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Bauman JE, Karam SD, O'Brien C, Mak G, Cho BC. Durvalumab in combination with chemoradiotherapy in patients with head and neck squamous cell carcinoma: Results from the Phase 1 CLOVER study. Head Neck 2024; 46:1152-1159. [PMID: 38494597 DOI: 10.1002/hed.27726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The Phase 1 CLOVER study (NCT03509012) assessed durvalumab in combination with concurrent chemoradiotherapy (cCRT) in patients with advanced solid tumors; we report results from the head and neck squamous cell carcinoma (HNSCC) cohort. METHODS Patients with histologically/cytologically confirmed locally advanced HNSCC, eligible for definitive cCRT and not considered for primary surgery, received durvalumab plus cisplatin and concurrent external beam radiation. Objectives were to assess safety/tolerability and preliminary efficacy. RESULTS Eight patients were enrolled. The most frequent any-cause adverse events (AEs) were nausea and radiation skin injury (each n = 5); most frequent grade 3/4 AEs were lymphopenia and stomatitis (each n = 3). No patients had dose-limiting toxicities. Objective response rate was 71.4% (5/7 patients; four complete responses, one partial response); disease control rate was 85.7% at 18 weeks and 83.3% at 48 weeks. CONCLUSIONS Durvalumab plus cCRT was tolerable and active in patients with unresected, locally advanced HNSCC.
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Affiliation(s)
- Julie E Bauman
- Department of Medicine, University of Arizona Cancer Center, Tucson, Arizona, USA
- George Washington University Cancer Center, Washington, DC, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cathy O'Brien
- Oncology Biometrics, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - Gabriel Mak
- Late Development Oncology, Oncology R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Byoung Chul Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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2
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Meng M, Liu X, Liang X, Chen X, Li Y. Cost-effectiveness analysis of durvalumab, tremelimumab, and etoposide-platinum in first-line treatment of extensive-stage small cell lung cancer. Medicine (Baltimore) 2024; 103:e37836. [PMID: 38640325 PMCID: PMC11029999 DOI: 10.1097/md.0000000000037836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Durvalumab plus etoposide-platinum (DEP) showed sustained overall survival improvements in patients with extensive-stage small-cell lung cancer (ES-SCLC) compared to etoposide-platinum (EP), but adding tremelimumab to DEP (DTEP) did not significantly improve outcomes. A third-party payer perspective is taken here to evaluate the cost-effectiveness of DTEP, DEP, and EP for ES-SCLC. METHODS The cost-effectiveness was evaluated by partitioning survival models into 3 mutually exclusive health states. In this model, clinical characteristics and outcomes were obtained from the CASPIAN. Model robustness was evaluated through 1-way deterministic and probabilistic sensitivity analyses. Outcome measurements included costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio, life-years, incremental net health benefit, and incremental net monetary benefit. The analysis was conducted with a 10-year lifetime horizon in a United States setting. RESULTS Compared with EP, DEP, and DTEP were associated with an increment of 0.480 and 0.313 life-years, and an increment of 0.247 and 0.165 QALYs, as well as a $139,788 and $170,331 increase in cost per patient. The corresponding ICERs were $565,807/QALY and $1033,456/QALY, respectively. The incremental net health benefit and incremental net monetary benefit of DEP or DTEP were -0.685 QALYs and -$102,729, or -0.971 QALYs and -$145,608 at a willingness to pay threshold of $150,000/QALY, respectively. Compared with DTEP, DEP was dominated. DTEP and DEP were 100% unlikely to be cost-effective if the willingness to pay threshold was $150,000/QALY. DEP was cost-effective compared to EP when durvalumab was priced below $0.994/mg. Compared with EP, DEP, and DTEP were unlikely to be considered cost-effective across all subgroups. CONCLUSION DEP and DTEP were not cost-effective options in the first-line treatment for ES-SCLC compared with EP, from the third-party payer perspective in the United States. Compared with DTEP, DEP was dominated.
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Affiliation(s)
- Mingyu Meng
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Xiaoxia Liu
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Xueyan Liang
- Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Xiaoyu Chen
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
- Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
| | - Yan Li
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China
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Mouri A, Watanabe S, Tokito T, Nagai Y, Saida Y, Imai H, Yamaguchi O, Kobayashi K, Kaira K, Kagamu H. Clinical Outcome of Nivolumab Plus Ipilimumab in Patients with Locally Advanced Non-Small-Cell Lung Cancer with Relapse after Concurrent Chemoradiotherapy followed by Durvalumab. Cancers (Basel) 2024; 16:1409. [PMID: 38611087 PMCID: PMC11011053 DOI: 10.3390/cancers16071409] [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: 03/11/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Nivolumab plus ipilimumab showed promising efficacy in patients with metastatic non-small-cell lung cancer (NSCLC). The efficacy of the nivolumab plus ipilimumab combination regimen in NSCLC patients who relapse after durvalumab consolidation following concurrent chemoradiotherapy (CCRT) has not been determined. Between January 2021 and June 2022, clinical data were retrospectively extracted from the medical records of patients with NSCLC who received nivolumab plus ipilimumab after CCRT and durvalumab consolidation. A total of 30 patients were included in this analysis. The median number of durvalumab treatment cycles was 11. Median PFS and OS with nivolumab plus ipilimumab were 4.2 months (95% confidence interval [CI]: 0.7-7.7) and 18.5 months (95% CI: 3.5-33.5), respectively. The 6-month and 12-month PFS rates were 46.7% (95% CI: 28.8-64.5) and 36.4% (95% CI: 19.0-53.7). In multivariate analysis, a significant correlation was observed between a durvalumab treatment duration of 6 months or more and PFS (p = 0.04) as well as OS (p = 0.001). Grade 3 adverse events, including pneumonitis, dermatitis, and colitis, occurred in 10% of the patients. This study suggests that nivolumab plus ipilimumab is effective, especially in patients who have received durvalumab for 6 months or more, and tolerable for patients who relapsed after durvalumab following CCRT.
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Affiliation(s)
- Atsuto Mouri
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka 350-1298, Japan; (A.M.); (H.I.); (O.Y.); (K.K.); (K.K.); (H.K.)
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan;
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan;
| | - Yoshiaki Nagai
- Division of Respiratory Medicine, Clinical Department of Internal Medicine, Jichi Medical University Saitama Medical Center, Saitama 330-0834, Japan;
| | - Yu Saida
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan;
| | - Hisao Imai
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka 350-1298, Japan; (A.M.); (H.I.); (O.Y.); (K.K.); (K.K.); (H.K.)
| | - Ou Yamaguchi
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka 350-1298, Japan; (A.M.); (H.I.); (O.Y.); (K.K.); (K.K.); (H.K.)
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka 350-1298, Japan; (A.M.); (H.I.); (O.Y.); (K.K.); (K.K.); (H.K.)
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka 350-1298, Japan; (A.M.); (H.I.); (O.Y.); (K.K.); (K.K.); (H.K.)
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka 350-1298, Japan; (A.M.); (H.I.); (O.Y.); (K.K.); (K.K.); (H.K.)
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4
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Seki T, Baba K, Hayashi T, Furuta R, Hirosawa H, Mitsui T, Maesaka H, Takasawa S, Miwa T, Tanaka K, Nakatsuji Y. Lung Cancer Wherein Durvalumab Induced Both Anti-CRMP-5 Antibody-related Paraneoplastic Neurological Syndromes and Neurological Adverse Events. Intern Med 2024; 63:1009-1014. [PMID: 37612090 DOI: 10.2169/internalmedicine.1771-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
A 68-year-old man with small-cell lung cancer developed anti-collapsin response-mediator protein (CRMP)-5 antibody-related paraneoplastic neurological syndrome (PNS) presenting with ataxia and chorea during treatment with durvalumab. As a result of steroid therapy, anti-CRMP-5 antibodies became negative, hyperintense lesions on brain magnetic resonance imaging disappeared, and neurological symptoms improved. After resuming durvalumab, he became unable to walk due to neurological adverse events (nAEs). There have been no reported cases manifesting PNSs and nAEs as a result of the same immune checkpoint inhibitors (ICIs) administered at different times. Resuming ICIs in patients diagnosed with PNSs should be performed with prudence.
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Affiliation(s)
- Tomokazu Seki
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Kousuke Baba
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Tomohiro Hayashi
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Risako Furuta
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Hiroaki Hirosawa
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Taichi Mitsui
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Hiroki Maesaka
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Syuhei Takasawa
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
| | - Toshiro Miwa
- First Department of Internal Medicine, Toyama University Hospital, Japan
| | - Keiko Tanaka
- Department of Animal Model Development, Bioresource Science Branch, Center for Bioresource-based Research, Brain Research Institute, Niigata University, Japan
| | - Yuji Nakatsuji
- Department of Neurology, Faculty of Medicine, University of Toyama, Japan
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Tsuji K, Mizugaki H, Yokoo K, Kobayashi M, Kawashima Y, Kimura N, Yokouchi H, Kikuchi H, Sumi T, Kawai Y, Kobashi K, Morita R, Ito K, Kitamura Y, Minemura H, Nakamura K, Aso M, Honjo O, Tanaka H, Takashina T, Tsurumi K, Sugisaka J, Tsukita Y, Konno S, Oizumi S. Durvalumab after chemoradiotherapy in non-small cell lung cancer with EGFR mutation: A real-world study (HOT2101). Cancer Sci 2024; 115:1273-1282. [PMID: 38287788 PMCID: PMC11006989 DOI: 10.1111/cas.16094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/01/2024] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
Durvalumab has been administered to patients with unresectable stage III non-small cell lung cancer (NSCLC). However, it remains unclear whether durvalumab benefits these patients with epidermal growth factor receptor (EGFR) mutation. We conducted a retrospective, multicenter study of patients with EGFR mutation who received chemoradiotherapy (CRT) between June 2018 and March 2021. We assessed patient characteristics, efficacy of durvalumab, and durvalumab safety before and after targeted therapy. We collected data on a total of 673 patients, of whom 401 (59.6%) underwent EGFR mutation testing. Fifty-one patients were EGFR positive and 311 were EGFR negative. In the EGFR-positive group, there were higher proportions of females, never-smokers, and patients with adenocarcinoma histology. Of the 51 patients in the positive group and 311 in the negative group who received CRT, 45 (88.2%) and 247 (79.4%) received durvalumab, with median progression-free survival of 23.0 and 24.2 months in the positive and negative groups, respectively (hazard ratio 1.03; 95% confidence interval: 0.64-1.67). The main adverse event was pneumonitis (positive group: 62.2%; 4.4% grade 3; negative group: 62.3%; 6.9% grade 3). No treatment-related deaths were observed. Of the 45 patients in the positive group who received durvalumab, 14 (31.1%) received targeted therapy after durvalumab at the data cutoff. One patient discontinued targeted therapy after developing pneumonitis. In patients with unresectable stage III NSCLC with EGFR mutation, durvalumab after CRT is potentially safe and effective. This may be a suitable treatment sequence for these patients.
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Affiliation(s)
- Kosuke Tsuji
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Hidenori Mizugaki
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
- Department of Advanced Medical DevelopmentThe Cancer Institute Hospital of Japanese Foundation for Cancer ResearchTokyoJapan
- Department of Respiratory MedicineNHO Hokkaido Cancer CenterSapporoJapan
| | - Keiki Yokoo
- Department of Respiratory MedicineTeine Keijinkai HospitalSapporoJapan
| | - Maki Kobayashi
- Department of Respiratory MedicineMiyagi Cancer CenterNatoriJapan
| | - Yosuke Kawashima
- Department of Pulmonary MedicineSendai Kousei HospitalSendaiJapan
| | - Nozomu Kimura
- Department of Respiratory MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Hiroshi Yokouchi
- Department of Respiratory MedicineNHO Hokkaido Cancer CenterSapporoJapan
| | - Hajime Kikuchi
- Department of Respiratory MedicineObihiro‐Kousei General HospitalObihiroJapan
| | - Toshiyuki Sumi
- Department of Respiratory MedicineHakodate Goryoukaku HospitalHakodateJapan
| | - Yasutaka Kawai
- Department of Respiratory MedicineOji General HospitalTomakomaiJapan
| | - Kenta Kobashi
- Department of Pulmonary MedicineSteel Memorial Muroran HospitalMuroranJapan
| | - Ryo Morita
- Department of Respiratory MedicineAkita Kousei Medical CenterAkitaJapan
| | - Kenichiro Ito
- Department of Respiratory MedicineKKR Sapporo Medical CenterSapporoJapan
| | - Yasuo Kitamura
- Department of Respiratory MedicineKushiro City General HospitalKushiroJapan
| | - Hiroyuki Minemura
- Department of Pulmonary MedicineFukushima Medical University School of MedicineFukushimaJapan
| | - Keiichi Nakamura
- Department of Respiratory MedicineNational Hospital Organization Asahikawa Medical CenterAsahikawaJapan
| | - Mari Aso
- Department of Respiratory MedicineYamagata Prefectural Central HospitalYamagataJapan
| | - Osamu Honjo
- Department of Respiratory MedicineSapporo Minami‐Sanjo HospitalSapporoJapan
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Graduate School of MedicineHirosaki UniversityHirosakiJapan
| | - Taichi Takashina
- Department of Respiratory MedicineIwamizawa Municipal General HospitalIwamizawaJapan
| | - Kyoji Tsurumi
- Department of Respiratory MedicineMiyagi Cancer CenterNatoriJapan
| | - Jun Sugisaka
- Department of Pulmonary MedicineSendai Kousei HospitalSendaiJapan
| | - Yoko Tsukita
- Department of Respiratory MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Satoshi Oizumi
- Department of Respiratory MedicineNHO Hokkaido Cancer CenterSapporoJapan
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Chan SL, Ryoo BY, Mo F, Chan LL, Cheon J, Li L, Wong KH, Yim N, Kim H, Yoo C. Multicentre phase II trial of cabozantinib in patients with hepatocellular carcinoma after immune checkpoint inhibitor treatment. J Hepatol 2024:S0168-8278(24)00216-2. [PMID: 38570034 DOI: 10.1016/j.jhep.2024.03.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND AND AIMS There has been a lack of prospective data on treatment after immune checkpoint inhibitor (ICI) in hepatocellular carcinoma (HCC). We conducted a phase II multicentred study on cabozantinib in HCC after ICI treatment. METHODS This is an investigator-initiated single-arm clinical trial involving academic centres in Hong Kong and Korea. Key eligibility criteria include diagnosis of HCC; refractoriness to prior ICI-based treatment; Child-Pugh A liver function. Maximally two prior lines of therapy were allowed. All patients were commenced cabozantinib at 60mg/day. The primary endpoint was progression-free survival (PFS). RESULTS Total 47 patients were recruited from Oct 2020 to May 2022. The median follow-up was 11.2 months. In the study, 27 and 20 patients received one and two prior therapies. The median PFS was 4.1 months (95%CI:3.3-5.3). The median OS was 9.9 months (95%CI:7.3-14.4), and the 1-year OS rate was 45.3%. Partial response and stable disease occurred in 3 (6.4%) and 36 (76.6%) of patients. When used as a second-line treatment (n=20), cabozantinib was associated with a median PFS and OS of 4.3 (95%CI:3.3-6.7) and 14.3 months (95%CI:8.9-NR). The corresponding median PFS and OS was 4.3 (95%CI:3.3-11.0) and 14.3 months (95%CI:9.0-NR) for those receiving ICI-based regimen with proven benefits (n=17). Commonest grade 3-4 TRAE was thrombocytopenia (6.4%). The median dose of cabozantinib was 40mg/day. The number of prior therapy was an independent prognosticator (one vs. two; HR=0.37; p=0.03). CONCLUSIONS Cabozantinib demonstrates efficacy in patients with prior ICI. The survival data of second-line cabozantinib following the first-line ICI regimen provide reference for clinical trial testing post-ICI therapy. The number of prior line of treatment may be considered a stratification factor in randomized study. IMPACT AND IMPLICATIONS There is a lack of prospective data on systemic therapy following prior immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC). The current phase II clinical trial reported the efficacy and safety data of cabozantinib in patients with prior ICI-based treatment. Exploratory analyses showed that the performance of cabozantinib differed significantly when used as second or third-line treatment. The above data could be used a reference for clinical practice and design of future clinical trials on subsequent treatment following ICIs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04588051.
