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Takam Kamga P, Mayenga M, Sebane L, Costantini A, Julie C, Capron C, Parent F, Seferian A, Guettier C, Emile JF, Giroux Leprieur E. Colony stimulating factor-1 (CSF-1) signalling is predictive of response to immune checkpoint inhibitors in advanced non-small cell lung cancer. Lung Cancer 2024; 188:107447. [PMID: 38176297 DOI: 10.1016/j.lungcan.2023.107447] [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: 08/23/2023] [Revised: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
The identification of biomarkers related to treatment in patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) represents a significant challenge. The aim of this study was to determine the predictive value of macrophage-related markers assessed in plasma and tissue samples of patients with NSCLC undergoing ICI treatment. This bicentric study included a prospective cohort of 88 patients with advanced NSCLC who received first-line therapy with ICI (either as monotherapy or in combination with chemotherapy) or chemotherapy alone (CT). Samples were collected from the patients at baseline and during follow-up. Plasma levels of CSF-1 and IL-34 were measured using ELISA, while expression levels of the macrophage receptors CD163 and CSF-1-R were evaluated using immunohistochemistry on lung biopsies. At baseline, the median plasma CSF-1 expression was higher in patients who did not respond to immunotherapy compared to those who responded (8898 pg/mL vs. 14031 pg/mL, p = 0.0005). Importantly, high CSF-1 levels at the initial assessment were associated with disease progression regardless of the treatment received. Furthermore, high CSF-1 levels were associated with shorter progression-free survival (PFS) and overall survival (OS) in patients receiving ICI therapy, but not in those treated with chemotherapy. There was no correlation between IL-34, CSF-1R, CD163 and therapeutic response. We observed in vitro that the activation of lymphocytes mediated by pembrolizumab was hindered by the treatment of PBMC with recombinant CSF-1, suggesting that CSF-1 creates a systemic immunosuppressive state that interferes with ICI treatment. In conclusion, baseline CSF-1 levels represent a potential predictive marker to ICI treatment in NSCLC.
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Affiliation(s)
- Paul Takam Kamga
- Université Paris-Saclay, UVSQ, EA4340 BECCOH, Boulogne-Billancourt, France
| | - Marie Mayenga
- Université Paris-Saclay, UVSQ, EA4340 BECCOH, Boulogne-Billancourt, France
| | - Louise Sebane
- Université Paris-Saclay, UVSQ, EA4340 BECCOH, Boulogne-Billancourt, France
| | - Adrien Costantini
- Université Paris-Saclay, UVSQ, EA4340 BECCOH, Boulogne-Billancourt, France; APHP - Hôpital Ambroise Paré, Department of Respiratory Diseases and Thoracic Oncology, Boulogne-Billancourt, France
| | - Catherine Julie
- Université Paris-Saclay, UVSQ, EA4340 BECCOH, Boulogne-Billancourt, France; APHP - Hôpital Ambroise Paré, Department of Pathology, Boulogne-Billancourt, France
| | - Claude Capron
- Université Paris-Saclay, UVSQ, EA4340 BECCOH, Boulogne-Billancourt, France; APHP - Hôpital Ambroise Paré, Department of Hematology Immunology, Boulogne-Billancourt, France
| | - Florence Parent
- APHP - Hôpital Bicêtre, Department of Pulmonology, Kremlin-Bicêtre, France
| | - Andrei Seferian
- APHP - Hôpital Bicêtre, Department of Pulmonology, Kremlin-Bicêtre, France
| | - Catherine Guettier
- APHP - Hôpital Bicêtre, Department of Pathology, Kremlin-Bicêtre, France
| | - Jean-François Emile
- Université Paris-Saclay, UVSQ, EA4340 BECCOH, Boulogne-Billancourt, France; APHP - Hôpital Ambroise Paré, Department of Pathology, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Université Paris-Saclay, UVSQ, EA4340 BECCOH, Boulogne-Billancourt, France; APHP - Hôpital Ambroise Paré, Department of Respiratory Diseases and Thoracic Oncology, Boulogne-Billancourt, France.
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Bellouard M, Donadieu J, Thiebot P, Giroux Leprieur E, Saiag P, Etting I, Dugues P, Abe E, Alvarez JC, Larabi IA. Validation of Liquid Chromatography Coupled with Tandem Mass Spectrometry for the Determination of 12 Tyrosine Kinase Inhibitors (TKIs) and Their Application to Therapeutic Drug Monitoring in Adult and Pediatric Populations. Pharmaceutics 2023; 16:5. [PMID: 38276485 PMCID: PMC10818921 DOI: 10.3390/pharmaceutics16010005] [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: 11/15/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Tyrosine kinase inhibitors (TKIs) are used as targeted cancer therapies in adults and have an off-label pediatric application for the treatment of Langerhans cell histiocytosis. A multitarget LC-MS/MS method was developed and validated for the determination of alectinib, alectinib-M4, binimetinib, cobimetinib, crizotinib, dabrafenib, encorafenib, imatinib, lorlatinib, osimertinib, AZ5104, and trametinib. A total of 150 µL of internal standard methanolic solution was added to 50 µL of plasma sample to precipitate proteins. After centrifugation, 10 µL of the supernatant was injected into the chromatographic system. The chromatographic separation was conducted on a Kinetex C18 Polar column with a gradient of 2 mM ammonium formate in 0.1% formic acid and acetonitrile over 5 min. Limits of detection and quantification, linearity, accuracy, precision, selectivity, carryover, matrix effect, recovery, and stability were evaluated and satisfied EMA guidelines on bioanalytical methods. This method has been successfully applied to the therapeutic drug monitoring (TDM) of adults with melanoma and lung cancer, as well as children with histiocytosis, to improve the pharmacokinetic data for these drugs, with the aim of enhancing the therapeutic management and follow-up of patients. Blood concentrations of trametinib and binimetinib were different in the two groups, highlighting the age-related inter-individual variability of these molecules and the need for TDM.
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Affiliation(s)
- Marie Bellouard
- Toxicology Laboratory, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France; (I.E.); (P.D.); (E.A.); (I.-A.L.); (J.-C.A.)
- Pediatric Hemato-Oncology Department, Trousseau Hospital, AP-HP, 75012 Paris, France;
| | - Jean Donadieu
- Pediatric Hemato-Oncology Department, Trousseau Hospital, AP-HP, 75012 Paris, France;
| | - Pauline Thiebot
- Toxicology Laboratory, Lariboisière Hospital, AP-HP, 75010 Paris, France;
| | | | - Philippe Saiag
- Dermatology Department, Ambroise Paré Hospital, AP-HP, 92100 Boulogne-Billancourt, France;
| | - Isabelle Etting
- Toxicology Laboratory, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France; (I.E.); (P.D.); (E.A.); (I.-A.L.); (J.-C.A.)
| | - Pamela Dugues
- Toxicology Laboratory, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France; (I.E.); (P.D.); (E.A.); (I.-A.L.); (J.-C.A.)
- Inserm U-1018, CESP, Team MOODS, Plateform MasSpecLab, Paris-Saclay/Versailles University, 78180 Montigny-le-Bretonneux, France
| | - Emuri Abe
- Toxicology Laboratory, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France; (I.E.); (P.D.); (E.A.); (I.-A.L.); (J.-C.A.)
| | - Jean-Claude Alvarez
- Toxicology Laboratory, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France; (I.E.); (P.D.); (E.A.); (I.-A.L.); (J.-C.A.)
- Inserm U-1018, CESP, Team MOODS, Plateform MasSpecLab, Paris-Saclay/Versailles University, 78180 Montigny-le-Bretonneux, France
| | - Islam-Amine Larabi
- Toxicology Laboratory, Raymond Poincaré Hospital, AP-HP, 92380 Garches, France; (I.E.); (P.D.); (E.A.); (I.-A.L.); (J.-C.A.)
- Inserm U-1018, CESP, Team MOODS, Plateform MasSpecLab, Paris-Saclay/Versailles University, 78180 Montigny-le-Bretonneux, France
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Ezzedine R, Canellas A, Naltet C, Wislez M, Azarian R, Seferian A, Giroux Leprieur E. Evaluation of Real-Life Chemoimmunotherapy Combination in Patients with Metastatic Small Cell Lung Carcinoma (SCLC): A Multicentric Case-Control Study. Cancers (Basel) 2023; 15:4593. [PMID: 37760561 PMCID: PMC10526821 DOI: 10.3390/cancers15184593] [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: 07/02/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The current first-line standard treatment for advanced small cell lung cancer (SCLC) is a combination of chemotherapy and immunotherapy. However, few efficacy data are available in a real-life settings, including frail patients. The aim of this study is to describe the real-life efficacy of chemoimmunotherapy in an unselected SCLC population. We conducted a retrospective multicenter study, which compared two cohorts of patients with treatment-naive metastatic SCLC treated in six academic centers in the Greater Paris area. Cohort 1 included patients treated with chemotherapy between January 2017 and December 2018, and cohort 2 included patients treated with chemoimmunotherapy between January 2019 and December 2020. A total of 153 consecutive patients were included (cohort 1: n = 96; cohort 2: n = 57). Clinical characteristics were similar between the two cohorts. Overall survival (OS) was statistically higher in cohort 2 (median survival 15.47 months) than in cohort 1 (median survival 9.5 months) (p = 0.0001). OS for patients with a performance status ≥2 and for patients ≥70 years old was not statistically different between the two cohorts. Chemoimmunotherapy efficacy was better compared to chemotherapy alone in case of brain or liver metastases. In conclusion, the combination of chemoimmunotherapy in metastatic SCLC appears to provide a real-life OS benefit. Dedicated clinical trials are needed to test this strategy in patients with impaired performance status or advanced age.
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Affiliation(s)
- Rémy Ezzedine
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Paré, 92104 Boulogne-Billancourt, France;
| | - Anthony Canellas
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Tenon, 75020 Paris, France;
| | - Charles Naltet
- Department of Respiratory Diseases, Hôpital Paris Saint Joseph, 75014 Paris, France;
| | - Marie Wislez
- Thoracic Oncology Unit, Pulmonology Department, APHP—Hôpital Cochin, Université Paris Cité, 75006 Paris, France;
| | - Reza Azarian
- Department of Respiratory Diseases, Hôpital Mignot, 78150 Le Chesnay, France;
| | - Andrei Seferian
- Department of Respiratory Diseases, APHP—Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France;
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Paré, 92104 Boulogne-Billancourt, France;
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Barlesi F, Tomasini P, Karimi M, Michiels S, Raimbourg J, Daniel C, Janicot H, Madroszyk A, Audigier-Valette C, Quoix E, Mazieres J, Moro-Sibilot D, Dansin E, Molinier O, Morel H, Pichon E, Cortot A, Otto J, Chomy FO, Souquet PJ, Cloarec N, Giroux Leprieur E, Bieche I, Lacroix L, Boyault S, Attignon V, Soubeyran I, Morel A, Tran-Dien A, Jacquet A, Dall'Olio FG, Jimenez M, Soria JC, Besse B. Comprehensive genome profiling in patients with metastatic non-small cell lung cancer: the precision medicine phase 2 randomized SAFIR02-Lung trial. Clin Cancer Res 2022; 28:4018-4026. [PMID: 35802649 DOI: 10.1158/1078-0432.ccr-22-0371] [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] [Received: 02/06/2022] [Revised: 04/20/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Targeted therapies (TT) and immune checkpoint blockers (ICB) have revolutionized the approach to non-small cell lung cancer (NSCLC) treatment in the era of precision medicine. Their impact as switch maintenance therapy based on molecular characterization is unknown. EXPERIMENTAL DESIGN SAFIR02-Lung was an open-label, randomized, phase 2 trial, involving 33 centers in France. We investigated eight TT (substudy-1) and one ICB (substudy-2), compared to standard-of-care as a maintenance strategy in advanced EGFR, ALK wild-type (wt) NSCLC patients without progression after first line chemotherapy, based on high-throughput genome analysis. The primary outcome was progression-free survival (PFS). RESULTS Among the 175 patients randomized in substudy-1, 116 received TT (selumetinib, vistusertib, capivasertib, AZD4547, AZD8931, vandetanib, olaparib, savolitinib) and 59 standard-of-care. Median PFS was 2.7 months (95% CI 1.6-2.9) with TT vs. 2.7 months (1.6-4.1) with standard-of-care (HR 0.97, 0.7-1.36; p=0.87). There were no significant differences in PFS within any molecular subgroup. In substudy-2, 183 patients were randomized, 121 received durvalumab and 62 standard-of-care. Median PFS was 3.0 months (2.3-4.4) with durvalumab versus 3.0 months (2.0-5.1) with standard-of-care (HR=0.86; 0.62-1.20; p=0.38). Preplanned subgroup analysis showed an enhanced benefit with durvalumab in patients with PD-L1 Tumor Proportion Score (TPS) ≥ 1%, (n=29, HR=0.29; 0.11-0.75) as compared to PD-L1 <1% (n=31, HR=0.71, 0.31-1.60, interaction p= 0.036). CONCLUSIONS Molecular profiling can feasibly be implemented to guide treatment choice for the maintenance strategy in EGFR/ALK wt NSCLC; in the current study it did not lead to substantial treatment benefits beyond durvalumab for PD-L1 ≥ 1 patients.
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Affiliation(s)
- Fabrice Barlesi
- Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Pascale Tomasini
- Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | | | | | | | | | - Henri Janicot
- CHU - Hopital Gabriel Montpied, Clermont-Ferrand, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alain Morel
- Institut de Cancérologie de l'Ouest, Angers, France
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Bilger G, Toffart AC, Darrason M, Duruisseaux M, Ulmer L, Wang P, Leprieur EG, Girard N, Massiani MA, Bore P, Descourt R, Pinsolle J, Valery S, Monnet I, Swalduz A, Tissot C, Fournel P, Baranzelli A, Cortot AB, Decroisette C. Paclitaxel–bevacizumab combination in advanced non-squamous non-small-cell lung cancer (NSCLC): AVATAX, a retrospective multicentric study. Ther Adv Med Oncol 2022; 14:17588359221099399. [PMID: 35694190 PMCID: PMC9174558 DOI: 10.1177/17588359221099399] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Compared with docetaxel, the phase-III trial, ULTIMATE, showed a significant
improvement of progression-free survival (PFS) with paclitaxel–bevacizumab
combination (PB) as second- or third-line treatment in advanced non-small
cell lung cancer (NSCLC). With the increase of immunotherapy treatment in
first-line settings, the optimal treatment after first-line failure must be
redefined. Methods: This multicentric retrospective study identified all advanced NSCLC patients
treated with PB as second-line therapy and beyond. The main efficacy
outcomes assessed were objective response rate (ORR), disease control rate
(DCR), PFS, and overall survival (OS). The adverse events were reported
according to Common Terminology Criteria for Adverse Events (CTCAE). Results: From January 2010 to February 2020, 314 patients in 16 centers received the
PB combination. Most patients were male (55%), with a median age of 60 years
(19–82), 95% had adenocarcinoma, 27% had a performance status ⩾2, 45% had
brain metastases at the time of inclusion. They mostly received the PB
combination either in second (20%) or in third-line (39%), and 28% were
treated just after ICI failure. ORR and DCR were 40% and 77%, respectively;
median PFS and OS were 5.7 [interquartile range (IQR): 3.2–9.6] and 10.8
[IQR: 5.3–19.6] months, respectively. All grade adverse events concerned 82%
of patients, including 53% asthenia and 39% neurotoxicity, and 25% of
patients continued monotherapy (mostly with bevacizumab) alone due to
toxicity. Median PFS for patients treated after ICI failure (ICI+) was
significantly superior compared with those not previously treated with ICI
(ICI−): 7.0 [IQR: 4.2–11.0] versus 5.2 [IQR: 2.9–8.8]
months, p = 0.01, without statistically significant
difference for OS between these two groups. In multivariate analysis,
factors associated with superior PFS were previous ICI treatment and
performance status of 0–1. Only a performance status of 0–1 was associated
with superior OS. Conclusion: PB combination as second-line treatment or beyond for advanced non-squamous
NSCLC had acceptable toxicity and a clinically relevant efficacy and is an
option as salvage treatment for these patients, more particularly after ICI
progression.
