ASCO data show more than 10% of patients on
IMFINZI plus chemotherapy had not progressed and remained on
treatment at two years vs. 2.9% on chemotherapy alone
Detailed results from an updated analysis of the Phase III
CASPIAN trial showed AstraZeneca’s IMFINZI in combination with a
choice of chemotherapies, etoposide plus either carboplatin or
cisplatin, demonstrated a sustained, clinically meaningful overall
survival (OS) benefit for adults with extensive-stage small cell
lung cancer (ES-SCLC) treated in the 1st-line setting.
The CASPIAN trial met the primary endpoint of OS in June 2019,
reducing the risk of death by 27% (based on a hazard ratio [HR] of
0.73; 95% confidence interval [CI] 0.59-0.91; p=0.0047) which
formed the basis of the US FDA approval in March 2020.
After a median follow up of more than two years, the latest
results for IMFINZI plus chemotherapy showed sustained efficacy,
maintaining a 25% reduction in the risk of death versus
chemotherapy alone (based on an HR of 0.75; 95% CI 0.62, 0.91;
nominal p=0.0032). Updated median OS was 12.9 months versus 10.5
for chemotherapy. In a post-hoc analysis, an estimated 22.2% of
patients treated with IMFINZI plus chemotherapy were alive at 24
months versus 14.4% for chemotherapy.
For IMFINZI plus chemotherapy, 11% of patients were alive and
progression-free at 24 months versus 2.9% for chemotherapy alone
(post-hoc). IMFINZI plus chemotherapy maintained a high confirmed
objective response rate (ORR) (68% versus 58%) and in a post-hoc
analysis, duration of response (DoR) for IMFINZI at 24 months was
13.5% versus 3.9% for chemotherapy. At 24 months, 12% of patients
in the IMFINZI plus chemotherapy arm remained on IMFINZI
treatment.
Luis Paz-Ares MD, Ph.D., Chair, Medical Oncology Department,
Hospital Universitario Doce de Octubre, Madrid, Spain and principal
investigator in the Phase III CASPIAN trial said: “These updated
results from the CASPIAN trial show a remarkable 22% of patients
still alive at 24 months, supporting the sustained benefits of
treatment with IMFINZI plus chemotherapy. This is an effective
1st-line treatment in the extensive-stage setting, where improving
outcomes has been a challenge and so few patients survive five
years.”
José Baselga, Executive Vice President, Oncology R&D, said:
“After two years median follow-up, IMFINZI continues to show
sustained and meaningful improvements in survival and prolonged
treatment response for patients facing this devastating and
aggressive disease. These data reinforce IMFINZI plus chemotherapy
as an important new standard of care for extensive-stage small cell
lung cancer patients, and this regimen offers patients convenient
dosing every four weeks during maintenance. We look forward to
bringing the benefits of IMFINZI to patients around the world.”
The second experimental arm in the CASPIAN trial testing
tremelimumab, an anti-CTLA4 monoclonal antibody, added to IMFINZI
and chemotherapy showed a trend towards OS, but did not reach
statistical significance compared to chemotherapy alone.
Summary of updated results:
Data cut-off date was January 27, 2020. Formal statistical
analysis was completed at the time of the interim analysis per
trial protocol. Therefore, no formal testing for statistical
significance could be performed in this updated analysis.
