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Cost-Effectiveness of Durvalumab After Chemoradiotherapy in Limited-Stage SCLC Durvalumab在有限期SCLC放化疗后的成本-效果
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-11-01 Epub Date: 2025-07-12 DOI: 10.1016/j.jtocrr.2025.100879
Sheng-Han Tsai MD , Jui-Hung Tsai MD , Li-Jun Chen MS , Szu-Chun Yang MD, PhD

Introduction

In the ADRIATIC trial, durvalumab consolidation therapy improved the overall survival and progression-free survival of patients with limited-stage SCLC responding to chemoradiotherapy. Based on the data, we aim to assess the cost-effectiveness of the therapy from the perspective of the Taiwanese health care sector.

Methods

Simulated patients with limited-stage SCLC responding to chemoradiotherapy were entered into a partitioned survival model comparing durvalumab consolidation with no consolidation therapy. The model inputs were derived from the ADRIATIC trial (survival outcomes, adverse events, and subsequent therapies), National Health Insurance payments (costs of physician visits, monitoring, drug administration, and end-of-life care), and the hospital cohort (utility values). A lifetime horizon and annual discount rate of 3% were applied. Subgroup, one-way deterministic, and probabilistic analyses were performed.

Results

Durvalumab consolidation therapy incurred an additional $91,734 USD and brought about 0.90 quality-adjusted life years (QALYs) gained, resulting in an incremental cost-effectiveness ratio (ICER) of $101,734 USD per QALY. The ICER remained higher than the willingness-to-pay threshold of $70,000 USD per QALY across most patient subgroups. The most influential factor for the ICER was the cost of durvalumab. If the 4-week drug cost could be reduced to $3893 USD, the ICER would fall below 70,000 USD per QALY. At the willingness-to-pay threshold, durvalumab consolidation therapy had a probability of 0.3% being cost-effective.

Conclusions

Our analysis suggests that durvalumab consolidation therapy is not cost-effective for patients with limited-stage SCLC. Reducing the price of the therapy enhances cost-effectiveness.
在ADRIATIC试验中,durvalumab巩固治疗改善了对放化疗有反应的有限期SCLC患者的总生存期和无进展生存期。基于这些数据,我们的目的是从台湾医疗保健部门的角度评估该疗法的成本效益。方法模拟对放化疗有反应的有限期SCLC患者进入分区生存模型,比较杜伐单抗巩固治疗和无巩固治疗。模型输入来自亚得里亚海试验(生存结果、不良事件和后续治疗)、国民健康保险支付(医生就诊、监测、药物管理和临终关怀的费用)和医院队列(效用值)。使用寿命期限和3%的年贴现率。进行亚组分析、单向确定性分析和概率分析。结果durvalumab巩固治疗增加了91,734美元,增加了0.90质量调整生命年(QALY),导致每个QALY的增量成本-效果比(ICER)为101,734美元。在大多数患者亚组中,ICER仍然高于每个QALY 7万美元的支付意愿阈值。对ICER影响最大的因素是杜伐单抗的成本。如果4周的药费可以降低到3893美元,ICER将降至每QALY 7万美元以下。在支付意愿阈值下,杜伐单抗巩固治疗的成本效益概率为0.3%。结论我们的分析表明,durvalumab巩固治疗对于有限期SCLC患者并不具有成本效益。降低治疗价格可以提高成本效益。
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引用次数: 0
ICTIS: A Novel Scoring System to Assess the Inclusivity of Advanced NSCLC Immunotherapy Trials ICTIS:一种评估晚期NSCLC免疫治疗试验包容性的新型评分系统
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-11-01 Epub Date: 2025-07-12 DOI: 10.1016/j.jtocrr.2025.100878
Kira Nguyen , Ashley Wei , Srinivas Govindan MD , Eziafa Oduah MD, PhD , Nagashree Seetharamu MD , Wint Yan Aung MD

Introduction

Immunotherapy has revolutionized the treatment of NSCLC. However, trials that led to approval of these agents and ongoing trials often include overly included overly restrictive exclusion criteria, limiting access for a significant proportion of patients. We propose the immunotherapy clinical trial inclusivity score (ICTIS), a scoring system to evaluate trial eligibility criteria for inclusivity.

Methods

ICTIS was developed using national guidelines and validated with a Cohen’s Kappa statistics of 0.807. Eligibility criteria for advanced NSCLC immunotherapy trials on ClinicalTrials.gov were scored using a binary scale (0 = exclusive, 1 = inclusive), with higher summed scores indicating higher inclusivity. Mean ICTIS scores were compared across lines of treatment, start date, and trial phase.

Results

The mean ICTIS score among 142 trials was 12.7 (SD 4), with 28 trials (19.7%) rated as excellent and 34 trials (23.9%) rated poor. The most restrictive criteria were Eastern Cooperative Oncology Group performance status (78.8%), organ function criteria of bilirubin (76.1%), and absolute neutrophil count (65.5%). First-line trials were significantly more exclusive to patients with pneumonitis history, with 64% exclusion versus 45.5% in second-line (χ2 = 4.917, p = 0.027). The platelet count requirement was more stringent in monotherapy trials. Inclusion of treated leptomeningeal disease improved over time (χ2 = 7.99, p = 0.018), but eligibility criteria remained consistent across different time periods, lines of treatment, and trial phases.

