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Auliac JB, Thomas PA, Bylicki O, Guisier F, Curcio H, AlainVegnenègre, Swalduz A, Wislez M, Le Treut J, Decroisette C, Basse V, Falchero L, De Chabot G, Moreau D, Huchot E, Lupo Mansuet A, Blons H, Chouaïd C, Greillier L. Resected EGFR-mutated non-small-cell lung cancers: incidence and outcomes in a European population (GFPC Exerpos Study). Ther Adv Med Oncol 2024; 16:17588359241236451. [PMID: 38455711 PMCID: PMC10919127 DOI: 10.1177/17588359241236451] [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: 05/30/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
Background Few epidemiological data are available on surgically treated Caucasian patients with non-small-cell lung cancers (NSCLCs) harboring epidermal growth factor receptor (EGFR) mutations. The main objective of this study was to describe, in the real-world setting, these patients' incidence, clinical, and tumoral characteristics. Methods The participating centers included all consecutive localized non-squamous NSCLC patients undergoing surgery between January 2018 and December 2019 in France. EGFR status was determined retrospectively when not available before surgery. Results The study includes 1391 no squamous NSCLC patients from 16 centers; EGFR status was determined before surgery in 692 (49.7%) of the cases and conducted as part of the study for 699 (50.3%); 171 (12.3%) were EGFR mutated; median age: 70 (range: 36-88) years; female: 59.6%; never smokers: 75.7%; non-squamous histology 97.7%, programmed death ligand-1 expression 0%/1-49%/⩾50 in 60.5%/25.7%/13.8%, respectively. Surgery was predominantly lobectomy (81%) or segmentectomy (14.9%), with systematic lymph node dissection in 95.9%. Resection completeness was R0 for 97%. Post-surgery staging was as follows: IA: 52%, IB: 16%, IIA: 4%, IIB: 10%, IIIA: 16%, and IIIB: 0.05%; EGFR mutation exon was Del19/exon 21 (L858R)/20/18 in 37.4%/36.8%/14%, and 6.4% of cases, respectively; 31 (18%) patients received adjuvant treatment (chemotherapy: 93%, EGFR tyrosine kinase inhibitor: 0%, radiotherapy: 20%). After a median follow-up of 31 (95% confidence interval: 29.6-33.1) months, 45 (26%) patients relapsed: 11/45 (24%) locally and 34 (76%) with metastatic progression. Median disease-free survival (DFS) and overall survival were not reached and 3-year DFS was 60%. Conclusion This real-world analysis provides the incidence and outcomes of resected EGFR-mutated NSCLCs in a European patient cohort.
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Affiliation(s)
- Jean-Bernard Auliac
- Service de Pneumologie, Pneumology Department, CHI Créteil, 40 Avenue de Verdun, Creteil 94010, France
| | | | - Olivier Bylicki
- Pneumology Department, Hôpital d’instruction des Armées Sainte-Anne, Toulon, France
| | - Florian Guisier
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, CHU Rouen, Rouen, France
| | - Hubert Curcio
- Oncology Department, Centre Francois Baclesse, Caen, France
| | - AlainVegnenègre
- Pneumology Department, CHU Limoges – Hopital Dupuytren, Limoges, France
| | - Aurelie Swalduz
- Department of Pneumology, Comprehensive Cancer Centre Léon Bérard, Lyon, France
| | - Marie Wislez
- Pneumology Department, Hôpital Cochin, AP-HP, Paris, France
| | - Jacques Le Treut
- Pneumology Department, Hôpital Européen Marseille, Marseille, France
| | - Chantal Decroisette
- Pneumology Department, Le Centre Hospitalier Annecy Genevois, Metz-Tessy, France
| | - Victor Basse
- Oncology Department, Clinique Saint-Yves, Vannes, France
| | - Lionel Falchero
- Pneumology Department, Hospital Center De Villefranche-Sur-Saône, Gleizé, France
| | - Gonzague De Chabot
- Oncology Department, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Diane Moreau
- Pneumology Department, Centre Hospitalier Universitaire de Saint Pierre de la Réunion, Saint-Pierre, Reunion Islands
| | - Eric Huchot
- Pneumology Department, Centre Hospitalier Universitaire Felix-Guyon, Saint Denis, France
| | - Audrey Lupo Mansuet
- Service d’Anatomie-Pathologique, Hôpital Cochin, Université de Paris, AP-HP, Paris, France
| | - Helene Blons
- HEGP Biochimie, UF de Pharmacogénétique et Oncologie Moléculaire, Paris, France
| | | | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, Hopital St. Marguerite Assistance Publique Hopitaux de Marseille, Marseille, France
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Parikh RB, Jordan P, Ciaravino RJ, Beasley RA, Patel AA, Owen DH, Amini A, Curti BD, Page R, Swalduz A, Beregi JP, Chrusciel J, Snyder E, Mukherjee P, Selby HM, Lee S, Weerasinghe R, Pindikuri S, Weiss JB, Wentland AL, Kirpalani A, Liu A, Gevaert O, Simon G, Aerts HJWL. Abstract 5618: Multi-institutional validation of a radiomics-based artificial intelligence method for predicting response to PD-1/PD-L1 immune checkpoint inhibitor (ICI) therapy in stage IV NSCLC. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5618] [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: 04/07/2023]
Abstract
Abstract
