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Kerpel-Fronius A, Megyesfalvi Z, Markóczy Z, Solymosi D, Csányi P, Tisza J, Kecskés A, Baranyi B, Csánky E, Dóka A, Gálffy G, Göcző K, Győry C, Horváth Z, Juhász T, Kállai Á, Kincses ZT, Király Z, Király-Incze E, Kostyál L, Kovács A, Kovács A, Kuczkó É, Makra Z, Maurovich Horvát P, Merth G, Moldoványi I, Müller V, Pápai-Székely Z, Papp D, Polgár C, Rózsa P, Sárosi V, Szalai Z, Székely A, Szuhács M, Tárnoki D, Tavaszi G, Turóczi-Kirizs R, Tóth L, Urbán L, Vaskó A, Vigh É, Dome B, Bogos K. HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program. Eur Radiol 2023:10.1007/s00330-023-10379-8. [PMID: 37921926 DOI: 10.1007/s00330-023-10379-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES The introduction of low-dose CT (LDCT) altered the landscape of lung cancer (LC) screening and contributed to the reduction of mortality rates worldwide. Here we report the final results of HUNCHEST-II, the largest population-based LDCT screening program in Hungary, including the screening and diagnostic outcomes, and the characteristics of the LC cases. METHODS A total of 4215 high-risk individuals aged between 50 and 75 years with a smoking history of at least 25 pack-years were assigned to undergo LDCT screening. Screening outcomes were determined based on the volume, growth, and volume doubling time of pulmonary nodules or masses. The clinical stage distribution of screen-detected cancers was compared with two independent practice-based databases consisting of unscreened LC patients. RESULTS The percentage of negative and indeterminate tests at baseline were 74.2% and 21.7%, respectively, whereas the prevalence of positive LDCT results was 4.1%. Overall, 76 LC patients were diagnosed throughout the screening rounds (1.8% of total participants), out of which 62 (1.5%) patients were already identified in the first screening round. The overall positive predictive value of a positive test was 58%. Most screen-detected malignancies were stage I LCs (60.7%), and only 16.4% of all cases could be classified as stage IV disease. The percentage of early-stage malignancies was significantly higher among HUNCHEST-II screen-detected individuals than among the LC patients in the National Koranyi Institute of Pulmonology's archive or the Hungarian Cancer Registry (p < 0.001). CONCLUSIONS HUNCHEST-II demonstrates that LDCT screening for LC facilitates early diagnosis, thus arguing in favor of introducing systematic LC screening in Hungary. CLINICAL RELEVANCE STATEMENT HUNCHEST-II is the so-far largest population-based low-dose CT screening program in Hungary. A positive test's overall positive predictive value was 58%, and most screen-detected malignancies were early-stage lesions. These results pave the way for expansive systematic screening in the region. KEY POINTS • Conducted in 18 medical facilities, HUNCHEST-II is the so far largest population-based low-dose CT screening program in Hungary. • The vast majority of screen-detected malignancies were early-stage lung cancers, and the overall positive predictive value of a positive test was 58%. • HUNCHEST-II facilitates early diagnosis, thus arguing in favor of introducing systematic lung cancer screening in Hungary.
