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Fu R, Xiong Y, Cai M, Li F, Chen R, Wu Y, Zhong W. Evaluation of molecular residual disease in operable non-small cell lung cancer with gene fusions, MET exon skipping or de novo MET amplification. Front Med 2024:10.1007/s11684-024-1060-z. [PMID: 38805102 DOI: 10.1007/s11684-024-1060-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/17/2024] [Indexed: 05/29/2024]
Abstract
Gene fusions and MET alterations are rare and difficult to detect in plasma samples. The clinical detection efficacy of molecular residual disease (MRD) based on circulating tumor DNA (ctDNA) in patients with non-small cell lung cancer (NSCLC) with these mutations remains unknown. This prospective, non-intervention study recruited 49 patients with operable NSCLC with actionable gene fusions (ALK, ROS1, RET, and FGFR1), MET exon 14 skipping or de novo MET amplification. We analyzed 43 tumor tissues and 111 serial perioperative plasma samples using 1021- and 338-gene panels, respectively. Detectable MRD correlated with a significantly higher recurrence rate (P < 0.001), yielding positive predictive values of 100% and 90.9%, and negative predictive values of 82.4% and 86.4% at landmark and longitudinal time points, respectively. Patients with detectable MRD showed reduced disease-free survival (DFS) compared to those with undetectable MRD (P < 0.001). Patients who harbored tissue-derived fusion/MET alterations in their MRD had reduced DFS compared to those who did not (P = 0.05). To our knowledge, this is the first comprehensive study on ctDNA-MRD clinical detection efficacy in operable NSCLC patients with gene fusions and MET alterations. Patients with detectable tissue-derived fusion/MET alterations in postoperative MRD had worse clinical outcomes.
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Affiliation(s)
- Rui Fu
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | | | - Miao Cai
- Geneplus-Beijing, Beijing, 102206, China
| | - Fang Li
- Geneplus-Beijing, Beijing, 102206, China
| | | | - Yilong Wu
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Wenzhao Zhong
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
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Dai Z, Xu J, Chang F, Zhou W, Ren T, Qiu J, Lu Y, Lu Y. The cost-effectiveness of iruplinalkib versus alectinib in anaplastic lymphoma kinase-positive crizotinib-resistant advanced non-small-cell lung cancer patients in China. Front Public Health 2024; 12:1333487. [PMID: 38699428 PMCID: PMC11064164 DOI: 10.3389/fpubh.2024.1333487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Background Iruplinalkib is a second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) with efficacy in patients with ALK-positive crizotinib-resistant advanced non-small cell lung cancer (NSCLC), which is independently developed by a Chinese pharmaceutical company. This study examined the cost-effectiveness of iruplinalkib versus alectinib in the Chinese healthcare setting. Methods A partitioned survival model was developed to project the economic and health outcomes. Efficacy was derived using unanchored matching-adjusted indirect comparison (MAIC). Cost and utility values were obtained from the literature and experts' opinions. Deterministic and probabilistic sensitivity analyses (PSA) were carried out to evaluate the model's robustness. Results Treatment with iruplinalkib versus alectinib resulted in a gain of 0.843 quality-adjusted life years (QALYs) with incremental costs of $20,493.27, resulting in an incremental cost-effectiveness ratio (ICER) of $24,313.95/QALY. Parameters related to relative efficacy and drug costs were the main drivers of the model outcomes. From the PSA, iruplinalkib had a 90% probability of being cost-effective at a willingness-to-pay threshold of $37,863.56/QALY. Conclusion Compared to alectinib, iruplinalkib is a cost-effective therapy for patients with ALK-positive crizotinib-resistant advanced NSCLC.
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Affiliation(s)
| | | | | | | | | | | | - Yun Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yuqiong Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
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Zhang X, Zhang H, Li LF, Feng L, Liu Q. Cost-Effectiveness Analysis of Pembrolizumab Plus Chemotherapy in Squamous Non-Small-Cell Lung Cancer in China. Risk Manag Healthc Policy 2023; 16:1849-1857. [PMID: 37719688 PMCID: PMC10505025 DOI: 10.2147/rmhp.s429394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose The five-year update data from the KEYNOTE-407 study have unveiled noteworthy improvements in survival outcomes achieved with pembrolizumab plus chemotherapy (Pembro+Chemo) compared to placebo plus chemotherapy (Placebo+Chemo) for patients with previously untreated metastatic squamous non-small cell lung cancer (NSCLC). Building upon this finding, our study sought to evaluate the cost-effectiveness of Pembro+Chemo, utilizing the latest available data, from the perspective of the Chinese health care system. Patients and Methods A Markov model was employed to compare the quality-adjusted life-year (QALY), life-year (LY), total cost, and incremental cost-effectiveness ratio (ICER) between Pembro+Chemo and Placebo+Chemo. The clinical and safety data were derived from the five-year update date of the KEYNOTE-407 study. Sensitivity analyses were conducted to assess the uncertainty of the model, and additional subgroup analyses were performed to explore specific subpopulations. Results For patients with previously untreated metastatic squamous NSCLC, the utilization of Pembro+Chemo resulted in a improvement of 0.61 quality-adjusted life years (QALYs) along with a cost reduction of $17,491.52 when compared to Placebo+Chemo. Notably, across various subgroups with different tumor proportion scores (TPS), Pembro+Chemo demonstrated enhanced QALYs and lower total costs. Conclusion From the perspective of the Chinese health care system, first-line Pembro+Chemo emerges as a dominant treatment option over Placebo+Chemo for the treatment of metastatic squamous NSCLC.
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Affiliation(s)
- Xin Zhang
- Department of Clinical Pharmacy, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, People’s Republic of China
| | - Huixian Zhang
- Department of Clinical Pharmacy, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, People’s Republic of China
| | - Lan-Fang Li
- Department of Clinical Pharmacy, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, People’s Republic of China
| | - Lei Feng
- Department of Clinical Pharmacy, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, People’s Republic of China
| | - Qiao Liu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Central South University, Changsha, Hunan, People’s Republic of China
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Li MSC, Mok KKS, Mok TSK. Developments in targeted therapy & immunotherapy-how non-small cell lung cancer management will change in the next decade: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:358. [PMID: 37675321 PMCID: PMC10477626 DOI: 10.21037/atm-22-4444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/08/2023] [Indexed: 09/08/2023]
Abstract
Background and Objective The adoption of targeted therapy and immunotherapy has revolutionised the treatment landscape of non-small cell lung cancer. For early staged disease, incorporation of targeted therapy and immunotherapy has recently been demonstrated to reduce recurrence. Development of targeted therapies in advanced lung cancer is driven by advanced genomic sequencing techniques, better understanding of drug resistance mechanisms, and improved drug designs. The list of targetable molecular alteration is continuously expanding, and next generation molecular therapies have shown promise in circumventing drug resistance. Lung cancer patients may achieve durable disease control with immune checkpoint inhibitors however most patients develop immunotherapy resistance. A wide spectrum of resistance mechanisms, ranging from impaired T-cell activation, presence of coinhibitory immune checkpoints, to immunosuppressive tumour microenvironment, have been proposed. A multitude of novel immunotherapy strategies are under development to target such resistance mechanisms. This review aims to provide a succinct overview in the latest development in targeted therapy and immunotherapy for NSCLC management. Methods We searched all original papers and reviews on targeted therapy and immunotherapy in non-small cell lung cancer (NSCLC) using PubMed in June 2022. Search terms included "non-small cell lung cancer", "targeted therapy", "immunotherapy", "EGFR", "ALK", "ROS1", "BRAF V600E", "MET", "RET", "KRAS", "HER2", "ERBB2", "NRG1", "immune checkpoint", "PD-1", "PD-L1", "CTLA4", "TIGIT", "VEGF", "cancer vaccine", "cellular therapy", "tumour microenvironment", "cytokine", and "gut microbiota". Key Content and Findings We first discuss the incorporation of targeted therapy and immunotherapy in early staged NSCLC. This includes the latest clinical data that led to the approval of neoadjuvant immunotherapy, adjuvant immunotherapy and adjuvant targeted therapy for early staged NSCLC. The second section focuses on targeted therapy in metastatic NSCLC. The list of targetable alteration now includes but is not limited to EGFR, ALK, ROS1, BRAF V600E, MET exon 14 skipping, RET, KRAS G12C, HER2 and NRG1. Potential drug resistance mechanisms and novel therapeutics under development are also discussed. The third section on immunotherapy in metastatic NSCLC, covers immunotherapy that are currently approved [anti-PD-(L)1 and anti-CTLA4], and agents that are under active research (e.g., anti-TIGIT, cancer vaccine, cellular therapy, cytokine and other TME modulating agents). Conclusions This review encompasses the latest updates in targeted therapy and immunotherapy in lung cancer management and discusses the future direction in the field.
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Affiliation(s)
- Molly S. C. Li
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Kevin K. S. Mok
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China
| | - Tony S. K. Mok
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China
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[Chinese Expert Consensus on Non-small Cell Lung Cancer with EGFR Exon 20 Insertion Mutations (2023 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2023; 26:325-337. [PMID: 37316442 PMCID: PMC10273153 DOI: 10.3779/j.issn.1009-3419.2023.106.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Indexed: 06/16/2023]
Abstract
With the development of precision diagnosis and treatment for non-small cell lung cancer (NSCLC), the epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations, as a rare subset of EGFR mutaions, have gradually attracted attention recently. The heterogeneity of EGFR ex20ins mutations is very high, different variants have different clinical benefits, and the prognosis is extremely poor. The available traditional treatment outcomes are poor in patients with EGFR ex20ins positive NSCLC and polymerase chain reaction (PCR) tests would miss aprocimately 50% of the variants. Therefore, high attention should be paid to EGFR ex20ins positive NSCLC during the clinical practice. The expert panel has formed a consensus on the standardized clinical diagnosis and treatment of EGFR ex20ins mutation NSCLC through reference to literature and clinical data, and combined with the experts' own clinical experience, the consensus recommendations including clinicopathologic characteristics, therapies, testing methods and recent relevant clinical trials for NSCLC patients with EGFR ex20ins mutation, in order to provide medication reference for clinical physicians at all levels.
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Grodzka A, Knopik-Skrocka A, Kowalska K, Kurzawa P, Krzyzaniak M, Stencel K, Bryl M. Molecular alterations of driver genes in non-small cell lung cancer: from diagnostics to targeted therapy. EXCLI JOURNAL 2023; 22:415-432. [PMID: 37346803 PMCID: PMC10279966 DOI: 10.17179/excli2023-6122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023]
Abstract
Lung cancer is the leading cause of cancer death all over the world. The majority (80-85 %) of lung cancer cases are classified as non-small cell lung cancer (NSCLC). Within NSCLC, adenocarcinoma (AC) and squamous cell carcinoma (SCC) are the most often recognized. The histological and immunohistochemical examination of NSCLC is a basic diagnostic tool, but insufficient for comprehensive therapeutic decisions. In some NSCLC patients, mainly adenocarcinoma, molecular alterations in driver genes, like EGFR, KRAS, HER2, ALK, MET, BRAF, RET, ROS1, and NTRK are recognized. The frequency of some of those changes is different depending on race, and between smokers and non-smokers. The molecular diagnostics of NSCLC using modern methods, like next-generation sequencing, is essential in estimating targeted, personalized therapy. In recent years, a breakthrough in understanding the importance of molecular studies for the precise treatment of NSCLC has been observed. Many new drugs were approved, including tyrosine kinase and immune checkpoint inhibitors. Clinical trials testing novel molecules like miRNAs and trials with CAR-T cells (chimeric antigen receptor - T cells) dedicated to NSCLC patients are ongoing.
