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Giustini NP, Jeong AR, Buturla J, Bazhenova L. Advances in Treatment of Locally Advanced or Metastatic Non-Small Cell Lung Cancer: Targeted Therapy. Clin Chest Med 2020; 41:223-235. [PMID: 32402358 DOI: 10.1016/j.ccm.2020.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The treatment of metastatic non-small cell lung cancer (NSCLC) is constantly evolving. Although the advent of immunotherapy has played an important role in the treatment of patients with NSCLC, the identification of driver mutations and the subsequent specific treatment of these targets often lead to durable responses while maintaining quality of life. This review delves into targeted therapies available for epidermal growth factor receptor, anaplastic lymphoma kinase, ROS1, neurotrophic tropomyosin receptor kinase, and BRAF- mutated NSCLC patients, as well as other mutations with promising novel drugs under clinical investigation.
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Affiliation(s)
- Nicholas P Giustini
- UCSD Moores Cancer Center, 3855 Health Sciences Drive MC #0987, La Jolla, CA 92093-0829, USA.
| | - Ah-Reum Jeong
- UCSD Moores Cancer Center, 3855 Health Sciences Drive MC #0987, La Jolla, CA 92093-0829, USA
| | - James Buturla
- UCSD Moores Cancer Center, 3855 Health Sciences Drive MC #0987, La Jolla, CA 92093-0829, USA
| | - Lyudmila Bazhenova
- UCSD Moores Cancer Center, 3855 Health Sciences Drive MC #0987, La Jolla, CA 92093-0829, USA
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Focus on ROS1-Positive Non-Small Cell Lung Cancer (NSCLC): Crizotinib, Resistance Mechanisms and the Newer Generation of Targeted Therapies. Cancers (Basel) 2020; 12:cancers12113293. [PMID: 33172113 PMCID: PMC7694780 DOI: 10.3390/cancers12113293] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Genetic rearrangements of the ROS1 gene account for up to 2% of NSCLC patients who sometimes develop brain metastasis, resulting in poor prognosis. This review discusses the tyrosine kinase inhibitor crizotinib plus updates and preliminary results with the newer generation of tyrosine kinase inhibitors, which have been specifically conceived to overcome crizotinib resistance, including brigatinib, cabozantinib, ceritinib, entrectinib, lorlatinib and repotrectinib. After introducing each agent’s properties, we provide suggestions on the best approaches to identify resistance mechanisms at an early stage, and we speculate on the most appropriate second-line therapies for patients who reported disease progression following crizotinib administration. Abstract The treatment of patients affected by non-small cell lung cancer (NSCLC) has been revolutionised by the discovery of druggable mutations. ROS1 (c-ros oncogene) is one gene with druggable mutations in NSCLC. ROS1 is currently targeted by several specific tyrosine kinase inhibitors (TKIs), but only two of these, crizotinib and entrectinib, have received Food and Drug Administration (FDA) approval. Crizotinib is a low molecular weight, orally available TKI that inhibits ROS1, MET and ALK and is considered the gold standard first-line treatment with demonstrated significant activity for lung cancers harbouring ROS1 gene rearrangements. However, crizotinib resistance often occurs, making the treatment of ROS1-positive lung cancers more challenging. A great effort has been undertaken to identify a new generation or ROS1 inhibitors. In this review, we briefly introduce the biology and role of ROS1 in lung cancer and discuss the underlying acquired mechanisms of resistance to crizotinib and the promising new agents able to overcome resistance mechanisms and offer alternative efficient therapies.
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Abstract
ROS1-rearranged non-small cell lung cancer (NSCLC) makes up approximately 1% to 2% of all NSCLC, is oncogenically driven by a constitutively activated ROS1 kinase paired with certain fusion partners, and can be detected by several different assays. These patients are initially treated with tyrosine kinase inhibitors (TKIs), which target the activated ROS1 kinase. Eventually these tumors develop resistance to initial TKI treatment through secondary kinase mutations that block TKI binding or activation of bypass signaling pathways, which subvert ROS1 as the driver of the malignancy. Investigation of several TKIs that have shown efficacy in secondary resistant patients is underway.
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Ergoren MC, Cobanogulları H, Temel SG, Mocan G. Functional coding/non-coding variants in EGFR, ROS1 and ALK genes and their role in liquid biopsy as a personalized therapy. Crit Rev Oncol Hematol 2020; 156:103113. [PMID: 33038629 DOI: 10.1016/j.critrevonc.2020.103113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
Personalized medicine holds promise to tailor the treatment options for patients' unique genetic make-up, behavioral and environmental background. Liquid biopsy is non-invasive technique and precise diagnosis and treatment approach. Significantly, NGS technologies have revolutionized the genomic medicine by novel identifying SNPs, indel mutations in both coding and non-coding regions and also a promising technology to accelerate the early detection and finding new biomarkers for diagnosis and treatment. The number of the bioinformatics tools have been rapidly increasing with the aim of learning more about the detected mutations either they have a pathogenic role or not. EGFR, ROS1 and ALK genes are members of the RTK family. Until now, mutations within these genes have been associated with many cancers and involved in resistance formation to TKIs. This review article summarized the findings about the mostly investigated variations in EGFR, ROS1 and ALK genes and their potential role in liquid biopsy approach.
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Affiliation(s)
- Mahmut Cerkez Ergoren
- Department of Medical Biology, Faculty of Medicine, Near East University, Nicosia, 99138, Cyprus; DESAM Institute, Near East University, 99138, Nicosia, Cyprus.
| | - Havva Cobanogulları
- Department of Medical Biology, Faculty of Medicine, Near East University, Nicosia, 99138, Cyprus; DESAM Institute, Near East University, 99138, Nicosia, Cyprus
| | - Sehime Gulsun Temel
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey; Department of Histology & Embryology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey; Department of Translational Medicine, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - Gamze Mocan
- Department of Medical Biology, Faculty of Medicine, Near East University, Nicosia, 99138, Cyprus; Department of Medical Pathology, Faculty of Medicine, Near East University, Nicosia, 99138, Cyprus
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Nagano T, Tachihara M, Nishimura Y. Molecular Mechanisms and Targeted Therapies Including Immunotherapy for Non-Small Cell Lung Cancer. Curr Cancer Drug Targets 2020; 19:595-630. [PMID: 30526458 DOI: 10.2174/1568009619666181210114559] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/21/2018] [Accepted: 11/28/2018] [Indexed: 12/21/2022]
Abstract
Lung cancer is the leading cause of cancer death worldwide. Molecular targeted therapy has greatly advanced the field of treatment for non-small cell lung cancer (NSCLC), which accounts for the majority of lung cancers. Indeed, gefitinib, which was the first molecular targeted therapeutic agent, has actually doubled the survival time of NSCLC patients. Vigorous efforts of clinicians and researchers have revealed that lung cancer develops through the activating mutations of many driver genes including the epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), c-ros oncogene 1 (ROS1), v-Raf murine sarcoma viral oncogene homolog B (BRAF), and rearranged during transfection (RET) genes. Although ALK, ROS1, and RET are rare genetic abnormalities, corresponding tyrosine kinase inhibitors (TKIs) can exert dramatic therapeutic effects. In addition to anticancer drugs targeting driver genes, bevacizumab specifically binds to human vascular endothelial growth factor (VEGF) and blocks the VEGF signaling pathway. The VEGF signal blockade suppresses angiogenesis in tumor tissues and inhibits tumor growth. In this review, we also explore immunotherapy, which is a promising new NSCLC treatment approach. In general, antitumor immune responses are suppressed in cancer patients, and cancer cells escape from the immune surveillance mechanism. Immune checkpoint inhibitors (ICIs) are antibodies that target the primary escape mechanisms, immune checkpoints. Patients who respond to ICIs are reported to experience longlasting therapeutic effects. A wide range of clinical approaches, including combination therapy involving chemotherapy or radiation plus adjuvant therapy, are being developed.
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Affiliation(s)
- Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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中国临床肿瘤学会非小细胞肺癌专家委员会. [Chinese Expert Consensus on Next Generation Sequencing Diagnosis
for Non-small Cell Lung Cancer (2020 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:741-761. [PMID: 32957170 PMCID: PMC7519957 DOI: 10.3779/j.issn.1009-3419.2020.101.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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RASAL1 and ROS1 Gene Variants in Hereditary Breast Cancer. Cancers (Basel) 2020; 12:cancers12092539. [PMID: 32906649 PMCID: PMC7563829 DOI: 10.3390/cancers12092539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Breast cancer is the second leading cause of death in women. Identifying novel genetic factors conferring BC predisposition is crucial to predict who is at increased risk of developing the disease, allowing for early detection and therapy, and optimized patient management. We identified germline pathogenic variants in familial breast cancer patients in ROS1 and RASAL1 genes. Further analysis in independent patient group will help understanding the role of these novel genes in breast cancer predisposition. Abstract Breast cancer (BC) is the second leading cause of death in women. BC patients with family history or clinical features suggestive of inherited predisposition are candidate to genetic testing to determine whether a hereditary cancer syndrome is present. We aimed to identify new predisposing variants in familial BC patients using next-generation sequencing approaches. We performed whole exome sequencing (WES) in first-degree cousin pairs affected by hereditary BC negative at the BRCA1/2 (BReast CAncer gene 1/2) testing. Targeted analysis, for the genes resulting mutated via WES, was performed in additional 131 independent patients with a suspected hereditary predisposition (negative at the BRCA1/2 testing). We retrieved sequencing data for the mutated genes from WES of 197 Italian unrelated controls to perform a case-controls collapsing analysis. We found damaging variants in NPL (N-Acetylneuraminate Pyruvate Lyase), POLN (DNA Polymerase Nu), RASAL1 (RAS Protein Activator Like 1) and ROS1 (ROS Proto-Oncogene 1, Receptor Tyrosine Kinase), shared by the corresponding cousin pairs. We demonstrated that the splice site alterations identified in NPL and ROS1 (in two different pairs, respectively) impaired the formation of the correct transcripts. Target analysis in additional patients identified novel and rare damaging variants in RASAL1 and ROS1, with a significant allele frequency increase in cases. Moreover, ROS1 achieved a significantly higher proportion of variants among cases in comparison to our internal control database of Italian subjects (p = 0.0401). Our findings indicate that germline variants in ROS1 and RASAL1 might confer susceptibility to BC.
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Marmarelis ME, Langer CJ. Treatment of Patients With Non–Small-Cell Lung Cancer Harboring Rare Oncogenic Mutations. Clin Lung Cancer 2020; 21:395-406. [DOI: 10.1016/j.cllc.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/23/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022]
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Li Y, Chen X, Qu Y, Fan JM, Li Y, Peng H, Zheng Y, Zhang Y, Zhang HB. Partial Response to Ceritinib in a Patient With Abdominal Inflammatory Myofibroblastic Tumor Carrying a TFG-ROS1 Fusion. J Natl Compr Canc Netw 2020; 17:1459-1462. [PMID: 31805529 DOI: 10.6004/jnccn.2019.7360] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT), a rare sarcoma, is primarily treated via resection of the mass. However, there is no standard treatment for recurrence or unresectable tumors. Almost 50% of IMTs carry ALK gene rearrangement that can be treated using ALK inhibitors, but therapeutic options for ALK-negative tumors are limited. This report describes a woman aged 22 years with unresectable ALK-negative IMT. Next-generation sequencing revealed a TFG-ROS1 fusion, and she had a partial response to the ROS1 inhibitor ceritinib. This report provides the first published demonstration of a patient with IMT with ROS1 fusion successfully treated using ceritinib. Our study suggests that targeting ROS1 fusions using the small molecule inhibitor shows promise as an effective therapy in patients with IMT carrying this genetic alteration, but this requires further investigation in large clinical trials.
