Advances in Treatment of Locally Advanced or Metastatic Non–Small Cell Lung Cancer

Giustini, Nicholas P.; Jeong, Ah-Reum; Buturla, James A.; Bazhenova, Lyudmila

doi:10.1016/j.ccm.2020.02.003

Cited by 19 publications

(14 citation statements)

References 114 publications

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“…The CFDA has so far approved only the EGFR and ALK TKIs, gefitinib, erlotinib, afatinib, osimertinib, crizotinib, ceritinib, and alectinib, and these are covered by medical insurance. This issue will be resolved when more targeted drugs are approved such as capmatinib, selpercatinib, and lorlatinib to treat ROS1, MET exon 14 skipping, and RET fusion ( 34 ). Secondly, physicians will be able to recommend patients with more mutation-positive clinical and pathological features for comprehensive genomic testing.…”

Section: Discussionmentioning

confidence: 99%

Treatment Patterns and Survival of Patients With Advanced Non-Small Cell Lung Cancer Guided by Comprehensive Genomic Profiling: Real-World Single-Institute Study in China

Cheng

Шао

et al. 2021

Front. Oncol.

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Although the National Comprehensive Cancer Network and the Chinese Society of Clinical Oncology guidelines recommend comprehensive genomic profiling of lung adenocarcinoma, it has not been widely applied in Chinese hospitals. This observational study aimed to determine real-world evidence of whether comprehensive genomic profiling can benefit the survival of patients with lung cancer. We investigated the frequency of genomic alterations, treatment strategies, and clinical outcomes in 233 patients with advanced non-small cell lung carcinoma who were routinely screened using a 508-gene panel. The most prevalent drivers were mutations of EGFR (51%), KRAS (9%), PIK3CA (7%), ALK (7%), MET (6%), and BRAF (5%). Mutations in tumor suppressor genes included TP53, KEAP1, RB1, PTEN, and APC. Median overall survival (OS) was significantly shorter among patients harboring KRAS (mutant, n = 17; WT, n = 154) and TP53 (mutant, n = 103; WT n =68) mutations (11.3 vs. 24.0 months; P = 0.16 and 18.7 vs. 28.7 months; P = 0.018, respectively). The OS was longer among patients with tumors harboring EGFR (P = 0.069) and ALK (P = 0.51) mutations. Most patients (65.4%) with the driver gene-positive (EGFR, ALK, and ROS1) tumors were received TKI treatment, whereas those with driver gene wild tumors (53.1%) chose platinum-based therapy. Univariate and multivariate analyses associated a shorter OS among patients with tumors harboring concomitant TP53 and EGFR mutations. These findings provide additional evidence from real-world on the potential importance of targeted therapies as a treatment option in NSCLC patients harboring clinically actionable mutation.

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Section: Discussionmentioning

confidence: 99%

Treatment Patterns and Survival of Patients With Advanced Non-Small Cell Lung Cancer Guided by Comprehensive Genomic Profiling: Real-World Single-Institute Study in China

Cheng

Шао

et al. 2021

Front. Oncol.

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“…EGFR-TKI treatment given in first-line setting is now highly recommended for patients suffering advanced-stage EGFR-mutant NSCLC. [ 38 ] However, a significant shorter PFS was found in PD-L1 positive group when EGFR-TKIs were given as the first-line treatment, which should deserve more attention within our clinical practice.…”

Section: Discussionmentioning

confidence: 99%

The predictive and prognostic effects of PD-L1 expression on TKI treatment and survival of EGFR-mutant NSCLC

Lan

Wang

et al. 2021

Medicine

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Whether programmed death-ligand 1 (PD-L1) expression could predict the outcome of tyrosine kinase inhibitor (TKI) treatment and prognosis of epidermal growth factor receptor (EGFR)-mutant nonsmall cell lung cancer (NSCLC) is remaining controversial. Potential studies were search from PubMed, Embase, and Web of Science databases. Pooled odds ratio of objective response rate was used to describe the relationship between PD-L1 expression and primary resistance to EGFR-TKIs. Pooled hazard ratios (HRs) of progression-free survival (PFS) and overall survival (OS) were included to assess the effects of PD-L1 status on the outcome of EGFR-TKI treatment and survival of EGFR-mutant NSCLCs. Eighteen eligible studies (1986 EGFR-mutant NSCLCs) were included in this meta-analysis. Positive PD-L1 expression correlated with lower objective response rate of EGFR-TKI treatment (odds ratio [95% confidence interval {CI}] = 0.52 [0.28–0.98], P = .043), while PFS (adjusted HR [95% CI] = 1.49 [0.96–1.89], P = .332) and OS (HR [95% CI] = 1.24 [0.70–2.20], P = .456) of EGFR-TKI treatment did not correlated with PD-L1 status. Furthermore, PD-L1 expression was not a predictive biomarker for the OS (HR [95% CI] = 1.43 [0.98–2.08], P = .062) in overall EGFR-mutant cohort. Positive PD-L1 expression indicated a higher incidence of primary resistance, but did not correlate with the PFS or OS of EGFR-TKI therapy. In addition, PD-L1 expression was unlikely a predictive biomarker for prognosis of EGFR-mutant NSCLCs.

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“…In the past decade, the use of molecularly targeted therapy has led to signi cantly longer survival in patients with EGFR or ALK sensitizing mutations [24]. However, previous studies focused mainly on concurrent administration of these therapies with RT as rst-line treatment for patients with advanced disease, which maybe place them at a higher risk of adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated Radiotherapy for Locally or Systemically Advanced Non-small Cell Lung Cancer

Zhang

Zhou

Han

et al. 2021

Preprint

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Background: Palliative thoracic radiotherapy (RT) can improve local control and survival in patients with unresectable locally or systemically advanced non-small cell lung cancer (NSCLC), but the optimal RT dose has not been well-defined. We investigated the survival outcomes of patients with NSCLC who underwent hypofractionated radiotherapy (HFRT).Methods: We retrospectively investigated survival and adverse effects among 74 patients with locally or systemically advanced NSCLC who received HFRT (45 Gy/15 fractions) at our institution.Results: The median overall survival (OS) was 18.7 months, with 1- and 2-year OS rates of 65.9% and 33.9%, respectively. The median local progression-free survival (LPFS) was 7.2 months, with 1- and 2-year LPFS rates of 27.9% and 9.4%, respectively. Sixteen patients (21.6%) developed grade ≤2 pneumonitis and 14 (19%) developed grade ≤2 esophagitis; no grades ≥3 pneumonitis or esophagitis occurred.Conclusions: HFRT is safe, tolerable, and effective for patients with unresectable locally or systemically advanced NSCLC exhibiting poor prognostic factors.

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Advances in Treatment of Locally Advanced or Metastatic Non–Small Cell Lung Cancer

Cited by 19 publications

References 114 publications

Treatment Patterns and Survival of Patients With Advanced Non-Small Cell Lung Cancer Guided by Comprehensive Genomic Profiling: Real-World Single-Institute Study in China

Treatment Patterns and Survival of Patients With Advanced Non-Small Cell Lung Cancer Guided by Comprehensive Genomic Profiling: Real-World Single-Institute Study in China

The predictive and prognostic effects of PD-L1 expression on TKI treatment and survival of EGFR-mutant NSCLC

Hypofractionated Radiotherapy for Locally or Systemically Advanced Non-small Cell Lung Cancer

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