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Shah AT, Blanchard I, Padda SK, Wakelee HA, Neal JW. Molecular Characteristics and Pretreatment Neutrophil-to-Lymphocyte Ratio as Predictors of Durable Clinical Benefit from Immune Checkpoint Inhibition in Non-Small Cell Lung Cancer. Clin Lung Cancer 2024; 25:550-559. [PMID: 38987048 PMCID: PMC11365775 DOI: 10.1016/j.cllc.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/06/2024] [Accepted: 06/15/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Prior research in non-small cell lung cancer (NSCLC) has shown that tumors with specific driver mutations may be less likely to respond to immune checkpoint inhibitors (ICI). In this analysis, we evaluated the characteristics of patients with durable clinical benefit (DCB) to ICI compared to those with no durable clinical benefit (NDB), with emphasis on the role of molecular alterations in EGFR, ALK, and ROS1 and pretreatment neutrophil-to-lymphocyte ratio (NLR). METHODS We retrospectively collected clinical characteristics and outcomes for patients who initiated ICI monotherapy for advanced NSCLC at Stanford University between April 2015 and May 2018. Patients were classified as having DCB if time on ICI therapy was greater than or equal to 180 days, or NDB if less than 180 days. Outcomes included best radiographic benefit while on ICI and survival from time of ICI initiation. RESULTS Of 123 patients treated with ICI for NSCLC, 28 patients had DCB (23%), while 95 had NDB (77%). Median overall survival from initiation of ICI in the 33 patients with molecular alterations in EGFR (n = 31), ALK, or ROS1 and NLR of 5.9 or higher was 2.0 months, compared to 8.1 months in patients with these genomic alterations and NLR less than 5.9. Median overall survival in patients without alterations in EGFR, ALK, or ROS1 and NLR of 5.9 or higher was 4.3 months, compared to 12.1 months in patients with NLR less than 5.9 (P = .023). CONCLUSIONS Elevation in pretreatment NLR was associated with significantly lower overall median survival from initiation of ICI, particularly when in combination with NSCLC with alterations in EGFR, ALK, or ROS1. This finding could influence clinical practice as NLR is readily available through routine blood testing.
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Affiliation(s)
| | - Isabelle Blanchard
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA
| | - Sukhmani K Padda
- Department of Hematology/Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, PA
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA
| | - Joel W Neal
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA.
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2
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Alzumaili BA, Fisch AS, Faquin WC, Nosé V, Randolph GW, Sadow PM. Detection of RAS p.Q61R by Immunohistochemistry in Practice: A Clinicopathologic Study of 217 Thyroid Nodules with Molecular Correlates. Endocr Pathol 2024:10.1007/s12022-024-09821-4. [PMID: 39096324 DOI: 10.1007/s12022-024-09821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/05/2024]
Abstract
RAS p.Q61R is the most prevalent hot-spot mutation in RAS and RAS-like mutated thyroid nodules. A few studies evaluated RAS p.Q61R by immunohistochemistry (RASQ61R-IHC). We performed a retrospective study of an institutional cohort of 150 patients with 217 thyroid lesions tested for RASQ61R-IHC, including clinical, cytologic and molecular data. RASQ61R-IHC was performed on 217 nodules (18% positive, 80% negative, and 2% equivocal). RAS p.Q61R was identified in 76% (n = 42), followed by RAS p.Q61K (15%; n = 8), and RAS p.G13R (5%; n = 3). NRAS p.Q61R isoform was the most common (44%; n = 15), followed by NRAS p.Q61K (17%; n = 6), KRAS p.Q61R (12%; n = 4), HRAS p.Q61R (12%; n = 4), HRAS p.Q61K (6%; n = 2), HRAS p.G13R (6%; n = 2), and NRAS p.G13R (3%; n = 1). RASQ61R-IHC was positive in 47% of noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP; 17/36), 22% of follicular thyroid carcinomas (FTC; 5/23), 10% of follicular thyroid adenomas (FTA; 4/40), and 8% of papillary thyroid carcinomas (PTC; 9/112). Of PTC studied (n = 112), invasive encapsulated follicular variant (IEFVPTC; n = 16) was the only subtype with positive RASQ61R-IHC (56%; 9/16). Overall, 31% of RAS-mutated nodules were carcinomas (17/54); and of the carcinomas, 94% (16/17) were low-risk per American Thyroid Associated (ATA) criteria, with only a single case (6%; 1/17) considered ATA high-risk. No RAS-mutated tumors recurred, and none showed local or distant metastasis (with a follow-up of 0-10 months). We found that most RAS-mutated tumors are low-grade neoplasms. RASQ61R-IHC is a quick, cost-effective, and reliable way to detect RAS p.Q61R in follicular-patterned thyroid neoplasia and, when malignant, guide surveillance.
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Affiliation(s)
- Bayan A Alzumaili
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Warren 219, Boston, MA, 02114, USA
| | - Adam S Fisch
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Warren 219, Boston, MA, 02114, USA
| | - William C Faquin
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Warren 219, Boston, MA, 02114, USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Vania Nosé
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Warren 219, Boston, MA, 02114, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Peter M Sadow
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Warren 219, Boston, MA, 02114, USA.
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA.
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3
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Willard N, Sholl L, Aisner D. Panel Sequencing for Targeted Therapy Selection in Solid Tumors. Clin Lab Med 2022; 42:309-323. [DOI: 10.1016/j.cll.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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4
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Wang Y, Zhou P, Cui C, He X, Bian Y, Wang X. The expression of Nanog protein and fibroblast growth factor-inducible molecule 14 in patients with non-small cell lung cancer and their relationship with pathological characteristics and prognosis. Transl Cancer Res 2022; 10:2470-2477. [PMID: 35116561 PMCID: PMC8797829 DOI: 10.21037/tcr-21-724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/19/2021] [Indexed: 12/25/2022]
Abstract
Background This study aimed to explore the expression of Nanog and fibroblast growth factor-inducible molecule 14 (Fn14) in patients with non-small cell lung cancer (NSCLC), and to explore their relationship with pathological characteristics and prognosis. Methods The clinical data of 89 patients with NSCLC admitted to this hospital from March 2015 to January 2019 were analyzed. The expression of Nanog and Fn14 in NSCLC tissues and normal tissues (5 cm around the tumor tissue) were analyzed by immunohistochemical staining. The relationship between Nanog and Fn14 expression and the patients’ pathological parameters was analyzed. Receiver operating characteristic curve (ROC) and Kaplan-Meier survival curves were drawn to analyze the influence of Nanog and Fn14 expression on prognosis, and logistic regression analysis was used to examine the related factors affecting the 2-year prognostic mortality of patients. Results The positive rates of Nanog and Fn14 in the observation group were significantly higher than those in the control group (P<0.05). The positive expression rates of Nanog and Fn14 were higher in patients with moderate/high differentiation, TNM stage III-IV, and lymph node metastasis (P<0.05). Among 89 patients with NSCLC, 25 patients died within 2 years of follow-up, with a survival rate of 71.91%. The mortality of patients with positive expression of Nanog and Fn14 was significantly higher than that of patients with negative expression (P<0.05). The median survival times of patients with negative and positive Nanog expression were (20.60±2.71) months and (18.03±2.11) months, respectively. The median survival times of patients with negative and positive Fn14 expression were (19.55±2.60) months and (15.65±2.14) months, respectively. The Kaplan-Meier survival curve showed that patients with both negative expression of Nanog and Fn14 had a longer survival time (P<0.05). Poor differentiation, TNM stage III-IV, lymph node metastasis, positive expression of Nanog, and positive expression of Fn14 were identified as risk factors affecting the prognostic mortality of patients with NSCLC (P<0.05). Conclusions Nanog and Fnl4 are closely related to the occurrence, development, and prognosis of NSCLC. Detection of their expression levels can provide reliable information for the early diagnosis of patients with NSCLC.
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Affiliation(s)
- Yaqian Wang
- General Medicine Department, Hengshui People's Hospital, Hengshui, China
| | - Ping Zhou
- Department of Thoracic Surgery, Hengshui People's Hospital, Hengshui, China
| | - Cunxiao Cui
- General Medicine Department, Hengshui People's Hospital, Hengshui, China
| | - Xinxia He
- General Medicine Department, Hengshui People's Hospital, Hengshui, China
| | - Yali Bian
- General Medicine Department, Hengshui People's Hospital, Hengshui, China
| | - Xiuzheng Wang
- Tuberculosis Department, The Affiliated Hospital of Hebei University, Baoding, China
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5
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Abstract
Technological innovation and rapid reduction in sequencing costs have enabled the genomic profiling of hundreds of cancer-associated genes as a component of routine cancer care. Tumour genomic profiling can refine cancer subtype classification, identify which patients are most likely to benefit from systemic therapies and screen for germline variants that influence heritable cancer risk. Here, we discuss ongoing efforts to enhance the clinical utility of tumour genomic profiling by integrating tumour and germline analyses, characterizing allelic context and identifying mutational signatures that influence therapy response. We also discuss the potential clinical utility of more comprehensive whole-genome and whole-transcriptome sequencing and ultra-sensitive cell-free DNA profiling platforms, which allow for minimally invasive, serial analyses of tumour-derived DNA in blood.
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Affiliation(s)
- Debyani Chakravarty
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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6
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Janovitz T, Williamson DFK, Wong KS, Dong F, Barletta JA. Genomic profile of columnar cell variant of papillary thyroid carcinoma. Histopathology 2021; 79:491-498. [PMID: 33783022 DOI: 10.1111/his.14374] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Columnar cell variant (CCV) is a rare papillary thyroid carcinoma subtype. The majority of CCV occur in older patients and are large, invasive tumours that pursue an aggressive clinical course. Rare well-circumscribed CCV occur in younger female patients and are comparatively indolent. METHODS AND RESULTS We retrospectively identified CCV with material available to perform targeted next-generation sequencing and correlated molecular results with clinicopathological features and outcome. Our cohort was comprised of nine CCV. Nearly all were aggressive tumours; however, one was predominantly well-circumscribed and arose in a thyroglossal duct cyst of a 26-year-old woman who had no evidence of disease at last follow-up. Seven (78%) cases demonstrated activating oncogenic driver alterations in BRAF, including BRAF V600E, an activating N486_P490del deletion, and BRAF-AGK fusions. Activating RAS mutations were seen in two (22%) cases. Additionally, three (33%) cases had TERT promoter mutations, four (44%) had loss of the tumour suppressor CDKN2A and one (11%) case had a loss of function TP53 mutation. Most cases (89%) also demonstrated copy number alterations, including recurrent gain of chromosome 1q (five cases) and losses of chromosome 9p (three cases) and 22q (four cases). The one case without secondary pathogenic mutations or copy number alterations was the tumour in the 26-year-old woman. CONCLUSIONS We found that CCV is primarily a BRAF-driven tumour, with most also harbouring secondary oncogenic mutations and multiple chromosomal gains and losses. Moreover, our findings suggest that molecular analysis could potentially be used to help risk stratify CCV.