There is an urgent clinical need to identify patients likely to benefit from immune checkpoint inhibitor ICI treatment. Approaches available in the clinic today, such as PD-L1 immunohistochemistry (IHC) and tumor mutation burden (TMB), are insufficient for this task, in part as differences in microenvironments expressed by individual tumors may lead to heterogeneous response patterns. Recent efforts exploring the utility of quantitative imaging (radiomic) biomarkers to predict response to ICIs have shown promise to provide a more accurate and scalable method. In contrast to previously published models, our work focuses on generalizable models for predicting individual lesion-level as well as patient-level response at 3-month follow-up per RECIST criteria, using a large multi-institutional “real-world” dataset. The models combine radiomics features with demographic, molecular, and laboratory values routinely available in patients’ electronic medical records. We analyzed radiomic characteristics of 6,295 primary and metastatic lesions from 1,206 metastatic NSCLC patients treated with anti-PD-1/anti-PD-L1 ICIs from 8 institutions across the US and Europe. Patients with unavailable PD-L1 IHC, imaging follow-up, or with oncogenic driver mutations were excluded from analysis, resulting in a total dataset of 766 subjects randomly assigned to training (N=514) and validation sets (N=252). Using gradient-boosted decision tree algorithms, we developed a multi-modal predictive model to identify patients responding to ICI therapy at 3-months and evaluated its performance against an imaging-only CT radiomics model and the clinical standard of care, biopsy-based PD-L1 IHC. The multi-modal model contains CT radiomic features capturing lesion heterogeneity and spicularity, patient demographics, PD-L1 TPS, and tumor burden volume in the lung, lymph nodes, and the liver. Under the two-tailed DeLong test, the multi-modal model demonstrated statistically significant benefit over the current standard of care (PD-L1 IHC) in predicting multi-lesion 3-month response: 0.81 (P=.005) area under the receiver operating characteristic curve (ROC-AUC) in first-line ICI monotherapy patients, 0.72 (P=.044) in all-lines ICI monotherapy, and 0.71 (P=.025) in all-lines ICI-chemotherapy combination. The imaging-only model demonstrated predictive performance comparable to PD-L1 IHC: 0.71 (P=.226), 0.61 (P=.905), 0.62 (P=.674) on the same cohorts respectively. A multi-modal CT radiomics-based approach demonstrated predictive accuracy benefit over the current clinical standard and may provide an opportunity for more personalized patient management, such as risk-based escalation/de-escalation of concurrent chemotherapy in NSCLC patients. We will evaluate this methodology in prospective studies.
Citation Format: Ravi B. Parikh, Petr Jordan, Rita J. Ciaravino, Ryan A. Beasley, Arpan A. Patel, Dwight H. Owen, Arya Amini, Brendan D. Curti, Ray Page, Aurelie Swalduz, Jean-Paul Beregi, Jan Chrusciel, Eric Snyder, Pritam Mukherjee, Heather M. Selby, Soohee Lee, Roshanthi Weerasinghe, Shwetha Pindikuri, Jakob B. Weiss, Andrew L. Wentland, Anish Kirpalani, An Liu, Olivier Gevaert, George Simon, Hugo JWL Aerts. Multi-institutional validation of a radiomics-based artificial intelligence method for predicting response to PD-1/PD-L1 immune checkpoint inhibitor (ICI) therapy in stage IV NSCLC. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5618.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ray Page
- 7The Center for Cancer & Blood Disorders, Fort Worth, TX
| | | | | | | | - Eric Snyder
- 3University of Rochester Medical Center, Rochester, NY
| | | | | | - Soohee Lee
- 12Providence Health & Services, Renton, WA
| | | | | | | | | | | | - An Liu
- 5City of Hope, Duarte, CA
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Bylicki O, Tomasini P, Radj G, Guisier F, Monnet I, Ricordel C, Bigay-Game L, Geier M, Chouaid C, Daniel C, Swalduz A, Toffart AC, Doubre H, Peloni JM, Moreau D, Subtil F, Grellard JM, Castera M, Clarisse B, Martins-Lavinas PH, Decroisette C, Greillier L. Atezolizumab with or without bevacizumab and platinum-pemetrexed in patients with stage IIIB/IV non-squamous non-small cell lung cancer with EGFR mutation, ALK rearrangement or ROS1 fusion progressing after targeted therapies: A multicentre phase II open-label non-randomised study GFPC 06-2018. Eur J Cancer 2023; 183:38-48. [PMID: 36801605 DOI: 10.1016/j.ejca.2023.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous reports showed limited efficacy of immune checkpoint inhibitors as single-agent treatment for non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation or ALK/ROS1 fusion. We aimed at evaluating the efficacy and safety of immune checkpoint inhibitor combined with chemotherapy and bevacizumab (when eligible) in this patient subgroup. METHODS We conducted a French national open-label multicentre non-randomised non-comparative phase II study in patients with stage IIIB/IV NSCLC, oncogenic addiction (EGFR mutation or ALK/ROS1 fusion), with disease progression after tyrosine kinase inhibitor and no prior chemotherapy. Patients received platinum, pemetrexed, atezolizumab, bevacizumab (PPAB cohort) or, if not eligible to bevacizumab, platinum-pemetrexed-atezolizumab (PPA cohort). The primary end-point was the objective response rate (RECIST v1.1) after 12 weeks, evaluated by blind independent central review. RESULTS 71 patients were included in PPAB cohort and 78 in PPA cohort (mean age, 60.4/66.1 years; women 69.0%/51.3%; EGFR mutation, 87.3%/89.7%; ALK rearrangement, 12.7%/5.1%; ROS1 fusion, 0%/6.4%, respectively). After 12 weeks, objective response rate was 58.2% (90% confidence interval [CI], 47.4-68.4) in PPAB cohort and 46.5% (90% CI, 36.3-56.9) in PPA cohort. Median progression-free survival and overall survival were 7.3 (95% CI 6.9-9.0) months and 17.2 (95% CI 13.7-NA) months in PPAB cohort and 7.2 (95% CI 5.7-9.2) months and 16.8 (95% CI 13.5-NA) months in PPA cohort, respectively. Grade 3-4 adverse events occurred in 69.1% of patients in PPAB cohort and 51.4% in PPA cohort; Grade 3-4 atezolizumab-related adverse events occurred in 27.9% and 15.3%, respectively. CONCLUSION Combination approach with atezolizumab with or without bevacizumab and platinum-pemetrexed achieved promising activity in metastatic EGFR-mutated or ALK/ROS1-rearranged NSCLC after tyrosine kinase inhibitor failure, with acceptable safety profile.
