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Garcia A, Rivera Rolon MDM, Barkoh B, Chen W, Luthra R, Roy-Chowdhuri S. Assessment of BRAF V600E (VE1) immunochemistry for the detection of BRAF V600E mutation in non-small cell lung carcinoma cytology specimens. Cancer Cytopathol 2023; 131:50-57. [PMID: 36200799 DOI: 10.1002/cncy.22648] [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: 06/24/2022] [Accepted: 08/30/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Non-small cell lung carcinoma (NSCLC) patients with BRAF V600E-mutated tumors respond to targeted therapy. Testing for BRAF V600E is commonly performed with molecular methods; however, a mutation-specific VE1 antibody clone can provide an alternative testing option using immunohistochemistry (IHC) for practices using single-gene testing and in situations when the specimen is inadequate for molecular testing. This study evaluates the usefulness of VE1 IHC in screening for BRAF V600E mutations in NSCLC cytology specimens. METHODS The authors retrospectively identified cytology cases with a diagnosis of NSCLC that had BRAF V600E IHC performed on cell block sections with the monoclonal VE1 antibody clone. The BRAF V600E IHC results were compared with those of molecular testing performed with an amplicon-based next-generation sequencing assay. RESULTS There were 201 NSCLC cases evaluated. The VE1 IHC was positive in seven of seven BRAF V600E-mutated tumors (100%) and was negative in 158 of 158 nonmutated BRAF V600E tumors (100%). Thirty cases did not undergo molecular testing, primarily because of insufficient tissue or because molecular testing was performed on an alternative specimen. Six cases showed equivocal weak/focal staining: Two cases demonstrated BRAF V600E mutations, and four cases were negative by molecular testing. CONCLUSIONS This study suggests that BRAF V600E IHC can be used reliably to screen NSCLC cytology specimens, and negative results strongly indicate the absence of a BRAF V600E mutation. Having a low threshold for equivocal staining is recommended with molecular confirmation of BRAF V600E for any cases demonstrating weak and/or focal cytoplasmic staining.
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Affiliation(s)
- Ashley Garcia
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria Del Mar Rivera Rolon
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bedia Barkoh
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei Chen
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rajyalakhsmi Luthra
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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2
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Reddy S, Hung LH, Sala-Torra O, Radich JP, Yeung CC, Yeung KY. A graphical, interactive and GPU-enabled workflow to process long-read sequencing data. BMC Genomics 2021; 22:626. [PMID: 34425749 PMCID: PMC8381503 DOI: 10.1186/s12864-021-07927-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/10/2021] [Indexed: 12/18/2022] Open
Abstract
Background Long-read sequencing has great promise in enabling portable, rapid molecular-assisted cancer diagnoses. A key challenge in democratizing long-read sequencing technology in the biomedical and clinical community is the lack of graphical bioinformatics software tools which can efficiently process the raw nanopore reads, support graphical output and interactive visualizations for interpretations of results. Another obstacle is that high performance software tools for long-read sequencing data analyses often leverage graphics processing units (GPU), which is challenging and time-consuming to configure, especially on the cloud. Results We present a graphical cloud-enabled workflow for fast, interactive analysis of nanopore sequencing data using GPUs. Users customize parameters, monitor execution and visualize results through an accessible graphical interface. The workflow and its components are completely containerized to ensure reproducibility and facilitate installation of the GPU-enabled software. We also provide an Amazon Machine Image (AMI) with all software and drivers pre-installed for GPU computing on the cloud. Most importantly, we demonstrate the potential of applying our software tools to reduce the turnaround time of cancer diagnostics by generating blood cancer (NB4, K562, ME1, 238 MV4;11) cell line Nanopore data using the Flongle adapter. We observe a 29x speedup and a 93x reduction in costs for the rate-limiting basecalling step in the analysis of blood cancer cell line data. Conclusions Our interactive and efficient software tools will make analyses of Nanopore data using GPU and cloud computing accessible to biomedical and clinical scientists, thus facilitating the adoption of cost effective, fast, portable and real-time long-read sequencing. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-021-07927-1.