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Affiliation(s)
- Anna Grodzka
- Department of Cell Biology, Faculty of Biology, Adam Mickiewicz University of Poznan, Poland
| | | | - Katarzyna Kowalska
- Department of Oncological Pathology, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poland
| | - Pawel Kurzawa
- Department of Oncological Pathology, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poland
- Department of Clinical Pathology and Immunology, Poznan University of Medical Sciences, Poland
| | - Monika Krzyzaniak
- Department of Oncological Pathology, University Clinical Hospital in Poznan, Poznan University of Medical Sciences, Poland
| | - Katarzyna Stencel
- Department of Clinical Oncology with the Subdepartment of Diurnal Chemotherapy, E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - Maciej Bryl
- Department of Clinical Oncology with the Subdepartment of Diurnal Chemotherapy, E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
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Liu SYM, Zheng MM, Pan Y, Liu SY, Li Y, Wu YL. Emerging evidence and treatment paradigm of non-small cell lung cancer. J Hematol Oncol 2023; 16:40. [PMID: 37069698 PMCID: PMC10108547 DOI: 10.1186/s13045-023-01436-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023] Open
Abstract
Research on biomarker-driven therapy and immune check-point blockade in non-small cell lung cancer (NSCLC) is rapidly evolving. The width and depth of clinical trials have also dramatically improved in an unprecedented speed. The personalized treatment paradigm evolved every year. In this review, we summarize the promising agents that have shifted the treatment paradigm for NSCLC patients across all stages, including targeted therapy and immunotherapy using checkpoint inhibitors. Based on recent evidence, we propose treatment algorithms for NSCLC and propose several unsolved clinical issues, which are being explored in ongoing clinical trials. The results of these trials are likely to impact future clinical practice.
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Affiliation(s)
- Si-Yang Maggie Liu
- Department of Hematology, The First Affiliated Hospital, Jinan University, Guangzhou, 510632, China
| | - Mei-Mei Zheng
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yi Pan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yangqiu Li
- Department of Hematology, The First Affiliated Hospital, Jinan University, Guangzhou, 510632, China.
- Institute of Hematology, School of Medicine, Key Laboratory for Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, 510632, China.
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
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Liu L, Li F, Zhao J, Zhuo X, Lai J, Wang J, Jiang F, Xu W, Luan F, Lin X, Yang S, Fu G. The Real-world Therapeutic Analysis of First-line Immunotherapy in Chinese Patients with Drive Gene Positive for Advanced Non-Small Cell Lung Cancer. J Cancer 2023; 14:952-965. [PMID: 37151388 PMCID: PMC10158514 DOI: 10.7150/jca.77199] [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: 07/17/2022] [Accepted: 03/08/2023] [Indexed: 05/09/2023] Open
Abstract
Background: Immune checkpoint inhibitors (ICIs) are widely used for treating advanced non-small cell lung cancer (NSCLC). However, some studies indicate that patients with genetic mutations do not benefit from immunotherapy. Hence, this study explored the efficacy of anti-programmed death-1 (PD-1) and anti-programmed death-ligand 1 (PD-L1) antibodies in the first-line treatment of advanced NSCLC with driver gene mutations in real-world settings. Methods: We retrospective analyzed patients with advanced NSCLC who treated with first-line anti-PD-1/PD-L1 antibodies at Shandong Provincial Hospital between May 2019 and October 2020. The patient's driver gene mutation status was identified using amplification refractory mutation system PCR (ARMS-PCR). The basic clinical characteristics, objective response rate (ORR), progression free survival (PFS), and other clinical data of patients were collected to evaluate the clinical efficacy and potential prognostic factors of treatment for patients with driver gene mutations. Results: A total of 430 patients' information was counted during this period, finally, 89 patients with NSCLC were enrolled in the study. The main pathological subtype of patients was adenocarcinoma (62.9%). The overall mutation rate was 44.9% (n = 40) and included following mutations: KRAS (n = 20), TP53 (n = 18), EGFR (n = 6), BRAF (n = 3), Her-2 (n = 3), MET (n = 3), ROS1 (n = 1), and NRAS (n = 1). The overall ORR was 44.30% and the disease control rate (DCR) was 82.23%. At the time of follow-up cut-off, the median PFS of all patients was 8.2 month. In NSCLC patients treated with ICI, median PFS was longer in mutation-negative patients than in mutation-positive patients (8.98 vs 7.07 months, P < 0.05). Survival benefit varied across mutational subgroups: KRAS patients could benefit from first-line immunotherapy (10.1 months, P < 0.05), patients with EGFR mutations have poor first-line immunotherapy outcomes, with a median PFS of only 3.0 months (P < 0.01), and patients with other mutation types having no significant difference in response from mutation-negative patients. In most mutation subgroups, immune combination therapy had longer PFS than immune monotherapy, and PD-L1 expression levels were positively correlated with clinical benefit in patients. Conclusion: In the real world, patients with KRAS mutations benefit from first-line immunotherapy, immune-combination modalities are more effective, and immune efficacy is positively correlated with PD-L1 expression; Patients with other driver mutations (BRAF, NRAS, Her2, MET, ROS1) benefit similarly to mutation-negative patients in first-line immunotherapy, and immunotherapy is recommended for first-line therapy; Immunotherapy is worse effective in patients with EGFR mutations, immunotherapy is not recommended in first-line therapy even patients with high PD-L1 expression.
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Affiliation(s)
- Lei Liu
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- The Clinical Medical College, Shandong First Medical University (Shandong Academy of Medicine), Jinan, Shandong, China
| | - Fuxia Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- The Clinical Medical College, Shandong First Medical University (Shandong Academy of Medicine), Jinan, Shandong, China
| | - Jing Zhao
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- The Clinical Medical College, Shandong First Medical University (Shandong Academy of Medicine), Jinan, Shandong, China
| | - Xiaoli Zhuo
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- The Clinical Medical College, Shandong First Medical University (Shandong Academy of Medicine), Jinan, Shandong, China
| | - Jingjiang Lai
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Oncology, The Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jingliang Wang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Oncology, The Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Fengxian Jiang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Oncology, The Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Wei Xu
- Department of Oncology, Shandong Provincial Hospital Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Fang Luan
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoyan Lin
- Department of Pathology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- ✉ Corresponding authors: Xiaoyan Lin, ; Shuping Yang, ; Guobin Fu,
| | - Shuping Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- ✉ Corresponding authors: Xiaoyan Lin, ; Shuping Yang, ; Guobin Fu,
| | - Guobin Fu
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Oncology, Shandong Provincial Hospital Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- ✉ Corresponding authors: Xiaoyan Lin, ; Shuping Yang, ; Guobin Fu,
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Yang W, Li T, Bai Y, Long Y, Gao M, Wang T, Jing F, Zhang F, Tao H, Ma J, Wang L, Hu Y. Efficacy and safety of pembrolizumab versus sintilimab treatment in patients with advanced squamous lung cancer: A real-world study in China. Front Oncol 2023; 13:1147903. [PMID: 37124534 PMCID: PMC10130366 DOI: 10.3389/fonc.2023.1147903] [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: 01/19/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Importance Both pembrolizumab and sintilimab have been approved by the Chinese State Drug Administration (NMPA) for the first-line treatment of patients with advanced squamous lung cancer. The differences of the two drugs in efficacy and safety are unclear. Objectives To compare the real-world efficacy and safety of first-line treatments in patients with advanced squamous lung cancer. Materials and methods This was a retrospective review of patients with advanced squamous carcinoma who received sintilimab or pembrolizumab in combination with chemotherapy as first-line therapy between June 2018 and April 2022 in the Chinese PLA Hospital. The primary objective was to compare the objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) between the two groups. Secondary objectives were to compare the disease control rate (DCR) and to analyze adverse events (AEs) between the two groups. Results A total of 164 patients were enrolled, including 63 patients (38.4%) in the sintilimab-combined chemotherapy group and 101 patients (61.6%) in the pembrolizumab-combined chemotherapy group. The ORR was 65.10% in the sintilimab group and 61.40% in the pembrolizumab group (P=0.634). The DCR was 92.10% and 92.10% in the sintilimab and pembrolizumab groups, respectively (P=0.991). The median PFS was 22.2 months for patients treated with sintilimab group compared with 16.5 months for patients treated with pembrolizumab group[hazard ratio (HR) = 0.743; 95% confidence interval (CI): 0.479-1.152; P = 0.599]. Patients treated with pembrolizumab did not achieve a median OS, and patients treated with sintilimab had a median OS of 30.7 months. In the sintilimab group, the incidence of all treatment-related adverse events (TRAEs) was 92.1% (58/63), and the incidence of grade 3-4 TRAEs of 42.9% (27/63). In the pembrolizumab group, the incidence of all TRAEs was 90.1% (91/101), and the incidence of grade 3-4 TRAEs was 37.6% (38/101). Conclusion In the clinical treatment of Chinese patients with advanced squamous lung cancer, first-line treatment with sintilimab in combination with chemotherapy provided similar efficacy to pembrolizumab in combination with chemotherapy, and the treatment-related adverse effect profiles were comparable between the two groups, including similar rates of grade 3-4 and all adverse events.
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Affiliation(s)
- Wenyu Yang
- School of Medicine, Nankai University, Tianjin, China
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Tao Li
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Yibing Bai
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Yaping Long
- School of Medicine, Nankai University, Tianjin, China
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Ming Gao
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Ting Wang
- School of Medicine, Nankai University, Tianjin, China
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Fangfang Jing
- Department of Oncology, The First Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Fan Zhang
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Haitao Tao
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Junxun Ma
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
| | - Lijie Wang
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
- *Correspondence: Lijie Wang, ; Yi Hu,
| | - Yi Hu
- Department of Medical Oncology, Senior Department of Oncology, The Fifth Medical Center, The General Hospital of the People's Liberation Army, Beijing, China
- *Correspondence: Lijie Wang, ; Yi Hu,
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Lin J, Liu J, Hao SG, Lan B, Zheng XB, Xiong JN, Zhang YQ, Gao X, Chen CB, Chen L, Huang YF, Luo H, Yi YT, Yi X, Lu JP, Zheng XW, Chen G, Wang XF, Chen Y. An EGFR L858R mutation identified in 1862 Chinese NSCLC patients can be a promising neoantigen vaccine therapeutic strategy. Front Immunol 2022; 13:1022598. [PMID: 36505399 PMCID: PMC9727402 DOI: 10.3389/fimmu.2022.1022598] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to develop a vaccine that targets mutation-derived neoantigen in Chinese non-small-cell lung cancer (NSCLC). Methods A cohort of 1862 Chinese NSCLC patients who underwent targeted sequencing with a 1021-gene panel was investigated. HLA typing was done using OptiType v1.0 and neoantigens were predicted by netMHCpan v4.0. HLA LOH was inferred using the lohhla algorithm and TMB were quantified by counting the total number of non-synonymous ones based on our panel data. CIBERSORT was utilized to estimate the TME in different EGFR mutant subtype by using TCGA data. Results HLA-A*11:01(42.59%) was the top one allele and HLA-A*33:03(12.94%) ranked 12th. EGFR L858R (22.61%) was the most prevalent gene variant. The binding affinity (IC50 MT = 22.9 nM) and shared frequency (2.93%) of EGFR L858R in combination with HLA-A*33:03 were optimal. In a subsequent further analysis on immunological features of EGFR mutant subtypes, 63.1% HLA loss of heterozygosity LOH (HLA LOH) and 0.37% (7 of 1862) B2M aberrations were found in our population, both had no significant association with EGFR mutant subtypes suggesting that the process of antigen presentation involved HLA LOH and B2M mechanisms in EGFR L858R is working. Tumor mutation burden (TMB) was investigated by utilizing our panel and showed that EGFR L858R had the lowest TMB compared with other EGFR mutant subtypes. In addition, analysis of 22 immune cell types from The Cancer Genome Atlas (TCGA) data showed EGFR L858R was correlated with low level of CD8 T cells, activated CD4 memory T cells and elevated level of macrophage M2 suggesting an inhibited tumor microenvironment (TME). Conclusion Our study identified that EGFR L858R neoantigen had the potential to generate cancer vaccines in NSCLC patients with HLA A*33:03. The neoantigen-based vaccines may become an effective salvage regimen for EGFR L858R subgroup after targeted therapy or immune checkpoint inhibitors (ICIs) failure.