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Affiliation(s)
- Tyler Janovitz
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Drew F K Williamson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fei Dong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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7
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Souza CP, Cinegaglia NC, Felix TF, Evangelista AF, Oliveira RA, Hasimoto EN, Cataneo DC, Cataneo AJM, Scapulatempo Neto C, Viana CR, de Paula FE, Drigo SA, Carvalho RF, Marques MMC, Reis RM, Reis PP. Deregulated microRNAs Are Associated with Patient Survival and Predicted to Target Genes That Modulate Lung Cancer Signaling Pathways. Cancers (Basel) 2020; 12:E2711. [PMID: 32971741 PMCID: PMC7563870 DOI: 10.3390/cancers12092711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022] Open
Abstract
(1) Background: Although the advances in diagnostic and treatment strategies, lung cancer remains the leading cause of cancer-related deaths, worldwide, with survival rates as low as 16% in developed countries. Low survival rates are mainly due to late diagnosis and the lack of effective treatment. Therefore, the identification of novel, clinically useful biomarkers is still needed for patients with advanced disease stage and poor survival. Micro(mi)RNAs are non-coding RNAs and potent regulators of gene expression with a possible role as diagnostic, prognostic and predictive biomarkers in cancer. (2) Methods: We applied global miRNA expression profiling analysis using TaqMan® arrays in paired tumor and normal lung tissues (n = 38) from treatment-naïve patients with lung adenocarcinoma (AD; n = 23) and lung squamous cell carcinoma (SCC; n = 15). miRNA target genes were validated using The Cancer Genome Atlas (TCGA) lung AD (n = 561) and lung SCC (n = 523) RNA-Seq datasets. (3) Results: We identified 33 significantly deregulated miRNAs (fold change, FC ≥ 2.0 and p < 0.05) in tumors relative to normal lung tissues, regardless of tumor histology. Enrichment analysis confirmed that genes targeted by the 33 miRNAs are aberrantly expressed in lung AD and SCC, and modulate known pathways in lung cancer. Additionally, high expression of miR-25-3p was significantly associated (p < 0.05) with poor patient survival, when considering both tumor histologies. (4) Conclusions: miR-25-3p may be a potential prognostic biomarker in non-small cell lung cancer. Genes targeted by miRNAs regulate EGFR and TGFβ signaling, among other known pathways relevant to lung tumorigenesis.
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Affiliation(s)
- Cristiano P. Souza
- Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.P.S.); (E.N.H.); (D.C.C.); (A.J.M.C.); (S.A.D.)
- Experimental Research Unity (UNIPEX), São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (N.C.C.); (T.F.F.)
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.F.E.); (C.S.N.); (C.R.V.); (F.E.d.P.); (M.M.C.M.); (R.M.R.)
| | - Naiara C. Cinegaglia
- Experimental Research Unity (UNIPEX), São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (N.C.C.); (T.F.F.)
| | - Tainara F. Felix
- Experimental Research Unity (UNIPEX), São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (N.C.C.); (T.F.F.)
| | - Adriane F. Evangelista
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.F.E.); (C.S.N.); (C.R.V.); (F.E.d.P.); (M.M.C.M.); (R.M.R.)
| | - Rogério A. Oliveira
- Department of Biostatistics, Plant Biology, Parasitology, and Zoology, Institute of Biosciences, São Paulo State University UNESP, Botucatu 18618-689, SP, Brazil;
| | - Erica N. Hasimoto
- Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.P.S.); (E.N.H.); (D.C.C.); (A.J.M.C.); (S.A.D.)
| | - Daniele C. Cataneo
- Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.P.S.); (E.N.H.); (D.C.C.); (A.J.M.C.); (S.A.D.)
| | - Antônio J. M. Cataneo
- Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.P.S.); (E.N.H.); (D.C.C.); (A.J.M.C.); (S.A.D.)
| | - Cristovam Scapulatempo Neto
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.F.E.); (C.S.N.); (C.R.V.); (F.E.d.P.); (M.M.C.M.); (R.M.R.)
| | - Cristiano R. Viana
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.F.E.); (C.S.N.); (C.R.V.); (F.E.d.P.); (M.M.C.M.); (R.M.R.)
| | - Flávia E. de Paula
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.F.E.); (C.S.N.); (C.R.V.); (F.E.d.P.); (M.M.C.M.); (R.M.R.)
| | - Sandra A. Drigo
- Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.P.S.); (E.N.H.); (D.C.C.); (A.J.M.C.); (S.A.D.)
- Experimental Research Unity (UNIPEX), São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (N.C.C.); (T.F.F.)
| | - Robson F. Carvalho
- Department of Structural and Functional Biology, Institute of Biosciences, São Paulo State University, UNESP, Botucatu 18618-689, SP, Brazil;
| | - Márcia M. C. Marques
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.F.E.); (C.S.N.); (C.R.V.); (F.E.d.P.); (M.M.C.M.); (R.M.R.)
- Barretos School of Health Sciences, Barretos 14785-002, SP, Brazil
| | - Rui M. Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil; (A.F.E.); (C.S.N.); (C.R.V.); (F.E.d.P.); (M.M.C.M.); (R.M.R.)
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s-PT Government Associate Laboratory, 410-057 Braga/Guimarães, Portugal
| | - Patricia P. Reis
- Department of Surgery and Orthopedics, Faculty of Medicine, São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (C.P.S.); (E.N.H.); (D.C.C.); (A.J.M.C.); (S.A.D.)
- Experimental Research Unity (UNIPEX), São Paulo State University, UNESP, Botucatu 18618-687, SP, Brazil; (N.C.C.); (T.F.F.)
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Andolfo I, Lasorsa VA, Manna F, Rosato BE, Formicola D, Iolascon A, Capasso M. Kinome multigenic panel identified novel druggable EPHB4-V871I somatic variant in high-risk neuroblastoma. J Cell Mol Med 2020; 24:6459-6471. [PMID: 32336043 PMCID: PMC7294133 DOI: 10.1111/jcmm.15297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 01/09/2023] Open
Abstract
Neuroblastoma (NB) is the most common extracranial neoplasm in children. The overall outcome for high‐risk NB patients is still unacceptable, therefore, it is critical to deeply understand molecular mechanisms associated with NB, which in turn can be utilized for developing drugs towards the treatment of NB. Protein kinases (TKs) play an essential role in the regulation of cell survival and proliferation. Different kinases, such as anaplastic lymphoma kinase (ALK), Aurora kinase, RET receptor tyrosine kinase, are potential therapeutic targets in various cancers, including NB. We analysed a cohort of 45 high‐risk NB patients and 9 NB cell lines by a targeted—(t)NGS custom gene panel (genes codifying for the kinase domains of 90 TKs). We identified somatic variants in four TK genes (ALK, EPHB4, LMTK3 and EPHB6) in NB patients and we functionally characterized an interesting somatic variant, V871I, in EPHB4 gene. EPHB4 plays a crucial role in cardiovascular development and regulates vascularization in cancer‐promoting angiogenesis, tumour growth and metastasis. Several EPHB4 mutations have previously been identified in solid and haematological tumour specimens but EPHB4 mutations were not described until now in NB. Interestingly, a re‐analysis of public CGH‐array showed that the EPHB4 gain is associated with advanced diseases in NB. We further demonstrated that higher EPHB4 expression is correlated to stage 4 of NB and with poor overall survival. Additionally, we also revealed that the EPHB4‐V871I accounts for increased proliferation, migration and invasion properties in two NB cell lines by acting on VEGF, c‐RAF and CDK4 target genes and by increasing the phosphorylation of ERK1‐2 pathway. The use of two EPHB4 inhibitors, JI‐101 and NVP‐BHG712, was able to rescue the phenotype driven by the variant. Our study suggested that EPHB4 is a promising therapeutic target in high‐risk NB.
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Affiliation(s)
- Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.,CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Vito A Lasorsa
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.,CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Francesco Manna
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.,CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Barbara E Rosato
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.,CEINGE, Biotecnologie Avanzate, Naples, Italy
| | | | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.,CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Mario Capasso
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.,CEINGE, Biotecnologie Avanzate, Naples, Italy.,IRCCS SDN, Naples, Italy
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9
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Anazawa T, Matsunaga H, Yamamoto S, Inaba R. Highly sensitive mutation quantification by high-dynamic-range capillary-array electrophoresis (HiDy CE). LAB ON A CHIP 2020; 20:1083-1091. [PMID: 32108835 DOI: 10.1039/c9lc00853e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A simple and robust ultra-small four-color-fluorescence detection system was developed by integrating its components, namely, a four-capillary array, an injection-molded-plastic four-lens array, a four-dichroic-mirror array, and a CMOS sensor, as one device. The developed system was applied to a high-dynamic-range capillary-array electrophoresis (HiDy CE) to quantify a rare EGFR mutant (MT) of exon 19 deletion in a large excess of EGFR wild type (WT). Samples with serially diluted MT and constant-concentration WT were co-amplified by competitive PCR and subjected to HiDy CE. The MT peak in each electropherogram was then compared to the WT peak. As a result, MT was quantified with high-sensitivity (LOD of 0.004% MT/WT) and four-orders-of-magnitude dynamic range (0.01-100% MT/WT) by HiDy CE. Moreover, compared with existing methods, HiDy CE achieves higher speed, higher sample throughput, and lower consumable cost per sample. It has therefore great potential to be used in clinical practice.
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Affiliation(s)
- Takashi Anazawa
- Research & Development Group, Hitachi, Ltd., 1-280 Higashi-koigakubo, Kokubunji, Tokyo 185-8601, Japan.
| | - Hiroko Matsunaga
- Research & Development Group, Hitachi, Ltd., 1-280 Higashi-koigakubo, Kokubunji, Tokyo 185-8601, Japan. and Present address: Research Organization for Nano and Life Innovation, Waseda University, 513 Waseda-tsurumaki-cho, Shinjuku, Tokyo 162-0041, Japan
| | - Shuhei Yamamoto
- Science & Medical Systems Business Group, Hitachi High-Technologies Corporation, 882 Ichige, Hitachinaka, Ibaraki 312-8504, Japan
| | - Ryoji Inaba
- Science & Medical Systems Business Group, Hitachi High-Technologies Corporation, 882 Ichige, Hitachinaka, Ibaraki 312-8504, Japan
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10
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Offin M, Feldman D, Ni A, Myers ML, Lai WV, Pentsova E, Boire A, Daras M, Jordan EJ, Solit DB, Arcila ME, Jones DR, Isbell JM, Beal K, Young RJ, Rudin CM, Riely GJ, Drilon A, Tabar V, DeAngelis LM, Yu HA, Kris MG, Li BT. Frequency and outcomes of brain metastases in patients with HER2-mutant lung cancers. Cancer 2019; 125:4380-4387. [PMID: 31469421 DOI: 10.1002/cncr.32461] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/13/2019] [Accepted: 06/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mutations in human epidermal growth factor receptor 2 (HER2; also known as ERBB2) are found in approximately 2% of lung adenocarcinomas. The frequency and clinical course of brain metastases in this oncogenic subset are ill defined. METHODS Baseline and subsequent development of brain metastases was evaluated in consecutive patients with HER2-mutant (n = 98), epidermal growth factor receptor (EGFR)-mutant (n = 200), and KRAS-mutant lung cancers (n = 200). RESULTS At metastatic diagnosis, the odds ratio (ORs) for brain metastases was similar for patients whose tumors harbored HER2 mutations (19%) in comparison with patients with KRAS mutations (24%; OR for HER2 vs KRAS, 0.7; P = .33) but lower compared to patients with EGFR mutations (31%; OR for HER2 vs EGFR, 0.5; P = .03). Patients with lung cancer and HER2 mutations developed more brain metastases on treatment than patients with KRAS mutations (28% vs 8%; hazard ratio [HR], 5.2; P < .001) and trended more than patients with EGFR mutations (28% vs 16%; HR, 1.7; P = .06). Patients with HER2 YVMA mutations also developed more brain metastases on treatment than patients with KRAS mutations (HR, 5.9; P < .001). The median overall survival (OS) was shorter for patients with HER2-mutant (1.6 years; P < .001) or KRAS-mutant lung cancers (1.1 years; P < .001) than patients with EGFR-mutant lung cancers (3.0 years). Brain metastases occurred in 47% of patients with HER2-mutant lung cancers, which imparted shorter OS (HR, 2.7; P < .001). CONCLUSIONS These data provide a framework for brain imaging surveillance in patients with HER2-mutant lung cancers and underpin the need to develop HER2-targeted agents with central nervous system activity.
