SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Department of Thoracic Head and Neck Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Lancet Oncol. 2020 Dec;21(12):1589-1601. doi: 10.1016/S1470-2045(20)30475-7. Epub 2020 Oct 27.
BACKGROUND: The Lung Cancer Master Protocol (Lung-MAP; S1400) is a completed biomarker-driven master protocol designed to address an unmet need for better therapies for squamous non-small-cell lung cancer. Lung-MAP (S1400) was created to establish an infrastructure for biomarker screening and rapid regulatory intent evaluation of targeted therapies and was the first biomarker-driven master protocol initiated with the US National Cancer Institute (NCI). METHODS: Lung-MAP (S1400) was done within the National Clinical Trials Network of the NCI using a public-private partnership. Eligible patients were aged 18 years or older, had stage IV or recurrent squamous non-small-cell lung cancer, had previously been treated with platinum-based chemotherapy, and had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. The study included a screening component using the FoundationOne assay (Foundation Medicine, Cambridge, MA, USA) for next-generation sequencing, and a clinical trial component with biomarker-driven substudies and non-match substudies for patients who were ineligible for biomarker-driven substudies. Patients were pre-screened and received their substudy assignment upon progression, or they were screened at progression and received their substudy assignment upon completion of testing. Patients could enrol onto additional substudies after progression on a substudy. The study is registered with ClinicalTrials.gov, NCT02154490, and all research related to Lung-MAP (S1400) is completed. FINDINGS: Between June 16, 2014, and Jan 28, 2019, 1864 patients enrolled and 1841 (98·9%) submitted tissue. 1674 (90·9%) of 1841 patients had biomarker results, and 1404 (83·9%) of 1674 patients received a substudy assignment. Of the assigned patients, 655 (46·7%) registered to a substudy. The biomarker-driven substudies evaluated taselisib (targeting PIK3CA alterations), palbociclib (cell cycle gene alterations), AZD4547 (FGFR alteration), rilotumumab plus erlotinib (MET), talazoparib (homologous recombination repair deficiency), and telisotuzumab vedotin (MET). The non-match substudies evaluated durvalumab, and nivolumab plus ipilimumab for anti-PD-1 or anti-PD-L1-naive disease, and durvalumab plus tremelimumab for anti-PD-1 or anti-PD-L1 relapsed disease. Combining data from the substudies, ten (7·0%) of 143 patients responded to targeted therapy, 53 (16·8%) of 315 patients responded to anti-PD-1 or anti-PD-L1 therapy for immunotherapy-naive disease, and three (5·4%) of 56 responded to docetaxel in the second line of therapy. Median overall survival was 5·9 months (95% CI 4·8-7·8) for the targeted therapy groups, 7·7 months (6·7-9·2) for the docetaxel groups, and 10·8 months (9·4-12·3) for the anti-PD-1 or anti-PD-L1-containing groups. Median progression-free survival was 2·5 months (95% CI 1·7-2·8) for the targeted therapy groups, 2·7 months (1·9-2·9) for the docetaxel groups, and 3·0 months (2·7-3·9) for the anti-PD-1 or anti-PD-L1-containing groups. INTERPRETATION: Lung-MAP (S1400) met its goal to quickly address biomarker-driven therapy questions in squamous non-small-cell lung cancer. In early 2019, a new screening protocol was implemented expanding to all histological types of non-small-cell lung cancer and to add focus on immunotherapy combinations for anti-PD-1 and anti-PD-L1 therapy-relapsed disease. With these changes, Lung-MAP continues to meet its goal to focus on unmet needs in the treatment of advanced lung cancers. FUNDING: US National Institutes of Health, and AbbVie, Amgen, AstraZeneca, Bristol Myers Squibb, Genentech, and Pfizer through the Foundation for the National Institutes of Health.
背景:肺癌综合治疗研究(Lung-MAP;S1400)是一项已完成的生物标志物驱动的综合治疗研究,旨在满足非小细胞肺癌鳞癌患者对更好治疗方案的迫切需求。Lung-MAP(S1400)的建立是为了建立一个生物标志物筛选的基础设施,并快速评估针对治疗靶点的靶向治疗药物的监管意向,这是第一个由美国国家癌症研究所(NCI)发起的生物标志物驱动的综合治疗研究。
方法:NCI 的国家临床试验网络采用公私合作伙伴关系开展了 Lung-MAP(S1400)研究。入组标准为年龄≥18 岁、IV 期或复发性非小细胞肺癌鳞癌、既往接受过铂类化疗、东部肿瘤协作组(ECOG)体能状态评分为 0-2 分的患者。该研究包括使用 FoundationOne 检测(Foundation Medicine,马萨诸塞州剑桥市)进行下一代测序的筛选部分,以及具有生物标志物驱动亚研究和不适合生物标志物驱动亚研究的非匹配亚研究的临床试验部分。患者在进展时进行预筛选并接受亚组分配,或者在完成检测后在进展时进行筛选并接受亚组分配。患者在亚组研究进展后可以继续参加其他亚组研究。该研究在 ClinicalTrials.gov 注册,NCT02154490,所有与 Lung-MAP(S1400)相关的研究均已完成。
结果:从 2014 年 6 月 16 日至 2019 年 1 月 28 日,共纳入 1864 例患者,1841 例(98.9%)患者提交了组织样本。1674 例(90.9%)患者有生物标志物结果,1404 例(83.9%)患者接受了亚组分配。在分配的患者中,655 例(46.7%)患者登记参加了亚组研究。生物标志物驱动的亚研究评估了 taselisib(针对 PIK3CA 改变)、palbociclib(细胞周期基因改变)、AZD4547(FGFR 改变)、rilotumumab 联合 erlotinib(MET)、talazoparib(同源重组修复缺陷)和 telisotuzumab vedotin(MET)。非匹配亚研究评估了 durvalumab 和 nivolumab 联合 ipilimumab 用于抗 PD-1 或抗 PD-L1 初治疾病,以及 durvalumab 联合 tremelimumab 用于抗 PD-1 或抗 PD-L1 复发疾病。将亚组研究的数据合并后,143 例患者中有 10 例(7.0%)对靶向治疗有反应,315 例免疫治疗初治患者中有 53 例(16.8%)对抗 PD-1 或抗 PD-L1 治疗有反应,56 例二线治疗患者中有 3 例(5.4%)对多西紫杉醇有反应。靶向治疗组的总生存期为 5.9 个月(95%CI 4.8-7.8),多西紫杉醇组为 7.7 个月(6.7-9.2),抗 PD-1 或抗 PD-L1 组为 10.8 个月(9.4-12.3)。靶向治疗组的无进展生存期为 2.5 个月(95%CI 1.7-2.8),多西紫杉醇组为 2.7 个月(1.9-2.9),抗 PD-1 或抗 PD-L1 组为 3.0 个月(2.7-3.9)。
解释:Lung-MAP(S1400)达到了快速解决鳞状非小细胞肺癌中生物标志物驱动治疗问题的目标。2019 年初,实施了新的筛选方案,扩大到所有非小细胞肺癌的组织学类型,并将重点放在抗 PD-1 和抗 PD-L1 治疗复发疾病的免疫治疗联合方案上。有了这些变化,Lung-MAP 继续满足其专注于晚期肺癌治疗中未满足需求的目标。
资金来源:美国国立卫生研究院和 AbbVie、Amgen、AstraZeneca、Bristol Myers Squibb、Genentech 和 Pfizer 通过国家卫生研究院基金会提供资金。
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