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Affiliation(s)
- Yong Li
- aDepartment of Oncology, and
| | | | | | | | - Yan Li
- aDepartment of Oncology, and
| | - Hui Peng
- bDepartment of Pathology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou; and
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Mack PC, Banks KC, Espenschied CR, Burich RA, Zill OA, Lee CE, Riess JW, Mortimer SA, Talasaz A, Lanman RB, Gandara DR. Spectrum of driver mutations and clinical impact of circulating tumor DNA analysis in non-small cell lung cancer: Analysis of over 8000 cases. Cancer 2020; 126:3219-3228. [PMID: 32365229 PMCID: PMC7383626 DOI: 10.1002/cncr.32876] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/16/2019] [Accepted: 11/12/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Circulating cell-free tumor DNA (ctDNA)-based mutation profiling, if sufficiently sensitive and comprehensive, can efficiently identify genomic targets in advanced lung adenocarcinoma. Therefore, the authors investigated the accuracy and clinical utility of a commercially available digital next-generation sequencing platform in a large series of patients with non-small cell lung cancer (NSCLC). METHODS Plasma-based comprehensive genomic profiling results from 8388 consecutively tested patients with advanced NSCLC were analyzed. Driver and resistance mutations were examined with regard to their distribution, frequency, co-occurrence, and mutual exclusivity. RESULTS Somatic alterations were detected in 86% of samples. The median variant allele fraction was 0.43% (range, 0.03%-97.62%). Activating alterations in actionable oncogenes were identified in 48% of patients, including EGFR (26.4%), MET (6.1%), and BRAF (2.8%) alterations and fusions (ALK, RET, and ROS1) in 2.3%. Treatment-induced resistance mutations were common in this cohort, including driver-dependent and driver-independent alterations. In the subset of patients who had progressive disease during EGFR therapy, 64% had known or putative resistance alterations detected in plasma. Subset analysis revealed that ctDNA increased the identification of driver mutations by 65% over standard-of-care, tissue-based testing at diagnosis. A pooled data analysis on this plasma-based assay demonstrated that targeted therapy response rates were equivalent to those reported from tissue analysis. CONCLUSIONS Comprehensive ctDNA analysis detected the presence of therapeutically targetable driver and resistance mutations at the frequencies and distributions predicted for the study population. These findings add support for comprehensive ctDNA testing in patients who are incompletely tested at the time of diagnosis and as a primary option at the time of progression on targeted therapies.
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Affiliation(s)
- Philip C. Mack
- Division of Hematology‐OncologyDepartment of Internal MedicineUniversity of California Davis Comprehensive Cancer CenterSacramentoCalifornia
- College of MedicineCalifornia Northstate UniversityElk GroveCalifornia
| | | | | | - Rebekah A. Burich
- Division of Hematology‐OncologyDepartment of Internal MedicineUniversity of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Oliver A. Zill
- Guardant Health, IncRedwood CityCalifornia
- Present address:
GenentechSouth San FranciscoCalifornia
| | | | - Jonathan W. Riess
- Division of Hematology‐OncologyDepartment of Internal MedicineUniversity of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | | | | | | | - David R. Gandara
- Division of Hematology‐OncologyDepartment of Internal MedicineUniversity of California Davis Comprehensive Cancer CenterSacramentoCalifornia
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Molecular mechanisms of resistance to BRAF and MEK inhibitors in BRAF V600E non-small cell lung cancer. Eur J Cancer 2020; 132:211-223. [PMID: 32388065 DOI: 10.1016/j.ejca.2020.03.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION BRAF is a confirmed therapeutic target in non-small cell lung cancer (NSCLC), as the BRAF inhibitor dabrafenib, in combination with the MEK inhibitor trametinib, is approved for the treatment of NSCLC harbouring BRAF V600E mutation. Scant evidence is available concerning the mechanisms of resistance to BRAF/MEK inhibitors in BRAFV600E NSCLC. PATIENTS AND METHODS Patients with BRAFV600E NSCLC with acquired resistance to BRAF/MEK inhibitors were included in the institutional, prospective MATCH-R (from "Matching Resistance") trial and underwent tumour and liquid biopsies at the moment of radiological progression. Extensive molecular analyses were performed, including targeted next-generation sequencing (NGS), whole-exome sequencing (WES), RNA sequencing and comparative genomic hybridisation (CGH) array. RESULTS Of the 11 patients included, eight had progressed on dabrafenib-trametinib combination, two on dabrafenib monotherapy and one on vemurafenib (BRAF inhibitor). Complete molecular analyses were available for seven patients, whereas an additional case had only targeted NGS and CGH array data. Among these eight patients, acquired molecular events potentially responsible for resistance were detected in three who progressed on dabrafenib-trametinib combination, that is, MEK1 K57N, RAS viral (v-ras) oncogene homolog (NRAS) Q61R and rat sarcoma viral oncogene homolog (KRAS) Q61R mutations. One patient progressing on dabrafenib monotherapy developed a PTEN frameshift mutation. No molecular hints addressing resistance emerged in the remaining four patients with analyses performed. Tumour mutational burden, evaluated by WES in seven patients, was low (median = 2.06 mutations/megabase, range = 1.57-3.75 mut/Mb). CONCLUSIONS Novel resistance mechanisms to BRAF/MEK inhibitors in BRAFV600E NSCLC were identified, pointing out the recurring involvement of the MAPK pathway and guiding the development of new treatment strategies.
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Sartore-Bianchi A, Pizzutilo EG, Marrapese G, Tosi F, Cerea G, Siena S. Entrectinib for the treatment of metastatic NSCLC: safety and efficacy. Expert Rev Anticancer Ther 2020; 20:333-341. [PMID: 32223357 DOI: 10.1080/14737140.2020.1747439] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: Gene fusions are strong driver alterations in various cancers, increasingly diagnosed with multiple testing techniques. ROS1 fusions can be found in 1-2% of non-small cell lung cancer (NSCLC) and several tyrosine kinase inhibitors (TKIs) have been tested in this oncogene-driven disease. NTRK fusions are characteristic of a few rare types of cancer, also infrequently seen in some common cancers including NSCLC. Entrectinib is a newer ROS1 and NTRK inhibitor developed across different tumor types harboring rearrangements in these genes. Entrectinib was granted FDA accelerated approval in August 2019 for the treatment of ROS1+ NSCLC and NTRK-driven solid tumors.Areas covered: This review covers the mechanism of action, safety, and efficacy of entrectinib in patients with metastatic NSCLC.Expert opinion: Entrectinib is an orally bioavailable TKI of TrkA, TrkB, TrkC, and ROS1, with the ability to cross the blood-brain barrier. Entrectinib was effective and well-tolerated in patients harboring ROS1- or NTRK-rearranged NSCLC treated within phase I and II studies. Entrectinib appears to be the most appropriate treatment choice for TKIs-naïve patients, especially in those presenting brain metastasis. Conversely, in case of systemic progression with the evidence of acquired resistance mutations in ROS1 or Trk proteins, a sequential therapy with entrectinib could not be successful.
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Affiliation(s)
- Andrea Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Elio Gregory Pizzutilo
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Giovanna Marrapese
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Tosi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
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Mezquita L, Swalduz A, Jovelet C, Ortiz-Cuaran S, Howarth K, Planchard D, Avrillon V, Recondo G, Marteau S, Benitez JC, De Kievit F, Plagnol V, Lacroix L, Odier L, Rouleau E, Fournel P, Caramella C, Tissot C, Adam J, Woodhouse S, Nicotra C, Auclin E, Remon J, Morris C, Green E, Massard C, Pérol M, Friboulet L, Besse B, Saintigny P. Clinical Relevance of an Amplicon-Based Liquid Biopsy for Detecting ALK and ROS1 Fusion and Resistance Mutations in Patients With Non-Small-Cell Lung Cancer. JCO Precis Oncol 2020; 4:PO.19.00281. [PMID: 32923908 PMCID: PMC7448797 DOI: 10.1200/po.19.00281] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Liquid biopsy specimen genomic profiling is integrated in non-small-cell lung cancer (NSCLC) guidelines; however, data on the clinical relevance for ALK /ROS1 alterations are scarce. We evaluated the clinical utility of a targeted amplicon-based assay in a large prospective cohort of patients with ALK/ROS1-positive NSCLC and its impact on outcomes. PATIENTS AND METHODS Patients with advanced ALK/ROS1-positive NSCLC were prospectively enrolled in the study by researchers at eight French institutions. Plasma samples were analyzed using InVisionFirst-Lung and correlated with clinical outcomes. RESULTS Of the 128 patients included in the study, 101 were positive for ALK and 27 for ROS1 alterations. Blood samples (N = 405) were collected from 29 patients naïve for treatment with tyrosine kinase inhibitors (TKI) or from 375 patients under treatment, including 105 samples collected at disease progression (PD). Sensitivity was 67% (n = 18 of 27) for ALK/ROS1 fusion detection. Higher detection was observed for ALK fusions at TKI failure (n = 33 of 74; 46%) versus in patients with therapeutic response (n = 12 of 109; 11%). ALK-resistance mutations were detected in 22% patients (n = 16 of 74) overall; 43% of the total ALK-resistance mutations identified occurred after next-generation TKI therapy. ALK G1202R was the most common mutation detected (n = 7 of 16). Heterogeneity of resistance was observed. ROS1 G2032R resistance was detected in 30% (n = 3 of 10). The absence of circulating tumor DNA mutations at TKI failure was associated with prolonged median overall survival (105.7 months). Complex ALK-resistance mutations correlated with poor overall survival (median, 26.9 months v NR for single mutation; P = .003) and progression-free survival to subsequent therapy (median 1.7 v 6.3 months; P = .003). CONCLUSION Next-generation, targeted, amplicon-based sequencing for liquid biopsy specimen profiling provides clinically relevant detection of ALK/ROS1 fusions in TKI-naïve patients and allows for the identification of resistance mutations in patients treated with TKIs. Liquid biopsy specimens from patients treated with TKIs may affect clinical outcomes and capture heterogeneity of TKI resistance, supporting their role in selecting sequential therapy.
