1
|
Gabriel L, McVeigh T, Macmahon S, Avila Z, Donovan L, Hunt I, Draper A, Minchom A, Popat S, Davidson M, Bhosle J, Milner Watts C, Hubank M, Yuan L, O'Brien M. Familial rare EGFR-mutant lung cancer syndrome: Review of literature and description of R776H family. Lung Cancer 2024; 191:107543. [PMID: 38569279 DOI: 10.1016/j.lungcan.2024.107543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/22/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Interest in hereditary lung cancer is increasing, in particular germline mutations in the Epidermal Growth Factor Receptor (EGFR) gene. We review the current literature on this topic, discuss risk of developing lung cancer, treatment and screening options and describe a family of 3 sisters with lung cancer and their unaffected mother all with a rare EGFR germline mutation (EGFR p.R776H). METHODS We searched PubMed, Medline, Embase, the Cochrane Library, Google Scholar and scanned reference lists of articles. Search terms included "EGFR germline" and "familial lung cancer" or "EGFR familial lung cancer". We also describe our experience of managing a family with rare germline EGFR mutant lung cancer. RESULTS Although the numbers are small, the described cases in the literature show several similarities. The patients are younger and usually have no or light smoking history. 50% of the patients were treated with a tyrosine kinase inhibitor (TKIs) with OS over six months. CONCLUSION Although rare, germline p.R776H EGFR lung cancer mutations are over-represented in light or never smoking female patients who often also possess an additional somatic EGFR mutation. Treatment with TKIs appears suitable but further research is needed into the appropriate screening regime for unaffected carriers or light/never smokers.
Collapse
Affiliation(s)
- L Gabriel
- Royal Marsden NHS Foundation Trust, London, England, UK.
| | - T McVeigh
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - S Macmahon
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - Z Avila
- St George's NHS Foundation Trust, London, England, UK
| | - L Donovan
- St George's NHS Foundation Trust, London, England, UK
| | - I Hunt
- St George's NHS Foundation Trust, London, England, UK
| | - A Draper
- St George's NHS Foundation Trust, London, England, UK
| | - A Minchom
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - S Popat
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - M Davidson
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - J Bhosle
- Royal Marsden NHS Foundation Trust, London, England, UK
| | | | - M Hubank
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - L Yuan
- Royal Marsden NHS Foundation Trust, London, England, UK
| | - Mer O'Brien
- Royal Marsden NHS Foundation Trust, London, England, UK
| |
Collapse
|
2
|
Wu X, Kumar R, Milner-Watts C, Walder D, Battisti NML, Minchom A, Bhosle J, O'Brien MER. The Predictive Value of the G8 Questionnaire in Older Patients with Lung Cancer or Mesothelioma before Systemic Treatment. Clin Oncol (R Coll Radiol) 2023; 35:e163-e172. [PMID: 36402621 DOI: 10.1016/j.clon.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/16/2022] [Revised: 09/21/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
AIMS The standard evaluation of older lung cancer or mesothelioma patients for systemic anti-cancer treatment, based on performance status, is inaccurate. We used the G8 questionnaire to assess a patient's fitness for chemotherapy and explored the correlations between G8 scores, treatment decisions and clinical outcomes. MATERIALS AND METHODS In total, 201 older patients (≥70 years) with advanced lung cancer or mesothelioma were prospectively assessed by standard clinical methods and a G8 questionnaire. Treatment decisions before and after reviewing the G8 score were documented. Patients were divided into low (<11), intermediate (11-14) and high (>14) G8 score groups. Patients' characteristics, treatment plans and clinical outcomes among each G8 score group were compared. Similar analyses were compared between good (<2) and poor (≥2) performance status. RESULTS 10.1% of patients' treatment plans changed after oncologists reviewed G8 scores. The G8 score correlated inversely with performance status. More patients with low G8 scores (22.5%) were offered the best supportive care compared with 4.5% in intermediate and 1.9% in high G8 score groups. More patients (30.1%) with low G8 scores had treatment changed from chemotherapy to best supportive care on the planned day of their treatment, compared with intermediate (7.5%) and high (6.1%) G8 score groups. High G8 score patients received higher chemotherapy intensity and survived longer than patients with intermediate or low G8 scores. CONCLUSIONS The G8 score with two cut-off values can predict functional status, chemotherapy tolerability and prognosis in older patients with lung cancer or mesothelioma, thus supporting oncologists on treatment decisions for this population.
Collapse
Affiliation(s)
- X Wu
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - R Kumar
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - D Walder
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - A Minchom
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J Bhosle
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - M E R O'Brien
- The Royal Marsden NHS Foundation Trust, Sutton, UK. Mary.O'
| |
Collapse
|
3
|
Zhang S, Cartwright E, Mullings S, Ferro Lopez L, Cunningham D, Chau I, Starling N, Popat S, O'Brien M, Bhosle J, Minchom A, Davidson M, Tokaca N, Lalondrelle S, Pickering L, Furness A, Turajlic S, Larkin J, José R, Young K. 87P Infliximab use in patients with checkpoint inhibitor toxicities: A tertiary centre experience. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
4
|
O'Sullivan H, MacMahon S, Cui W, Milner-Watts C, Tokaca N, Bhosle J, Davidson M, Minchom A, Yousaf N, O'Brien M, Popat S. MA12.09 Frequency and Detectability of Uncommon EGFR Mutations in NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.148] [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: 11/15/2022]
|
5
|
Jabbour SK, Cho BC, Bria E, Kato T, Bhosle J, Gainor JF, Reguart N, Wang L, Morgensztern D, Shentu Y, Kim SJ, Souza F, Reck M. Rationale and Design of the Phase III KEYLYNK-012 Study of Pembrolizumab and Concurrent Chemoradiotherapy Followed by Pembrolizumab With or Without Olaparib for Stage III Non-Small-Cell Lung Cancer. Clin Lung Cancer 2022; 23:e342-e346. [PMID: 35618629 PMCID: PMC10865425 DOI: 10.1016/j.cllc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy is a standard therapy for patients with stage III non-small-cell lung cancer (NSCLC). Durvalumab is an approved treatment option following concurrent chemoradiotherapy in the absence of disease progression. The multicenter, phase III, randomized, placebo- and active-controlled, double-blind KEYLYNK-012 study evaluates whether initiation of immunotherapy with pembrolizumab concurrently with chemoradiotherapy, followed by post-chemoradiotherapy pembrolizumab with or without olaparib improves outcomes for participants with stage III NSCLC. (ClinicalTrials.gov: NCT04380636) METHODS: Eligible participants are aged ≥18 years with previously untreated, pathologically confirmed, stages IIIA-C, squamous or nonsquamous NSCLC not suitable for surgery with curative intent. Participants will be randomized 1:1:1 to platinum-doublet chemotherapy plus radiotherapy with pembrolizumab (Groups A and B) or concurrent chemoradiotherapy alone (Group C) for 3 cycles. In the absence of disease progression, participants will receive pembrolizumab plus olaparib placebo (Group A), pembrolizumab plus olaparib (Group B), or durvalumab monotherapy (Group C). Dual primary endpoints are progression-free survival per RECIST version 1.1 by independent central review and overall survival. RESULTS Enrollment began on July 6, 2020, and is ongoing at approximately 190 sites. CONCLUSION KEYLYNK-012 will provide important information on the efficacy and safety of pembrolizumab combined with concurrent chemoradiotherapy and subsequent pembrolizumab with or without olaparib in participants with unresectable stage III NSCLC.
Collapse
Affiliation(s)
- Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ.
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Emilio Bria
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Justin F Gainor
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | | | - Luhua Wang
- Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital, Shenzhen, China
| | | | | | | | | | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| |
Collapse
|
6
|
Woll P, Gaunt P, Danson S, Steele N, Ahmed S, Mulatero C, Shah R, Bhosle J, Hodgkinson E, Watkins B, Billingham L. Olaparib as maintenance treatment in patients with chemosensitive small cell lung cancer (STOMP): A randomised, double-blind, placebo-controlled phase II trial. Lung Cancer 2022; 171:26-33. [PMID: 35872530 DOI: 10.1016/j.lungcan.2022.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Small cell lung cancer (SCLC) responds well to chemoradiotherapy but frequently relapses. Here, we evaluate activity and safety of the poly (adenosine diphosphate (ADP)-ribose) polymerase (PARP) inhibitor olaparib as maintenance treatment for patients with chemoresponsive SCLC. MATERIALS AND METHODS Eligible patients had complete or partial response to first line chemotherapy or chemoradiotherapy for SCLC. Patients were randomised 2:2:1:1 to olaparib 300 mg twice a day (BD), olaparib 200 mg three times a day (TDS), placebo BD or placebo TDS. The primary outcome was progression-free survival time (PFS). The trial design had 80% power to detect a 3-month difference in median PFS based on a one-sided 5% significance level. Secondary outcome measures included overall survival time (OS), adverse events and quality of life. ISRCTN 73164486, EudraCT 2010-021165-76. RESULTS 220 patients were randomised: 74 placebo, 73 olaparib BD, 73 olaparib TDS. Median PFS (90% confidence interval (CI)) was 2·5 (1·8, 3·7), 3·7 (3·1, 4·6) and 3·6 (2·8, 4·7) months in the placebo, olaparib BD and TDS arms, respectively. There was no significant difference in PFS between olaparib and placebo for either BD (Hazard Ratio (HR) (90%CI) 0·76 (0·57, 1·02), P = 0·125 or TDS 0·86, (0·64, 1·15), P = 0·402. Common adverse events on olaparib were fatigue, nausea, anaemia, vomiting and anorexia. Of 214 patients who discontinued treatment before 24 months, toxicity was the reason cited for 66 (18 placebo, 24 olaparib BD, 24 olaparib TDS). CONCLUSION This trial does not provide sufficient evidence that either the BD or TDS regimen for maintenance olaparib monotherapy improves PFS or OS in an unselected SCLC population to warrant further research. Toxicity for olaparib was similar to other studies.
