1
|
Furrer K, Weder W, Eboulet EI, Betticher D, Pless M, Stupp R, Krueger T, Perentes JY, Schmid RA, Lardinois D, Furrer M, Früh M, Peters S, Curioni-Fontecedro A, Stahel RA, Rothschild SI, Hayoz S, Opitz I. Extended resection for potentially operable stage III NSCLC patients after neoadjuvant treatment. J Thorac Cardiovasc Surg 2022; 164:1587-1602.e5. [DOI: 10.1016/j.jtcvs.2022.03.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 03/01/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
|
2
|
König D, Schär S, Vuong D, Guckenberger M, Furrer K, Opitz I, Weder W, Rothschild SI, Ochsenbein A, Zippelius A, Addeo A, Mark M, Eboulet EI, Hayoz S, Thierstein S, Betticher DC, Ris HB, Stupp R, Curioni-Fontecedro A, Peters S, Pless M, Früh M. Long-term outcomes of operable stage III NSCLC in the pre-immunotherapy era: results from a pooled analysis of the SAKK 16/96, SAKK 16/00, SAKK 16/01, and SAKK 16/08 trials. ESMO Open 2022; 7:100455. [PMID: 35398718 PMCID: PMC9011017 DOI: 10.1016/j.esmoop.2022.100455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/20/2022] [Accepted: 02/28/2022] [Indexed: 12/25/2022] Open
Abstract
Background Chemoradiotherapy with durvalumab consolidation has yielded excellent results in stage III non-small-cell lung cancer (NSCLC). Therefore, it is essential to identify patients who might benefit from a surgical approach. Material and methods Data from 437 patients with operable stage III NSCLC enrolled in four consecutive Swiss Group for Clinical Cancer Research (SAKK) trials (16/96, 16/00, 16/01, 16/08) were pooled and outcomes were analyzed in 431 eligible patients. All patients were treated with three cycles of induction chemotherapy (cisplatin/docetaxel), followed in some patients by neoadjuvant radiotherapy (44 Gy, 22 fractions) (16/00, 16/01, 16/08) and cetuximab (16/08). Results With a median follow-up time of 9.3 years (range 8.5-10.3 years), 5- and 10-year overall survival (OS) rates were 37% and 25%, respectively. Overall, 342 patients (79%) underwent tumor resection, with a complete resection (R0) rate of 80%. Patients (n = 272, 63%) with R0 had significantly longer OS compared to patients who had surgery but incomplete resection (64.8 versus 19.2 months, P < 0.001). OS for patients who achieved pathological complete remission (pCR) (n = 66, 15%) was significantly better compared to resected patients without pCR (86.5 versus 37.0 months, P = 0.003). For patients with pCR, the 5- and 10-year event-free survival and OS rates were 45.7% [95% confidence interval (CI) 32.8% to 57.7%] and 28.1% (95% CI 15.2% to 42.6%), and 58.2% (95% CI 45.2% to 69.2%) and 45.0% (95% CI 31.5% to 57.6%), respectively. Conclusion We report favorable long-term outcomes in patients with operable stage III NSCLC treated with neoadjuvant chemotherapy with cisplatin and docetaxel ± neoadjuvant sequential radiotherapy from four prospective SAKK trials. Almost two-third of the patients underwent complete resection after neoadjuvant therapy. We confirm R0 resection and pCR as important predictors of outcome. Combined modality treatment in operable stage III NSCLC results in 5- and 10-year survival rates of 37% and 25%. Long-term survival for patients with incomplete resection is poor. Complete resection and pCR are important predictors for outcome.
Collapse
Affiliation(s)
- D König
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland.