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Affiliation(s)
- Jing Lin
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jun Liu
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | | | - Bin Lan
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Tumor Biotherapy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Xiao-bin Zheng
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Jia-ni Xiong
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | | | - Xuan Gao
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China,Department of Translational Medicine, GenePlus- Shenzhen Clinical Laboratory, ShenZhen, China
| | - Chuan-ben Chen
- Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Ling Chen
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yu-fang Huang
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Hong Luo
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yu-ting Yi
- Geneplus-Beijing Institute, Beijing, China
| | - Xin Yi
- Geneplus-Beijing Institute, Beijing, China
| | - Jian-ping Lu
- Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Department of Pathology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Xiong-wei Zheng
- Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Department of Pathology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Gang Chen
- Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Department of Pathology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Xue-feng Wang
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Tumor Biotherapy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,The Third Affiliated Hospital of Soochow University, Institutes for Translational Medicine, Soochow University, Suzhou, China,*Correspondence: Yu Chen, ; Xue-feng Wang,
| | - Yu Chen
- Department of Medical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,Cancer Bio-immunotherapy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China,*Correspondence: Yu Chen, ; Xue-feng Wang,
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11
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[Consensus on Application of Third-generation EGFR-TKI in EGFR Mutated NSCLC
(2022 Version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:627-641. [PMID: 36172727 PMCID: PMC9549424 DOI: 10.3779/j.issn.1009-3419.2022.101.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Chen P, Wang X, Zhu S, Li H, Rui M, Wang Y, Sun H, Ma A. Economic evaluation of sintilimab plus chemotherapy vs. pembrolizumab plus chemotherapy for the treatment of first-line advanced or metastatic squamous NSCLC. Front Public Health 2022; 10:956792. [PMID: 36016894 PMCID: PMC9395965 DOI: 10.3389/fpubh.2022.956792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/13/2022] [Indexed: 01/24/2023] Open
Abstract
Background and objective Sintilimab has superior efficacy and safety in patients with advanced or metastatic squamous non-small cell lung cancer (NSCLC), but its cost-effectiveness in China is unclear. This study is to evaluate the cost-effectiveness of sintilimab plus chemotherapy vs. pembrolizumab plus chemotherapy for locally advanced or metastatic squamous NSCLC in China. Methods From the perspective of the Chinese health system, the partitioned survival model with three health states was established in a 3-week cycle and a lifetime time horizon. The two-stage method was used to estimate the overall survival hazard ratios to avoid the bias by crossover design in ORIENT-12 and KEYNOTE-407 studies. The anchored matching adjusted indirect comparison method (MAIC) was used for indirect comparison based on the individual patient data from ORIENT-12 and the publicly published KEYNOTE-407 study due to the lack of head-to-head clinical trials. Only direct medical costs were included, and utilities were derived from the published literature in the base case analysis. Sensitivity analysis was also performed to verify the robustness of the model results. In addition, the scenario analysis where the utilities were derived from the Quality of Life Questionnaire-Core 30 (QLQ-C30) scale in the ORIENT-12 by mapping to the EuroQol-5-dimension 5-level (EQ-5D-5L) was carried out to explore the uncertainty of the results. Results Compared with pembrolizumab + chemotherapy, sintilimab + chemotherapy incurred a lower lifetime cost ($12,321 vs. 36,371) and yielded fewer quality-adjusted life-years (QALYs) (0.9902 vs. 1.0085), which resulted in an incremental cost-effectiveness ratio (ICER) of $1,314,208/QALY. A sintilimab strategy is a cost-effectiveness option under the WTP of 1-3 times the GDP per capita in China ($11,250/QALY~$33,749/QALY). The utility value of the post-progression, the unit cost of albumin paclitaxel, and the utility value of the progression-free state were the main drivers in the deterministic sensitivity analysis (DSA). According to the probabilistic sensitivity analysis (PSA), sintilimab + chemotherapy was 100% cost-effective when the WTP was 1-3 times China's per capita GDP. The results of the scenario analysis showed that sintilimab + chemotherapy obtained more QALYs (1.2319 vs. 1.1815) and lower costs ($12,321 vs. 36,371), which implied that sintilimab + chemotherapy may dominate the pembrolizumab + chemotherapy. Conclusion Compared with pembrolizumab + chemotherapy, sintilimab + chemotherapy is more cost-effective for first-line treatment in Chinese patients with locally advanced or metastatic squamous NSCLC.
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Affiliation(s)
- Pingyu Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Xintian Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Shengwen Zhu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Hongchao Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Mingjun Rui
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yingcheng Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Haikui Sun
- Innovent Biologics (Suzhou) Co., Ltd., Suzhou, China
| | - Aixia Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China,Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China,*Correspondence: Aixia Ma
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13
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Comparison of Efficacy and Safety of Brigatinib in First-Line Treatments for Patients with Anaplastic Lymphoma Kinase-Positive Non-Small-Cell Lung Cancer: A Systematic Review and Indirect Treatment Comparison. J Clin Med 2022; 11:jcm11112963. [PMID: 35683354 PMCID: PMC9181407 DOI: 10.3390/jcm11112963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Background: The relative efficacy and safety of brigatinib compared with other next-generation anaplastic lymphoma kinase (ALK) inhibitors remains unclear, as first-line head-to-head trials have not been conducted. (2) Methods: Electronic databases were systematically searched for eligible randomized controlled trials (RCT) from January 2010 to October 2021. Outcomes evaluated by indirect treatment comparison (ITC) included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and safety. (3) Results: Nine RCTs with 2484 patients assessing crizotinib, ceritinib, alectinib, brigatinib, ensartinib, and lorlatinib were included. In intent-to-treat (ITT) patients, brigatinib significantly prolonged blinded independent review committee-assessed PFS compared with crizotinib (HR: 0.48, 95% CI: 0.35 to 0.66) and ceritinib (HR: 0.38, 95% CI: 0.23, 0.60) and had a comparable PFS with other 2nd-generation ALK inhibitors. Subgroup analyses of patients with baseline brain metastases and Asian patients yielded results similar to the base case. Brigatinib significantly reduced the risk of death compared with crizotinib (HR: 0.50, 95% CI: 0.28, 0.87) after adjusting for treatment crossover in the crizotinib arm. No significant differences were observed in OS between brigatinib and other next-generation ALK inhibitors. Brigatinib had significantly superior effects in ORR and intracranial ORR compared to crizotinib. The incidence of grade ≥3 AEs was similar between brigatinib and other next-generation ALK inhibitors (except for alectinib), while brigatinib could significantly delay the time to worsening in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) global health status (GHS)/quality of life (QoL) vs. crizotinib (HR: 0.69, 95% CI: 0.49, 0.98). (4) Conclusions: Brigatinib had longer PFS compared to crizotinib and ceritinib and had comparable efficacy and safety profile with other 2nd-generation ALK inhibitors in first-line treatments for patients with ALK-positive non-small-cell lung cancer.
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14
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Xiong A, Wang J, Zhou C. Immunotherapy in the First-Line Treatment of NSCLC: Current Status and Future Directions in China. Front Oncol 2021; 11:757993. [PMID: 34900707 PMCID: PMC8654727 DOI: 10.3389/fonc.2021.757993] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022] Open
Abstract
Lung cancer causes significant morbidity and mortality in China and worldwide. In China, lung cancer accounts for nearly one-fourth of all cancer deaths. Non-small cell lung cancer (NSCLC) is the predominant type of lung cancer, accounting for approximately 80%–85% of all lung cancer cases. Immunotherapy with immune checkpoint inhibitors (ICIs) is revolutionizing the treatment of NSCLC. Immune checkpoint molecules, including PD-1/PD-L1 and CTLA-4, can suppress immune responses by delivering negative signals to T cells. By interfering with these immunosuppressive axes, ICIs unleash antitumor immune responses, ultimately eliminating cancer cells. ICIs have demonstrated promising antitumor efficacy in NSCLC, and mounting evidence supports the use of ICIs in treatment-naïve patients with advanced NSCLC. A comprehensive overview of current and emerging ICIs for the first-line treatment of NSCLC in China will facilitate a better understanding of NSCLC immunotherapy using ICIs and optimize the clinical use of ICIs in previously untreated Chinese patients with NSCLC. Herein, we review the efficacy and safety of currently approved and investigational ICIs as the first-line treatment of NSCLC in China. We also discuss the challenges limiting more widespread use of ICIs and future directions in the first-line treatment of NSCLC using ICIs.
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Affiliation(s)
- Anwen Xiong
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Jiali Wang
- Medical Research Lab (MRL) Global Medical Affairs, MSD China, Shanghai, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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15
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Sun S, Du W, Sun Q, Zhao X, Qin B, Shi D, Wan C, Wu Z. Driver gene alterations profiling of Chinese non-small cell lung cancer and the effects of co-occurring alterations on immunotherapy. Cancer Med 2021; 10:7360-7372. [PMID: 34599863 PMCID: PMC8525092 DOI: 10.1002/cam4.4178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
Background Molecular testing for alterations in oncogenic driver genes and targeted therapies have become standard procedures for non‐small cell lung cancer (NSCLC) patients. However, little evidence has shed light on the pattern of co‐existence of driver genes in NSCLC, and whether they may have different tumor features affecting immunotherapy is still unclarified. Methods Genomic alterations in 14 lung cancer‐related genes were conducted in 3440 Chinese NSCLC patients using next‐generation sequencing. Meanwhile, tumor mutational burden and immunotherapy dataset from the Memorial sloan kettering cancer center (MSKCC) and lung adenocarcinoma dataset from The Cancer Genome Atlas (TCGA) were utilized for analyzing the impact of the co‐occurring alterations on patients’ survival following immunotherapy. Results In this cohort, 90.17% of patients had at least one somatic alteration in the 14 genes, including 51% of co‐occurring alterations. TP53 and epidermal growth factor receptor (EGFR) were the most prevalent genes (54.74% and 53.55%, respectively), followed by KRAS, ERBB2, ALK, PIK3CA, ROS1, RET, MET, BRAF, KIT, FGFR1, PDGFRA, and NRAS. The prevalence of TP53, EGFR, and ERBB2 in our cohort were significantly higher than that from the TCGA database, whereas KRAS, BRAF, and PDGFRA were significantly lower than the latter. Furthermore, the patients who harbored multiple alterations (8.86%, 31/350) in eight driver genes survived longer and have a higher tumor mutation burden compared to the patients with a single alteration. Similar result was found between the patients with co‐occurring alteration of EGFR and other driver genes and the patients with single EGFR alteration. Meanwhile, we found a distinct immune cell infiltration feature between patients with single and multiple driver gene alterations, as well as between patients with only EGFR alteration and co‐occurring groups. Conclusion This study identified a unique driver gene feature and found patients harboring co‐occurring alterations of EGFR and other driver genes may benefit from immunotherapy, which may provide more therapeutic selections for EGFR‐mutated NSCLC patients and merit additional investigation.
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Affiliation(s)
- Shengjie Sun
- Medical Oncology Department, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenjuan Du
- Training Department of Medical Service Department, General Hospital of People's Liberation Army, Beijing, China
| | - Qiong Sun
- Medical Oncology Department, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao Zhao
- Medical Oncology Department, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Boyu Qin
- Medical Oncology Department, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Duozhi Shi
- Department of Medicine, Lifehealthcare Clinical Laboratories, Hangzhou, China
| | - Chong Wan
- Department of Medicine, Lifehealthcare Clinical Laboratories, Hangzhou, China
| | - Zhiyong Wu
- Medical Oncology Department, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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16
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Selecting the optimal immunotherapy regimen in driver-negative metastatic NSCLC. Nat Rev Clin Oncol 2021; 18:625-644. [PMID: 34168333 DOI: 10.1038/s41571-021-00520-1] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
The treatment landscape of driver-negative non-small-cell lung cancer (NSCLC) is rapidly evolving. Immune-checkpoint inhibitors, specifically those targeting PD-1 or PD-L1, have demonstrated durable efficacy in a subset of patients with NSCLC, and these agents have become the cornerstone of first-line therapy. Approved immunotherapeutic strategies for treatment-naive patients now include monotherapy, immunotherapy-exclusive regimens or chemotherapy-immunotherapy combinations. Decision making in this space is complex given the absence of head-to-head prospective comparisons, although a thorough analysis of long-term efficacy and safety data from pivotal clinical trials can provide insight into the optimal management of each subset of patients. Indeed, histological subtype and the extent of tumour cell PD-L1 expression are paramount to regimen selection, although other clinicopathological factors and patient preferences might also be relevant in certain scenarios. Finally, several emerging biomarkers and novel therapeutic strategies are currently under investigation, and these might further refine the current treatment paradigm. In this Review, we discuss the current treatment landscape and detail our approach to first-line immunotherapy regimen selection for patients with advanced-stage, driver-negative NSCLC.