Collapse
Affiliation(s)
- Penella Woll
- University of Sheffield, Sheffield, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Piers Gaunt
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sarah Danson
- University of Sheffield, Sheffield, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
| | - Nicola Steele
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Samreen Ahmed
- University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Riyaz Shah
- Maidstone Hospital, Maidstone, United Kingdom
| | | | | | - Ben Watkins
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
7
|
Cui W, Milner-Watts C, O'Sullivan H, Lyons H, Minchom A, Bhosle J, Davidson M, Yousaf N, Scott S, Faull I, Kushnir M, Nagy R, O'Brien M, Popat S. Up-front cell-free DNA next generation sequencing improves target identification in UK first line advanced non-small cell lung cancer (NSCLC) patients. Eur J Cancer 2022; 171:44-54. [PMID: 35704974 DOI: 10.1016/j.ejca.2022.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/01/2022] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Genomic sequencing is necessary for first-line advanced non-small cell lung cancer (aNSCLC) treatment decision-making. Tissue next generation sequencing (NGS) is standard but tissue quantity, quality, and time-to-results remains problematic. Here, we compare upfront cell-free-DNA (cfDNA) NGS clinical utility against routine tissue testing in patients with aNSCLC. METHODS cfDNA-NGS was performed in consecutive, newly identified aNSCLC patients between December 2019-October 2021 alongside routine tissue genotyping. Variants were interpreted using AMP/ASCO/CAP guidelines. The primary endpoint was tier-1 variants detected on cfDNA-NGS. cfDNA-NGS results were compared to tissue results. RESULTS Of 311 patients, 282 (91%) had an informative cfDNA-NGS test; 118 (38%) patients had a tier-1 variant identified by cfDNA-NGS. Of 243 patients with paired tissue-cfDNA tests, 122 (50%) tissue tests were informative; 85 (35%) tissue tests identified a tier-1 variant. cfDNA-NGS detected 39 additional tier-1 variants compared to tissue alone, increasing the tier-1 detection rate by 46% (from 85 to 124). The sensitivity of cfDNA-NGS relative to tissue was 75% (25% tissue tier-1 variants were not detected on cfDNA-NGS); 33% of cfDNA tier-1 variants were not identified on tissue tests. Median time from request-to-report was shorter for cfDNA-NGS versus tissue (8 versus 22 days; p < 0.0001). A total of 245 (79%) patients received first-line systemic-therapy: 49 (20%) with cfDNA-NGS results alone. Median time from sampling-to-commencement of first-line treatment was shorter for cfDNA-NGS blood draw versus first tissue biopsy (16 versus 35 days; p < 0.0001). CONCLUSIONS cfDNA-NGS increased the tier-1 variant detection rate with high concordance with tissue, and halves time-to-treatment. 'Plasma-first' upfront cfDNA-NGS use should be considered routinely for aNSCLC.
Collapse
Affiliation(s)
- Wanyuan Cui
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Hazel O'Sullivan
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Hannah Lyons
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anna Minchom
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jaishree Bhosle
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Michael Davidson
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nadia Yousaf
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sophie Scott
- Guardant Health Inc, Redwood City, CA, United States
| | - Iris Faull
- Guardant Health Inc, Redwood City, CA, United States
| | | | - Rebecca Nagy
- Guardant Health Inc, Redwood City, CA, United States
| | - Mary O'Brien
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sanjay Popat
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Thoracic Oncology, Institute of Cancer Research, London, United Kingdom.
| |
Collapse
|
8
|
Hindocha S, Campbell D, Ahmed M, Giorgakoudi K, Sharma B, Yousaf N, Molyneaux P, Hunter B, Kalsi H, Cui W, Davidson M, Bhosle J, Minchom A, Locke I, McDonald F, O'Brien M, Popat S, Lee RW. Immune Checkpoint Inhibitor and Radiotherapy-Related Pneumonitis: An Informatics Approach to Determine Real-World Incidence, Severity, Management, and Resource Implications. Front Med (Lausanne) 2021; 8:764563. [PMID: 34790682 PMCID: PMC8591134 DOI: 10.3389/fmed.2021.764563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/25/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
Pneumonitis is a well-described, potentially life-threatening adverse effect of immune checkpoint inhibitors (ICI) and thoracic radiotherapy. It can require additional investigations, treatment, and interruption of cancer therapy. It is important for clinicians to have an awareness of its incidence and severity, however real-world data are lacking and do not always correlate with findings from clinical trials. Similarly, there is a dearth of information on cost impact of symptomatic pneumonitis. Informatics approaches are increasingly being applied to healthcare data for their ability to identify specific patient cohorts efficiently, at scale. We developed a Structured Query Language (SQL)-based informatics algorithm which we applied to CT report text to identify cases of ICI and radiotherapy pneumonitis between 1/1/2015 and 31/12/2020. Further data on severity, investigations, medical management were also acquired from the electronic health record. We identified 248 cases of pneumonitis attributable to ICI and/or radiotherapy, of which 139 were symptomatic with CTCAE severity grade 2 or more. The grade ≥2 ICI pneumonitis incidence in our cohort is 5.43%, greater than the all-grade 1.3–2.7% incidence reported in the literature. Time to onset of ICI pneumonitis was also longer in our cohort (mean 4.5 months, range 4 days-21 months), compared to the median 2.7 months (range 9 days−19.2 months) described in the literature. The estimated average healthcare cost of symptomatic pneumonitis is £3932.33 per patient. In this study we use an informatics approach to present new real-world data on the incidence, severity, management, and resource burden of ICI and radiotherapy pneumonitis. To our knowledge, this is the first study to look at real-world incidence and healthcare resource utilisation at the per-patient level in a UK cancer hospital. Improved management of pneumonitis may facilitate prompt continuation of cancer therapy, and improved outcomes for this not insubstantial cohort of patients.
Collapse
Affiliation(s)
- Sumeet Hindocha
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom.,Artificial Intelligence (AI) for Healthcare Centre for Doctoral Training, Imperial CollegeLondon, London, United Kingdom.,Early Diagnosis and Detection, The National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Des Campbell
- Performance & Information Department, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Merina Ahmed
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Kyriaki Giorgakoudi
- Early Diagnosis and Detection, The National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom.,School of Health Sciences, City University of London, London, United Kingdom
| | - Bhupinder Sharma
- Radiology Department, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Nadia Yousaf
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Philip Molyneaux
- Fibrosis Research Group, Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Benjamin Hunter
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom.,Early Diagnosis and Detection, The National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Hardeep Kalsi
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Wanyuan Cui
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Michael Davidson
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Jaishree Bhosle
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Anna Minchom
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Imogen Locke
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Fiona McDonald
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Mary O'Brien
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Sanjay Popat
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Richard W Lee
- Lung Unit, The Royal Marsden, National Health Service (NHS) Foundation Trust, London, United Kingdom.,Early Diagnosis and Detection, The National Institute for Health Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom.,Fibrosis Research Group, Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
9
|
Jabbour SK, Cho BC, Bria E, Kato T, Bhosle J, Gainor JF, Reguart N, Wang L, Morgensztern D, Gurary E, Ashraf TB, Lara-Guerra H, Reck M. Phase 3 study of pembrolizumab with concurrent chemoradiation therapy followed by pembrolizumab with or without olaparib versus concurrent chemoradiation therapy followed by durvalumab in unresectable, locally advanced, stage III non-small cell lung cancer: KEYLYNK-012. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps8580] [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
TPS8580 Background: Pembrolizumab, an anti‒PD-1 antibody is standard of care therapy for metastatic non‒small-cell lung cancer (NSCLC) as monotherapy and in combination with chemotherapy. Durvalumab, an anti–PD-L1 antibody, is approved for unresectable, stage III NSCLC without disease progression following concurrent chemoradiation therapy (CCRT). Early trials of pembrolizumab in combination with chemoradiotherapy, either concurrently or as consolidation, showed acceptable tolerability and promising PFS in patients with unresectable stage III NSCLC. Early data suggest the combination of poly(ADP-ribose) polymerase (PARP) plus anti–PD-(L)1 inhibition can enhance treatment effects. KEYLYNK-012 (NCT04380636) is evaluating pembrolizumab plus CCRT followed by pembrolizumab with/without the PARP inhibitor olaparib vs CCRT followed by durvalumab in patients with unresectable, locally advanced, stage III NSCLC. Methods: This global phase 3, randomized, placebo- and active-controlled, double-blind study is enrolling patients aged ≥18 y with previously untreated, pathologically confirmed, stage IIIA–C NSCLC, an ECOG PS of 0 or 1, and a tumor sample available for PD-L1 evaluation. Patients are randomized 1:1:1 to CCRT (platinum-doublet chemotherapy [cisplatin plus pemetrexed or etoposide; or carboplatin plus paclitaxel] plus radiotherapy 60 Gy over 6 wks [cycles 2–3]) with pembrolizumab 200 mg Q3W (groups A and B) or CCRT alone (group C) for 3 cycles. This is followed by pembrolizumab 200 mg Q3W for 17 cycles plus placebo (group A) or olaparib 300 mg BID (group B); or durvalumab 10 mg/kg Q2W for 26 cycles (group C). Randomization is stratified by disease stage (IIIA vs IIIB/IIIC), tumor histology (squamous vs nonsquamous), PD-L1 tumor proportion score (≥50% vs < 50%) and region (East Asia vs North America/Western Europe/UK vs other). PFS (RECIST v1.1 by blinded independent central review [BICR]) and OS are dual primary endpoints. Secondary endpoints include ORR, duration of response, safety and tolerability, and quality-of-life outcomes. Tumor response will be evaluated per RECIST v1.1 by BICR after CCRT and at regular intervals throughout the study until disease progression, new cancer therapy, study withdrawal, or death. AEs will be graded by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.0. Enrollment began July 6, 2020 and is ongoing at 204 sites in 24 countries. Clinical trial information: NCT04380636.
