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A Phase I Trial of Atezolizumab and Varlilumab in Combination With Radiation in Patients With Metastatic NSCLC Atezolizumab和Varlilumab联合放疗治疗转移性NSCLC患者的I期试验
IF 3 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1016/j.jtocrr.2024.100687

Introduction

Anti-programmed cell death 1 (PD-1) immunotherapy is the standard of care for metastatic NSCLC but many tumors develop resistance. We hypothesized that combining a T-cell agonist such as varlilumab (anti-CD27 antibody) with checkpoint inhibition may be synergistic and this synergy may be potentiated further by using targeted radiation (RT).

Methods

We conducted an open-label, single-center, phase I trial (NCT04081688) to determine the safety and clinical benefit of the atezolizumab and varlilumab in combination with palliative RT in patients with advanced or metastatic NSCLC with progression on prior programmed cell death ligand 1therapy. On day 1 of each 21-day cycle, patients received varlilumab followed by atezolizumab on day 2. RT to a lung lesion was administered between cycle 1 and cycle 2.

Results

A total of 15 patients were enrolled (one patient did not start treatment). The median age was 64 years; 10 patients were female. Eight patients (57%) had at least one treatment-related adverse event (AE) and 7 (50%) had at least one grade III or worse treatment-related AE. There was only one grade III immune-related AE requiring steroids (1 diarrhea and colitis); there were no treatment-related deaths. Of the 12 patients evaluable for efficacy, three patients had stable disease (2 with stable disease > 4 mo) and the clinical benefit rate was 25%. The median progression-free survival was two months and the median overall survival was 6.4 months.

Conclusions

Varlilumab in combination with atezolizumab and RT was safe and well tolerated; no additional signal was identified for toxicity. Clinical activity for the combination was modest with 25% of patients with stable disease as the best response.

导言抗程序性细胞死亡1(PD-1)免疫疗法是治疗转移性NSCLC的标准疗法,但许多肿瘤会产生耐药性。我们假设,将T细胞激动剂如varlilumab(抗CD27抗体)与检查点抑制剂结合使用可能会产生协同作用,而使用靶向放射(RT)可能会进一步增强这种协同作用。方法我们进行了一项开放标签、单中心、I期试验(NCT04081688),以确定atezolizumab和varlilumab联合姑息性RT治疗既往接受过程序性细胞死亡配体1治疗且病情进展的晚期或转移性NSCLC患者的安全性和临床获益。在每个21天周期的第1天,患者接受varlilumab治疗,然后在第2天接受atezolizumab治疗。在第1周期和第2周期之间对肺部病灶进行RT治疗。结果共有15名患者入选(1名患者未开始治疗)。中位年龄为64岁;10名患者为女性。8名患者(57%)至少出现过一次治疗相关不良事件(AE),7名患者(50%)至少出现过一次III级或更严重的治疗相关不良事件。只有1例III级免疫相关不良反应需要使用类固醇(1例腹泻和结肠炎);没有治疗相关死亡病例。在可进行疗效评估的 12 例患者中,3 例患者病情稳定(2 例病情稳定 4 个月),临床获益率为 25%。中位无进展生存期为2个月,中位总生存期为6.4个月。结论Varlilumab与atezolizumab和RT联合治疗安全且耐受性良好;未发现额外的毒性信号。联合用药的临床活性不高,25%的患者病情稳定,这是最佳反应。
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引用次数: 0
The Overlooked Cornerstone in Precise Medicine: Personalized Postoperative Surveillance Plan for NSCLC 被忽视的精准医疗基石:针对 NSCLC 的个性化术后监控计划
IF 3 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1016/j.jtocrr.2024.100701

Non-small cell lung cancer recurrence after curative-intent surgery remains a challenge despite advancements in treatment. We review postoperative surveillance strategies and their impact on overall survival, highlighting recommendations from clinical guidelines and controversies. Studies suggest no clear benefit from more intensive imaging, whereas computed tomography scans reveal promise in detecting recurrence. For early-stage disease, including ground-glass opacities and adenocarcinoma in situ or minimally invasive adenocarcinoma, less frequent surveillance may suffice owing to favorable prognosis. Liquid biopsy, especially circulating tumor deoxyribonucleic acid, holds potential for detecting minimal residual disease. Clinicopathologic factors and genomic profiles can also provide information about site-specific metastases. Machine learning may enable personalized surveillance plans on the basis of multi-omics data. Although precision medicine transforms non-small cell lung cancer treatment, optimizing surveillance strategies remains essential. Tailored surveillance strategies and emerging technologies may enhance early detection and improve patients’ survival, necessitating further research for evidence-based protocols.

