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Xiao D, Deng Q, He D, Huang Y, Liang W, Wang F, Yang H. High Tumor Mutation Burden and DNA Repair Gene Mutations are Associated with Primary Resistance to Crizotinib in ALK-Rearranged Lung Cancer. Onco Targets Ther 2021; 14:4809-4817. [PMID: 34552337 PMCID: PMC8450189 DOI: 10.2147/ott.s325443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background About 20% of patients with ALK-rearranged non-small cell lung cancer (NSCLC) develop acquired resistance to tyrosine kinase inhibitor (TKI) during the first 6 months. This study aimed to examine the molecular mechanisms of early TKI resistance and prognosis in ALK-rearranged NSCLC. Methods Ten patients with ALK-rearranged NSCLC were included: five who developed rapid resistance to crizotinib (progression-free survival (PFS) ≤3 months) and five who exhibited a good response to crizotinib (PFS ≥36 months). The tumor specimens were subjected to whole-exome sequencing (WES). The validation cohort included 19 patients with ALK-rearranged NSCLC who received crizotinib; targeted sequencing of 43 selected genes was performed. The effect of the TP53 G245S mutation on crizotinib sensitivity was tested in H3122 cells. Results Mutations in DNA repair-associated genes were identified in primary resistance to crizotinib. Patients with a poor response to crizotinib harbored a greater burden of somatic mutations than those with a good response [median somatic mutations, 136 (range, 72-180) vs 31 (range, 10-48)]. Compared with the patients carrying wild-type TP53 or TP53 exon 3 deletion, 29 patients with TP53 G245S mutation showed a shorter survival time (P < 0.05), with a median PFS of 3 (95% CI: 1.9-4.1) months and a median overall survival of 7 (95% CI: 3.4-10.5) months. TP53 mutation promoted the proliferation of EML4-ALK-rearranged H3122 cells by approximately 3 folds (P < 0.001). H3122 cells with TP53 mutant were more sensitive to crizotinib compared with control cells. Conclusion A higher mutation burden and mutations in DNA repair gene, including TP53, were potentially associated with primary resistance to crizotinib in ALK-rearranged NSCLC. An immune-checkpoint inhibition strategy could be examined, which might overcome primary resistance to crizotinib in ALK-rearranged NSCLC.
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Affiliation(s)
- Dakai Xiao
- Research Center forTranslational Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People's Republic of China
| | - Qiuhua Deng
- Research Center forTranslational Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People's Republic of China
| | - Dongyun He
- Department of Thoracic Oncology, State Key Laboratory of Respiratory Diseases, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People's Republic of China
| | - Ying Huang
- Department of Thoracic Oncology, State Key Laboratory of Respiratory Diseases, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People's Republic of China
| | - Wenchi Liang
- Department of Thoracic Oncology, State Key Laboratory of Respiratory Diseases, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People's Republic of China
| | - Fengnan Wang
- Department of Thoracic Oncology, State Key Laboratory of Respiratory Diseases, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People's Republic of China
| | - Haihong Yang
- Department of Thoracic Oncology, State Key Laboratory of Respiratory Diseases, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People's Republic of China
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Schokrpur S, Hilburn V, Giustini N, Bazhenova L. An overview of alectinib hydrochloride as a treatment option for ALK positive non-small cell lung cancer. Expert Opin Pharmacother 2021; 22:1815-1824. [PMID: 34225542 DOI: 10.1080/14656566.2021.1948014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Alectinib is a second-generation inhibitor of anaplastic lymphoma kinase (ALK) and RET. Phase III clinical trials have established its superiority to crizotinib in the first-line ALK inhibitor-naïve setting. Studies also support its use over chemotherapy in the post-crizotinib setting. It is currently one of several FDA- and EMA-approved ALK inhibitors, and it is listed as a preferred initial therapy for treatment-naïve ALK-positive non-small cell lung cancer (NSCLC).Areas covered: Herein, the authors provide the reader with details of the chemical structure, pharmacologic properties, resistance mutations, phase I, II, and III clinical trials, and safety profile of alectinib. Furthermore, the authors provide the reader with the expert opinion and future perspectives on the drug.Expert opinion: Alectinib compares favorably to other second-generation ALK inhibitors with regards to safety, tolerability, and efficacy. Based on currently available data, it is an appropriate first-line option. Ongoing studies will better resolve the ideal sequencing of ALK inhibitors in the treatment of ALK-positive NSCLC.