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Affiliation(s)
| | - Zsolt Megyesfalvi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Zsolt Markóczy
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Diana Solymosi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Péter Csányi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Judit Tisza
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Anita Kecskés
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | | | - Eszter Csánky
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital - Semmelweis Member State Hospital, Miskolc, Hungary
| | - Adrienn Dóka
- Vas County Markusovszky University Teaching Hospital, Szombathely, Hungary
| | | | - Katalin Göcző
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Csilla Győry
- Petz Aladár University Teaching Hospital, Győr, Hungary
| | - Zsolt Horváth
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Tünde Juhász
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching, Nyíregyháza, Hungary
| | - Árpád Kállai
- Hódmezővásárhely- Makó Healthcare Services Center, Hódmezővásárhely, Hungary
| | - Zsigmond T Kincses
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsolt Király
- Pulmonological Institute of Veszprém County, Farkasgyepű, Hungary
| | - Enikő Király-Incze
- Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - László Kostyál
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital - Semmelweis Member State Hospital, Miskolc, Hungary
| | - Anita Kovács
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - András Kovács
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
| | - Éva Kuczkó
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Zsuzsanna Makra
- Hódmezővásárhely- Makó Healthcare Services Center, Hódmezővásárhely, Hungary
| | | | | | | | | | - Zsolt Pápai-Székely
- Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - Dávid Papp
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Csaba Polgár
- National Institute of Oncology, Budapest, Hungary
| | - Péter Rózsa
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
- MediConcept, Budapest, Hungary
| | - Veronika Sárosi
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
| | | | | | - Marianna Szuhács
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching, Nyíregyháza, Hungary
| | | | - Gábor Tavaszi
- Törökbálint Institute of Pulmonology, Törökbálint, Hungary
| | | | | | | | | | - Éva Vigh
- Vas County Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Balazs Dome
- National Koranyi Institute of Pulmonology, Budapest, Hungary.
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Department of Translational Medicine, Lund University, Lund, Sweden.
| | - Krisztina Bogos
- National Koranyi Institute of Pulmonology, Budapest, Hungary
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Kiss Z, Gálffy G, Müller V, Moldvay J, Sárosi V, Pápai-Székely Z, Csada E, Kerpel-Fronius A, Király Z, Szász Z, Hódi G, Polányi Z, Kovács K, Karamousouli E, Knollmajer K, Szabó TG, Berta A, Vokó Z, Rokszin G, Abonyi-Tóth Z, Barcza Z, Tamási L, Bogos K. Significant changes in advanced lung cancer survival during the past decade in Hungary: impact of modern immunotherapy and the COVID-19 pandemic. Front Oncol 2023; 13:1207295. [PMID: 37860193 PMCID: PMC10584310 DOI: 10.3389/fonc.2023.1207295] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
Objective The approval of immunotherapy (I-O) for the treatment of late-stage non-small cell lung cancer (NSCLC) opened new perspectives in improving survival outcomes. However, survival data have not yet been provided from the period of the Covid-19 pandemic. The aims of our study were to assess and compare survival outcomes of patients with advanced LC receiving systemic anticancer treatment (SACT) before and after the approval of immunotherapy in Hungary, and to examine the impact of pandemic on survival outcomes using data from the Hungarian National Health Insurance Fund (NHIF) database. Methods This retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with advanced stage lung cancer (LC) (ICD-10 C34) between 1 January 2011 and 31 December 2021 and received SACT treatment without LC-related surgery. Survival rates were evaluated by year of diagnosis, sex, age, and LC histology. Results In total, 35,416 patients were newly diagnosed with advanced LC and received SACT during the study period (mean age at diagnosis: 62.1-66.3 years). In patients with non-squamous cell carcinoma, 3-year survival was significantly higher among those diagnosed in 2019 vs. 2011-2012 (28.7% [95% CI: 26.4%-30.9%] vs. 14.45% [95% CI: 13.21%-15.69%], respectively). In patients with squamous cell carcinoma, 3-year survival rates were 22.3% (95% CI: 19.4%-25.2%) and 13.37% (95% CI: 11.8%-15.0%) in 2019 and 2011-2012, respectively, the change was statistically significant. Compared to 2011-2012, the hazard ratio of survival change for non-squamous cell carcinoma patients was 0.91, 0.82, and 0.62 in 2015-2016, 2017-2018, and 2019, respectively (p<0.001 for all cases). In the squamous cell carcinoma group, corresponding hazard ratios were 0.93, 0.87, and 0.78, respectively (p<0.001 for all cases). Survival improvements remained significant in both patient populations during the Covid-19 pandemic (2020-2021). No significant improvements were found in the survival of patients with small cell carcinoma. Platinum-based chemotherapy was the most common first-line treatment in all diagnostic periods, however, the proportion of patients receiving first- or second-line immunotherapy significantly increased during the study period. Conclusion 3-year survival rates of NSCLC almost doubled among patients with non-squamous cell carcinoma and significantly improved at squamous cell carcinoma over the past decade in Hungary. Improvements could potentially be attributable by the introduction of immunotherapy and were not offset by the Covid-19 pandemic.
