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Garon EB, Cho BC, Luft A, Alatorre-Alexander J, Geater SL, Trukhin D, Kim SW, Ursol G, Hussein M, Lim FL, Yang CT, Araujo LH, Saito H, Reinmuth N, Kohlmann M, Lowery C, Mann H, Peters S, Mok TS, Johnson ML. A Brief Report of Durvalumab With or Without Tremelimumab in Combination With Chemotherapy as First-Line Therapy for Metastatic Non-Small-Cell Lung Cancer: Outcomes by Tumor PD-L1 Expression in the Phase 3 POSEIDON Study. Clin Lung Cancer 2024; 25:266-273.e5. [PMID: 38584069 DOI: 10.1016/j.cllc.2024.03.003] [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: 10/18/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Edward B Garon
- David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | | | | | | | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Maen Hussein
- Florida Cancer Specialists - Sarah Cannon Research Institute, Leesburg, FL
| | | | | | | | | | - Niels Reinmuth
- Asklepios Lung Clinic, Member of the German Center for Lung Research (DZL), Munich-Gauting, Germany
| | | | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Tony S Mok
- Chinese University of Hong Kong, Hong Kong, China
| | - Melissa L Johnson
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
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2
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Garon EB, Cho BC, Luft A, Alatorre-Alexander J, Geater SL, Kim SW, Ursol G, Hussein M, Lim FL, Yang CT, Araujo LH, Saito H, Reinmuth N, Medic N, Mann H, Shi X, Peters S, Mok T, Johnson M. Patient-reported outcomes with durvalumab, with or without tremelimumab, plus chemotherapy as first-line treatment for metastatic non-small-cell lung cancer (POSEIDON). Lung Cancer 2023; 186:107422. [PMID: 37992595 DOI: 10.1016/j.lungcan.2023.107422] [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: 07/10/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES In the phase 3 POSEIDON study, first-line tremelimumab plus durvalumab and chemotherapy significantly improved overall survival and progression-free survival versus chemotherapy in metastatic non-small-cell lung cancer (NSCLC). We present patient-reported outcomes (PROs). PATIENTS AND METHODS Treatment-naïve patients were randomized 1:1:1 to tremelimumab plus durvalumab and chemotherapy, durvalumab plus chemotherapy, or chemotherapy. PROs (prespecified secondary endpoints) were assessed using the European Organisation for Research and Treatment of Cancer 30-item core quality of life questionnaire version 3 (QLQ-C30) and its 13-item lung cancer module (QLQ-LC13). We analyzed time to deterioration (TTD) of symptoms, functioning, and global health status/quality of life (QoL) from randomization by log-rank test and improvement rates by logistic regression. RESULTS 972/1013 (96 %) patients randomized completed baseline QLQ-C30 and QLQ-LC13 questionnaires, with scores comparable between treatment arms. Patients receiving tremelimumab plus durvalumab and chemotherapy versus chemotherapy had longer median TTD for all PRO items. Hazard ratios for TTD favored tremelimumab plus durvalumab and chemotherapy for all items except diarrhea; 95 % confidence intervals did not cross 1.0 for global health status/QoL, physical functioning, cognitive functioning, pain, nausea/vomiting, insomnia, constipation, hemoptysis, dyspnea, and pain in other parts. For durvalumab plus chemotherapy, median TTD was longer versus chemotherapy for all items except nausea/vomiting and diarrhea. Hazard ratios favored durvalumab plus chemotherapy for all items except appetite loss; 95 % confidence intervals did not cross 1.0 for global health status/QoL, physical functioning, role functioning, dyspnea, and pain in other parts. For both immunotherapy plus chemotherapy arms, improvement rates in all PRO items were numerically higher versus chemotherapy, with odds ratios > 1. CONCLUSIONS Tremelimumab plus durvalumab and chemotherapy delayed deterioration in symptoms, functioning, and global health status/QoL compared with chemotherapy. Together with significant improvements in survival, these results support tremelimumab plus durvalumab and chemotherapy as a first-line treatment option in metastatic NSCLC.
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Affiliation(s)
- Edward B Garon
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | | | | | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Maen Hussein
- Florida Cancer Specialists - Sarah Cannon Research Institute, Leesburg, FL, USA
| | | | | | | | | | - Niels Reinmuth
- Asklepios Lung Clinic, member of the German Center for Lung Research (DZL), Munich-Gauting, Germany
| | | | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Tony Mok
- Chinese University of Hong Kong, Hong Kong, China
| | - Melissa Johnson
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN, USA
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3
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Kim HR, Awad MM, Navarro A, Gottfried M, Peters S, Csőszi T, Cheema PK, Rodriguez-Abreu D, Wollner M, Yang JCH, Mazieres J, Orlandi FJ, Luft A, Gümüş M, Kato T, Kalemkerian GP, Luo Y, Santorelli ML, Pietanza MC, Rudin CM. Patient-Reported Health-Related Quality of Life in KEYNOTE-604: Pembrolizumab or Placebo Added to Etoposide and Platinum as First-Line Therapy for Extensive-Stage SCLC. JTO Clin Res Rep 2023; 4:100572. [PMID: 37954964 PMCID: PMC10637979 DOI: 10.1016/j.jtocrr.2023.100572] [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: 06/01/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction In the phase 3 KEYNOTE-604 study (NCT03066778), pembrolizumab plus etoposide and platinum chemotherapy (EP) significantly (p = 0.0023) improved progression-free survival versus placebo plus EP in previously untreated extensive-stage SCLC (ES-SCLC). We present health-related quality of life (HRQoL) results from KEYNOTE-604. Methods Patients with stage IV SCLC were randomized 1:1 to pembrolizumab 200 mg or placebo every 3 weeks for 35 cycles plus four cycles of EP. Secondary end points included mean change from baseline to week 18 in the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (QLQ-C30) global health status/quality of life (GHS/QoL) scale and time to deterioration in the composite outcome of cough, chest pain, or dyspnea from QLQ-C30 and QLQ-Lung Cancer Module 13. Two-sided, nominal p values are reported. Results A total of 439 patients completed at least one QLQ-C30 and QLQ-Lung Cancer Module 13 assessment (pembrolizumab + EP, n = 221; placebo + EP, n = 218). GHS/QoL scores improved from baseline to week 18: least squares mean (95% confidence interval [CI]) changes were 8.7 (5.3-12.1) for pembrolizumab plus EP and 4.2 (0.9-7.5) for placebo plus EP. Between-group differences in least squares mean scores were improved for pembrolizumab plus EP (4.4 [95% CI: 0.2-8.7], p = 0.040]). Median time to deterioration for the composite end point was not reached and 8.7 (95% CI: 5.9-not reached) months, respectively (hazard ratio = 0.80 [95% CI: 0.56-1.14], p = 0.208). Conclusions First-line pembrolizumab plus EP therapy maintained HRQoL in patients with ES-SCLC and may be associated with greater improvement than placebo plus EP. Together with the efficacy and safety findings in KEYNOTE-604, HRQoL data support the benefit of pembrolizumab in ES-SCLC.
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Affiliation(s)
- Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Mark M. Awad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alejandro Navarro
- Clinical Research Department (VHIO) and Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maya Gottfried
- Oncology Department, Meir Medical Center, Kfar-Saba, Israel
| | - Solange Peters
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Tibor Csőszi
- Department of Oncology, Hetenyi G Korhaz Onkologiai Kozpont, Szolnok, Hungary
| | - Parneet K. Cheema
- Division of Medical Oncology, William Osler Health System, University of Toronto, Brampton, Ontario, Canada
| | - Delvys Rodriguez-Abreu
- Medical Oncology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Mirjana Wollner
- Department of Medical Oncology, Rambam Medical Center, Haifa, Israel
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital and Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Julien Mazieres
- Department of Thoracic Oncology, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Alexander Luft
- Department of Oncology No. 1 (Thoracic Surgery), Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | - Mahmut Gümüş
- Department of Medical Oncology, Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Gregory P. Kalemkerian
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yiwen Luo
- Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, New Jersey
| | - Melissa L. Santorelli
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, New Jersey
| | | | - Charles M. Rudin
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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4
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Gutierrez M, Lam WS, Hellmann MD, Gubens MA, Aggarwal C, Tan DSW, Felip E, Chiu JWY, Lee JS, Yang JCH, Garon EB, Finocchiaro G, Ahn MJ, Luft A, Landers GA, Basso A, Ma H, Kobie J, Palcza J, Cristescu R, Fong L, Snyder A, Yuan J, Herbst RS. Biomarker-directed, pembrolizumab-based combination therapy in non-small cell lung cancer: phase 2 KEYNOTE-495/KeyImPaCT trial interim results. Nat Med 2023:10.1038/s41591-023-02385-6. [PMID: 37429923 DOI: 10.1038/s41591-023-02385-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/03/2023] [Indexed: 07/12/2023]
Abstract
Although pembrolizumab confers clinical benefit in non-small cell lung cancer (NSCLC), only a subset of patients will respond due to a heterogenous tumor microenvironment. KEYNOTE-495/KeyImPaCT is an ongoing biomarker-directed, adaptively randomized phase 2 study investigating first-line pembrolizumab (200 mg every 3 weeks) + lenvatinib (20 mg daily), anti-CTLA-4 quavonlimab (25 mg every 6 weeks) or anti-LAG-3 favezelimab (200 mg or 800 mg every 3 weeks) in advanced NSCLC. Patients were categorized by T-cell-inflamed gene expression profile (TcellinfGEP) and tumor mutational burden (TMB) status and randomly assigned 1:1:1 to receive pembrolizumab + lenvatinib, pembrolizumab + quavonlimab or pembrolizumab + favezelimab. The primary outcome was investigator-assessed objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1 using pre-specified efficacy thresholds for each biomarker-defined subgroup (>5% (TcellinfGEPlowTMBnon-high (group I)), >20% (TcellinfGEPlowTMBhigh (group II) and TcellinfGEPnon-lowTMBnon-high (group III)) and >45% (TcellinfGEPnon-lowTMBhigh (group IV))). Secondary outcomes were progression-free survival, overall survival and safety. At data cutoff, ORR ranges were 0-12.0% in group I, 27.3-33.3% in group II, 13.6-40.9% in group III and 50.0-60.0% in group IV. ORR with pembrolizumab + lenvatinib in group III met the pre-specified efficacy threshold. The safety profile of each treatment arm was consistent with the known safety profile of each combination. These data demonstrate the feasibility of prospective TcellinfGEP and TMB assessment to study the clinical activity of first-line pembrolizumab-based combination therapies in advanced NSCLC. ClinicalTrials.gov registration: NCT03516981 .
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Affiliation(s)
| | - Wei-Sen Lam
- Fiona Stanley Hospital and Western Australia Country Health Service, Perth, WA, Australia
| | - Matthew D Hellmann
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Oncology Research and Development, AstraZeneca, New York, NY, USA
| | - Matthew A Gubens
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Charu Aggarwal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Shao Weng Tan
- National Cancer Centre and SingHealth Duke NUS Academic Medical Centre, Singapore, Singapore
| | - Enriqueta Felip
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Joanne W Y Chiu
- University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong, China
| | - Jong-Seok Lee
- Seoul National University, Bundang Hospital, Seongnam, South Korea
| | - James Chih-Hsin Yang
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei City, Taiwan
| | - Edward B Garon
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, South Korea
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, Saint Petersburg, Russia
| | | | | | - Hua Ma
- Merck & Co., Inc., Rahway, NJ, USA
- Biostatistics, Pfizer, Collegeville, PA, USA
| | | | | | | | - Lawrence Fong
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Alexandra Snyder
- Merck & Co., Inc., Rahway, NJ, USA
- Generate Biomedicines, Somerville, MA, USA
| | | | - Roy S Herbst
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA.
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5
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Maulucci F, Disanto G, Bianco G, Pileggi M, Fischer U, Padlina G, Strambo D, Michel P, Kahles T, Nedeltchev K, Fisch U, Bonati L, Kägi G, Escribano Paredes JB, Carrera E, Nyffeler T, Bolognese M, Wegener S, Luft A, Schelosky L, Medlin F, von Reding A, Peters N, Renaud S, Mono ML, Remonda L, Machi P, Psychogios MN, Kaesmacher J, Mordasini P, Cereda CW. Endovascular therapy outcome in isolated posterior cerebral artery occlusion strokes: A multicenter analysis of the Swiss Stroke Registry. Eur Stroke J 2023; 8:575-580. [PMID: 37231695 PMCID: PMC10334166 DOI: 10.1177/23969873221150125] [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] [Indexed: 11/29/2023] Open
Abstract
PURPOSE There is little data on the safety and efficacy of endovascular treatment (EVT) in comparison with intravenous thrombolysis (IVT) in acute ischemic stroke due to isolated posterior cerebral artery occlusion (IPCAO). We aimed to investigate the functional and safety outcomes of stroke patients with acute IPCAO treated with EVT (with or without prior bridging IVT) compared to IVT alone. METHODS We did a multicenter retrospective analysis of data from the Swiss Stroke Registry. The primary endpoint was overall functional outcome at 3 months in patients undergoing EVT alone or as part of bridging, compared with IVT alone (shift analysis). Safety endpoints were mortality and symptomatic intracranial hemorrhage. EVT and IVT patients were matched 1:1 using propensity scores. Differences in outcomes were examined using ordinal and logistic regression models. FINDINGS Out of 17,968 patients, 268 met the inclusion criteria and 136 were matched by propensity scores. The overall functional outcome at 3 months was comparable between the two groups (EVT vs IVT as reference category: OR = 1.42 for higher mRS, 95% CI = 0.78-2.57, p = 0.254). The proportion of patients independent at 3 months was 63.2% in EVT and 72.1% in IVT (OR = 0.67, 95% CI = 0.32-1.37, p = 0.272). Symptomatic intracranial hemorrhages were overall rare and present only in the IVT group (IVT = 5.9% vs EVT = 0%). Mortality at 3 months was also similar between the two groups (IVT = 0% vs EVT = 1.5%). CONCLUSION In this multicenter nested analysis, EVT and IVT in patients with acute ischemic stroke due to IPCAO were associated with similar overall good functional outcome and safety. Randomized studies are warranted.