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Affiliation(s)
- Geoffroy Bilger
- Centre Hospitalier Universitaire de Grenoble, 38700 Grenoble, France. Oncology, Grenoble University Hospital, Grenoble, France
| | - Anne-Claire Toffart
- Centre Hospitalier Universitaire de Grenoble, Grenoble, FranceOncology, Grenoble University Hospital, Grenoble, France
| | - Marie Darrason
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Hôpital Lyon-Sud, CHU Lyon, Pierre-Bénite, France
- Department of Pneumology and Thoracic Oncology, University Hospital of Lyon, Pierre-Bénite, France
- Institut de Recherches Philosophiques de Lyon, Université Lyon 3, Lyon, France
- Lyon Institute of Philosophical Research, Lyon 3 University, Lyon, France
| | | | - Lucie Ulmer
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
| | | | | | | | | | - Paul Bore
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Julian Pinsolle
- Unité de pneumologie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | | | | | - Aurélie Swalduz
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | - Claire Tissot
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Pierre Fournel
- Service d’Oncologie Médicale, Institut de Cancérologie, CHU de Saint-Etienne, Saint-Etienne Cedex 2, France
| | - Anne Baranzelli
- Unité de pneumologie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Alexis B. Cortot
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
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Takam Kamga P, Swalduz A, Costantini A, Julié C, Emile JF, Pérol M, Avrillon V, Ortiz-Cuaran S, de Saintigny P, Leprieur EG. High Circulating Sonic Hedgehog Protein Is Associated With Poor Outcome in EGFR-Mutated Advanced NSCLC Treated With Tyrosine Kinase Inhibitors. Front Oncol 2022; 11:747692. [PMID: 34970481 PMCID: PMC8712335 DOI: 10.3389/fonc.2021.747692] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Growing preclinical evidence has suggested that the Sonic hedgehog (Shh) pathway is involved in resistance to tyrosine kinase inhibitor (TKI) therapy for EGFR-mutated (EGFRm) non-small cell lung cancer (NSCLC). However, little is known concerning the prognostic value of this pathway in this context. Materials and Methods We investigated the relationship between plasma levels of Shh and EGFRm NSCLC patients’ outcome with EGFR TKIs. We included 74 consecutive patients from two institutions with EGFRm advanced NSCLC treated by EGFR TKI as first-line therapy. Plasma samples were collected longitudinally for each patient and were analyzed for the expression of Shh using an ELISA assay. The activation of the Shh–Gli1 pathway was assessed through immunohistochemistry (IHC) of Gli1 and RT-qPCR analysis of the transcripts of Gli1 target genes in 14 available tumor biopsies collected at diagnosis (baseline). Results Among the 74 patients, only 61 had baseline (diagnosis) plasma samples, while only 49 patients had plasma samples at the first evaluation. Shh protein was detectable in all samples at diagnosis (n = 61, mean = 1,041.2 ± 252.5 pg/ml). Among the 14 available tumor biopsies, nuclear expression of Gli1 was observed in 57.1% (8/14) of patients’ biopsies. Shh was significantly (p < 0.05) enriched in youth (age < 68), male, nonsmokers, patients with a PS > 1, and patients presenting more than 2 metastatic sites and L858R mutation. Higher levels of Shh correlated with poor objective response to TKI, shorter progression-free survival (PFS), and T790M-independent mechanism of resistance. In addition, the rise of plasma Shh levels along the treatment was associated with the emergence of drug resistance in patients presenting an initial good therapy response. Conclusion These data support that higher levels of plasma Shh at diagnosis and increased levels of Shh along the course of the disease are related to the emergence of TKI resistance and poor outcome for EGFR-TKI therapy, suggesting that Shh levels could stand both as a prognostic and as a resistance biomarker for the management of EGFR-mutated NSCLC patients treated with EGFR-TKI.
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Affiliation(s)
- Paul Takam Kamga
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France
| | - Aurélie Swalduz
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Adrien Costantini
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Catherine Julié
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP-Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Jean-François Emile
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP-Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Maurice Pérol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Virginie Avrillon
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Sandra Ortiz-Cuaran
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Pierre de Saintigny
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Etienne Giroux Leprieur
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Pare, Boulogne-Billancourt, France
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7
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Giroux Leprieur E, Hélias-Rodzewicz Z, Takam Kamga P, Costantini A, Julie C, Corjon A, Dumenil C, Dumoulin J, Giraud V, Labrune S, Garinet S, Chinet T, Emile JF. Sequential ctDNA whole-exome sequencing in advanced lung adenocarcinoma with initial durable tumor response on immune checkpoint inhibitor and late progression. J Immunother Cancer 2021; 8:jitc-2020-000527. [PMID: 32581058 PMCID: PMC7319709 DOI: 10.1136/jitc-2020-000527] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite prolonged tumor response to immune checkpoint inhibitors (ICIs) for a subset of patients with advanced non-small cell lung cancer (NSCLC), a secondary resistance will occur for a majority of these patients. The understanding of late progression mechanisms with ICIs is important to improve future treatment strategies. METHODS We performed whole-exome sequencing (WES) on circulating tumor DNA and compared molecular profiles between the beginning of ICI treatment and tumor progression in patients with advanced NSCLC treated with ICIs and who had initial and prolonged tumor response with secondary progression, after at least 6 months of treatment. RESULTS We identified eight patients who experienced initial and durable tumor response, and secondary tumor progression after 6 months of treatment, with available paired blood samples (diagnosis and progression). All had lung adenocarcinoma, three had programmed-death ligand-1 expression ≥50% in immunohistochemistry and all presented low blood tumor mutational burden (bTMB). Seven patients received nivolumab in second-line or more, and one received pembrolizumab as first-line treatment. WES at progression showed clonal selection with molecular alterations of Wnt pathway-related genes, increase of copy number aberrations in cancer-related genes and loss of tumor-suppressor genes (such as PTEN) or of genes associated with immune response (such as B2M). No difference in term of bTMB was observed at progression. CONCLUSIONS This is the first study describing putative molecular mechanisms associated with late progression under ICI in lung cancer. Studies on treatment strategies adapted to these mechanisms are needed.
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Affiliation(s)
- Etienne Giroux Leprieur
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France .,Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Zofia Hélias-Rodzewicz
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Paul Takam Kamga
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France
| | - Adrien Costantini
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Catherine Julie
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Alexandre Corjon
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Simon Garinet
- Department of Molecular Biology, APHP - Hopital Europeen Georges Pompidou, Paris, France
| | - Thierry Chinet
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Respiratory DIseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Jean-François Emile
- Université Paris-Saclay, UVSQ, EA 4340 BECCOH, Boulogne-Billancourt, France.,Department of Pathology, APHP - Hopital Ambroise Pare, Boulogne-Billancourt, France
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8
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Bilger G, Girard N, Doubre H, Giaj Levra M, Giroux Leprieur E, Giraud F, Decroisette C, Livartowski A, Massiani MA. Discontinuation of immune checkpoint inhibitor (ICI) above 18 months of treatment in real-life patients with non-small cell lung cancer (NSCLC): INTEPI, a multicentric retrospective study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9082] [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
9082 Background: The optimal treatment duration of ICIs for patients with NSCLC remains uncertain. In phase 3 clinical trials, treatment continued for two years or until disease progression, and results from CheckMate 153 trial suggest to continue beyond one year. Real life data are missing. Methods: This multi-centric retrospective study presents data on real-life patients who discontinued treatment after at least 18 months of ICI monotherapy, their tumour being still controlled. Their characteristics, the causes of discontinuation of ICI, and their outcome are described. Results: Between July 2015 and May 2018, 107 patients had their tumour controlled after at least 18 months of treatment. Among them, 54 (50%) patients discontinued ICI: 76% male, median age 63, 91% PS 0-1, 54% adenocarcinoma, 20% with brain metastases, PD-L1 expression level available for 18 (33%) patients (2 < 1%, 8 btw 1-50% and 8 > 50%), 93% treated after 1st line. The median duration of treatment was 26 months. Treatment was stopped by choice of the prescriber and toxicity in 46% and 22% respectively. With a median follow up of 21 months from ICI discontinuation, 18 (33%) patients had a tumor progression with a median time of 10 months (2-33). From discontinuation, overall survival (OS) and progression free survival (PFS) were 90% and 71% respectively at 12 months and 84% and 63% respectively at 24 months. Duration of disease control after ICI cessation seemed to be correlated to the best tumor response at treatment discontinuation, with a PFS rates at 12 months of 73% for complete response (CR n = 11), 77% for partial response (PR n = 37), 22% for patients with stable disease (SD n = 6), 80% for CR and/or complete metabolic response with 18F-FDG PET/CT (CMR) and 65% for others. Fourteen patients out of the 18 in the relapse group received a subsequent treatment : 7 were retreated with ICI (with best response 14% PR and 86% SD) and 5 received a localized therapy with 60% CR. Conclusions: Our study in real life provides new insight into the long-term outcomes of patients treated with ICI for at least 18 months before discontinuation in the absence of PD. CR and CMR with FDG-PET before therapy discontinuation may be a positive factor for a prolonged disease control upon discontinuation.
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Affiliation(s)
- Geoffroy Bilger
- Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Nicolas Girard
- Institut Curie, Institut du Thorax Curie-Montsouris, Paris, France
| | | | | | | | - Frédérique Giraud
- Department of Respiratory Medicine, Cochin Hospital, Paris Descartes University, AP-HP, CARPEM, Immunomodulatory Therapies Multidisciplinary Study Group (CERTIM), Paris, France
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9
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Bilger G, Toffart AC, Darasson M, Duruisseaux M, Ulmer L, Wang P, Giroux Leprieur E, Girard N, Massiani MA, Bore P, Descourt R, Pinsolle J, Valery S, Monnet I, Swalduz A, Tissot C, Fournel P, Baranzelli A, Cortot A, Decroisette C. Efficacy of weekly paclitaxel-bevacizumab combination in advanced nonsquamous non-small cell lung cancer (NSCLC): AVATAX, a retrospective multicentric study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21086] [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
e21086 Background: With the growing role of immunotherapy (ICI) as first-line setting for advanced NSCLC, strategies must be redefined after failure. The combination paclitaxel-bevacizumab showed in the ULTIMATE trial a significant superiority versus docetaxel as second or third-line treatment. Limited restropective studies has demonstrated unexpected efficacy of chemotherapy after prior progression on ICI. This combination could be use as salvage treatment following ICI. Methods: This multi-centric retrospective study identifies patients treated with the combination paclitaxel-bevacizumab in metastatic non-squamous NSCLC as second-line therapy or beyond. Main objectives were to describe safety and efficacy of this combination, with a special attention to the sub-group treated just after ICI. Results: From January 2010 to February 2020, 314 patients started the paclitaxel-bevacizumab combination : 55% male, with a median age of 60 years, 27% with a performance status ≥2, 45% with brain metastases. A majority of patients were treated in second (20%) and third-line (39%), and 28% were treated just after ICI failure (88/314). Objective response rate (ORR) was 40% and disease control rate was 77 %. Median progression-free survival (PFS) and overall survival (OS) were 5,7 months [IQ,3,2–9,6] and 10,8 months [IQ,5,3–19,6] respectively. All grades adverse events concerned 82% of patients, including 53% asthenia and 39% neurotoxicity, and 25% of patients continued a monotherapy alone due to toxicity. Median PFS for patients treated after ICI failure (ICI+) was significantly superior compare to those not previously treated with ICI (ICI-) : 7,0 months [IQ,4,2–11,0] vs 5,2 months [IQ,2,9–8,8] p (log-rank) = 0,01. There was not statistically significant difference in term of OS between this two groups. In multivariate analysis, factors associated with superior PFS were previous ICI treatment (ICI+) and performance status. Conclusions: This study confirms an acceptable toxicity profile associated with interesting efficacy of the combination paclitaxel-bevacizumab as second-line treatment or beyond for non–squamous NSCLC patients, particularly after progression with ICI.
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Affiliation(s)
- Geoffroy Bilger
- Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | | | - Marie Darasson
- URCOT, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | - Michaël Duruisseaux
- URCOT, Hôpital Louis Pradel, Hospices Civils de Lyon Cancer Institute, Lyon, France
| | - Lucie Ulmer
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
| | | | | | | | | | - Paul Bore
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | | | | | | | - Aurélie Swalduz
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | - Claire Tissot
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | - Pierre Fournel
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | | | - Alexis Cortot
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
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10
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Malapelle U, Leprieur EG, Kamga PT, Chiasseu MT, Rolfo C. Editorial: Emerging Biomarkers for NSCLC: Recent Advances in Diagnosis and Therapy. Front Oncol 2021; 11:694578. [PMID: 34055656 PMCID: PMC8160459 DOI: 10.3389/fonc.2021.694578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Pare, Boulogne-Billancourt, France.,EA 4340 BECCOH, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Paul Takam Kamga
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Marius Tresor Chiasseu
- Cellular Neuroscience, Neurodegeneration and Repair Program, Yale University School of Medicine, New Haven, CT, United States.,Departments of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Christian Rolfo
- Thoracic Medical Oncology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, Baltimore, MD, United States
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11
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Mehlman C, Takam Kamga P, Costantini A, Julié C, Dumenil C, Dumoulin J, Ouaknine J, Giraud V, Chinet T, Emile JF, Giroux Leprieur E. Baseline Hedgehog Pathway Activation and Increase of Plasma Wnt1 Protein Are Associated with Resistance to Immune Checkpoint Inhibitors in Advanced Non-Small-Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13051107. [PMID: 33807552 PMCID: PMC7962040 DOI: 10.3390/cancers13051107] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 12/26/2022] Open
Abstract
Hedgehog (Hh) and Wingless-type (Wnt) pathways are associated with resistance to immune checkpoint inhibitors (ICIs) in preclinical studies. This study aimed to assess the association between expression and activation levels of Wnt and Sonic Hedgehog (Shh) pathways and resistance to ICIs in advanced NSCLC patients treated with ICI. Hh and Wnt pathways activation was assessed by immunohistochemistry (Gli1 and beta-catenin) on corresponding tumor tissues, and by plasma concentrations of Shh and Wnt (Wnt1, Wnt2 and Wnt3) at ICI introduction and at the first clinical evaluation. Sixty-three patients were included, with 36 patients (57.1%) with available tissue. Response rate was lower in Gli1+ NSCLC (20.0%) compared to Gli1 negative (Gli-) NSCLC (55.6%) (p = 0.015). Rate of primary resistance was 69.8%, vs. 31.2%, respectively (p = 0.04), and median progression-free survival (PFS) was 1.9 months (interquartile range (IQR) 1.2-5.7) vs. 6.1 months (1.6-26.0), respectively (p = 0.08). Median PFS and overall survival were shorter in case of increase of Wnt1 concentration during ICI treatment compared to other patients: 3.9 months vs. 11.2 months (p = 0.008), and 15.3 months vs. not reached (p = 0.003). In conclusion, baseline activation of Hh pathway and increase of Wnt1 concentrations during ICI treatment were associated with poor outcome in NSCLC patients treated with ICIs.
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Affiliation(s)
- Camille Mehlman
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
| | - Paul Takam Kamga
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
| | - Adrien Costantini
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Catherine Julié
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Pathology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Julia Ouaknine
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Thierry Chinet
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
| | - Jean-François Emile
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Pathology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (C.M.); (P.T.K.); (A.C.); (C.J.); (T.C.); (J.-F.E.)
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hopital Ambroise Pare, 92100 Boulogne-Billancourt, France; (C.D.); (J.D.); (J.O.); (V.G.)
