Three-Year Safety, Tolerability, and Health-Related Quality of Life Outcomes of Adjuvant Osimertinib in Patients With Resected Stage IB to IIIA EGFR-Mutated NSCLC: Updated Analysis From the Phase 3 ADAURA Trial

INTRODUCTION

In ADAURA, adjuvant osimertinib significantly improved disease-free survival versus placebo in resected stage IB to IIIA EGFR-mutated NSCLC. We report in-depth analyses of three-year safety, tolerability, and health-related quality of life (HRQoL) from ADAURA.

METHODS

Patients were randomized 1:1 to osimertinib 80 mg or placebo once daily for up to 3 years. Safety assessments were performed at baseline, week 2, week 4, week 12, and every 12 weeks until treatment completion or discontinuation, and 28 days after treatment was stopped. The SF-36 survey measured HRQoL at baseline, week 12, week 24, and every 24 weeks until recurrence, treatment completion or discontinuation. Data cutoff: April 11, 2022.

RESULTS

Safety and HRQoL analysis sets: osimertinib, n = 337 and n = 339; placebo, n = 343 each. Median (range) total exposure duration was longer with osimertinib versus placebo: 35.8 (0-38) versus 25.1 (0-39) months. Most adverse events (AEs) were first reported within 12 months of starting treatment (osimertinib 97%, placebo 86%). AEs leading to dose reduction, interruption or discontinuation were reported in 12%, 27% and 13% respectively of patients with osimertinib; 1%, 13% and 3% with placebo. Stomatitis and diarrhea were the most common AEs leading to osimertinib dose reduction or interruption; interstitial lung disease was the most common leading to osimertinib discontinuation (per protocol). There were no differences in time to deterioration for SF-36 physical, mental component summaries between osimertinib and placebo.

CONCLUSIONS

No new safety signals were reported and HRQoL was maintained with 3 years of adjuvant osimertinib treatment. Combined with significant efficacy benefit, these data further support adjuvant osimertinib in stage IB to IIIA EGFR-mutated NSCLC.

Adjuvant Osimertinib for Resected EGFR-Mutated Stage IB-IIIA Non-Small-Cell Lung Cancer: Updated Results From the Phase III Randomized ADAURA Trial

PURPOSE

The phase III ADAURA (ClinicalTrials.gov identifier: NCT02511106) primary analysis demonstrated a clinically significant disease-free survival (DFS) benefit with adjuvant osimertinib versus placebo in EGFR-mutated stage IB-IIIA non-small-cell lung cancer (NSCLC) after complete tumor resection (DFS hazard ratio [HR], 0.20 [99.12% CI, 0.14 to 0.30]; P < .001). We report an updated exploratory analysis of final DFS data.

METHODS

Overall, 682 patients with stage IB-IIIA (American Joint Committee on Cancer/Union for International Cancer Control, seventh edition) EGFR-mutated (exon 19 deletion/L858R) NSCLC were randomly assigned 1:1 (stratified by stage, mutational status, and race) to receive osimertinib 80 mg once-daily or placebo for 3 years. The primary end point was DFS by investigator assessment in stage II-IIIA disease analyzed by stratified log-rank test; following early reporting of statistical significance in DFS, no further formal statistical testing was planned. Secondary end points included DFS in stage IB-IIIA, overall survival, and safety. Patterns of recurrence and CNS DFS were prespecified exploratory end points.

RESULTS

At data cutoff (April 11, 2022), in stage II-IIIA disease, median follow-up was 44.2 months (osimertinib) and 19.6 months (placebo); the DFS HR was 0.23 (95% CI, 0.18 to 0.30); 4-year DFS rate was 70% (osimertinib) and 29% (placebo). In the overall population, DFS HR was 0.27 (95% CI, 0.21 to 0.34); 4-year DFS rate was 73% (osimertinib) and 38% (placebo). Fewer patients treated with osimertinib had local/regional and distant recurrence versus placebo. CNS DFS HR in stage II-IIIA was 0.24 (95% CI, 0.14 to 0.42). The long-term safety profile of osimertinib was consistent with the primary analysis.

CONCLUSION

These updated data demonstrate prolonged DFS benefit over placebo, reduced risk of local and distant recurrence, improved CNS DFS, and a consistent safety profile, supporting the efficacy of adjuvant osimertinib in resected EGFR-mutated NSCLC.