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Affiliation(s)
- Michael Offin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Daniel Feldman
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ai Ni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mackenzie L Myers
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - W Victoria Lai
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Elena Pentsova
- Weill Cornell Medical College, New York, New York.,Neurology Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adrienne Boire
- Weill Cornell Medical College, New York, New York.,Neurology Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mariza Daras
- Weill Cornell Medical College, New York, New York.,Neurology Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emmet J Jordan
- Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - David B Solit
- Weill Cornell Medical College, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Marie-Josée & Henry R. Kravis Center for Molecular Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Weill Cornell Medical College, New York, New York.,Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James M Isbell
- Weill Cornell Medical College, New York, New York.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J Young
- Weill Cornell Medical College, New York, New York.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles M Rudin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Gregory J Riely
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Alexander Drilon
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Viviane Tabar
- Weill Cornell Medical College, New York, New York.,Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa M DeAngelis
- Weill Cornell Medical College, New York, New York.,Neurology Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helena A Yu
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Mark G Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Bob T Li
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
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11
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Teneng I, Picchi MA, Leng S, Dagucon CP, Ramalingam S, Tellez CS, Belinsky SA. DNA-PKc deficiency drives pre-malignant transformation by reducing DNA repair capacity in concert with reprogramming the epigenome in human bronchial epithelial cells. DNA Repair (Amst) 2019; 79:1-9. [PMID: 31055244 PMCID: PMC6551272 DOI: 10.1016/j.dnarep.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/11/2019] [Accepted: 04/13/2019] [Indexed: 12/14/2022]
Abstract
The expression of DNA-dependent protein kinase catalytic subunit (DNA-PKc) is highly variable in smokers and reduced enzyme activity has been associated with risk for lung cancer. An in vitro model of lung pre-malignancy was used to evaluate the role of double-strand break DNA repair capacity in transformation of hTERT/CDK4 immortalized human bronchial epithelial cells (HBECs) and reprograming of the epigenome. Here we show that knockdown of DNA-PKc to levels simulating haploinsufficiency dramatically reduced DNA repair capacity following challenge with bleomycin and significantly increased transformation efficiency of HBEC lines exposed weekly for 12 weeks to this radiomimetic. Transformed HBEC lines with wild type or knockdown of DNA-PKc showed altered expression of more than 1,000 genes linked to major cell regulatory pathways involved in lung cancer. While lung cancer driver mutations were not detected in transformed clones, more than 300 genes that showed reduced expression associated with promoter methylation in transformed clones or predictive for methylation in malignant tumors were identified. These studies support reduced DNA repair capacity as a key factor in the initiation and clonal expansion of pre-neoplastic cells and double-strand break DNA damage as causal for epigenetic mediated silencing of many lung cancer-associated genes. The fact that DNA damage, repair, and epigenetic silencing of genes are causal for many other cancers that include colon and prostate extends the generalizability and impact of these findings.
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Affiliation(s)
- Ivo Teneng
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Maria A Picchi
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Shuguang Leng
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | | | - Suresh Ramalingam
- Department of Hematology and Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Carmen S Tellez
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Steven A Belinsky
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA.
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12
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Genomic landscape of a metastatic malignant proliferating tricholemmal tumor and its response to PI3K inhibition. NPJ Precis Oncol 2019; 3:5. [PMID: 30793038 PMCID: PMC6377617 DOI: 10.1038/s41698-019-0077-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/03/2018] [Indexed: 11/08/2022] Open
Abstract
Proliferating tricholemmal tumors (PTTs) are rare benign neoplasms that arise from the outer sheath of a hair follicle. Occasionally, these PTTs undergo malignant transformation to become malignant proliferating tricholemmal tumors (MPTTs). Little is known about the molecular alterations, malignant progression, and management of MPTTs. Here, we describe the case of a 58-year-old female that had a widely metastatic MPTT that harbored an activating PIK3CA mutation and was sensitive to the PI3K inhibitor, alpelisib (BYL719). We review the available literature on metastatic MPTT, detail the patient's course, and present a whole genome analysis of this rare tumor.
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13
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Patil T, Smith DE, Bunn PA, Aisner DL, Le AT, Hancock M, Purcell WT, Bowles DW, Camidge DR, Doebele RC. The Incidence of Brain Metastases in Stage IV ROS1-Rearranged Non-Small Cell Lung Cancer and Rate of Central Nervous System Progression on Crizotinib. J Thorac Oncol 2018; 13:1717-1726. [PMID: 29981925 PMCID: PMC6204290 DOI: 10.1016/j.jtho.2018.07.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Central nervous system (CNS) metastases in lung cancer are a frequent cause of morbidity and mortality. There are conflicting data on the incidence of CNS metastases in stage IV ROS1-positive NSCLC and the rate of CNS progression during crizotinib therapy. METHODS A retrospective review of 579 patients with stage IV NSCLC between June 2008 and December 2017 was performed. Brain metastases and oncogene status (ROS1, ALK receptor tyrosine kinase gene [ALK], EGFR, KRAS, BRAF, and others) were recorded. We measured progression-free survival and time to CNS progression in ROS1-positive and ALK-positive patients who were taking crizotinib. RESULTS We identified 33 ROS1-positive and 115 ALK-positive patients with stage IV NSCLC. The incidences of brain metastases for treatment-naive, stage IV ROS1-positive and ALK-positive NSCLC were 36% (12 of 33) and 34% (39 of 115), respectively. There were no statistically significant differences in incidence of brain metastases across ROS1, ALK, EGFR, KRAS, BRAF, or other mutations. Complete survival data were available for 19 ROS1-positive and 83 ALK-positive patients. The median progression-free survival times for ROS1-positive and ALK-positive patients were 11 and 8 months, respectively (p = 0.304). The CNS was the first and sole site of progression in 47% of ROS1-positive (nine of 19) and 33% of ALK-positive (28 of 83) patients, with no statistically significant differences between these groups (p = 0.610). CONCLUSIONS Brain metastases are common in treatment-naive stage IV ROS1-positive NSCLC, though the incidence does not differ from that in other oncogene cohorts. The CNS is a common first site of progression in ROS1-positive patients who are taking crizotinib. This study reinforces the importance of developing CNS-penetrant tyrosine kinase inhibitors for patients with ROS1-positive NSCLC.
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Affiliation(s)
- Tejas Patil
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Derek E Smith
- Department of Pediatrics, Cancer Center Biostatistics Core, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Paul A Bunn
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Dara L Aisner
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Anh T Le
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark Hancock
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - William T Purcell
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel W Bowles
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - D Ross Camidge
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert C Doebele
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
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14
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Tessema M, Rossi MR, Picchi MA, Yingling CM, Lin Y, Ramalingam SS, Belinsky SA. Common cancer-driver mutations and their association with abnormally methylated genes in lung adenocarcinoma from never-smokers. Lung Cancer 2018; 123:99-106. [PMID: 30089603 PMCID: PMC6331003 DOI: 10.1016/j.lungcan.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Lung adenocarcinoma in never-smokers accounts for 15-20% of all lung cancer. Although targetable mutations are more prevalent in these tumors, the biological and clinical importance of coexisting and/or mutually exclusive abnormalities is just emerging. This study evaluates the relationships between common genetic and epigenetic aberrations in these tumors. MATERIALS AND METHODS Next-generation sequencing was employed to screen 20 commonly mutated cancer-driver genes in 112 lung adenocarcinomas from never-smokers. The relationship of these mutations with cancer-related methylation of 59 genes, and geographical/ethnic differences in the prevalence for mutations compared to multiple East Asian never-smoker lung adenocarcinoma cohorts was studied. RESULTS The most common driver mutation detected in 40% (45/112) of the tumors was EGFR, followed by TP53 (18%), SETD2 (11%), and SMARCA4 (11%). Over 72% (81/112) of the cases have mutation of at least one driver gene. While 30% (34/112) of the tumors have co-mutations of two or more genes, 42% (47/112) have only one driver gene mutation. Differences in the prevalence for some of these mutations were seen between adenocarcinomas in East Asian versus US (mainly Caucasian) never-smokers including a significantly lower rate of EGFR mutation among the US patients. Interestingly, aberrant methylation of multiple cancer-related genes was significantly associated with EGFR wildtype tumors. Among 15 differentially methylated genes by EGFR mutation, 14 were more commonly methylated in EGFR wildtype compared to mutant tumors. These findings were independently validated using publicly available data. CONCLUSION Most lung adenocarcinomas from never-smokers harbor targetable mutation/co-mutations. In the absence of EGFR mutation that drives 40% of these tumors, EGFR wildtype tumors appear to develop by acquiring aberrant promoter methylation that silences tumor-suppressor genes.
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Affiliation(s)
- Mathewos Tessema
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA.
| | - Michael R Rossi
- Departments of Pathology and Laboratory Medicine, Radiation Oncology, USA
| | - Maria A Picchi
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Christin M Yingling
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Yong Lin
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Suresh S Ramalingam
- Hematology and Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Steven A Belinsky
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, USA.
