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Nassar AH, Kim SY, Aredo JV, Feng J, Shepherd F, Xu C, Kaldas D, Gray JE, Dilling TJ, Neal JW, Wakelee HA, Liu Y, Lin SH, Abuali T, Amini A, Nie Y, Patil T, Lobachov A, Bar J, Fitzgerald B, Fujiwara Y, Marron TU, Thummalapalli R, Yu H, Owen DH, Sharp J, Farid S, Rocha P, Arriola E, D'Aiello A, Cheng H, Whitaker R, Parikh K, Ashara Y, Chen L, Sankar K, Harris JP, Nagasaka M, Ayanambakkam A, Velazquez AI, Ragavan M, Lin JJ, Piotrowska Z, Wilgucki M, Reuss J, Luders H, Grohe C, Baena Espinar J, Feiner E, Punekar SR, Gupta S, Leal T, Kwiatkowski DJ, Mak RH, Adib E, Naqash AR, Goldberg SB. Consolidation Osimertinib Versus Durvalumab Versus Observation After Concurrent Chemoradiation in Unresectable EGFR-Mutant NSCLC: A Multicenter Retrospective Cohort Study. J Thorac Oncol 2024:S1556-0864(24)00032-7. [PMID: 38278303 DOI: 10.1016/j.jtho.2024.01.012] [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: 11/05/2023] [Revised: 12/31/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Durvalumab improves survival when used as consolidation therapy after chemoradiation (CRT) in patients with stage III NSCLC. The optimal consolidation therapy for patients with EGFR-mutant (EGFRmut) stage III NSCLC remains unknown. METHODS In this multi-institutional, international retrospective analysis across 24 institutions, we evaluated outcomes in patients with stage III EGFRmut NSCLC treated with concurrent CRT followed by consolidation therapy with osimertinib, durvalumab, or observation between 2015 and 2022. Kaplan-Meier method was used to estimate real-world progression-free survival (rwPFS, primary end point) and overall survival (secondary end point). Treatment-related adverse events (trAEs) during consolidation treatment were defined using Common Terminology Criteria for Adverse Events version 5.0. Multivariable Cox regression analysis was used. RESULTS Of 136 patients with stage III EGFRmut NSCLC treated with definitive concurrent CRT, 56 received consolidation durvalumab, 33 received consolidation osimertinib, and 47 was on observation alone. Baseline characteristics were similar across the three cohorts. With a median follow-up of 46 months for the entire cohort, the median duration of treatment was not reached (NR) for osimertinib (interquartile range: NR-NR) and was 5.5 (interquartile range: 2.4-10.8) months with durvalumab. After adjusting for nodal status, stage III A/B/C, and age, patients treated with consolidation osimertinib had significantly longer 24-month rwPFS compared to those treated with durvalumab or in the observation cohorts (osimertinib: 86%, durvalumab: 30%, observation: 27%, p < 0.001 for both comparisons). There was no difference in rwPFS between the durvalumab and the observation cohorts. No significant difference in overall survival across the three cohorts was detected, likely due to the limited follow-up. Any-grade trAE occurred in 52% (2 [6.1%] grade ≥3) and 48% (10 [18%] grade ≥3) of patients treated with osimertinib and durvalumab, respectively. Of 45 patients who progressed on consolidation durvalumab, 37 (82%) subsequently received EGFR tyrosine kinase inhibitors. Of these, 14 (38%) patients developed trAEs including five patients with pneumonitis (14%; 2 [5.4%] grade ≥3) and five patients with diarrhea (14%; 1 [2.7%] grade ≥3). CONCLUSIONS This study suggests that among patients with stage III unresectable NSCLC with a sensitizing EGFR mutation, consolidation osimertinib was associated with a significantly longer rwPFS compared to durvalumab or observation. No unanticipated safety signals were observed with consolidation osimertinib.