Altered expression of CYP17A1 and CYP19A1 in undescended testes of dogs with unilateral cryptorchidism

Cryptorchidism is the most common disorder of sex development in dogs and testosterone plays a crucial role in the inguinal phase of the testes descending into the scrotum. The molecular background of impaired testosterone synthesis in the testes of cryptorchid dogs is poorly elucidated. In this study, we analyzed the expression of four genes involved in testicular steroidogenesis (CYP17A1, CYP19A1, HSD3B2 and HSD17B3) in undescended and contralateral scrotal testes from inguinal unilateral cryptorchid dogs (n = 13) and from the scrotal gonads of normal males (n = 15). We found that transcript level of CYP17A1 was significantly increased in inguinal gonads, while the level of CYP19A1 was decreased. For these two genes, we analyzed the methylation level of single CpG sites in the promoter region localized within putative target sites for testicular transcription factors (NUR77, CREB, CAR and HSF2). A correlation between decreased methylation in the promoter of CYP17A1 and its increased transcript level in undescended gonads was observed, but the change in protein level was not significant. We also resequenced the 5'-flanking region of both genes and two known polymorphic sites, SNP in CYP17A1 and an indel in CYP19A1, were found. However, the distribution of the variants in affected (n = 80) and control (n = 75) dogs was not associated with cryptorchidism. We tentatively conclude that the altered expression of CYP17A1 and CYP19A1 in undescended testes could be caused by their exposure to increased temperature in the body. Furthermore, we showed that the identified polymorphisms cannot be considered markers associated with a predisposition to cryptorchidism.

Disorder of sex development in a cat with chromosome mosaicism 37,X/38,X,r(Y)

An 18-month-old European shorthair cat was subjected to genetic studies due to ambiguous external genitalia (underdeveloped both penis and scrotum). Further anatomic and histopathological studies revealed the presence of abdominal, atrophic testes and uterus. Cytogenetic analysis showed two cell lines, one with X monosomy-37,X [90% of the analysed metaphase spreads], and other line had 38 chromosomes with normal X chromosome and abnormally small Y-derived chromosome-38,X,der(Y) [10%]. Further fluorescence in situ hybridization study with telomeric probe revealed a ring structure of the der(Y). Eight Y chromosome-specific genes, SRY, TETY1, TETY2, CUL4BY, CYORF15, HSFY, FLJ36031Y and ZFY, were detected. We conclude that the described abnormality of the reproductive system, leading to sterility, was caused by a very rare type of chromosomal mosaicism-37,X/38,X,r(Y).

Genetics of Adiposity in Large Animal Models for Human Obesity-Studies on Pigs and Dogs

The role of domestic mammals in the development of human biomedical sciences has been widely documented. Among these model species the pig and dog are of special importance. Both are useful for studies on the etiology of human obesity. Genome sequences of both species are known and advanced genetic tools [eg, microarray SNP for genome wide association studies (GWAS), next generation sequencing (NGS), etc.] are commonly used in such studies. In the domestic pig the accumulation of adipose tissue is an important trait, which influences meat quality and fattening efficiency. Numerous quantitative trait loci (QTLs) for pig fatness traits were identified, while gene polymorphisms associated with these traits were also described. The situation is different in dog population. Generally, excessive accumulation of adipose tissue is considered, similar to humans, as a complex disease. However, research on the genetic background of canine obesity is still in its infancy. Between-breed differences in terms of adipose tissue accumulation are well known in both animal species. In this review we show recent advances of studies on adipose tissue accumulation in pigs and dogs, and their potential importance for studies on human obesity.

Testiculaire aandoening van seksuele differentiatie (78,XX SRY-negatief) bij een vrouwelijke Franse buldog

Een tien maanden oude, vermeend vrouwelijke, intacte Franse buldog werd op de Faculteit Diergeneeskunde te Merelbeke (UGent) aangeboden met een vergrote clitoris en purulente vaginale uitvloei. Als therapie werd voorgesteld om de vergrote clitoris te verwijderen om verdere irritatie te vermijden en tegelijkertijd een gonadectomie uit te voeren aangezien de eigenaars geen fokplannen hadden. Intraoperatief werd een afwijkende genitaaltractus vastgesteld, waarbij macroscopisch een normaal uitziende baarmoeder aanwezig was maar waarbij de gonaden testes leken in plaats van ovaria. Histologisch onderzoek van het verwijderde weefsel toonde aan dat het inderdaad over bilaterale testes aansluitend op een normale baarmoeder ging. Karyotypering en de moleculaire analyse van het SRY-gen resulteerden in een 78,XX SRY-negatief karyotype. Bij de Franse buldog werd bijgevolg finaal een 78,XX SRY-negatief testiculaire aandoening van seksuele differentiatie, i.e. “disorder of sex development” (DSD) gediagnosticeerd.