尽管治疗手段不断进步,但非小细胞肺癌治愈性手术后的复发仍是一项挑战。我们回顾了术后监测策略及其对总生存率的影响,重点介绍了临床指南的建议和争议。研究表明,加强影像学检查并没有明显的益处,而计算机断层扫描则显示出检测复发的前景。对于早期疾病,包括磨玻璃不透明、原位腺癌或微小浸润性腺癌,由于预后良好,监测频率较低即可。液体活检,尤其是循环肿瘤脱氧核糖核酸,具有检测微小残留疾病的潜力。临床病理因素和基因组图谱也能提供有关特定部位转移的信息。机器学习可以在多组学数据的基础上制定个性化的监控计划。虽然精准医疗改变了非小细胞肺癌的治疗,但优化监测策略仍然至关重要。量身定制的监控策略和新兴技术可能会提高早期检测率,改善患者的生存状况,因此有必要进一步研究循证方案。
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引用次数: 0
Real-World Treatment and Outcomes in ALK-Rearranged NSCLC: Results From a Large U.S.-Based Database ALK 重排非小细胞肺癌的实际治疗情况和结果;来自美国大型数据库的结果
IF 3 Q2 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.1016/j.jtocrr.2024.100662

Introduction

ALK–rearranged advanced NSCLC (aNSCLC) represents 4% of all NSCLCs, and multiple ALK-targeted therapies (ALK-inhibitors) are now available for use. Little is known about changes in treatment patterns, or how prognostic factors and sequence of therapy may impact overall survival in the real-world setting. We aim to describe initial and subsequent treatments used, survival outcomes, prognostic factors, and the impact of treatment on overall survival in the largest (N = 739) real-world cohort of patients with ALK+ aNSCLC reported in the literature.

Methods

Retrospective observational cohort study with data drawn from a U.S.-based electronic health record–derived, deidentified database. Eligible patients were diagnosed with ALK+ aNSCLC between 2011-2020 and were treated in multiple different cancer clinics and across multiple geographic regions throughout the United States.

Results

From a cohort of 63,667 patients with aNSCLC, 739 patients with ALK+ NSCLC were eligible for analysis, median age was 63 years, 54% patients were female, and 85% were managed in community setting. More than 168 different treatment sequences were observed, and treatment utilization changed over time. Cohort median overall survival was 37 months (95% confidence interval: 33–45). Positive prognostic factors were as follows: never-smoking history, younger age, treatment in an academic setting, and initial early stage at diagnosis. Initial treatment with a second-generation ALK-inhibitor was associated with improved survival compared with chemotherapy.

Conclusions

For people with ALK+ aNSCLC, this study has identified several important clinical prognostic factors and is practice affirming; first-line treatment with a second-generation ALK-inhibitor improves survival compared with chemotherapy.

导言ALK重组晚期NSCLC(aNSCLC)占所有NSCLC的4%,目前已有多种ALK靶向疗法(ALK抑制剂)可供使用。人们对治疗模式的变化,或预后因素和治疗顺序如何影响真实世界中的总生存期知之甚少。我们旨在描述文献报道的最大(N = 739)ALK+ aNSCLC 患者真实世界队列中使用的初始和后续治疗、生存结果、预后因素以及治疗对总生存期的影响。结果在63667名ANSCLC患者中,有739名ALK+ NSCLC患者符合分析条件,中位年龄为63岁,54%的患者为女性,85%的患者在社区接受治疗。观察到超过168种不同的治疗顺序,治疗利用率随时间而变化。队列中位总生存期为 37 个月(95% 置信区间:33-45)。积极的预后因素如下:从未吸烟、年龄较小、在学术机构接受治疗、诊断时处于早期阶段。结论对于ALK+ aNSCLC患者,本研究发现了几个重要的临床预后因素,并肯定了这一做法;与化疗相比,使用第二代ALK抑制剂进行一线治疗可提高生存率。
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引用次数: 0
Brief Report: Understanding Program-Level Impact of COVID-19 in Lung Cancer Screening Programs in the United States 简要报告:了解 COVID-19 对美国肺癌筛查计划的影响
IF 3 Q2 ONCOLOGY Pub Date : 2024-07-31 DOI: 10.1016/j.jtocrr.2024.100709

Introduction

Lung cancer screening (LCS) reduces lung cancer mortality, yet uptake pre– and post–coronavirus disease 2019 (COVID-19) remains low. The impact of COVID-19 on LCS programs across the United States is unknown. Ours is the first multi-institutional study to identify barriers to LCS experienced during the pandemic. Our work will hopefully inform the development of targeted resources to facilitate increased uptake of LCS.

Methods

A nationwide survey of Centers of Excellence (SCOE) in LCS was conducted by GO2 for Lung Cancer Foundation. In 2021, survey items included questions regarding program structure, screening rates, and systemic barriers to LCS delivery experienced amid COVID-19.