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Affiliation(s)
- Stephen L Chan
- State Key Laboratory of Translational Oncology; Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Frankie Mo
- Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Landon L Chan
- Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jaekyung Cheon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Leung Li
- Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kwan H Wong
- Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Nicole Yim
- Department of Clinical Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Hyeyeong Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Käsmann L, Degerli E, El-Marouk K, Manapov F. Case report: Incidental MALT lymphoma of the left adrenal gland mimicking a metastatic spread within durvalumab maintenance treatment in inoperable stage III non-small cell lung cancer. Front Oncol 2024; 14:1226422. [PMID: 38567155 PMCID: PMC10985782 DOI: 10.3389/fonc.2024.1226422] [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: 05/21/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Durvalumab after chemotherapy in non-operable stage III non-small cell lung cancer (NSCLC) is the standard of care worldwide. We present a patient with the incidental discovery of a unilateral MALT lymphoma of the adrenal gland and adrenalitis during durvalumab maintenance treatment detected by 18F-FDG-PET/CT. We assessed the clinical and histopathological findings, radiological examinations and overall treatment. Our work emphasizes the significance of considering other differential diagnoses and the importance of multidisciplinary treatment of the findings, especially within clinical trials.
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Affiliation(s)
- Lukas Käsmann
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Partner Site Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Esra Degerli
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Karim El-Marouk
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Private Practise ´Die RADIOLOGIE´, Munich, Germany
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8
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Li DH, Xiong XZ. Immune Checkpoint Inhibitor-Associated Systemic Sclerosis in the Treatment of a Small Cell Lung Cancer Patient with Durvalumab: A Case Report. Clin Cosmet Investig Dermatol 2024; 17:663-669. [PMID: 38524396 PMCID: PMC10959325 DOI: 10.2147/ccid.s451386] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
As one of the key cancer treatment measures, immune-checkpoint inhibitors (ICIs) have revolutionized the treatment landscape of various cancers, including malignancies previously thought to be untreatable. Immune checkpoint inhibitors work by targeting the dysfunctional immune system, to enhance cancer-cell killing by CD8-positive T cells. Despite the beneficial effects of ICIs, these treatments are also linked to a novel class of side effects, termed immune-related adverse events (irAEs). Immune-related adverse events can affect multiple organ systems, such as endocrine, neurological, gastroenteric, dermatologic, ocular, hepatic, renal, and rheumatic ones. While variable in severity, irAEs can be associated with significant morbidity, mortality, cessation of ICI treatment and can be potentially life-threatening sometimes. Among varieties of irAEs, dermatological manifestations are frequently reported, since they can be easily observed. Here, we present a case of a 74-year-old patient with widespread fibrosis of skin, eventually diagnosed as diffuse cutaneous systemic sclerosis after the treatment with durvalumab for small cell lung cancer (SCLC). Prompt recognition and treatment of immune-checkpoint inhibitors-associated systemic sclerosis may help enhance tolerance to ICIs and ensure better performance in treating tumors.
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Affiliation(s)
- De-Hu Li
- Department of Pulmonary and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xian-Zhi Xiong
- Department of Pulmonary and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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9
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Hayne D, Ong K, Swarbrick N, McCombie SP, Moe A, Hawks C, Viswambaram P, Conduit C, Liow E, Spalding L, Lim J, Ferguson T, Meehan K, Davis ID, Redfern AD. The SUB-urothelial DUrvalumab InjEction-1 (SUBDUE-1) trial: first-in-human trial in patients with bladder cancer. BJU Int 2024. [PMID: 38469652 DOI: 10.1111/bju.16325] [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] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To assess the safety of sub-urothelial injection of durvalumab and examine the impact on tissue and circulating immune cell populations. PATIENTS AND METHODS The patients were chemotherapy and immunotherapy naïve (bacille Calmette-Guérin allowed) with non-metastatic muscle-invasive bladder cancer or non-muscle-invasive bladder cancer planned for radical cystectomy (RC). The study was a Phase Ib 3 + 3 dose-escalation design with sub-urothelial injection of durvalumab at three pre-determined doses (25, 75, 150 mg) diluted in 25 mL normal saline, injected at 25 locations (25 × 1 mL injections), at least 2 weeks before RC. RESULTS A total of 11 patients were recruited (10 male, one female). No significant changes were reported on American Urological Association Symptom Score or O'Leary Interstitial Cystitis Scale. In all, 14 adverse events (AEs) were reported (10 Grade 1, three Grade 2, one Grade 3), none considered immune-related. No Grade 4 or 5 AEs were recorded. All the patients underwent RC. Tissue immune populations changed following durvalumab injection (P = 0.012), with a statistically significant increase in M2-macrophage (CD163) when comparing the 25-150 mg dose (P = 0.021). Basal/mixed cancers showed a larger CD163 increase than luminal cancers (P = 0.033). CONCLUSION Sub-urothelial injection of durvalumab is feasible and safe without immune-related AEs and shows local immunological effects.
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Affiliation(s)
- Dickon Hayne
- UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
- South Metropolitan Health Service, Murdoch, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Katherine Ong
- South Metropolitan Health Service, Murdoch, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Nicole Swarbrick
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Steve P McCombie
- UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
- South Metropolitan Health Service, Murdoch, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Andrew Moe
- UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Cynthia Hawks
- UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
- South Metropolitan Health Service, Murdoch, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Pravin Viswambaram
- UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Ciara Conduit
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Elizabeth Liow
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
- Monash Health, Clayton, Victoria, Australia
| | - Lisa Spalding
- Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
- University of Western Australia Centre for Medical Research, Nedlands, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Jayne Lim
- UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Thomas Ferguson
- South Metropolitan Health Service, Murdoch, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Katie Meehan
- UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
- Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Ian D Davis
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
- Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
| | - Andrew D Redfern
- UWA Medical School, University of Western Australia, Crawley, Western Australia, Australia
- South Metropolitan Health Service, Murdoch, Western Australia, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
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10
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Unome S, Imai K, Miwa T, Hanai T, Suetsugu A, Takai K, Suzui N, Miyazaki T, Shimizu M. A Case of Unresectable Combined Hepatocellular-cholangiocarcinoma Treated with Combination Therapy Consisting of Durvalumab Plus Tremelimumab. Intern Med 2024:3071-23. [PMID: 38432964 DOI: 10.2169/internalmedicine.3071-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Combined hepatocellular cholangiocarcinoma is a rare and challenging primary liver malignancy that lacks any established standard treatments for unresectable cases. We herein present the first known case of a 49-year-old woman diagnosed with unresectable combined hepatocellular-cholangiocarcinoma, who underwent novel chemotherapy involving durvalumab plus tremelimumab combination therapy. The treatment was temporarily discontinued owing to immune-related adverse events, such as rash, and the patient was subsequently managed with systemic steroid therapy; however, the disease progressed after two courses of this treatment. Further studies are needed to validate the efficacy and safety of immune checkpoint inhibitors such as durvalumab and tremelimumab for the treatment of unresectable combined hepatocellular cholangiocarcinoma.
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Affiliation(s)
- Shinji Unome
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Japan
| | - Takao Miwa
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Japan
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Japan
| | - Atsushi Suetsugu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Japan
| | | | | | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Japan
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11
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Chamseddine S, LaPelusa M, Xiao L, Mohamed YI, Lee SS, Hu ZI, Hatia RI, Hassan M, Yao JC, Duda DG, Datar S, Amin HM, Kaseb AO. Plasma Growth Hormone as a Prognostic Biomarker to Durvalumab and Tremelimumab in Patients with Advanced Hepatocellular Carcinoma. J Hepatocell Carcinoma 2024; 11:455-461. [PMID: 38463542 PMCID: PMC10921889 DOI: 10.2147/jhc.s452564] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction In this study, we explored the potential of plasma growth hormone (GH) as a prognostic biomarker in patients with advanced HCC treated with durvalumab plus tremelimumab (D+T). Methods In this study, we included 16 patients with advanced HCC who received D+T at MD Anderson Cancer Center between 2022 and 2023 and had plasma GH measurements recorded before treatment. Plasma GH levels were measured from prospectively collected blood samples and were correlated with progression-free survival (PFS) and overall survival (OS). The cutoff for normal GH levels in women and men was defined as ≤3.7 μg/L and ≤0.9 μg/L, respectively. The Kaplan-Meier method was employed to compute the median OS and PFS, while the Log rank test was applied to compare the survival outcomes between the GH-high and GH-low groups. Results Sixteen patients were included in this analysis, two female and fourteen male, with a median age of 65.5 years. At the time of the analysis, the 6-month OS rate was 100% among GH-low patients (6 patients) and 30% among GH-high patients (10 patients). OS was significantly longer in GH-low patients (not evaluable) compared to GH-high patients (3.94 months) (p = 0.030). PFS was also significantly longer in GH-low patients (not evaluable) compared to the GH-high patients (1.87 months) (p = 0.036). Conclusion Plasma GH is a prognostic biomarker in patients with advanced HCC treated with D+T. Given the relatively small patient cohort size, this finding should be further validated in larger randomized clinical trials in advanced HCC patients.
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Affiliation(s)
- Shadi Chamseddine
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael LaPelusa
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yehia I Mohamed
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sunyoung S Lee
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zishuo Ian Hu
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rikita I Hatia
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Manal Hassan
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James C Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dan G Duda
- Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Saumil Datar
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hesham M Amin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Fortuny M, Sanduzzi-Zamparelli M, Reig M. Systemic therapies in hepatocellular carcinoma: A revolution? United European Gastroenterol J 2024; 12:252-260. [PMID: 38267015 PMCID: PMC10954433 DOI: 10.1002/ueg2.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/06/2023] [Indexed: 01/26/2024] Open
Abstract
The evolution in systemic therapies in hepatocellular carcinoma (HCC) signifies a strategy of high-cost, high-gain innovation that originated with sorafenib, despite its limited impact on tumor response. This strategic approach paved the way for the emergence of a second wave of the short-lived competitive advantage, exemplified by the incorporation of atezolizumab plus bevacizumab and tremelimumab plus durvalumab. In the context of safety concerns within the liver cancer domain, the IMBRAVE150 and HIMALAYA trials boldly incorporated bevacizumab and tremelimumab, respectively, demonstrating the continuation of the high-risk, high-reward innovation paradigm. This review delves into the strengths, weaknesses, opportunities, and threats analysis of systemic therapies in the field of HCC.
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Affiliation(s)
- Marta Fortuny
- Barcelona Clinic Liver Cancer (BCLC) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Liver Oncology Unit, Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marco Sanduzzi-Zamparelli
- Barcelona Clinic Liver Cancer (BCLC) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Liver Oncology Unit, Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Maria Reig
- Barcelona Clinic Liver Cancer (BCLC) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Liver Oncology Unit, Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Barcelona University, Barcelona, Spain
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13
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Purcell E, Niu Z, Owen S, Grzesik M, Radomski A, Kaehr A, Onukwugha NE, Winkler HF, Ramnath N, Lawrence T, Jolly S, Nagrath S. Circulating tumor cells reveal early predictors of disease progression in patients with stage III NSCLC undergoing chemoradiation and immunotherapy. Cell Rep 2024; 43:113687. [PMID: 38261515 DOI: 10.1016/j.celrep.2024.113687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/02/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
Circulating tumor cells (CTCs) are early signs of metastasis and can be used to monitor disease progression well before radiological detection by imaging. Using an ultrasensitive graphene oxide microfluidic chip nanotechnology built with graphene oxide sheets, we were able to demonstrate that CTCs can be specifically isolated and molecularly characterized to predict future progression in patients with stage III non-small cell lung cancer (NSCLC). We analyzed CTCs from 26 patients at six time points throughout the treatment course of chemoradiation followed by immune checkpoint inhibitor immunotherapy. We observed that CTCs decreased significantly during treatment, where a larger decrease in CTCs predicted a significantly longer progression-free survival time. Durvalumab-treated patients who have future progression were observed to have sustained higher programmed death ligand 1+ CTCs compared to stable patients. Gene expression profiling revealed phenotypically aggressive CTCs during chemoradiation. By using emerging innovative bioengineering approaches, we successfully show that CTCs are potential biomarkers to monitor and predict patient outcomes in patients with stage III NSCLC.
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Affiliation(s)
- Emma Purcell
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Zeqi Niu
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sarah Owen
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Madeline Grzesik
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Abigail Radomski
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anna Kaehr
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nna-Emeka Onukwugha
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Nithya Ramnath
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Theodore Lawrence
- Michigan Medicine, Department of Radiation Oncology, Ann Arbor, MI 48105, USA; Rogel Cancer Center, Ann Arbor, MI 48105, USA
| | - Shruti Jolly
- Michigan Medicine, Department of Radiation Oncology, Ann Arbor, MI 48105, USA; Rogel Cancer Center, Ann Arbor, MI 48105, USA.
| | - Sunitha Nagrath
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Rogel Cancer Center, Ann Arbor, MI 48105, USA.
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14
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Sangro B, Chan SL, Kelley RK, Lau G, Kudo M, Sukeepaisarnjaroen W, Yarchoan M, De Toni EN, Furuse J, Kang YK, Galle PR, Rimassa L, Heurgué A, Tam VC, Van Dao T, Thungappa SC, Breder V, Ostapenko Y, Reig M, Makowsky M, Paskow MJ, Gupta C, Kurland JF, Negro A, Abou-Alfa GK. Four-year overall survival update from the phase III HIMALAYA study of tremelimumab plus durvalumab in unresectable hepatocellular carcinoma. Ann Oncol 2024:S0923-7534(24)00049-8. [PMID: 38382875 DOI: 10.1016/j.annonc.2024.02.005] [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: 12/22/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND In the phase III HIMALAYA study (NCT03298451) in unresectable hepatocellular carcinoma (uHCC), STRIDE (Single Tremelimumab Regular Interval Durvalumab) significantly improved overall survival (OS) versus sorafenib; durvalumab monotherapy was noninferior to sorafenib for OS. Results reported herein are from a 4-year updated OS analysis of HIMALAYA. PATIENTS AND METHODS Participants with uHCC and no previous systemic treatment were randomized to STRIDE (n = 393), durvalumab (n = 389), or sorafenib (n = 389). The updated data cut-off was 23 January 2023. OS and serious adverse events (AEs) were assessed. Additionally, baseline characteristics and subsequent therapies were analyzed in long-term survivors (≥36 months beyond randomization). RESULTS For STRIDE, durvalumab, and sorafenib, median [95% confidence interval (CI)] follow-up was 49.12 months (46.95-50.17 months), 48.46 months (46.82-49.81 months), and 47.31 months (45.08-49.15 months), respectively. OS hazard ratio (95% CI) for STRIDE versus sorafenib was 0.78 (0.67-0.92). The 36-month OS rate for STRIDE was 30.7% versus 19.8% for sorafenib. The 48-month OS rate remained higher for STRIDE at 25.2%, versus 15.1% for sorafenib. The long-term OS benefit of STRIDE was observed across clinically relevant subgroups and was further improved in participants who achieved disease control. Long-term survivors with STRIDE (n = 103) included participants across clinically relevant subgroups, and 57.3% (59/103) had no reported subsequent anticancer therapy. No new serious treatment-related AEs occurred with STRIDE from the primary analysis (17.5%; 68/388). Durvalumab maintained OS noninferiority to sorafenib and no late-onset safety signals were identified. CONCLUSIONS These data represent the longest follow-up to date in phase III studies in uHCC. The unprecedented 3- and 4-year OS rates reinforce the sustained long-term OS benefit of STRIDE versus sorafenib. STRIDE maintained a tolerable yet differentiated safety profile from other current uHCC therapies. Results continue to support the long-term benefits of STRIDE in a diverse population, reflective of uHCC globally.
