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Brueckl W, Reck M, Rawluk J, Schaefer H, Neben K, Moeller M, Krueger S, Kokowski K, Ficker J, Schueler A, Laack E. 1230P Elderly patients treated with afatinib in clinical practice: Final results of the GIDEON study in EGFR mutated NSCLC in Germany. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Brueckl WM, Reck M, Rittmeyer A, Kollmeier J, Wesseler C, Wiest GH, Christopoulos P, Stenzinger A, Tufman A, Hoffknecht P, Ulm B, Reich F, Ficker JH, Laack E. Efficacy of docetaxel plus ramucirumab as palliative second-line therapy following first-line chemotherapy plus immune-checkpoint-inhibitor combination treatment in patients with non-small cell lung cancer (NSCLC) UICC stage IV. Transl Lung Cancer Res 2021; 10:3093-3105. [PMID: 34430350 PMCID: PMC8350088 DOI: 10.21037/tlcr-21-197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/25/2021] [Indexed: 12/26/2022]
Abstract
Background Chemotherapy plus immune-checkpoint inhibitor (CTx+ICI) therapy has become the preferred 1st line treatment in patients with metastatic NSCLC without oncogenic driven mutations. However, the optimal subsequent 2nd line treatment is not defined and several alternatives exist. The purpose of this analysis was to evaluate the efficacy of 2nd line docetaxel plus ramucirumab (D+R) initiated after failure of 1st line CTx+ICI. Methods Retrospective data were collected during routine care from German thoracic oncology centers. Only patients who had received at least one course of 2nd line D+R were included. ORR, PFS, OS and numbers of courses of D+R were investigated with PFS after initiation of D+R being the primary endpoint. Results Seventy-seven patients met the inclusion criteria. 2nd line treatment with D+R achieved an ORR and DCR of 32.5% and 62.4%, respectively. Median PFS for 2nd line therapy was 3.9 months with a DOR of 6.4 months. Median OS of 15.5 and 7.5 months were observed from the start of 1st line therapy and 2nd line treatment, respectively. No unexpected toxicities occurred. Presence of KRAS mutations was associated with significantly worse median PFS to D+R (2.8 vs. 4.5 months in wild-type cases; P=0.021) and was an independent predictor of inferior PFS in multivariate analysis. Conclusions D+R is an effective and safe 2nd line treatment after failure of 1st line CTx+ICI irrespective of NSCLC histology. However, patients with a KRAS mutation did not benefit from D+R in terms of PFS and will require further investigations.
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Affiliation(s)
- Wolfgang M Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany.,Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, Lung Clinic, Grosshansdorf, Germany
| | - Achim Rittmeyer
- Lungenfachklinik Immenhausen, Ambulanz für pneumologische Onkologie, Kassel, Germany
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany
| | - Claas Wesseler
- Asklepios Tumorzentrum Hamburg, Klinikum Harburg, Hamburg, Germany
| | - Gunther H Wiest
- Asklepios Tumorzentrum Hamburg, Klinikum Harburg, Hamburg, Germany
| | | | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Heidelberg, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Amanda Tufman
- Medizinische Klinik V, Pneumologie, Klinikum der Universität München, Member of the German Center for Lung Research, CPC-M, Munich, Germany
| | - Petra Hoffknecht
- Lungenzentrum Osnabrueck, Klinik für Thoraxonkologie, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - Bernhard Ulm
- Unabhängige statistische Beratung Bernhard Ulm, Munich, Germany
| | - Fabian Reich
- Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany.,Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine/Nuernberg Lung Cancer Center, Nuernberg General Hospital, Nuremberg, Germany.,Paracelsus Medical University Nuremberg, Nuremberg, Germany
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Illini O, Hochmair MJ, Fabikan H, Weinlinger C, Tufman A, Swalduz A, Lamberg K, Hashemi SMS, Huemer F, Vikström A, Wermke M, Absenger G, Addeo A, Banerji S, Calles A, Clarke S, Di Maio M, Durand A, Duruisseaux M, Itchins M, Kääränien OS, Krenn F, Laack E, de Langen AJ, Mohorcic K, Pall G, Passaro A, Prager G, Rittmeyer A, Rothenstein J, Schumacher M, Wöll E, Valipour A. Selpercatinib in RET fusion-positive non-small-cell lung cancer (SIREN): a retrospective analysis of patients treated through an access program. Ther Adv Med Oncol 2021; 13:17588359211019675. [PMID: 34178121 PMCID: PMC8202258 DOI: 10.1177/17588359211019675] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Rearranged during transfection (RET) gene fusions are rare genetic drivers in non-small cell lung cancer (NSCLC). Selective RET-inhibitors such as selpercatinib have shown therapeutic activity in early clinical trials; however, their efficacy in the real-world setting is unknown. METHODS A retrospective efficacy and safety analysis was performed on data from RET fusion-positive NSCLC patients who participated in a selpercatinib access program (named patient protocol) between August 2019 and January 2021. RESULTS Data from 50 patients with RET fusion-positive advanced NSCLC treated with selpercatinib at 27 centers in 12 countries was analyzed. Most patients were Non-Asian (90%), female (60%), never-smokers (74%), with a median age of 65 years (range, 38-89). 32% of the patients had known brain metastasis at the time of selpercatinib treatment. Overall, 13 patients were treatment-naïve, while 37 were pretreated with a median of three lines of therapy (range, 1-8). The objective response rate (ORR) was 68% [95% confidence interval (CI), 53-81] in the overall population. The disease control rate was 92%. The median progression-free survival was 15.6 months (95% CI, 8.8-22.4) after a median follow-up of 9 months. In patients with measurable brain metastases (n = 8) intracranial ORR reached 100%. In total, 88% of patients experienced treatment-related adverse events (TRAEs), a large majority of them being grade 1 or 2. The most common grade ⩾ 3 TRAEs were increased liver enzyme levels (in 10% of patients), prolonged QTc time (4%), abdominal pain (4%), hypertension (4%), and fatigue/asthenia (4%). None of patients discontinued selpercatinib treatment for safety reasons. No new safety concerns were observed, nor where there any treatment-related death. CONCLUSIONS In this real-world setting, the selective RET-inhibitor selpercatinib demonstrated durable systemic and intracranial antitumor activity in RET fusion-positive NSCLC and was well tolerated.
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Affiliation(s)
- Oliver Illini
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Brünner Strasse 68, Vienna, 1210, Austria
| | - Maximilian Johannes Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Hannah Fabikan
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Christoph Weinlinger
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Klinikum der Universitaet Muenchen, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung, CPC-M, Munich, Bayern, Germany
| | | | - Kristina Lamberg
- Department of Pulmonary and Allergic diseases, Uppsala University hospital, Uppsala, Sweden
| | - Sayed M. S. Hashemi
- Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Florian Huemer
- Department of Respiratory Care, Ludwig Boltzmann Institute Lung Health, Klinik Penzing, Vienna, Austria
| | - Anders Vikström
- Pulmonary clinic, University hospital Linköping, Linköping, Sweden
| | - Martin Wermke
- Medical Faculty C.-G.-Carus, NCT/UCC Early Clinical Trial Unit Dresden, Technical University Dresden, Germany
| | - Gudrun Absenger
- Department of Oncology, Medical University of Graz, Graz, Austria
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Shantanu Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Antonio Calles
- Medical Oncology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Stephen Clarke
- Medical Oncology Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Italy
- Medical Oncology, Ordine Mauriziano Hospital, Torino, Italy
| | - Alice Durand
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Michaël Duruisseaux
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France
- Oncopharmacology Laboratory, Cancer Research Center of Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Malinda Itchins
- Medical Oncology Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Florian Krenn
- LKH Hochsteiermark – Standort Leoben, Abteilung für Lungenkrankheiten, Austria
| | - Eckart Laack
- Studiengesellschaft Hämato-Onkologie Hamburg, Hamburg, Germany
| | | | - Katja Mohorcic
- Medical Oncology Unit, University Clinic Golnik, Golnik, Slovenia
| | - Georg Pall
- Department of Internal Medicine V, Hematology/Oncology, University Hospital Innsbruck, Innsbruck, Austria
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Gerald Prager
- Department of Medicine I, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Achim Rittmeyer
- LKI Lungenfachklinik Immenhausen, Department of Thoracic Oncology, Immenhausen, Germany
| | - Jeffrey Rothenstein
- R.S. McLaughlin Durham Regional Cancer Center at Lakeridge Health, Adjunct Assistant Professor Queen’s University, Ontario, Canada
| | - Michael Schumacher
- Department of Pneumology, Ordensklinikum Elisabethinen Linz, Linz, Austria
| | - Ewald Wöll
- Department Internal Medicine, St. Vinzenz Krankenhaus Betriebs GmbH, Sanatoriumstr. 43, 6511 Zams, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna
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Brückl WM, Reck M, Griesinger F, Schäfer H, Kortsik C, Gaska T, Rawluk J, Krüger S, Kokowski K, Budweiser S, Ficker JH, Hoffmann C, Schüler A, Laack E. Afatinib as first-line treatment in patients with EGFR-mutated non-small cell lung cancer in routine clinical practice. Ther Adv Med Oncol 2021; 13:17588359211012361. [PMID: 33995597 PMCID: PMC8111535 DOI: 10.1177/17588359211012361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Lung cancer is a leading cause of cancer-related death in Germany and worldwide. Non-small cell lung cancer (NSCLC) comprises ~80% of lung cancer diagnoses; in White patients, around 10% of NSCLC cases are epidermal growth factor receptor mutation-positive (EGFRm+). Head-to-head clinical trials have demonstrated superior efficacy with second-/third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) versus first-generation EGFR TKIs in EGFRm+ NSCLC. Data from routine clinical practice are necessary to confirm that clinical trial findings are transferable to real-world populations. Methods: In NCT02047903, a prospective non-interventional study in Germany, patients with EGFRm+ NSCLC received first-line afatinib until disease progression or intolerable adverse events. Key objectives were progression-free survival (PFS) rate at 12 months, objective response rate (ORR) and overall survival (OS). Safety/tolerability was also assessed. Results: Of 152 patients, 106 (69.7%) were female, 20 (13.1%) patients had an uncommon EGFR mutation and 51 patients (33.6%) had brain metastases. A starting dose of <40 mg was received by 39 (25.7%) patients. Overall, the 12-month PFS rate was 50.2% while the median PFS was 12.2 months. The ORR was 74.6% and the median OS was 30.4 months. In patients with brain metastases and uncommon mutations, the median PFS was 10.5 and 10.7 months, and the ORR was 77.3% and 83.3%, respectively. Treatment effectiveness was similar in patients with a starting dose of <40 mg (median PFS: 16.4 months; ORR, 81.3%) and a starting dose of 40 mg (median PFS: 10.8 months; ORR, 72.1%). Adverse drug reactions were manageable and consistent with the known afatinib safety profile. Conclusion: The results support clinical trial data for afatinib in routine clinical practice, including in patients generally excluded from clinical trials. Outcomes were positive in patients with uncommon EGFR mutations and in those with brain metastases. Treatment benefit was also seen in patients receiving a <40 mg afatinib starting dose, supporting patient-tailored dosing.
