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Bian DJ, Lazaratos AM, Maritan SM, Quaiattini A, Zeng Z, Zhu Z, Sener U, Malani R, Kim YJ, Ichihara E, Cohen V, Rose AA, Bouganim N, Dankner M. Osimertinib is associated with improved outcomes in pre-treated non-small cell lung cancer leptomeningeal metastases: A systematic review and meta-analysiss. Heliyon 2024; 10:e29668. [PMID: 38698967 PMCID: PMC11064091 DOI: 10.1016/j.heliyon.2024.e29668] [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: 09/19/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024] Open
Abstract
Purpose Leptomeningeal metastasis (LM) is a severe complication of non-small cell lung cancer (NSCLC). In patients with NSCLC LM harboring epidermal growth factor receptor (EGFR) mutations, osimertinib is favored over alternative EGFR tyrosine kinase inhibitors (TKIs). However, the efficacy of osimertinib relative to other EGFR-TKIs is not well established for patients with LM. We aimed to compare the efficacy of EGFR-TKIs in EGFR-mutated NSCLC LM. Methods This systematic review and meta-analysis performed according to PRISMA guidelines included studies of adult patients with EGFR-mutated NSCLC and a diagnosis of LM who received an EGFR-TKI for the treatment of LM. We searched Medline ALL, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science Core Collection. The evaluation of biases was done by using the Ottawa-Newscastle scale. The hazard ratio was used as the parameter of interest for overall survival (OS) and central nervous system-specific progression-free survival (PFS). Results 128 publications were included with 243 patients and 282 lines of EGFR-TKI for NSCLC LM that met inclusion criteria. The median PFS in patients receiving any EGFR-TKI was 9.1 months, and the median OS was 14.5 months. In univariate analyses of the entire cohort, osimertinib treatment demonstrated significantly prolonged PFS, but not OS, compared to other EGFR-TKIs. Osimertinib demonstrated significantly prolonged PFS and OS in the subset of patients who were previously treated with EGFR-TKIs, but not in EGFR-TKI naïve patients. Conclusion Osimertinib is associated with improved outcomes compared to other EGFR-TKIs, particularly in patients previously treated with EGFR-TKIs. An important limitation is that most patients were derived from retrospective reports. These results highlight the need for prospective studies for this difficult-to-treat patient population.
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Affiliation(s)
- David J.H. Bian
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anna-Maria Lazaratos
- Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Sarah M. Maritan
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Andrea Quaiattini
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Zhimin Zeng
- Department of Oncology, the Second affiliated hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center Shanghai, Shanghai, China
| | - Ugur Sener
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Rachna Malani
- Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Eiki Ichihara
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Shikata-cho, Kita-Ku, Okayama City, Okayama, Japan
| | - Victor Cohen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - April A.N. Rose
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nathaniel Bouganim
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Matthew Dankner
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Rosalind and Morris Goodman Cancer Institute, Montreal, Quebec, Canada
- Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Sakurai T, Tuchida A, Nishida H. Significance of an epidermal growth factor receptor mutation in cerebrospinal fluid for leptomeningeal metastasis and successful treatment with osimertinib: A case report and literature review. eNeurologicalSci 2020; 22:100303. [PMID: 33367120 PMCID: PMC7749422 DOI: 10.1016/j.ensci.2020.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Takeo Sakurai
- Department of Neurology, Gifu Prefectural General Medical Center, Gifu, 4-6-1 Noisshiki, Gifu 500-8717, Japan
| | - Akimasa Tuchida
- Department of Respiratory Medicine, Gifu Prefectural General Medical Center, Gifu, 4-6-1 Noisshiki, Gifu 500-8717, Japan
| | - Hiroshi Nishida
- Department of Neurology, Gifu Prefectural General Medical Center, Gifu, 4-6-1 Noisshiki, Gifu 500-8717, Japan
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Abstract
Leptomeningeal metastasis (LM) results from dissemination of cancer cells to both the leptomeninges (pia and arachnoid) and cerebrospinal fluid (CSF) compartment. Breast cancer, lung cancer, and melanoma are the most common solid tumors that cause LM. Recent approval of more active anticancer therapies has resulted in improvement in survival that is partly responsible for an increased incidence of LM. Neurologic deficits, once manifest, are mostly irreversible, and often have a significant impact on patient quality of life. LM-directed therapy is based on symptom palliation, circumscribed use of neurosurgery, limited field radiotherapy, intra-CSF and systemic therapies. Novel methods of detecting LM include detection of CSF circulating tumor cells and tumor cell-free DNA. A recent international guideline for a standardization of response assessment in LM may improve cross-trial comparisons as well as within-trial evaluation of treatment. An increasing number of retrospective studies suggest that molecular-targeted therapy, such as EGFR and ALK inhibitors in lung cancer, trastuzumab in HER2+ breast cancer, and BRAF inhibitors in melanoma, may be effective as part of the multidisciplinary management of LM. Prospective randomized trials with standardized response assessment are needed to further validate these preliminary findings.