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Affiliation(s)
- Olivier Bylicki
- Department of Pneumology, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
| | - Pascale Tomasini
- Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
| | - Gervais Radj
- Department of Medical Oncology, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Florian Guisier
- CHU Rouen, Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Normandie Univ, UNIROUEN, EA4108 LITIS Lab, QuantIF Team and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Isabelle Monnet
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Charles Ricordel
- Department of Pneumology, CHU Rennes, Univ Rennes 1, INSERM, OSS (Oncogenesis Stress Signaling), UMR_S 1242, CLCC Eugene Marquis, F-35000 Rennes, France
| | - Laurence Bigay-Game
- Department of Pneumology & Thoracic Oncology, CHU Toulouse-Hôpital Larrey, Toulouse, France
| | | | - Christos Chouaid
- CHU Rouen, Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Normandie Univ, UNIROUEN, EA4108 LITIS Lab, QuantIF Team and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Catherine Daniel
- Thoracic Oncology Service, Thorax Institute Curie Montsouris, Institut Curie, Paris, France
| | - Aurelie Swalduz
- Department of Pneumology, Comprehensive Cancer Centre Léon Bérard, Lyon, France
| | | | | | - Jean-Michel Peloni
- Department of Pneumology, Maison de Santé Protestante de Bordeaux-Bagatelle, Talence, France
| | - Diane Moreau
- Department of Pneumology and Oncology, Medical University of Felix Guyon, Reunion Island, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Jean-Michel Grellard
- Clinical Research Department, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Marie Castera
- Clinical Research Department, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Benedicte Clarisse
- Clinical Research Department, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Pedro-Henrique Martins-Lavinas
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Chantal Decroisette
- Department of Pneumology & Thoracic Oncology, CH Annecy-Genevois, 74370 Metz-Tessy, France
| | - Laurent Greillier
- Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
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Illini O, Fabikan H, Swalduz A, Krenbek D, Vikström A, Schumacher M, Dudnik E, Studnicka M, Öhman R, Wurm R, Wannesson L, Peled N, Kian W, Bar J, Daher S, Addeo A, Rotem O, Pall G, Zer A, Saad A, Cufer T, Sorotsky H, Hashemi S, Mohorcic K, Stoff R, Rovitsky Y, Keren-Rosenberg S, Winder T, Weinlinger C, Valipour A, Hochmair M. EP08.02-122 Real-world Experience with Capmatinib in MET Exon 14-mutated Non-small Cell Lung Cancer (RECAP). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.805] [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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Mehlman C, Swalduz A, Monnet I, Morin C, Guisier F, Curcio H, Du Rusquec P, Cortot A, Gounant V, Abbar B, Duchemann B, Giroux-Leprieur E, Pierret T, Quilot F, Cadranel J, Fallet V. 995P Effectiveness of combination of osimertinib with another targeted therapy in advanced EGFR mutated non-small cell lung cancer harbouring other oncogenic drivers: The real-world COMPOSIT study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1121] [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: 11/01/2022] Open
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Auliac J, Simmoneau Y, Thomas P, Guisier F, Bylicki O, Curcio H, Swalduz A, Wislez M, Geier M, J. Le Treut, Decroisette C, Falchero L, Tricard J, Moreau D, Huchot E, De Chabot G, Leroy K, Mansuet AL, Chouaid C, Greillier L. 937P Incidence and outcomes of EGFR mutated non-small cell lung cancer treated with surgery: EXERPOS GFPC study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1063] [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: 11/01/2022] Open
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Chour A, Denis J, Lafitte C, Mascaux C, Zysman M, Lemaitre A, Swalduz A, Gounant V, Cortot A, Darrason M, Cadranel J, Auclin E, Basse C, Tissot C, Decroisette C, Bombaron P, Giroux-Leprieur E, Falchero L, Lebossé F, Duruisseaux M. 37P Sotorasib-induced liver and non-liver toxicity associated with sequential sotorasib following anti-PD(L)1 in KRASG12C mutant lung cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.046] [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: 11/01/2022] Open
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Bilger G, Toffart A, Darrason M, Duruisseaux M, Ulmer L, Wang P, Leprieur EG, Girard N, Massiani M, Bore P, Descourt R, Pinsolle J, Valery S, Monnet I, Swalduz A, Tissot C, Fournel P, Baranzelli A, Cortot A, Decroisette C. P25.01 Efficacy of Weekly Paclitaxel-Bevacizumab Combination in Advanced NSCLC: AVATAX, A Retrospective Multicentric Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.380] [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: 12/01/2022]
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Basse C, Swalduz A, Mc Leer A, Moro-Sibilot D, Remon J, Girard N. [NSCLC and new oncogenic mutations: Diagnosis and perspectives]. Rev Mal Respir 2021; 38:477-488. [PMID: 34020835 DOI: 10.1016/j.rmr.2021.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
