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Srinivasan AR. Treat to target in Crohn's disease: A practical guide for clinicians. World J Gastroenterol 2024; 30:50-69. [PMID: 38293329 PMCID: PMC10823901 DOI: 10.3748/wjg.v30.i1.50] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/23/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
A treat-to-target (T2T) approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease. The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE)-II guidelines specify short, intermediate, and long-term treatment goals, documenting specific treatment targets to be achieved at each of these timepoints. Scheduled appraisal of Crohn's disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified. Consensus treatment targets in Crohn's disease comprise combination clinical and patient-reported outcome remission, in conjunction with biomarker normalisation and endoscopic healing. Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing, clinicians must consider that this may not always be appropriate, acceptable, or achievable in all patients. This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets. The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques, particularly intestinal ultrasound, holds great promise; as do emerging treatment targets such as transmural healing. Two randomised clinical trials, namely, CALM and STARDUST, have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn's disease. Findings from these studies reflect that patient subgroups and Crohn's disease characteristics likely to benefit most from a T2T approach, remain to be clarified. Moreover, outside of clinical trials, data pertaining to the real-world effectiveness of a T2T approach remains scare, highlighting the need for pragmatic real-world studies. Despite the obvious promise of a T2T approach, a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake. This highlights the need to describe strategies, processes, and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice. Hence, this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn's disease.
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Affiliation(s)
- Ashish R Srinivasan
- Department of Gastroenterology, Austin Health, Victoria, Melbourne 3083, Australia
- Department of Gastroenterology, Eastern Health, Victoria, Melbourne 3128, Australia
- Department of Medicine, University of Melbourne, Victoria, Melbourne 3052, Australia
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Lu S, Yu XM, Hu YP, Ma ZY, Li XY, Li WD, Liu YP, Wang D, Wang XW, Wang ZH, Wu JX, Zhong DS, Li GF, He WY, Bao YY, Yuan Y, Fan JH. [Response characteristics of tislelizumab combined with chemotherapy in first-line treatment of locally advanced or metastatic non-squamous non-small cell lung cancer]. Zhonghua Zhong Liu Za Zhi 2023; 45:358-367. [PMID: 37078218 DOI: 10.3760/cma.j.cn112152-20220928-00662] [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] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Objective: To investigate the response characteristics of patients with locally advanced/metastatic non-squamous non-small cell lung cancer (nsq-NSCLC) treated with tislelizumab in combination with chemotherapy in the first line. Methods: Patients with nsq-NSCLC who achieved complete or partial remission after treatment with tislelizumab in combination with chemotherapy or chemotherapy alone in the RATIONALE 304 study, as assessed by an independent review board, were selected to analyze the response characteristics and safety profile of the responders. Time to response (TTR) was defined as the time from randomization to the achievement of first objective response. Depth of response (DpR) was defined as the maximum percentage of tumor shrinkage compared with the sum of the baseline target lesion length diameters. Results: As of January 23, 2020, 128 patients treated with tislelizumab in combination with chemotherapy achieved objective tumor response (responders), representing 57.4%(128/223) of the intention-to-treat population, with a TTR of 5.1 to 33.3 weeks and a median TTR of 7.9 weeks. Of the responders (128), 50.8%(65) achieved first remission at the first efficacy assessment (week 6), 31.3%(40) at the second efficacy assessment (week 12), and 18.0%(23) at the third and subsequent tumor assessments. The percentages of responders who achieved a depth of tumor response of 30% to <50%, 50% to <70% and 70% to 100% were 45.3%(58/128), 28.1%(36/128) and 26.6%(34/128), respectively, with median progression-free survival (PFS) of 9.0 months (95% CI: 7.7 to 9.9 months), 11.5 months (95% CI: 7.7 months to not reached) and not reached (95% CI: 11.8 months to not estimable), respectively. Tislelizumab plus chemotherapy were generally well tolerated in responders with similar safety profile to the overall safety population. Conclusion: Among responders to tislelizumab in combination with chemotherapy for nsq-NSCLC, 82.0%(105/128) achieves response within the first two tumor assessments (12 weeks) and 18.0%(23/128) achieves response at later (18 to 33 weeks) assessments, and there is a trend toward prolonged PFS in responders with deeper tumor response.