EPi + IMFINZI
(n=268)
EPi
(n=269)
OS (primary endpoint)
Number of deaths
210 (78.4%)
231 (85.9%)
Hazard ratio
0.75 (0.62, 0.91)
Nominal p-value
0.0032
Median in months
(95% CI)
12.9 (11.3, 14.7)
10.5 (9.3, 11.2)
OS rate (24 months)ii,iii
22.2%
14.4%
PFS (secondary endpoint)
Number (%) of patients with
event
234 (87.3%)
236 (87.7%)
Hazard ratio (95% CI)
0.80 (0.66, 0.96)
Median in months
(95% CI)
5.1 (4.7, 6.2)
5.4 (4.8, 6.2)
PFS rate (6 months)
45.4%
45.8%
PFS rate (12 months)
17.9%
5.3%
PFS rate (24 months)iii
11.0%
2.9%
ORR (secondary endpoint)iv,v
Number (%) of patients with
response
182 (67.9%)
156 (58.0%)
Odds ratio (95% CI)
1.53 (1.08, 2.18)
DoR at 24 monthsiii,iv
13.5%
3.9%
Ongoing IMFINZI, n (%)iii
32 (12%)
0
- Etoposide plus investigator choice of carboplatin or cisplatin
chemotherapy.
- OS rate is an estimated proportion of patients alive at 24
months.
- Post-hoc analysis.
- Confirmed responses according to investigator assessment per
RECIST v1.1.
- Unconfirmed ORR was a prespecified secondary endpoint per
protocol.
The safety and tolerability for IMFINZI plus chemotherapy was
consistent with the known safety profile of these medicines.
Results showed 62.3% of patients experienced a Grade 3 or 4 adverse
event with IMFINZI plus chemotherapy (all causes) versus 62.8% with
chemotherapy alone. The percentage of patients discontinuing
treatment (all causes) was 10.2% for IMFINZI plus chemotherapy and
9.4% for chemotherapy alone.
IMFINZI in combination with etoposide and either carboplatin or
cisplatin is currently under regulatory review for the treatment of
ES-SCLC in the 1st-line setting in the EU and Japan.
Updated results from the CASPIAN trial were presented during the
2020 American Society of Clinical Oncology ASCO20 Virtual
Scientific Program on May 29-31, 2020. Several presentations
featured during the meeting will showcase AstraZeneca’s leadership
in lung cancer across early and late-stage disease and reinforce
the Company’s biomarker-driven approach.
Important Safety Information
There are no contraindications for IMFINZI® (durvalumab).
IMFINZI can cause serious, potentially fatal adverse reactions
including immune-mediated pneumonitis, hepatitis, colitis,
endocrinopathies, nephritis, dermatologic reactions, other
immune-mediated adverse reactions, infection, and infusion-related
reactions. Please refer to the full Prescribing Information for
important dosage modification and management information specific
to adverse reactions.
Immune-Mediated Pneumonitis
IMFINZI can cause immune-mediated pneumonitis, defined as
requiring use of corticosteroids. Fatal cases have been reported.
Monitor patients for signs and symptoms of pneumonitis and evaluate
with radiographic imaging when suspected. Administer
corticosteroids for Grade 2 or greater pneumonitis. Withhold
IMFINZI for Grade 2 pneumonitis; permanently discontinue for Grade
3 or 4 pneumonitis.
In clinical studies enrolling 1889 patients with various cancers
who received IMFINZI, pneumonitis occurred in 5% of patients,
including Grade 3 (0.8%), Grade 4 (<0.1%), and Grade 5 (0.3%)
pneumonitis. Pneumonitis led to discontinuation of IMFINZI in 1.5%
of the 1889 patients. The incidence of pneumonitis (including
radiation pneumonitis) was higher in patients in the PACIFIC study
who completed treatment with definitive chemoradiation within 42
days prior to initiation of IMFINZI (34%) compared to patients in
other clinical studies (2.3%) in which radiation therapy was
generally not administered immediately prior to initiation of
IMFINZI. In the PACIFIC study, the incidence of Grade 3 pneumonitis
was 3.4% and of Grade 5 pneumonitis was 1.1% in the IMFINZI arm. In
the PACIFIC study, pneumonitis led to discontinuation of IMFINZI in
6% of patients.
The frequency and severity of immune-mediated pneumonitis were
similar whether IMFINZI was given as a single agent in patients
with various cancers or in combination with chemotherapy in
patients with ES-SCLC.