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Affiliation(s)
- Shiruyeh Schokrpur
- Division of Hematology, Oncology University of California San Diego Moores Cancer Center, San Diego, California, USA
| | - Van Hilburn
- Division of Pharmacy, University of California San Diego, San Diego, California, USA
| | - Nicholas Giustini
- Division of Hematology, Oncology University of California San Diego Moores Cancer Center, San Diego, California, USA
| | - Lyudmila Bazhenova
- Division of Hematology, Oncology University of California San Diego Moores Cancer Center, San Diego, California, USA
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Kauffmann-Guerrero D, Kahnert K, Huber RM. Treatment Sequencing for Anaplastic Lymphoma Kinase-Rearranged Non-Small-Cell Lung Cancer. Drugs 2021; 81:87-100. [PMID: 33226527 PMCID: PMC8154809 DOI: 10.1007/s40265-020-01445-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Non-small-cell lung cancer (NSCLC) accounts for about 85% of all lung cancer cases and is the leading cause of cancer-related deaths. Most NSCLC patients are diagnosed with advanced disease and require systemic treatment. Despite emerging advances in chemotherapy and immunotherapy, the prognosis of stage IV patients remains poor. However, the discovery of oncogenic driver mutations including mutations in the epidermal growth factor receptor (EGFR), the anaplastic lymphoma kinase (ALK) and others, characterize a subset of patients with the opportunity of targeted therapies. Fusions between the ALK and echinoderm microtubule-associated protein-like 4 (EML4) are present in ∼ 3-5% of patients with NSCLC. Several first-, second-, and third-generation ALK tyrosine kinase inhibitors (TKIs) have been developed in the last decade and have tremendously changed treatment options and outcomes of ALK-positive NSCLC patients. With increasing treatment options, treatment sequence decisions have become more and more complex. ALK-mutations, fusion variants, or activation of by-pass pathways result in treatment resistance during the course of treatment in nearly all patients. Mutation-guided treatment sequencing can lead to better outcomes, and re-biopsy or liquid-biopsy should be performed whenever possible in case of disease progression in ALK-rearranged patients. In the future, combinational treatment of ALK TKIs with other pathway-inhibitors might further improve patients' treatment options and outcomes. Here, we review the data for currently available ALK TKIs, discuss approaches of treatment sequencing, and give an outlook on emerging developments.
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Affiliation(s)
- Diego Kauffmann-Guerrero
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V and Thoracic Oncology Centre Munich (TOM), Hospital of the University of Munich (LMU), Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Medizinische Klinik, Ziemssenstraße 1, 80336, Munich, Germany
| | - Kathrin Kahnert
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V and Thoracic Oncology Centre Munich (TOM), Hospital of the University of Munich (LMU), Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Medizinische Klinik, Ziemssenstraße 1, 80336, Munich, Germany
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V and Thoracic Oncology Centre Munich (TOM), Hospital of the University of Munich (LMU), Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Medizinische Klinik, Ziemssenstraße 1, 80336, Munich, Germany.
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Lin HM, Pan X, Hou P, Huang H, Wu Y, Ren K, Jahanzeb M. Economic burden in patients with ALK + non-small cell lung cancer, with or without brain metastases, receiving second-line anaplastic lymphoma kinase (ALK) inhibitors. J Med Econ 2020; 23:894-901. [PMID: 32347754 DOI: 10.1080/13696998.2020.1762620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aims: To describe the real-world economic burden of patients with anaplastic lymphoma kinase-positive (ALK+) non-small cell lung cancer (NSCLC) treated with post-crizotinib, second-line ALK inhibitor therapy.Materials and methods: Retrospective analysis using data from US Optum: Clinformatics Data Mart administrative claims database. Adult patients with ALK + NSCLC treated with ceritinib or alectinib as second-line ALK inhibitors between 1 January 2011 and 30 September 2017 were included. Healthcare costs and resource utilization for up to 1 year of therapy were calculated on a per-patient-per-month (PPPM) basis and stratified by presence or absence of brain metastases (BM). Multivariate regression analysis was performed to identify factors associated with costs. Top ten cost drivers of non-inpatient procedure costs were recorded.Results: One hundred and twelve patients received second-line ALK inhibitors. Total mean PPPM healthcare costs were $23,984 for all patients receiving up to 1 year of post-crizotinib, second-line ALK inhibitor therapy. Total mean PPPM costs for patients with BM on or prior to post-crizotinib, second-line ALK inhibitor therapy were 1.37-times as high as those for patients without BM (p = 0.0406). Mean PPPM outpatient visits and inpatient hospitalization stays were higher for patients with BM versus no BM. The main cost drivers for non-inpatient procedures were radiation therapy, medications, and diagnostic radiology.Limitations: Analyses did not include newer ALK-directed therapies. BM development after the index date (defined as the date of the first claim for a second-line ALK inhibitor) may have been misclassified as non-BM. Findings may not be generalizable to patients with no health insurance coverage.Conclusions: Treatment of patients with ALK + NSCLC with ceritinib or alectinib as post-crizotinib, second-line ALK inhibitor therapy represents a high economic burden. Healthcare costs and resource utilization were significantly higher for patients with ALK + NSCLC with BM versus no BM.