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Affiliation(s)
- Wolfgang M Brückl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Ernst-Nathan-Str.1, Nuremberg, 90419, Germany
| | - Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius Hospital, University Department Internal Medicine-Oncology, University Medicine, Oldenburg, Germany
| | - Harald Schäfer
- Department of Pneumonology, SHG-Clinic Voelklingen, Germany
| | | | - Tobias Gaska
- Department of Hematology and Oncology, St. Josef Clinic, Paderborn, Germany
| | - Justyna Rawluk
- Faculty of Medicine, University of Freiburg, Germany; Department of Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Stefan Krüger
- Department for Pneumology, Cardiology and Intensive Care Medicine, Florence-Nightingale-Hospital, Düsseldorf, Germany
| | - Konrad Kokowski
- Department of Pneumonology, Bogenhausen Hospital, Munich, Germany
| | - Stephan Budweiser
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre, Rosenheim, Germany
| | - Joachim H Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Christopher Hoffmann
- Human Pharma Country Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Andrea Schüler
- Human Pharma Country Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
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Frost N, Christopoulos P, Kauffmann-Guerrero D, Stratmann J, Riedel R, Schaefer M, Alt J, Gütz S, Christoph DC, Laack E, Faehling M, Fischer R, Fenchel K, Haen S, Heukamp L, Schulz C, Griesinger F. Lorlatinib in pretreated ALK- or ROS1-positive lung cancer and impact of TP53 co-mutations: results from the German early access program. Ther Adv Med Oncol 2021; 13:1758835920980558. [PMID: 33613692 PMCID: PMC7876585 DOI: 10.1177/1758835920980558] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/17/2020] [Indexed: 01/31/2023] Open
Abstract
Introduction: We report on the results of the German early access program (EAP) with the third-generation ALK- and ROS1-inhibitor lorlatinib. Patients and Methods: Patients with documented treatment failure of all approved ALK/ROS1-specific therapies or with resistance mutations not covered by approved inhibitors or leptomeningeal carcinomatosis were enrolled and analyzed. Results: In total, 52 patients were included [median age 57 years (range 32–81), 54% female, 62% never smokers, 98% adenocarcinoma]; 71% and 29% were ALK- and ROS1-positive, respectively. G1202R and G2032R resistance mutations prior to treatment with lorlatinib were observed in 10 of 26 evaluable patients (39%), 11 of 39 patients showed TP53 mutations (28%). Thirty-six patients (69%) had active brain metastases (BM) and nine (17%) leptomeningeal carcinomatosis when entering the EAP. Median number of prior specific TKIs was 3 (range 1–4). Median duration of treatment, progression-free survival (PFS), response rate and time to treatment failure were 10.4 months, 8.0 months, 54% and 13.0 months. Calculated 12-, 18- and 24-months survival rates were 65, 54 and 47%, overall survival since primary diagnosis (OS2) reached 79.6 months. TP53 mutations were associated with a substantially reduced PFS (3.7 versus 10.8 month, HR 3.3, p = 0.003) and were also identified as a strong prognostic biomarker (HR for OS2 3.0 p = 0.02). Neither prior treatments with second-generation TKIs nor BM had a significant influence on PFS and OS. Conclusions: Our data from real-life practice demonstrate the efficacy of lorlatinib in mostly heavily pretreated patients, providing a clinically meaningful option for patients with resistance mutations not covered by other targeted therapies and those with BM or leptomeningeal carcinomatosis.
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Affiliation(s)
- Nikolaj Frost
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, D-13353, Germany Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany, and Translational Research Center Heidelberg, Member of the German Center for Lung Research (DZL)
| | - Diego Kauffmann-Guerrero
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V University of Munich (LMU), Thoracic Oncology Centre Munich (TOM), Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Bayern, Germany
| | - Jan Stratmann
- Department of Internal Medicine II, University Clinic of Frankfurt, Frankfurt, Germany
| | - Richard Riedel
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Monica Schaefer
- HELIOS Klinikum Emil-von-Behring, Lungenklinik Heckeshorn, Berlin, Germany
| | - Jürgen Alt
- Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center Mainz, Mainz, Germany
| | - Sylvia Gütz
- Department of Respiratory Medicine and Cardiology, Evangelisches Diakonissenkrankenhaus Leipzig, Leipzig, Germany
| | - Daniel C Christoph
- Department of Hematology and Oncology, Evang. Kliniken Essen-Mitte, Essen, Germany
| | | | - Martin Faehling
- Department of Cardiology, Angiology and Pneumonology, Klinikum Esslingen, Esslingen, Germany
| | | | - Klaus Fenchel
- Private Practice for Hematology and Oncology, Saalfeld, Germany
| | - Sebastian Haen
- Department of Hematology and Oncology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christian Schulz
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Frank Griesinger
- Department Internal Medicine-Oncology, Pius Hospital, Oldenburg, Germany
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Wolf J, Seto T, Han JY, Reguart N, Garon EB, Groen HJM, Tan DSW, Hida T, de Jonge M, Orlov SV, Smit EF, Souquet PJ, Vansteenkiste J, Hochmair M, Felip E, Nishio M, Thomas M, Ohashi K, Toyozawa R, Overbeck TR, de Marinis F, Kim TM, Laack E, Robeva A, Le Mouhaer S, Waldron-Lynch M, Sankaran B, Balbin OA, Cui X, Giovannini M, Akimov M, Heist RS. Capmatinib in MET Exon 14-Mutated or MET-Amplified Non-Small-Cell Lung Cancer. N Engl J Med 2020; 383:944-957. [PMID: 32877583 DOI: 10.1056/nejmoa2002787] [Citation(s) in RCA: 471] [Impact Index Per Article: 117.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Among patients with non-small-cell lung cancer (NSCLC), MET exon 14 skipping mutations occur in 3 to 4% and MET amplifications occur in 1 to 6%. Capmatinib, a selective inhibitor of the MET receptor, has shown activity in cancer models with various types of MET activation. METHODS We conducted a multiple-cohort, phase 2 study evaluating capmatinib in patients with MET-dysregulated advanced NSCLC. Patients were assigned to cohorts on the basis of previous lines of therapy and MET status (MET exon 14 skipping mutation or MET amplification according to gene copy number in tumor tissue). Patients received capmatinib (400-mg tablet) twice daily. The primary end point was overall response (complete or partial response), and the key secondary end point was response duration; both end points were assessed by an independent review committee whose members were unaware of the cohort assignments. RESULTS A total of 364 patients were assigned to the cohorts. Among patients with NSCLC with a MET exon 14 skipping mutation, overall response was observed in 41% (95% confidence interval [CI], 29 to 53) of 69 patients who had received one or two lines of therapy previously and in 68% (95% CI, 48 to 84) of 28 patients who had not received treatment previously; the median duration of response was 9.7 months (95% CI, 5.6 to 13.0) and 12.6 months (95% CI, 5.6 to could not be estimated), respectively. Limited efficacy was observed in previously treated patients with MET amplification who had a gene copy number of less than 10 (overall response in 7 to 12% of patients). Among patients with MET amplification and a gene copy number of 10 or higher, overall response was observed in 29% (95% CI, 19 to 41) of previously treated patients and in 40% (95% CI, 16 to 68) of those who had not received treatment previously. The most frequently reported adverse events were peripheral edema (in 51%) and nausea (in 45%); these events were mostly of grade 1 or 2. CONCLUSIONS Capmatinib showed substantial antitumor activity in patients with advanced NSCLC with a MET exon 14 skipping mutation, particularly in those not treated previously. The efficacy in MET-amplified advanced NSCLC was higher in tumors with a high gene copy number than in those with a low gene copy number. Low-grade peripheral edema and nausea were the main toxic effects. (Funded by Novartis Pharmaceuticals; GEOMETRY mono-1 ClinicalTrials.gov number, NCT02414139.).
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Affiliation(s)
- Jürgen Wolf
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Takashi Seto
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Ji-Youn Han
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Noemi Reguart
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Edward B Garon
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Harry J M Groen
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Daniel S W Tan
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Toyoaki Hida
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Maja de Jonge
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Sergey V Orlov
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Egbert F Smit
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Pierre-Jean Souquet
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Johan Vansteenkiste
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Maximilian Hochmair
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Enriqueta Felip
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Makoto Nishio
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Michael Thomas
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Kadoaki Ohashi
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Ryo Toyozawa
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Tobias R Overbeck
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Filippo de Marinis
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Tae-Min Kim
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Eckart Laack
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Anna Robeva
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Sylvie Le Mouhaer
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Maeve Waldron-Lynch
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Banu Sankaran
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - O Alejandro Balbin
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Xiaoming Cui
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Monica Giovannini
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Mikhail Akimov
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Rebecca S Heist
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
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Brueckl WM, Reck M, Rittmeyer A, Kollmeier J, Wesseler C, Wiest GH, Christopoulos P, Tufman A, Hoffknecht P, Ulm B, Reich F, Ficker JH, Laack E. Efficacy of Docetaxel Plus Ramucirumab as Palliative Third-Line Therapy Following Second-Line Immune-Checkpoint-Inhibitor Treatment in Patients With Non-Small-Cell Lung Cancer Stage IV. Clin Med Insights Oncol 2020; 14:1179554920951358. [PMID: 32884390 PMCID: PMC7440727 DOI: 10.1177/1179554920951358] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/23/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Antiangiogenic agents have been shown to stimulate the immune system and cause synergistic effects with chemotherapy. Effects might be even stronger after immune-checkpoint-inhibitor (ICI) therapy. The purpose of this analysis was to evaluate the efficacy of ramucirumab plus docetaxel (R + D) as third-line treatment after failure of a first-line platinum-based chemotherapy and a second-line ICI treatment in patients with non-small-cell lung cancer (NSCLC) stage IV. METHODS Retrospective data were collected from 9 German thoracic oncology centers. Only patients who had received at least 1 cycle of third-line R + D were included. The numbers of cycles, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were investigated. RESULTS Sixty-seven patients met the criteria for inclusion. Third-line treatment with R + D achieved an ORR of 36% and a disease control rate (DCR) of 69%. Median PFS for third-line therapy was 6.8 months with a duration of response (DOR) of 10.2 months. A median OS of 29 months was observed from the start of first-line therapy with a median OS of 11.0 months from the start of third-line treatment. No unexpected toxicities occurred. CONCLUSION R + D is a highly effective and safe third-line treatment after failure of second-line programmed cell death protein 1/programmed cell death-ligand 1 (PD1/PD-L1)-derived ICI therapy irrespective of NSCLC histology. As there may be synergistic effects of second- and third-line treatments, this sequence is a very suitable option for patients not treated with first-line ICI. In addition, R + D should continue to be investigated as a second-line treatment option after failure of chemotherapy plus ICI in the palliative first-line treatment.
