151
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Brandi G, Farioli A, Astolfi A, Biasco G, Tavolari S. Genetic heterogeneity in cholangiocarcinoma: a major challenge for targeted therapies. Oncotarget 2016; 6:14744-53. [PMID: 26142706 PMCID: PMC4558112 DOI: 10.18632/oncotarget.4539] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/11/2015] [Indexed: 02/07/2023] Open
Abstract
Cholangiocarcinoma (CC) encompasses a group of related but distinct malignancies whose lack of a stereotyped genetic signature makes challenging the identification of genomic landscape and the development of effective targeted therapies. Accumulated evidences strongly suggest that the remarkable genetic heterogeneity of CC may be the result of a complex interplay among different causative factors, some shared by most human cancers while others typical of this malignancy. Currently, considerable efforts are ongoing worldwide for the genetic characterization of CC, also using advanced technologies such as next-generation sequencing (NGS). Undoubtedly this technology could offer an unique opportunity to broaden our understanding on CC molecular pathogenesis. Despite this great potential, however, the high complexity in terms of factors potentially contributing to genetic variability in CC calls for a more cautionary application of NGS to this malignancy, in order to avoid possible biases and criticisms in the identification of candidate actionable targets. This approach is further justified by the urgent need to develop effective targeted therapies in this disease. A multidisciplinary approach integrating genomic, functional and clinical studies is therefore mandatory to translate the results obtained by NGS into effective targeted therapies for this orphan disease.
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Affiliation(s)
- Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy.,"G. Prodi" Interdepartmental Center for Cancer Research (C.I.R.C.), University of Bologna, Bologna, Italy.,GICO- Italian Group of Cholangiocarcinoma, Italy
| | - Andrea Farioli
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Annalisa Astolfi
- "G. Prodi" Interdepartmental Center for Cancer Research (C.I.R.C.), University of Bologna, Bologna, Italy
| | - Guido Biasco
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy.,"G. Prodi" Interdepartmental Center for Cancer Research (C.I.R.C.), University of Bologna, Bologna, Italy
| | - Simona Tavolari
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy.,Center for Applied Biomedical Research (C.R.B.A.), S. Orsola- Malpighi University Hospital, Bologna, Italy
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152
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Baumann M, Krause M, Overgaard J, Debus J, Bentzen SM, Daartz J, Richter C, Zips D, Bortfeld T. Radiation oncology in the era of precision medicine. Nat Rev Cancer 2016; 16:234-49. [PMID: 27009394 DOI: 10.1038/nrc.2016.18] [Citation(s) in RCA: 512] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Technological advances and clinical research over the past few decades have given radiation oncologists the capability to personalize treatments for accurate delivery of radiation dose based on clinical parameters and anatomical information. Eradication of gross and microscopic tumours with preservation of health-related quality of life can be achieved in many patients. Two major strategies, acting synergistically, will enable further widening of the therapeutic window of radiation oncology in the era of precision medicine: technology-driven improvement of treatment conformity, including advanced image guidance and particle therapy, and novel biological concepts for personalized treatment, including biomarker-guided prescription, combined treatment modalities and adaptation of treatment during its course.
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Affiliation(s)
- Michael Baumann
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden
- OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden
- National Center for Tumor Diseases (NCT), Fetscherstrasse 74, 01307 Dresden
- German Cancer Consortium (DKTK) Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Oncology, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Mechthild Krause
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden
- OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden
- National Center for Tumor Diseases (NCT), Fetscherstrasse 74, 01307 Dresden
- German Cancer Consortium (DKTK) Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Oncology, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Jürgen Debus
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University of Heidelberg Medical School and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg
- Heidelberg Ion Therapy Center (HIT), Department of Radiation Oncology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120 Heidelberg
- German Cancer Consortium (DKTK) Heidelberg, Germany
| | - Søren M Bentzen
- Department of Epidemiology and Public Health and Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene Street S9a03, Baltimore, Maryland 21201, USA
| | - Juliane Daartz
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital and Harvard Medical School, 1000 Blossom Street Cox 362, Boston, Massachusetts 02114, USA
| | - Christian Richter
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden
- OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden
- National Center for Tumor Diseases (NCT), Fetscherstrasse 74, 01307 Dresden
- German Cancer Consortium (DKTK) Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Daniel Zips
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- German Cancer Consortium Tübingen, Postfach 2669, 72016 Tübingen
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Strasse 3, 72016 Tübingen, Germany
| | - Thomas Bortfeld
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital and Harvard Medical School, 1000 Blossom Street Cox 362, Boston, Massachusetts 02114, USA
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153
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Thomas A, Chen Y, Steinberg SM, Luo J, Pack S, Raffeld M, Abdullaev Z, Alewine C, Rajan A, Giaccone G, Pastan I, Miettinen M, Hassan R. High mesothelin expression in advanced lung adenocarcinoma is associated with KRAS mutations and a poor prognosis. Oncotarget 2016; 6:11694-703. [PMID: 26028668 PMCID: PMC4484487 DOI: 10.18632/oncotarget.3429] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/24/2015] [Indexed: 02/06/2023] Open
Abstract
Mesothelin is a cell surface glycoprotein which is highly expressed in several epithelial cancers and may have a role in cell adhesion and metastases. In this study, we used prospectively obtained clinical and pathological data to characterize mesothelin expression in advanced lung adenocarcinoma. Tissue was obtained from patients who underwent molecular profiling of potentially actionable genes on a trial of molecular profiling and targeted therapies in advanced thoracic malignancies. We immunohistochemically evaluated the intensity, and the percentage of cells expressing mesothelin in 93 advanced lung adenocarcinomas. The evaluation was blinded for molecular data and outcome. Mutations of EGFR, KRAS, BRAF, AKT1, PIK3CA and HER2 were assessed by pyrosequencing; HER2 amplification and ALK translocation were assessed by fluorescence in situ hybridization. 53% of advanced lung adenocarcinomas expressed mesothelin to some degree; high mesothelin expression, defined as mesothelin positivity in more than 25% of cells, was found in 24% of patients. High mesothelin expression was associated with inferior survival (median 18.2 months vs. 32.9 months; P = 0.014). High mesothelin expression was strongly associated with mutant KRAS (P < 0.0001) and wild-type EGFR (P = 0.002). Our results provide strong rationale to explore anti-mesothelin targeted therapies in advanced lung adenocarcinoma especially in the KRAS-mutant subgroup.
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Affiliation(s)
- Anish Thomas
- Thoracic and GI Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yuanbin Chen
- Thoracic and GI Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Ji Luo
- Laboratory of Cancer Biology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Svetlana Pack
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Zied Abdullaev
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christine Alewine
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arun Rajan
- Thoracic and GI Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Ira Pastan
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Markku Miettinen
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Raffit Hassan
- Thoracic and GI Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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154
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Sun S, Zhang Z. Patient-derived xenograft platform of OSCC: a renewable human bio-bank for preclinical cancer research and a new co-clinical model for treatment optimization. Front Med 2016; 10:104-10. [PMID: 26926009 DOI: 10.1007/s11684-016-0432-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/27/2015] [Indexed: 12/23/2022]
Abstract
Advances in next-generation sequencing and bioinformatics have begun to reveal the complex genetic landscape in human cancer genomes, including oral squamous cell carcinoma (OSCC). Sophisticated preclinical models that fully represent intra- and inter-tumoral heterogeneity are required to understand the molecular diversity of cancer and achieve the goal of personalized therapies. Over the last decade, patient-derived xenograft (PDX) models generated from human tumor samples that can retain the histological and genetic features of their donor tumors have been shown to be the preferred preclinical tool in translational cancer research compared with other conventional preclinical models. Specifically, genetically well-defined PDX models can be applied to accelerate targeted antitumor drug development and biomarker discovery. Recently, we have successfully established and characterized an OSCC PDX panel as part of our tumor bio-bank for translational cancer research. In this paper, we discuss the establishment, characterization, and preclinical applications of the PDX models. In particular, we focus on the classification and applications of the PDX models based on validated annotations, including clinicopathological features, genomic profiles, and pharmacological testing information. We also explore the translational value of this well-annotated PDX panel in the development of co-clinical trials for patient stratification and treatment optimization in the near future. Although various limitations still exist, this preclinical approach should be further tested and improved.