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Qiu X, Wang Y, Liu F, Peng L, Fang C, Qian X, Zhang X, Wang Q, Xiao Z, Chen R, Yuan S, Li Y. Survival and prognosis analyses of concurrent PIK3CA mutations in EGFR mutant non-small cell lung cancer treated with EGFR tyrosine kinase inhibitors. Am J Cancer Res 2021; 11:3189-3200. [PMID: 34249454 PMCID: PMC8263631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/24/2021] [Indexed: 06/13/2023] Open
Abstract
In non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation, the prognostic impact of a concurrent Phosphoinositide-3-kinase catalytic alpha polypeptide (PIK3CA) mutation was still unknown. Some studies have shown that EGFR mutant NSCLC patients treated with EGFR tyrosine kinase inhibitors (TKIs) when concurrent PIK3CA mutation have a worse prognosis and shorter survival time. This study conducted a retrospective analysis of NSCLC patients with EGFR mutant or concurrent PIK3CA mutations from January 2015 to October 2019 in the First Affiliated Hospital of Nanchang University. Relative to EGFR alone mutations (Single-Mt), we found that NSCLC patients with EGFR mutations coexisting with PIK3CA mutations (Double-Mt) treated with EGFR-TKIs had a shorter median time to progression (TTP): 7.8 months versus 10.9 months (Double-Mt versus Single-Mt, P = 0.001), and decrease in median overall survival (OS): 20.6 months versus 32.4 months (P < 0.001). The objective response rate (ORR) between Double-Mt and Single-Mt was 36.7% versus 61.9% (P = 0.044), disease control rates (DCR) was 80.1% versus 91.7% (P = 0.179). Obviously, EGFR-TKIs for EGFR mutate NSCLC patients when concurrent PIK3CA mutations have a worse prognosis and shorter survival time.
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Affiliation(s)
- Xiaotong Qiu
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Yong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Fen Liu
- Critical Care Medicine, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Lihong Peng
- Department of Medical Oncology, The Affiliated Ji’an Hospital of Nanchang University (Ji’an Central People’s Hospital)106 Jinggangshan Road, Ji’an 343000, China
| | - Chen Fang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Xiaoyin Qian
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Xinwei Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Qian Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Zhehao Xiao
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Renfang Chen
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Shangkun Yuan
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
| | - Yong Li
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University17 Yongwai Zheng Road, Nanchang 330000, China
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Wu L, Zhong W, Li A, Qiu Z, Xie R, Shi H, Lu S. Successful treatment of EGFR T790M-mutant non-small cell lung cancer with almonertinib after osimertinib-induced interstitial lung disease: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:950. [PMID: 34350265 PMCID: PMC8263887 DOI: 10.21037/atm-21-2823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022]
Abstract
Third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) have revolutionized the standard treatment for EGFR T790M-positive non-small cell lung cancer (NSCLC). Osimertinib is one of the third-generation EGFR-TKIs and is currently the most advanced in clinical development. Interstitial lung disease (ILD) is a potentially fatal side effect of osimertinib use. Successful rechallenge with the second-generation TKI afatinib following osimertinib-induced ILD has been reported. However, few reports have discussed the safety and efficacy of third-generation TKI rechallenge in this patient population. In this paper, a case of lung adenocarcinoma is retrospectively analyzed, and the relevant literature is reviewed. The patient was initially diagnosed with early lung cancer, for which surgical treatment was performed. The postoperative diagnosis indicated stage IB (pT2N0M0) right lung adenocarcinoma. Genetic testing (amplification-refractory mutation system) revealed EGFR exon 19 deletion. More than 2 years after surgery, multiple metastases occurred in both lungs, so gefitinib (250 mg per day) was administered. However, 6 months after the start of gefitinib treatment, the tumor progressed. Lung tumor biopsy was performed for genetic testing (NGS) and an EGFR T790M mutation was observed. Subsequently, second-line treatment with osimertinib (80 mg per day) was given for 3 months. The evaluated response suggested a partial response (PR) with the occurrence of grade 3 ILD. Pemetrexed plus bevacizumab chemotherapy was subsequently administered, resulting in stable disease. However, following a severe drug reaction after six courses, the patient’s chemotherapy was discontinued. Another third-generation TKI, almonertinib (110 mg per day), was rechallenged based on no ILD having been reported in a phase I/II study of this drug. After 4 months of almonertinib administration and 6 months without ILD recurrence, partial remission was attained. This is the first report of successful treatment with almonertinib after osimertinib-induced ILD. The results suggested that almonertinib had a significant effect in patients with EGFR T790M mutation, with fewer side effects and better survival benefits for patients with advanced lung cancer.
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Affiliation(s)
- Longqiu Wu
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Wenjuan Zhong
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - An Li
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Zhengang Qiu
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Ruilian Xie
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Huaqiu Shi
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Shun Lu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Zhai SS, Yu H, Gu TT, Li YX, Lei Y, Zhang HY, Zhen TH, Gao YG. Lung adenocarcinoma harboring rare epidermal growth factor receptor L858R and V834L mutations treated with icotinib: A case report. World J Clin Cases 2020; 8:3841-3846. [PMID: 32953862 PMCID: PMC7479576 DOI: 10.12998/wjcc.v8.i17.3841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors are widely used for the treatment of non-small-cell lung cancer with EGFR mutations. However, patients with rare, even compound EGFR mutations have different responses to EGFR-tyrosine-kinase inhibitors, which bring uncertainty to clinical treatment.
CASE SUMMARY A 45-year-old female patient presented with a 3-mo history of cough and white sputum without chest pain. Chest computed tomography revealed lung space-occupying lesions and multiple lymphadenectasis. Bronchoscopy and pathology suggested lung adenocarcinoma. Compound variation of EGFR gene (exon 21 L858R/V834L) was detected in both tissue and circulating tumor deoxyribonucleic acid samples. As a result of next-generation sequencing and her family’s wishes, the patient was given oral treatment with icotinib hydrochloride (125 mg/d, tid) from March 21, 2019 and has achieved stable disease for the last 1 year.
CONCLUSION Non-small cell lung adenocarcinoma with EGFR L858R/V834L was treated successfully with icotinib, and it may be a new medication treatment option.
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Affiliation(s)
- Shu-Sen Zhai
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Hui Yu
- Cancer Research Institute, YuceBio, Shenzhen 518000, Guangdong Province, China
| | - Tian-Tian Gu
- Cancer Research Institute, YuceBio, Shenzhen 518000, Guangdong Province, China
| | - Yan-Xia Li
- Cancer Research Institute, YuceBio, Shenzhen 518000, Guangdong Province, China
| | - Yan Lei
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Hai-Yan Zhang
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Tong-Huan Zhen
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
| | - Yun-Ge Gao
- Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
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Chen X, Xu B, Li Q, Xu X, Li X, You X, Yu Z. Genetic profile of non-small cell lung cancer (NSCLC): A hospital-based survey in Jinhua. Mol Genet Genomic Med 2020; 8:e1398. [PMID: 32657049 PMCID: PMC7507563 DOI: 10.1002/mgg3.1398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/18/2020] [Accepted: 06/15/2020] [Indexed: 01/06/2023] Open
Abstract
Background We describe the clinical features, genetic profile, and their correlation in NSCLC patients. Methods A total of 256 Chinese patients with NSCLC were enrolled in this study. NGS‐based genomic profiling of major lung cancer‐related genes was performed on formalin‐fixed paraffin‐embedded tumor samples. Results Of 256 patients with NSCLC, 219 were adenocarcinoma and most of them were in the early stage. Among patients, 63.3% patients have more than two gene mutations. By analyzing variant allele frequency (VAF), we found that the median VAF has significant differences between squamous cell carcinoma and adenocarcinoma, as well as early stage and advanced stage. The frequency of mutations in EGFR, MET, and RET were significantly higher in nonsmokers than in smokers. Besides, Pearson correlation analysis found that ALK, BRAF, and MET mutations had a strong correlation with age. Notably, higher frequencies of ALK and BRAF alterations were associated with younger age, while more frequent MET mutations appear in the patients at age 55 or older. Conclusion More unique features of cancer driver genes in Chinese NSCLC were identified by next‐generation sequencing. These findings highlighted that it is necessary to carry out targeted detection according to different clinical features for NSCLC.
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Affiliation(s)
- Xianguo Chen
- Department of Thoracic SurgeryJinhua Municipal Central HospitalJinhua Hospital of Zhejiang UniversityJinhuaChina
| | - Bo Xu
- Department of Thoracic SurgeryJinhua Municipal Central HospitalJinhua Hospital of Zhejiang UniversityJinhuaChina
| | - Qiang Li
- Hangzhou D.A. Medical LaboratoryHangzhouChina
| | - Xiaoyi Xu
- Department of Thoracic SurgeryJinhua Municipal Central HospitalJinhua Hospital of Zhejiang UniversityJinhuaChina
| | - Xianshuai Li
- Department of Thoracic SurgeryJinhua Municipal Central HospitalJinhua Hospital of Zhejiang UniversityJinhuaChina
| | - Xia You
- Hangzhou D.A. Medical LaboratoryHangzhouChina
| | - Zhaonan Yu
- Hangzhou D.A. Medical LaboratoryHangzhouChina
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Liu SY, Sun H, Zhou JY, Jie GL, Xie Z, Shao Y, Zhang X, Ye JY, Chen CX, Zhang XC, Zhou Q, Yang JJ, Wu YL. Clinical characteristics and prognostic value of the KRAS G12C mutation in Chinese non-small cell lung cancer patients. Biomark Res 2020; 8:22. [PMID: 32607238 PMCID: PMC7318746 DOI: 10.1186/s40364-020-00199-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background The KRAS mutation is the second most common genetic variant in Chinese non-small cell lung cancer (NSCLC) patients. At the 2019th World Conference of Lung Cancer, the KRAS G12C-specific inhibitor AMG510 showed promising results in the phase I clinical trial. However, the frequency, clinical characteristics, and prognostic significance of the KRAS G12C mutation in Chinese NSCLC patients are rarely reported. Methods Next-generation sequencing was used to confirm the KRAS mutation status in 40,804 NSCLC patients from multiple centers (mCohort). Survival data were collected retrospectively from 1456 patients at one of the centers, the Guangdong Lung Cancer Institute (iCohort). Results In the mCohort, 3998 patients (9.8%) were confirmed to harbor a KRAS mutation, of whom 1179 (29.5%) had the G12C subtype. In the iCohort, 130 NSCLC patients (8.9%) had a KRAS mutation and 42 (32.3%) had the G12C subtype. The G12C subgroup included more male patients (85.2% vs 67.4%, P < 0.0001) and more smokers (76.2% vs 53.4%, P = 0.02) than did the non-G12C subgroup. Both the KRAS mutation group and KRAS G12C mutation subgroup were associated with a shorter median overall survival (OS) than wildtype tumors (15.1 vs 26.7 months, hazard ratio [HR]KRAS = 1.50, P = 0.002; 18.3 vs 26.7 months, HRG12C = 1.66, P = 0.007). In Cox regression analysis, smoking (HR = 1.39, P = 0.05) and stage IV disease (HR = 2.72, P < 0.001) remained as independent predictors of shorter OS. Both the KRAS mutation (HR = 1.30, P = 0.07) and KRAS G12C mutation (HR = 1.47, P = 0.07) reached borderline significance. Conclusions In the largest sample used thus for, our study found that approximately 10% of Chinese NSCLC patients had KRAS mutations. Of these, nearly 30% harbored the KRAS G12C mutation subtype, which was most common in male smokers. The KRAS G12C mutation is a biomarker of poor prognosis in Chinese NSCLC patients, which could potentially be improved by G12C-specific inhibitors in the future. (296 words)
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Affiliation(s)
- Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou, 510080 China
| | - Hao Sun
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou, 510080 China
| | - Jia-Ying Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou, 510080 China
| | - Guang-Ling Jie
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou, 510080 China
| | - Zhi Xie
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou, 510080 China
| | - Yang Shao
- Nanjing Geneseeq Technology Inc., Nanjing, 210032 China
| | - Xian Zhang
- Nanjing Geneseeq Technology Inc., Nanjing, 210032 China
| | - Jun-Yi Ye
- Burning Rock Biotech, Guangzhou, 510000 China
| | | | - Xu-Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou, 510080 China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou, 510080 China
| | - Jin-Ji Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou, 510080 China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Er Road, Guangzhou, 510080 China
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Unique Genetic Characteristics and Clinical Prognosis of Female Patients with Lung Cancer Harboring RET Fusion Gene. Sci Rep 2020; 10:10387. [PMID: 32587276 PMCID: PMC7316706 DOI: 10.1038/s41598-020-66883-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/29/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives: Since no report on the genetic characteristics of RET fusions in female patients with lung cancer is available, this study revealed the genetic and prognostic characteristics of female patients with lung cancer harboring RET fusion gene for the first time. Materials and Methods: The molecular portfolios of 1,652 patients with lung cancer who underwent targeted next-generation sequencing for screening candidate oncogenic drivers in their histological specimens from January 2016 to December 2018 were investigated in this study. Results: RET fusions were identified in 23 cases, 15 females [2.2% (15/685)] and eight males [0.9% (8/902)]. The most common fusions were KIF5B–RET in females [80% (12/15)] and CCDC6–RET in males [50% (4/8)], along with some rare RET fusions, including SLC39A8–RET, ITIH2–RET, FYCO1–RET and SLC25A36–RET in females, and MIR3924–RET, ZBTB41–RET and ITGA8–RET in males. Interestingly, the highly positive, moderate positive, and negative rates of PD–L1 staining in females were 33.3%, 8.3% and 58.3%, respectively; whereas those in males were 0%, 57.1% and 42.9%. Additionally, the progression-free survival (PFS) of stage IV patients was comparatively shorter in females, shown by the medians of 4.0 months in females and 6.0 months in males (P = 0.029). A 43-year-old female patient with metastatic lung adenocarcinoma, who harbored KIF5B–RET fusion and had highly positive PD–L1 staining, received nivolumab as second-line treatment. A partial response was achieved and remained for more than five months. Conclusion: Unique genetic characteristics and poor prognosis are found in female patients with lung cancer harboring RET fusion gene. Immune checkpoint inhibitors are a potential option for patients with high expression of PD–L1.