Results

A total of 99 programs representing 1112 screening sites responded. A median of 868 patients were screened during the year of 2020. Patient recruitment, patient education, and in-person service access were negatively affected by COVID-19, whereas the use of telemedicine was positively affected. Coordination of care and timely reporting of results were largely unaffected by the pandemic.

Conclusions

Our findings provide a real-world snapshot of how COVID-19 affected LCS from a program perspective. These findings highlight ongoing challenges with educating and engaging those at high risk for lung cancer in LCS. Program resources should be directed toward increasing adherence to LCS among eligible patients.

导言肺癌筛查(LCS)可降低肺癌死亡率,但 2019 年冠状病毒疾病(COVID-19)前后的肺癌筛查率仍然很低。COVID-19 对美国各地肺癌筛查项目的影响尚不清楚。我们的研究是第一项多机构研究,旨在确定大流行期间LCS遇到的障碍。我们的工作有望为开发有针对性的资源提供信息,从而促进更多的人接受 LCS。方法 GO2 为肺癌基金会开展了一项全国范围的 LCS 卓越中心 (SCOE) 调查。2021 年,调查项目包括项目结构、筛查率以及 COVID-19 中遇到的 LCS 系统障碍等问题。2020 年全年筛查的患者人数中位数为 868 人。COVID-19对患者招募、患者教育和现场服务的获得产生了负面影响,而对远程医疗的使用产生了积极影响。我们的研究结果提供了一个真实世界的缩影,从项目的角度说明了 COVID-19 对 LCS 的影响。这些发现凸显了在教育和吸引肺癌高危人群参与肺癌防治方面持续存在的挑战。应将项目资源用于提高符合条件的患者对 LCS 的依从性。
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引用次数: 0
Antibiotic Use and Survival in Patients With Late-Stage NSCLC Treated With Chemoimmunotherapy 化疗免疫疗法晚期 NSCLC 患者的抗生素使用与生存率
IF 3 Q2 ONCOLOGY Pub Date : 2024-07-31 DOI: 10.1016/j.jtocrr.2024.100710

Introduction

Immunotherapy has improved survival in patients with advanced NSCLC. Efficacy may decrease when patients are treated with antibiotics, possibly due to gut microbiome disruption, but few studies have investigated this using real-world, patient-level populations in the United States.

Methods

We have analyzed antibiotic use in patients with stage IV first, primary NSCLC diagnosed in 2015 and treated with chemotherapy or chemoimmunotherapy, drawn from the Surveillance, Epidemiology, and End Results-Medicare data set. Patients had to have continuous part A, part B, and part D Medicare coverage. Survival was determined through Kaplan-Meier and Cox proportional hazards models. All data analyses were performed using SAS.

Results

The study included 788 patients, 440 (56%) of whom received antibiotics within 2 months before or after starting systemic treatment. The median follow-up time was 11.64 months. There was a statistically significant difference in survival for patients who received antibiotics (p = 0.007) and who had more than 1 round of antibiotics versus zero or 1 round (p < 0.0001). After adjustment, receipt of antibiotics (hazard ratio [HR]adj: 1.17, 95% confidence interval [CI]: 0.99–1.37) and receipt of multiple rounds of antibiotics (HRadj: 1.35, 95% CI: 1.14–1.60) were statistically significantly associated with worse survival. Among just those receiving chemoimmunotherapy (n = 203; 26%), there was still an increased risk of death for those receiving multiple antibiotic rounds (HRadj: 1.52, 95% CI: 1.09–2.13).

Conclusions

Antibiotic use concurrent with chemoimmunotherapy seems to be associated with worse survival. This is more pronounced when more cycles of antibiotics are given.

