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Powell CA, Modi S, Iwata H, Takahashi S, Smit EF, Siena S, Chang DY, Macpherson E, Qin A, Singh J, Taitt C, Shire N, Camidge DR. Pooled analysis of drug-related interstitial lung disease and/or pneumonitis in nine trastuzumab deruxtecan monotherapy studies. ESMO Open 2022; 7:100554. [PMID: 35963179 PMCID: PMC9434416 DOI: 10.1016/j.esmoop.2022.100554] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/10/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction This pooled analysis of nine phase I and II trastuzumab deruxtecan (T-DXd) monotherapy studies described drug-related interstitial lung disease (ILD)/pneumonitis in patients treated with T-DXd. Methods Patients who received T-DXd across nine studies were included. Investigator-assessed ILD/pneumonitis events were retrospectively reviewed by an independent adjudication committee; events adjudicated as drug-related ILD/pneumonitis are summarized. Results The analysis included 1150 patients (breast cancer, 44.3%; gastric cancer, 25.6%; lung cancer, 17.7%; colorectal cancer, 9.3%; other cancer, 3.0%). Median treatment duration was 5.8 (range, 0.7-56.3) months, with a median of 4 (range, 1-27) prior lines of therapy. The overall incidence of adjudicated drug-related ILD/pneumonitis was 15.4% (grade 5, 2.2%). Most patients with ILD/pneumonitis experienced low-grade events (grade 1 or 2, 77.4%); 87.0% had their first event within 12 months [median, 5.4 (range, <0.1-46.8) months] of their first dose of T-DXd. Based on data review, adjudicated ILD/pneumonitis onset occurred earlier than identified by investigators for 53.2% of events [median difference in onset date, 43 (range, 1-499) days]. Stepwise Cox regression identified several baseline factors potentially associated with increased risk of adjudicated drug-related ILD/pneumonitis: age <65 years, enrollment in Japan, T-DXd dose >6.4 mg/kg, oxygen saturation <95%, moderate/severe renal impairment, presence of lung comorbidities, and time since initial diagnosis >4 years. Conclusions In this pooled analysis of heavily treated patients, the incidence of ILD/pneumonitis was 15.4%, with most being low grade and occurring in the first 12 months of treatment. The benefit–risk of T-DXd treatment is positive; however, some patients may be at increased risk of developing ILD/pneumonitis, and further investigation is needed to confirm ILD/pneumonitis risk factors. Close monitoring and proactive management of ILD/pneumonitis are warranted for all. Interstitial lung disease (ILD)/pneumonitis is a significant adverse event related to trastuzumab deruxtecan (T-DXd). This pooled analysis of nine T-DXd monotherapy studies evaluated ILD/pneumonitis risk in 1150 heavily pretreated patients. Overall incidence of adjudicated T-DXd-related ILD/pneumonitis was 15.4% (grade 1 or 2, 77.4%; grade 5, 2.2%). Within 12 months of their first T-DXd dose, 87.0% of patients had their first event [median, 5.4 (range, <0.1-46.8) months]. Proactive monitoring and prompt diagnosis and management are important to improving ILD/pneumonitis event outcomes.
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Affiliation(s)
- C A Powell
- Catherine and Henry J. Gaisman Division of Pulmonary Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - S Modi
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - H Iwata
- Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - S Takahashi
- Medical Oncology, The Cancer Institute Hospital of JFCR, Koto, Tokyo, Japan
| | - E F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan; Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - D-Y Chang
- National Taiwan University Hospital, Taipei City, Taiwan
| | | | - A Qin
- Daiichi Sankyo Inc., Basking Ridge, USA
| | - J Singh
- Daiichi Sankyo Inc., Basking Ridge, USA
| | - C Taitt
- Daiichi Sankyo Inc., Basking Ridge, USA
| | - N Shire
- AstraZeneca Pharmaceuticals, Gaithersburg, USA