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Hu Y, Yang X, Nie L, Zhao D, An J, Li B. [Analysis of Clinical Characteristics and Driver Genes in 405 Patients with Lung Cancer Complicated with Tuberculosis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:337-342. [PMID: 32336065 PMCID: PMC7260389 DOI: 10.3779/j.issn.1009-3419.2020.101.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
背景与目的 随着肺癌研究进展, 靶向治疗、免疫检查点抑制剂等新的治疗方法已经开始应用于肺癌患者, 因此需要进一步了解合并肺结核的肺癌患者的临床及实验室特点, 从而为此类患者的临床治疗提供新的思路。本研究目的是分析肺癌合并肺结核患者的临床特征、驱动基因检测结果及其之间关系。 方法 回顾性分析我院2014年1月-2019年12月收治的405例肺癌合并肺结核患者, 应用统计学方法分析其临床特征与驱动基因状态之间的关系。 结果 405例肺癌合并肺结核患者中男性占77.3%, 有吸烟史患者占85.3%, 病理类型以肺腺癌为主, 当胸部影像学有空洞改变时以鳞癌为主要类型。214例患者进行驱动基因检测, 表皮生长因子受体(epidermal growth factor receptor, EGFR)基因突变率为35.9%, 其中41.8%为外显子19缺失突变, 50.9%为外显子21 L858R突变。当胸部影像有空洞改变时, EGFR突变率显著降低(16.1%)。间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK)融合基因检测阳性率为2.5%, 原癌基因1酪氨酸激酶(c-ros oncogene 1 receptor kinase, ROS1)突变率为1.9%, 肉瘤病毒致癌基因同源物B1(V-raf murine sarcoma viral oncogene homolog B1, BRAF)基因突变率为1.1%, 克尔斯滕大鼠肉瘤病毒致癌基因同源物(Kirsten Rat Sarcoma Viral Oncogene Homolog, KRAS)基因突变率为10.1%。女性肺癌合并肺结核患者基因突变率为50.0%, 男性为27.9%。 结论 肺癌合并肺结核患者以有吸烟史的男性患者为主, 病理类型以腺癌为主。基因突变阳性率与单纯肺癌无明显差异, 但是当胸部影像有空洞表现时, 基因突变率显著降低。
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Affiliation(s)
- Ying Hu
- Department of Oncology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Xinjie Yang
- Department of Oncology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Lihui Nie
- Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Dan Zhao
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Jun An
- Department of Medical Records, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Baolan Li
- Department of Oncology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
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Wang A, Zhang X, Yi J, Zhu M, Zhang Y. Successful treatment of advanced lung adenocarcinoma complicated with Lambert-Eaton myasthenic syndrome: A case report and literature review. Thorac Cancer 2020; 11:1334-1338. [PMID: 32154996 PMCID: PMC7180587 DOI: 10.1111/1759-7714.13385] [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: 12/09/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/28/2022] Open
Abstract
Lambert-Eaton myasthenic syndrome (LEMS) is a rare disease characterized by involvement of the neuromuscular junction. Most cases have an underlying malignancy, especially small-cell lung cancer (SCLC), while adenocarcinoma is less common. Here, we report a rare case of metastatic lung adenocarcinoma complicated with LEMS. In this case, L858R mutation was detected in the 21st exon of the EGFR gene. First-line treatment with gefitinib was given, and the patient has survived for more than six years. Early diagnosis of LEMS and timely and effective treatment can result in a good prognosis. We also searched for "lung cancer", or "carcinoma of lung", or "adenocarcinoma of lung", or "Lambert-Eaton myasthenic syndrome" in PubMed until 1 December 2019. Seven cases of lung adenocarcinoma complicated with LEMS were found, most of which had a poor prognosis. KEY POINTS: This article reports a rare case of metastatic lung adenocarcinoma with EGFR mutation, complicated with LEMS. Gefitinib was given as first-line treatment, and resulted in a good prognosis.
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Affiliation(s)
- Aili Wang
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Tuberculosis, Shijiazhuang Fifth Hospital, Hebei, China
| | - Jiawen Yi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Min Zhu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
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Zhang L, Bai L, Liu X, Liu Y, Li S, Liu J, Zhang S, Yang C, Ren X, Cheng Y. Factors related to rapid progression of non-small cell lung cancer in Chinese patients treated using single-agent immune checkpoint inhibitor treatment. Thorac Cancer 2020; 11:1170-1179. [PMID: 32134200 PMCID: PMC7180579 DOI: 10.1111/1759-7714.13370] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/26/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of non‐small cell lung cancer (NSCLC). While rapid progression (RP) has been proposed as a non‐negligible pattern of response to ICIs, its definition and related factors remain unclear. This study aimed to develop a clinical definition of RP and to identify related factors. Methods We retrospectively evaluated Chinese patients who had received an ICI as second‐line or later treatment for locally advanced or metastatic NSCLC at a single center. We defined RP as radiological progression at the first response assessment (<2 months after starting the ICI), as well as confirmation of progressive disease or cancer‐related death occurring at <3 months. The clinical outcomes were compared for patients with RP or non‐RP to identify prognostic factors. Results The study evaluated 74 eligible patients with detailed records regarding their ICI therapy, including 25 patients (33.8%) who had experienced RP. Relative to patients with non‐RP, patients with RP had significantly shorter median progression‐free survival (1.7 months [95% CI: 1.4–2.0 months] vs. 6.3 months [95% CI 5.2–7.3 months], P < 0.001; hazard ratio: 0.14, 95% CI: 0.08–0.25) and significantly shorter median overall survival (8.2 months [95% CI 3.0–13.4 months] vs. 22.6 months [95% CI 17.0–28.1 months], P < 0.001; hazard ratio: 0.27, 95% CI: 0.15–0.49). Multivariate analysis revealed that RP was independently predicted by the presence of ≥3 metastatic sites (P = 0.039) and a neutrophil‐to‐lymphocyte ratio of ≥3 (P = 0.044). Conclusions Among NSCLC patients, RP was a common response to ICI monotherapy and was associated with dramatically reduced progression‐free and overall survival. Care is needed when selecting ICI monotherapy for these patients, especially if they have ≥3 metastatic sites or a neutrophil‐to‐lymphocyte ratio of ≥3. Key points Significant findings of the study: Patients with rapid progression after immune checkpoint inhibitor monotherapy had poor survival outcomes. The number of metastatic sites and the neutrophil‐to‐lymphocyte ratio may independently predict treatment response in this setting.What this study adds: This is the first study to evaluate rapid progression after second‐line or later single‐agent immunotherapy in a Chinese population. Our findings may help establish effective immunotherapy strategies for NSCLC.
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Affiliation(s)
- Liang Zhang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Cancer Immunology and Biotherapy, Tianjin, China.,Division of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China.,The Third Division of Medical Oncology, Jilin Cancer Hospital, Changchun, China
| | - Lianwei Bai
- The Third Division of Medical Oncology, Jilin Cancer Hospital, Changchun, China
| | - Xianhong Liu
- Division of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Ying Liu
- Division of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Shuang Li
- Division of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Jingjing Liu
- Division of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Shuang Zhang
- Division of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Changliang Yang
- Division of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Xiubao Ren
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Cancer Immunology and Biotherapy, Tianjin, China
| | - Ying Cheng
- Division of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
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Liu S, Zhou J, Li W, Sun H, Zhang Y, Yan H, Chen Z, Chen C, Ye J, Yang J, Zhou Q, Zhang X, Wu Y. Concomitant genetic alterations having greater impact on the clinical benefit of EGFR-TKIs in EGFR-mutant advanced NSCLC than BIM deletion polymorphism. Clin Transl Med 2020; 10:337-345. [PMID: 32508032 PMCID: PMC7240862 DOI: 10.1002/ctm2.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/07/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In previous studies, the predictive role of BIM deletion polymorphism with respect to responses to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) has been controversial. The potential reasons for these inconsistent findings were unknown. METHODS Data from CTONG0901 clinical trial and medical records of Guangdong Lung Cancer Institute (GLCI) were retrospectively pooled. A total of 194 and 141 EGFR-mutant non-small cell lung cancer (NSCLC) patients treated with first- and second-generation EGFR-TKIs were examined in the CTONG0901 and GLCI cohorts, respectively. Sixty-eight patients were treated with third-generation EGFR-TKIs in the GLCI cohort. The BIM gene status was examined by next-generation sequencing. RESULTS The frequency of BIM deletion polymorphism was 11.3% and 17.0% in CTONG0901 and GLCI cohorts, respectively. For first- and second-generation EGFR-TKIs in CTONG0901 cohort, objective response (ORR) was 54.5% in BIM deletion group versus 56.4% in wild-type BIM group (P = .87); disease control rate (DCR) was 90.9% versus 88.4% (P = 1.00); progression-free survival (PFS) was 10.5 versus 11.2 months (P = .59); and overall survival (OS) was 20.5 versus 20.5 months (P = .73). In GLCI cohort, ORR was 54.2% versus 60.7% (P = .55); DCR was 91.7% versus 96.6% (P = .27); PFS was 10.1 versus 11.6 months (P = .63); and OS was 58.5 versus 45.0 months (P = .93). For third-generation EGFR-TKIs, ORR was 18.2% versus 63.2% (P = .02); DCR was 81.8% versus 96.5%, (P = .12); PFS was 5.8 versus 9.0 months (P = .13); and OS was 30.0 versus 24.8 months (P = .85). Cox regression analysis showed that concomitant genetic alterations could adversely affect the response to EGFR-TKIs, but not BIM deletion. CONCLUSIONS The presence of BIM deletion showed no relation to an impaired response to first-, second-, and third-generation EGFR-TKIs in NSCLC patients. The factors influencing the response of EGFR-TKIs were concomitant genetic alterations, but not BIM deletion.