- Correspondence: ; Tel.: +33-149-095-802; Fax: +33-149-095-806
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12
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Costantini A, Takam Kamga P, Julie C, Corjon A, Dumenil C, Dumoulin J, Ouaknine J, Giraud V, Chinet T, Rottman M, Emile JF, Giroux Leprieur E. Plasma Biomarkers Screening by Multiplex ELISA Assay in Patients with Advanced Non-Small Cell Lung Cancer Treated with Immune Checkpoint Inhibitors. Cancers (Basel) 2020; 13:cancers13010097. [PMID: 33396187 PMCID: PMC7795942 DOI: 10.3390/cancers13010097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/09/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 12/22/2022] Open
Abstract
Simple Summary There is an unmet need for new predictive biomarkers associated with efficacy and immune-related toxicity of immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC). In this study, we performed multiplex ELISA screening in plasma from 35 consecutive patients with advanced NSCLC treated with nivolumab or pembrolizumab, allowing large-scale screening for 48 cytokines involved in immune response and tumour proliferation. We found an association between ICIs efficacy and three cytokines: soluble hepatocyte growth factor (sHGF), soluble Fibroblast Growth Factor (sFGF) and interleukine-12 (IL-12). Moreover, TNF-α, IL-16, IL-12p40 and MCP3 were candidate biomarkers for predicting grade 3–4 immune-related toxicity. This exploratory study shows the potential role of new plasma biomarkers in advanced NSCLC treated with ICIs. Abstract Immune checkpoint inhibitors (ICIs) are commonly used in patients with advanced non-small cell lung cancer (NSCLC). An unmet need remains for new biomarkers associated with ICIs. In this study, consecutive patients with advanced NSCLC treated with nivolumab or pembrolizumab were included. Plasma at ICIs initiation was prospectively collected and a multiplex ELISA assay testing 48 cytokines and growth factors was performed. Exploratory endpoints were the association between plasma biomarkers with outcome and grade III–IV immune related adverse events (irAEs). Thirty-five patients were included. Patients without clinical benefit (n = 22) had higher pre-ICI soluble Hepatocyte Growth Factor (sHGF) (210.9 vs. 155.8 pg/mL, p = 0.010), lower pre-ICI soluble Fibroblast Growth Factor (sFGF) (4.0 vs. 4.8 pg/mL, p = 0.043) and lower pre-ICI interleukine-12 (IL-12) (1.3 vs. 2.2 pg/mL, p = 0.043) concentrations. Patients with early progression (n = 23) had higher pre-ICIs sHGF (206.2 vs. 155.8 pg/mL, p = 0.025) concentrations. Patients with low sHGF levels at ICIs initiation had longer progression-free survival and overall survival than those with high sHGF levels: respectively 2.5 vs. 8.0 months (p = 0.002), and 5.5 vs. 35.0 months (p = 0.001). TNF-α, IL-16, IL-12p40 and MCP3 were associated with high grade irAEs. This study shows the potential association between several plasma biomarkers with outcome and grade 3–4 IrAEs in advanced NSCLC treated with ICIs.
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Affiliation(s)
- Adrien Costantini
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
| | - Paul Takam Kamga
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
| | - Catherine Julie
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
- Department of Pathology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France;
| | - Alexandre Corjon
- Department of Pathology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France;
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
| | - Julia Ouaknine
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
| | - Martin Rottman
- Department of Microbiology, APHP—Hôpital Raymond Poincaré, 92380 Garches, France;
- UMR 1173, UVSQ, Université Paris-Saclay, 78180 Montigny-le-Bretonneux, France
| | - Jean-François Emile
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
- Department of Pathology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France;
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France; (A.C.); (C.D.); (J.D.); (J.O.); (V.G.); (T.C.)
- EA 4340 BECCOH, UVSQ, Université Paris-Saclay, 92100 Boulogne-Billancourt, France; (P.T.K.); (C.J.); (J.-F.E.)
- Correspondence: ; Tel.: +33-1-49-09-58-02
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13
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Sesé L, Nguyen Y, Giroux Leprieur E, Annesi-Maesano I, Cavalin C, Goupil de Bouillé J, Demestier L, Dhote R, Tandjaoui-Lambiotte Y, Bauvois A, Pépin M, Curac S, Beaune S, Duchemann B, Nunes H. Impact of socioeconomic status in patients hospitalised for COVID-19 in the Greater Paris area. Eur Respir J 2020; 56:13993003.02364-2020. [PMID: 33154032 PMCID: PMC7651837 DOI: 10.1183/13993003.02364-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/16/2020] [Indexed: 12/03/2022]
Abstract
In the USA, coronavirus disease 2019 (COVID-19) is more likely to affect and kill African Americans [1], which raises the question of the contribution of several factors, including genetic background, socioeconomic status (SES), and comorbidities [2]. According to the French National Institute of Statistics and Economic Studies (INSEE) the highest excess mortality rate in France, during March and April 2020, linked to COVID-19 was found in the Seine-Saint-Denis (SSD) district [3]. SSD is the poorest district of Greater Paris [4]. We hypothesise that precarity influences the initial severity of COVID-19. Individual precarity seems to be associated with the initial severity of COVID-19 in hospitalised patients under the age of 70 years. Low socioeconomic status may contribute to the excess mortality observed in the poorest district of Greater Paris.https://bit.ly/3kuStXS
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Affiliation(s)
- Lucile Sesé
- Dept of Physiology and Pulmonology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University of Paris Nord, Bobigny, France
| | - Yann Nguyen
- Dept of Internal Medicine, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Clichy, France
| | - Etienne Giroux Leprieur
- Dept of Pulmonology and Thoracic Oncology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University UVSQ, EA 4340 BECCOH, Boulogne, France
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Dept, Institute Pierre Louis of Epidemiology and Public Health, INSERM, and UPMC Sorbonne Université, Medical School Saint Antoine, Paris, France
| | - Catherine Cavalin
- Social Science Research Institute (IRISSO, UMR CNRS-INRA 7170-1427), Paris-Dauphine University, PSL, Paris, France
| | - Jeanne Goupil de Bouillé
- Dept of Infectious Diseases, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University of Paris Nord, Bobigny, France
| | - Louis Demestier
- Dept of Gastroenterology and Pancreatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Clichy, France
| | - Robin Dhote
- Dept of Internal Medicine, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University of Paris Nord, Bobigny, France
| | - Yacine Tandjaoui-Lambiotte
- Dept of Reanimation, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University of Paris Nord, Bobigny, France
| | - Adeline Bauvois
- Dept of Infectious Diseases, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University UVSQ, EA 4340 BECCOH, Boulogne, France
| | - Marion Pépin
- Dept of Geriatrics, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University UVSQ, EA 4340 BECCOH, Boulogne, France
| | - Sonja Curac
- Emergency Dept, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Clichy, France
| | - Sébastien Beaune
- Emergency Dept, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University UVSQ, EA 4340 BECCOH, Boulogne, France
| | - Boris Duchemann
- Dept of Oncology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University of Paris Nord, Bobigny, France.,Both authors contributed equally
| | - Hilario Nunes
- Dept of Pulmonology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University of Paris Nord, INSERM1272, Bobigny, France.,Both authors contributed equally
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14
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Ortiz-Cuaran S, Mezquita L, Swalduz A, Aldea M, Mazieres J, Leonce C, Jovelet C, Pradines A, Avrillon V, Chumbi Flores WR, Lacroix L, Loriot Y, Westeel V, Ngo-Camus M, Tissot C, Raynaud C, Gervais R, Brain E, Monnet I, Giroux Leprieur E, Caramella C, Mahier-Aït Oukhatar C, Hoog-Labouret N, de Kievit F, Howarth K, Morris C, Green E, Friboulet L, Chabaud S, Guichou JF, Perol M, Besse B, Blay JY, Saintigny P, Planchard D. Circulating Tumor DNA Genomics Reveal Potential Mechanisms of Resistance to BRAF-Targeted Therapies in Patients with BRAF-Mutant Metastatic Non-Small Cell Lung Cancer. Clin Cancer Res 2020; 26:6242-6253. [PMID: 32859654 DOI: 10.1158/1078-0432.ccr-20-1037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/11/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The limited knowledge on the molecular profile of patients with BRAF-mutant non-small cell lung cancer (NSCLC) who progress under BRAF-targeted therapies (BRAF-TT) has hampered the development of subsequent therapeutic strategies for these patients. Here, we evaluated the clinical utility of circulating tumor DNA (ctDNA)-targeted sequencing to identify canonical BRAF mutations and genomic alterations potentially related to resistance to BRAF-TT, in a large cohort of patients with BRAF-mutant NSCLC. EXPERIMENTAL DESIGN This was a prospective study of 78 patients with advanced BRAF-mutant NSCLC, enrolled in 27 centers across France. Blood samples (n = 208) were collected from BRAF-TT-naïve patients (n = 47), patients nonprogressive under treatment (n = 115), or patients at disease progression (PD) to BRAF-TT (24/46 on BRAF monotherapy and 22/46 on BRAF/MEK combination therapy). ctDNA sequencing was performed using InVisionFirst-Lung. In silico structural modeling was used to predict the potential functional effect of the alterations found in ctDNA. RESULTS BRAFV600E ctDNA was detected in 74% of BRAF-TT-naïve patients, where alterations in genes related with the MAPK and PI3K pathways, signal transducers, and protein kinases were identified in 29% of the samples. ctDNA positivity at the first radiographic evaluation under treatment, as well as BRAF-mutant ctDNA positivity at PD were associated with poor survival. Potential drivers of resistance to either BRAF-TT monotherapy or BRAF/MEK combination were identified in 46% of patients and these included activating mutations in effectors of the MAPK and PI3K pathways, as well as alterations in U2AF1, IDH1, and CTNNB1. CONCLUSIONS ctDNA sequencing is clinically relevant for the detection of BRAF-activating mutations and the identification of alterations potentially related to resistance to BRAF-TT in BRAF-mutant NSCLC.
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Affiliation(s)
- Sandra Ortiz-Cuaran
- Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.
| | - Laura Mezquita
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France.,Department of Medical Oncology, Hospital Clinic, Laboratory of Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Aurélie Swalduz
- Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.,Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | - Mihalea Aldea
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Julien Mazieres
- Department of Respiratory Disease, Larrey Hospital, University Hospital of Toulouse, Paul Sabatier University, Toulouse, France
| | - Camille Leonce
- Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France
| | - Cecile Jovelet
- Translational Research Laboratory, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Virginie Avrillon
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | | | - Ludovic Lacroix
- Translational Research Laboratory, Gustave Roussy Cancer Campus, Villejuif, France
| | - Yohann Loriot
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Maud Ngo-Camus
- Department of Early Drug Development, Gustave Roussy Cancer Campus, Villejuif, France
| | - Claire Tissot
- University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | | | | | - Isabelle Monnet
- Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | | | - Caroline Caramella
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | | | | | | | | | - Luc Friboulet
- Université Paris-Saclay, Gustave Roussy Cancer Campus, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Sylvie Chabaud
- Department of Clinical Research, Centre Léon Bérard, Lyon, France
| | - Jean-François Guichou
- Centre de Biochimie Structurale (CBS), INSERM, CNRS, Université de Montpellier, Montpellier, France
| | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | - Pierre Saintigny
- Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France. .,Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | - David Planchard
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France.
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Gobbini E, Toffart AC, Pérol M, Assié JB, Duruisseaux M, Coupez D, Dubos C, Westeel V, Delaunay M, Guisier F, Veillon R, Gounant V, Giroux Leprieur E, Vanel FR, Chaabane N, Dansin E, Babey H, Decroisette C, Barlesi F, Daniel C, Fournel P, Mezquita L, Oulkhouir Y, Canellas A, Duchemann B, Molinier O, Alcazer V, Moro-Sibilot D, Levra MG. Immune Checkpoint Inhibitors Rechallenge Efficacy in Non-Small-Cell Lung Cancer Patients. Clin Lung Cancer 2020; 21:e497-e510. [PMID: 32605892 DOI: 10.1016/j.cllc.2020.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 01/30/2020] [Revised: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Immune checkpoint inhibitor (ICPi) rechallenge could represent an attractive option in non-small-cell lung cancer (NSCLC), yet no sufficient data supporting this strategy are available. This retrospective observational multicenter national study explored the efficacy of anti-programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1) rechallenge in advanced NSCLC patients, looking for potential clinical features associated with greater outcomes. PATIENTS AND METHODS We retrospectively collected data from 144 advanced NSCLC patients whose disease was rechallenged with ICPis after ≥ 12 weeks of discontinuation. The progression-free survival (PFS) and overall survival (OS) were calculated from first or second ICPi initiation to disease progression (PFS1 and PFSR, respectively), death, or last follow-up (OS1, OSR), respectively. RESULTS The median (interquartile range) age was 63 (58-70) years. Most patients were male (67%) and smokers (87%). Most had adenocarcinomas (62%) and/or stage IV disease at diagnosis (66%). The best response at rechallenge was not associated with that under the first ICPi (P = 1.10-1). The median (95% confidence interval) PFS1 and PFSR were 13 (10-16.5) and 4.4 (3-6.5) months, respectively. The median (95% confidence interval) OS1 and OSR were 3.3 (2.9-3.9) and 1.5 (1.0-2.1) years, respectively. Longer PFSR and OSR were found in patients discontinuing first ICPi because of toxicity or clinical decision, those not receiving systemic treatment between the two ICPis, and those with good Eastern Cooperative Oncology Group performance status at rechallenge. Only performance status proved to affect outcomes at multivariate analysis. CONCLUSION Patients discontinuing first ICPi because of toxicity or clinical decision, those able to maintain a treatment-free period, and those with good performance status may be potential candidates for rechallenge.
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Affiliation(s)
- Elisa Gobbini
- Thoracic Oncology Unit SHUPP, CHU Grenoble-Alpes, Grenoble, France; Cancer Research Center Lyon, Center Léon Bérard, Lyon, France.
