METHODS In this phase 3, open-label study, we randomly assigned previously untreated patients in East Asia who had advanced pulmonary adenocarcinoma and who were nonsmokers or former light smokers to receive gefitinib (250 mg per day) (609 patients) or carboplatin (at a dose calculated to produce an area under the curve of 5 or 6 mg per milliliter per minute) plus paclitaxel (200 mg per square meter of body-surface area) (608 patients). The primary end point was progression-free survival. RESULTS The 12-month rates of progression-free survival were 24.9% with gefitinib and 6.7% with carboplatin–paclitaxel. The study met its primary objective of showing the noninferiority of gefitinib and also showed its superiority, as compared with carboplatin– paclitaxel, with respect to progression-free survival in the intention-to-treat population (hazard ratio for progression or death, 0.74; 95% confidence interval [CI], 0.65 to 0.85; P<0.001). In the subgroup of 261 patients who were positive for the epidermal growth factor receptor gene (EGFR) mutation, progression-free survival was significantly longer among those who received gefitinib than among those who received carboplatin–paclitaxel (hazard ratio for progression or death, 0.48; 95% CI, 0.36 to 0.64; P<0.001), whereas in the subgroup of 176 patients who were negative for the mutation, progression-free survival was significantly longer among those who received carboplatin–paclitaxel (hazard ratio for progression or death with gefitinib, 2.85; 95% CI, 2.05 to 3.98; P<0.001). The most common adverse events were rash or acne (in 66.2% of patients) and diarrhea (46.6%) in the gefitinib group and neurotoxic effects (69.9%), neutropenia (67.1%), and alopecia (58.4%) in the carboplatin–paclitaxel group. CONCLUSIONS Gefitinib is superior to carboplatin–paclitaxel as an initial treatment for pulmonary adenocarcinoma among nonsmokers or former light smokers in East Asia. The presence in the tumor of a mutation of the EGFR gene is a strong predictor of a better outcome with gefitinib. (ClinicalTrials.gov number, NCT00322452.)

https://www.nejm.org/doi/pdf/10.1056/NEJMoa0810699

Gefitinib or Carboplatin–Paclitaxel in Pulmonary Adenocarcinoma

We have constructed a series of plasmid vectors (pBAD vectors) containing the PBAD promoter of the araBAD (arabinose) operon and the gene encoding the positive and negative regulator of this promoter, araC. Using the phoA gene and phoA fusions to monitor expression in these vectors, we show that the ratio of induction/repression can be 1,200-fold, compared with 50-fold for PTAC-based vectors. phoA expression can be modulated over a wide range of inducer (arabinose) concentrations and reduced to extremely low levels by the presence of glucose, which represses expression. Also, the kinetics of induction and repression are very rapid and significantly affected by the ara allele in the host strain. Thus, the use of this system which can be efficiently and rapidly turned on and off allows the study of important aspects of bacterial physiology in a very simple manner and without changes of temperature. We have exploited the tight regulation of the PBAD promoter to study the phenotypes of null mutations of essential genes and explored the use of pBAD vectors as an expression system.

Tight regulation, modulation, and high-level expression by vectors containing the arabinose PBAD promoter.

In the planned interim analysis of data for the first 200 patients, progression-free survival was significantly longer in the gefitinib group than in the standard-chemotherapy group (hazard ratio for death or disease progression with gefitinib, 0.36; P<0.001), resulting in early termination of the study. The gefitinib group had a significantly longer median progression-free survival (10.8 months, vs. 5.4 months in the chemotherapy group; hazard ratio, 0.30; 95% confidence interval, 0.22 to 0.41; P<0.001), as well as a higher response rate (73.7% vs. 30.7%, P<0.001). The median overall survival was 30.5 months in the gefitinib group and 23.6 months in the chemotherapy group (P = 0.31). The most common adverse events in the gefitinib group were rash (71.1%) and elevated amino transferase levels (55.3%), and in the chemotherapy group, neutropenia (77.0%), anemia (64.6%), appetite loss (56.6%), and sensory neuropathy (54.9%). One patient receiving gefitinib died from interstitial lung disease. CONCLUSIONS First-line gefitinib for patients with advanced non–small-cell lung cancer who were selected on the basis of EGFR mutations improved progression-free survival, with acceptable toxicity, as compared with standard chemotherapy. (UMIN-CTR number, C000000376.)