| | - S Schär
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D Vuong
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - K Furrer
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - I Opitz
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - W Weder
- Clinics for Thoracic Surgery, Bethanien, Zurich, Switzerland
| | - S I Rothschild
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - A Ochsenbein
- Department of Medical Oncology, University Hospital of Bern (Inselspital), Bern, Switzerland
| | - A Zippelius
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - A Addeo
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - M Mark
- Department of Oncology, Cantonal Hospital of Graubünden, Chur, Switzerland
| | - E I Eboulet
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - S Hayoz
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - S Thierstein
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D C Betticher
- Clinics of Medical Oncology, Cantonal Hospital of Fribourg (HFR), Fribourg, Switzerland
| | - H-B Ris
- Clinics for Thoracic Surgery, Hôpital du Valais, Sion, Switzerland
| | - R Stupp
- Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - A Curioni-Fontecedro
- Department of Medical Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - S Peters
- Department of Medical Oncology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - M Pless
- Department of Medical Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - M Früh
- Department of Medical Oncology/Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
3
|
Denzler S, Vuong D, Bogowicz M, Pavic M, Frauenfelder T, Thierstein S, Eboulet EI, Maurer B, Schniering J, Gabryś HS, Schmitt-Opitz I, Pless M, Foerster R, Guckenberger M, Tanadini-Lang S. Impact of CT convolution kernel on robustness of radiomic features for different lung diseases and tissue types. Br J Radiol 2021; 94:20200947. [PMID: 33544646 DOI: 10.1259/bjr.20200947] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES In this study, we aimed to assess the impact of different CT reconstruction kernels on the stability of radiomic features and the transferability between different diseases and tissue types. Three lung diseases were evaluated, i.e. non-small cell lung cancer (NSCLC), malignant pleural mesothelioma (MPM) and interstitial lung disease related to systemic sclerosis (SSc-ILD) as well as four different tissue types, i.e. primary tumor, largest involved lymph node ipsilateral and contralateral lung. METHODS Pre-treatment non-contrast enhanced CT scans from 23 NSCLC, 10 MPM and 12 SSc-ILD patients were collected retrospectively. For each patient, CT scans were reconstructed using smooth and sharp kernel in filtered back projection. The regions of interest (ROIs) were contoured on the smooth kernel-based CT and transferred to the sharp kernel-based CT. The voxels were resized to the largest voxel dimension of each cohort. In total, 1386 features were analyzed. Feature stability was assessed using the intraclass correlation coefficient. Features above the stability threshold >0.9 were considered stable. RESULTS We observed a strong impact of the reconstruction method on stability of the features (at maximum 26% of the 1386 features were stable). Intensity features were the most stable followed by texture and wavelet features. The wavelet features showed a positive correlation between percentage of stable features and size of the ROI (R2 = 0.79, p = 0.005). Lymph node radiomics showed poorest stability (<10%) and lung radiomics the largest stability (26%). Robustness analysis done on the contralateral lung could to a large extent be transferred to the ipsilateral lung, and the overlap of stable lung features between different lung diseases was more than 50%. However, results of robustness studies cannot be transferred between tissue types, which was investigated in NSCLC and MPM patients; the overlap of stable features for lymph node and lung, as well as for primary tumor and lymph node was very small in both disease types. CONCLUSION The robustness of radiomic features is strongly affected by different reconstruction kernels. The effect is largely influenced by the tissue type and less by the disease type. ADVANCES IN KNOWLEDGE The study presents to our knowledge the most complete analysis on the impact of convolution kernel on the robustness of CT-based radiomics for four relevant tissue types in three different lung diseases. .
Collapse
Affiliation(s)
- Sarah Denzler
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Diem Vuong
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marta Bogowicz
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Matea Pavic
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | | | - Britta Maurer
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Janine Schniering
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Hubert Szymon Gabryś
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Isabelle Schmitt-Opitz
- Department of Thoracic Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Miklos Pless
- Department of Medical Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Robert Foerster
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| |
Collapse
|
4
|