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Nishio M, Ji J, Hotta K, Chiu CH, Lee JS, Azuma K, Kim SW, Wu SY, Dvorkin M, Trukhin D, Havel L, Hochmair M, Özgüroğlu M, Bar J, Chen Y, Goldman J, Byrne N, Laud P, Shire N, Paz-Ares L. Overall survival with first-line durvalumab plus platinum-etoposide in patients with extensive-stage (ES)-SCLC in CASPIAN: Subgroup findings from Asia. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz446.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Golozar A, Collins J, Fraeman K, Nordstrom B, Mcewen R, Shire N, Higgs B. OA07.02 LKB1 Mutations in Metastatic Non-Small Cell Lung Cancer (mNSCLC): Prognostic Value in the Real World. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paz-Ares L, Chen Y, Reinmuth N, Hotta K, Trukhin D, Statsenko G, Hochmair M, Özgüroğlu M, Ji J, Voitko O, Poltoratskiy A, Ponce S, Verderame F, Havel L, Bondarenko I, Kazarnowicz A, Losonczy G, Conev N, Armstrong J, Byrne N, Shire N, Jiang H, Goldman J. PL02.11 Overall Survival with Durvalumab Plus Etoposide-Platinum in First-Line Extensive-Stage SCLC: Results from the CASPIAN Study. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Senan S, Shire N, Mak G, Yao W, Jiang H. ADRIATIC: A phase III trial of durvalumab ± tremelimumab after concurrent chemoradiation for patients with limited stage small cell lung cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz071.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hoyle C, Klein A, Patel K, Shire N, Wang H, Chu B, Ouwens M, Nordstrom B, Horne L, Arkenau HT. Match-adjusted indirect comparison of durvalumab and chemotherapy for locally advanced or metastatic urothelial carcinoma (UC) following failure of platinum-based therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.116] [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
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Cronin-Fenton D, Dalvi T, Hedgeman E, Norgaard M, Petersen L, Hansen H, Fryzek J, Lawrence D, Walker J, Mellemgaard A, Rasmussen T, Shire N, Rigas J, Potter D, Hamilton-Dutoit S, Sorensen H. P2.01-043 PD-L1 Expression, EGFR and KRAS Mutations in First-Line Therapy (1L) for Non-Small Cell Lung Cancer (NSCLC) Patients. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pai S, Cohen E, Lin D, Fountzilas G, Kim E, Mehlhorn H, Baste N, Clayburgh D, Lipworth L, Resteghini C, Shara N, Fujii T, Zhang J, Stokes M, Lawrence D, Khaliq A, Melillo G, Shire N. RetroSpective cohort stUdy of PD-L1 expression in REcurrent and/or MEtastatic squamous cell carcinoma of the head and neck (SUPREME-HN). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stokes M, Wang R, Wildsmith S, Secrier M, Angell H, Barker C, Walker J, Scorer P, Rebelatto M, Shire N. Relationship between PD-L1 expression and survival in head and neck squamous cell carcinoma (HNSCC) patients (pts). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cronin-Fenton D, Dalvi T, Hedgeman E, Norgaard M, Pedersen L, Mortensen K, Midta A, Shire N, Brody R, Fryzek J, Lawrence D, Rigas J, Potter D, Walker J, Mellemgaard A, Rasmussen T, Hamilton-Dutoit S, Sørensen H. An interim assessment of key biomarkers (programmed cell death receptor ligand 1 (PD-L1) expression and epidermal growth factor receptor (EGFR) in third-line therapy non-small cell lung cancer (NSCLC) patients: A Danish cohort study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.26] [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: 11/14/2022] Open
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Lejnine S, Marton MJ, Wang IM, Howell BJ, Webber AL, Maxwell JW, Shire N, Malkov V, Lunceford J, Zeremski M, Sun A, Ruddy M, Talal AH. Gene expression analysis in serial liver fine needle aspirates. J Viral Hepat 2015; 22:64-76. [PMID: 24475909 PMCID: PMC4721927 DOI: 10.1111/jvh.12213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/08/2013] [Indexed: 12/21/2022]
Abstract
No method with low morbidity presently exists for obtaining serial hepatic gene expression measurements in humans. While hepatic fine needle aspiration (FNA) has lower morbidity than core needle biopsy, applicability is limited due to blood contamination, which confounds quantification of gene expression changes. The aim of this study was to validate FNA for assessment of hepatic gene expression. Liver needle biopsies and FNA procedures were simultaneously performed on 17 patients with chronic hepatitis C virus infection with an additional FNA procedure 1 week later. Nine patients had mild/moderate fibrosis and eight advanced fibrosis. Gene expression profiling was performed using Affymetrix microarrays and TaqMan qPCR; pathway analysis was performed using Ingenuity. We developed a novel strategy that applies liver-enriched normalization genes to determine the percentage of liver in the FNA sample, which enables accurate gene expression measurements overcoming biases derived from blood contamination. We obtained almost identical gene expression results (ρ = 0.99, P < 0.0001) comparing needle biopsy and FNA samples for 21 preselected genes. Gene expression results were also validated in dogs. These data suggest that liver FNA is a reliable method for serial hepatic tissue sampling with potential utility for a variety of preclinical and clinical applications.