Immune-Mediated Hepatitis
IMFINZI can cause immune-mediated hepatitis, defined as
requiring use of corticosteroids. Fatal cases have been reported.
Monitor patients for signs and symptoms of hepatitis during and
after discontinuation of IMFINZI, including clinical chemistry
monitoring. Administer corticosteroids for Grade 2 or higher
elevations of ALT, AST, and/or total bilirubin. Withhold IMFINZI
for ALT or AST greater than 3 but less than or equal to 8 times the
ULN or total bilirubin greater than 1.5 but less than or equal to 5
times the ULN; permanently discontinue IMFINZI for ALT or AST
greater than 8 times the ULN or total bilirubin greater than 5
times the ULN or concurrent ALT or AST greater than 3 times the ULN
and total bilirubin greater than 2 times the ULN with no other
cause.
In clinical studies enrolling 1889 patients with various cancers
who received IMFINZI, hepatitis occurred in 12% of patients,
including Grade 3 (4.4%), Grade 4 (0.4%), and Grade 5 (0.2%)
hepatitis. Hepatitis led to discontinuation of IMFINZI in 0.7% of
the 1889 patients.
Immune-Mediated Colitis
IMFINZI can cause immune-mediated colitis, defined as requiring
use of corticosteroids. Administer corticosteroids for Grade 2 or
greater colitis or diarrhea. Withhold IMFINZI for Grade 2 colitis
or diarrhea; permanently discontinue for Grade 3 or 4 colitis or
diarrhea.
In clinical studies enrolling 1889 patients with various cancers
who received IMFINZI, colitis or diarrhea occurred in 18% of
patients, including Grade 3 (1.0%) and Grade 4 (0.1%)
immune-mediated colitis. Diarrhea or colitis led to discontinuation
of IMFINZI in 0.4% of the 1889 patients.
Immune-Mediated Endocrinopathies
IMFINZI can cause immune-mediated endocrinopathies, including
thyroid disorders, adrenal insufficiency, type 1 diabetes mellitus,
and hypophysitis/hypopituitarism. Monitor patients for clinical
signs and symptoms of endocrinopathies.
- Thyroid disorders—Monitor thyroid function prior to and
periodically during treatment. Initiate hormone replacement therapy
or medical management of hyperthyroidism as clinically indicated.
Withhold IMFINZI for Grades 2–4 hyperthyroidism, until clinically
stable. Continue IMFINZI for hypothyroidism.
In clinical studies enrolling 1889 patients
with various cancers who received IMFINZI, hypothyroidism occurred
in 11% of patients, while hyperthyroidism occurred in 7% of
patients. Thyroiditis occurred in 0.9% of patients, including Grade
3 (<0.1%) thyroiditis. Hypothyroidism was preceded by
thyroiditis or hyperthyroidism in 25% of patients.
- Adrenal insufficiency—Administer corticosteroids as
clinically indicated and withhold IMFINZI until clinically stable
for Grade 2 or higher adrenal insufficiency. In clinical studies
enrolling 1889 patients with various cancers who received IMFINZI,
adrenal insufficiency occurred in 0.7% of patients, including Grade
3 (<0.1%) adrenal insufficiency.
- Type 1 diabetes mellitus—Initiate treatment with insulin
as clinically indicated. Withhold IMFINZI for Grades 2–4 type 1
diabetes mellitus, until clinically stable. In clinical studies
enrolling 1889 patients with various cancers who received IMFINZI,
type 1 diabetes mellitus occurred in <0.1% of patients.
- Hypophysitis—Administer corticosteroids and hormone
replacement as clinically indicated and withhold IMFINZI until
clinically stable for Grade 2 or higher hypophysitis.
Hypopituitarism leading to adrenal insufficiency and diabetes
insipidus occurred in <0.1% of 1889 patients with various
cancers who received IMFINZI.