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Affiliation(s)
- Shuyang Sun
- Department of Oral and Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Zhiyuan Zhang
- Department of Oral and Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China.
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155
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Fiore LD, Brophy MT, Turek S, Kudesia V, Ramnath N, Shannon C, Ferguson R, Pyarajan S, Fiore MA, Hornberger J, Lavori P. The VA Point-of-Care Precision Oncology Program: Balancing Access with Rapid Learning in Molecular Cancer Medicine. BIOMARKERS IN CANCER 2016; 8:9-16. [PMID: 26949343 PMCID: PMC4772906 DOI: 10.4137/bic.s37548] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/15/2015] [Accepted: 12/22/2015] [Indexed: 01/26/2023]
Abstract
The Department of Veterans Affairs (VA) recognized the need to balance patient-centered care with responsible creation of generalizable knowledge on the effectiveness of molecular medicine tools. Embracing the principles of the rapid learning health-care system, a new clinical program called the Precision Oncology Program (POP) was created in New England. The POP integrates generalized knowledge about molecular medicine in cancer with a database of observations from previously treated veterans. The program assures access to modern genomic oncology practice in the veterans affairs (VA), removes disparities of access across the VA network of clinical centers, disseminates the products of learning that are generalizable to non-VA settings, and systematically presents opportunities for patients to participate in clinical trials of targeted therapeutics.
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Affiliation(s)
- Louis D Fiore
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA
| | - Mary T Brophy
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA
| | - Sara Turek
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA
| | - Valmeek Kudesia
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA
| | - Nithya Ramnath
- VA Ann Arbor Healthcare System, the University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Colleen Shannon
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA
| | - Ryan Ferguson
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA
| | - Saiju Pyarajan
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA
| | - Melissa A Fiore
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Department of Veterans Affairs Office of Research and Development-Cooperative Studies Program, Washington DC, USA
| | - John Hornberger
- Cedar Associates, Menlo Park, CA, USA.; Department of Health Research and Policy, Stanford University, Stanford, CA, USA.; Department of Medicine, Stanford University, Stanford, CA, USA
| | - Philip Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.; Department of Statistics, Stanford University, Stanford, CA, USA
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156
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Kou T, Kanai M, Matsumoto S, Okuno Y, Muto M. The possibility of clinical sequencing in the management of cancer. Jpn J Clin Oncol 2016; 46:399-406. [PMID: 26917600 DOI: 10.1093/jjco/hyw018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 01/31/2016] [Indexed: 02/07/2023] Open
Abstract
Comprehensive genomic profiling using next-generation sequencing technologies provides insights into understanding the genomic architecture of human cancer. This new understanding of the cancer genome allows us to identify many more genomic alterations occurring within tumors than before, some of which could be potential therapeutic targets through molecular targeted agents. Currently, a large number of molecular targeted agents are being developed, and consequently, cancer treatment is rapidly shifting from empiric therapy employing cytotoxic anticancer drugs to genotype-directed therapy using molecular targeted agents. In current daily clinical practice, hotspot-based single-gene assays that detect RAS mutations in colorectal cancer or EGFR mutations in non-small cell lung cancer are widely used to identify variants. However, it is becoming evident that more comprehensive genomic analysis is crucial in identifying the patient population that may benefit from molecular targeted therapy and the accelerated development of novel drugs for early clinical trials. For these purposes, an increasing number of gene panel-based targeted sequencing is commercially available in clinical practice from sequencing companies. Despite several challenges in implementing this approach, comprehensive genomic profiling and identification of actionable mutations is likely to become one of the standard options in the management of cancer in the near future. The use of clinical sequencing has the potential to usher a new era in precision medicine for cancer diagnosis and treatment. In this review, we discuss the application of comprehensive genomic profiling using next-generation sequencing technologies in clinical oncology and address the current challenges for its implementation.
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Affiliation(s)
- Tadayuki Kou
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto Department of Clinical Oncology, Kyoto University Hospital Cancer Center, Kyoto
| | - Masashi Kanai
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto Department of Clinical Oncology, Kyoto University Hospital Cancer Center, Kyoto
| | - Shigemi Matsumoto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto Department of Clinical Oncology, Kyoto University Hospital Cancer Center, Kyoto
| | - Yasushi Okuno
- Department of Clinical System Onco-Informatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto Department of Clinical Oncology, Kyoto University Hospital Cancer Center, Kyoto
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157
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Overman MJ, Morris V, Kee B, Fogelman D, Xiao L, Eng C, Dasari A, Shroff R, Mazard T, Shaw K, Vilar E, Raghav K, Shureiqi I, Liang L, Mills GB, Wolff RA, Hamilton S, Meric-Bernstam F, Abbruzzese J, Morris J, Maru D, Kopetz S. Utility of a molecular prescreening program in advanced colorectal cancer for enrollment on biomarker-selected clinical trials. Ann Oncol 2016; 27:1068-1074. [PMID: 27045102 DOI: 10.1093/annonc/mdw073] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/15/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Incorporation of multiple enrichment biomarkers into prospective clinical trials is an active area of investigation, but the factors that determine clinical trial enrollment following a molecular prescreening program have not been assessed. PATIENTS AND METHODS Patients with 5-fluorouracil-refractory metastatic colorectal cancer at the MD Anderson Cancer Center were offered screening in the Assessment of Targeted Therapies Against Colorectal Cancer (ATTACC) program to identify eligibility for companion phase I or II clinical trials with a therapy targeted to an aberration detected in the patient, based on testing by immunohistochemistry, targeted gene sequencing panels, and CpG island methylation phenotype assays. RESULTS Between August 2010 and December 2013, 484 patients were enrolled, 458 (95%) had a biomarker result, and 157 (32%) were enrolled on a clinical trial (92 on biomarker-selected and 65 on nonbiomarker selected). Of the 458 patients with a biomarker result, enrollment on biomarker-selected clinical trials was ninefold higher for predefined ATTACC-companion clinical trials as opposed to nonpredefined biomarker-selected clinical trials, 17.9% versus 2%, P < 0.001. Factors that correlated positively with trial enrollment in multivariate analysis were higher performance status, older age, lack of standard of care therapy, established patient at MD Anderson, and the presence of an eligible biomarker for an ATTACC-companion study. Early molecular screening did result in a higher rate of patients with remaining standard of care therapy enrolling on ATTACC-companion clinical trials, 45.1%, in contrast to nonpredefined clinical trials, 22.7%; odds ratio 3.1, P = 0.002. CONCLUSIONS Though early molecular prescreening for predefined clinical trials resulted in an increase rate of trial enrollment of nonrefractory patients, the majority of patients enrolled on clinical trials were refractory to standard of care therapy. Within molecular prescreening programs, tailoring screening for preidentified and open clinical trials, temporally linking screening to treatment and optimizing both patient and physician engagement are efforts likely to improve enrollment on biomarker-selected clinical trials. CLINICAL TRIALS NUMBER The study NCT number is NCT01196130.
