Viñolas
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain
| | - Noemi Reguart
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain
| | - Benjamin Besse
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Laura Mezquita
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain
| | - Edouard Auclin
- Medical and Thoracic Oncology Department, Hôpital Européen Georges Pompidou AP-HP, Université de Paris, France.
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26
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Mencoboni M, Ceppi M, Bruzzone M, Taveggia P, Cavo A, Scordamaglia F, Gualco M, Filiberti RA. Effectiveness and Safety of Immune Checkpoint Inhibitors for Patients with Advanced Non Small-Cell Lung Cancer in Real-World: Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13061388. [PMID: 33808533 PMCID: PMC8003199 DOI: 10.3390/cancers13061388] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The benefit of programmed death-1/programmed death ligand-1 (PD-1/PD-L1) immunotherapy, particularly of nivolumab, pembrolizumab and atezolizumab, in the second-line setting of patients with non-small cell lung cancer has been documented in randomized clinical trials, showing improvements in global survival and in the overall response rate. Nevertheless, patients enrolled in these studies met strict eligibility criteria, allowing for the treatment of patients that do not reflect the broader oncology patient population. Experiences from real-world data are useful in providing further evidence of the benefit of treatment in a wider range of patients, including those underrepresented in clinical trials. We performed a meta-analysis to evaluate the outcomes in non-small cell lung cancer patients treated in everyday practice with these drugs as the second line, and more generally with immunotherapy with checkpoint inhibitors (ICIs), showing that the efficacy and safety were comparable to those in selected studies. Results may encourage to treat patients excluded from randomized studies. Abstract Immunotherapy based on anti PD-1/PD-L1 inhibitors is the new standard of advanced non-small cell lung cancers. Pembrolizumab, nivolumab and atezolizumab are used in clinical practice. The strict eligibility criteria of clinical trials do not allow researchers to fully represent treatment effects in the patients that will ultimately use these drugs. We performed a systematic review and a meta-analysis to evaluate the effectiveness and safety of these drugs, and more generally of ICIs, as second-line therapy in NSCLC patients in real world practice. MEDLINE, PubMed, Scopus and Web of Science were searched to include original studies published between January 2015 and April 2020. A total of 32 studies was included in the meta-analysis. The overall radiological response rate (ORR), disease control rate (DCR), median progression-free survival (PFS) and overall survival (OS) were 21%, 52%, 3.35 months and 9.98 months, respectively. The results did not change when analysis was adjusted for Eastern Cooperative Oncology Group performance status (ECOG PS) and age. A unitary increase in the percent of patients with liver and CNS metastases reduced the occurrence of DCR by 7% (p < 0.001) and the median PFS by 2% (p = 0.010), respectively. The meta-analysis showed that the efficacy and safety of immunotherapy in everyday practice is comparable to that in clinical trials.
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Affiliation(s)
- Manlio Mencoboni
- SSD Oncologia Ospedale Villa Scassi, ASL 3 Genovese, 16149 Genova, Italy; (M.M.); (P.T.); (A.C.)
| | - Marcello Ceppi
- Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.C.); (M.B.)
| | - Marco Bruzzone
- Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.C.); (M.B.)
| | - Paola Taveggia
- SSD Oncologia Ospedale Villa Scassi, ASL 3 Genovese, 16149 Genova, Italy; (M.M.); (P.T.); (A.C.)
| | - Alessia Cavo
- SSD Oncologia Ospedale Villa Scassi, ASL 3 Genovese, 16149 Genova, Italy; (M.M.); (P.T.); (A.C.)
| | | | - Marina Gualco
- SC Anatomia Patologica Ospedale Villa Scassi, ASL 3 Genovese, 16149 Genova, Italy;
| | - Rosa Angela Filiberti
- Clinical Epidemiology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.C.); (M.B.)
- Correspondence:
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27
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Rizzo MM, Bluthgen MV, Recondo G, Naveira M, Perfetti A, Rizzi F, Kuzminin A, Faura V, Cerini M, Videla A, Silva C, Lupinacci L, Minatta N. Outcomes of patients with non-small cell lung cancer and poor performance status treated with immune checkpoint inhibitors in the real-world setting. Int J Clin Oncol 2021; 26:1057-1064. [PMID: 33715058 DOI: 10.1007/s10147-021-01896-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Immune-checkpoint inhibitors (ICIs) are standard treatments for metastatic non-small cell lung cancer (NSCLC). Patients with poor performance status (PS) are underrepresented in clinical trials. We evaluate the efficacy and safety of ICIs in a real-world setting. METHODS We conducted a multi-institutional retrospective study to assess clinical outcomes of NSCLC treated with ICIs. We categorized pts within two groups (PS 0-1 vs 2) and assessed clinical outcomes and safety. RESULTS Two hundred and sixty nine patients were included, 44 patients (16.4%) had baseline PS 2 and 223 patients (82.9%) PS 0-1. The overall response rate (ORR) was 30.4%, median PFS was 7.26 months (95% CI 5.1-9.4), and median OS was 15.18 months (95% CI 9.5-20.9). Patients with a PS 2 were most likely to received ICIs in the second or later line (84.1% vs 64.6%; p = 0.01), had baseline steroids (21.4% vs 8.2%; p 0.010), lower response rate (16.7% vs 34.5%; p 0.02) and clinical benefit (35.7% vs 71%; p 0.000) compared to PS 0-1 pts. Moreover, PS ≥ 2 patients had shorter PFS, median 2.2 months (95% CI 1.3-3.1) compared to 9.9 months (95% CI 6.7-13.1] and shorter OS, 3.3 months (95% CI 2.6-4.2) versus 24.1 months (95% CI 16.1-32.1), respectively. PS was significantly associated with PFS and OS in multivariate analysis. As it was expected, immunotherapy was well tolerated with a safety profile comparable to the previous published data. CONCLUSION Based on these retrospective results, patients with poor baseline performance status seem to have poor clinical outcomes with ICIs in the real-world setting.