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Affiliation(s)
- Si‐Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | - Jia‐Ying Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | - Wen‐Feng Li
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | - Hao Sun
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | - Yi‐Chen Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | - Hong‐Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | - Zhi‐Hong Chen
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | | | - Jun‐Yi Ye
- Burning Rock BiotechGuangzhou510000China
| | - Jin‐Ji Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | - Xu‐Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
| | - Yi‐Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of MedicineSouth China University of TechnologyGuangzhou510080China
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Smolle E, Leithner K, Olschewski H. Oncogene addiction and tumor mutational burden in non-small-cell lung cancer: Clinical significance and limitations. Thorac Cancer 2019; 11:205-215. [PMID: 31799812 PMCID: PMC6997016 DOI: 10.1111/1759-7714.13246] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 12/25/2022] Open
Abstract
Lung cancer incidence has increased worldwide over the past decades, with non-small cell lung cancer (NSCLC) accounting for the vast majority (85%) of lung cancer specimens. It is estimated that lung cancer causes about 1.7 million global deaths per year worldwide. Multiple trials have been carried out, with the aim of finding new effective treatment options. Lately, special focus has been placed on immune checkpoint (PD1/PD-L1) inhibitors which impact the tumor immune microenvironment. Tumor mutational burden (TMB) has been found to predict response to immune checkpoint inhibitors. Conversely, recent studies have weakened the significance of TMB as a predictor of response to therapy and survival. In this review article, we discuss the significance of TMB, as well as possible limitations. Furthermore, we give a concise overview of mutations frequently found in NSCLC, and discuss the significance of oncogene addiction in lung cancer as an essential driver of tumorigenesis and tumor progression.
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Affiliation(s)
- Elisabeth Smolle
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Katharina Leithner
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Yin K, Feng HB, Li LL, Chen Y, Xie Z, Lv ZY, Guo WB, Lu DX, Yang XN, Yan WQ, Wu YL, Zhang XC. Low frequency of mutation of epidermal growth factor receptor (EGFR) and arrangement of anaplastic lymphoma kinase (ALK) in primary pulmonary lymphoepithelioma-like carcinoma. Thorac Cancer 2019; 11:346-352. [PMID: 31794146 PMCID: PMC6997003 DOI: 10.1111/1759-7714.13271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background Primary pulmonary lymphoepithelioma‐like carcinoma (PLELC) is a rare and unique subtype of lung cancer. However, the prevalence of driver alterations, such as epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements, and the response of tyrosine kinase inhibitor (TKIs) in PLELC has not been thoroughly investigated. Method We retrospectively reviewed the genetic profiles and treatment course of 330 PLELC patients at the Guangdong Lung Cancer Institute (GLCI) from 1st January, 2008 to 30th December, 2018. We searched and analyzed related literature published in PubMed and Web of Science from 1st January, 2000 and 31th August, 2019 based on their mention of “driver mutations” and “the response of TKIs to mutant PLELC”. Results Genetic alterations of EGFR/ALK were tested in 203 patients (203/330, 61.5%). Five patients (5/175, 2.9%) had EGFR mutation and three patients (3/140, 2.1%) had ALK alteration. From the total of 15 articles identified from electronic searches, 1071 PLELC cases mentioned the driver mutations. EGFR mutation and ALK rearrangement were detected in 15 patients and one patient, respectively. In total, there were four EGFR/ALK mutant PLELC patients who received targeted therapy as palliative treatment at the GLCI and in the literature. However, there was disease progression in all cases one month after use of TKIs. Conclusion The mutation rates of EGFR and ALK were low in PLELC. EGFR and ALK TKIs showed limited response in EGFR/ALK mutant PLELC. Further studies are needed to explore other molecular targets to optimize the therapeutic strategy for PLELC.
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Affiliation(s)
- Kai Yin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hui-Bo Feng
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin-Lin Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Chen
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi Xie
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi-Yi Lv
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei-Bang Guo
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dan-Xia Lu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Qing Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xu-Chao Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Medical Research Center, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
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Yang Y, Wu B, Huang L, Shi M, Liu Y, Zhao Y, Wang L, Lu S, Chen G, Li B, Xie C, Fang J, Yang N, Zhang Y, Cui J, Song Y, Zhang C, Mei X, Cao B, Yang L, Cheng Y, Ying K, Sun T, Ren B, Yu Q, Liao Z, Pei Z, Wang M, Zhou J, Yu S, Feng G, Wan H, Wang H, Gao S, Wang J, An G, Geng Y, Ji Y, Yuan Y, Ma S, Jia Z, Hu M, Zhou H, Yu J, Sun X, Zhang L. Biosimilar candidate IBI305 plus paclitaxel/carboplatin for the treatment of non-squamous non-small cell lung cancer. Transl Lung Cancer Res 2019; 8:989-999. [PMID: 32010577 PMCID: PMC6976344 DOI: 10.21037/tlcr.2019.12.23] [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] [Received: 09/30/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bevacizumab is a monoclonal antibody (mAb) against vascular endothelial growth factor (VEGF) and used for treatments of various cancers. Due to the high costs of bevacizumab treatments, a biosimilar provides an affordable alternative therapy for cancer patients. METHODS In this randomized, double-blind, multicenter, phase 3 study, locally advanced, metastatic or recurrent non-squamous non-small cell lung cancer (NSCLC) patients with wild-type epidermal growth factor receptor were enrolled and randomized (1:1) into IBI305 or bevacizumab groups. Patients received 6 cycles of paclitaxel/carboplatin plus IBI305 or bevacizumab 15 mg/kg intravenously followed by IBI305 or bevacizumab 7.5 mg/kg maintenance until disease progression, unacceptable toxicity or death. The primary endpoint was confirmed objective response rate (ORR) by an independent radiological review committee (IRRC) and secondary endpoints included disease control rate (DCR), progression-free survival (PFS), duration of response (DOR), overall survival (OS) and safety. RESULTS A total of 450 NSCLC patients were enrolled (224 in IBI305 group and 226 in bevacizumab group). ORRs were 44.3% for IBI305 and 46.4% for bevacizumab, and the ORR ratio was 0.95 (90% CI: 0.803 to 1.135), within the predefined equivalence margin of 0.75 to 1.33. No significant difference in PFS (7.64 vs. 7.77 m, P=0.9987) was observed between the 2 groups. Serious adverse events (AEs) occurred in 33.5% (75/224) of patients in the IBI305 group and 37.6% (85/226) in the bevacizumab group. AEs ≥ grade 3 were similar in the IBI305 and bevacizumab groups [84.4% (189/224) vs. 89.8% (203/226), P=0.085]. CONCLUSIONS IBI305 is similar to bevacizumab in terms of efficacy and safety. TRIAL REGISTRATION Clinicaltrials.org Identifier: NCT02954172. Registered on 3 November 2016. Https://clinicaltrials.gov/.
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Affiliation(s)
- Yunpeng Yang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510000, China
| | - Bin Wu
- Department of Respiratory Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China
| | - Linian Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Bengbu Medical College, Bangbu 233000, China
| | - Meiqi Shi
- Department of Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Yunpeng Liu
- Department of Oncology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Yanqiu Zhao
- Department of Respiratory Medicine, Henan Cancer Hospital, Zhengzhou 450003, China
| | - Lijun Wang
- Department of Tumor radiotherapy, The Second Affiliated Hospital of Xingtai Medical College, Xingtai 054000, China
| | - Shun Lu
- Department of Oncology, Shanghai Chest Hospital, Shanghai 200030, China
| | - Gongyan Chen
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Baolan Li
- General Department, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Conghua Xie
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jian Fang
- Department of Oncology, Peking University Cancer Hospital, Beijing 100142, China
| | - Nong Yang
- Department of Pulmonary Gastroenterology, Hunan Cancer Hospital, Changsha 410006, China
| | - Yiping Zhang
- Department of Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jiuwei Cui
- Department of Oncology, The First Hospital of Jilin University, Changchun 130000, China
| | - Yong Song
- Department of Respiratory Medicine, General Hospital of Eastern Theater Command, Nanjing 210002, China
| | - Cuiying Zhang
- Department of Oncology, Inner Mongolia People’s Hospital, Hohhot 010017, China
| | - Xiaodong Mei
- Department of Respiratory Medicine, An Hui Provincial Hospital, Hefei 230000, China
| | - Bangwei Cao
- Department of Oncology, Peking Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lan Yang
- Department of Respiratory Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
| | - Ying Cheng
- Department of Oncology, Jilin Cancer Hospital, Changchun 130000, China
| | - Kejing Ying
- Department of Respiratory Medicine, Sir Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Tao Sun
- Department of Internal Medicine, Liaoning Cancer Hospital & Institute, Shenyang 110046, China
| | - Biyong Ren
- Department of Respiratory Medicine, Chongqing three Gorges Central Hospital, Chongqing 404000, China
| | - Qitao Yu
- Department of Oncology, The Cancer Hospital of Guangxi Zhuang Autonomous Region, Nanning 530000, China
| | - Zijun Liao
- Department of Internal Medicine, Shaanxi Provincial Tumor Hospital, Xi’an 710061, China
| | - Zhidong Pei
- Department of Oncology, Luoyang Central Hospital Affiliated To Zhengzhou University, Luoyang 471009, China
| | - Mengzhao Wang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing 100005, China
| | - Jianying Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital Zhejiang University, Hangzhou 310003, China
| | - Shiying Yu
- Department of Oncology, Tongji Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Guosheng Feng
- Department of Chemotherapy, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530000, China
| | - Huiping Wan
- Department of Oncology, Jiangxi People’s Hospital, Nanchang 330000, China
| | - Huaqing Wang
- Department of Oncology, Tianjin People’s Hospital, Tianjin 300121, China
| | - Shegan Gao
- Department of Oncology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China
| | - Jinliang Wang
- Department of Oncology, General Hospital of PLA, Beijing 100853, China
| | - Guangyu An
- Department of Oncology, Beijing Chao-Yang Hospital, Beijing 100020, China
| | - Yi Geng
- Department of Oncology, Baoji Central Hospital, Baoji 721008, China
| | - Yanxia Ji
- Department of Oncology, Handan Central Hospital, Handan 056001, China
| | - Ying Yuan
- Department of Oncology, The Second Affiliated Hospital Zhejiang University, Hangzhou 310009, China
| | - Shenglin Ma
- Department of Oncology, Hangzhou First People’s Hospital, Hangzhou 310002, China
| | - Zhongyao Jia
- Department of Oncology, Linyi People’s Hospital, Linyi 276003, China
| | - Mu Hu
- Department of Chest Surgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Hui Zhou
- Innovent Biologics, Inc., Suzhou 215123, China
| | - Jie Yu
- Innovent Biologics, Inc., Suzhou 215123, China
| | - Xing Sun
- Innovent Biologics, Inc., Suzhou 215123, China
| | - Li Zhang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510000, China
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30
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Tian P, Cheng X, Zhao Z, Zhang Y, Bao C, Wang Y, Cai S, Ma G, Huang Y. Spectrum of Pathogenic Germline Mutations in Chinese Lung Cancer Patients through Next-Generation Sequencing. Pathol Oncol Res 2019; 26:109-114. [PMID: 31721094 DOI: 10.1007/s12253-019-00771-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/22/2019] [Indexed: 02/05/2023]
Abstract
Lung cancer is currently a leading cause of cancer-associated mortality worldwide. Despite the increasing evidences of variants that were associated with lung cancer risk, investigations of genetic factors and their roles in genetic susceptibility to lung cancer were limited. Here we systematically investigated the spectrum of pathogenic germline mutations in Chinese population with lung cancer. Genomic profiling of DNA was performed through next-generation sequencing (NGS) on tissue biopsy from 1764 Chinese lung cancer patients with a 381 cancer gene panel between January 01, 2017 and May 07, 2019. Patients with germline mutations were identified, and their clinical information were collected. Of 1764 patients with lung cancer, 67 (3.8%) patients were identified to carry pathogenic or likely pathogenic germline mutations in 25 cancer predisposition genes, with a frequency of 3.6% in lung adenocarcinoma (49/1349), 4.3% in squamous cell lung cancer (14/322), 5.6% in small cell lung cancer (4/72), and none in lung adenosquamous carcinoma (0/21), respectively. The highest pathogenic germline mutational prevalence were found in BRCA2 (0.79%), CHEK2 (0.40%), BRCA1 (0.34%), and TP53 (0.34%). Two splice mutations were reported for the first time in this study. Notably, a majority (85.5%) of the detected germline mutations fell in DNA damage repair pathways.