The development of new targeted therapies in non-small cell lung carcinoma (NSCLC) depends on a better understanding of the molecular basis of carcinogenesis, a knowledge of the role of molecular aberrations in disease progression and the development of molecular biology platforms with the capacity to identify new biomarkers. In the current article, we review the techniques routinely used in cancer molecular biology platforms as well as new techniques under development. These new NSCLC biomarkers have been made available to clinicians and biologists in parallel with the development of targeted drugs. New molecular abnormalities of EGFR exon 20, HER2, MET, RET, BRAF, ROS1 and NTRK have been identified and there have been clinical trials of the most innovative targeted drugs.
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Affiliation(s)
- C Basse
- Institut du thorax curie Montsouris, institut Curie, Paris, France
| | | | - A Mc Leer
- Département d'anatomie et cytologie pathologiques, UF pathologie moléculaire, CHU Grenoble-Alpes, CS10217 cedex, 38043 Grenoble, France; Service physiologie et pneumologie, UF oncologie thoracique, CHU Grenoble-Alpes, CS10217 cedex, 38043 Grenoble, France; Inserm U1209 CNRS UMR5309, université Grenoble Alpes, Institute for advanced biosciences, Grenoble, France
| | - D Moro-Sibilot
- Service physiologie et pneumologie, UF oncologie thoracique, CHU Grenoble-Alpes, CS10217 cedex, 38043 Grenoble, France; Inserm U1209 CNRS UMR5309, université Grenoble Alpes, Institute for advanced biosciences, Grenoble, France.
| | - J Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Delfos, HM Hospitales, Barcelona, Espagne
| | - N Girard
- Institut du thorax curie Montsouris, institut Curie, Paris, France
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Mezquita L, Swalduz A, Auclin E, Carter M, Steendam C, Aldea M, Scheffler M, Corral J, Viteri S, Segui E, Barba A, Dubbink E, Planchard D, Vasseur D, Reyes R, Caramella C, Recondo G, Saintigny P, Blackhall F, Dingemans A, Besse B. P84.01 The ARIA Study: Activity of Next-Generation ALK TKIs Based on ALK Resistance Mutations Detected by Liquid Biopsy in ALK Positive NSCLC Patients. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1200] [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: 10/21/2022]
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Heudel P, Chabaud S, Perol D, Flechon A, Fayette J, Combemale P, Tredan O, Desseigne F, de la Fouchardiere C, Boyle H, Perol M, Bachelot T, Cassier P, Avrillon V, Terret C, Michallet AS, Neidhardt-Berard EM, Nicolas-Virelizier E, Dufresne A, Belhabri A, Brahmi M, Lebras L, Nicolini F, Sarabi M, Rey P, Bonneville-Levard A, Rochefort P, Provensal AM, Eberst L, Assaad S, Swalduz A, Saintigny P, Toussaint P, Guillermin Y, Castets M, Coutzac C, Meeus P, Dupré A, Durand T, Crochet H, Fervers B, Gomez F, Rivoire M, Gregoire V, Claude L, Chassagne-Clement C, Pilleul F, Mognetti T, Russias B, Soubirou JL, Lasset C, Chvetzoff G, Mehlen P, Beaupère S, Zrounba P, Ray-Coquard I, Blay JY. Immune checkpoint inhibitor treatment of a first cancer is associated with a decreased incidence of second primary cancer. ESMO Open 2021; 6:100044. [PMID: 33516148 PMCID: PMC7844579 DOI: 10.1016/j.esmoop.2020.100044] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background Second primary cancers (SPCs) are diagnosed in over 5% of patients after a first primary cancer (FPC). We explore here the impact of immune checkpoint inhibitors (ICIs) given for an FPC on the risk of SPC in different age groups, cancer types and treatments. Patients and methods The files of the 46 829 patients diagnosed with an FPC in the Centre Léon Bérard from 2013 to 2018 were analyzed. Structured data were extracted and electronic patient records were screened using a natural language processing tool, with validation using manual screening of 2818 files of patients. Univariate and multivariate analyses of the incidence of SPC according to patient characteristics and treatment were conducted. Results Among the 46 829 patients, 1830 (3.9%) had a diagnosis of SPC with a median interval of 11.1 months (range 0-78 months); 18 128 (38.7%) received cytotoxic chemotherapy (CC) and 1163 (2.5%) received ICIs for the treatment of the FPC in this period. SPCs were observed in 7/1163 (0.6%) patients who had received ICIs for their FPC versus 437/16 997 (2.6%) patients receiving CC and no ICIs for the FPC versus 1386/28 669 (4.8%) for patients receiving neither CC nor ICIs for the FPC. This reduction was observed at all ages and for all histotypes analyzed. Treatment with ICIs and/or CC for the FPC are associated with a reduced risk of SPC in multivariate analysis. Conclusion Immunotherapy with ICIs alone and in combination with CC was found to be associated with a reduced incidence of SPC for all ages and cancer types. From 2013 to 2018, 3.9% of the 46 829 patients diagnosed with a first cancer presented with an SPC. Treatment of the first cancer with ICIs was associated with a major reduction of SPC. CC given for an FPC was also associated with a lower magnitude of reduction of SPC. There were no SPC in cancer patients treated with ICIs in the localized phase of their first cancer.