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Affiliation(s)
- Manglio Miguel Rizzo
- Hospital Universitario Austral, Av. Pte. Perón 1500, Derqui, Pilar, Buenos Aires, Argentina.
| | | | - Gonzalo Recondo
- Centro de Educación Médica E Investigaciones Clínicas (CEMIC). Av. Gral. Las Heras 2900, CABA, Buenos Aires, Argentina
| | - Martin Naveira
- Hospital Británico de Buenos Aires, CABA, Perdriel 74, Buenos Aires, Argentina
| | - Aldo Perfetti
- Hospital Donación Francisco Santojanni, Pilar 950, Buenos Aires, Argentina
| | - Florencia Rizzi
- Hospital Alemán, CABA, Av. Pueyrredón 1640, Buenos Aires, Argentina
| | - Alejandro Kuzminin
- Centro de Educación Médica E Investigaciones Clínicas (CEMIC). Av. Gral. Las Heras 2900, CABA, Buenos Aires, Argentina
| | - Victoria Faura
- Hospital Británico de Buenos Aires, CABA, Perdriel 74, Buenos Aires, Argentina
| | - Matías Cerini
- Hospital Italiano de Buenos Aires, CABA, Pres. Tte. Gral. Juan Domingo Perón, 4190, Buenos Aires, Argentina
| | - Alejandro Videla
- Hospital Universitario Austral, Av. Pte. Perón 1500, Derqui, Pilar, Buenos Aires, Argentina
| | - Carlos Silva
- Hospital Universitario Austral, Av. Pte. Perón 1500, Derqui, Pilar, Buenos Aires, Argentina
| | - Lorena Lupinacci
- Hospital Italiano de Buenos Aires, CABA, Pres. Tte. Gral. Juan Domingo Perón, 4190, Buenos Aires, Argentina
| | - Nicolás Minatta
- Hospital Italiano de Buenos Aires, CABA, Pres. Tte. Gral. Juan Domingo Perón, 4190, Buenos Aires, Argentina
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Modified Glasgow Prognostic Score predicts survival among advanced non-small cell lung carcinoma patients treated with anti-PD1 agents. Anticancer Drugs 2021; 32:567-574. [PMID: 33661189 DOI: 10.1097/cad.0000000000001060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Immune checkpoint inhibitors were approved for advanced nonsmall cell lung cancer (NSCLC) treatment. Despite improved survival, not all patients benefit from these agents. Here, the prognostic impact of pretreatment modified Glasgow Prognostic Score (mGPS) and neutrophil-to-lymphocyte ratio (NLR) was assessed. From 77 patients included, 83.2% received at least one prior systemic therapy. Immune-related adverse events (irAE) occurred in 20 patients. A lower mGPS was associated with higher median overall survival (OS), and a lower Eastern Cooperative Oncology Group (ECOG), irAE and fewer metastatic sites with better survival. A trend towards greater OS and progression-free survival (PFS) was stated among patients with NLR <5. mGPS 0 was associated with better survival; ≥3 metastatic sites with worse PFS and OS; ECOG >2 with worse OS and irAE with better survival. Pretreatment mGPS seems to be useful for predicting survival among advanced NSCLC patients treated with anti-programmed cell death 1 drugs, with ECOG performance status, irAE occurrence, and number of metastatic sites acting as survival predictors.
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Mielgo-Rubio X, Uribelarrea EA, Cortés LQ, Moyano MS. Immunotherapy in non-small cell lung cancer: Update and new insights. J Clin Transl Res 2021; 7:1-21. [PMID: 34104805 PMCID: PMC8177026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/15/2020] [Accepted: 11/15/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The treatment of non-small-cell lung carcinoma (NSCLC) has changed markedly in recent years as a result of two major treatment milestones: Targeted therapy and immunotherapy. Since 2015, immunotherapy has been changing the paradigm of NSCLC treatment in different settings and has contributed to improve the quality of life of these patients. The most widely used immunotherapy strategy in clinical practice is currently PD-1 and CTLA-4 immune checkpoint inhibition-based immunotherapy. Initial successful results came from an improvement in overall survival for pretreated patients, and immunotherapy subsequently moved to a first-line palliative setting as monotherapy, in combination with chemotherapy or as double-checkpoint inhibition. With regard to earlier stages, consolidation immunotherapy after chemoradiation has also changed the paradigm of unresectable NSCLC, with marked benefits in terms of disease-free and overall survival. During the last few years, efforts have focused on the introduction of immunotherapy in earlier stages as neoadjuvant treatment for potentially resectable tumors and in an adjuvant setting, with some very promising results. AIM In this manuscript, we provide both an agile and thorough review of the role of immunotherapy in non-small cell lung cancer, a critical analysis of the most important studies, current indications, the role of biomarkers, new insights, and future challenges. RELEVANCE FOR PATIENTS Immunotherapy has revolutionized the treatment of non-small cell lung cancer patients reaching better survival outcomes in first and second palliative setting and in unresectable stage III tumors. Next year's immunotherapy will also introduce in earlier stages. Through an extensive knowledge of the mechanisms of action and of immunotherapy-based studies, the best treatment alternative can be offered to patients, helping to improve their survival and cure rates.
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Affiliation(s)
- Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | | | - María Sereno Moyano
- Department of Medical Oncology, Hospital Universitario Infanta Sofía, Alcobendas, Madrid, Spain
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Arias Ron D, Areses Manrique MC, Mosquera Martínez J, García González J, Afonso Afonso FJ, Lázaro Quintela M, Fernández Núñez N, Azpitarte Raposeiras C, Amenedo Gancedo M, Santomé Couto L, García Campelo MR, Muñoz Iglesias J, Ruiz Bañobre J, Vilchez Simo R, Casal Rubio J, Campos Balea B, Carou Frieiro I, Alonso-Jaudenes Curbera G, Anido Herranz U, García Mata J, Fírvida Pérez JL. Efficacy and safety of Nivolumab in older patients with pretreated lung cancer: A subgroup analysis of the Galician lung cancer group. J Geriatr Oncol 2020; 12:410-415. [PMID: 33357975 DOI: 10.1016/j.jgo.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/14/2020] [Accepted: 11/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nivolumab is an anti PD1 immunotherapy drug approved for advanced Non-Small Cell Lung Cancer (NSCLC) patients who previously received at least one prior line of treatment. Older patients are often not represented in clinical trials and drugs with acceptable safety profiles are necessary. We aim to report the efficacy and safety profile of Nivolumab in the real-world older subgroup of the Galician lung cancer group study. PATIENTS AND METHODS We retrospectively reviewed 188 advanced NSCLC patients treated with at least one prior therapy. We collected data from patients who were ≥70 years old treated with Nivolumab in second or subsequent lines. Patient characteristics, treatment efficacy (overall survival, progression-free survival, and response rate), and safety profile were reported. RESULTS Thirty-eight patients aged ≥70 years were included in the subgroup analysis. The median age was 74.5 years, a high percentage of patients were males (95%), most had a Performance Status of 1 (79%) and only 13% were non-smokers. The predominant histology was adenocarcinoma (53%), and 18% of patients received 2 or more lines. The median Progression-Free Survival was 7.53 months (CI 4.3-17.3, p = 0.15) and the median Overall Survival was 14.85 months (CI 10.5-20.7, p = 0.44). The objective response rate was 42%. No new adverse events were reported in comparison to a global population. CONCLUSIONS The efficacy and safety profile of Nivolumab in advanced NSCLC patients treated with at least one prior therapy and age ≥70 years old can be overlapped to a global population. Further prospective trials are needed to define and confirm these results.