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Affiliation(s)
- B Sangro
- Liver Unit and HPB Oncology Area, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain.
| | - S L Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Sir Yue-Kong Pao Center for Cancer, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - R K Kelley
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - G Lau
- Humanity and Health Clinical Trial Center, Humanity and Health Medical Group, Hong Kong SAR, China
| | - M Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - W Sukeepaisarnjaroen
- Department of Medicine, Songklanagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - M Yarchoan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, USA
| | - E N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - J Furuse
- Kanagawa Cancer Center, Yokohama, Japan
| | - Y K Kang
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - P R Galle
- Department of Internal Medicine I, University Medical Center, Mainz, Germany
| | - L Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan; Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Heurgué
- Department of Hepato-Gastroenterology, Robert-Debré Hospital, Reims, France
| | - V C Tam
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Canada
| | - T Van Dao
- Cancer Research and Clinical Trials Center, Department of Optimal Therapy, National Cancer Hospital, Hanoi, Vietnam
| | - S C Thungappa
- Health Care Global Enterprises Ltd, Bangalore, India
| | - V Breder
- N. N. Blokhin Russian Cancer Research Center, Chemotherapy Unit, Moscow, Russia
| | - Y Ostapenko
- Department of Minimally Invasive and Endoscopic Surgery, Interventional Radiology, National Cancer Institute, Kyiv, Ukraine
| | - M Reig
- Barcelona Clinic Liver Cancer (BCLC), Liver Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Makowsky
- Oncology R&D, Late-Stage Development, AstraZeneca, Gaithersburg
| | - M J Paskow
- Global Medical Affairs, AstraZeneca, Gaithersburg
| | - C Gupta
- Oncology Biometrics, Late Oncology Statistics, AstraZeneca, Wilmington
| | - J F Kurland
- Oncology R&D, Late-Stage Development, AstraZeneca, Gaithersburg
| | - A Negro
- Oncology R&D, Late-Stage Development, AstraZeneca, Gaithersburg
| | - G K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, Cornell University, New York; Weill Medical College, Cornell University, New York, USA; Trinity College Dublin, Dublin, Ireland
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15
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Tarafdar N, Sachdeva M, Savinova I, Lytvyn Y, Maliyar K, Georgakopoulos JR, Mufti A, Yeung J. Onset of psoriasis with immune checkpoint inhibitor therapy: A systematic review. J Am Acad Dermatol 2024; 90:392-395. [PMID: 37797837 DOI: 10.1016/j.jaad.2023.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/28/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Nawar Tarafdar
- Western University, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Muskaan Sachdeva
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Iryna Savinova
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Yuliya Lytvyn
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.
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16
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Monge C, Xie C, Myojin Y, Coffman-D'Annibale KL, Hrones D, Brar G, Wang S, Budhu A, Figg WD, Cam M, Finney R, Levy EB, Kleiner DE, Steinberg SM, Wang XW, Redd B, Wood BJ, Greten TF. Combined immune checkpoint inhibition with durvalumab and tremelimumab with and without radiofrequency ablation in patients with advanced biliary tract carcinoma. Cancer Med 2024; 13:e6912. [PMID: 38205877 PMCID: PMC10904979 DOI: 10.1002/cam4.6912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/22/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Current standard of care for advanced biliary tract cancer (BTC) is gemcitabine, cisplatin plus anti-PD1/PD-L1, but response rates are modest. The purpose of this study was to explore the efficacy and safety of durvalumab (anti-PD-L1) and tremelimumab (anti-CTLA-4), with and without an interventional radiology (IR) procedure in advanced BTC. METHODS Eligible patients with advanced BTC who had received or refused at least one prior line of systemic therapy were treated with tremelimumab and durvalumab for four combined doses followed by monthly durvalumab alone with and without an IR procedure until the progression of disease or unacceptable toxicity. Objective response was assessed through CT or MRI by Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1) every 8 weeks. Adverse events (AEs) were recorded and managed. The primary endpoint was 6-month progression-free survival (PFS). RESULTS Twenty-three patients with advanced BTC were enrolled; 17 patients were assigned to treatment with durvalumab and tremelimumab (Durva/Treme); and 6 patients were treated with the combination of durvalumab, tremelimumab plus IR procedure (Durva/Treme + IR). The best clinical responses in the Durva/Treme arm were partial response (n = 1), stable disease (n = 5), progressive disease (n = 5), and in the Durva/Treme + IR arm: partial response (n = 0), stable disease (n = 3), progressive disease (n = 3). The median PFS was 2.2 months (95% CI: 1.3-3.1 months) in the Durva/Treme arm and 2.9 months (95% CI: 1.9-4.7 months) in the Durva/Treme + IR arm (p = 0.27). The median OS was 5.1 months (95% CI: 2.5-6.9 months) in the Durva/Treme arm and 5.8 months (95% CI: 2.9-40.1 months) in the Durva/Treme + IR arm (p = 0.31). The majority of AEs were grades 1-2. CONCLUSION Durva/Treme and Durva/Treme + IR showed similar efficacy. With a manageable safety profile. Larger studies are needed to fully characterize the efficacy of Durva/Treme ± IR in advanced BTC.
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Affiliation(s)
- Cecilia Monge
- Gastrointestinal Malignancies Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Changqing Xie
- Gastrointestinal Malignancies Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yuta Myojin
- Gastrointestinal Malignancies Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kelley L Coffman-D'Annibale
- Gastrointestinal Malignancies Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Donna Hrones
- Gastrointestinal Malignancies Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Gagandeep Brar
- Gastrointestinal Malignancies Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sophie Wang
- Gastrointestinal Malignancies Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anuradha Budhu
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Liver Cancer Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - William D Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Maggie Cam
- Center for Collaborative Bioinformatics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Richard Finney
- Center for Collaborative Bioinformatics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elliot B Levy
- Center for Interventional Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Xin Wei Wang
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Liver Cancer Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bernadette Redd
- Radiology and Imaging Sciences, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bradford J Wood
- Center for Collaborative Bioinformatics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Tim F Greten
- Gastrointestinal Malignancies Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Liver Cancer Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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17
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Trinh JQ, Xiong Y, Smith LM, Abughanimeh O, Marr AS, Ganti AK. Durvalumab Outcomes in Stage III Non-small Cell Lung Cancer: A Single-institution Study. Anticancer Res 2024; 44:605-612. [PMID: 38307589 DOI: 10.21873/anticanres.16849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND/AIM The PACIFIC trial demonstrated improved survival in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with durvalumab following definitive concurrent chemoradiotherapy (CRT). This study sought to explore real-world outcomes with durvalumab consolidation therapy at our institution. PATIENTS AND METHODS We retrospectively identified patients diagnosed with stage III NSCLC at our institution from January 2012 to January 2022. We created two cohorts: one who received durvalumab following definitive CRT and a historical one who did not. Primary outcomes of interest included median progression-free survival (PFS) and overall survival (OS). Additionally, we performed subgroup analysis on the durvalumab cohort to explore the associations between survival and time to durvalumab initiation, PD-L1 expression, and neutrophil-to-lymphocyte ratio (NLR). RESULTS We identified 79 patients with locally advanced NSCLC who were not surgical candidates. Patients treated with durvalumab (n=44) had significantly improved survival compared to the historical cohort (n=35) including a median PFS of 17.4 months versus 8.0 months (p=0.0019) and a median OS of 37.0 months versus 17.0 months (log-rank p-value=0.07, Wilcoxon p-value=0.02). Within the durvalumab group, outcomes did not significantly differ between those who initiated therapy before or after 42 days of finishing CRT, between various PD-L1 expression levels, or between high or low NLR. CONCLUSION Patients who received durvalumab as consolidation therapy following definitive CRT demonstrated significantly improved survival compared to a historical cohort who did not receive durvalumab. Furthermore, durvalumab appears to benefit patients regardless of time to initiation, PD-L1 expression, or NLR.
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Affiliation(s)
- Jonathan Q Trinh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, U.S.A.;
| | - Ying Xiong
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Omar Abughanimeh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, U.S.A
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Alissa S Marr
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, U.S.A
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, U.S.A
| | - Apar K Ganti
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, U.S.A
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, U.S.A
- Department of Internal Medicine, VA Nebraska Western Iowa Health System, Omaha, NE, U.S.A
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18
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Goetze T, Gonzalez-Carmona MA, Kochen L, Agaoglu NB, Al-Batran SE, Habibzada T, Pons M, Brunner M, Ettrich TJ, Köhne CH, Roderburg C, Modest D. ADJUBIL: phase II study of adjuvant immunotherapy with STRIDE regimen with/without capecitabine in biliary tract cancers. Future Oncol 2024; 20:307-315. [PMID: 38410920 DOI: 10.2217/fon-2023-0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Biliary tract cancer is a highly heterogeneous group of gastrointestinal cancers, and the only curative treatment is surgery, which is only applicable at early stages of the malignancy. ADJUBIL, a phase II trial (NCT05239169), aims to evaluate immunotherapy with durvalumab and tremelimumab with or without capecitabine in adjuvant situations for biliary tract cancers. A total of 40 prospective patients will be randomly assigned following surgery, consisting of a two-arm feasibility pilot part with a pick-the-winner design with durvalumab and tremelimumab in combination with or without capecitabine.
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Affiliation(s)
- Thorsten Goetze
- Krankenhaus Nordwest, University Cancer Center Frankfurt, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany
- Frankfurter Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany
| | | | - Lisa Kochen
- Frankfurter Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany
| | - Nihat Bugra Agaoglu
- Frankfurter Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany
| | - Salah-Eddin Al-Batran
- Krankenhaus Nordwest, University Cancer Center Frankfurt, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany
- Frankfurter Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany
| | - Timorshah Habibzada
- Krankenhaus Nordwest, University Cancer Center Frankfurt, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany
| | - Miriam Pons
- Frankfurter Institut für Klinische Krebsforschung IKF GmbH am Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488 Frankfurt, Germany
| | - Marius Brunner
- Universitätsklinikum Göttingen, Robert Koch Straße 40, 37075 Göttingen, Germany
| | - Thomas J Ettrich
- Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Claus-Henning Köhne
- Department of Gynaekology,Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany
| | | | - Dominik Modest
- Department of Hematology, Oncology, and Cancer Immunology (CVK)Charité Berlin, Augustenburger Platz 1 Ostring 1, 13353 Berlin, Germany
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19
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Ying B, Tang T, Zhang LX, Xiong JW, Zhao KF, Li JW, Wu G. Precision therapy for intrahepatic cholangiocarcinoma: A case report on adjuvant treatment in a recurrent patient after surgery and literature review. Oncol Lett 2024; 27:56. [PMID: 38192668 PMCID: PMC10773204 DOI: 10.3892/ol.2023.14189] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/23/2023] [Indexed: 01/10/2024] Open
Abstract
A 37-year-old female patient was diagnosed with intrahepatic cholangiocarcinoma (ICC), with the lesion located in the right lobe of the liver. Despite radical resection, postoperative adjuvant chemotherapy and a combination of adjuvant chemotherapy and immunotherapy, the patient continued to experience multiple instances of intrahepatic tumor metastases. Furthermore, the patient exhibited significant adverse reactions to systemic chemotherapy and had poor treatment tolerance. Guidance from paraffin section fluorescence in situ hybridization gene sequencing was used to select a combination of immunotherapy and targeted therapy treatments with programmed cell death 1 (PD-1)/PD-1 ligand 1 antibody durvalumab and the targeted drug pemigatinib. The patient tolerated the treatment and has continued to survive for 28 months. According to imaging evaluations, the lesions continued to decrease, with some disappearing completely. The tumor marker carbohydrate antigen 19-9 remained normal for >9 weeks during the treatment. This report described the patient's treatment process in detail and briefly reviewed relevant literature on the treatment progress of postoperative patients with ICC.
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Affiliation(s)
- Bao Ying
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Tao Tang
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Li-Xing Zhang
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jian-Wei Xiong
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Kai-Feng Zhao
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jia-Wei Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Guo Wu
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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20
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Ciammella P, Cozzi S, Borghetti P, Galaverni M, Nardone V, Ruggieri MP, Sepulcri M, Scotti V, Bruni A, Zanelli F, Piro R, Tagliavini E, Botti A, Iori F, Alì E, Bennati C, Tiseo M. Redetermination of PD-L1 expression after chemio-radiation in locally advanced PDL1 negative NSCLC patients: retrospective multicentric analysis. Front Oncol 2024; 14:1325249. [PMID: 38357196 PMCID: PMC10866304 DOI: 10.3389/fonc.2024.1325249] [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: 10/20/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Background Chemoradiation therapy (CRT) is the treatment of choice for locally advanced non-small cell lung cancer (LA-NSCLC). Several clinical trials that combine programmed cell death 1 (PD1) axis inhibitors with radiotherapy are in development for patients with LA-NSCLC. However, the effect of CRT on tumor cells programmed cell death ligand-1 (PD-L1) expression is unknown. Methods In this multicentric retrospective study, we analyzed paired NSCLC specimens that had been obtained pre- and post-CRT. PD-L1 expression on tumor cells was studied by immunohistochemistry. The purpose of this study was to evaluate the feasibility, risk of complications, and clinical relevance of performing re-biopsy after CRT in patients with PD-L1 negative LA-NSCLC. Results Overall, 31 patients from 6 centers with PD-L1 negative LA-NSCLC were analyzed. The percentage of tumor cells with PD-L1 expression significantly increased between pre- and post-CRT specimens in 14 patients (45%). Nine patients had unchanged PD-L1 expression after CRT, in five patients the rebiopsy material was insufficient for PD-L1 analysis and in two patients no tumor cells at rebiopsy were found. The post-rebiopsy complication rate was very low (6%). All patients with positive PD-L1 re-biopsy received Durvalumab maintenance after CRT, except one patient who had a long hospitalization for tuberculosis reactivation. Median PFS of patients with unchanged or increased PD-L1 expression was 10 and 16.9 months, respectively. Conclusion CRT administration can induce PD-L1 expression in a considerable fraction of PD-L1 negative patients at baseline, allowing them receiving the maintenance Durvalumab in Europe. Hence, after a definitive CRT, PD-L1 redetermination should be considered in patients with LA-NSCLC PD-L1 negative, to have a better selection of maintenance Durvalumab candidates.