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Affiliation(s)
- Laura Mezquita
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | - Aurélie Swalduz
- Department of Medical Oncology, Centre Léon Bérard Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM U1052, CNRS UMR5286, Centre Léon Bérard, Cancer Research Center of Lyon, 69008 Lyon, France
| | - Cécile Jovelet
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Sandra Ortiz-Cuaran
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM U1052, CNRS UMR5286, Centre Léon Bérard, Cancer Research Center of Lyon, 69008 Lyon, France
| | | | - David Planchard
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | | | - Gonzalo Recondo
- INSERM U981, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Solène Marteau
- Department of Medical Oncology, Centre Léon Bérard Lyon, France
| | | | | | | | - Ludovic Lacroix
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Luc Odier
- Department of Pneumology, Hôpital Nord-Ouest Villefranche, Villefranche Sur Saône, France
| | - Etienne Rouleau
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Pierre Fournel
- Department of Medical Oncology, Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez, France
| | | | - Claire Tissot
- Department of Pneumology, CHU Nord Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Julien Adam
- Pathology Department, Gustave Roussy, Villejuif, France
| | | | - Claudio Nicotra
- Early Drug Development Department, Gustave Roussy, Villejuif, France
| | - Edouard Auclin
- Medical Oncology Department, George Pompidou Hospital, Paris, France
| | | | | | | | - Christophe Massard
- INSERM U981, Gustave Roussy, Université Paris Saclay, Villejuif, France
- Early Drug Development Department, Gustave Roussy, Villejuif, France
| | - Maurice Pérol
- Department of Medical Oncology, Centre Léon Bérard Lyon, France
| | - Luc Friboulet
- INSERM U981, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
- INSERM U981, Gustave Roussy, Université Paris Saclay, Villejuif, France
- Paris-Sud University, Orsay, France
| | - Pierre Saintigny
- Department of Medical Oncology, Centre Léon Bérard Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM U1052, CNRS UMR5286, Centre Léon Bérard, Cancer Research Center of Lyon, 69008 Lyon, France
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Sato H, Schoenfeld AJ, Siau E, Lu YC, Tai H, Suzawa K, Kubota D, Lui AJW, Qeriqi B, Mattar M, Offin M, Sakaguchi M, Toyooka S, Drilon A, Rosen NX, Kris MG, Solit D, De Stanchina E, Davare MA, Riely GJ, Ladanyi M, Somwar R. MAPK Pathway Alterations Correlate with Poor Survival and Drive Resistance to Therapy in Patients with Lung Cancers Driven by ROS1 Fusions. Clin Cancer Res 2020; 26:2932-2945. [PMID: 32122926 DOI: 10.1158/1078-0432.ccr-19-3321] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/21/2020] [Accepted: 02/25/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE ROS1 tyrosine kinase inhibitors (TKI) provide significant benefit in lung adenocarcinoma patients with ROS1 fusions. However, as observed with all targeted therapies, resistance arises. Detecting mechanisms of acquired resistance (AR) is crucial to finding novel therapies and improve patient outcomes. EXPERIMENTAL DESIGN ROS1 fusions were expressed in HBEC and NIH-3T3 cells either by cDNA overexpression (CD74/ROS1, SLC34A2/ROS1) or CRISPR-Cas9-mediated genomic engineering (EZR/ROS1). We reviewed targeted large-panel sequencing data (using the MSK-IMPACT assay) patients treated with ROS1 TKIs, and genetic alterations hypothesized to confer AR were modeled in these cell lines. RESULTS Eight of the 75 patients with a ROS1 fusion had a concurrent MAPK pathway alteration and this correlated with shorter overall survival. In addition, the induction of ROS1 fusions stimulated activation of MEK/ERK signaling with minimal effects on AKT signaling, suggesting the importance of the MAPK pathway in driving ROS1 fusion-positive cancers. Of 8 patients, 2 patients harbored novel in-frame deletions in MEK1 (MEK1delE41_L54) and MEKK1 (MEKK1delH907_C916) that were acquired after ROS1 TKIs, and 2 patients harbored NF1 loss-of-function mutations. Expression of MEK1del or MEKK1del, and knockdown of NF1 in ROS1 fusion-positive cells activated MEK/ERK signaling and conferred resistance to ROS1 TKIs. Combined targeting of ROS1 and MEK inhibited growth of cells expressing both ROS1 fusion and MEK1del. CONCLUSIONS We demonstrate that downstream activation of the MAPK pathway can mediate of innate acquired resistance to ROS1 TKIs and that patients harboring ROS1 fusion and concurrent downstream MAPK pathway alterations have worse survival. Our findings suggest a treatment strategy to target both aberrations.
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Affiliation(s)
- Hiroki Sato
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adam J Schoenfeld
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan Siau
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yue Christine Lu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Huichun Tai
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ken Suzawa
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daisuke Kubota
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allan J W Lui
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Besnik Qeriqi
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marissa Mattar
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Offin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Masakiyo Sakaguchi
- Department of Cell Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinichi Toyooka
- Department of Thoracic, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Alexander Drilon
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neal X Rosen
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark G Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Solit
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elisa De Stanchina
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monika A Davare
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Gregory J Riely
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York. .,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Romel Somwar
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
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65
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Palve V, Liao Y, Remsing Rix LL, Rix U. Turning liabilities into opportunities: Off-target based drug repurposing in cancer. Semin Cancer Biol 2020; 68:209-229. [PMID: 32044472 DOI: 10.1016/j.semcancer.2020.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 12/12/2022]
Abstract
Targeted drugs and precision medicine have transformed the landscape of cancer therapy and significantly improved patient outcomes in many cases. However, as therapies are becoming more and more tailored to smaller patient populations and acquired resistance is limiting the duration of clinical responses, there is an ever increasing demand for new drugs, which is not easily met considering steadily rising drug attrition rates and development costs. Considering these challenges drug repurposing is an attractive complementary approach to traditional drug discovery that can satisfy some of these needs. This is facilitated by the fact that most targeted drugs, despite their implicit connotation, are not singularly specific, but rather display a wide spectrum of target selectivity. Importantly, some of the unintended drug "off-targets" are known anticancer targets in their own right. Others are becoming recognized as such in the process of elucidating off-target mechanisms that in fact are responsible for a drug's anticancer activity, thereby revealing potentially new cancer vulnerabilities. Harnessing such beneficial off-target effects can therefore lead to novel and promising precision medicine approaches. Here, we will discuss experimental and computational methods that are employed to specifically develop single target and network-based off-target repurposing strategies, for instance with drug combinations or polypharmacology drugs. By illustrating concrete examples that have led to clinical translation we will furthermore examine the various scientific and non-scientific factors that cumulatively determine the success of these efforts and thus can inform the future development of new and potentially lifesaving off-target based drug repurposing strategies for cancers that constitute important unmet medical needs.
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Affiliation(s)
- Vinayak Palve
- Department of Drug Discovery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Yi Liao
- Department of Drug Discovery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Lily L Remsing Rix
- Department of Drug Discovery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA
| | - Uwe Rix
- Department of Drug Discovery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 33612, USA.
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66
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Guo Y, Cao R, Zhang X, Huang L, Sun L, Zhao J, Ma J, Han C. Recent Progress in Rare Oncogenic Drivers and Targeted Therapy For Non-Small Cell Lung Cancer. Onco Targets Ther 2019; 12:10343-10360. [PMID: 31819518 PMCID: PMC6886531 DOI: 10.2147/ott.s230309] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/09/2019] [Indexed: 12/21/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is frequently associated with oncogenic driver mutations, which play an important role in carcinogenesis and cancer progression. Targeting epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase rearrangements has become standard therapy for patients with these aberrations because of the greater improvement of survival, tolerance, and quality-of-life compared to chemotherapy. Clinical trials for emerging therapies that target other less common driver genes are generating mixed results. Here, we review the literature on rare drivers in NSCLC with frequencies lower than 5% (e.g., ROS1, RET, MET, BRAF, NTRK, HER2, NRG1, FGFR1, PIK3CA, DDR2, and EGFR exon 20 insertions). In summary, targeting rare oncogenic drivers in NSCLC has achieved some success. With the development of new inhibitors that target these rare drivers, the spectrum of targeted therapy has been expanded, although acquired resistance is still an unavoidable problem.
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Affiliation(s)
- Yijia Guo
- Department of Oncology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China
| | - Rui Cao
- Department of Oncology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China
| | - Xiangyan Zhang
- Department of Oncology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China
| | - Letian Huang
- Department of Oncology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China
| | - Li Sun
- Department of Oncology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China
| | - Jianzhu Zhao
- Department of Oncology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China
| | - Jietao Ma
- Department of Oncology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China
| | - Chengbo Han
- Department of Oncology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China
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67
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Liu WJ, Du Y, Wen R, Yang M, Xu J. Drug resistance to targeted therapeutic strategies in non-small cell lung cancer. Pharmacol Ther 2019; 206:107438. [PMID: 31715289 DOI: 10.1016/j.pharmthera.2019.107438] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
Rapidly developing molecular biology techniques have been employed to identify cancer driver genes in specimens from patients with non-small cell lung cancer (NSCLC). Inhibitors and antibodies that specifically target driver gene-mediated signaling pathways to suppress tumor growth and progression are expected to extend the survival time and further improve the quality of life of patients. However, the health of patients with advanced and metastatic NSCLC presents significant challenges due to treatment resistance, mediated by cancer driver gene alteration, epigenetic alteration, and tumor heterogeneity. In this review, we discuss two different resistance mechanisms in NSCLC targeted therapies, namely changes in the targeted oncogenes (on-target resistance) and changes in other related signaling pathways (off-target resistance) in tumor cells. We highlight the conventional mechanisms of drug resistance elicited by the complex heterogeneous microenvironment of NSCLC during targeted therapy, including mutations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), the receptor tyrosine kinase ROS proto-oncogene 1 (ROS1), and the serine/threonine-protein kinase BRAF (v-Raf murine sarcoma viral oncogene homolog B). We also discuss the mechanism of action of less common oncoproteins, as in-depth understanding of these molecular mechanisms is important for optimizing treatment strategies.
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Affiliation(s)
- Wen-Juan Liu
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, China
| | - Yue Du
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ru Wen
- Department of Medicine, Stanford University School of Medicine, California, USA
| | - Ming Yang
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, China.
| | - Jian Xu
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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68
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Shaw AT, Solomon BJ, Chiari R, Riely GJ, Besse B, Soo RA, Kao S, Lin CC, Bauer TM, Clancy JS, Thurm H, Martini JF, Peltz G, Abbattista A, Li S, Ou SHI. Lorlatinib in advanced ROS1-positive non-small-cell lung cancer: a multicentre, open-label, single-arm, phase 1-2 trial. Lancet Oncol 2019; 20:1691-1701. [PMID: 31669155 DOI: 10.1016/s1470-2045(19)30655-2] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lorlatinib is a potent, brain-penetrant, third-generation tyrosine kinase inhibitor (TKI) that targets ALK and ROS1 with preclinical activity against most known resistance mutations in ALK and ROS1. We investigated the antitumour activity and safety of lorlatinib in advanced, ROS1-positive non-small-cell lung cancer (NSCLC). METHODS In this open-label, single-arm, phase 1-2 trial, we enrolled patients (aged ≥18 years) with histologically or cytologically confirmed advanced ROS1-positive NSCLC, with or without CNS metastases, with an Eastern Cooperative Oncology Group performance status of 2 or less (≤1 for phase 1 only) from 28 hospitals in 12 countries worldwide. Lorlatinib 100 mg once daily (escalating doses of 10 mg once daily to 100 mg twice daily in phase 1 only) was given orally in continuous 21-day cycles until investigator-determined disease progression, unacceptable toxicity, withdrawal of consent, or death. The primary endpoint was overall and intracranial tumour response, assessed by independent central review. Activity endpoints were assessed in patients who received at least one dose of lorlatinib. This study is ongoing and is registered with ClinicalTrials.gov, NCT01970865. FINDINGS Between Jan 22, 2014, and Oct 2, 2016, we assessed 364 patients, of whom 69 with ROS1-positive NSCLC were enrolled. 21 (30%) of 69 patients were TKI-naive, 40 (58%) had previously received crizotinib as their only TKI, and eight (12%) had previously received one non-crizotinib ROS1 TKI or two or more ROS1 TKIs. The estimated median duration of follow-up for response was 21·1 months (IQR 15·2-30·3). 13 (62%; 95% CI 38-82) of 21 TKI-naive patients and 14 (35%; 21-52) of 40 patients previously treated with crizotinib as their only TKI had an objective response. Intracranial responses were achieved in seven (64%; 95% CI 31-89) of 11 TKI-naive patients and 12 (50%; 29-71) of 24 previous crizotinib-only patients. The most common grade 3-4 treatment-related adverse events were hypertriglyceridaemia (13 [19%] of 69 patients) and hypercholesterolaemia (ten [14%]). Serious treatment-related adverse events occurred in five (7%) of 69 patients. No treatment-related deaths were reported. INTERPRETATION Lorlatinib showed clinical activity in patients with advanced ROS1-positive NSCLC, including those with CNS metastases and those previously treated with crizotinib. Because crizotinib-refractory patients have few treatment options, lorlatinib could represent an important next-line targeted agent. FUNDING Pfizer.