Conclusions

Despite the release of national guidelines, immunotherapy trials have overall retained restrictive eligibility criteria. ICTIS provides a standardized framework for evaluating inclusivity and can assist in designing immunotherapy studies to be more inclusive.
免疫疗法已经彻底改变了非小细胞肺癌的治疗。然而,导致这些药物获得批准的试验和正在进行的试验通常包括过度纳入过于严格的排除标准,限制了很大一部分患者的使用。我们提出了免疫治疗临床试验包容性评分(ICTIS),这是一个评估试验包容性资格标准的评分系统。方法sictis采用国家指南开发,采用0.807的Cohen’s Kappa统计量进行验证。临床试验网站ClinicalTrials.gov上晚期NSCLC免疫治疗试验的资格标准采用二元评分(0 =排他,1 =包容),总得分越高,包容性越高。比较不同治疗线、开始日期和试验阶段的平均ICTIS评分。结果142项试验的ICTIS平均评分为12.7 (SD 4),其中优28项(19.7%),差34项(23.9%)。最严格的标准是东部肿瘤合作组表现状态(78.8%)、胆红素器官功能标准(76.1%)和绝对中性粒细胞计数(65.5%)。一线试验对有肺炎史的患者的排他性更高,排他性为64%,二线试验为45.5% (χ2 = 4.917, p = 0.027)。单药治疗试验对血小板计数的要求更为严格。随着时间的推移,治疗后的轻脑膜疾病的纳入情况有所改善(χ2 = 7.99, p = 0.018),但不同时间段、治疗线和试验阶段的入选标准保持一致。尽管发布了国家指南,但免疫治疗试验总体上保留了限制性的资格标准。ICTIS提供了一个评估包容性的标准化框架,可以帮助设计更具包容性的免疫治疗研究。
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引用次数: 0
Monotherapy With Immune Checkpoint Blockade Improves Survival Outcomes in KRAS-Mutant but Not KRAS Wild-Type Metastatic Lung Adenocarcinoma: Validation From an Extended Swedish Cohort 免疫检查点阻断单药治疗可改善KRAS突变型而非KRAS野生型转移性肺腺癌的生存结局:来自瑞典扩展队列的验证
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-10-01 Epub Date: 2025-07-17 DOI: 10.1016/j.jtocrr.2025.100880
Ella A. Eklund MD , Sama I. Sayin MD, PhD , Jonas Smith Jonsson MD , Hannes van Renswoude MD , Jan Nyman MD, PhD , Andreas Hallqvist MD, PhD , Clotilde Wiel PhD , Volkan I. Sayin PhD
<div><h3>Introduction</h3><div>Immune checkpoint blockade (ICB) is a standard first-line treatment for stage IV NSCLC without actionable oncogenic alterations. <em>KRAS</em> mutations, prevalent in 30% to 40% lung adenocarcinomas (LUAD) in Western populations, currently lack targeted first-line therapies. This study aimed to assess the predictive value of <em>KRAS</em> mutations for clinical outcomes after distinct ICB regimens, validating our previous findings in a larger cohort with extended follow-up.</div></div><div><h3>Methods</h3><div>We conducted a retrospective multicenter study including consecutive stage IV LUAD patients (n = 424) treated with either ICB or platinum-doublet chemotherapy between 2016 and 2021 in Western Sweden. Patient demographics, tumor characteristics, treatment details, and survival outcomes were retrospectively collected from patient charts and the Swedish National Lung Cancer Registry. <em>KRAS</em> mutational status was assessed by next-generation sequencing. Primary end points included overall survival (OS) and progression-free survival (PFS), analyzed using Kaplan-Meier curves and multivariate Cox regression.</div></div><div><h3>Results</h3><div>Among 424 patients diagnosed with metastatic LUAD, 40% harbored <em>KRAS</em> mutations (<em>KRAS</em><sup>MUT</sup>). <em>KRAS</em><sup>MUT</sup> patients exhibited significant improvement in OS (16 versus 8 mo, <em>p</em> < 0.001) and PFS (8 mo versus 5 mo, <em>p</em> < 0.001) with ICB monotherapy. In contrast, <em>KRAS</em> wild-type (<em>KRAS</em><sup>WT</sup>) patients derived no survival advantage from ICB monotherapy (OS, 8 mo versus 8 mo, <em>p</em> = 0.648; PFS 4 mo versus 5 mo, <em>p</em> = 0.871) although they did so with chemoimmunotherapy (OS, 15 mo versus 8 mo, <em>p</em> = 0.032; PFS, 6 mo vs 5 mo, <em>p</em> = 0.033). On multivariate analysis, monotherapy was confirmed as an independent factor improving outcomes in KRAS-mutated patients (hazard ratio [HR] 0.533, 95% confidence interval 0.311-0.912, <em>p</em> = 0.018). Finally, we identified <em>KRAS</em><sup>G12C</sup> (OS: 13.7 mo versus 10.5 mo, <em>p</em> = 0.0046, PFS: 7.7 mo versus 6.2 mo, <em>p</em> = 0.002) and <em>KRAS</em><sup>G12V</sup> (OS: 24.2 mo versus 7.2 mo, <em>p</em> = 0.0204; PFS: 13.7 mo versus 4.5 mo, <em>p</em> = 0.063) but not <em>KRAS</em><sup>G12D</sup> (OS, 5.8 mo versus 6.2 mo, <em>p</em> = 0.777; PFS, 4.6 mo versus 3.2 mo, <em>p</em> = 0.694) as distinctly and independently predictive of improved survival after receiving ICB-containing treatment.</div></div><div><h3>Conclusions</h3><div><em>KRAS</em> mutations predict substantial and sustained clinical benefit from first-line ICB monotherapy in metastatic LUAD, whereas <em>KRAS</em> wild-type patients do not. <em>KRAS</em><sup>G12C</sup> and <em>KRAS</em><sup>G12V</sup> mutations confer improved survival, whereas <em>KRAS</em><sup>G12D</sup> does not. Integrating <em>KRAS</em> mutation status into clinical practice could
免疫检查点阻断(ICB)是IV期非小细胞肺癌的标准一线治疗方法,没有可操作的致癌改变。KRAS突变在西方人群中普遍存在于30%至40%的肺腺癌(LUAD)中,目前缺乏靶向一线治疗方法。本研究旨在评估不同ICB方案后KRAS突变对临床结果的预测价值,在更大的随访队列中验证我们之前的发现。方法:我们在瑞典西部进行了一项回顾性多中心研究,包括2016年至2021年间连续接受ICB或铂双药化疗的IV期LUAD患者(n = 424)。从患者图表和瑞典国家肺癌登记处回顾性收集患者人口统计资料、肿瘤特征、治疗细节和生存结果。通过下一代测序评估KRAS突变状态。主要终点包括总生存期(OS)和无进展生存期(PFS),使用Kaplan-Meier曲线和多变量Cox回归进行分析。结果在424例诊断为转移性LUAD的患者中,40%携带KRAS突变(KRASMUT)。KRASMUT患者在ICB单药治疗下的OS(16个月vs 8个月,p < 0.001)和PFS(8个月vs 5个月,p < 0.001)均有显著改善。相比之下,KRAS野生型(KRASWT)患者没有从ICB单药治疗中获得生存优势(OS, 8个月vs 8个月,p = 0.648; PFS 4个月vs 5个月,p = 0.871),尽管他们在化疗免疫治疗中获得了生存优势(OS, 15个月vs 8个月,p = 0.032; PFS, 6个月vs 5个月,p = 0.033)。多因素分析证实,单药治疗是改善kras突变患者预后的独立因素(风险比[HR] 0.533, 95%可信区间[0.311-0.912],p = 0.018)。最后,我们确定KRASG12C (OS: 13.7个月对10.5个月,p = 0.0046, PFS: 7.7个月对6.2个月,p = 0.002)和KRASG12V (OS: 24.2个月对7.2个月,p = 0.0204; PFS: 13.7个月对4.5个月,p = 0.063),但KRASG12D (OS, 5.8个月对6.2个月,p = 0.777; PFS, 4.6个月对3.2个月,p = 0.694)不能作为接受含icb治疗后生存率改善的明显和独立预测指标。结论:在转移性LUAD患者中,skras突变预示着一线ICB单药治疗可带来实质性和持续的临床获益,而KRAS野生型患者则不然。KRASG12C和KRASG12V突变可提高生存率,而KRASG12D则不能。将KRAS突变状态整合到临床实践中可以指导个性化治疗策略,优化IV期LUAD的免疫治疗效果。
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引用次数: 0
Local Ablative Therapy Followed by Osimertinib Rechallenge in Oligoprogressive, EGFR-Mutated NSCLC: A Phase 2 Study 在少进展、egfr突变的非小细胞肺癌中,局部消融治疗后再注射奥西替尼:一项2期研究
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-10-01 Epub Date: 2025-08-06 DOI: 10.1016/j.jtocrr.2025.100886
Azam Ghafoor MD , Nitin Roper MD , Chul Kim MD, MPH , Chuong D. Hoang MD , Aparna H. Kesarwala MD, PhD , Kevin A. Camphausen MD , Kamran Farouq BS , Elizabeth Akoth RN, BSN, MSN , Corrine Keen RN, BSN, MS , Eva Szabo MD , Hadi Bhageri MD , Arun Rajan MD , Udayan Guha MD, PhD

