ABSTRACT
Background: Afatinib is indicated for advanced-stage non-small-cell lung cancer (NSCLC) with Epidermal Growth Factor Receptor (EGFR) and uncommon mutations. However, real-world studies on this topic are limited. This study aimed to evaluate afatinib as first-line therapy for locally advanced and metastatic NSCLC with uncommon EGFR mutations. Patients and methods: A retrospective study included 92 patients with advanced NSCLC with uncommon and compound EGFR mutations, treated with afatinib as first-line therapy. Patients were followed up and evaluated every 3 months or when symptoms of progressive disease arose. The endpoints were objective response rate (ORR), time-to-treatment failure (TTF), and adverse events. Results: The G719X EGFR mutation had the highest occurrence rate (53.3% for both monotherapy and the compound). By contrast, the compound mutation G719X-S768I was observed at a rate of 22.8%. The ORR was 75%, with 15.2% of patients achieving complete response. The overall median TTF was 13.8 months. Patients with the G719X EGFR mutation (single and compound) had a median TTF of 19.3 months, longer than that of patients with other mutations, who had a median TTF of 11.2 months. Patients with compound EGFR mutations (G719X and S768I) demonstrated a median TTF of 23.2 months compared to that of 12.3 months for other mutations. Tolerated doses of 20 or 30 mg achieved a longer median TTF of 17.1 months compared to 11.2 months with 40 mg. Median TTF differed between patients with and without brain metastasis, at 11.2 and 16.9 months, respectively. Rash (55.4%) and diarrhea (53.3%) were the most common adverse events, primarily grades 1 and 2. Other side effects occurred at a low rate. Conclusion: Afatinib is effective for locally advanced metastatic NSCLC with uncommon EGFR mutations. Patients with G719X, compound G719X-S768I mutations, and tolerated doses of 20 or 30 mg had a longer median TTF than those with other mutations.
ABSTRACT
Therapeutic antibodies that block vascular endothelial growth factor (VEGF) show clinical benefits in treating nonsmall cell lung cancers (NSCLCs) by inhibiting tumor angiogenesis. Nonetheless, the therapeutic effects of systemically administered anti-VEGF antibodies are often hindered in NSCLCs because of their limited distribution in the lungs and their adverse effects on normal tissues. These challenges can be overcome by delivering therapeutic antibodies in their mRNA form to lung endothelial cells, a primary target of VEGF-mediated pulmonary angiogenesis, to suppress the NSCLCs. In this study, we synthesized derivatives of poly(ß-amino esters) (PBAEs) and prepared nanoparticles to encapsulate the synthetic mRNA encoding bevacizumab, an anti-VEGF antibody used in the clinic. Optimization of nanoparticle formulations resulted in a selective lung transfection after intravenous administration. Notably, the optimized PBAE nanoparticles were distributed in lung endothelial cells, resulting in the secretion of bevacizumab. We analyzed the protein corona on the lung- and spleen-targeting nanoparticles using proteomics and found distinctive features potentially contributing to their organ-selectivity. Lastly, bevacizumab mRNA delivered by the lung-targeting PBAE nanoparticles more significantly inhibited tumor proliferation and angiogenesis than recombinant bevacizumab protein in orthotopic NSCLC mouse models, supporting the therapeutic potential of bevacizumab mRNA therapy and its selective delivery through lung-targeting nanoparticles. Our proof-of-principle results highlight the clinical benefits of nanoparticle-mediated mRNA therapy in anticancer antibody treatment in preclinical models.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Animals , Mice , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , Bevacizumab/pharmacology , Bevacizumab/therapeutic use , Vascular Endothelial Growth Factor A/genetics , Vascular Endothelial Growth Factor A/metabolism , Endothelial Cells/metabolism , Nanomedicine , RNA, Messenger/genetics , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/genetics , Vascular Endothelial Growth Factors , Polymers/therapeutic use , Lung/metabolism , Angiogenesis Inhibitors/pharmacology , Angiogenesis Inhibitors/therapeutic useABSTRACT
BACKGROUND: This study aimed to evaluate the efficacy and side effects of first-line afatinib treatment in a real-world setting in Vietnam. METHODS: This retrospective study was conducted across nine hospitals in Vietnam. Advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients who received afatinib as first-line therapy between April 2018 and June 2022 were included, and patient medical records were reviewed. Key outcomes were overall response rate (ORR), time-to-treatment failure (TTF), and tolerability. RESULTS: A total of 343 patients on first-line afatinib were eligible for the study. EGFR exon 19 deletion (Del19) alone was detected in 46.9% of patients, L858R mutation alone in 26.3%, and other uncommon EGFR mutations, including compound mutations, in 26.8%. Patients with brain metastases at baseline were 25.4%. Patients who received 40 mg, 30 mg, and 20 mg as starting doses of afatinib were 58.6%, 39.9%, and 1.5%, respectively. The ORR was 78.1% in the overall population, 82.6% in the Del19 mutation subgroup, 73.3% in the L858R mutation subgroup, and 75.0% in the uncommon mutation subgroup (p > 0.05). The univariate and multivariate analyses indicate that the ORR increased when the starting dose was 40 mg compared to starting doses below 40 mg (83.9% vs. 74.3%, p = 0.034). The median TTF (mTTF) was 16.7 months (CI 95%: 14.8-18.5) in all patients, with a median follow-up time of 26.2 months. The mTTF was longer in patients in the common EGFR mutation subgroup (Del19/L858R) than in those in the uncommon mutation subgroup (17.5 vs. 13.8 months, p = 0.045) and in those without versus with brain metastases at baseline (17.5 vs. 15.1 months, p = 0.049). There were no significant differences in the mTTF between subgroups based on the starting dose of 40 mg and < 40 mg (16.7 vs. 16.9 months, p > 0.05). The most common treatment-related adverse events (any grade/grade ≥ 3) were diarrhea (55.4%/3.5%), rash (51.9%/3.2%), paronychia (35.3%/5.0%), and stomatitis (22.2%/1.2%). CONCLUSIONS: Afatinib demonstrated clinical effectiveness and good tolerability in Vietnamese EGFR-mutant NSCLC patients. In our real-world setting, administering a starting dose below 40 mg might result in a reduction in ORR; however, it might not have a significant impact on TTF.