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15
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Press RH, Zhang C, Cassidy RJ, Ferris MJ, Zhong J, Steuer CE, Pillai RN, Owonikoko TK, Kahn S, Ramalingam SS, Patel PR, Curran WJ, Shu HKG, Sica GL, Higgins KA. Targeted sequencing and intracranial outcomes of patients with lung adenocarcinoma brain metastases treated with radiotherapy. Cancer 2018; 124:3586-3595. [DOI: 10.1002/cncr.31589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/09/2018] [Accepted: 04/30/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Robert H. Press
- Department of Radiation Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Chao Zhang
- Bioinformatics and Biostatistics; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Richard J. Cassidy
- Department of Radiation Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Matthew J. Ferris
- Department of Radiation Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Jim Zhong
- Department of Radiation Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Conor E. Steuer
- Department of Hematology and Medical Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Rathi N. Pillai
- Department of Hematology and Medical Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Taofeek K. Owonikoko
- Department of Hematology and Medical Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Shannon Kahn
- Department of Radiation Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Suresh S. Ramalingam
- Department of Hematology and Medical Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Pretesh R. Patel
- Department of Radiation Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Walter J. Curran
- Department of Radiation Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Hui-Kuo G. Shu
- Department of Radiation Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Gabriel L. Sica
- Department of Pathology; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Kristin A. Higgins
- Department of Radiation Oncology; Winship Cancer Institute, Emory University; Atlanta Georgia
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16
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Zhou QY, Yuan F, Zhang XH, Zhou YL, Zhang XX. Simultaneous multiple single nucleotide polymorphism detection based on click chemistry combined with DNA-encoded probes. Chem Sci 2018; 9:3335-3340. [PMID: 29780463 PMCID: PMC5932596 DOI: 10.1039/c8sc00307f] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/21/2018] [Indexed: 12/30/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) are emerging as important biomarkers for disease diagnosis, prognostics and disease pathogenesis. As one type of disease is always connected to several SNP sites, there is great demand for a reliable multiple SNP detection method. Herein, we mimicked a ligation reaction based on DNA ligase and originally utilized an enzyme-free DNA template-directed click reaction for SNP detection. With 5'-alkyne and 3'-azide groups labelled on two oligonucleotide probes, the target DNA-directed Cu(i)-catalyzed alkyne-azide cycloaddition (CuAAC) click reaction produced a new DNA strand with a triazole backbone, as a mimic of a DNA phosphodiester linkage. Trace amounts of the target (as low as 25 fmol in 50 μL) could be sensitively detected using capillary gel electrophoresis with laser-induced fluorescence (CGE-LIF). Meanwhile, SNP caused an obvious difference in the efficiency of the click reaction, and 0.5% SNP could be easily detected. More importantly, multiplexed SNP detection in a one tube reaction was successfully achieved only by encoding different lengths of the DNA probes for the different SNP sites.
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Affiliation(s)
- Qian-Yu Zhou
- Beijing National Laboratory for Molecular Sciences (BNLMS) , MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering , College of Chemistry , Peking University , Beijing 100871 , China . ; ; ; Tel: +86-10-62754112
| | - Fang Yuan
- Beijing National Laboratory for Molecular Sciences (BNLMS) , MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering , College of Chemistry , Peking University , Beijing 100871 , China . ; ; ; Tel: +86-10-62754112
| | - Xiao-Hui Zhang
- Beijing National Laboratory for Molecular Sciences (BNLMS) , MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering , College of Chemistry , Peking University , Beijing 100871 , China . ; ; ; Tel: +86-10-62754112
| | - Ying-Lin Zhou
- Beijing National Laboratory for Molecular Sciences (BNLMS) , MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering , College of Chemistry , Peking University , Beijing 100871 , China . ; ; ; Tel: +86-10-62754112
| | - Xin-Xiang Zhang
- Beijing National Laboratory for Molecular Sciences (BNLMS) , MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering , College of Chemistry , Peking University , Beijing 100871 , China . ; ; ; Tel: +86-10-62754112
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17
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Fertig EJ, Ozawa H, Thakar M, Howard JD, Kagohara LT, Krigsfeld G, Ranaweera RS, Hughes RM, Perez J, Jones S, Favorov AV, Carey J, Stein-O'Brien G, Gaykalova DA, Ochs MF, Chung CH. CoGAPS matrix factorization algorithm identifies transcriptional changes in AP-2alpha target genes in feedback from therapeutic inhibition of the EGFR network. Oncotarget 2018; 7:73845-73864. [PMID: 27650546 PMCID: PMC5342018 DOI: 10.18632/oncotarget.12075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/02/2016] [Indexed: 01/03/2023] Open
Abstract
Patients with oncogene driven tumors are treated with targeted therapeutics including EGFR inhibitors. Genomic data from The Cancer Genome Atlas (TCGA) demonstrates molecular alterations to EGFR, MAPK, and PI3K pathways in previously untreated tumors. Therefore, this study uses bioinformatics algorithms to delineate interactions resulting from EGFR inhibitor use in cancer cells with these genetic alterations. We modify the HaCaT keratinocyte cell line model to simulate cancer cells with constitutive activation of EGFR, HRAS, and PI3K in a controlled genetic background. We then measure gene expression after treating modified HaCaT cells with gefitinib, afatinib, and cetuximab. The CoGAPS algorithm distinguishes a gene expression signature associated with the anticipated silencing of the EGFR network. It also infers a feedback signature with EGFR gene expression itself increasing in cells that are responsive to EGFR inhibitors. This feedback signature has increased expression of several growth factor receptors regulated by the AP-2 family of transcription factors. The gene expression signatures for AP-2alpha are further correlated with sensitivity to cetuximab treatment in HNSCC cell lines and changes in EGFR expression in HNSCC tumors with low CDKN2A gene expression. In addition, the AP-2alpha gene expression signatures are also associated with inhibition of MEK, PI3K, and mTOR pathways in the Library of Integrated Network-Based Cellular Signatures (LINCS) data. These results suggest that AP-2 transcription factors are activated as feedback from EGFR network inhibition and may mediate EGFR inhibitor resistance.
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Affiliation(s)
- Elana J Fertig
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Hiroyuki Ozawa
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Manjusha Thakar
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Jason D Howard
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Luciane T Kagohara
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Gabriel Krigsfeld
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Ruchira S Ranaweera
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.,Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Robert M Hughes
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Jimena Perez
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Siân Jones
- Personal Genome Diagnostics, Baltimore, MD, USA
| | - Alexander V Favorov
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.,Vavilov Institute of General Genetics, Moscow, Russia.,Research Institute for Genetics and Selection of Industrial Microorganisms, Moscow, Russia
| | - Jacob Carey
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Genevieve Stein-O'Brien
- Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA.,Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Daria A Gaykalova
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael F Ochs
- Department of Mathematics and Statistics, The College of New Jersey, Ewing Township, NJ, USA
| | - Christine H Chung
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.,Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
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18
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Kim E, Feldman R, Wistuba II. Update on EGFR Mutational Testing and the Potential of Noninvasive Liquid Biopsy in Non–Small-cell Lung Cancer. Clin Lung Cancer 2018; 19:105-114. [DOI: 10.1016/j.cllc.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/08/2017] [Indexed: 12/14/2022]
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19
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Clinical prognostic value of the isocitrate dehydrogenase 1 single-nucleotide polymorphism rs11554137 in glioblastoma. J Neurooncol 2018; 138:307-313. [DOI: 10.1007/s11060-018-2796-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/04/2018] [Indexed: 11/27/2022]
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20
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Lv X, Zhao M, Yi Y, Zhang L, Guan Y, Liu T, Yang L, Chen R, Ma J, Yi X. Detection of Rare Mutations in CtDNA Using Next Generation Sequencing. J Vis Exp 2017. [PMID: 28872127 DOI: 10.3791/56342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The analysis of circulating tumor DNA (ctDNA) using next-generation sequencing (NGS) has become a valuable tool for the development of clinical oncology. However, the application of this method is challenging due to its low sensitivity in analyzing the trace amount of ctDNA in the blood. Furthermore, the method may generate false positive and negative results from this sequencing and subsequent analysis. To improve the feasibility and reliability of ctDNA detection in the clinic, here we present a technique which enriches rare mutations for sequencing, Enrich Rare Mutation Sequencing (ER-Seq). ER-Seq can distinguish a single mutation out of 1 x 107 wild-type nucleotides, which makes it a promising tool to detect extremely low frequency genetic alterations and thus will be very useful in studying disease heterogenicity. By virtue of the unique sequencing adapter's ligation, this method enables an efficient recovery of ctDNA molecules, while at the same time correcting for errors bidirectionally (sense and antisense). Our selection of 1021 kb probes enriches the measurement of target regions that cover over 95% of the tumor-related driver mutations in 12 tumors. This cost-effective and universal method enables a uniquely successful accumulation of genetic data. After efficiently filtering out background error, ER-seq can precisely detect rare mutations. Using a case study, we present a detailed protocol demonstrating probe design, library construction, and target DNA capture methodologies, while also including the data analysis workflow. The process to carry out this method typically takes 1-2 days.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xin Yi
- Geneplus-Beijing Institute;
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21
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Abstract
Advances in lung cancer genomics have revolutionized the diagnosis and treatment of this heterogeneous and clinically significant group of tumors. This article provides a broad overview of the most clinically relevant oncogenic alterations in common and rare lung tumors, with an emphasis on the pathologic correlates of the major oncogenic drivers, including EGFR, KRAS, ALK, and MET. Illustrations emphasize the morphologic diversity of lung adenocarcinoma, including genotype-phenotype correlations of genomic evolution in tumorigenesis. Molecular diagnostic approaches, including PCR-based testing, massively parallel sequencing, fluorescence in situ hybridization, and immunohistochemistry are reviewed.
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Affiliation(s)
- Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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22
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Tanaka H, Ishikawa K, Mizuno M, Toyokuni S, Kajiyama H, Kikkawa F, Metelmann HR, Hori M. State of the art in medical applications using non-thermal atmospheric pressure plasma. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41614-017-0004-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Thomas De Montpréville V, Ghigna MR, Lacroix L, Lemoine A, Besse B, Mercier O, Fadel É, Dorfmuller P, Le Chevalier T. EGFR and KRAS molecular genotyping for pulmonary carcinomas: Feasibility of a simple and rapid technique implementable in any department of pathology. Pathol Res Pract 2017; 213:793-798. [DOI: 10.1016/j.prp.2017.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 12/16/2022]
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24
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Cassidy RJ, Zhang X, Patel PR, Shelton JW, Escott CE, Sica GL, Rossi MR, Hill CE, Steuer CE, Pillai RN, Ramalingam SS, Owonikoko TK, Behera M, Force SD, Fernandez FG, Curran WJ, Higgins KA. Next-generation sequencing and clinical outcomes of patients with lung adenocarcinoma treated with stereotactic body radiotherapy. Cancer 2017; 123:3681-3690. [PMID: 28608966 DOI: 10.1002/cncr.30794] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/04/2017] [Accepted: 04/26/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Genetic aberrations are well characterized in lung adenocarcinomas (LACs) and clinical outcomes have been influenced by targeted therapies in the advanced setting. Stereotactic body radiotherapy (SBRT) is the standard-of-care therapy for patients with nonoperable, early-stage LAC, but to the authors' knowledge, no information is available regarding the impact of genomic changes in these patients. The current study sought to determine the frequency and clinical impact of genetic aberrations in this population. METHODS Under an Institutional Review Board-approved protocol, the records of 242 consecutive patients with early-stage lung cancers were reviewed; inclusion criteria included LAC histology with an adequate tumor sample for the successful use of next-generation sequencing and fluorescence in situ hybridization testing. Univariate analysis was performed to identify factors associated with clinical outcomes. RESULTS LAC samples from 98 of the 242 patients were reviewed (40.5%), of whom 45 patients (46.0%) had genetic testing. The following mutations were noted: KRAS in 20.0% of samples, BRAF in 2.2% of samples, SMAD family member 4 (SMAD4) in 4.4% of samples, epidermal growth factor receptor (EGFR) in 15.6% of samples, STK1 in 2.2% of samples, tumor protein 53 (TP53) in 15.6% of samples, and phosphatase and tensin homolog (PTEN) in 2.2% of samples. The following gene rearrangements were observed: anaplastic lymphoma kinase (ALK) in 8.9% of samples, RET in 2.2% of samples, and MET amplification in 17.8% of samples. The median total delivered SBRT dose was 50 grays (range, 48-60 grays) over a median of 5 fractions (range, 3-8 fractions). The KRAS mutation was associated with worse local control (odds ratio [OR], 3.64; P<.05). MET amplification was associated with worse regional (OR, 4.64; P<.05) and distant (OR, 3.73; P<.05) disease control. CONCLUSIONS To the authors' knowledge, the current series is the first to quantify genetic mutations and their association with clinical outcomes in patients with early-stage LAC treated with SBRT. KRAS mutations were associated with worse local control and MET amplification was associated with worse regional and distant disease control, findings that need to be validated in a prospective setting. Cancer 2017;123:3681-3690. © 2017 American Cancer Society.