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Affiliation(s)
- Amin H Nassar
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - So Yeon Kim
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Jacqueline V Aredo
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jamie Feng
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Frances Shepherd
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Chao Xu
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - David Kaldas
- Department of Internal Medicine, University of South Florida, Tampa, Florida; Department of Clinical Oncology, Cairo University, Cairo, Egypt
| | - Jhanelle E Gray
- Thoracic Oncology Program, Moffitt Cancer Center, Tampa, Florida
| | - Thomas J Dilling
- Thoracic Oncology Program, Moffitt Cancer Center, Tampa, Florida
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yufei Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tariq Abuali
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Yunan Nie
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Tejas Patil
- Department of Medicine, University of Colorado Cancer Center, Aurora, Colorado
| | - Anastasiya Lobachov
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jair Bar
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bailey Fitzgerald
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yu Fujiwara
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas U Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rohit Thummalapalli
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helena Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Dwight H Owen
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - John Sharp
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Saira Farid
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Pedro Rocha
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Edurne Arriola
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Angelica D'Aiello
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Haiying Cheng
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ryan Whitaker
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Luxi Chen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kamya Sankar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jeremy P Harris
- Department of Radiation Oncology, University of California Irvine Medical Center, Orange, California
| | - Misako Nagasaka
- Division of Hematology and Oncology, Department of Medicine, University of California Irvine Medical Center, Orange, California
| | | | - Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Meera Ragavan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Jessica J Lin
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Zofia Piotrowska
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Molly Wilgucki
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Joshua Reuss
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Heike Luders
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Christian Grohe
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | | | - Ella Feiner
- Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Salman R Punekar
- Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Shruti Gupta
- Department of Hematology and Medical Oncology, Thoracic Medical Oncology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Ticiana Leal
- Department of Hematology and Medical Oncology, Thoracic Medical Oncology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | | | - Raymond H Mak
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elio Adib
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Sarah B Goldberg
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut.
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Deng J, Peng DH, Fenyo D, Yuan H, Lopez A, Levin DS, Meynardie M, Quinteros M, Ranieri M, Sahu S, Lau SCM, Shum E, Velcheti V, Punekar SR, Rekhtman N, Dowling CM, Weerasekara V, Xue Y, Ji H, Siu Y, Jones D, Hata AN, Shimamura T, Poirier JT, Rudin CM, Hattori T, Koide S, Papagiannakopoulos T, Neel BG, Bardeesy N, Wong KK. In vivo metabolomics identifies CD38 as an emergent vulnerability in LKB1 -mutant lung cancer. bioRxiv 2023:2023.04.18.537350. [PMID: 37131623 PMCID: PMC10153147 DOI: 10.1101/2023.04.18.537350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
LKB1/STK11 is a serine/threonine kinase that plays a major role in controlling cell metabolism, resulting in potential therapeutic vulnerabilities in LKB1-mutant cancers. Here, we identify the NAD + degrading ectoenzyme, CD38, as a new target in LKB1-mutant NSCLC. Metabolic profiling of genetically engineered mouse models (GEMMs) revealed that LKB1 mutant lung cancers have a striking increase in ADP-ribose, a breakdown product of the critical redox co-factor, NAD + . Surprisingly, compared with other genetic subsets, murine and human LKB1-mutant NSCLC show marked overexpression of the NAD+-catabolizing ectoenzyme, CD38 on the surface of tumor cells. Loss of LKB1 or inactivation of Salt-Inducible Kinases (SIKs)-key downstream effectors of LKB1- induces CD38 transcription induction via a CREB binding site in the CD38 promoter. Treatment with the FDA-approved anti-CD38 antibody, daratumumab, inhibited growth of LKB1-mutant NSCLC xenografts. Together, these results reveal CD38 as a promising therapeutic target in patients with LKB1 mutant lung cancer. SIGNIFICANCE Loss-of-function mutations in the LKB1 tumor suppressor of lung adenocarcinoma patients and are associated with resistance to current treatments. Our study identified CD38 as a potential therapeutic target that is highly overexpressed in this specific subtype of cancer, associated with a shift in NAD homeostasis.