IRB approval number

STUDY-19-00500.
导言免疫疗法提高了晚期 NSCLC 患者的生存率。可能由于肠道微生物组的破坏,患者接受抗生素治疗时疗效可能会下降,但很少有研究利用美国真实世界的患者群体对此进行调查。方法我们分析了2015年确诊的IV期初治NSCLC患者中使用抗生素的情况,这些患者接受了化疗或化学免疫疗法,数据来自监测、流行病学和最终结果-医疗保险数据集。患者必须连续参加 A 部分、B 部分和 D 部分医疗保险。生存率通过卡普兰-梅耶(Kaplan-Meier)和考克斯比例危险模型确定。所有数据分析均使用 SAS 进行。研究共纳入 788 名患者,其中 440 人(56%)在开始系统治疗前后 2 个月内接受了抗生素治疗。中位随访时间为 11.64 个月。接受过抗生素治疗的患者(p = 0.007)与接受过一轮以上抗生素治疗的患者(p <0.0001)在生存率上有显著统计学差异。经调整后,接受抗生素治疗(危险比[HR]adj:1.17,95% 置信区间[CI]:0.99-1.37)和接受多轮抗生素治疗(HRadj:1.35,95% 置信区间[CI]:1.14-1.60)在统计学上与较差的生存率显著相关。仅在接受化学免疫疗法的患者(n = 203;26%)中,接受多轮抗生素治疗的患者死亡风险仍然增加(HRadj:1.52,95% CI:1.09-2.13)。结论化疗免疫疗法同时使用抗生素似乎与生存率降低有关,当使用抗生素的周期越多,生存率越低。
{"title":"Antibiotic Use and Survival in Patients With Late-Stage NSCLC Treated With Chemoimmunotherapy","authors":"","doi":"10.1016/j.jtocrr.2024.100710","DOIUrl":"10.1016/j.jtocrr.2024.100710","url":null,"abstract":"<div><h3>Introduction</h3><div>Immunotherapy has improved survival in patients with advanced NSCLC. Efficacy may decrease when patients are treated with antibiotics, possibly due to gut microbiome disruption, but few studies have investigated this using real-world, patient-level populations in the United States.</div></div><div><h3>Methods</h3><div>We have analyzed antibiotic use in patients with stage IV first, primary NSCLC diagnosed in 2015 and treated with chemotherapy or chemoimmunotherapy, drawn from the Surveillance, Epidemiology, and End Results-Medicare data set. Patients had to have continuous part A, part B, and part D Medicare coverage. Survival was determined through Kaplan-Meier and Cox proportional hazards models. All data analyses were performed using SAS.</div></div><div><h3>Results</h3><div>The study included 788 patients, 440 (56%) of whom received antibiotics within 2 months before or after starting systemic treatment. The median follow-up time was 11.64 months. There was a statistically significant difference in survival for patients who received antibiotics (<em>p</em> = 0.007) and who had more than 1 round of antibiotics versus zero or 1 round (<em>p</em> &lt; 0.0001). After adjustment, receipt of antibiotics (hazard ratio [HR]<sub>adj</sub>: 1.17, 95% confidence interval [CI]: 0.99–1.37) and receipt of multiple rounds of antibiotics (HR<sub>adj</sub>: 1.35, 95% CI: 1.14–1.60) were statistically significantly associated with worse survival. Among just those receiving chemoimmunotherapy (n = 203; 26%), there was still an increased risk of death for those receiving multiple antibiotic rounds (HR<sub>adj</sub>: 1.52, 95% CI: 1.09–2.13).</div></div><div><h3>Conclusions</h3><div>Antibiotic use concurrent with chemoimmunotherapy seems to be associated with worse survival. This is more pronounced when more cycles of antibiotics are given.</div></div><div><h3>IRB approval number</h3><div>STUDY-19-00500.</div></div>","PeriodicalId":17675,"journal":{"name":"JTO Clinical and Research Reports","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tarlatamab for Large Cell Neuroendocrine Carcinoma in a Young Adult: A Case Report 塔拉他单抗治疗一名年轻成人的大细胞神经内分泌癌:病例报告
IF 3 Q2 ONCOLOGY Pub Date : 2024-07-31 DOI: 10.1016/j.jtocrr.2024.100712

A 20-year-old man with metastatic large cell neuroendocrine carcinoma of the lung was treated with the delta-like ligand 3–targeting bispecific T cell engager, tarlatamab. Treatment was complicated by transient cytokine release syndrome but resulted in a partial response. Bispecific T cell engagers may offer a novel treatment approach for large cell neuroendocrine carcinoma of the lung.

一名患有转移性肺大细胞神经内分泌癌的 20 岁男子接受了 delta-like ligand 3 靶向双特异性 T 细胞捕获剂 tarlatamab 的治疗。治疗过程中出现了一过性细胞因子释放综合征,但最终取得了部分疗效。双特异性T细胞捕获剂可能会为肺大细胞神经内分泌癌提供一种新的治疗方法。
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引用次数: 0
Immune Cell Dynamics in EGFR-Mutated NSCLC Treated With Afatinib and Pembrolizumab: Results From a Phase IB Study 用阿法替尼和 Pembrolizumab 治疗表皮生长因子受体 (EGFR) 突变的非小细胞肺癌 (NSCLC) 的免疫细胞动态:IB期研究结果
IF 3 Q2 ONCOLOGY Pub Date : 2024-07-14 DOI: 10.1016/j.jtocrr.2024.100706

Introduction

EGFR-mutated NSCLC is minimally responsive to programmed cell death protein 1 or programmed death-ligand 1 blockade. We evaluated the safety, tolerability, and immunomodulatory effects of the EGFR tyrosine kinase inhibitor (TKI) afatinib in combination with the programmed cell death protein 1 antibody pembrolizumab in patients with EGFR-mutant NSCLC.