Sequence analysis of three canine adipokine genes revealed an association between TNF polymorphisms and obesity in Labrador dogs

Obesity is an emerging health problem in purebred dogs. Due to their crucial role in energy homeostasis control, genes encoding adipokines are considered candidate genes, and their variants may be associated with predisposition to obesity. Searching for polymorphism was carried out in three adipokine genes (TNF, RETN and IL6). The study was performed on 260 dogs, including lean (n = 109), overweight (n = 88) and obese (n = 63) dogs. The largest cohort was represented by Labrador Retrievers (n = 136). Altogether, 24 novel polymorphisms were identified: 12 in TNF (including one missense SNP), eight in RETN (including one missense SNP) and four in IL6. Distributions of five common SNPs (two in TNF, two in RETN and one in IL6) were further analyzed with regard to body condition score. Two SNPs in the non-coding parts of TNF (c.-40A>C and c.233+14G>A) were associated with obesity in Labrador dogs. The obtained results showed that the studied adipokine genes are highly polymorphic and two polymorphisms in the TNF gene may be considered as markers predisposing Labrador dogs to obesity.

Polymorphism in 3' untranslated region of the pig PPARA gene influences its transcript level and is associated with adipose tissue accumulation

The PPARA (peroxisome proliferator-activated receptor-α) gene encodes a nuclear receptor that plays an important role in fatty acid catabolism by transcriptional regulation of genes involved in fatty acid oxidation and can be considered as a candidate gene for fatness traits in the pig. The aim of the study was to search for a functional polymorphism in 3' untranslated region (UTR), their association with production traits, and postnatal PPARA transcript level in 2 skeletal muscles (longissimus and semimembranosus) of 5 commercial pig breeds (Polish Landrace [PL], Polish Large White [PLW], Duroc, Pietrain, and Pulawska). Altogether, 9 novel polymorphisms (8 SNP and 1 indel) were found in the 3' UTR. The in silico analysis revealed 6 putative microRNA target sequences in the analyzed region. The c.*636A>G substitution was widely distributed across breeds and located near the putative target sequence for miR-224. The relative PPARA transcript level was higher (P < 0.05) in LM of AA than in those of GG homozygous animals for SNP c.*636A>G. The luciferase assay revealed that miR-224 probably acts as a negative regulator of the PPARA expression in pig adipocytes (P = 2.9 × 10(-7)), but we did not observe the effect of the A or G alleles on the interaction between miR-224 and its putative target sequence. We hypothesize that the 2 predominant haplotypes, differing at 4 sites (including c.*636A>G), present different architecture of its 3' UTR and it could affect the level of the transcript. The c.*636A>G SNP, analyzed in PL and PLW, was significantly associated with backfat thickness at 3 points (P < 0.05) and intramuscular fat content (P < 0.01) in PL. Suggestive associations were found between 4 SNP (c.*321A>C, c.*324G>C, c.*626T>C, and c.*636A>G) and fatty acid contents in LM and subcutaneous and visceral fat tissue of PL, PLW, Duroc and Pietrain pigs. The PPARA mRNA level was higher in semimembranosus muscle than in LM (P = 8.38 × 10(-12)) in a general comparison and the same trend was found in most breeds (except for PL) and at all tested days of age (60, 90, 120, 150, 180, and 210 d). The effect of breed was highly significant in a general comparison (P = 0.48 × 10(-8)), but there was no common expression pattern in both muscles among different age groups. We conclude that the c.*636A>G SNP in the PPARA gene can be considered in PL breed as a useful genetic marker for adipose tissue accumulation.

Effect of three common SNPs in 5'-flanking region of LEP and ADIPOQ genes on their expression in Polish obese children and adolescents

Genes encoding adipokines are considered as candidates for human obesity. In this study we analyzed the expression of leptin (LEP) and adiponectin (ADIPOQ) genes in relation to common 5′-flanking or 5′UTR variants: -2548G>A (LEP), 19A>G (LEP) and -11377C>G (ADIPOQ) in Polish obese children and adolescents. Relative transcription levels in the subcutaneous adipose tissue (real time RT–PCR) and serum protein concentrations (RIA) were measured in 48 obese subjects with known genotypes at three polymorphic sites and in five non-obese controls. None of the studied polymorphisms altered significantly the expression. Significantly elevated relative transcription levels of the LEP gene (P < 0.05) and serum leptin concentrations (P < 0.01) were recorded in obese patients, when compared with the non-obese controls, but such differences were not found for the ADIPOQ gene. Interestingly, the leptin to adiponectin protein concentration ratio (L/A) was approximately sevenfold higher in obese children and adolescents when compared with the non-obese controls (P < 0.001). Taking into consideration the observed relationship between the genotypes and the gene expression level we suggest that these SNPs are not conclusive markers for predisposition to obesity in Polish children and adolescents. On the other hand, we confirmed that the leptin to adiponectin gene expression ratio (L/A) is an informative index characterizing obesity.