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Affiliation(s)
- F Maulucci
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - G Disanto
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - G Bianco
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - M Pileggi
- Stroke Centre, Interventional and Diagnostic Neuroradiology, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
| | - U Fischer
- Department of Neurology, University Hospital Bern, Bern, Switzerland
- Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland
| | - G Padlina
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - D Strambo
- Lausanne University Hospital, Stroke Centre, Neurology Service, Lausanne, Switzerland
| | - P Michel
- Lausanne University Hospital, Stroke Centre, Neurology Service, Lausanne, Switzerland
| | - T Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - K Nedeltchev
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - U Fisch
- Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland
| | - L Bonati
- Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland
| | - G Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - E Carrera
- Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - T Nyffeler
- Luzerner Kantonsspital, Centre of Neurology and Neurorehabilitation, Luzern, Switzerland
| | - M Bolognese
- Luzerner Kantonsspital, Centre of Neurology and Neurorehabilitation, Luzern, Switzerland
| | - S Wegener
- Universitätsspital Zürich, Neurology, Zürich, Switzerland
| | - A Luft
- Universitätsspital Zürich, Neurology, Zürich, Switzerland
| | - L Schelosky
- Kantonsspital Münsterlingen, Division of Neurology, Münsterlingen, Switzerland
| | - F Medlin
- Stroke Unit, Division of Neurology, HFR Fribourg, Fribourg, Switzerland
| | - A von Reding
- Neurology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - N Peters
- Stroke Centre, Klinik Hirslanden, Zurich, Switzerland
| | - S Renaud
- Division of Neurology, Pourtalès Hospital, Neuchatel, Switzerland
| | - M-L Mono
- Stadtspital Waid und Triemli, Stroke Unit, Zürich, Switzerland
| | - L Remonda
- Department of Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - P Machi
- Department of Interventional Neuroradiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - M-N Psychogios
- Department of Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - J Kaesmacher
- University Hospital Bern, Inselspital, Interventional Neuroradiology, Bern, Switzerland
| | - P Mordasini
- University Hospital Bern, Inselspital, Interventional Neuroradiology, Bern, Switzerland
| | - C W Cereda
- Stroke Centre, Neurology Department, Neurocentre of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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6
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Novello S, Kowalski DM, Luft A, Gümüş M, Vicente D, Mazières J, Rodríguez-Cid J, Tafreshi A, Cheng Y, Lee KH, Golf A, Sugawara S, Robinson AG, Halmos B, Jensen E, Schwarzenberger P, Pietanza MC, Paz-Ares L. Pembrolizumab Plus Chemotherapy in Squamous Non-Small-Cell Lung Cancer: 5-Year Update of the Phase III KEYNOTE-407 Study. J Clin Oncol 2023; 41:1999-2006. [PMID: 36735893 PMCID: PMC10082300 DOI: 10.1200/jco.22.01990] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/21/2022] [Accepted: 12/07/2022] [Indexed: 02/05/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We report 5-year efficacy and safety outcomes from the phase III KEYNOTE-407 study (ClinicalTrials.gov identifier: NCT02775435). Eligible patients with previously untreated, metastatic squamous non-small-cell lung cancer (NSCLC) were randomly assigned 1:1 to pembrolizumab 200 mg or placebo plus carboplatin and paclitaxel/nab-paclitaxel once every 3 weeks for four cycles, followed by pembrolizumab or placebo for up to 35 cycles. Primary end points were overall survival (OS) and progression-free survival (PFS) per RECIST version 1.1 by blinded independent central review (BICR). Five hundred fifty-nine patients were randomly assigned in the intention-to-treat population (pembrolizumab plus chemotherapy, n = 278; placebo plus chemotherapy, n = 281). The median time from random assignment to data cutoff was 56.9 (range, 49.9-66.2) months. OS and PFS were improved with pembrolizumab plus chemotherapy versus placebo plus chemotherapy (hazard ratio [95% CI], 0.71 [0.59 to 0.85] and 0.62 [0.52 to 0.74]), with 5-year OS rates of 18.4% versus 9.7%, respectively. Toxicity was manageable. Among 55 patients who completed 35 cycles of pembrolizumab, the objective response rate was 90.9% and the 3-year OS rate after completion of 35 cycles (approximately 5 years after random assignment) was 69.5%. Pembrolizumab plus chemotherapy maintained an OS and PFS benefit versus placebo plus chemotherapy in previously untreated, metastatic squamous NSCLC and is a standard-of-care first-line treatment option for metastatic squamous NSCLC regardless of programmed death ligand 1 expression.
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Affiliation(s)
- Silvia Novello
- Department of Oncology, University of Turin, Azienda Ospedaliero Universitaria San Luigi, Turin, Italy
| | - Dariusz M. Kowalski
- Department of Lung Cancer and Thoracic Tumours, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Alexander Luft
- Department of Oncology No. 1 (Thoracic Surgery), Leningrad Regional Clinical Hospital, Saint Petersburg, Russia
| | - Mahmut Gümüş
- Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - David Vicente
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Julien Mazières
- Thoracic Oncology, Hôpital Larrey, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | | | - Ali Tafreshi
- Wollongong Private Hospital and Wollongong Oncology, Wollongong, NSW, Australia
| | - Ying Cheng
- Department of Oncology, Jilin Cancer Hospital, Changchun, China
| | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea
| | - Alexander Golf
- Medical Oncology, Universitätskinikum Tübingen, Tuebingen, Germany
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Andrew G. Robinson
- Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, Canada
| | - Balazs Halmos
- Montefiore Medical Center/Albert Einstein College of Medicine, The Bronx, NY
| | - Erin Jensen
- Biostatistics and Research Decision Sciences, Merck & Co, Inc, Rahway, NJ
| | | | | | - Luis Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, H12O-CNIO Lung Cancer Unit, Universidad Complutense & Ciberonc, Madrid, Spain
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7
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Reinmuth N, Cho B, Luft A, Alexander JA, Geater SL, Laktionov K, Kim SW, Ursol G, Hussein M, Lim F, Yang CT, Araujo L, Saito H, Barrett K, Lowery C, Tattersfield R, Peters S, Garon E, Mok T, Johnson M. 12MO Patterns of response in metastatic (m) NSCLC after 2 and 4 cycles of chemotherapy (CT), alone or with durvalumab (D) ± tremelimumab (T), in the phase III POSEIDON study. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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8
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Johnson ML, Cho BC, Luft A, Alatorre-Alexander J, Geater SL, Laktionov K, Kim SW, Ursol G, Hussein M, Lim FL, Yang CT, Araujo LH, Saito H, Reinmuth N, Shi X, Poole L, Peters S, Garon EB, Mok T. Durvalumab With or Without Tremelimumab in Combination With Chemotherapy as First-Line Therapy for Metastatic Non-Small-Cell Lung Cancer: The Phase III POSEIDON Study. J Clin Oncol 2023; 41:1213-1227. [PMID: 36327426 PMCID: PMC9937097 DOI: 10.1200/jco.22.00975] [Citation(s) in RCA: 98] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/13/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The open-label, phase III POSEIDON study evaluated tremelimumab plus durvalumab and chemotherapy (T + D + CT) and durvalumab plus chemotherapy (D + CT) versus chemotherapy alone (CT) in first-line metastatic non-small-cell lung cancer (mNSCLC). METHODS Patients (n = 1,013) with EGFR/ALK wild-type mNSCLC were randomly assigned (1:1:1) to tremelimumab 75 mg plus durvalumab 1,500 mg and platinum-based chemotherapy for up to four 21-day cycles, followed by durvalumab once every 4 weeks until progression and one additional tremelimumab dose; durvalumab plus chemotherapy for up to four 21-day cycles, followed by durvalumab once every 4 weeks until progression; or chemotherapy for up to six 21-day cycles (with or without maintenance pemetrexed; all arms). Primary end points were progression-free survival (PFS) and overall survival (OS) for D + CT versus CT. Key alpha-controlled secondary end points were PFS and OS for T + D + CT versus CT. RESULTS PFS was significantly improved with D + CT versus CT (hazard ratio [HR], 0.74; 95% CI, 0.62 to 0.89; P = .0009; median, 5.5 v 4.8 months); a trend for improved OS did not reach statistical significance (HR, 0.86; 95% CI, 0.72 to 1.02; P = .0758; median, 13.3 v 11.7 months; 24-month OS, 29.6% v 22.1%). PFS (HR, 0.72; 95% CI, 0.60 to 0.86; P = .0003; median, 6.2 v 4.8 months) and OS (HR, 0.77; 95% CI, 0.65 to 0.92; P = .0030; median, 14.0 v 11.7 months; 24-month OS, 32.9% v 22.1%) were significantly improved with T + D + CT versus CT. Treatment-related adverse events were maximum grade 3/4 in 51.8%, 44.6%, and 44.4% of patients receiving T + D + CT, D + CT, and CT, respectively; 15.5%, 14.1%, and 9.9%, respectively, discontinued treatment because of treatment-related adverse events. CONCLUSION D + CT significantly improved PFS versus CT. A limited course of tremelimumab added to durvalumab and chemotherapy significantly improved OS and PFS versus CT, without meaningful additional tolerability burden, representing a potential new option in first-line mNSCLC.
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Affiliation(s)
- Melissa L. Johnson
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | | | | | - Konstantin Laktionov
- Federal State Budgetary Institution “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation (N.N. Blokhin NMRCO), Moscow, Russia
| | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Maen Hussein
- Florida Cancer Specialists—Sarah Cannon Research Institute, Leesburg, FL
| | | | | | | | | | - Niels Reinmuth
- Asklepios Lung Clinic, member of the German Center for Lung Research (DZL), Munich-Gauting, Germany
| | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | | | - Tony Mok
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong, China
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Cho B, Luft A, Alatorre Alexander J, Lucien Geater S, Laktionov K, Sang-We K, Ursol G, Hussein M, Lim Farah L, Yang C, Araujo L, Saito H, Reinmuth N, Lai Z, Mann H, Shi X, Peters S, Garon E, Mok T, Johnson M. 326P Durvalumab (D) ± tremelimumab (T) + chemotherapy (CT) in 1L metastatic (m) NSCLC: Overall survival (OS) update from POSEIDON after median follow-up (mFU) of approximately 4 years (y). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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10
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Garon E, Cho B, Luft A, Alatorre-Alexander J, Geater S, Kim SW, Ursol G, Hussein M, Lim F, Yang CT, Araujo L, Saito H, Reinmuth N, Kohlmann M, Shi X, Mann H, Peters S, Mok T, Johnson M. EP08.01-027 Durvalumab (D) ± Tremelimumab (T) + Chemotherapy (CT) in 1L Metastatic NSCLC: Outcomes by Tumour PD-L1 Expression in POSEIDON. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11
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Peters S, Cho B, Luft A, Alatorre-Alexander J, Geater S, Kim SW, Ursol G, Hussein M, Lim F, Yang CT, Araujo L, Saito H, Reinmuth N, Stewart R, Lai Z, Doake R, Krug L, Garon E, Mok T, Johnson M. OA15.04 Association Between KRAS/STK11/KEAP1 Mutations and Outcomes in POSEIDON: Durvalumab ± Tremelimumab + Chemotherapy in mNSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Novello S, Kowalski D, Luft A, Gumus M, Vicente Baz D, Mazieres J, Rodriguez Cid J, Tafreshi A, Cheng Y, Lee K, Golf A, Sugawara S, Robinson A, Halmos B, Jensen E, Schwarzenberger P, Pietanza M, Paz-Ares L. 974MO 5-year update from KEYNOTE-407: Pembrolizumab plus chemotherapy in squamous non-small cell lung cancer (NSCLC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Cho BC, Reinmuth N, Luft A, Alatorre-Alexander J, Geater SL, Trukhin D, Kim SW, Ursol G, Hussein MA, Lim FL, Yang CT, Araujo LH, Saito H, Marotti M, Barrett K, Shi X, Peters S, Garon EB, Mok TSK, Johnson ML. Durvalumab (D) +/- tremelimumab (T) + chemotherapy (CT) in first-line (1L) metastatic (m) NSCLC: AE management in POSEIDON. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9035 Background: In the Phase 3 POSEIDON study in 1L mNSCLC, adding T to D+CT resulted in statistically significant improvements in PFS and OS vs CT. No new safety signals were identified and treatment discontinuations due to treatment-related AEs (TRAEs) were similar for the T+D+CT and D+CT arms (15.5% and 14.1%). Here we present details of AEs and their management. Methods: 1013 pts with EGFR/ ALK wild-type mNSCLC were randomized 1:1:1 to 1L T+D+CT, D+CT or CT. Safety was assessed in all treated pts. Results: 330, 334 and 333 pts received T+D+CT, D+CT and CT; 78%, 82% and 74% received at least 4 cycles of platinum-based CT. The most common grade 3/4 TRAEs were hematologic (anemia in 17%, 15% and 20% of pts in the T+D+CT, D+CT and CT arms and neutropenia in 16%, 13% and 12%) and most were managed using standard approaches per local practice; 22%, 18% and 16% of pts received colony stimulating factors and 22%, 21% and 26% received blood transfusions. All grade immune-mediated AEs (imAEs) occurred in 34%, 19% and 5% of pts in the T+D+CT, D+CT and CT arms; a higher incidence of diarrhea/colitis, dermatitis/rash and endocrinopathies was seen with the addition of T to D+CT (Table). Grade 3/4 imAEs occurred in 10%, 7% and 2% of pts in the T+D+CT, D+CT and CT arms, and serious imAEs in 10%, 6% and 1%; imAEs led to discontinuation of any study treatment in 6%, 4% and 0.6%, and led to death in 0.6%, 0.3% and 0%. Most imAEs were low grade and manageable with systemic corticosteroids (received by 26%, 13% and 4% of pts in the T+D+CT, D+CT and CT arms) or endocrine therapy (12%, 8% and 1%). Median time from first dose to onset of imAEs (TTO) was generally > 60 days and the majority of non-endocrine imAEs resolved (Table). Conclusions: In POSEIDON, the safety profile of all regimens was manageable per standard guidelines and in line with the known profiles of D, T+D and CT; the most common grade 3/4 TRAEs were those typically associated with CT. As expected, more imAEs occurred with T+D+CT than D+CT, but the incidence of grade 3 or 4 imAEs, imAE-related deaths and treatment discontinuations due to imAEs was generally similar in the IO arms. T+D did not compromise the ability to administer planned CT. Clinical trial information: NCT03164616. [Table: see text]
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Affiliation(s)
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russian Federation
| | | | | | | | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Maen A. Hussein
- Florida Cancer Specialists – Sarah Cannon Research Institute, Leesburg, FL
| | | | | | - Luiz H. Araujo
- Instituto Nacional de Cancer-INCA, Rio De Janeiro, Brazil
| | | | | | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Garon E, Cho B, Luft A, Alatorre-Alexander J, Geater S, Trukhin D, Kim SW, Ursol G, Hussein M, Lim F, Yang CT, Araujo L, Saito H, Reinmuth N, Medic N, Mann H, Shi X, Peters S, Mok T, Johnson M. 5MO Patient reported outcomes (PROs) with 1L durvalumab (D), with or without tremelimumab (T), plus chemotherapy (CT) in metastatic (m) NSCLC: Results from POSEIDON. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Chang J, Wu YL, Lu S, Wang J, Mok T, Zhang L, Feng J, Wu L, Tu HY, Zhang Y, Luft A, Zhou JY, Ma Z, Lu Y, Hu C, Shi Y, Poddubskaya E, Soo RA, Chia YH, Penrod JR, Taylor F, Lawrance R, Blum SI, Sun X, Juarez-Garcia A, Moreno-Koehler A, Li A, Li A, Cheng Y. Three-year follow-up and patient-reported outcomes from CheckMate 078: Nivolumab versus docetaxel in a predominantly Chinese patient population with previously treated advanced non-small cell lung cancer. Lung Cancer 2022; 165:71-81. [PMID: 35093625 DOI: 10.1016/j.lungcan.2021.12.009] [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: 10/08/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In the phase 3 CheckMate 078 study, nivolumab prolonged overall survival (OS) and showed a favorable safety profile versus docetaxel in a predominantly Chinese patient population with previously treated advanced non-small cell lung cancer (aNSCLC). However, long-term efficacy, safety, and health-related quality of life findings with second-line nivolumab are very limited in Asian patients with previously treated aNSCLC. Here, we report updated clinical data and patient-reported outcomes (PROs) from the phase 3 CheckMate 078 trial with a 3-year minimum follow-up. MATERIALS AND METHODS Patients with aNSCLC and disease progression after platinum-doublet chemotherapy were randomized 2:1 to nivolumab (3 mg/kg every 2 weeks) or docetaxel (75 mg/m2 every 3 weeks) until progression or unacceptable toxicity. The primary endpoint was OS; secondary endpoints included objective response rate, progression-free survival, safety, and disease-related symptom deterioration assessed using the Lung Cancer Symptom Scale (LCSS) by Week 12. Additional PRO assessments were exploratory endpoints. RESULTS At ≥ 37.3 months follow-up, 3-year OS rates were 19% with nivolumab and 12% with docetaxel; 30% and 0% of responders remained in response for ≥ 3 years, respectively. Incidence of treatment-related adverse events occurring after 2 years was lower than during the first 2 years. No new treatment-related deaths were reported. By Week 12 of treatment, rates of disease-related symptom deterioration were 32% with nivolumab and 47% with docetaxel. Completion rates for PRO questionnaires were ≥ 80% in both arms. Clinically meaningful and sustained improvements in LCSS Average Symptom Burden Index scores and delayed time to first symptom deterioration were observed with nivolumab against docetaxel. CONCLUSIONS At 3 years, nivolumab continued to demonstrate survival benefit versus docetaxel, exhibiting improvements in disease-related symptoms and overall health status in a predominantly Chinese patient population with previously treated aNSCLC. No new safety signals were observed. These findings are similar to the global population.