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Affiliation(s)
- David Arias Ron
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain.
| | | | | | - Jorge García González
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | | | | | | | | | | | | | | | - Jose Muñoz Iglesias
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Juan Ruiz Bañobre
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | - Rocío Vilchez Simo
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Begoña Campos Balea
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Iria Carou Frieiro
- Medical Oncology Department, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | | | - Urbano Anido Herranz
- Medical Oncology Department, Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS), Santiago de Compostela 15706, Spain
| | - Jesús García Mata
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
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Ge X, Zhang Z, Zhang S, Yuan F, Zhang F, Yan X, Han X, Ma J, Wang L, Tao H, Li X, Zhi X, Huang Z, Hofman P, Prelaj A, Banna GL, Mutti L, Hu Y, Wang J. Immunotherapy beyond progression in patients with advanced non-small cell lung cancer. Transl Lung Cancer Res 2020; 9:2391-2400. [PMID: 33489801 PMCID: PMC7815351 DOI: 10.21037/tlcr-20-1252] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Immune checkpoint inhibitors (ICIs) represent a great breakthrough in the treatment of advanced non-small cell lung cancer (aNSCLC). However, whether immunotherapy beyond progression (IBP) is effective for aNSCLC has yet to be established. Therefore, a retrospective clinical study was conducted to investigate the efficacy of IBP in patients with aNSCLC under real-world conditions. Methods A total of 125 Chinese patients with aNSCLC who experienced progressive disease (PD) after receiving monotherapy or combination therapy (combined with chemotherapy or/and antiangiogenic therapy) with programmed cell death-1 (PD-1)/programmed cell death ligand-1 (PD-L1) inhibitors between January 2015 and March 2019 were enrolled. Patients who were treated with ICIs for more than 6 weeks after PD were defined as IBP (n=39), while those who received ICI treatment for less than 6 weeks or discontinued it due to PD were defined as non-IBP (n=86). Patient clinical characteristics were evaluated. An optimization-based method was applied to balance the clinical baseline characteristics between the two groups. Results In total population, the IBP group had longer overall survival (median OS, 26.6 vs. 9.5 months; HR, 0.40; 95% CI: 0.23–0.69; P<0.001) and progression-free survival (median PFS, 8.9 vs. 4.1 months; HR, 0.41; 95% CI: 0.26–0.65; P<0.001), compared with the non-IBP group. Despite no significant difference in objective response rate (ORR, 15.4% vs. 11.6%, P=0.560), disease control rate (DCR) was significantly higher in the IBP group (89.7% vs. 61.6%, P<0.001). After balancing baseline covariates, the IBP group also had longer OS (median: 26.6 vs. 10.7 months; HR, 0.40; 95% CI: 0.19–0.84; P=0.015) and PFS (median: 9.7 vs. 4.3 months; HR, 0.28; 95% CI: 0.15–0.51; P<0.001), with a benefit in either of patients previously treated with ICI monotherapy or in combination therapy and with non-response to the previously ICI. Conclusions IBP is associated with longer OS and PFS in patients with aNSCLC. Our findings may suggest new therapeutic options for patients with aNSCLC who experienced disease progression after initial immunotherapy.
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Affiliation(s)
- Xiangwei Ge
- Medical School of Chinese PLA, Beijing, China.,Department of Oncology, the Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhibo Zhang
- Department of Oncology, the Second Medical Center, Chinese PLA General Hospital, Beijing, China.,The 78th Group Army Hospital of Chinese PLA, Mudanjiang, China
| | - Sujie Zhang
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Fang Yuan
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Fan Zhang
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Xiang Yan
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Xiao Han
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Junxun Ma
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Lijie Wang
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Haitao Tao
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyan Li
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyu Zhi
- Medical School of Chinese PLA, Beijing, China.,Department of Oncology, the Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | | | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France
| | - Arsela Prelaj
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.,Department of Electronics, Information, and Bioengineering, Polytechnic University of Milan, Milan, Italy
| | - Giuseppe Luigi Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Luciano Mutti
- Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - Yi Hu
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Jinliang Wang
- Department of Oncology, the Second Medical Center, Chinese PLA General Hospital, Beijing, China.,Department of Oncology, Chinese PLA General Hospital, Beijing, China
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Schouten RD, Egberink L, Muller M, De Gooijer CJ, van Werkhoven E, van den Heuvel MM, Baas P. Nivolumab in pre-treated advanced non-small cell lung cancer: long term follow up data from the Dutch expanded access program and routine clinical care. Transl Lung Cancer Res 2020; 9:1736-1748. [PMID: 33209597 PMCID: PMC7653122 DOI: 10.21037/tlcr-19-698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background For advanced non-small cell lung cancer anti-PD-1 treatment has become standard care in first and second line treatment in recent years. Because many of the clinical trials with anti-PD-1 drugs have only recently been completed, long term follow up data of patients treated with these agents is scarce, even more so of patients treated in real life clinical care. We present long term follow up of patients treated with nivolumab. Methods Two hundred forty-eight patients with pre-treated, advanced NSCLC who received nivolumab between August 2015 and December 2018 were included in this retrospective cohort study. Overall survival and progression free survival rates were calculated for the total cohort and for subgroups defined by clinical characteristics, responses to treatment, and other parameters. Data on further lines of treatment and characteristics of long term survivors were also collected. Results Median overall survival in the total cohort was 8.1 months, median progression free survival was 2.8 months. Overall survival after two and three years was 23.8% and 17.1%, respectively. Good ECOG performance scores, absence of liver metastases, experiencing treatment-related toxicity, and response to nivolumab were significantly associated with longer overall survival and progression free survival. Three-year survival rate among patients with an objective response was 55.3%. Survival for more than two years without subsequent therapy after nivolumab was observed in 13.3% of patients. Conclusions The results from our study confirm that long term survival rates of patients treated with nivolumab for advanced NSCLC in a real world clinical setting are comparable to survival rates shown in clinical trials.