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Affiliation(s)
- Zoltán Kiss
- MSD Pharma Hungary Ltd, Budapest, Hungary
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - Gabriella Gálffy
- Pulmonology Hospital Törökbálint, Department of Pulmonology, Törökbálin, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Judit Moldvay
- 1st Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
- 2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | | | - Zsolt Pápai-Székely
- Fejér County Szent György, University Teaching Hospital, Székesfehérvár, Hungary
| | - Edit Csada
- Csongrád-Csanád County Hospital for Chest Diseases, Deszk, Hungary
| | - Anna Kerpel-Fronius
- National Korányi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | - Zsolt Király
- Veszprém County Pulmonary Hospital, Farkasgyepű, Hungary
| | - Zoltán Szász
- Department of Pulmonology, Petz Aladár University Teaching Hospital, Győr, Hungary
| | - Gábor Hódi
- MSD Pharma Hungary Ltd, Budapest, Hungary
| | | | | | | | | | | | | | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- Department of Biostatistics, University of Veterinary Medicine, Budapest, Hungary
| | | | - Lilla Tamási
- Pulmonology Hospital Törökbálint, Department of Pulmonology, Törökbálin, Hungary
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Budapest, Hungary
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Robotka Z, Szabó KG, Tóth I, Szöllősi Z, Barna T, Pápai-Székely Z, Grmela G, Slárku I, Csánky E. [Rare case of primary pulmonary myxoid sarcoma]. Orv Hetil 2023; 164:1077-1083. [PMID: 37422888 DOI: 10.1556/650.2023.32781] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 07/11/2023]
Abstract
Mesenchymal tumors of the lungs are rare, mostly aggressive, with a high metastatic rate, representing only 0.013-1.1% of all pulmonary malignancies. Primary pulmonary myxoid sarcoma is an extremely rare type of lung sarcoma and stands as a separate entity in the 2015 WHO classification, characterized by EWSR1-CREB fusion gene. So far, 37 myxoid sarcoma cases have been reported. We offer an overview of the most important characteristics of pulmonary myxoid sarcoma and differential diagnosis, while reviewing the reported cases. We present the case of a 47-year-old patient with pulmonary myxoid sarcoma, who was diagnosed with a right central pulmonary mass, showing rapid endobronchial progression, complicated by empyema. EWSR1 gene translocation could not be detected. During chemotherapy, tumor progression occurred. Molecular genetic examinations revealed MET gene exon 14 skipping mutation, based on which tyrosine-kinase inhibitor treatment was administered. Pulmonary myxoid sarcoma can be classified as a nonvascular, spindle cell entity of mesenchymal tumors, with the characteristic EWSR1-CREB1 gene translocation. The male-female ratio is similar, with a slightly higher incidence in middle-aged women (1.5 : 1). Patients' average age is 44 years; with predilection in the right upper lobe (62%), or endobronchially (85%). Without specific symptoms, diagnosis is often cumbersome. Immunohistochemical methods, typical hystological image and molecular genetic tests confirm the diagnosis. Pulmonary myxoid sarcoma is a rare entity, without specific symptoms. In our case, myxoid sarcoma was complicated by empyema, which was drained. Because of advanced stage, surgical resection was not an option. Radical surgery offers the best results, in inoperable cases therapeutic recommendations for sarcomas are the guiding principles. Our case belongs to the rare group of myxoid sarcomas, where MET activating mutation was detected, making it eligible for targeted treatment. Orv Hetil. 2023; 164(27): 1077-1083.