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Affiliation(s)
- M J Overman
- Department of Gastrointestinal Medical Oncology.
| | - V Morris
- Department of Gastrointestinal Medical Oncology
| | - B Kee
- Department of Gastrointestinal Medical Oncology
| | - D Fogelman
- Department of Gastrointestinal Medical Oncology
| | - L Xiao
- Department of Biostatistics
| | - C Eng
- Department of Gastrointestinal Medical Oncology
| | - A Dasari
- Department of Gastrointestinal Medical Oncology
| | - R Shroff
- Department of Gastrointestinal Medical Oncology
| | - T Mazard
- Department of Gastrointestinal Medical Oncology
| | - K Shaw
- Department of Sheikh Khalifa Nahyan Ben Zayed Institute for Personalized Cancer Therapy
| | - E Vilar
- Department of Gastrointestinal Medical Oncology; Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston
| | - K Raghav
- Department of Gastrointestinal Medical Oncology
| | - I Shureiqi
- Department of Gastrointestinal Medical Oncology
| | | | - G B Mills
- Department of Sheikh Khalifa Nahyan Ben Zayed Institute for Personalized Cancer Therapy; Department of Systems Biology
| | - R A Wolff
- Department of Gastrointestinal Medical Oncology
| | | | - F Meric-Bernstam
- Department of Sheikh Khalifa Nahyan Ben Zayed Institute for Personalized Cancer Therapy; Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Abbruzzese
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham
| | | | | | - S Kopetz
- Department of Gastrointestinal Medical Oncology
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158
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Yachida S, Wood LD, Suzuki M, Takai E, Totoki Y, Kato M, Luchini C, Arai Y, Nakamura H, Hama N, Elzawahry A, Hosoda F, Shirota T, Morimoto N, Hori K, Funazaki J, Tanaka H, Morizane C, Okusaka T, Nara S, Shimada K, Hiraoka N, Taniguchi H, Higuchi R, Oshima M, Okano K, Hirono S, Mizuma M, Arihiro K, Yamamoto M, Unno M, Yamaue H, Weiss MJ, Wolfgang CL, Furukawa T, Nakagama H, Vogelstein B, Kiyono T, Hruban RH, Shibata T. Genomic Sequencing Identifies ELF3 as a Driver of Ampullary Carcinoma. Cancer Cell 2016; 29:229-40. [PMID: 26806338 PMCID: PMC5503303 DOI: 10.1016/j.ccell.2015.12.012] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/16/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023]
Abstract
Ampullary carcinomas are highly malignant neoplasms that can have either intestinal or pancreatobiliary differentiation. To characterize somatic alterations in ampullary carcinomas, we performed whole-exome sequencing and DNA copy-number analysis on 60 ampullary carcinomas resected from clinically well-characterized Japanese and American patients. We next selected 92 genes and performed targeted sequencing to validate significantly mutated genes in an additional 112 cancers. The prevalence of driver gene mutations in carcinomas with the intestinal phenotype is different from those with the pancreatobiliary phenotype. We identified a characteristic significantly mutated driver gene (ELF3) as well as previously known driver genes (TP53, KRAS, APC, and others). Functional studies demonstrated that ELF3 silencing in normal human epithelial cells enhances their motility and invasion.
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Affiliation(s)
- Shinichi Yachida
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan; Division of Cancer Genomics, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo 1040045, Japan.
| | - Laura D Wood
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Masami Suzuki
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Erina Takai
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Yasushi Totoki
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Mamoru Kato
- Department of Bioinformatics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Claudio Luchini
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Yasuhito Arai
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Hiromi Nakamura
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Natsuko Hama
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Asmaa Elzawahry
- Department of Bioinformatics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Fumie Hosoda
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Tomoki Shirota
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Nobuhiko Morimoto
- Division of Medical Elemental Technology Development, Department of Advanced Analysis Technology, R&D Group, Olympus Corporation, Tokyo 1630914, Japan
| | - Kunio Hori
- Division of Medical Elemental Technology Development, Department of Advanced Analysis Technology, R&D Group, Olympus Corporation, Tokyo 1630914, Japan
| | - Jun Funazaki
- Division of Medical Elemental Technology Development, Department of Advanced Analysis Technology, R&D Group, Olympus Corporation, Tokyo 1630914, Japan
| | - Hikaru Tanaka
- Division of Virology, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo 1040045, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo 1040045, Japan
| | - Satoshi Nara
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo 1040045, Japan
| | - Kazuaki Shimada
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo 1040045, Japan
| | - Nobuyoshi Hiraoka
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo 1040045, Japan
| | - Hirokazu Taniguchi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo 1040045, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 1628666, Japan
| | - Minoru Oshima
- Department of Gastroenterological Surgery, Kagawa University, Kagawa 7610793, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Kagawa University, Kagawa 7610793, Japan
| | - Seiko Hirono
- Second Department of Surgery, Wakayama Medical University, Wakayama 6418509, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai Miyagi 9808575, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima 7348551, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo 1628666, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai Miyagi 9808575, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama 6418509, Japan
| | - Matthew J Weiss
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Christopher L Wolfgang
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Toru Furukawa
- Institute for Integrated Medical Science, Tokyo Women's Medical University, Tokyo 1628666, Japan
| | - Hitoshi Nakagama
- Division of Carcinogenesis and Cancer Prevention, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Bert Vogelstein
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; The Ludwig Center and The Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, MD 21287, USA
| | - Tohru Kiyono
- Division of Carcinogenesis and Cancer Prevention, National Cancer Center Research Institute, Tokyo 1040045, Japan
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Tatsuhiro Shibata
- Division of Cancer Genomics, National Cancer Center Research Institute, Tokyo 1040045, Japan; Laboratory of Molecular Medicine, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo 1088639, Japan
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159
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Carter CA, Rajan A, Keen C, Szabo E, Khozin S, Thomas A, Brzezniak C, Guha U, Doyle LA, Steinberg SM, Xi L, Raffeld M, Tomita Y, Lee MJ, Lee S, Trepel JB, Reckamp KL, Koehler S, Gitlitz B, Salgia R, Gandara D, Vokes E, Giaccone G. Selumetinib with and without erlotinib in KRAS mutant and KRAS wild-type advanced nonsmall-cell lung cancer. Ann Oncol 2016; 27:693-9. [PMID: 26802155 DOI: 10.1093/annonc/mdw008] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND KRAS mutations in NSCLC are associated with a lack of response to epidermal growth factor receptor inhibitors. Selumetinib (AZD6244; ARRY-142886) is an oral selective MEK kinase inhibitor of the Ras/Raf/MEK/ERK pathway. PATIENTS AND METHODS Advanced nonsmall-cell lung cancer (NSCLC) patients failing one to two prior regimens underwent KRAS profiling. KRAS wild-type patients were randomized to erlotinib (150 mg daily) or a combination of selumetinib (150 mg daily) with erlotinib (100 mg daily). KRAS mutant patients were randomized to selumetinib (75 mg b.i.d.) or the combination. The primary end points were progression-free survival (PFS) for the KRAS wild-type cohort and objective response rate (ORR) for the KRAS mutant cohort. Biomarker studies of ERK phosphorylation and immune subsets were carried out. RESULTS From March 2010 to May 2013, 89 patients were screened; 41 KRAS mutant and 38 KRAS wild-type patients were enrolled. Median PFS in the KRAS wild-type arm was 2.4 months [95% confidence interval (CI) 1.3-3.7] for erlotinib alone and 2.1 months (95% CI 1.8-5.1) for the combination. The ORR in the KRAS mutant group was 0% (95% CI 0.0% to 33.6%) for selumetinib alone and 10% (95% CI 2.1% to 26.3%) for the combination. Combination therapy resulted in increased toxicities, requiring dose reductions (56%) and discontinuation (8%). Programmed cell death-1 expression on regulatory T cells (Tregs), Tim-3 on CD8+ T cells and Th17 levels were associated with PFS and overall survival in patients receiving selumetinib. CONCLUSIONS This study failed to show improvement in ORR or PFS with combination therapy of selumetinib and erlotinib over monotherapy in KRAS mutant and KRAS wild-type advanced NSCLC. The association of immune subsets and immune checkpoint receptor expression with selumetinib may warrant further studies.