Introduction

Osimertinib has exhibited impressive efficacy in advanced EGFR-mutated NSCLC; however, resistance is inevitable. We hypothesized that local ablative therapy (LAT) for oligoprogressive disease (up to five sites), followed by osimertinib rechallenge, would be safe and provide additional second progression-free survival (PFS2) benefit.

Methods

This prospective phase 2 trial enrolled EGFR-mutated NSCLC patients in three cohorts: tyrosine kinase inhibitor (TKI)–naive (cohort 1), previously treated with TKI and developed acquired T790M resistance mutation (cohort 2), or previously treated with osimertinib and developed resistance (cohort 3). Patients in cohorts 1 and 2 received upfront osimertinib followed by LAT on oligoprogression, followed by osimertinib rechallenge. Cohort 3 patients underwent LAT on enrollment, followed by osimertinib rechallenge. The primary end points were safety, tolerability, and PFS2 among the patients who underwent LAT across all three cohorts combined. Secondary end points were PFS1 and overall response rates.

Results

A total of 37 patients with EGFR-mutated NSCLC were enrolled; 25 in cohort 1, nine in cohort 2, and three in cohort 3. A total of 21 patients received LAT across all three cohorts combined, yielding a median PFS2 of 3.7 months (95% confidence interval: 1.9–4.6 mo) for this population. A subgroup with exceptionally long PFS2 was identified that achieved lower tumor burden and circulating tumor DNA–negative minimal residual disease of the EGFR clone with osimertinib before undergoing LAT. Most adverse events related to LAT were grades 1 and 2.