| | | | - Maurice Pérol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | | | - Michaël Duruisseaux
- Unité de Recherche Commune en Oncologie Thoracique (URCOT), Hospices Civils de Lyon Cancer Institute, Lyon, France; Anticancer Antibodies Laboratory, Cancer Research Center of Lyon, Inserm 1052, CNRS 5286, Lyon, France; Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Dahna Coupez
- Thoracic Oncology Unit, CHU Nantes, Nantes, France
| | - Catherine Dubos
- Thoracic Oncology Unit, Center François Baclesse, Caen, France
| | | | | | - Florian Guisier
- Pneumology, Thoracic Oncology, and Respiratory Intensive Care Unit, CHU Rouen, Rouen, France
| | - Rémi Veillon
- Respiratory Diseases Department, F-33000, CHU Bordeaux, Bordeaux, France
| | - Valérie Gounant
- Thoracic Oncology Department, CIC 1425 INSERM, Center Bichat, Paris, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Pare, Paris, France
| | | | - Nouha Chaabane
- Pulmonology Service, AP-HP Paris Center University Hospitals, Cochin Hospital, Paris, France
| | - Eric Dansin
- Thoracic Oncology Unit, Center Oscar Lambret, Lille, France
| | - Hélène Babey
- Thoracic Oncology Unit, CHRU Brest, Brest, France
| | | | - Fabrice Barlesi
- Aix-Marseille Université, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Catherine Daniel
- Thoracic Oncology Unit, Institute Curie, Paris/Saint Cloud, France
| | - Pierre Fournel
- Medical Oncology Department, Institut de Cancérologie de la Loire, Saint, France
| | - Laura Mezquita
- Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif, France
| | | | - Anthony Canellas
- Pulmonology Unit, APHP Hôpital Tenon and GRC 04 Theranoscan Sorbonne University, Paris, France
| | | | | | - Vincent Alcazer
- Cancer Research Center Lyon, Center Léon Bérard, Lyon, France
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16
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Mehlman C, Cadranel J, Lacave R, Rousseau-Bussac G, Pujals A, Girard N, Bieche I, Gounant V, Théou-Anton N, Friard S, Trédaniel J, Blons H, Dujon C, Duchemann B, Schischmanoff PO, Chinet T, Giroux Leprieur E. Efficacy of osimertinib and histomolecular profile at progression in EGFR-mutated lung cancer. Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa370] [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: 11/05/2022]
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17
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Mehlman C, Cadranel J, Rousseau-Bussac G, Lacave R, Pujals A, Girard N, Callens C, Gounant V, Théou-Anton N, Friard S, Trédaniel J, Blons H, Dujon C, Duchemann B, Schischmanoff PO, Chinet T, Giroux Leprieur E. Resistance mechanisms to osimertinib in EGFR-mutated advanced non-small-cell lung cancer: A multicentric retrospective French study. Lung Cancer 2019; 137:149-156. [PMID: 31600593 DOI: 10.1016/j.lungcan.2019.09.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 07/24/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The understanding of histo-molecular mechanisms associated with resistance to osimertinib is a critical step to define the optimal treatment strategy in advanced EGFR-mutated Non-Small-Cell-Lung-Cancer (NSCLC). MATERIALS AND METHODS We performed a multicentric retrospective analysis on a cohort of consecutive patients treated with osimertinib for an advanced EGFR-mutated NSCLC and collected histo-molecular data from plasma and tumor samples at the time of progression. Next-generation sequencing (NGS) was performed for all samples. Best Overall Response Rate (ORR), Progression Free Survival (PFS), Overall Survival (OS) and data on treatment post-progression efficacy were also collected. RESULTS Two-hundred and twenty-six patients were included from 9 Academic French Hospitals between April 2015-October 2018. Osimertinib was given in second-line or more in 219 patients (97%). Best ORR was 52% and best central nervous system ORR was 56%. Median PFS and OS were 9.5 months (IQR 4.0-17.2) and 24 months (IQR 12.4-NR) respectively. At the time of analysis, 150 patients (66%) had tumor progression. Among them, 73 contributive samples (56 tumor biopsies) were available. The most frequent molecular alterations were C797S mutation (n = 9 (13%)) and MET amplification (n = 8 (11%)). Histologic transformation occurred in 5 patients (9% of tumor biopsies). In T790M + NSCLC, loss of T790 M occurred in 68% of cases. Median PFS and OS with treatment beyond progression were 6.0 months (IQR 2.0-10.4) and 15.1 months (IQR 6.7-NR) respectively and longer in case of osimertinib continuation beyond progression. CONCLUSION We confirmed the efficacy of osimertinib in patients with advanced EGFR mutation positive NSCLC. At progression, the most frequent molecular alterations were MET amplification and C797S mutation.
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Affiliation(s)
- Camille Mehlman
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, EA 4340 BECCOH, UVSQ, Paris Saclay University, Boulogne-Billancourt, France
| | - Jacques Cadranel
- Chest Department-Thoracic Oncology Expert Center, AP-HP, Groupe Hospitalier HUEP, Hopital Tenon, Paris, France, and Sorbonne University, Paris, France
| | | | - Roger Lacave
- Department of Solide Tumours Genetic, AP-HP, Groupe Hospitalier HUEP, Tenon Hospital, Paris, France, and Sorbonne University, Paris, France
| | - Anaïs Pujals
- Department of Pathology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Nicolas Girard
- Thorax Institute, Institute Curie and PSL University, Paris, France
| | | | - Valérie Gounant
- Thoracic Oncology Department, University Hospital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Nathalie Théou-Anton
- Genetics Department, University Hospital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Sylvie Friard
- Pneumology Department, Foch Hospital, Suresnes, France
| | - Jean Trédaniel
- Pneumology Department, Saint-Joseph Hospital, Paris, France
| | - Hélène Blons
- Molecular Biology Department, Georges Pompidou European Hospital, AP- HP, Paris, France and INSERM UMR-S1147, CNRS SNC 5014, Saints-Pères Research Center, Paris-Descartes University, Sorbonne Paris Cité University, Paris, France
| | - Cécile Dujon
- Pneumology Department, André Mignot Hospital, Le Chesnay, France
| | - Boris Duchemann
- Oncology Department, Avicenne Hospital, AP-HP, Bobigny, France and Paris XIII University, Sorbonne Paris Cité, Paris, France and Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, Villejuif, France
| | - Pierre Olivier Schischmanoff
- Department of Molecular Oncogenetics, Avicenne Hospital, AP-HP, Bobigny, France and INSERM UMR U978/Paris XIII University, Sorbonne Paris Cité University, Paris, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, EA 4340 BECCOH, UVSQ, Paris Saclay University, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Hopital Ambroise Pare, EA 4340 BECCOH, UVSQ, Paris Saclay University, Boulogne-Billancourt, France.
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18
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Costantini A, Takam Kamga P, Dumenil C, Chinet T, Emile JF, Giroux Leprieur E. Plasma Biomarkers and Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer: New Tools for Better Patient Selection? Cancers (Basel) 2019; 11:cancers11091269. [PMID: 31470546 PMCID: PMC6769436 DOI: 10.3390/cancers11091269] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 07/31/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape for patients with non-small cell lung cancer (NSCLC). Although some patients can experience important response rates and improved survival, many others do not benefit from ICIs developing hyper-progressive disease or immune-related adverse events. This underlines the need to select biomarkers for ICIs use in order to better select patients. There is currently no universally validated robust biomarker for daily use of ICIs. Programmed death-ligand 1 (PD-L1) or tumor mutational burden (TMB) are sometimes used but still have several limitations. Plasma biomarkers are a promising approach in ICI treatment. This review will describe the development of novel plasma biomarkers such as soluble proteins, circulating tumor DNA (ctDNA), blood TMB, and blood microbiome in NSCLC patients treated with ICIs and their potential use in predicting response and toxicity.
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Affiliation(s)
- Adrien Costantini
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Paul Takam Kamga
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France
- Department of Pathology, APHP-Hôpital Ambroise Pare, 92100 Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France.
- EA 4340 BECCOH, UVSQ, Université Paris Saclay, 92100 Boulogne-Billancourt, France.
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Ouaknine Krief J, Helly de Tauriers P, Dumenil C, Neveux N, Dumoulin J, Giraud V, Labrune S, Tisserand J, Julie C, Emile JF, Chinet T, Giroux Leprieur E. Role of antibiotic use, plasma citrulline and blood microbiome in advanced non-small cell lung cancer patients treated with nivolumab. J Immunother Cancer 2019; 7:176. [PMID: 31292005 PMCID: PMC6621972 DOI: 10.1186/s40425-019-0658-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 12/17/2018] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent data suggested a role of gut microbiota and antibiotic use on immune checkpoint inhibitors efficacy. We aimed to evaluate the impact of early use of antibiotic (EUA), blood microbiome and plasmatic citrulline (marker of the intestinal barrier) on nivolumab efficacy in non-small cell lung cancer (NSCLC). METHODS We included all consecutive patients with advanced NSCLC treated with nivolumab in our Department between 2014 and 2017. Blood microbiome was analyzed at month (M) M0 and M2. Citrulline rates were evaluated at M0, M2, M4 and M6. RESULTS Seventy-two patients were included (EUA in 42%). Overall survival (OS) was longer without EUA (median 13.4 months) than with EUA (5.1 months, p = 0.03). Thirty-five patients (49%) had plasma samples available. High citrulline rate (≥20 μM) at M0 was associated with tumor response (p = 0.084) and clinical benefit (nivolumab > 6 months) (p = 0.002). Median progression-free survival (PFS) was 7.9 months (high citrulline) vs 1.6 months (low citrulline) (p < 0.0001), and median OS were respectively non reached vs 2.2 months (p < 0.0001). Patients with EUA had lower median citrulline rates at M0: 21 μM (IQR 15.0-30.8) vs 32 μM (IQR 24.0-42.0) without EUA (p = 0.044). The presence of specific bacterial DNA in blood at M0 was associated with response and clinical benefit (Peptostreptococcae, Paludibaculum, Lewinella) or with tumor progression (Gemmatimonadaceae). Multivariate analyses on PFS and OS confirmed the prognostic role of citrulline and blood microbiome. CONCLUSIONS EUA is associated with shorter OS with nivolumab and lower citrulline rates. Plasma citrulline and blood microbiome appear to be promising predictive factors of nivolumab efficacy.
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Affiliation(s)
- Julia Ouaknine Krief
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Pierre Helly de Tauriers
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Nathalie Neveux
- Department of Biochemistry, APHP – Hopital Cochin, Paris, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Julie Tisserand
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Catherine Julie
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Department of Pathology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Department of Pathology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Hopital Ambroise Pare, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
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Dacosta-Noble P, Costantini A, Dumenil C, Dumoulin J, Helly de Tauriers P, Giraud V, Labrune S, Emile JF, Alvarez JC, Chinet T, Giroux Leprieur E. Positive plasma cotinine during platinum-based chemotherapy is associated with poor response rate in advanced non-small cell lung cancer patients. PLoS One 2019; 14:e0219080. [PMID: 31260495 PMCID: PMC6602197 DOI: 10.1371/journal.pone.0219080] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Patients with advanced non-small cell lung cancer (NSCLC) are most of the time treated with a first-line cytotoxic chemotherapy. Tobacco use is responsible for 90% of lung cancer. The aim of this study was to evaluate the impact of smoking continuation during first-line chemotherapy on tumor response in advanced-stage NSCLC. MATERIALS AND METHODS All patients with an advanced-stage NSCLC (IIIb or IV), treated with first-line platinum-based chemotherapy in our Department between June 2013 and July 2017 were included. Smoking status was assessed at inclusion by self-report, then at the tumor assessment consultation after 2 months of treatment, by both self-report and plasmatic cotinine measurement. Chemotherapy response, progression-free survival (PFS), overall survival (OS) and stage 3-4 toxicity were registered. RESULTS Ninety-seven patients were included: 8 (8%) declared to be non-smokers, 56 (58%) current smokers and 33 (34%) former smokers at diagnosis. At the first tumor evaluation, 24 (25%) self-reported as active smokers and 73 (75%) as non-smokers; overall response rate (ORR) was respectively 38% and 48% (p = 0.373). Fifty-four patients had a plasmatic cotinine evaluation at the first tumor evaluation. Seventeen patients (32%) had a positive cotinine rate (median 108ng/mL, IQR 31-236). Six patients (35%) had positive cotinine rate whereas declaring to be non-smokers at the first tumor evaluation. ORR was 18% in case of positive cotinine rate, and 57% when negative (p = 0.007). Regardless of the method for smoking status evaluation, PFS, OS and grade 3-4 toxicities were similar between smoker and non-smoker patients at the first tumor evaluation. CONCLUSION Smoking continuation during platinum-based chemotherapy, reflected by positive plasma cotinine rate, was associated with a poor ORR.
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Affiliation(s)
- Philippine Dacosta-Noble
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Adrien Costantini
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Pierre Helly de Tauriers
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- Centre de Ressources Biologiques, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
| | - Jean-Claude Alvarez
- AP-HP, Hôpital Raymond Poincaré, Service de Pharmacologie Toxicologie, INSERM U-1173, UVSQ, Université Paris-Saclay, Garches, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP-Hopital Ambroise Paré, Boulogne-Billancourt, France
- EA 4340, UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
- * E-mail:
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Cortot AB, Madroszyk A, Giroux Leprieur E, Molinier O, Quoix EA, Berard H, Otto J, Rault I, Raimbourg J, Hureaux J, Moreau L, Debieuvre D, Morel H, Denis MG, Amour E, Morin F, Moro-Sibilot D, Cadranel J. Phase II randomized trial of afatinib with or without cetuximab as first-line treatment for EGFR mutated non-small cell lung cancer (NSCLC) patients (IFCT-1503 ACE-Lung). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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
9079 Background: First-line treatment of metastatic EGFR-mutated NSCLC relies on EGFR-TKIs. However, all patients (pts) eventually develop progression. Dual inhibition of EGFR with afatinib (A), an irreversible pan-erbB TKI, and cetuximab (C), an EGFR monoclonal antibody, has shown activity in EGFR-mutated pts with acquired resistance to TKIs, regardless of the T790M status. Methods: We conducted a phase II randomized trial in advanced NSCLC pts harboring an activating EGFR mutation, who had not received prior therapy. Pts were treated with A (40 mg/d) until progression alone or with C 500 mg/m² every 2 weeks during 6 months (mos) (beginning at D15 at 250 mg/m²). Primary endpoint was time-to-treatment failure (TTF) at 9 mos for pts with del19 and L858R mutations. Secondary endpoints include safety, progression-free survival (PFS), overall survival (OS). Prospective monitoring of the T790M mutation was performed on circulating tumoral DNA (ctDNA) by digital PCR. Results: Trial was stopped early due to futility analysis after 118 pts were enrolled (59 in each arm). Baseline characteristics were balanced between the 2 arms, and especially for the types of EGFR mutation (del19, 55.9 vs 50.8%; L858R, 39 vs 40.7%; others, 5.1 vs 8.5% in AC and A arms, respectively). Treatment-related AEs of any grades were similar, although there was an excess of grade 3 AEs in the AC arm (50 vs 37.3%), but no of grade 5. The excess in grade 3-5 AEs was essentially due to cutaneous (96.6 vs 81.4%), eyes (32.8 vs 27.1%), hematological (22.4 vs 15.3%) but not to digestive toxicities (89.7 vs 98.3%). Among the 117 pts included in the efficacy analysis, 9-months TTF was 63.3% (47.5-75.6) in arm A and 65.8% (50.1-77.66) in arm AC. Median TTF was 11.1 mos (8.3-not reached [NR]) and 10.8 mos (9.2-13.7) in arms A and AC, respectively. Median PFS was 11.1 mos (8.3-NR) and 12.8 mos (9.2-13.7), respectively. Median OS was 20.8 mos (17.5-NR) and NR (17-NR), respectively. Conclusions: Efficacy of AC was similar to that of A alone. These results don’t support further evaluation of this combination in this setting. Results of ctDNA monitoring will be reported during the meeting. Clinical trial information: NCT02716311.
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Affiliation(s)
| | | | | | | | | | - Henri Berard
- Hopital D'instruction Des Armes Sainte-Anne, Toulon, France
| | | | | | | | | | - Lionel Moreau
- Centre Hospitalier Pneumologie Colmar, Colmar, France
| | | | | | | | | | - Franck Morin
- Intergroupe Francophone de Cancérologie Thoracique, Paris, France
| | | | - Jacques Cadranel
- Hôpital Tenon, AP-HP and Faculté de Médecine Pierre et Marie Curie, Université Paris VI, Paris, France
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22
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Ortiz-Cuaran S, Mazières J, Swalduz A, Flores WRC, Loriot Y, Westeel V, Pradines A, Tissot C, Duchene CC, Raynaud C, Quantin X, Gervais R, Brain E, Monnet I, Leprieur EG, Neymarc S, Avrillon V, Marteau S, Martinez S, Clapisson G, Girerd-Chambaz N, Mahier C, Hoog-Labouret N, Kievit FD, Howarth K, Green E, Morris C, Pérol M, Blay JY, Saintingy P. Abstract 1841: Integrative analysis of resistance to BRAF-targeted therapies in lung adenocarcinomas. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: BRAF mutations occur in 2 to 3% of patients (pts) with non-small cell lung cancer (NSCLC). In these pts vemurafenib, a selective oral BRAF inhibitor is associated with a response rate (RR) of 42%, rising to 64% for combination treatment with dabrafenib and trametinib. Despite initial responses, most pts ultimately develop resistance to therapy. Mechanisms of resistance to BRAF inhibitors in NSCLC have only been reported in 2 pts (acquired KRAS G12D and primary resistance due to BRAF G469L)
Objective: To assess the molecular mechanisms of resistance and to monitor disease response to treatment using liquid biopsies in NSCLC pts treated with BRAF inhibitors.