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Affiliation(s)
- Wolfgang M Brueckl
- Nuremberg Lung Cancer Center, Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Martin Reck
- LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Achim Rittmeyer
- Ambulanz für pneumologische Onkologie, Lungenfachklinik Immenhausen, Kassel, Germany
| | - Jens Kollmeier
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Claas Wesseler
- Asklepios Tumorzentrum Hamburg, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Gunther H Wiest
- Asklepios Tumorzentrum Hamburg, Asklepios Klinikum Harburg, Hamburg, Germany
| | | | - Amanda Tufman
- Medizinische Klinik und Poliklinik V (Pneumologie), Klinikum der Universität München, Munich, Germany
| | - Petra Hoffknecht
- Zentrum Klinik für Thoraxonkologie im Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - Bernhard Ulm
- Unabhängige statistische Beratung Bernhard Ulm, Munich, Germany
| | - Fabian Reich
- Nuremberg Lung Cancer Center, Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Joachim H Ficker
- Nuremberg Lung Cancer Center, Department of Respiratory Medicine, Allergology and Sleep Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Eckart Laack
- Hämato-Onkologie Hamburg, Praxis, Hamburg, Germany
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Groen HJ, Akerley WL, Souquet PJ, Laack E, Han JY, Smit EF, Mansfield AS, Garon EB, Wolf J, Tan DSW, Heist RS, Waldron-Lynch M, Le Mouhaer S, Nwana N, Giovannini M, Orlov S. Capmatinib in patients with METex14-mutated or high-level MET-amplified advanced non–small-cell lung cancer (NSCLC): results from cohort 6 of the phase 2 GEOMETRY mono-1 study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9520 Background: Capmatinib (INC280) has shown promising efficacy in patients (pts) with MET exon 14 ( METex14)–mutated NSCLC who were pretreated (cohort 4) or treatment (tx)-naïve (cohort 5b) in the ongoing, multicohort, phase 2 GEOMETRY mono-1 study. We report the results for pts enrolled in the expansion cohort 6 with either high-level MET amplification (gene copy number [GCN] ≥10) or METex14 mutation (any MET GCN) whose disease progressed on 1 prior line of systemic therapy. Methods: Adult pts (≥18 years), ECOG PS 0–1 who had ALK and EGFR wt, stage IIIB/IV NSCLC (any histology) received capmatinib tablets 400 mg twice daily (with or without food). Key efficacy endpoints were overall response rate (ORR) and duration of response (DOR) by blinded independent review committee (BIRC) per RECIST v1.1. Other secondary endpoints included investigator-assessed ORR, DOR, disease control rate (DCR), progression-free survival (PFS; BIRC and investigator assessment) and safety. Results: As of Jan 6, 2020, 34 NSCLC pts with METex14 mutation (n = 31) or high-level MET amplification (n = 3) were included in this analysis. Tx was ongoing for 38.2% of pts. In METex14-mutated NSCLC pts, per BIRC assessment: ORR was 48.4%, median DOR was 6.93 months (mo, not yet mature, 95% CI: 4.17–NE) and median PFS was 8.11 mo (not yet mature, 95% CI: 4.17–9.86). Investigator-assessed responses were similar to BIRC assessment (Table). Only 3 pts with high-level MET amplification were included in this cohort due to challenges in enrollment. All 3 pts had stable disease per BIRC assessment and were on treatment for 48, 85 and 97 days. Most common AEs (≥25%, all grades, N = 34) were peripheral edema (64.7%), nausea (35.3%), fatigue (29.4%), back pain (26.5%) and vomiting (26.5%). Data for pts with brain metastasis will be presented at the ASCO 2020 meeting. Conclusions: Capmatinib was confirmed to be efficacious in 2nd line, METex14-mutated NSCLC pts. This is the first cohort where capmatinib has been administered without fasting restriction and data confirm the favorable safety profile. Clinical trial information: NCT02414139 . [Table: see text]
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Affiliation(s)
- Harry J.M. Groen
- University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Eckart Laack
- Studiengesellschaft Hämato-Onkologie Hamburg, Hamburg, Germany
| | - Ji-Youn Han
- National Cancer Center, Gyeonggi-Do, South Korea
| | | | | | | | - Juergen Wolf
- Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | | | | | | | | | - Ngozi Nwana
- Novartis Pharmaceutical Corporation, East Hanover, NJ
| | | | - Sergey Orlov
- LLC Medicinskie Tekhnologii, St. Petersburg, Russian Federation
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Brückl W, Reck M, Laack E, Hermes B, Rawluk J, Huber R, Hoffmann C, Schueler A. Sequential treatment with afatinib followed by 3rd generation EGFR-TKI – subgroup analysis of the GIDEON trial: A prospective non-interventional study (NIS) in EGFR mutated NSCLC patients in Germany. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Laack E, Hoffmann C, Reck M, Schaefer H, Kortsik C, Griesinger F, Schueler A, Brückl W. Patients with brain metastases treated with afatinib in clinical practice: Results from the prospective non-interventional study GIDEON. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Brückl W, Laack E, Hoffmann C, Zhou C, Wu Y. P2.01-79 Afatinib in EGFR Mutation-Positive (EGFRm+) NSCLC Harbouring Uncommon Mutations: Experience in ‘Real-World’ Clinical Practice. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Brückl W, Laack E, Kortsik C, Schaefer H, Reck M, Maerten A, Hoffmann C. Elderly patients treated with afatinib in clinical practice: Results from the prospective non-interventional study GIDEON. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Garon EB, Reinmuth N, Falchero L, Garcia Garcia Y, Hureaux J, Gore I, Harris RP, Bidoli P, Baldini E, Ros S, Laack E, Mitchell P, Wolf M, O'Byrne KJ, Zibdawi L, Jao K, Spigel D, Li A, Rabindran SK, Pichon E. CheckMate 384: Phase IIIb/IV trial of nivolumab (nivo) 480 mg Q4W versus 240 mg Q2W after ≤ 12 months of nivo in previously treated advanced NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
100 Background: Nivo is approved as 240 mg Q2W in the EU and Japan and 240 mg Q2W or 480 mg Q4W in the US and Canada for second-line treatment (tx) of advanced NSCLC. Pharmacokinetic modeling in various tumors predicts that exposure, efficacy and safety can be maintained with less frequent Q4W dosing, which may provide a more convenient tx option. We present an interim analysis of efficacy and safety from CheckMate 384 (NCT02713867), an international, open-label, randomized phase 3b/4 trial evaluating less frequent nivo dosing (480 mg Q4W vs 240 mg Q2W) in patients (pts) with advanced NSCLC and prior Q2W nivo tx. Methods: Pts (N = 329) with previously treated histologically confirmed stage IIIB/IV or recurrent NSCLC, ECOG performance status 0–2, and prior tx with nivo 3 mg/kg or 240 mg Q2W for ≤12 mo, with ≥2 consecutive assessments of complete / partial response or stable disease, were randomized 1:1 to nivo 480 mg Q4W or 240 mg Q2W over a 30-min infusion. Co-primary endpoints: post-randomization (RND) progression-free survival rates (PFS) at 6 mo and 1 y. Secondary endpoints included safety. Due to tx landscape changes in NSCLC, statistical analyses were amended for a reduced sample size. One-sided 95% CIs were generated to compare PFS rates; presented data analyses are descriptive. Results: Of 166 and 163 pts randomized to 480 mg Q4W and 240 mg Q2W, 164 and 161 pts were treated, respectively. Median follow-up was 9.5 mo (480 mg Q4W) and 10.2 mo (240 mg Q2W). Baseline characteristics were balanced between tx arms. Stratified PFS rates post-RND were comparable between tx arms at 6 mo and 1 y (Table). Safety profiles were similar; any grade tx-related adverse events (TRAEs) and TRAEs leading to discontinuation were reported in 48% vs 61% and 6% vs 9% of pts with 480 mg Q4W vs 240 mg Q2W. No tx-related deaths were reported. Conclusions: Nivo 480 mg Q4W showed similar efficacy and safety to 240 mg Q2W in pts with disease control on nivo, supporting the potential use of 480 mg Q4W as a more convenient dosing option for second-line NSCLC tx. Clinical trial information: NCT02713867. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Ira Gore
- Alabama Oncology, Birmingham, AL
| | | | - Paolo Bidoli
- Azienda Socio Sanitaria Territoriale-ASST di Monza, Monza, Italy
| | - Editta Baldini
- Oncology Department, Medical Oncology Division, San Luca Hospital, Lucca, Italy
| | - Silverio Ros
- Department of Internal Medicine, University of Murcia, Murcia, Spain
| | | | | | | | | | - Labib Zibdawi
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Kevin Jao
- Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - David Spigel
- Sarah Cannon Research Institute/Tennessee Oncology Nashville, PLLC, Nashville, TN
| | - Ang Li
- Bristol-Myers Squibb, Princeton, NJ
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14
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Brueckl W, Laack E, Reck M, Griesinger F, Schäfer H, Kortsik C, Gaska T, Rawluk J, Krüger S, Kokowski K, Budweiser S, Schueler A, Kiessling S. Efficacy of afatinib in the clinical practice: First results of the GIDEON trial: A prospective non-interventional study (NIS) in EGFR mutated NSCLC in Germany. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Stratmann JA, Michels S, Hornetz S, Christoph DC, Sackmann S, Spengler W, Bischoff H, Schäfer M, Alt J, Müller A, Laack E, Kimmich M, Griesinger F, Sebastian M. Efficacy and safety analysis of the German expanded access program of osimertinib in patients with advanced, T790M-positive non-small cell lung cancer. J Cancer Res Clin Oncol 2018; 144:2457-2463. [PMID: 30244389 DOI: 10.1007/s00432-018-2754-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/11/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Osimertinib, a third-generation irreversible mutant-selective inhibitor of EGFR kinase activity was clinically evaluated in the AURA trials, where it showed high clinical efficacy and a favorable toxicity profile in patients with acquired exon 20-EGFR pT790M mutation. We provide the clinical data of the German expanded access program that further characterizes the efficacy and safety of osimertinib in a heterogeneous patient population outside clinical trials. METHODS We performed a retrospective data analysis on patients who were included into the German osimertinib EAP. RESULTS Of 81 patients enrolled, 51 patients (62.9%) with sufficient case report form data were available for efficacy and safety analysis. Unconfirmed overall response rate was 80.0% with 2 patients (3.9%) achieving a complete remission and 37 patients (72.5%) having a partial remission. Disease control rate was 95.9% and only two patients showed refractory disease. Disease control rate did not correlate with clinical characteristics and was independent of number as well as type of the previous therapy line(s). Estimated progression-free survival was 10.1 months (95% CI 9.2-11.0 months). Osimertinib showed a favorable toxicity profile with no dose reductions in our observation period, even in patients with low performance status. Median survival from first diagnosis to data cut-off was 47.3 months (95% CI 43.3-51.9 months). Repeated tissue/liquid biopsy of three patients in our cohort who showed disease progression revealed an amplification of MET. CONCLUSIONS We confirm safety and efficacy of osimertinib with high response rates among all subgroups, including patients with poor performance status and multiple prior therapy lines. Amplification of MET might mediate acquired resistance to osimertinib.
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Affiliation(s)
- Jan A Stratmann
- Department of Hematology and Oncology, Johann Wolfgang Goethe University Hospital of Frankfurt, Theodor Stern Kai 7, 60596, Frankfurt am Main, Germany.
| | - Sebastian Michels
- Lung Cancer Group Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sofia Hornetz
- Department of Hematology and Oncology, Johann Wolfgang Goethe University Hospital of Frankfurt, Theodor Stern Kai 7, 60596, Frankfurt am Main, Germany
| | - Daniel C Christoph
- Department of Medical Oncology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Sandra Sackmann
- Department of Pneumology, Clinic Bremen-Ost, Züricher Str. 40, 28325, Bremen, Germany
| | - Werner Spengler
- Department of Internal Medicine II, University Hospital of Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany
| | - Helge Bischoff
- Department of Thoracic Oncology, University Hospital of Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Monica Schäfer
- Helios Clinic Emil von Behring, Walterhöferstr. 11, 14165, Berlin, Germany
| | - Jürgen Alt
- Department of Internal Medicine III, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Annette Müller
- Department of Hematology and Oncology, University Hospital of Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Eckart Laack
- Hämato-Onkologie Hamburg, Stader Straße 203c, 21075, Hamburg, Germany
| | - Martin Kimmich
- Department of Pneumology, Clinic Schillerhoehe, Solitudestr. 18, 70839, Gerlingen, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius Hospital Oldenburg, Georgstraße 12, 26121, Oldenburg, Germany
| | - Martin Sebastian
- Department of Hematology and Oncology, Johann Wolfgang Goethe University Hospital of Frankfurt, Theodor Stern Kai 7, 60596, Frankfurt am Main, Germany
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16
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Speckmann C, Sahoo SS, Rizzi M, Hirabayashi S, Karow A, Serwas NK, Hoemberg M, Damatova N, Schindler D, Vannier JB, Boulton SJ, Pannicke U, Göhring G, Thomay K, Verdu-Amoros JJ, Hauch H, Woessmann W, Escherich G, Laack E, Rindle L, Seidl M, Rensing-Ehl A, Lausch E, Jandrasits C, Strahm B, Schwarz K, Ehl SR, Niemeyer C, Boztug K, Wlodarski MW. Corrigendum: Clinical and Molecular Heterogeneity of RTEL1 Deficiency. Front Immunol 2017; 8:1250. [PMID: 28989339 PMCID: PMC5630696 DOI: 10.3389/fimmu.2017.01250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/20/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Carsten Speckmann
- Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sushree Sangita Sahoo
- Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany.,Spemann Graduate School of Biology and Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Marta Rizzi
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Department of Rheumatology and Clinical Immunology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Shinsuke Hirabayashi
- Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Axel Karow
- Department of Pediatrics, University of Bern, Bern, Switzerland
| | - Nina Kathrin Serwas
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Marc Hoemberg
- Department of Pediatric Hematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Natalja Damatova
- Department of Medical Genetics, Biozentrum, University of Wuerzburg, Wuerzburg, Germany
| | - Detlev Schindler
- Department of Medical Genetics, Biozentrum, University of Wuerzburg, Wuerzburg, Germany
| | - Jean-Baptiste Vannier
- Telomere Replication and Stability Group, MRC London Institute of Medical Sciences (LMS), London, United Kingdom
| | - Simon J Boulton
- Telomere Replication and Stability Group, MRC London Institute of Medical Sciences (LMS), London, United Kingdom
| | - Ulrich Pannicke
- Institute for Transfusion Medicine, Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Wuerttemberg - Hessen, University Ulm, Ulm, Germany
| | - Gudrun Göhring
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Kathrin Thomay
- Department of Pediatric Hematology and Oncology, Justus Liebig-University, Giessen, Germany
| | - J J Verdu-Amoros
- Department of Pediatric Hematology and Oncology, Justus Liebig-University, Giessen, Germany
| | - Holger Hauch
- Department of Pediatric Hematology and Oncology, Justus Liebig-University, Giessen, Germany
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, Justus Liebig-University, Giessen, Germany
| | - Gabriele Escherich
- Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Eckart Laack
- Hemato-Oncology Clinic Hamburg, Hamburg, Germany
| | - Liliana Rindle
- Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Maximilian Seidl
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Institute of Pathology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Anne Rensing-Ehl
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ekkehart Lausch
- Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Christine Jandrasits
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Brigitte Strahm
- Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Klaus Schwarz
- Institute for Transfusion Medicine, Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Wuerttemberg - Hessen, University Ulm, Ulm, Germany
| | - Stephan R Ehl
- Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany.,Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte Niemeyer
- Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Department of Pediatrics and Adolescent Medicine, St. Anna Kinderspital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Marcin W Wlodarski
- Faculty of Medicine, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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17
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Speckmann C, Sahoo SS, Rizzi M, Hirabayashi S, Karow A, Serwas NK, Hoemberg M, Damatova N, Schindler D, Vannier JB, Boulton SJ, Pannicke U, Göhring G, Thomay K, Verdu-Amoros JJ, Hauch H, Woessmann W, Escherich G, Laack E, Rindle L, Seidl M, Rensing-Ehl A, Lausch E, Jandrasits C, Strahm B, Schwarz K, Ehl SR, Niemeyer C, Boztug K, Wlodarski MW. Clinical and Molecular Heterogeneity of RTEL1 Deficiency. Front Immunol 2017; 8:449. [PMID: 28507545 PMCID: PMC5410638 DOI: 10.3389/fimmu.2017.00449] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/31/2017] [Indexed: 12/30/2022] Open
Abstract
Typical features of dyskeratosis congenita (DC) resulting from excessive telomere shortening include bone marrow failure (BMF), mucosal fragility, and pulmonary or liver fibrosis. In more severe cases, immune deficiency and recurring infections can add to disease severity. RTEL1 deficiency has recently been described as a major genetic etiology, but the molecular basis and clinical consequences of RTEL1-associated DC are incompletely characterized. We report our observations in a cohort of six patients: five with novel biallelic RTEL1 mutations p.Trp456Cys, p.Ile425Thr, p.Cys1244ProfsX17, p.Pro884_Gln885ins53X13, and one with novel heterozygous mutation p.Val796AlafsX4. The most unifying features were hypocellular BMF in 6/6 and B-/NK-cell lymphopenia in 5/6 patients. In addition, three patients with homozygous mutations p.Trp456Cys or p.Ile425Thr also suffered from immunodeficiency, cerebellar hypoplasia, and enteropathy, consistent with Hoyeraal-Hreidarsson syndrome. Chromosomal breakage resembling a homologous recombination defect was detected in patient-derived fibroblasts but not in hematopoietic compartment. Notably, in both cellular compartments, differential expression of 1243aa and 1219/1300aa RTEL1 isoforms was observed. In fibroblasts, response to ionizing irradiation and non-homologous end joining were not impaired. Telomeric circles did not accumulate in patient-derived primary cells and lymphoblastoid cell lines, implying alternative pathomechanisms for telomeric loss. Overall, RTEL1-deficient cells exhibited a phenotype of replicative exhaustion, spontaneous apoptosis and senescence. Specifically, CD34+ cells failed to expand in vitro, B-cell development was compromised, and T-cells did not proliferate in long-term culture. Finally, we report on the natural history and outcome of our patients. While two patients died from infections, hematopoietic stem cell transplantation (HSCT) resulted in sustained engraftment in two patients. Whether chemotherapy negatively impacts on the course and onset of other DC-related symptoms remains open at present. Early-onset lung disease occurred in one of our patients after HSCT. In conclusion, RTEL deficiency can show a heterogeneous clinical picture ranging from mild hypocellular BMF with B/NK cell lymphopenia to early-onset, very severe, and rapidly progressing cellular deficiency.