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Affiliation(s)
- Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiation Oncology Department, Centre Lèon Bèrard, Lyon, France
| | - Paolo Borghetti
- Dipartimento di Radioterapia Oncologica, Università e ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marco Galaverni
- Radiation Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Valerio Nardone
- Dipartimento di Medicina di Precisione, Università degli Studi della Campania “L. Vanvitelli, Napoli, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Sepulcri
- Radiation Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Vieri Scotti
- Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessio Bruni
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Francesca Zanelli
- Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Piro
- Pulmonology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Tagliavini
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Bennati
- Department of Hematology-Onco, S Maria delle Croci Hospital, Ravenna, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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21
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Han X, Zhang H, Sun K, Li J, Wu W, Liu K, Yu Z. Durvalumab with or without tremelimumab for patients with recurrent or metastatic squamous cell carcinoma of the head and neck: a systematic review and meta-analysis. Front Immunol 2024; 14:1302840. [PMID: 38299153 PMCID: PMC10827947 DOI: 10.3389/fimmu.2023.1302840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Objective Head and neck squamous cell carcinoma (HNSCC) ranks as the sixth most prevalent cancer worldwide, significantly impacting patients' quality of life. Immune checkpoint inhibitors (ICI) have been employed in the treatment of recurrent/metastatic (R/M)-HNSCC patients. This meta-analysis aims to assess the efficacy and safety of durvalumab monotherapy compared to the combination of durvalumab and tremelimumab in R/M-HNSCC patients. Methods Relevant studies were systematically searched in PubMed, Embase, and Cochrane Library databases. All articles comparing durvalumab monotherapy with the combination with durvalumab and tremelimumab in R/M-HNSCC treatment were included. Additionally, the references of identified studies were screened if necessary. Result A total of 1298 patients from three studies comparing durvalumab with durvalumab and tremelimumab in treating R/M-HNSCC were include in this meta-analysis. Our findings revealed no significant difference in objective response rate (ORR) [odds ratio (OR): 1.15, 95% confidence interval (CI): 0.85 to 1.56, P = 0.36] and disease control rate (DCR) (OR=1.08, 95%CI: 0.86 to 1.37, P = 0.51). Similar outcomes were observed in overall survival (OS), progression-free survival (PFS), and duration of response (DoR). Regarding safety, there was no significant difference in the incidence of treatment-related adverse events (trAEs) between the two groups (OR=1.26, 95%CI: 0.81 to 1.94, P = 0.30). However, patients treated with the combination therapy exhibited a higher incidence of grade 3-4 trAEs (OR=1.93, 95%CI: 1.36 to 2.73, P = 0.0002) and a greater likelihood of discontinuing treatment due to trAEs (OR=2.07, 95%CI: 1.12 to 3.85, P = 0.02). There was no significant difference in the occurrence of severe trAEs leading to death (OR=1.36, 95%CI: 0.47 to 3.96, P = 0.57). Conclusion This meta-analysis suggests that R/M-HNSCC patients receiving the combination of durvalumab and tremelimumab may achieve comparable outcomes in terms of ORR, DCR, OS, PFS, and DoR, without significant differences. However, the combination therapy is associated with a higher incidence of grade 3-4 trAEs and an increased likelihood of treatment discontinuation due to trAEs. These findings highlight the need for cautious consideration of the combination of durvalumab and tremelimumab in R/M-HNSCC patients, which should be further evaluated in high-quality studies.
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Affiliation(s)
- Xiao Han
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haidong Zhang
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kai Sun
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Li
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wanjuan Wu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kai Liu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhenkun Yu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- The Nanjing Medical Key Laboratory of Laryngopharynx and Head and Neck Neoplasm, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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22
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Khreisat A, Bartosek N, Amal T, Dalal B. Durvalumab-Induced Myocarditis and Dilated Cardiomyopathy in a Patient With Non-small Cell Lung Cancer: A Diagnostic Conundrum. Cureus 2024; 16:e51456. [PMID: 38298285 PMCID: PMC10829531 DOI: 10.7759/cureus.51456] [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] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
Immune checkpoint inhibitors have been a therapeutic oncological breakthrough in managing diverse malignancies. We present a 78-year-old male with stage IIIb non-small cell lung cancer (NSCLC) managed by concurrent chemotherapy with carboplatin/pemetrexed and radiotherapy followed by monthly durvalumab injections. He presented to the hospital with shortness of breath and fluid overload after eight months of starting durvalumab. Workup, including laboratory investigations, coronary angiography, and stress myocardial magnetic resonance imaging, increased our suspicion for the diagnosis of durvalumab-induced myocarditis and nonischemic dilated cardiomyopathy. He was managed with aggressive diuresis and pulse dose steroids with an improvement in his symptoms and his cardiac function. This case illustrates an under-reported clinical side effect in the era of advancement in oncological immunotherapy.
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Affiliation(s)
- Ali Khreisat
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
| | | | - Tanya Amal
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
| | - Bhavinkumar Dalal
- Pulmonary Critical Care Medicine, Corewell Health William Beaumont Hospital, Royal Oak, USA
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23
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Vasilakaki S, Vathiotis I, Panagiotou E, Dimakakos E, Gomatou G, Kotteas E. Molecular interactions of antibodies with PD-1/PD-L1 proteins. Immunotherapy 2024; 16:21-28. [PMID: 38054258 DOI: 10.2217/imt-2023-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Aim: To compare the protein-protein interactions of antibodies targeting PD-1 and its ligand (PD-L1) with their targets in an attempt to explain the antibodies' binding affinity. Materials & methods: The structural features of complexes between pembrolizumab, nivolumab, durvalumab, atezolizumab, avelumab and PD-1/PD-L1 are described, with the use of software and based on crystallographic data. Results: Pembrolizumab has more structural features, including the number and type of the bonds and total binding surface area, which could rationalize its different clinical behavior compared with nivolumab. Similarly, protein-protein interactions with PD-L1 differ among durvalumab, atezolizumab and avelumab. Conclusion: Differential protein-protein interactions between antibodies and PD-1/PD-L1 may indicate differential clinical activity; however, further research is needed to provide evidence.
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Affiliation(s)
- Sofia Vasilakaki
- Chemistry Department, National & Kapodistrian University of Athens, Panepistimiopolis, Athens, 15771, Greece
| | - Ioannis Vathiotis
- Oncology Unit, Third Department of Medicine, Sotiria General Hospital, 152 Mesogeion Avenue, Athens, 11527, Greece
| | - Emmanouil Panagiotou
- Oncology Unit, Third Department of Medicine, Sotiria General Hospital, 152 Mesogeion Avenue, Athens, 11527, Greece
| | - Evangelos Dimakakos
- Oncology Unit, Third Department of Medicine, Sotiria General Hospital, 152 Mesogeion Avenue, Athens, 11527, Greece
| | - Georgia Gomatou
- Oncology Unit, Third Department of Medicine, Sotiria General Hospital, 152 Mesogeion Avenue, Athens, 11527, Greece
| | - Elias Kotteas
- Oncology Unit, Third Department of Medicine, Sotiria General Hospital, 152 Mesogeion Avenue, Athens, 11527, Greece
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24
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Firoozi MR, Sadeghi-Mohammadi S, Asadi M, Shekari N, Seyed Nejad F, Alizade-Harakiyan M, Soleimani Z, Zarredar H. Durvalumab and taxane family combination therapy enhances the antitumoral effects for NSCLC: An in vitro study. Cell Biochem Funct 2024; 42:e3919. [PMID: 38269512 DOI: 10.1002/cbf.3919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024]
Abstract
Immunotherapy has lately become the most preferred cancer treatment method, and for non-small cell lung cancer (NSCLC) first-line treatment, there are many immunotherapy options. This study aimed to assess the effectiveness and toxicity of paclitaxel (PTX), docetaxel (DTX) chemotherapy, immune checkpoint inhibitor treatment (durvalumab; DVL), and their combination in NSCLC. A-549 cells were treated with DVL in combination with PTX and DTX (a quarter of the IC50 ) to investigate their anticancer effects on these cells. The MTT assay, wound healing tests, and double-staining with Annexin V/PI were used to assess the cell viability, apoptosis, and migration. The results showed that a combination of 0.35 mg/mL DVL with 6.5 μg/mL PTX and 1.75 μg/mL DTX produced a synergistic effect with CI values of 0.88, 0.37, and 0.81, respectively. Moreover, the PTX + DTX + DVL combination led to a significantly increased apoptotic rate up to 88.70 ± 3.39% in the A549 cell line compared to monotherapy (p < .001). In addition, we found that the combination therapy with these agents increased the expression level of Bax, Cas-3, p53, and Bax/Bcl-2 ratio in all experimental groups. In conclusion, the results suggest that combining anti-PD-L1 antibody therapy with chemotherapy may provide a promising approach to enhance treatment outcomes and be a potentially efficacious strategy for treating NSCLC patients. Further research and clinical investigations are needed to elucidate the underlying molecular mechanisms and validate the therapeutic potential of these compounds in vivo.
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Affiliation(s)
- Mohammad-Reza Firoozi
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Sadeghi-Mohammadi
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Milad Asadi
- Department of Basic Oncology, Health Institute of Ege University, Izmir, Turkey
| | - Najibeh Shekari
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Seyed Nejad
- Department of Radiation Oncology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Alizade-Harakiyan
- Department of Radiation Oncology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Soleimani
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Habib Zarredar
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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25
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Alhusari L, Abdallah M, Al-Madani A, Nwanwene K, Lawrence LM, Pacioles T. A Rare Presentation of Small Bowel Perforation Secondary to Microscopic Metastasis of Non-small Cell Lung Cancer (NSCLC): A Case Report. Cureus 2023; 15:e50383. [PMID: 38213343 PMCID: PMC10782881 DOI: 10.7759/cureus.50383] [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] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Gastrointestinal tract perforation (GITP) due to metastatic lung cancer is an exceptionally rare occurrence. Symptoms can range from mild abdominal discomfort to severe and life-threatening bowel perforation. In this case presentation, we describe an unusual instance involving squamous non-small cell lung cancer (NSCLC), where microscopic metastases in the small bowel led to bowel perforation. Our patient, a 71-year-old male with a history of stage IIIa squamous cell carcinoma in the right lung and smoking history, completed chemoradiation therapy and is currently undergoing treatment with durvalumab. He presented to the ED with complaints of abdominal pain, nausea, and abdominal distention. His review of systems revealed no other significant issues, and his vital signs were stable. However, the abdominal examination revealed noticeable distention with tenderness upon palpation and guarding. Laboratory results were significant for leukocytosis with a left shift of neutrophils and mildly elevated kidney function. A CT scan of the abdomen and pelvis revealed widespread pneumoperitoneum, indicating a bowel perforation. Consequently, the patient underwent an urgent exploratory laparotomy, during which a small bowel perforation measuring 0.6 cm x 0.3 cm in the jejunum was identified, necessitating the resection of the affected bowel segment. Intraoperative esophagogastroduodenoscopy (EGD) showed normal findings. The histopathological examination of the resected bowel revealed clusters of squamous cell carcinoma with a desmoplastic reaction, affecting the submucosal and muscular layers at the site of the defect, with surgical margins free of tumor or inflammation. This finding indicated metastatic disease originating from the known lung squamous cell carcinoma. After the operation, the patient was admitted to the ICU due to septic shock caused by E. coli and Klebsiella peritonitis, requiring intubation and circulatory support with pressors. Ultimately, he was discharged following treatment. This case underscores the rarity of symptomatic bowel perforation from micro-metastasis in squamous NSCLC and emphasizes the need for rigorous assessment and timely surgical intervention. However, it is important to recognize the significant risk of complications and a high mortality rate, leading to a challenging prognosis. As such, individuals with a known history of lung carcinoma who present with abdominal symptoms should undergo comprehensive evaluation to prevent life-threatening complications through early intervention.
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Affiliation(s)
- Leena Alhusari
- Internal Medicine Residency Program, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Mahmoud Abdallah
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Abdallah Al-Madani
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Kemnasom Nwanwene
- Hematology and Medical Oncology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Logan M Lawrence
- Pathology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
- Pathology, Mountain Health Network, Huntington, USA
| | - Toni Pacioles
- Hematology and Oncology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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McCall NS, Janopaul-Naylor JR, McGinnis HS, Kesarwala AH, Tian S, Stokes WA, Shelton JW, Steuer CE, Carlisle JW, Leal TA, Ramalingam SS, Bradley JD, Higgins KA. Safety and efficacy of durvalumab after concurrent chemoradiation in Black patients with locally advanced non-small cell lung cancer. Cancer 2023; 129:3713-3723. [PMID: 37354070 DOI: 10.1002/cncr.34915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/10/2023] [Accepted: 03/02/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The PACIFIC trial established consolidative durvalumab after concurrent chemoradiation as standard-of-care in patients with stage III or unresectable non-small cell lung cancer (NSCLC). Black patients, however, comprised just 2% (n = 14) of randomized patients in this trial, warranting real-world evaluation of the PACIFIC regimen in these patients. METHODS This single-institution, multi-site study included 105 patients with unresectable stage II/III NSCLC treated with concurrent chemoradiation followed by durvalumab between 2017 and 2021. Overall survival (OS), progression-free survival (PFS), and grade ≥3 pneumonitis-free survival (PNFS) were compared between Black and non-Black patients using Kaplan-Meier and Cox regression analyses. RESULTS A total of 105 patients with a median follow-up of 22.8 months (interquartile range, 11.3-37.3 months) were identified for analysis, including 57 Black (54.3%) and 48 (45.7%) non-Black patients. The mean radiation prescription dose was higher among Black patients (61.5 ± 2.9 Gy vs. 60.5 ± 1.9 Gy; p = .031), but other treatment characteristics were balanced between groups. The median OS (not-reached vs. 39.7 months; p = .379) and PFS (31.6 months vs. 19.3 months; p = .332) were not statistically different between groups. Eight (14.0%) Black patients discontinued durvalumab due to toxicity compared to 13 (27.1%) non-Black patients (p = .096). The grade ≥3 pneumonitis rate was similar between Black and non-Black patients (12.3% vs. 12.5%; p = .973), and there was no significant difference in time to grade ≥3 PNFS (p = .904). Three (5.3%) Black patients and one (2.1%) non-Black patient developed grade 5 pneumonitis. CONCLUSIONS The efficacy and tolerability of consolidative durvalumab after chemoradiation appears to be comparable between Black and non-Black patients.
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Affiliation(s)
- Neal S McCall
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - James R Janopaul-Naylor
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - H Scott McGinnis
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Aparna H Kesarwala
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - William A Stokes
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Joseph W Shelton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Jennifer W Carlisle
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Ticiana A Leal
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Jeffrey D Bradley
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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27
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Abou-Alfa GK, Lau G, Kudo M, Chan SL, Kelley RK, Furuse J, Sukeepaisarnjaroen W, Kang YK, Dao TV, De Toni EN, Rimassa L, Breder V, Vasilyev A, Heurgué A, Tam VC, Mody K, Thungappa SC, Ostapenko Y, Yau T, Azevedo S, Varela M, Cheng AL, Qin S, Galle PR, Ali S, Gupta C, Makowsky M, Kurland JF, Negro A, Sangro B. Plain language summary of the HIMALAYA study: tremelimumab and durvalumab for unresectable hepatocellular carcinoma (liver cancer). Future Oncol 2023; 19:2505-2516. [PMID: 37671641 DOI: 10.2217/fon-2023-0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary of results from a phase 3 clinical study called HIMALAYA. HIMALAYA looked at treatment with one dose of a medication called tremelimumab combined with multiple doses of a medication called durvalumab (the STRIDE regimen) or multiple doses of durvalumab alone. These treatments were compared with a medication called sorafenib in participants with unresectable hepatocellular carcinoma (HCC). HCC is a type of liver cancer that is difficult to treat because it is often diagnosed when it is unresectable, meaning it can no longer be removed with surgery. Sorafenib has been the main treatment for unresectable HCC since 2007. However, people who take sorafenib may experience side effects that can reduce their quality of life, so alternative medicines are being trialed. Tremelimumab and durvalumab are types of drugs called immunotherapies, and they both work in different ways to help the body's immune system fight cancer. WHAT WERE THE RESULTS OF THE STUDY? Participants who took STRIDE lived longer than participants who took sorafenib, whilst participants who took durvalumab alone lived a similar length of time as participants who took sorafenib. Participants who took STRIDE or durvalumab had a lower relative risk of experiencing worsening in their quality of life than participants who took sorafenib. The side effects that participants who received STRIDE or durvalumab experienced were expected for these types of treatments and could mostly be managed. WHAT DO THE RESULTS OF THE STUDY MEAN? Overall, STRIDE is more effective than sorafenib for people with unresectable HCC.