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Affiliation(s)
- Jianhua Chang
- Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China.
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Second Road, Guangzhou 510080, China.
| | - Shun Lu
- Shanghai Chest Hospital, 241 Huaihai West Road, Shanghai 200030, China.
| | - Jie Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China.
| | - Tony Mok
- State Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Hong Kong, China.
| | - Li Zhang
- Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou 510060, China.
| | - Jifeng Feng
- Jiangsu Cancer Hospital, 42 Bai Zi Ting, Nanjing 210000, China.
| | - Lin Wu
- Hunan Cancer Hospital, 283 Tongzipo Road, Changsha 410013, China.
| | - Hai-Yan Tu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Second Road, Guangzhou 510080, China.
| | - Yiping Zhang
- Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou 310022, China.
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, 45-49 Lunacharskogo Avenue, St. Petersburg 194291, Russian Federation.
| | - Jian-Ying Zhou
- The First Affiliated Hospital of College of Medicine, 79 Qingchun Road, Hangzhou 310003, China.
| | - Zhiyong Ma
- The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, 127 Dongming Road, Zhengzhou 450008, China.
| | - You Lu
- West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China.
| | - Chengping Hu
- Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China.
| | - Yuankai Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China.
| | - Elena Poddubskaya
- Clinical Center VitaMed, 10 Seslavinskaya Street, Moscow, Russian Federation.
| | - Ross A Soo
- National University Hospital, 1E Kent Ridge Road, 119228 Singapore, Singapore.
| | - Yee Hong Chia
- Johns Hopkins Singapore Pte Ltd, 11 Jalan Tan Tock Seng, 308433 Singapore, Singapore.
| | | | | | | | | | | | | | | | - Ang Li
- Bristol Myers Squibb, Princeton, NJ 08540, USA.
| | - Amy Li
- Bristol Myers Squibb, Princeton, NJ 08540, USA.
| | - Ying Cheng
- Jilin Cancer Hospital, 1018 Huguang Road, Changchun 130012, China.
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16
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Filioglo A, Simaan N, Honig A, Heldner MR, von Rennenberg R, Pezzini A, Padjen V, Rentzos A, Altersberger VL, Baumgartner P, Zini A, Grisendi I, Aladdin S, Gomori JM, Pilgram-Pastor SM, Scheitz JF, Magoni M, Berisavac I, Nordanstig A, Psychogios M, Luft A, Gentile M, Assenza F, Arnold M, Nolte CH, Gamba M, Ercegovac M, Jood K, Engelter ST, Wegener S, Forlivesi S, Zedde M, Gensicke H, Tatlisumak T, Cohen JE, Leker RR. Outcomes after reperfusion therapies in patients with ACA stroke: A multicenter cohort study from the EVATRISP collaboration. J Neurol Sci 2022; 432:120081. [PMID: 34920158 DOI: 10.1016/j.jns.2021.120081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/10/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown. METHODS Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis. RESULTS Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (±bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p = 0.044) and proximal ACA occlusions (43% vs. 24%, p = 0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p = 0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT. DISCUSSION Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.
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Affiliation(s)
- A Filioglo
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - N Simaan
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Honig
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - M R Heldner
- Department of Neurology, University Hospital Bern, Switzerland
| | - R von Rennenberg
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy
| | - V Padjen
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Rentzos
- Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital and Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - V L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - P Baumgartner
- University Hospital Zurich and University of Zurich, Switzerland
| | - A Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - I Grisendi
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Aladdin
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - J M Gomori
- Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S M Pilgram-Pastor
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - J F Scheitz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - M Magoni
- U.O Vascular Neurology, Stroke Unit, ASST Spedali Civili, Brescia, Italy
| | - I Berisavac
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Nordanstig
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland
| | - A Luft
- University Hospital Zurich and University of Zurich, Switzerland
| | - M Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - F Assenza
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Arnold
- Department of Neurology, University Hospital Bern, Switzerland
| | - C H Nolte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Center for Stroke Research, Berlin, Berlin Institute of Health, Berlin, Germany
| | - M Gamba
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - M Ercegovac
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K Jood
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - S Wegener
- University Hospital Zurich and University of Zurich, Switzerland
| | - S Forlivesi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - M Zedde
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - H Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - T Tatlisumak
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J E Cohen
- Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - R R Leker
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Yang JH, Luft A, De La Mora Jiménez E, Lee J, Koralewski P, Karadurmus N, Sugawara S, Livi L, Basappa N, Quantin X, Dudnik J, Moran Ortiz D, Mekhail T, Okpara C, Zimmer Z, Samkari A, Bhagwati N, Csőszi T. 120O Pembrolizumab (Pembro) with or without lenvatinib (Lenva) in first-line metastatic NSCLC with PD-L1 TPS ≥1% (LEAP-007): A phase III, randomized, double-blind study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Socinski MA, Waller CF, Idris T, Bondarenko I, Luft A, Beckmann K, Vishweswaramurthy A, Loganathan S, Donnelly C, Hummel MA, Shapiro R, Woods M, Rao A, Nayak VG, Ranganna G, Barve A. Phase III double-blind study comparing the efficacy and safety of proposed biosimilar MYL-1402O and reference bevacizumab in stage IV non-small-cell lung cancer. Ther Adv Med Oncol 2021; 13:17588359211045845. [PMID: 34819997 PMCID: PMC8606731 DOI: 10.1177/17588359211045845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/14/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose: This phase III study compared the efficacy and safety of proposed biosimilar MYL-1402O with reference bevacizumab (BEV), as first-line treatment for patients with stage IV non-squamous non-small-cell lung cancer. Patients and methods: Patients were randomly assigned (1:1) to receive MYL-1402O or bevacizumab with carboplatin-paclitaxel up to 18 weeks (6 cycles), followed by up to 24 weeks (8 cycles) of bevacizumab monotherapy. The primary objective was comparison of overall response rate (ORR), based on independently reviewed best tumor responses as assessed during the first 18 weeks. ORR was analyzed per US Food and Drug Administration (ratio of ORR) and European Medicines Agency (difference in ORRs) requirements for equivalence evaluation. Secondary end points included progression-free survival, disease control rate, duration of response, overall survival, safety, and immunogenicity over a period of 42 weeks, and pharmacokinetics (up to 18 weeks). Results: A total of 671 patients were included in the intent-to-treat population. The ratio of ORR was 0.96 [confidence interval (CI) 0.83, 1.12] and the difference in ORR was −1.6 (CI −9.0, 5.9) between treatment arms; CIs were within the predefined equivalence margins. Overall, the incidence of treatment-emergent adverse events and serious adverse events was comparable. Treatment-emergent anti-drug antibody (ADA) positivity was transient, with no notable differences between treatment arms (6.5% versus 4.8% ADA positivity rate in MYL-1402O versus BEV, respectively). The incidence of neutralizing antibody post-baseline was lower in the MYL-1402O arm (0.6%) compared to the bevacizumab arm (2.5%). Conclusions: MYL-1402O is therapeutically equivalent to bevacizumab, based on the ORR analyses, with comparable secondary endpoints. Trial Registry Information EU Clinical Trials Register, Registration # EudraCT no. 2015-005141-32https://www.clinicaltrialsregister.eu/ctr-search/search?query=2015-005141-32 Plain language summary Previous studies established bioequivalence of the proposed bevacizumab biosimilar MYL-1402O to reference bevacizumab. In this randomized, double-blind, phase III trial, MYL-1402O (n = 337) demonstrated comparable efficacy to bevacizumab (n = 334) in treating advanced non-squamous non-small-cell lung cancer per Food and Drug Administration and European Medicines Agency requirements for equivalence; the ratio of objective response rate (ORR) was 0.96 [90% confidence interval (CI) 0.83, 1.12] and the difference in ORR (MYL-1402O:bevacizumab) was −1.6 (95% CI −9.0, 5.9). Median progression-free survival at 42 weeks was comparable: 7.6 (7.0, 9.5) with MYL-1402O versus 9.0 (7.2, 9.7) months (p = 0.0906) with bevacizumab, by independent review. Treatment-emergent adverse events leading to death (2.4% vs 1.5%), serious adverse events (17.6% vs 16.7%), and antidrug antibodies (6.5% vs 4.8%), were comparable in the MYL-1402O vs bevacizumab arms, respectively. The incidence of neutralizing antibody post-baseline was lower with MYL-1402O (0.6%) than with bevacizumab (2.5%). These findings confirm therapeutic equivalence of MYL-1402O to bevacizumab, providing opportunities for improving access to bevacizumab.