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Frankel D, Nanni-Metellus I, Robaglia-Schlupp A, Tomasini P, Guinde J, Barlesi F, Astoul P, Ouafik L, Amatore F, Secq V, Kaspi E, Roll P. Detection of EGFR, KRAS and BRAF mutations in metastatic cells from cerebrospinal fluid. Clin Chem Lab Med 2018; 56:851-856. [PMID: 29306909 DOI: 10.1515/cclm-2017-0527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND In lung adenocarcinoma, molecular profiling of actionable genes has become essential to set up targeted therapies. However, the feasibility and the relevance of molecular profiling from the cerebrospinal fluid (CSF) in the context of meningeal metastasis have been poorly assessed. METHODS We selected patients with stage IV lung adenocarcinoma harbouring metastatic cells in the CSF after cytological analysis. Seven samples from six patients were eligible for molecular testing of epidermal growth factor receptor (EGFR), V-Ki-ras2 Kirsten rat sarcoma viral oncogene homologue (KRAS), v-Raf murine sarcoma viral oncogene homologue B1 (BRAF) and human epidermal growth factor receptor 2 (HER2) mutations using quantitative polymerase chain reaction (PCR) high-resolution melting curve analysis and Sanger sequencing after DNA extraction from the cell pellets of the CSF. RESULTS Five patients showed mutations in one or two actionable genes, two harboured an EGFR mutation (exons 19 and 21), one only a KRAS mutation, one both EGFR and KRAS mutations and one a BRAF mutation. In all cases, the results of mutation testing provided new major information for patient management, leading to therapeutic adaptation. CSF molecular analysis identified mutations not detected in other neoplastic sites for two patients. In one case, the EGFR p.Thr790Met was identified. CSF was also the only sample available for genetic testing for almost all patients at the time of disease progression. CONCLUSIONS When cancer cells are present in the CSF, the molecular profiling from the cell pellets is relevant, as it can detect supplemental or different mutations compared to a previous analysis of the primitive tumour or plasma cell-free DNA and allows the adaptation of the treatment strategy.