The pig CART (cocaine- and amphetamine-regulated transcript) gene and association of its microsatellite polymorphism with production traits

The cocaine- and amphetamine-regulated transcript (CART) gene is a candidate gene that may affect performance and body composition traits in the pig. The purpose of this study was to establish the chromosomal localization and genomic sequence of the porcine CART gene, search for polymorphism and analyse its phenotypic effect in 644 pigs representing two breeds, Polish Large White (PLW) and Polish Landrace (PL), and a synthetic line 990 (L990). The CART gene was fluorescence in situ hybridization (FISH)-mapped to the chromosome 16q21. The 1878 bp DNA fragment covering three exons, two introns and the 5' flanking region was sequenced and analysed. A new A/G single nucleotide polymorphism (SNP) at position -238 bp was found. The coding sequence was conserved between porcine and human CART genes. Previously unknown short tandem repeat polymorphism (CA)(2)(CG)(n)(CA)(n) was identified in intron 2. Three alleles 251, 253 and 259 bp were found. The 251-bp allele was predominant in all the analysed populations of pigs, whereas the 253-bp allele occurred with the lowest frequency. The statistical analysis revealed significant allelic additive effects on meat content in carcass (p < 0.05) and abdominal fat weight (p < 0.01) in PLW, and meat content in carcass (p < 0.05) and backfat thickness (p < 0.05) in PL. Our study confirmed that chromosome region harbouring the CART gene is a promising quantitative trait loci for pig production traits.

Polymorphism of the porcine leptin gene promoter and analysis of its association with gene expression and fatness traits

We describe for the first time a 245 bp fragment of the porcine leptin gene promoter in the proximity of the transcription start site. Altogether, 720 pigs were screened with the PCR-SSCP technique for polymorphism in this region. Four SNPs, segregating as two haplotypes, have been identified, one of them (C113G) in the putative consensus site for the AP-2 transcription factor. This polymorphism was evenly distributed in the Duroc breed (n=21) and was absent in the Polish Landrace (n=248) and Pietrain breed (n=12). In the Polish Large White (n=191) and synthetic line 990 (n=243), allele G occurred with a very low frequency. The investigation was performed to test if the C113G SNP affects leptin mRNA level in subcutaneous fat and leptin protein concentration in serum. Additionally, the effect of this polymorphism on fatness traits was statistically analyzed. Although there was a trend toward decreased expression in GG animals, the differences were not significant between genotypes. We also found no evidence for an association of the LEP promoter genotype with the analyzed fatness traits.

Association of a New SNP in Promoter Region of the PorcineFABP3Gene with Fatness Traits in a Polish Synthetic Line

Associations between FABP3 (alternatively named H-FABP) gene polymorphisms and fatness traits were tested in two pig breeds (Polish Large White and Polish Landrace) and one synthetic line - 990. Three known single nucleotide polymorphisms, detected by HinfI, MspI and HaeIII restriction enzymes, were analyzed. Moreover, three new polymorphisms in the 5' regulatory region were identified: C(-221)T, C(-160)G and T(-158)G, but only the third one was widely distributed and correlated with backfat thickness in line 990. The obtained results suggest that the FABP3 gene is linked with an unknown gene directly affecting backfat thickness, but the analyzed polymorphisms do not influence fatness traits.

An effect of a missense mutation in the porcine melanocortin-4 receptor (MC4R) gene on production traits in Polish pig breeds is doubtful

A missense G-A SNP in the porcine melanocortin-4 receptor (MC4R) gene that causes an Asp-Asn substitution at position 298 of the corresponding MC4R protein is considered to be economically important, although published results on its effect are inconsistent. We analysed the association of this MC4R polymorphism with production traits in 679 gilts from two breeds, Polish Large White (PLW) and Polish Landrace (PL), as well as one synthetic line 990. The frequency of the A allele differed significantly among the breeds with frequencies of 0.76, 0.29 and 0.16 in PLW, PL and line 990 respectively. There was no evidence of an effect of this polymorphism on daily food intake, backfat thickness or abdominal fat. The A allele was correlated with higher test daily gains and lower levels of intramuscular fat in PL, and increased levels of intramuscular fat in PLW.