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Affiliation(s)
- Mark A Socinski
- AdventHealth Cancer Institute, 2501 North Orange Avenue, Suite 289, Orlando, FL 32803, USA
| | - Cornelius F Waller
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Centre Freiburg, Freiburg, Germany
| | | | - Igor Bondarenko
- Dnipropetrovsk Medical Academy, Dnipropetrovsk Oblast, Ukraine
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, St. Petersburg, Russian Federation
| | - Katrin Beckmann
- Mylan Healthcare GmbH (A Viatris Company), Hannover, Germany
| | | | | | | | | | | | | | - Anita Rao
- Biocon Research Ltd., Bangalore, India
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Gutierrez M, Lam WS, Hellmann M, Gubens M, Aggarwal C, Weng Tan DS, Felip E, Chiu JWY, Lee JS, Yang JCH, Garon E, Finocchiaro G, Ahn MJ, Luft A, Landers G, Basso A, Ma H, Kobie J, Palcza J, Cristescu R, Fong L, Snyder A, Yuan J, Herbst R. 457 KEYNOTE-495/KeyImPaCT: interim analysis of a randomized, biomarker-directed, phase 2 trial of pembrolizumab-based combination therapy for non–small cell lung cancer (NSCLC). J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundT-cell–inflamed gene expression profile (TcellinfGEP) and tumor mutational burden (TMB) are clinically validated biomarkers that independently predict pembrolizumab response. This study investigated prospective TcellinfGEP and TMB assessment in evaluating first-line pembrolizumab-based combination therapies; the different treatment combinations evaluated may provide insight into the unique biology of each biomarker subgroup.MethodsKEYNOTE-495/KeyImPaCT is a group-sequential, adaptively randomized, multisite, open-label, phase 2 study investigating first-line pembrolizumab plus the VEGF/FGFR inhibitor lenvatinib, CTLA-4 inhibitor quavonlimab (MK-1308), or LAG-3 inhibitor favezelimab (MK-4280) in patients with advanced NSCLC. DNA and RNA were extracted from tumor tissue to determine TcellinfGEP and TMB; patients were assigned to one of four biomarker-defined subgroups (TcellinfGEPlowTMBlow, TcellinfGEPlowTMBhigh, TcellinfGEPhighTMBlow, TcellinfGEPhighTMBhigh) and randomly assigned 1:1:1 to receive pembrolizumab (200mg IV Q3W)+lenvatinib (20mg oral QD), pembrolizumab+quavonlimab (75mg IV Q6W), or pembrolizumab+favezelimab (200mg [n=30] or 800mg [n=34] Q3W; the initial prespecified dose was 200mg but changed to 800mg based on emerging data). The primary end point was investigator-assessed ORR per RECIST v1.1. Multiple interim analyses will be performed until the prespecified clinical signal is observed. The first interim analysis for each combination therapy occurred after ≥10 patients had ≥12 weeks of follow-up.ResultsAt the data cutoff (January 11, 2021), 208 patients were treated (pembrolizumab+lenvatinib, n=72; pembrolizumab+quavonlimab, n=72; pembrolizumab+favezelimab 200mg, n=30; pembrolizumab+favezelimab 800mg, n=34). The overall assay success rate for testing and determining TcellinfGEP and TMB was 94%. In patients treated with pembrolizumab+lenvatinib, pembrolizumab+quavonlimab, or pembrolizumab+favezelimab, ORRs were generally highest in the TcellinfGEPhighTMBhigh subgroup (table 1); response rates were similar across combinations within this subgroup. ORR was low across combinations within the TcellinfGEPlowTMBlow subgroup. Treatment-related adverse events (TRAEs) occurred in 88%, 65%, 57%, and 59% of patients in the pembrolizumab+lenvatinib, pembrolizumab+quavonlimab, pembrolizumab+favezelimab 200mg and pembrolizumab+favezelimab 800mg arms, respectively. Consistent with the known TRAEs of these agents, most TRAEs were grade 1 or 2 in severity except in the pembrolizumab+lenvatinib arm (grade 3–5, 63%). Three deaths from TRAEs occurred (pembrolizumab+lenvatinib [n=2], brain hemorrhage and myocardial infarction; pembrolizumab+favezelimab 800 mg [n=1], pneumonitis).Abstract 457 Table 1Confirmed ORR by Therapy and Biomarker StatusConclusionsThese data demonstrate the feasibility and clinical usefulness of prospective TcellinfGEP and TMB assessment to study the clinical activity of three first-line pembrolizumab-based combination therapies in patients with advanced NSCLC. Although sample sizes were small, the TcellinfGEPhighTMBhigh subgroup demonstrated the best response among the biomarker subgroups for all three combination therapies; further validation is needed to determine additional signals and may be addressed as more mature data become available.AcknowledgementsJeanne Fahey, PhD, of Merck & Co., Inc., Kenilworth, New Jersey, USA, provided critical review of the abstract. Elisha Dettman PhD, Mark Ayers MS, and Andrey Loboda PhD of Merck & Co., Inc., Kenilworth, New Jersey, USA, provided critical review of study translational data. Medical writing and/or editorial assistance was provided by Shane Walton, PhD, and Lei Bai, PhD, of ApotheCom (Yardley, PA, USA). This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.Trial RegistrationClinicalTrials.gov, NCT03516981Ethics ApprovalThe study protocol and all amendments were approved by the relevant institutional review board or ethics committee at each study site. All patients provided written informed consent to participate in the clinical trial.
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Felip E, Altorki N, Zhou C, Csőszi T, Vynnychenko I, Goloborodko O, Luft A, Akopov A, Martinez-Marti A, Kenmotsu H, Chen YM, Chella A, Sugawara S, Voong D, Wu F, Yi J, Deng Y, McCleland M, Bennett E, Gitlitz B, Wakelee H. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase 3 trial. Lancet 2021; 398:1344-1357. [PMID: 34555333 DOI: 10.1016/s0140-6736(21)02098-5] [Citation(s) in RCA: 564] [Impact Index Per Article: 188.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Novel adjuvant strategies are needed to optimise outcomes after complete surgical resection in patients with early-stage non-small-cell lung cancer (NSCLC). We aimed to evaluate adjuvant atezolizumab versus best supportive care after adjuvant platinum-based chemotherapy in these patients. METHODS IMpower010 was a randomised, multicentre, open-label, phase 3 study done at 227 sites in 22 countries and regions. Eligible patients were 18 years or older with completely resected stage IB (tumours ≥4 cm) to IIIA NSCLC per the Union Internationale Contre le Cancer and American Joint Committee on Cancer staging system (7th edition). Patients were randomly assigned (1:1) by a permuted-block method (block size of four) to receive adjuvant atezolizumab (1200 mg every 21 days; for 16 cycles or 1 year) or best supportive care (observation and regular scans for disease recurrence) after adjuvant platinum-based chemotherapy (one to four cycles). The primary endpoint, investigator-assessed disease-free survival, was tested hierarchically first in the stage II-IIIA population subgroup whose tumours expressed PD-L1 on 1% or more of tumour cells (SP263), then all patients in the stage II-IIIA population, and finally the intention-to-treat (ITT) population (stage IB-IIIA). Safety was evaluated in all patients who were randomly assigned and received atezolizumab or best supportive care. IMpower010 is registered with ClinicalTrials.gov, NCT02486718 (active, not recruiting). FINDINGS Between Oct 7, 2015, and Sept 19, 2018, 1280 patients were enrolled after complete resection. 1269 received adjuvant chemotherapy, of whom 1005 patients were eligible for randomisation to atezolizumab (n=507) or best supportive care (n=498); 495 in each group received treatment. After a median follow-up of 32·2 months (IQR 27·4-38·3) in the stage II-IIIA population, atezolizumab treatment improved disease-free survival compared with best supportive care in patients in the stage II-IIIA population whose tumours expressed PD-L1 on 1% or more of tumour cells (HR 0·66; 95% CI 0·50-0·88; p=0·0039) and in all patients in the stage II-IIIA population (0·79; 0·64-0·96; p=0·020). In the ITT population, HR for disease-free survival was 0·81 (0·67-0·99; p=0·040). Atezolizumab-related grade 3 and 4 adverse events occurred in 53 (11%) of 495 patients and grade 5 events in four patients (1%). INTERPRETATION IMpower010 showed a disease-free survival benefit with atezolizumab versus best supportive care after adjuvant chemotherapy in patients with resected stage II-IIIA NSCLC, with pronounced benefit in the subgroup whose tumours expressed PD-L1 on 1% or more of tumour cells, and no new safety signals. Atezolizumab after adjuvant chemotherapy offers a promising treatment option for patients with resected early-stage NSCLC. FUNDING F Hoffmann-La Roche and Genentech.
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Affiliation(s)
- Enriqueta Felip
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Nasser Altorki
- Division of Thoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Caicun Zhou
- Department of Oncology, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Tibor Csőszi
- Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet, Szolnok, Hungary
| | - Ihor Vynnychenko
- Regional Municipal Institution Sumy Regional Clinical Oncology Dispensary, Sumy State University, Sumy, Ukraine
| | - Oleksandr Goloborodko
- MI Zaporizhzhia Regional Clinical Oncological Dispensary Zaporizhzhia SMU Ch of Oncology, Zaporizhzhya, Ukraine
| | - Alexander Luft
- Department of Thoracic Surgery, Leningrad Regional Clinical Hospital, Saint Petersburg, Russia
| | - Andrey Akopov
- Research Institute of Pulmonology, Pavlov State Medical University, Saint Petersburg, Russia
| | - Alex Martinez-Marti
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Antonio Chella
- Pneumology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Miyagi, Japan
| | | | - Fan Wu
- Roche (China) Holding, Shanghai, China
| | - Jing Yi
- Genentech, South San Francisco, CA, USA
| | - Yu Deng
- Genentech, South San Francisco, CA, USA
| | | | | | | | - Heather Wakelee
- Department of Medicine, Division of Oncology, Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA, USA
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Johnson M, Cho B, Luft A, Alatorre-Alexander J, Geater S, Laktionov K, Vasiliev A, Trukhin D, Kim S, Ursol G, Hussein M, Lim F, Yang C, Araujo L, Saito H, Reinmuth N, Shi X, Poole L, Peters S, Garon E, Mok T. PL02.01 Durvalumab ± Tremelimumab + Chemotherapy as First-line Treatment for mNSCLC: Results from the Phase 3 POSEIDON Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wakelee HA, Altorki NK, Zhou C, Csőszi T, Vynnychenko IO, Goloborodko O, Luft A, Akopov A, Martinez-Marti A, Kenmotsu H, Chen YM, Chella A, Sugawara S, Gitlitz BJ, Bennett E, Wu F, Yi J, Deng Y, McCleland M, Felip E. IMpower010: Primary results of a phase III global study of atezolizumab versus best supportive care after adjuvant chemotherapy in resected stage IB-IIIA non-small cell lung cancer (NSCLC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8500] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8500 Background: Adjuvant platinum-based chemotherapy (chemo) provides only a modest 5-year survival benefit in fully resected, high-risk early-stage NSCLC. We report the primary disease-free survival (DFS) results from the pre-planned interim analysis of IMpower010, a randomized phase 3 open-label trial of adjuvant atezolizumab (atezo; anti–PD-L1) vs best supportive care (BSC) after adjuvant chemo in patients (pts) with early-stage resected NSCLC. Methods: Eligible pts had completely resected (4-12 weeks prior to enrollment) Stage IB (≥4 cm)-IIIA NSCLC (AJCC/UICC v7) and ECOG PS 0-1. A total of 1280 pts were enrolled, and 1269 pts received up to four 21-day cycles of cisplatin-based chemo (plus pemetrexed, docetaxel, gemcitabine or vinorelbine). Of these pts (n=1269), 1005 were subsequently randomized 1:1 to 16 cycles of atezo 1200 mg Q3W or BSC. The primary endpoint of investigator-assessed DFS and secondary endpoint of overall survival (OS) were tested hierarchically: first DFS in the PD-L1 TC ≥1% (SP263) subgroup with Stage II-IIIA disease, then DFS in all randomized pts with Stage II-IIIA disease, then DFS in the ITT population (Stage IB-IIIA) and finally OS in the ITT population. Efficacy assessments were based on randomized pts. Safety was assessed in the safety-evaluable population, defined as pts who received ≥1 dose of atezo or who had ≥1 post-baseline safety assessment if randomized to the BSC arm. Results: At data cutoff (January 21, 2021), median follow-up was 32.2 months in the ITT population. Baseline characteristics were generally balanced between arms. Atezo showed statistically significant DFS benefit vs BSC in the PD-L1 TC ≥1% Stage II-IIIA and all randomized Stage II-IIIA populations; the significance boundary was not crossed for DFS in the ITT population (Table). OS data were immature and not formally tested. Pts in the atezo arm received a median of 16 (range, 1-16) atezo doses. Any-grade AEs occurred in 92.7% (atezo) and 70.7% (BSC); events were Grade 3/4 in 21.8% and 11.5%, respectively. Grade 5 treatment-related AEs occurred in 0.8% of pts in the atezo arm. AEs leading to atezo discontinuation occurred in 18.2% of atezo-treated pts. Conclusions: IMpower010 met its primary endpoint, showing DFS benefit with adjuvant atezo vs BSC after adjuvant chemo in pts with resected Stage II-IIIA NSCLC, with pronounced benefit in the PD-L1 TC ≥1% subgroup. The safety profile of atezo was consistent with prior experience of atezo monotherapy across indications and lines of therapy. Funding: F. Hoffmann-La Roche Ltd. Clinical trial information: NCT02486718. [Table: see text]
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Affiliation(s)
| | - Nasser K. Altorki
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Caicun Zhou
- Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Tibor Csőszi
- Jász-Nagykun Szolnok Megyei Hetényi Géza Kórház-Rendelointézet, Szolnok, Hungary
| | - Ihor O. Vynnychenko
- Regional Municipal Institution Sumy Regional Clinical Oncology Dispensary, Sumy, Ukraine
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, Saint-Petersburg, Russian Federation
| | - Andrey Akopov
- Pavlov State Medical University, Saint-Petersburg, Russian Federation
| | - Alex Martinez-Marti
- Medical Oncology Department, Vall d´Hebron University Hospital/Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Yuh-Min Chen
- Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital and Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Antonio Chella
- Unit of Pneumology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | | | | | - Fan Wu
- Roche China, Shanghai, China
| | - Jing Yi
- Genentech, Inc., South San Francisco, CA
| | - Yu Deng
- Genentech, Inc, South San Francisco, CA
| | | | - Enriqueta Felip
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
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Spigel DR, Vicente D, Ciuleanu TE, Gettinger S, Peters S, Horn L, Audigier-Valette C, Pardo Aranda N, Juan-Vidal O, Cheng Y, Zhang H, Shi M, Luft A, Wolf J, Antonia S, Nakagawa K, Fairchild J, Baudelet C, Pandya D, Doshi P, Chang H, Reck M. Second-line nivolumab in relapsed small-cell lung cancer: CheckMate 331 ☆. Ann Oncol 2021; 32:631-641. [PMID: 33539946 DOI: 10.1016/j.annonc.2021.01.071] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [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: 07/31/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with relapsed small-cell lung cancer (SCLC) have few treatment options and dismal survival. Phase I/II data show activity of nivolumab in previously treated SCLC. PATIENTS AND METHODS CheckMate 331 is a randomized, open-label, phase III trial of nivolumab versus standard chemotherapy in relapsed SCLC. Patients with relapse after first-line, platinum-based chemotherapy were randomized 1 : 1 to nivolumab 240 mg every 2 weeks or chemotherapy (topotecan or amrubicin) until progression or unacceptable toxicity. Primary endpoint was overall survival (OS). RESULTS Overall, 284 patients were randomized to nivolumab and 285 to chemotherapy. Minimum follow-up was 15.8 months. No significant improvement in OS was seen with nivolumab versus chemotherapy [median OS, 7.5 versus 8.4 months; hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.72-1.04; P = 0.11]. A survival benefit with nivolumab was suggested in patients with baseline lactate dehydrogenase ≤ upper limit of normal and in those without baseline liver metastases. OS (nivolumab versus chemotherapy) was similar in patients with programmed death-ligand 1 combined positive score ≥1% versus <1%. Median progression-free survival was 1.4 versus 3.8 months (HR, 1.41; 95% CI, 1.18-1.69). Objective response rate was 13.7% versus 16.5% (odds ratio, 0.80; 95% CI, 0.50-1.27); median duration of response was 8.3 versus 4.5 months. Rates of grade 3 or 4 treatment-related adverse events were 13.8% versus 73.2%. CONCLUSION Nivolumab did not improve survival versus chemotherapy in relapsed SCLC. No new safety signals were seen. In exploratory analyses, select baseline characteristics were associated with improved OS for nivolumab.
