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Wu W, Yu S, Huang J, Qi Q, Wu Y, Dong J. Molecular heterogeneity and treatment outcome of EGFR exon 20 insertion mutations in Chinese patients with advanced non-small cell lung cancer: insights from a large-scale real-world study. BMC Cancer 2024; 24:1010. [PMID: 39143560 PMCID: PMC11323489 DOI: 10.1186/s12885-024-12773-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION This retrospective study aimed to investigate treatment patterns and outcomes in patients with NSCLC harboring EGFR20ins in China. EGFR20ins mutations are associated with poor responses to EGFR-TKIs, and limited real-world data exist regarding the efficacy of various treatment modalities. METHODS In this retrospective, single-center study, treatment outcomes, including PFS and ORR, were evaluated for different treatment regimens based on imaging assessments. The impact of mutation heterogeneity on treatment efficacy was also explored. RESULTS Data from 302 patients diagnosed with NSCLC with EGFR20ins were analyzed. EGFR-TKI monotherapy demonstrated suboptimal PFS compared to platinum-based chemotherapy in the first-line setting (3.00 m vs. 6.83 m, HR = 3.674, 95%CI = 2.48-5.44, p < 0.001). Platinum plus pemetrexed plus bevacizumab combination therapy showed improved PFS and ORR compared to platinum plus pemetrexed (7.50m vs. 5.43 m, HR = 0.593, 95%CI = 0.383-0.918, p = 0.019). In later-line treatments, monotherapy with EGFR-TKIs or ICIs exhibited suboptimal efficacy. The specific EGFR20ins subtype, A763_Y764insFQEA, showed favorable responses to EGFR-TKIs in real-world settings. CONCLUSIONS This large-scale real-world study provides valuable insights into the treatment patterns and outcomes of NSCLC patients with EGFR20ins mutations in China. These findings contribute to the understanding of EGFR20ins treatment and provide real-world benchmark for future clinical trials and drug development.
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Affiliation(s)
- Weirui Wu
- Department of Intergrated Therapy in Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, East Dong Feng Road, Guangzhou, Guangdong, 510060, China
- Zhongshan School of Medicine, Sun Yat-Sen University, No. 74, Zhong Shan Er Lu, Guangzhou, Guangdong, 510060, China
| | - Silin Yu
- Department of Intergrated Therapy in Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, East Dong Feng Road, Guangzhou, Guangdong, 510060, China
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510060, China
| | - Jinsheng Huang
- Department of Intergrated Therapy in Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, East Dong Feng Road, Guangzhou, Guangdong, 510060, China
| | - Qi Qi
- Department of Intergrated Therapy in Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, East Dong Feng Road, Guangzhou, Guangdong, 510060, China
- Zhongshan School of Medicine, Sun Yat-Sen University, No. 74, Zhong Shan Er Lu, Guangzhou, Guangdong, 510060, China
| | - Yongyi Wu
- Department of Intergrated Therapy in Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, East Dong Feng Road, Guangzhou, Guangdong, 510060, China
- Zhongshan School of Medicine, Sun Yat-Sen University, No. 74, Zhong Shan Er Lu, Guangzhou, Guangdong, 510060, China
| | - Jun Dong
- Department of Intergrated Therapy in Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, East Dong Feng Road, Guangzhou, Guangdong, 510060, China.
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Tóth LJ, Mokánszki A, Méhes G. The rapidly changing field of predictive biomarkers of non-small cell lung cancer. Pathol Oncol Res 2024; 30:1611733. [PMID: 38953007 PMCID: PMC11215025 DOI: 10.3389/pore.2024.1611733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024]
Abstract
Lung cancer is a leading cause of cancer-related death worldwide in both men and women, however mortality in the US and EU are recently declining in parallel with the gradual cut of smoking prevalence. Consequently, the relative frequency of adenocarcinoma increased while that of squamous and small cell carcinomas declined. During the last two decades a plethora of targeted drug therapies have appeared for the treatment of metastasizing non-small cell lung carcinomas (NSCLC). Personalized oncology aims to precisely match patients to treatments with the highest potential of success. Extensive research is done to introduce biomarkers which can predict the effectiveness of a specific targeted therapeutic approach. The EGFR signaling pathway includes several sufficient targets for the treatment of human cancers including NSCLC. Lung adenocarcinoma may harbor both activating and resistance mutations of the EGFR gene, and further, mutations of KRAS and BRAF oncogenes. Less frequent but targetable genetic alterations include ALK, ROS1, RET gene rearrangements, and various alterations of MET proto-oncogene. In addition, the importance of anti-tumor immunity and of tumor microenvironment has become evident recently. Accumulation of mutations generally trigger tumor specific immune defense, but immune protection may be upregulated as an aggressive feature. The blockade of immune checkpoints results in potential reactivation of tumor cell killing and induces significant tumor regression in various tumor types, such as lung carcinoma. Therapeutic responses to anti PD1-PD-L1 treatment may correlate with the expression of PD-L1 by tumor cells. Due to the wide range of diagnostic and predictive features in lung cancer a plenty of tests are required from a single small biopsy or cytology specimen, which is challenged by major issues of sample quantity and quality. Thus, the efficacy of biomarker testing should be warranted by standardized policy and optimal material usage. In this review we aim to discuss major targeted therapy-related biomarkers in NSCLC and testing possibilities comprehensively.