Conclusions

This is the first prospective trial exploring local therapy and osimertinib rechallenge on oligoprogression on osimertinib. Interim analysis revealed that PFS2 in the intention-to-treat patients did not meet its primary goal when compared with historical data on continuation of first-generation EGFR TKIs after LAT. However, definite LAT can be carefully considered in patients using circulating tumor DNA–negative minimal residual disease status as a biomarker for predicting who will benefit from continuation of osimertinib post-LAT.
奥西替尼在晚期egfr突变的NSCLC中显示出令人印象深刻的疗效;然而,阻力是不可避免的。我们假设对于少进展性疾病(最多5个部位)的局部消融治疗(LAT),随后再用奥西替尼治疗,将是安全的,并提供额外的第二次无进展生存期(PFS2)获益。该前瞻性2期试验纳入了egfr突变的NSCLC患者,分为三个队列:酪氨酸激酶抑制剂(TKI)初治(队列1),先前接受过TKI治疗并发生获得性T790M耐药突变(队列2),或先前接受过奥西替尼治疗并发生耐药(队列3)。第1组和第2组的患者首先接受奥西替尼治疗,然后在进展缓慢时接受LAT治疗,然后再接受奥西替尼治疗。队列3患者在入组时接受LAT,随后接受奥西替尼再挑战。主要终点是所有三个队列中接受LAT的患者的安全性、耐受性和PFS2。次要终点为PFS1和总有效率。结果共纳入37例egfr突变的NSCLC患者;1组25人,2组9人,3组3人。在所有三个队列中,共有21例患者接受了LAT治疗,该人群的中位PFS2为3.7个月(95%置信区间:1.9-4.6个月)。发现了一个具有异常长PFS2的亚组,在接受LAT之前使用奥西替尼实现了较低的肿瘤负荷和循环肿瘤dna阴性的EGFR克隆的最小残留病。与LAT相关的大多数不良事件为1级和2级。结论:这是首个探索局部治疗和奥西替尼再挑战对奥西替尼寡进展的前瞻性试验。中期分析显示,与LAT后继续使用第一代EGFR TKIs的历史数据相比,意向治疗患者的PFS2未达到其主要目标。然而,在使用循环肿瘤dna阴性最小残留疾病状态作为预测谁将从LAT后继续使用奥西替尼获益的生物标志物的患者中,可以仔细考虑明确的LAT。
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引用次数: 0
Complete Response to BET Inhibitor in Primary Pulmonary NUT Carcinoma With Single-Cell Sequencing-Based Analysis: A Case Report 基于单细胞测序分析的原发性肺NUT癌对BET抑制剂的完全缓解:一例报告
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-10-01 Epub Date: 2025-08-05 DOI: 10.1016/j.jtocrr.2025.100885
Zhuomiao Ye MD , Xin Li PhD , Minghui Zhang PhD , Fei Xie MD , Xiangwen Luo MSc , Chao Deng MD , Dan Yang MSc , Mingzhu Yin PhD
NUT carcinoma is a rare and highly aggressive malignancy characterized by rapid progression, resistance to conventional therapies, and an extremely poor prognosis. This report presents a 36-year-old patient with stage IIIB primary pulmonary NUT carcinoma who achieved remarkable clinical outcomes with NHWD-870 monotherapy, a novel BET inhibitor. After just 1 month of treatment, imaging revealed a partial response, and a complete response was achieved within 5 months. Postoperative pathologic examination confirmed no residual cancer cells, and the patient has remained disease-free without recurrence or metastasis to date. To explore the underlying mechanisms of this therapeutic response, single-cell RNA sequencing was performed on the tumor tissue, revealing enhanced activity of immune cells, particularly effector CD8+ T-cells, within the tumor microenvironment. This suggests that NHWD-870 exerts its effects through both direct tumor suppression and modulation of the immune microenvironment. This case highlights the exceptional efficacy of BET inhibitors in the treatment of NUT carcinoma, as evidenced by the first report of complete response achieved with BET inhibitor monotherapy, and supports their potential as a personalized therapeutic strategy.
NUT癌是一种罕见的高侵袭性恶性肿瘤,其特点是进展迅速,对常规治疗有耐药性,预后极差。本文报道了一位36岁的IIIB期原发性肺NUT癌患者,他通过NHWD-870单药治疗(一种新型BET抑制剂)取得了显著的临床效果。仅在治疗1个月后,影像学显示部分缓解,并在5个月内达到完全缓解。术后病理检查证实无残留癌细胞,患者至今无复发或转移。为了探索这种治疗反应的潜在机制,对肿瘤组织进行了单细胞RNA测序,揭示了肿瘤微环境中免疫细胞,特别是效应CD8+ t细胞的活性增强。这表明NHWD-870通过直接抑制肿瘤和调节免疫微环境发挥作用。该病例强调了BET抑制剂治疗NUT癌的特殊疗效,首次报道的BET抑制剂单药治疗完全缓解证明了这一点,并支持其作为个性化治疗策略的潜力。
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引用次数: 0
Long-term Survival Analysis From PERLA, A Phase II Randomized Trial of Dostarlimab With Chemotherapy Versus Pembrolizumab With Chemotherapy in Metastatic Nonsquamous NSCLC 来自PERLA的长期生存分析,一项多斯塔利单抗联合化疗与派姆单抗联合化疗治疗转移性非鳞状NSCLC的II期随机试验
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-10-01 Epub Date: 2025-09-04 DOI: 10.1016/j.jtocrr.2025.100900
Sun Min Lim MD, PhD , Ana Laura Ortega Granados MD , Gustavo dix Junqueira Pinto MD, MSc , Christian Sebastián Fuentes MD , Giuseppe Lo Russo MD , Michael Schenker MD , Jin Seok Ahn MD, PhD , Filippo de Marinis MD , Kenneth Locke Jr. PhD , Zsolt Szijgyarto PhD , Elena Buss MSc , Neda Stjepanovic MD, PhD , Ivan Diaz-Padilla MD, PhD , Solange Peters MD, PhD

Introduction

PERLA is a global, double-blind, phase II trial comparing anti–programmed cell death protein 1 antibodies, dostarlimab, and pembrolizumab in combination with chemotherapy (D+CT and P+CT, respectively) in patients with metastatic nonsquamous NSCLC without actionable genomic aberrations in the first-line setting.

Methods

Patients were randomized 1:1 to receive not more than 35 cycles of 500 mg dostarlimab or 200 mg pembrolizumab, with less than or equal to 35 cycles of 500 mg/m2 pemetrexed and less than or equal to 4 cycles of cisplatin (75 mg/m2) or carboplatin (area under the curve 5 mg/mL/min) every 3 weeks. The primary end point was the overall response rate by blinded independent central review. The secondary end points included progression-free survival (PFS) on the basis of investigator assessment, overall survival (OS), and safety. Here, we reported on the long-term OS, PFS, and safety analyses.