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Affiliation(s)
- Robert D Schouten
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lucie Egberink
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mirte Muller
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cornedine J De Gooijer
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michel M van den Heuvel
- Department of Respiratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pulmonology, Leiden University Medical Centre, Leiden, The Netherlands
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Efficacy and Safety of Nivolumab in Previously Treated Patients With Non–Small-cell Lung Cancer: Real World Experience in Argentina. Clin Lung Cancer 2020; 21:e380-e387. [DOI: 10.1016/j.cllc.2020.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/21/2020] [Accepted: 02/13/2020] [Indexed: 12/12/2022]
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Friedlaender A, Metro G, Signorelli D, Gili A, Economopoulou P, Roila F, Banna G, De Toma A, Camerini A, Christopoulou A, Lo Russo G, Banini M, Galetta D, Jimenez B, Collazo-Lorduy A, Calles A, Baxevanos P, Linardou H, Kosmidis P, Mountzios G, Garassino MC, Addeo A. Impact of performance status on non-small-cell lung cancer patients with a PD-L1 tumour proportion score ≥50% treated with front-line pembrolizumab. Acta Oncol 2020; 59:1058-1063. [PMID: 32762415 DOI: 10.1080/0284186x.2020.1781249] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives: We retrospectively analysed patients with advanced non-small-cell lung cancer (NSCLC) harbouring high PD-L1 expression (>50%) and treated with front-line pembrolizumab, comparing outcomes of patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 to those with PS 0-1.Methods: Data were collected by 16 participating centres. All patients with NSCLC and high PD-L1, treated with first-line pembrolizumab were included. We collected medical data from patient files, pathology and laboratory reports. Patient characteristics, comorbidities, PS, and tumour characteristics were reported. Overall survival (OS), progression-free survival (PFS) and response rate (RR) were calculated.Results: 302 patients were included, 246 with PS 0-1, 56 with PS 2. RR was 72% among patients with PS 0-1 compared to 45% with PS2 (odds ratio (OR) 0.31 (95% CI: 0.17-0.57), p < .001). Median PFS was 2.6 months (95% CI: 1.9-5.1) among patients with PS2 and 11.3 months (95% CI: 8.5-14.4) among those with PS 0-1. Median OS was 7.8 months (95% CI: 2.5-10.7) in the PS2 group, not reached in the PS 0-1 group. PS 2 remained predictive of poor outcomes in multivariate analysis.Conclusion: PS 2 is a strong independent predictor of poor response and survival in NSCLC patients with high PD-L1, treated with front-line pembrolizumab. Prospective randomised trials comparing immunotherapy to chemotherapy in this population would be welcome.
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Affiliation(s)
- Alex Friedlaender
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Giulio Metro
- Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Diego Signorelli
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy
| | - Alessio Gili
- Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Fausto Roila
- Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | - Alessandro De Toma
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy
| | - Andrea Camerini
- U.O.C. Oncologia, Ospedale Versilia, Lido di Camaiore (LU), Italy
| | | | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy
| | - Marco Banini
- Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Domenico Galetta
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Beatriz Jimenez
- Medical Oncology, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | | | - Antonio Calles
- Division of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Panagiotis Baxevanos
- Second Department of Medical Oncology, Saint Savvas Anti-Cancer Hospital, Athens, Greece
| | - Helena Linardou
- First Department of Medical Oncology, Metropolitan Hospital, Athens, Greece
| | - Paris Kosmidis
- Second Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - Giannis Mountzios
- Second Department of Medical Oncology, Henry Dunant Hospital Center, Athens, Greece
| | - Marina C. Garassino
- Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy
| | - Alfredo Addeo
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
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Hu ZY, Huang WY, Zhang L, Huang B, Chen SC, Li XL. Expression of AKT and p-AKT protein in lung adenocarcinoma and its correlation with PD-L1 protein and prognosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1172. [PMID: 33241021 PMCID: PMC7576079 DOI: 10.21037/atm-20-5865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background The PI3K/AKT/mTOR signaling pathway were significantly associated with EGFR mutation in lung adenocarcinoma (LUAD), but its correlation with PD-L1 protein and prognosis are not clear. The aim of this study was to evaluate the expression of AKT and phosphorylated AKT (p-AKT) in LUAD and its correlation with programmed death ligand-1 (PD-L1); and to analyze the factors affecting LUAD prognosis. Methods The expression of AKT, p-AKT, and PD-L1 was examined using immunohistochemistry in LUAD tissues from 110 patients who underwent surgical treatment. Results AKT protein expression was examined in 64.5% (71/110) of the LUAD samples, and p-AKT protein expression was examined in 44.5% (49/110) of the LUAD samples. The positive rate of PD-L1 at TC1/2/3 was 38.2% (42/110). AKT and p-AKT expression was significantly associated with epidermal growth factor receptor (EGFR) mutation (P=0.016, P=0.014 respectively). Pearson's correlation analysis indicated a negative correlation of p-AKT with PD-L1 protein (P=0.022). Out of the 62 patients with EGFR mutation, the expression of PD-L1 was negatively correlated with that of p-AKT protein (P=0.032). The expressions of AKT and p-AKT were not associated with prognosis. Multivariate analysis showed that tumor-node-metastasis (TNM) stage (P=0.013) and differentiation (P=0.046) were independent prognostic factors for overall survival. Conclusions PI3K/AKT/mTOR in the downstream pathway of EGFR may negatively regulate the expression of PD-L1, which may partly explain why patients with EGFR mutation respond poorly to PD-1/PD-L1 inhibitors.
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Affiliation(s)
- Zhi-Ying Hu
- Department of Thoracic Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.,Department of Respiratory and Critical Care Medicine, Dalian Third People's Hospital, Dalian, China
| | - Wan-Yi Huang
- Department of aging Science and Pharmacology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Lei Zhang
- Department of Oncology, Shenyang Fifth People Hospital, Shenyang, China
| | - Bo Huang
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Shu-Chen Chen
- Department of Thoracic Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Xiao-Ling Li
- Department of Thoracic Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
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Kim YJ, Oremus M, Chen HH, McFarlane T, Shah D, Horton S. Real-world effectiveness of nivolumab in patients with non-small-cell lung cancer: a systematic review and meta-analysis. Future Oncol 2020; 16:2045-2058. [DOI: 10.2217/fon-2020-0248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The effectiveness of immunotherapies for non-small-cell lung cancer under real-world clinical settings remains uncertain. Materials & methods: Systematic searches of PubMed, EMBASE and Web of Science were conducted. Random-effects models were used to estimate pooled median overall survival and progression-free survival estimates. Results: 36 studies of nivolumab were included for narrative synthesis and 11 of these studies were included for meta-analysis. Age, sex, histology and prior lines of treatment did not affect survival outcomes, while Eastern Cooperative Oncology Group Performance Status and brain metastasis were inversely associated with survival. In the meta-analysis, nivolumab was associated with 9.6 months (95% CI: 8.4–10.9) of overall survival and 2.6 months (95% CI: 1.6–3.6) of progression-free survival. Conclusion: Very-low-certainty evidence suggested the real-world effectiveness of nivolumab was consistent with those observed in the clinical trials.