Methods

Patients with advanced EGFR-mutant NSCLC with progression (PD) on previous EGFR TKI(s), aged above or equal to 18 years, Eastern Cooperative Oncology Group performance status less than or equal to 1, acceptable organ function, no significant autoimmune disease, measurable disease, and controlled brain metastases were eligible. Primary end point was determination of the maximum tolerated dose and recommended phase 2 dose. Serial specimens were collected to assess for alterations in cytokines and immune cell subsets by quantitative immunofluorescence in tissue and Luminex and flow cytometry in the blood.

Results

A total of 11 patients were enrolled, six in dose finding and five in dose expansion. No dose-limiting toxicities were observed. The maximum tolerated dose was determined to be afatinib 40 mg orally daily and pembrolizumab 200 mg intravenously every 21 days. Four (36%) patients had immune-related adverse events (irAEs). Ten patients were assessable for response: two partial response, seven stable disease, and one PD. Peripheral natural killer and natural killer T-cells (p = 0.027, p = 0.01) increased and exhausted CD8+ T-cells decreased on treatment (p = 0.0035). Peripheral CD4/CD8 T-cells (area under the curve = 0.96, p = 0.042) and central memory T-cells (CD4/CD8) (area under the curve = 1.0, p = 0.0006) increased in patients who had disease control more than 6 months or partial response to afatinib/pembrolizumab as did CD3+ T-cells in a patient with progression-free survival more than 6 months after afatinib/pembrolizumab treatment.

Conclusions

Afatinib and pembrolizumab were found to have modest activity associated with irAEs after PD on previous EGFR TKI setting. Proinflammatory changes in immune cell subsets in tissue and blood were detected and associated with antitumor activity and irAEs.

导言表皮生长因子受体(EGFR)突变的非小细胞肺癌对程序性细胞死亡蛋白1或程序性死亡配体1的阻断反应微弱。我们评估了EGFR酪氨酸激酶抑制剂(TKI)阿法替尼联合程序性细胞死亡蛋白1抗体pembrolizumab治疗EGFR突变NSCLC患者的安全性、耐受性和免疫调节作用。方法符合以下条件的晚期表皮生长因子受体突变型NSCLC患者:既往接受过表皮生长因子受体抑制剂(TKI)治疗,病情进展(PD);年龄大于或等于18岁;东部合作肿瘤学组(Eastern Cooperative Oncology Group)表现状态小于或等于1;器官功能可接受;无明显自身免疫性疾病;病情可测量;脑转移得到控制。主要终点是确定最大耐受剂量和第二阶段推荐剂量。通过组织中的定量免疫荧光和血液中的 Luminex 及流式细胞术,收集序列标本以评估细胞因子和免疫细胞亚群的变化。未观察到剂量限制性毒性。确定的最大耐受剂量为每日口服阿法替尼40毫克,每21天静脉注射pembrolizumab 200毫克。4名患者(36%)出现了免疫相关不良事件(irAEs)。10名患者可评估反应:2名部分反应,7名病情稳定,1名病情恶化。治疗期间,外周自然杀伤细胞和自然杀伤 T 细胞增加(p = 0.027,p = 0.01),CD8+ T 细胞减少(p = 0.0035)。外周 CD4/CD8 T 细胞(曲线下面积 = 0.96,p = 0.042)和中枢记忆 T 细胞(CD4/CD8)(曲线下面积 = 1.0,p = 0.结论阿法替尼和pembrolizumab在既往EGFR TKI治疗PD后具有与irAEs相关的适度活性。检测到组织和血液中免疫细胞亚群的促炎性变化与抗肿瘤活性和irAEs有关。
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引用次数: 0
Combination of Cytologic Findings and Circulating Tumor DNA From Cerebrospinal Fluid Revealed SCLC Transformation in Patients With Leptomeningeal Metastases of Lung Adenocarcinoma 结合细胞学和脑脊液中的ctDNA,揭示肺腺癌多脑膜转移患者的小细胞肺癌转化过程
IF 3 Q2 ONCOLOGY Pub Date : 2024-07-06 DOI: 10.1016/j.jtocrr.2024.100704

Introduction

Transformation to SCLC is a resistance mechanism to tyrosine kinase inhibitor in EGFR-mutated lung adenocarcinoma (LUAD). Nevertheless, the clinical and molecular features of SCLC transformation in LUAD with leptomeningeal metastases (LM) are scarce.

Methods

We retrospectively collected 237 patients with NSCLC who underwent lumbar puncture owing to suggestion of LM. All SCLC transformation in cerebrospinal fluid (CSF) was confirmed by two experienced pathologists using cytologic evaluation. CSF circulating tumor DNA (ctDNA) was tested by next-generation sequencing.

