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Neoadjuvant FOLF(IRIN)OX Chemotherapy for Resectable Pancreatic Adenocarcinoma: A Multicenter Randomized Noncomparative Phase II Trial (PANACHE01 FRENCH08 PRODIGE48 study).
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-04 DOI: 10.1200/JCO-24-01378
Lilian Schwarz, Jean-Baptiste Bachet, Aurelia Meurisse, Olivier Bouché, Eric Assenat, Guillaume Piessen, Pascal Hammel, Nicolas Regenet, Julien Taieb, Olivier Turrini, Francois Paye, Anthony Turpin, Francois-Regis Souche, Christophe Laurent, Reza Kianmanesh, Pierre Michel, Dewi Vernerey, Jean-Yves Mabrut, Celia Turco, Stephanie Truant, Antonio Sa Cunha

Purpose: Despite limited RCTs, neoadjuvant chemotherapy (NAC) shows promise for resectable pancreatic adenocarcinoma (rPAC). Few prospective results are available on completing the full therapeutic sequence and oncologic outcomes with NAC.

Methods: The PANACHE01-PRODIGE48 phase II trial randomly assigned 153 patients with rPAC (2:2:1) to four cycles of NAC (modified leucovorin, fluorouracil, irinotecan, and oxaliplatin [mFOLFIRINOX], arm 1; leucovorin, fluorouracil, and oxaliplatin [FOLFOX], arm 2) or up-front surgery (control) across 28 French centers (February 2017-July 2020). The primary objective was to evaluate the feasibility and efficacy of these NAC regimens. Two binary primary end points included 1-year overall survival (OS) postrandomization and the rate of patients completing the full therapeutic sequence. Event-free survival (EFS) assessed time to failure, defined as progression before surgery, unresectable/metastatic disease at surgery, recurrence, or death.

Results: The primary objective was achieved for arm 1. In the intention-to-treat population, 70.8% (90% CI, 60.8 to 79.6) and 68% (90% CI, 55.5 to 78.8) completed the therapeutic sequence in arm 1 and arm 2, respectively. Within 12 months postrandomization, 84.3% (90% CI, 75.3 to 90.9) and 71.4% (90% CI, 59.0 to 81.8) of the patients were alive in arm 1 and arm 2, respectively. Treatment was safe and well-tolerated in both NAC arms. Arm 2 was stopped after interim analysis for lack of efficacy (H0 rejection for 1-year OS). One-year EFS rates were 51.4% (95% CI, 41.0 to 64.3), 43.1% (95% CI, 31.3 to 59.5), and 38.7% (95% CI, 24.1 to 62.0) in arm 1, arm 2, and control arm, respectively.

Conclusion: The feasibility and efficacy of mFOLFIRINOX in the perioperative setting are confirmed concerning therapeutic sequence completion and oncologic outcomes, supporting ongoing trials (PREOPANC3, Alliance AO21806). Further research is needed to identify patients who benefit from NAC (ClinicalTrials.gov identifier: NCT02959879; EudraCT: 2015-001851-65).

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引用次数: 0
Taletrectinib in ROS1+ Non-Small Cell Lung Cancer: TRUST.
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-03 DOI: 10.1200/JCO-25-00275
Maurice Pérol, Wei Li, Nathan A Pennell, Geoffrey Liu, Yuichiro Ohe, Filippo De Braud, Misako Nagasaka, Enriqueta Felip, Anwen Xiong, Yongchang Zhang, Huijie Fan, Xicheng Wang, Shuanglian Li, Rose K Lai, Feiwu Ran, Xianyu Zhang, Wenfeng Chen, Lyudmila Bazhenova, Caicun Zhou

Purpose: Taletrectinib is an oral, potent, CNS-active, selective, next-generation ROS1 tyrosine kinase inhibitor (TKI). We report integrated efficacy and safety from registrational taletrectinib studies in ROS1+ non-small cell lung cancer.

Methods: TRUST-I and TRUST-II were phase II, single-arm, open-label, nonrandomized, multicenter trials. Efficacy outcomes were pooled from TRUST-I and TRUST-II pivotal cohorts. The safety population comprised all patients treated with once-daily oral taletrectinib 600 mg pooled across the taletrectinib clinical program. The primary end point was independent review committee-assessed confirmed objective response rate (cORR). Secondary outcomes included intracranial (IC)-ORR, progression-free survival (PFS), duration of response (DOR), and safety.

Results: As of June 7, 2024, the efficacy-evaluable population included 273 patients in TRUST-I and TRUST-II. Among TKI-naïve patients (n = 160), the cORR was 88.8% and the IC-cORR was 76.5%; in TKI-pretreated patients (n = 113), the cORR was 55.8% and the IC-cORR was 65.6%. In TKI-naïve patients, the median DOR and median PFS were 44.2 and 45.6 months, respectively. In TKI-pretreated patients, the median DOR and median PFS were 16.6 and 9.7 months. The cORR in patients with G2032R mutation was 61.5% (8 of 13). Among 352 patients treated with taletrectinib 600 mg once daily, the most frequent treatment-emergent adverse events (TEAEs) were GI events (88%) and elevated AST (72%) and ALT (68%); most were grade 1. Neurologic TEAEs were infrequent (dizziness, 21%; dysgeusia, 15%) and mostly grade 1. TEAEs leading to discontinuations (6.5%) were low.