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Affiliation(s)
- Alice T Shaw
- Massachusetts General Hospital, Boston, MA, USA.
| | | | - Rita Chiari
- Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | - Benjamin Besse
- Gustave Roussy Cancer Campus, Villejuif, France; Department of Cancer Medicine, Paris-Sud University, Orsay, France
| | - Ross A Soo
- National University Cancer Institute, Singapore, Singapore
| | - Steven Kao
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Chia-Chi Lin
- National Taiwan University Hospital, Taipei, Taiwan
| | - Todd M Bauer
- Sarah Cannon Cancer Research Institute and Tennessee Oncology, PLLC, Nashville, TN, USA
| | - Jill S Clancy
- Pfizer Global Product Development-Oncology, Cambridge, MA, USA
| | - Holger Thurm
- Pfizer Global Product Development-Oncology, La Jolla, CA, USA
| | | | | | | | - Sherry Li
- Pfizer Global Product Development-Oncology, La Jolla, CA, USA
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69
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Dos Santos W, Sobanski T, de Carvalho AC, Evangelista AF, Matsushita M, Berardinelli GN, de Oliveira MA, Reis RM, Guimarães DP. Mutation profiling of cancer drivers in Brazilian colorectal cancer. Sci Rep 2019; 9:13687. [PMID: 31548566 PMCID: PMC6757044 DOI: 10.1038/s41598-019-49611-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022] Open
Abstract
The molecular basis of colorectal cancer (CRC) can guide patient prognosis and therapy. In Brazil, knowledge on the CRC mutation landscape is limited. Here, we investigated the mutation profile of 150 cancer-related genes by next-generation sequencing and associated with microsatellite instability (MSI) and genetic ancestry in a series of 91 Brazilian CRC patients. Driver mutations were found in the APC (71.4%), TP53 (56.0%), KRAS (52.7%), PIK3CA (15.4%) and FBXW7 (10.9%) genes. Overall, genes in the MAPK/ERK, PIK3/AKT, NOTCH and receptor tyrosine kinase signaling pathways were mutated in 68.0%, 23.1%, 16.5%, and 15.3% of patients, respectively. MSI was found in 13.3% of tumors, most of which were proximal (52.4%, P< 0.001) and had a high mutation burden. European genetic ancestry was predominant (median of 83.1%), followed by Native American (4.1%), Asian (3.4%) and African (3.2%). NF1 and BRAF mutations were associated with African ancestry, while TP53 and PIK3CA mutations were inversely correlated with Native American ancestry. Our study suggests that Brazilian CRC patients exhibit a mutation profile similar to other populations and identify the most frequently mutated genes, which could be useful in future target therapies and molecular cancer screening strategies.
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Affiliation(s)
| | - Thais Sobanski
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | | | | | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.
- Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, 4710-057, Portugal.
- 3ICVS/3B's-PT Government Associate Laboratory, Braga, 4710-057, Portugal.
| | - Denise Peixoto Guimarães
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.
- Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil.
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Facchinetti F, Friboulet L. Profile of entrectinib and its potential in the treatment of ROS1-positive NSCLC: evidence to date. LUNG CANCER (AUCKLAND, N.Z.) 2019; 10:87-94. [PMID: 31572036 PMCID: PMC6747675 DOI: 10.2147/lctt.s190786] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/30/2019] [Indexed: 12/24/2022]
Abstract
ROS1 inhibition provides impressive survival benefits in ROS1-rearranged non-small cell lung cancer (NSCLC) patients. Crizotinib is the only tyrosine kinase inhibitor (TKI) approved by both FDA and EMA for the treatment of ROS1-positive lung cancer. In addition, several TKI have been tested with preliminary proofs of success in this oncogene-driven disease, either in the post-crizotinib setting or as first-line targeted agents. Here we present the evidence concerning entrectinib, an ALK/ROS1/NTRK inhibitor developed across different tumor types harboring rearrangements in these genes, in the context of ROS1-driven NSCLC. Of interest, in August 2019 entrectinib was granted by FDA accelerated approval for the treatment of ROS1-rearranged NSCLC, as well as of NTRK-driven solid tumors.
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Affiliation(s)
- Francesco Facchinetti
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
| | - Luc Friboulet
- INSERM U981, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
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71
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Bebb DG, Agulnik J, Albadine R, Banerji S, Bigras G, Butts C, Couture C, Cutz JC, Desmeules P, Ionescu DN, Leighl NB, Melosky B, Morzycki W, Rashid-Kolvear F, Lab C, Sekhon HS, Smith AC, Stockley TL, Torlakovic E, Xu Z, Tsao MS. Crizotinib inhibition of ROS1-positive tumours in advanced non-small-cell lung cancer: a Canadian perspective. Curr Oncol 2019; 26:e551-e557. [PMID: 31548824 PMCID: PMC6726257 DOI: 10.3747/co.26.5137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The ros1 kinase is an oncogenic driver in non-small-cell lung cancer (nsclc). Fusion events involving the ROS1 gene are found in 1%-2% of nsclc patients and lead to deregulation of a tyrosine kinase-mediated multi-use intracellular signalling pathway, which then promotes the growth, proliferation, and progression of tumour cells. ROS1 fusion is a distinct molecular subtype of nsclc, found independently of other recognized driver mutations, and it is predominantly identified in younger patients (<50 years of age), women, never-smokers, and patients with adenocarcinoma histology. Targeted inhibition of the aberrant ros1 kinase with crizotinib is associated with increased progression-free survival (pfs) and improved quality-of-life measures. As the sole approved treatment for ROS1-rearranged nsclc, crizotinib has been demonstrated, through a variety of clinical trials and retrospective analyses, to be a safe, effective, well-tolerated, and appropriate treatment for patients having the ROS1 rearrangement. Canadian physicians endorse current guidelines which recommend that all patients with nonsquamous advanced nsclc, regardless of clinical characteristics, be tested for ROS1 rearrangement. Future integration of multigene testing panels into the standard of care could allow for efficient and cost-effective comprehensive testing of all patients with advanced nsclc. If a ROS1 rearrangement is found, treatment with crizotinib, preferably in the first-line setting, constitutes the standard of care, with other treatment options being investigated, as appropriate, should resistance to crizotinib develop.
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Affiliation(s)
- D G Bebb
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - J Agulnik
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - R Albadine
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - S Banerji
- Manitoba: Department of Medical Oncology, University of Manitoba, Winnipeg (Banerji)
| | - G Bigras
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - C Butts
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - C Couture
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - J C Cutz
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - P Desmeules
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - D N Ionescu
- British Columbia: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (Ionescu); BC Cancer-Vancouver Centre, Vancouver (Melosky)
| | - N B Leighl
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - B Melosky
- British Columbia: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (Ionescu); BC Cancer-Vancouver Centre, Vancouver (Melosky)
| | - W Morzycki
- Nova Scotia: Queen Elizabeth iiHealth Sciences Centre and Dalhousie University, Halifax (Morzycki, Xu)
| | - F Rashid-Kolvear
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
- Manitoba: Department of Medical Oncology, University of Manitoba, Winnipeg (Banerji)
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
- British Columbia: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (Ionescu); BC Cancer-Vancouver Centre, Vancouver (Melosky)
- Nova Scotia: Queen Elizabeth iiHealth Sciences Centre and Dalhousie University, Halifax (Morzycki, Xu)
- Saskatchewan: Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority and University of Saskatchewan, Saskatoon (Torlakovic)
| | - Clin Lab
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - H S Sekhon
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - A C Smith
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - T L Stockley
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - E Torlakovic
- Saskatchewan: Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority and University of Saskatchewan, Saskatoon (Torlakovic)
| | - Z Xu
- Nova Scotia: Queen Elizabeth iiHealth Sciences Centre and Dalhousie University, Halifax (Morzycki, Xu)
| | - M S Tsao
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
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Pasini L, Ulivi P. Liquid Biopsy for the Detection of Resistance Mechanisms in NSCLC: Comparison of Different Blood Biomarkers. J Clin Med 2019; 8:jcm8070998. [PMID: 31323990 PMCID: PMC6678791 DOI: 10.3390/jcm8070998] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/28/2019] [Accepted: 07/05/2019] [Indexed: 12/17/2022] Open
Abstract
The use of targeted agents and immunotherapy for the treatment of advanced non-small-cell lung cancer (NSCLC) has made it mandatory to characterize tumor tissue for patient selection. Moreover, the development of agents that are active against specific resistance mechanisms arising during treatment make it equally important to characterize the tumor tissue at progression by performing tissue re-biopsy. Given that tumor tissue is not always available for molecular characterization due to the paucity of diagnostic specimens or problems relating to the carrying out of invasive procedures, the use of liquid biopsy represents a valid approach to overcoming these difficulties. The most common material used for liquid biopsy in this setting is plasma-derived cell free DNA (cfDNA), which originates from cells undergoing apoptosis or necrosis. However, other sources of tumor material can be considered, such as extracellular vesicle (EV)-derived nucleic acids, which are actively secreted from living cells and closely correspond to tumor dynamics. In this review, we discuss the role of liquid biopsy in the therapeutic management of NSCLC with particular regard to targeted therapy and immunotherapy, and analyze the pros and cons of the different types of samples used in this context.
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Affiliation(s)
- Luigi Pasini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
| | - Paola Ulivi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy.