Immune-Mediated Nephritis
IMFINZI can cause immune-mediated nephritis, defined as evidence
of renal dysfunction requiring use of corticosteroids. Fatal cases
have occurred. Monitor patients for abnormal renal function tests
prior to and periodically during treatment with IMFINZI. Administer
corticosteroids as clinically indicated. Withhold IMFINZI for
creatinine greater than 1.5 to 3 times the ULN; permanently
discontinue IMFINZI and administer corticosteroids in patients with
creatinine greater than 3 times the ULN.
In clinical studies enrolling 1889 patients with various cancers
who received IMFINZI, nephritis (reported as any of the following:
increased creatinine or urea, acute kidney injury, renal failure,
decreased glomerular filtration rate, tubulointerstitial nephritis,
decreased creatinine clearance, glomerulonephritis, and nephritis)
occurred in 6.3% of the patients including Grade 3 (1.1%), Grade 4
(0.2%), and Grade 5 (0.1%) nephritis. IMFINZI was discontinued in
0.3% of the 1889 patients.
Immune-Mediated Dermatologic Reactions
IMFINZI can cause immune-mediated rash. Stevens Johnson Syndrome
(SJS)/toxic epidermal necrolysis (TEN) has occurred with other
products in this class. Administer corticosteroids for Grade 2 rash
or dermatitis lasting for more than 1 week or for Grade 3 or 4 rash
or dermatitis. Withhold IMFINZI for Grade 2 rash or dermatitis
lasting longer than 1 week or Grade 3 rash or dermatitis;
permanently discontinue IMFINZI in patients with Grade 4 rash or
dermatitis.
In clinical studies enrolling 1889 patients with various cancers
who received IMFINZI, 26% of patients developed rash or dermatitis
and 0.4% of the patients developed vitiligo. Rash or dermatitis led
to discontinuation of IMFINZI in 0.1% of the 1889 patients.
Other Immune-Mediated Adverse Reactions
IMFINZI can cause severe and fatal immune-mediated adverse
reactions. These immune-mediated reactions may involve any organ
system. While immune-mediated reactions usually manifest during
treatment with IMFINZI, immune-mediated adverse reactions can also
manifest after discontinuation of IMFINZI. For suspected
immune-mediated adverse reactions, exclude other causes and
initiate corticosteroids as clinically indicated. Withhold IMFINZI
for Grade 3 immune-mediated adverse reactions, unless clinical
judgment indicates discontinuation; permanently discontinue IMFINZI
for Grade 4 adverse reactions.
The following clinically significant, immune-mediated adverse
reactions occurred at an incidence of less than 1% each in 1889
patients who received IMFINZI: aseptic meningitis, hemolytic
anemia, immune thrombocytopenic purpura, myocarditis, myositis, and
ocular inflammatory toxicity, including uveitis and keratitis.
Additional clinically significant immune-mediated adverse reactions
have been seen with other products in this class (see Warnings and
Precautions Section 5.7 of IMFINZI full Prescribing
Information).
Infection
IMFINZI can cause serious infections, including fatal cases.
Monitor patients for signs and symptoms of infection and treat as
clinically indicated. Withhold IMFINZI for Grade 3 or 4 infection,
until clinically stable.
In clinical studies enrolling 1889 patients with various cancers
who received IMFINZI, infections occurred in 43% of patients,
including Grade 3 (8%), Grade 4 (1.9%), and Grade 5 (1.0%). The
overall incidence of infections in IMFINZI-treated patients in the
PACIFIC study (56%) was higher compared to patients in other
clinical studies (38%) in which radiation therapy was generally not
administered immediately prior to initiation of IMFINZI. In
patients with UC in Study 1108 (n=182), the most common Grade 3 or
higher infection was urinary tract infections, which occurred in 4%
of patients. In patients with Stage III NSCLC in the PACIFIC study,
the most common Grade 3 or higher infection was pneumonia, which
occurred in 5% of patients.