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Affiliation(s)
- Huamao M Lin
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Xiaoyun Pan
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Peijie Hou
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Hui Huang
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Yanyu Wu
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Kaili Ren
- Global Outcomes Research, Millennium Pharmaceuticals, Inc. (A wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, MA, USA
| | - Mohammad Jahanzeb
- Florida Precision Oncology, a division of 21st Century Oncology, Boca Raton, FL, USA
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Miyazaki K, Sato S, Kodama T, Numata T, Endo T, Yamamoto Y, Shimizu K, Yamada H, Hayashihara K, Okauchi S, Satoh H, Yamada Y, Tamura T, Saito K, Kikuchi N, Kurishima K, Ishikawa H, Watanabe H, Shiozawa T, Hizawa N, Funayama Y, Hayashi S, Nakamura H, Yamashita T. Clinicopathological Features in Elderly ALK-rearranged Non-small Cell Lung Cancer Patients. In Vivo 2020; 34:2001-2007. [PMID: 32606173 DOI: 10.21873/invivo.11998] [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: 03/21/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/10/2022]
Abstract
AIM To clarify the clinicopathological features in elderly anaplastic lymphoma kinase (ALK) rearranged non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS A retrospective study was performed in 129 ALK rearranged NSCLC patients diagnosed between April 2008 and March 2019 in fifteen Institutions of the Ibaraki prefecture, Japan. RESULTS Median age of patients was 63 years. In 59 patients aged 65 and older, the proportions of patients with advanced stage and those treated with ALK-tyrosine kinase inhibitor (TKI) were lower than those younger than 65 years. There was no difference in overall survival (OS) between the two age groups. Among the elderly patients, no difference was observed in OS between the patients aged 65-69 and those aged 70 and older. In 89 patients treated with TKI, no significant differences were observed in the progression-free survival of TKIs and OS between patients aged 65 and older and those younger than 65, respectively. CONCLUSION Evaluation of ALK gene status and TKI treatment are desirable even for elderly patients.
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Affiliation(s)
- Kunihiko Miyazaki
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Shinya Sato
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Takahide Kodama
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Takeshi Numata
- Division of Respiratory Medicine, Mito Medical Center, Mito, Japan
| | - Takeo Endo
- Division of Respiratory Medicine, Mito Medical Center, Mito, Japan
| | - Yusuke Yamamoto
- Division of Respiratory Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Kei Shimizu
- Division of Respiratory Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Hideyasu Yamada
- Division of Respiratory Medicine, Hitachinaka General Hospital-Hitachinaka Medical Center, University of Tsukuba, Hitachinaka, Japan
| | - Kenji Hayashihara
- Division of Respiratory Medicine, Ibarakihigashi Hospital, Tokai, Japan
| | - Shinichiro Okauchi
- Divisions of Respiratory Medicine and Thoracic Surgery, Mito Kyodo General Hospital-Mito Medical Center, University of Tsukuba, Mito, Japan
| | - Hiroaki Satoh
- Divisions of Respiratory Medicine and Thoracic Surgery, Mito Kyodo General Hospital-Mito Medical Center, University of Tsukuba, Mito, Japan
| | - Yutaka Yamada
- Respiratory Center, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Tomohiro Tamura
- Respiratory Center, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Kazuto Saito
- Division of Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Norihiro Kikuchi
- Division of Respiratory Medicine, Kasumigaura Medical Center Hospital, Tsuchiura, Japan
| | - Koichi Kurishima
- Division of Respiratory Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hiroichi Ishikawa
- Division of Respiratory Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hiroko Watanabe
- Division of Respiratory Medicine, Tsukuba Kinen Hospital, Tsukuba, Japan
| | | | - Nobuyuki Hizawa
- Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasunori Funayama
- Division of Respiratory Medicine Tsukuba, Gakuen General Hospital, Tsukuba, Japan
| | - Shigen Hayashi
- Division of Respiratory Medicine, Ibaraki Seinan Medical Center Hospital, Sakai, Japan
| | - Hiroyuki Nakamura