Results

At the end of the study (September 10, 2024), the median follow-up time (mo) for PFS was 30.4 for D+CT and 30.4 for P+CT. The median PFS (mo [95% confidence interval (CI)]) was 8.8 (6.9–11.0) for D+CT and 6.8 (4.9–7.1) for P+CT (hazard ratio 0.77 [95% CI: 0.58–1.03] at 79% maturity). The median follow-up time (mo) for OS was 35.5 for D+CT and 35.2 for P+CT. The median OS (mo [95% CI]) was 20.2 (14.5–27.3) and 15.9 (11.6–19.3), respectively (hazard ratio 0.75 [95% CI: 0.55–1.02] at 70% maturity). Safety profiles were similar between arms and consistent with previous analyses.

Conclusions

This long-term analysis reaffirms previous observations that D+CT exhibited similar efficacy to P+CT and exhibits strong clinical efficacy as a first-line treatment for patients with metastatic nonsquamous NSCLC.

Clinical trial registration

NCT04581824.
perla是一项全球性、双盲、II期试验,比较抗程序性细胞死亡蛋白1抗体、多斯塔利单抗和派姆单抗联合化疗(分别为D+CT和P+CT)在一线环境中无可操作基因组异常的转移性非鳞状NSCLC患者中的疗效。方法患者按1:1随机分组,接受不超过35个周期的500 mg的多司来单抗或200 mg的派姆单抗,培美曲塞≤35个周期的500 mg/m2,顺铂≤4个周期(75 mg/m2)或卡铂(曲线下面积5mg /mL/min)每3周。主要终点是盲法独立中心评价的总缓解率。次要终点包括基于研究者评估的无进展生存期(PFS)、总生存期(OS)和安全性。在这里,我们报告了长期的OS、PFS和安全性分析。结果研究结束时(2024年9月10日),PFS的中位随访时间(mo) D+CT为30.4,P+CT为30.4。D+CT的中位PFS (mo[95%可信区间(CI)]为8.8 (6.9-11.0),P+CT的中位PFS为6.8(4.9-7.1)(79%成熟度时风险比0.77 [95% CI: 0.58-1.03])。D+CT组OS的中位随访时间为35.5,P+CT组为35.2。中位OS (mo [95% CI])分别为20.2(14.5-27.3)和15.9(11.6-19.3)(70%成熟度时风险比为0.75 [95% CI: 0.55-1.02])。两组的安全性相似,与之前的分析一致。这项长期分析证实了先前的观察结果,即D+CT与P+CT具有相似的疗效,并且作为转移性非鳞状NSCLC患者的一线治疗具有很强的临床疗效。临床试验注册号:nct04581824。
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引用次数: 0
Evaluation of the Safety, Pharmacokinetics, and Antitumor Activity of Tusamitamab Ravtansine in Patients With Nonsquamous NSCLC With High or Moderate Expression of Carcinoembryonic Antigen-Related Cell Adhesion Molecule 5 Tusamitamab Ravtansine在癌胚抗原相关细胞粘附分子高或中度表达的非鳞状NSCLC患者中的安全性、药代动力学和抗肿瘤活性评价
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-10-01 Epub Date: 2025-05-15 DOI: 10.1016/j.jtocrr.2025.100844
Anas Gazzah MD , Charles Ricordel MD, PhD , Antoine Italiano MD, PhD , Byoung Chul Cho MD, PhD , Emiliano Calvo MD, PhD , Dong-Wan Kim MD, PhD , Carole Helissey MD , Jin-Soo Kim MD, PhD , Maria Vieito Villar MD , Francois Ghiringhelli HDR , Victor Moreno MD, PhD , Sophie Cousin MD , Luis Paz-Ares MD, PhD , Nathalie Fagniez Pharm D , Mustapha Chadjaa MD , Anne-Laure Bauchet DECVP, PhD , Christine Soufflet MD , Nina Masson MSc , Fabrice Barlesi MD, PhD

Introduction

Tusamitamab ravtansine is an antibody-drug conjugate targeting cells expressing carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5) with a maytansinoid payload, DM4. This phase 1b dose-expansion study (NCT02187848) evaluated its safety, pharmacokinetics, and preliminary antitumor activity in patients with nonsquamous NSCLC (NSq NSCLC).

Methods

Patients aged above or equal to 18 years with advanced or metastatic NSq NSCLC, life expectancy more than or equal to 12 weeks, and high (≥2+ intensity in ≥50% of tumor cells) or moderate (≥2+ intensity in 1%–49% of tumor cells) CEACAM5 expression (assessed by immunohistochemistry) received intravenous tusamitamab ravtansine 100 mg/m2 every 2 weeks.

Results

A total of 64 patients with high and 28 with moderate CEACAM5 expression received a median of 8.0 (1–69) and 4.5 (1–38) treatment cycles, respectively. High expressors had 13 confirmed partial responses and 28 stable diseases (objective response rate, 20.3%; 95% confidence interval [CI]: 12.3%–31.7%, p < 0.0001); median duration of response was 6.7 months, and median time to progression was 3.7 months (95% CI: 2.7–5.1 mo). Moderate expressors had two confirmed partial responses (objective response rate, 7.1%; 95% CI: 2.0%–22.7%, p = 0.4117) and 15 stable diseases.
Treatment-emergent adverse events (AEs) occurred in 78.3% of patients (72/92), 37.0% (34/92) of patients required dose modifications, and 5.4% (5/92) discontinued treatment. The most common treatment-emergent AEs included asthenia (37.0%), keratitis (29.3%), and dyspnea (23.9%). Corneal AEs occurred in 38.0% (35/92), typically grade 1/2, reversible, and manageable by dose modifications.