Infusion-Related Reactions
IMFINZI can cause severe or life-threatening infusion-related
reactions. Monitor patients for signs and symptoms of an
infusion-related reaction. Interrupt or slow the rate of infusion
for Grades 1–2 infusion-related reactions; permanently discontinue
for Grades 3–4 infusion-related reactions.
In clinical studies enrolling 1889 patients with various cancers
who received IMFINZI, infusion-related reactions occurred in 2.2%
of patients, including Grade 3 (0.3%).
Embryo-Fetal Toxicity
Based on its mechanism of action and data from animal studies,
IMFINZI can cause fetal harm when administered to a pregnant woman.
There are no data on the use of IMFINZI in pregnant women. Advise
pregnant women of the potential risk to a fetus and advise women of
reproductive potential to use effective contraception during
treatment and for at least 3 months after the last dose of
IMFINZI.
Lactation
There is no information regarding the presence of IMFINZI in
human milk; however, because of the potential for adverse reactions
in breastfed infants from IMFINZI, advise women not to breastfeed
during treatment and for at least 3 months after the last dose.
Most Common Adverse Reactions
- In patients with extensive-stage SCLC in the CASPIAN study
(n=265), the most common adverse reactions (≥20%) were nausea,
fatigue/asthenia, and alopecia. The most common Grade 3 or 4
adverse reaction (≥3%) was fatigue/asthenia (3.4%)
- In patients with extensive-stage SCLC in the CASPIAN study
(n=265), IMFINZI was discontinued due to adverse reactions in 7% of
the patients receiving IMFINZI plus chemotherapy. Serious adverse
reactions occurred in 31% of patients receiving IMFINZI plus
chemotherapy. The most frequent serious adverse reactions reported
in at least 1% of patients were febrile neutropenia (4.5%),
pneumonia (2.3%), anemia (1.9%), pancytopenia (1.5%), pneumonitis
(1.1%), and COPD (1.1%). Fatal adverse reactions occurred in 4.9%
of patients receiving IMFINZI plus chemotherapy
The safety and effectiveness of IMFINZI have not been
established in pediatric patients.
Indications
IMFINZI, in combination with etoposide and either carboplatin or
cisplatin, is indicated for the first-line treatment of adult
patients with extensive-stage small cell lung cancer (ES-SCLC).
Please see complete Prescribing Information, including
Medication Guide.
NOTES TO EDITORS
About CASPIAN
CASPIAN is a randomized, open-label, multi-center, global, Phase
III trial in the 1st-line treatment of 805 patients with ES-SCLC.
The trial compared IMFINZI in combination with etoposide and either
carboplatin or cisplatin chemotherapy, or IMFINZI and chemotherapy
with the addition of a second immunotherapy, tremelimumab, versus
chemotherapy alone. In the experimental arms, patients were treated
with up to four cycles of chemotherapy. In comparison, the control
arm allowed up to six cycles of chemotherapy and optional
prophylactic cranial irradiation. The trial is being conducted in
more than 200 centers across 23 countries, including the US, in
Europe, South America, Asia and the Middle East. The primary
endpoint is OS in each of the experimental arms.
About Small Cell Lung Cancer
Lung cancer is the leading cause of cancer death among both men
and women and accounts for about one-quarter of all cancer deaths
in the United States: more than breast, prostate and colorectal
cancers combined.1 Lung cancer is broadly split into non-small cell
lung cancer (NSCLC) and SCLC, with about 15% classified as SCLC.2
SCLC is a highly aggressive, fast-growing form of lung cancer that
typically recurs and progresses rapidly despite initial response to
chemotherapy.3,4 About two thirds of SCLC patients are diagnosed
with ES-SCLC, in which the cancer has spread widely through the
lung or to other parts of the body.5 Prognosis is particularly
poor, as only 6% of all SCLC patients will be alive five years
after diagnosis.6
About IMFINZI® (durvalumab)
IMFINZI is a human monoclonal antibody that binds to PD-L1 and
blocks the interaction of PD-L1 with PD-1 and CD80, countering the
tumor’s immune-evading tactics and releasing the inhibition of
immune responses.