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Affiliation(s)
- Carsten Speckmann
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sushree Sangita Sahoo
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Spemann Graduate School of Biology and Medicine, University of Freiburg, Freiburg, Germany
| | - Marta Rizzi
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Rheumatology and Clinical Immunology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Shinsuke Hirabayashi
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Axel Karow
- Department of Paediatrics, Univeristy of Bern, Bern, Switzerland
| | - Nina Kathrin Serwas
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Marc Hoemberg
- Department of Pediatric Hematology and Oncology, Children’s Hospital, University of Cologne, Cologne, Germany
| | - Natalja Damatova
- Department of Medical Genetics, Biozentrum, University of Wuerzburg, Wuerzburg, Germany
| | - Detlev Schindler
- Department of Medical Genetics, Biozentrum, University of Wuerzburg, Wuerzburg, Germany
| | - Jean-Baptiste Vannier
- Telomere Replication and Stability Group, MRC London Institute of Medical Sciences (LMS), London, UK
| | - Simon J. Boulton
- Telomere Replication and Stability Group, MRC London Institute of Medical Sciences (LMS), London, UK
| | - Ulrich Pannicke
- Institute for Transfusion Medicine, Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Wuerttemberg – Hessen, University Ulm, Ulm, Germany
| | - Gudrun Göhring
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Kathrin Thomay
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - J. J. Verdu-Amoros
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Holger Hauch
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, Justus-Liebig-University, Giessen, Germany
| | - Gabriele Escherich
- Clinic of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eckart Laack
- Hemato-Oncology Clinic Hamburg, Hamburg, Germany
| | - Liliana Rindle
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Seidl
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Institute of Pathology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Anne Rensing-Ehl
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ekkehart Lausch
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Jandrasits
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Brigitte Strahm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Schwarz
- Institute for Transfusion Medicine, Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Wuerttemberg – Hessen, University Ulm, Ulm, Germany
| | - Stephan R. Ehl
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Freiburg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- St. Anna Kinderspital and Children’s Cancer Research Instutute, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Marcin W. Wlodarski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Freiburg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
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18
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Schuler M, Fischer JR, Grohé C, Gütz S, Thomas M, Kimmich M, Schneider CP, Laack E, Märten A. Experience with afatinib in patients with non-small cell lung cancer progressing after clinical benefit from gefitinib and erlotinib. Oncologist 2014; 19:1100-9. [PMID: 25232040 DOI: 10.1634/theoncologist.2014-0103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Afatinib, an irreversible ErbB family blocker, demonstrated superiority to chemotherapy as first-line treatment in patients with EGFR-mutated non-small cell lung cancer (NSCLC). Afatinib is also active in patients progressing on EGFR tyrosine kinase inhibitors (EGFR-TKIs). We report the results of a large cohort of NSCLC patients receiving afatinib within a compassionate-use program (CUP). PATIENTS AND METHODS Patients with advanced NSCLC progressing after one line or more of chemotherapy and one line or more of EGFR-TKI treatment with either an EGFR mutation or documented clinical benefit were enrolled. Data collection was not monitored or verified by central review. The intention of this CUP was to provide controlled preregistration access to afatinib for patients with life-threatening diseases and no other treatment option. RESULTS From May 2010 to October 2013, 573 patients (65% female; median age: 64 years [range: 28-89 years]) were enrolled, with strong participation of community oncologists. Comorbidities were allowed, including second malignancies in 11% of patients. EGFR mutation status was available in 391 patients (72%), and 83% tested mutation positive. Median time to treatment failure (TTF) of 541 patients treated with afatinib was 3.7 months (range: 0.0 to >29.0 months). Median TTF was 4.0 and 2.7 months in patients with adenocarcinomas and squamous cell carcinomas, respectively, and 4.6 months in patients with EGFR-mutated NSCLC. Adverse events were generally manageable. CONCLUSION Afatinib was able to be given in a real-world setting to heavily pretreated patients with EGFR-mutated or EGFR-TKI-sensitive NSCLC. Acknowledging the constraints of data collection in a CUP, afatinib appears to be safe and to confer some clinical benefit in this population.
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Affiliation(s)
- Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Jürgen R Fischer
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Christian Grohé
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Sylvia Gütz
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Michael Thomas
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Martin Kimmich
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Claus-Peter Schneider
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Eckart Laack
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | - Angela Märten
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany; Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany, Department of Medical Oncology, Klinik Löwenstein, Löwenstein, Germany; Department of Respiratory Medicine, Evangelische· Lungenklinik, Berlin, Germany; Department of Pneumology, Evangelisches Diakonissenkrankenhaus, Leipzig, Germany; Translational Lung Research Center Heidelberg, Heidelberg, Germany; Department of Pneumology and Thoracic Oncology, Klinik Schillerhoehe, Gerlingen, Germany; Department of Hematology and Medical Oncology, Zentralklinik, Bad Berka, Germany; Haemato-Oncology Hamburg, Hamburg, Germany; Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
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Paz-Ares LG, de Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann AH, Visseren-Grul C, Gridelli C. PARAMOUNT: Final overall survival results of the phase III study of maintenance pemetrexed versus placebo immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer. J Clin Oncol 2013; 31:2895-902. [PMID: 23835707 DOI: 10.1200/jco.2012.47.1102] [Citation(s) in RCA: 445] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE In the phase III PARAMOUNT trial, pemetrexed continuation maintenance therapy reduced the risk of disease progression versus placebo (hazard ratio [HR], 0.62; 95% CI, 0.49 to 0.79; P < .001). Here we report final overall survival (OS) and updated safety data. PATIENTS AND METHODS In all, 939 patients with advanced nonsquamous non-small-cell lung cancer (NSCLC) received four cycles of pemetrexed-cisplatin induction therapy; then, 539 patients with no disease progression and Eastern Cooperative Oncology Group performance status 0 or 1 were randomly assigned (2:1) to maintenance pemetrexed (500 mg/m(2) on day 1 of 21-day cycles; n = 359) or placebo (n = 180). Log-rank test compared OS between arms as measured from random assignment (α = .0498). RESULTS The mean number of maintenance cycles was 7.9 (range, one to 44) for pemetrexed and 5.0 (range, one to 38) for placebo. After 397 deaths (pemetrexed, 71%; placebo, 78%) and a median follow-up of 24.3 months for alive patients (95% CI, 23.2 to 25.1 months), pemetrexed therapy resulted in a statistically significant 22% reduction in the risk of death (HR, 0.78; 95% CI, 0.64 to 0.96; P = .0195; median OS: pemetrexed, 13.9 months; placebo, 11.0 months). Survival on pemetrexed was consistently improved for all patient subgroups, including induction response: complete/partial responders (n = 234) OS HR, 0.81; 95% CI, 0.59 to 1.11 and stable disease (n = 285) OS HR, 0.76; 95% CI, 0.57 to 1.01). Postdiscontinuation therapy use was similar: pemetrexed, 64%; placebo, 72%. No new safety findings emerged. Drug-related grade 3 to 4 anemia, fatigue, and neutropenia were significantly higher in pemetrexed-treated patients. CONCLUSION Pemetrexed continuation maintenance therapy is well-tolerated and offers superior OS compared with placebo, further demonstrating that it is an efficacious treatment strategy for patients with advanced nonsquamous NSCLC and good performance status who did not progress during pemetrexed-cisplatin induction therapy.
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Affiliation(s)
- Luis G Paz-Ares
- Servicio de Oncología Médica, University Hospital Virgen del Rocío, Seville, Spain.