Strategy: We performed a longitudinal genomic analysis of circulating-tumor DNA (ctDNA) in BRAF-mutated NSCLC pts treated in the AcSé vemurafenib program (NCT02304809) (n=44), or with the combination of dabrafenib and trametinib (n=6). We have collected 24 samples at baseline, 45 during follow-up and 9 at progressive disease (PD). ctDNA genotyping of 36 genes was performed using the Inivata InVisionFirst™ assay. Functional analyses of potentially resistant mutations and in vitro strategies to revert the resistant phenotype are ongoing.
Results: Our preliminary analyses showed that BRAF mutations were detected at diagnosis in 16/24 pts, including 12 BRAF V600E mutations and 4 non-V600E mutations (i.e. G466V, G596R, G469A and K601E). 4/12 (34%) of BRAF V600E-mutated pts presented coexistent mutations, in FGFR2, CTNNB1, IDH1 or PI3KCA, whereas concomitant mutations in KRAS, NRAS or MYC were found in 3/4 (75%) of non-V600E cases. Analyses of response to treatment vs mutational profile will be presented. For the remaining 8/24 pts, TP53 mutations were found in 5 pts in absence of BRAF mutations, and no mutations were detected in 3 pts. Mechanisms of resistance were evaluated in 9 pts. One patient who progressed after 11 months on vemurafenib had MAP2K1 C121S and NFE2L2 p.31-32:GV/X mutations. In this patient, longitudinal ctDNA profiling revealed agreement between the %AF of BRAF and TP53 mutations and response to treatment, and detectable levels of the BRAF V600E and the MAP2K1 C121S mutations up to 6 months before the clinical confirmation of PD. Acquired PI3KCA H1047R and E545K mutations were seen in two pts, respectively, who progressed after 15 and 7 months of vemurafenib. Finally, a fourth patient who relapsed after 3 months on vemurafenib, presented a KRAS G12C mutation. All 4 cases also presented detectable levels of the BRAF V600E mutation at PD. In 3/8 pts, we detected the BRAF V600E mutation at PD but no other mutations; drivers of resistance may be present in genes outside this panel. ctDNA sequencing data on additional 7 pts at PD will be presented.
Conclusion: Our results suggest that ctDNA genotyping might be an informative tool for monitoring disease response and resistance in NSCLC pts treated with BRAF-targeted therapies.
Citation Format: Sandra Ortiz-Cuaran, Julien Mazières, Aurélie Swalduz, Washington René Chumbi Flores, Yohan Loriot, Virginie Westeel, Anne Pradines, Claire Tissot, Christelle Clement Duchene, Christine Raynaud, Xavier Quantin, Radj Gervais, Etienne Brain, Isabelle Monnet, Etienne Giroux Leprieur, Séverine Neymarc, Virginie Avrillon, Solène Marteau, Séverine Martinez, Gilles Clapisson, Nathalie Girerd-Chambaz, Celine Mahier, Nathalie Hoog-Labouret, Frank de Kievit, Karen Howarth, Emma Green, Clive Morris, Maurice Pérol, Jean-Yves Blay, Pierre Saintingy. Integrative analysis of resistance to BRAF-targeted therapies in lung adenocarcinomas [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 1841.
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Affiliation(s)
| | - Julien Mazières
- 2Hôpital Larrey, Centre Hospitalier Universitaire, Toulouse, France
| | | | | | | | | | - Anne Pradines
- 7Centre de Recherche en Cancérologie de Toulouse, CRCT, Toulouse, France
| | - Claire Tissot
- 8Hôpital Nord, CHU de Saint-Étienne, Saint-Étienne, France
| | | | | | - Xavier Quantin
- 11Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Radj Gervais
- 12Hospital Center University (CHU) Caen, Caen, France
| | - Etienne Brain
- 13CLCC Rene Huguenin Institut Curie, Saint Cloud, France
| | - Isabelle Monnet
- 14Centre Hospitalier Intercommunal de Créteil (CHI), Créteil, France
| | | | | | | | - Solène Marteau
- 1Centre Léon Bérard / Cancer Research Center of Lyon, Lyon, France
| | | | | | | | | | | | | | | | - Emma Green
- 17Inivata Ltd., Cambridge, United Kingdom
| | | | | | | | - Pierre Saintingy
- 1Centre Léon Bérard / Cancer Research Center of Lyon, Lyon, France
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23
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Dumenil C, Massiani MA, Dumoulin J, Giraud V, Labrune S, Chinet T, Giroux Leprieur E. Clinical factors associated with early progression and grade 3-4 toxicity in patients with advanced non-small-cell lung cancers treated with nivolumab. PLoS One 2018; 13:e0195945. [PMID: 29684049 PMCID: PMC5912777 DOI: 10.1371/journal.pone.0195945] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 12/17/2017] [Accepted: 04/03/2018] [Indexed: 02/08/2023] Open
Abstract
Introduction The prognosis of advanced non-small-cell lung cancer (NSCLC) has been improved by development of immune checkpoint inhibitors (ICIs) such as nivolumab for second-line treatment. As phase III trials include only selected patients, we here investigated the clinical factors associated with efficacy and safety of nivolumab in ‘real life’ patients with advanced NSCLC. Methods Clinical and histological characteristics, therapies and survival data of all consecutive patients with advanced NSCLC included prospectively and treated by nivolumab in two French academic hospitals between February 2015 and December 2016 were examined. Results Sixty-seven patients were included, mostly male (69%), current or former smokers (87%) with PS <2 (73%). Median age was 68.5 years and 42% were aged ≥70 years. According to uni- and multi-variate analyses, only PS 2 (OR = 0.17, 95% CI 0.03–0.99, p = 0.049) and number of previous treatment lines (OR = 0.33, 95% CI 0.13–0.85, p = 0.022) were significantly negatively associated with tumor control. Worse progression-free survival (PFS) was significantly associated with PS 2 (HR = 5.17, 95% CI 1.99–13.43, p = 0.001) and use of steroids (HR = 3.27, 95% CI 1.39–7.69, p = 0.006). Worse overall survival was associated with symptomatic brain metastasis (HR = 3.15, 95% CI 1.23–8.85, p = 0.029). Treatment-related adverse events occurred in 47 patients (70%), symptomatic brain metastasis being significantly associated with Grade ≥3 toxicity (OR = 8.13, 95% CI 1.21–55.56, p = 0.031). Age and nutritional status were not associated with response, PFS, OS or toxicity. Conclusion Our results suggest that nivolumab is not beneficial or safe for patients with PS 2 and symptomatic brain metastases.
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Affiliation(s)
- Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Marie-Ange Massiani
- Department of Medical Oncology, René Huguenin Hospital, Curie Institute, Saint-Cloud, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
- EA4340, University of Versailles Saint-Quentin-en-Yvelines, Paris-Saclay University, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP—Ambroise Pare Hospital, Boulogne-Billancourt, France
- EA4340, University of Versailles Saint-Quentin-en-Yvelines, Paris-Saclay University, Boulogne-Billancourt, France
- * E-mail:
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24
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Costantini A, Julie C, Dumenil C, Hélias-Rodzewicz Z, Tisserand J, Dumoulin J, Giraud V, Labrune S, Chinet T, Emile JF, Giroux Leprieur E. Predictive role of plasmatic biomarkers in advanced non-small cell lung cancer treated by nivolumab. Oncoimmunology 2018; 7:e1452581. [PMID: 30221046 PMCID: PMC6136870 DOI: 10.1080/2162402x.2018.1452581] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [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: 01/11/2018] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/17/2022] Open
Abstract
Immune checkpoint inhibitors, as nivolumab, are used in advanced non-small cell lung cancer (NSCLC). However, no associated biomarker is validated in clinical practice with this drug. We investigated herein immune-related blood markers in patients with advanced NSCLC treated with nivolumab. Plasma of 43 consecutive patients were prospectively collected at time of the diagnosis of cancer, at the initiation of nivolumab and at the first tumour evaluation (2 months). Concentrations of PD-L1 (sPD-L1), soluble PD-L2 (sPD-L2), Interleukine-2 (sIl-2), Interferon-gamma (sIFN-γ), and Granzyme B (sGranB) were quantified by ELISA. Cell free RNA was quantified by Reverse Transcriptase -PCR), and plasmatic microRNAs (miRNAs) were evaluated by targeted sequencing. Expression of PD-L1 on tumour biopsies was performed by immunohistochemistry using E13LN. High sPD-L1 at 2 months and increase of sPD-L1 concentrations were associated with poor response and absence of clinical benefit (nivolumab treatment less than 6 months). The variation of sPD-L1 concentrations were confirmed by RNA quantification. sPD-L1 concentrations were not correlated with PD-L1 expression on corresponding tumour samples. Low sGranB at nivolumab initiation was also associated with poor response. High sPD-L1 and low sGranB were associated with poor progression-free survival (PFS) and overall survival (OS). Low sPD-L2, low sIl-2 and high sIFN-γ were associated with grade 3-4 toxicities. Finally, miRNA screening showed that patients with clinical benefit (n = 9) had down-expression of miRNA-320b and -375 compared to patients with early progression at 2 months (n = 9). In conclusion, our results highlight the interest of circulating biomarkers in patients treated with nivolumab.
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Affiliation(s)
- Adrien Costantini
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Catherine Julie
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Pathology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Coraline Dumenil
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Zofia Hélias-Rodzewicz
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Pathology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Julie Tisserand
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Pathology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Violaine Giraud
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Sylvie Labrune
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Thierry Chinet
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Pathology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
- Department of Respiratory Diseases and Thoracic Oncology, APHP – Ambroise Pare Hospital, Boulogne-Billancourt, France
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25
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Sebane L, El-Hajjam M, Puyo P, Longchampt E, Giroux Leprieur E. Successful pulmonary arterial embolization followed by curative surgery for a lepidic predominant lung adenocarcinoma with severe hypoxemia. BMC Surg 2018; 18:20. [PMID: 29631581 PMCID: PMC5891942 DOI: 10.1186/s12893-018-0351-1] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/28/2018] [Indexed: 12/25/2022] Open
Abstract
Background Lepidic predominant adenocarcinoma is characterized by frequent refractory hypoxemia due to intrapulmonary shunting. Severe hypoxemia can induce perioperative complications in case of thoracic surgery. Case presentation We report a case of a 67 year-old woman with localized lepidic adenocarcinoma in the right lower lobe with severe hypoxemia. A selective arterial lung embolization allowed an instantaneous correction of the hypoxemia, and a curative lobectomy was safely performed 1 week after without any complication. The staging was pT3N0M0, and the patient received adjuvant chemotherapy. Conclusions This is the first case-report of successful endovascular embolization before curative surgery for a lepidic predominant lung adenocarcinoma.
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Affiliation(s)
- Louise Sebane
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Mostafa El-Hajjam
- Department of Radiology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Philippe Puyo
- Department of Thoracic Surgery, Foch Hospital, Suresnes, France
| | | | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. .,EA4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France.
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26
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Tolani B, Hoang NT, Acevedo LA, Giroux Leprieur E, Li H, He B, Jablons DM. Preclinical characterization of therapeutic antibodies targeted at the carboxy-terminus of Sonic hedgehog. Oncotarget 2018; 9:14311-14323. [PMID: 29581846 PMCID: PMC5865672 DOI: 10.18632/oncotarget.24510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/10/2018] [Indexed: 12/15/2022] Open
Abstract
The Sonic Hedgehog (Shh) signaling pathway has been implicated in the development and tumor progression of a number of human cancers. Using synthetic peptide mimics to mount an immune response, we generated a mouse mAb to the carboxy (C)-terminus of the Shh protein and characterized its preclinical antitumor effects. In vitro screening guided selection of the best candidate for mAb scale-up production and therapeutic development. C-term anti-Shh, Ab 1C11-2G4 was selected based on ELISA screens, Western blotting, and flow cytometric analyses. Purified Ab 1C11-2G4 was shown to recognize and bind both Shh peptide mimics and cell surface Shh. Administration of Ab 1C11-2G4 not only reduced cell viability in 7 cancer cell lines but also significantly inhibitted tumor growth in a xenograft model of A549 lung cancer cells. Ex vivo analyses of xenograft tumors revealed a reduction in Shh signal transduction and apoptosis in 2G4-treated mice. Collectively, our results provide early demonstration of the antitumor utility of antibodies specific for the C-terminal region of Shh, and support continued development to evaluate their potential efficacy in cancers in which Shh activity is elevated.
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Affiliation(s)
- Bhairavi Tolani
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Ngoc T Hoang
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Luis A Acevedo
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Etienne Giroux Leprieur
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.,Respiratory Diseases and Thoracic Oncology Department, APHP-Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Hui Li
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Biao He
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - David M Jablons
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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27
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Giroux Leprieur E, Herbretau G, Dumenil C, Julie C, Giraud V, Labrune S, Dumoulin J, Tisserand J, Emile JF, Blons H, Chinet T. Circulating tumor DNA evaluated by Next-Generation Sequencing is predictive of tumor response and prolonged clinical benefit with nivolumab in advanced non-small cell lung cancer. Oncoimmunology 2018; 7:e1424675. [PMID: 29721388 DOI: 10.1080/2162402x.2018.1424675] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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: 11/14/2017] [Revised: 12/18/2017] [Accepted: 01/03/2018] [Indexed: 01/05/2023] Open
Abstract
Nivolumab is an anti-PD1 antibody, given in second-line or later treatment in advanced non-small cell lung cancer (NSCLC). The objective of this study was to describe the predictive value of circulating tumor DNA (ctDNA) on the efficacy of nivolumab in advanced NSCLC. We prospectively included all consecutive patients with advanced NSCLC treated with nivolumab in our Department between June 2015 and October 2016. Plasma samples were obtained before the first injection of nivolumab and at the first tumor evaluation with nivolumab. ctDNA was analyzed by Next-Generation Sequencing (NGS), and the predominant somatic mutation was followed for each patient and correlated with tumor response, clinical benefit (administration of nivolumab for more than 6 months), and progression-free survival (PFS). Of 23 patients, 15 had evaluable NGS results at both times of analysis. ctDNA concentration at the first tumor evaluation and ctDNA change correlated with tumor response, clinical benefit and PFS. ROC curve analyses showed good diagnostic performances for tumor response and clinical benefit, both for ctDNA concentration at the first tumor evaluation (tumor response: positive predictive value (PPV) at 100.0% and negative predictive value (NPV) at 71.0%; clinical benefit: PPV at 83.3% and NPV 77.8%) and the ctDNA change (tumor response: PPV 100.0% and NPV 62.5%; clinical benefit: PPV 100.0% and NPV 80.0%). Patients without ctDNA concentration increase >9% at 2 months had a long-term benefit of nivolumab. In conclusion, NGS analysis of ctDNA allows the early detection of tumor response and long-term clinical benefit with nivolumab in NSCLC.