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Affiliation(s)
- Diane Frankel
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Isabelle Nanni-Metellus
- APHM, Faculté de Médecine Nord, Laboratoire de Transfert d'Oncologie Biologique, Marseille, France
| | - Andrée Robaglia-Schlupp
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Pascale Tomasini
- APHM, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France.,Aix Marseille Univ, INSERM, CRO2, Marseille, France
| | - Julien Guinde
- Aix Marseille Univ, INSERM, MMG, Marseille, France.,APHM, Hôpital Nord, Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France
| | - Fabrice Barlesi
- APHM, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France.,Aix Marseille Univ, INSERM, CRO2, Marseille, France
| | - Philippe Astoul
- APHM, Hôpital Nord, Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France.,Aix Marseille Univ, Marseille, France
| | - L'Houcine Ouafik
- APHM, Faculté de Médecine Nord, Laboratoire de Transfert d'Oncologie Biologique, Marseille, France.,Aix Marseille Univ, INSERM, CRO2, Marseille, France
| | - Florent Amatore
- APHM, Hôpital Nord, Département de Dermatologie, Marseille, France
| | - Véronique Secq
- APHM, Hôpital Nord, Service Hospitalier d'Anatomie et Cytologie Pathologiques, Marseille, France.,Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmette, CRCM, Marseille, France
| | - Elise Kaspi
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Patrice Roll
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
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Rigakos G, Liakou CI, Felipe N, Orkoulas-Razis D, Razis E. Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis. Cancer Control 2017; 24:9-21. [DOI: 10.1177/107327481702400103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | | | - Naillid Felipe
- Hygeia Hospital, Athens, Greece, Boston University School of Medicine, Baltimore, Maryland
| | - Dennis Orkoulas-Razis
- Boston, Massachusetts, and University of Maryland School of Medicine, Baltimore, Maryland
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Le Rhun E, Taillibert S, Chamberlain MC. Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. Surg Neurol Int 2013; 4:S265-88. [PMID: 23717798 PMCID: PMC3656567 DOI: 10.4103/2152-7806.111304] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/11/2013] [Indexed: 11/04/2022] Open
Abstract
Leptomeningeal metastasis (LM) results from metastatic spread of cancer to the leptomeninges, giving rise to central nervous system dysfunction. Breast cancer, lung cancer, and melanoma are the most frequent causes of LM among solid tumors in adults. An early diagnosis of LM, before fixed neurologic deficits are manifest, permits earlier and potentially more effective treatment, thus leading to a better quality of life in patients so affected. Apart from a clinical suspicion of LM, diagnosis is dependent upon demonstration of cancer in cerebrospinal fluid (CSF) or radiographic manifestations as revealed by neuraxis imaging. Potentially of use, though not commonly employed, today are use of biomarkers and protein profiling in the CSF. Symptomatic treatment is directed at pain including headache, nausea, and vomiting, whereas more specific LM-directed therapies include intra-CSF chemotherapy, systemic chemotherapy, and site-specific radiotherapy. A special emphasis in the review discusses novel agents including targeted therapies, that may be promising in the future management of LM. These new therapies include anti-epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors erlotinib and gefitinib in nonsmall cell lung cancer, anti-HER2 monoclonal antibody trastuzumab in breast cancer, anti-CTLA4 ipilimumab and anti-BRAF tyrosine kinase inhibitors such as vermurafenib in melanoma, and the antivascular endothelial growth factor monoclonal antibody bevacizumab are currently under investigation in patients with LM. Challenges of managing patients with LM are manifold and include determining the appropriate patients for treatment as well as the optimal route of administration of intra-CSF drug therapy.