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Affiliation(s)
- Zsófia Robotka
- 1 Borsod Abaúj Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Tüdőgyógyászati Osztály Miskolc Magyarország
| | - Károly Gábor Szabó
- 2 Borsod Abaúj Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Mellkassebészeti Osztály Miskolc Magyarország
| | - Imre Tóth
- 2 Borsod Abaúj Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Mellkassebészeti Osztály Miskolc Magyarország
| | - Zoltán Szöllősi
- 3 Borsod Abaúj Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Patológiai Osztály Miskolc Magyarország
| | - Tibor Barna
- 3 Borsod Abaúj Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Patológiai Osztály Miskolc Magyarország
| | - Zsolt Pápai-Székely
- 4 Fejér Vármegyei Szent György Egyetemi Oktató Kórház, Pulmonológiai Osztály Székesfehérvár Magyarország
| | - Gábor Grmela
- 4 Fejér Vármegyei Szent György Egyetemi Oktató Kórház, Pulmonológiai Osztály Székesfehérvár Magyarország
| | - Ilona Slárku
- 1 Borsod Abaúj Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Tüdőgyógyászati Osztály Miskolc Magyarország
| | - Eszter Csánky
- 1 Borsod Abaúj Zemplén Vármegyei Központi Kórház és Egyetemi Oktatókórház, Tüdőgyógyászati Osztály Miskolc Magyarország
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Reinmuth N, Juan-Vidal O, Horváth Z, Kowalski D, Kryzhanivska A, Csánky E, Gálffy G, Bryl M, Vicente D, Vynnychenko I, Pápai-Székely Z, Armstrong J, Dalvi T, Shrestha Y, Xie M, Jiang H, Bondarenko I. Abstract CT533: Durvalumab (D) plus tremelimumab (T) in platinum-refractory/resistant extensive-stage small cell lung cancer (ES-SCLC): Efficacy, safety and ctDNA dynamics from Arm A of the phase 2 BALTIC study. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct533] [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
Background: Molecular response based on ctDNA dynamics may be predictive of benefit from immunotherapy in NSCLC, complementing radiologic disease assessment and potentially enabling early clinical decision-making, but data in SCLC are lacking. The phase 2, multi-arm, signal-searching BALTIC study (NCT02937818) assessed novel treatment combinations in platinum-refractory/resistant ES-SCLC; we report efficacy, safety, and exploratory ctDNA and PD-L1 analyses from pts who received D + T in Arm A.
Methods: Eligible pts had ES-SCLC, progressive disease (PD) during or within 90 days of completing 1L platinum-based CT, WHO PS 0-1, and life expectancy ≥8 weeks. In Arm A, pts received D 1500 mg + T 75 mg q4w for 4 cycles, followed by maintenance D 1500 mg q4w until PD. The primary endpoint was ORR (investigator assessment, RECIST v1.1). Secondary endpoints included DCR, PFS, OS, and safety and tolerability. Prespecified exploratory analyses included assessment of baseline/on-treatment ctDNA levels measured by maximum variant allele frequency (MaxVAF), and PD-L1 expression on tumor cells (TC) and immune cells (IC) (VENTANA PD-L1 [SP263] Assay).