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Affiliation(s)
- P Heudel
- Centre Léon Bérard, Lyon, France
| | | | - D Perol
- Centre Léon Bérard, Lyon, France
| | | | | | | | - O Tredan
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - H Boyle
- Centre Léon Bérard, Lyon, France
| | - M Perol
- Centre Léon Bérard, Lyon, France
| | - T Bachelot
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - C Terret
- Centre Léon Bérard, Lyon, France
| | | | | | | | - A Dufresne
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | - M Brahmi
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - L Lebras
- Centre Léon Bérard, Lyon, France
| | - F Nicolini
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - M Sarabi
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - P Rey
- Centre Léon Bérard, Lyon, France
| | | | | | | | - L Eberst
- Centre Léon Bérard, Lyon, France
| | - S Assaad
- Centre Léon Bérard, Lyon, France
| | | | - P Saintigny
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - M Castets
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - C Coutzac
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - P Meeus
- Centre Léon Bérard, Lyon, France
| | - A Dupré
- Centre Léon Bérard, Lyon, France
| | - T Durand
- Centre Léon Bérard, Lyon, France
| | | | | | - F Gomez
- Centre Léon Bérard, Lyon, France
| | - M Rivoire
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - L Claude
- Centre Léon Bérard, Lyon, France
| | | | - F Pilleul
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | | | | | - C Lasset
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - P Mehlen
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - S Beaupère
- Centre Léon Bérard, Lyon, France; Unicancer, Paris, France
| | | | - I Ray-Coquard
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - J-Y Blay
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France; Unicancer, Paris, France.
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12
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Bylicki O, Clarisse B, Grellard JM, Swalduz A, Castera-Tellier M, Ferlandin S, Monnet I, Greillier L, Descourt R, Peron J, Chouaid C, Gervais R. 1411TiP GFPC 06-2018: A multicenter non-randomized phase II study evaluating platinum-pemetrexed-atezolizumab (+/-bevacizumab) for patients with stage IIIB/IV non-squamous non-small cell lung cancer with EGFR mutations, ALK rearrangement or ROS1 fusion progressing after targeted therapies. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1725] [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: 11/28/2022] Open
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13
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Basse C, Swalduz A, Levra MG, Girard N, Remon J, Moro-Sibilot D. [Immunotherapy of metastatic non-small cell lung cancer from first line to resistance and its management]. Bull Cancer 2020; 107:779-791. [PMID: 32532420 DOI: 10.1016/j.bulcan.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 01/22/2023]
Abstract
Immunotherapy alone or in combination with chemotherapy is now an integral part of the treatment of metastatic NSCLC. This treatment is transforming the management of these cancers, with 20-30% of patients achieving long survival. However, disease progression under treatment is still the rule for the majority of patients, raising problems both in understanding its mechanisms and in subsequent appropriate management. This study examines current therapeutic options and proposes solutions to circumvent resistance to immunotherapy. The mechanisms of resistance to these treatments is also analysed.
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MESH Headings
- Anaplastic Lymphoma Kinase/genetics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/therapy
- Clinical Trials, Phase III as Topic
- Combined Modality Therapy/methods
- Disease Progression
- Drug Resistance, Neoplasm/physiology
- Genes, erbB-1
- Humans
- Immunotherapy/methods
- Immunotherapy, Adoptive/methods
- Lung Neoplasms/genetics
- Lung Neoplasms/mortality
- Lung Neoplasms/therapy
- Mutation
- Receptors, Chimeric Antigen/therapeutic use
- Translocation, Genetic
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Affiliation(s)
- Clémence Basse
- Institut du thorax Curie Montsouris, institut Curie, Paris, France
| | - Aurelie Swalduz
- Centre Léon-Bérard, département d'oncologie médicale, Lyon, France
| | - Matteo Giaj Levra
- CHU de Grenoble-Alpes, oncologie thoracique SHUPP, CS10217 cedex, 38043 Grenoble, France; Hospital HM Delfos, HM Hospitales, Centro Integral Oncológico Clara-Campal (HM-CIOCC), Department of Medical Oncology, Barcelona, Espagne; Université Grenoble-Alpes, Institute for Advanced Biosciences, Inserm U1209 CNRS UMR5309, Grenoble, France
| | - Nicolas Girard
- Institut du thorax Curie Montsouris, institut Curie, Paris, France
| | - Jordi Remon
- Hospital HM Delfos, HM Hospitales, Centro Integral Oncológico Clara-Campal (HM-CIOCC), Department of Medical Oncology, Barcelona, Espagne
| | - Denis Moro-Sibilot
- CHU de Grenoble-Alpes, oncologie thoracique SHUPP, CS10217 cedex, 38043 Grenoble, France.