Conclusions

Tusamitamab ravtansine demonstrated a favorable safety profile, objective responses, and antitumor activity in patients with high CEACAM5-expressing NSq NSCLC.
tusamitamab ravtansine是一种抗体-药物偶联物,靶向表达癌胚抗原相关细胞粘附分子5 (CEACAM5)的细胞,具有美坦素类有效载荷DM4。这项1b期剂量扩展研究(NCT02187848)评估了其在非鳞状NSCLC (NSq NSCLC)患者中的安全性、药代动力学和初步抗肿瘤活性。方法年龄≥18岁的晚期或转移性NSq NSCLC患者,预期寿命≥12周,CEACAM5高表达(≥50%肿瘤细胞≥2+强度)或中等表达(≥1%-49%肿瘤细胞≥2+强度)(免疫组化评估),每2周静脉注射tusamitamab ravtansine 100mg /m2。结果CEACAM5高表达患者64例,中等表达患者28例,治疗周期中位数分别为8.0(1-69)和4.5(1-38)。高表达者13例确诊部分缓解,28例病情稳定(客观缓解率20.3%,95%可信区间[CI]: 12.3% ~ 31.7%, p < 0.0001);中位缓解持续时间为6.7个月,中位进展时间为3.7个月(95% CI: 2.7-5.1个月)。中度表达者有2例确诊部分缓解(客观缓解率为7.1%;95% CI: 2.0% ~ 22.7%, p = 0.4117), 15例病情稳定。78.3%的患者(72/92)发生了治疗后出现的不良事件(ae), 37.0%(34/92)的患者需要调整剂量,5.4%(5/92)的患者停止治疗。最常见的治疗突发事件包括虚弱(37.0%)、角膜炎(29.3%)和呼吸困难(23.9%)。角膜不良事件发生率为38.0%(35/92),通常为1/2级,可逆,通过剂量调整可控制。结论usamitamab ravtansine在ceacam5高表达NSq NSCLC患者中具有良好的安全性、客观疗效和抗肿瘤活性。
{"title":"Evaluation of the Safety, Pharmacokinetics, and Antitumor Activity of Tusamitamab Ravtansine in Patients With Nonsquamous NSCLC With High or Moderate Expression of Carcinoembryonic Antigen-Related Cell Adhesion Molecule 5","authors":"Anas Gazzah MD ,&nbsp;Charles Ricordel MD, PhD ,&nbsp;Antoine Italiano MD, PhD ,&nbsp;Byoung Chul Cho MD, PhD ,&nbsp;Emiliano Calvo MD, PhD ,&nbsp;Dong-Wan Kim MD, PhD ,&nbsp;Carole Helissey MD ,&nbsp;Jin-Soo Kim MD, PhD ,&nbsp;Maria Vieito Villar MD ,&nbsp;Francois Ghiringhelli HDR ,&nbsp;Victor Moreno MD, PhD ,&nbsp;Sophie Cousin MD ,&nbsp;Luis Paz-Ares MD, PhD ,&nbsp;Nathalie Fagniez Pharm D ,&nbsp;Mustapha Chadjaa MD ,&nbsp;Anne-Laure Bauchet DECVP, PhD ,&nbsp;Christine Soufflet MD ,&nbsp;Nina Masson MSc ,&nbsp;Fabrice Barlesi MD, PhD","doi":"10.1016/j.jtocrr.2025.100844","DOIUrl":"10.1016/j.jtocrr.2025.100844","url":null,"abstract":"<div><h3>Introduction</h3><div>Tusamitamab ravtansine is an antibody-drug conjugate targeting cells expressing carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5) with a maytansinoid payload, DM4. This phase 1b dose-expansion study (NCT02187848) evaluated its safety, pharmacokinetics, and preliminary antitumor activity in patients with nonsquamous NSCLC (NSq NSCLC).</div></div><div><h3>Methods</h3><div>Patients aged above or equal to 18 years with advanced or metastatic NSq NSCLC, life expectancy more than or equal to 12 weeks, and high (≥2+ intensity in ≥50% of tumor cells) or moderate (≥2+ intensity in 1%–49% of tumor cells) CEACAM5 expression (assessed by immunohistochemistry) received intravenous tusamitamab ravtansine 100 mg/m<sup>2</sup> every 2 weeks.</div></div><div><h3>Results</h3><div>A total of 64 patients with high and 28 with moderate CEACAM5 expression received a median of 8.0 (1–69) and 4.5 (1–38) treatment cycles, respectively. High expressors had 13 confirmed partial responses and 28 stable diseases (objective response rate, 20.3%; 95% confidence interval [CI]: 12.3%–31.7%, <em>p</em> &lt; 0.0001); median duration of response was 6.7 months, and median time to progression was 3.7 months (95% CI: 2.7–5.1 mo). Moderate expressors had two confirmed partial responses (objective response rate, 7.1%; 95% CI: 2.0%–22.7%, <em>p</em> = 0.4117) and 15 stable diseases.</div><div>Treatment-emergent adverse events (AEs) occurred in 78.3% of patients (72/92), 37.0% (34/92) of patients required dose modifications, and 5.4% (5/92) discontinued treatment. The most common treatment-emergent AEs included asthenia (37.0%), keratitis (29.3%), and dyspnea (23.9%). Corneal AEs occurred in 38.0% (35/92), typically grade 1/2, reversible, and manageable by dose modifications.</div></div><div><h3>Conclusions</h3><div>Tusamitamab ravtansine demonstrated a favorable safety profile, objective responses, and antitumor activity in patients with high CEACAM5-expressing NSq NSCLC.</div></div>","PeriodicalId":17675,"journal":{"name":"JTO Clinical and Research Reports","volume":"6 10","pages":"Article 100844"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Corrigendum to “Associations of Tissue Tumor Mutational Burden and Mutational Status With Clinical Outcomes With Pembrolizumab Plus Chemotherapy Versus Chemotherapy For Metastatic NSCLC [JTO Clinical and Research Reports Vol. 4 No. 1: 100431] “组织肿瘤突变负担和突变状态与Pembrolizumab联合化疗与化疗治疗转移性NSCLC临床结果的关联”的勘误[JTO临床与研究报告Vol. 4 No. 1: 100431]
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-10-01 Epub Date: 2025-09-02 DOI: 10.1016/j.jtocrr.2025.100892
Marina C. Garassino MD , Shirish Gadgeel MD , Silvia Novello MD, PhD , Balazs Halmos MD , Enriqueta Felip MD , Giovanna Speranza MD , Rina Hui PhD , Edward B. Garon MD , Hidehito Horinouchi MD, PhD , Shunichi Sugawara MD, PhD , Delvys Rodriguez-Abreu MD, PhD , Martin Reck MD , Razvan Cristescu PhD , Deepti Aurora-Garg PhD , Andrey Loboda PhD , Jared Lunceford PhD , Julie Kobie PhD , Mark Ayers MS , Bilal Piperdi MD , M. Catherine Pietanza MD , Luis Paz-Ares MD, PhD