Effects of hypoxia and elevated carbon dioxide concentration on water flux through Populus roots

Restricted gas exchange between the rhizosphere and aerial environment reduces the concentration of oxygen (O(2)) and elevates the concentration of carbon dioxide (CO(2)) in the root zone, thereby leading to increased resistance to root water uptake. In this study, the effects of hypoxia and 20% CO(2) on water flux (J(v)) through roots of hybrid poplar (Populus trichocarpa Torr. & A. Gray x P. deltoides Bartr. ex Marsh) were measured in detached root systems under pressure in solution culture. Because stomata closed and there was no change in foliar water potential in hypoxic plants, root resistance was measured in detached systems as opposed to using whole plant measurements. However, under aerated conditions root resistance values were similar in intact plants and excised roots. Water fluxes through pressurized root systems treated with nitrogen and low oxygen (< 2% O(2)), elevated CO(2) (20% CO(2)), and low O(2) with elevated CO(2) concentrations were reduced to 40, 51 and 58%, respectively, of J(v) of plants aerated with ambient air. Reductions in J(v) occurred more rapidly in response to elevated CO(2) than to low O(2) concentrations. The effects of low O(2) and elevated CO(2) were not additive. Changes in pH that resulted from elevated CO(2) concentrations did not account for the reduction in J(v). When root systems of intact plants were pretreated for 24 or 48 h with low O(2) concentration, J(v) measured on pressurization was reduced by 33 and 48%, respectively, compared to aerated roots. Stomatal conductance was also reduced, however, so leaf water potential of plants with hypoxic roots were similar to those of aerated controls.

A cholinergic antagonist blocks cold stress-induced alterations in rat adrenal tyrosine hydroxylase mRNA

The role of nicotinic cholinergic transmission in cold stress-induced alterations in rat adrenomedullary tyrosine hydroxylase (TH) mRNA was investigated by RNA dot-blot hybridization, using a cloned TH cDNA probe. Chlorisondamine, a ganglionic blocking agent, greatly attenuated the induction of TH mRNA levels caused by cold exposure, whereas carbachol and nicotine, cholinergic agonists, increased TH mRNA in control animals. These results suggest that cholinergic nicotinic receptors play a key role in the transsynaptic induction of adrenal TH gene expression.

Effect of chronic cold exposure on tyrosine hydroxylase mRNA in rat adrenal gland

The effect of chronic stress on the levels of tyrosine hydroxylase (TH) RNA in rat adrenal gland was investigated by RNA-DNA hybridization using a cloned TH cDNA probe. Results of dot-blot hybridization experiments and northern analysis demonstrate that exposure of animals to cold for 1 week results in a 4-5-fold increase in the relative abundance of TH mRNA. This increase in TH mRNA level may underlie the increase in adrenal TH activity that is known to occur when rats are exposed to such cold stress.

The relationship between catecholamine levels in the hypothalamus and amygdala under influence of glucose overloading in hungry and sated rats

The effect of intragastric glucose infusion (1.5 g per rat) to sated rats on the catecholamine content in the medial basal and lateral hypothalamic regions and in the nuclei of the amygdaloid body was investigated. The effect of glucose overloading on the noradrenaline (NA) and dopamine (DA) content in the ventromedial (VMH) and arcuate hypothalamic nuclei was also studied in rats deprived of food for 48 hr. Glucose administration to rats fed ad lib. resulted in an increase in NA in the VMH and a decrease in DA in the central nucleus of the amygdaloid body. In fasted animals glucose overloading partially reversed the changes of NA concentration in the arcuate nucleus produced by starvation, whereas in the VMH glucose was not effective in producing any changes of catecholamine content. Possible interrelations between the amygdala and hypothalamus in respect to the role of catecholamines in the regulation of food intake are discussed.

Hunger induced changes in the noradrenaline and dopamine contents in various nuclei of the limbic system in rats

Teh effect of 48 hr food deprivation on noradrenaline (NA) and dopamine (DA) content in the dorsomedial, ventromedial and arcuate hypothalamic nuclei, in the anterior and posterior part of medial forebrain bundle, in the medial preoptic region, nucleus of diagonal band (septum), and in the central, medial and basal nuclei of the amygdaloid complex was investigated by radioenzymatic assay. It was found that starvation resulted in decreased NA and DA levels in arcuate and ventromedial nuclei, and increased DA content in the posterior medial forebrain bundle. A statistically insignificant increase of DA in the central amygdaloid nucl. was also observed.

Effects of manganese on substrate oxidation and oxidative phoshorylation in rat liver mitochondria

In vitro Mn2+ decreases respiration at metabolic state III and at the uncoupled state. Pretreatment with Mn2+ decreased also ADP to oxygen ratio in rat liver and brain mitochondria. The mechanism of manganese toxicity involving suppression of substrate oxidation and decrease of oxidative phosphorylation efficiency in brain mitochondria is discussed.