/pdf/gefitinib-or-chemotherapy-for-non-small-cell-lung-cancer-3i0ao547wt.pdf

Gefitinib or Chemotherapy for Non–Small-Cell Lung Cancer with Mutated EGFR

The epidermal growth factor receptor (EGFR) kinase inhibitors gefitinib and erlotinib are effective treatments for lung cancers with EGFR activating mutations, but these tumors invariably develop drug resistance. Here, we describe a gefitinib-sensitive lung cancer cell line that developed resistance to gefitinib as a result of focal amplification of the MET proto-oncogene. inhibition of MET signaling in these cells restored their sensitivity to gefitinib. MET amplification was detected in 4 of 18 (22%) lung cancer specimens that had developed resistance to gefitinib or erlotinib. We find that amplification of MET causes gefitinib resistance by driving ERBB3 (HER3)–dependent activation of PI3K, a pathway thought to be specific to EGFR/ERBB family receptors. Thus, we propose that MET amplification may promote drug resistance in other ERBB-driven cancers as well.

https://science.sciencemag.org/content/sci/316/5827/1039.full.pdf

MET Amplification Leads to Gefitinib Resistance in Lung Cancer by Activating ERBB3 Signaling

Background Oncogenic fusion genes consisting of EML4 and anaplastic lymphoma kinase (ALK) are present in a subgroup of non–small-cell lung cancers, representing 2 to 7% of such tumors. We explored the therapeutic efficacy of inhibiting ALK in such tumors in an early-phase clinical trial of crizotinib (PF-02341066), an orally available small-molecule inhibitor of the ALK tyrosine kinase. Methods After screening tumor samples from approximately 1500 patients with non–small-cell lung cancer for the presence of ALK rearrangements, we identified 82 patients with advanced ALK-positive disease who were eligible for the clinical trial. Most of the patients had received previous treatment. These patients were enrolled in an expanded cohort study instituted after phase 1 dose escalation had established a recommended crizotinib dose of 250 mg twice daily in 28-day cycles. Patients were assessed for adverse events and response to therapy. Results Patients with ALK rearrangements tended to be younger than those without the rearrangements, and most of the patients had little or no exposure to tobacco and had adenocarcinomas. At a mean treatment duration of 6.4 months, the overall response rate was 57% (47 of 82 patients, with 46 confirmed partial responses and 1 confirmed complete response); 27 patients (33%) had stable disease. A total of 63 of 82 patients (77%) were continuing to receive crizotinib at the time of data cutoff, and the estimated probability of 6-month progression-free survival was 72%, with no median for the study reached. The drug resulted in grade 1 or 2 (mild) gastrointestinal side effects. Conclusions The inhibition of ALK in lung tumors with the ALK rearrangement resulted in tumor shrinkage or stable disease in most patients. (Funded by Pfizer and others; ClinicalTrials.gov number, NCT00585195.)

/pdf/anaplastic-lymphoma-kinase-inhibition-in-non-small-cell-lung-4chlx92dsn.pdf

Anaplastic Lymphoma Kinase Inhibition in Non–Small-Cell Lung Cancer

Purpose This study was undertaken to investigate the efficacy and the feasibility of gefitinib for chemotherapy-naive patients with advanced non–small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. Patients and Methods The EGFR gene status in various tumor samples obtained from chemotherapy-naive advanced NSCLC patients was examined by DNA sequencing of EGFR exons 18 to 23. Patients harboring EGFR mutations received gefitinib (250 mg/d) alone. The response rate, progression-free survival (PFS), and toxicity profile were assessed prospectively. Results Between June 2004 and October 2005, 75 patients were examined for the EGFR status, and 25 patients (33%) harbored EGFR mutations. EGFR mutations were significantly frequent in females (P < .01) and never or light smokers (P < .001). Sixteen patients with EGFR mutations were enrolled onto the study. The overall response rate in these patients was 75% (95% CI, 54% to 96%), and the disease control rate was 88% (95% CI, 71%...

https://ascopubs.org/doi/pdf/10.1200/JCO.2005.05.4692

Prospective phase II study of gefitinib for chemotherapy-naive patients with advanced non-small-cell lung cancer with epidermal growth factor receptor gene mutations.