Conclusion: Taletrectinib showed a high response rate with durable responses, robust IC activity, prolonged PFS, favorable safety, and low rates of neurologic adverse events in TKI-naïve and pretreated patients.

{"title":"Taletrectinib in <i>ROS1</i>+ Non-Small Cell Lung Cancer: TRUST.","authors":"Maurice Pérol, Wei Li, Nathan A Pennell, Geoffrey Liu, Yuichiro Ohe, Filippo De Braud, Misako Nagasaka, Enriqueta Felip, Anwen Xiong, Yongchang Zhang, Huijie Fan, Xicheng Wang, Shuanglian Li, Rose K Lai, Feiwu Ran, Xianyu Zhang, Wenfeng Chen, Lyudmila Bazhenova, Caicun Zhou","doi":"10.1200/JCO-25-00275","DOIUrl":"https://doi.org/10.1200/JCO-25-00275","url":null,"abstract":"<p><strong>Purpose: </strong>Taletrectinib is an oral, potent, CNS-active, selective, next-generation ROS1 tyrosine kinase inhibitor (TKI). We report integrated efficacy and safety from registrational taletrectinib studies in <i>ROS1</i>+ non-small cell lung cancer.</p><p><strong>Methods: </strong>TRUST-I and TRUST-II were phase II, single-arm, open-label, nonrandomized, multicenter trials. Efficacy outcomes were pooled from TRUST-I and TRUST-II pivotal cohorts. The safety population comprised all patients treated with once-daily oral taletrectinib 600 mg pooled across the taletrectinib clinical program. The primary end point was independent review committee-assessed confirmed objective response rate (cORR). Secondary outcomes included intracranial (IC)-ORR, progression-free survival (PFS), duration of response (DOR), and safety.</p><p><strong>Results: </strong>As of June 7, 2024, the efficacy-evaluable population included 273 patients in TRUST-I and TRUST-II. Among TKI-naïve patients (n = 160), the cORR was 88.8% and the IC-cORR was 76.5%; in TKI-pretreated patients (n = 113), the cORR was 55.8% and the IC-cORR was 65.6%. In TKI-naïve patients, the median DOR and median PFS were 44.2 and 45.6 months, respectively. In TKI-pretreated patients, the median DOR and median PFS were 16.6 and 9.7 months. The cORR in patients with G2032R mutation was 61.5% (8 of 13). Among 352 patients treated with taletrectinib 600 mg once daily, the most frequent treatment-emergent adverse events (TEAEs) were GI events (88%) and elevated AST (72%) and ALT (68%); most were grade 1. Neurologic TEAEs were infrequent (dizziness, 21%; dysgeusia, 15%) and mostly grade 1. TEAEs leading to discontinuations (6.5%) were low.</p><p><strong>Conclusion: </strong>Taletrectinib showed a high response rate with durable responses, robust IC activity, prolonged PFS, favorable safety, and low rates of neurologic adverse events in TKI-naïve and pretreated patients.</p>","PeriodicalId":15384,"journal":{"name":"Journal of Clinical Oncology","volume":" ","pages":"JCO2500275"},"PeriodicalIF":42.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
NOTCH1 Mutation and Survival Analysis of Tislelizumab in Advanced or Metastatic Esophageal Squamous Cell Carcinoma: A Biomarker Analysis From the Randomized, Phase III, RATIONALE-302 Trial.
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-03 DOI: 10.1200/JCO-24-01818
Zhihao Lu, Wenting Du, Xi Jiao, Yanni Wang, Jingwen Shi, Yang Shi, Yongqian Shu, Zuoxing Niu, Hiroki Hara, Jun Wu, Chih-Hung Hsu, Eric Van Cutsem, Malcolm V Brock, Zhang Zhang, Ningning Ding, Yun Zhang, Zhirong Shen, Lin Shen

Purpose: Although multiple agents targeting PD-1 have been approved as second-line treatment for esophageal squamous cell carcinoma (ESCC), only a fraction of patients derive long-term survival. Hence, reliable predictive biomarkers are urgently needed.

Methods: Comprehensive tumor genomic profiling and transcriptome sequencing were performed on samples from the RATIONALE-302 study. We also conducted single-cell RNA sequencing analysis on Notch1 knockdown ESCC murine models to further explore the potential molecular mechanisms underlying anti-PD-1 benefit.

Results: We identified NOTCH1 mutation as a potential predictive biomarker for longer overall survival (OS) with tislelizumab versus chemotherapy (18.4 months v 5.3 months; hazard ratio, 0.35 [95% CI, 0.17 to 0.71]). At the transcriptional level, type I IFN (IFN-I)/toll-like receptor expression signatures were positively associated with OS benefit of tislelizumab, whereas B-cell and neutrophil signatures predicted unfavorable OS. Exploratory analyses showed that the presence of NOTCH1 mutation correlated with enrichment of IFN-I signatures and reduced infiltration of B cells and neutrophils. In murine models, comparative single-cell transcriptome analyses further revealed that Notch1 deficiency facilitated a more immunologically activated tumor microenvironment which potentiated anti-PD-1 treatment.

Conclusion: Our data provide novel insights for anti-PD-1 treatment selection using NOTCH1 mutations and may provide a rationale for combination therapy in ESCC.