Vuong D, Tanadini-Lang S, Wu Z, Marks R, Unkelbach J, Hillinger S, Eboulet EI, Thierstein S, Peters S, Pless M, Guckenberger M, Bogowicz M. Radiomics Feature Activation Maps as a New Tool for Signature Interpretability. Front Oncol 2020; 10:578895. [PMID: 33364192 PMCID: PMC7753181 DOI: 10.3389/fonc.2020.578895] [Citation(s) in RCA: 8] [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: 07/01/2020] [Accepted: 10/22/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction In the field of personalized medicine, radiomics has shown its potential to support treatment decisions. However, the limited feature interpretability hampers its introduction into the clinics. Here, we propose a new methodology to create radiomics feature activation maps, which allows to identify the spatial-anatomical locations responsible for signature activation based on local radiomics. The feasibility of this technique will be studied for histological subtype differentiation (adenocarcinoma versus squamous cell carcinoma) in non-small cell lung cancer (NSCLC) using computed tomography (CT) radiomics. Materials and Methods Pre-treatment CT scans were collected from a multi-centric Swiss trial (training, n=73, IIIA/N2 NSCLC, SAKK 16/00) and an independent cohort (validation, n=32, IIIA/N2/IIIB NSCLC). Based on the gross tumor volume (GTV), four peritumoral region of interests (ROI) were defined: lung_exterior (expansion into the lung), iso_exterior (expansion into lung and soft tissue), gradient (GTV border region), GTV+Rim (GTV and iso_exterior). For each ROI, 154 radiomic features were extracted using an in-house developed software implementation (Z-Rad, Python v2.7.14). Features robust against delineation variability served as an input for a multivariate logistic regression analysis. Model performance was quantified using the area under the receiver operating characteristic curve (AUC) and verified using five-fold cross validation and internal validation. Local radiomic features were extracted from the GTV+Rim ROI using non-overlapping 3x3x3 voxel patches previously marked as GTV or rim. A binary activation map was created for each patient using the median global feature value from the training. The ratios of activated/non-activated patches of GTV and rim regions were compared between histological subtypes (Wilcoxon test). Results Iso_exterior, gradient, GTV+Rim showed good performances for histological subtype prediction (AUCtraining=0.68-0.72 and AUCvalidation=0.73-0.74) whereas GTV and lung_exterior models failed validation. GTV+Rim model feature activation maps showed that local texture feature distribution differed significantly between histological subtypes in the rim (p=0.0481) but not in the GTV (p=0.461). Conclusion In this exploratory study, radiomics-based prediction of NSCLC histological subtypes was predominantly based on the peritumoral region indicating that radiomics activation maps can be useful for tracing back the spatial location of regions responsible for signature activation.
Collapse
Affiliation(s)
- Diem Vuong
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Ze Wu
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Robert Marks
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jan Unkelbach
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Eric Innocents Eboulet
- Department of Clinical Trial Management, Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Sandra Thierstein
- Department of Clinical Trial Management, Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Miklos Pless
- Department of Medical Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marta Bogowicz
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| |
Collapse
|
5
|
Mark M, Froesch P, Eboulet EI, Addeo A, Pless M, Rothschild SI, Janthur WD, Burmeister H, Friedlaender A, Schneider M, Metaxas Y, Joerger M, Wannesson L, Schwitter M, Baudoux N, Weindler S, Biaggi-Rudolf C, Früh M. SAKK 19/17: safety analysis of first-line durvalumab in patients with PD-L1 positive, advanced nonsmall cell lung cancer and a performance status of 2. Cancer Immunol Immunother 2020; 70:1255-1262. [PMID: 33130956 DOI: 10.1007/s00262-020-02757-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/01/2020] [Accepted: 10/14/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The safety of first-line (1L) durvalumab in patients with advanced nonsmall-cell lung cancer (NSCLC) and an Eastern Cooperative Oncology Group (ECOG) performance status of 2 (PS2) is unknown. This is an interim unplanned safety analysis of the study SAKK 19/17 for patients with metastatic NSCLC with programmed death-ligand 1 (PD-L1) expression in ≥ 25% of tumor cells and an ECOG PS2 treated with 1L durvalumab. This safety analysis was triggered by the SAKK data and safety monitoring board due to a high mortality rate observed after the recruitment of the first 21 patients. METHODS This single-arm phase II study recruited patients with metastatic NSCLC with PD-L1 in ≥ 25% and ECOG PS2. Patients received durvalumab 1500 mg every four weeks. The trial aims to recruit 48 patients in total. This report includes safety analyses only. Adverse events (AEs) were assessed using National Cancer Institute Common Terminology Criteria for AEs (NCI CTCAE) Version 5.0. Efficacy data including the primary endpoint overall survival at 6 months and secondary endpoints (objective response rate, progression-free survival, and quality of life) will be reported at a later time point. RESULTS The data from 21 patients were available at this interim safety analysis. Among these, 13 deaths (13/21; 62%) were reported, including one treatment-related fatal colonic perforation at 9 months after treatment initiation (1/13; 8%). Twelve deaths were not treatment-related (12/13; 92%), and mostly attributed to tumor progression (10/13; 77%). Of note, seven deaths (7/13; 54%) occurred during the first 5 weeks (range 0.6-4.7 weeks) after treatment initiation. Four (4/7; 57%) were respiratory failures attributed to tumor progression. One of these patients (25%) had pre-existing COPD, and three (75%) had baseline dyspnea grade 2-3 related to the tumor. Grade ≥ 3 treatment-related AEs (TRAEs) included colonic perforation (grade 5), abdominal pain, and colitis (grade 3 each) in one patient, and fatigue (grade 3) in another. Other Grade ≥ 3 AEs unrelated to treatment were all of pulmonary origin: lung infections (19%), dyspnea (24%), cough (5%), and bronchial obstruction (5%). CONCLUSIONS 1L durvalumab in patients with ECOG PS2 and metastatic NSCLC with PD-L1 expression ≥ 25% resulted in an unexpectedly high number of fatal early events due to rapid tumor progression. We recommend to avoid treatment with 1 L durvalumab of patients who are highly symptomatic from the tumor, particularly those with respiratory symptoms. The study is continuing its accrual after an amendment excluding these patients.