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Becker DJ, Iyengar AD, Punekar SR, Kaakour D, Griffin M, Nicholson J, Gold HT. Diabetes mellitus and colorectal carcinoma outcomes: a meta-analysis. Int J Colorectal Dis 2020; 35:1989-1999. [PMID: 32564124 DOI: 10.1007/s00384-020-03666-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The impact of diabetes mellitus (DM) on colorectal cancer (CRC) outcomes remains unknown. We studied this by conducting a meta-analysis to evaluate (1) CRC outcomes with and without DM and (2) treatment patterns. METHODS We searched PubMed, EMBASE, Google Scholar, and CINAHL for full-text English studies from 1970 to 12/31/2017. We searched keywords, subject headings, and MESH terms to locate studies of CRC outcomes/treatment and DM. Studies were evaluated by two oncologists. Of 14,332, 48 met inclusion criteria. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, we extracted study location, design, DM definition, covariates, comparison groups, outcomes, and relative risks and/or hazard ratios. We utilized a random-effects model to pool adjusted risk estimates. Primary outcomes were all-cause mortality (ACM), disease-free survival (DFS), relapse-free survival (RFS), and cancer-specific survival (CSS). The secondary outcome was treatment patterns. RESULTS Forty-eight studies were included, 42 in the meta-analysis, and 6 in the descriptive analysis, totaling > 240,000 patients. ACM was 21% worse (OR 1.21, 95% CI 1.15-1.28) and DFS was 75% worse (OR 1.75, 95% CI: 1.33-2.31) in patients with DM. No differences were detected in CSS (OR 1.10, 95% CI 0.98-1.23) or RFS (OR 1.12, 95% CI 0.91-1.38). Descriptive analysis of treatment patterns in CRC and DM suggested potentially less adjuvant therapy use in cases with DM and CRC. CONCLUSIONS Our meta-analysis suggests that patients with CRC and DM have worse ACM and DFS than patients without DM, suggesting that non-cancer causes of death in may account for worse outcomes.
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Affiliation(s)
- Daniel J Becker
- Grossman School of Medicine, New York University, New York, NY, 10016, USA
| | - Arjun D Iyengar
- Grossman School of Medicine, New York University, New York, NY, 10016, USA
| | - Salman R Punekar
- Grossman School of Medicine, New York University, New York, NY, 10016, USA.
| | - Dalia Kaakour
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Megan Griffin
- Grossman School of Medicine, New York University, New York, NY, 10016, USA
| | - Joseph Nicholson
- Grossman School of Medicine, New York University, New York, NY, 10016, USA
| | - Heather T Gold
- Grossman School of Medicine, New York University, New York, NY, 10016, USA
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Becker DJ, Iyengar AD, Punekar SR, Ng J, Zaman A, Loeb S, Becker KD, Makarov D. Treatment of Metastatic Castration-resistant Prostate Cancer With Abiraterone and Enzalutamide Despite PSA Progression. Anticancer Res 2019; 39:2467-2473. [PMID: 31092441 DOI: 10.21873/anticanres.13366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM National guidelines offer little guidance on the use of PSA progression (PSA increase as defined below) as a clinical endpoint in metastatic castration-resistant prostate cancer (mCRPC). The aim of the study was to examine treatment patterns/outcomes with abiraterone (abi)/enzalutamide (enza) throughout PSA progression and near the end of life (EOL). PATIENTS AND METHODS Cases of mCRPC treated with abi or enza from the New York Veterans Affairs (VA) from 6/2011-8/2017 were reviewed. Regression analyses were conducted to identify factors associated with continuation of abi/enza treatment up to the EOL, and survival. RESULTS Of 184 patients, 72 received abi alone, 28 received enza alone, and 84 received both. Treatment was changed for PSA progression alone in 39.1% (abi) and 25.7% (enza) of patients. A total of 37 patients (20%) received abi/enza within 1 month before death, 30% of whom were receiving hospice services. Older patients and black patients were less likely to receive abi/enza up to the EOL. CONCLUSION Abi/enza are frequently discontinued for PSA progression alone and continued at EOL. The clinical benefit of these practices warrants additional study.
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Affiliation(s)
| | | | | | - Jason Ng
- New York University School of Medicine, New York, NY, U.S.A
| | - Anika Zaman
- New York University School of Medicine, New York, NY, U.S.A
| | - Stacy Loeb
- New York University School of Medicine, New York, NY, U.S.A
| | | | - Danil Makarov
- New York University School of Medicine, New York, NY, U.S.A
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