Molecular features of gastroenteropancreatic neuroendocrine carcinoma: A comparative analysis with lung neuroendocrine carcinoma and digestive adenocarcinomas

Objective: There is an ongoing debate about whether the management of gastroenteropancreatic(GEP)neuroendocrine carcinoma(NEC) should follow the guidelines of small-cell lung cancer(SCLC). We aim to identify the genetic differences of GEPNEC and its counterpart.Methods: We recruited GEPNEC patients as the main cohort, with lung NEC and digestive adenocarcinomas as comparative cohorts. All patients undergone next-generation sequencing(NGS). Different gene alterations were compared and analyzed between GEPNEC and lung NEC(LNEC), GEPNEC and adenocarcinoma to yield the remarkable genes.Results: We recruited 257 patients, including 99 GEPNEC, 57 LNEC, and 101 digestive adenocarcinomas.Among the mutations, KRAS, RB1, TERT, IL7R, and CTNNB1 were found to have different gene alterations between GEPNEC and LNEC samples. Specific genes for each site were revealed: gastric NEC(TERT amplification),colorectal NEC(KRAS mutation), and bile tract NEC(ARID1A mutation). The gene disparities between small-cell NEC(SCNEC) and large-cell NEC(LCNEC) were KEAP1 and CDH1. Digestive adenocarcinoma was also compared with GEPNEC and suggested RB1, APC, and KRAS as significant genes. The TP53/RB1 mutation pattern was associated with first-line effectiveness. Putative targetable genes and biomarkers in GEPNEC were identified in22.2% of the patients, and they had longer progression-free survival(PFS) upon targetable treatment [12.5 months vs. 3.0 months, HR=0.40(0.21-0.75), P=0.006].Conclusions: This work demonstrated striking gene distinctions in GEPNEC compared with LNEC and adenocarcinoma and their clinical utility.

Efficacy and safety of anlotinib plus penpulimab as second-line treatment for small cell lung cancer:A multicenter,open-label,single-arm phase II trial

Background:Currently,the need for new therapeutic strategies involving programmed cell death protein-1(PD-1)monoclonal antibodies in the second-line setting of small cell lung cancer(SCLC)is urgent.This study aimed to evaluate the efficacy and safety of anlotinib plus penpulimab as a second-line treatment for patients with SCLC who progressed after first-line platinum-based chemotherapy.Methods:This study included the patients from Cohort 4 of a single-arm,open-label,multicenter,phase II clinical trial.A safety run-in phase was performed under anlotinib(10/12 mg quaque die[QD],days 1–14)plus penpulimab(200 mg intravenously[IV],day 1)in a 21-day cycle,followed by the formal trial in which the patients received anlotinib(12 mg QD,days 1–14)plus penpulimab(200 mg IV,day 1)in a 21-day cycle.The primary endpoint of the safety run-in phase was safety.The primary endpoint of the formal trial phase was the objective response rate(ORR).Results:From April 28,2020,to November 24,2020,21 patients were enrolled from 11 hospitals,including 2 in the safety run-in phase and 19 in the formal trial phase.In the formal trial phase,the ORR was 42.1%(8/19;95%confidence interval[CI]:17.7–66.6%).The median progression-free survival was 4.8 months(95%CI:2.9–11.3 months),and the median overall survival was 13.0 months(95%CI:4.6–not applicable[NA]months).The incidence of grade 3 treatment-related adverse events(TRAEs)was 52.4%(11/21),and the incidence of treatment-related serious adverse events(AEs)was 28.6%(6/21).Two AE-related deaths occurred.The most common AEs were hypertension(57.1%,12/21),hypothyroidism(42.9%,9/21),and hypertriglyceridemia(38.1%,8/21).Conclusions:In patients with SCLC who progressed after first-line platinum-based chemotherapy,the second-line anlotinib plus penpulimab treatment demonstrates promising anti-cancer activity and a manageable safety profile,which warrants further investigation.

Clinical outcomes of atezolizumab in combination with etoposide/platinum for treatment of extensive-stage small-cell lung cancer:A real-world,multicenter,retrospective,controlled study in China

Objective:Atezolizumab along with chemotherapy has prolonged the survival of patients with extensive-stage small-cell lung cancer(ES-SCLC)worldwide,although real-world(RW)data are lacking in China.This study was designed to evaluate the efficacy and clinical outcomes of atezolizumab plus etoposide/platinum(EP).Methods:Data obtained in this retrospective study were captured from six oncology units of five medical facilities from January 2019 to April 2022.For first-line treatments,atezolizumab combined with EP vs.EP alone,we primarily evaluated progression-free survival(PFS);other efficacy indicators,including overall survival(OS),objective response rate(ORR),and patterns of SCLC progression and adverse events(AEs)were assessed.Results:The primary analysis included data from 225 patients,of whom 133 received EP along with atezolizumab(atezolizumab group)and 92 received EP alone(EP group).The PFS duration of the atezolizumab group[7.10 months;95%confidence interval(95%CI),6.53-9.00]exceeded that of the EP group(6.50 months;95%CI,4.83-7.53).Overall,the hazard ratio(HR)was 0.69(95%CI,0.49-0.97)(P=0.029);particularly,the HR was 0.54(95%CI,0.36-0.80)among patients undergoing≥4 chemotherapy cycles and 0.33(95%CI,0.20-0.56)among individuals with atezolizumab maintenance.The ORR and disease-control rate(DCR)were similar between the two groups.Because of incomplete OS data,the median OS was not determined for either group.Bone marrow suppression was the most common AE detected(58.6%)in the atezolizumab group.Immune-related AEs occurred in 19 patients in the atezolizumab group(14.3%),with only one case of grade 3 encephalitis.Conclusions:This RW study in China demonstrated improved clinical outcomes of atezolizumab along with EP for ES-SCLC,particularly in the chemosensitive population.These results align with the results of the IMpower133 study,although the impact of this treatment modality on OS warrants additional follow-up studies.