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Affiliation(s)
- Richard J Cassidy
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Xinyan Zhang
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Joseph W Shelton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Chase E Escott
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Gabriel L Sica
- Department of Pathology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Michael R Rossi
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Charles E Hill
- Department of Pathology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Conor E Steuer
- Department of Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Rathi N Pillai
- Department of Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Taofeek K Owonikoko
- Department of Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Madhusmita Behera
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Seth D Force
- Department of Thoracic Surgery, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Felix G Fernandez
- Department of Thoracic Surgery, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
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25
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Gonzalez RS, Washington K, Shi C. Current applications of molecular pathology in colorectal carcinoma. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s41241-017-0020-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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26
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Polosukhina D, Love HD, Correa H, Su Z, Dahlman KB, Pao W, Moses HL, Arteaga CL, Lovvorn HN, Zent R, Clark PE. Functional KRAS mutations and a potential role for PI3K/AKT activation in Wilms tumors. Mol Oncol 2017; 11:405-421. [PMID: 28188683 PMCID: PMC5378659 DOI: 10.1002/1878-0261.12044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/18/2017] [Accepted: 02/02/2017] [Indexed: 12/18/2022] Open
Abstract
Wilms tumor (WT) is the most common renal neoplasm of childhood and affects 1 in 10 000 children aged less than 15 years. These embryonal tumors are thought to arise from primitive nephrogenic rests that derive from the metanephric mesenchyme during kidney development and are characterized partly by increased Wnt/β-catenin signaling. We previously showed that coordinate activation of Ras and β-catenin accelerates the growth and metastatic progression of a murine WT model. Here, we show that activating KRAS mutations can be found in human WT. In addition, high levels of phosphorylated AKT are present in the majority of WT. We further show in a mouse model and in renal epithelial cells that Ras cooperates with β-catenin to drive metastatic disease progression and promotes in vitro tumor cell growth, migration, and colony formation in soft agar. Cellular transformation and metastatic disease progression of WT cells are in part dependent on PI3K/AKT activation and are inhibited via pharmacological inhibition of this pathway. Our studies suggest both KRAS mutations and AKT activation are present in WT and may represent novel therapeutic targets for this disease.
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Affiliation(s)
- Dina Polosukhina
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold D Love
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hernan Correa
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zengliu Su
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Kimberly B Dahlman
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.,Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Pao
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.,Department of Medicine (Hematology-Oncology), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold L Moses
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.,Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine (Hematology-Oncology), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos L Arteaga
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.,Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine (Hematology-Oncology), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roy Zent
- Department of Medicine, Nephrology & Cancer Biology Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter E Clark
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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27
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Garcia EP, Minkovsky A, Jia Y, Ducar MD, Shivdasani P, Gong X, Ligon AH, Sholl LM, Kuo FC, MacConaill LE, Lindeman NI, Dong F. Validation of OncoPanel: A Targeted Next-Generation Sequencing Assay for the Detection of Somatic Variants in Cancer. Arch Pathol Lab Med 2017; 141:751-758. [PMID: 28557599 DOI: 10.5858/arpa.2016-0527-oa] [Citation(s) in RCA: 336] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT - The analysis of somatic mutations across multiple genes in cancer specimens may be used to aid clinical decision making. The analytical validation of targeted next-generation sequencing panels is important to assess accuracy and limitations. OBJECTIVE - To report the development and validation of OncoPanel, a custom targeted next-generation sequencing assay for cancer. DESIGN - OncoPanel was designed for the detection of single-nucleotide variants, insertions and deletions, copy number alterations, and structural variants across 282 genes with evidence as drivers of cancer biology. We implemented a validation strategy using formalin-fixed, paraffin-embedded, fresh or frozen samples compared with results obtained by clinically validated orthogonal technologies. RESULTS - OncoPanel achieved 98% sensitivity and 100% specificity for the detection of single-nucleotide variants, and 84% sensitivity and 100% specificity for the detection of insertions and deletions compared with single-gene assays and mass spectrometry-based genotyping. Copy number detection achieved 86% sensitivity and 98% specificity compared with array comparative genomic hybridization. The sensitivity of structural variant detection was 74% compared with karyotype, fluorescence in situ hybridization, and polymerase chain reaction. Sensitivity was affected by inconsistency in the detection of FLT3 and NPM1 alterations and IGH rearrangements due to design limitations. Limit of detection studies demonstrated 98.4% concordance across triplicate runs for variants with allele fraction greater than 0.1 and at least 50× coverage. CONCLUSIONS - The analytical validation of OncoPanel demonstrates the ability of targeted next-generation sequencing to detect multiple types of genetic alterations across a panel of genes implicated in cancer biology.
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Affiliation(s)
- Elizabeth P Garcia
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Alissa Minkovsky
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Yonghui Jia
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Matthew D Ducar
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Priyanka Shivdasani
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Xin Gong
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Azra H Ligon
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Lynette M Sholl
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Frank C Kuo
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Laura E MacConaill
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Neal I Lindeman
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
| | - Fei Dong
- From the Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital (Drs Garcia, Minkovsky, Jia, Ligon, Sholl, Kuo, MacConaill, Lindeman, and Dong, Messrs Ducar and Gong, and Ms. Shivdasani), and the Center for Cancer Genome Discovery, Dana Farber Cancer Institute (Mr Ducar and Dr MacConaill), Harvard Medical School, Boston, Massachusetts
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28
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McGowan M, Hoven AS, Lund-Iversen M, Solberg S, Helland Å, Hirsch FR, Brustugun OT. PIK3CA mutations as prognostic factor in squamous cell lung carcinoma. Lung Cancer 2017; 103:52-57. [DOI: 10.1016/j.lungcan.2016.11.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 01/01/2023]
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29
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Abramson VG, Supko JG, Ballinger T, Cleary JM, Hilton JF, Tolaney SM, Chau NG, Cho DC, Pearlberg J, Lager J, Shapiro GI, Arteaga CL. Phase Ib Study of Safety and Pharmacokinetics of the PI3K Inhibitor SAR245408 with the HER3-Neutralizing Human Antibody SAR256212 in Patients with Solid Tumors. Clin Cancer Res 2016; 23:3520-3528. [PMID: 28031425 DOI: 10.1158/1078-0432.ccr-16-1764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/05/2016] [Accepted: 12/14/2016] [Indexed: 11/16/2022]
Abstract
Purpose: This phase Ib study was designed to determine the MTD, safety, preliminary efficacy, and pharmacokinetics of the HER3 (ErbB3) mAb SAR256212 in combination with the oral PI3K inhibitor SAR245408 for patients with metastatic or locally advanced solid tumors.Experimental Design: Patients received the combination of intravenous SAR256212 and oral SAR245408 in a 3 + 3 dose-escalation design until occurrence of disease progression or dose-limiting toxicity. Objective response rate, pharmacokinetics, pharmacodynamics, and PIK3CA mutational status were also evaluated.Results: Twenty-seven patients were enrolled. Thirteen of 20 patients tested (65%) had a hotspot-activating mutation in PIK3CA in their tumor. The MTD was determined to be SAR256212 at 40 mg/kg loading dose followed by 20 mg/kg weekly, plus SAR245408 200 mg daily. Dose-limiting toxicities included rash and hypotension; the most frequent treatment-related side effect was diarrhea (66.7%). Twenty-three patients were evaluable for efficacy, of which 12 patients (52.2%) had stable disease and 11 patients (47.8%) had progression of disease as best response. In this study with a limited sample size, there was no difference in best response between patients with PI3KCA-mutant versus PIK3CA wild-type tumors (P = 0.07). The concurrent administration of SAR245408 and SAR256212 did not appear to have an effect on the pharmacokinetics of either drug.Conclusions: The combination of SAR256212 and SAR245408 resulted in stable disease as the best response. Side effects seen in combination were similar to the profiles of each individual drug. Patient outcome was the same regardless of tumor PI3KCA mutation status. Clin Cancer Res; 23(14); 3520-8. ©2016 AACR.
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Affiliation(s)
- Vandana G Abramson
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey G Supko
- Clinical Pharmacology Laboratory, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Tarah Ballinger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James M Cleary
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John F Hilton
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sara M Tolaney
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Breast Oncology Program, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicole G Chau
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel C Cho
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | | | | | - Geoffrey I Shapiro
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. .,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carlos L Arteaga
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee. .,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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30
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Abstract
In a Perspective, James Topham and Marco Marra discuss progress in the use of genomic information to guide cancer treatment.