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Affiliation(s)
| | - Ling-Hong Hung
- School of Engineering and Technology, University of Washington, 98402, Tacoma, WA, USA
| | - Olga Sala-Torra
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 98109, Seattle, WA, USA
| | - Jerald P Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 98109, Seattle, WA, USA.,Clinical Research Division, Kurt Enslein Endowed Chair, Fred Hutchinson Cancer Research Center, 98109, Seattle, WA, USA.,Department of Medicine, University of Washington, 98109, Seattle, WA, USA
| | - Cecilia Cs Yeung
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 98109, Seattle, WA, USA.,Department of Laboratory Medicine and Pathology, University of Washington, 98109, Seattle, WA, USA
| | - Ka Yee Yeung
- School of Engineering and Technology, University of Washington, 98402, Tacoma, WA, USA.
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3
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VanderLaan PA, Roy-Chowdhuri S. Current and future trends in non-small cell lung cancer biomarker testing: The American experience. Cancer Cytopathol 2021; 128:629-636. [PMID: 32885913 DOI: 10.1002/cncy.22313] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/04/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022]
Abstract
Biomarker testing in patients with advanced stage non-small cell lung cancer provides essential information that can be used to select the most appropriate therapy. The regular updates of guideline recommendations reflect the growing number of biomarkers that must be assessed, and as such signal the shift from single-gene assays to more comprehensive genomic profiling using next-generation sequencing modalities. Cytology and small biopsy specimens have proven to be more than adequate substrates for these types of ancillary molecular testing; however, other alternative testing substrates are beginning to emerge. These include so-called liquid biopsies as well the supernatant fluid from cytology specimens, both of which have demonstrated promise for use in the clinical realm. This review will briefly cover the current state of non-small cell lung cancer biomarker testing in the United States, with a focus on these novel nonconventional substrates that are increasingly being incorporated into testing paradigms.
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Affiliation(s)
- Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sinchita Roy-Chowdhuri
- Division of Pathology and Laboratory Medicine, Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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4
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Goulart BHL, Chennupati S, Fedorenko CR, Ramsey SD. Access to Tyrosine Kinase Inhibitors and Survival in Patients with Advanced EGFR + and ALK + Positive Non-small-cell Lung Cancer Treated in the Real-World. Clin Lung Cancer 2021; 22:e723-e733. [PMID: 33685820 DOI: 10.1016/j.cllc.2021.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION We assessed the proportion of patients with advanced epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) positive non-small-cell lung cancer (NSCLC) who receive tyrosine kinase inhibitors (TKIs) in the real-world, predictors of TKI use, and impact of TKI therapy on overall survival (OS). MATERIALS AND METHODS We identified patients diagnosed with stage IV EGFR+ and ALK+ positive NSCLC from January 1, 2010 to December 31, 2018, in the Cancer Surveillance System registry and linked their records to Medicare and commercial insurance claims. We reported the proportions of patients with 1 or more TKI claims versus no TKI claims and used logistic regression to identify predictors of TKI use. We evaluated the effect of TKI use on OS by applying extended Cox proportional hazard models with TKI use as a time-dependent exposure and landmark analysis in a subcohort (N = 105). We adjusted Cox models for confounding patient characteristics. RESULTS Of 117 eligible patients (median age = 69; 62% women; 88% EGFR+), 21 (17.9%) had no TKI claims. Diagnosis in 2015 to 2018 was independently associated with lower likelihood of TKI therapy compared with 2010 to 2014 (adjusted odds ratio, 0.29; P = .020). TKI use was associated with longer OS in a multivariate extended Cox model and in the landmark analysis (adjusted hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.33; 0.99; P = .048; adjusted HR, 0.55; 95% CI, 0.30; 1.00; P = .050). CONCLUSION Approximately 18% of patients with advanced EGFR+ and ALK+ positive NSCLC do not receive TKIs and have inferior survival. Further studies need to investigate barriers of access to TKIs in biomarker-selected patients.