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Affiliation(s)
- Emilie Le Rhun
- Breast Unit, Department of Medical Oncology, Centre Oscar Lambret and Department of Neuro Oncology, Roger Salengro Hospital, University Hospital, Lille, France
| | - Sophie Taillibert
- Neurology, Mazarin and Radiation Oncology, Pitié Salpétrière Hospital, University Pierre et Marie Curie, Paris VI, Paris, France
| | - Marc C. Chamberlain
- Neurology and Neurological Surgery, University of Washington, Fred Hutchinson Research Cancer Center, Seattle, WA, USA
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Kanaji N, Bandoh S, Ishii T, Kushida Y, Haba R, Kohno K, Dobashi H, Ohnishi H, Matsunaga T. Detection of Epidermal Growth Factor Receptor Mutations in a Few Cancer Cells from Transbronchial Cytologic Specimens by Reverse Transcriptase-Polymerase Chain Reaction. Mol Diagn Ther 2012; 15:353-9. [DOI: 10.1007/bf03256471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kanaji N, Bandoh S, Ishii T, Kushida Y, Haba R, Kohno K, Dobashi H, Ohnishi H, Matsunaga T. Detection of epidermal growth factor receptor mutations in a few cancer cells from transbronchial cytologic specimens by reverse transcriptase-polymerase chain reaction. Mol Diagn Ther 2012. [PMID: 22117119 DOI: 10.2165/11595700-000000000-00000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutational status has the potential to be useful for determining prospective therapies in patients with non-small cell lung cancer (NSCLC) when analyzed in transbronchial cell specimens. The efficacy of RNA-based methods for the detection of EGFR mutations in transbronchial cell specimens has not been studied. Ultrafast Papanicolaou (UFP) staining is a method used in the immediate assessment of cytology during bronchoscopic examination. OBJECTIVES The aims of this study were (i) to compare the efficacy of RNA-based methodology for the detection of EGFR mutations with DNA-based methodology; and (ii) to assess the analysis of EGFR mutational status in transbronchial cell specimens, utilizing UFP staining. METHODS EGFR mutant PC9 and NCI-H1975 cells were combined with wild-type EGFR white blood cells (WBCs), and the RNA and DNA were extracted. The sensitivity for the detection of EGFR mutations was determined. Polymerase chain reaction (PCR)-based methods, including reverse transcriptase (RT)-PCR and PCR-restriction fragment length polymorphism (RFLP), and sequencing were performed to detect the EGFR mutations. Seventy-one cell samples from bronchoscopic examinations that utilized UFP staining in patients with NSCLC were also analyzed for EGFR mutations. RESULTS EGFR mutations were detected in a small number of cancer cells (ten cells), even in the presence of 1 × 10(6) WBCs, by the RNA-based methodology (either RT-PCR or PCR-RFLP) [sensitivity: <10(-5)]. However, the DNA-based method exhibited lower sensitivity (10(-1)). EGFR mutations were detected in 21 of 71 NSCLC samples (29.6%) and in 19 of 43 adenocarcinomas (44.2%) by the RNA-based methodology. The DNA-based methodology failed to detect EGFR mutations in several cases, while the RNA-based methodology was able to detect them. CONCLUSIONS Rapid diagnosis during bronchoscopy, utilizing UFP staining, contributed to the selection of the best samples for genetic analysis. EGFR mutations could be detected in a small number of cancer cells by the RNA-based methodology, with higher sensitivity than the DNA-based methodology, even in samples where numerous normal cells were present. Our present strategy can be integrated into the clinical process without additional invasive examination of patients and provides information regarding the EGFR mutational status.
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Affiliation(s)
- Nobuhiro Kanaji
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan.
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Abstract
Leptomeningeal metastasis (LMD) is a lethal complication caused by a variety of cancers, typically developing late in the disease course. It is associated with major neurologic disabilities and short survival. The incidence of LMD may increase because of longer survival of patients who have cancer, and because of the use of newer large-molecule therapies with poor central nervous system penetration. To achieve improved outcomes for patients who have LMD, new treatments need to reach the meninges and cerebrospinal fluid and interact with relevant molecular targets. Some of the agents currently in testing may contribute to this goal. To allow for better outcomes through earlier treatment, advances in diagnosis are needed. By using agents with higher therapeutic indices, in patients with a lower burden of disease (identified earlier with clinical or molecular markers) it should be possible to achieve gradual improvements in outcomes for patients suffering from this devastating disease.
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Affiliation(s)
- Morris D Groves
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe, Unit 431, Houston, TX 77030, USA.
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Detection of Epithelial Growth Factor Receptor Mutations in Cerebrospinal Fluid from Patients with Lung Adenocarcinoma Suspected of Neoplastic Meningitis. J Thorac Oncol 2011; 6:1215-20. [DOI: 10.1097/jto.0b013e318219aaae] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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