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73
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Masuda K, Fujiwara Y, Shinno Y, Mizuno T, Sato J, Morita R, Matsumoto Y, Murakami S, Goto Y, Kanda S, Horinouchi H, Yamamoto N, Ohe Y. Efficacy and safety of crizotinib in patients with ROS1 rearranged non-small cell lung cancer: a retrospective analysis. J Thorac Dis 2019; 11:2965-2972. [PMID: 31463126 DOI: 10.21037/jtd.2019.07.44] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Tyrosine kinase inhibitors (TKIs) are remarkably effective in patients with non-small cell lung carcinoma (NSCLC) harboring driver gene mutations and rearrangements. Crizotinib, a small-molecule TKI, has been demonstrated to be an efficacious drug against c-ros oncogene 1-rearranged NSCLC (ROS1-NSCLC) in clinical trials. However, information regarding the use of crizotinib in clinical practice in Japan is limited. Methods Subjects with a definite diagnosis of advanced/relapsed ROS1-NSCLC were selected from consecutive NSCLC patients treated at the National Cancer Center Hospital between December 2014 and May 2018. We retrospectively assessed the efficacy and safety of crizotinib in clinical practice. Results Among 24 patients with ROS1-NSCLC, the ROS1 rearrangement status was assessed using reverse transcription polymerase chain reaction (RT-PCR) (n=17), fluorescence in situ hybridization (FISH) (n=8), or next-generation sequencing (n=5) (some overlap occurred). Thirteen patients were treated with crizotinib in clinical practice. Among the 10 patients in whom clinical efficacy could be evaluated, the objective response rate (ORR) was 80.0% [95% confidence interval (CI), 49.0 to 94.3]. The median follow-up time was 35.5 months (95% CI, 8.9 to 44.6), the median progression-free survival (PFS) time was 10.0 months (95% CI, 5.1 to 27.0), and the median overall survival (OS) time was 28.7 months (95% CI, 6.7 to not reached). The most common adverse events were an aspartate/alanine aminotransferase (AST/ALT) increased and vision disorder. No severe adverse events related to crizotinib occurred. Conclusions The use of crizotinib in patients with ROS1-NSCLC was effective and well tolerated in clinical practice in Japan without severe adverse events.
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Affiliation(s)
- Ken Masuda
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Shinno
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Takaaki Mizuno
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Sato
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryo Morita
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuji Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shuji Murakami
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shintaro Kanda
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Yamamoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Michels S, Massutí B, Schildhaus HU, Franklin J, Sebastian M, Felip E, Grohé C, Rodriguez-Abreu D, Abdulla DS, Bischoff H, Brandts C, Carcereny E, Corral J, Dingemans AMC, Pereira E, Fassunke J, Fischer RN, Gardizi M, Heukamp L, Insa A, Kron A, Menon R, Persigehl T, Reck M, Riedel R, Rothschild SI, Scheel AH, Scheffler M, Schmalz P, Smit EF, Limburg M, Provencio M, Karachaliou N, Merkelbach-Bruse S, Hellmich M, Nogova L, Büttner R, Rosell R, Wolf J. Safety and Efficacy of Crizotinib in Patients With Advanced or Metastatic ROS1-Rearranged Lung Cancer (EUCROSS): A European Phase II Clinical Trial. J Thorac Oncol 2019; 14:1266-1276. [DOI: 10.1016/j.jtho.2019.03.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 12/21/2022]
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75
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Resistance mechanisms and potent-targeted therapies of ROS1-positive lung cancer. Cancer Chemother Pharmacol 2019; 84:679-688. [DOI: 10.1007/s00280-019-03902-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
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76
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Guisier F, Piton N, Salaun M, Thiberville L. ROS1-rearranged NSCLC With Secondary Resistance Mutation: Case Report and Current Perspectives. Clin Lung Cancer 2019; 20:e593-e596. [PMID: 31395437 DOI: 10.1016/j.cllc.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/24/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Florian Guisier
- Service de Pneumologie, Oncologie Thoracique, et Soins Intensifs Respiratoires, CHU Charles Nicolle, Rouen, France; LITIS QuantIF EA4108, Normandie University, Rouen, France; INSERM CIC 1404, CHU Charles Nicolle, Rouen, France.
| | - Nicolas Piton
- Service d'Anatomie et Cytologie Pathologiques, CHU Charles Nicolle, Rouen, France
| | - Mathieu Salaun
- Service de Pneumologie, Oncologie Thoracique, et Soins Intensifs Respiratoires, CHU Charles Nicolle, Rouen, France; LITIS QuantIF EA4108, Normandie University, Rouen, France; INSERM CIC 1404, CHU Charles Nicolle, Rouen, France
| | - Luc Thiberville
- Service de Pneumologie, Oncologie Thoracique, et Soins Intensifs Respiratoires, CHU Charles Nicolle, Rouen, France; LITIS QuantIF EA4108, Normandie University, Rouen, France; INSERM CIC 1404, CHU Charles Nicolle, Rouen, France
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77
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Dimou A, Ou SHI, Doebele RC. Dramatic Response to Lorlatinib in a Patient With CD74-ROS1-Positive Lung Adenocarcinoma With Acquired F2004V Mutation. JCO Precis Oncol 2019; 3:1900013. [PMID: 32914039 PMCID: PMC7450917 DOI: 10.1200/po.19.00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Sai-Hong I Ou
- University of California School of Medicine, Irvine, Orange, CA
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78
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Molecular Analysis of Plasma From Patients With ROS1-Positive NSCLC. J Thorac Oncol 2019; 14:816-824. [PMID: 30664990 DOI: 10.1016/j.jtho.2019.01.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Circulating tumor DNA analysis is an emerging genotyping strategy that can identify tumor-specific genetic alterations in plasma including mutations and rearrangements. Detection of ROS1 fusions in plasma requires genotyping approaches that cover multiple breakpoints and target a variety of fusion partners. Compared to other molecular subsets of NSCLC, experience with detecting ROS1 genetic alterations in plasma is limited. METHODS To describe the spectrum of ROS1 fusions in NSCLC and determine sensitivity for detecting ROS1 fusions in plasma, we queried the Guardant Health plasma dataset and an institutional tissue database and compared plasma findings to tissue results. In addition, we used the Guardant360 NGS assay to detect potential genetic mediators of resistance in plasma from patients with ROS1-positive NSCLC who were relapsing on crizotinib. RESULTS We detected seven distinct fusion partners in plasma, most of which (n = 6 of 7) were also represented in the tissue dataset. Fusions pairing CD74 with ROS1 predominated in both cohorts (plasma: n = 35 of 56, 63%; tissue: n = 26 of 52, 50%). There was 100% concordance between the specific tissue- and plasma-detected ROS1 fusion for seven patients genotyped with both methods. Sensitivity for detecting ROS1 fusions in plasma at relapse on ROS1-directed therapy was 50%. Six (33%) of 18 post-crizotinib plasma specimens harbored ROS1 kinase domain mutations, five of which were ROS1 G2032R. Two (11%) post-crizotinib plasma specimens had genetic alterations (n = 1 each BRAF V600E and PIK3CA E545K) potentially associated with ROS1-independent signaling. CONCLUSIONS Plasma genotyping captures the spectrum of ROS1 fusions observed in tissue. Plasma genotyping is a promising approach to detecting mutations that drive resistance to ROS1-directed therapies.
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Hegde A, Hong DS, Behrang A, Ali SM, Juckett L, Meric-Bernstam F, Subbiah V. Activity of Brigatinib in Crizotinib and Ceritinib-Resistant ROS1- Rearranged Non-Small-Cell Lung Cancer. JCO Precis Oncol 2019; 3. [PMID: 32775947 DOI: 10.1200/po.18.00267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Aparna Hegde
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - David S Hong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amini Behrang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Vivek Subbiah
- University of Texas MD Anderson Cancer Center, Houston, TX
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Lee J, Sun JM, Lee SH, Ahn JS, Park K, Choi YL, Ahn MJ. Efficacy and Safety of Lorlatinib in Korean Non-Small-Cell Lung Cancer Patients With ALK or ROS1 Rearrangement Whose Disease Failed to Respond to a Previous Tyrosine Kinase Inhibitor. Clin Lung Cancer 2018; 20:215-221. [PMID: 30683630 DOI: 10.1016/j.cllc.2018.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/11/2018] [Accepted: 12/25/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Non-small-cell lung cancer (NSCLC) patients harboring ALK or ROS1 rearrangements invariably acquire resistance to the first- and second-generation tyrosine kinase inhibitors (TKIs), most notably ALK G1202R and ROS1 G2032R. Lorlatinib, a novel third-generation TKI, produced remarkable results from the first-in-man phase 1 trial: an overall response rate of 46% and 50% for previously treated ALK- and ROS1-positive patients, respectively. However, the efficacy of lorlatinib has not been widely validated in Asian patients. PATIENTS AND METHODS Patients with advanced NSCLC with ALK or ROS1 rearrangements who initiated lorlatinib therapy between November 2016 and July 2018 were retrospectively analyzed. RESULTS Twelve consecutive patients were included. The median age was 55 years (range, 36-76 years). Ten (83%) had ALK-positive NSCLC and 2 (17%) had ROS1-positive NSCLC. All patients had a history of first- or second-generation ALK TKI receipt. Two ALK-positive patients and one ROS1-positive patient had the G1202R and G2032R mutations, respectively. The overall response rate was 64% and the disease control rate was 91%. Of the 3 ALK-positive patients with intracranial target lesions, 1 (33%) had a complete response and 2 (67%) a partial response, producing an intracranial objective response of 100%. The median progression-free survival was 6.5 months (range, 1.0-16.5 months). The most common adverse event was hypercholesterolemia (83%), and no adverse event-related dose reductions or treatment discontinuations were reported. CONCLUSION This study is the first to report that lorlatinib is an important novel therapeutic option for Asian patients who have advanced NSCLC harboring ALK/ROS1 mutations whose disease progressed during treatment with first- and second-generation TKIs.
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Affiliation(s)
- Jiyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Yang T, Xu R, Yan B, Li F, Liu H. Elevation of tumor mutation burden in ROS1-fusion lung adenocarcinoma resistant to crizotinib: A case report. Medicine (Baltimore) 2018; 97:e13797. [PMID: 30593165 PMCID: PMC6314749 DOI: 10.1097/md.0000000000013797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Although most of non-small cell lung cancer (NSCLC) patients with ROS1-fusions respond to crizotinb, acquired resistance eventually develop. The next-generations of ROS1 inhibitors have made some achievements, but the effects of immunotherapy have not been explored. PATIENT CONCERNS A 44-year-old Chinese women presented with cough and dyspnea with a history of advanced lung adenocarcinoma. DIAGNOSIS A PET/CT scan revealed primary tumors in bilateral lung lobes and multiple metastases in lymph nodes and bones. And ultrasound-guided left cervical lymph node biopsy revealed the pathological diagnosis was poor differentiated lung adenocarcinoma. INTERVENTIONS The patients was started to be treated with 4 cycles of pemetrexed, carboplatin and bevacizumab, followed by one cycle of docetaxel, cisplatin and bevacizumab. As the ROS1-fusion was found by next generation sequencing, the patient received crizotinib treatment about 3 months. OUTCOMES After 5 cycles of chemotherapy, CT scans revealed increased size of bilateral lobe nodules indicative of progressive disease (PD). Then the patient received treatment of crizotinib and his progression-free survival reached 3 months. Due to uncontrollable disease progression, the patient expired. LESSONS The genetic profile of NSCLC patients might be altered in various therapeutic processes. Thus, repeated genetic testing might be important at each progression. Moreover, immunotherapy might be a powerful weapon to overcome the resistance to Tyrosine kinase inhibitors (TKIs) in future.