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Sack PM, Hampel J, Bröning S, Petersen KU, Andritzky B, Andritzky B, Laack E, Thomasius R. Was limitiert schulische Tabakprävention? Präv Gesundheitsf 2013. [DOI: 10.1007/s11553-013-0388-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pujol JL, Molinier O, El-Kouri C, Favier L, Godbert B, Gatineau M, Hilgers W, Uwer L, Paz-Ares L, Demarinis F, Dediu M, Thomas M, Bidoli P, Sahoo T., Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann A, Visseren-Grul C., Gridelli C. PARAMOUNT : résultats finaux de survie globale de la phase 3 comparant un traitement de maintenance par Pem + BSC vs placebo (plb) + BSC après un ttt d’induction par Pem-Cisplatine (Cis) dans les CBNPC non épidermoïdes (NE) avancés. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Obasaju C, Paz-Ares L, De Marinis F, Dediu M, Thomas M, Pujol J, Bidoli P, Molinier O, Sahoo T, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann A, Visseren-Grul C, Gridelli C. Maintenance Pemetrexed (PEM) Plus Best Supportive Care (BSC) Versus Placebo Plus BSC after PEM Plus Cisplatin for Advanced Nonsquamous NSCLC. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)31933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Reck M, Paz-Ares L, De Marinis F, Molinier O, Prasad Sahoo T, Laack E, John W, Zimmermann A, Visseren-Grul C, Gridelli C. Paramount: Descriptive Subgroup Analyses of Final Overall Survival (OS) for the Phase III Study of Maintenance Pemetrexed (PEM) Versus Placebo (PLB) Following Induction Treatment with PEM Plus Cisplatin (CIS) for Advanced Nonsquamous (NS) Non-Small Cell Lung Cancer (NSCLC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33787-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Paz-Ares L, De Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral Jaime J, Melemed S, John WJ, Chouaki N, Zimmermann A, Visseren-Grul C, Gridelli C. PARAMOUNT: Final overall survival (OS) results of the phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo (plb) plus BSC immediately following induction treatment with pem plus cisplatin (cis) for advanced nonsquamous (NS) non-small cell lung cancer (NSCLC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.18_suppl.lba7507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7507 Background: The PARAMOUNT trial showed that pem continuation maintenance therapy significantly reduced the risk of disease progression over plb (HR=0.62; 95% CI: 0.49-0.79; p <0.0001) in patients (pts) with advanced NS NSCLC who had not progressed during pem-cis induction. Here we present the final OS data. Methods: In a double-blind, plb-controlled study, alpha-controlled for OS, 939 pts received induction (4 cycles of pem 500 mg/m2 and cis 75 mg/m2 on d1 of 21d cycles), and 539 pts who had not progressed and had an ECOG performance status (PS) of 0/1 were randomized (2:1) to maintenance pem (500 mg/m2, on day 1 of 21-day cycles) plus BSC or plb plus BSC until disease progression. All received B12, folic acid, and dexamethasone. After 397 deaths, a log-rank test compared OS between arms using anominal α level of 0.0498. Results: Pt characteristics were balanced between arms: median age 61 years; 58% men; 32% PS 0; 95% Caucasian; 86% adenocarcinoma; 45% complete/partial response (CR/PR) to induction. Pem resulted in a statistically significant 22% reduction in risk of death (HR=0.78). The HR was the same when measured from the beginning of induction. Survival improvement was similar for pts with an induction outcome of CR/PR versus stable disease. Conclusions: Pem continuation maintenance therapy offers superior OS compared with plb. These final results confirm that pem-cis induction followed by continuation pem further benefits pts compared with induction therapy alone, offering a change in the treatment paradigm for advanced NS NSCLC. [Table: see text]
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Affiliation(s)
- Luis Paz-Ares
- University Hospital - Virgen del Rocio, Seville, Spain
| | | | - Mircea Dediu
- Medical Oncology Department, Institute of Oncology, Bucharest, Romania
| | - Michael Thomas
- Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Eckart Laack
- Ambulantes Krebszentrum Hamburg, Hamburg, Germany
| | - Martin Reck
- Hospital Großhansdorf, Großhansdorf, Germany
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Paz-Ares L, De Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral Jaime J, Melemed S, John WJ, Chouaki N, Zimmermann A, Visseren-Grul C, Gridelli C. PARAMOUNT: Final overall survival (OS) results of the phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo (plb) plus BSC immediately following induction treatment with pem plus cisplatin (cis) for advanced nonsquamous (NS) non-small cell lung cancer (NSCLC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.lba7507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7507 The full, final text of this abstract will be available at abstract.asco.org at 12:01 AM (EDT) on Monday, June 4, 2012, and in the Annual Meeting Proceedings online supplement to the June 20, 2012, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Monday edition of ASCO Daily News.
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Affiliation(s)
- Luis Paz-Ares
- University Hospital - Virgen del Rocio, Seville, Spain
| | | | - Mircea Dediu
- Medical Oncology Department, Institute of Oncology, Bucharest, Romania
| | - Michael Thomas
- Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Eckart Laack
- Ambulantes Krebszentrum Hamburg, Hamburg, Germany
| | - Martin Reck
- Hospital Großhansdorf, Großhansdorf, Germany
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Paz-Ares L, de Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann AH, Visseren-Grul C, Gridelli C. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol 2012. [PMID: 22341744 DOI: 10.1016/s1470-2045(12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Patients with advanced non-squamous non-small-cell lung cancer (NSCLC) benefit from pemetrexed maintenance therapy after induction therapy with a platinum-containing, non-pemetrexed doublet. The PARAMOUNT trial investigated whether continuation maintenance with pemetrexed improved progression-free survival after induction therapy with pemetrexed plus cisplatin. METHODS In this double-blind, multicentre, phase 3, randomised placebo-controlled trial, patients with advanced non-squamous NSCLC aged 18 years or older, with no previous systemic chemotherapy for lung cancer, with at least one measurable lesion, and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 participated. Before randomisation, patients entered an induction phase which consisted of four cycles of induction pemetrexed (500 mg/m(2)) plus cisplatin (75 mg/m(2)) on day 1 of a 21-day cycle. Patients who did not progress after completion of four cycles of induction and who had an ECOG performance status of 0 or 1 were stratified according to disease stage (IIIB or IV), ECOG performance status (0 or 1), and induction response (complete or partial response, or stable disease), and randomly assigned (2:1 ratio) to receive maintenance therapy with either pemetrexed (500 mg/m(2) every 21 days) plus best supportive care or placebo plus best supportive care until disease progression. Randomisation was done with the Pocock and Simon minimisation method. Patients and investigators were masked to treatment assignment. The primary endpoint was progression-free survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT00789373. FINDINGS Of the 1022 patients enrolled, 939 participated in the induction phase. Of these, 539 patients were randomly assigned to receive continuation maintenance with pemetrexed plus best supportive care (n=359) or with placebo plus best supportive care (n=180). Among the 359 patients randomised to continuation maintenance with pemetrexed, there was a significant reduction in the risk of disease progression over the placebo group (HR 0·62, 95% CI 0·49-0·79; p<0·0001). The median progression-free survival, measured from randomisation, was 4·1 months (95% CI 3·2-4·6) for pemetrexed and 2·8 months (2·6-3·1) for placebo. Possibly treatment-related laboratory grade 3-4 adverse events were more common in the pemetrexed group (33 [9%] of 359 patients) than in the placebo group (one [<1%] of 180 patients; p<0·0001), as were non-laboratory grade 3-5 adverse events (32 [9%] of 359 patients in the pemetrexed group; eight [4%] of 180 patients in the placebo group; p=0·080); one possibly treatment-related death was reported in each group. The most common adverse events of grade 3-4 in the pemetrexed group were anaemia (16 [4%] of 359 patients), neutropenia (13 [4%]), and fatigue (15 [4%]). In the placebo group, these adverse events were less common: anaemia (one [<1%] of 180 patients), neutropenia (none), and fatigue (one <1%]). The most frequent serious adverse events were anaemia (eight [2%] of 359 patients in the pemetrexed group vs none in the placebo group) and febrile neutropenia (five [1%] vs none). Discontinuations due to drug-related adverse events occurred in 19 (5%) patients in the pemetrexed group and six (3%) patients in the placebo group. INTERPRETATION Continuation maintenance with pemetrexed is an effective and well tolerated treatment option for patients with advanced non-squamous NSCLC with good performance status who have not progressed after induction therapy with pemetrexed plus cisplatin. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Luis Paz-Ares
- Instituto de Biomedicina de Sevilla, University Hospital Virgen del Rocío, Seville, Spain.
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Paz-Ares L, de Marinis F, Dediu M, Thomas M, Pujol JL, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed S, John W, Chouaki N, Zimmermann AH, Visseren-Grul C, Gridelli C. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol 2012; 13:247-55. [PMID: 22341744 DOI: 10.1016/s1470-2045(12)70063-3] [Citation(s) in RCA: 429] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients with advanced non-squamous non-small-cell lung cancer (NSCLC) benefit from pemetrexed maintenance therapy after induction therapy with a platinum-containing, non-pemetrexed doublet. The PARAMOUNT trial investigated whether continuation maintenance with pemetrexed improved progression-free survival after induction therapy with pemetrexed plus cisplatin. METHODS In this double-blind, multicentre, phase 3, randomised placebo-controlled trial, patients with advanced non-squamous NSCLC aged 18 years or older, with no previous systemic chemotherapy for lung cancer, with at least one measurable lesion, and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 participated. Before randomisation, patients entered an induction phase which consisted of four cycles of induction pemetrexed (500 mg/m(2)) plus cisplatin (75 mg/m(2)) on day 1 of a 21-day cycle. Patients who did not progress after completion of four cycles of induction and who had an ECOG performance status of 0 or 1 were stratified according to disease stage (IIIB or IV), ECOG performance status (0 or 1), and induction response (complete or partial response, or stable disease), and randomly assigned (2:1 ratio) to receive maintenance therapy with either pemetrexed (500 mg/m(2) every 21 days) plus best supportive care or placebo plus best supportive care until disease progression. Randomisation was done with the Pocock and Simon minimisation method. Patients and investigators were masked to treatment assignment. The primary endpoint was progression-free survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT00789373. FINDINGS Of the 1022 patients enrolled, 939 participated in the induction phase. Of these, 539 patients were randomly assigned to receive continuation maintenance with pemetrexed plus best supportive care (n=359) or with placebo plus best supportive care (n=180). Among the 359 patients randomised to continuation maintenance with pemetrexed, there was a significant reduction in the risk of disease progression over the placebo group (HR 0·62, 95% CI 0·49-0·79; p<0·0001). The median progression-free survival, measured from randomisation, was 4·1 months (95% CI 3·2-4·6) for pemetrexed and 2·8 months (2·6-3·1) for placebo. Possibly treatment-related laboratory grade 3-4 adverse events were more common in the pemetrexed group (33 [9%] of 359 patients) than in the placebo group (one [<1%] of 180 patients; p<0·0001), as were non-laboratory grade 3-5 adverse events (32 [9%] of 359 patients in the pemetrexed group; eight [4%] of 180 patients in the placebo group; p=0·080); one possibly treatment-related death was reported in each group. The most common adverse events of grade 3-4 in the pemetrexed group were anaemia (16 [4%] of 359 patients), neutropenia (13 [4%]), and fatigue (15 [4%]). In the placebo group, these adverse events were less common: anaemia (one [<1%] of 180 patients), neutropenia (none), and fatigue (one <1%]). The most frequent serious adverse events were anaemia (eight [2%] of 359 patients in the pemetrexed group vs none in the placebo group) and febrile neutropenia (five [1%] vs none). Discontinuations due to drug-related adverse events occurred in 19 (5%) patients in the pemetrexed group and six (3%) patients in the placebo group. INTERPRETATION Continuation maintenance with pemetrexed is an effective and well tolerated treatment option for patients with advanced non-squamous NSCLC with good performance status who have not progressed after induction therapy with pemetrexed plus cisplatin. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Luis Paz-Ares
- Instituto de Biomedicina de Sevilla, University Hospital Virgen del Rocío, Seville, Spain.
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Pujol JL, Paz-Ares L, Demarinis F, Dediu M, Thomas M, Molinier O, Bidoli P, Sahoo TP, Laack E, Reck M, El Kouri C, Favier L, Corral J, Martinet Y, Melemed S, John W, Zimmermann A, Chouaki N, Gridelli C. PARAMOUNT : phase 3 comparant un traitement (ttt) de maintenance par Pemetrexed (Pem) plus soins de support (BSC) versus placebo plus BSC après un ttt d’induction par Pem-Cisplatine (Cispt) dans les CBNPC non épidermoïdes avancés. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Vansteenkiste J, Solomon B, Boyer M, Wolf J, Miller N, Di Scala L, Pylvaenaeinen I, Petrovic K, Dimitrijevic S, Anrys B, Laack E. Everolimus in Combination with Pemetrexed in Patients with Advanced Non-small Cell Lung Cancer Previously Treated with Chemotherapy: A Phase I Study Using a Novel, Adaptive Bayesian Dose-Escalation Model. J Thorac Oncol 2011; 6:2120-9. [DOI: 10.1097/jto.0b013e3182307ede] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Paz-Ares LG, De Marinis F, Dediu M, Thomas M, Pujol J, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed SA, John WJ, Chouaki N, Zimmerman A, Visseren Grul CM, Gridelli C. PARAMOUNT: Phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo plus BSC immediately following induction treatment with pem plus cisplatin for advanced nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.cra7510] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CRA7510 Background: The PARAMOUNT trial investigated whether pem continuation maintenance therapy improves progression-free survival (PFS) after pem-cisplatin induction therapy in patients (pts) with advanced nonsquamous NSCLC. Methods: In this double-blind, placebo-controlled trial, 939 pts participated in the induction phase, specified as four cycles of induction pem (500 mg/m2) and cisplatin (75 mg/m2) on day 1 of a 21-day cycle. Pts who had not progressed during pem-cisplatin induction and had an Eastern Cooperative Oncology Group performance status (PS) of 0/1 (n=539; 57.4%) were randomized (2:1, stratified for disease stage, PS, and induction response) to maintenance pem (500 mg/m2 on day 1 of a 21-day cycle) plus BSC (n=359) or placebo plus BSC (n=180) until disease progression. All pts received vitamin B12, folic acid, and dexamethasone. The primary endpoint was PFS (target: HR=0.65, two-sided alpha=0.05; 90% power with minimum of 238 events). Results: Pt characteristics were balanced between arms: median age=61 years; 58% male; 95% Caucasian; 32% PS 0; 91% stage IV; 87% adenocarcinoma; and 45% induction complete/partial response. Pem continuation maintenance resulted in a 36% reduction in the risk of progression (HR=0.64, 95% CI: 0.51-0.81; P=0.00025). The median independently reviewed PFS (472 pts, 297 events), measured from randomization, was 3.9 months (95% CI: 3.0-4.2) on the pem arm, and 2.6 months (95% CI: 2.2-2.9) on the placebo arm. The disease control rate (% pts with response/stable disease) was 71.8% on the pem arm, and 59.6% on the placebo arm (P=0.009). The drug-related serious adverse event (AE) rate was 8.9% on the pem arm, and 9.2% of pts had grade 3/4 laboratory Common Toxicity Criteria AEs. On the placebo arm, the rates were 2.8% and 0.6%, respectively. Discontinuations due to AEs were 5.3% on the pem arm, 3.3% on the placebo arm. Conclusions: PARAMOUNT met its primary endpoint and showed that pem continuation maintenance following pem-cisplatin induction is an effective and well tolerated treatment for pts with advanced nonsquamous NSCLC.