Results: 41 pts received treatment with D + T (median age 63 years; 76% male; 76% PS 1). At the data cut-off (DCO; Jun 22, 2020), median treatment duration was 12 weeks, with 3 pts ongoing D treatment (these pts had received ≥38, ≥21, and ≥19 doses of D, respectively, at DCO). Confirmed ORR was 7.3% (95% CI 1.54‒19.92; 3 partial responses [PR]). DCR at 12 weeks was 27%. 21 pts (51%) were PD-L1 evaluable. Of 12 pts with PD-L1 expression (TC or IC) ≥1%, 3 (25%) had a best response of PR or stable disease, compared with 1 (11%) of 9 pts with PD-L1 (TC or IC) <1%. Median PFS was 1.84 mo (95% CI 1.77‒1.91) and median OS was 5.36 mo (95% CI 2.89‒7.23). Grade 3/4 treatment-related adverse events (TRAEs) occurred in 8 pts (20%); TRAEs led to treatment discontinuation in 5 pts (12%) and death in 1 pt (hemorrhagic enterocolitis). 26 pts (63%) were evaluable for ctDNA at baseline, and 10 pts (24%) had on-treatment ctDNA data. Pts with baseline MaxVAF in low (n=9), medium (n=8), and high (n=9) tertiles had a median OS of 12.8, 4.5, and 2.3 mo, respectively. Pts with a decrease in on-treatment ctDNA level (delta MaxVAF <0) had a longer median OS (12.0 mo) vs those with an increase (5.6 mo).
Conclusions: Although limited antitumor activity was observed in refractory/resistant ES-SCLC in BALTIC, association of lower baseline ctDNA levels (MaxVAF) with longer OS may reflect the prognostic effect of disease burden. Association of on-treatment reduction in ctDNA level with longer OS suggests potential use of ctDNA as a surrogate of treatment response in ES-SCLC. Further analyses in larger datasets and in a randomized setting are warranted.
Citation Format: Niels Reinmuth, Oscar Juan-Vidal, Zsolt Horváth, Dariusz Kowalski, Anna Kryzhanivska, Eszter Csánky, Gabriella Gálffy, Maciej Bryl, David Vicente, Ihor Vynnychenko, Zsolt Pápai-Székely, Jon Armstrong, Tapashi Dalvi, Yashaswi Shrestha, Mingchao Xie, Haiyi Jiang, Igor Bondarenko. Durvalumab (D) plus tremelimumab (T) in platinum-refractory/resistant extensive-stage small cell lung cancer (ES-SCLC): Efficacy, safety and ctDNA dynamics from Arm A of the phase 2 BALTIC study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT533.
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Affiliation(s)
| | | | - Zsolt Horváth
- 3Bacs-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Dariusz Kowalski
- 4Department of Lung Cancer and Chest Tumours, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Kryzhanivska
- 5Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Eszter Csánky
- 6Department of Pulmonology, Semmelweis Hospital, Miskolc, Hungary
| | | | - Maciej Bryl
- 8Oncology Department, E.J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - David Vicente
- 9Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | | | | | | | - Igor Bondarenko
- 14Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine
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Urbán L, Dóczi R, Vodicska B, Tihanyi D, Horváth M, Kormos D, Takács I, Pápai-Székely Z, Póka-Farkas Z, Várkondi E, Schwáb R, Hegedüs C, Vályi-Nagy I, Peták I. Major Clinical Response to Afatinib Monotherapy in Lung Adenocarcinoma Harboring EGFR Exon 20 Insertion Mutation. Clin Lung Cancer 2020; 22:e112-e115. [PMID: 33082101 DOI: 10.1016/j.cllc.2020.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
Affiliation(s)
- László Urbán
- Mátraháza University and Teaching Hospital, Mátraháza, Hungary.
| | - Róbert Dóczi
- Oncompass Medicine Hungary Ltd, Budapest, Hungary
| | | | - Dóra Tihanyi
- Oncompass Medicine Hungary Ltd, Budapest, Hungary
| | | | - Dóra Kormos
- BAZ County Central and Teaching Hospital, Department of Internal Medicine and Lymphomatherapy V., Miskolc, Hungary
| | - István Takács
- BAZ County Central and Teaching Hospital, Department of Internal Medicine and Lymphomatherapy V., Miskolc, Hungary; Faculty of Healthcare, University of Miskolc, Miskolc, Hungary
| | - Zsolt Pápai-Székely
- Mátraháza University and Teaching Hospital, Mátraháza, Hungary; Fejér County and University Teaching Hospital, Székesfehérvár, Hungary
| | | | | | | | | | - István Vályi-Nagy
- Centrum Hospital of Southern Pest, National Hematology and Infectology Institute, Budapest, Hungary
| | - István Peták
- Oncompass Medicine Hungary Ltd, Budapest, Hungary; Department of Pharmacology, Semmelweis University, Budapest, Hungary; Department of Pharmaceutical Sciences, University of Illinois at Chicago, Chicago, IL.