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Affiliation(s)
- S. Lejnine
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - M. J. Marton
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - I.-M. Wang
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - B. J. Howell
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - A. L. Webber
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - J. W. Maxwell
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - N. Shire
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - V. Malkov
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - J. Lunceford
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - M. Zeremski
- Division of Gastroenterology and Hepatology and Center for the Study of Hepatitis C, Weill Cornell Medical College, New York, NY, USA
| | - A. Sun
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - M. Ruddy
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - A. H. Talal
- Division of Gastroenterology and Hepatology and Center for the Study of Hepatitis C, Weill Cornell Medical College, New York, NY, USA
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Neff GW, Shire N, Ruiz P, O'Brien C, Garcia M, Dela Garza J, Rudich SR, Reddy KR. The Importance of Clinical Parameters When Differentiating Cholestatic Hepatitis C Virus From Allograft Rejection. Transplant Proc 2005; 37:4397-402. [PMID: 16387130 DOI: 10.1016/j.transproceed.2005.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Indexed: 12/16/2022]
Abstract
BACKGROUND The exact cause and appropriate treatment for cholestasis following liver transplantation in recipients with hepatitis C virus recurrence (RHCV) are difficult to determine. Our objective was to determine the diagnostic accuracy of clinical and histological parameters in liver transplant recipients with RHCV and concurrent cholestasis. METHODS A retrospective analysis from June 1996 to May 2003 was performed on adult liver transplant (OLT) recipients with hepatitis C virus. Patients with cholestasis (bilirubin >5 mg/dL, 6 months after OLT) were selected. Demographics, etiology, immune suppression, clinical and histologic outcomes, and virologic features were evaluated. Patients were divided into two groups based on clinical and histological criteria: (1) patients with parameters suggestive of cholestatic HCV; and (2) patients with parameters consistent with acute cellular rejection. RESULTS Thirty-seven patients met study criteria (20 males). The average age was 54 years (range = 14-72), and time from transplant to jaundice was 769 days (range = 48-2981). The groups were comparable regarding HCV viral load, age, gender, time from transplant, and United Network of Organ Sharing status at time of transplant. Retransplantation was performed in two patients in group 1, neither of whom survived, and in three patients in group 2, all of whom survived. Clinical parameters correlated well with diagnosis of cholestasis (r = 0.85, P < .001) whereas histological evaluation did not (r = 0.11, P = .53). Mortality in group 1 was 78% (7 of 9) vs. 50% (13 of 26) in group 2. Median duration of survival following liver transplantation in group 1 was 132 days versus 435 days in group 2. CONCLUSION Clinical diagnosis parameters for RHCV with cholestasis appear more accurate than histology parameters and should be the primary consideration in directing therapy. Despite timely diagnosis, cholestatic RHCV LTx recipients have a poor prognosis.
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Affiliation(s)
- G W Neff
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio 45267-0595, USA.
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Neff GW, delaGarza J, Shire N, Nishida S, O'Brien CB, Safdar K, Madariaga J, Schiff E, Ruiz P. The long-term effects of immune suppression on liver transplant recipients with recurrent hepatitis C viral infection. Transplant Proc 2005; 36:3065-7. [PMID: 15686695 DOI: 10.1016/j.transproceed.2004.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Adequate immune suppression following liver transplantation in recipients with recurrence of hepatitis C virus (HCV) is not standardized. The aim of this study was to evaluate the association between immune suppression protocol and the clinical/histological parameters in HCV transplant recipients with an HCV recurrence. METHODS A retrospective analysis was performed on recipients of liver transplants from June 1998 to October 2003 who experienced HCV recurrence. Only patients with liver biopsies at 3 to 5 years following liver transplantation were included in the analysis. The data set included: patient demographics, immune suppression, antiviral therapies, as well as histology to evaluate ductopenia and chronic rejection. Patients divided into groups of high, medium, and low immune suppression were subdivided by treatment with versus without interferon. A control group with similar demographics suffering from cryptogenic cirrhosis was used for comparison. RESULTS During this period 45 patients had liver biopsies at 3 to 5 years posttransplantation. Their mean age was 56.5 years and mean time from transplant to biopsy was 1543 days. Their average posttransplant survival was 1964 days. There was no difference among the three groups with respect to HCV RNA levels (log(10) IU/mL), age, gender, time from transplant, donor age, and UNOS status. Median HCV RNA levels within the three groups were comparable at various time periods pre- and posttransplant. CONCLUSION The development of chronic allograft damage following transplantation in recipients with recurrent HCV tended to be worse among patients with low levels of immune suppression, suggesting the importance of therapy to maintain allograft function.
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Affiliation(s)
- G W Neff
- University of Cincinnati, School of Medicine, Cincinnati, Ohio, USA
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