{"title":"<i>NOTCH1</i> Mutation and Survival Analysis of Tislelizumab in Advanced or Metastatic Esophageal Squamous Cell Carcinoma: A Biomarker Analysis From the Randomized, Phase III, RATIONALE-302 Trial.","authors":"Zhihao Lu, Wenting Du, Xi Jiao, Yanni Wang, Jingwen Shi, Yang Shi, Yongqian Shu, Zuoxing Niu, Hiroki Hara, Jun Wu, Chih-Hung Hsu, Eric Van Cutsem, Malcolm V Brock, Zhang Zhang, Ningning Ding, Yun Zhang, Zhirong Shen, Lin Shen","doi":"10.1200/JCO-24-01818","DOIUrl":"https://doi.org/10.1200/JCO-24-01818","url":null,"abstract":"<p><strong>Purpose: </strong>Although multiple agents targeting PD-1 have been approved as second-line treatment for esophageal squamous cell carcinoma (ESCC), only a fraction of patients derive long-term survival. Hence, reliable predictive biomarkers are urgently needed.</p><p><strong>Methods: </strong>Comprehensive tumor genomic profiling and transcriptome sequencing were performed on samples from the RATIONALE-302 study. We also conducted single-cell RNA sequencing analysis on <i>Notch1</i> knockdown ESCC murine models to further explore the potential molecular mechanisms underlying anti-PD-1 benefit.</p><p><strong>Results: </strong>We identified <i>NOTCH1</i> mutation as a potential predictive biomarker for longer overall survival (OS) with tislelizumab versus chemotherapy (18.4 months <i>v</i> 5.3 months; hazard ratio, 0.35 [95% CI, 0.17 to 0.71]). At the transcriptional level, type I IFN (IFN-I)/toll-like receptor expression signatures were positively associated with OS benefit of tislelizumab, whereas B-cell and neutrophil signatures predicted unfavorable OS. Exploratory analyses showed that the presence of <i>NOTCH1</i> mutation correlated with enrichment of IFN-I signatures and reduced infiltration of B cells and neutrophils. In murine models, comparative single-cell transcriptome analyses further revealed that <i>Notch1</i> deficiency facilitated a more immunologically activated tumor microenvironment which potentiated anti-PD-1 treatment.</p><p><strong>Conclusion: </strong>Our data provide novel insights for anti-PD-1 treatment selection using <i>NOTCH1</i> mutations and may provide a rationale for combination therapy in ESCC.</p>","PeriodicalId":15384,"journal":{"name":"Journal of Clinical Oncology","volume":" ","pages":"JCO2401818"},"PeriodicalIF":42.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Timely Reporting of Patient-Reported Outcomes in Cancer Clinical Trials: An Ethical Imperative. 及时报告癌症临床试验中患者报告的结果:一项伦理责任。
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-21 DOI: 10.1200/JCO-24-02021
Eric C Blackstone, Fabio Efficace, Jeffrey A Meyerhardt, Gregory A Abel
{"title":"Timely Reporting of Patient-Reported Outcomes in Cancer Clinical Trials: An Ethical Imperative.","authors":"Eric C Blackstone, Fabio Efficace, Jeffrey A Meyerhardt, Gregory A Abel","doi":"10.1200/JCO-24-02021","DOIUrl":"10.1200/JCO-24-02021","url":null,"abstract":"","PeriodicalId":15384,"journal":{"name":"Journal of Clinical Oncology","volume":" ","pages":"1176-1179"},"PeriodicalIF":42.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reply to: Concerns on Potential Risk of Roxadustat in Promoting Tumor Progression: Double-Edged Sword of Hypoxia-Inducible Factor-1α Activation. 回复:对罗沙司他促进肿瘤进展的潜在风险的担忧:缺氧诱导因子-1α激活的双刃剑。
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-13 DOI: 10.1200/JCO-24-02610
George M Rodgers, Jeffrey A Gilreath
{"title":"Reply to: Concerns on Potential Risk of Roxadustat in Promoting Tumor Progression: Double-Edged Sword of Hypoxia-Inducible Factor-1α Activation.","authors":"George M Rodgers, Jeffrey A Gilreath","doi":"10.1200/JCO-24-02610","DOIUrl":"10.1200/JCO-24-02610","url":null,"abstract":"","PeriodicalId":15384,"journal":{"name":"Journal of Clinical Oncology","volume":" ","pages":"1267-1268"},"PeriodicalIF":42.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pancreatic Adenocarcinoma: Long-Term Outcomes of Adjuvant Therapy in the ESPAC4 Phase III Trial. 胰腺腺癌:ESPAC4 III期试验中辅助治疗的长期结果
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-05 DOI: 10.1200/JCO.24.01118
Daniel H Palmer, Richard Jackson, Christoph Springfeld, Paula Ghaneh, Charlotte Rawcliffe, Christopher M Halloran, Olusola Faluyi, David Cunningham, Jonathan Wadsley, Suzanne Darby, Tim Meyer, Roopinder Gillmore, Pehr Lind, Bengt Glimelius, Stephen Falk, Yuk Ting Ma, Gary William Middleton, Sebastian Cummins, Paul J Ross, Harpreet Wasan, Alec McDonald, Tom Crosby, Pascal Hammel, David Borg, Sharmila Sothi, Juan W Valle, Arianeb Mehrabi, Peter Bailey, Christine Tjaden, Christoph Michalski, Thilo Hackert, Markus W Büchler, John P Neoptolemos

Purpose: The ESPAC4 trial showed that adjuvant chemotherapy with gemcitabine plus capecitabine (GemCap) produced longer overall survival (OS) than gemcitabine monotherapy. Subsequently, the PRODIGE24-CCTG PA.6 trial showed even longer survival for modified fluorouracil, folinic acid, irinotecan, and oxaliplatin (mFOLFIRINOX) than gemcitabine but had more restrictive eligibility criteria. Our aim was to analyze the ESPAC4 survival on long-term follow-up.

