Real world experience of treatment and outcome in ALK-rearranged metastatic nonsmall cell lung cancer: A multicenter study from India

Patel, Amol; Batra, Ullas; Prasad, Kuruswamy Thurai; Dabkara, Deepak; Ghosh, Joydeep; Sharma, M.; Singh, Navneet; Suresh, P.; Jain, Praveen; Malik, Prabhat Singh; Choudhary, Priyanshu; Ganguly, Sandip; Khurana, Sachin; Ms, Shivashankara; Bothra, Sneha; Muthu, Valliappan; Biswas, Bivas

doi:10.1016/j.currproblcancer.2020.100571

Cited by 21 publications

(15 citation statements)

References 16 publications

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“…Use of gefitinib as the commonest EGFR TKI, of crizotinib as the commonest ALK inhibitor and of chemotherapy being administered prior to TKI initiation is consistent with available data from this country [9][10][11]. There are no well-defined risk factors for occurrence of TKI related thyroid dysfunction.…”

Section: Discussionsupporting

confidence: 78%

Thyroid dysfunction in non-small cell lung cancer patients treated with epidermal growth factor receptor and anaplastic lymphoma kinase inhibitors: Results of a prospective cohort

et al. 2021

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Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) Tyrosine Kinase Inhibitors (TKIs) are the preferred treatment option for patients with advanced/metastatic non-small cell lung cancer (NSCLC) harboring EGFR mutations and ALK rearrangements respectively. TKIs can theoretically induce thyroid dysfunction via actions on many levels of the hypothalamic-pituitary-thyroid axis. However, there are no published studies on occurrence of thyroid dysfunction related to use of EGFR/ALK TKIs in lung cancer. The current study aimed to prospectively and comprehensively evaluate incidence of thyroid dysfunction in NSCLC patients treated with EGFR and ALK inhibitors. Methods: This prospective observational study at a tertiary care referral hospital included histologically/cytologically proven advanced/metastatic NSCLC patients treated with EGFR and ALK inhibitors over a period of 15 months. Thyroid function tests (including anti-TPO antibody) were done at baseline and repeated every month for first three months and then every three monthly for 12 months. Results: Six different drugs (EGFR and ALK inhibitors) were used for treatment of 50 NSCLC patients enrolled. Of these, four drugs caused thyroid dysfunction (EGFR inhibitors erlotinib, gefitinib and ALK inhibitors ceritinib, crizotinib). Thyroid dysfunction typically occurred at 1 month following start of TKI treatment. Prevalence of thyroid dysfunction was 8%. Distribution of subclinical (not requiring treatment) and overt thyroid dysfunction (requiring specific treatment) was 4% each. All patients were asymptomatic. Both patients with overt thyroid dysfunction had hypothyroidism while subclinical dysfunction was equally distributed between hypo-and hyperthyroidism. All patients who developed thyroid dysfunction derived expected clinical benefit and none required TKI dose interruption or stoppage. Conclusions: NSCLC patients may need to be monitored for occurrence of thyroid dysfunction during treatment with EGFR and ALK TKIs.

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Section: Discussionsupporting

confidence: 78%

Thyroid dysfunction in non-small cell lung cancer patients treated with epidermal growth factor receptor and anaplastic lymphoma kinase inhibitors: Results of a prospective cohort

et al. 2021

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“…1.0 [ 18 ]. Subjects with sensitizing EGFR mutation or ALK rearrangement were treated with appropriate EGFR tyrosine kinase or ALK inhibitors, respectively [ 19 , 20 ].…”

Section: Methodsmentioning

confidence: 99%

Programmed death-ligand 1 expression and tumor-infiltrating lymphocytes in non-small cell lung cancer: association with clinicopathologic parameters

Garg

Prasad

Singh

et al. 2021

J Pathol Transl Med

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Background: Data on the prevalence of programmed death-ligand 1 (PD-L1) expression and tumor-infiltrating lymphocytes (TILs) in non-small cell lung cancer (NSCLC) and their clinical significance in Indian patients are limited. Methods: Newly diagnosed NSCLC cases (adenocarcinoma or squamous cell carcinoma [SqCC] histology) were included in the present study. The TILs were evaluated based on morphology on hematoxylin and eosin-stained slides. PD-L1 expression in tumors was assessed using immunohistochemistry with rabbit monoclonal antibody (SP263) on the Ventana automated immunostainer. Tumors with PD-L1 expression > 50% on tumor cells were considered PD-L1-positive. Tumors in which TILs occupy > 25% of stroma were considered to have high TILs. The association of PD-L1 expression and TILs with various clinical parameters including overall survival (OS) was investigated. Results: The present study included 128 cases of NSCLC (67 adenocarcinoma, 61 SqCC). PD-L1 positivity was observed in 17.2% of the patients with NSCLC. Baseline characteristics of PD-L1-positive subjects were similar to PD-L1-negative subjects except for a higher prevalence of liver metastasis (18.2% vs. 2.8%; p = .018) and a higher probability of diagnosis from extrapulmonary biopsies. High TILs were observed in 26.6% of the subjects. However, PD-L1 expression and high TIL did not affect OS. Conclusions: PD-L1 positivity and high TILs were observed in 20% and 25% of the patients with NSCLC, respectively, however, neither were predictors of survival in SqCC.

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“…ALK/ROS1 inhibitors are well-tolerated agents with very good safety profile and greater efficacy in ALK/ROS1-rearranged NSCLC, and hence, anti-ALK/ROS1 TKI should be the only agents to treat this groups of patients. [9] Chemotherapy should be avoided, whenever feasible. c. NSCLC without any driver mutation: NSCLC with PDL1 tumor proportion score (TPS) by DAKO 22C3 ≥50% should be treated with single-agent pembrolizumab, wherever applicable due to high cost of therapy.…”

Section: Unresectable Stage III Non-small Cell Lung Cancermentioning

confidence: 99%

How We Treat lung Cancer during SARS-Cov-2 (COVID-19) Pandemic in India?

Biswas

Ganguly

Dabkara

et al. 2020

Indian Journal of Medical and Paediatric Oncology

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Real world experience of treatment and outcome in ALK-rearranged metastatic nonsmall cell lung cancer: A multicenter study from India

Cited by 21 publications

References 16 publications

Thyroid dysfunction in non-small cell lung cancer patients treated with epidermal growth factor receptor and anaplastic lymphoma kinase inhibitors: Results of a prospective cohort

Thyroid dysfunction in non-small cell lung cancer patients treated with epidermal growth factor receptor and anaplastic lymphoma kinase inhibitors: Results of a prospective cohort

Programmed death-ligand 1 expression and tumor-infiltrating lymphocytes in non-small cell lung cancer: association with clinicopathologic parameters

How We Treat lung Cancer during SARS-Cov-2 (COVID-19) Pandemic in India?

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