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Reinmuth N, Cho B, Lee K, Luft A, Ahn MJ, Schneider J, Shepherd F, Geater S, Pápai-Székely Z, Van Ngoc T, Garassino M, Liu F, Clemett D, Thiyagarajah P, Ouwens M, Scheuring U, Peters S, Rizvi N. Effect of post-study immunotherapy (IO) on overall survival (OS) outcome in patients with metastatic (m) NSCLC treated with first-line durvalumab (D) vs chemotherapy (CT) in the phase III MYSTIC study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz094.003] [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: 12/21/2022] Open
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Markóczy Z, Sárosi V, Kudaba I, Gálffy G, Turay ÜY, Demirkazik A, Purkalne G, Somfay A, Pápai-Székely Z, Rásó E, Ostoros G. Erlotinib as single agent first line treatment in locally advanced or metastatic activating EGFR mutation-positive lung adenocarcinoma (CEETAC): an open-label, non-randomized, multicenter, phase IV clinical trial. BMC Cancer 2018; 18:598. [PMID: 29801465 PMCID: PMC5970529 DOI: 10.1186/s12885-018-4283-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/02/2017] [Accepted: 03/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Erlotinib is approved for the first line treatment of epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer. Since the number of prospective studies in Caucasian patients treated in routine clinical setting is limited we conducted a multicenter, phase IV clinical trial to determine the efficacy and safety of erlotinib and to demonstrate the feasibility of the validated standardized companion diagnostic method of EGFR mutation detection. Methods 651 chemonaive, cytologically or histologically verified advanced stage lung adenocarcinoma patients from Hungary, Turkey and Latvia were screened for exon19 microdeletions and exon21 L858R EGFR mutations using the companion diagnostic EGFR test. EGFR mutation-positive, locally advanced or metastatic lung adenocarcinoma patients received as first line treatment erlotinib at 150 mg/day. The primary endpoint was progression-free survival (PFS). Results 62 EGFR mutation-positive patients (9.5% of screened) were included in the safety/intent-to-treat cohort. Median PFS was 12.8 months (95%CI, 9.9–15.8), objective response rate and one-year survival was 66.1% and 82.5%, respectively. Most frequent treatment related adverse events were diarrhoea and rash. Eastern Oncology Cooperative Group Performance Status (ECOG PS), smoking status and M1a/M1b disease stage were significant prognosticators of PFS (p = 0.017, p = 0.045 and p = 0.002, respectively). There was no significant difference in PFS between the subgroups stratified by gender, age or exon19 vs exon21 mutation. Conclusions Our study confirmed the efficacy and safety of first line erlotinib monotherapy in Caucasian patients with locally advanced or metastatic lung adenocarcinoma carrying activating EGFR mutations based on the screening with the approved companion diagnostic procedure. Trial registration ClinicalTrials.gov Identifier: NCT01609543.
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Affiliation(s)
- Zsolt Markóczy
- National Koranyi Institute of TB and Pulmonology, Piheno ut 1, Budapest, H-1122, Hungary
| | | | - Iveta Kudaba
- Riga East University Hospital Oncology Center, Riga, Latvia
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Ülkü Yilmaz Turay
- Clinic of Chest Diseases, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Ahmet Demirkazik
- Department of Medical Oncology, Ibn-i Sina Hospital, Ankara University Medical Faculty, Ankara, Turkey
| | - Gunta Purkalne
- Oncology Institute, Riga Stradins University, Riga, Latvia
| | - Attila Somfay
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | | | - Erzsébet Rásó
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- National Koranyi Institute of TB and Pulmonology, Piheno ut 1, Budapest, H-1122, Hungary.