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Affiliation(s)
- Yong-Jin Kim
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
| | - Mark Oremus
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
| | - Helen H Chen
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
| | - Thomas McFarlane
- University of Waterloo, School of Pharmacy, Kitchener, ON N2G 1C5, Canada
| | - Devanshi Shah
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
| | - Susan Horton
- University of Waterloo, School of Public Health & Health Systems, Waterloo, ON N2L 3G1, Canada
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Real-World Effectiveness of Nivolumab Monotherapy After Prior Systemic Therapy in Advanced Non-Small-Cell Lung Cancer in the United States. Clin Lung Cancer 2020; 22:e35-e47. [PMID: 33187914 DOI: 10.1016/j.cllc.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/08/2020] [Accepted: 07/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In phase 3 clinical trials, nivolumab prolonged overall survival (OS) compared to chemotherapy in patients with previously treated advanced non-small-cell lung cancer (NSCLC). This retrospective real-world study evaluated OS in patients receiving nivolumab for previously treated advanced NSCLC primarily in US community hospitals. PATIENTS AND METHODS Patient data were taken from electronic health records in the Flatiron Health oncology database. OS was evaluated in patients receiving nivolumab monotherapy for nonsquamous or squamous advanced NSCLC after prior chemotherapy; subgroup analyses were performed by Eastern Cooperative Oncology Group performance status (ECOG PS), age, and other baseline characteristics. Cox analysis was used to determine OS predictors. RESULTS Of 3019 included patients, 1968 (65%) had nonsquamous and 1051 (35%) had squamous histology. In both cohorts, approximately 20% of patients had a verified ECOG PS ≥ 2, and > 25% were aged ≥ 75 years. For all patients, median OS in the nonsquamous and squamous cohorts was 8.6 months (95% confidence interval [CI], 8.0-9.3) and 7.4 months (95% CI, 6.8-8.5), respectively; for those with ECOG PS 0-1, median OS was 10.8 months (95% CI, 9.8-11.8) and 8.7 months (95% CI, 7.6-9.7), respectively. In both cohorts, programmed death ligand 1 expression ≥ 1% and ECOG PS 0-1 were associated with longer OS (P < .05); the number of prior lines of therapy and age ≥ 75 years had no significant association with OS. CONCLUSIONS This study confirmed the effectiveness of nivolumab monotherapy for previously treated advanced NSCLC in real-world clinical practice. Poor ECOG PS, but not advanced age, was associated with shorter OS.
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Veraldi M, Esposito S, Naturale MD, Oradei M, Cosco D, Francesco AED, Cicchetti A, Bidino RD. Real-world data on patients with metastatic non-small-cell lung cancer treated with checkpoint inhibitors in an Italian Teaching Hospital in 2015-2018. J Oncol Pharm Pract 2020; 27:877-886. [PMID: 32686615 DOI: 10.1177/1078155220941586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Non-small-cell lung carcinoma (NSCLC) accounts for 85-90% of all forms of lung cancer. Immuno-oncology represents a valid new approach but the high cost requires a specific evaluation of the health outcomes. This study describes the real-world efficacy, safety and cost profiles of the new anti-PD-1 immune-checkpoint inhibitors nivolumab and pembrolizumab on a cohort of 56 selected patients with advanced NSCLC. METHODS A retrospective, observational analysis was conducted on patients treated with immune checkpoint inhibitors from September 2015 to September 2018 at Azienda Ospedaliera Universitaria "Mater Domini" in Catanzaro, Italy. Data sources were medical records, internal prescription cards and reports of adverse reactions. RESULTS Fifty-six patients were diagnosed with advanced NSCLC, 64.3% characterized by a non-squamous histology, 30.3% squamous and 5.4% not specified. First-line treatment with pembrolizumab was administered to 11 patients for an average of 4.4 months, while 45 patients were treated with nivolumab for an average of 8.6 months. Data showed a survival rate of 95% after 6 months and 88% after 12 months. Most patients received immunotherapy as a second-line or subsequent treatment. In terms of prior therapy among all the patients, 43 had received platinum-based treatments. Indirect comparison with other real-world data studies showed variability in methodologies and an alignment in terms of results. CONCLUSION This study, based on real-world data, was a first step in the assessment of the impact of the introduction of a significant new class of treatments, i.e. immunotherapy, and covers patients, treatments and outcomes, as well as organizational and economic variables.
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Affiliation(s)
- Marianna Veraldi
- Pharmacy Unit, "Mater Domini" University Hospital, Catanzaro, Italy
| | | | - Maria D Naturale
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Oradei
- Health Technology Assessment Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Donato Cosco
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | | | - Americo Cicchetti
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rossella Di Bidino
- Health Technology Assessment Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Knetki-Wróblewska M, Kowalski DM, Krzakowski M. Nivolumab for Previously Treated Patients with Non-Small-Cell Lung Cancer-Daily Practice versus Clinical Trials. J Clin Med 2020; 9:jcm9072273. [PMID: 32708936 PMCID: PMC7408765 DOI: 10.3390/jcm9072273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Based on the results of the CheckMate 017 and CheckMate 057 studies, nivolumab therapy has become a new standard treatment for both squamous and non-squamous non-small-cell lung cancer (NSCLC). However, due to the specific inclusion criteria of these clinical trials, the efficacy and safety of nivolumab in real-world practice were not certain. In general, the real-world results of nivolumab treatment have been consistent with those obtained in clinical trials. Additional analyses of the real-world data have made the identification of prognostic factors possible. Good performance status is the most significant predictor of clinical benefit. Brain metastases, liver metastases, EGFR mutation, malignant pleural effusion, and a high number of metastatic sites were identified as negative prognostic factors. By contrast, a longer time to disease progression (>6 months) from the beginning of prior chemotherapy and an objective response to chemotherapy seem to have positive prognostic value in the case of nivolumab treatment. In terms of patient age, the data are inconclusive. Some blood biomarkers can also be considered significant prognostic factors.