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14
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Remon J, Swalduz A, Planchard D, Ortiz-Cuaran S, Mezquita L, Lacroix L, Jovelet C, Rouleau E, Leonce C, De Kievit F, Morris C, Jones G, Mercier K, Howarth K, Green E, Pérol M, Saintigny P, Besse B. Outcomes in oncogenic-addicted advanced NSCLC patients with actionable mutations identified by liquid biopsy genomic profiling using a tagged amplicon-based NGS assay. PLoS One 2020; 15:e0234302. [PMID: 32525942 PMCID: PMC7289417 DOI: 10.1371/journal.pone.0234302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 07/12/2019] [Accepted: 05/22/2020] [Indexed: 11/19/2022] Open
Abstract
Circulating tumor DNA (ctDNA)-based molecular profiling is rapidly gaining traction in clinical practice of advanced cancer patients with multi-gene next-generation sequencing (NGS) panels. However, clinical outcomes remain poorly described and deserve further validation with personalized treatment of patients with genomic alterations detected in plasma ctDNA. Here, we describe the outcomes, disease control rate (DCR) at 3 months and progression-free survival (PFS) in oncogenic-addicted advanced NSCLC patients with actionable alterations identified in plasma by ctDNA liquid biopsy assay, InVisionFirst®-Lung. A pooled retrospective analysis was completed of 81 advanced NSCLC patients with all classes of alterations predicting response to current FDA approved drugs: sensitizing common EGFR mutations (78%, n = 63) with T790M (73%, 46/63), ALK / ROS1 gene fusions (17%, n = 14) and BRAF V600E mutations (5%, n = 4). Actionable driver alterations detected in liquid biopsy were confirmed by prior tissue genomic profiling in all patients, and all patients received personalized treatment. Of 82 patients treated with matched targeted therapies, 10% were at first-line, 41% at second-line, and 49% beyond second-line. Acquired T790M at TKI relapse was detected in 73% (46/63) of patients, and all prospective patients (34/46) initiated osimertinib treatment based on ctDNA results. The 3-month DCR was 86% in 81 evaluable patients. The median PFS was of 14.8 months (12.1–22.9m). Baseline ctDNA allelic fraction of genomic driver did not correlate with the response rate of personalized treatment (p = 0.29). ctDNA molecular profiling is an accurate and reliable tool for the detection of clinically relevant molecular alterations in advanced NSCLC patients. Clinical outcomes with targeted therapies endorse the use of liquid biopsy by amplicon-based NGS ctDNA analysis in first line and relapse testing for advanced NSCLC patients.
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Affiliation(s)
- Jordi Remon
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | | | - David Planchard
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | | | - Laura Mezquita
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Ludovic Lacroix
- Laboratoire de Recherche Translationnelle, Gustave Roussy, Villejuif, France
| | - Cecile Jovelet
- Laboratoire de Recherche Translationnelle, Gustave Roussy, Villejuif, France
| | - Etienne Rouleau
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | | | | | | | - Greg Jones
- Inivata, Granta Park, Cambridge, United Kingdom
| | | | | | - Emma Green
- Inivata, Granta Park, Cambridge, United Kingdom
| | | | | | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
- Université Paris-Sud, Orsay, France
- * E-mail:
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15
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Pierret T, Fontaine É, Pérol M, Avrillon V, Swalduz A, Pinsolle J, Giaj-Levra M, Moro-Sibilot D, Toffart A. [Enteral nutrition in malnourished patients with lung cancer]. Rev Mal Respir 2020; 37:349-351. [PMID: 32279889 DOI: 10.1016/j.rmr.2020.02.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Affiliation(s)
- T Pierret
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France.