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Affiliation(s)
- D R Spigel
- Oncology Department, Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, USA.
| | - D Vicente
- Department of Medical Oncology, Hosp Univ Virgen Macarena, Seville, Spain
| | - T E Ciuleanu
- Medical Oncology, Prof. Dr. Ion Chiricuta Institute of Oncology and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | - S Gettinger
- Medical Oncology, Yale Cancer Center, New Haven, USA
| | - S Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - L Horn
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, USA
| | | | - N Pardo Aranda
- Thoracic Unit, Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - O Juan-Vidal
- Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain
| | - Y Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, Jilin, China
| | - H Zhang
- Department of Oncology, Tangdu Hospital, Xi'an, Shaanxi, China
| | - M Shi
- Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - A Luft
- Department of Thoracic Surgery, Leningrad Regional Clinical Hospital, St. Petersburg, Russian Federation
| | - J Wolf
- Clinic I for Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - S Antonia
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - K Nakagawa
- Department of Medical Oncology, Kindai University Hospital, Osaka, Japan
| | - J Fairchild
- Clinical Development, Bristol Myers Squibb, Princeton, USA
| | - C Baudelet
- Global Drug Development, Biometrics & Data Sciences, Bristol Myers Squibb, Princeton, USA
| | - D Pandya
- Translational Pathology, Bristol Myers Squibb, Princeton, USA
| | - P Doshi
- Translational Medicine, Bristol Myers Squibb, Princeton, USA
| | - H Chang
- Translational Bioinformatics, Bristol Myers Squibb, Princeton, USA
| | - M Reck
- Thoracic Oncology, LungenClinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
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Rizvi NA, Cho BC, Reinmuth N, Lee KH, Luft A, Ahn MJ, van den Heuvel MM, Cobo M, Vicente D, Smolin A, Moiseyenko V, Antonia SJ, Le Moulec S, Robinet G, Natale R, Schneider J, Shepherd FA, Geater SL, Garon EB, Kim ES, Goldberg SB, Nakagawa K, Raja R, Higgs BW, Boothman AM, Zhao L, Scheuring U, Stockman PK, Chand VK, Peters S. Durvalumab With or Without Tremelimumab vs Standard Chemotherapy in First-line Treatment of Metastatic Non-Small Cell Lung Cancer: The MYSTIC Phase 3 Randomized Clinical Trial. JAMA Oncol 2021; 6:661-674. [PMID: 32271377 PMCID: PMC7146551 DOI: 10.1001/jamaoncol.2020.0237] [Citation(s) in RCA: 391] [Impact Index Per Article: 130.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Question Does first-line durvalumab treatment with or without tremelimumab improve survival outcomes vs chemotherapy in patients with metastatic non–small cell lung cancer? Findings In this phase 3 randomized clinical trial including 1118 patients with non–small cell lung cancer, although the trial did not meet its primary end points, treatment with durvalumab resulted in a numerically reduced risk of death vs chemotherapy in patients with programmed cell death ligand 1 expression on at least 25% of tumor cells. In exploratory analyses, a blood tumor mutational burden threshold of at least 20 mutations per megabase was identified for optimal clinical benefit with durvalumab plus tremelimumab vs chemotherapy. Meaning These findings highlight the need for further investigation and prospective validation of blood tumor mutational burden as a predictive biomarker for immunotherapy. Importance Checkpoint inhibitors targeting programmed cell death 1 or its ligand (PD-L1) as monotherapies or in combination with anti–cytotoxic T-lymphocyte–associated antigen 4 have shown clinical activity in patients with metastatic non–small cell lung cancer. Objective To compare durvalumab, with or without tremelimumab, with chemotherapy as a first-line treatment for patients with metastatic non–small cell lung cancer. Design, Setting, and Participants This open-label, phase 3 randomized clinical trial (MYSTIC) was conducted at 203 cancer treatment centers in 17 countries. Patients with treatment-naive, metastatic non–small cell lung cancer who had no sensitizing EGFR or ALK genetic alterations were randomized to receive treatment with durvalumab, durvalumab plus tremelimumab, or chemotherapy. Data were collected from July 21, 2015, to October 30, 2018. Interventions Patients were randomized (1:1:1) to receive treatment with durvalumab (20 mg/kg every 4 weeks), durvalumab (20 mg/kg every 4 weeks) plus tremelimumab (1 mg/kg every 4 weeks, up to 4 doses), or platinum-based doublet chemotherapy. Main Outcomes and Measures The primary end points, assessed in patients with ≥25% of tumor cells expressing PD-L1, were overall survival (OS) for durvalumab vs chemotherapy, and OS and progression-free survival (PFS) for durvalumab plus tremelimumab vs chemotherapy. Analysis of blood tumor mutational burden (bTMB) was exploratory. Results Between July 21, 2015, and June 8, 2016, 1118 patients were randomized. Baseline demographic and disease characteristics were balanced between treatment groups. Among 488 patients with ≥25% of tumor cells expressing PD-L1, median OS was 16.3 months (95% CI, 12.2-20.8) with durvalumab vs 12.9 months (95% CI, 10.5-15.0) with chemotherapy (hazard ratio [HR], 0.76; 97.54% CI, 0.56-1.02; P = .04 [nonsignificant]). Median OS was 11.9 months (95% CI, 9.0-17.7) with durvalumab plus tremelimumab (HR vs chemotherapy, 0.85; 98.77% CI, 0.61-1.17; P = .20). Median PFS was 3.9 months (95% CI, 2.8-5.0) with durvalumab plus tremelimumab vs 5.4 months (95% CI, 4.6-5.8) with chemotherapy (HR, 1.05; 99.5% CI, 0.72-1.53; P = .71). Among 809 patients with evaluable bTMB, those with a bTMB ≥20 mutations per megabase showed improved OS for durvalumab plus tremelimumab vs chemotherapy (median OS, 21.9 months [95% CI, 11.4-32.8] vs 10.0 months [95% CI, 8.1-11.7]; HR, 0.49; 95% CI, 0.32-0.74). Treatment-related adverse events of grade 3 or higher occurred in 55 (14.9%) of 369 patients who received treatment with durvalumab, 85 (22.9%) of 371 patients who received treatment with durvalumab plus tremelimumab, and 119 (33.8%) of 352 patients who received treatment with chemotherapy. These adverse events led to death in 2 (0.5%), 6 (1.6%), and 3 (0.9%) patients, respectively. Conclusions and Relevance The phase 3 MYSTIC study did not meet its primary end points of improved OS with durvalumab vs chemotherapy or improved OS or PFS with durvalumab plus tremelimumab vs chemotherapy in patients with ≥25% of tumor cells expressing PD-L1. Exploratory analyses identified a bTMB threshold of ≥20 mutations per megabase for optimal OS benefit with durvalumab plus tremelimumab. Trial Registration ClinicalT rials.gov Identifier: NCT02453282
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Affiliation(s)
- Naiyer A Rizvi
- Division of Hematology/Oncology, Columbia University Medical Center, New York, New York
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Alexander Luft
- Department of Oncology No. 1 (Thoracic Surgery), Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | - Myung-Ju Ahn
- Department of Hematology and Oncology, Samsung Medical Center, Seoul, South Korea
| | | | - Manuel Cobo
- Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - David Vicente
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alexey Smolin
- Department of Radiology, Burdenko Main Military Clinical Hospital, Moscow, Russia
| | | | - Scott J Antonia
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Gilles Robinet
- Service de Pneumologie, Centre Hospitalier Régional Universitaire de Brest-Hôpital Morvan, Brest, France
| | - Ronald Natale
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, California
| | - Jeffrey Schneider
- Department of Hematology and Oncology, NYU Winthrop Hospital, Mineola, New York
| | - Frances A Shepherd
- Princess Margaret Cancer Centre and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Edward B Garon
- David Geffen School of Medicine, University of California/TRIO-US Network, Los Angeles
| | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Sarah B Goldberg
- Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut
| | - Kazuhiko Nakagawa
- Faculty of Medicine, Department of Medical Oncology, Kindai University, Osaka, Japan
| | | | | | | | | | | | | | | | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Kim H, Awad M, Navarro A, Gottfried M, Peters S, Csőszi T, Cheema P, Rodriguez-Abreu D, Wollner M, Yang JH, Mazieres J, Orlandi F, Luft A, Gümüş M, Kato T, Kalemkerian G, Luo Y, Santorelli M, Pietanza M, Rudin C. 1782MO Health-related quality of life (HRQoL) in KEYNOTE-604: Pembrolizumab (pembro) or placebo added to etoposide and platinum (EP) as first-line therapy for ES-SCLC. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pasquier P, Luft A, Gillard J, Boutonnet M, Vallet C, Pontier JM, Duron-Martinaud S, Dia A, Puyeo L, Debrus F, Prunet B, Beaume S, de Saint Maurice G, Meaudre E, Ficko C, Merens A, Raharisson G, Conte B, Dorandeu F, Canini F, Michel R, Ausset S, Escarment J. How do we fight COVID-19? Military medical actions in the war against the COVID-19 pandemic in France. BMJ Mil Health 2020; 167:269-274. [PMID: 32759228 DOI: 10.1136/bmjmilitary-2020-001569] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 06/20/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 01/06/2023]
Abstract
'We are at war', French President Emmanuel Macron said in an address to the nation on 16 March 2020. As part of this national effort, the French Military Medical Service (FMMS) is committed to the fight against COVID-19. This original report aimed to describe and detail actions that the FMMS has carried out in the nationwide fight against the COVID-19 pandemic in France, as well as overseas. Experts in the field reported major actions conducted by the FMMS during the COVID-19 pandemic in France. In just few weeks, the FMMS developed ad hoc medical capabilities to support national health authorities. It additionally developed adaptive, collective en route care via aeromedical and naval units and deployed a military intensive care field hospital. A COVID-19 crisis cell coordinated the French Armed Forces health management. The French Military Centre for Epidemiology and Public Health provided all information needed to guide the decision-making process. Medical centres of the French Armed Forces organised the primary care for military patients, with the widespread use of telemedicine. The Paris Fire Brigade and the Marseille Navy Fire Battalion emergency departments ensured prehospital management of patients with COVID-19. The eight French military training hospitals cooperated with civilian regional health agencies. The French military medical supply chain supported all military medical treatment facilities in France as well as overseas, coping with a growing shortage of medical equipment. The French Armed Forces Biomedical Research Institute performed diagnostics, engaged in multiple research projects, updated the review of the scientific literature on COVID-19 daily and provided expert recommendations on biosafety. Finally, even students of the French military medical academy volunteered to participate in the fight against the COVID-19 pandemic. In conclusion, in an unprecedented medical crisis, the FMMS engaged multiple innovative and adaptive actions, which are still ongoing, in the fight against COVID-19. The collaboration between military and civilian healthcare systems reinforced the shared objective to achieve the goal of 'saving the greatest number'.
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Affiliation(s)
- Pierre Pasquier
- Percy Military Training Hospital, French Military Health Service, Clamart, France .,Ecole du Val-de-Grâce French Military Medical Academy, Paris, France
| | - A Luft
- Direction Centrale du Service de Santé des Armées, Paris, France
| | - J Gillard
- Direction Centrale du Service de Santé des Armées, Paris, France
| | - M Boutonnet
- Percy Military Training Hospital, French Military Health Service, Clamart, France.,Ecole du Val-de-Grâce French Military Medical Academy, Paris, France
| | - C Vallet
- Service Médical de la Force d'Action Navale, French Military Health Service, Toulon, France
| | - J-M Pontier
- Cephismer, Centre d'Expertise Plongée pour la Marine Nationale, French Military Health Service, Toulon, France
| | | | - A Dia
- Centre d'épidémiologie et de Santé Publique des Armées, French Military Health Service, Marseille, France
| | - L Puyeo
- Direction de la Médecine des forces, French Military Health Service, Tours, France
| | - F Debrus
- Direction de la Médecine des forces, French Military Health Service, Tours, France
| | - B Prunet
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Emergency Department, Brigade de Sapeurs-Pompiers de Paris, Paris, France
| | - S Beaume
- Bataillon des Marins-Pompiers de Marseille, French Military Health Service, Marseille, France
| | - G de Saint Maurice
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Legouest Military Training Hospital, French Military Health Service, Metz, France
| | - E Meaudre
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Sainte-Anne Military Training Hospital, French Military Health Service, Toulon, France
| | - C Ficko
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Bégin Military Training Hospital, French Military Health Service, Saint-Mandé, France
| | - A Merens
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Bégin Military Training Hospital, French Military Health Service, Saint-Mandé, France
| | - G Raharisson
- Direction Centrale du Service de Santé des Armées, Paris, France
| | - B Conte
- Direction des approvisionnements en produits de santé des armées, French Military Health Service, Orléans, France
| | - F Dorandeu
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Institut de Recherche Biomédicale des Armées, French Military Health Service, Brétigny-sur-Orge, France
| | - F Canini
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Institut de Recherche Biomédicale des Armées, French Military Health Service, Brétigny-sur-Orge, France
| | - R Michel
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Écoles Militaires de Santé, French Military Health Service, Lyon-Bron, France
| | - S Ausset
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,Écoles Militaires de Santé, French Military Health Service, Lyon-Bron, France
| | - J Escarment
- Ecole du Val-de-Grâce French Military Medical Academy, Paris, France.,French Military Health Service, Paris, France
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Reck M, Luft A, Bondarenko I, Shevnia S, Trukhin D, Kovalenko NV, Vacharadze K, Andrea F, Hontsa A, Choi J, Shin D. A phase III, randomized, double-blind, multicenter study to compare the efficacy, safety, pharmacokinetics, and immunogenicity between SB8 (proposed bevacizumab biosimilar) and reference bevacizumab in patients with metastatic or recurrent nonsquamous non-small cell lung cancer. Lung Cancer 2020; 146:12-18. [DOI: 10.1016/j.lungcan.2020.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
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Rudin CM, Awad MM, Navarro A, Gottfried M, Peters S, Csőszi T, Cheema PK, Rodriguez-Abreu D, Wollner M, Yang JCH, Mazieres J, Orlandi FJ, Luft A, Gümüş M, Kato T, Kalemkerian GP, Luo Y, Ebiana V, Pietanza MC, Kim HR. Pembrolizumab or Placebo Plus Etoposide and Platinum as First-Line Therapy for Extensive-Stage Small-Cell Lung Cancer: Randomized, Double-Blind, Phase III KEYNOTE-604 Study. J Clin Oncol 2020; 38:2369-2379. [PMID: 32468956 DOI: 10.1200/jco.20.00793] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Pembrolizumab monotherapy has shown antitumor activity in patients with small-cell lung cancer (SCLC). The randomized, double-blind, phase III KEYNOTE-604 study compared pembrolizumab plus etoposide and platinum (EP) with placebo plus EP for patients with previously untreated extensive-stage (ES) SCLC. METHODS Eligible patients were randomly assigned 1:1 to pembrolizumab 200 mg once every 3 weeks or saline placebo for up to 35 cycles plus 4 cycles of EP. Primary end points were progression-free survival (PFS; RECIST version 1.1, blinded central review) and overall survival (OS) in the intention-to-treat population. Objective response rate (ORR) and duration of response were secondary end points. Prespecified efficacy boundaries were one-sided P = .0048 for PFS and .0128 for OS. RESULTS Of the 453 participants, 228 were randomly assigned to pembrolizumab plus EP and 225 to placebo plus EP. Pembrolizumab plus EP significantly improved PFS (hazard ratio [HR], 0.75; 95% CI, 0.61 to 0.91; P = .0023). Twelve-month PFS estimates were 13.6% with pembrolizumab plus EP and 3.1% with placebo plus EP. Although pembrolizumab plus EP prolonged OS, the significance threshold was not met (HR, 0.80; 95% CI, 0.64 to 0.98; P = .0164). Twenty-four-month OS estimates were 22.5% and 11.2%, respectively. ORR was 70.6% in the pembrolizumab plus EP group and 61.8% in the placebo plus EP group; the estimated proportion of responders remaining in response at 12 months was 19.3% and 3.3%, respectively. In the pembrolizumab plus EP and placebo plus EP groups, respectively, any-cause adverse events were grade 3-4 in 76.7% and 74.9%, grade 5 in 6.3% and 5.4%, and led to discontinuation of any drug in 14.8% and 6.3%. CONCLUSION Pembrolizumab plus EP significantly improved PFS compared with placebo plus EP as first-line therapy for patients with ES-SCLC. No unexpected toxicities were seen with pembrolizumab plus EP. These data support the benefit of pembrolizumab in ES-SCLC.