Methods: The OS of 732 ESPAC4 patients comparing 367 randomly assigned to gemcitabine and 365 to GemCap was previously reported after a median follow-up time of 43.2 months (95% CI, 39.7 to 45.5) and 458 deaths. Analysis was now carried out after a median follow-up of 104 months (101-108) and 566 deaths.

Results: The median OS was 29.5 months (27.5-32.1) for all patients, 28.4 months (25.2-32.0) in the gemcitabine group and 31.6 months (26.5-38.0) in the GemCap group (hazard ratio [HR], 0.83 [0.71 to 0.98]; P = .031). R0 patients given gemcitabine had a median survival of 32.2 months (27.9-41.6) compared with 49.9 months (39.0-82.3) for those given GemCap (HR, 0.63 [0.47 to 0.84]; P = .002). Lymph node-negative patients had significantly higher 5 year OS rates on GemCap (59% [49%-71%]) than gemcitabine (53% [42%-66%]; HR, 0.63 [0.41 to 0.98]; P = .04) but not those with positive lymph nodes (P = .225). The OS advantage for GemCap was retained in the PRODIGE24 subgroup of 193 (26.4%) ESPAC4 patients not eligible for PRODIGE24 with a median survival of 20.7 (16.2-27.3) months in patients allocated to gemcitabine compared with 25.9 (22.3-30.2) months for ineligible patients allocated to GemCap (HR, 0.71 [95% CI, 0.52 to 0.98]; χ2log-rank-1df = 4.31; P = .038).

Conclusion: GemCap is a standard option for patients not eligible for mFOLFIRINOX. Exploratory evidence suggests that GemCap may be particularly efficacious in R0 patients and also in lymph node-negative patients.