- Division of Respiratory Medicine, Tokyo Medical University, Ibaraki Medical Center, Ami-machi, Japan
| | - Takaaki Yamashita
- Division of Respiratory Medicine, JA Toride Medical Center Hospital, Toride, Japan
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Lin HM, Pan X, Hou P, Allen S, Baumann P, Hochmair MJ. Real-world treatment duration in ALK-positive non-small-cell lung cancer patients receiving brigatinib through the early access program. Future Oncol 2020; 16:1031-1041. [PMID: 32338548 DOI: 10.2217/fon-2019-0849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To assess time-to-treatment discontinuation (TTD) of brigatinib following treatment with ALK tyrosine kinase inhibitor(s) (TKIs) in patients with ALK-positive (ALK+) non-small-cell lung cancer (NSCLC) receiving brigatinib through the international early access program. Patients & analysis: Analysis was performed for patients with ALK+ NSCLC treated with prior ALK TKIs, including next-generation ALK TKIs. Results: Data for 604 patients (21 countries), including patients with prior next-generation ALK TKIs, were reported. The median TTD of brigatinib in patients with prior crizotinib, alectinib, ceritinib or lorlatinib was 10.0, 8.7, 10.3 and 7.5 months, respectively. Conclusion: Brigatinib appears to be effective and tolerable in real-world clinical practice regardless of prior treatment with first or NG ALK TKIs.
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Affiliation(s)
- Huamao M Lin
- Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | | | - Peijie Hou
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Susan Allen
- Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | - Pia Baumann
- Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research & Pulmonary Oncology, Department of Respiratory & Critical Care Medicine, Krankenhaus Nord, Vienna, Austria
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Tomasini P, Egea J, Souquet-Bressand M, Greillier L, Barlesi F. Alectinib in the treatment of ALK-positive metastatic non-small cell lung cancer: clinical trial evidence and experience with a focus on brain metastases. Ther Adv Respir Dis 2019; 13:1753466619831906. [PMID: 30786826 PMCID: PMC6385324 DOI: 10.1177/1753466619831906] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Molecular profiling of metastatic nonsquamous non-small cell lung cancer (NSCLC) is required to guide the treatment strategy. Anaplastic lymphoma kinase (ALK) gene rearrangements are found in approximately 5% of lung adenocarcinomas and are associated with specific clinical features including a high risk of brain metastases. Crizotinib was the first ALK inhibitor developed and it demonstrated improved outcomes in patients with ALK-positive advanced NSCLC in comparison with chemotherapy. However, despite an initial response, all ALK-positive NSCLC patients develop acquired resistance to crizotinib. Because the most frequent mechanism of resistance is the development of a secondary ALK mutation, second (ceritinib, alectinib, brigatinib) and third-generation (lorlatinib) ALK inhibitors were developed. Alectinib is a second-generation ALK inhibitor and was shown to be effective for a broad spectrum of ALK rearrangements and ALK mutations. It was also shown to have high intracranial efficacy. In this article, we review clinical trial evidence of alectinib efficacy as well as publications reporting the experience of alectinib in daily practice, with a focus on brain metastases.
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Affiliation(s)
- Pascale Tomasini
- Aix Marseille University, APHM, CNRS, INSERM, CRCM, Hôpital Nord, Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
| | - Julie Egea
- Aix Marseille University, APHM, CNRS, INSERM, CRCM, Hôpital Nord, Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
| | - Maxime Souquet-Bressand
- Aix Marseille University, APHM, CNRS, INSERM, CRCM, Hôpital Nord, Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
| | - Laurent Greillier
- Aix Marseille University, APHM, CNRS, INSERM, CRCM, Hôpital Nord, Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
| | - Fabrice Barlesi
- Service d'Oncologie Multidisciplinaire et Innovations Thérapeutiques, Hôpital Nord, Chemin des Bourrely, 13915 Marseille Cedex, FranceAix Marseille University, APHM, CNRS, INSERM, CRCM, Hôpital Nord, Oncologie Multidisciplinaire et Innovations Thérapeutiques, Marseille, France
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