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Affiliation(s)
- C A Carter
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda
| | - A Rajan
- Medical Oncology Branch, Center for Cancer Research
| | - C Keen
- Medical Oncology Branch, Center for Cancer Research
| | - E Szabo
- Lung & Upper Aerodigestive Cancer Research Group Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda
| | - S Khozin
- Medical Oncology Branch, Center for Cancer Research
| | - A Thomas
- Medical Oncology Branch, Center for Cancer Research
| | - C Brzezniak
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda
| | - U Guha
- Medical Oncology Branch, Center for Cancer Research
| | - L A Doyle
- Cancer Therapy Evaluation Program, National Institutes of Health, Bethesda
| | - S M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research
| | - L Xi
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda
| | - M Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda
| | - Y Tomita
- Medical Oncology Branch, Center for Cancer Research
| | - M J Lee
- Medical Oncology Branch, Center for Cancer Research
| | - S Lee
- Medical Oncology Branch, Center for Cancer Research
| | - J B Trepel
- Medical Oncology Branch, Center for Cancer Research
| | - K L Reckamp
- Department of Hematology and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte
| | - S Koehler
- Department of Hematology and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte
| | - B Gitlitz
- Department of Internal Medicine, University of Southern California, Los Angeles
| | - R Salgia
- Radiation and Cellular Oncology, University of Chicago, Medicine and Biological Sciences, Chicago
| | - D Gandara
- Division of Hematology and Oncology, University of California at Davis Cancer Center, Sacramento
| | - E Vokes
- Radiation and Cellular Oncology, University of Chicago, Medicine and Biological Sciences, Chicago
| | - G Giaccone
- Medical Oncology Branch, Center for Cancer Research Lombardi Comprehensive Cancer Center, Georgetown University, Washington, USA
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160
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Abstract
Lung cancer is the leading cause of cancer-related deaths in United States, accounting for more than one-fourth of the deaths annually. Although comparatively rare and relatively less studied, genetic abnormalities other than epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) rearrangements, and Kirsten rat sarcoma (KRAS) mutations account for significant proportion of the driver mutations identified thus far. The targeted agents against B-rapidly accelerated fibrosarcoma (BRAF) V600E mutation, MNNG-HOS transforming gene (MET) pathway, ROS1 rearrangement, rearranged during transfection (RET) rearrangement, and HER2 pathways offer promising therapeutic options. Recruiting patients with these rarer mutations to well-designed, large multicenter trials to further validate the use of targeted agents remains a challenge. The clinical data and ongoing trials with these agents are reviewed in this article.
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Affiliation(s)
- Nabin Khanal
- a Department of Internal Medicine , Creighton University Medical Center , Omaha , NE , USA
| | - Apar Kishor Ganti
- b Division of Oncology-Hematology, Department of Internal Medicine , VA-Nebraska Western Iowa Health Care System , Omaha , NE , USA.,c Division of Oncology-Hematology, Department of Internal Medicine , University of Nebraska Medical Center , Omaha , NE , USA
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161
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Rodriguez EF, Monaco SE. Recent advances in the pathology and molecular genetics of lung cancer: A practical review for cytopathologists. J Am Soc Cytopathol 2016; 5:252-265. [PMID: 31042502 DOI: 10.1016/j.jasc.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/21/2016] [Accepted: 02/23/2016] [Indexed: 11/17/2022]
Abstract
Lung cancer is one of the most common causes of cancer-related death worldwide. Better understanding of the molecular genetic characteristics of non-small cell lung carcinoma (NSCLC), particularly adenocarcinoma, has opened the opportunity for targeted therapies. With the different molecular abnormalities and the different responses to new targeted therapies based on the histological subtype of NSCLC, there came a need to further classify NSCLC into squamous cell carcinoma and adenocarcinoma, and to perform the appropriate molecular testing in these different subtypes to guide management decisions. Given that approximately 70% of lung cancer patients have only small biopsies or cytology specimens available, incorporating the testing of these specimens into the cytopathology laboratory has been crucial. Herein, we review current concepts and recommendations on NSCLC subtyping and molecular testing that are relevant for the cytopathology community.
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Affiliation(s)
- Erika F Rodriguez
- Department of Pathology, Johns Hopkins University, Carnegie 469-Pathology, 600 North Wolfe Street, Baltimore, Maryland.
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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162
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Villanueva A. Selected summary for the 2015 Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE). Hepat Oncol 2016; 3:5-8. [PMID: 30191022 DOI: 10.2217/hep.15.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Liver cancer is now ranked second in terms of cancer-related mortality worldwide; with limited treatment options for patients at advanced stages it remains a growing health problem. All Phase III clinical trials testing molecular therapies after sorafenib have so far failed, and there is still not a validated oncogene addiction loop. Despite the present huge challenges, advancements in the recent years have been remarkable. The Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE) was designed to promote scientific exchanges of international and regional experts in the study and management of liver cancer. Over the years it has consolidated as a major resource to provide a thorough update to clinicians and researchers located in the Asia-Pacific region in different aspects of liver cancer. Attendance at these meetings is exceptional, with an average of 1000 attendees at each conference. As predicted, the 2015 edition provided an outstanding overview of the latest developments in the clinical management and molecular pathogenesis of the disease.
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Affiliation(s)
- Augusto Villanueva
- Liver Cancer Program, Divisions of Liver Diseases & Hematology/Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, NY 10029, USA
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163
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Fang B. RAS signaling and anti-RAS therapy: lessons learned from genetically engineered mouse models, human cancer cells, and patient-related studies. Acta Biochim Biophys Sin (Shanghai) 2016; 48:27-38. [PMID: 26350096 DOI: 10.1093/abbs/gmv090] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/09/2015] [Indexed: 12/13/2022] Open
Abstract
Activating mutations of oncogenic RAS genes are frequently detected in human cancers. The studies in genetically engineered mouse models (GEMMs) reveal that Kras-activating mutations predispose mice to early onset tumors in the lung, pancreas, and gastrointestinal tract. Nevertheless, most of these tumors do not have metastatic phenotypes. Metastasis occurs when tumors acquire additional genetic changes in other cancer driver genes. Studies on clinical specimens also demonstrated that KRAS mutations are present in premalignant tissues and that most of KRAS mutant human cancers have co-mutations in other cancer driver genes, including TP53, STK11, CDKN2A, and KMT2C in lung cancer; APC, TP53, and PIK3CA in colon cancer; and TP53, CDKN2A, SMAD4, and MED12 in pancreatic cancer. Extensive efforts have been devoted to develop therapeutic agents that target enzymes involved in RAS posttranslational modifications, that inhibit downstream effectors of RAS signaling pathways, and that kill RAS mutant cancer cells through synthetic lethality. Recent clinical studies have revealed that sorafenib, a pan-RAF and VEGFR inhibitor, has impressive benefits for KRAS mutant lung cancer patients. Combination therapy of MEK inhibitors with either docetaxel, AKT inhibitors, or PI3K inhibitors also led to improved clinical responses in some KRAS mutant cancer patients. This review discusses knowledge gained from GEMMs, human cancer cells, and patient-related studies on RAS-mediated tumorigenesis and anti-RAS therapy. Emerging evidence demonstrates that RAS mutant cancers are heterogeneous because of the presence of different mutant alleles and/or co-mutations in other cancer driver genes. Effective subclassifications of RAS mutant cancers may be necessary to improve patients' outcomes through personalized precision medicine.
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Affiliation(s)
- Bingliang Fang
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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164
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Cortinovis D, Abbate M, Bidoli P, Pelizzoni D, Canova S. Interpretation of lung cancer study outcomes. J Thorac Dis 2015; 7:E541-7. [PMID: 26716052 DOI: 10.3978/j.issn.2072-1439.2015.11.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Lung cancer is the leading cause of cancer death in developed countries. However, in the last few years we observed an important acceleration in drug development due to oncogenic driver tumors discovery. Sharing and putting together preclinical data from benchmark and data from clinical research is the scientific paradigm that allows real breakthrough in clinical practice in this field, but only a few targeted agents are worthy and practice changing. The clinical research and proper use of statistical methodology are the pillars to continue to achieve important goals like improvement of overall survival. A good medical oncologist should be able to critically read a scientific paper and move from the observed outcomes into clinical perspective. Despite clinical improvements, sometimes the union of promising targeted agents and optimistic expectations misrepresent the reality and the value of clinical research. In this article, we try to analyze the meaning of statistical assumptions from clinical trials, especially in lung cancer, through a critical review of the concept of value-based medicine. We also attempt to give the reader some practical tools to weigh scientific value of literature reports.