目的:ESPAC4试验显示,吉西他滨联合卡培他滨(GemCap)辅助化疗比吉西他滨单药治疗产生更长的总生存期(OS)。随后,PRODIGE24-CCTG PA.6试验显示,改良氟尿嘧啶、亚叶酸、伊立替康和奥沙利铂(mFOLFIRINOX)的生存期比吉西他滨更长,但有更严格的资格标准。我们的目的是分析ESPAC4的长期随访生存率。方法:在中位随访时间为43.2个月(95% CI, 39.7至45.5)和458例死亡后,732例ESPAC4患者的OS(其中367例随机分配给吉西他滨,365例随机分配给GemCap)被报道。在中位随访104个月(101-108)和566例死亡后进行分析。结果:所有患者的中位OS为29.5个月(27.5-32.1),吉西他滨组为28.4个月(25.2-32.0),GemCap组为31.6个月(26.5-38.0)(风险比[HR], 0.83 [0.71 ~ 0.98];P = .031)。R0患者给予吉西他滨的中位生存期为32.2个月(27.9-41.6),而给予GemCap的中位生存期为49.9个月(39.0-82.3)(HR, 0.63 [0.47 - 0.84];P = .002)。淋巴结阴性患者的5年OS率(59%[49%-71%])显著高于吉西他滨(53% [42%-66%]);HR, 0.63 [0.41 ~ 0.98];P = 0.04),而淋巴结阳性组无统计学意义(P = 0.225)。在PRODIGE24亚组193例(26.4%)不适合接受PRODIGE24治疗的ESPAC4患者中,GemCap的OS优势保持不变,分配给吉西他滨的患者中位生存期为20.7(16.2-27.3)个月,而分配给GemCap的不符合条件的患者中位生存期为25.9(22.3-30.2)个月(HR, 0.71 [95% CI, 0.52 - 0.98];χ2log-rank-1df = 4.31;P = .038)。结论:GemCap是不符合mFOLFIRINOX条件的患者的标准选择。探索性证据表明,GemCap可能对R0患者和淋巴结阴性患者特别有效。
{"title":"Pancreatic Adenocarcinoma: Long-Term Outcomes of Adjuvant Therapy in the ESPAC4 Phase III Trial.","authors":"Daniel H Palmer, Richard Jackson, Christoph Springfeld, Paula Ghaneh, Charlotte Rawcliffe, Christopher M Halloran, Olusola Faluyi, David Cunningham, Jonathan Wadsley, Suzanne Darby, Tim Meyer, Roopinder Gillmore, Pehr Lind, Bengt Glimelius, Stephen Falk, Yuk Ting Ma, Gary William Middleton, Sebastian Cummins, Paul J Ross, Harpreet Wasan, Alec McDonald, Tom Crosby, Pascal Hammel, David Borg, Sharmila Sothi, Juan W Valle, Arianeb Mehrabi, Peter Bailey, Christine Tjaden, Christoph Michalski, Thilo Hackert, Markus W Büchler, John P Neoptolemos","doi":"10.1200/JCO.24.01118","DOIUrl":"10.1200/JCO.24.01118","url":null,"abstract":"<p><strong>Purpose: </strong>The ESPAC4 trial showed that adjuvant chemotherapy with gemcitabine plus capecitabine (GemCap) produced longer overall survival (OS) than gemcitabine monotherapy. Subsequently, the PRODIGE24-CCTG PA.6 trial showed even longer survival for modified fluorouracil, folinic acid, irinotecan, and oxaliplatin (mFOLFIRINOX) than gemcitabine but had more restrictive eligibility criteria. Our aim was to analyze the ESPAC4 survival on long-term follow-up.</p><p><strong>Methods: </strong>The OS of 732 ESPAC4 patients comparing 367 randomly assigned to gemcitabine and 365 to GemCap was previously reported after a median follow-up time of 43.2 months (95% CI, 39.7 to 45.5) and 458 deaths. Analysis was now carried out after a median follow-up of 104 months (101-108) and 566 deaths.</p><p><strong>Results: </strong>The median OS was 29.5 months (27.5-32.1) for all patients, 28.4 months (25.2-32.0) in the gemcitabine group and 31.6 months (26.5-38.0) in the GemCap group (hazard ratio [HR], 0.83 [0.71 to 0.98]; <i>P</i> = .031). R0 patients given gemcitabine had a median survival of 32.2 months (27.9-41.6) compared with 49.9 months (39.0-82.3) for those given GemCap (HR, 0.63 [0.47 to 0.84]; <i>P</i> = .002). Lymph node-negative patients had significantly higher 5 year OS rates on GemCap (59% [49%-71%]) than gemcitabine (53% [42%-66%]; HR, 0.63 [0.41 to 0.98]; <i>P</i> = .04) but not those with positive lymph nodes (<i>P</i> = .225). The OS advantage for GemCap was retained in the PRODIGE24 subgroup of 193 (26.4%) ESPAC4 patients not eligible for PRODIGE24 with a median survival of 20.7 (16.2-27.3) months in patients allocated to gemcitabine compared with 25.9 (22.3-30.2) months for ineligible patients allocated to GemCap (HR, 0.71 [95% CI, 0.52 to 0.98]; χ<sup>2</sup><sub>log-rank-1df</sub> = 4.31; <i>P</i> = .038).</p><p><strong>Conclusion: </strong>GemCap is a standard option for patients not eligible for mFOLFIRINOX. Exploratory evidence suggests that GemCap may be particularly efficacious in R0 patients and also in lymph node-negative patients.</p>","PeriodicalId":15384,"journal":{"name":"Journal of Clinical Oncology","volume":" ","pages":"1240-1253"},"PeriodicalIF":42.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Larotrectinib for Newly Diagnosed Infantile Fibrosarcoma and Other Pediatric NTRK Fusion-Positive Solid Tumors (Children's Oncology Group ADVL1823). larorectinib用于新诊断的婴儿纤维肉瘤和其他儿童NTRK融合阳性实体瘤(儿童肿瘤组ADVL1823)。
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-01 Epub Date: 2024-12-09 DOI: 10.1200/JCO-24-01854
Theodore W Laetsch, Stephan Voss, Kathleen Ludwig, David Hall, Donald A Barkauskas, Steven G DuBois, Joan Ronan, Erin R Rudzinski, Amanda Memken, Krystal Robinson, Joel Sorger, Joel M Reid, Teena Bhatla, Brian D Crompton, Alanna J Church, Elizabeth Fox, Brenda J Weigel

Purpose: The TRK inhibitor larotrectinib is US Food and Drug Administration approved for NTRK fusion-positive solid tumors that lack a satisfactory alternative or have progressed after treatment but has not been systematically studied as a frontline therapy with a defined duration of treatment. ADVL1823 evaluated larotrectinib in patients with newly diagnosed NTRK fusion-positive solid tumors with response-adapted duration of therapy and local control.

Methods: Patients received larotrectinib twice daily in 28-day cycles for a predefined duration of treatment, ranging from 6 to 26 cycles depending on response to therapy and surgical resectability. The primary end point was the objective response rate (ORR) within six cycles in patients with infantile fibrosarcoma (IFS); patients with other histologic diagnoses were analyzed in a separate cohort. Secondary objectives included event-free survival (EFS) and overall survival (OS).

Results: Thirty-three patients were enrolled: 18 with IFS and 15 with other solid tumors. The ORR within six cycles was 94% (17/18; 95% adjusted CI, 72.7 to 98.6) among children with IFS and 60% (9/15; 95% CI, 32.3 to 83.7) among children with other solid tumors. Six percent (2/33; 95% CI, 0.7 to 22.2) patients developed progressive disease while on therapy. Two-year EFS and OS among these groups were 82.2% (95% CI, 54.3 to 93.9) and 93.8% (95% CI, 63.2 to 99.1) for IFS and 80% (95% CI, 50.0 to 93.1) and 93.3% (95% CI, 61.3 to 99.0) for other solid tumors, respectively. Patients undergoing surgical resection of their tumor had prolonged EFS, with only 1 of 16 such patients experiencing disease progression. Four of 33 patients had dose-limiting toxicities.

Conclusion: Larotrectinib is highly active in patients with newly diagnosed NTRK fusion-positive solid tumors. Larotrectinib should be a frontline option for patients with IFS and other NTRK fusion-positive solid tumors. Local control with surgical resection remains important in the treatment of patients with IFS.