Collapse
Affiliation(s)
- Salma K. Jabbour
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Emilio Bria
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Jaishree Bhosle
- Lung Unit, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Justin F. Gainor
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | | | - Luhua Wang
- Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital, Shenzhen, China
| | | | | | | | | | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| |
Collapse
|
10
|
Joshi K, Muhith A, Obeid M, Milner-Watts C, Yousaf N, Popat S, Davidson M, Bhosle J, O'Brien M, Minchom A. Safety monitoring of two and four-weekly adjuvant durvalumab for patients with stage III NSCLC: implications for the COVID-19 pandemic and beyond. Lung Cancer 2021; 156:147-150. [PMID: 33965281 PMCID: PMC8086258 DOI: 10.1016/j.lungcan.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/17/2021] [Accepted: 04/23/2021] [Indexed: 12/01/2022]
Abstract
Durvalumab is the first approved adjuvant immunotherapy agent for patients with stage III NSCLC treated with concurrent chemoradiotherapy and is associated with improved overall survival. In order to minimise the number of hospital visits for patients receiving durvalumab during the COVID-19 pandemic we implemented 4-weekly (20 mg/kg) durvalumab in place of 2-weekly infusions at The Royal Marsden Hospital. We assessed the potential impact of the safety of a 4-weekly schedule in patients receiving adjuvant durvalumab. We carried out a retrospective study of 40 patients treated with 2-weekly and 4-weekly infusions of durvalumab prior to and during the COVID-19 pandemic. Clinical documentation was analysed from 216 consultations across 40 patients receiving 2-weekly durvalumab and 66 consultations of 14 patients who switched from 2-weekly to 4-weekly durvalumab during the COVID-19 pandemic. In patients receiving 2-weekly durvalumab, the rate of grade 3 and 4 toxicities was 15 % compared to 7% in patients receiving 4-weekly durvalumab. Pre-existing autoimmune disease was considered a risk factor for the development of grade 3 or 4 toxicities. We did not observe any difference in the rate of grade 1 and 2 toxicities between the two groups. Our findings support the use of 4-weekly durvalumab during the COVID-19 pandemic and beyond, obviating the need for 2-weekly face-to-face consultations and blood tests, relevant given the current pandemic and the need to re-structure cancer services to minimise patient hospital visits and exposure to SARS-CoV-2.
Collapse
Affiliation(s)
- Kroopa Joshi
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Abdul Muhith
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Mariam Obeid
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Charlotte Milner-Watts
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Nadia Yousaf
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Sanjay Popat
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Michael Davidson
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Jaishree Bhosle
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Mary O'Brien
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Anna Minchom
- Lung Unit, Department of Medical Oncology, The Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK; The Drug Development Unit, The Royal Marsden Hospital/Institute of Cancer Research, Downs Road, Sutton, SM2 5PT, UK.
| |
Collapse
|
11
|
Manickavasagar T, Yuan W, Carreira S, Gurel B, Miranda S, Ferreira A, Crespo M, Riisnaes R, Baker C, O'Brien M, Bhosle J, Popat S, Banerji U, Lopez J, de Bono J, Minchom A. HER3 expression and MEK activation in non-small-cell lung carcinoma. Lung Cancer Manag 2021; 10:LMT48. [PMID: 34084213 PMCID: PMC8162178 DOI: 10.2217/lmt-2020-0031] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: We explore HER3 expression in lung adenocarcinoma (adeno-NSCLC) and identify potential mechanisms of HER3 expression. Materials & methods: Tumor samples from 45 patients with adeno-NSCLC were analyzed. HER3 and HER2 expression were identified using immunohistochemistry and bioinformatic interrogation of The Cancer Genome Atlas (TCGA). Results: HER3 was highly expressed in 42.2% of cases. ERBB3 copy number did not account for HER3 overexpression. Bioinformatic analysis of TCGA demonstrated that MEK activity score (a surrogate of functional signaling) did not correlate with HER3 ligands. ERBB3 RNA expression levels were significantly correlated with MEK activity after adjusting for EGFR expression. Conclusion: HER3 expression is common and is a potential therapeutic target by virtue of frequent overexpression and functional downstream signaling. HER3 expression is common in adeno-NSCLC and is a potential therapeutic target by virtue of frequent overexpression and functional downstream signaling.
Collapse
Affiliation(s)
| | - Wei Yuan
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Suzanne Carreira
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Bora Gurel
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Susana Miranda
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Ana Ferreira
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Mateus Crespo
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Ruth Riisnaes
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Chloe Baker
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Mary O'Brien
- Lung Unit, Royal Marsden Hospital, Sutton, SM2 5PT, UK
| | | | - Sanjay Popat
- Lung Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Johann de Bono
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK
| | - Anna Minchom
- Drug Development Unit, Royal Marsden Hospital, Downs Road, Sutton, London, SM2 5PT, UK.,Lung Unit, Royal Marsden Hospital, Sutton, SM2 5PT, UK
| |
Collapse
|
12
|
Cui W, Milner-Watts C, Saith S, Bhosle J, Minchom A, Davidson M, Page S, Locke I, Yousaf N, Popat S, O'Brien M. 180P Incidence of brain metastases (BM) in newly diagnosed stage IV NSCLC during COVID-19. J Thorac Oncol 2021. [PMCID: PMC7997776 DOI: 10.1016/s1556-0864(21)02022-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
13
|
Cui W, Milner-Watts C, Lyons H, Yousaf N, Minchom A, Bhosle J, Davidson M, Scott S, Faull I, Nagy R, O'Brien M, Popat S. 163P Circulating tumour (ct) DNA next generation sequencing (NGS) in UK advanced non-small cell lung cancer (aNSCLC) patients (pts). J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)02005-0] [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: 10/21/2022]
|
14
|
Cui W, Yousaf N, Bhosle J, Minchom A, Nicholson AG, Ahmed M, McDonald F, Locke I, Lee R, O'Brien M, Popat S. Real-world outcomes in thoracic cancer patients with severe Acute respiratory syndrome Coronavirus 2 (COVID-19): Single UK institution experience. Cancer Treat Res Commun 2020; 25:100261. [PMID: 33310368 PMCID: PMC7709731 DOI: 10.1016/j.ctarc.2020.100261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/01/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022]
Abstract
The immediate morbidity from COVID-19 is high in UK thoracic cancer patients. Mortality, hospitalisation and treatment interruption rates were high. All patients who died were current or ex-smokers.
Background UK COVID-19 mortality rates are amongst the highest globally. Controversy exists on the vulnerability of thoracic cancer patients. We describe the characteristics and sequelae of patients with thoracic cancer treated at a UK cancer centre infected with COVID-19. Methods Patients undergoing care for thoracic cancer diagnosed with COVID-19 (RT-PCR/radiology/clinically) between March-June 2020 were included. Data were extracted from patient records. Results Thirty-two patients were included: 14 (43%) diagnosed by RT-PCR, 18 (57%) by radiology and/or convincing symptoms. 88% had advanced thoracic malignancies. Eleven of 14 (79%) patients diagnosed by RT-PCR and 12 of 18 (56%) patients diagnosed by radiology/clinically were hospitalised, of which four (29%) and 2 (11%) patients required high-dependency/intensive care respectively. Three (21%) patients diagnosed by RT-PCR and 2 (11%) patients diagnosed by radiology/clinically required non-invasive ventilation; none were intubated. Complications included pneumonia and sepsis (43% and 14% respectively in patients diagnosed by RT-PCR; 17% and 11% respectively in patients diagnosed by radiology/clinically). In patients receiving active cancer treatment, therapy was delayed/ceased in 10/12 (83%) and 7/11 (64%) patients diagnosed by RT-PCR and radiology/clinically respectively. Nine (28%) patients died; all were smokers. Median time from symptom onset to death was 7 days (range 3–37). Conclusions The immediate morbidity from COVID-19 is high in thoracic cancer patients. Hospitalisation and treatment interruption rates were high. Improved risk-stratification models for UK cancer patients are urgently needed to guide safe cancer-care delivery without compromising efficacy.