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Affiliation(s)
- S Lu
- Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - X M Yu
- Department of Thoracic Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Y P Hu
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan 430079, China
| | - Z Y Ma
- Department of Respiratory Medicine, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou University, Zhengzhou 450003, China
| | - X Y Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - W D Li
- Department of Medical Oncology, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou 510095, China
| | - Y P Liu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang 110001, China
| | - D Wang
- Department of Oncology, Army Sepcialty Medical Center, Chongqing 400042, China
| | - X W Wang
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Z H Wang
- Department of Medical Oncology, Shandong Cancer Hospital, Jinan 250117, China
| | - J X Wu
- Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - D S Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - G F Li
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650118, China
| | - W Y He
- BeiGene (Beijing) Co., Ltd., Beijing 100022, China
| | - Y Y Bao
- BeiGene (Shanghai) Co., Ltd., Shanghai 200020, China
| | - Y Yuan
- BeiGene (Shanghai) Co., Ltd., Shanghai 200020, China
| | - J H Fan
- BeiGene (Beijing) Co., Ltd., Beijing 100022, China
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Tang Y, Xia B, Xie R, Xu X, Zhang M, Wu K, Wang B, Ma S. Timing in combination with radiotherapy and patterns of disease progression in non-small cell lung cancer treated with EGFR-TKI. Lung Cancer 2019; 140:65-70. [PMID: 31884128 DOI: 10.1016/j.lungcan.2019.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/03/2019] [Accepted: 12/17/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Tyrosine kinase inhibitor (TKI) has been the standard of care for advanced non-small cell lung cancers (NSCLC) harboring epidermal growth factor receptor (EGFR) mutation, but these tumors invariably develop drug resistance. As progression most frequently advances in sites of original disease, our study sought to explore the time to response for NSCLC to TKI therapy and the patterns of disease progression, to provide evidence for timing and candidates for local therapy intervention. MATERIALS AND METHODS A cohort of 105 EGFR-mutated IIIB or IV NSCLC patients treated with EGFR-TKI were retrospectively analyzed. The disease progression patterns were divided into 3 categories: progression in sites of original disease, progression in new distant sites, and combined progression. RESULTS Before cut-off date, 80 patients had disease progression. Thirty-three (41.25 %) patients had progression in sites of original disease, 34 (42.5 %) patients had progression in new sites and 13 (16.25 %) patients had combined progression, respectively. The median time to response for responders was 2.00 months (95 %CI 1.28-2.92 months), and the median time to maximal tumor shrinkage for SD patients was 2.00 months (95 %CI 1.42-2.58 months). Multivariate logistic regression model showed that the 21 exon mutation is related to the incidence of original site failure. CONCLUSION Over 1/3 of the patients progress at the original sites, which indicated that this subset of patients may benefit from local therapy. Moreover, as the results indicate that considerable shrinkage for TKI therapy occurs in first two months after TKI initiation, local therapy can be adopted after this timepoint, before disease progression. We also propose EGFR gene mutation type as potential inclusion criteria to identify candidates for combined local therapy.
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Affiliation(s)
- Yi Tang
- Department of Radiation Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261 Huansha Road, Shangcheng District, Hangzhou 310006, Zhejiang, China; Department of Radiation Oncology, Hangzhou Cancer Hospital, No.34 Yanguan Lane, Shangcheng District, Hangzhou 310008, Zhejiang, China
| | - Bing Xia
- Department of Radiation Oncology, Hangzhou Cancer Hospital, No.34 Yanguan Lane, Shangcheng District, Hangzhou 310008, Zhejiang, China
| | - Ruifei Xie
- Department of Radiation Oncology, Hangzhou Cancer Hospital, No.34 Yanguan Lane, Shangcheng District, Hangzhou 310008, Zhejiang, China
| | - Xiao Xu
- Department of Radiation Oncology, Hangzhou Cancer Hospital, No.34 Yanguan Lane, Shangcheng District, Hangzhou 310008, Zhejiang, China
| | - Minna Zhang
- Department of Radiation Oncology, Hangzhou Cancer Hospital, No.34 Yanguan Lane, Shangcheng District, Hangzhou 310008, Zhejiang, China
| | - Kan Wu
- Department of Radiation Oncology, Hangzhou Cancer Hospital, No.34 Yanguan Lane, Shangcheng District, Hangzhou 310008, Zhejiang, China
| | - Bing Wang
- Department of Radiation Oncology, Hangzhou Cancer Hospital, No.34 Yanguan Lane, Shangcheng District, Hangzhou 310008, Zhejiang, China
| | - Shenglin Ma
- Department of Radiation Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261 Huansha Road, Shangcheng District, Hangzhou 310006, Zhejiang, China; Department of Radiation Oncology, Hangzhou Cancer Hospital, No.34 Yanguan Lane, Shangcheng District, Hangzhou 310008, Zhejiang, China.
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