Purpose Amrubicin, a new anthracycline agent, and topotecan are both active for previously treated small-cell lung cancer (SCLC). No comparative study of these agents has been reported. This randomized phase II study was conducted to select amrubicin or topotecan for future evaluation. Patients and Methods Patients with SCLC previously treated with platinum-containing chemotherapy were randomly assigned to receive amrubicin (40 mg/m2 on days 1 through 3) or topotecan (1.0 mg/m2 on days 1 through 5). Patients were stratified by Eastern Cooperative Oncology Group performance status (0, 1, or 2) and type of relapse (chemotherapy sensitive or refractory). The primary end point was overall response rate (ORR), and secondary end points were progression-free survival (PFS), overall survival, and toxicity profile. Results From February 2004 to July 2007, 60 patients were enrolled, and 59 patients (36 patients with sensitive and 23 patients with refractory relapse) were assessable for efficacy and safety evaluatio...

https://ascopubs.org/doi/pdf/10.1200/jco.2008.18.1974

Randomized Phase II Trial Comparing Amrubicin With Topotecan in Patients With Previously Treated Small-Cell Lung Cancer: North Japan Lung Cancer Study Group Trial 0402

Colony-Specificity in Compound Ascidians as Tested by Fusion Experiments:A Preliminary Report

In this article the ionization rate of phosphorus doped in poly-Si gate and band gap narrowing caused by carrier–carrier interactions and carrier–ion interactions are self-consistently calculated by using a simple algorithm that is formulated phenomenologically. As a result, the ionization rate is found to be unity when the phosphorus concentration is less than 3×1019 cm−3, and becomes lower rapidly with the increase of the concentration larger than 3×1019 cm−3. Using this result, in a wide oxide voltage region, we can reproduce the oxide voltage dependence of the measured tunneling current from the gate in various samples (tOX=2.1, 2.8, and 3.4 nm) with the same tunneling mass (mOX=0.42m0), where m0 is the free electron mass. In particular, we show why the incomplete ionization can reproduce the tunneling current from the gate even in a lower oxide voltage region where the complete ionization cannot do so. Furthermore, a local band gap narrowing, which is described by an additional band gap narrowing due...

Effects of incomplete ionization of impurities in poly-Si gate and band gap narrowing on direct tunneling gate leakage current

Gametogenesis of a compound ascidian Botryllus primigenus was studied histologically. On either side of the zooid (stage 9), in the gonadal space between the epidermis and the atrial epithelium, either a single testis or a complex of an egg follicle and a testis can be formed. The egg follicle consists of a single ovum (occasionally two ova) and its accessory cells and is connected with the atrial epithelium by the follicle stalk. The eff follicle is always accompanied by the brood pouch, a diverticulum of the atrial cavity. The testis is equipped with a vestigial spermiduct and is attached to the atrial epithelium. Buds of stage 8 comprise, besides the developing testes and egg follicles, loose aggregations of hemoblasts and oocytes of early developmental stages, which are already accompanied by primary follicular cells. Both the oocytes and the primary follicular cells seem to arise from the hemoblasts. The young oocytes are isolated in the gonadal space of the buds and are transferred to buds of the succeeding generations until they finally mature. In the bud of stage 3, a compact mass of cells appears, attaching to the inner vesicle on either side of the body. It is derived from the hemoblasts lodged there in the preceding generation and presumably also from the circulating hemoblasts. When the cell mass receives a large oocyte derived from the preceding generation, part of the cell mass differentiates into egg envelopes, forming an egg follicle, and a follicle stalk and the remainder into a testis. When the cell mass receives no oocyte, it differentiates as a whole into a testis. In the egg follicle thus formed, the outer and inner follicular cells increase in number by mitotic division. Subsequently, initial test cells are derived from the inner follicle by migration across the developing chorion; then they increase in number by mitosis. In the testis, meiosis and spermiogenesis take place.

Hiroshi Watanabe

Papers

Prospective phase II study of gefitinib for chemotherapy-naive patients with advanced non-small-cell lung cancer with epidermal growth factor receptor gene mutations.

Randomized Phase II Trial Comparing Amrubicin With Topotecan in Patients With Previously Treated Small-Cell Lung Cancer: North Japan Lung Cancer Study Group Trial 0402

Colony-Specificity in Compound Ascidians as Tested by Fusion Experiments:A Preliminary Report

Effects of incomplete ionization of impurities in poly-Si gate and band gap narrowing on direct tunneling gate leakage current

Studies on the formation of germ cells in a compound ascidian Botryllus primigenus Oka