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82
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Dagogo-Jack I, Stevens SE, Lin JJ, Nagy R, Ferris L, Shaw AT, Gainor JF. Emergence of a RET V804M Gatekeeper Mutation During Treatment With Vandetanib in RET-Rearranged NSCLC. J Thorac Oncol 2018; 13:e226-e227. [DOI: 10.1016/j.jtho.2018.06.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 06/25/2018] [Accepted: 06/25/2018] [Indexed: 12/01/2022]
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83
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Michels S, Scheffler M, Wagener S, Plenker D, Scheel A, Nogová L, Schultheis A, Fischer RN, Abdulla DS, Riedel R, Bunck A, Kobe C, Baus W, Merkelbach-Bruse S, Sos ML, Büttner R, Wolf J. Loss of G2032R Resistance Mutation Upon Chemotherapy Treatment Enables Successful Crizotinib Rechallenge in a Patient With ROS1-Rearranged NSCLC. JCO Precis Oncol 2018; 2:1-6. [DOI: 10.1200/po.18.00121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sebastian Michels
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Matthias Scheffler
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Svenja Wagener
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Dennis Plenker
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Andreas Scheel
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Lucia Nogová
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Anne Schultheis
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Rieke N. Fischer
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Diana S.Y. Abdulla
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Richard Riedel
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Anne Bunck
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Wolfgang Baus
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Martin L. Sos
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Reinhard Büttner
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
| | - Jürgen Wolf
- All authors: University Hospital of Cologne; Martin L. Sos, University of Cologne, Cologne, Germany
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Kato Y, Ninomiya K, Ohashi K, Tomida S, Makimoto G, Watanabe H, Kudo K, Matsumoto S, Umemura S, Goto K, Ichihara E, Ninomiya T, Kubo T, Sato A, Hotta K, Tabata M, Toyooka S, Maeda Y, Kiura K. Combined effect of cabozantinib and gefitinib in crizotinib-resistant lung tumors harboring ROS1 fusions. Cancer Sci 2018; 109:3149-3158. [PMID: 30053332 PMCID: PMC6172052 DOI: 10.1111/cas.13752] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 12/21/2022] Open
Abstract
The ROS1 tyrosine kinase inhibitor (TKI) crizotinib has shown dramatic effects in patients with non‐small cell lung cancer (NSCLC) harboring ROS1 fusion genes. However, patients inevitably develop resistance to this agent. Therefore, a new treatment strategy is required for lung tumors with ROS1 fusion genes. In the present study, lung cancer cell lines, HCC78 harboring SLC34A2‐ROS1 and ABC‐20 harboring CD74‐ROS1, were used as cell line‐based resistance models. Crizotinib‐resistant HCC78R cells were established from HCC78. We comprehensively screened the resistant cells using a phosphor‐receptor tyrosine kinase array and RNA sequence analysis by next‐generation sequencing. HCC78R cells showed upregulation of HB‐EGF and activation of epidermal growth factor receptor (EGFR) phosphorylation and the EGFR signaling pathway. Recombinant HB‐EGF or EGF rendered HCC78 cells or ABC‐20 cells resistant to crizotinib. RNA sequence analysis by next‐generation sequencing revealed the upregulation of AXL in HCC78R cells. HCC78R cells showed marked sensitivity to EGFR‐TKI or anti‐EGFR antibody treatment in vitro. Combinations of an AXL inhibitor, cabozantinib or gilteritinib, and an EGFR‐TKI were more effective against HCC78R cells than monotherapy with an EGFR‐TKI or AXL inhibitor. The combination of cabozantinib and gefitinib effectively inhibited the growth of HCC78R tumors in an in vivo xenograft model of NOG mice. The results of this study indicated that HB‐EGF/EGFR and AXL play roles in crizotinib resistance in lung cancers harboring ROS1 fusions. The combination of cabozantinib and EGFR‐TKI may represent a useful alternative treatment strategy for patients with advanced NSCLC harboring ROS1 fusion genes.
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Affiliation(s)
- Yuka Kato
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kiichiro Ninomiya
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kadoaki Ohashi
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Shuta Tomida
- Department of Biobank, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Go Makimoto
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromi Watanabe
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenichiro Kudo
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shingo Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shigeki Umemura
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Eiki Ichihara
- Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Takashi Ninomiya
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshio Kubo
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Akiko Sato
- Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Katsuyuki Hotta
- Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan.,Center for Innovative Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Masahiro Tabata
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Kiura
- Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan
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Gong B, Oh-Hara T, Fujita N, Katayama R. 3D culture system containing gellan gum restores oncogene dependence in ROS1 rearrangements non-small cell lung cancer. Biochem Biophys Res Commun 2018; 501:527-533. [PMID: 29738763 DOI: 10.1016/j.bbrc.2018.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 11/29/2022]
Abstract
The ROS1 fusion gene has been identified in approximately 1% of non-small cell lung cancer (NSCLC) cases. Several clinical studies have highlighted ROS1 as a promising therapeutic target because crizotinib, a multi-targeted drug against ROS1, ALK, and the MET proto-oncogene, has elicited remarkable responses in ROS1-rearrangements NSCLC. However, acquired resistance mediated by ROS1 kinase domain mutations has been identified and a system to assess ROS1 inhibitors for these resistant mutations is necessary for the promotion of drug development. Publicly available NSCLC cell lines harboring the ROS1 fusion gene are limited to only HCC78 cells carrying SLC34A2-ROS1. This cell line exhibits resistance to ROS1 inhibitors through activation of the EGFR pathway, although the cells were established from ROS1-TKI naïve pleural effusion. Here, we demonstrate that 3D culture with gellan gum can restore the ROS1 oncogene dependence of HCC78 cells by upregulating the expression of the ROS1 fusion gene and reducing the activity of the EGFR pathway. Moreover, we established the HCC78xe3 cell line, a subclone of the HCC78 cell line, by repeated in vitro cultures from tumor xenografts and created xenograft tumors three times using in vitro cultured cells. This eventually enabled us to engraft and stably grow the cells in vivo, and subsequently evaluate various ROS1 inhibitors against HCC78xe3 cells by overexpressing crizotinib-resistant mutations in the ROS1 kinase domain including G2032R and D2033 N. We newly found that lorlatinib, a next generation ROS1/ALK inhibitor, remain the activity against D2033 N mutation. Furthermore, we demonstrated that HCC78xe3 cells expressing SLC34A2-ROS1 G2032R, and D2033 N, but not wild type (WT) cells, were resistant to crizotinib in vivo. Taken together, our data suggested that 3D cultures of HCC78 might reflect the features in patients and this new system will be a useful tool for evaluating ROS1 inhibitors.
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Affiliation(s)
- Bo Gong
- Cancer Chemotherapy Center, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan; Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5, Kashiwanoha, Kashiwa-shi, Chiba, 277-8561, Japan
| | - Tomoko Oh-Hara
- Cancer Chemotherapy Center, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Naoya Fujita
- Cancer Chemotherapy Center, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan; Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5, Kashiwanoha, Kashiwa-shi, Chiba, 277-8561, Japan
| | - Ryohei Katayama
- Cancer Chemotherapy Center, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
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86
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Gou W, Zhou X, Liu Z, Wang L, Shen J, Xu X, Li Z, Zhai X, Zuo D, Wu Y. CD74-ROS1 G2032R mutation transcriptionally up-regulates Twist1 in non-small cell lung cancer cells leading to increased migration, invasion, and resistance to crizotinib. Cancer Lett 2018; 422:19-28. [DOI: 10.1016/j.canlet.2018.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/16/2018] [Accepted: 02/20/2018] [Indexed: 01/18/2023]
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87
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McCoach CE, Le AT, Gowan K, Jones K, Schubert L, Doak A, Estrada-Bernal A, Davies KD, Merrick DT, Bunn PA, Purcell WT, Dziadziuszko R, Varella-Garcia M, Aisner DL, Camidge DR, Doebele RC. Resistance Mechanisms to Targeted Therapies in ROS1+ and ALK+ Non-small Cell Lung Cancer. Clin Cancer Res 2018; 24:3334-3347. [PMID: 29636358 DOI: 10.1158/1078-0432.ccr-17-2452] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/23/2018] [Accepted: 04/03/2018] [Indexed: 12/13/2022]
Abstract
Purpose: Despite initial benefit from tyrosine kinase inhibitors (TKIs), patients with advanced non-small cell lung cancer (NSCLC) harboring ALK (ALK+) and ROS1 (ROS1+) gene fusions ultimately progress. Here, we report on the potential resistance mechanisms in a series of patients with ALK+ and ROS1+ NSCLC progressing on different types and/or lines of ROS1/ALK-targeted therapy.Experimental Design: We used a combination of next-generation sequencing (NGS), multiplex mutation assay, direct DNA sequencing, RT-PCR, and FISH to identify fusion variants/partners and copy-number gain (CNG), kinase domain mutations (KDM), and copy-number variations (CNVs) in other cancer-related genes. We performed testing on 12 ROS1+ and 43 ALK+ patients.Results: One of 12 ROS1+ (8%) and 15 of 43 (35%) ALK + patients harbored KDM. In the ROS1+ cohort, we identified KIT and β-catenin mutations and HER2-mediated bypass signaling as non-ROS1-dominant resistance mechanisms. In the ALK+ cohort, we identified a novel NRG1 gene fusion, a RET fusion, 2 EGFR, and 3 KRAS mutations, as well as mutations in IDH1, RIT1, NOTCH, and NF1 In addition, we identified CNV in multiple proto-oncogenes genes including PDGFRA, KIT, KDR, GNAS, K/HRAS, RET, NTRK1, MAP2K1, and others.Conclusions: We identified a putative TKI resistance mechanism in six of 12 (50%) ROS1 + patients and 37 of 43 (86%) ALK+ patients. Our data suggest that a focus on KDMs will miss most resistance mechanisms; broader gene testing strategies and functional validation is warranted to devise new therapeutic strategies for drug resistance. Clin Cancer Res; 24(14); 3334-47. ©2018 AACR.
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Affiliation(s)
- Caroline E McCoach
- Division of Medical Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California.
| | - Anh T Le
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Katherine Gowan
- Department of Pediatrics, Section of Hematology, Oncology, and Bone Marrow Transplant, University of Colorado, Aurora, Colorado
| | - Kenneth Jones
- Department of Pediatrics, Section of Hematology, Oncology, and Bone Marrow Transplant, University of Colorado, Aurora, Colorado
| | - Laura Schubert
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Andrea Doak
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Adriana Estrada-Bernal
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Kurtis D Davies
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel T Merrick
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul A Bunn
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - W Tom Purcell
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Marileila Varella-Garcia
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Dara L Aisner
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - D Ross Camidge
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert C Doebele
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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88
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Gkolfinopoulos S, Mountzios G. Beyond EGFR and ALK: targeting rare mutations in advanced non-small cell lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:142. [PMID: 29862231 DOI: 10.21037/atm.2018.04.28] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Lung cancer remains the leading cause of cancer-related death in men and women, despite its constantly declining rates in incidence and mortality in the developed world. The past decade has witnessed an unprecedented rise in the development of molecular targeted therapies in various types of tumors. In non-small cell lung cancer (NSCLC), the greatest paradigm shift is the implementation of EGFR and ALK tyrosine kinase inhibitors in the first line and subsequent lines of therapy, with impressive results. Though less frequent than the molecular alterations in the aforementioned genes, a number of aberrations in potential oncogenic drivers has been discovered, namely mutations in the genes KRAS, BRAF, HER2, PI3KCA and DDR2, ROS1 and RET rearrangements and MET, HER2 and FGFR1 gene amplifications. A great number of clinical trials are currently underway, evaluating agents specifically designed to target these alterations, with mixed results so far. The greatest cumulative benefit offered by these trials is that, despite their success or failure in their objective goals, they have provided us with a better understanding of the complexity of the molecular intracellular processes, necessitating thus the accurate interpretation of the preclinical data in order to appropriately select the patients that may derive benefit from targeted treatment strategies.