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40
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Navani V, Graves MC, Bowden NA, Van Der Westhuizen A. Immune checkpoint blockade in solid organ tumours: Choice, dose and predictors of response. Br J Clin Pharmacol 2020; 86:1736-1752. [PMID: 32384184 DOI: 10.1111/bcp.14352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/02/2020] [Accepted: 04/27/2020] [Indexed: 02/06/2023] Open
Abstract
Immune checkpoint blockade has transformed outcomes across solid organ tumours. Monoclonal antibodies targeting the negative inhibitory cytotoxic T lymphocyte-associated protein 4 and programmed-death 1/programmed death-ligand 1 axis can lead to deep and durable responses across several tumour streams in the advanced setting. This immunotherapy approach is increasingly used earlier in the treatment paradigm. A rapidly evolving regulatory, reimbursement and drug development landscape has accompanied this novel class of immunotherapy. Unfortunately, only a small proportion of patients respond meaningfully to these agents. Here we review how the underlying tumoural genomic, histological and immunological characteristics interact within various patient phenotypes, leading to variations in response to checkpoint blockade. Concurrently, we outline the clinical trial and real-world evidence that allows for appropriate selection of agent, dose and schedule in solid organ malignancies. An exploration of current trends in basic and translational research in immune checkpoint blockade accompanies a commentary on future clinical directions for checkpoint blockade in oncology.
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Affiliation(s)
| | - Moira C Graves
- University of Newcastle and Centre for Human Drug Research, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Nikola A Bowden
- University of Newcastle and Centre for Human Drug Research, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Andre Van Der Westhuizen
- University of Newcastle and Centre for Human Drug Research, Hunter Medical Research Institute, Newcastle, NSW, Australia.,Calvary Mater Hospital, Newcastle, NSW, Australia
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41
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Barlesi F, Dixmier A, Debieuvre D, Raspaud C, Auliac JB, Benoit N, Bombaron P, Moro-Sibilot D, Audigier-Valette C, Asselain B, Egenod T, Rabeau A, Fayette J, Sanchez ML, Labourey JL, Westeel V, Lamoureux P, Cotte FE, Allan V, Daumont M, Dumanoir J, Reynaud D, Calvet CY, Ozan N, Pérol M. Effectiveness and safety of nivolumab in the treatment of lung cancer patients in France: preliminary results from the real-world EVIDENS study. Oncoimmunology 2020; 9:1744898. [PMID: 33457089 PMCID: PMC7790497 DOI: 10.1080/2162402x.2020.1744898] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
EVIDENS is an ongoing, prospective, non-interventional study evaluating the effectiveness and safety of nivolumab in lung cancer patients in France (ClinicalTrials.gov NCT03382496). Adults with a pathologically confirmed diagnosis of lung cancer and initiating treatment with nivolumab were recruited from 146 sites in France. This analysis included only patients with non-small cell lung cancer (NSCLC) who received ≥1 nivolumab infusion, and evaluated patient characteristics at the time of nivolumab initiation and its effectiveness and safety after a median follow-up of 18 months. A total of 1,420 patients with NSCLC were included, most of whom had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0–1 (82.9%), non-squamous histology (69.2%) and stage IV disease (91.4%). Brain metastases were present in 19.9% of patients. Nivolumab was a second-line or ≥third-line regimen in 73.6% and 26.1% of patients, respectively. Almost all patients had prior chemotherapy (99.7%). Median overall survival was 11.2 months (95% confidence interval [CI]: 10.0–12.4). ECOG PS, smoking status, corticosteroids at baseline, epidermal growth factor receptor mutation status, presence of symptomatic brain metastases and treatment-related adverse events (TRAEs) were independent predictors of survival. Grade 3 and 4 TRAEs were reported in 105 (7.4%) and 12 (0.8%) patients, respectively; no treatment-related deaths were reported. Preliminary results of the EVIDENS study confirm the effectiveness and safety of nivolumab, mostly in pre-treated advanced NSCLC patients, with similar benefits to those observed in the phase III randomized clinical trials, despite a broader study population.
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Affiliation(s)
- Fabrice Barlesi
- CNRS, INSERM, CRCM, Assistance Publique Hôpitaux de Marseille, Hopital Nord, Pavillon Mistral, 6ème Étage A, Chemin des Bourrely, Aix Marseille University, Marseille, France
| | - Adrien Dixmier
- Department of Pulmonology, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Didier Debieuvre
- Respiratory Medicine Department, Groupe Hospitalier De La Région Mulhouse Sud-Alsace, Hopital Emile Muller, Mulhouse, France
| | | | - Jean-Bernard Auliac
- Department of Pulmonology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Nicolas Benoit
- Department of Pulmonology, Clinique de l'Europe, Amiens, France
| | - Pierre Bombaron
- Department of Pulmonology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Denis Moro-Sibilot
- Thoracic Oncology Unit, SHUPP, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble Cedex, France
| | | | | | - Thomas Egenod
- Department of Cutaneous and Thoracic Oncology, Centre Hospitalier Universitaire Dupuytren, Limoges, France
| | - Audrey Rabeau
- Thoracic Oncology Department, Centre Hospitalier Universitaire de Toulouse, Hopital Rangueil, Toulouse, France
| | - Jérôme Fayette
- Department of Medicine, Centre Léon Bérard, Lyon, France
| | - Myriam Locatelli Sanchez
- Department of Thoracic Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | | | - Virginie Westeel
- Chest Disease Department, University Hospital, INSERM UMR 1098, University of Bourgogne Franche-Comté, Besançon, France
| | | | | | | | | | | | | | | | | | - Maurice Pérol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
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Chai Q, Shen Y, Du J, Zhu J, Wu B. Economic burden of patients with advanced non-small-cell lung cancer receiving nivolumab versus chemotherapy in China. Immunotherapy 2020; 12:245-254. [PMID: 32189542 DOI: 10.2217/imt-2020-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: As new treatment patterns are gradually being used in patients with non-small-cell lung cancer, it is necessary to have a better understanding of real-world data on clinical practices and their potential impact on healthcare resource utilization (HCRU). Patients & methods: A retrospective observational study was conducted with electronic medical records from Shanghai Chest Hospital. Hospitalized patients treated with nivolumab or second-line chemotherapy were included. Results: A total of 296 patients were included in this study, of whom 187 were treated with nivolumab. About 74.33% received nivolumab monotherapy at different doses. The mean cost of nivolumab was $3334.14 (±86.69). Nivolumab decreased inpatient days to 1.9545 days with a more stable cost and HCRU per cycle. Conclusion: Nivolumab is expensive but it reduces other HCRU.