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Affiliation(s)
- László József Tóth
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Kim S, Lee Y, Song BR, Sim H, Kang EH, Hwang M, Yu N, Hong S, Park C, Ahn BC, Lim EJ, Hwang KH, Park SY, Choi JH, Lee GK, Han JY. Drug Response of Patient-Derived Lung Cancer Cells Predicts Clinical Outcomes of Targeted Therapy. Cancers (Basel) 2024; 16:778. [PMID: 38398169 PMCID: PMC10887363 DOI: 10.3390/cancers16040778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Intratumor heterogeneity leads to different responses to targeted therapies, even within patients whose tumors harbor identical driver oncogenes. This study examined clinical outcomes according to a patient-derived cell (PDC)-based drug sensitivity test in lung cancer patients treated with targeted therapies. From 487 lung cancers, 397 PDCs were established with a success rate of 82%. In 139 PDCs from advanced non-small-cell lung cancer (NSCLC) patients receiving targeted therapies, the standardized area under the curve (AUC) values for the drugs was significantly correlated with their tumor response (p = 0.002). Among 59 chemo-naive EGFR/ALK-positive NSCLC patients, the PDC non-responders showed a significantly inferior response rate (RR) and progression-free survival (PFS) for the targeted drugs than the PDC responders (RR, 25% vs. 78%, p = 0.011; median PFS, 3.4 months [95% confidence interval (CI), 2.8-4.1] vs. 11.8 months [95% CI, 6.5-17.0], p < 0.001). Of 25 EGFR-positive NSCLC patients re-challenged with EGFR inhibitors, the PDC responder showed a higher RR than the PDC non-responder (42% vs. 15%). Four patients with wild-type EGFR or uncommon EGFR-mutant NSCLC were treated with EGFR inhibitors based on their favorable PDC response to EGFR inhibitors, and two patients showed dramatic responses. Therefore, the PDC-based drug sensitivity test results were significantly associated with clinical outcomes in patients with EGFR- or ALK-positive NSCLC. It may be helpful for predicting individual heterogenous clinical outcomes beyond genomic alterations.
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Affiliation(s)
- Sunshin Kim
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
| | - Youngjoo Lee
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
- Center for Lung Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (B.-C.A.); (E.J.L.); (K.H.H.); (J.-H.C.)
- Division of Hematology and Oncology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Republic of Korea
| | - Bo Ram Song
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
| | - Hanna Sim
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
| | - Eun Hye Kang
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
| | - Mihwa Hwang
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
| | - Namhee Yu
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
| | - Sehwa Hong
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
| | - Charny Park
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
| | - Beung-Chul Ahn
- Center for Lung Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (B.-C.A.); (E.J.L.); (K.H.H.); (J.-H.C.)
- Division of Hematology and Oncology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Republic of Korea
| | - Eun Jin Lim
- Center for Lung Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (B.-C.A.); (E.J.L.); (K.H.H.); (J.-H.C.)
| | - Kum Hui Hwang
- Center for Lung Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (B.-C.A.); (E.J.L.); (K.H.H.); (J.-H.C.)
| | - Seog-Yun Park
- Department of Pathology, National Cancer Center, Goyang 10408, Republic of Korea; (S.-Y.P.); (G.K.L.)
| | - Jin-Ho Choi
- Center for Lung Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (B.-C.A.); (E.J.L.); (K.H.H.); (J.-H.C.)
| | - Geon Kook Lee
- Department of Pathology, National Cancer Center, Goyang 10408, Republic of Korea; (S.-Y.P.); (G.K.L.)
| | - Ji-Youn Han
- Research Institute, National Cancer Center, Goyang 10408, Republic of Korea; (S.K.); (Y.L.); (B.R.S.); (H.S.); (E.H.K.); (M.H.); (N.Y.); (S.H.); (C.P.)
- Center for Lung Cancer, National Cancer Center, Goyang 10408, Republic of Korea; (B.-C.A.); (E.J.L.); (K.H.H.); (J.-H.C.)
- Division of Hematology and Oncology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Republic of Korea
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Pan B, Liang J, Shi H, Rao K, Guo W, Zhan C. Epidemiological characteristics and therapeutic advances of EGFR exon 20 insertion mutations in non-small cell lung cancer. Thorac Cancer 2023; 14:3247-3258. [PMID: 37795778 PMCID: PMC10665789 DOI: 10.1111/1759-7714.15127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
The third most prevalent type of epidermal growth factor receptor (EGFR) mutation, EGFR exon 20 insertions (EGFRex20ins), involves 2%-12% of all cases of EGFR-positive non-small cell lung cancer (NSCLC). Approximately 90% of the mutations occur within the loop structure region, and the most frequently reported subtypes are A767_V769dup and S768_D770dup, which together account for almost 50% of instances. Apart from the unique subtype of A763_Y764insFQEA, NSCLCs with EGFRex20ins are resistant to approved EGFR tyrosine kinase inhibitors (TKIs) and are also insensitive to chemotherapy or immunotherapy. A new modality of treatment for NSCLC patients with EGFRx20ins has been established with the approval of mobocertinib and amivantamab. There are also numerous novel targeted treatments for NSCLC with EGFRex20ins in development, which are anticipated to improve this patient population's survival even further. This review provides a reference for the clinical management of these patients by summarizing the most recent epidemiological, and clinicopathological characteristics, diagnostic techniques, and therapeutic advances of EGFRex20ins in NSCLC.
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Affiliation(s)
- Binyang Pan
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Haochun Shi
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Kungeng Rao
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Weigang Guo
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Department of Thoracic Surgery and UrologyShigatse People's HospitalShigatseChina
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
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