{"title":"Corrigendum to “Associations of Tissue Tumor Mutational Burden and Mutational Status With Clinical Outcomes With Pembrolizumab Plus Chemotherapy Versus Chemotherapy For Metastatic NSCLC [JTO Clinical and Research Reports Vol. 4 No. 1: 100431]","authors":"Marina C. Garassino MD ,&nbsp;Shirish Gadgeel MD ,&nbsp;Silvia Novello MD, PhD ,&nbsp;Balazs Halmos MD ,&nbsp;Enriqueta Felip MD ,&nbsp;Giovanna Speranza MD ,&nbsp;Rina Hui PhD ,&nbsp;Edward B. Garon MD ,&nbsp;Hidehito Horinouchi MD, PhD ,&nbsp;Shunichi Sugawara MD, PhD ,&nbsp;Delvys Rodriguez-Abreu MD, PhD ,&nbsp;Martin Reck MD ,&nbsp;Razvan Cristescu PhD ,&nbsp;Deepti Aurora-Garg PhD ,&nbsp;Andrey Loboda PhD ,&nbsp;Jared Lunceford PhD ,&nbsp;Julie Kobie PhD ,&nbsp;Mark Ayers MS ,&nbsp;Bilal Piperdi MD ,&nbsp;M. Catherine Pietanza MD ,&nbsp;Luis Paz-Ares MD, PhD","doi":"10.1016/j.jtocrr.2025.100892","DOIUrl":"10.1016/j.jtocrr.2025.100892","url":null,"abstract":"","PeriodicalId":17675,"journal":{"name":"JTO Clinical and Research Reports","volume":"6 10","pages":"Article 100892"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lung Cancer in Patients of African Descent: A Transcontinental Review of Epidemiology, Disparities, Outcomes, and Opportunities for Equity in Africa, North America, South America, and the Caribbean 非裔肺癌患者:非洲、北美、南美和加勒比地区流行病学、差异、结果和公平机会的跨大陆回顾
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-10-01 Epub Date: 2025-08-06 DOI: 10.1016/j.jtocrr.2025.100887
Elvis Obomanu MD , Colton Jones MD , Verna Vanderpuye MD , Nazik Hammad MD
Lung cancer in people of African descent is characterized by transcontinental disparities driven by epidemiologic heterogeneity, systemic inequities, and unequal access to health care. Globally, lung cancer incidence and mortality rates vary; however, underdiagnosis and late-stage presentation in low- and middle-income countries obscure the true prevalence of lung cancer because of limited cancer registries and diagnostic infrastructure. In Africa, most patients with lung cancer present at an advanced stage, primarily because of health illiteracy, misdiagnosis, delayed referrals, and inadequate treatment infrastructure. Although tobacco smoking remains a dominant risk factor worldwide, African populations are disproportionately exposed to environmental and occupational hazards, which substantially elevate their lung cancer risk. In North America, Black people experience disproportionately poor outcomes, including lower rates of lung cancer screening, early diagnosis, surgical intervention, and higher mortality rates compared with their White counterparts. In the Caribbean and South America, Black people continue to face racial infrastructural constraints, racial inequities, and elevated exposure to environmental and occupational carcinogens. Systemic barriers perpetuate these disparities, including limited access to screening, genomic testing, and guideline-concordant therapies.
Achieving equity in lung cancer outcomes requires strategic initiatives, including the expansion of lung cancer registries in Africa, the Caribbean, and South America, to inform evidence-based interventions. Urgent national and international measures focused on prevention and care for populations of African descent, implementing robust tobacco control policies, addressing systemic and racial inequities, and strengthening health care systems to report and manage lung cancer efficiently are essential steps toward reducing disparities. A transcontinental collaborative approach that includes establishing lung cancer research consortia is vital to share best practices in screening protocols, optimize early detection strategies and treatment, and advocate for policy reforms that address the global burden of lung cancer in populations of African descent.
非洲人后裔肺癌的特点是由流行病学异质性、系统性不平等和获得卫生保健机会不平等造成的跨大陆差异。在全球范围内,肺癌发病率和死亡率各不相同;然而,由于癌症登记和诊断基础设施有限,低收入和中等收入国家的诊断不足和晚期表现掩盖了肺癌的真实患病率。在非洲,大多数肺癌患者处于晚期,主要原因是卫生文盲、误诊、转诊延误和治疗基础设施不足。尽管吸烟仍然是世界范围内的一个主要风险因素,但非洲人口不成比例地暴露于环境和职业危害中,这大大提高了他们患肺癌的风险。在北美,与白人相比,黑人经历了不成比例的不良结果,包括肺癌筛查、早期诊断、手术干预的比例较低,死亡率较高。在加勒比和南美洲,黑人继续面临着种族基础设施限制、种族不平等以及环境和职业致癌物暴露的增加。系统性障碍使这些差异持续存在,包括筛查、基因组检测和符合指南的治疗的有限机会。实现肺癌结果的公平需要采取战略举措,包括扩大非洲、加勒比和南美洲的肺癌登记,为循证干预措施提供信息。紧急采取国家和国际措施,重点关注非洲人后裔的预防和护理,实施强有力的烟草控制政策,解决系统性和种族不平等问题,以及加强卫生保健系统以有效报告和管理肺癌,这些都是缩小差距的重要步骤。包括建立肺癌研究联盟在内的跨洲合作方法对于分享筛查方案的最佳做法、优化早期发现战略和治疗以及倡导政策改革以解决非洲人后裔肺癌的全球负担至关重要。
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引用次数: 0
First-line Selpercatinib or Chemotherapy and Pembrolizumab in Patients From East Asia With RET Fusion–Positive NSCLC: A LIBRETTO-431 Subgroup Analysis 东亚RET融合阳性NSCLC患者的一线Selpercatinib或化疗和Pembrolizumab: LIBRETTO-431亚组分析
IF 3.5 Q2 ONCOLOGY Pub Date : 2025-10-01 Epub Date: 2025-06-20 DOI: 10.1016/j.jtocrr.2025.100868
Koichi Goto MD, PhD , Herbert H. Loong M.B.B.S. , Caicun Zhou MD, PhD , Kazumi Nishino MD, PhD , Dae Ho Lee MD, PhD , Se-Hoon Lee MD , James Chih-Hsin Yang MD, PhD , Dan Liu PhD , Minji Kim Uh PhD , Hongmei Han MS, MAS , Tarun Puri MD , Aimee Bence Lin PhD , Ying Cheng MD