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Affiliation(s)
- Qingqing Chai
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200000, China.,School of Medicine, Shanghai Jiao Tong University, Shanghai 200000, China
| | - Yunjie Shen
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200000, China
| | - Jiangyang Du
- School of Medicine, Shanghai Jiao Tong University, Shanghai 200000, China.,Medical Decision & Economic Group, Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200000, China
| | - Jun Zhu
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200000, China
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Immunotherapy rechallenge after nivolumab treatment in advanced non-small cell lung cancer in the real-world setting: A national data base analysis. Lung Cancer 2020; 140:99-106. [DOI: 10.1016/j.lungcan.2019.12.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/20/2019] [Accepted: 12/30/2019] [Indexed: 01/09/2023]
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44
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Wang S, Hu C, Xie F, Liu Y. Use of Programmed Death Receptor-1 and/or Programmed Death Ligand 1 Inhibitors for the Treatment of Brain Metastasis of Lung Cancer. Onco Targets Ther 2020; 13:667-683. [PMID: 32158220 PMCID: PMC6986404 DOI: 10.2147/ott.s235714] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/24/2019] [Indexed: 02/05/2023] Open
Abstract
The central nervous system (CNS) is regarded as an immune privileged environment; however, changes in the neuroimmunology paradigm have led to an increased interest in systematic immunotherapy in lung cancer therapy. The presence of the lymphatic system in the CNS as well as the physiological and biochemical changes in the blood–brain barrier in the tumor microenvironment suggests that immunocytes are fully capable of entering and exiting the CNS. Emerging clinical data suggest that inhibitors of programmed death receptor-1/programmed death ligand 1 (PD-1/PD-L1) can stimulate surrounding T cells and thus have antitumor effects in the CNS. For example, PD-1 antibody (pembrolizumab) monotherapy has displayed a 20–30% encephalic response rate in patients with brain metastases from malignant melanoma or non-small cell lung cancer. Combined application of nivolumab and ipilimumab anti-PD-1 and anti-cytotoxic T-lymphocyte-associated protein 4 showed an encephalic response rate of 55% in patients with brain metastases of melanoma. Further evidence is required to verify these response rates and identify the mechanisms of curative effects and drug tolerance. While regional treatments such as whole-brain radiosurgery, stereotactic radiosurgery, and brain surgery remain the mainstream, PD-1/PD-L1 inhibitors display potential decreased neurotoxic effects. To date, five drugs have been approved for use in patients with encephalic metastases of lung carcinoma: the anti-PD-1 drugs, pembrolizumab and nivolumab, and the anti-PD-L1 agents, atezolizumab, durvalumab, and avelumab. In recent years, clinical trials of inhibitors in combination with other drugs to treat brain metastasis have also emerged. This review summarizes the biological principles of PD-1/PD-L1 immunotherapy for brain metastasis of lung cancer, as well as ongoing clinical trials to explore unmet needs.
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Affiliation(s)
- Shiqiang Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, People's Republic of China
| | - Chongling Hu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, People's Republic of China
| | - Fei Xie
- Department of Neurosurgery, Ziyang First People's Hospital, Ziyang 641300, People's Republic of China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
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Figueiredo A, Almeida M, Almodovar M, Alves P, Araújo A, Araújo D, Barata F, Barradas L, Barroso A, Brito U, Camacho E, Canário D, Cardoso T, Chaves A, Costa L, Cunha J, Duarte J, Estevinho F, Felizardo M, Fernandes J, Ferreira L, Ferreira L, Fidalgo P, Freitas C, Garrido P, Gil N, Hasmucrai D, Jesus E, Lopes J, de Macedo J, Meleiro A, Neveda R, Nogueira F, Pantorotto M, Parente B, Pego A, Rocha M, Roque J, Santos C, Saraiva J, Silva E, Silva S, Simões S, Soares M, Teixeira E, Timóteo T, Hespanhol V. Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC). Pulmonology 2020; 26:10-17. [DOI: 10.1016/j.pulmoe.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022] Open
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Nivolumab-induced small bowel obstruction and perforation: a rare but life-threatening side effect of immunotherapy. Emerg Radiol 2019; 27:107-110. [PMID: 31823117 DOI: 10.1007/s10140-019-01731-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/14/2019] [Indexed: 12/19/2022]
Abstract
We present a case of a 58-year-old female with anti-PD-1 immunotherapy-related small bowel perforation. The patient was on long-term therapy with nivolumab for metastatic non-small cell lung cancer. She presented to the emergency department with acute abdominal pain, in which the CT revealed a short segment of dilated distal ileum proximal to a very short segment of bowel with mural thickening and a perforation near the transition point. The patient underwent subsequent laparotomy, which confirmed the CT findings and revealed a short-segment of friable and dilated loop of distal ileum proximal to a stricture and a small perforation at the transition point. Pathological analysis revealed mural thickening at the site of stricture without evidence of malignancy with focal necrosis and perforation at the transition point. Bowel perforation in the setting of anti-PD-1 immunotherapy is rare, but life-threatening complication, and should be considered in oncology patients on immunotherapy presenting with severe abdominal pain.
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Ruiz-Bañobre J, Areses-Manrique MC, Mosquera-Martínez J, Cortegoso A, Afonso-Afonso FJ, de Dios-Álvarez N, Fernández-Núñez N, Azpitarte-Raposeiras C, Amenedo M, Santomé L, Fírvida-Pérez JL, García-Campelo R, García-González J, Casal-Rubio J, Vázquez S. Evaluation of the lung immune prognostic index in advanced non-small cell lung cancer patients under nivolumab monotherapy. Transl Lung Cancer Res 2019; 8:1078-1085. [PMID: 32010585 DOI: 10.21037/tlcr.2019.11.07] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The lung immune prognostic index (LIPI) has been proposed as a new categorical blood-based biomarker to select advanced non-small cell lung cancer (NSCLC) patients for anti-programmed cell death-1 (PD-1) or programmed death ligand 1 (PD-L1) therapy. In this study, we investigate for the first time to the best of our knowledge the prognostic and predictive utility of the LIPI in a multicenter nivolumab monotherapy-based cohort. We retrospectively analyzed the influence of the baseline LIPI on overall survival (OS), progression-free survival (PFS), disease control rate (DCR), and overall response rate (ORR) among 153 patients of a cohort of 188 advanced NSCLC patients treated with nivolumab in the second line of therapy or beyond. Worse LIPI was significantly associated with shorter OS in univariate [hazard ratio (HR) =3.12, 95% confidence interval (CI), 2.12-4.60; P<0.0001] and multivariate (HR =3.67, 95% CI, 1.96-6.86; P<0.0001) analyses. Worse LIPI was associated with shorter PFS (HR =1.45, 95% CI, 1.05-2.03; P=0.03), but this correlation did not reach statistical significance in multivariate analysis (HR =1.49, 95% CI, 0.94-2.38; P=0.09). Worse LIPI was associated with lower DCR in univariate [odds ratio (OR) =0.41, 95% CI, 0.24-0.70; P=0.001] and multivariate (OR =0.44, 95% CI, 0.25-0.78; P=0.005) analyses. This study confirms the utility of the LIPI in prognostication and disease control prediction in advanced NSCLC patients treated with nivolumab in the second line of therapy or beyond.