Results

Tumor cells in CSF samples were found in 111 patients (111 of 237, 46.8%), and eight cases (eight of 111, 7.2%) were identified as having SCLC cells in CSF. Seven patients carried the EGFR mutation, including four patients with EGFR exon 19 deletion and three patients with EGFR exon 21 L858R mutation. Another patient harbored ERBB2 insertion. Seven of these patients were resistant to targeted therapy. CSF ctDNA analysis reported that TP53 and RB1 mutations were common. The median time from the diagnosis of advanced NSCLC to SCLC transformation found in CSF was 9.7 months (95% confidence interval [CI]: 4.0–17.5 mo). The median overall survival since the initial diagnosis of metastatic NSCLC was 15.3 months (95% CI: 1.2–29.4 mo). The median overall survival after SCLC transformation detected in CSF was 5.0 months (95% CI: 4.0–5.9 mo).

Conclusions

SCLC transformation may be revealed in CSF by both cytologic evaluation and ctDNA, not just in tissue that underwent rebiopsy. SCLC transformation of CSF is informative for resistance mechanism in patients with LUAD with LM on tyrosine kinase inhibitor progression, which was associated with poor survival.

导言向SCLC转化是表皮生长因子受体(EGFR)突变的肺腺癌(LUAD)对酪氨酸激酶抑制剂的一种耐药机制。方法 我们回顾性地收集了237例因出现脑脊液转移(LM)而接受腰椎穿刺的NSCLC患者。所有脑脊液(CSF)中的 SCLC 转移均由两位经验丰富的病理学家通过细胞学评估确认。结果111例患者(237例中有111例,占46.8%)的CSF样本中发现了肿瘤细胞,8例(111例中有8例,占7.2%)被确定为CSF中有SCLC细胞。七名患者携带表皮生长因子受体突变,其中四名患者的表皮生长因子受体外显子19缺失,三名患者的表皮生长因子受体外显子21 L858R突变。另一名患者携带 ERBB2 插入基因。其中七名患者对靶向治疗耐药。CSF ctDNA分析显示,TP53和RB1突变很常见。从诊断为晚期NSCLC到CSF中发现SCLC转化的中位时间为9.7个月(95%置信区间[CI]:4.0-17.5个月)。转移性 NSCLC 初次诊断后的中位总生存期为 15.3 个月(95% 置信区间:1.2-29.4 个月)。在CSF中检测到SCLC转化后的中位总生存期为5.0个月(95% CI:4.0-5.9个月)。CSF中的SCLC转化可为酪氨酸激酶抑制剂治疗进展期LM的LUAD患者的耐药机制提供信息,而LM的耐药机制与患者的生存率较低有关。
{"title":"Combination of Cytologic Findings and Circulating Tumor DNA From Cerebrospinal Fluid Revealed SCLC Transformation in Patients With Leptomeningeal Metastases of Lung Adenocarcinoma","authors":"","doi":"10.1016/j.jtocrr.2024.100704","DOIUrl":"10.1016/j.jtocrr.2024.100704","url":null,"abstract":"<div><h3>Introduction</h3><p>Transformation to SCLC is a resistance mechanism to tyrosine kinase inhibitor in <em>EGFR</em>-mutated lung adenocarcinoma (LUAD). Nevertheless, the clinical and molecular features of SCLC transformation in LUAD with leptomeningeal metastases (LM) are scarce.</p></div><div><h3>Methods</h3><p>We retrospectively collected 237 patients with NSCLC who underwent lumbar puncture owing to suggestion of LM. All SCLC transformation in cerebrospinal fluid (CSF) was confirmed by two experienced pathologists using cytologic evaluation. CSF circulating tumor DNA (ctDNA) was tested by next-generation sequencing.</p></div><div><h3>Results</h3><p>Tumor cells in CSF samples were found in 111 patients (111 of 237, 46.8%), and eight cases (eight of 111, 7.2%) were identified as having SCLC cells in CSF. Seven patients carried the <em>EGFR</em> mutation, including four patients with <em>EGFR exon 19 deletion</em> and three patients with <em>EGFR</em> <em>exon</em> <em>21 L858R</em> mutation. Another patient harbored <em>ERBB2</em> insertion. Seven of these patients were resistant to targeted therapy. CSF ctDNA analysis reported that <em>TP53</em> and <em>RB1</em> mutations were common. The median time from the diagnosis of advanced NSCLC to SCLC transformation found in CSF was 9.7 months (95% confidence interval [CI]: 4.0–17.5 mo). The median overall survival since the initial diagnosis of metastatic NSCLC was 15.3 months (95% CI: 1.2–29.4 mo). The median overall survival after SCLC transformation detected in CSF was 5.0 months (95% CI: 4.0–5.9 mo).</p></div><div><h3>Conclusions</h3><p>SCLC transformation may be revealed in CSF by both cytologic evaluation and ctDNA, not just in tissue that underwent rebiopsy. SCLC transformation of CSF is informative for resistance mechanism in patients with LUAD with LM on tyrosine kinase inhibitor progression, which was associated with poor survival.</p></div>","PeriodicalId":17675,"journal":{"name":"JTO Clinical and Research Reports","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666364324000742/pdfft?md5=870ec4f4f2918aac97890cf20e833f5f&pid=1-s2.0-S2666364324000742-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reproducibility of Assessment of Lepidic (Noninvasive) Patterns in Lung Adenocarcinoma With Cytokeratin Immunostain Compared With Hematoxylin and Eosin and the Proposed New International Association for the Study of Lung Cancer (IASLC) Algorithm 用细胞角蛋白免疫印迹评估肺腺癌鳞状(非侵袭性)模式的再现性与苏木精和伊红以及拟议的 IASLC 新算法进行比较
IF 3 Q2 ONCOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.jtocrr.2024.100682
Ellen Yang MD, FRCPC , Najd Alshamlan MD , Katrina Hueniken MSc , Jessica Weiss MSc , Michael Cabanero MD , Ming-Sound Tsao MD, FRCPC