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Affiliation(s)
- James T. Topham
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, Canada
| | - Marco A. Marra
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
- * E-mail:
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31
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Goff LW, Cardin DB, Whisenant JG, Du L, Koyama T, Dahlman KB, Salaria SN, Young RT, Ciombor KK, Gilbert J, Smith SJ, Chan E, Berlin J. A phase I trial investigating pulsatile erlotinib in combination with gemcitabine and oxaliplatin in advanced biliary tract cancers. Invest New Drugs 2016; 35:95-104. [PMID: 27853997 PMCID: PMC5306261 DOI: 10.1007/s10637-016-0406-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/08/2016] [Indexed: 12/30/2022]
Abstract
Advanced biliary tract cancers (ABTC) are among the deadliest malignancies with limited treatment options after progression on standard-of-care chemotherapy, which includes gemcitabine (GEM) and oxaliplatin (OX). The epidermal growth factor receptor inhibitor erlotinib has been explored in ABTC with modest efficacy. Erlotinib given continuously may antagonize the action of chemotherapy against cycling tumor cells, but pulsatile dosing of erlotinib with chemotherapy may improve efficacy. The purpose of this study was to assess the safety of pulsatile erlotinib with GEMOX. This was a single-institution phase Ib study that enrolled adult patients with unresectable or metastatic biliary tract, pancreas, duodenal, or ampullary carcinomas that have not received any prior treatment for their disease. Dose escalation followed a standard 3 + 3 design, and dose-limiting toxicities (DLTs) were any treatment-related, first course non-hematologic grade ≥ 3 toxicity, except nausea/vomiting, or grade 4 hematologic toxicity. A dose expansion cohort in ABTC was treated at the MTD. Twenty-eight patients were enrolled and 4 dose levels were explored. The MTD was erlotinib 150 mg + GEM 800 mg/m2 + OX 85 mg/m2. DLTs were diarrhea and anemia. Most frequent toxicities were nausea (78 %), fatigue (71 %), neuropathy (68 %), and diarrhea (61 %), predominantly grade 1–2. In the ABTC patients, the objective response and disease control rates were 29 % and 94 %, respectively, and median overall survival was 18 months. Erlotinib plus GEMOX was well tolerated. Encouraging anti-tumor activity was seen as evidenced by a high disease control rate and longer median OS than standard chemotherapy in the patients with ABTC.
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Affiliation(s)
- Laura W Goff
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB 777, Nashville, TN, 37232, USA. .,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Dana B Cardin
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB 777, Nashville, TN, 37232, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer G Whisenant
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB 777, Nashville, TN, 37232, USA
| | - Liping Du
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Safia N Salaria
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB 777, Nashville, TN, 37232, USA
| | - Ruth T Young
- Vanderbilt-Ingram Cancer Center at Cool Springs, Franklin, TN, USA
| | | | - Jill Gilbert
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB 777, Nashville, TN, 37232, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Emily Chan
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB 777, Nashville, TN, 37232, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jordan Berlin
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Avenue, PRB 777, Nashville, TN, 37232, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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32
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Abstract
The rise of genomically targeted therapies and immunotherapy has revolutionized the practice of oncology in the last 10–15 years. At the same time, new technologies and the electronic health record (EHR) in particular have permeated the oncology clinic. Initially designed as billing and clinical documentation systems, EHR systems have not anticipated the complexity and variety of genomic information that needs to be reviewed, interpreted, and acted upon on a daily basis. Improved integration of cancer genomic data with EHR systems will help guide clinician decision making, support secondary uses, and ultimately improve patient care within oncology clinics. Some of the key factors relating to the challenge of integrating cancer genomic data into EHRs include: the bioinformatics pipelines that translate raw genomic data into meaningful, actionable results; the role of human curation in the interpretation of variant calls; and the need for consistent standards with regard to genomic and clinical data. Several emerging paradigms for integration are discussed in this review, including: non-standardized efforts between individual institutions and genomic testing laboratories; “middleware” products that portray genomic information, albeit outside of the clinical workflow; and application programming interfaces that have the potential to work within clinical workflow. The critical need for clinical-genomic knowledge bases, which can be independent or integrated into the aforementioned solutions, is also discussed.
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Affiliation(s)
- Jeremy L Warner
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA. .,Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37232, USA. .,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
| | - Sandeep K Jain
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37232, USA.,Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| | - Mia A Levy
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37232, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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33
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Jamshidi N, Huang D, Abtin FG, Loh CT, Kee ST, Suh RD, Yamamoto S, Das K, Dry S, Binder S, Enzmann DR, Kuo MD. Genomic Adequacy from Solid Tumor Core Needle Biopsies of ex Vivo Tissue and in Vivo Lung Masses: Prospective Study. Radiology 2016; 282:903-912. [PMID: 27755912 DOI: 10.1148/radiol.2016132230] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To identify the variables and factors that affect the quantity and quality of nucleic acid yields from imaging-guided core needle biopsy. Materials and Methods This study was approved by the institutional review board and compliant with HIPAA. The authors prospectively obtained 232 biopsy specimens from 74 patients (177 ex vivo biopsy samples from surgically resected masses were obtained from 49 patients and 55 in vivo lung biopsy samples from computed tomographic [CT]-guided lung biopsies were obtained from 25 patients) and quantitatively measured DNA and RNA yields with respect to needle gauge, number of needle passes, and percentage of the needle core. RNA quality was also assessed. Significance of correlations among variables was assessed with analysis of variance followed by linear regression. Conditional probabilities were calculated for projected sample yields. Results The total nucleic acid yield increased with an increase in the number of needle passes or a decrease in needle gauge (two-way analysis of variance, P < .0001 for both). However, contrary to calculated differences in volume yields, the effect of needle gauge was markedly greater than the number of passes. For example, the use of an 18-gauge versus a 20-gauge biopsy needle resulted in a 4.8-5.7 times greater yield, whereas a double versus a single pass resulted in a 2.4-2.8 times greater yield for 18- versus 20-gauge needles, respectively. Ninety-eight of 184 samples (53%) had an RNA integrity number of at least 7 (out of a possible score of 10). Conclusion With regard to optimizing nucleic acid yields in CT-guided lung core needle biopsies used for genomic analysis, there should be a preference for using lower gauge needles over higher gauge needles with more passes. ©RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on October 21, 2016.
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Affiliation(s)
- Neema Jamshidi
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Danshan Huang
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Fereidoun G Abtin
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Christopher T Loh
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Stephen T Kee
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Robert D Suh
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Shota Yamamoto
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Kingshuk Das
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Sarah Dry
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Scott Binder
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Dieter R Enzmann
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Michael D Kuo
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
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Somatic Mutation Spectrum of Non-Small-Cell Lung Cancer in African Americans: A Pooled Analysis. J Thorac Oncol 2016; 10:1430-6. [PMID: 26301800 DOI: 10.1097/jto.0000000000000650] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The mutational profile of non-small-cell lung cancer (NSCLC) has become an important tool in tailoring therapy to patients, with clear differences according to the population of origin. African Americans (AAs) have higher lung cancer incidence and mortality than Caucasians, yet discrepant results have been reported regarding the frequency of somatic driver mutations. We hypothesized that NSCLC has a distinct mutational profile in this group. METHODS We collected NSCLC samples resected from self-reported AAs in five sites from Tennessee, Michigan, and Ohio. Gene mutations were assessed by either SNaPshot or next generation sequencing, and ALK translocations were evaluated by fluorescence in situ hybridization. RESULTS Two hundred sixty patients were included, mostly males (62.3%) and smokers (86.6%). Eighty-one samples (31.2%) were squamous cell carcinomas. The most frequently mutated genes were KRAS (15.4%), epidermal growth factor receptor (EGFR, 5.0%), PIK3CA (0.8%), BRAF, NRAS, ERBB2, and AKT1 (0.4% each). ALK translocations were detected in two nonsquamous tumors (1.7%), totaling 61 cases (23.5%) with driver oncogenic alterations. Among 179 nonsquamous samples, 54 (30.2%) presented a driver alteration. The frequency of driver alterations altogether was lower than that reported in Caucasians, whereas no difference was detected in either EGFR or KRAS mutations. Overall survival was longer among patients with EGFR mutations. CONCLUSIONS We demonstrated that NSCLC from AAs has a different pattern of somatic driver mutations than from Caucasians. The majority of driver alterations in this group are yet to be described, which will require more comprehensive panels and assessment of noncanonical alterations.
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Magliacane G, Grassini G, Bartocci P, Francaviglia I, Dal Cin E, Barbieri G, Arrigoni G, Pecciarini L, Doglioni C, Cangi MG. Rapid targeted somatic mutation analysis of solid tumors in routine clinical diagnostics. Oncotarget 2016; 6:30592-603. [PMID: 26435479 PMCID: PMC4741554 DOI: 10.18632/oncotarget.5190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/28/2015] [Indexed: 12/20/2022] Open
Abstract
Tumor genotyping is an essential step in routine clinical practice and pathology laboratories face a major challenge in being able to provide rapid, sensitive and updated molecular tests. We developed a novel mass spectrometry multiplexed genotyping platform named PentaPanel to concurrently assess single nucleotide polymorphisms in 56 hotspots of the 5 most clinically relevant cancer genes, KRAS, NRAS, BRAF, EGFR and PIK3CA for a total of 221 detectable mutations. To both evaluate and validate the PentaPanel performance,we investigated 1025 tumor specimens of 6 different cancer types (carcinomas of colon, lung, breast, pancreas, and biliary tract, and melanomas), systematically addressing sensitivity, specificity, and reproducibility of our platform. Sanger sequencing was also performed for all the study samples. Our data showed that PentaPanel is a high throughput and robust tool, allowing genotyping for targeted therapy selection of 10 patients in the same run, with a practical turnaround time of 2 working days. Importantly, it was successfully used to interrogate different DNAs isolated from routinely processed specimens (formalin-fixed paraffin embedded, frozen, and cytological samples), covering all the requirements of clinical tests. In conclusion, the PentaPanel platform can provide an immediate, accurate and cost effective multiplex approach for clinically relevant gene mutation analysis in many solid tumors and its utility across many diseases can be particularly relevant in multiple clinical trials, including the new basket trial approach, aiming to identify appropriate targeted drug combination strategies.
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Affiliation(s)
- Gilda Magliacane
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Greta Grassini
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Elena Dal Cin
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Gianluigi Arrigoni
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Lorenza Pecciarini
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Claudio Doglioni
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Maria Giulia Cangi
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milano, Italy
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Implications of MDSCs-targeting in lung cancer chemo-immunotherapeutics. Pharmacol Res 2016; 110:25-34. [DOI: 10.1016/j.phrs.2016.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/23/2016] [Accepted: 05/04/2016] [Indexed: 12/23/2022]
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Warner JL, Wang L, Pao W, Sosman JA, Atreya RV, Carney P, Levy MA. CUSTOM-SEQ: a prototype for oncology rapid learning in a comprehensive EHR environment. J Am Med Inform Assoc 2016; 23:692-700. [PMID: 27008846 PMCID: PMC4926743 DOI: 10.1093/jamia/ocw008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/08/2016] [Accepted: 01/13/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND As targeted cancer therapies and molecular profiling become widespread, the era of "precision oncology" is at hand. However, cancer genomes are complex, making mutation-specific outcomes difficult to track. We created a proof-of-principle, CUSTOM-SEQ: Continuously Updating System for Tracking Outcome by Mutation, to Support Evidence-based Querying, to automatically calculate and display mutation-specific survival statistics from electronic health record data. METHODS Patients with cancer genotyping were included, and clinical data was extracted through a variety of algorithms. Results were refreshed regularly and injected into a standard reporting platform. Significant results were highlighted for visual cueing. A subset was additionally stratified by stage, smoking status, and treatment exposure. RESULTS By August 2015, 4310 patients with a median follow-up of 17 months had sufficient data for survival calculation. As expected, epidermal growth factor receptor (EGFR) mutations in lung cancer were associated with superior overall survival, hazard ratio (HR) = 0.53 (P < .001), validating the approach. Guanine nucleotide binding protein (G protein), q polypeptide (GNAQ) mutations in melanoma were associated with inferior overall survival, a novel finding (HR = 3.42, P < .001). Smoking status was not prognostic for epidermal growth factor receptor-mutated lung cancer patients, who also lived significantly longer than their counterparts, even with advanced disease (HR = 0.54, P = .001). INTERPRETATION CUSTOM-SEQ represents a novel rapid learning system for a precision oncology environment. Retrospective studies are often limited by study of specific time periods and can lead to incomplete conclusions. Because data is continuously updated in CUSTOM-SEQ, the evidence base is constantly growing. Future work will allow users to interactively explore populations by demographics and treatment exposure, in order to further investigate significant mutation-specific signals.