IMFINZI is approved in the curative-intent setting of
unresectable, Stage III NSCLC after chemoradiation therapy in the
US, Japan, China, across the EU and in many other countries, based
on the Phase III PACIFIC trial. IMFINZI is approved for the
1st-line treatment of ES-SCLC in combination with SoC chemotherapy
in the US and Singapore. IMFINZI is also approved for previously
treated patients with advanced bladder cancer in the US and a small
number of other countries.
As part of a broad development program, IMFINZI is also being
tested as a monotherapy and in combination with tremelimumab, an
anti-CTLA4 monoclonal antibody and potential new medicine, as a
treatment for patients with NSCLC, SCLC, bladder cancer, head and
neck cancer, liver cancer, biliary tract cancer, cervical cancer
and other solid tumors.
About tremelimumab
Tremelimumab is a human monoclonal antibody and potential new
medicine that targets the activity of cytotoxic
T-lymphocyte-associated protein 4 (CTLA-4). Tremelimumab blocks the
activity of CTLA-4, contributing to T cell activation and boosting
the immune response to cancer. Tremelimumab is being tested in a
clinical trial program in combination with IMFINZI in NSCLC,
bladder cancer, head and neck cancer and liver cancer cancers.
About AstraZeneca Support Programs
AstraZeneca strives to ensure that appropriate patients and
their oncologists have access to IMFINZI and relevant support
resources. These include educational resources, an Oncology Nurse
Educator program and affordability and reimbursement programs, such
as Access 360™.
Additionally, AstraZeneca has launched Lighthouse, a program
that provides support to patients during any immune-mediated
adverse events they may encounter during treatment, through
medically trained Lighthouse Advocates. The program aims to make
patients’ treatment experience as comfortable as possible. Find out
more about Lighthouse at LighthouseProgram.com or call
1-855-LHOUSE1(1-855-546-8731).
About AstraZeneca in lung cancer
AstraZeneca has a comprehensive portfolio of approved and
potential new medicines in late-stage development for the treatment
of different forms of lung cancer spanning different histologies,
several stages of disease, lines of therapy and modes of action. We
aim to address the unmet needs of patients with EGFR-mutated tumors
as a genetic driver of disease, which occur in 10-15% of NSCLC
patients in the US and EU and 30-40% of NSCLC patients in Asia,
with the approved medicine osimertinib, and ongoing Phase III
trials ADAURA, LAURA, and FLAURA2.7,8 We are also committed to
addressing tumor mechanisms of resistance through the ongoing Phase
II trials SAVANNAH and ORCHARD which test osimertinib in
combination with savolitinib, a selective inhibitor of c-MET
receptor tyrosine kinase, along with other potential new medicines.
Trastuzumab deruxtecan, a HER2-directed antibody drug conjugate is
in development for metastatic non-squamous HER2-overexpressing or
HER2-mutated NSCLC including trials in combination with other
anticancer treatments.
Our extensive Immuno-Oncology development program focuses on
lung cancer patients without a targetable genetic mutation which
represents up to three-quarters of all patients with lung cancer.9
IMFINZI, an anti-PDL1 antibody, is in development for patients with
advanced disease (Phase III trials POSEIDON and PEARL) and for
patients in earlier stages of disease including
potentially-curative settings (Phase III trials MERMAID-1, AEGEAN,
ADJUVANT BR.31, PACIFIC-2, PACIFIC-4, PACIFIC-5, and ADRIATIC) both
as monotherapy and in combination with tremelimumab and/or
chemotherapy. IMFINZI is also in development in the Phase II
combination trials NeoCOAST, COAST and HUDSON in combination with
potential new medicines from the early-stage pipeline including
trastuzumab deruxtecan.