Introduction

Lepidic growth is considered noninvasive in lung nonmucinous adenocarcinoma, whereas other patterns are invasive. Considerable interobserver variability in assessing “invasion” has been reported. We assessed the utility of cytokeratin 7 (CK7) stain and recently proposed International Association for the Study of Lung Cancer criteria to improve assessment of noninvasion in lung adenocarcinoma.

Methods

Four pathologists (two staff, two trainees) assessed 158 hematoxylin and eosin (HE)- and CK7-stained slides of 108 pT1N0-2 nonmucinous lung adenocarcinoma cases. Scoring took place in four rounds. First, sections were independently scored for percentage of noninvasive or probable noninvasive and invasive or probable invasive patterns. Second, after a consensus scoring algorithm for CK7 was formulated, the slides were rescored. Subsequent third-round scoring was conducted only on HE slides using the 2023 International Association for the Study of Lung Cancer proposed criteria, and fourth-round scoring on both HE and CK7 slides simultaneously. Intraclass correlation coefficient (ICC) was calculated for each round. Recurrence-free survival was assessed using Cox proportional hazards regression methods.

Results

In the first two rounds, interobserver concordance was consistently higher with CK7 (ICC range = 0.44–0.6) than HE (range = 0.24–0.49) scores. The IASLC proposed algorithm improved ICC of HE scores to 0.60 (95% confidence interval: 0.52–0.67), and round 4 HE and CK7 combined improved ICC to 0.75 (95% confidence interval: 0.70–0.80). Continuous measures of averaged noninvasive and probable noninvasive scores on HE were associated with improved recurrence-free survival (hazard ratio: 0.83–0.86).

Conclusions

CK7 staining consistently increased interobserver concordance in assessment of invasive versus noninvasive patterns than HE. Combining CK7 with the 2023 IASLC criteria for morphologic features of invasion may further improve the interobservers’ concordance for the recognition of lepidic growth in nonmucinous lung adenocarcinoma.