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Affiliation(s)
| | | | - Alejandro Navarro
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - Tibor Csőszi
- Hetényi Géza Kórház Onkológiai Központ, Szolnok, Hungary
| | - Parneet K Cheema
- William Osler Health System, University of Toronto, Brampton, Ontario, Canada
| | - Delvys Rodriguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - James Chih-Hsin Yang
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Julien Mazieres
- Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | - Mahmut Gümüş
- Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Hye Ryun Kim
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Rudin CM, Awad MM, Navarro A, Gottfried M, Peters S, Csőszi T, Cheema PK, Rodriguez-Abreu D, Wollner M, Czyzewicz G, Yang JCH, Mazieres J, Orlandi FJ, Luft A, Gumus M, Kato T, Kalemkerian GP, Luo Y, Pietanza MC, Kim HR. KEYNOTE-604: Pembrolizumab (pembro) or placebo plus etoposide and platinum (EP) as first-line therapy for extensive-stage (ES) small-cell lung cancer (SCLC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9001 Background: Pembro monotherapy showed durable antitumor activity as third-line or later therapy for metastatic SCLC, leading to FDA approval in that setting. KEYNOTE-604 was a double-blind, phase 3 study of pembro + EP vs placebo + EP as first-line therapy for ES-SCLC (NCT03066778). Methods: Eligible patients (pts) with previously untreated ES-SCLC and no untreated CNS metastases were randomized 1:1 to pembro 200 mg Q3W or saline placebo for up to 35 cycles plus 4 cycles of standard-dose EP. Pts with CR or PR after cycle 4 could receive PCI at investigator discretion. Randomization was stratified by platinum choice (carboplatin vs cisplatin), ECOG PS (0 vs 1), and LDH (≤ULN vs > ULN). Primary endpoints were OS and PFS (RECIST v1.1, blinded central review) in the ITT population. ORR, DOR, and safety were secondary endpoints. OS and PFS treatment differences were assessed by the stratified log-rank test. The protocol specified 2 interim analyses (IAs) and a final analysis (FA). Prespecified efficacy boundaries were one-sided P = 0.0048 for PFS at IA2 (prespecified final PFS analysis) and 0.0128 for OS at FA. Results: 453 pts were randomized. 223/228 pts assigned to pembro + EP and 222/225 assigned to placebo + EP received ≥1 dose of assigned treatment; 1 pt assigned to pembro + EP received placebo + EP in error. Median age was 65 y, 74% had ECOG PS 1, and 57% had LDH > ULN; more pts in the pembro + EP arm had baseline brain metastases (14% vs 10%). At FA (median follow-up, 21.6 mo), 9% of pts in the pembro + EP arm and 1% in the placebo + EP arm remained on study treatment; 12% and 14% received PCI. At IA2 (median follow-up, 13.5 mo), pembro + EP significantly improved PFS in the ITT population (HR 0.75 [95% CI 0.61-0.91], P = 0.0023; median 4.5 vs 4.3 mo). At FA, pembro + EP prolonged OS in the ITT population, but the significance threshold was not met (HR 0.80 [95% CI 0.64-0.98], P = 0.0164; median 10.8 vs 9.7 mo). In a post hoc analysis of OS in the as-treated population, the nominal P value was smaller than the significance threshold (HR 0.78 [95% CI 0.63-0.97], P = 0.0124). ORR at FA was 71% for pembro + EP vs 62% for placebo + EP; median DOR was 4.2 vs 3.7 mo. Observed AEs were as expected; any-cause AEs were grade 3-4 in 77% vs 75%, grade 5 in 6% vs 5%, and led to discontinuation in 15% vs 6%. Conclusions: Pembro + EP significantly improved PFS and prolonged OS compared with placebo + EP as first-line therapy for pts with ES-SCLC. No unexpected toxicities were seen with pembro + EP. These data support the benefit of pembro-containing regimens for ES-SCLC. Clinical trial information: NCT03066778.
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Affiliation(s)
| | | | - Alejandro Navarro
- Medical Oncology Department, Vall d´Hebron University Hospital/Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Tibor Csőszi
- Hetenyi G Korhaz, Onkologiai Kozpont, Szolnok, Hungary
| | | | - Delvys Rodriguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas De Gran Canaria, Spain
| | | | | | - James Chih-Hsin Yang
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Julien Mazieres
- Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, St. Petersburg, Russian Federation
| | - Mahmut Gumus
- Istanbul Medeniyet University Hospital, Istanbul, Turkey
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Mazieres J, Kowalski D, Luft A, Vicente D, Tafreshi A, Gümüş M, Laktionov K, Hermes B, Cicin I, Rodríguez-Cid J, Wilson J, Kato T, Ramlau R, Novello S, Reddy S, Kopp HG, Piperdi B, Li X, Burke T, Paz-Ares L. Health-Related Quality of Life With Carboplatin-Paclitaxel or nab-Paclitaxel With or Without Pembrolizumab in Patients With Metastatic Squamous Non-Small-Cell Lung Cancer. J Clin Oncol 2019; 38:271-280. [PMID: 31751163 DOI: 10.1200/jco.19.01348] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In the phase 3 KEYNOTE-407 study, the addition of pembrolizumab to carboplatin-paclitaxel/nab-paclitaxel significantly improved overall survival, progression-free survival, and objective response rate in patients with previously untreated metastatic squamous non-small-cell lung cancer (NSCLC), with little impact on severe toxicity. We present patient-reported outcomes (PROs) from KEYNOTE-407. METHODS Patients were randomly assigned to receive 4 cycles of pembrolizumab 200 mg or placebo once every 3 weeks plus carboplatin plus paclitaxel or nab-paclitaxel, followed by pembrolizumab or placebo for an additional 31 cycles. Health-related quality of life (HRQoL) was evaluated using the European Organisation for Research and Treatment of Cancer Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and Quality of Life Questionnaire-Lung Cancer Module 13 (QLQ-LC13). Key PRO endpoints were change from baseline to weeks 9 and 18 (during and after platinum therapy) in the QLQ-C30 global health status/quality of life (GHS/QoL) score and time to deterioration in the composite endpoint of cough, chest pain, or dyspnea from the QLQ-C30 and QLQ-LC13. Two-sided, nominal P values are provided. RESULTS A total of 554 and 553 patients completed ≥ 1 QLQ-C30 or ≥ 1 QLQ-LC13 assessment, respectively. GHS/QoL score improved for the pembrolizumab-combination group (least squares [LS] mean [95% CI] change from baseline: week 9, 1.8 [-0.9 to 4.4]; week 18, 4.3 [1.7 to 6.9]) and deteriorated in the placebo-combination group (week 9, -1.8 [-4.4 to 0.7]; week 18, -0.57 [-3.3 to 2.2]). Between-group differences were improved for the pembrolizumab-combination group (difference in LS mean scores: week 9, 3.6 [95% CI, 0.3 to 6.9], nominal P = .0337; week 18, 4.9 [1.4 to 8.3], nominal P = .0060). Median time to deterioration in cough, chest pain, or dyspnea was not reached in either group (hazard ratio, 0.79; 95% CI, 0.58 to 1.06]; nominal P = .125). CONCLUSION Addition of pembrolizumab to chemotherapy maintained or improved HRQoL measurements relative to baseline and improved HRQoL versus chemotherapy alone at weeks 9 and 18. These results support use of pembrolizumab plus chemotherapy as first-line therapy for metastatic squamous NSCLC.
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Affiliation(s)
- Julien Mazieres
- Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | - David Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - Ali Tafreshi
- Wollongong Oncology and University of Wollongong, Wollongong, NSW, Australia
| | - Mahmut Gümüş
- Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | | | | | | | | | | | - Rodryg Ramlau
- Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Hans-Georg Kopp
- Robert-Bosch Cancer Center, Klinik Schillerhöhe, Gerlingen, Germany
| | | | | | | | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, CNIO-H12o Lung Cancer Unit, Universidad Complutense and Ciberonc, Madrid, Spain
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Reck M, Luft A, Bondarenko I, Shevnia S, Trukhin D, Kovalenko N, Vacharadze K, Andrea F, Hontsa A, Choi J, Shin D. A phase III study comparing SB8, a proposed bevacizumab biosimilar, and reference bevacizumab in patients with metastatic or recurrent non-squamous NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reinmuth N, Boothman AM, Cho B, Lee K, Luft A, Ahn MJ, Scott M, Whiteley J, Walker J, Karwe V, Mukhopadhyay P, Thiyagarajah P, Scheuring U, Rizvi N. PD-L1 expression in primary tumour vs metastatic samples in the phase III MYSTIC study in first-line metastatic (m) NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rizvi N, Cho B, Reinmuth N, Lee K, Luft A, Ahn M, Papadimitrakopoulou V, Heymach J, Scheuring U, Higgs B, Ye J, Kuziora M, Wu S, Liu F, Si H, Peters S. OA04.07 Mutations Associated with Sensitivity or Resistance to Immunotherapy in mNSCLC: Analysis from the MYSTIC Trial. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.428] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rizvi NA, Cho BC, Reinmuth N, Lee KH, Luft A, Ahn MJ, van den Heuvel M, Dols MC, Vicente D, Smolin A, Moiseyenko V, Antonia SJ, Nakagawa K, Goldberg SB, Kim ES, Walker J, Raja R, Liu F, Scheuring UJ, Peters S. Blood tumor mutational burden (bTMB) and tumor PD-L1 as predictive biomarkers of survival in MYSTIC: First-line durvalumab (D) ± tremelimumab (T) versus chemotherapy (CT) in metastatic (m) NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9016 Background: MYSTIC, an open-label, Ph3 trial of first-line D (anti-PD-L1) ± T (anti-CTLA-4) vs platinum-based CT, showed an improvement in OS with D vs CT in pts with tumor cell PD-L1 expression ≥25% (PD-L1 TC ≥25%; HR 0.76 [97.54% CI 0.56–1.02], p = 0.036). Exploratory analyses showed bTMB was a predictive biomarker for OS with D±T vs CT. We report further exploratory analyses of OS according to PD-L1 and bTMB. Methods: Immunotherapy/CT-naïve pts with mNSCLC were randomized (1:1:1) to D, D+T or CT. bTMB levels (mut/Mb) were evaluated with the GuardantOMNI platform (Guardant Health), and PD-L1 TC expression with the VENTANA PD-L1 (SP263) IHC assay. Results: D improved OS vs CT in pts with PD-L1 TC ≥25% across bTMB levels (PD-L1 TC ≥25%/bTMB≥20 HR 0.79 [95% CI 0.45, 1.39]; PD-L1 TC ≥25%/bTMB < 20 HR 0.64 [95% CI 0.45, 0.90]). In contrast, D+T improved OS vs CT in pts with bTMB≥20 across different PD-L1 TC expression levels (Table; PD-L1 TC ≥25%/bTMB≥20 HR 0.44 [95% CI 0.23, 0.84]; PD-L1 TC < 1%/bTMB≥20 HR 0.42 [95% CI 0.17, 0.97]). Additional cutoffs and outcomes in subgroups defined by both biomarkers will be presented. Conclusions: These exploratory analyses from MYSTIC support PD-L1 TC expression as an appropriate predictive biomarker for OS with D vs CT, while suggesting bTMB as a predictive biomarker for OS with D+T in mNSCLC. These biomarkers appear to be independent and both may be important for mNSCLC treatment decisions. Interpretation of these data may be limited by small sample sizes; further investigations are warranted. Clinical trial information: NCT02453282. [Table: see text]
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Affiliation(s)
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, Oncology Department, Lunacharskogo Prospect, Russian Federation
| | | | - Michel van den Heuvel
- Department of Thoracic Oncology, Netherlands Cancer Institute (NKI), Amsterdam, Netherlands
| | - Manuel Cobo Dols
- Hospital Universitario Regional Málaga, Instituto de Investigaciones Biomédicas Málaga (IBIMA), Málaga, Spain
| | - David Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
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- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Garon EB, Cho BC, Reinmuth N, Lee KH, Luft A, Ahn MJ, Robinet G, Le Moulec S, Natale R, Schneider JG, Shepherd FA, Garassino MC, Geater SL, Papai-Szekely Z, Van Ngoc T, Liu F, Scheuring UJ, Rydén A, Peters S, Rizvi NA. Patient-reported outcomes (PROs) with first-line durvalumab (D) ± tremelimumab (T) versus chemotherapy (CT) in metastatic NSCLC: Results from MYSTIC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9048 Background: MYSTIC, an open-label, Phase 3 trial of first-line D (anti-PD-L1) ± T (anti-CTLA-4) vs platinum CT in mNSCLC, showed an improvement in overall survival (OS) with D vs CT in pts with tumor cell PD-L1 expression ≥25% (TC ≥25% [primary analysis population]; D vs CT, HR 0.76 [97.54% CI 0.56–1.02], p = 0.036; D+T vs CT, HR 0.85 [98.77% CI 0.61–1.17], p = 0.202). Here we summarize PROs from MYSTIC. Methods: Immunotherapy/CT-naïve mNSCLC pts were randomized (1:1:1) to D, D+T, or CT. Symptoms, function, and global health status/quality of life (QoL) were assessed using the EORTC QLQ-C30 v3 questionnaire and its lung cancer module, QLQ-LC13. A change in score from baseline ≥10 points was predefined as clinically meaningful (CM). Mean changes from baseline (over 12 mos) for prespecified symptoms were analyzed using a mixed model for repeated measures (MMRM). Time from randomization to the first CM deterioration (TTD) was analyzed. Results: Among pts with PD-L1 TC ≥25% (n = 488), there were no differences between arms in symptoms, function, or global health status/QoL at baseline. Compliance with completing the questionnaires was ≥60% to wk 120 in the D±T arms, and to wk 40 (C30) and wk 44 (LC13) in the CT arm. MMRM analysis showed significant between-arm differences in changes from baseline in favor of D for fatigue (difference vs CT −9.5) and appetite loss (−11.9; CM), and D+T for fatigue (−11.7; CM). Significantly longer TTD (median, mos) was seen with D and D+T vs CT for appetite loss (12.8 and 5.6 vs 4.5), constipation (14.6 and 9.0 vs 5.5), nausea/vomiting (16.7 and 9.7 vs 4.5), and dyspnea (10.6 and 7.4 vs 5.6); D vs CT for diarrhea (16.3 vs 9.0), insomnia (9.3 vs 6.2), and hemoptysis (not reached vs 10.3); and D+T vs CT for fatigue (5.6 vs 2.0). Significantly longer TTD (median, mos) was also seen with D and D+T vs CT for function (cognitive [9.1 and 6.6 vs 5.2], physical [9.0 and 7.4 vs 4.2], role [D vs CT only; 7.3 vs 3.7], social [12.9 and 5.4 vs 5.2]), and global health status/QoL (5.9 and 6.8 vs 5.5). Conclusions: Pts with PD-L1 TC ≥25% treated with D±T had a reduced symptom burden over time and longer TTD for symptoms, function, and global health status/QoL compared to pts receiving CT. Clinical trial information: NCT02453282.