Collapse
Affiliation(s)
- Michael Mark
- Department of Medical Oncology/Hematology, Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland.
| | - Patrizia Froesch
- Department of Medical Oncology, EOC-Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | | | - Alfredo Addeo
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Miklos Pless
- Department of Medical Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Sacha I Rothschild
- Department of Medical Oncology, Universitätsspital Basel, Basel, Switzerland
| | | | - Henning Burmeister
- Department of Medical Oncology, Spital STS AG Thun/Onko-Netz, Thun, Switzerland
| | - Alex Friedlaender
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Yannis Metaxas
- Department of Medical Oncology/Hematology, Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland
| | - Markus Joerger
- Department of Medical Oncology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Luciano Wannesson
- Department of Medical Oncology, EOC-Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Michael Schwitter
- Department of Medical Oncology/Hematology, Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland
| | - Nathalie Baudoux
- Department of Oncology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Susanne Weindler
- Department of Medical Oncology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | | | - Martin Früh
- Department of Medical Oncology, Kantonsspital St. Gallen, St Gallen, Switzerland.,University of Bern, Bern, Switzerland
| | | |
Collapse
|
6
|
Aeppli S, Eboulet EI, Eisen T, Escudier B, Fischer S, Larkin J, Gruenwald V, McDermott D, Oldenburg J, Omlin A, Porta C, Rini B, Schmidinger M, Sternberg C, Rothermundt C. Impact of COVID-19 pandemic on treatment patterns in metastatic clear cell renal cell carcinoma. ESMO Open 2020; 5:e000852. [PMID: 32669298 PMCID: PMC7368485 DOI: 10.1136/esmoopen-2020-000852] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The coronavirus pandemic has provoked discussions among healthcare providers how to manage cancer patients when faced with the threat of severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) infection. Immune checkpoint inhibitor (ICI) containing regimens are standard of care in the majority of metastatic clear cell renal cell carcinoma (mccRCC) patients. It remains unclear whether therapies should be modified in response to the COVID-19 pandemic. METHODS We performed an online survey among physicians involved in the treatment of mccRCC, and 41 experts responded. Questions focused on criteria relevant for treatment decision outside the pandemic and the modifications of systemic therapy during COVID-19. FINDINGS For the majority of experts (73%), the combination of International metastatic renal cell carcinoma Database Consortium (IMDC) risk category and patient fitness are two important factors for decision-making. The main treatment choice in fit, favourable risk patients outside the pandemic is pembrolizumab/axitinib for 53%, avelumab/axitinib, sunitinib or pazopanib for 13% of experts each. During the pandemic, ICI-containing regimens are chosen less often in favour of a tyrosine kinase inhibitors (TKI) monotherapy, mainly sunitinib or pazopanib (35%).In fit, intermediate/poor-risk patients outside the pandemic, over 80% of experts choose ipilimumab/nivolumab, in contrast to only 41% of physicians during COVID-19, instead more TKI monotherapies are given. In patients responding to established therapies with ICI/ICI or ICI/TKI combinations, most participants modify treatment regimen by extending cycle length, holding one ICI or even both. CONCLUSION mccRCC treatment modifications in light of the coronavirus pandemic are variable, with a shift from ICI/ICI to ICI/TKI or TKI monotherapy.