Introduction

Selpercatinib’s consistent efficacy and manageable safety profile were observed in patients with RET fusion–positive NSCLC across geographies in single-arm studies (LIBRETTO-001 and LIBRETTO-321). Here, we report the efficacy and safety of the phase 3 study LIBRETTO-431 in patients from East Asia.

Methods

LIBRETTO-431 (NCT04194944) is a randomized, open-label phase 3 trial comparing first-line selpercatinib versus pemetrexed and platinum with or without pembrolizumab. Geography (East Asia versus non-East Asia) was a stratification factor. Efficacy end points including progression-free survival (PFS), objective response rate, and duration of response as assessed by means of blinded independent central review were evaluated in patients from East Asia. Pharmacokinetics were assessed in the selpercatinib group. Safety data were collected for all patients who received at least one dose of study treatment.

Results

Of the 261 patients enrolled, 142 (54.4%) were from East Asia, with 116 randomized to the intention-to-treat-pembrolizumab population (selpercatinib: n = 75, control: n = 41). With a median follow-up of 19.4 and 21.2 months in the selpercatinib and control groups respectively, the median PFS in patients from East Asia was not yet reached for selpercatinib (95% confidence interval (CI): 16.4–not evaluable) versus 11.1 months (95% CI: 7.0–16.8) for control (hazard ratio: 0.38 [95%CI: 0.22–0.68]; p = 0.0008). Safety and pharmacokinetics were consistent with those previously reported across the development program and adverse events were generally manageable with dose adjustments.

Conclusions

Consistent with results in the overall LIBRETTO-431 population, selpercatinib exhibited superior PFS compared with chemotherapy plus pembrolizumab in patients from East Asia with a manageable safety profile. These data further highlight the importance of early comprehensive genomic testing and the use of selpercatinib as a preferred first-line regimen in patients with RET fusion–positive NSCLC across geographies.
在单臂研究(LIBRETTO-001和LIBRETTO-321)中,selpercatinib在不同地区的RET融合阳性NSCLC患者中具有一致的疗效和可管理的安全性。在此,我们报告了3期研究LIBRETTO-431在东亚患者中的有效性和安全性。方法:slibretto -431 (NCT04194944)是一项随机、开放标签的3期试验,比较了一线selpercatinib与培美曲塞和铂在使用或不使用派姆单抗时的疗效。地理(东亚与非东亚)是一个分层因素。疗效终点包括无进展生存期(PFS)、客观缓解率和持续时间,通过盲法独立中心评价在东亚患者中进行评估。观察自泊替尼组的药代动力学。收集了所有接受至少一剂研究治疗的患者的安全性数据。在纳入的261例患者中,142例(54.4%)来自东亚,其中116例随机分配到意向治疗派姆单抗人群(selpercatinib: n = 75,对照组:n = 41)。selpercatinib组和对照组的中位随访时间分别为19.4和21.2个月,selpercatinib组东亚患者的中位PFS尚未达到(95%置信区间(CI): 16.4 -不可评估),而对照组的中位PFS为11.1个月(95% CI: 7.0-16.8)(风险比:0.38 [95%CI: 0.22-0.68]; p = 0.0008)。安全性和药代动力学与先前在整个开发项目中报道的一致,不良事件通常可以通过剂量调整来控制。与LIBRETTO-431总体人群的结果一致,selpercatinib在东亚患者中与化疗加派姆单抗相比表现出更高的PFS,并且具有可控的安全性。这些数据进一步强调了早期全面基因组检测的重要性,以及将selpercatinib作为RET融合阳性NSCLC患者首选一线治疗方案的重要性。
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