Role of Immune Checkpoint Inhibitor Therapy in Advanced EGFR-Mutant Non-Small Cell Lung Cancer
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In this article, the authors reviewed previous and ongoing clinical studies of ICI therapy in advanced EGFRm NSCLC and discussed advances in understanding the differences in the tumor biology and tumor microenvironment (TME) of EGFRs.Abstract:
Over the last decade, the treatment of advanced non-small cell lung cancer (NSCLC) has undergone rapid changes with innovations in oncogene-directed therapy and immune checkpoint inhibitors. In patients with NSCLC that harbors an epidermal growth factor receptor (EGFR) gene mutation (EGFRm), newer-generation tyrosine kinase inhibitors (TKIs) are providing unparalleled survival benefit and tolerability. Unfortunately, most of these patients will experience disease progression and thus an urgent need exists for improved subsequent lines of therapies. The concurrent revolution in immune checkpoint inhibitor (ICI) therapy is providing novel first and second line treatment options with improved clinical outcomes in wild-type EGFR (EGFRwt) NSCLC; however, the application of ICI therapy to advanced EGFRm NSCLC patients is controversial. Early studies demonstrated the inferiority of ICI monotherapy to EGFR TKI therapy in the first line setting and inferiority to chemotherapy in the second line setting. Additionally, combination ICI and EGFR TKI therapies have demonstrated increased toxicities, and EGFR TKI therapy given after first-line ICI therapy has been correlated with severe adverse events. Nonetheless, combination ICI therapies including dual-ICI blockade and ICI, chemotherapy, and angiogenesis inhibitors are areas of active study with some intriguing signals in preliminary studies. Here, we review previous and ongoing clinical studies of ICI therapy in advanced EGFRm NSCLC. We reviewed the data on ICI therapy in NSCLC with ALK, ROS1, BRAF, c-MET, RET, and NTRK mutations in a separate manuscript. We discuss advances in understanding the differences in the tumor biology and tumor microenvironment (TME) of EGFRm NSCLC tumors that may lead to novel approaches to enhance ICI efficacy. It is our goal to equip the reader with a knowledge of current therapies, past and current clinical trials, and exciting avenues of research that provide the promise of novel approaches and improved outcomes for patients with advanced EGFRm NSCLC.read more
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Sequential chemotherapy and icotinib as first-line treatment for advanced epidermal growth factor receptor-mutated non-small cell lung cancer
TL;DR: A sequential combination of chemotherapy and EGfr-tyrosine kinase inhibitor is feasible for stage IV EGFR-mutated NSCLC patients.
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A Closer Look at EGFR Inhibitor Resistance in Non-Small Cell Lung Cancer through the Lens of Precision Medicine
Martin Sattler,Isa Mambetsariev,Jeremy Fricke,Tingting Tan,Sariah Liu,Nagarajan Vaidehi,Evan Pisick,Tamara Mirzapoiazova,Adam G. Rock,Amartej Merla,Sunil Sharma,Ravi Salgia +11 more
TL;DR: In this article , the duality between genetic and nongenetic EGFR inhibitor drug resistance is discussed and summarize current team medicine approaches, wherein clinical developments, hand in hand with drug development research, drive potential opportunities for combination therapy.
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TL;DR: Nivolumab was associated with even greater efficacy than docetaxel across all end points in subgroups defined according to prespecified levels of tumor-membrane expression (≥1, ≥5%, and ≥10%) of the PD-1 ligand.
Journal ArticleDOI
Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer
Julie R. Brahmer,Karen L. Reckamp,Paul Baas,Lucio Crinò,Wilfried Eberhardt,Elena Poddubskaya,Scott J. Antonia,Adam Pluzanski,Everett E. Vokes,Esther Holgado,David M. Waterhouse,Neal Ready,Justin F. Gainor,Osvaldo Arén Frontera,Libor Havel,Martin Steins,Marina Chiara Garassino,Joachim G.J.V. Aerts,Manuel Domine,Luis Paz-Ares,Martin Reck,Christine Baudelet,Christopher T. Harbison,Brian Lestini,David R. Spigel +24 more
TL;DR: Among patients with advanced, previously treated squamous-cell NSCLC, overall survival, response rate, and progression-free survival were significantly better with nivolumab than with docetaxel, regardless of PD-L1 expression level.
Journal ArticleDOI
Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial.
Roy S. Herbst,Paul Baas,Dong Wan Kim,Enriqueta Felip,Jose Luis Perez-Gracia,Ji Youn Han,Julian R. Molina,Joo Hang Kim,Catherine Dubos Arvis,Myung-Ju Ahn,Margarita Majem,Mary J. Fidler,Gilberto de Castro,Marcelo Garrido,Gregory M. Lubiniecki,Yue Shentu,Ellie Im,Marisa Dolled-Filhart,Edward B. Garon +18 more
TL;DR: In this article, the authors evaluated the efficacy of pembrolizumab for patients with previously treated, PD-L1-positive, advanced non-small-cell lung cancer.
Journal ArticleDOI
Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study
Caicun Zhou,Yi-Long Wu,Gongyan Chen,Jifeng Feng,Xiaoqing Liu,Changli Wang,Shucai Zhang,Jie Wang,Songwen Zhou,Shengxiang Ren,Shun Lu,Li Zhang,Chengping Hu,Chunhong Hu,Yi Luo,Lei Chen,Ming Ye,Jian'An Huang,Xiuyi Zhi,Yiping Zhang,Qingyu Xiu,Jun Ma,Changxuan You +22 more
TL;DR: It is suggested that erlotinib is important for first-line treatment of patients with advanced EGFR mutation-positive NSCLC, and was associated with more favourable tolerability than standard chemotherapy.