导言在肺非粘液腺癌中,浸润性生长被认为是非侵袭性的,而其他形态则是侵袭性的。据报道,在评估 "侵袭 "时,观察者之间存在相当大的差异。我们评估了细胞角蛋白 7(CK7)染色和最近提出的国际肺癌研究协会标准对改善肺腺癌非侵袭性评估的实用性。方法四名病理学家(两名工作人员,两名实习生)评估了 108 例 pT1N0-2 非粘液性肺腺癌的 158 张苏木精和伊红(HE)及 CK7 染色切片。评分分四轮进行。首先,根据非浸润性或可能非浸润性和浸润性或可能浸润性模式的百分比对切片进行独立评分。其次,在对 CK7 的评分算法达成共识后,对切片进行重新评分。随后的第三轮评分仅对 HE 切片进行,采用 2023 年国际肺癌研究协会提出的标准,第四轮评分同时对 HE 和 CK7 切片进行。每轮评分均计算类内相关系数(ICC)。结果 在前两轮评分中,CK7评分的观察者间一致性(ICC范围=0.44-0.6)始终高于HE评分(ICC范围=0.24-0.49)。IASLC 提出的算法将 HE 评分的 ICC 提高到了 0.60(95% 置信区间:0.52-0.67),第 4 轮 HE 和 CK7 的组合将 ICC 提高到了 0.75(95% 置信区间:0.70-0.80)。HE上平均非侵袭性和可能非侵袭性评分的连续测量与无复发生存率的改善相关(危险比:0.83-0.86)。结论CK7染色比HE能持续提高侵袭性与非侵袭性模式评估的观察者间一致性。将 CK7 与 2023 年 IASLC 侵袭形态学特征标准相结合,可进一步提高观察者之间在识别非黏液性肺腺癌鳞状生长方面的一致性。
{"title":"Reproducibility of Assessment of Lepidic (Noninvasive) Patterns in Lung Adenocarcinoma With Cytokeratin Immunostain Compared With Hematoxylin and Eosin and the Proposed New International Association for the Study of Lung Cancer (IASLC) Algorithm","authors":"Ellen Yang MD, FRCPC ,&nbsp;Najd Alshamlan MD ,&nbsp;Katrina Hueniken MSc ,&nbsp;Jessica Weiss MSc ,&nbsp;Michael Cabanero MD ,&nbsp;Ming-Sound Tsao MD, FRCPC","doi":"10.1016/j.jtocrr.2024.100682","DOIUrl":"10.1016/j.jtocrr.2024.100682","url":null,"abstract":"<div><h3>Introduction</h3><p>Lepidic growth is considered noninvasive in lung nonmucinous adenocarcinoma, whereas other patterns are invasive. Considerable interobserver variability in assessing “invasion” has been reported. We assessed the utility of cytokeratin 7 (CK7) stain and recently proposed International Association for the Study of Lung Cancer criteria to improve assessment of noninvasion in lung adenocarcinoma.</p></div><div><h3>Methods</h3><p>Four pathologists (two staff, two trainees) assessed 158 hematoxylin and eosin (HE)- and CK7-stained slides of 108 pT1N0-2 nonmucinous lung adenocarcinoma cases. Scoring took place in four rounds. First, sections were independently scored for percentage of noninvasive or probable noninvasive and invasive or probable invasive patterns. Second, after a consensus scoring algorithm for CK7 was formulated, the slides were rescored. Subsequent third-round scoring was conducted only on HE slides using the 2023 International Association for the Study of Lung Cancer proposed criteria, and fourth-round scoring on both HE and CK7 slides simultaneously. Intraclass correlation coefficient (ICC) was calculated for each round. Recurrence-free survival was assessed using Cox proportional hazards regression methods.</p></div><div><h3>Results</h3><p>In the first two rounds, interobserver concordance was consistently higher with CK7 (ICC range = 0.44–0.6) than HE (range = 0.24–0.49) scores. The IASLC proposed algorithm improved ICC of HE scores to 0.60 (95% confidence interval: 0.52–0.67), and round 4 HE and CK7 combined improved ICC to 0.75 (95% confidence interval: 0.70–0.80). Continuous measures of averaged noninvasive and probable noninvasive scores on HE were associated with improved recurrence-free survival (hazard ratio: 0.83–0.86).</p></div><div><h3>Conclusions</h3><p>CK7 staining consistently increased interobserver concordance in assessment of invasive versus noninvasive patterns than HE. Combining CK7 with the 2023 IASLC criteria for morphologic features of invasion may further improve the interobservers’ concordance for the recognition of lepidic growth in nonmucinous lung adenocarcinoma.</p></div>","PeriodicalId":17675,"journal":{"name":"JTO Clinical and Research Reports","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666364324000523/pdfft?md5=505547fe19126cb010ec9fc15e678934&pid=1-s2.0-S2666364324000523-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141042571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Successful Lorlatinib Rechallenge After Severe Drug-Induced Psychosis in ALK-Positive Metastatic NSCLC: A Case Report ALK 阳性转移性非小细胞肺癌(NSCLC)患者在严重的药物诱发精神病后成功重试洛拉替尼:病例报告
IF 3 Q2 ONCOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.jtocrr.2024.100689

Neurocognitive adverse events (NAEs) have been reported in up to 60% of patients on lorlatinib, a potent central nervous system–active ALK inhibitor. Manifestations may include psychotic, mood, speech, and cognitive symptoms. Current guidance recommends permanent discontinuation of lorlatinib in cases of grade IV NAEs. Here, we report a case of successful rechallenge of dose-reduced lorlatinib after recovery of grade IV psychosis in a patient with ALK-positive NSCLC.

据报道,在服用中枢神经系统活性 ALK 强效抑制剂洛拉替尼(lorlatinib)的患者中,神经认知不良事件(NAEs)的发生率高达 60%。表现可能包括精神、情绪、言语和认知症状。目前的指南建议,在出现IV级非神经系统毒性反应时,应永久停用lorlatinib。在此,我们报告了一例ALK阳性NSCLC患者在恢复IV级精神病后成功重新挑战剂量降低后的lorlatinib的病例。
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引用次数: 0
期刊
JTO Clinical and Research Reports
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