ABSTRACT
AIM: Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) approved for patients with EGFR mutated non-small cell lung cancer as first-line treatment. However, treatment resistance inevitably emerges and may present as oligo-progressive disease (OPD) or systemic progressive disease (SPD). The incidence of OPD on first-line osimertinib is unknown. METHODS: We retrospectively analyzed patients who received first-line osimertinib at 13 Swiss centers. The rate of OPD (PD in ≤ 5 lesions) and treatment outcomes were analyzed. RESULTS: The median age of the 148 patients was 68.2 years (range. 38.0-93.3). There were 62 % females, 83 % with a PS ≤ 1, 59 % never smokers, 57 % of patients with an EGFR exon 19 deletion and 37 % with EGFR p.L858R exon 21. 77 % experienced OPD. Median overall survival (OS) was 51.6 months (95 % CI, 38.4-65.0). Median progression-free survival (PFS) was 19.2 (95 % CI, 14.3-23.5) and 8.7 (95 % CI, 2.8-15.6) months for patients with common and uncommon EGFR mutations. Patients with OPD compared to SPD had a significantly longer time to treatment failure and longer OS of (22.9 vs. 10.8 months, p < 0.001 and 51.6 vs. 26.4 months, p = 0.004, respectively). The most common organ sites of PD were lung (62 %), brain (30 %), lymph nodes (30 %), bone (27 %) and pleura (27 %). Twenty-six patients (45 %) with OPD received local ablative treatment (LAT). The OS of OPD patients with LAT was 60.0 (95 % CI, 51.6-NA) vs. 51.4 (95 % CI 38.4-65.3) months (p = 0.43) without LAT. CONCLUSION: The rate of OPD of patients receiving first line osimertinib was 77 %. Patients with OPD had a significantly better OS compared to patients with SPD (51.6 vs. 26.4 months). Patients with OPD receiving LAT had the longest median OS (60.0 months).
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Female , Humans , Male , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/genetics , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , Cohort Studies , Retrospective Studies , Switzerland , Protein Kinase Inhibitors/pharmacology , Aniline Compounds/therapeutic use , ErbB Receptors/genetics , MutationABSTRACT
Pleural malignant mesothelioma is a rare tumour of the pleural epithelium, which progresses by infiltration into the lung parenchyma, the chest wall, and the mediastinum. Haematogenous spreading may occur in the late stages of the disease. Spinal involvement is exceptional and usually occurs in the vertebral body or epidural space, and intradural location of a mesothelioma is even more uncommon. In this article, a MEDLINE literature review on intradural mesothelioma was conducted and four intradural mesothelioma cases in the English literature were retrieved: one in the intradural extramedullary location and three with intramedullary growth. Additionally, we report a 50-year-old patient with a pleural malignant mesothelioma that spreads across the dura into the spinal cord at T5.
Subject(s)
Mesothelioma/secondary , Pleural Neoplasms/diagnosis , Spinal Cord Neoplasms/secondary , Brown-Sequard Syndrome/diagnosis , Brown-Sequard Syndrome/surgery , Dura Mater/pathology , Dura Mater/surgery , Humans , Laminectomy , Magnetic Resonance Imaging , Male , Mesothelioma/diagnosis , Mesothelioma/surgery , Microsurgery , Middle Aged , Nerve Compression Syndromes/diagnosis , Nerve Compression Syndromes/surgery , Neurologic Examination , Pleural Neoplasms/surgery , Spinal Cord Neoplasms/diagnosis , Spinal Cord Neoplasms/surgery , Spinal Nerve Roots/pathology , Spinal Nerve Roots/surgery , Thoracic Vertebrae/pathology , Thoracic Vertebrae/surgeryABSTRACT
BACKGROUND: The aim of this study was to assess the pharmacology, toxicity and activity of high-dose ifosfamide mesna +/- GM-CSF administered by a five-day continuous infusion at a total ifosfamide dose of 12-18 g/m2 in adult patients with advanced sarcomas. PATIENTS AND METHODS: Between January 1991 and October 1992 32 patients with advanced or metastatic sarcoma were entered the study. Twenty-seven patients were pretreated including twenty-three with prior ifosfamide at less than 8 g/m2 total dose/cycle. In 25 patients (27 cycles) extensive pharmacokinetic analyses were performed. RESULTS: The area under the plasma concentration-time curve (AUC) for ifosfamide increased linearly with dose while the AUC's of the metabolites measured in plasma by thin-layer chromatography did not increase with dose, particularly that of the active metabolite isophosphoramide mustard. Furthermore the AUC of the inactive carboxymetabolite did not increase with dose. Interpatient variability of pharmacokinetic parameters was high. Dose-limiting toxicity was myelosuppression at 18 g/m2 total dose with grade 4 neutropenia in five of six patients and grade 4 thrombocytopenia in four of six patients. Therefore the maximum tolerated dose was considered to be 18 g/m2 total dose. There was one CR and eleven PR in twenty-nine evaluable patients (overall response rate 41%). CONCLUSION: Both the activation and inactivation pathways of ifosfamide are non-linear and saturable at high-doses although the pharmacokinetics of the parent drug itself are dose linear. Ifosfamide doses greater than 14-16 g/m2 per cycle appear to result in a relative decrease of the active metabolite isophosphoramide mustard. These data suggest a dose-dependent saturation or even inhibition of ifosfamide metabolism by increasing high dose ifosfamide and suggest the need for further metabolic studies.