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Affiliation(s)
- L. G. Paz-Ares
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - F. De Marinis
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - M. Dediu
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - M. Thomas
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - J. Pujol
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - P. Bidoli
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - O. Molinier
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - T. P. Sahoo
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - E. Laack
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - M. Reck
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - J. Corral
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - S. A. Melemed
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - W. J. John
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - N. Chouaki
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - A. Zimmerman
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - C. M. Visseren Grul
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
| | - C. Gridelli
- Hospital Universitario Virgen del Rocío, Seville, Spain; San Camillo-Forlanini Hospital, Rome, Italy; Medical Oncology Department, Institute of Oncology, Bucharest, Romania; Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Montpellier University Hospital, Montpellier, France; Az Ospedale S. Gerardo, Monza, Italy; Le Mans Regional Hospital, Le Mans, France; Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; Ambulantes Krebszentrum Hamburg, Hamburg, Germany; Hospital
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Paz-Ares LG, De Marinis F, Dediu M, Thomas M, Pujol J, Bidoli P, Molinier O, Sahoo TP, Laack E, Reck M, Corral J, Melemed SA, John WJ, Chouaki N, Zimmerman A, Visseren Grul CM, Gridelli C. PARAMOUNT: Phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo plus BSC immediately following induction treatment with pem plus cisplatin for advanced nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.cra7510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Thöm I, Andritzky B, Schuch G, Burkholder I, Edler L, Johansen JS, Bokemeyer C, Schumacher U, Laack E. Elevated pretreatment serum concentration of YKL-40-An independent prognostic biomarker for poor survival in patients with metastatic nonsmall cell lung cancer. Cancer 2010; 116:4114-21. [PMID: 20564116 DOI: 10.1002/cncr.25196] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The glycoprotein YKL-40 is synthesized both by cancer cells and by tumor-associated macrophages and plays a functional role in tumor progression. Consequently, high serum YKL-40 levels have been associated with a poor prognosis in patients with several cancer types. However, the role of YKL-40 has not been established in nonsmall cell lung cancer (NSCLC). METHODS Pretreatment serum levels of YKL-40 were determined in 189 patients with NSCLC (143 men and 46 women; median age, 62 years;, age range, 41-76 years). Twelve percent of patients had stage IIIB disease, and 88% had stage IV disease. Ninety-eight patients received combined gemcitabine and vinorelbine, and 91 received combined gemcitabine, vinorelbine, and cisplatin as first-line chemotherapy. The median overall survival was 37 weeks. RESULTS Patients had a median serum YKL-40 level of 209 ng/mL (range, 19-2153 ng/mL). No correlation was observed between overall survival and the type of chemotherapy regimen used, tumor stage, sex, or histologic types. Patients with high serum YKL-40 levels (greater than the median level for all patients [209 ng/mL]) had a significantly shorter survival than patients with serum YKL-40 levels below the median (median survival, 32 weeks vs 41 weeks; P = .007). In multivariate analysis, the serum YKL-40 level, the presence of bone lesions, and the serum lactate dehydrogenase level were independent, statistically significant prognostic factors. CONCLUSIONS The pretreatment serum YKL-40 level was identified as a new, independent prognostic biomarker in patients with metastatic NSCLC and may help to determine the individual prognosis of these patients.
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Affiliation(s)
- Ina Thöm
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Laack E, Sauter G, Bokemeyer C. Lessons learnt from gefitinib and erlotinib: Key insights into small-molecule EGFR-targeted kinase inhibitors in non-small cell lung cancer. Lung Cancer 2010; 69:259-64. [DOI: 10.1016/j.lungcan.2010.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 05/07/2010] [Accepted: 05/13/2010] [Indexed: 01/22/2023]
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Thöm I, Schmid K, Burkholder I, Johansen JS, Bokemeyer C, Schumacher U, Laack E. Relationship of YKL-40 protein expression in pulmonary adenocarcinoma and prognosis. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ciuleanu T, Brodowicz T, Zielinski C, Kim JH, Krzakowski M, Laack E, Wu YL, Bover I, Begbie S, Tzekova V, Cucevic B, Pereira JR, Yang SH, Madhavan J, Sugarman KP, Peterson P, John WJ, Krejcy K, Belani CP. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet 2009; 374:1432-40. [PMID: 19767093 DOI: 10.1016/s0140-6736(09)61497-5] [Citation(s) in RCA: 831] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several studies have shown the efficacy, tolerability, and ease of administration of pemetrexed-an antifolate antineoplastic agent-in patients with advanced non-small-cell lung cancer. We assessed pemetrexed as maintenance therapy in patients with this disease. METHODS This randomised double-blind study was undertaken in 83 centres in 20 countries. 663 patients with stage IIIB or IV disease who had not progressed on four cycles of platinum-based chemotherapy were randomly assigned (2:1 ratio) to receive pemetrexed (500 mg/m(2), day 1) plus best supportive care (n=441) or placebo plus best supportive care (n=222) in 21-day cycles until disease progression. Treatment was randomised with the Simon and Pocock minimisation method. Patients and investigators were masked to treatment. All patients received vitamin B(12), folic acid, and dexamethasone. The primary endpoint of progression-free survival and the secondary endpoint of overall survival were analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00102804. FINDINGS All randomly assigned participants were analysed. Pemetrexed significantly improved progression-free survival (4.3 months [95% CI 4.1-4.7] vs 2.6 months [1.7-2.8]; hazard ratio [HR] 0.50, 95% CI 0.42-0.61, p<0.0001) and overall survival (13.4 months [11.9-15.9] vs 10.6 months [8.7-12.0]; HR 0.79, 0.65-0.95, p=0.012) compared with placebo. Treatment discontinuations due to drug-related toxic effects were higher in the pemetrexed group than in the placebo group (21 [5%] vs three [1%]). Drug-related grade three or higher toxic effects were higher with pemetrexed than with placebo (70 [16%] vs nine [4%]; p<0.0001), specifically fatigue (22 [5%] vs one [1%], p=0.001) and neutropenia (13 [3%] vs 0, p=0.006). No pemetrexed-related deaths occurred. Relatively fewer patients in the pemetrexed group than in the placebo group received systemic post-discontinuation therapy (227 [51%] vs 149 [67%]; p=0.0001). INTERPRETATION Maintenance therapy with pemetrexed is well tolerated and offers improved progression-free and overall survival compared with placebo in patients with advanced non-small-cell lung cancer. FUNDING Eli Lilly.
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Belani CP, Brodowicz T, Ciuleanu T, Kim JH, Krzakowski M, Laack E, Wu YL, Peterson P, Krejcy K, Zielinski C. Maintenance pemetrexed (Pem) plus best supportive care (BSC) versus placebo (Plac) plus BSC: A randomized phase III study in advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.18_suppl.cra8000] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CRA8000 Background: Pemetrexed's efficacy, favorable tolerability profile, and ease of administration provided a strong rationale for evaluation as maintenance therapy in patients (pts) with advanced NSCLC. We present the final analyses for all outcomes, including overall survival (OS), from a phase III study of Pem vs. Plac (Ciuleanu, J Clin Oncol 26, 2008, A 8011) in pts with stage IIIB/IV NSCLC who had not progressed on four cycles of platinum-based chemotherapy. Methods: In this double-blind trial, pts were randomized 2:1 to receive Pem (500 mg/m2, day 1) plus BSC or Plac plus BSC in 21-day cycles until disease progression. All pts received vitamin B12, folic acid, and dexamethasone. The final OS analysis was performed using an unadjusted Cox model. Overall α = 0.05 for PFS and OS. Results: In the 663 randomized pts (Pem 441: Plac 222), Pem resulted in significantly better OS (13.4 vs. 10.6 mos [HR 0.79, 95% CI: 0.65–0.95, P = 0.012]). As reported earlier, Pem also had better PFS (P <0.00001) and response (P <0.001) ( Table ). The improvements in PFS and OS were observed primarily in patients with non-squamous histology (PFS HR = 0.47 and OS HR = 0.70). Treatment by histology interaction for OS was significant (P = 0.038). Drug-related grade 3/4 toxicities were higher for Pem (16% vs 4%; P <0.001); specifically, fatigue (5% vs 0.5%) and neutropenia (2.9% vs. 0%). Grade 3/4 toxicities did not increase significantly in pts who received ≥6 and ≥10 cycles of Pem. There were no Pem-related deaths. Fewer pts in the Pem arm (51.5% vs 67.1%; P <0.001) received systemic post-discontinuation therapy. Conclusions: Pem maintenance therapy is well tolerated and offers superior OS and PFS compared with Plac, making it a new treatment paradigm for patients with advanced NSCLC who respond to initial therapy. This trial further validates that Pem has greater efficacy in patients with non-squamous histology. [Table: see text] [Table: see text]
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Affiliation(s)
- C. P. Belani
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
| | - T. Brodowicz
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
| | - T. Ciuleanu
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
| | - J. H. Kim
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
| | - M. Krzakowski
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
| | - E. Laack
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
| | - Y. L. Wu
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
| | - P. Peterson
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
| | - K. Krejcy
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
| | - C. Zielinski
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University of Vienna, General Hospital of Vienna, and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria
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Belani CP, Brodowicz T, Ciuleanu T, Kim JH, Krzakowski M, Laack E, Wu YL, Peterson P, Krejcy K, Zielinski C. Maintenance pemetrexed (Pem) plus best supportive care (BSC) versus placebo (Plac) plus BSC: A randomized phase III study in advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.cra8000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CRA8000 The full, final text of this abstract will be available in Part II of the 2009 ASCO Annual Meeting Proceedings, distributed onsite at the Meeting on May 30, 2009, and as a supplement to the June 20, 2009, issue of the Journal of Clinical Oncology. [Table: see text]
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Affiliation(s)
- C. P. Belani
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
| | - T. Brodowicz
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
| | - T. Ciuleanu
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
| | - J. H. Kim
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
| | - M. Krzakowski
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
| | - E. Laack
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
| | - Y. L. Wu
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
| | - P. Peterson
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
| | - K. Krejcy
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
| | - C. Zielinski
- Penn State Hershey Cancer Institute, Hershey, PA; Medical University Vienna General Hospital and CECOG, Vienna, Austria; Oncology Institute Ion Chiricuta and CECOG, Cluj, Romania; Yonsei Cancer Center, Seoul, Republic of Korea; Centre of Oncology-Institute and CECOG, Warsaw, Poland; University Cancer Center Hamburg, Eppendorf, Germany; Guangdong Province People's Hospital, Guangzhou, China; Eli Lilly and Company, Indianapolis, IN; Eli Lilly Regional Operations, Vienna, Austria; Medical University of
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Thöm I, Schult-Kronefeld O, Burkholder I, Schuch G, Andritzky B, Kastendieck H, Edler L, Wagener C, Bokemeyer C, Schumacher U, Laack E. Expression of CEACAM-1 in pulmonary adenocarcinomas and their metastases. Anticancer Res 2009; 29:249-254. [PMID: 19331157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND CEACAM-1 is involved in intercellular adhesion and is expressed in a variety of human tissues. In cases of malignant transformation, a down-regulation or loss of CEACAM-1 has been shown. In contrast, CEACAM-1 is not expressed in normal lung tissue or melanocytes. It has been demonstrated that an expression in these tissues is associated with the development of metastatic disease. The aim of the present investigation was to analyze a possible association between the expression of CEACAM-1 in pulmonary adenocarcinomas and their lymph node and hematogenous metastatic cells. PATIENTS AND METHODS CEACAM-1 expression was immunhistochemically evaluated in primary tumors, lymph nodes and distant metastases of 96 patients with metastatic pulmonary adenocarcinoma who had undergone surgery between 1999 and 2002. RESULTS Expression of CEACAM-1 was shown in 78 out of 96 primary tumors (81.3%). A significant positive correlation was found between CEACAM-1 expression on cells of the primary tumor, lymph node metastases (p < 0.005) and hematogenous metastases (p = 0.03). CEACAM-1 expression did not correlate with stage, gender, grading or patients' age. Compared to patients with tumors not expressing CEACAM-1, patients with a CEACAM-1-expressing tumor had a shorter median overall survival (21 vs. 28 months) and progression-free survival (11.7 vs. 16.3 months). CONCLUSION CEACAM-1 is expressed in most primary pulmonary adenocarcinomas. This investigation demonstrates that its expression is preserved in lymph node and hematogenous metastases, indicating that its expression is of functional significance for both metastatic sites. These results support the prognostic relevance of the expression of CEACAM-1 in pulmonary adenocarcinoma.