Collapse
Affiliation(s)
- Stefanie Aeppli
- Medical Oncology and Haematology, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | | | - Tim Eisen
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Bernard Escudier
- Department Medical Oncology, Gustave Roussy, Villejuif, Île-de-France, France
| | - Stefanie Fischer
- Medical Oncology and Haematology, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - James Larkin
- Medical Oncology, Royal Marsden Hospital NHS Trust, London, London, UK
| | - Viktor Gruenwald
- Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, University Hospital Essen, Essen, Germany
| | - David McDermott
- Kidney Cancer Program, Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jan Oldenburg
- Division of Medicine an Laboratory Sciences, Akershus University Hospital, Lorenskog, Norway
| | - Aurelius Omlin
- Medical Oncology and Haematology, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| | - Camillo Porta
- Biomedical Sciences and Human Oncology, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Brian Rini
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Cora Sternberg
- Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Christian Rothermundt
- Medical Oncology and Haematology, Kantonsspital St Gallen, Sankt Gallen, Switzerland
| |
Collapse
|
7
|
Metaxas Y, Früh M, Eboulet EI, Grosso F, Pless M, Zucali PA, Ceresoli GL, Mark M, Schneider M, Maconi A, Perrino M, Biaggi-Rudolf C, Froesch P, Schmid S, Waibel C, Appenzeller C, Rauch D, von Moos R. Lurbinectedin as second- or third-line palliative therapy in malignant pleural mesothelioma: an international, multi-centre, single-arm, phase II trial (SAKK 17/16). Ann Oncol 2020; 31:495-500. [PMID: 32085891 DOI: 10.1016/j.annonc.2019.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Systemic second- and third-line therapies for malignant pleural mesothelioma (MPM) result in a median progression-free survival (mPFS) of <2 months and median overall survival (mOS) of 6-9 months. Lurbinectedin binds to the DNA of the regulatory region while inhibiting tumour-associated macrophage transcription. In early trials, encouraging outcomes occurred in patients (pts) with MPM treated with lurbinectedin. We aimed to generate lurbinectedin efficacy and safety data among pts with progressive MPM. PATIENTS AND METHODS Pts with progressing MPM treated with first-line platinum-pemetrexed chemotherapy with or without immunotherapy received lurbinectedin monotherapy. Treatment was given intravenously at 3.2 mg/m2 dose every 3 weeks until progression or unacceptable toxicity. Using Simon's two-stage design, the primary endpoint, progression-free survival (PFS) at 12 weeks (PFS12wks), was met if achieved by ≥21 pts (p0 ≤35% versus p1 ≥55%). RESULTS Forty-two pts from nine centres across Switzerland and Italy were recruited. Histology was epithelioid in 33 cases, sarcomatoid in 5, and biphasic in 4. Overall 10/42 (23.8%) underwent prior immunotherapy and 14/42 (33.3%) had progressed ≤6 months after first-line chemotherapy. At data cut-off PFS12wks was met by 22/42 pts (52.4%; 90% confidence interval (CI): 38.7% to 63.5%; P = 0.015) with an mPFS of 4.1 months and mOS of 11.1 months. The best response was complete and partial remission observed in one patient each and stable disease in 20 pts. The duration of disease control was 6.6 months (95% CI: 5.2-7.4). No significant difference in PFS12wks, mPFS, and mOS was recorded in epithelioid versus non-epithelioid cases and pts with prior immunotherapy versus those without. Similar mPFS but shorter mOS were observed among pts who progressed within ≤6 months after first-line chemotherapy. Lurbinectedin-related grade 3-4 toxicity was seen in 21 pts, mostly being neutropenia (23.8%) and fatigue (16.7%). CONCLUSIONS The primary efficacy endpoint was reached with acceptable toxicity. Lurbinectedin showed promising activity regardless of histology, prior immunotherapy, or outcome on prior treatment. CLINICALTRIALS. GOV IDENTIFIER NCT03213301.
Collapse
Affiliation(s)
- Y Metaxas
- Department of Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland.
| | - M Früh
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St Gallen, Switzerland; University of Bern, Bern, Switzerland
| | | | - F Grosso
- Mesothelioma Unit - Oncology, SS. Antonio and C. Arrigo Hospital, Alessandria, Italy
| | - M Pless
- Department of Medical Oncology and Haematology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - P A Zucali
- Humanitas Cancer Centre, Humanitas Research Hospital, Rozzano, Italy
| | - G L Ceresoli
- Oncology Unit, Humanitas Clinic Gavazzeni, Bergamo, Italy
| | - M Mark
- Department of Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland
| | | | - A Maconi
- Scientific Research and Development Department, SS Antonio e Biagio e Cesare Arrigo, General Hospital, Alessandria, Italy
| | - M Perrino
- Humanitas Cancer Centre, Humanitas Research Hospital, Rozzano, Italy
| | | | - P Froesch
- Department of Oncology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - S Schmid
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - C Waibel
- Division of Haematology and Oncology, Kantonsspital Baden, Baden, Switzerland
| | - C Appenzeller
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - D Rauch
- Oncology Centre, Hospital STS AG, Thun, Switzerland
| | - R von Moos
- Department of Oncology/Haematology, Kantonsspital Graubünden, Chur, Switzerland
| |
Collapse
|