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Affiliation(s)
- Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Medical College, Cornell University, New York, NY, USA
| | - George Lau
- Humanity & Health Clinical Trial Center, Humanity & Health Medical Group, Hong Kong SAR, China
| | - Masatoshi Kudo
- Department of Gastroenterology & Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Stephen L Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Sir Yue-Kong Pao Center for Cancer, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Robin Kate Kelley
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | | | | | - Yoon Koo Kang
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Tu Van Dao
- Cancer Research & Clinical Trials Center, Department of Optimal Therapy, National Cancer Hospital, Hanoi, Vietnam
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valeriy Breder
- Chemotherapy Department №17, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Alexander Vasilyev
- Department of Oncology, Railway Clinical Hospital, St. Petersburg, Russia
| | - Alexandra Heurgué
- Department of HepatoGastroenterology, Robert-Debré Hospital, Reims, France
| | - Vincent C Tam
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Kabir Mody
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Yurii Ostapenko
- Department of Minimally Invasive & Endoscopic Surgery, Interventional Radiology, National Cancer Institute, Kiev, Ukraine
| | - Thomas Yau
- Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
| | - Sergio Azevedo
- UPCO-Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - María Varela
- Liver Unit, Hospital Universitario Central de Asturias, Universidad de Oviedo, IUOPA, ISPA, FINBA, Oviedo, Spain
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center & National Taiwan University Hospital, Taipei, Taiwan
| | - Shukui Qin
- PLA Cancer Center, Nanjing Bayi Hospital, Nanjing, China
| | | | | | | | | | | | | | - Bruno Sangro
- Liver Unit & HPB Oncology Area, Clínica Universidad de Navarra & CIBEREHD, Pamplona, Spain
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Patel SA, Gibson MK, Deal A, Sheth S, Heiling H, Johnson SM, Douglas K, Flores M, Blumberg J, Lumley C, Yarbrough WG, Shen C, Chera BS, Bauman JR, Hackman T, Weiss J. A phase 2 study of neoadjuvant chemotherapy plus durvalumab in resectable locally advanced head and neck squamous cell carcinoma. Cancer 2023; 129:3381-3389. [PMID: 37395170 DOI: 10.1002/cncr.34930] [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: 01/19/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Patients with locally advanced head and neck squamous cell cancer (HNSCC) are treated with surgery followed by adjuvant (chemo) radiotherapy or definitive chemoradiation, but recurrence rates are high. Immune checkpoint blockade improves survival in patients with recurrent/metastatic HNSCC; however, the role of chemo-immunotherapy in the curative setting is not established. METHODS This phase 2, single-arm, multicenter study evaluated neoadjuvant chemo-immunotherapy with carboplatin, nab-paclitaxel, and durvalumab in patients with resectable locally advanced HNSCC. The primary end point was a hypothesized pathologic complete response rate of 50%. After chemo-immunotherapy and surgical resection, patients received study-defined, pathologic risk adapted adjuvant therapy consisting of either durvalumab alone (low risk), involved field radiation plus weekly cisplatin and durvalumab (intermediate risk), or standard chemoradiation plus durvalumab (high risk). RESULTS Between December 2017 and November 2021, 39 subjects were enrolled at three centers. Oral cavity was the most common primary site (69%). A total of 35 of 39 subjects underwent planned surgical resection; one subject had a delay in surgery due to treatment-related toxicity. The most common treatment-related adverse events were cytopenias, fatigue, and nausea. Post treatment imaging demonstrated an objective response rate of 57%. Pathologic complete response and major pathologic response were achieved in 29% and 49% of subjects who underwent planned surgery, respectively. The 1-year progression-free survival was 83.8% (95% confidence interval, 67.4%-92.4%). CONCLUSIONS Neoadjuvant carboplatin, nab-paclitaxel, and durvalumab before surgical resection of HNSCC were safe and feasible. Although the primary end point was not met, encouraging rates of pathologic complete response and clinical to pathologic downstaging were observed.
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Affiliation(s)
- Shetal A Patel
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael K Gibson
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center and the Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Allison Deal
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Siddharth Sheth
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hillary Heiling
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven M Johnson
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathe Douglas
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Flores
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey Blumberg
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine Lumley
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wendell G Yarbrough
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Colette Shen
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bhishamjit S Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica R Bauman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Trevor Hackman
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jared Weiss
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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29
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Oh DY, He AR, Qin S, Chen LT, Okusaka T, Vogel A, Kim JW, Suksombooncharoen T, Lee MA, Kitano M, Burris H, Bouattour M, Tanasanvimon S, McNamara MG, Zaucha R, Avallone A, Tan B, Cundom J, Lee CK, Takahashi H, Ikeda M, Chen JS, Wang J, Makowsky M, Rokutanda N, Żotkiewicz M, Kurland JF, Cohen G, Valle JW. Plain language summary of the TOPAZ-1 study: durvalumab and chemotherapy for advanced biliary tract cancer. Future Oncol 2023; 19:2277-2289. [PMID: 37746835 DOI: 10.2217/fon-2023-0468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary describing the results of a Phase III study called TOPAZ-1. The study looked at treatment with durvalumab (a type of immunotherapy) and chemotherapy to treat participants with advanced biliary tract cancer (BTC). Advanced BTC is usually diagnosed at late stages of disease, when it cannot be cured by surgery. This study included participants with advanced BTC who had not received previous treatment, or had their cancer come back at least 6 months after receiving treatment or surgery that aimed to cure their disease. Participants received treatment with durvalumab and chemotherapy or placebo and chemotherapy. The aim of this study was to find out if treatment with durvalumab and chemotherapy could increase the length of time that participants with advanced BTC lived, compared with placebo and chemotherapy. WHAT WERE THE RESULTS OF THE STUDY? Participants who took durvalumab and chemotherapy had a 20% lower chance of experiencing death at any point in the study compared with participants who received placebo and chemotherapy. The side effects experienced by participants were similar across treatment groups, and less than 12% of participants in either treatment group had to stop treatment due to treatment-related side effects. WHAT DO THE RESULTS OF THE STUDY MEAN? Overall, these results support durvalumab and chemotherapy as a new treatment option for people with advanced BTCs. Based on the results of this study, durvalumab is now approved for the treatment of adults with advanced BTCs in combination with chemotherapy by government organizations in Europe, the United States and several other countries.
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Affiliation(s)
- Do-Youn Oh
- Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Aiwu Ruth He
- Division of Hematology & Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Shukui Qin
- Cancer Center of Nanjing, Jinling Hospital, Nanjing, China
| | - Li-Tzong Chen
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, & National Institute of Cancer Research, Tainan, & National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Takuji Okusaka
- Department of Hepatobiliary & Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Arndt Vogel
- Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jin Won Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | | | - Myung Ah Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University, Seoul, South Korea
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Howard Burris
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN, USA
| | - Mohamed Bouattour
- Department of Liver Cancer Unit, AP-HP Hopital Beaujon, Paris, France
| | - Suebpong Tanasanvimon
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Mairead G McNamara
- Division of Cancer Sciences, The University of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | - Renata Zaucha
- Department of Oncology & Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Antonio Avallone
- Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale, Naples, Italy
| | - Benjamin Tan
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Juan Cundom
- Instituto de Investigaciones Metabolicas, Buenos Aires, Argentina
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary & Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Jen-Shi Chen
- Department of Hematology-Oncology, Linkou Chang-Gung MemorialHospital & Chang-Gung University, Tao-yuan City, Taiwan
| | | | | | | | | | | | | | - Juan W Valle
- Division of Cancer Sciences, The University of Manchester/The Christie NHS Foundation Trust, Manchester, UK
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30
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Lim K, Abegesah A, Fan C, He JZ, Song X, Chen C, Negro A, Makowsky M, Gupta C, Ren S, Phipps A, Gibbs M, Zhou D. Population Pharmacokinetics and Exposure-Response Analysis of Tremelimumab 300 mg Single Dose Combined with Durvalumab 1500 mg Q4W (STRIDE) in Patients with Unresectable Hepatocellular Carcinoma. J Clin Pharmacol 2023; 63:1221-1231. [PMID: 37300457 DOI: 10.1002/jcph.2288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/31/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
A novel single-dose regimen of 300 mg tremelimumab in combination with durvalumab (STRIDE) has demonstrated a favorable benefit-risk profile in the phase 1/2 Study 22 trial (in patients with unresectable hepatocellular carcinoma, uHCC) and in the phase 3 HIMALAYA study. The current analysis evaluated the population pharmacokinetics (PopPK) of tremelimumab and durvalumab, and the exposure-response (ER) relationship for efficacy and safety of STRIDE in patients with uHCC. Previous PopPK models for tremelimumab and durvalumab were updated using data from previous studies in various cancers combined with data from Study 22 and HIMALAYA. Typical population mean parameters and associated inter- and intra-individual variability were assessed, as was the influence of covariates. Individual exposure metrics were derived from the individual empirical Bayes estimates as drivers for ER analysis related to efficacy and safety from HIMALAYA. The observed pharmacokinetics of tremelimumab in uHCC were well described by a 2-compartment model with both linear and time-dependent clearance. All identified covariates changed tremelimumab PK parameters by <25%, and thus had minimal clinical relevance; similar results were obtained from durvalumab PopPK analysis. None of tremelimumab or durvalumab exposure metrics were significantly associated with overall survival (OS), progression-free survival (PFS), or adverse events. Baseline aspartate aminotransferase and neutrophil-to-lymphocyte ratio (NLR) were associated with OS (P < .001) by the Cox proportional hazards model. No covariate was identified as a significant factor for PFS. No dose adjustment for tremelimumab or durvalumab is needed based on PopPK covariate analyses or ER analyses. Our findings support the novel STRIDE dosing regimen in patients with uHCC.
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Affiliation(s)
- KyoungSoo Lim
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Aburough Abegesah
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Chunling Fan
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Jimmy Zhijian He
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Xuyang Song
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Cecil Chen
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, South San Francisco, CA, USA
| | - Alejandra Negro
- Clinical Development, Oncology R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Mallory Makowsky
- Clinical Development, Oncology R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Charu Gupta
- Oncology Biometrics, Oncology R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Song Ren
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Alex Phipps
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Megan Gibbs
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Waltham, MA, USA
| | - Diansong Zhou
- Clinical Pharmacology & Quantitative Pharmacology, BioPharmaceuticals R&D, AstraZeneca, Waltham, MA, USA
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31
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Moss TT, Stavem K, Aandahl A, Gløersen AS, Grønberg BH, Neumann K, Vedeler CA, Lundqvist C. Case Report: Limbic encephalitis following treatment with durvalumab for small-cell lung cancer. Front Immunol 2023; 14:1278761. [PMID: 37908347 PMCID: PMC10613972 DOI: 10.3389/fimmu.2023.1278761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Background Durvalumab is an immune checkpoint Inhibitor (ICIs) that is used in the treatment of malignant tumors, such as lung cancer and melanoma. ICIs are associated with immune-related adverse events including autoimmune encephalitis, although both paraneoplastic phenomena and ICI treatment may lead to autoimmunity. Case presentation We describe a 72-year old male patient with small-cell lung cancer, who during adjuvant treatment with Durvalumab developed GABABR1 and GAD65 antibodies and both diabetes and autoimmune limbic encephalitis. Because he was followed prospectively as part of a treatment study, we had access to repeated serum samples and cognitive assessments over time prior to developing encephalitis and diabetes, in addition to later assessments. A high titer of GABABR1 antibodies appeared early, while GAD65 antibodies appeared later with a lower titer in parallel with the development of diabetes. As he subsequently developed clinical signs of encephalitis, verified by EEG and brain MRI, he also had CSF GABABR1 antibodies. Durvalumab was discontinued and steroid treatment with subsequent plasmapheresis were started, resulting in reduction of both CSF and serum antibody levels. Clinical signs of encephalitis gradually improved. Conclusion This case illustrates the importance of being aware of possible serious autoimmune adverse reactions, including neurological syndromes such as encephalitis, when treating patients with high risk of para-neoplasia with ICIs. In addition, the case shows the development of autoantibodies over time.
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Affiliation(s)
- Thomas T. Moss
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Astrid Aandahl
- Department of Immunology and Transfusion Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Anne S. Gløersen
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
| | - Bjørn H. Grønberg
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Oncology, St. Olavs Hospital, Trondheim, Norway
| | - Kirill Neumann
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
| | - Christian A. Vedeler
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christofer Lundqvist
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Torasawa M, Horinouchi H, Yagishita S, Utsumi H, Okuda K, Takekoshi D, Ito S, Wakui H, Murata S, Kaku S, Okuma K, Matsumoto Y, Shinno Y, Okuma Y, Yoshida T, Goto Y, Yamamoto N, Araya J, Ohe Y, Fujita Y. Exploratory analysis to predict pneumonitis during durvalumab consolidation therapy for patients with locally advanced non-small cell lung cancer from proteomic profiling of circulating extracellular vesicles. Thorac Cancer 2023; 14:2909-2923. [PMID: 37614219 PMCID: PMC10569905 DOI: 10.1111/1759-7714.15077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Risk factors for predicting pneumonitis during durvalumab consolidation after chemoradiotherapy (CRT) in locally advanced non-small cell lung cancer (LA-NSCLC) are still lacking. Extracellular vesicles (EVs) play a crucial role in intercellular communication and are potential diagnostic tools for various diseases. METHODS We retrospectively collected predurvalumab treatment serum samples from patients treated with durvalumab for LA-NSCLC, isolated EVs using anti-CD9 and anti-CD63 antibodies, and performed proteomic analyses. We examined EV proteins that could predict the development of symptomatic pneumonitis (SP) during durvalumab treatment. Potential EV-protein biomarkers were validated in an independent cohort. RESULTS In the discovery cohort, 73 patients were included, 49 with asymptomatic pneumonitis (AP) and 24 with SP. Of the 5797 proteins detected in circulating EVs, 33 were significantly elevated (fold change [FC] > 1.5, p < 0.05) in the SP group, indicating enrichment of the nuclear factor kappa B (NF-κB) pathway. Patients with high levels of EV-RELA, an NF-κB subunit, had a higher incidence of SP than those with low levels of EV-RELA (53.8% vs. 13.4%, p = 0.0017). In the receiver operating characteristic analysis, EV-RELA demonstrated a higher area under the curve (AUC) than lung V20 (0.76 vs. 0.62) and was identified as an independent risk factor in the multivariate logistic regression analysis (p = 0.008, odds ratio 7.72). Moreover, high EV-RELA was also a predictor of SP in the validation cohort comprising 43 patients (AUC of 0.80). CONCLUSIONS Circulating EV-RELA may be a predictive marker for symptomatic pneumonitis in patients with LA-NSCLC treated with durvalumab.