| | - É Fontaine
- Unité de nutrition artificielle, CHU Grenoble-Alpes, Grenoble, France; Inserm U 1055 université Grenoble Alpes, Grenoble, France
| | - M Pérol
- Oncologie thoracique, centre Léon-Bérard, Lyon, France
| | - V Avrillon
- Oncologie thoracique, centre Léon-Bérard, Lyon, France
| | - A Swalduz
- Oncologie thoracique, centre Léon-Bérard, Lyon, France
| | - J Pinsolle
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France
| | - M Giaj-Levra
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France; Inserm U 1209/CNRS UMR 5309, centre de recherche UGA, institut pour l'avancée des Biosciences, La Tronche, France
| | - D Moro-Sibilot
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France; Inserm U 1209/CNRS UMR 5309, centre de recherche UGA, institut pour l'avancée des Biosciences, La Tronche, France
| | - A Toffart
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France; Inserm U 1209/CNRS UMR 5309, centre de recherche UGA, institut pour l'avancée des Biosciences, La Tronche, France
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16
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Boussageon M, Ortiz-Cuaran S, Chabaud S, Pérol D, Avrillon V, Mastroianni B, Fayette J, Ghiringhelli F, Neidhardt E, Swalduz A, Paulus V, Kaderbhai C, Fumet J, Saintigny P, Perol M. P1.01-116 Early Immune-Related Adverse Events Under PD-1/PD-L1 Inhibitors Predict Better Progression-Free Survival in NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.831] [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: 11/16/2022]
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17
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Ortiz-Cuaran S, Mezquita L, Swalduz A, Aldea M, Mazieres J, Jovelet C, Flores WC, Lacroix L, Loriot Y, Friboulet L, Westeel V, Ngocamus M, Pradines A, Tissot C, Duchene CC, Raynaud C, Quantin X, Gervais R, Brain E, Monnet I, Leprieur EG, Avrillon V, Mahier-Aït Oukhatar C, Hoog-Labouret N, De Kievit F, Howarth K, Guichou J, Morris C, Green E, Perol M, Besse B, Blay J, Saintigny P, Planchard D. MA21.07 Circulating Tumor DNA Analysis Depicts Potential Mechanisms of Resistance to BRAF-Targeted Therapies in BRAF+ Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Ortiz - Cuaran S, Mezquita L, Swalduz A, Aldea M, Mazieres J, Jovelet C, Lacroix L, Pradines A, Avrillon V, MahierAït Oukhatar C, Hoog-Labouret N, Howarth K, Guichou JF, Morris C, Green E, Perol M, Besse B, Blay JY, Saintigny P, Planchard D. Circulating tumour DNA (ctDNA) analysis depicts mechanisms of resistance and tumour response to BRAF inhibitors in BRAF-mutant non-small cell lung cancer (NSCLC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.078] [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: 11/12/2022] Open
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19
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Swalduz A, Mezquita L, Ortiz-Cuaran S, Jovelet C, Avrillon V, Planchard D, Marteau S, Recondo G, Martinez S, Howarth K, Plagnol V, Morris C, Green E, Odier L, Lacroix L, Hominal S, Rouleau E, Tissot C, Caramella C, Fournel P, Friboulet L, Pérol M, Besse B, Saintigny P. MA16.09 Feasibility, Clinical Relevance of ALK/ROS1 Fusion Variant Detection by Liquid Biopsy in Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.454] [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: 10/28/2022]
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20
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Remon J, Mezquita L, Ortiz-Cuaran S, Jovelet C, Lacroix L, Morris C, Green E, Saintigny P, Besse B, Swalduz A, Howarth K, Rouleau E, De Kievit F, Baker-Neblett K, Roitt S, Plagnol V, Perol M, Planchard D. Clinical outcomes in patients with advanced NSCLC treated with targeted therapies, with actionable mutations identified by InVisionFirst ctDNA assay. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy318.006] [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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21
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Mezquita L, Hu Y, Howarth K, Jovelet C, Planchard D, Lacroix L, Swalduz A, Ortiz-Cuaran S, Avrillon V, Plagnol V, Beeler J, Baker-Neblett K, Jones G, Rosenfeld N, Morris C, Green E, Kim ES, Perol M, Saintigny P, Liu SV, Oxnard GR, Besse B. Abstract 4581: Feasibility of an amplicon-based liquid biopsy for ALK and ROS1 fusions in advanced non-small cell lung cancer (NSCLC) patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4581] [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: 11/16/2022]
Abstract
Abstract
INTRODUCTION Circulating tumor DNA (ctDNA) is a surrogate material for somatic mutation detection, such as EGFR, BRAF or KRAS mutations in NSCLC patients, however the applicability of this technique for ALK and ROS1 fusion detection is poorly described. The aim of this combined analysis was to evaluate an amplicon-based ctDNA technology in a cohort of ALK and ROS1 positive NSCLC patients. METHODS ALK and ROS1 positive NSCLC patients were prospectively enrolled or retrospective specimens selected, to be included across 6 international centres. ALK/ROS1 positive status was determined by standard of care (FISH/IHC or NGS). The analysis of EML4-ALK fusions (variant 1,2,3) and ROS1 fusions (with partner genes CD74, SLC34A2, SDC4 and EZR) was performed using the InVision™ platform. RESULTS Patients included (n=65; 59 ALK, 6 ROS1): 35 (55%) females, 40 (63%) non-smokers, median age of 59 years, stage IV disease (88%) adenocarcinoma (97%). All patients were ALK/ROS positive by IHC (32), FISH (45) and/or tissue NGS (10). Samples (n=98) were collected across multiple timepoints. In total, 31 patients were fusion positive (25 ALK, 6 ROS1). Among treatment-naïve patients, sensitivity was 78% for ALK and 100% for ROS1. In contrast, fusions were detected in minority of samples (7/57) in patients responding to treatment. In patients with ctDNA positive ALK fusion (n=25): 8 patients (32%) presented the EML4-ALK variant 1; 2 (8%) the variant 2 and 15 (60%) the variant 3. In the ROS1 population (n=6), rearrangement with chromosome 5, resulting in CD74-ROS1 was seen in 4 of cases and translocation with chromosome 4 to generate SLC34A2-ROS1 occurred in 2 of cases. All patients had unique DNA fusion junctions identified and will be described, providing an insight at the DNA level of the molecular mechanisms leading to ALK and ROS1 driven lung cancers. Breakpoint microhomology was observed at the fusion junction in 50% of cases, ranging from 1 to 7bp. A 4bp insertion of non-templated DNA was seen in one case, with the remaining 47% of cases most likely the result of non-homologous end joining. Evidence for enrichment of microhomologous sequences and clustering of breaks within the introns will be investigated and reported at the conference. CONCLUSION The detection of ALK and ROS1 fusions using the amplicon-based NGS Invision liquid biopsy platform is feasible in routine clinical practice. Good sensitivity for clinically actionable ALK and ROS structural rearrangements in untreated advanced NSCLC patients was demonstrated.