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Affiliation(s)
- Ina Thöm
- Department of Oncology and Hematology, Bone Marrow Transplantation Section, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Thöm I, Rogers C, Andritzky B, Witzel I, Schuch G, Hossfeld DK, Bokemeyer C, Laack E. Single-Center Management of 136 Patients with Cancer of Unknown Primary Site (CUP Syndrome) Over a Period of 10 Years. ACTA ACUST UNITED AC 2009; 32:741-6. [DOI: 10.1159/000252797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ciuleanu TE, Brodowicz T, Belani CP, Kim J, Krzakowski M, Laack E, Wu Y, Peterson P, Adachi S, Zielinski CC. Maintenance pemetrexed plus best supportive care (BSC) versus placebo plus BSC: A phase III study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Thoem I, Johansen JS, Andritzky B, Schuch G, Burkholder I, Edler L, Bokemeyer C, Schumacher U, Laack E. Elevated pretreatment serum concentration of YKL-40—An independent prognostic biomarker for poor survival in patients with metastatic non-small cell lung cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.19044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Laack E, Bokemeyer C, Hossfeld DK. Adjuvant chemotherapy after complete resection of non-small cell lung cancer. Dtsch Arztebl Int 2008; 105:249-54. [PMID: 19629205 PMCID: PMC2696776 DOI: 10.3238/arztebl.2008.0249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 12/04/2007] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In non-small cell lung cancer (NSCLC) surgical resection is the treatment of choice in stages I and II of the disease; but even of this selected group of patients, almost half suffer recurrence following complete resection, usually in the form of distant metastases. The role of adjuvant systemic chemotherapy has been investigated extensively in the last two decades. METHODS Selective literature review of randomized phase III trials. RESULTS AND DISCUSSION There is currently no indication for adjuvant chemotherapy in patients with stage IA disease, whereas the role of adjuvant chemotherapy for stage IB disease remains controversial. To treat a patient with stage IB disease should be an individualized decision depending on age, tumor size, vascular invasion, and patient preference. Adjuvant chemotherapy is now the standard of care after complete resection of stage II-IIIA NSCLC. Patients considered for adjuvant chemotherapy should be under 75 years of age, have no contraindications to cisplatin-based chemotherapy, and should be in a good performance status after surgery. Currently the standard adjuvant chemotherapy regimen is a combination containing cisplatin and vinorelbine.
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Affiliation(s)
- Eckart Laack
- II. Medizinische Klinik, Onkologisches Zentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany.
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Görn M, Habermann CR, Anige M, Thöm I, Schuch G, Andritzky B, Brandl S, Burkholder I, Edler L, Hossfeld DK, Bokemeyer C, Laack E. A Pilot Study of Docetaxel and Trofosfamide as Second-Line ‘Metronomic’ Chemotherapy in the Treatment of Metastatic Non-Small Cell Lung Cancer (NSCLC). ACTA ACUST UNITED AC 2008; 31:185-9. [DOI: 10.1159/000118626] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bartsch G, Eggert K, Soker S, Fiedler W, Laack E, Volkmer BG, Gschwend J, Bokemeyer C, Hautmann R, Schuch G. [Development of angiogenesis inhibitory combination therapies for treatment of renal cell carcinoma]. Urologe A 2007; 46:1289-90. [PMID: 17624513 DOI: 10.1007/s00120-007-1393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Bartsch
- Abteilung für Urologie und Kinderurologie, Urologische Universitätsklinik und Poliklinik Ulm, Prittwitzstrasse 43, 89075 Ulm.
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Schneider C, Schott-von Römer K, Gütz S, Raack B, Dierkesmann R, Laack E, Guschall W, Schmittel A, Gatzemeier U. Biomarker analysis from TRUST, a trial of erlotinib in non-small cell lung cancer (NSCLC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7674 Background: The EGFR tyrosine kinase inhibitor erlotinib significantly prolonged survival and improved QoL in relapsed NSCLC patients (pts) (Shepherd et al. NEJM 2005;353:123). TRUST is an ongoing, single arm, international, multicenter trial providing erlotinib access to pts with advanced NSCLC (>6,500 enrolled). Methods: Stage IIIb/IV NSCLC; failed (1–2 regimens) or unsuitable for chemotherapy. Pts received erlotinib 150 mg/day p.o. until progression or unacceptable toxicity. Pts were assessed for response, progression free survival (PFS), overall survival (OS) and safety. Where possible, tumor tissue samples were collected from German centers and centrally assessed by; immunohistochemistry (IHC; EGFR, pMAPK), fluorescence in-situ hybridization (FISH; EGFR gene copy number), and DNA sequencing (EGFR, KRAS gene mutations). Results were assessed for correlations with treatment benefit. Results: Nov 2006, biomarker data were available for 287 of 393 German pts; median age 65 yrs (range 33–90). Baseline characteristics (%): male/female (59/41); Caucasian/Oriental/no data (99/1/<1); non-smoker/former or current smoker (25/75); adenocarcinoma/squamous cell/BAC/large cell/other/no data (57/33/3/2/1/4). 40% received erlotinib 2nd line. Of 230 pts with response data, 7.4% had a complete or partial response. Median PFS was 11.0 weeks (95% CI: 9.0–13.1). Preliminary analyses showed EGFR IHC+ (=10% staining; 223/278) pts (vs EGFR IHC-) had longer OS (HR=0.75; p=0.1) and PFS (HR=0.71; p=0.03). OS (HR=0.53; p=0.02) and PFS (HR=0.38; p=0.0001) were significantly prolonged in EGFR FISH+ (28/133) vs FISH- pts. Pts with KRAS mutations (17/107) had shorter OS (HR=1.5; p=0.18) and PFS (HR=1.6; p=0.08) vs wildtype. pMAPK+ status (29/108) was associated with shorter OS (HR=2.6; p<0.0001) and PFS (HR=1.6; p=0.0007). Conclusion: As TRUST is a single arm study, conclusions on the prognostic or predictive significance of these biomarkers cannot be drawn. Erlotinib treated NSCLC pts with EGFR IHC+, EGFR FISH+ or pMAPK- tumors may have better outcomes than those with EGFR IHC-, EGFR FISH-, and pMAPK+ tumors, but to prospectively assess the predictive value of these biomarkers, a randomized phase III study is ongoing (BO18192, SATURN). [Table: see text]
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Affiliation(s)
- C. Schneider
- Zentralklinik Bad Berka, Bad Berka, Germany; University of Heidelberg, Heidelberg, Germany; City Hospital Sanct George, Leipzig, Germany; Internal Medicine, Celle, Germany; Hospital Schillerhöhe, Gerlingen, Germany; University Hospital, Hamburg-Eppendorf, Hamburg, Germany; Clinic for Lung Diseases, Lostau, Germany; Charite, Berlin, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - K. Schott-von Römer
- Zentralklinik Bad Berka, Bad Berka, Germany; University of Heidelberg, Heidelberg, Germany; City Hospital Sanct George, Leipzig, Germany; Internal Medicine, Celle, Germany; Hospital Schillerhöhe, Gerlingen, Germany; University Hospital, Hamburg-Eppendorf, Hamburg, Germany; Clinic for Lung Diseases, Lostau, Germany; Charite, Berlin, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - S. Gütz
- Zentralklinik Bad Berka, Bad Berka, Germany; University of Heidelberg, Heidelberg, Germany; City Hospital Sanct George, Leipzig, Germany; Internal Medicine, Celle, Germany; Hospital Schillerhöhe, Gerlingen, Germany; University Hospital, Hamburg-Eppendorf, Hamburg, Germany; Clinic for Lung Diseases, Lostau, Germany; Charite, Berlin, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - B. Raack
- Zentralklinik Bad Berka, Bad Berka, Germany; University of Heidelberg, Heidelberg, Germany; City Hospital Sanct George, Leipzig, Germany; Internal Medicine, Celle, Germany; Hospital Schillerhöhe, Gerlingen, Germany; University Hospital, Hamburg-Eppendorf, Hamburg, Germany; Clinic for Lung Diseases, Lostau, Germany; Charite, Berlin, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - R. Dierkesmann
- Zentralklinik Bad Berka, Bad Berka, Germany; University of Heidelberg, Heidelberg, Germany; City Hospital Sanct George, Leipzig, Germany; Internal Medicine, Celle, Germany; Hospital Schillerhöhe, Gerlingen, Germany; University Hospital, Hamburg-Eppendorf, Hamburg, Germany; Clinic for Lung Diseases, Lostau, Germany; Charite, Berlin, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - E. Laack
- Zentralklinik Bad Berka, Bad Berka, Germany; University of Heidelberg, Heidelberg, Germany; City Hospital Sanct George, Leipzig, Germany; Internal Medicine, Celle, Germany; Hospital Schillerhöhe, Gerlingen, Germany; University Hospital, Hamburg-Eppendorf, Hamburg, Germany; Clinic for Lung Diseases, Lostau, Germany; Charite, Berlin, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - W. Guschall
- Zentralklinik Bad Berka, Bad Berka, Germany; University of Heidelberg, Heidelberg, Germany; City Hospital Sanct George, Leipzig, Germany; Internal Medicine, Celle, Germany; Hospital Schillerhöhe, Gerlingen, Germany; University Hospital, Hamburg-Eppendorf, Hamburg, Germany; Clinic for Lung Diseases, Lostau, Germany; Charite, Berlin, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - A. Schmittel
- Zentralklinik Bad Berka, Bad Berka, Germany; University of Heidelberg, Heidelberg, Germany; City Hospital Sanct George, Leipzig, Germany; Internal Medicine, Celle, Germany; Hospital Schillerhöhe, Gerlingen, Germany; University Hospital, Hamburg-Eppendorf, Hamburg, Germany; Clinic for Lung Diseases, Lostau, Germany; Charite, Berlin, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - U. Gatzemeier
- Zentralklinik Bad Berka, Bad Berka, Germany; University of Heidelberg, Heidelberg, Germany; City Hospital Sanct George, Leipzig, Germany; Internal Medicine, Celle, Germany; Hospital Schillerhöhe, Gerlingen, Germany; University Hospital, Hamburg-Eppendorf, Hamburg, Germany; Clinic for Lung Diseases, Lostau, Germany; Charite, Berlin, Germany; Hospital Grosshansdorf, Hamburg, Germany
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Andritzky B, Adler S, Burkholder I, Thöm I, Schuch G, Görn M, Schilling G, Edler L, Bokemeyer C, Laack E. Analysis of 94 patients with advanced biliary tract cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15172 Background: Cholangiocarcinoma or gallbladder cancer are often diagnosed at an advanced stage with limited treatment options. Methods: Between 1994 and 2004, 94 patients (pts) (47 male, 47 female) with advanced biliary tract cancer were treated at the Department of Oncology and Hematology, University Hospital Hamburg-Eppendorf. Clinical and histopathological characteristics, response to chemotherapy, and survival were investigated in a retrospective analysis. Median age was 59 years (range 30–80) and median Karnofsky performance status was 90%. Predominant histologic type was adenocarcinoma (94.7%). Primary tumor sites were extrahepatic bile duct (29.9%), gallbladder (28.7%), intrahepatic bile duct (10.6%), ampulla of Vater (2.1%), not specified (28.7%). Predominant localizations of metastases were liver (73 pts (77.7%)), lymph nodes (49 pts (52.1%)) and the peritoneum (14 pts (14.9%)). 33 pts (35.1%) underwent surgery of the primary tumor at time of diagnosis. Results: 72 of 94 pts (76.6%) received a first-line chemotherapy, all together 10 different chemotherapy regimens were used. The median number of cycles was 2.5 (range 1 - 12). A single agent chemotherapy with gemcitabine was the most often adminstered regimen (23 pts (31.9%)), followed by carboplatin and etoposide plus whole body hyperthermia (12 pts (16.7%)) and 5- fluorouracil and folic acid (10 pts (13.9%)). The overall response rate was 8.3% (95% CI 3.1 - 17.3) (34.7% SD, 47.2% PD, 9.7% not evaluable). Second-line chemotherapy was given in 27 patients, which induced no tumor response, but a stable disease rate of 22.2%. Median time to follow- up was 44.8 months. Survival was calculated for all 94 pts since time of diagnosis. Median overall survival was 12.2 months and median progression-free survival 9.2 months. The median overall survival time for the 72 pts who were treated with chemotherapy was 14.0 months, and for the 22 pts who did not receive chemotherapy 10.7 months (p=0.2). Conclusions: Our analysis showed a poor prognosis for patients with advanced biliary tract cancer. Response rate to chemotherapy was low. Therefore, well tolerated cytotoxic agents should be used and new treatment strategies (including molecular targeted therapy) should be further investigated. No significant financial relationships to disclose.