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Affiliation(s)
- Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Guillaume Herbretau
- INSERM UMR-S1147, CNRS SNC 5014, Saints-Pères Research Center, 45 rue des Saints-Pères Paris-Descartes University, Sorbonne Paris Cité University, Paris, France.,Department of Molecular Biology, Georges Pompidou European Hospital, 20 rue Leblanc, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Catherine Julie
- EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France.,Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Julie Tisserand
- EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France.,Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jean-François Emile
- EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France.,Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Hélène Blons
- INSERM UMR-S1147, CNRS SNC 5014, Saints-Pères Research Center, 45 rue des Saints-Pères Paris-Descartes University, Sorbonne Paris Cité University, Paris, France.,Department of Molecular Biology, Georges Pompidou European Hospital, 20 rue Leblanc, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA4340, Biomarqueursen Cancérologie et Onco-Hématologie, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
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Wang L, Dumenil C, Julié C, Giraud V, Dumoulin J, Labrune S, Chinet T, Emile JF, He B, Giroux Leprieur E. Molecular characterization of circulating tumor cells in lung cancer: moving beyond enumeration. Oncotarget 2017; 8:109818-109835. [PMID: 29312651 PMCID: PMC5752564 DOI: 10.18632/oncotarget.22651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/20/2017] [Indexed: 12/30/2022] Open
Abstract
Molecular characterization of tumor cells is a key step in the diagnosis and optimal treatment of lung cancer. However, analysis of tumor samples, often corresponding to small biopsies, can be difficult and does not accurately reflect tumor heterogeneity. Recent studies have shown that isolation of circulating tumor cells (CTCs) is feasible in non-small cell lung cancer patients, even at early disease stages. The amount of CTCs corresponds to the metastatic potential of the tumor and to patient prognosis. Moreover, molecular analyses, even at the single-cell level, can be performed on CTCs. This review describes the technologies currently available for detecting and capturing CTCs, the potential for downstream molecular diagnostics, and the clinical applications of CTCs isolated from lung cancer patients as screening, prognostic, and predictive tools. Main limitations of CTCs are also discussed.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.,Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Coraline Dumenil
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Catherine Julié
- Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA 4340 "Biomarqueurs en Cancérologie et Onco-Hématologie" UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA 4340 "Biomarqueurs en Cancérologie et Onco-Hématologie" UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Jean-François Emile
- Department of Pathology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA 4340 "Biomarqueurs en Cancérologie et Onco-Hématologie" UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Biao He
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Etienne Giroux Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA 4340 "Biomarqueurs en Cancérologie et Onco-Hématologie" UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
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Giroux Leprieur E, Tolani B, Li H, Leguay F, Hoang NT, Acevedo LA, Jin JQ, Tseng HH, Yue D, Kim IJ, Wislez M, Wang C, Jablons DM, He B. Membrane-bound full-length Sonic Hedgehog identifies cancer stem cells in human non-small cell lung cancer. Oncotarget 2017; 8:103744-103757. [PMID: 29262597 PMCID: PMC5732763 DOI: 10.18632/oncotarget.21781] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 09/05/2017] [Indexed: 12/04/2022] Open
Abstract
The mechanism of Sonic Hedgehog (Shh) pathway activation in non-small cell lung cancer (NSCLC) is poorly described. Using an antibody against the Shh C-terminal domain, we found a small population of Shh-positive (Shh+) cells in NSCLC cells. The objective of this study was to characterize these Shh+ cells. Shh+ and Shh- cells were sorted by using Fluorescence Activated Cell Sorting (FACS) on 12 commercial NSCLC cell lines. Functional analyses on sorted cells were performed with gene expression assays (qRT-PCR and microarray) and cells were treated with cytotoxic chemotherapy and a targeted inhibitor of Shh signaling (GDC0449). We used in vivo models of nude mice inoculated with Shh+ and Shh- sorted cells and drug-treated cells. Finally, we confirmed our results in fresh human NSCLC samples (n=48) paired with normal lung tissue. We found that Shh+ cells produced an uncleaved, full-length Shh protein detected on the membranes of these cells. Shh+ cells exerted a paracrine effect on Shh- cells, inducing their proliferation and migration. Shh+ cells were chemo-resistant and showed features of cancer stem cells (CSCs) in vitro and in vivo. Pharmacological inhibition of the Shh pathway suppressed their CSC features. A high percentage of Shh+ cells was associated with poor prognosis in early-stage NSCLC patients. In conclusion, we describe for the first time the presence of an abnormal membrane-bound full-length Shh protein in human cancer cells that allows the identification of CSCs in vitro and in vivo.
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Affiliation(s)
- Etienne Giroux Leprieur
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.,Department of Respiratory Diseases and Thoracic Oncology, APHP - Ambroise Pare Hospital, Boulogne-Billancourt, France.,EA 4340, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Bhairavi Tolani
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Hui Li
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Fleur Leguay
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Ngoc T Hoang
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Luis A Acevedo
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Joy Q Jin
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Hsin-Hui Tseng
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Dongsheng Yue
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.,Department of Lung Cancer, Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Il-Jin Kim
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Marie Wislez
- Sorbonne University, UPMC GRC-04 Theranoscan, Department of Respiratory Diseases, APHP - Tenon Hospital, Paris, France
| | - Changli Wang
- Department of Lung Cancer, Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - David M Jablons
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Biao He
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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Baldacci S, Mazieres J, Tomasini P, Girard N, Guisier F, Audigier-Valette C, Monnet I, Wislez M, Pérol M, Dô P, Dansin E, Leduc C, Giroux Leprieur E, Moro-Sibilot D, Tulasne D, Kherrouche Z, Labreuche J, Cortot AB. Outcome of EGFR-mutated NSCLC patients with MET-driven resistance to EGFR tyrosine kinase inhibitors. Oncotarget 2017; 8:105103-105114. [PMID: 29285237 PMCID: PMC5739624 DOI: 10.18632/oncotarget.21707] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 02/21/2017] [Accepted: 08/04/2017] [Indexed: 12/24/2022] Open
Abstract
Background Several mechanisms of acquired resistance to EGFR tyrosine kinase inhibitors (TKIs) in EGFR-mutated NSCLC have been described including the T790M mutation and MET amplification. Whereas T790M mutation confers prolonged survival and sensitivity to 3rd generation TKIs, data are lacking on clinical features and outcome of MET-driven resistant EGFR-mutated NSCLC patients. Methods Patients with metastatic EGFR-mutated NSCLC displaying high MET overexpression or MET amplification, detected on a biopsy performed after progression on EGFR TKI, were identified in 15 centers. Clinical and molecular data were retrospectively collected. Results Forty two patients were included. The median overall survival (OS), and the median post EGFR TKI progression overall survival (PPOS) were 36.2 months [95%CI 27.3-66.5] and 18.5 months [95%CI 10.6-27.4] respectively. Nineteen out of 36 tumors tested for MET FISH had MET amplification. A T790M mutation was found in 11/41 (26.8%) patients. T790M-positive patients had a better OS than T790M-negative patients (p=0.0224). Nineteen patients received a MET TKI. Objective response was reported in 1 out of 12 evaluable patients treated with a MET inhibitor as a single agent and in 1 of 2 patients treated with a combination of MET and EGFR TKIs. Conclusion MET-driven resistance to EGFR TKI defines a specific pattern of resistance characterized by low objective response rate to MET inhibitors given alone and overlapping with T790M mutations. Further studies are warranted to define adequate therapeutic strategies for MET-driven resistance to EGFR TKI.
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Affiliation(s)
- Simon Baldacci
- CHU Lille, Thoracic Oncology Department, Univ. Lille, Siric ONCOLille, Lille, France.,Univ. Lille, CNRS, Institut Pasteur de Lille, UMR 8161, M3T, Mechanisms of Tumorigenesis and Targeted Therapies, Lille, France
| | - Julien Mazieres
- Toulouse University Hospital, Université Paul Sabatier, Toulouse, France
| | - Pascale Tomasini
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology & Therapeutic Innovations Department, Marseille, France
| | - Nicolas Girard
- Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Florian Guisier
- Rouen University Hospital, Thoracic oncology unit & Normandy University, IRIB, LITIS Lab, EA 4103 QuantIF team, Rouen, France
| | | | - Isabelle Monnet
- Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Maurice Pérol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Pascal Dô
- Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France
| | | | | | | | - Denis Moro-Sibilot
- Unité d'Oncologie Thoracique, Service de Pneumologie, CHU Grenoble-Alpes, La Tronche, France
| | - David Tulasne
- Univ. Lille, CNRS, Institut Pasteur de Lille, UMR 8161, M3T, Mechanisms of Tumorigenesis and Targeted Therapies, Lille, France
| | - Zoulika Kherrouche
- CHU Lille, Thoracic Oncology Department, Univ. Lille, Siric ONCOLille, Lille, France.,Univ. Lille, CNRS, Institut Pasteur de Lille, UMR 8161, M3T, Mechanisms of Tumorigenesis and Targeted Therapies, Lille, France
| | | | - Alexis B Cortot
- CHU Lille, Thoracic Oncology Department, Univ. Lille, Siric ONCOLille, Lille, France.,Univ. Lille, CNRS, Institut Pasteur de Lille, UMR 8161, M3T, Mechanisms of Tumorigenesis and Targeted Therapies, Lille, France
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Corny J, Costantini A, Renet S, Fallet V, Jouveshomme S, Giroux Leprieur E, Duchemann B, Selvarathnam S, Beaussier H, Brosseau S, Hajouiji L, Taillade L, Doucet L, Zalcman G, Friard S, Tredaniel J, Wislez M, Jardin M, Cadranel J. Real-life use of nivolumab in non-small cell lung cancer: A multicentric cohort to determine its clinical efficacy and predictive factors of early progression. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20543] [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
e20543 Background: Nivolumab (NIV) is now widely used in ≥ 2ndline of advanced non-small cell lung cancer (NSCLC). The aims of this real-life study were (1) to evaluate its efficacy, (2) to identify predictive factors of worsening under NIV. Methods: This retrospective multicentric study (8 Thoracic Oncology regional centers) included all patients treated by NIV in 2015 (follow-up until 2016, June 30th). Demographics and tumor characteristics were extracted. Objective tumor response was assessed by computerized tomography (RECIST v1.1). Median NIV treatment duration and overall survival (OS) were calculated. Clinical and biological factors evaluated as predictive markers of earlyprogression (discontinuation before 1stevaluation) were: NSCLC histology, PS, smoking-history, number of previous chemotherapy received and initial albumine (alb), C-reactive protein (CRP) and lactate dehydrogenase (LDH) serum levels. For these factors, patients quickly worsened and responders were compared (Student’s t-test, Chi-2 test). Results: Our cohort included 297 patients (non-squamous NSCLC n = 181 [61%]; PS > 1 n = 66 [22%]). At first evaluation, partial response was observed in 16% (n = 47), stable disease in 18% (n = 54) and progression in 49% (n = 144). A total of 45 patients (15%) were early progressors and no evaluation could be performed. Median NIV duration of treatment was 2.8 months [0-15], OS 6.9 months [0-16] (n = 146 still alive on June 30th, 2016). Early progressor patients were PS > 1 in 42% versus (vs) 21% for responders (mean PS 1.7 vs 1.0 for responders (p < 0.001)) and an alb level of 29.9 g/L vs 33.6 (p = 0.03). Mean CRP (p = 0.06) and LDH (p = 0.08) serum levels, NSCLC histology (p = 0.64), smoking-history (p = 0.08), number of previous chemotherapy (p = 0.90) were non-significant. Conclusions: This study confirms that NIV may be effective in NSCLC, with a 16% objective response rate. However early progression observed in 15% of patients was associated with a lower initial alb level and a higher PS. Missing data for LDH and CRP levels may have influenced their non-significance. Further studies must be realized to determine the interest of these factors as predictive markers.
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Affiliation(s)
| | | | - Sophie Renet
- Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | - Etienne Giroux Leprieur
- Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (Paris Public Hospitals), Boulogne-Billancourt, France
| | - Boris Duchemann
- Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (Paris Public Hospitals), Bobigny, France
| | | | | | - Solenn Brosseau
- Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (Paris public hospitals), Paris, France
| | | | - Laurent Taillade
- Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | - Meryam Jardin
- Groupe Hospitalier Paris Saint Joseph, Paris, France
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Baldacci S, Mazieres J, Tomasini P, Girard N, Guisier F, Valette CA, Monnet I, Wislez M, Pérol M, Dô P, Dansin E, Leduc C, Leprieur EG, Moro-Sibilot D, Kherrouche Z, Labreuche J, Cortot A. P3.02b-051 Outcome of Advanced EGFR-Mutated NSCLC Patients with MET-Driven Acquired Resistance to EGFR TKI. Results of the METEORE Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1718] [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: 10/20/2022]
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Mussat E, Giraud V, Julie C, Chinet T, Leprieur EG. Fatal Haemoptysis Associated with Dramatic Response to Crizotinib in an ALK-Rearranged Lung Adenocarcinoma. J Clin Diagn Res 2016; 10:XD01-XD03. [PMID: 27134984 DOI: 10.7860/jcdr/2016/17805.7428] [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: 11/12/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Abstract
The presence of an ALK (Anaplastic Lymphoma Kinase) rearrangement is a rare molecular feature in Non-Small Cell Lung Carcinoma (NSCLC), and concerns mainly non- or light smokers, young patients, with adenocarcinoma histological type. These tumours are particularly sensitive to Alk-targeted therapies, as crizotinib. Crizotinib is usually well-tolerated. We report a case of fatal haemoptysis associated with dramatic response to crizotinib in a patient with an ALK-rearranged lung adenocarcinoma. The patient presented a mediastinal invasion with tracheal involvement and compression of the right pulmonary artery. The initial evolution under crizotinib was good with tumour response. At 6 weeks of crizotinib the patient presented a massive haemoptysis with a tracheobronchial fistula and pneumomediastinum. She died of acute respiratory failure. Our case is the first to report a fatal effect of crizotinib associated with tumour necrosis and good tumour response on a massive mediastinal infiltration. Precautions are recommended with the use of crizotinib in proximal lung tumours with vascular invasion.
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Affiliation(s)
- Elodie Mussat
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France
| | - Violaine Giraud
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France
| | - Catherine Julie
- Faculty, Department of Pathology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France
| | - Thierry Chinet
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France. EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France. EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
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Giroux Leprieur E, Wislez M. [Crizotinib: At last in first-line treatment of advanced-stage ALK-rearranged non-small cell lung cancer]. Bull Cancer 2016; 103:125-6. [PMID: 26822904 DOI: 10.1016/j.bulcan.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Etienne Giroux Leprieur
- AP-HP, hôpital Ambroise-Paré, service de pneumologie et oncologie thoracique, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, laboratoire EA4340, biomarqueurs en cancérologie et onco-hématologie, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marie Wislez
- AP-HP, hôpital Tenon, service de pneumologie, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France.
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Giroux Leprieur E, Fallet V, Wislez M. [Modalities of use of ceritinib (Zykadia™), a 2nd generation ALK inhibitor, in advanced stage non-small cell lung cancer]. Bull Cancer 2015; 102:1053-7. [PMID: 26597476 DOI: 10.1016/j.bulcan.2015.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022]
Abstract
Around 4% of advanced non-small cell lung cancers (NSCLC) harbor a ALK rearrangement, with high sensitivity to ALK inhibitor as crizotinib. However, the vast majority of these tumors end with a tumor progression after several months of treatment with crizotinib. Ceritinib is a 2nd generation ALK inhibitor, which showed high efficiency in NSCLC with ALK rearrangement. Results from phase I trial showed a response rate at 58% in these tumors, with a similar rate for previously crizotinib-treated patients or crizotinib-naïve patients. Moreover, cerebral responses were observed with ceritinib. Preliminary date from a phase 2 trial confirmed these results. These promising results allowed a European marketing authorization (autorisation de mise sur le marché [AMM]) since May 2015 for the treatment of advanced NSCLC with ALK rearrangement and resistance or intolerance to crizotinib.
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Affiliation(s)
- Etienne Giroux Leprieur
- AP-HP, hôpital Ambroise-Paré, service de pneumologie et oncologie thoracique, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Université Versailles - Saint-Quentin-en-Yvelines, laboratoire EA4340, biomarqueurs en cancérologie et onco-hématologie, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Vincent Fallet
- Groupe hospitalier Paris - Saint-Joseph, service de pneumologie, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Marie Wislez
- AP-HP, hôpital Tenon, service de pneumologie, 4, rue de la Chine, 75020 Paris, France; UPMC université Paris 06, GRC n(o) 04, Theranoscan, Sorbonne universités, 75252 Paris, France.