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Affiliation(s)
- Panwen Tian
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiangyang Cheng
- The first affiliated hospital of Guangzhou medical university, Guangzhou, China
| | - Zhengyi Zhao
- The Medical Department, 3D Medicines Inc., Shanghai, China
| | - Yuzi Zhang
- The Medical Department, 3D Medicines Inc., Shanghai, China
| | - Celimuge Bao
- The Information System Department, 3D Medicines Inc., Shanghai, China
| | - Yanyan Wang
- The Information System Department, 3D Medicines Inc., Shanghai, China
| | - Shangli Cai
- The Medical Department, 3D Medicines Inc., Shanghai, China
| | - Guowei Ma
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, China.
| | - Ying Huang
- Department of Respiratory, First Affiliated Hospital of Army Military Medical University, 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China.
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31
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Meng H, Guo X, Sun D, Liang Y, Lang J, Han Y, Lu Q, Zhang Y, An Y, Tian G, Yuan D, Xu S, Geng J. Genomic Profiling of Driver Gene Mutations in Chinese Patients With Non-Small Cell Lung Cancer. Front Genet 2019; 10:1008. [PMID: 31749831 PMCID: PMC6842958 DOI: 10.3389/fgene.2019.01008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 09/23/2019] [Indexed: 01/15/2023] Open
Abstract
Worldwide, especially in China, lung cancer accounts to a major cause of mortality related to cancer. Treatment decisions mainly depend on oncogenic driver mutations, which offer novel therapeutic targets for anticancer therapy. However, studies of genomic profiling of driver gene mutations in mainland China are rare. Hence, this is an extensive study of these mutations in Non-small-cell lung cancer (NSCLC) Chinese patients. Comparison of driver gene mutations of lung adenocarcinoma with other races showed that the mutational frequencies were similar within the different East Asian populations, while there were differences between East Asian and non-Asian populations. Further, four promising candidates for druggable mutations of epidermal growth factor receptor (EGFR) were revealed that open up avenues to develop and design personal therapeutic approaches for patients harboring mutations. These results will help to develop personalized therapy targeting NSCLC.
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Affiliation(s)
- Hongxue Meng
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xuejie Guo
- Department of Medicine, Geneis (Beijing) Co., Ltd., Beijing, China
| | - Dawei Sun
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yuebin Liang
- Department of Medicine, Geneis (Beijing) Co., Ltd., Beijing, China
| | - Jidong Lang
- Department of Medicine, Geneis (Beijing) Co., Ltd., Beijing, China
| | - Yingmin Han
- Department of Medicine, Geneis (Beijing) Co., Ltd., Beijing, China
| | - Qingqing Lu
- Department of Medicine, Geneis (Beijing) Co., Ltd., Beijing, China
| | - Yanxiang Zhang
- Department of Medicine, Geneis (Beijing) Co., Ltd., Beijing, China
| | - Yanxin An
- Department of Medicine, Geneis (Beijing) Co., Ltd., Beijing, China
| | - Geng Tian
- Department of Medicine, Geneis (Beijing) Co., Ltd., Beijing, China
| | - Dawei Yuan
- Department of Medicine, Geneis (Beijing) Co., Ltd., Beijing, China
| | - Shidong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jingshu Geng
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China
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32
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Zhang M, He J, Li T, Hu H, Li X, Xing H, Wang J, Yang F, Ma Q, Liu B, Tang C, Abliz Z, Liu X. Accurate Classification of Non-small Cell Lung Cancer (NSCLC) Pathology and Mapping of EGFR Mutation Spatial Distribution by Ambient Mass Spectrometry Imaging. Front Oncol 2019; 9:804. [PMID: 31555581 PMCID: PMC6722907 DOI: 10.3389/fonc.2019.00804] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/07/2019] [Indexed: 12/25/2022] Open
Abstract
Objectives: Tumor pathology examination especially epidermal growth factor receptor (EGFR) mutations molecular testing has been integral part of lung cancer clinical practices. However, the EGFR mutations spatial distribution characteristics remains poorly investigated, which is critical to tumor heterogeneity analysis and precision diagnosis. Here, we conducted an exploratory study for label-free lung cancer pathology diagnosis and mapping of EGFR mutation spatial distribution using ambient mass spectrometry imaging (MSI). Materials and Methods: MSI analysis were performed in 55 post-operative non-small cell lung cancer (NSCLC) tumor and paired normal tissues to distinguish tumor from normal and classify pathology. We then compared diagnostic sensitivity of MSI and ADx-amplification refractory mutation system (ARMS) for the detection of EGFR mutation in pathological confirmed lung adenocarcinoma (AC) and explored EGFR mutations associated biomarkers to depict EGFR spatial distribution base on ambient MSI. Results: Of 55 pathological confirmed NSCLC, MSI achieved a diagnostic sensitivity of 85.2% (23/27) and 82.1% (23/28) for AC and squamous cell carcinoma (SCC), respectively. Among 27 AC, there were 17 EGFR-wild-type and 10 EGFR-mutated-positive samples detected by ARMS, and MSI achieved a diagnostic sensitivity of 82.3% (14/17) and 80% (8/10) for these two groups. Several phospholipids were specially enriched in AC compared with SCC tissues, with the higher ions intensity of phospholipids in EGFR-mutated-positive compared with EGFR-wild-type AC tissues. We also found EGFR mutations distribution was heterogeneous in different regions of same tumor by multi-regions ARMS detection, and only the regions with higher ions intensity of phospholipids were EGFR-mutated-positive. Conclusion: MSI method could accurately distinguish tumor pathology and subtypes, and phospholipids were reliable EGFR mutations associated biomarkers, phospholipids imaging could intuitively visualize EGFR mutations spatial distribution, may facilitate our understanding of tumor heterogeneity.
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Affiliation(s)
- Min Zhang
- Academy of Military Medical Science, Beijing, China.,Department of Lung Cancer, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiuming He
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tiegang Li
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Haixu Hu
- Laboratory of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Hao Xing
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Qunfeng Ma
- Department of Thoracic Surgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bing Liu
- Laboratory of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chuanhao Tang
- Department of Oncology, Peking University International Hospital, Beijing, China
| | - Zeper Abliz
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Center for Imaging and Systems Biology, Minzu University of China, Beijing, China
| | - Xiaoqing Liu
- Department of Lung Cancer, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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33
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Liang W, Guo M, Pan Z, Cai X, Li C, Zhao Y, Liang H, Yang H, Wang Z, Chen W, Xu C, Yang X, Sun J, He P, Gu X, Yin W, He J. Association between certain non-small cell lung cancer driver mutations and predictive markers for chemotherapy or programmed death-ligand 1 inhibition. Cancer Sci 2019; 110:2014-2021. [PMID: 31033100 PMCID: PMC6549909 DOI: 10.1111/cas.14032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 12/22/2022] Open
Abstract
This study aimed to analyze the association between driver mutations and predictive markers for some anti–tumor agents in non–small cell lung cancer (NSCLC). A cohort of 785 Chinese patients with NSCLC who underwent resection from March 2016 to November 2017 in the First Affiliated Hospital of Guangzhou Medical University was investigated. The specimens were subjected to hybridization capture and sequence of 8 important NSCLC‐related driver genes. In addition, the slides were tested for PD‐L1, excision repair cross‐complementation group 1 (ERCC1), ribonucleotide reductase subunit M1 (RRM1), thymidylate synthase (TS) and β‐tubulin III by immunohistochemical staining. A total of 498 (63.4%) patients had at least 1 driver gene alteration. Wild‐type, EGFR rare mutation (mut), ALK fusion (fus), RAS mut, RET fus and MET mut had relatively higher proportions of lower ERCC1 expression. EGFR 19del, EGFR L858R, EGFR rare mut, ALK fus, HER2 mut, ROS1 fus and MET mut were more likely to have TS low expression. Wild‐type, EGFR L858R, EGFR rare mut and BRAF mut were associated with lower β‐tubulin III expression. In addition, wild‐type, RAS mut, ROS1 fus, BRAF and MET mut had higher proportion of PD‐L1 high expression. As a pilot validation, 21 wild‐type patients with advanced NSCLC showed better depth of response and response rate to taxanes compared with pemetrexed/gemcitabine (31.2%/60.0% vs 26.6%/45.5%). Our study may aid in selecting the optimal salvage regimen after targeted therapy failure, or the chemo‐regimen where targeted therapy has not been a routine option. Further validation is warranted.
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Affiliation(s)
- Wenhua Liang
- Department of Thoracic Surgery/Oncology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Minzhang Guo
- Department of Thoracic Surgery/Oncology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenkui Pan
- Department of Oncology, Qingdao Municipal Hospital, Qingdao, China
| | - Xiuyu Cai
- Department of General Internal Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Caichen Li
- Department of Thoracic Surgery/Oncology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yi Zhao
- Department of Thoracic Surgery/Oncology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery/Oncology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haiying Yang
- Medical Affair, Linkdoc Technology, Beijing, China
| | - Zhen Wang
- Medical Affair, Linkdoc Technology, Beijing, China
| | - Wenting Chen
- Medical Affair, Linkdoc Technology, Beijing, China
| | - Chuhong Xu
- Medical Affair, Linkdoc Technology, Beijing, China
| | - Xinyun Yang
- Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ping He
- Department of Pathology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Gu
- Department of Pathology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiqiang Yin
- Department of Thoracic Surgery/Oncology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery/Oncology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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34
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Lin X, Dong W, Lai X, Feng W, Yu X, Gu Q, Wang C, Xiao W, Zheng X. The clinical value of circulating tumor DNA detection in advanced non-small cell lung cancer. Transl Cancer Res 2019; 8:170-179. [PMID: 35116746 PMCID: PMC8797680 DOI: 10.21037/tcr.2019.01.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/14/2019] [Indexed: 11/25/2022]
Abstract
Background Circulating tumor DNA (ctDNA) is a kind of cell-free DNA which comes from tumor cells and effectively reflects the molecular characteristics of tumors, which providing us a novel method to explore its clinical therapeutic value in advanced lung cancer. Methods A total of 36 patients with advanced non-small cell lung cancer (NSCLC) were enrolled in this study, including 28 cases of adenocarcinoma and 8 cases of squamous cell carcinoma. Next-generation sequencing based ctDNA detection, tissue DNA (tDNA) detection, corresponding survival analysis, and retrospective statistics were performed to explore the feasibility of clinical practice directed by molecular characteristics in NSCLC. Results Epidermal growth factor receptor mutation (EGFR mutation) took over the highest mutation frequency (36.11%) in 36 samples, and the subsequent genes were PIK3CA, BRAF, KRAS, NRAS, MAP2K1, and GNAQ; 11 patients were detected with multiple gene mutations, including 8 cases with double gene mutations, 1 case with three gene mutations, and 2 cases with four gene mutations, and the subsequent 12-month survival observation revealed that patients with less mutations also had a longer OS (10.37±0.74 vs. 7.08±1.43 months, P=0.034). Twenty-one patients with EGFR mutation and subsequently treated with EGFR-tyrosine kinase inhibitor (TKI) combined chemotherapy, had significantly longer PFS than those with EGFR wild type and treated with chemotherapy in next 5-year monitoring test (18.00±4.41 vs. 7.33±1.58 months, P=0.024). Conclusions Gene mutation in advanced lung cancer is complex, and ctDNA detection has important guiding significance in clinical treatment of advanced NSCLC.