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Affiliation(s)
| | - Giannis Mountzios
- Medical Oncology Department, 251 Air Force General Hospital, Athens, Greece
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89
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Facchinetti F, Friboulet L. Lorlatinib in ALK- and ROS1-positive NSCLC: the future has a start. Transl Lung Cancer Res 2018; 7:S103-S106. [PMID: 29782561 PMCID: PMC5943229 DOI: 10.21037/tlcr.2018.02.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - Luc Friboulet
- INSERM, U981, Gustave Roussy Cancer Campus, Université Paris Sud, Villejuif, France
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90
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Wu YL, Yang JCH, Kim DW, Lu S, Zhou J, Seto T, Yang JJ, Yamamoto N, Ahn MJ, Takahashi T, Yamanaka T, Kemner A, Roychowdhury D, Paolini J, Usari T, Wilner KD, Goto K. Phase II Study of Crizotinib in East Asian Patients With ROS1-Positive Advanced Non-Small-Cell Lung Cancer. J Clin Oncol 2018; 36:1405-1411. [PMID: 29596029 DOI: 10.1200/jco.2017.75.5587] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Approximately 1% to 2% of non-small-cell lung cancers (NSCLCs) harbor a c-ros oncogene 1 ( ROS1) rearrangement. Crizotinib, an inhibitor of anaplastic lymphoma kinase (ALK), ROS1, and MET, has shown marked antitumor activity in a small expansion cohort of patients with ROS1-positive advanced NSCLC from an ongoing phase I study. We assessed the efficacy and safety of crizotinib in the largest cohort of patients with ROS1-positive advanced NSCLC. Patients and Methods This phase II, open-label, single-arm trial enrolled East Asian patients with ROS1-positive (assessed through validated AmoyDx assay [Amoy Diagnostics, Xiamen, China] at three regional laboratories) advanced NSCLC who had received three or fewer lines of prior systemic therapies. Patients were to receive oral crizotinib at a starting dose of 250 mg twice daily and continued treatment until Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1-defined progression (by independent radiology review [IRR]), unacceptable toxicity, or withdrawal of consent. The primary end point was objective response rate (ORR) by IRR. Results In the efficacy and safety analyses, 127 patients were included, with 49.6% still receiving treatment at data cutoff. ORR by IRR was 71.7% (95% CI, 63.0% to 79.3%), with 17 complete responses and 74 partial responses. ORRs were similar irrespective of the number of prior lines of therapy, and responses were durable (median duration of response, 19.7 months; 95% CI, 14.1 months to not reached). Median progression-free survival by IRR was 15.9 months (95% CI, 12.9 to 24.0 months). No new safety signals associated with crizotinib were reported. Conclusion This study demonstrated clinically meaningful benefit and durable responses with crizotinib in East Asian patients with ROS1-positive advanced NSCLC. Crizotinib was generally well tolerated, with a safety profile consistent with previous reports.
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Affiliation(s)
- Yi-Long Wu
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - James Chih-Hsin Yang
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Dong-Wan Kim
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Shun Lu
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Jianying Zhou
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Takashi Seto
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Jin-Ji Yang
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Noboru Yamamoto
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Myung-Ju Ahn
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Toshiaki Takahashi
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Takeharu Yamanaka
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Allison Kemner
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Debasish Roychowdhury
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Jolanda Paolini
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Tiziana Usari
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Keith D Wilner
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
| | - Koichi Goto
- Yi-Long Wu and Jin-Ji Yang, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou; Shun Lu, Jiao Tong University, Shanghai; Jianying Zhou, First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; James Chih-Hsin Yang, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China; Dong-Wan Kim, Seoul National University Hospital; Myung-Ju Ahn, Samsung Medical Center, Seoul, South Korea; Takashi Seto, National Kyushu Cancer Center, Fukuoka; Noboru Yamamoto, National Cancer Center Hospital, Tokyo; Toshiaki Takahashi, Shizuoka Cancer Center, Shizuoka; Takeharu Yamanaka, Yokohama City University School of Medicine, Yokohama; Koichi Goto, National Cancer Center Hospital East, Kashiwa, Japan; Allison Kemner and Debasish Roychowdhury, OxOnc Development, Princeton, NJ; Nirvan Consultants, Lexington, MA; Jolanda Paolini and Tiziana Usari, Pfizer, Milan, Italy; and Keith D. Wilner, Pfizer, La Jolla, CA
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91
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Progress in the Management of Advanced Thoracic Malignancies in 2017. J Thorac Oncol 2018; 13:301-322. [PMID: 29331646 DOI: 10.1016/j.jtho.2018.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 12/21/2022]
Abstract
The treatment paradigm of NSCLC underwent a major revolution during the course of 2017. Immune checkpoint inhibitors (ICIs) brought remarkable improvements in response and overall survival both in unselected pretreated patients and in untreated patients with programmed death ligand 1 expression of 50% or more. Furthermore, compelling preliminary results were reported for new combinations of anti-programmed cell death 1/programmed death ligand 1 agents with chemotherapy or anti-cytotoxic T-lymphocyte associated protein 4 inhibitors. The success of the ICIs appeared to extend to patients with SCLC, mesothelioma, or thymic tumors. Furthermore, in SCLC, encouraging activity was reported for an experimental target therapy (rovalpituzumab teserine) and a new chemotherapeutic agent (lurbinectedin). For oncogene-addicted NSCLC, next-generation tyrosine kinase inhibitors (TKIs) (such as osimertinib or alectinib) have demonstrated increased response rates and progression-free survival compared with first-generation TKIs in patients with both EGFR-mutated and ALK receptor tyrosine kinase gene (ALK)-rearranged NSCLC. However, because of the lack of mature overall survival data and considering the high efficacy of these drugs in patients with NSCLC previously exposed to first- or second-generation TKIs, definitive conclusions concerning the best treatment sequence cannot yet be drawn. In addition, new oncogenes such as mutant BRAF, tyrosine-protein kinase met gene (MET) and erb-b2 receptor tyrosine kinase 2 gene (HER2), and ret proto-oncogene (RET) rearrangements have joined the list of potential targetable drivers. In conclusion, the field of thoracic oncology is on the verge of a breakthrough that will open up many promising new therapeutic options for physicians and patients. The characterization of biomarkers predictive of sensitivity or resistance to immunotherapy and the identification of the optimal therapeutic combinations (for ICIs) and treatment sequence (for oncogene-addicted NSCLC) represent the toughest upcoming challenges in the domain of thoracic oncology.
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92
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Added Value of Whole-Exome and Transcriptome Sequencing for Clinical Molecular Screenings of Advanced Cancer Patients With Solid Tumors. Cancer J 2018; 24:153-162. [DOI: 10.1097/ppo.0000000000000322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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93
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Koeppel F, Blanchard S, Jovelet C, Genin B, Marcaillou C, Martin E, Rouleau E, Solary E, Soria JC, André F, Lacroix L. Whole exome sequencing for determination of tumor mutation load in liquid biopsy from advanced cancer patients. PLoS One 2017; 12:e0188174. [PMID: 29161279 PMCID: PMC5697854 DOI: 10.1371/journal.pone.0188174] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/02/2017] [Indexed: 01/28/2023] Open
Abstract
Tumor mutation load (TML) has been proposed as a biomarker of patient response to immunotherapy in several studies. TML is usually determined by tumor biopsy DNA (tDNA) whole exome sequencing (WES), therefore TML evaluation is limited by informative biopsy availability. Circulating cell free DNA (cfDNA) provided by liquid biopsy is a surrogate specimen to biopsy for molecular profiling. Nevertheless performing WES on DNA from plasma is technically challenging and the ability to determine tumor mutation load from liquid biopsies remains to be demonstrated. In the current study, WES was performed on cfDNA from 32 metastatic patients of various cancer types included into MOSCATO 01 (NCT01566019) and/or MATCHR (NCT02517892) molecular triage trials. Results from targeted gene sequencing (TGS) and WES performed on cfDNA were compared to results from tumor tissue biopsy. In cfDNA samples, WES mutation detection sensitivity was 92% compared to targeted sequencing (TGS). When comparing cfDNA-WES to tDNA-WES, mutation detection sensitivity was 53%, consistent with previously published prospective study comparing cfDNA-TGS to tDNA-TGS. For samples in which presence of tumor DNA was confirmed in cfDNA, tumor mutation load from liquid biopsy was correlated with tumor biopsy. Taken together, this study demonstrated that liquid biopsy may be applied to determine tumor mutation load. Qualification of liquid biopsy for interpretation is a crucial point to use cfDNA for mutational load estimation.
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Affiliation(s)
- Florence Koeppel
- Genomic Platform–Molecular Biopathology Unit and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | | | - Cécile Jovelet
- Genomic Platform–Molecular Biopathology Unit and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Bérengère Genin
- IntegraGen SA, Genopole CAMPUS 1 bat, G8, EVRY, Paris, France
| | | | - Emmanuel Martin
- IntegraGen SA, Genopole CAMPUS 1 bat, G8, EVRY, Paris, France
| | - Etienne Rouleau
- Genomic Platform–Molecular Biopathology Unit and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Eric Solary
- INSERM U1170, Gustave Roussy, Faculté de Médecine Paris-Sud, Université Paris-Saclay, Villejuif, France
- Department of Hematology, Gustave Roussy, Villejuif, France
| | - Jean-Charles Soria
- Drug Development Department (DITEP), Gustave Roussy, and Université Paris-Sud, Villejuif, France
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM U981, Gustave Roussy, Université Paris XI, Villejuif, France
| | - Fabrice André
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM U981, Gustave Roussy, Université Paris XI, Villejuif, France
| | - Ludovic Lacroix
- Genomic Platform–Molecular Biopathology Unit and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
- * E-mail:
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94
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Lin JJ, Shaw AT. Recent Advances in Targeting ROS1 in Lung Cancer. J Thorac Oncol 2017; 12:1611-1625. [PMID: 28818606 PMCID: PMC5659942 DOI: 10.1016/j.jtho.2017.08.002] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/05/2017] [Accepted: 08/08/2017] [Indexed: 01/03/2023]
Abstract
ROS1 is a validated therapeutic target in NSCLC. In a phase I study, the multitargeted MET proto-oncogene, receptor tyrosine kinase/anaplastic lymphoma kinase/ROS1 inhibitor crizotinib demonstrated remarkable efficacy in ROS1-rearranged NSCLCs and consequently gained approval by the United States Food and Drug Administration and by the European Medicines Agency in 2016. However, similar to other oncogene-driven lung cancers, ROS1-rearranged lung cancers treated with crizotinib eventually acquire resistance, leading to disease relapse. Novel ROS1 inhibitors and therapeutic strategies are therefore needed. Insights into the mechanisms of resistance to ROS1-directed tyrosine kinase inhibitors are now beginning to emerge and are helping to guide the development of new ROS1 inhibitors. This review discusses the biology and diagnosis of ROS1-rearranged NSCLC, and current and emerging treatment options for this disease. Future challenges in the field are highlighted.