目的:TRK抑制剂larorectinib是美国食品和药物管理局批准用于缺乏令人满意的替代方案或治疗后进展的NTRK融合阳性实体瘤,但尚未系统研究作为一线治疗并确定治疗持续时间。ADVL1823评估了larorectinib在新诊断的NTRK融合阳性实体瘤患者中的治疗效果,治疗时间与局部控制相适应。方法:患者接受larorectinib治疗,每日2次,28天为一个预定的治疗周期,根据对治疗的反应和手术切除性,治疗周期从6到26个周期不等。主要终点是婴儿纤维肉瘤(IFS)患者6个周期内的客观缓解率(ORR);其他组织学诊断的患者在单独的队列中进行分析。次要目标包括无事件生存期(EFS)和总生存期(OS)。结果:33例患者入组:IFS患者18例,其他实体瘤患者15例。6个周期内的ORR为94% (17/18;95%校正CI, 72.7 - 98.6), 60% (9/15;95% CI, 32.3 - 83.7)。6% (2/33;95% CI, 0.7 - 22.2)患者在治疗期间病情进展。这些组中IFS的两年EFS和OS分别为82.2% (95% CI, 54.3至93.9)和93.8% (95% CI, 63.2至99.1),其他实体瘤的两年EFS和OS分别为80% (95% CI, 50.0至93.1)和93.3% (95% CI, 61.3至99.0)。接受手术切除肿瘤的患者有延长的EFS, 16例患者中只有1例出现疾病进展。33例患者中有4例出现剂量限制性毒性。结论:larorectinib在新诊断的NTRK融合阳性实体瘤患者中具有高度活性。larorectinib应该成为IFS和其他NTRK融合阳性实体瘤患者的一线治疗选择。局部控制与手术切除仍然是治疗IFS患者的重要方法。
{"title":"Larotrectinib for Newly Diagnosed Infantile Fibrosarcoma and Other Pediatric <i>NTRK</i> Fusion-Positive Solid Tumors (Children's Oncology Group ADVL1823).","authors":"Theodore W Laetsch, Stephan Voss, Kathleen Ludwig, David Hall, Donald A Barkauskas, Steven G DuBois, Joan Ronan, Erin R Rudzinski, Amanda Memken, Krystal Robinson, Joel Sorger, Joel M Reid, Teena Bhatla, Brian D Crompton, Alanna J Church, Elizabeth Fox, Brenda J Weigel","doi":"10.1200/JCO-24-01854","DOIUrl":"10.1200/JCO-24-01854","url":null,"abstract":"<p><strong>Purpose: </strong>The TRK inhibitor larotrectinib is US Food and Drug Administration approved for <i>NTRK</i> fusion-positive solid tumors that lack a satisfactory alternative or have progressed after treatment but has not been systematically studied as a frontline therapy with a defined duration of treatment. ADVL1823 evaluated larotrectinib in patients with newly diagnosed <i>NTRK</i> fusion-positive solid tumors with response-adapted duration of therapy and local control.</p><p><strong>Methods: </strong>Patients received larotrectinib twice daily in 28-day cycles for a predefined duration of treatment, ranging from 6 to 26 cycles depending on response to therapy and surgical resectability. The primary end point was the objective response rate (ORR) within six cycles in patients with infantile fibrosarcoma (IFS); patients with other histologic diagnoses were analyzed in a separate cohort. Secondary objectives included event-free survival (EFS) and overall survival (OS).</p><p><strong>Results: </strong>Thirty-three patients were enrolled: 18 with IFS and 15 with other solid tumors. The ORR within six cycles was 94% (17/18; 95% adjusted CI, 72.7 to 98.6) among children with IFS and 60% (9/15; 95% CI, 32.3 to 83.7) among children with other solid tumors. Six percent (2/33; 95% CI, 0.7 to 22.2) patients developed progressive disease while on therapy. Two-year EFS and OS among these groups were 82.2% (95% CI, 54.3 to 93.9) and 93.8% (95% CI, 63.2 to 99.1) for IFS and 80% (95% CI, 50.0 to 93.1) and 93.3% (95% CI, 61.3 to 99.0) for other solid tumors, respectively. Patients undergoing surgical resection of their tumor had prolonged EFS, with only 1 of 16 such patients experiencing disease progression. Four of 33 patients had dose-limiting toxicities.</p><p><strong>Conclusion: </strong>Larotrectinib is highly active in patients with newly diagnosed <i>NTRK</i> fusion-positive solid tumors. Larotrectinib should be a frontline option for patients with IFS and other <i>NTRK</i> fusion-positive solid tumors. Local control with surgical resection remains important in the treatment of patients with IFS.</p>","PeriodicalId":15384,"journal":{"name":"Journal of Clinical Oncology","volume":" ","pages":"1188-1197"},"PeriodicalIF":42.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adjuvant Dose-Dense Chemotherapy in Hormone Receptor-Positive Breast Cancer. 激素受体阳性乳腺癌的辅助剂量密集化疗。
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-02 DOI: 10.1200/JCO-24-01875
Otto Metzger Filho, Karla Ballman, Jordan Campbell, Minetta Liu, Jennifer Ligibel, Mark Watson, Eveline Chen, Lili Du, Daniel Stover, Lisa Carey, Ann Partridge, Jeffrey Kirshner, Hyman Muss, Clifford Hudis, Eric P Winer, Larry Norton, W Fraser Symmans

Purpose: In light of evolving evidence that some patients with node-positive estrogen receptor-positive (ER+) disease may receive less benefit from chemotherapy, this study reports 12-year outcomes of the C9741 trial overall, and by the sensitivity to endocrine therapy (SET2,3) test index, a biomarker measuring endocrine transcriptional activity, to identify patients most likely to benefit from dose-dense chemotherapy.