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Affiliation(s)
- Bernardo H L Goulart
- Fred Hutchinson Cancer Research Center, Seattle, WA; Hutchinson Institute for Cancer Outcomes Research (HICOR), Seattle, WA.
| | - Shasank Chennupati
- Fred Hutchinson Cancer Research Center, Seattle, WA; Hutchinson Institute for Cancer Outcomes Research (HICOR), Seattle, WA
| | - Catherine R Fedorenko
- Fred Hutchinson Cancer Research Center, Seattle, WA; Hutchinson Institute for Cancer Outcomes Research (HICOR), Seattle, WA
| | - Scott D Ramsey
- Fred Hutchinson Cancer Research Center, Seattle, WA; Hutchinson Institute for Cancer Outcomes Research (HICOR), Seattle, WA; University of Washington Medical Center, Seattle, WA
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5
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Heher YK. Something's Lost and Something's Gained: Seeing Reference Laboratory Quality from Both Sides, Now. Clin Lab Med 2020; 40:341-356. [PMID: 32718504 DOI: 10.1016/j.cll.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Growing regulatory burdens, payment model changes, and increased complexity in laboratory medicine have contributed to an increased reliance on reference laboratories. Although reference laboratories often offer rapid, low cost, high quality testing, outsourcing laboratory tests can create quality and patient safety vulnerabilities particularly in the pre-analytic and post-analytic phases of the test cycle. Disconnects in governance, policy, and information technology between the reference laboratory and the referring provider conspire to increase risk. Laboratory leaders seeking to reduce risk and improve quality must ensure clear and collaborative oversight, monitor meaningful quality metrics, and integrate feedback from ordering providers.
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6
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Galuppini F, Dal Pozzo CA, Deckert J, Loupakis F, Fassan M, Baffa R. Tumor mutation burden: from comprehensive mutational screening to the clinic. Cancer Cell Int 2019; 19:209. [PMID: 31406485 PMCID: PMC6686509 DOI: 10.1186/s12935-019-0929-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/04/2019] [Indexed: 12/27/2022] Open
Abstract
The recent advent of immunomodulatory therapies into the clinic has demanded the identification of innovative predictive biomarkers to identify patients most likely to respond to immunotherapy and support the design of tailored clinical trials. Current molecular testing for selection of patients with gastrointestinal or pulmonary carcinomas relies on the prevalence of PD-L1 expression in tumor as well as immune cells by immunohistochemistry and/or on the evaluation of the microsatellite status. Tumor Mutational Burden (TMB) has emerged as a promising novel biomarker in this setting to further aid in patient selection. This has been facilitated by the increasing implementation of molecular pathology laboratories with comprehensive next generation sequencing (NGS) technologies. However, the significant overall costs and expertise required for the interpretation of NGS data has limited TMB evaluation in routine diagnostics, so far. This review focuses on the current use of TMB analysis in the clinical setting in the context of immune checkpoint inhibitor therapies.
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Affiliation(s)
- Francesca Galuppini
- 1Department of Medicine, Surgical Pathology Unit, University of Padua, Via Aristide Gabelli, 61, 35121 Padua, Italy
| | - Carlo Alberto Dal Pozzo
- 1Department of Medicine, Surgical Pathology Unit, University of Padua, Via Aristide Gabelli, 61, 35121 Padua, Italy
| | | | - Fotios Loupakis
- 3Veneto Institute of Oncology, IOV-IRCCS, Oncology Unit 1, Padua, Italy
| | - Matteo Fassan
- 1Department of Medicine, Surgical Pathology Unit, University of Padua, Via Aristide Gabelli, 61, 35121 Padua, Italy
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Reyes R, Mayo-de-las-Casas C, Teixidó C, Cabrera C, Marín E, Vollmer I, Jares P, Garzón M, Molina-Vila MÁ, Reguart N. Clinical Benefit From BRAF/MEK Inhibition in a Double Non-V600E BRAF Mutant Lung Adenocarcinoma: A Case Report. Clin Lung Cancer 2019; 20:e219-e223. [DOI: 10.1016/j.cllc.2019.02.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/11/2019] [Accepted: 02/21/2019] [Indexed: 02/09/2023]
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8
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Hofman P. Advances in theranostic biomarkers for lung cancer from clinical to molecular pathology. J Thorac Dis 2019; 11:S1-S2. [PMID: 30775022 DOI: 10.21037/jtd.2018.10.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Paul Hofman
- Université Côte d'Azur, CHU Nice, FHU OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France.,Université Côte d'Azur, CNRS, INSERM, IRCAN, FHU OncoAge, Team 4, Nice, France.,Université Côte d'Azur, CHU Nice, FHU OncoAge, Hospital-Integrated Biobank (BB-0033-00025), Nice, France
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