Collapse
Affiliation(s)
- Wanyuan Cui
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nadia Yousaf
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jaishree Bhosle
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anna Minchom
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Merina Ahmed
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Fiona McDonald
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Imogen Locke
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Richard Lee
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; ICR NIHR Biomedical Research Centre
| | - Mary O'Brien
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sanjay Popat
- Lung Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom; Thoracic Oncology, Institute of Cancer Research, London, United Kingdom.
| |
Collapse
|
15
|
Angelis V, Tippu Z, Joshi K, Reis S, Gronthoud F, Fribbens C, Okines A, Stanway S, Cottier E, McGrath S, Watkins D, Noble J, Bhosle J, Gerlinger M, Hamid I, Soliman H, Nenclares P, Jones R, Harrington K, Gennatas S. Defining the true impact of coronavirus disease 2019 in the at-risk population of patients with cancer. Eur J Cancer 2020; 136:99-106. [PMID: 32659475 PMCID: PMC7340059 DOI: 10.1016/j.ejca.2020.06.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND In light of the coronavirus disease 2019 (COVID-19) pandemic, cancer centres in the United Kingdom and Europe re-organised their services at an unprecedented pace, and many patients with cancer have had their treatments severely disrupted. Patients with cancer were considered at high risk on sparse evidence, and despite a small number of emerging observational studies, the true incidence and impact of COVID-19 in the 'at-risk' population of patients with cancer is yet to be defined. METHODS Epidemiological and clinical data were collected prospectively for patients attending the Royal Marsden Hospital and three network hospitals between March 1st and April 30th 2020 that were confirmed to have Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. Significance of clinical and pathological characteristics was assessed using the Fisher's exact test and Wilcoxon rank sum test, whilst univariate and multivariate logistic regression models were used to further assess risk. The number of patients attending in March/April 2020 for face-to-face attendances was also extracted. FINDINGS During the 2-month study period, 867 of 13,489 (6.4%) patients met the criteria leading to swab testing. Of the total at-risk population, only 113 of 13,489 (0.84%) were swab positive, 101 of 13,489 (0.75%) required hospital admission and 29 of 13,489 (0.21%) died of COVID-19. Of the patients that attended the hospital to receive cytotoxic chemotherapy alone or in combination with other therapy, 59 of 2001 (2.9%) were admitted to the hospital for COVID-19-related issues and 20 of 2001 (1%) died. Of the patients that collected targeted treatments, 16 of 1126 (1.4%) were admitted and 1 of 1126 (0.1%) died. Of the 11 patients that had received radiotherapy, 6 of 1042 (0.6%) required inpatient admission and 2 of 1042 (0.2%) died. INTERPRETATIONS Administration of systemic anticancer therapy appears to be associated with a modest risk of severe COVID-19 infection. Based on this snapshot taken as the first wave of COVID-19 hit our practice, we conclude that continuation of active cancer treatment, even in the palliative setting, is appropriate.
Collapse
Affiliation(s)
| | - Zayd Tippu
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Kroopa Joshi
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - Sara Reis
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Firza Gronthoud
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | | | - Alicia Okines
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK; The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
| | - Susannah Stanway
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK; Croydon University Hospital, 530 London Rd, Thornton Heath CR7 7YE, UK
| | - Emma Cottier
- Croydon University Hospital, 530 London Rd, Thornton Heath CR7 7YE, UK
| | - Sophie McGrath
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - David Watkins
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - Jillian Noble
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK; Croydon University Hospital, 530 London Rd, Thornton Heath CR7 7YE, UK
| | - Jaishree Bhosle
- Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - Marco Gerlinger
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK; Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK
| | - Intan Hamid
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Heba Soliman
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Pablo Nenclares
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK
| | - Robin Jones
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK; The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
| | - Kevin Harrington
- Royal Marsden Hospital NHS Trust, Fulham Road, London, SW3 6JJ, UK; The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
| | | |
Collapse
|
16
|
Cui W, Milner-Watts C, Faull I, Nagy R, Scott S, Minchom A, Bhosle J, Yousaf N, O'Brien M, Popat S. 1352P Circulating tumour (ct) DNA next generation sequencing (NGS) in advanced non-small cell lung cancer (mNSCLC): A UK single institution experience. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1666] [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: 10/23/2022] Open
|
17
|
Page S, Milner-Watts C, Perna M, Janzic U, Vidal N, Kaudeer N, Ahmed M, McDonald F, Locke I, Minchom A, Bhosle J, Welsh L, O'Brien M. Systemic treatment of brain metastases in non-small cell lung cancer. Eur J Cancer 2020; 132:187-198. [PMID: 32380429 DOI: 10.1016/j.ejca.2020.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
Brain metastases (BrMs) are associated with significant morbidity and are found in up to 50% of patients with advanced non-small cell lung cancer (NSCLC). Most of the literature focuses on symptomatic BrMs, with a lack of baseline brain imaging in asymptomatic patients. Unfortunately, much of the data on local treatments with or without systemic treatment is retrospective. Clinical trials of systemic treatments largely exclude patients with BrMs. Chemotherapy is an active treatment for BrM with response rates in the brain similar to other sites of disease. Targeted systemic treatments in patients with driver mutations (EGFR and ALK-MET to date) have impressive central nervous system (CNS) penetrance and response rates. Unfortunately, no prospective data can currently guide the timings or modality of local therapies with systemic treatments in these patients who have a high incidence of CNS disease, but retrospective data suggest that early local therapies may give better intracranial progression-free survival (ICPFS). Recent immunotherapy trials have included patients with BrMs. These patients have largely been pre-treated with local therapies and are asymptomatic. Thus, the current standard is becoming, early local therapies before or in conjunction with immunotherapy agents. The approach seems to be safe. Prospective studies are needed in NSCLC BrMs patients to make sure any benefit from local therapies on the ICPFS and quality of life is not overlooked. Here we report what we think are reasonable conclusions from the available data and make suggestions for future clinical trials in the management of NSCLC BrMs.
Collapse
Affiliation(s)
| | | | - Marco Perna
- Azienda Ospedaliero Universitaria Careggi, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Tokaca N, Gomes F, Lau S, Jackson A, Gradwell M, Gyi M, Reinius M, Valentine E, Winn E, Bhosle J, O’Brien M, Yousaf N, Blackhall F, Gilligan D, Treece S, Yip K, Geldart T, Baluch S, Gulliford T, Muthuramalingam S, Dancey G, Britten A, Brock J, Stokoe J, Jain P, Franks K, Toy E, Newsom-Davis T, Khan O, Greystoke A, Ali C, Leonard P, Summers Y, Popat S. Real-world outcomes with pembrolizumab in patients with treatment-naive advanced/metastatic NSCLC in the UK: multicentre retrospective observational study. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30124-2] [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]
|
19
|
O'Brien MER, Sarker D, Bhosle J, Thillai K, Yap TA, Uttenreuther-Fischer M, Pemberton K, Jin X, Wiebe S, de Bono J, Spicer J. A phase I study to assess afatinib in combination with carboplatin or with carboplatin plus paclitaxel in patients with advanced solid tumors. Cancer Chemother Pharmacol 2018; 82:757-766. [PMID: 30088048 PMCID: PMC6182763 DOI: 10.1007/s00280-018-3661-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/30/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Afatinib, an irreversible ErbB family blocker, has demonstrated preclinical antitumor activity with chemotherapy. METHODS As part of a phase I trial in patients with advanced solid tumors (NCT00809133; 3 + 3 dose-escalation design), we determined the maximum tolerated dose (MTD) of afatinib with carboplatin (A/C) or with carboplatin plus paclitaxel (A/C/P). Starting doses: afatinib 20 mg/day, carboplatin AUC6 (A/C) with paclitaxel 175 mg/m2 (A/C/P) (chemotherapy: Day 1 of 21-day cycles). The primary objective was to determine the MTDs; safety, pharmacokinetics and antitumor activity were also evaluated. RESULTS Thirty-eight patients received A/C (n = 12) or A/C/P (n = 26). No dose-limiting toxicities (DLTs) were reported with A(20 mg)/C(AUC6). One patient experienced DLT in the A(40 mg)/C(AUC6) cohort (grade 3 acneiform rash); A(40 mg)/C(AUC6) was determined as the recommended phase II dose (RP2D) for A/C. Two patients each had DLTs with A(20 mg/day)/C(AUC6)/P(175 mg/m2): fatigue, infection, diarrhea, small intestine hemorrhage, dehydration, renal impairment, neutropenic sepsis (n = 1), mucositis (n = 1); A(40 mg)/C(AUC5)/P(175 mg/m2): febrile neutropenia (n = 1), mucositis, fatigue (n = 1); and A(30 mg)/C(AUC5)/P(175 mg/m2): stomatitis (n = 1), mucositis (n = 1). No DLT was observed with A(20 mg)/C(AUC5)/P(175 mg/m2), determined as the RP2D for A/C/P. The most frequent drug-related adverse events were (A/C; A/C/P): rash (75%; 73%), fatigue (67%; 69%), and diarrhea (58%; 88%). Drug plasma concentrations were similar between cycles, suggesting no drug-drug interactions. Objective response rates in these heavily pretreated patients were A/C, 3/12 (25%); A/C/P, 5/26 (19%). CONCLUSIONS Afatinib 40 mg/day (approved monotherapy dose) with carboplatin AUC6, and afatinib 20 mg/day with carboplatin AUC5 and paclitaxel 175 mg/m2 demonstrated manageable safety and antitumor activity. Afatinib > 20 mg/day in the triple combination was not well tolerated.