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Affiliation(s)
| | - Marida Abbate
- Medical Oncology Unit, S Gerardo Hospital, Monza, Italy
| | - Paolo Bidoli
- Medical Oncology Unit, S Gerardo Hospital, Monza, Italy
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165
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Sridhara R, He K, Nie L, Shen YL, Tang S. Current Statistical Challenges in Oncology Clinical Trials in the Era of Targeted Therapy. Stat Biopharm Res 2015. [DOI: 10.1080/19466315.2015.1094673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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166
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Ang C, Miura JT, Gamblin TC, He R, Xiu J, Millis SZ, Gatalica Z, Reddy SK, Yee NS, Abou-Alfa GK. Comprehensive multiplatform biomarker analysis of 350 hepatocellular carcinomas identifies potential novel therapeutic options. J Surg Oncol 2015; 113:55-61. [PMID: 26661118 DOI: 10.1002/jso.24086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/20/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Effective therapies for hepatocellular carcinoma (HCC) are limited. Molecular profiling of HCC was performed to identify novel therapeutic targets. METHODS 350 HCC samples were evaluated using a multiplatform profiling service (Caris Life Sciences, Phoenix, AZ), including gene sequencing, amplification, and protein expression. RESULTS EGFR, TOPO1, PD-1, TOP2A, SPARC, and c-Met were overexpressed in 25-83% of samples. Decreased expression of RRM1,TS, PTEN, and MGMT occurred in 31-82% of samples. TP53 was mutated in 30%, CTNNB1 in 20%, and BRCA2 in 18%; other gene mutation rates were <5%. TP53-mutated tumors showed significantly higher TOPO2A (90% vs. 38%, P < 0.0001) and TS (56% vs. 29%, P = 0.0139) expression. CTNNB1-mutated tumors had significantly higher AR (56% vs. 21%, P = 0.0017), SPARC (61% vs. 29%, P = 0.0135), PDL1 (29% vs. 0%, P = 0.0256) expression, and BRCA2 mutations (50% vs. 6%, P = 0.0458). Metastases exhibited significantly higher infiltration by PD-1+ lymphocytes (79% vs. 50%, P = 0.047) and TS (31% vs. 14%, P < 0.0003) than primary HCC. CONCLUSIONS Multiplatform profiling reveals molecular heterogeneity in HCC and identifies potential therapies including tyrosine kinase, PI3 kinase, or PARP inhibitors for molecular subtypes. Chemotherapy may benefit some tumors. CTNNB1-mutated tumors may respond to multi-target inhibition. These limited and preliminary data require clinical validation.
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Affiliation(s)
- Celina Ang
- Department of Medicine, Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John T Miura
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - T Clark Gamblin
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ruth He
- Department of Medicine, Hematology/Oncology, Georgetown University Medical Center, Washington, DC
| | | | | | | | | | - Nelson S Yee
- Department of Medicine, Hematology/Oncology, Penn State Hershey Cancer Institute, Hershey, Pennsylvania
| | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Hematology/Oncology, Weill Cornell Medical College, New York, New York
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167
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Histological tumor typing in the age of molecular profiling. Pathol Res Pract 2015; 211:897-900. [DOI: 10.1016/j.prp.2015.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 01/16/2023]
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168
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Friedman AA, Letai A, Fisher DE, Flaherty KT. Precision medicine for cancer with next-generation functional diagnostics. Nat Rev Cancer 2015; 15:747-56. [PMID: 26536825 PMCID: PMC4970460 DOI: 10.1038/nrc4015] [Citation(s) in RCA: 398] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Precision medicine is about matching the right drugs to the right patients. Although this approach is technology agnostic, in cancer there is a tendency to make precision medicine synonymous with genomics. However, genome-based cancer therapeutic matching is limited by incomplete biological understanding of the relationship between phenotype and cancer genotype. This limitation can be addressed by functional testing of live patient tumour cells exposed to potential therapies. Recently, several 'next-generation' functional diagnostic technologies have been reported, including novel methods for tumour manipulation, molecularly precise assays of tumour responses and device-based in situ approaches; these address the limitations of the older generation of chemosensitivity tests. The promise of these new technologies suggests a future diagnostic strategy that integrates functional testing with next-generation sequencing and immunoprofiling to precisely match combination therapies to individual cancer patients.
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Affiliation(s)
- Adam A Friedman
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA
| | - Anthony Letai
- Dana-Farber Cancer Institute, Harvard Medical School, 440 Brookline Avenue, Mayer 430, Boston, Massachusetts 02215, USA
| | - David E Fisher
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA
- Dermatology and Cutaneous Biology Research Center, Massachusetts General Hospital, 149 East 13th Street, Charlestown, Massachusetts 02129, USA
| | - Keith T Flaherty
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA
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169
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Mazières J, Barlesi F, Filleron T, Besse B, Monnet I, Beau-Faller M, Peters S, Dansin E, Früh M, Pless M, Rosell R, Wislez M, Fournel P, Westeel V, Cappuzzo F, Cortot A, Moro-Sibilot D, Milia J, Gautschi O. Lung cancer patients with HER2 mutations treated with chemotherapy and HER2-targeted drugs: results from the European EUHER2 cohort. Ann Oncol 2015; 27:281-6. [PMID: 26598547 DOI: 10.1093/annonc/mdv573] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/07/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND HER2 mutations have been identified as oncogenic drivers in lung cancers and are found in 1-2% of lung adenocarcinomas. There is, to date, no standard of care for these patients. We thus aim to study the therapeutic outcomes of patients harboring HER2 mutations and establish the efficacy of various drug regimens. PATIENTS AND METHODS This retrospective cohort study in European centers assessed patients with advanced non-small-cell lung cancer (NSCLC), a known HER2 exon-20 insertion, treated with chemotherapy and/or HER2-targeted drugs. RESULTS We identified 101 eligible patients from 38 centers: median age 61 years (range: 30-87), 62.4% women, 60.4% never-smokers. All tumors were adenocarcinomas. Concomitant EGFR mutations, ALK translocations, and ROS translocations were observed in 5, 1, and 1 patients, respectively. The median number of treatment lines was 3 (range: 1-11). The median overall survival was 24 months. Overall response rate (ORR) and the median progression-free survival (PFS) with conventional chemotherapy (excluding targeted therapies) were 43.5% and 6 months in first-line (n = 93), and 10% and 4.3 months in second-line (n = 52) therapies. Sixty-five patients received HER2-targeted therapies: trastuzumab = 57, neratinib = 14, afatinib = 9, lapatinib = 5, T-DM1 = 1. ORR was 50.9% and PFS was 4.8 months with trastuzumab or T-DM1. CONCLUSION This series shows the chemosensitivity of HER2-driven NSCLC, and the potential interest of HER2-targeted agents. Our results should help to define the best therapeutic strategy for these patients and to orient future clinical trials.
