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Di Noia V, D'Aveni A, D'Argento E, Rossi S, Ghirardelli P, Bortolotti L, Vavassori V, Bria E, Ceresoli GL. Treating disease progression with osimertinib in EGFR-mutated non-small-cell lung cancer: novel targeted agents and combination strategies. ESMO Open 2021; 6:100280. [PMID: 34634633 PMCID: PMC8506968 DOI: 10.1016/j.esmoop.2021.100280] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 01/10/2023] Open
Abstract
A precision medicine approach has been successfully applied in medical oncology for the treatment of non-small-cell lung cancer (NSCLC) through the identification of targetable driver molecular aberrations; activating mutations of epidermal growth factor receptor (EGFR) are the most common. Osimertinib, a third-generation, wild-type sparing, irreversible EGFR tyrosine kinase inhibitor (TKI), originally showed a striking activity after progression to first- and second-generation EGFR-TKIs when T790M resistance mutation was identified. Thereafter, upfront use of osimertinib became the standard of care based on overall survival benefit over first-generation TKIs erlotinib and gefitinib as reported in the FLAURA trial. For patients progressing on osimertinib, identification of resistance mechanisms is crucial to develop novel targeted therapeutic approaches. Moreover, innovative drugs or combination therapies are being developed for cases in which a specific resistance mechanism is not identifiable. In this review, the post-osimertinib treatment options for EGFR-mutated NSCLC are analyzed, with an outlook to ongoing clinical trials. An algorithm to guide clinicians in managing progression on osimertinib is proposed.
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Affiliation(s)
- V Di Noia
- Medical Oncology 1 Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - A D'Aveni
- Department of Medical Oncology 1, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - E D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - S Rossi
- Department of Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - P Ghirardelli
- Department of Medical Oncology 1, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - L Bortolotti
- Department of Medical Oncology 1, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - V Vavassori
- Department of Medical Oncology 1, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - E Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Istituto di Medicina Interna e Geriatria, Università; Cattolica del Sacro Cuore, Rome, Italy
| | - G L Ceresoli
- Department of Medical Oncology 1, Cliniche Humanitas Gavazzeni, Bergamo, Italy
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Banna GL, Cortellini A, Cortinovis DL, Tiseo M, Aerts JGJV, Barbieri F, Giusti R, Bria E, Grossi F, Pizzutilo P, Berardi R, Morabito A, Genova C, Mazzoni F, Di Noia V, Signorelli D, Gelibter A, Macerelli M, Rastelli F, Chiari R, Rocco D, Gori S, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Montrone M, Citarella F, Marco R, Cantini L, Nigro O, D'Argento E, Buti S, Minuti G, Landi L, Guaitoli G, Lo Russo G, De Toma A, Donisi C, Friedlaender A, De Giglio A, Metro G, Porzio G, Ficorella C, Addeo A. The lung immuno-oncology prognostic score (LIPS-3): a prognostic classification of patients receiving first-line pembrolizumab for PD-L1 ≥ 50% advanced non-small-cell lung cancer. ESMO Open 2021; 6:100078. [PMID: 33735802 PMCID: PMC7988288 DOI: 10.1016/j.esmoop.2021.100078] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background To stratify the prognosis of patients with programmed cell death-ligand 1 (PD-L1) ≥ 50% advanced non-small-cell lung cancer (aNSCLC) treated with first-line immunotherapy. Methods Baseline clinical prognostic factors, the neutrophil-to-lymphocyte ratio (NLR), PD-L1 tumour cell expression level, lactate dehydrogenase (LDH) and their combination were investigated by a retrospective analysis of 784 patients divided between statistically powered training (n = 201) and validation (n = 583) cohorts. Cut-offs were explored by receiver operating characteristic (ROC) curves and a risk model built with validated independent factors by multivariate analysis. Results NLR < 4 was a significant prognostic factor in both cohorts (P < 0.001). It represented 53% of patients in the validation cohort, with 1-year overall survival (OS) of 76.6% versus 44.8% with NLR > 4, in the validation series. The addition of PD-L1 ≥ 80% (21% of patients) or LDH < 252 U/l (25%) to NLR < 4 did not result in better 1-year OS (of 72.6% and 74.1%, respectively, in the validation cohort). Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 [P < 0.001, hazard ratio (HR) 2.04], pretreatment steroids (P < 0.001, HR 1.67) and NLR < 4 (P < 0.001, HR 2.29) resulted in independent prognostic factors. A risk model with these three factors, namely, the lung immuno-oncology prognostic score (LIPS)-3, accurately stratified three OS risk-validated categories of patients: favourable (0 risk factors, 40%, 1-year OS of 78.2% in the whole series), intermediate (1 or 2 risk factors, 54%, 1-year OS 53.8%) and poor (>2 risk factors, 5%, 1-year OS 10.7%) prognosis. Conclusions We advocate the use of LIPS-3 as an easy-to-assess and inexpensive adjuvant prognostic tool for patients with PD-L1 ≥ 50% aNSCLC. Immunotherapy/chemoimmunotherapy combinations are currently not superior to immunotherapy alone for high PD-L1 aNSCLC. NLR with a cut-off of 4 was validated as an independent prognostic factor for immunotherapy in high PD-L1 aNSCLC. The addition of either PD-L1 ≥ 80% or LDH < 252 U/l to NLR < 4 did not result in better prognostic stratification. The LIPS-3 is a validated 3-class prognostic classification based on the NLR, ECOG PS and pretreatment steroids. The LIPS-3 is a routinely assessable adjuvant prognostic tool for high PD-L1 aNSCLC patients.
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Affiliation(s)
- G L Banna
- Oncology Department, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - A Cortellini
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | | | - M Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - J G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - F Barbieri
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - R Giusti
- Medical Oncology, St. Andrea Hospital, Rome, Italy
| | - E Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Pizzutilo
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Temorid 'Giovanni Paolo II', Bari, Italy
| | - R Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - A Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, Italy
| | - C Genova
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - F Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - V Di Noia
- Medical Oncology, University Hospital of Foggia, Foggia, Italy
| | - D Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Gelibter
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - M Macerelli
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | - F Rastelli
- Medical Oncology, Fermo Area Vasta 4, Fermo, Italy
| | - R Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud 'Madre Teresa Di Calcutta', Monselice, Italy
| | - D Rocco
- Pneumo-Oncology Unit, Monaldi Hospital, Naples, Italy
| | - S Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella VR, Italy
| | - M De Tursi
- Department of Medical, Oral & Biotechnological Sciences University G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - P Di Marino
- Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy
| | - G Mansueto
- Medical Oncology, F. Spaziani Hospital, Frosinone, Italy
| | - F Zoratto
- Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy
| | - M Filetti
- Medical Oncology, St. Andrea Hospital, Rome, Italy
| | - M Montrone
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Temorid 'Giovanni Paolo II', Bari, Italy
| | - F Citarella
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - R Marco
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - L Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - O Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | - E D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - S Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - L Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - G Guaitoli
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - G Lo Russo
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - A De Toma
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - C Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - A Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - A De Giglio
- Division of Medical Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - G Porzio
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - C Ficorella
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - A Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
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Landriscina M, Quirino M, Sciamanna I, Pittoggi C, D'Argento E, Schinzari G, Di Leonardo G, Cassano A, Spadafora C, Barone C. Reverse transcriptase inhibitors reduce tumor growth in vivo and induce cell differentiation. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- M. Landriscina
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
| | - M. Quirino
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
| | - I. Sciamanna
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
| | - C. Pittoggi
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
| | - E. D'Argento
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
| | - G. Schinzari
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
| | - G. Di Leonardo
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
| | - A. Cassano
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
| | - C. Spadafora
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
| | - C. Barone
- Catholic University, Rome, Italy; Istituto Superiore di Sanità, Rome, Italy
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