Collapse
Affiliation(s)
| | - Debashis Sarker
- King's College London, Guy's Hospital, 3rd Floor Bermondsey Wing, London, UK
| | | | - Kiruthikah Thillai
- King's College London, Guy's Hospital, 3rd Floor Bermondsey Wing, London, UK
| | - Timothy A Yap
- Royal Marsden NHS Foundation Trust, Downs Road, Sutton, UK
| | | | | | - Xidong Jin
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Sabrina Wiebe
- Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Johann de Bono
- Royal Marsden NHS Foundation Trust, Downs Road, Sutton, UK
| | - James Spicer
- King's College London, Guy's Hospital, 3rd Floor Bermondsey Wing, London, UK.
| |
Collapse
|
20
|
Kumar R, Walder D, Pejanaute A, Gunapala R, Bhosle J, Yousef N, Popat S, McDonald F, Locke I, Harrington K, Tree A, Lalondrelle S, Huddart R, O’Brien M, Ahmed M. Phase I dose escalation of pembrolizumab given concurrently with palliative thoracic radiotherapy (RT) for NSCLC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.087] [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: 11/14/2022] Open
|
21
|
Tokaca N, O'Brien M, Bhosle J, Yousaf N, Kumar R, Popat S, Walder D. 149P Real-world outcomes with first-line afatinib in EGFR mutant NSCLC adenocarcinoma: A single centre experience exploring effects of dose-reduction. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30423-4] [Citation(s) in RCA: 2] [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: 11/29/2022]
|
22
|
Kumar R, Joharatnam N, Pealing J, Walder D, Milner-Watts C, Yousaf N, Bhosle J, Popat S, O’Brien M. Lactate dehydrogenase and neutrophil-lymphocyte ratio as clinical predictors of outcome to PD-1/PD-L1 inhibitors in advanced non-small cell lung cancer. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30123-5] [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: 10/18/2022]
|
23
|
Milner-Watts C, Kumar R, Gunapala R, Walder D, Minchom A, Yousef N, Popat S, Bhosle J, O’Brien M. Less frequent monitoring of response in patients with advanced thoracic malignancies receiving palliative chemotherapy, does not adversely impact patient care. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30127-2] [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: 11/28/2022]
|
24
|
Dolly S, Brandão M, Taylor C, Gunapala R, Myerson J, Waddell T, Popat S, Bhosle J, O’Brien M. The impact of the UK Government ‘two week rule’ (TWR) on lung cancer stage and 5-year survival – a decade of experience from the Royal Marsden Hospital (RMH). Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30070-9] [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: 10/18/2022]
|
25
|
Kumar R, Brandao M, Joharatnam N, Pealing J, Walder D, Minchom A, Milner-Watts C, Moorcraft S, Turkes F, Yousaf N, Bhosle J, Popat S, O’Brien M. P2.07-049 Early Clinical Predictors of Progressive Disease or Non-Response to PD-1/PD-L1 Inhibitors in Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1305] [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: 10/18/2022]
|
26
|
Tokaca N, Barth S, O'Brien M, Bhosle J, Fotiadis N, Wotherspoon A, Thompson L, Popat S. Molecular Adequacy of Image-Guided Rebiopsies for Molecular Retesting in Advanced Non-Small Cell Lung Cancer: A Single-Center Experience. J Thorac Oncol 2017; 13:63-72. [PMID: 28989040 DOI: 10.1016/j.jtho.2017.09.1958] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 05/17/2017] [Revised: 09/13/2017] [Accepted: 09/22/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION In the era of biomarker-driven systemic therapy for advanced NSCLC, the role of routine repeated biopsies for decision making outside EGFR-mutant disease remains unproven. We report our center's experience of safety and adequacy for molecular retesting of tumor material obtained from image-guided lung rebiopsies in NSCLC. METHODS We performed a retrospective case note analysis of patients undergoing image-guided lung rebiopsies at a single cancer center between 2011 and 2014. The primary objective was to determine the pathological success rate. Secondary and exploratory objectives were to determine technical success rate, histological concordance, molecular adequacy, genotypes identified, and complication rate. RESULTS In all, 103 patients underwent transthoracic image-guided procedures. A total of 66 rebiopsies in NSCLC were identified and analyzed. The pathological success rate was 87.1%. A high histological discordance rate was observed (12 of 52 evaluable cases [23.1%]). Pretest molecular adequacy as determined by the lung pathologist was 78.8% (52 of 66). Of 52 adequate samples 51 were sent for molecular analysis, with a total of 209 genes analyzed (including EGFR, ALK receptor tyrosine kinase gene [ALK], KRAS, BRAF, dicoidin domain receptor tyrosine kinase 2 gene [DDR2], NRAS, ROS1, and rearranged during transfection proto-oncogene gene [RET]). The rate of postgenotyping molecular adequacy was 87.1% (182 of 209). Overall, 20 new potentially actionable mutations were identified, with 13 of 66 patients (19.7%) starting to receive new targeted treatment as a result. Overall, rebiopsies informed clinical decision making in 63.6% of cases. The rates of complications were 15% for pneumothorax, 3% for pneumothorax requiring chest drain, and 8% for hemoptysis. CONCLUSIONS We have validated the pathological and molecular adequacy rates of rebiopsies and demonstrated clinical utility in routine decision making.
Collapse
Affiliation(s)
- Nadza Tokaca
- Lung Unit, Royal Marsden Hospital, London, United Kingdom
| | - Sarah Barth
- Lung Unit, Royal Marsden Hospital, London, United Kingdom
| | - Mary O'Brien
- Lung Unit, Royal Marsden Hospital, London, United Kingdom
| | | | - Nicos Fotiadis
- Department of Interventional Radiology, Royal Marsden Hospital, London, United Kingdom
| | - Andrew Wotherspoon
- Department of Histopathology, Royal Marsden Hospital, London, United Kingdom
| | - Lisa Thompson
- The Centre of Molecular Pathology, Institute of Cancer Research, Sutton, United Kingdom
| | | |
Collapse
|
27
|
Minchom A, Thavasu P, Ahmad Z, Stewart A, Georgiou A, O’Brien MER, Popat S, Bhosle J, Yap TA, de Bono J, Banerji U. A study of PD-L1 expression in KRAS mutant non-small cell lung cancer cell lines exposed to relevant targeted treatments. PLoS One 2017; 12:e0186106. [PMID: 28982179 PMCID: PMC5628934 DOI: 10.1371/journal.pone.0186106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/25/2017] [Indexed: 12/26/2022] Open
Abstract
We investigated PD-L1 changes in response to MEK and AKT inhibitors in KRAS mutant lung adenocarcinoma (adeno-NSCLC). PD-L1 expression was quantified using immunofluorescence and co-culture with a jurkat cell-line transfected with NFAT-luciferase was used to study if changes in PD-L1 expression in cancer cell lines were functionally relevant. Five KRAS mutant cell lines with high PD-L1 expression (H441, H2291, H23, H2030 and A549) were exposed to GI50 inhibitor concentrations of a MEK inhibitor (trametinib) and an AKT inhibitor (AZD5363) for 3 weeks. Only 3/5 (H23, H2030 and A549) and 2/5 cell lines (H441 and H23) showed functionally significant increases in PD-L1 expression when exposed to trametinib or AZD5363 respectively. PD-L1 overexpression is not consistent and is unlikely to be an early mechanism of resistance to KRAS mutant adeno-NSCLC treated with MEK or AKT inhibitors.
Collapse
Affiliation(s)
- Anna Minchom
- The Lung Unit, Department of Medicine, The Royal Marsden, Sutton, United Kingdom
| | - Parames Thavasu
- The Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Zai Ahmad
- The Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Adam Stewart
- The Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Alexandros Georgiou
- The Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Mary E. R. O’Brien
- The Lung Unit, Department of Medicine, The Royal Marsden, Sutton, United Kingdom
| | - Sanjay Popat
- The Lung Unit, The Royal Marsden, London, United Kingdom
| | - Jaishree Bhosle
- The Lung Unit, Department of Medicine, The Royal Marsden, Sutton, United Kingdom
| | - Timothy A. Yap
- The Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Johann de Bono
- The Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Udai Banerji
- The Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
- * E-mail:
| |
Collapse
|
28
|
Capelan M, Roda D, Geuna E, Rihawi K, Bodla S, Kaye SB, Bhosle J, Banerji U, O'Brien M, de Bono JS, Popat S, Yap TA. Phase I clinical trials in patients with advanced non-small cell lung cancer treated within a Drug Development Unit: What have we learnt? Lung Cancer 2017; 111:6-11. [PMID: 28838399 DOI: 10.1016/j.lungcan.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/25/2017] [Revised: 06/05/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Despite advances in novel drug development for patients with advanced non-small cell lung cancer (NSCLC), there are still only a limited number of approved treatments. We therefore evaluated the clinical outcomes of patients with advanced NSCLC referred to a dedicated phase I clinical trials unit assessed baseline clinical factors associated with successful enrollment onto phase I trials. MATERIAL AND METHODS We conducted a retrospective study involving patients with advanced NSCLC referred to the Drug Development Unit at the RMH between January 2005 and December 2013. RESULTS 257 patients with advanced NSCLC were referred for consideration of phase I trials, of which only 89 (35%) patients successfully commenced phase I trials. The commonest reasons for not entering study included poor ECOG performance status and rapid disease progression. A multivariate analysis identified that ECOG performance status (0-1) and RMH prognostic score (0-1) were associated with successful enrollment onto phase I trials (p<0.001). Single agent therapies included novel agents against the phosphatidylinositol-3 kinase pathway, insulin growth factor-1 receptor and pan-HER family tyrosine kinases. These trial therapies were well tolerated and mainly associated with grade 1-2 adverse events, with a minority experiencing grade 3 toxicities. Nine (10%) patients, 4 with known EGFR or KRAS mutations, achieved RECIST partial responses. Median time to progression was 2.6 months and median overall survival was 8.1 months for patients enrolled. CONCLUSIONS Phase I trial therapies were generally well tolerated with potential antitumor benefit for patients with advanced NSCLC. Early referral to drug development units at time of disease progression should be considered to enhance the odds of patient participation in these studies.