Methods: In all, 1,973 patients were randomly assigned to dose-dense versus conventional chemotherapy. Hazard ratios (HRs) for prognosis and for predictive interaction with chemotherapy schedule were estimated from Cox models of long-term disease-free survival (DFS) and overall survival (OS). SET2,3 was tested on the 682 banked RNA samples from ER+ cancers.

Results: Dose-dense chemotherapy improved DFS in the overall study population by 23% (HR, 0.77 [95% CI, 0.66 to 0.90]) and OS by 20% (HR, 0.80 [95% CI, 0.67 to 0.95]); the benefits of dose-dense therapy were seen for ER+ and ER-negative subsets, without significant interaction between treatment arm and ER status. Low SET2,3 status was highly prognostic, but also predicted improved outcomes from dose-dense chemotherapy (interaction P = .0998 for DFS; 0.027 for OS), independent of menopausal status. Specifically, low endocrine transcriptional activity predicted benefit from dose-dense chemotherapy, whereas tumor burden and proliferation-driven signatures for molecular subtype classification did not.

Conclusion: At 12-year follow-up, C9741 confirmed the sustained long-term benefit of adjuvant dose-dense chemotherapy for node-positive breast cancer. SET2,3 identified patients with ER+ breast cancer who benefited from dose-dense chemotherapy, and specifically, this benefit was predicted by low endocrine activity in the cancer, rather than tumor burden, molecular subtype, or menopausal status.

目的:有证据表明,一些雌激素受体阳性(ER+)的结节阳性患者可能从化疗中获益较少,有鉴于此,本研究报告了C9741试验12年的总体结果,并通过内分泌治疗敏感性(SET2,3)测试指数(一种测量内分泌转录活性的生物标志物)来确定最有可能从剂量密集化疗中获益的患者:总共有1973名患者被随机分配接受剂量密集化疗和常规化疗。根据长期无病生存期(DFS)和总生存期(OS)的Cox模型估算出预后的危险比(HRs)以及与化疗方案之间的预测性相互作用。对 682 例 ER+ 癌症的 RNA 库样本进行了 SET2,3 检验:结果:在整个研究人群中,剂量密集化疗使DFS提高了23%(HR,0.77[95% CI,0.66至0.90]),OS提高了20%(HR,0.80[95% CI,0.67至0.95]);在ER+和ER阴性亚群中,剂量密集治疗都能带来益处,但治疗组与ER状态之间没有显著的交互作用。低SET2,3状态是高度预后因素,但也预示着剂量密集化疗可改善预后(DFS的交互作用P = 0.0998;OS的交互作用P = 0.027),与绝经状态无关。具体来说,低内分泌转录活性可预测剂量密集化疗的获益,而肿瘤负荷和分子亚型分类的增殖驱动特征则不能预测:在12年的随访中,C9741证实了结节阳性乳腺癌辅助剂量密集化疗的长期持续获益。SET2,3发现了从剂量密集化疗中获益的ER+乳腺癌患者,特别是,这种获益是由癌症的低内分泌活性而非肿瘤负荷、分子亚型或绝经状态预测的。
{"title":"Adjuvant Dose-Dense Chemotherapy in Hormone Receptor-Positive Breast Cancer.","authors":"Otto Metzger Filho, Karla Ballman, Jordan Campbell, Minetta Liu, Jennifer Ligibel, Mark Watson, Eveline Chen, Lili Du, Daniel Stover, Lisa Carey, Ann Partridge, Jeffrey Kirshner, Hyman Muss, Clifford Hudis, Eric P Winer, Larry Norton, W Fraser Symmans","doi":"10.1200/JCO-24-01875","DOIUrl":"10.1200/JCO-24-01875","url":null,"abstract":"<p><strong>Purpose: </strong>In light of evolving evidence that some patients with node-positive estrogen receptor-positive (ER+) disease may receive less benefit from chemotherapy, this study reports 12-year outcomes of the C9741 trial overall, and by the sensitivity to endocrine therapy (SET2,3) test index, a biomarker measuring endocrine transcriptional activity, to identify patients most likely to benefit from dose-dense chemotherapy.</p><p><strong>Methods: </strong>In all, 1,973 patients were randomly assigned to dose-dense versus conventional chemotherapy. Hazard ratios (HRs) for prognosis and for predictive interaction with chemotherapy schedule were estimated from Cox models of long-term disease-free survival (DFS) and overall survival (OS). SET2,3 was tested on the 682 banked RNA samples from ER+ cancers.</p><p><strong>Results: </strong>Dose-dense chemotherapy improved DFS in the overall study population by 23% (HR, 0.77 [95% CI, 0.66 to 0.90]) and OS by 20% (HR, 0.80 [95% CI, 0.67 to 0.95]); the benefits of dose-dense therapy were seen for ER+ and ER-negative subsets, without significant interaction between treatment arm and ER status. Low SET2,3 status was highly prognostic, but also predicted improved outcomes from dose-dense chemotherapy (interaction <i>P</i> = .0998 for DFS; 0.027 for OS), independent of menopausal status. Specifically, low endocrine transcriptional activity predicted benefit from dose-dense chemotherapy, whereas tumor burden and proliferation-driven signatures for molecular subtype classification did not.</p><p><strong>Conclusion: </strong>At 12-year follow-up, C9741 confirmed the sustained long-term benefit of adjuvant dose-dense chemotherapy for node-positive breast cancer. SET2,3 identified patients with ER+ breast cancer who benefited from dose-dense chemotherapy, and specifically, this benefit was predicted by low endocrine activity in the cancer, rather than tumor burden, molecular subtype, or menopausal status.</p>","PeriodicalId":15384,"journal":{"name":"Journal of Clinical Oncology","volume":" ","pages":"1229-1239"},"PeriodicalIF":42.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2024.3.
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-01 Epub Date: 2025-02-27 DOI: 10.1200/JCO-24-02786
Natasha B Leighl, Nofisat Ismaila, Greg Durm, Narjust Florez, Janet Freeman-Daily, Bruna Pellini, Deebya Raj Mishra, Erin L Schenk, Lecia Sequist, Navneet Singh, Lyudmila Bazhenova

Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual. ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating clinician and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and 2). Updates are published regularly and can be found at https://ascopubs.org/nsclc-non-da-living-guideline.

{"title":"Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2024.3.","authors":"Natasha B Leighl, Nofisat Ismaila, Greg Durm, Narjust Florez, Janet Freeman-Daily, Bruna Pellini, Deebya Raj Mishra, Erin L Schenk, Lecia Sequist, Navneet Singh, Lyudmila Bazhenova","doi":"10.1200/JCO-24-02786","DOIUrl":"10.1200/JCO-24-02786","url":null,"abstract":"<p><p><i>Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the</i> <i>ASCO Guidelines Methodology Manual</i><i>. ASCO Living Guidelines follow the</i> <i>ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines</i><i>. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating clinician and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and 2). Updates are published regularly and can be found at</i> <i>https://ascopubs.org/nsclc-non-da-living-guideline</i>.</p>","PeriodicalId":15384,"journal":{"name":"Journal of Clinical Oncology","volume":" ","pages":"e17-e30"},"PeriodicalIF":42.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Datopotamab Deruxtecan in Advanced or Metastatic Non-Small Cell Lung Cancer With Actionable Genomic Alterations: Results From the Phase II TROPION-Lung05 Study.
IF 42.1 1区 医学 Q1 ONCOLOGY Pub Date : 2025-04-01 Epub Date: 2025-01-06 DOI: 10.1200/JCO-24-01349
Jacob Sands, Myung-Ju Ahn, Aaron Lisberg, Byoung Chul Cho, George Blumenschein, Elaine Shum, Elvire Pons Tostivint, Yasushi Goto, Kiyotaka Yoh, Rebecca Heist, Junichi Shimizu, Jong-Seok Lee, Paul Baas, David Planchard, Maurice Pérol, Enriqueta Felip, Wu-Chou Su, Hong Zebger-Gong, Lan Lan, Chelsea Liu, Paul Howarth, Rachel Chiaverelli, Luis Paz-Ares

Purpose: Datopotamab deruxtecan (Dato-DXd) is a trophoblast cell-surface antigen-2-directed antibody-drug conjugate with a highly potent topoisomerase I inhibitor payload. The TROPION-Lung05 phase II trial (ClinicalTrials.gov identifier: NCT04484142) evaluated the safety and clinical activity of Dato-DXd in patients with advanced/metastatic non-small cell lung cancer (NSCLC) with actionable genomic alterations progressing on or after targeted therapy and platinum-based chemotherapy.

Patients and methods: Patients received Dato-DXd 6 mg/kg once every 3 weeks. The primary end point was objective response rate (ORR) by blinded independent central review. Secondary end points included duration of response (DOR), safety, tolerability, and survival.

Results: Among 137 patients who received at least 1 dose of Dato-DXd, 71.5% received at least three lines of prior therapies for advanced/metastatic disease. Overall, 56.9% had EGFR mutations and 24.8% had ALK rearrangements. Median treatment duration was 4.4 months (range, 0.7-20.6). The confirmed ORR was 35.8% (95% CI, 27.8 to 44.4) overall, and 43.6% (95% CI, 32.4 to 55.3) and 23.5% (95% CI, 10.7 to 41.2) in those with EGFR mutations and ALK rearrangements, respectively. The median DOR was 7.0 months (95% CI, 4.2 to 9.8), and the overall disease control rate was 78.8% (95% CI, 71.0 to 85.3). Grade ≥3 treatment-related adverse events (TRAEs) occurred in 28.5% of patients. The most common TRAE was stomatitis (preferred term; any grade: 56.2%; grade ≥3: 9.5%). Five (3.6%) patients experienced adjudicated treatment-related interstitial lung disease/pneumonitis, with 1 (0.7%) grade 5 event.

Conclusion: Encouraging and durable antitumor activity was observed with Dato-DXd in this heavily pretreated advanced/metastatic NSCLC population with actionable genomic alterations. The rate of treatment-related grade ≥3 toxicities was comparable with previous observations, and no new safety signals were observed.

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Journal of Clinical Oncology
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