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Leprieur EG, Fernandez D, Chatellier G, Klotz S, Giraud P, Durdux C. Acute radiation pneumonitis after conformational radiotherapy for nonsmall cell lung cancer: clinical, dosimetric, and associated-treatment risk factors. J Cancer Res Ther 2014; 9:447-51. [PMID: 24125981 DOI: 10.4103/0973-1482.119339] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Conformational thoracic radiotherapy (CTR) is a key-treatment in locally advanced nonsmall cell lung cancer (LA-NSCLC). Acute radiation pneumonitis (ARP) is one of the major complications. AIMS To evaluate the predictors of ARP after CTR in the treatment of LA-NSCLC. MATERIALS AND METHODS A total of 47 consecutive patients (pts) were treated with CTR for LA-NSCLC and retrospectively analyzed. The mean total dose of radiation therapy (RT) was 65 Gy, with respiratory gating (RG) in 19 cases. Induction and concomitant chemotherapy was performed in 33 pts (70%) and 41 pts (87%), respectively. RESULTS Eleven pts (23%) had an ARP resulting in death for one pt. In univariate analysis, age, sex, pretherapeutic value of forced expiratory volume (FEV), not-gated radiotherapy and type of concomitant chemotherapy did not appear as contributing factors in contrast to the administration of induction gemcitabine ( p = 0.03). The occurrence of ARP was significantly associated with nontumor lung volumes irradiated to 13 Gy (V13, p = 0.04), 20 Gy (V20, p = 0.02), and 25 Gy (V25, p = 0.006), the mean lung dose ( p = 0.008) and lung normal tissue complication probability (NTCP) ( p = 0.004). In multivariate logistic regression analysis, the occurrence of ARP was significantly associated with age >75 years (odds ratio (OR) = 16.72, confidence interval (CI) 95% 1.77-157.87) and administration of induction gemcitabine (OR = 18.08, CI 95% 1.09-300.08). CONCLUSION ARP is a common acute complication, requiring close posttreatment follow-up, particularly for elderly patients. The use of gemcitabine before radiation should be avoided. The benefits and risks of CTR must be carefully analyzed, according to the dosimetric parameters.
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Affiliation(s)
- Etienne Giroux Leprieur
- Department of Respiratory Diseases, Hôpital Ambroise Paré, 9 Avenue Charles-de-Gaulle 92100 Boulogne-Billancourt; University Versailles-Saint Quentin en Yvelines, 9 Boulevard d'Alembert, 78280 Guyancourt, France
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Giroux Leprieur E, Hirata T, Mo M, Chen Z, Okamoto J, Clement G, Li H, Wislez M, Jablons DM, He B. The homeobox gene EMX2 is a prognostic and predictive marker in malignant pleural mesothelioma. Lung Cancer 2014; 85:465-71. [PMID: 25023662 DOI: 10.1016/j.lungcan.2014.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Malignant pleural mesothelioma (MPM) is a highly aggressive neoplasm with a poor prognosis and limited treatment options. EMX2 is a homeobox transcription factor that may regulate key developmental pathways known to promote tumorigenesis. In this study, we evaluated the prognostic and predictive significance of EMX2 expression in MPM. MATERIALS AND METHODS Fifty surgically resected MPM specimens were studied. Quantitative real-time RT-PCR was used to analyze EMX2 mRNA expression. Association of EMX2 levels with clinical outcomes was evaluated with using the Kaplan-Meier method and a multivariate Cox proportional hazards regression model. RESULTS EMX2 expression was significantly associated with IMIG stage (p<0.001) and smoking history (p=0.006). Cox hazard regression modeling identified low-EMX2 expression as a negative prognostic factor in progression-free survival by both univariate (p=0.002) and multivariate analysis (p=0.002). Kaplan-Meier analysis revealed significant differences in progression-free survival between low- and high-EMX expressing groups in all patients (p=0.001), and also when grouped by early (I/II) stage disease (p<0.001), patients undergoing pleurectomy (p<0.001) and patients with an epitheliod subtype (p<0.004). Furthermore, EMX2 expression predicted response to neoadjuvant chemotherapy. High-EMX2 expression was associated with decreased progression-free survival after neoadjuvant therapy, suggesting that induction therapy should be avoided in these patients. CONCLUSIONS EMX2 expression is downregulated in advanced cases of malignant pleural mesothelioma and may serve as an important prognostic and predictive molecular biomarker of progression-free survival.
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Affiliation(s)
- Etienne Giroux Leprieur
- Thoracic Oncology Program, Department of Surgery, University of California, San Francisco, San Francisco, CA 94115, United States; Sorbonne Universities, UPMC Paris 6 University, GRC04 Theranoscan, F-75252 Paris, France; Respiratory Diseases and Thoracic Oncology Department, Ambroise Pare Hospital - APHP, Versailles Saint Quentin en Yvelines University, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Tomomi Hirata
- Thoracic Oncology Program, Department of Surgery, University of California, San Francisco, San Francisco, CA 94115, United States; Department of Surgery, Division of Thoracic Surgery, Nippon Medical School, Tokyo 113-8602, Japan
| | - Minli Mo
- School of Life Sciences, Tsinghua University, Beijing 10084, China
| | - Zhao Chen
- Thoracic Oncology Program, Department of Surgery, University of California, San Francisco, San Francisco, CA 94115, United States
| | - Junichi Okamoto
- Thoracic Oncology Program, Department of Surgery, University of California, San Francisco, San Francisco, CA 94115, United States; Department of Surgery, Division of Thoracic Surgery, Nippon Medical School, Tokyo 113-8602, Japan
| | - Genevieve Clement
- Thoracic Oncology Program, Department of Surgery, University of California, San Francisco, San Francisco, CA 94115, United States
| | - Hui Li
- Thoracic Oncology Program, Department of Surgery, University of California, San Francisco, San Francisco, CA 94115, United States
| | - Marie Wislez
- Sorbonne Universities, UPMC Paris 6 University, GRC04 Theranoscan, F-75252 Paris, France
| | - David M Jablons
- Thoracic Oncology Program, Department of Surgery, University of California, San Francisco, San Francisco, CA 94115, United States; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Biao He
- Thoracic Oncology Program, Department of Surgery, University of California, San Francisco, San Francisco, CA 94115, United States; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94143, United States.
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Vieira T, Antoine M, Ruppert AM, Fallet V, Duruisseaux M, Giroux Leprieur E, Poulot V, Rabbe N, Sclick L, Beau-Faller M, Lacave R, Lavole A, Cadranel J, Wislez M. Blood vessel invasion is a major feature and a factor of poor prognosis in sarcomatoid carcinoma of the lung. Lung Cancer 2014; 85:276-81. [PMID: 24997135 DOI: 10.1016/j.lungcan.2014.06.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/30/2014] [Accepted: 06/08/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Pulmonary sarcomatoid carcinomas (SC) are highly disseminated types of non-small-cell lung carcinoma. Their prognosis is poor. New therapeutic targets are needed to improve disease management. MATERIALS AND METHODS From 1995 to 2013, clinical and survival data from all consecutive patients with surgically treated SC were collected. Pathological and biomarker analyses were performed: TTF1, P63, c-MET and ALK expression (immunohistochemistry), PAS staining, ALK rearrangement (FISH), and EGFR, KRAS, HER2, BRAF, PIK3CA, and MET genes mutations (PCR). RESULTS Seventy-seven patients were included. Median age was 61 years (53-69). Histological subtypes were pleomorphic carcinoma (78%), carcinosarcoma (12%), and giant-cell and/or spindle-cell carcinoma (10%). Blood vessel invasion (BVI) was present in 90% of cases. Morphology and immunohistochemistry were indicative of an adenocarcinoma, squamous, and adenosquamous origin in 41.5%, 17% and 11.5%, respectively, 30% remained not-otherwise-specified. KRAS, PIK3CA, EGFR, and MET mutations were found in 31%, 8%, 3%, and 3%, respectively. No tumors had HER2 or BRAF mutations, or ALK rearrangement, whereas 34% had a c-MET positive score. Five-year overall survival (OS) was 29% for the whole population. At multivariate analysis, tumor size <50mm (HR=1.96 [1.04-3.73], p=0.011), no lymph-node metastasis (HR=3.25 [1.68-6.31], p<0.0001), no parietal pleural invasion (HR=1.16 [1.06-1.28], p=0.002), no BVI (HR=1.22 [1.06-1.40], p=0.005), and no squamous component (HR=3.17 [1.48-6.79], p=0.01) were associated with longer OS. Biomarkers did not influence OS. CONCLUSION Dedifferentiation in NSCLC could lead to SC and an epithelial subtype component could influence outcome. BVI was present in almost all SCs and was an independent factor of poor prognosis.
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Affiliation(s)
- Thibault Vieira
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service de Pneumologie, F-75970 Paris, France
| | - Martine Antoine
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service d'Anatomie pathologique, F-75970 Paris, France
| | - Anne-Marie Ruppert
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service de Pneumologie, F-75970 Paris, France
| | - Vincent Fallet
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | - Michael Duruisseaux
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | | | - Virginie Poulot
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Plateforme de Génomique des Tumeurs Solides, F-75970 Paris, France
| | - Nathalie Rabbe
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | - Laurene Sclick
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | - Michele Beau-Faller
- Hôpital de Hautepierre, Laboratoire de Biochimie et de biologie moléculaire, F-67098 Strasbourg, France
| | - Roger Lacave
- AP-HP, Hôpital Tenon, Plateforme de Génomique des Tumeurs Solides, F-75970 Paris, France
| | - Armelle Lavole
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France
| | - Jacques Cadranel
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service de Pneumologie, F-75970 Paris, France
| | - Marie Wislez
- Sorbonne Universités, UPMC Univ Paris 06, GRC n°04, Theranoscan, F-75252 Paris, France; AP-HP, Hôpital Tenon, Service de Pneumologie, F-75970 Paris, France.
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Rozensztajn N, Ruppert AM, Lavole A, Leprieur EG, Duruisseaux M, Vieira T, Rabbe N, Lacave R, Antoine M, Cadranel J, Wislez M. Factors associated with early progression of non-small-cell lung cancer treated by epidermal growth factor receptor tyrosine-kinase inhibitors. Cancer Med 2014; 3:61-9. [PMID: 24408092 PMCID: PMC3930390 DOI: 10.1002/cam4.180] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/19/2013] [Accepted: 11/20/2013] [Indexed: 12/30/2022] Open
Abstract
Epidermal growth factor receptor tyrosine-kinase inhibitors (EGFR-TKI) are a therapeutic option as second-line therapy in non-small-cell lung carcinoma (NSCLC), regardless of the EGFR gene status. Identifying patients with early progression during EGFR-TKI treatment will help clinicians to choose the best regimen, TKI or chemotherapy. From a prospective database, all patients treated with gefitinib or erlotinib between 2001 and 2010 were retrospectively reviewed. Patients were classified into two groups according to their tumor response by RECIST after 45 days of treatment, progressive disease (PD) or controlled disease (CD). Two hundred and sixty-eight patients were treated with EGFR-TKI, among whom 239 were classified as PD (n = 75) and CD (n = 164). Median overall survival was 77 days (95% CI 61-109) for PD and 385 days (95% CI 267-481) for CD. Patients with PD were of younger age (P = 0.004) and more frequently current smokers (P = 0.001) had more frequently a performance status ≥2 (P = 0.012), a weight loss ≥10% (P = 0.025), a shorter time since diagnosis (P < 0.0001), a pathological classification as non-otherwise-specified NSCLC (P = 0.01), and the presence of abdominal metastases (P = 0.008). In multivariate analysis, abdominal metastases were the only factor associated with early progression (odds ratio (OR) 2.17, 95% CI [1.12-4.19]; P = 0.021). Wild-type EGFR versus mutated EGFR was associated with early progression. The presence of abdominal metastasis was independently associated with early progression in metastatic NSCLC receiving EGFR-TKI.
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Affiliation(s)
- Nathalie Rozensztajn
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
| | - Anne-Marie Ruppert
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Armelle Lavole
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
| | - Etienne Giroux Leprieur
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Michael Duruisseaux
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Thibault Vieira
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Nathalie Rabbe
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Roger Lacave
- Plateforme de Biologie moléculaire, Service de Cytologie et Biologie Tumorale, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
| | - Martine Antoine
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
- Service d'Anatomie Pathologique, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
| | - Jacques Cadranel
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
| | - Marie Wislez
- Service de Pneumologie, Hôpital TenonAP-HP, 4 rue de la Chine, Paris, 75970, France
- Equipe de Recherche2/GRC-UPMC04 Theranoscan, Université Pierre et Marie Curie Paris 6, Hôpital Tenon4 rue de la Chine, Paris, France
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Giroux Leprieur E, Dumenil C, Labrune S, Giraud V, Chinet T. Bilateral pneumothorax complicating cystic metastases of bronchial squamous cell carcinoma under erlotinib. Tumori 2013. [PMID: 23748835 DOI: 10.1700/1283.14213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cystic lung metastases are a rare presentation in non-small cell lung cancer and occurs mainly in squamous cell carcinoma. We present the case of a 57-year-old woman with a lung squamous cell carcinoma and cystic lung metastases, who developed bilateral metachronous pneumothorax while being administered erlotinib in third-line treatment. The apparition of a pneumothorax under chemotherapy is most often the result of tumor necrosis and formation of bronchopleural fistula. However, very few cases have been reported under targeted therapies, and to our knowledge this is the first case under erlotinib. This complication is potentially life-threatening, especially due to the possibility of pneumothorax bilateralization.
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Affiliation(s)
- Etienne Giroux Leprieur
- Department of Pulmonology and Thoracic Oncology, Ambroise Paré Hospital - APHP, Versailles - Saint Quentin en Yvelines University, Boulogne-Billancourt, France.
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Leprieur EG, Dumenil C, Labrune S, Giraud V, Chinet T. Bilateral pneumothorax complicating cystic metastases of bronchial squamous cell carcinoma under erlotinib. Tumori 2013; 99:e77-9. [DOI: 10.1177/030089161309900234] [Citation(s) in RCA: 2] [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: 01/15/2023]
Abstract
Cystic lung metastases are a rare presentation in non-small cell lung cancer and occurs mainly in squamous cell carcinoma. We present the case of a 57-year-old woman with a lung squamous cell carcinoma and cystic lung metastases, who developed bilateral metachronous pneumothorax while being administered erlotinib in third-line treatment. The apparition of a pneumothorax under chemotherapy is most often the result of tumor necrosis and formation of bronchopleural fistula. However, very few cases have been reported under targeted therapies, and to our knowledge this is the first case under erlotinib. This complication is potentially life-threatening, especially due to the possibility of pneumothorax bilateralization.
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Affiliation(s)
- Etienne Giroux Leprieur
- Department of Pulmonology and Thoracic Oncology,
Ambroise Paré Hospital - APHP, Versailles - Saint Quentin en Yvelines University,
Boulogne-Billancourt, France
| | - Coraline Dumenil
- Department of Pulmonology and Thoracic Oncology,
Ambroise Paré Hospital - APHP, Versailles - Saint Quentin en Yvelines University,
Boulogne-Billancourt, France
| | - Sylvie Labrune
- Department of Pulmonology and Thoracic Oncology,
Ambroise Paré Hospital - APHP, Versailles - Saint Quentin en Yvelines University,
Boulogne-Billancourt, France
| | - Violaine Giraud
- Department of Pulmonology and Thoracic Oncology,
Ambroise Paré Hospital - APHP, Versailles - Saint Quentin en Yvelines University,
Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Pulmonology and Thoracic Oncology,
Ambroise Paré Hospital - APHP, Versailles - Saint Quentin en Yvelines University,
Boulogne-Billancourt, France
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Leprieur EG. [Lung cancer in the elderly: diagnostic and treatment specifics]. Soins Gerontol 2012:26-30. [PMID: 22852500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The diagnosis and treatment of elderly patients with lung cancer must take into account a number of specificities. The geriatric assessment is a fundamental stage in the initial examination.The treatment of localised forms involves surgery, with a slightly higher morbimortality in elderly compared to younger patients, resulting in the need for a rigorous selection of patients. Advanced forms are treated with chemotherapy or targeted therapies, treatment which is adapted to the patient and the tumour.