Collapse
Affiliation(s)
- Marta Capelan
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Desamparados Roda
- Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Elena Geuna
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Karim Rihawi
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Shankar Bodla
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Stan B Kaye
- Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | | | - Udai Banerji
- Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Mary O'Brien
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Johann S de Bono
- Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Sanjay Popat
- Royal Marsden NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Timothy A Yap
- Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom.
| |
Collapse
|
29
|
Minchom AR, Thavasu P, Ahmad Z, Stewart A, Georgiou A, O'Brien MER, Popat S, Bhosle J, Yap TA, Bono JD, Banerji U. Abstract 2627: A study of dynamic changes in PD-L1 expression in KRAS mutant adenocarcinoma of the lung exposed to signal transduction inhibitors. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2627] [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: 11/16/2022]
Abstract
Abstract
Aim
MEK and AKT inhibitors inhibit signaling down steam of KRAS and are being evaluated as single agents or in combination with other anticancer drugs for the treatment of KRAS mutant adenocarcinoma of the lung (adeno-NSCLC). We investigated whether increased PD-L1 expression with functional T cell inhibitory consequences were a common mechanism of resistance to these drugs in this setting.
Material and Methods
A panel of 10 KRAS mutant adeno-NSCLC cell lines were studied. Cells were exposed to GI50 concentrations of a MEK (trametinib) and AKT (AZD5363) inhibitor for 6hrs, 24hrs and 3 weeks. PD-L1 expression on cell lines was studied by immunofluorescence. Immunofluorescence at various time points were expressed as a ratio of values in drug treated cells compared to untreated control. Functional consequences of PD-L1 expression were studied using a T cell cancer cell line (Jurkat) transfected with a luciferase reporter where co-culture of cancer cells expressing PD-L1 led to reduction in luminescence. Luminescence at various time points were expressed as ratio of luminescence values of drug treated cells compared to untreated controls.
Results
Following characterization of expression of PD-L1 in 10 KRAS mutant adeno-NSCLC cell lines, 5 cell lines with the highest expression of PD-L1 was chosen for functional assays (H441, H2291, H23, H2030 and A549). When exposed to trametinib for 3 weeks, 3/5 cell lines (H23, H2030 and A549) showed an statistically significant increase in expression of PD-L1 (range 1.1-2.4) however significant reduction of luciferase activity was only observed in H23 and H2030, 0.93 and 0.75, p= 0.018 and p=0.01 respectively. When exposed to AZD5363 for 3 weeks, 3/5 cell lines (H441, H23 and H2030) showed a statistically significant increase in PD-L1 expression (range 1.3-1.9) however significant reduction in luciferase reduction was seen in only H441 and H23, 0.86 and 0.76, p= 0.03 and p= 0.04 respectively.
Conclusion
Chronic exposure of KRAS mutant cell lines to MEK and AKT inhibitors cause minor increases in PD-L1 expression but this does not result in functional inhibition of T cells in all instances. Consequently, a functional increase in PD-L1 expression is unlikely to be a common mechanism of resistance to MEK and AKT inhibitors in KRAS mutant adeno-NSCLC.
1
Citation Format: Anna R. Minchom, Parames Thavasu, Zai Ahmad, Adam Stewart, Alexandros Georgiou, Mary ER O'Brien, Sanjay Popat, Jaishree Bhosle, Timothy A. Yap, Johann de Bono, Udai Banerji. A study of dynamic changes in PD-L1 expression in KRAS mutant adenocarcinoma of the lung exposed to signal transduction inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2627. doi:10.1158/1538-7445.AM2017-2627
Collapse
Affiliation(s)
| | | | - Zai Ahmad
- 1Institute of Cancer Research, Sutton, United Kingdom
| | - Adam Stewart
- 1Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - Sanjay Popat
- 3Royal Marsden Hospital, Chelsea, United Kingdom
| | | | | | | | - Udai Banerji
- 1Institute of Cancer Research, Sutton, United Kingdom
| |
Collapse
|
30
|
Kumar R, Walder D, Bhosle J, Yap T, O'Brien M, Popat S, Thompson L, Macmahon S, Palma J, Gonzalez de Castro D. Diagnostic EGFR testing with ctDNA versus tumour in patients with advanced non-small cell lung cancer (NSCLC): The Royal Marsden experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx091.015] [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: 11/13/2022] Open
|
31
|
Papadatos-Pastos D, Roda D, De Miguel Luken MJ, Petruckevitch A, Jalil A, Capelan M, Michalarea V, Lima J, Diamantis N, Bhosle J, Molife LR, Banerji U, de Bono JS, Popat S, O'Brien MER, Yap TA. Clinical outcomes and prognostic factors of patients with advanced mesothelioma treated in a phase I clinical trials unit. Eur J Cancer 2017; 75:56-62. [PMID: 28214659 DOI: 10.1016/j.ejca.2016.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/03/2016] [Revised: 12/04/2016] [Accepted: 12/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND We have previously reported a prognostic score for patients in phase I trials in the Drug Development Unit, treated at the Royal Marsden Hospital (RPS). The RPS is an objective tool used in patient selection for phase I trials based on albumin, number of disease sites and LDH. Patients with mesothelioma are often selected for phase I trials as the disease remains localised for long periods of time. We have now reviewed the clinical outcomes of patients with relapsed malignant mesothelioma (MM) and propose a specific mesothelioma prognostic score (m-RPS) that can help identify patients who are most likely to benefit from early referral. METHODS Patients who participated in 38 phase I trials between September 2003 and November 2015 were included in the analysis. Efficacy was assessed by response rate, median overall survival (OS) and progression-free survival (PFS). Univariate (UVA) and multivariate analyses (MVA) were carried out to develop the m-RPS. RESULTS A total of 65 patients with advanced MM were included in this retrospective study. The PFS was 2.5 months (95% confidence interval [CI] 2.0-3.1 months) and OS was 8 months (95% CI 5.6-9.8 months). A total of four (6%) patients had RECIST partial responses, whereas 26 (40%) patients had RECIST stable disease >3 months. The m-RPS was developed comprising of three different prognostic factors: a neutrophil: lymphocyte ratio greater than 3, the presence of more than two disease sites (including lymph nodes as a single site of disease) and albumin levels less than 35 from the MVA. Patients each received a score of 1 for the presence of each factor. Patients in group A (m-RPS 0-1; n = 35) had a median OS of 13.4 months (95% CI 8.5-21.6), whereas those in group B (m-RPS 2-3; n = 30) had a median OS of 4.0 months (95% CI 2.9-7.1, P < 0.0001). A total of 56 (86%) patients experienced G1-2 toxicities, whereas reversible G3-4 toxicities were observed in 18 (28%) patients. Only 10 (15%) patients discontinued phase I trials due to toxicity. CONCLUSIONS Phase I clinical trial therapies were well tolerated with early signals of antitumour activity in advanced MM patients. The m-RPS is a useful tool to assess MM patient suitability for phase I trials and should now be prospectively validated.
Collapse
Affiliation(s)
| | - Desam Roda
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | | | - Ann Petruckevitch
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Awais Jalil
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Marta Capelan
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Vasiliki Michalarea
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Joao Lima
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Nikolaos Diamantis
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Jaishree Bhosle
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - L Rhoda Molife
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Johann S de Bono
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Sanjay Popat
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Mary E R O'Brien
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - Timothy A Yap
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom.
