ABSTRACT
Background: In recent years, osimertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), has been recommended as a first-line treatment for EGFR-mutant advanced non-small cell lung cancer (NSCLC). A phase III study (AENEAS) to assess the efficacy and safety of aumolertinib, another third-generation EGFR-TKI, vs. gefitinib as a first-line treatment in patients with locally advanced or metastatic NSCLC harboring EGFR mutations has also achieved positive results. Despite the improvements in progression-free survival (PFS) and overall survival (OS) of third- vs. first-generation EGFR-TKIs, combined treatment strategies to postpone drug resistance and further prolong survival benefits remain to be explored. Methods: We conducted a nonrandomized phase II trial (ChiCTR2000035140) of an oral multitarget antiangiogenic TKI (anlotinib) with third-generation EGFR-TKIs (osimertinib or aumolertinib) in untreated patients with EGFR mutation and advanced NSCLC. Anlotinib and the third-generation EGFR-TKIs were orally administrated (anlotinib at a dose of 12 mg once every other day and osimertinib at 80 mg once daily or aumolertinib at 110 mg once daily). The primary end point of the study was the objective response rate (ORR). Secondary endpoints included the disease control rate (DCR), OS, PFS, and safety of the combined treatment. Results: Enrollment was ceased due to treatment-related adverse events (trAEs) after 11 of 35 planned patients were treated. Among these 11 patients, two were lost to follow-up, and the treatment of five of the remaining nine patients was discontinued due to trAEs, including stomachache, rash, hyponatremia, pulmonary embolism, and interstitial pneumonia. AEs of grade 3 or worse were observed in five patients, but no treatment-related death occurred in these patients. Conclusions: Combining anlotinib and third-generation EGFR-TKIs in untreated EGFR-mutant patients with advanced NSCLC demonstrated significantly increased toxicity, suggesting that the combined treatment strategy was an inappropriate therapeutic choice in this setting.
ABSTRACT
In this study, a composite multilayer film onto gold was constructed from two charged building blocks, i.e., negatively charged graphene oxide (GO) and a branched polycation (polyethylenimine, PEI) via layer-by-layer (LbL) self-assembly technology, and this process was monitored in situ with quartz crystal microbalance (QCM) under different experimental conditions. This included the differences in frequency (Δf) as well as the changes in dissipation to yield information on the absorbed mass and viscoelastic properties of the formed PEI/GO multilayer films. The experimental conditions were optimized to obtain a high amount of the adsorbed mass of the self-assembled multilayer film. The surface morphology of the PEI/GO multilayer film onto gold was studied with atomic force microscopy (AFM). It was found that the positively charged PEI chains were combined with the oppositely charged GO to form an assembled film on the QCM sensor surface, in a wrapped and curled fashion. Raman and UV-vis spectra also showed that the intensities of the GO-characteristic signals are almost linearly related to the layer number. To explore the films for their use in divalent ion detection, the frequency response of the PEI/GO multilayer-modified QCM sensor to the exposure of aqueous solutions solution of Cu2+, Ca2+, Zn2+, and Sn2+ was further studied using QCM. Based on the Sauerbrey equation and the weight of different ions, the number of metal ions adsorbed per unit area on the surface of QCM sensors was calculated. For metal ion concentrations of 40 ppm, the adsorption capacities per unit area of Cu2+, Zn2+, Sn2+, and Ca2+ were found to be 1.7, 3.2, 0.7, and 4.9 nmol/cm2, respectively. Thus, in terms of the number of adsorbed ions per unit area, the QCM sensor modified by PEI/GO multilayer film shows the largest adsorption capacity of Ca2+. This can be rationalized by the relative hydration energies.