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Affiliation(s)
- Jeremy L Warner
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA. Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA.
| | - Lucy Wang
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
| | - William Pao
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA
| | - Jeffrey A Sosman
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA
| | - Ravi V Atreya
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Pam Carney
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
| | - Mia A Levy
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA. Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA. Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
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Hutton JE, Wang X, Zimmerman LJ, Slebos RJC, Trenary IA, Young JD, Li M, Liebler DC. Oncogenic KRAS and BRAF Drive Metabolic Reprogramming in Colorectal Cancer. Mol Cell Proteomics 2016; 15:2924-38. [PMID: 27340238 DOI: 10.1074/mcp.m116.058925] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Indexed: 12/13/2022] Open
Abstract
Metabolic reprogramming, in which altered utilization of glucose and glutamine supports rapid growth, is a hallmark of most cancers. Mutations in the oncogenes KRAS and BRAF drive metabolic reprogramming through enhanced glucose uptake, but the broader impact of these mutations on pathways of carbon metabolism is unknown. Global shotgun proteomic analysis of isogenic DLD-1 and RKO colon cancer cell lines expressing mutant and wild type KRAS or BRAF, respectively, failed to identify significant differences (at least 2-fold) in metabolic protein abundance. However, a multiplexed parallel reaction monitoring (PRM) strategy targeting 73 metabolic proteins identified significant protein abundance increases of 1.25-twofold in glycolysis, the nonoxidative pentose phosphate pathway, glutamine metabolism, and the phosphoserine biosynthetic pathway in cells with KRAS G13D mutations or BRAF V600E mutations. These alterations corresponded to mutant KRAS and BRAF-dependent increases in glucose uptake and lactate production. Metabolic reprogramming and glucose conversion to lactate in RKO cells were proportional to levels of BRAF V600E protein. In DLD-1 cells, these effects were independent of the ratio of KRAS G13D to KRAS wild type protein. A study of 8 KRAS wild type and 8 KRAS mutant human colon tumors confirmed the association of increased expression of glycolytic and glutamine metabolic proteins with KRAS mutant status. Metabolic reprogramming is driven largely by modest (<2-fold) alterations in protein expression, which are not readily detected by the global profiling methods most commonly employed in proteomic studies. The results indicate the superiority of more precise, multiplexed, pathway-targeted analyses to study functional proteome systems. Data are available through MassIVE Accession MSV000079486 at ftp://MSV000079486@massive.ucsd.edu.
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Affiliation(s)
| | | | - Lisa J Zimmerman
- From the ‡Department of Biochemistry, ¶Jim Ayers Institute for Precancer Detection and Diagnosis
| | - Robbert J C Slebos
- From the ‡Department of Biochemistry, ¶Jim Ayers Institute for Precancer Detection and Diagnosis
| | | | - Jamey D Young
- ‖Chemical & Biomolecular Engineering, **Molecular Physiology & Biophysics
| | - Ming Li
- ‡‡Department of Biostatistics, Vanderbilt University, Nashville, Tennessee 37232
| | - Daniel C Liebler
- From the ‡Department of Biochemistry, ¶Jim Ayers Institute for Precancer Detection and Diagnosis,
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Cernomaz AT, Macovei II, Pavel I, Grigoriu C, Marinca M, Baty F, Peter S, Zonda R, Brutsche M, Grigoriu BD. Comparison of next generation sequencing, SNaPshot assay and real-time polymerase chain reaction for lung adenocarcinoma EGFR mutation assessment. BMC Pulm Med 2016; 16:88. [PMID: 27215400 PMCID: PMC4877937 DOI: 10.1186/s12890-016-0250-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/16/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The epidermal growth factor receptor (EGFR) mutation status assessment has become increasingly important given the significant impact of tyrosine kinase inhibitors in lung cancer management. Our aim was to compare real life operational characteristics for three EGFR mutation assays - two targeted approaches and a next generation sequencing (NGS) technique. METHODS EGFR mutation status was assessed for lung adenocarcinoma samples (formalin fixed- paraffin embedded samples) using qPCR, SNaPshot and NGS (Ion Torrent™) techniques. RESULTS A total of 15 high clinical significance mutations were identified by at least one technique from the total of 64 samples. All mutations were identified by the TaqMan qPCR technique while SNaPshot in conjunction with fragment analysis identified 11 EGFR mutations. The NGS approach followed by an automatic analysis using the default calling parameters identified 10 mutations from the SNaPshot/qPCR panel and other three insertions, five point mutations and 58 silent variants; manual data review identified all 15 high significance mutations. CONCLUSIONS Performance was similar for high tumor content samples but careful data analysis and post hoc variant calling filter alterations were necessary in order to obtain robust results from low tumor content samples by NGS. NGS is able to generate a comprehensive mutational profile albeit at a higher cost and workload. Result interpretation should take into account not only general run parameters such as mean read depth but also relative coverage and read distribution; currently there is an acute need to define firm recommendations/standards concerning NGS data interpretation and quality control.
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Affiliation(s)
- Andrei-Tudor Cernomaz
- Department of Thoracic Oncology, Regional Institute of Oncology, University of Medicine and Pharmacy Iasi, Str. Gen. Berthelot, 2-4, Iasi, 700384, Romania
| | - Ina Iuliana Macovei
- Lung Cancer Molecular Diagnostic Laboratory, University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Ionut Pavel
- Lung Cancer Molecular Diagnostic Laboratory, University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Carmen Grigoriu
- Pathology Department, University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Mihai Marinca
- Oncology Department, Regional Institute of Oncology, University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Florent Baty
- Department of Pulmonary Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Simona Peter
- Lung Cancer Molecular Diagnostic Laboratory, University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Radu Zonda
- Lung Cancer Molecular Diagnostic Laboratory, University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Martin Brutsche
- Department of Pulmonary Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Bogdan- Dragos Grigoriu
- Department of Thoracic Oncology, Regional Institute of Oncology, University of Medicine and Pharmacy Iasi, Str. Gen. Berthelot, 2-4, Iasi, 700384, Romania. .,Lung Cancer Molecular Diagnostic Laboratory, University of Medicine and Pharmacy Iasi, Iasi, Romania.
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Owonikoko TK, Zhang G, Kim HS, Stinson RM, Bechara R, Zhang C, Chen Z, Saba NF, Pakkala S, Pillai R, Deng X, Sun SY, Rossi MR, Sica GL, Ramalingam SS, Khuri FR. Patient-derived xenografts faithfully replicated clinical outcome in a phase II co-clinical trial of arsenic trioxide in relapsed small cell lung cancer. J Transl Med 2016; 14:111. [PMID: 27142472 PMCID: PMC4855771 DOI: 10.1186/s12967-016-0861-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/12/2016] [Indexed: 02/03/2023] Open
Abstract
Background SCLC has limited treatment options and inadequate preclinical models. Promising activity of arsenic trioxide (ASO) recorded in conventional preclinical models of SCLC supported the clinical evaluation of ASO in patients. We assessed the efficacy of ASO in relapsed SCLC patients and in corresponding patient-derived xenografts (PDX). Methods Single arm, Simon 2-stage, phase II trial to enroll patients with relapsed SCLC who have failed at least one line of therapy. ASO was administered as an intravenous infusion over 1–2 h daily for 4 days in week 1 and for 2 days in weeks 2–6 of an 8-week cycle. Treatment continued until disease progression. Pretreatment tumor biopsy was employed for PDX generation through direct implantation into subcutaneous pockets of SCID mice without in vitro manipulation and serially propagated for five generations. Ex vivo efficacy of cisplatin (3 mg/kg i.p. weekly) and ASO (3.75 mg/kg i.p. every other day) was tested in PDX representative of platinum sensitive and platinum refractory SCLC. Results The best response in 17 evaluable patients was stable disease in 2 (12 %), progressive disease in 15 (88 %) patients and median time-to-progression of seven (range 1–7) weeks. PDX was successfully grown in 5 of 9 (56 %) transplanted biopsy samples. Serially-propagated PDXs preserved characteristic small cell histology and genomic stability confirmed by immunohistochemistry, short tandem repeat (STR) profiling and targeted sequencing. ASO showed in vitro cytotoxicity but lacked in vivo efficacy against SCLC PDX tumor growth. Conclusions Cisplatin inhibited growth of PDX derived from platinum-sensitive SCLC but was ineffective against PDX from platinum-refractory SCLC. Strong concordance between clinical and ex vivo effects of ASO and cisplatin in SCLC supports the use of PDX models to prescreen promising anticancer agents prior to clinical testing in SCLC patients. Trial Registration The study was registered at http://www.clinicaltrials.gov (NCT01470248) Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0861-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Taofeek K Owonikoko
- Department of Hematology & Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road, NE, Suite C3080, Atlanta, GA, 30322, USA.