| |
Collapse
|
32
|
Walder D, Bhosle J, Ratoff J. 54: How reliable is the chest X-ray to diagnose lung cancer in symptomatic patients? An audit of a single South London NHS Trust. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30104-6] [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: 11/29/2022]
|
33
|
Hellmann M, Antonia S, Ponce S, Ott P, Calvo E, Taylor M, Ready N, Hann C, De Braud F, Eder JP, Jäger D, Ascierto P, Horn L, Amin A, Evans J, Moreno V, Atmaca A, Pillai R, Bhosle J, Bono P, Reguart N, Schneider J, Brossart P, Diamond J, Sharma P, Lassen U, Lin CS, Tschaika M, Selvaggi G, Spigel D. MA09.05 Nivolumab Alone or with Ipilimumab in Recurrent Small Cell Lung Cancer (SCLC): 2-Year Survival and Updated Analyses from the Checkmate 032 Trial. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.446] [Citation(s) in RCA: 17] [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: 12/01/2022]
|
34
|
Minchom A, Punwani R, Filshie J, Bhosle J, Nimako K, Myerson J, Gunapala R, Popat S, O'Brien M. P3.05-006 Anxiolytic Effect of Acupuncture in a Phase II Study of Acupuncture and Morphine for Dyspnea in Lung Cancer and Mesothelioma. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.2168] [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]
|
35
|
Kumar R, Bhosle J, Yap T, Minchom A, Walder D, Ali Z, Ratnayake G, Yousaf N, Popat S, Gunapala R, O'Brien M. PUB129 Optimal Frequency of Tumor Response Evaluation during Palliative Chemotherapy in the Management of Patients with Advanced Thoracic Cancers. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.2100] [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: 11/29/2022]
|
36
|
Tokaca N, Espinasse A, Petruckevitch A, Ellis S, Yousaf N, Bhosle J, O'Brien M, Popat S. 167: A phase I/II trial of combination nab-paclitaxel and nintedanib or nab-paclitaxel and placebo in relapsed NSCLC adenocarcinoma (N3). Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30217-9] [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]
|
37
|
Tokaca N, Crawford M, Greystoke A, Appel W, Lal R, Steele N, Ali C, Bezecny P, Fernando S, Karapanagiotou E, Skailes G, Dorey N, Harrow S, Bhosle J, Khan O, Newsom-Davis T, Spicer J, Toy L, O'Brien M, Gunapala R, Lu S, Popat S. 69: Outcomes with nintedanib and docetaxel in patients with relapsed NSCLC adenocarcinoma treated within the UK Nintedanib Individual Patient Supply programme. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30119-8] [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: 11/28/2022]
|
38
|
Gao F, O'Brien M, Sarker D, Bhosle J, Yap TA, Uttenreuther-Fischer MM, Pemberton K, Goeldner RG, Wiebe S, De Bono JS, Spicer JF. A phase I study of afatinib combined with carboplatin or carboplatin plus paclitaxel in patients (pts) with advanced solid tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fangfei Gao
- Kings College London, Guys Hospital, London, United Kingdom
| | - Mary O'Brien
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom
| | - Debashis Sarker
- King's College London, Guy's Hospital, London, United Kingdom
| | | | | | | | | | | | - Sabrina Wiebe
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Johann S. De Bono
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - James F. Spicer
- King's College London, Guy's Hospital, London, United Kingdom
| |
Collapse
|
39
|
Harris SJ, O'Carrigan B, Lopez JS, Bhosle J, Banerji U, Popat S, De Bono JS, O'Brien ME, Yap TA. Clinical outcomes of advanced small cell lung cancer patients (SCLC pts) on phase I (Ph I) trials in the Drug Development Unit (DDU) at the Royal Marsden Hospital (RMH). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Brent O'Carrigan
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | | | - Udai Banerji
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | - Sanjay Popat
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Johann S. De Bono
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | | |
Collapse
|
40
|
Pender A, Rana S, Garcia-Murillas I, Cutts R, Gonzalez D, O'Brien M, Bhosle J, Turner NC, Popat S, Downward J. Simultaneous EGFR mutation detection and copy number assessment in circulating tumour DNA (ctDNA) to inform molecular methods of therapy resistance and plasma ctDNA content in lung adenocarcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e23027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Sareena Rana
- The Institute of Cancer Research, London, United Kingdom
| | | | - Ros Cutts
- The Institute of Cancer Research, London, United Kingdom
| | - David Gonzalez
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Mary O'Brien
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Sanjay Popat
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | |
Collapse
|
41
|
Puglisi M, Stewart A, Thavasu P, Frow M, Carreira S, Minchom A, Punwani R, Bhosle J, Popat S, Ratoff J, de Bono J, Yap TA, O''Brien M, Banerji U. Characterisation of the Phosphatidylinositol 3-Kinase Pathway in Non-Small Cell Lung Cancer Cells Isolated from Pleural Effusions. Oncology 2016; 90:280-8. [PMID: 27082424 DOI: 10.1159/000444928] [Citation(s) in RCA: 6] [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] [Received: 12/15/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We hypothesised that it was possible to quantify phosphorylation of important nodes in the phosphatidylinositol 3-kinase (PI3K) pathway in cancer cells isolated from pleural effusions of patients with non-small cell lung cancer (NSCLC) and study their correlation to somatic mutations and clinical outcomes. MATERIALS AND METHODS Cells were immunomagnetically separated from samples of pleural effusion in patients with NSCLC. p-AKT, p-S6K and p-GSK3β levels were quantified by ELISA; targeted next-generation sequencing was used to characterise mutations in 26 genes. RESULTS It was possible to quantify phosphoproteins in cells isolated from 38/43 pleural effusions. There was a significant correlation between p-AKT and p-S6K levels [r = 0.85 (95% confidence interval 0.73-0.92), p < 0.0001], but not p-AKT and p-GSK3β levels [r = 0.19 (95% confidence interval -0.16 to 0.5), p = 0.3]. A wide range of mutations was described and p-S6K was higher in samples that harboured at least one mutation compared to those that did not (p = 0.03). On multivariate analysis, p-S6K levels were significantly associated with poor survival (p < 0.01). CONCLUSION Our study has shown a correlation between p-AKT levels and p-S6K, but not GSK3β, suggesting differences in regulation of the distal PI3K pathway by AKT. Higher p-S6K levels were associated with adverse survival, making it a critically important target in NSCLC.
Collapse
|
42
|
Weller A, O'Brien MER, Ahmed M, Popat S, Bhosle J, McDonald F, Yap TA, Du Y, Vlahos I, deSouza NM. Mechanism and non-mechanism based imaging biomarkers for assessing biological response to treatment in non-small cell lung cancer. Eur J Cancer 2016; 59:65-78. [PMID: 27016624 DOI: 10.1016/j.ejca.2016.02.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 12/18/2022]
Abstract
Therapeutic options in locally advanced non-small cell lung cancer (NSCLC) have expanded in the past decade to include a palate of targeted interventions such as high dose targeted thermal ablations, radiotherapy and growing platform of antibody and small molecule therapies and immunotherapies. Although these therapies have varied mechanisms of action, they often induce changes in tumour architecture and microenvironment such that response is not always accompanied by early reduction in tumour mass, and evaluation by criteria other than size is needed to report more effectively on response. Functional imaging techniques, which probe the tumour and its microenvironment through novel positron emission tomography and magnetic resonance imaging techniques, offer more detailed insights into and quantitation of tumour response than is available on anatomical imaging alone. Use of these biomarkers, or other rational combinations as readouts of pathological response in NSCLC have potential to provide more accurate predictors of treatment outcomes. In this article, the robustness of the more commonly available positron emission tomography and magnetic resonance imaging biomarker indices is examined and the evidence for their application in NSCLC is reviewed.
Collapse
Affiliation(s)
- A Weller
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK.
| | - M E R O'Brien
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - M Ahmed
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - S Popat
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - J Bhosle
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - F McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - T A Yap
- Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - Y Du
- Department of Nuclear Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Surrey, SM2 5PT, UK
| | - I Vlahos
- Radiology Department, St George's Hospital NHS Trust, London, SW17 0QT, UK
| | - N M deSouza
- CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK
| |
Collapse
|
43
|
Dumas L, Macklin-Doherty A, Wu X, O'Brien M, Popat S, Yap T, Bhosle J. 72 The Royal Marsden NHS Foundation Trust experience of maintenance pemetrexed following first-line cisplatin/pemetrexed in advanced non-squamous lung cancer. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30089-7] [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: 11/17/2022]
|
44
|
Kordbacheh T, Kumar R, Biondo A, Tan R, Yap T, Popat S, Bhosle J, O'Brien M. 47 Completion of the clinical audit cycle for delivery of molecular testing service for patients with non-small-cell lung cancer referred to the Royal Marsden. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30064-2] [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: 11/27/2022]
|
45
|
Kumar R, Lu SK, Minchom A, Sharp A, Davidson M, Gunapala R, Yap TA, Bhosle J, Popat S, O'Brien MER. A phase 1b trial of the combination of an all-oral regimen of capecitabine and erlotinib in advanced non-small cell lung cancer in Caucasian patients. Cancer Chemother Pharmacol 2015; 77:375-83. [PMID: 26706729 DOI: 10.1007/s00280-015-2950-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 10/07/2015] [Accepted: 12/14/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Erlotinib is active in advanced non-small cell lung cancer (aNSCLC) particularly in patients with EGFR-sensitizing mutations. The thymidylate synthase inhibitors are active in NSCLC, but capecitabine is not well studied. This study explored the safety and activity of this oral combination. METHODS This phase Ib trial used a 3 + 3 escalation design with a combination of erlotinib (100 mg daily) with increasing doses of capecitabine (500, 750 and 1000 mg/m(2) BD, 14/21 days), in first- and second-line aNSCLC of adenocarcinoma histology. The DLT was any drug-induced toxicity ≥grade (G)2 causing dose interruption or dose delay during the first 2 cycles. RESULTS Forty patients were recruited, and 1 patient had an EGFR mutation. Dose escalation stopped at capecitabine 1000 mg/m(2) with expansion to 6 patients due to unpredicted DLTs in 2/6 patients: G2 creatinine rise, G2 anaemia, G3 atrial fibrillation and G3 pneumonia. MTD was capecitabine 750 mg/m(2). First-line dose escalation at the MTD led to unpredicted DLTs in 3/4 patients (G3 troponin rise, G2 rash and G2 hyperbilirubinaemia). MTD expansion in the second-line setting was well tolerated. The most common drug toxicities were gastrointestinal (35 %), followed by skin disorders (28 %). The response rate was 3 % with a disease control rate of 34 %. Median progressive-free survival was 1.6 months (95 % CI 1.4-3.5), and median overall survival was 6.1 months (95 % CI 5.1-10.1). CONCLUSION The MTD for the combination of capecitabine and erlotinib is 750 mg/m(2) BD, 14/21 days, and 100 mg daily, respectively, which is lower than predicted. Capecitabine did not improve the efficacy of erlotinib in aNSCLC unselected for EGFR mutation.