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Affiliation(s)
- Juan Ruiz-Bañobre
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain
| | | | | | - Alexandra Cortegoso
- Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain.,Medical Oncology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Noemí de Dios-Álvarez
- Medical Oncology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - Margarita Amenedo
- Medical Oncology Department, Centro Oncológico de Galicia, A Coruña, Spain
| | - Lucía Santomé
- Medical Oncology Department, Hospital Povisa, Vigo, Spain
| | | | - Rosario García-Campelo
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Jorge García-González
- Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain.,Medical Oncology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Joaquín Casal-Rubio
- Medical Oncology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Sergio Vázquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
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Bjørnhart B, Hansen KH, Jørgensen TL, Herrstedt J, Schytte T. Efficacy and safety of immune checkpoint inhibitors in a Danish real life non-small cell lung cancer population: a retrospective cohort study. Acta Oncol 2019; 58:953-961. [PMID: 31081424 DOI: 10.1080/0284186x.2019.1615636] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: To investigate effect and toxicity of immune checkpoint inhibition (ICI) in a Danish real-life non-small cell lung cancer (NSCLC) population. By including patients underrepresented in clinical trials, such as those with brain metastasis (BM), higher age, more comorbidity and poorer performance status (ECOG), comparison of unselected patients to clinical trial populations is possible. Material and methods: Real life data were gathered from 118 consecutive NSCLC patients with incurable NSCLC treated with ICI at the Department of Oncology at the University Hospital of Odense, Denmark from September 2015 to April 2018. Immune-related adverse events (irAEs) grades 3-5 were registered prospectively during the same period. Additional patient related data were obtained retrospectively from patients' files. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier estimates, the log-rank test and cox regression analysis performed for factors affecting survival. Results: Median age for patients was 66 years (IQR 59-71) and 62 years (range: 55-64) for those with BM. Females 63%; adenocarcinoma (AC)/squamous/others 69%/23%/8%; ECOG ≥ 2 10%; bone/brain/liver metastases 36%/18%/15%; PD-L1 (TPS) <1%/ ≥ 1%/ ≤ 49%/ ≥ 50%/NR: 3%/14%/68%/15%; baseline autoimmunity 10%, Charlson's Comorbidity Index Score (CCIS) ≥ 2 39%, treatment line: 1st/2nd/ ≥ 3rd 39%/30%/31%. Median OS for patients receiving ICI in ≥2 line was 11.5 months versus not reached in first line (HR 2.6, [95% CI: 1.3-5.0], p = .005). For patients with BM, the median OS was 8.2 months (HR 1.38, [95% CI: 0.7-2.5], p = .37). Twenty-four percent of patients terminated ICI due to irAE grades 3-5 alone (grade 5, n = 1), which were not associated with higher age or BM. Conclusions: OS and PFS were comparable to clinical trial reports. Long-lasting remission is also possible in patients with BM. Real-life populations have higher rates of irAE grades 3 and 4 than reported in clinical trials, but it does not seem to impact median OS.
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Affiliation(s)
- Birgitte Bjørnhart
- Department of Clinical Oncology, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karin H. Hansen
- Department of Clinical Oncology, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Trine L. Jørgensen
- Department of Clinical Oncology, Odense University Hospital, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Jørn Herrstedt
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
- Department of Clinical Oncology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Tine Schytte
- Department of Clinical Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Faehling M, Kopp M, Schwenk B, Fallscheer S, Kramberg S, Eckert R. Immuno-Oncological Treatment and Tumor Mass in Non-Small Cell Lung Cancer: Case-Control Analysis of Overall Survival in Routine Clinical Practice. Oncology 2019; 97:228-235. [DOI: 10.1159/000500885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/26/2019] [Indexed: 11/19/2022]
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Burdett N, Hsu K, Xiong L, Tapia-Rico G, Beckmann K, Karapetis C, Brown MP. Cancer outcomes in patients requiring immunosuppression in addition to corticosteroids for immune-related adverse events after immune checkpoint inhibitor therapy. Asia Pac J Clin Oncol 2019; 16:e139-e145. [PMID: 31215775 DOI: 10.1111/ajco.13177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/27/2019] [Indexed: 12/28/2022]
Abstract
AIM To examine the cancer-specific outcomes for patients who experience immune-related adverse events requiring immunosuppression beyond corticosteroids. METHODS We performed a retrospective case series of patients between January 1, 2009 and April 1, 2018, across three metropolitan hospitals in Adelaide, South Australia. Eligible patients were identified from pharmacy records. Patients with a solid organ malignancy had discontinued checkpoint inhibitor therapy due to toxicity, and required immunosuppression in addition to corticosteroids to treat any immune-related adverse event. RESULTS From 3860 patient dispensation records of immunosuppressive medications, 19 eligible patients were identified. Eight received a CTLA-4 inhibitor, four a PD-1 inhibitor, five combination immunotherapy, and two remained blinded. Sixteen patients had melanoma and three had non-small cell lung cancer. Median time to treatment failure was 8.7 months, and median overall survival was 9.4 months. Of those evaluable, the objective response rate was 35%, while 53% had progressive disease. Four patients died due to complications of their irAE, while six died from progressive disease. CONCLUSION Patients who received immunosuppression for checkpoint inhibitor therapy toxicity had variable outcomes. This in part reflects a heterogeneous population, and the evolution of irAE management over time. Several patients continued to derive a benefit after cessation of therapy despite the use of immunosuppressive medications; conversely, four died as a direct consequence of their irAE. Physicians should promptly introduce immunosuppressive therapy in patients not responding to corticosteroids to mitigate the risk of life-threatening adverse events, given that current evidence does not clearly demonstrate a detriment to cancer-specific outcomes.
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Affiliation(s)
- Nikki Burdett
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kristin Hsu
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Libo Xiong
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Gonzalo Tapia-Rico
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kerri Beckmann
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Christos Karapetis
- Flinders Medical Centre, Bedford Park, South Australia, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia
| | - Michael P Brown
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia
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