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Affiliation(s)
- Edward B. Garon
- David Geffen School of Medicine, University of California/TRIO-US Network, Los Angeles, CA
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Cheongju, South Korea
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, Oncology Department, Lunacharskogo Prospect, Russian Federation
| | | | | | | | - Ronald Natale
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA
| | | | - Frances A. Shepherd
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
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Reinmuth N, Cho B, Lee K, Luft A, Ahn MJ, Schneider J, Shepherd F, Geater S, Pápai-Székely Z, Van Ngoc T, Garassino M, Liu F, Clemett D, Thiyagarajah P, Ouwens M, Scheuring U, Peters S, Rizvi N. Effect of post-study immunotherapy (IO) on overall survival (OS) outcome in patients with metastatic (m) NSCLC treated with first-line durvalumab (D) vs chemotherapy (CT) in the phase III MYSTIC study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz094.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Cho B, Reinmuth N, Lee K, Ahn MJ, Luft A, Van den Heuvel M, Dols MC, Smolin A, Vicente D, Moiseyenko V, Antonia S, Moulec SL, Robinet G, Natale R, Garon E, Nakagawa K, Liu F, Thiyagarajah P, Peters S, Rizvi N. Efficacy and safety of first-line durvalumab (D) ± tremelimumab (T) vs platinum-based chemotherapy (CT) based on clinical characteristics in patients with metastatic (m) NSCLC: Results from MYSTIC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz094.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Rizvi N, Chul Cho B, Reinmuth N, Lee K, Ahn MJ, Luft A, van den Heuvel M, Cobo M, Smolin A, Vicente D, Moiseyenko V, Antonia S, Le Moulec S, Robinet G, Natale R, Nakagawa K, Zhao L, Stockman P, Chand V, Peters S. Durvalumab with or without tremelimumab vs platinum-based chemotherapy as first-line treatment for metastatic non-small cell lung cancer: MYSTIC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy511.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Paz-Ares L, Luft A, Vicente D, Tafreshi A, Gümüş M, Mazières J, Hermes B, Çay Şenler F, Csőszi T, Fülöp A, Rodríguez-Cid J, Wilson J, Sugawara S, Kato T, Lee KH, Cheng Y, Novello S, Halmos B, Li X, Lubiniecki GM, Piperdi B, Kowalski DM. Pembrolizumab plus Chemotherapy for Squamous Non-Small-Cell Lung Cancer. N Engl J Med 2018; 379:2040-2051. [PMID: 30280635 DOI: 10.1056/nejmoa1810865] [Citation(s) in RCA: 2286] [Impact Index Per Article: 381.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Standard first-line therapy for metastatic, squamous non-small-cell lung cancer (NSCLC) is platinum-based chemotherapy or pembrolizumab (for patients with programmed death ligand 1 [PD-L1] expression on ≥50% of tumor cells). More recently, pembrolizumab plus chemotherapy was shown to significantly prolong overall survival among patients with nonsquamous NSCLC. METHODS In this double-blind, phase 3 trial, we randomly assigned, in a 1:1 ratio, 559 patients with untreated metastatic, squamous NSCLC to receive 200 mg of pembrolizumab or saline placebo for up to 35 cycles; all the patients also received carboplatin and either paclitaxel or nanoparticle albumin-bound [nab]-paclitaxel for the first 4 cycles. Primary end points were overall survival and progression-free survival. RESULTS After a median follow-up of 7.8 months, the median overall survival was 15.9 months (95% confidence interval [CI], 13.2 to not reached) in the pembrolizumab-combination group and 11.3 months (95% CI, 9.5 to 14.8) in the placebo-combination group (hazard ratio for death, 0.64; 95% CI, 0.49 to 0.85; P<0.001). The overall survival benefit was consistent regardless of the level of PD-L1 expression. The median progression-free survival was 6.4 months (95% CI, 6.2 to 8.3) in the pembrolizumab-combination group and 4.8 months (95% CI, 4.3 to 5.7) in the placebo-combination group (hazard ratio for disease progression or death, 0.56; 95% CI, 0.45 to 0.70; P<0.001). Adverse events of grade 3 or higher occurred in 69.8% of the patients in the pembrolizumab-combination group and in 68.2% of the patients in the placebo-combination group. Discontinuation of treatment because of adverse events was more frequent in the pembrolizumab-combination group than in the placebo-combination group (13.3% vs. 6.4%). CONCLUSIONS In patients with previously untreated metastatic, squamous NSCLC, the addition of pembrolizumab to chemotherapy with carboplatin plus paclitaxel or nab-paclitaxel resulted in significantly longer overall survival and progression-free survival than chemotherapy alone. (Funded by Merck Sharp & Dohme; KEYNOTE-407 ClinicalTrials.gov number, NCT02775435 .).
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Affiliation(s)
- Luis Paz-Ares
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Alexander Luft
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - David Vicente
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Ali Tafreshi
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Mahmut Gümüş
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Julien Mazières
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Barbara Hermes
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Filiz Çay Şenler
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Tibor Csőszi
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Andrea Fülöp
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Jerónimo Rodríguez-Cid
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Jonathan Wilson
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Shunichi Sugawara
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Terufumi Kato
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Ki Hyeong Lee
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Ying Cheng
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Silvia Novello
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Balazs Halmos
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Xiaodong Li
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Gregory M Lubiniecki
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Bilal Piperdi
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
| | - Dariusz M Kowalski
- From Hospital Universitario 12 de Octubre, Spanish National Cancer Research Center, Universidad Complutense and Ciberonc, Madrid (L.P.-A.), and Hospital Universitario Virgen Macarena, Seville (D.V.) - both in Spain; Leningrad Regional Clinical Hospital, St. Petersburg, Russia (A.L.); Wollongong Oncology and Wollongong Private Hospital, Wollongong, NSW, Australia (A.T.); Istanbul Medeniyet University Hospital, Istanbul (M.G.), and Ankara University, Ankara (F.Ç.Ş.) - both in Turkey; Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France (J.M.); Universitätsklinikum Tübingen, Tübingen, Germany (B. Hermes); Jász-Nagykun-Szolnok County Hospital, Szolnok (T.C.), and Országos Korányi TBC és Pulmonológiai Intézet, Budapest (A.F.) - both in Hungary; Oncology Center, Medica Sur Hospital, Mexico City (J.R.-C.); Humber River Regional Hospital, Toronto (J.W.); Sendai Kousei Hospital, Sendai (S.S.), and the Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheong-ju, South Korea (K.H.L.); Jilin Cancer Hospital, Changchun, China (Y.C.); University of Turin, Orbassano, Italy (S.N.); Montefiore Medical Center-Albert Einstein College of Medicine, New York (B. Halmos); Merck, Kenilworth, NJ (X.L., G.M.L., B.P.); and the Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland (D.M.K.)
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Kato T, Lee S, Cheng Y, Lee GW, Lee K, Luft A, Trigo J, Hui R, Balint B, Robinson A, Okamoto I, Gerstner G, Paz-Ares L, Li X, Shentu Y, Piperdi B, Tafreshi A. Carboplatin-paclitaxel/nab-paclitaxel with or without pembrolizumab in first-line metastatic squamous NSCLC: Results from the KEYNOTE-407 east Asia subgroup. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy425.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mazières J, Kowalski D, Luft A, Vicente D, Tafreshi A, Gümüş M, Laktionov K, Hermes B, Cicin I, Rodríguez-Cid J, Wilson J, Kato T, Ramlau R, Novello S, Reddy S, Piperdi B, Li X, Burke T, Paz-Ares L. Health-related quality of life (HRQoL) for pembrolizumab or placebo plus carboplatin and paclitaxel or nab-paclitaxel in patients with metastatic squamous NSCLC: Data from KEYNOTE-407. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chau I, Al-Batran SE, Luft A, Kowalyszyn R, Hernandez C, Pfeiffer P, Wojcik E, Bodoky G, Madi A, Brenner B, De Vita F, Folprecht G, Peltola K, Lorenzen S, Denlinger C, Liepa A, Das M, Wei R, Fuchs C. Quality-of-life (QoL) results from RAINFALL: A randomized, double-blind, placebo (PL)-controlled phase III study of cisplatin (Cis) plus capecitabine (Cape) or 5FU with or without ramucirumab (RAM) as first-line therapy for metastatic gastric or gastroesophageal junction (G-GEJ) cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Paz-Ares LG, Luft A, Tafreshi A, Gumus M, Mazieres J, Hermes B, Cay Senler F, Fülöp A, Rodriguez-Cid J, Sugawara S, Cheng Y, Novello S, Halmos B, Shentu Y, Kowalski D. Phase 3 study of carboplatin-paclitaxel/nab-paclitaxel (Chemo) with or without pembrolizumab (Pembro) for patients (Pts) with metastatic squamous (Sq) non-small cell lung cancer (NSCLC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.105] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | | | - Mahmut Gumus
- Kartal Research and Training Hospital, Istanbul, Turkey
| | - Julien Mazieres
- Hôpital Larrey, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | | | - Filiz Cay Senler
- Ankara University Department of Medical Oncology, Ankara, Turkey
| | - Andrea Fülöp
- Országos Korányi TBC és Pulmonológiai Intézet, Budapest, Hungary, Budapest, Hungary
| | | | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Ying Cheng
- Department of Oncology, Cancer Hospital of Jilin Province, Changchun, China
| | - Silvia Novello
- Department of Oncology, University of Turin, Orbassano, Italy
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Vitalis V, Carfantan C, Montcriol A, Peyrefitte S, Luft A, Pouget T, Sailliol A, Ausset S, Meaudre E, Bordes J. Early transfusion on battlefield before admission to role 2: A preliminary observational study during "Barkhane" operation in Sahel. Injury 2018; 49:903-910. [PMID: 29248187 DOI: 10.1016/j.injury.2017.11.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/24/2017] [Revised: 11/10/2017] [Accepted: 11/22/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Haemorrage is the leading cause of death after combat related injuries and bleeding management is the cornerstone of management of these casualties. French armed forces are deployed in Barkhane operation in the Sahel-Saharan Strip who represents an immense area. Since this constraint implies evacuation times beyond doctrinal timelines, an institutional decision has been made to deploy blood products on the battlefield and transfuse casualties before role 2 admission if indicated. The purpose of this study was to evaluate the transfusion practices on battlefield during the first year following the implementation of this policy. MATERIALS AND METHODS Prospective collection of data about combat related casualties categorized alpha evacuated to a role 2. Battlefield transfusion was defined as any transfusion of blood product (red blood cells, plasma, whole blood) performed by role 1 or Medevac team before admission at a role 2. Patients' characteristics, battlefield transfusions' characteristics and complications were analysed. RESULTS During the one year study, a total of 29 alpha casualties were included during the period study. Twenty-eight could be analysed, 7/28 (25%) being transfused on battlefield, representing a total of 22 transfusion episodes. The most frequently blood product transfused was French lyophilized plasma (FLYP). Most of transfusion episodes occurred during medevac. Compared to non-battlefield transfused casualties, battlefield transfused casualties suffered more wounded anatomical regions (median number of 3 versus 2, p = 0.04), had a higher injury severity score (median ISS of 45 versus 25, p = 0,01) and were more often transfused at role 2, received more plasma units and whole blood units. There was no difference in evacuation time to role 2 between patients transfused on battlefield and non-transfused patients. There was no complication related to battlefield transfusions. Blood products transfusion onset on battlefield ranged from 75 min to 192 min after injury. CONCLUSION Battlefield transfusion for combat-related casualties is a logistical challenge. Our study showed that such a program is feasible even in an extended area as Sahel-Saharan Strip operation theatre and reduces time to first blood product transfusion for alpha casualties. FLYP is the first line blood product on the battlefield.