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Affiliation(s)
- Jessica J Lin
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Alice T Shaw
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
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95
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Abstract
The expanding spectrum of both established and candidate oncogenic driver mutations identified in non-small-cell lung cancer (NSCLC), coupled with the increasing number of clinically available signal transduction pathway inhibitors targeting these driver mutations, offers a tremendous opportunity to enhance patient outcomes. Despite these molecular advances, advanced-stage NSCLC remains largely incurable due to therapeutic resistance. In this Review, we discuss alterations in the targeted oncogene ('on-target' resistance) and in other downstream and parallel pathways ('off-target' resistance) leading to resistance to targeted therapies in NSCLC, and we provide an overview of the current understanding of the bidirectional interactions with the tumour microenvironment that promote therapeutic resistance. We highlight common mechanistic themes underpinning resistance to targeted therapies that are shared by NSCLC subtypes, including those with oncogenic alterations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), ROS1 proto-oncogene receptor tyrosine kinase (ROS1), serine/threonine-protein kinase b-raf (BRAF) and other less established oncoproteins. Finally, we discuss how understanding these themes can inform therapeutic strategies, including combination therapy approaches, and overcome the challenge of tumour heterogeneity.
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Affiliation(s)
- Julia Rotow
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, 505 Parnassus Avenue, Box 1270, San Francisco, California 94143, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, Box 0981, San Francisco, California 94143, USA
| | - Trever G Bivona
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco, 505 Parnassus Avenue, Box 1270, San Francisco, California 94143, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, Box 0981, San Francisco, California 94143, USA
- Cellular and Molecular Pharmacology, University of California San Francisco, Box 2140, San Francisco, California 94158, USA
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96
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Daoud A, Chu QS. Targeting Novel but Less Common Driver Mutations and Chromosomal Translocations in Advanced Non-Small Cell Lung Cancer. Front Oncol 2017; 7:222. [PMID: 29034207 PMCID: PMC5626928 DOI: 10.3389/fonc.2017.00222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 09/01/2017] [Indexed: 01/25/2023] Open
Abstract
Discovery of the epidermal growth factor receptor gene mutation and the anaplastic lymphoma kinase chromosomal translocation in non-small cell lung cancer has prompted efforts around the world to identify many less common targetable oncogenic drivers. Such concerted efforts have been variably successful in both non-squamous and squamous cell carcinomas of the lung. Some of the targeted therapies for these oncogenic drivers have received regulatory approval for clinical use, while others have modest clinical benefit. In this mini-review, several of these targets will be reviewed.
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Affiliation(s)
- Alia Daoud
- Department of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Quincy S. Chu
- Department of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
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97
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Abstract
ROS1 is a receptor tyrosine kinase that has recently been shown to undergo gene rearrangements in~1%-2% of non-small cell lung carcinoma (NSCLC) and in a variety of other tumours including cholangiocarcinoma, gastric carcinoma, colorectal carcinoma and in spitzoid neoplasms, glioblastoma and inflammatory myofibroblastic tumours. The ROS1 gene fusion undergoes constitutive activation, regulates cellular proliferation and is implicated in carcinogenesis. ROS1 fusions can be detected by fluorescence in situ hybridisation, real-time PCR, sequencing-based techniques and immunohistochemistry-based methods in clinical laboratories. The small molecule tyrosine kinase inhibitor, crizotinib has been shown to be an effective inhibitor of ROS1 and has received Food and Drug Administration approval for treatment of advanced NSCLC. The current review is an update on the clinical findings and detection methods of ROS1 in clinical laboratories in NSCLC and other tumours.
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Affiliation(s)
- Prodipto Pal
- Department of Laboratory Medicine and Pathobiology, University Health Network - University of Toronto, Toronto, Canada
| | - Zanobia Khan
- Department of Laboratory Medicine and Pathobiology, University Health Network - Lakeridge Regional Health Center, Toronto, Canada
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98
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Kobayashi T, Fujimoto H, D'Alessandro-Gabazza C, Gabazza EC, Hataji O. Recent studies move closer to answering questions about sequential therapy for anaplastic lymphoma kinase-rearranged non-small cell lung cancer. J Thorac Dis 2017; 9:2847-2851. [PMID: 29221254 DOI: 10.21037/jtd.2017.08.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Tetsu Kobayashi
- Department of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hajime Fujimoto
- Department of Pulmonary and Critical Care Medicine, Faculty and Graduate School of Medicine, Mie University, Tsu, Japan
| | | | - Esteban C Gabazza
- Department of Immunology, Faculty and Graduate School of Medicine, Mie University, Tsu, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan
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99
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Xu CW, Wang WX, Huang RF, He C, Liao XH, Zhu YC, Du KQ, Zhuang W, Chen YP, Chen G, Fang MY. Patient harboring a novel PIK3CA point mutation after acquired resistance to crizotinib in an adenocarcinoma with ROS1 rearrangement: A case report and literature review. Thorac Cancer 2017; 8:714-719. [PMID: 28845578 PMCID: PMC5668514 DOI: 10.1111/1759-7714.12496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 01/21/2023] Open
Abstract
ROS1 rearrangement occurs in 1–2% of non‐small cell lung cancer (NSCLC) cases. These patients would benefit from treatment with the anaplastic lymphoma kinase inhibitor, crizotinib; however, resistance to crizotinib inevitably develops in such patients despite an initial response. The mechanism of acquired resistance to crizotinib in patients with NSCLC with ROS1 rearrangement has not yet been identified. Herein, we report a case of a 66‐year‐old woman diagnosed with adenocarcinoma. PCR revealed no EGFR or ALK mutations. After the patient underwent several rounds of chemotherapy, crizotinib was administered. The disease explosively progressed six months later. A novel PIK3CA gene point mutation (p.L531P) was detected by next generation sequencing. This case is the second report of bypass activation conferred crizotinib resistance in a patient with NSCLC with ROS1‐rearrangement, but is the first to confirm that activation of the mTOR signaling pathway leads to acquired crizotinib resistance.
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Affiliation(s)
- Chun-Wei Xu
- Department of Pathology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Wen-Xian Wang
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, China
| | - Rong-Fang Huang
- Department of Pathology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Cheng He
- Department of Pathology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xing-Hui Liao
- Department of Tumor Molecular Laboratory, Zhejiang Rongjun Hospital, Jiaxing, China
| | - You-Cai Zhu
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Kai-Qi Du
- Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Wu Zhuang
- Department of Medical Thoracic Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yan-Ping Chen
- Department of Pathology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Gang Chen
- Department of Pathology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Mei-Yu Fang
- Department of Comprehensive Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
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100
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Gainor JF, Tseng D, Yoda S, Dagogo-Jack I, Friboulet L, Lin JJ, Hubbeling HG, Dardaei L, Farago AF, Schultz KR, Ferris LA, Piotrowska Z, Hardwick J, Huang D, Mino-Kenudson M, Iafrate AJ, Hata AN, Yeap BY, Shaw AT. Patterns of Metastatic Spread and Mechanisms of Resistance to Crizotinib in ROS1-Positive Non-Small-Cell Lung Cancer. JCO Precis Oncol 2017; 2017:PO.17.00063. [PMID: 29333528 PMCID: PMC5766287 DOI: 10.1200/po.17.00063] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The ROS1 tyrosine kinase is activated through ROS1 gene rearrangements in 1-2% of non-small cell lung cancer (NSCLC), conferring sensitivity to treatment with the ALK/ROS1/MET inhibitor crizotinib. Currently, insights into patterns of metastatic spread and mechanisms of crizotinib resistance among ROS1-positive patients are limited. PATIENTS AND METHODS We reviewed clinical and radiographic imaging data of patients with ROS1- and ALK-positive NSCLC in order to compare patterns of metastatic spread at initial metastatic diagnosis. To determine molecular mechanisms of crizotinib resistance, we also analyzed repeat biopsies from a cohort of ROS1-positive patients progressing on crizotinib. RESULTS We identified 39 and 196 patients with advanced ROS1- and ALK-positive NSCLC, respectively. ROS1-positive patients had significantly lower rates of extrathoracic metastases (ROS1 59.0%, ALK 83.2%, P=0.002), including lower rates of brain metastases (ROS1 19.4%, ALK 39.1%; P = 0.033), at initial metastatic diagnosis. Despite similar overall survival between ALK- and ROS1-positive patients treated with crizotinib (median 3.0 versus 2.5 years, respectively; P=0.786), ROS1-positive patients also had a significantly lower cumulative incidence of brain metastases (34% vs. 73% at 5 years; P<0.0001). Additionally, we identified 16 patients who underwent a total of 17 repeat biopsies following progression on crizotinib. ROS1 resistance mutations were identified in 53% of specimens, including 9/14 (64%) non-brain metastasis specimens. ROS1 mutations included: G2032R (41%), D2033N (6%), and S1986F (6%). CONCLUSIONS Compared to ALK rearrangements, ROS1 rearrangements are associated with lower rates of extrathoracic metastases, including fewer brain metastases, at initial metastatic diagnosis. ROS1 resistance mutations, particularly G2032R, appear to be the predominant mechanism of resistance to crizotinib, underscoring the need to develop novel ROS1 inhibitors with activity against these resistant mutants.
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Affiliation(s)
- Justin F. Gainor
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Diane Tseng
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Satoshi Yoda
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Ibiayi Dagogo-Jack
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Luc Friboulet
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Jessica J. Lin
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Harper G. Hubbeling
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Leila Dardaei
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Anna F. Farago
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Katherine R. Schultz
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Lorin A. Ferris
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Zofia Piotrowska
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - James Hardwick
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Donghui Huang
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Mari Mino-Kenudson
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - A. John Iafrate
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Aaron N. Hata
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Beow Y. Yeap
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
| | - Alice T. Shaw
- Justin F. Gainor, Diane Tseng, Satoshi Yoda, Ibiayi Dagogo-Jack, Jessica J. Lin, Harper G. Hubbeling, Leila Dardaei, Anna F. Farago, Katherine R. Schultz, Lorin A. Ferris, Zofia Piotrowska, Mari Mino-Kenudson, A. John Iafrate, Aaron N. Hata, Beow Y. Yeap, and Alice T. Shaw, Massachusetts General Hospital, Boston, MA; Luc Friboulet, Institut National de la Santé et de la Recherche Médicale U981, Villejuif, France; and James Hardwick and Donghui Huang, Pfizer Worldwide Research and Development, La Jolla, CA
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