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Affiliation(s)
- Masahiro Torasawa
- Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | | | - Shigehiro Yagishita
- Division of Molecular PharmacologyNational Cancer Center Research InstituteTokyoJapan
| | - Hirofumi Utsumi
- Division of Respiratory Diseases, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Keitaro Okuda
- Division of Respiratory Diseases, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Daisuke Takekoshi
- Division of Respiratory Diseases, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Saburo Ito
- Division of Respiratory Diseases, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Hiroshi Wakui
- Division of Respiratory Diseases, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Saori Murata
- Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
| | - Sawako Kaku
- Department of Diagnostic RadiologyNational Cancer Center HospitalTokyoJapan
| | - Kae Okuma
- Department of Radiation OncologyNational Cancer Center HospitalTokyoJapan
| | - Yuji Matsumoto
- Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
| | - Yuki Shinno
- Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
| | - Yusuke Okuma
- Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
| | - Tatsuya Yoshida
- Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
- Department of Experimental TherapeuticsNational Cancer Center HospitalTokyoJapan
| | - Yasushi Goto
- Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
| | - Noboru Yamamoto
- Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
- Department of Experimental TherapeuticsNational Cancer Center HospitalTokyoJapan
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yuichiro Ohe
- Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
| | - Yu Fujita
- Division of Respiratory Diseases, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
- Division of Next‐Generation Drug Development Research, Research Center for Medical SciencesThe Jikei University School of MedicineTokyoJapan
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Grassi E, Zingaretti C, Petracci E, Corbelli J, Papiani G, Banchelli I, Valli I, Frassineti GL, Passardi A, Di Bartolomeo M, Pietrantonio F, Gelsomino F, Carandina I, Banzi M, Martella L, Bonetti AV, Boccaccino A, Molinari C, Marisi G, Ugolini G, Nanni O, Tamberi S. Phase II study of capecitabine-based concomitant chemoradiation followed by durvalumab as a neoadjuvant strategy in locally advanced rectal cancer: the PANDORA trial. ESMO Open 2023; 8:101824. [PMID: 37774508 PMCID: PMC10594026 DOI: 10.1016/j.esmoop.2023.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND This study investigated the efficacy of chemoradiotherapy (CRT) followed by durvalumab as neoadjuvant therapy of locally advanced rectal cancer. PATIENTS AND METHODS The PANDORA trial is a prospective, phase II, open-label, single-arm, multicenter study aimed at evaluating the efficacy and safety of preoperative treatment with durvalumab (1500 mg every 4 weeks for three administrations) following long-course radiotherapy (RT) plus concomitant capecitabine (5040 cGy RT in 25-28 fractions over 5 weeks and capecitabine administered at 825 mg/m2 twice daily). The primary endpoint was the pathological complete response (pCR) rate; secondary endpoints were the proportion of clinical complete remissions and safety. The sample size was estimated assuming a null pCR proportion of 0.15 and an alternative pCR proportion of 0.30 (α = 0.05, power = 0.80). The proposed treatment could be considered promising if ≥13 pCRs were observed in 55 patients (EudraCT: 2018-004758-39; NCT04083365). RESULTS Between November 2019 and August 2021, 60 patients were accrued, of which 55 were assessable for the study's objectives. Two patients experienced disease progression during treatment. Nineteen out of 55 eligible patients achieved a pCR (34.5%, 95% confidence interval 22.2% to 48.6%). Regarding toxicity related to durvalumab, grade 3 adverse events (AEs) occurred in four patients (7.3%) (diarrhea, skin toxicity, transaminase increase, lipase increase, and pancolitis). Grade 4 toxicity was not observed. In 20 patients (36.4%), grade 1-2 AEs related to durvalumab were observed. The most common were endocrine toxicity (hyper/hypothyroidism), dermatologic toxicity (skin rash), and gastrointestinal toxicity (transaminase increase, nausea, diarrhea, constipation). CONCLUSION This study met its primary endpoint showing that CRT followed by durvalumab could increase pCR with a safe toxicity profile. This combination is a promising, feasible strategy worthy of further investigation.
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Affiliation(s)
- E Grassi
- Medical Oncology Unit, "Degli Infermi" Hospital, AUSL della Romagna, Faenza
| | - C Zingaretti
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - E Petracci
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - J Corbelli
- Medical Oncology Unit, "Degli Infermi" Hospital, AUSL della Romagna, Faenza
| | - G Papiani
- Medical Oncology Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna
| | - I Banchelli
- Pathology Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna
| | - I Valli
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - G L Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - A Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - M Di Bartolomeo
- Gastroenterological Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - F Pietrantonio
- Gastroenterological Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - F Gelsomino
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, Modena
| | - I Carandina
- Department of Medical Oncology, "Sant'Anna" University Hospital of Ferrara, Ferrara
| | - M Banzi
- Medical Oncology Unit, "Santa Maria Nuova" Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia
| | - L Martella
- Department of Medical Oncology, "Sant'Anna" University Hospital of Ferrara, Ferrara
| | - A V Bonetti
- Department of Medical Oncology, "Mater Salutis" Hospital, Legnago
| | - A Boccaccino
- Medical Oncology Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna
| | - C Molinari
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - G Marisi
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - G Ugolini
- General Surgery Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna, Italy
| | - O Nanni
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - S Tamberi
- Medical Oncology Unit, "Degli Infermi" Hospital, AUSL della Romagna, Faenza; Medical Oncology Unit, "Santa Maria delle Croci" Hospital, AUSL della Romagna, Ravenna.
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Mikami E, Nakamichi S, Nagano A, Misawa K, Hayashi A, Tozuka T, Takano N, Noro R, Maebayashi K, Kubokura H, Terasaki Y, Kubota K, Seike M. Successful Treatment with Definitive Concurrent Chemoradiotherapy Followed by Durvalumab Maintenance Therapy in a Patient with Tracheal Adenoid Cystic Carcinoma. Intern Med 2023; 62:2731-2735. [PMID: 36642523 PMCID: PMC10569923 DOI: 10.2169/internalmedicine.1142-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/04/2022] [Indexed: 01/15/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare type of malignant tracheal tumor originating from the secretory glands. Complete surgical resection is the current standard of care for tracheal ACC. However, there have been few case reports of chemoradiotherapy for unresectable tracheal ACC. We herein report a 28-year-old man with unresectable tracheal ACC who received concurrent chemoradiotherapy (CCRT) followed by maintenance therapy with durvalumab. CCRT was completed with a good response and safety, and the patient is currently receiving durvalumab as maintenance therapy. Durvalumab after CCRT can be a treatment option for patients with unresectable tracheal ACC.
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Affiliation(s)
- Erika Mikami
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Atsuhiro Nagano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazuhito Misawa
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Anna Hayashi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takehiro Tozuka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Natsuki Takano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Rintaro Noro
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Katsuya Maebayashi
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Hirotoshi Kubokura
- Department of Thoracic Surgery, Graduate School of Medicine, Nippon Medical School Musashikosugi Hospital, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Japan
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Moore AM, Nooruddin Z, Reveles KR, Datta P, Whitehead JM, Franklin K, Alkadimi M, Williams MH, Williams RA, Smith S, Reichelderfer R, Cotarla I, Brannman L, Frankart A, Mulrooney T, Hsieh K, Simmons DJ, Jones X, Frei CR. Durvalumab Treatment Patterns for Patients with Unresectable Stage III Non-Small Cell Lung Cancer in the Veterans Health Administration (VHA): A Nationwide, Real-World Study. Curr Oncol 2023; 30:8411-8423. [PMID: 37754526 PMCID: PMC10529719 DOI: 10.3390/curroncol30090611] [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: 08/22/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Durvalumab is approved for the treatment of adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This real-world study describes patient characteristics and durvalumab treatment patterns (number of doses and therapy duration; treatment initiation delays, interruptions, discontinuations, and associated reasons) among VHA-treated patients. METHODS This was a retrospective cohort study of adults with unresectable stage III NSCLC receiving durvalumab at the VHA between 1 January 2017 and 30 June 2020. Patient characteristics and treatment patterns were presented descriptively. RESULTS A total of 935 patients were included (median age: 69 years; 95% males; 21% Blacks; 46% current smokers; 16% ECOG performance scores ≥ 2; 50% squamous histology). Durvalumab initiation was delayed in 39% of patients (n = 367). Among the 200 patients with recorded reasons, delays were mainly due to physician preference (20%) and CRT toxicity (11%). Overall, patients received a median (interquartile range) of 16 (7-24) doses of durvalumab over 9.0 (2.9-11.8) months. Treatment interruptions were experienced by 19% of patients (n = 180), with toxicity (7.8%) and social reasons (2.6%) being the most cited reasons. Early discontinuation occurred in 59% of patients (n = 551), largely due to disease progression (24.2%) and toxicity (18.2%). CONCLUSIONS These real-world analyses corroborate PACIFIC study results in terms of the main reasons for treatment discontinuation in a VHA population with worse prognostic factors, including older age, predominantly male sex, and poorer performance score. One of the main reasons for durvalumab initiation delays, treatment interruptions, or discontinuations was due to toxicities. Patients could benefit from improved strategies to prevent, identify, and manage CRT and durvalumab toxicities timely and effectively.
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Affiliation(s)
- Amanda M. Moore
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA; (A.M.M.); (K.R.R.); (X.J.)
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.N.); (P.D.); (J.M.W.); (K.F.); (M.A.); (S.S.)
| | - Zohra Nooruddin
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.N.); (P.D.); (J.M.W.); (K.F.); (M.A.); (S.S.)
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
| | - Kelly R. Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA; (A.M.M.); (K.R.R.); (X.J.)
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.N.); (P.D.); (J.M.W.); (K.F.); (M.A.); (S.S.)
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
| | - Paromita Datta
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.N.); (P.D.); (J.M.W.); (K.F.); (M.A.); (S.S.)
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
| | - Jennifer M. Whitehead
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.N.); (P.D.); (J.M.W.); (K.F.); (M.A.); (S.S.)
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
| | - Kathleen Franklin
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.N.); (P.D.); (J.M.W.); (K.F.); (M.A.); (S.S.)
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
| | - Munaf Alkadimi
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.N.); (P.D.); (J.M.W.); (K.F.); (M.A.); (S.S.)
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
| | | | - Ryan A. Williams
- MD Anderson Cancer Center, Houston, TX 77030, USA; (M.H.W.); (R.A.W.)
| | - Sarah Smith
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.N.); (P.D.); (J.M.W.); (K.F.); (M.A.); (S.S.)
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
| | - Renee Reichelderfer
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
| | - Ion Cotarla
- AstraZeneca US Medical Affairs, Gaithersburg, MD 20878, USA; (I.C.); (T.M.); (K.H.); (D.J.S.)
| | - Lance Brannman
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA;
| | - Andrew Frankart
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Tiernan Mulrooney
- AstraZeneca US Medical Affairs, Gaithersburg, MD 20878, USA; (I.C.); (T.M.); (K.H.); (D.J.S.)
| | - Kristin Hsieh
- AstraZeneca US Medical Affairs, Gaithersburg, MD 20878, USA; (I.C.); (T.M.); (K.H.); (D.J.S.)
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Daniel J. Simmons
- AstraZeneca US Medical Affairs, Gaithersburg, MD 20878, USA; (I.C.); (T.M.); (K.H.); (D.J.S.)
| | - Xavier Jones
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA; (A.M.M.); (K.R.R.); (X.J.)
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
| | - Christopher R. Frei
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA; (A.M.M.); (K.R.R.); (X.J.)
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA; (Z.N.); (P.D.); (J.M.W.); (K.F.); (M.A.); (S.S.)
- Audie L. Murphy Veterans Hospital, South Texas Veterans Health Care System, San Antonio, TX 78229, USA;
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Moore AM, Nooruddin Z, Reveles KR, Koeller JM, Whitehead JM, Franklin K, Datta P, Alkadimi M, Brannman L, Cotarla I, Frankart AJ, Mulrooney T, Jones X, Frei CR. Health Equity in Patients Receiving Durvalumab for Unresectable Stage III Non-Small Cell Lung Cancer in the US Veterans Health Administration. Oncologist 2023; 28:804-811. [PMID: 37335901 PMCID: PMC10485300 DOI: 10.1093/oncolo/oyad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Real-world evidence is limited regarding the relationship between race and use of durvalumab, an immunotherapy approved for use in adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This study aimed to evaluate if durvalumab treatment patterns differed by race in patients with unresectable stage III NSCLC in a Veterans Health Administration (VHA) population. MATERIALS AND METHODS This was a retrospective analysis of White and Black adults with unresectable stage III NSCLC treated with durvalumab presenting to any VHA facility in the US from January 1, 2017, to June 30, 2020. Data captured included baseline characteristics and durvalumab treatment patterns, including treatment initiation delay (TID), interruption (TI), and discontinuation (TD); defined as CRT completion to durvalumab initiation greater than 42 days, greater than 28 days between durvalumab infusions, and more than 28 days from the last durvalumab dose with no new durvalumab restarts, respectively. The number of doses, duration of therapy, and adverse events were also collected. RESULTS A total of 924 patients were included in this study (White = 726; Black = 198). Race was not a significant factor in a multivariate logistic regression model for TID (OR, 1.39; 95% CI, 0.81-2.37), TI (OR, 1.58; 95% CI, 0.90-2.76), or TD (OR, 0.84; 95% CI, 0.50-1.38). There were also no significant differences in median (interquartile range [IQR]) number of doses (White: 15 [7-24], Black: 18 [7-25]; P = .25) or median (IQR) duration of therapy (White: 8.7 months [2.9-11.8], Black: 9.8 months [3.6-12.0]; P = .08), although Black patients were less likely to experience an immune-related adverse event (28% vs. 36%, P = .03) and less likely to experience pneumonitis (7% vs. 14%, P < .01). CONCLUSION Race was not found to be linked with TID, TI, or TD in this real-world study of patients with unresectable stage III NSCLC treated with durvalumab at the VHA.
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Affiliation(s)
- Amanda M Moore
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Zohra Nooruddin
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Kelly R Reveles
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jim M Koeller
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jennifer M Whitehead
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Kathleen Franklin
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Paromita Datta
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Munaf Alkadimi
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Lance Brannman
- Oncology Business Unit, Global Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA
| | - Ion Cotarla
- Oncology Business Unit, US Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA
| | - Andrew J Frankart
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Tiernan Mulrooney
- Oncology Business Unit, US Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, MD, USA
| | - Xavier Jones
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Christopher R Frei
- Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA
- Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Research Service, Audie L. Murphy Memorial Veterans Hospital Division, South Texas Veterans Health Care System, San Antonio, TX, USA
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Carloni R, Sabbioni S, Rizzo A, Ricci AD, Palloni A, Petrarota C, Cusmai A, Tavolari S, Gadaleta-Caldarola G, Brandi G. Immune-Based Combination Therapies for Advanced Hepatocellular Carcinoma. J Hepatocell Carcinoma 2023; 10:1445-1463. [PMID: 37701562 PMCID: PMC10493094 DOI: 10.2147/jhc.s390963] [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: 02/22/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fourth most frequent cause of cancer-related death worldwide. HCC frequently presents as advanced disease at diagnosis, and disease relapse following radical surgery is frequent. In recent years, immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced HCC, particularly with the introduction of atezolizumab/bevacizumab as the new standard of care for first-line treatment. Recently, dual immune checkpoint blockade with durvalumab plus tremelimumab has also emerged as an effective first-line treatment for advanced HCC and most of the research is currently focused on developing combination treatments based mainly on ICIs. In this review, we will discuss the rationale and ongoing clinical trials of immune-based combination therapies for the treatment of advanced HCC, also focusing on new immunotherapy strategies such as chimeric antigen receptor T cells (CAR-T) and anti-cancer vaccines.