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Affiliation(s)
- J Mazières
- Thoracic Oncology Unit, Larrey Hospital, Centre Hospitalier Universitaire de Toulouse, Toulouse University III (Paul Sabatier), Toulouse
| | - F Barlesi
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille
| | - T Filleron
- Clinical Research Unit, Biostatistics, Cancer University Institute of Toulouse Oncopole, Toulouse
| | - B Besse
- Thoracic Oncology Section, Gustave Roussy Cancer Campus, Villejuif
| | - I Monnet
- Pulmonology Department, Centre hospitalier intercommunal, Créteil
| | - M Beau-Faller
- Chest Department, Strasbourg University Hospital, Strasbourg, France
| | - S Peters
- Medical Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - E Dansin
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - M Früh
- Department of Oncology and Hematology, Cantonal Hospital of St Gallen, St Gallen
| | - M Pless
- Department of Medical Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - R Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - M Wislez
- Pulmonary Medicine Unit, AP-HP, Hôpital Tenon, Paris
| | - P Fournel
- Medical Oncology Department, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez
| | - V Westeel
- Pulmonology Department, Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France
| | - F Cappuzzo
- Medical Oncology Department, Istituto Toscano Tumori, Ospedale Civile, Livorno, Italy
| | - A Cortot
- Pulmonology Department, Centre Hospitalier Universitaire, Lille
| | - D Moro-Sibilot
- Department of Thoracic Oncology, Centre Hospitalier Universitaire, Grenoble, France
| | - J Milia
- Thoracic Oncology Unit, Larrey Hospital, Centre Hospitalier Universitaire de Toulouse, Toulouse University III (Paul Sabatier), Toulouse
| | - O Gautschi
- Medical Oncology, Cantonal Hospital Luzern, Luzern, Switzerland
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170
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Abdelraouf F, Sharp A, Maurya M, Mair D, Wotherspoon A, Leary A, Gonzalez de Castro D, Bhosle J, Nassef A, Gaafar T, Popat S, Yap TA, O'Brien M. Focused molecular analysis of small cell lung cancer: feasibility in routine clinical practice. BMC Res Notes 2015; 8:688. [PMID: 26581482 PMCID: PMC4652351 DOI: 10.1186/s13104-015-1675-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 02/02/2023] Open
Abstract
Background There is an urgent need to identify molecular signatures in small cell lung cancer (SCLC) that may select patients who are likely to respond to molecularly targeted therapies. In this study, we investigate the feasibility of undertaking focused molecular analyses on routine diagnostic biopsies in patients with SCLC. Methods A series of histopathologically confirmed formalin-fixed, paraffin-embedded SCLC specimens were analysed for epidermal growth factor receptors (EGFR), KRAS, NRAS and BRAF mutations, ALK gene rearrangements and MET amplification. EGFR and KRAS mutation testing was evaluated using real time polymerase chain reaction (RT-PCR cobas®), BRAF and NRAS mutations using multiplex PCR and capillary electrophoresis-single strand conformation analysis, and ALK and MET aberrations with fluorescent in situ hybridization. All genetic aberrations detected were validated independently. Results A total of 105 patients diagnosed with SCLC between July 1990 and September 2006 were included. 60 (57 %) patients had suitable tumour tissue for molecular testing. 25 patients were successfully evaluated for all six pre-defined molecular aberrations. Eleven patients failed all molecular analysis. No mutations in EGFR, KRAS and NRAS were detected, and no ALK gene rearrangements or MET gene amplifications were identified. A V600E substitution in BRAF was detected in a Caucasian male smoker diagnosed with SCLC with squamoid and glandular features. Conclusion The paucity of patients with sufficient tumour tissue, quality of DNA extracted and low frequency of aberrations detected indicate that alternative molecular characterisation approaches are necessary, such as the use of circulating plasma DNA in patients with SCLC.
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Affiliation(s)
- Fatma Abdelraouf
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Adam Sharp
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,The Institute of Cancer Research, London, UK.
| | - Manisha Maurya
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Debbie Mair
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Andrew Wotherspoon
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Alex Leary
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - David Gonzalez de Castro
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Jaishree Bhosle
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
| | - Ayatallah Nassef
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Taghrid Gaafar
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Sanjay Popat
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,National Heart and Lung institute, London, UK.
| | - Timothy A Yap
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK. .,The Institute of Cancer Research, London, UK.
| | - Mary O'Brien
- Lung Cancer Unit, Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT, UK.
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Nörz D, Grottke A, Bach J, Herzberger C, Hofmann BT, Nashan B, Jücker M, Ewald F. Discontinuing MEK inhibitors in tumor cells with an acquired resistance increases migration and invasion. Cell Signal 2015; 27:2191-200. [PMID: 26210887 DOI: 10.1016/j.cellsig.2015.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Development of small molecular inhibitors against BRAF and MEK has been a breakthrough in the treatment of malignant melanoma. However, the long-term effect is foiled in virtually all patients by the emergence of resistant tumor cell populations. Therefore, mechanisms resulting in the acquired resistance against BRAF and MEK inhibitors have gained much attention and several strategies have been proposed to overcome tumor resistance, including interval treatment or withdrawal of these compounds after disease progression. METHODS Using a panel of cell lines with an acquired resistance against MEK inhibitors, we have evaluated the sensitivity of these cells against compounds targeting AKT/mTOR signaling, as well as novel ERK1/2 inhibitors. Furthermore, the effects of withdrawal of MEK inhibitor on migration in resistant cell lines were analyzed. RESULTS We demonstrate that withdrawal of BRAF or MEK inhibitors in tumor cells with an acquired resistance results in reactivation of ERK1/2 signaling and upregulation of EMT-inducing transcription factors, leading to a highly migratory and invasive phenotype of cancer cells. Furthermore, we show that migration in these cells is independent from AKT/mTOR signaling. However, combined targeting of AKT/mTOR using MK-2206 and AZD8055 efficiently inhibits proliferation in all resistant tumor cell lines analyzed. CONCLUSIONS We propose that combined targeting of MEK/AKT/mTOR or treatment with a novel ERK1/2 inhibitor downstream of BRAF/MEK suppresses proliferation as well as migration and invasion in resistant tumor cells. We provide a rationale against the discontinuation of BRAF or MEK inhibitors in patients with an acquired resistance, and provide a rationale for combined targeting of AKT/mTOR and MEK/ERK1/2, or direct targeting of ERK1/2 as an effective treatment strategy.
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Affiliation(s)
- Dominik Nörz
- Center for Experimental Medicine, Institute of Biochemistry and Signal Transduction, University Medical Center Hamburg-Eppendorf, Germany.
| | - Astrid Grottke
- Center for Experimental Medicine, Institute of Biochemistry and Signal Transduction, University Medical Center Hamburg-Eppendorf, Germany.
| | - Johanna Bach
- Center for Experimental Medicine, Institute of Biochemistry and Signal Transduction, University Medical Center Hamburg-Eppendorf, Germany.
| | - Christiane Herzberger
- Center for Experimental Medicine, Institute of Biochemistry and Signal Transduction, University Medical Center Hamburg-Eppendorf, Germany.
| | - Bianca T Hofmann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Germany.
| | - Bjorn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse52, 20246 Hamburg, Germany.
| | - Manfred Jücker
- Center for Experimental Medicine, Institute of Biochemistry and Signal Transduction, University Medical Center Hamburg-Eppendorf, Germany.
| | - Florian Ewald
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse52, 20246 Hamburg, Germany.
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172
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Parisot JP, Thorne H, Fellowes A, Doig K, Lucas M, McNeil JJ, Doble B, Dobrovic A, John T, James PA, Lipton L, Ashley D, Hayes T, McMurrick P, Richardson G, Lorgelly P, Fox SB, Thomas DM. "Cancer 2015": A Prospective, Population-Based Cancer Cohort-Phase 1: Feasibility of Genomics-Guided Precision Medicine in the Clinic. J Pers Med 2015; 5:354-69. [PMID: 26529019 PMCID: PMC4695860 DOI: 10.3390/jpm5040354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/21/2015] [Accepted: 10/09/2015] [Indexed: 12/12/2022] Open
Abstract
“Cancer 2015” is a longitudinal and prospective cohort. It is a phased study whose aim was to pilot recruiting 1000 patients during phase 1 to establish the feasibility of providing a population-based genomics cohort. Newly diagnosed adult patients with solid cancers, with residual tumour material for molecular genomics testing, were recruited into the cohort for the collection of a dataset containing clinical, molecular pathology, health resource use and outcomes data. 1685 patients have been recruited over almost 3 years from five hospitals. Thirty-two percent are aged between 61–70 years old, with a median age of 63 years. Diagnostic tumour samples were obtained for 90% of these patients for multiple parallel sequencing. Patients identified with somatic mutations of potentially “actionable” variants represented almost 10% of those tumours sequenced, while 42% of the cohort had no mutations identified. These genomic data were annotated with information such as cancer site, stage, morphology, treatment and patient outcomes and health resource use and cost. This cohort has delivered its main objective of establishing an upscalable genomics cohort within a clinical setting and in phase 2 aims to develop a protocol for how genomics testing can be used in real-time clinical decision-making, providing evidence on the value of precision medicine to clinical practice.