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Giroux Leprieur E, Antoine M, Vieira T, Duruisseaux M, Poulot V, Rabbe N, Belmont L, Gounant V, Lavole A, Milleron B, Lacave R, Cadranel J, Wislez M. Clinicopathologic and molecular factors associated with early progressive disease after front-line platinum-doublet chemotherapy (CT) for advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18075] [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
e18075 Background: The majority of cases of NSCLC are diagnosed at an advanced stage and treated with a platinum-doublet CT. However, some patients are resistant to this treatment and develop early progressive disease. We investigated the clinicopathologic and molecular characteristics of such patients. Methods: All consecutive patients with NSCLC IIIB−IV treated with a platinum-doublet CT between 2003 and 2006 were included. Platinum resistance was defined as early progressive disease at the first tumor assessment according to WHO criteria. The clinical, histologic and molecular characteristics (EGFR:exon 19, 20, 21 and KRAS:exon 2 by PCR sequencing; ALK by IHC, confirmed by FISH) and survival of patients with early progression (P) and controlled disease (C) were compared by univariate analysis. Factors differing between the two groups with a p-value <0.25 in univariate analysis were entered into multivariate analysis. Results: 178 patients were included (mean age 59.1 years, 66.3% male, 54.5% smokers). Platinum was associated with gemcitabine (52.2%), paclitaxel (32.6%) or docetaxel (11.8%). The first tumor assessment was carried out after a median of three cycles [range 1−4]. Forty-six (25.8%) patients had early progression. Overall survival of P-group was significantly shorter than that of C-group (median 5 months vs. 15.1 months, respectively; p <0.0001). Clinical presentation was similar in the two groups. The sarcomatoid histologic subtype was more common among P-group than C-group (10.9% vs. 1.5%, respectively; p=0.057). The proportion of EGFR (5.2% vs. 9.6%, respectively; p=0.224) and KRAS mutations (11.1% vs. 5.7%, respectively; p=0.357), and expression of ALK (6.3% vs. 2.5%, respectively; p=0.327) did not differ significantly between the two groups. In multivariate analysis, sarcomatoid histologic subtype was the only factor associated with early progression [OR=7.50, 95%CI: 1.02−55.45; p=0.048]. Conclusions: Patients with early progression had a shorter survival than controlled patients. Sarcomatoid histologic subtype was the only independent factor associated with early progressive disease.
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Affiliation(s)
| | - Martine Antoine
- Servie d'Anatomie Pathologique, Hopital Tenon, Université Pierre et Marie Curie, Paris, France
| | - Thibault Vieira
- Laboratoire ER2 Université Pierre et Marie Curie, Hopital Tenon, Paris, France
| | - Michael Duruisseaux
- Laboratoire ER2 Université Pierre et Marie Curie, Hopital Tenon, Paris, France
| | - Virginie Poulot
- Laboratoire ER2 Université Pierre et Marie Curie, Hopital Tenon, Paris, France
| | - Nathalie Rabbe
- Laboratoire ER2 Université Pierre et Marie Curie, Hopital Tenon, Paris, France
| | - Laure Belmont
- Service de Pneumologie Hopital Tenon Université Pierre et Marie Curie, Paris, France
| | - Valérie Gounant
- Service de Pneumologie Hopital Tenon Université Pierre et Marie Curie, Paris, France
| | - Armelle Lavole
- Service de Pneumologie Hopital Tenon Université Pierre et Marie Curie, Paris, France
| | - Bernard Milleron
- Service de Pneumologie Hopital Tenon Université Pierre et Marie Curie, Paris, France
| | - Roger Lacave
- Laboratoire ER2 Université Pierre et Marie Curie, Hopital Tenon, Paris, France
| | - Jacques Cadranel
- Service de Pneumologie Hopital Tenon Université Pierre et Marie Curie, Paris, France
| | - Marie Wislez
- Service de Pneumologie Hopital Tenon Université Pierre et Marie Curie, Paris, France
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Vieira T, Cazes A, Pierre B, Zemoura L, Monnet I, De Cremoux H, Chouaid C, Duruisseaux M, Giroux Leprieur E, Belmont L, Lavole A, Cadranel J, Wislez M. Is conventional chemotherapy effective in advanced sarcomatoid lung cancers? J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18102] [Citation(s) in RCA: 2] [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
e18102 Background: Sarcomatoid lung cancers (SC) are associated with poor prognosis. A few studies suggest that these tumors are resistant to platinum-based chemotherapy. Methods: Between January 1994 and October 2011, all consecutive patients with SC were screened from six French centers. Patients with advanced disease and treated with first-line chemotherapy were included in this study. Clinical data, staging (TNM 2009 classification), drugs and response to chemotherapy (RECIST 1.1) at first tumor assessment were reported. Factors associated with progressive disease (PD) in univariate (p<0.2) were included in multivariate analysis. Results: 111 patients with SC were screened. 51 had advanced stage and were treated by a first-line chemotherapy. Among them, 27 (53%) had initial advanced disease and 24 (47%) had relapse after radical surgery or radiotherapy. Patients were 60.7±3 years old, 69% were male, 86% smokers and 86% were symptomatic. PS was 0 (57%), 1 (39%) 2 (4%). Stages at the diagnosis were I (15.5%), II (13.5%), IIIA (20%), IIIB (6%), IV (45%). Histological subtype were pleomorphic (70%), pure sarcoma-like (20%) unspecified (6%), carcino-sarcoma (4%). 38 (75%) received a platinum based-combination and 13 (25%) a monotherapy. Drug given alone or combined with platin were gemcitabine (23%), navelbine (16%), placlitaxel (16%), docetaxel (12%), pemetrexed (9.8%), ifosfamide (9.8%), vepeside (4%) and others (11%). At first tumor assessment, PD and disease control rates were 71% and 29%, respectively. Median progression free survival was 2 months IC95% [1.3, 2.7]. Median overall survival was 6 months [3.2, 8.8]. In univariate analysis, age, gender, smoking status, numbers of metastatic locations, histological subtypes, monotherapy vs platin-based combinations, relapse after radical treatment vs initial advanced disease were not associated with PD. In multivariate analysis, initial advanced disease was the only independent factor of PD (OR 4.59 [1.17, 18] p=0.03). Conclusions: Our series confirm that advanced SC are refractory to conventional chemotherapy. Molecular characterizations are needed to improve therapeutic strategy.
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Affiliation(s)
- Thibault Vieira
- Service de Pneumologie et de Réanimation, Hôpital Tenon APHP, Paris, France
| | - Aurelie Cazes
- Service d'Anatomo-Pathologie, Hôpital Européen Georges Pompidou APHP, Paris, France
| | - Bonnette Pierre
- Service de Chirurgie Thoracique, Hôpital Foch, Suresne, France
| | - Leila Zemoura
- Service d'Anatomo-Pathologie Hôpital Foch, Suresne, France
| | - Isabelle Monnet
- Service de Pneumologie et Pathologie Professionnel, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Hubert De Cremoux
- Service de Pneumologie Hôpital d'Argenteuil, Argenteuil Cedex, France
| | - Christos Chouaid
- Service de Pneumologie, Hopital Saint-Antoine APHP, Paris, France
| | - Michael Duruisseaux
- Laboratoire ER2 Université Pierre et Marie Curie, Hopital Tenon, Paris, France
| | | | - Laure Belmont
- Service de Pneumologie Hopital Tenon Université Pierre et Marie Curie, Paris, France
| | - Armelle Lavole
- Hôpital Tenon, AP-HP and Faculté de Médecine Pierre et Marie Curie, Université Paris VI, Paris, France
| | - Jacques Cadranel
- Service de Pneumologie Hopital Tenon Université Pierre et Marie Curie, Paris, France
| | - Marie Wislez
- Service de Pneumologie Hopital Tenon Université Pierre et Marie Curie, Paris, France
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Giroux Leprieur E, Lavole A, Ruppert AM, Gounant V, Wislez M, Cadranel J, Milleron B. Factors associated with long-term survival of patients with advanced non-small cell lung cancer. Respirology 2012; 17:134-42. [PMID: 21943088 DOI: 10.1111/j.1440-1843.2011.02070.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Only a small proportion of patients with advanced non-small cell lung cancer (NSCLC) have a life expectancy greater than 2 years. The aim of this study was to identify the factors associated with long-term survival of patients with advanced NSCLC. METHODS Patients who had received chemotherapy for stage IIIb or IV NSCLC that was not amenable to radiotherapy were studied retrospectively. Data were gathered prospectively from a comprehensive database. Long-term survivors (>2 years) were compared with the other patients, with respect to clinical, biological and tumour-node-metastasis criteria. RESULTS Data for 245 consecutive patients were collected. Thirty nine patients (15.9%) survived for more than 2 years. Long-term survivors were more likely to have had metastases at fewer sites (P = 0.008), an absence of bone metastases (P = 0.01), a performance status (PS) of 0-1 at first progression of the tumour (P = 0.002), a tumour that was controlled with first (P < 0.0001) and second-line (P = 0.004) chemotherapy, maintenance therapy (P = 0.001), curative surgery (P < 0.0001), time to first progression of the tumour of >3 months (P < 0.0001), normal LDH levels at diagnosis (P = 0.049), and a haemoglobin concentration >110 g/L at first progression of the tumour (P = 0.02). In multivariate analysis, surgery, maintenance treatment, time to first progression of the tumour of >3 months, a PS of 0-1 at first progression, the number of chemotherapy agents received, and LDH levels, were significant predictors of long-term survival. CONCLUSIONS Assessment of these factors, and the use of maintenance therapy, when possible, may identify a population of patients with NSCLC that is likely to have a prolonged life expectancy.
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Affiliation(s)
- Etienne Giroux Leprieur
- Thoracic Oncology Unit, Respiratory Diseases Department, Tenon Hospital, APHP and Paris VI University, Paris.
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Duruisseaux M, Antoine M, Rabbe N, Poulot V, Leprieur EG, Lavolé A, Cadranel J, Wislez M. Abstract A10: Prognostic significance of CXCL10/CXCR3 overexpression in mucinous bronchioloalveolar carcinoma. Clin Cancer Res 2012. [DOI: 10.1158/1078-0432.12aacriaslc-a10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The 2004 WHO Pathological classification distinguishes two cytological subtypes of bronchioloalveolar carcinoma (BAC): mucinous (M) and non-mucinous (NM). This distinction appears to be relevant in terms of clinical characteristics, prognostic and treatment effectiveness. We attempted to better characterize the molecular profile of M relative to NM.
Experimental procedures: Bronchoalveolar lavage fluid (BALF) supernatants from M-BACs (n = 23) and NM-BACs (n = 11) were analyzed for 30 cytokines (IL-1β, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17, FGF, PDGF, HGF, VEGF, Eotaxin, G-CSF, GM-CSF, IFNγ, CXCL-1, CXCL-8, CXCL-10, MCP-1, MIP-1α, MIP-1β, TNF-α, RANTES, VCAM-1) by Bio-Plex multiplex bead-based assay (BIORAD, Marne la Coquette, France). Cytokines of interest expression was studied on paraffin embedded specimens from surgical specimens (n = 45) using immunochemistry. EGFR and K-ras mutation analysis using direct PCR and Alk overexpression detection using immunochemistry were also performed. Univariate and multivariate analysis by Cox model was undertaken to identify the variables associated with a risk for shortened survival.
Summary of results: Among the 30 chemokines analyzed, CXCL10 was the only one for which concentration was significantly higher in BALF supernatants from M-BAC (n = 23) compared to NM-BAC (n = 11) and control (n = 4) (p = 0.041). The cellular source of CXCL10 was not yet identified while CXCR3, its receptor, was expressed by tumor cells. CXCR3 was more frequently and more intensively expressed in M-BAC (n = 21) than in NM-BAC (n = 24) (52% vs 17%, p=0.023 and 52±16 vs 12±6, p = 0.047, respectively). EGFR mutation was never found in M-BAC (0%, 0/21) while present in 21% (5/24) of NM-BAC (p = 0.026). K-ras mutation and Alk overexpression did not differ between the two subtypes (2/21 vs 1/24, p > 0,05 and 3/21 vs 2/24, p > 0,05, respectively). The expression of CXCR3 was not associated with EGFR or K-ras mutation or Alk overexpression. In univariate analysis, factors associated with shorter survival were CXCL10 BALF concentration (HR=2.615, 95% CI: 1.102–6.206), PS > 0 (HR=1.308, 95% CI: 1.131–1.726) and bilateral extension (HR=2.914, 95% CI: 1.208–7.031). Multivariate analysis did not show any independent prognostic factor.
Conclusions: Our results show a CXCL10/CXCR3 overexpression in M-BAC compared to NM-BAC and suggest an association between CXCL10 overexpression and shorter survival.
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Affiliation(s)
- Michael Duruisseaux
- 1Université Pierre et Marie Curie, Paris, France, 2Hôpital Tenon, Paris, France
| | - Martine Antoine
- 1Université Pierre et Marie Curie, Paris, France, 2Hôpital Tenon, Paris, France
| | - Nathalie Rabbe
- 1Université Pierre et Marie Curie, Paris, France, 2Hôpital Tenon, Paris, France
| | - Virginie Poulot
- 1Université Pierre et Marie Curie, Paris, France, 2Hôpital Tenon, Paris, France
| | | | - Armelle Lavolé
- 1Université Pierre et Marie Curie, Paris, France, 2Hôpital Tenon, Paris, France
| | - Jacques Cadranel
- 1Université Pierre et Marie Curie, Paris, France, 2Hôpital Tenon, Paris, France
| | - Marie Wislez
- 1Université Pierre et Marie Curie, Paris, France, 2Hôpital Tenon, Paris, France
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Giroux Leprieur E, Labrune S, Giraud V, Gendry T, Cobarzan D, Chinet T. Delay between the initial symptoms, the diagnosis and the onset of specific treatment in elderly patients with lung cancer. Clin Lung Cancer 2012; 13:363-8. [PMID: 22264658 DOI: 10.1016/j.cllc.2011.11.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [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: 09/05/2011] [Revised: 11/13/2011] [Accepted: 11/14/2011] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The proportion of elderly patients with lung cancer is increasing. The objectives of this study were to describe the initial symptoms in elderly patients (≥ 70 years) with lung cancer and to describe the diagnostic and treatment delays. PATIENTS AND METHODS We reviewed all consecutive patients with lung cancer that were diagnosed between 2006 and 2008 in our department. The initial symptoms and delays in the diagnosis and treatment in elderly patients were compared with those of younger patients. RESULTS One hundred ninety-three patients were included (26 small-cell cancers and 167 non-small-cell lung cancers [NSCLCs]). Ninety-two patients (47.7%) were ≥ 70 years old. No statistical differences were identified between the 2 groups concerning initial symptoms. In elderly patients, the delay between the initial symptoms and the first visit with a thoracic oncologist (median 1.6 months [IQR 23 days-3.3 months]), the delay between the first visit and the specific treatment (median 1.1 months [IQR 18 days-1.8 months]), and the delay between initial symptoms and the specific treatment (median 3 months [IQR 2-5.7 months]) were similar to those in the younger patients (P = .101, P = .084, and P = .671, respectively). Eighty-four percent of the elderly patients were actively treated vs. 98% of the younger patients (P = .001). CONCLUSION We identified no differences regarding the initial symptoms in elderly patients with lung cancer compared with those in younger patients. The delays in diagnosis and treatment were similar between the 2 groups.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/mortality
- Adenocarcinoma/therapy
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Large Cell/diagnosis
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/therapy
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/therapy
- Combined Modality Therapy
- Delayed Diagnosis/statistics & numerical data
- Female
- Follow-Up Studies
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/mortality
- Lung Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Practice Guidelines as Topic/standards
- Prognosis
- Retrospective Studies
- Small Cell Lung Carcinoma/diagnosis
- Small Cell Lung Carcinoma/mortality
- Small Cell Lung Carcinoma/therapy
- Survival Rate
- Time Factors
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Affiliation(s)
- Etienne Giroux Leprieur
- Department of Pulmonary Diseases, Hopital Ambroise Pare, AP-HP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
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Cudennec T, Leprieur EG. [Specific treatments in oncology and the elderly]. Soins Gerontol 2011:45-46. [PMID: 21526547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Tristan Cudennec
- Pneumologue, hôpital Ambroise Paré, (AP-HP), Boulogne Billancourt.
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