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Affiliation(s)
- B. Andritzky
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - S. Adler
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - I. Burkholder
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - I. Thöm
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - G. Schuch
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - M. Görn
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - G. Schilling
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - L. Edler
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - C. Bokemeyer
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - E. Laack
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany
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Bartsch G, Eggert K, Loges S, Fiedler W, Laack E, Hautmann R, Gschwend J, Bokemeyer C, Schuch G. Comparison of combination treatment with endostatin, soluble neuropilin-1 and thrombospondin-2 to single inhibitors in antiangiogenic therapy of renal cell carcinoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15648 Background: Combinations of cytotoxic drugs lead to increased activity and minimize resistance compared to single agents in tumor therapy. Similarly, antiangiogenic treatment could be improved by combinations targeting different pathways. We investigated a combination of endogenous inhibitors using endostatin (ES), soluble Neuropilin-1 (sNP-1), and thrombospondin-2 (TSP-2) in a model of renal cell carcinoma. Methods: Porcine aortic endothelial cells have been engineered for stable production of angiogenic inhibitors by lipofection and were encapsulated in sodium alginate microbeads. Proliferation of human umbilical vein endothelial cells or Renca renal carcinoma cells was examined after incubation with different microbeads. Similarly, effects of inhibitors on endothelial cell function were tested in tube formation and in vitro wound assays. Microbeads were implanted into SCID mice with subcutaneously growing tumors derived from Renca cells or in mice developing lung metastases after intravenous injection of tumor cells. Results: Factors released from microbeads inhibited endothelial cell function but had no effect on tumor cell proliferation in vitro. In vivo, subcutaneous tumor growth was inhibited similarly by each angiogenic inhibitor alone. After 30 days mean tumor weight was 1.3 g in controls and 0.17, 0.18, 0.18g in ES, sNP-1, and TSP-2 treated mice, respectively. Tumor weight in mice treated with all three inhibitors was further reduced to 0.03g. Histological analyses confirmed antiangiogenic activity by inhibition of microvessel density in treated tumors. In a metastastic model treatment with angiogenic inhibitors induced a significant reduction in size and number of lung metastases with additive effects when factors were used in combination. Conclusions: We conclude that combination therapy targeting multiple angiogenic pathways has synergistic activity and could help to avoid resistance to single inhibitors in tumor treatment. No significant financial relationships to disclose.
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Affiliation(s)
- G. Bartsch
- University Hospital Ulm, Ulm, Germany; University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - K. Eggert
- University Hospital Ulm, Ulm, Germany; University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - S. Loges
- University Hospital Ulm, Ulm, Germany; University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - W. Fiedler
- University Hospital Ulm, Ulm, Germany; University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - E. Laack
- University Hospital Ulm, Ulm, Germany; University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - R. Hautmann
- University Hospital Ulm, Ulm, Germany; University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - J. Gschwend
- University Hospital Ulm, Ulm, Germany; University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - C. Bokemeyer
- University Hospital Ulm, Ulm, Germany; University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - G. Schuch
- University Hospital Ulm, Ulm, Germany; University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
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Laack E, Schneider C, Gutjahr T, Heinmöller E, Lutz V, Moecks J, Rohr K, Schmidtgen C, Spleiss O, Reck M. Association between different potential predictive markers from TRUST, a trial of erlotinib in non-small cell lung cancer (NSCLC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7651 Background: Recent studies have examined potential predictive markers in NSCLC patients (pts) treated with EGFR tyrosine kinase inhibitors. However, few data are available on inter-relationships between different markers. Clinical and molecular markers were analyzed for patients from TRUST, an open label, non-randomized trial initiated to provide erlotinib access to pts with advanced NSCLC. Methods: 393 German pts (99% Caucasian) with stage IIIb/IV NSCLC were included. Markers/characteristics assessed were: EGFR (282 pts) and phosphorylated MAPK (pMAPK; 109 pts) using immunohistochemistry (IHC; positive status was defined as: ≥10% of tumor cells with any membrane staining for EGFR; and H-score ≥200 for pMAPK), EGFR gene copy number (135 pts) using fluorescence in-situ hybridization (FISH), EGFR mutations (86 pts), KRAS mutations (108 pts), tumor type (281 pts), smoking status (392 pts) and gender (393 pts). Results: EGFR FISH+ pts were likely to also be EGFR IHC+: 92.9% (26/28) of EGFR FISH+ pts were EGFR IHC+, and 92.6% of EGFR IHC- pts were also EGFR FISH- (p<0.1). pMAPK expression status was not related to other markers. 15.7% (17/108) pts had KRAS and 7.0% (6/86) had EGFR mutations; no pts had mutations in both genes, indicating that these mutations might be mutually exclusive. Both KRAS mutations and histology were associated with smoking status. 94.1% (16/17) pts with KRAS mutations and 91.6% (87/95) pts with squamous-cell carcinoma were smokers. In female pts, the occurrence of adenocarcinoma was significantly higher (73.6% vs 55.4% in males; p<0.001), possibly influenced by a lower incidence of smokers in this group (51.3% vs 92.2% in males; p<0.001). Conclusions: The availability of a large number of tumor samples from the TRUST study, and assessment of a broad range of markers allows investigation of relationships between various tumor/patient characteristics. Understanding these complex inter-relationships may shed light on the role of each marker. Specific combinations of markers may prove useful in predicting clinical benefit from erlotinib. As the study is ongoing, additional data will be available and presented. No significant financial relationships to disclose.
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Affiliation(s)
- E. Laack
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - C. Schneider
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - T. Gutjahr
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - E. Heinmöller
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - V. Lutz
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - J. Moecks
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - K. Rohr
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - C. Schmidtgen
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - O. Spleiss
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
| | - M. Reck
- University Hospital Hamburg-Eppendorf, Hamburg, Germany; Zentralklinik Bad Berka, Bad Berka, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Klinikum Kassel, Kassel, Germany; Roche Diagnostics GmbH, Penzberg, Germany; Targos Molecular Pathology, Kassel, Germany; Hospital Grosshansdorf, Hamburg, Germany
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Gorn M, Habermann C, Thom I, Schuch G, Andritzky B, Brandl S, Burkholder I, Hossfeld DK, Bokemeyer C, Laack E. A pilot study of weekly docetaxel and daily trofosfamide as metronomic second-line chemotherapy in the treatment of metastatic non-small cell lung cancer (NSCLC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.18105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18105 Background: An emerging notion for the treatment of advanced solid malignancies in adults is to manage it as a chronic disease and aim to keep tumor burden and associated symptoms at the lowest possible level. One of the most promising strategies to achieve this is to target the tumor vasculature using modified, “metronomic”, dosing schedules. We conducted a pilot study of weekly docetaxel in combination with daily trofosfamide as a metronomic second-line regimen in patients (pts) with metastatic non-small cell lung cancer (NSCLC). Methods: From March 2003 to November 2005, 21 pts with stage IV disease who had one prior chemotherapy were enrolled. Pts received docetaxel 25 mg/m2 on days 1, 8 and 15, every 4 weeks plus trofosfamide 50mg per day. Results: Median age: 60 years; gender: 18 male (85.7%), 3 female (14.3%); median Karnofsky PS: 80%; histologic subtypes: 8 squamous cell carcinomas (38.1%), 7 adenocarcinomas (33.3%), 6 large cell carcinomas (28.6%); previous chemotherapy: platinum-based in 15 pts (71.4%), platinum-free in 6 pts (28.6%). A total of 62 chemotherapy cycles were administered. The median number of cycles per pt was 3 (range 1 - 8). The intent-to-treat overall response rate was 19% (95% CI 5.5 - 41.9) 1 CR (4.8%), 2 PR (14.3%), 9 SD (42.9%), 8 PD (38.1%). The median overall survival from onset of second-line therapy was 6.9 months (95% CI 5.0 - 13.9 months), the median progression-free survival 2.9 months (95% CI 1.58 - 6.28 months), the 1-year survival rate 28.6% (95% CI 14.5 - 56.2%), and the 2-year survival rate 7.1% (95% CI 1.26 - 40.6%). Hematological and non-hematological toxicities were mild. No grade 4 toxicity was observed. Conclusions: To the best of our knowledge, this is the first trial that combines docetaxel and trofosfamide for the treatment of NSCLC. Our results suggest that the concept of metronomic chemotherapy is a valuable addition to the treatment of NSCLC. The combination of docetaxel and trofosfamide is active and well tolerated as second-line therapy in pts with metastatic NSCLC. No significant financial relationships to disclose.
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Affiliation(s)
- M. Gorn
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
| | - C. Habermann
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
| | - I. Thom
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
| | - G. Schuch
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
| | - B. Andritzky
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
| | - S. Brandl
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
| | - I. Burkholder
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
| | - D. K. Hossfeld
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
| | - C. Bokemeyer
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
| | - E. Laack
- University Hospital Eppendorf, Hamburg, Germany; German Cancer Research Center, Heidelberg, Germany; Oncology Center, Hamburg, Germany
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50
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Schuch G, Schäfer E, Eggert K, Loges S, Görn M, Laack E, Bokemeyer C, Fiedler W. The tyrosine kinase src plays a crucial role in leukemic cell proliferation in AML. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.10531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10531 Background: Src-family tyrosine kinases are known to be involved in signal transduction pathways of growth factors and cytokines in hematopoetic cells. While the role of other src family members has been studied widely, only few data exist about c-src in leukemia. The actual study was performed to analyze src mutations in leukemic cells and to determine the role of pp60src in leukemic cell proliferation. Methods: AML cell lines and primary samples were analyzed for expression and activation of src by RT-PCR and Western blot analyses. Mutational analyses were performed by sequencing of C-terminal cDNA from 60 AML samples. The effects of src inhibition were studied by src-specific inhibitors PP1 and PP2 or by siRNA transfection. Effetcs of src inhibition were monitored in proliferation assays and analyzes of signalling through Erk1/2 and apoptosis by annexin V staining and DNA laddering. Results: In all 60 patients analyzed expression of c-src mRNA was detected by RT-PCR. Western blot analyses confirmed strong expression of src on the protein level and revealed a robust activation of the protein as determined by tyrosine phosphorylation. Incubation of leukemic cells with PP1 and PP2 caused significant inhibition of proliferation in a dose dependent manner. Similar results were observed after transfection with specific siRNAs. Src inhibition blocked phosphorylation of pp60src, Erk1/2 and induced apoptosis in leukemic cells. Mutational analyses as performed by SSCP/heteroduplex and bi-directionally sequencing revealed wildtype sequence in cell lines and 60 clinical samples. Conclusions: In summary, pp60src is highly expressed and activated in cell lines and clinical samples of human AML. Moreover, phosphorylation of src is essential for leukemic cell proliferation. Underlying mutations in the coding sequence of c-src causing constitutive activation could be excluded. These data suggest that pp60src plays a crucial role in AML and src inhibition by targeted therapy might offer a useful new approach in the treatment of AML. No significant financial relationships to disclose.
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Affiliation(s)
- G. Schuch
- University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - E. Schäfer
- University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - K. Eggert
- University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - S. Loges
- University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - M. Görn
- University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - E. Laack
- University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - C. Bokemeyer
- University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
| | - W. Fiedler
- University Hospital Medical Center Hamburg-Eppendo, Hamburg, Germany
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