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Affiliation(s)
- John P Parisot
- Division of Cancer Research, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne VIC 3002, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville VIC 3010, Australia.
| | - Heather Thorne
- Division of Cancer Research, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne VIC 3002, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville VIC 3010, Australia.
| | - Andrew Fellowes
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne VIC 3002, Australia.
| | - Ken Doig
- Division of Cancer Research, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne VIC 3002, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville VIC 3010, Australia.
| | - Mark Lucas
- Department of Epidemiology and Preventative Medicine, Alfred Centre, Monash University, Prahran VIC 3181, Australia.
| | - John J McNeil
- Department of Epidemiology and Preventative Medicine, Alfred Centre, Monash University, Prahran VIC 3181, Australia.
| | - Brett Doble
- Centre for Health Economics, Monash University, Clayton VIC 3800, Australia.
| | - Alexander Dobrovic
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville VIC 3010, Australia.
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne VIC 3002, Australia.
- Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg VIC 3084, Australia.
- Department of Pathology, The University of Melbourne, Parkville VIC 3010, Australia.
- School of Cancer Medicine, La Trobe University, Bundoora VIC 3084, Australia.
| | - Thomas John
- School of Cancer Medicine, La Trobe University, Bundoora VIC 3084, Australia.
- Medical Oncology, Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg VIC 3084, Australia.
| | - Paul A James
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne VIC 3002, Australia.
| | - Lara Lipton
- Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne Health, Parkville VIC 3010, Australia.
| | - David Ashley
- The Andrew Love Cancer Centre, Geelong Hospital, Barwon Health, Geelong VIC 3220, Australia.
| | - Theresa Hayes
- Warrnambool Hospital, SouthWest Healthcare, Warrnambool VIC 3280, Australia.
| | - Paul McMurrick
- Department of Surgery, Cabrini Institute, Cabrini Health, Malvern VIC 3144, Australia.
| | - Gary Richardson
- Haematology and Oncology, Cabrini Institute, Cabrini Health, Malvern VIC 3144, Australia.
| | - Paula Lorgelly
- Centre for Health Economics, Monash University, Clayton VIC 3800, Australia.
| | - Stephen B Fox
- Division of Cancer Research, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne VIC 3002, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville VIC 3010, Australia.
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne VIC 3002, Australia.
- Department of Pathology, The University of Melbourne, Parkville VIC 3010, Australia.
| | - David M Thomas
- Division of Cancer Research, Peter MacCallum Cancer Centre, 7 St Andrews Place, East Melbourne VIC 3002, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville VIC 3010, Australia.
- The Kinghorn Cancer Centre and Garvan Institute, Victoria Street, Darlinghurst 2010, NSW, Australia.
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173
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Abstract
There is now compelling evidence that the molecular heterogeneity of cancer is associated with disparate phenotypes with variable outcomes and therapeutic responsiveness to therapy in histologically indistinguishable cancers. This diversity may explain why conventional clinical trial designs have mostly failed to show efficacy when patients are enrolled in an unselected fashion. Knowledge of the molecular phenotype has the potential to improve therapeutic selection and hence the early delivery of the optimal therapeutic regimen. Resolution of the challenges associated with a more stratified approach to health care will ensure more precise diagnostics and enhance therapeutic selection, which will improve overall outcomes.
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Affiliation(s)
- Nigel B Jamieson
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, UK; Academic Unit of Surgery, School of Medicine, College of Medical, Veterinary and Life Sciences, Glasgow Royal Infirmary, University of Glasgow, Alexandra Parade, Glasgow G31 2ER, UK; West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - David K Chang
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, UK; The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria Street, Darlinghurst, New South Wales 2010, Australia; Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; Department of Surgery, Bankstown Hospital, Eldridge Road, Bankstown, Sydney, New South Wales 2200, Australia; Faculty of Medicine, South Western Sydney Clinical School, University of NSW, Goulburn St, Liverpool, New South Wales 2170, Australia
| | - Andrew V Biankin
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1BD, UK; The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria Street, Darlinghurst, New South Wales 2010, Australia; Cancer Research Program, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; Department of Surgery, Bankstown Hospital, Eldridge Road, Bankstown, Sydney, New South Wales 2200, Australia; Faculty of Medicine, South Western Sydney Clinical School, University of NSW, Goulburn St, Liverpool, New South Wales 2170, Australia.
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174
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Weichert W. [Limitations, pitfalls and perspectives of diagnostic massive parallel sequencing efforts in oncology]. DER PATHOLOGE 2015; 36 Suppl 2:162-6. [PMID: 26391247 DOI: 10.1007/s00292-015-0073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tremendous developments in the field of predictive biomarkers for treatment with targeted drugs together with impressive advances in the field of massive parallel sequencing (MPS) technologies have revolutionized the concept of personalized medicine in oncology. Although these developments hold great promise for our patients, we must be aware of important limitations and pitfalls in routine diagnostic high throughput sequencing. This includes scientific, technical, social but also economic aspects which have to be addressed. In this article, the respective topics are systematically analyzed and considerations and possible solutions for the successful implementation of MPS technologies into patient care are discussed.
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Affiliation(s)
- W Weichert
- Institut für Pathologie, Universitätsklinikum Heidelberg, Universität Heidelberg und Nationales Centrum für Tumorerkrankungen (NCT), Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland. .,Institut für Pathologie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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175
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Catenacci DVT. Expansion platform type II: testing a treatment strategy. Lancet Oncol 2015; 16:1276-8. [PMID: 26342235 DOI: 10.1016/s1470-2045(15)00224-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Daniel V T Catenacci
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL 60637, USA.
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176
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Stenzinger A, Weichert W, Lennerz JK, Klauschen F. Basket Trials: Just the End of the First Quarter. J Clin Oncol 2015; 33:2823-4. [DOI: 10.1200/jco.2015.62.1516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Albrecht Stenzinger
- University Hospital Heidelberg, and National Center for Tumor Diseases, Heidelberg, Germany
| | - Wilko Weichert
- University Hospital Heidelberg, National Center for Tumor Diseases, and German Cancer Consortium, Heidelberg, Germany
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177
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Thomas A, Lopez-Chavez A, Giaccone G. Reply to A. Stenzinger et al. J Clin Oncol 2015; 33:2824. [PMID: 26169619 DOI: 10.1200/jco.2015.62.7323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anish Thomas
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | - Giuseppe Giaccone
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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178
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Huang K, Luo A, Li X, Li S, Wang S. Chemotherapy-induced neutropenia during adjuvant treatment for cervical cancer patients: development and validation of a prediction model. Int J Clin Exp Med 2015; 8:10835-10844. [PMID: 26379877 PMCID: PMC4565260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/04/2015] [Indexed: 06/05/2023]
Abstract
UNLABELLED An artificial neuron network (ANN) model combining both the genetic risk factors and clinical factorsmay be effective in prediction of chemotherapy-induced adverse events. PURPOSE To identify genetic factors and clinical factors associated with bone marrow suppression in cervical cancer patient, and to build a model for chemotherapy-induced neutropenia prediction. METHODS We performed a genome wide association study on a cohort to identify genetic determinants. Samples were genotyped using the Axiom CHB 1.0. The primary analyses focused on the scan of 657178 single-nucleotide polymorphisms (SNPs). Artificial neural network were used to integrating clinical factors and genetic factors to predict the occurrence of neutropenia. RESULTS 32 variants associated with neutropenia in the patients after chemotherapy were found (P<1 × 10(-4)). During internal validation and external validation, artificial neural network performed well in predicting neutropenia with considerable accuracy, which is 88.9% and 81.7% respectively. ROC analysis had acceptable areas under the curve of 0.897 for the internal validation sample and 0.782 for the external validation sample. CONCLUSION Neutropenia may be associated with both genetic factors and clinical factors. Our study found that the artificial neural networks model based on the multiple risk factors jointly, can effectively predict the occurring of neutropenia, which provides some guidance before the starting of chemotherapy.