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Affiliation(s)
- Riccardo Carloni
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Sabbioni
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Rizzo
- Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico “Don Tonino Bello”, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Angela Dalia Ricci
- Medical Oncology Unit, National Institute of Gastroenterology, “Saverio de Bellis” Research Hospital, Bari, Italy
| | - Andrea Palloni
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cataldo Petrarota
- Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico “Don Tonino Bello”, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Antonio Cusmai
- Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico “Don Tonino Bello”, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Simona Tavolari
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Giovanni Brandi
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Zhang C, Wang K, Zhang H, Liu J, Zheng C, Tao J, Lin L, Zhai L. Onychopathy Following Durvalumab Treatment for Extensive-Stage Small-Cell Lung Cancer: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:2429-2432. [PMID: 37694194 PMCID: PMC10492564 DOI: 10.2147/ccid.s415119] [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: 06/21/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Abstract
Patients treated with immune checkpoint inhibitors (ICIS) are prone to immune related adverse events (irAEs), making it important to pay attention to these adverse events. Herein, we report a case of onychopathy after treatment of extensive small cell lung cancer (ES-SCLC) with durvalumab; this is the first report of onychopathy caused by durvalumab in a patient with lung cancer. The change in the patient's nails mainly manifested in the form of pigmentation and the thickening of the nails. Antifungal ointment was ineffective, and these changes were unrelated to malnutrition or any other factors. In addition, this case shows that onychopathy may occur within 2 years after treatment, indicating that these patients need long-term follow-up.
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Affiliation(s)
- Cuifen Zhang
- the First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Ke Wang
- the First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Hong Zhang
- the First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Jingjing Liu
- the First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Chuangjie Zheng
- the First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Jiahao Tao
- the First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Lizhu Lin
- Cancer Center, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Linzhu Zhai
- Cancer Center, Departments of Radiation Oncology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
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Waterhouse D, Yong C, Frankart A, Brannman L, Mulrooney T, Robert N, Aguilar KM, Ndukum J, Cotarla I. Durvalumab real-world treatment patterns and outcomes in patients with stage III non-small-cell lung cancer treated in a US community setting. Future Oncol 2023; 19:1905-1916. [PMID: 37497677 DOI: 10.2217/fon-2023-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Background: For eligible patients with unresectable stage III non-small-cell lung cancer, durvalumab consolidation therapy following chemoradiotherapy is the standard of care. Methods: This was a retrospective study of durvalumab-treated patients diagnosed between 1 August 2017 and 29 February 2020. Electronic health record data were assessed descriptively, with Kaplan-Meier methods used for duration of treatment and overall survival (OS). Results: Among 528 patients (median age 70 years, 51.5% male), the median duration of treatment was 7.1 months (95% CI: 6.0-9.0). Estimated 1- and 2-year OS rates were 83.5 and 64.0%, respectively, with median OS not reached. Conclusion: This study confirmed an OS benefit with durvalumab after chemoradiotherapy in a real-world setting, consistent with the results from the PACIFIC phase III clinical trial.
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Affiliation(s)
- David Waterhouse
- Oncology Hematology Care, Inc. 5053 Wooster Rd, Cincinnati, OH 45226
| | - Candice Yong
- AstraZeneca, 1 MedImmune Way, Gaithersburg, Maryland 20878
| | - Andrew Frankart
- Department of Radiation Oncology, University of Cincinnati, 2600 Clifton Ave. Cincinnati, OH 45221
| | - Lance Brannman
- AstraZeneca, 1 MedImmune Way, Gaithersburg, Maryland 20878
| | | | | | | | | | - Ion Cotarla
- AstraZeneca, 1 MedImmune Way, Gaithersburg, Maryland 20878
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40
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Nam JH, Yeo CD, Park CK, Kim SK, Kim JS, Kim YH, Kim JW, Kim SJ, Lee SH, Kang HS. Identification of predictive factors for early relapse in patients with unresectable stage III non-small cell lung cancer receiving consolidation durvalumab after concurrent chemoradiation therapy. Thorac Cancer 2023; 14:2657-2664. [PMID: 37519059 PMCID: PMC10493476 DOI: 10.1111/1759-7714.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Patients with locally advanced, unresectable, non-small cell lung cancer (NSCLC) receiving definitive concurrent chemoradiation therapy (CCRT) benefit from durvalumab consolidation therapy. However, predictive factors for early relapse during durvalumab maintenance have not yet been identified. METHODS The present study included the lung cancer cohort of the Catholic Medical Centers at the Catholic University of Korea from January 2018 to December 2021. A total of 51 NSCLC patients treated with durvalumab consolidation therapy after definitive CCRT were included in the analysis. Early relapse was defined as patients experiencing relapse within 6 months of starting initial durvalumab therapy. RESULTS Among the 51 patients, 15 (29.4%) relapsed during the study period. Median time from initial therapy of durvalumab to progression was 451.00 ± 220.87 days (95% confidence interval [CI]: 18.10-883.90) in overall patients. In multivariate analysis, younger age (adjusted odds ratio [aOR], 0.792; 95% CI: 0.642-0.977; p = 0.030), higher pack-years (aOR, 1.315; 95% CI: 1.058-1.635; p = 0.014), non-COPD (aOR, 0.004; 95% CI: 0.000-0.828; p = 0.004) and anemia (aOR, 234.30; 95% CI: 1.212-45280.24; p = 0.042), were independent predictive factors for early relapse during durvalumab consolidation therapy. CONCLUSION Younger age, higher number of pack-years, non-COPD, and anemia were independent predictive factors for early relapse during durvalumab consolidation therapy in patients with unresectable stage III NSCLC after definitive CCRT. Careful patient selection and clinical attention are needed for high-risk individuals.
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Affiliation(s)
- Jung Hyun Nam
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Chang Dong Yeo
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Chan Kwon Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Sung Kyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Vincent's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Yong Hyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Jin Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Seung Joon Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Hye Seon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
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Preti BTB, Sanatani MS, Breadner D, Lakkunarajah S, Scott C, Esmonde-White C, McArthur E, Rodrigues G, Chaudhary M, Mutsaers A, Sachdeva R, Vincent MD. Real-World Analysis of Durvalumab after Chemoradiation in Stage III Non-Small-Cell Lung Cancer. Curr Oncol 2023; 30:7713-7721. [PMID: 37623040 PMCID: PMC10453685 DOI: 10.3390/curroncol30080559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
The 2017 PACIFIC trial heralded the incorporation of routine adjuvant durvalumab following curative-intent chemoradiation for stage III non-small-cell lung cancer (NSCLC). However, carefully selected clinical trial populations can differ significantly from real-world populations, which can have implications on treatment toxicities and outcomes, making it difficult to accurately counsel patients. Consequently, we performed a real-world, retrospective analysis of outcomes and toxicities in 118 patients with stage III NSCLC treated with durvalumab after platinum-based chemoradiotherapy. The data were collected from patients who underwent treatment at a single, tertiary-level Canadian cancer centre from May 2018 to October 2020. The variables collected included patient demographics, treatment specifics, progression-free survival, overall survival, and immune-related adverse events (IRAE) from durvalumab. Descriptive statistics were used for toxicity analysis, and progression-free survival and overall survival estimates were calculated using the Kaplan-Meier method. The statistical analyses indicated a 64.4% (n = 76) toxicity rate, with a 21% (n = 25) toxicity rate of grade 3+ IRAEs. The most common documented IRAEs were pneumonitis (n = 44; 40%), followed by rash (n = 20; 18%) and thyroid dysfunction (n = 17; 15%). FEV1 and DLCO were not found to be associated predictors of pneumonitis toxicity. The median PFS and OS were estimated to be >1.7 years and >2.7 years, respectively.
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Affiliation(s)
- Beatrice T. B. Preti
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Michael S. Sanatani
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Daniel Breadner
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Suganija Lakkunarajah
- Department of Medical Oncology, University of British Columbia, Victoria, ON V8R 6V5, Canada
| | - Carolyn Scott
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
| | - Caroline Esmonde-White
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
| | - Eric McArthur
- London Health Sciences Centre, London, ON M5S 1A8, Canada
| | - George Rodrigues
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Radiation Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Mitali Chaudhary
- Temerty School of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Adam Mutsaers
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Radiation Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Robin Sachdeva
- Department of Medical Oncology, University of British Columbia, Victoria, ON V8R 6V5, Canada
| | - Mark D. Vincent
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
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42
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Denault MH, Feng J, Kuang S, Shokoohi A, Leung B, Liu M, Berthelet E, Laskin J, Sun S, Zhang T, Ho C, Melosky B. Beyond PACIFIC: Real-World Outcomes of Adjuvant Durvalumab According to Treatment Received and PD-L1 Expression. Curr Oncol 2023; 30:7499-7507. [PMID: 37623024 PMCID: PMC10453050 DOI: 10.3390/curroncol30080543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
Adjuvant durvalumab after chemoradiotherapy (CRT) is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). A post hoc exploratory analysis of PACIFIC revealed no OS benefit in the PD-L1 < 1% subgroup. This retrospective analysis assesses the real-world impact of durvalumab on OS according to PD-L1 tumor proportion score (TPS). Patients with stage III, unresectable NSCLC treated by CRT, with available PD-L1 TPS, from 1 March 2018 to 31 December 2020, at BC Cancer, British Columbia, Canada were included. Patients were divided into two groups, CRT + durvalumab and CRT alone. OS and PFS were analyzed in the PD-L1 ≥ 1% and <1% subgroups. A total of 134 patients were included in the CRT + durvalumab group and 117, in the CRT alone group. Median OS was 35.9 months in the CRT + durvalumab group and 27.4 months in the CRT alone group [HR 0.59 (95% CI 0.42-0.83), p = 0.003]. Durvalumab improved OS in the PD-L1 ≥ 1% [HR 0.53 (95% CI 0.34-0.81), p = 0.003, n = 175], but not in the <1% subgroup [HR 0.79 (95% CI 0.44-1.42), p = 0.4, n = 76]. This retrospective study demonstrates a statistically significant improvement in OS associated with durvalumab after CRT in PD-L1 ≥ 1%, but not PD-L1 < 1% NSCLC. Variables not accounted for may have biased the survival analysis. A prospective study would bring more insight.
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Affiliation(s)
- Marie-Hélène Denault
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
| | - Jamie Feng
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Shelley Kuang
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Aria Shokoohi
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Bonnie Leung
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Mitchell Liu
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Eric Berthelet
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Janessa Laskin
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Sophie Sun
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Tina Zhang
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Cheryl Ho
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Barbara Melosky
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
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43
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Rimini M, Fornaro L, Lonardi S, Niger M, Lavacchi D, Pressiani T, Lucchetti J, Giordano G, Pretta A, Tamburini E, Pirrone C, Rapposelli IG, Diana A, Martinelli E, Garajová I, Simionato F, Schirripa M, Formica V, Vivaldi C, Caliman E, Rizzato MD, Zanuso V, Nichetti F, Angotti L, Landriscina M, Scartozzi M, Ramundo M, Pastorino A, Daniele B, Cornara N, Persano M, Gusmaroli E, Cerantola R, Salani F, Ratti F, Aldrighetti L, Cascinu S, Rimassa L, Antonuzzo L, Casadei-Gardini A. Durvalumab plus gemcitabine and cisplatin in advanced biliary tract cancer: An early exploratory analysis of real-world data. Liver Int 2023; 43:1803-1812. [PMID: 37452505 DOI: 10.1111/liv.15641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/15/2023] [Accepted: 05/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The TOPAZ-1 phase III trial reported a survival benefit with the anti-programmed death cell ligand 1 (anti-PD-L1) durvalumab in combination with gemcitabine and cisplatin in patients with advanced biliary tract cancer. The present study investigated the efficacy and safety of this new standard treatment in a real-world setting. METHODS The analysed population included patients with unresectable, locally advanced or metastatic adenocarcinoma of the biliary tract treated with durvalumab in combination with gemcitabine and cisplatin at 17 Italian centres. The primary endpoint of the study was progression-free survival (PFS), whereas secondary endpoints included overall survival (OS), overall response rate (ORR) and safety. Unadjusted and adjusted hazard ratios (HRs) by baseline characteristics were calculated using the Cox proportional hazards model. RESULTS From February 2022 to November 2022, 145 patients were enrolled. After a median follow-up of 8.5 months (95% CI: 7.9-13.6), the median PFS was 8.9 months (95% CI: 7.4-11.7). Median OS was 12.9 months (95% CI: 10.9-12.9). The investigator-assessed confirmed ORR was 34.5%, and the disease control rate was 87.6%. Any grade adverse events (AEs) occurred in 137 patients (94.5%). Grades 3-4 AEs occurred in 51 patients (35.2%). The rate of immune-mediated AEs (imAEs) was 22.7%. Grades 3-4 imAEs occurred in 2.1% of the patients. In univariate analysis, non-viral aetiology, ECOG PS >0 and NLR ≥3 correlated with shorter PFS. CONCLUSION The results reported in this first real-world analysis mostly confirmed the results achieved in the TOPAZ-1 trial in terms of PFS, ORR and safety.
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Affiliation(s)
- Margherita Rimini
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Jessica Lucchetti
- Division of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Andrea Pretta
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Emiliano Tamburini
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | - Chiara Pirrone
- Medical Oncology Unit 1, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Anna Diana
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Erika Martinelli
- Medical Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingrid Garajová
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Francesca Simionato
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Marta Schirripa
- Medical Oncology Unit, Department of Oncology and Hematology, Belcolle Hospital, Viterbo, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Caterina Vivaldi
- Medical Oncology, University Hospital of Pisa, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Enrico Caliman
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Mario Domenico Rizzato
- Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valentina Zanuso
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Computational Oncology, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lorenzo Angotti
- Division of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Matteo Landriscina
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - Matteo Ramundo
- Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy
| | | | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, Napoli, Italy
| | - Noemi Cornara
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mara Persano
- Oncology Unit, San Martino Hospital, Oristano, Italy
| | - Eleonora Gusmaroli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Cerantola
- Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Francesca Salani
- Medical Oncology, University Hospital of Pisa, Pisa, Italy
- Institute of Interdisciplinary Research "Health Science", Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Cascinu
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Casadei-Gardini
- Medical Oncology Department, IRCSS San Raffaele Scientific Institute, Milan, Italy
- Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy
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Diaz-Rodriguez PE, Muns-Aponte CM, Velazquez-Acevedo SI, Ortiz-Malave CM, Acevedo J, Merced-Ortiz FG. An Uncommon Case of Myocarditis Secondary to Durvalumab Plus Tremelimumab. Cureus 2023; 15:e43628. [PMID: 37719633 PMCID: PMC10504866 DOI: 10.7759/cureus.43628] [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] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Tumor immunotherapy is an important clinical strategy for the treatment of various solid and hematological malignancies, and its use is on the rise. Immune checkpoint inhibitors (ICIs) are immunotherapies that boost anticancer immune responses by targeting receptors on the surface of T-lymphocytes. Two important ICIs are anti-programmed death ligand-1 (anti-PD-L1) monoclonal antibodies and anti-cytotoxic T-lymphocyte-associated antigen-4 (anti-CTLA-4) monoclonal antibodies. Tremelimumab (anti-CTLA-4) and durvalumab (anti-PD-L1) have been shown to be effective monotherapies. However, their combination has demonstrated effective and encouraging antitumor activity with manageable safety in patients with unresectable hepatocellular carcinoma. We present the case of an 80-year-old male with hepatocellular carcinoma who had undergone drug-eluting bead transarterial chemoembolization (DEB-TACE) on three occasions and had been started on a combination of ICIs, durvalumab, and tremelimumab. He subsequently developed various immune-related adverse effects in different organ systems, including hepatic and cardiovascular complications. Appropriate treatment was administered, but ultimately, he passed away. We aim to discuss the initial evaluation for suspected immune-related adverse events, specifically those related to myocarditis and its various manifestations, prognosis, and treatment.