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Affiliation(s)
- V Vitalis
- French Medical Unit, Medical Centre of Lyon, France
| | - C Carfantan
- French Military Medical Service, Operational Headquarters, France
| | - A Montcriol
- Sainte Anne Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Toulon, France
| | - S Peyrefitte
- French Medical Unit, Naval Special Operations Commandos Command, Lanester, France
| | - A Luft
- French Military Medical Service, Operational Headquarters, France
| | - T Pouget
- French Military Blood Institute, Clamart, France
| | - A Sailliol
- French Military Blood Institute, Clamart, France
| | - S Ausset
- Percy Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Clamart, France & Val de Grâce Military Academy, Paris, France
| | - E Meaudre
- Sainte Anne Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Toulon, France
| | - J Bordes
- Sainte Anne Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Toulon, France; 7th Paratrooper Forward Surgical Unit, France.
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Reck M, Luft A, Szczesna A, Havel L, Kim SW, Akerley W, Pietanza MC, Wu YL, Zielinski C, Thomas M, Felip E, Gold K, Horn L, Aerts J, Nakagawa K, Lorigan P, Pieters A, Kong Sanchez T, Fairchild J, Spigel D. Phase III Randomized Trial of Ipilimumab Plus Etoposide and Platinum Versus Placebo Plus Etoposide and Platinum in Extensive-Stage Small-Cell Lung Cancer. J Clin Oncol 2017; 34:3740-3748. [PMID: 27458307 DOI: 10.1200/jco.2016.67.6601] [Citation(s) in RCA: 357] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Patients with extensive-stage disease small-cell lung cancer (SCLC) have poor survival outcomes despite first-line chemotherapy with etoposide and platinum. This randomized, double-blind phase III study evaluated the efficacy and safety of ipilimumab or placebo plus etoposide and platinum in patients with newly diagnosed extensive-stage disease SCLC. Patients and Methods Patients were randomly assigned at a ratio of one to one to receive chemotherapy with etoposide and platinum (cisplatin or carboplatin) plus ipilimumab 10 mg/kg or placebo every 3 weeks for a total of four doses each in a phased induction schedule (chemotherapy in cycles one to four; ipilimumab or placebo beginning in cycle three up to cycle six), followed by ipilimumab or placebo maintenance every 12 weeks. Primary end point was overall survival (OS) among patients receiving at least one dose of blinded study therapy. Results Of 1,132 patients randomly assigned, 954 received at least one dose of study therapy (chemotherapy plus ipilimumab, n = 478; chemotherapy plus placebo, n = 476). Median OS was 11.0 months for chemotherapy plus ipilimumab versus 10.9 months for chemotherapy plus placebo (hazard ratio, 0.94; 95% CI, 0.81 to 1.09; P = .3775). Median progression-free survival was 4.6 months for chemotherapy plus ipilimumab versus 4.4 months for chemotherapy plus placebo (hazard ratio, 0.85; 95% CI, 0.75 to 0.97). Rates and severity of treatment-related adverse events were similar between arms, except for diarrhea, rash, and colitis, which were more frequent with chemotherapy plus ipilimumab. Rate of treatment-related discontinuation was higher with chemotherapy plus ipilimumab (18% v 2% with chemotherapy plus placebo). Five treatment-related deaths occurred with chemotherapy plus ipilimumab and two with chemotherapy plus placebo. Conclusion Addition of ipilimumab to chemotherapy did not prolong OS versus chemotherapy alone in patients with newly diagnosed extensive-stage disease SCLC. No new or unexpected adverse events were observed with chemotherapy plus ipilimumab. Several ongoing studies are evaluating ipilimumab in combination with programmed death-1 inhibitors in SCLC.
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Affiliation(s)
- Martin Reck
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Alexander Luft
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Aleksandra Szczesna
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Libor Havel
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sang-We Kim
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wallace Akerley
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Maria Catherine Pietanza
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Yi-Long Wu
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Christoph Zielinski
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michael Thomas
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Enriqueta Felip
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kathryn Gold
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Leora Horn
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Joachim Aerts
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kazuhiko Nakagawa
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Lorigan
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Anne Pieters
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Teresa Kong Sanchez
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Justin Fairchild
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Spigel
- Martin Reck, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf; Michael Thomas, Translational Lung Research Center Heidelberg, Thoraxklinik im Universitätsklinikum Heidelberg, Heidelberg, Germany; Alexander Luft, Leningrad Regional Clinical Hospital, Leningrad, Russia; Aleksandra Szczesna, Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy w Otwocku, Otwocku, Poland; Libor Havel, Hospital Na Bulovce, Prague, Czech Republic; Sang-We Kim, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; Wallace Akerley, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Maria Catherine Pietanza, Memorial Sloan Kettering Cancer Center, New York, NY; Kathryn Gold, University of Texas MD Anderson Cancer Center, Houston, TX; Leora Horn, Vanderbilt-Ingram Cancer Center; David Spigel, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN; Anne Pieters, Teresa Kong Sanchez, and Justin Fairchild, Bristol-Myers Squibb, Princeton, NJ; Yi-long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong, People's Republic of China; Christoph Zielinski, Medical University of Vienna, Vienna, Austria; Enriqueta Felip, Vall d'Hebron University Hospital, Barcelona, Spain; Joachim Aerts, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Kazuhiko Nakagawa, Kinki University Hospital, Osaka, Japan; and Paul Lorigan, the Christie NHS Foundation Trust, Manchester, United Kingdom
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Ajani J, Udrea A, Sarosiek T, Shenker M, Morgan C, Pikiel J, Wojcik E, Swinson D, Joseph M, Luft A, Salek T, Tournigand C, Ferry D, Zhang Y, Long A, Kuo WL, Gao L, Kauh J, Mansoor W. A dose-response study of ramucirumab treatment in patients with gastric cancer/gastroesophageal junction adenocarcinoma: Primary results of 4 dosing regimens in the phase 2 trial I4T-MC-JVDB. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Spigel DR, Luft A, Depenbrock H, Ramlau R, Khalil M, Kim JH, Mayo C, Chao GY, Obasaju C, Natale R. An Open-Label, Randomized, Controlled Phase II Study of Paclitaxel-Carboplatin Chemotherapy With Necitumumab Versus Paclitaxel-Carboplatin Alone in First-Line Treatment of Patients With Stage IV Squamous Non-Small-Cell Lung Cancer. Clin Lung Cancer 2017; 18:480-488. [PMID: 28365238 DOI: 10.1016/j.cllc.2017.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/01/2016] [Revised: 02/08/2017] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The combination of necitumumab with gemcitabine-cisplatin significantly improved overall survival (OS) in patients with stage IV squamous non-small-cell lung cancer (NSCLC), in the phase III SQUamous NSCLC treatment with the Inhibitor of EGF REceptor (SQUIRE) trial. Paclitaxel-carboplatin was selected as an alternative standard of care in the current phase II study. PATIENTS AND METHODS Patients were randomized (stratified according to Eastern Cooperative Oncology Group performance status and sex) 2:1 to ≤ six 3-week cycles (Q3W) of paclitaxel and carboplatin with or without necitumumab. Chemotherapy was paclitaxel 200 mg/m2 on day 1 Q3W and carboplatin area under the curve 6 on day 1 Q3W. Necitumumab 800 mg, on days 1 and 8, was continued until disease progression or intolerable toxicity occurred. The primary end point was objective response rate (ORR) on the basis of Response Evaluation Criteria In Solid Tumors version 1.1. RESULTS One hundred sixty-seven patients were randomized to the necitumumab-containing arm (n = 110) or the chemotherapy-only arm (n = 57). The combination of necitumumab with chemotherapy resulted in an ORR of 48.9% versus 40.0%. Median progression-free survival and OS were 5.4 versus 5.6 months (hazard ratio [HR], 1.0) and 13.2 versus 11.2 months (HR, 0.83; P = .379) in each treatment arm, respectively. Disease control rate was 87.2% versus 84.0%. Grade ≥ 3 adverse events typically associated with epidermal growth factor receptor (EGFR) monoclonal antibodies showing a > 2% increase were hypomagnesemia (5.7% vs. 0) and rash (2.8% vs. 0). Any Grade thromboembolic events occurred in < 4% of patients in either arm. CONCLUSION The results of our study support previously reported results that the combination of necitumumab with chemotherapy improves survival in patients with advanced squamous NSCLC and shows a safety profile consistent with that of EGFR monoclonal antibodies.
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Affiliation(s)
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | | | - Rodryg Ramlau
- Department of Oncology, Poznań University of Medical Sciences, Poznań, Poland
| | | | - Joo-Hang Kim
- CHA Bundang Medical Center, CHA University, Gyeonggi-do, Korea
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Ciuleanu T, Socinski M, Obasaju C, Luft A, Szczęsna A, Ramlau R, Bálint B, Molinier O, Depenbrock H, Nanda S, Paz-Ares L, Thatcher N. OA23.02 Efficacy and Safety of Necitumumab Continuation Monotherapy in Patients with EGFR-Expressing Tumors in SQUIRE, a Phase 3 Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Knowledge of performance can activate the striatum, a key region of the reward system and highly relevant for motivated behavior. Using functional magnetic resonance imaging, striatal activity linked to knowledge of performance was measured during the training of a repetitive arc-tracking task. Knowledge of performance was given after a random selection of trials or after good performance. The third group received knowledge of performance after good performance plus a monetary reward. Skill learning was measured from pre- to post- (acquisition) and from post- to 24h posttraining (consolidation). Our results demonstrate an influence of feedback on motor skill learning. Adding a monetary reward after good performance leads to better consolidation and higher ventral striatal activation than knowledge of performance alone. In turn, rewarding strategies that increase ventral striatal response during training of a motor skill may be utilized to improve skill consolidation.
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Affiliation(s)
- M Widmer
- University Hospital of Zurich, Zurich, Switzerland; Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland; Neural Control of Movement Lab, ETH Zurich, Zurich, Switzerland.
| | - N Ziegler
- Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - J Held
- University Hospital of Zurich, Zurich, Switzerland; Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - A Luft
- University Hospital of Zurich, Zurich, Switzerland; Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - K Lutz
- University Hospital of Zurich, Zurich, Switzerland; Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland; Institute of Psychology, University of Zurich, Zurich, Switzerland
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Reck M, Socinski MA, Luft A, Szczęsna A, Dediu M, Ramlau R, Losonczy G, Molinier O, Schumann C, Gralla RJ, Bonomi P, Brown J, Soldatenkova V, Chouaki N, Obasaju C, Peterson P, Thatcher N. The Effect of Necitumumab in Combination with Gemcitabine plus Cisplatin on Tolerability and on Quality of Life: Results from the Phase 3 SQUIRE Trial. J Thorac Oncol 2016; 11:808-18. [PMID: 26980471 DOI: 10.1016/j.jtho.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 01/06/2016] [Revised: 02/26/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Necitumumab, a second-generation, recombinant human immunoglobulin G1 epidermal growth factor receptor antibody in the phase 3 SQUIRE trial (NCT00981058), increased survival benefit for patients randomized to receive necitumumab plus gemcitabine-cisplatin compared with those who received gemcitabine-cisplatin. Here we characterize health-related quality of life (HRQoL) and tolerability results. METHODS A total of 1093 patients with stage IV squamous non-small cell lung cancer were randomized 1:1 to receive necitumumab (800 mg absolute dose intravenously [IV]) plus gemcitabine-cisplatin (gemcitabine = 1250 mg/m(2) IV on days 1 and 8; cisplatin = 75 mg/m(2) IV on day 1) or gemcitabine-cisplatin alone (every 21 days) for up to six cycles. Patients receiving necitumumab plus gemcitabine-cisplatin without disease progression continued necitumumab until progression. HRQoL was measured by Eastern Cooperative Oncology Group performance status, the Lung Cancer Symptom Scale (LCSS), and the European Quality of Life Five-Dimensions questionnaire. Efficacy and LCSS outcomes were analyzed using the baseline maximum severity score of the LCSS. Tolerability was measured in terms of exposure to the study treatment and adverse events. Hospitalization rates were collected. RESULTS Most patients in both study arms similarly maintained Eastern Cooperative Oncology Group performance status and comparable LCSS and European Quality of Life Five-Dimensions questionnaire assessments. Patients with a higher baseline LCSS had a greater survival benefit on the necitumumab arm. Chemotherapy exposure was similar in both treatment arms; 51% of patients on the necitumumab plus gemcitabine-cisplatin arm continued on single-agent necitumumab. The most frequent grade 4 adverse events were neutropenia (6.1% versus 7.9%) and thrombocytopenia (3.2% versus 4.3%) in the necitumumab plus gemcitabine-cisplatin versus gemcitabine-cisplatin arms, respectively. Hospitalizations were slightly higher with necitumumab plus gemcitabine-cisplatin (36.4%) than with gemcitabine-cisplatin (34.0%). CONCLUSIONS The addition of necitumumab to gemcitabine-cisplatin was well tolerated, did not negatively affect HRQoL or toxicity, and particularly benefited patients with more severe baseline symptoms or lower HRQoL.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf, Germany.
| | - Mark A Socinski
- Lung Cancer Section, Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | | | - Mircea Dediu
- Institute of Oncology "Alexandru Trestioreanu," Bucharest, Romania
| | - Rodryg Ramlau
- Poznan University of Medical Sciences, Poznań, Poland
| | - György Losonczy
- Semmelweis University Department of Pulmonology, Budapest, Hungary
| | | | - Christian Schumann
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany; Clinic for Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Kempten-Oberallgaeu Hospitals, Kempten, Germany
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