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Affiliation(s)
- Kecheng Huang
- Department of Gynecology & Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, Hubei, China
| | - Aiyue Luo
- Department of Gynecology & Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, Hubei, China
| | - Xiong Li
- Department of Gynecology & Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, Hubei, China
| | - Shuang Li
- Department of Gynecology & Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, Hubei, China
| | - Shixuan Wang
- Department of Gynecology & Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, Hubei, China
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179
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Kumar M, Ernani V, Owonikoko TK. Biomarkers and targeted systemic therapies in advanced non-small cell lung cancer. Mol Aspects Med 2015; 45:55-66. [PMID: 26187108 DOI: 10.1016/j.mam.2015.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/24/2015] [Indexed: 01/15/2023]
Abstract
The last decade has witnessed significant growth in therapeutic options for patients diagnosed with lung cancer. This is due in major part to our improved technological ability to interrogate the genomics of cancer cells, which has enabled the development of biologically rational anticancer agents. The recognition that lung cancer is not a single disease entity dates back many decades to the histological subclassification of malignant neoplasms of the lung into subcategories of small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). While SCLC continues to be regarded as a single histologic and therapeutic category, the NSCLC subset has undergone additional subcategorizations with distinct management algorithms for specific histologic and molecular subtypes. The defining characteristics of these NSCLC subtypes have evolved into important tools for prognosis and for predicting the likelihood of benefit when patients are treated with anticancer agents.
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Affiliation(s)
- Mukesh Kumar
- Department of Hematology & Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Vinicius Ernani
- Department of Hematology & Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Taofeek K Owonikoko
- Department of Hematology & Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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180
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Lara PN, Longmate J, Mack PC, Kelly K, Socinski MA, Salgia R, Gitlitz B, Li T, Koczywas M, Reckamp KL, Gandara DR. Phase II Study of the AKT Inhibitor MK-2206 plus Erlotinib in Patients with Advanced Non-Small Cell Lung Cancer Who Previously Progressed on Erlotinib. Clin Cancer Res 2015; 21:4321-6. [PMID: 26106072 DOI: 10.1158/1078-0432.ccr-14-3281] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/03/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Preclinical modeling in non-small cell lung cancer (NSCLC) showed that stimulation with hepatocyte growth factor (HGF), the ligand for MET, could reverse the cytostatic and cytotoxic effects of the EGFR inhibitor erlotinib in erlotinib-sensitive cell lines. Inhibitors of AKT signaling mitigated this HGF-mediated resistance, partially restoring erlotinib activity. We conducted a phase II trial of erlotinib plus MK-2206, a highly selective inhibitor of AKT, in NSCLC patients. EXPERIMENTAL DESIGN Eligible patients must have progressed following prior benefit from erlotinib, defined as response or stable disease > 12 weeks. Treatment consisted of erlotinib 150 mg orally every day + MK-2206 45 mg orally every alternate day on a 28-day cycle. Primary endpoints were RECIST response rate > 30% (stratum 1: EGFR mutant) and disease control rate (DCR) > 20% at 12 weeks (stratum 2: EGFR wild-type). RESULTS Eighty patients were enrolled, 45 and 35 in stratum 1 and 2, respectively. Most common attributable adverse events (all grade 3) were rash, diarrhea, fatigue, and mucositis. Response and DCR were, respectively, 9% and 40% in stratum 1; 3% and 47% in stratum 2. Median progression-free survival was 4.4 months in stratum 1 and 4.6 months in stratum 2. CONCLUSIONS Combination MK-2206 and erlotinib met its primary endpoint in erlotinib-pretreated patients with EGFR wild-type NSCLC. Although activity was seen in EGFR-mutated NSCLC, this did not exceed a priori estimates. AKT pathway inhibition merits further clinical evaluation in EGFR wild-type NSCLC.
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Affiliation(s)
- Primo N Lara
- University of California Davis Comprehensive Cancer Center, Sacramento, California.
| | - Jeff Longmate
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Philip C Mack
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Karen Kelly
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Mark A Socinski
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Ravi Salgia
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Barbara Gitlitz
- USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Tianhong Li
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | | | - Karen L Reckamp
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - David R Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, California
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181
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Zota VE, Magliocco AM. Molecular Technologies in the Clinical Diagnostic Laboratory. Cancer Control 2015; 22:142-51. [PMID: 26068758 DOI: 10.1177/107327481502200204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND New technologies for molecular analysis are increasing our ability to diagnose cancer. METHODS Several molecular analysis technologies are reviewed and their use in the clinical laboratory is discussed. RESULTS Select key technologies, including polymerase chain reaction and next-generation sequencing, are helping transform our ability to analyze cancer specimens. As these technological advances become more and more incorporated into routine diagnostic testing, our classification systems are likely to be impacted and our approach to treatment transformed. The routine use of such technology also brings challenges for analysis and reimbursement. CONCLUSION These advances in technology will change the way we diagnose, monitor, and treat patients with cancer.
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Affiliation(s)
- Victor E Zota
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL 33612, USA.
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182
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Rothschild SI. Targeted Therapies in Non-Small Cell Lung Cancer-Beyond EGFR and ALK. Cancers (Basel) 2015; 7:930-49. [PMID: 26018876 PMCID: PMC4491691 DOI: 10.3390/cancers7020816] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/07/2015] [Accepted: 05/13/2015] [Indexed: 01/30/2023] Open
Abstract
Systemic therapy for non-small cell lung cancer (NSCLC) has undergone a dramatic paradigm shift over the past decade. Advances in our understanding of the underlying biology of NSCLC have revealed distinct molecular subtypes. A substantial proportion of NSCLC depends on oncogenic molecular aberrations (so-called "driver mutations") for their malignant phenotype. Personalized therapy encompasses the strategy of matching these subtypes with effective targeted therapies. EGFR mutations and ALK translocation are the most effectively targeted oncogenes in NSCLC. EGFR mutations and ALK gene rearrangements are successfully being targeted with specific tyrosine kinase inhibitors. The number of molecular subgroups of NSCLC continues to grow. The scope of this review is to discuss recent data on novel molecular targets as ROS1, BRAF, KRAS, HER2, c-MET, RET, PIK3CA, FGFR1 and DDR2. Thereby the review will focus on therapeutic strategies targeting these aberrations. Moreover, the emerging challenge of acquired resistance to initially effective therapies will be discussed.
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Affiliation(s)
- Sacha I Rothschild
- Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
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183
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Refining the treatment of NSCLC according to histological and molecular subtypes. Nat Rev Clin Oncol 2015; 12:511-26. [PMID: 25963091 DOI: 10.1038/nrclinonc.2015.90] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In the past decade, the characterization of non-small-cell lung cancer (NSCLC) into subtypes based on genotype and histology has resulted in dramatic improvements in disease outcome in select patient subgroups. In particular, molecularly targeted agents that inhibit EGFR or ALK are approved for the treatment of NSCLC harbouring genetic alterations in the genes encoding these proteins. Although acquired resistance usually limits the duration of response to these therapies, a number of new agents have proven effective at tackling specific resistance mechanisms to first-generation inhibitors. Large initiatives are starting to address the role of biomarker-driven targeted therapy in squamous lung cancers, and in the adjuvant setting. Immunotherapy undeniably holds great promise and our understanding of subsets of NSCLC based on patterns of immune response is continuing to evolve. In addition, efforts are underway to identify rare genomic subsets through genomic screening, functional studies, and molecular characterization of exceptional responders. This Review provides an overview of the key developments in the treatment of NSCLC, and discusses potential strategies to further optimize therapy by targeting disease subtypes.
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184
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Redig AJ, Jänne PA. Basket trials and the evolution of clinical trial design in an era of genomic medicine. J Clin Oncol 2015; 33:975-7. [PMID: 25667288 DOI: 10.1200/jco.2014.59.8433] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Amanda J Redig
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Pasi A Jänne
- Dana-Farber Cancer Institute, Harvard Medical School, and Brigham and Women's Hospital, Boston, MA
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