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Affiliation(s)
| | | | | | | | - Jose Acevedo
- Internal Medicine, Veterans Affairs Caribbean Healthcare System, San Juan, PRI
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Liu W, Huo G, Chen P. First-line tremelimumab plus durvalumab and chemotherapy versus chemotherapy alone for metastatic non-small cell lung cancer: a cost-effectiveness analysis in the United States. Front Pharmacol 2023; 14:1163381. [PMID: 37547328 PMCID: PMC10398575 DOI: 10.3389/fphar.2023.1163381] [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: 02/10/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Importance: In the open-label phase III POSEIDON randomized clinical trial (RCT), a limited course of tremelimumab plus durvalumab and chemotherapy (T + D + CT) indicated in the first-line treatment of metastatic non-small cell lung cancer (mNSCLC), progression-free survival, and overall survival (OS) were substantially improved without significant additional tolerance burden compared to chemotherapy (CT). However, given the high cost of T + D + CT, its value needs to be evaluated in terms of both potency and cost. Objective: To evaluate the cost-effectiveness of T + D + CT versus CT in individuals with previously untreated mNSCLC from a U.S. payer perspective. Design, setting, and participants: A three-state Markov model was adopted to weigh the lifetime costs and effectiveness of T + D + CT versus CT for the treatment of first-line mNSCLC, according to the results of the POSEIDON phase III RCT involving 675 individuals with mNSCLC. Individuals were simulated to undergo either T + D + CT for up to four 21-day cycles, followed by durvalumab once every 4 weeks until disease progression or unacceptable toxic effects and one additional tremelimumab dose, or CT for up to six 21-day cycles (with or without pemetrexed maintenance; all groups) in the analysis. Main outcomes and measures: Lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were evaluated with a willingness-to-pay (WTP) threshold of $ 100,000 to $ 150,000 per QALY. The uncertainty of the model was investigated using univariate and probabilistic sensitivity analysis. Results: T + D + CT produced additional 0.36 QALYs with additional costs of $ 217,694, compared to CT, giving rise to ICERs of $ 608,667.86/QALY. The univariate sensitivity analysis demonstrated that the outcomes were most sensitive to the cost of durvalumab. Other variables with a large or moderate influence were the utility of progression-free survival state, utility of progressive disease state, and cost of tremelimumab. Probability sensitivity analysis revealed that T + D + CT had a 0% probability of cost-effectiveness in individuals with mNSCLC at a willingness-to-pay threshold of $ 100,000 to $ 150,000 per QALY. Conclusion and relevance: In this model, T + D + CT was estimated to be less cost-effective than CT for patients with mNSCLC at a WTP threshold of $ 100,000 to $ 150,000 per QALY in the United States. When new combination therapies with remarkable effect become pivotal in the first-line treatment, the price reduction of durvalumab and tremelimumab may be necessary to achieve cost-effectiveness in future possible context.
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Langberg CW, Horndalsveen H, Helland Å, Haakensen VD. Factors associated with failure to start consolidation durvalumab after definitive chemoradiation for locally advanced NSCLC. Front Oncol 2023; 13:1217424. [PMID: 37476372 PMCID: PMC10354813 DOI: 10.3389/fonc.2023.1217424] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction The introduction of consolidation immunotherapy after chemoradiotherapy has improved outcome for patients with locally advanced non-small cell lung cancer. However, not all patients receive this treatment. This study identifies factors associated with failure to start durvalumab as consolidation therapy with the aim of optimizing treatment, supportive care and prehabilitation to ensure that more patients complete the planned treatment. Materials and methods Patients from two clinical trials and a named patient use program, were included in this study. All patients received platinum-doublet chemotherapy concomitant with radiotherapy to a total dose of 60-66 gray. Patient characteristics, cancer treatment, toxicity, performance status and laboratory data before and after chemoradiotherapy were recorded and patients who never started durvalumab were compared with those who did. Results A total of 101 patients were included, of which 83 started treatments with durvalumab after chemoradiotherapy. The 18 patients who did not start durvalumab had significantly higher lactate dehydrogenase at baseline and a worse performance status, cumulative toxicity and higher c-reactive protein after completed chemoradiotherapy. Data also suggest that pre-treatment diabetes and reduced hemoglobin and/or diffusion capacity of the lungs for carbon monoxide contribute to the risk of treatment abruption. Conclusion Treatment plan disruption rate was 18%. Systemic inflammation and performance status were associated with failure to receive durvalumab after chemoradiation. Further studies are needed to confirm findings and prospective trials should investigate whether prehabilitation and supportive treatment could help more patients finishing the planned treatment. Clinical Trial Registration clinicaltrials.gov, identifier NCT03798535; NCT04392505.
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Affiliation(s)
| | - Henrik Horndalsveen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Åslaug Helland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vilde Drageset Haakensen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
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Borghetti P, Volpi G, Facheris G, Cossali G, Mataj E, La Mattina S, Singh N, Imbrescia J, Bonù ML, Tomasini D, Vitali P, Greco D, Bezzi M, Melotti F, Benvenuti M, Borghesi A, Grisanti S, Buglione di Monale e Bastia M. Unresectable stage III non-small cell lung cancer: could durvalumab be safe and effective in real-life clinical scenarios? Results of a single-center experience. Front Oncol 2023; 13:1208204. [PMID: 37469420 PMCID: PMC10352832 DOI: 10.3389/fonc.2023.1208204] [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: 04/18/2023] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction The standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC) is chemoradiotherapy (CRT) followed by consolidation durvalumab as shown in the PACIFIC trial. The purpose of this study is to evaluate clinical outcomes and toxicities regarding the use of durvalumab in a real clinical scenario. Methods A single-center retrospective study was conducted on patients with a diagnosis of unresectable stage III NSCLC who underwent radical CRT followed or not by durvalumab. Tumor response after CRT, pattern of relapse, overall survival (OS) and progression-free survival (PFS), and toxicity profile were investigated. Results Eighty-five patients met the inclusion criteria. The median age was 67 years (range 45-82 years). Fifty-two patients (61.2%) started sequential therapy with durvalumab. The main reason for excluding patients from the durvalumab treatment was the expression of PD-L1 < 1%. Only two patients presented a grade 4 or 5 pneumonitis. A median follow-up (FU) of 20 months has been reached. Forty-five patients (52.9%) had disease progression, and 21 (24.7%) had a distant progression. The addition of maintenance immunotherapy confirmed a clinical benefit in terms of OS and PFS. Two-year OS and PFS were respectively 69.4% and 54.4% in the durvalumab group and 47.9% and 24.2% in the no-durvalumab group (p = 0.015, p = 0.007). Conclusion In this real-world study, patients treated with CRT plus durvalumab showed clinical outcomes and toxicities similar to the PACIFIC results. Maintenance immunotherapy after CRT has been shown to be safe and has increased the survival of patients in clinical practice.
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Affiliation(s)
- Paolo Borghetti
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Giulia Volpi
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Giorgio Facheris
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Gianluca Cossali
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Eneida Mataj
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Salvatore La Mattina
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Navdeep Singh
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Jessica Imbrescia
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Marco Lorenzo Bonù
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Davide Tomasini
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Paola Vitali
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Diana Greco
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Michela Bezzi
- Division of Pneumology, University Hospital Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Flavia Melotti
- Institute of Pathology, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Mauro Benvenuti
- Thoracic Surgery, Department of Cardio-Thoracic Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
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Piombino C, Tonni E, Oltrecolli M, Pirola M, Pipitone S, Baldessari C, Dominici M, Sabbatini R, Vitale MG. Immunotherapy in urothelial cancer: current status and future directions. Expert Rev Anticancer Ther 2023; 23:1141-1155. [PMID: 37772970 DOI: 10.1080/14737140.2023.2265572] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/27/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Since 2016, the progressive use of immune checkpoint inhibitors (ICIs) starting from second-line treatment has led to an improvement in overall survival in locally advanced and metastatic urothelial cancer (UC). Clinical trials are underway testing the role of ICIs since the first stages of the disease, alone or in combination with standard therapies. AREAS COVERED This review summarizes the current updated evidence regarding the role of ICIs in the different stages of UC, the ongoing clinical trials exploring the potential benefit of immunotherapy alone or in combination with standard-of-care therapies, as well as the promising association of ICIs with antibody-drug conjugates (ADCs). EXPERT OPINION In the first-line setting, ICIs alone in platinum-unfit patients have shown unconvincing results; the ongoing EV-302 trial will probably suggest enfortumab vedotin plus pembrolizumab as a new effective option. The optimal duration of maintenance immunotherapy is still to be determined, finding a balance with the risk-benefit profile. The clinical benefit of ICIs as second-line treatment is limited to a subset of patients that cannot be definitively established yet. In the next 5 years, a lot of new ADCs will likely emerge for the treatment of UC.
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Affiliation(s)
- Claudia Piombino
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Elena Tonni
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Marco Oltrecolli
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Marta Pirola
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Stefania Pipitone
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Cinzia Baldessari
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Massimo Dominici
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Roberto Sabbatini
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
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Zou Y, Ren X, Zhang H, Wang Y, Wang H, Bai R, Zhang Z, Sun G, Xu L. Efficacy and safety of durvalumab + chemotherapy vs. atezolizumab + chemotherapy in the treatment of small‑cell lung cancer: a retrospective comparative cohort study. J Thorac Dis 2023; 15:3339-3349. [PMID: 37426159 PMCID: PMC10323594 DOI: 10.21037/jtd-23-588] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
Background Durvalumab and atezolizumab have recently been approved in extensive small cell lung cancer (SCLC) with moderate median overall survival (OS) improvements. However, only limited data exist regarding the impact of immunotherapy in real-world SCLC patients. This study sought to assess the efficacy and safety of atezolizumab plus chemotherapy and durvalumab plus chemotherapy in the treatment of SCLC in a real-world setting. Methods A retrospective cohort study of all patients treated for SCLC with chemotherapy with PD-L1 inhibitor, at 3 centers in China between February 1, 2020 and April 30, 2022. Patient characteristics, adverse-events and survival analyses were conducted. Results A total of 143 patients were enrolled in this study, 100 were treated with durvalumab and the remainder with atezolizumab. The baseline characteristics of the two groups were fundamentally balanced before using PD-L1 inhibitors (P>0.05). The median OS (mOS) of the patients who received durvalumab or atezolizumab as the first-line treatment were 22.0 and 10.0 months, respectively (P=0.03). Survival analysis of patients with brain metastasis (BM) revealed that the median progression-free survival (mPFS) of patients without BM treated with durvalumab plus chemotherapy (5.5 months) was longer than that of those with BM (4.0 months) (P=0.03). In contrast, in the atezolizumab plus chemotherapy regimen, BM did not affect survival. In addition, the addition of radiotherapy to treatment with PD-L1 inhibitors in combination with chemotherapy has a tendency to improve long-term survival. As for safety analysis, there was no significant difference in the incidence of immune-related adverse events (IRAEs) during PD-L1 inhibitor therapy between the 2 groups (P>0.05). And during treatment with immunochemotherapy, radiotherapy was not associated with the development of IRAE (P=0.42) but increased the risk of immune-related pneumonitis (P=0.026). Conclusions The implication of this study for clinical practice is a preference for durvalumab in first-line immunotherapy for SCLC. In addition, appropriate radiotherapy during treatment with PD-L1 inhibitors in combination with chemotherapy may prolong long-term survival, but the occurrence of immune-related pneumonitis should be vigilant. Data from this study are limited and the baseline characteristics of the two populations still need to be more finely classified.
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Affiliation(s)
- Yuxia Zou
- Department of Respiratory Oncology, The Anhui Provincial Cancer Hospital/The First Affiliated Hospital of University of Science and Technology of China (USTC) West District, Hefei, China
| | - Xueru Ren
- Department of Respiratory Oncology, The Anhui Provincial Cancer Hospital/The First Affiliated Hospital of University of Science and Technology of China (USTC) West District, Hefei, China
| | - Huanhuan Zhang
- Department of Respiratory Oncology, The Anhui Provincial Cancer Hospital/The First Affiliated Hospital of University of Science and Technology of China (USTC) West District, Hefei, China
| | - Yuenan Wang
- Department of Respiratory Oncology, The Anhui Provincial Cancer Hospital/The First Affiliated Hospital of University of Science and Technology of China (USTC) West District, Hefei, China
| | - Hanqi Wang
- Department of Respiratory Oncology, The Anhui Provincial Cancer Hospital/The First Affiliated Hospital of University of Science and Technology of China (USTC) West District, Hefei, China
| | - Rubing Bai
- Department of Respiratory Oncology, The Anhui Provincial Cancer Hospital/The First Affiliated Hospital of University of Science and Technology of China (USTC) West District, Hefei, China
| | - Zhihong Zhang
- Department of Respiratory Oncology, The Anhui Provincial Cancer Hospital/The First Affiliated Hospital of University of Science and Technology of China (USTC) West District, Hefei, China
| | - Gengyun Sun
- Department of Respiratory Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ling Xu
- Department of Interventional Pulmonary Diseases, The Anhui Chest Hospital, Hefei, China
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50
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Okonogi N, Murata K, Yamada S, Habu Y, Hori M, Kurokawa T, Inaba Y, Fujiwara T, Fujii Y, Hanawa M, Kawasaki Y, Hattori Y, Suzuki K, Tsuyuki K, Wakatsuki M, Koto M, Hasegawa S, Ishikawa H, Hanaoka H, Shozu M, Tsuji H, Usui H. A Phase Ib Study of Durvalumab (MEDI4736) in Combination with Carbon-Ion Radiotherapy and Weekly Cisplatin for Patients with Locally Advanced Cervical Cancer (DECISION Study): The Early Safety and Efficacy Results. Int J Mol Sci 2023; 24:10565. [PMID: 37445743 DOI: 10.3390/ijms241310565] [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: 05/28/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
We conducted a phase Ib study to examine the safety of a combination of carbon-ion RT (CIRT) with durvalumab (MEDI4736; AstraZeneca) in patients with locally advanced cervical cancer. This was an open-label, single-arm study with a modified 3 + 3 design. Patients with newly diagnosed histologically proven locally advanced cervical cancer were enrolled. All patients received 74.4 Gy of CIRT in 20 fractions and concurrent weekly cisplatin (chemo-CIRT) at a dose of 40 mg/m2. Durvalumab was administered (1500 mg/body) at weeks two and six. The primary endpoint was the incidence of adverse events (AEs) and serious AEs (SAEs), including dose-limiting toxicity (DLT). All three enrolled patients completed the treatment without interruption. One patient developed hypothyroidism after treatment and was determined to be an SAE. No other SAEs were observed. The patient recovered after levothyroxine sodium hydrate treatment. None of the AEs, including hypothyroidism, were associated with DLT in the present study. All three patients achieved complete responses within the CIRT region concerning treatment efficacy. This phase 1b trial demonstrates the safety of combining chemo-CIRT and durvalumab for locally advanced cervical cancer in the early phase. Further research is required as only three patients were included in this study.
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Affiliation(s)
- Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Kazutoshi Murata
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Yuji Habu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Makoto Hori
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Tomoya Kurokawa
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yosuke Inaba
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Tadami Fujiwara
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yasuhisa Fujii
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Michiko Hanawa
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, 4-1-3 Hiroo, Shibuya-Ku, Tokyo 150-0012, Japan
| | - Yoko Hattori
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Kazuko Suzuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Kyoko Tsuyuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Sumitaka Hasegawa
- Department of Charged Particle Therapy Research, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hirokazu Usui
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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