Subject(s)
Afatinib , Brain Neoplasms , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Humans , Afatinib/therapeutic use , Brain Neoplasms/drug therapy , Brain Neoplasms/secondary , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/genetics , Carcinoma, Non-Small-Cell Lung/pathology , Cohort Studies , ErbB Receptors/genetics , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Mutation , Protein Kinase Inhibitors/therapeutic use , Retrospective Studies , Vietnam/epidemiologyABSTRACT
Phosphodiesterase type 5 inhibitors (PDE-5i) are the first-line medication for oral erectile dysfunction, which are used according to the prescription of doctors. However, these substances have been found illegally in supplementary foods. The quality and safety of dietary supplements for enhancing male sexual performance have been questioned, raising the need for continual development of analytical methods. Liquid chromatography coupled with high-resolution mass spectrometry has become one of the most effective methods to identify and measure PDE-5i concentration. In this research, we focused on (i) developing and validating an effective screening and quantitation method for more than 53 PDE-5i in ingredients and supplementary products using LC-Q-Exactive after a simple sample extraction and (ii) assessing PDE-5i content in natural-based supplementary products available in Vietnam market. The extraction method used a small amount of organic solvent, which makes it more environmentally friendly (greener). The developed method has a limit of detection of 0.4 mg/kg, a limit of quantitation of 1.2 mg/kg, recoveries from 80 to 110%, and repeatability lower than 15%. Ninety-two herbal supplementary foods and ingredients used for enhancement of male sexual performance available in Vietnamese markets were collected. Fourteen PDE-5i including conventional and novel analogous were detected and measured in eighteen food supplements and two formulation ingredient samples.
ABSTRACT
Bensulfuron-methyl is an herbicide widely used for weed control although its residues cause damage to other crops during crop rotations. In this study, the biodegrading activity of bensulfuron-methyl by a plant growth-promoting bacterial strain was carried out. Methylopila sp. DKT isolated from soil was determined for bensulfuron-methyl degradation and phosphate solubilization in the liquid media and soil. Moreover, the effects of the herbicide on peanut development and the role of Methylopila sp. DKT on the growth promotion of peanut were investigated. The results showed that the isolate effectively utilized the compound as a sole carbon source and solubilized low soluble inorganic phosphates. Methylopila sp. DKT also utilized 2-amino-4,6-dimethoxypyrimidine, a metabolite of bensulfuron-methyl degradation, as a sole carbon and energy source, and released ammonium and nitrate. The supplementation with Methylopila sp. DKT in soil increased the peanut biomass and the phosphorus content in the plant. In addition, the inoculation with Methylopila sp. DKT in soil and peanut cultivation increased the bensulfuron-methyl degradation by 57.7% for 1 month, which suggests that both plants and the bacterial isolate play a key role in herbicide degradation. These results indicate that the studied strain has a high potential for soil remediation and peanut growth promotion.
Subject(s)
Arachis/growth & development , Biodegradation, Environmental , Methylocystaceae/metabolism , Soil Microbiology , Sulfonylurea Compounds/metabolism , Biomass , Herbicides/metabolism , Methylocystaceae/genetics , Phosphorus/analysis , Phylogeny , RNA, Ribosomal, 16S/geneticsABSTRACT
A chloroaniline-degrading bacterial strain isolated from polluted sediment in the Mekong River was identified as Geobacter sp. KT5. The obtained isolate was found to utilize a wide range of trichloroanilines (TCAs), dichloroanilines (DCAs), monochloroanilines (MACs), and aniline as sources of carbon and energy. It also used Fe(III) as a terminal electron acceptor under anaerobic conditions. Among the chlorinated anilines, KT5 utilized 2,3,4-trichloroaniline (234TCA) with the highest rate (2.48 ± 0.32 µM day-1). On determining the degradation pathway for chloroanilines (CAs) in Geobacter sp. KT5, it showed that the removal of ortho and para halogen was dominant. Firstly, KT5 ortho-dechlorinated some TCAs to DCAs, and then reductively transformed them into MACs and aniline prior to complete degradation with the iron reduction stoichiometry and release of nitrogen and chlorine. The KT5 augmentation in sediment slurry enhanced the degradation of CAs and aniline; however, the anaerobic degradation rates in slurry were significantly lower compared to those in liquid media.