About AstraZeneca’s approach to Immuno-Oncology (IO)
Immuno-oncology (IO) is a therapeutic approach designed to
stimulate the body’s immune system to attack tumors. Our IO
portfolio is anchored by immunotherapies that have been designed to
overcome anti-tumor immune suppression. We are invested in using IO
approaches that deliver long-term survival for new groups of
patients across tumor types.
We are pursuing a comprehensive clinical-trial program that
includes IMFINZI as a monotherapy and in combination with
tremelimumab in multiple tumor types, stages of disease, and lines
of therapy, and where relevant using the PD-L1 biomarker as a
decision-making tool to define the best potential treatment path
for a patient. In addition, the ability to combine the IO portfolio
with radiation, chemotherapy, small targeted molecules from across
AstraZeneca’s Oncology pipeline, and from research partners, may
provide new treatment options across a broad range of tumors.
About AstraZeneca in Oncology
AstraZeneca has a deep-rooted heritage in oncology and offers a
quickly growing portfolio of new medicines that has the potential
to transform patients' lives and the Company's future. With six new
medicines launched between 2014 and 2020, and a broad pipeline of
small molecules and biologics in development, we are committed to
advancing oncology as a key growth driver for AstraZeneca focused
on lung, ovarian, breast and blood cancers. In addition to
AstraZeneca's main capabilities, we are actively pursuing
innovative partnerships and investments that accelerate the
delivery of our strategy, as illustrated by the investment in
Acerta Pharma in hematology.
By harnessing the power of four scientific platforms –
Immuno-Oncology, Tumor Drivers and Resistance, DNA Damage Response
and Antibody Drug Conjugates – and by championing the development
of personalized combinations, AstraZeneca has the vision to
redefine cancer treatment and, one day, eliminate cancer as a cause
of death.
About AstraZeneca
AstraZeneca (LSE/STO/NYSE: AZN) is a global, science-led
biopharmaceutical company that focuses on the discovery,
development and commercialization of prescription medicines,
primarily for the treatment of diseases in three therapy areas -
Oncology, Cardiovascular, Renal & Metabolism, and Respiratory
& Immunology. AstraZeneca operates in over 100 countries and
its innovative medicines are used by millions of patients
worldwide. For more information, please visit
www.astrazeneca-us.com and follow us on Twitter @AstraZenecaUS.
References
- American Cancer Society. Key Statistics for Lung Cancer.
Available at
https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html.
Accessed May 2020.
- American Cancer Society. What is Lung Cancer?. Available at
https://www.cancer.org/cancer/lung-cancer/about/what-is.html.
Accessed May 2020.
- NIH Medline Plus. Lung Cancer-Small Cell. Available at
https://medlineplus.gov/ency/article/000122.htm. Accessed May
2020.
- Oronsky B, et al. What's New in SCLC? A Review. Neoplasia.
2017;19(10):842–847.
- ASCO Cancer.net. Lung Cancer – Stages. Available at
https://www.cancer.net/cancer-types/lung-cancer-small-cell/stages.
Accessed May 2020.
- ASCO Cancer.net. Lung Cancer – Small Cell: Statistics.
Available at
https://www.cancer.net/cancer-types/lung-cancer-small-cell/statistics.
Accessed May 2020.
- Keedy VL, et al. American Society of Clinical Oncology
Provisional Clinical Opinion: Epidermal Growth Factor Receptor
(EGFR) Mutation Testing for Patients with Advanced Non-Small-Cell
Lung Cancer Considering First-Line EGFR Tyrosine Kinase Inhibitor
Therapy. J Clin Oncol. 2011:29;2121-27.
- Ellison G, et al. EGFR Mutation Testing in Lung Cancer: A
Review of Available Methods and Their Use for Analysis of Tumour
Tissue and Cytology Samples. J Clin Pathol. 2013:66;79-89.
- Pakkala, S, et al. Personalized Therapy for Lung Cancer:
Striking a Moving Target. JCI Insight. 2018;3(15):e120858.
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