Citation Format: Laura Mezquita, Yuebi Hu, Karen Howarth, Cecile Jovelet, David Planchard, Ludovic Lacroix, Aurelie Swalduz, Sandra Ortiz-Cuaran, Virginie Avrillon, Vincent Plagnol, John Beeler, Katherine Baker-Neblett, Greg Jones, Nitzan Rosenfeld, Clive Morris, Emma Green, Edward S. Kim, Maurice Perol, Pierre Saintigny, Stephen V. Liu, Geoff R. Oxnard, Benjamin Besse. Feasibility of an amplicon-based liquid biopsy for ALK and ROS1 fusions in advanced non-small cell lung cancer (NSCLC) patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4581.
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Affiliation(s)
| | - Yuebi Hu
- 2Dana Farber Cancer Institute, Boston, MA
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22
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Ortiz-Cuaran S, Swalduz A, Leonce C, Martinez S, Clapisson G, Marteau S, Avrillon V, Green E, Morris C, Pérol M, Saintigny P. Longitudinal circulating-tumor DNA profiling of EGFR-mutated lung adenocarcinoma patients treated with EGFR-tyrosine kinase inhibitors. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx507] [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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23
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Ortiz-Cuaran S, Swalduz A, Green E, Avrillon V, Epstein M, Howarth K, Marteau S, Morris CD, Perol M, Saintigny P. Circulating tumor DNA profiling of lung cancer patients treated with EGFR inhibitors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e23060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
e23060 Background: The presence of a targetable driver mutation in nearly 50% non-small cell lung cancer (NSCLC) patients has enabled tailoring therapy regimens to improve survival. Serial repeat biopsies can offer an instrumental indication into the longitudinal evolution of cancer. However, tissue biopsies are invasive and can provide insufficient material for molecular testing. Mutation detection in plasma DNA as a “liquid biopsy” has been suggested as non-invasive approach to monitor tumor dynamics over time. Methods: We established an institutional protocol (NCT01511288) for the collection of liquid biopsies from stage IIIB/IV NSCLC patients either untreated, under therapy or progressive on therapy with a TKI. This protocol has included 134 NSCLC patients for whom clinical, pathological and genomic information is collected prospectively. Analyses were performed by Inivata using InVision (enhanced tagged-amplicon sequencing). Results: So far, samples from 50 patients have been analyzed. InVision allowed the detection of driver mutations in 20 plasma samples obtained at diagnosis. Tissue was unavailable for molecular analysis in 8/20 samples. We observed a concordance rate in mached plasma and tissue samples, of 92,3% (n = 12). In plasma samples from patients that relapsed under erlotinib or gefitinib we evidenced the EGFR T790M mutation in 57% of patients, with a concordance rate of 90,9%. Interestingly, analysis of serial samples collected from 3 patients under EGFR-targeted therapy showed the emergence of an EGFR T790M mutation 11 weeks before the radiographic confirmation of progression (P1); differential dynamics in the allelic fractions of mutated clones that reflected the pattern of dissociated tumor response to treatment (P2) and the presence of concomitant EGFR activating and T790M mutations, together with an EGFR C797G, BRAF V600E and KRAS G12D in a patient who progressed under osimertinib (P3). Conclusions: Our preliminary results provide further evidence on the use of liquid biopsies for monitoring disease response, resistance to treatment and tumor heterogeneity. Subsequently, we will evaluate the utility of liquid biopsies in the clinical setting to understand the dynamics of mutant clones over time.
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Affiliation(s)
- Sandra Ortiz-Cuaran
- INSERM U1052, CNRS UMR 5286, Cancer Research Center of Lyon, Université de Lyon, Centre Léon Bérard, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon, Lyon, France
| | - Aurelie Swalduz
- INSERM U1052, CNRS UMR 5286, Cancer Research Center of Lyon, Université de Lyon, Centre Léon Bérard, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon, Lyon, France
| | | | | | | | | | - Solène Marteau
- INSERM U1052, CNRS UMR 5286, Cancer Research Center of Lyon, Université de Lyon, Centre Léon Bérard, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon, Lyon, France
| | | | - Maurice Perol
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | - Pierre Saintigny
- INSERM U1052, CNRS UMR 5286, Cancer Research Center of Lyon, Université de Lyon, Centre Léon Bérard, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon, Lyon, France
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