Collapse
Affiliation(s)
- Rajiv Kumar
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - Shir Kiong Lu
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - Anna Minchom
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - Adam Sharp
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - Michael Davidson
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - Ranga Gunapala
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - Timothy A Yap
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - Jaishree Bhosle
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - Sanjay Popat
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - Mary E R O'Brien
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK. Mary.O'
| |
Collapse
|
46
|
Abdelraouf F, Sharp A, Maurya M, Mair D, Wotherspoon A, Leary A, Gonzalez de Castro D, Bhosle J, Nassef A, Gaafar T, Popat S, Yap TA, O'Brien M. Focused molecular analysis of small cell lung cancer: feasibility in routine clinical practice. BMC Res Notes 2015; 8:688. [PMID: 26581482 PMCID: PMC4652351 DOI: 10.1186/s13104-015-1675-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 02/02/2023] Open
Abstract
Background There is an urgent need to identify molecular signatures in small cell lung cancer (SCLC) that may select patients who are likely to respond to molecularly targeted therapies. In this study, we investigate the feasibility of undertaking focused molecular analyses on routine diagnostic biopsies in patients with SCLC. Methods A series of histopathologically confirmed formalin-fixed, paraffin-embedded SCLC specimens were analysed for epidermal growth factor receptors (EGFR), KRAS, NRAS and BRAF mutations, ALK gene rearrangements and MET amplification. EGFR and KRAS mutation testing was evaluated using real time polymerase chain reaction (RT-PCR cobas®), BRAF and NRAS mutations using multiplex PCR and capillary electrophoresis-single strand conformation analysis, and ALK and MET aberrations with fluorescent in situ hybridization. All genetic aberrations detected were validated independently. Results A total of 105 patients diagnosed with SCLC between July 1990 and September 2006 were included. 60 (57 %) patients had suitable tumour tissue for molecular testing. 25 patients were successfully evaluated for all six pre-defined molecular aberrations. Eleven patients failed all molecular analysis. No mutations in EGFR, KRAS and NRAS were detected, and no ALK gene rearrangements or MET gene amplifications were identified. A V600E substitution in BRAF was detected in a Caucasian male smoker diagnosed with SCLC with squamoid and glandular features. Conclusion The paucity of patients with sufficient tumour tissue, quality of DNA extracted and low frequency of aberrations detected indicate that alternative molecular characterisation approaches are necessary, such as the use of circulating plasma DNA in patients with SCLC.
Collapse
Affiliation(s)
- Fatma Abdelraouf
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Adam Sharp
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,The Institute of Cancer Research, London, UK.
| | - Manisha Maurya
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Debbie Mair
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Andrew Wotherspoon
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Alex Leary
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - David Gonzalez de Castro
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Jaishree Bhosle
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Ayatallah Nassef
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Taghrid Gaafar
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Sanjay Popat
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,National Heart and Lung institute, London, UK.
| | - Timothy A Yap
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,The Institute of Cancer Research, London, UK.
| | - Mary O'Brien
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| |
Collapse
|
47
|
Nimako K, Ayite B, Priest K, Severn J, Fries HM, Gunapala R, Bhosle J, Popat S, O'Brien M. A randomised assessment of the use of a quality of life questionnaire with or without intervention in patients attending a thoracic cancer clinic. Eur J Cancer Care (Engl) 2015; 26. [PMID: 26556778 DOI: 10.1111/ecc.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2015] [Indexed: 12/01/2022]
Abstract
The study examined the impact of using a quality of life (QoL) questionnaire during a clinic to identify QoL issues and to improve QoL. 138 patients were randomised (1:1:1) to either (1) an Intervention group that completed the European Organisation for Research and Treatment of Cancer-Core Quality of Life Questionnaire and Lung Cancer Module (EORTC QLQ-C30 and LC13) at baseline and received feedback during a clinic, (2) an Attention group that completed the questionnaire at baseline without feedback and (3) a Control group that did not complete the questionnaire. All patients completed the same questionnaire 6 weeks later and a contact diary during the study period. There was a significant difference between the Intervention and Control groups for the mean number of QoL issues identified at baseline (4.69 vs. 2.81, P = 0.006) and the mean number of actions taken (4.41 vs. 2.46, P = 0.004). At 6 weeks, there was no difference between the groups in global QoL (Intervention vs. Control group, P = 0.596; Attention vs. Control, P = 0.973). The results suggest that the completion of the EORTC QLQ-C30 LC13 with feedback improves communication and increases the number of QoL issues identified and actions taken. However, the intervention does not impact on QoL per se. Clinicaltrials.gov: NCT01213745.
Collapse
Affiliation(s)
- K Nimako
- The Royal Marsden Hospital, NHS Foundation Trust, Sutton, UK.,Surrey and Sussex Healthcare NHS Trust, Surrey, UK
| | - B Ayite
- The Royal Marsden Hospital, NHS Foundation Trust, Sutton, UK
| | - K Priest
- The Royal Marsden Hospital, NHS Foundation Trust, Sutton, UK
| | - J Severn
- The Royal Marsden Hospital, NHS Foundation Trust, Sutton, UK
| | - H M Fries
- The Royal Marsden Hospital, NHS Foundation Trust, Sutton, UK
| | - R Gunapala
- The Royal Marsden Hospital, NHS Foundation Trust, Sutton, UK
| | - J Bhosle
- The Royal Marsden Hospital, NHS Foundation Trust, Sutton, UK
| | - S Popat
- The Royal Marsden Hospital, NHS Foundation Trust, Sutton, UK.,Molecular Genetics and Genomics Group, Imperial College London, London, UK
| | - M O'Brien
- The Royal Marsden Hospital, NHS Foundation Trust, Sutton, UK
| |
Collapse
|
48
|
Pender A, Garcia-Murillas I, Rana S, Cutts RJ, Kelly G, Fenwick K, Kozarewa I, Gonzalez de Castro D, Bhosle J, O’Brien M, Turner NC, Popat S, Downward J. Efficient Genotyping of KRAS Mutant Non-Small Cell Lung Cancer Using a Multiplexed Droplet Digital PCR Approach. PLoS One 2015; 10:e0139074. [PMID: 26413866 PMCID: PMC4586384 DOI: 10.1371/journal.pone.0139074] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/09/2015] [Indexed: 01/09/2023] Open
Abstract
Droplet digital PCR (ddPCR) can be used to detect low frequency mutations in oncogene-driven lung cancer. The range of KRAS point mutations observed in NSCLC necessitates a multiplex approach to efficient mutation detection in circulating DNA. Here we report the design and optimisation of three discriminatory ddPCR multiplex assays investigating nine different KRAS mutations using PrimePCR™ ddPCR™ Mutation Assays and the Bio-Rad QX100 system. Together these mutations account for 95% of the nucleotide changes found in KRAS in human cancer. Multiplex reactions were optimised on genomic DNA extracted from KRAS mutant cell lines and tested on DNA extracted from fixed tumour tissue from a cohort of lung cancer patients without prior knowledge of the specific KRAS genotype. The multiplex ddPCR assays had a limit of detection of better than 1 mutant KRAS molecule in 2,000 wild-type KRAS molecules, which compared favourably with a limit of detection of 1 in 50 for next generation sequencing and 1 in 10 for Sanger sequencing. Multiplex ddPCR assays thus provide a highly efficient methodology to identify KRAS mutations in lung adenocarcinoma.
Collapse
Affiliation(s)
- Alexandra Pender
- Lung Cancer Group, Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
| | - Isaac Garcia-Murillas
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Sareena Rana
- Lung Cancer Group, Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Rosalind J. Cutts
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Gavin Kelly
- The Francis Crick Institute, London, United Kingdom
| | - Kerry Fenwick
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Iwanka Kozarewa
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | | | - Jaishree Bhosle
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mary O’Brien
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nicholas C. Turner
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- The Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Sanjay Popat
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Julian Downward
- Lung Cancer Group, Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
| |
Collapse
|
49
|
Papadatos-Pastos D, Roda D, Luken MDM, Jalil A, Diamantis N, Michalarea V, Lima J, Capelan M, Bodla S, Bhosle J, Molife R, O'Brien M, Banerji U, Popat S, Yap T. 339 Clinical outcome and prognostic factors of patients (pts) with relapsed mesothelioma on phase I trials in the Drug Development Unit (DDU) of the Royal Marsden Hospital (RMH). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30202-7] [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: 10/22/2022]
|
50
|
Abstract
The epidemiology of non-small-cell lung cancer (NSCLC) has changed with a new pattern of disease emerging - a form of adenocarcinoma in mostly younger female patients, who are never or light smokers and more frequently in East Asian populations. Description of EGF receptor (EGFR) mutations has allowed new management strategies to evolve. Oral targeted therapies have broadened the treatment options in the advanced setting with the potential for periods of long term response. The brain is a common site of metastases with EGFR mutated lung cancer typically displaying asymptomatic, small volume, multiple lesions that respond to treatment. We explore the role of local and system therapies for brain metastases in this disease including the role of EGFR inhibitors.
Collapse
|