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Pápai-Székely Z. SC19.04 Endobronchial Palliation in Thoracic Malignancies. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.108] [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: 11/25/2022]
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Richardson F, Richardson K, Sennello G, Young D, Orlov S, Pápai-Székely Z, Keshavjee S, Kim J, Cerfolio R, Shepherd FA. Biomarker analysis from completely resected NSCLC patients enrolled in an adjuvant erlotinib clinical trial (RADIANT). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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
7520 Background: RADIANT is a phase III trial comparing erlotinib 150 mg daily vs. placebo (2:1) in stage IB-IIIA NSCLC patients with EGFR-positive tumors (IHC and/or FISH), following complete surgical resection. Planned accrual is 945 patients. Correlative biomarker studies on primary tumor tissue, whole blood, and serum are key components of the study. Methods: Tumor tissue was evaluated by IHC for protein expression of EGFR (PharmDx Kit, Dako with + ≥ 1% positive tumor cells), by FISH for gene expression of EGFR (Vysis, Abbott), and by Wave HS for EGFR and Kras mutations. Results: Among 655 tissue samples analyzed, 96% were EGFR IHC+ and 74% EGFR FISH+. Of the 476 tissue samples analyzed to date for mutations (mut), 12% had activating EGFR and 19% had Kras mut. Preliminary comparisons suggest that EGFR mut rate increased while Kras mut rate decreased with tumor stage. EGFR mut occurred in 29/178 (16%) females (F) vs. 23/271 (8%) males (M), 19/57 (33%) Asians (A) vs. 33/392 (8%) non-Asians (NA), and 29/66 (44%) never smokers (NS) vs. 23/383 (6%) current or former smokers (S). The differences between A vs. NA and NS vs. S were significantly different (P <0.0001) for all comparisons made. Kras mut occurred in 40/180 (22%) F vs. 48/280 (17%) M, 4/57 (7%) A vs. 84/403 (21%) NA, and 3/68 (4%) NS vs. 85/392 (22%) S. The difference between A vs. NA and NS vs. S were significantly different (P ≤0.0389) for all comparisons made. In adenoca, 51/254 (20%) had EGFR and 79/261 (30%) had Kras mut, and in SCC, 0/157 (0%) had EGFR and 3/162 (2%) had Kras mut. One tumor sample demonstrated both an activating EGFR and Kras mut. Conclusions: Ongoing comprehensive biomarker assessment in the RADIANT population indicates successful sample collection and analysis. FISH positivity rates are greater than observed in late-stage tumors. Remaining results in this early-stage population are consistent with those observed in advanced-stage disease. Once complete, this study will provide a robust biomarker dataset on which to evaluate predictive and prognostic response markers, which may help determine who may benefit from treatment with erlotinib in the adjuvant setting. [Table: see text]
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Affiliation(s)
- F. Richardson
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
| | - K. Richardson
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
| | - G. Sennello
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
| | - D. Young
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
| | - S. Orlov
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
| | - Z. Pápai-Székely
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
| | - S. Keshavjee
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
| | - J. Kim
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
| | - R. Cerfolio
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
| | - F. A. Shepherd
- OSI Pharmaceuticals, Boulder, CO; Saint-Petersburg State Medical University, Saint-Petersburg, Russian Federation; Fejer Megyei Szent Gyorgy Korhaz, Szekesfehervar, Hungary; Princess Margaret Hospital, Toronto, ON, Canada; Severance Hospital Yonsei University College of Medicine, Seoul, Republic of Korea; University of Alabama at Birmingham, Birmingham, AL
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