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Affiliation(s)
- Xiao Lin
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Wentao Dong
- 1Gene Bio-tech Co., Ltd., Hangzhou 310051, China
| | - Xiaojing Lai
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Wei Feng
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Xiaofu Yu
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qing Gu
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | | | - Wen Xiao
- 1Gene Bio-tech Co., Ltd., Hangzhou 310051, China
| | - Xiao Zheng
- Department of Thoracic Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China
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Tfayli AH, Fakhri GB, Al Assaad MS. Prevalence of the epidermal growth factor receptor mutations in lung adenocarcinoma patients from the Middle East region. Ann Thorac Med 2019; 14:173-178. [PMID: 31333766 PMCID: PMC6611202 DOI: 10.4103/atm.atm_344_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lung cancer remains a major cause of cancer mortality with a 5-year survival in advanced stages around 4%. Platinum-based chemotherapy was routinely used as the standard of care in patients with advanced nonsmall cell lung cancer, but it is being progressively replaced by targeted molecular therapy. One of the molecular aberrations harbored by lung adenocarcinoma is the epidermal growth factor receptor (EGFR). A large ethnic variation has been reported in the prevalence of EGFR mutations in patients with lung adenocarcinoma. Data regarding its prevalence from the Middle East area remains limited. This paper aims at reviewing the data available for the prevalence of this mutation in the Middle Eastern patient population and comparing it with other reported series.
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Affiliation(s)
- Arafat Hussein Tfayli
- Department of Internal Medicine, Division of Hematology and Oncology, American University of Beirut, Beirut, Lebanon
| | - Ghina Bassam Fakhri
- Department of Internal Medicine, Division of Hematology and Oncology, American University of Beirut, Beirut, Lebanon
| | - Majd Sassine Al Assaad
- Department of Internal Medicine, Division of Hematology and Oncology, American University of Beirut, Beirut, Lebanon
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Wang N, Zhang T. Downregulation of MicroRNA-135 Promotes Sensitivity of Non-Small Cell Lung Cancer to Gefitinib by Targeting TRIM16. Oncol Res 2018; 26:1005-1014. [PMID: 29295721 PMCID: PMC7844745 DOI: 10.3727/096504017x15144755633680] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Personalized treatment targeting the epidermal growth factor receptor (EGFR) may be a promising new treatment of non-small cell lung cancer (NSCLC). Gefitinib, a tyrosine kinase inhibitor, is the first drug for NSCLC, which unfortunately easily leads to drug resistance. Our study aimed to explore the functional role of microRNA (miR)-135 in the sensitivity to gefitinib of NSCLC cells. Expression of miR-135 in normal cells and NSCLC cells was assessed, followed by the effects of abnormally expressed miR-135 on cell viability, migration, invasion, apoptosis, sensitivity to gefitinib, and the expression levels of adhesion molecules and programmed death ligand 1 (PD-L1) in H1650 and H1975 cells. Next, the possible target gene of miR-135 was screened and verified. Finally, the potential involvement of the JAK/STAT signaling pathway was investigated. Expression of miR-135 was upregulated in NSCLC cells, and miR-135 silencing repressed cell viability, migration, and invasion, but increased cell apoptosis and sensitivity to gefitinib. E-cadherin and β-catenin were significantly upregulated, but PD-L1 was downregulated by the silencing of miR-135. Subsequently, tripartite-motif (TRIM) 16 was screened and verified to be a target gene of miR-135, and miR-135 suppression was shown to function through upregulation of TRIM16 expression. Phosphorylated levels of the key kinases in the JAK/STAT pathway were reduced by silencing miR-135 by targeting TRIM16. In conclusion, miR-135 acted as a tumor promoter, and its suppression could improve sensitivity to gefitinib by targeting TRIM16 and inhibition of the JAK/STAT pathway.
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Affiliation(s)
- Ning Wang
- Department of Thoracic Surgery, Shengli Oilfield Central Hospital, Dongying, P.R. China
| | - Tingting Zhang
- Department of Oncology, Shengli Oilfield Central Hospital, Dongying, P.R. China
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Liu SY, Wu YL. Ongoing clinical trials of PD-1 and PD-L1 inhibitors for lung cancer in China. J Hematol Oncol 2017; 10:136. [PMID: 28679395 PMCID: PMC5499002 DOI: 10.1186/s13045-017-0506-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/26/2017] [Indexed: 12/22/2022] Open
Abstract
Compared to chemotherapy, promising results have been obtained by blocking the PD-1 pathway using antibodies that inhibit programmed cell death protein 1 (PD-1) or programmed cell death protein ligand 1 (PD-L1). Furthermore, global researchers and doctors are exploring how to optimize this immunotherapy in 270 clinical studies. However, Chinese clinical trials of these agents remain in the early stages. We summarize the ongoing international and domestic clinical trials using PD-1 and PD-L1 inhibitors to treat lung cancer. This information can help researchers better understand the active and approved clinical trials in China, as well as the ongoing research regarding PD-1 and PD-L1 inhibitors.
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Affiliation(s)
- Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences and School of Medicine of South China University of Technology, 106 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences and School of Medicine of South China University of Technology, 106 Zhongshan 2nd Road, Guangzhou, 510080, China.
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Zhou Q, Song Y, Zhang X, Chen GY, Zhong DS, Yu Z, Yu P, Zhang YP, Chen JH, Hu Y, Feng GS, Song X, Shi Q, Yang LL, Zhang PH, Wu YL. A multicenter survey of first-line treatment patterns and gene aberration test status of patients with unresectable Stage IIIB/IV nonsquamous non-small cell lung cancer in China (CTONG 1506). BMC Cancer 2017; 17:462. [PMID: 28673332 PMCID: PMC5496179 DOI: 10.1186/s12885-017-3451-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 06/26/2017] [Indexed: 02/06/2023] Open
Abstract
Background In recent years, systemic chemotherapy and molecular targeted therapy have become standard first-line treatments for locally advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC). The objective of this survey was to investigate first-line anticancer treatment patterns and gene aberration test status of patients with advanced nonsquamous NSCLC in China. Methods Patients included in this study had unresectable Stage IIIB/IV nonsquamous NSCLC and were admitted during August 2015 to March 2016 into one of 12 tertiary hospitals throughout China for first-line anticancer treatment. Patient data (demographics, NSCLC histologic type, Eastern Cooperative Oncology Group [ECOG] Performance Status [PS], gene aberration test and results [if performed], and first-line anticancer treatment regimen) were extracted from medical charts and entered into Medical Record Abstraction Forms (MERAFs), which were collated for analysis. Results Overall, 1041 MERAFs were collected and data from 932 MERAFs were included for analysis. Patients with unresectable Stage IIIB/IV nonsquamous NSCLC had a median age of 59 years, 56.4% were male, 58.2% were never smokers, 95.0% had adenocarcinoma, and 92.9% had an ECOG PS ≤1. A total of 665 (71.4%) patients had gene aberration tests; 46.5% (309/665) had epidermal growth factor receptor (EGFR) gene mutations, 11.5% (48/416) had anaplastic lymphoma kinase (ALK) gene fusions, and 0.8% (1/128) had a c-ros oncogene 1 gene fusion. The most common first-line treatment regimen for unresectable Stage IIIB/IV nonsquamous NSCLC was chemotherapy (72.5%, 676/932), followed by tyrosine kinase inhibitors (TKIs; 26.1%, 243/932), and TKIs plus chemotherapy (1.4%, 13/932). Most chemotherapy regimens were platinum-doublet regimens (93.5%, 631/676) and pemetrexed was the most common nonplatinum chemotherapy-backbone agent (70.2%, 443/631) in platinum-doublet regimens. Most EGFR mutation-positive patients (66.3%, 205/309) were treated with EGFR-TKIs. Conclusions Findings from our survey of 12 tertiary hospitals throughout China showed an increased rate of gene aberration testing, compared with those rates reported in previous surveys, for patients with advanced nonsquamous NSCLC. In addition, pemetrexed/platinum-doublet chemotherapy was the predominant first-line chemotherapy regimen for this population. Most patients were treated based on their gene aberration test status and results. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3451-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Yong Song
- Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu, China
| | | | - Gong-Yan Chen
- The Tumor Hospital affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Dian-Sheng Zhong
- General Hospital of Tianjin Medical University, Heping, Tianjin, China
| | - Zhuang Yu
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ping Yu
- Sichuan Cancer Hospital, Chengdu, Sichuan, China
| | | | | | - Yi Hu
- Chinese PLA General Hospital, Beijing, China
| | - Guo-Sheng Feng
- The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xia Song
- Shanxi Cancer Hospital, Taiyuan, Shanxi, China
| | - Qiang Shi
- Lilly Suzhou Pharmaceutical Co., Ltd, Shanghai, China
| | - Lu Lu Yang
- Lilly Suzhou Pharmaceutical Co., Ltd, Shanghai, China
| | | | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
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Liu SY, Mok T, Wu YL. Novel targeted agents for the treatment of lung cancer in China. Cancer 2015; 121 Suppl 17:3089-96. [PMID: 26331815 DOI: 10.1002/cncr.29522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 11/09/2022]
Abstract
Since the discovery of epidermal growth factor receptor mutations and epidermal growth factor receptor tyrosine kinase inhibitors, lung cancer treatment in China has entered the precision era. However, novel targeted agents based on novel biomarkers still need to be developed. In the current study, the authors review the biomarker features of lung cancer in the Chinese population and the novel agents that are aimed at novel targets. Furthermore, they discuss issues that require improvement for the production of novel drugs and provided future directions for development in China.
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Affiliation(s)
- Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tony Mok
- State Key Laboratory of Southern China, The Chinese University of Hong Kong, Sir Y.K. Pau Cancer Center, Prince of Wales Hospital, Hong Kong, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
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Anaplastic Lymphoma Kinase Variants and the Percentage of ALK-Positive Tumor Cells and the Efficacy of Crizotinib in Advanced NSCLC. Clin Lung Cancer 2015; 17:223-31. [PMID: 26454342 DOI: 10.1016/j.cllc.2015.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/06/2015] [Accepted: 09/11/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer patients exhibited heterogeneous magnitude of response and duration time to criztotinib treatment. This study explored ALK variants and the percentage of ALK-positive cells using fluorescent in situ hybridization (FISH) on clinical efficacy of crizotinib. PATIENTS AND METHODS A total of 120 patients with ALK rearrangement who were treated with criztotinib were enrolled. ALK variants were clarified in 61 patients, and ALK percentages were evaluated using FISH in 114 ALK-positive patients. Retrospectively, objective response rate, and progression-free survival (PFS) were evaluated. RESULTS A total of 61 patients with specific ALK variants were divided into 3 subgroups, echinoderm microtubule-associated protein like 4 (EML4)-ALK variant 1 (n = 22), EML4-ALK variant 3a/b (n = 18), and other ALK variants (n = 21). Median PFS in the 3 subgroups was 11.0 months (95% confidence interval [CI], 5.5-16.5), 10.9 months (95% CI, 5.9-15.8), 7.4 months (95% CI, 3.2-11.6), respectively, and no significant difference (P = .795) existed among them. The percentage of ALK-positive cells in FISH analysis was weakly correlated with PFS (rs = 0.235; P = .015). Additionally, it was also weakly correlated with best response to crizotinib (rs = 0.288; P = .003). Overall, there were 45, 49, and 26 patients receiving first, second, and third or further-line crizotinib, respectively. Median PFS in the first-line setting (10.5 months; 95% CI, 8.6-12.4) was significantly longer than that in the second-line setting (8.3 months; 95% CI, 4.7-12.0; P = .020). CONCLUSION Anaplastic lymphoma kinase variants might have no correlation with clinical response to crizotinib. The percentage of ALK-positive cells might correlate with the extent of benefit from crizotinib treatment.
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