X. Lyu

Objective To compare the effectiveness and safety of tofacitinib versus calcineurin inhibitor (CNI) as initial immunosuppressive regimen for anti-melanoma differentiation-associated gene 5-positive dermatomyositis with interstitial lung disease (MDA5 + DM-ILD). Methods Adult Chinese patients with newly diagnosed MDA5 + DM-ILD (ILD course <3 months) from five tertiary referral centres between April 2014 and January 2023 were included in this retrospective cohort study. The primary effectiveness end-point was lung transplantation-free survival within 1 year. Propensity score-based inverse probability of treatment weighting (IPTW) was applied for adjustment in this real-world study. Results In the eligible cohort, a total of 94 (32.4%) and 105 (46.7%) patients died or underwent lung transplantation within 1 year in the tofacitinib group (n=290) and the CNI group (n=225), respectively. After adjustment by IPTW, patients’ lung transplantation-free survival rate within 1 year was significantly higher in the tofacitinib group compared to the CNI group (log-rank p=0.013). Multivariable Cox analysis performed in the IPTW dataset revealed that the hazard ratio of tofacitinib versus CNI for 1-year survival was 0.72 (95% CI 0.56–0.94; p=0.013). The adjusted difference of survival rate was 9.3% (95% CI 2.8–15.8%). Alternative analytic strategies yielded consistent results in sensitivity analyses. Patients aged <60 years, without rapidly progressive ILD, or with baseline arterial oxygen tension/inspiratory oxygen fraction ≥300 mmHg might benefit more from tofacitinib. Opportunistic infection was the major treatment-related serious adverse event, with generally comparable incidence (42.4% versus 45.3%). Conclusion In this large multicentre cohort study, tofacitinib showed significantly more benefits for 1-year lung transplantation-free survival than calcineurin inhibitors in MDA5 + DM-ILD.

BACKGROUND: Fibroblast growth factor receptor (FGFR) alterations are established therapeutic targets in cholangiocarcinoma and urothelial carcinoma but remain understudied in colorectal cancer (CRC). This study investigates the prevalence, clinicopathological correlates, and prognostic impact of FGFR alterations in CRC. PATIENTS AND METHODS: We analyzed 608 stage I-IV CRC samples (2014-2024) through next-generation sequencing (NGS) and immunohistochemistry (IHC). FGFR genomic status was correlated with survival outcomes using Kaplan-Meier and Cox regression analyses. External validation of FGFR genomic alterations was carried out using the 19 datasets (n = 6998) with prognostic impact validated through The Cancer Genome Atlas Colon and Rectum Adenocarcinoma (COREAD) dataset (Firehose Legacy, n = 640), both accessed via cBioPortal database. RESULTS: Large-scale genomic profiling of CRC [n = 7606 (608 in-house + 6998 public cohorts)] identified FGFR1 amplification (3.8% prevalence) as the predominant FGFR alteration subtype. Multivariable analysis confirmed FGFR alterations as independent predictors of poor disease-free survival [DFS; hazard ratio (HR) 2.58, P = 0.0002] and progression-free survival (PFS; HR 2.17, P = 0.0011), with FGFR1 amplification showing strongest prognostic impact (DFS HR 2.91, PFS HR 2.52, P < 0.01). Notably, the prognostic magnitude of FGFR alterations was comparable to KRAS/BRAF mutations in both localized and metastatic CRC. In addition, we established a semiquantitative immunoreactive score (IRS) system achieving 95.2% concordance with NGS (κ = 0.901), enabling reliable FGFR1 screening in routine pathology workflows. CONCLUSIONS: This study provides the first comprehensive characterization of FGFR genomic alterations in CRC through large-scale profiling (n = 7606), establishing FGFR1 amplification as the predominant alteration. Unlike FGFR2/3-driven malignancies, FGFR1-amplified CRC exhibited aggressive clinical behavior and inferior survival outcomes across disease stages. To address the diagnostic challenges in routine practice, we further developed a validated immunohistochemical scoring system (IRS), establishing a cost-effective and clinically feasible alternative to molecular assays for identifying FGFR1-driven CRC subsets.