According to a review of the efficacy and safety of various therapeutic approaches for the treatment of advanced non-small cell lung cancer (aNSCLC), the toxicity profiles linked to these medications differ between Asian and Western populations. The research was presented at the IASLC 2019 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer in Barcelona, Spain.

Particular epidemiologic differences in Asian vs Western patients with NSCLC, such as the increased prevalence of EGFR driver mutations in the former group, and their impact on treatment response to EGFR inhibitors, have been recognized for some time. Furthermore, there is evidence that the tolerability of some targeted therapies, chemotherapies, and immune checkpoint inhibitor (ICI) therapies also differs between Asian and Western populations treated for aNSCLC. Nevertheless, many of the factors underlying these observed differences are not well understood.

Highlighted in this presentation was the possibly higher incidence of pneumonitis observed in studies of Asian patients with aNSCLC receiving ICI therapy. While the overall response rate of 17% observed in predominantly Chinese patients with advanced NSCLC treated with nivolumab monotherapy in the Checkpoint 078 trial (ClinicalTrial.gov Identifier: NCT02613507) was similar to that observed in studies of Western populations,2 the incidence of pneumonitis reported in studies of Asian patients treated with ICI monotherapy may be higher than that observed in Western patients.

“Many genetic studies have revealed the prevalence of genetic polymorphisms (ie. mutations of SFTPC, ABCA3; telomere-associated genes like TERT, TERC, RTELI, PARN; single nucleotide polymorphism of MUC5B, etc.) was associated with susceptibility to interstitial lung disease in Japanese [patients],” the study author commented.

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In addition, the incidence of interstitial lung disease was reported to be higher in Japanese compared with Western patients with aNSCLC treated with the EGFR tyrosine kinase inhibitors gefitinib and erlotinib.

Similarly, a higher incidence of hematological toxicities, particularly grade 3/4 neutropenia, was been seen in Japanese patients compared with patients in the US and Europe who received docetaxel for the treatment of lung cancer.

“More genomic mapping and preclinical research should be implemented to explore the relationship between ethnic diversity and varying degrees of response,” the presenting study author noted in the study abstract.

Furthermore, the importance of conducting clinical trials in Asian patients with aNSCLC, particularly with respect to the evaluation of ICIs — as well as the inclusion of populations of patients infected with hepatitis B virus (HBV) due to the high incidence of HBV infection in the Asian population — were mentioned as areas of unmet need.

References

  1. Hu J.  Any difference on efficacy and toxicity between East and West? Presented at: IASLC 2019 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer; September 7-10, 2019; Barcelona, Spain. Abstract JCSE01-03.
  2. Wu YL, Lu S, Cheng Y, et al.  Nivolumab versus docetaxel in a predominantly Chinese patient population with previously treated advanced NSCLC: CheckMate 078 randomized phase III clinical trial. J Thorac Oncol. 2019;14(5):867-875.

This article originally appeared on Cancer Therapy Advisor