| | - Guojing Zhang
- Department of Hematology & Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road, NE, Suite C3080, Atlanta, GA, 30322, USA
| | - Hyun S Kim
- Department of Radiology, Division of Interventional Radiology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, 30322, USA
| | | | - Rabih Bechara
- Department of Medicine, Division of Interventional Pulmonology, Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Chao Zhang
- Department of Biostatistics, Rollins School of Public Health and Biostatistics Shared Resource, Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Zhengjia Chen
- Department of Biostatistics, Rollins School of Public Health and Biostatistics Shared Resource, Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Nabil F Saba
- Department of Hematology & Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road, NE, Suite C3080, Atlanta, GA, 30322, USA
| | - Suchita Pakkala
- Department of Hematology & Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road, NE, Suite C3080, Atlanta, GA, 30322, USA
| | - Rathi Pillai
- Department of Hematology & Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road, NE, Suite C3080, Atlanta, GA, 30322, USA
| | - Xingming Deng
- Department of Radiation Oncology, Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Shi-Yong Sun
- Department of Hematology & Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road, NE, Suite C3080, Atlanta, GA, 30322, USA
| | - Michael R Rossi
- Department of Radiation Oncology, Winship Cancer Institute, Atlanta, GA, 30322, USA.,Department of Pathology, Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Gabriel L Sica
- Department of Pathology, Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Suresh S Ramalingam
- Department of Hematology & Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road, NE, Suite C3080, Atlanta, GA, 30322, USA
| | - Fadlo R Khuri
- Department of Hematology & Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road, NE, Suite C3080, Atlanta, GA, 30322, USA
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Barlesi F, Mazieres J, Merlio JP, Debieuvre D, Mosser J, Lena H, Ouafik L, Besse B, Rouquette I, Westeel V, Escande F, Monnet I, Lemoine A, Veillon R, Blons H, Audigier-Valette C, Bringuier PP, Lamy R, Beau-Faller M, Pujol JL, Sabourin JC, Penault-Llorca F, Denis MG, Lantuejoul S, Morin F, Tran Q, Missy P, Langlais A, Milleron B, Cadranel J, Soria JC, Zalcman G. Routine molecular profiling of patients with advanced non-small-cell lung cancer: results of a 1-year nationwide programme of the French Cooperative Thoracic Intergroup (IFCT). Lancet 2016; 387:1415-1426. [PMID: 26777916 DOI: 10.1016/s0140-6736(16)00004-0] [Citation(s) in RCA: 669] [Impact Index Per Article: 83.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The molecular profiling of patients with advanced non-small-cell lung cancer (NSCLC) for known oncogenic drivers is recommended during routine care. Nationally, however, the feasibility and effects on outcomes of this policy are unknown. We aimed to assess the characteristics, molecular profiles, and clinical outcomes of patients who were screened during a 1-year period by a nationwide programme funded by the French National Cancer Institute. METHODS This study included patients with advanced NSCLC, who were routinely screened for EGFR mutations, ALK rearrangements, as well as HER2 (ERBB2), KRAS, BRAF, and PIK3CA mutations by 28 certified regional genetics centres in France. Patients were assessed consecutively during a 1-year period from April, 2012, to April, 2013. We measured the frequency of molecular alterations in the six routinely screened genes, the turnaround time in obtaining molecular results, and patients' clinical outcomes. This study is registered with ClinicalTrials.gov, number NCT01700582. FINDINGS 18,679 molecular analyses of 17,664 patients with NSCLC were done (of patients with known data, median age was 64·5 years [range 18-98], 65% were men, 81% were smokers or former smokers, and 76% had adenocarcinoma). The median interval between the initiation of analysis and provision of the written report was 11 days (IQR 7-16). A genetic alteration was recorded in about 50% of the analyses; EGFR mutations were reported in 1947 (11%) of 17,706 analyses for which data were available, HER2 mutations in 98 (1%) of 11,723, KRAS mutations in 4894 (29%) of 17,001, BRAF mutations in 262 (2%) of 13,906, and PIK3CA mutations in 252 (2%) of 10,678; ALK rearrangements were reported in 388 (5%) of 8134 analyses. The median duration of follow-up at the time of analysis was 24·9 months (95% CI 24·8-25·0). The presence of a genetic alteration affected first-line treatment for 4176 (51%) of 8147 patients and was associated with a significant improvement in the proportion of patients achieving an overall response in first-line treatment (37% [95% CI 34·7-38·2] for presence of a genetic alteration vs 33% [29·5-35·6] for absence of a genetic alteration; p=0·03) and in second-line treatment (17% [15·0-18·8] vs 9% [6·7-11·9]; p<0·0001). Presence of a genetic alteration was also associated with improved first-line progression-free survival (10·0 months [95% CI 9·2-10·7] vs 7·1 months [6·1-7·9]; p<0·0001) and overall survival (16·5 months [15·0-18·3] vs 11·8 months [10·1-13·5]; p<0·0001) compared with absence of a genetic alteration. INTERPRETATION Routine nationwide molecular profiling of patients with advanced NSCLC is feasible. The frequency of genetic alterations, acceptable turnaround times in obtaining analysis results, and the clinical advantage provided by detection of a genetic alteration suggest that this policy provides a clinical benefit. FUNDING French National Cancer Institute (INCa).
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Affiliation(s)
- Fabrice Barlesi
- Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille University, Centre d'Investigation Clinique, Marseille, France.
| | - Julien Mazieres
- Hôpital Larrey, Centre Hospitalier Universitaire, Université Paul Sabatier, Toulouse, France
| | - Jean-Philippe Merlio
- Centre Hospitalier Universitaire de Bordeaux, Pôle Biologie et Anatomie Pathologique, Pessac, France; Université de Bordeaux, Histologie et Pathologie Moléculaires des Tumeurs, Bordeaux, France
| | | | - Jean Mosser
- Centre Hospitalier Universitaire de Rennes, Département de Génomique et Génétique Moléculaire, Plateforme INCA, Rennes, France
| | - Hervé Lena
- Hôpital Pontchaillou, Service de Pneumologie, Centre Hospitalier Universitaire, Rennes, France
| | - L'Houcine Ouafik
- Assistance Publique Hôpitaux de Marseille, Service de Transfert d'Oncologie Biologique, Aix Marseille University, Marseille, France
| | - Benjamin Besse
- Gustave Roussy, Cancer Campus, Villejuif, France; University Paris-Sud, Châtenay-Malabry, France
| | - Isabelle Rouquette
- Institut Universitaire du Cancer de Toulouse, Oncopôle, Service d'Anatomie Pathologique, Toulouse, France
| | - Virginie Westeel
- Université de Franche-Comté, EA3181, Centre Hospitalier Universitaire Jean Minjoz, Service de Pneumologie, Besançon, France
| | - Fabienne Escande
- Centre Hospitalier Universitaire de Lille, Département de Biochimie et Biologie Moléculaire, Centre de Biologie Pathologie, Lille, France
| | - Isabelle Monnet
- Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie et de Pathologie Professionnelle, Créteil, France
| | - Antoinette Lemoine
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Paris-Sud, Service d'Oncogénétique- Oncomolpath, Université Paris 11, Villejuif, France
| | - Rémi Veillon
- Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Respiratoires, Pessac, France
| | - Hélène Blons
- UMR-S1147, INSERM, Université Paris Descartes, Assistance Publique Hôpitaux de Paris Département de Biologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Pierre-Paul Bringuier
- Hôpital Edouard Herriot, Service d'Anatomie et de Cytologie Pathologique, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon Cancer Research Center, UMR 1057 INSERM, Lyon, France
| | - Régine Lamy
- Centre Hospitalier de Bretagne Sud, Service d'Oncologie Médicale, Lorient, France
| | - Michèle Beau-Faller
- Centre Hospitalier Universitaire de Hautepierre, Laboratoire de Biochimie et de Biologie Moléculaire & Plate-forme de Génomique des Cancers, Strasbourg, France
| | - Jean-Louis Pujol
- Centre Hospitalier Universitaire de Montpellier, Unité d'Oncologie Thoracique, Pôle Cœur Poumon, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Jean-Christophe Sabourin
- Centre Hospitalier Universitaire de Rouen, Département d'Anatomie et de Cytologie Pathologiques, Rouen, France
| | | | - Marc G Denis
- Centre Hospitalier Universitaire de Nantes, Laboratoire de Biochimie, Nantes, France
| | - Sylvie Lantuejoul
- Centre Hospitalier Universitaire A Michallon, Département d'Anatomie et Cytologie Pathologiques DACP, Institut de Biologie et de Pathologie, Université Joseph Fourier-INSERM U 823, Institut Albert Bonniot, Grenoble, France
| | - Franck Morin
- Clinical Research Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Quân Tran
- Clinical Research Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Pascale Missy
- Clinical Research Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Alexandra Langlais
- Biostatistics Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Bernard Milleron
- Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Sorbonne Universités, UPMC Université Paris 06, Paris, France
| | - Jacques Cadranel
- Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Sorbonne Universités, UPMC Université Paris 06, Paris, France
| | - Jean-Charles Soria
- Gustave Roussy, Cancer Campus, Villejuif, France; University Paris-Sud, Châtenay-Malabry, France
| | - Gérard Zalcman
- Centre Hospitalier Universitaire de Caen, Service de Pneumologie et Oncologie Thoracique, Centre de Recherche Clinique, Université de Caen-Basse Normandie, Caen, France
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Integrated digital error suppression for improved detection of circulating tumor DNA. Nat Biotechnol 2016; 34:547-555. [PMID: 27018799 PMCID: PMC4907374 DOI: 10.1038/nbt.3520] [Citation(s) in RCA: 726] [Impact Index Per Article: 90.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/26/2016] [Indexed: 01/06/2023]
Abstract
High-throughput sequencing of circulating tumor DNA (ctDNA) promises to facilitate personalized cancer therapy. However, low quantities of cell-free DNA (cfDNA) in the blood and sequencing artifacts currently limit analytical sensitivity. To overcome these limitations, we introduce an approach for integrated digital error suppression (iDES). Our method combines in silico elimination of highly stereotypical background artifacts with a molecular barcoding strategy for the efficient recovery of cfDNA molecules. Individually, these two methods each improve the sensitivity of cancer personalized profiling by deep sequencing (CAPP-Seq) by ~3 fold, and synergize when combined to yield ~15-fold improvements. As a result, iDES-enhanced CAPP-Seq facilitates noninvasive variant detection across hundreds of kilobases. Applied to clinical non-small cell lung cancer (NSCLC) samples, our method enabled biopsy-free profiling of EGFR kinase domain mutations with 92% sensitivity and 96% specificity and detection of ctDNA down to 4 in 105 cfDNA molecules. We anticipate that iDES will aid the noninvasive genotyping and detection of ctDNA in research and clinical settings.
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Warner JL, Rioth MJ, Mandl KD, Mandel JC, Kreda DA, Kohane IS, Carbone D, Oreto R, Wang L, Zhu S, Yao H, Alterovitz G. SMART precision cancer medicine: a FHIR-based app to provide genomic information at the point of care. J Am Med Inform Assoc 2016; 23:701-10. [PMID: 27018265 DOI: 10.1093/jamia/ocw015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/26/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Precision cancer medicine (PCM) will require ready access to genomic data within the clinical workflow and tools to assist clinical interpretation and enable decisions. Since most electronic health record (EHR) systems do not yet provide such functionality, we developed an EHR-agnostic, clinico-genomic mobile app to demonstrate several features that will be needed for point-of-care conversations. METHODS Our prototype, called Substitutable Medical Applications and Reusable Technology (SMART)® PCM, visualizes genomic information in real time, comparing a patient's diagnosis-specific somatic gene mutations detected by PCR-based hotspot testing to a population-level set of comparable data. The initial prototype works for patient specimens with 0 or 1 detected mutation. Genomics extensions were created for the Health Level Seven® Fast Healthcare Interoperability Resources (FHIR)® standard; otherwise, the prototype is a normal SMART on FHIR app. RESULTS The PCM prototype can rapidly present a visualization that compares a patient's somatic genomic alterations against a distribution built from more than 3000 patients, along with context-specific links to external knowledge bases. Initial evaluation by oncologists provided important feedback about the prototype's strengths and weaknesses. We added several requested enhancements and successfully demonstrated the app at the inaugural American Society of Clinical Oncology Interoperability Demonstration; we have also begun to expand visualization capabilities to include cancer specimens with multiple mutations. DISCUSSION PCM is open-source software for clinicians to present the individual patient within the population-level spectrum of cancer somatic mutations. The app can be implemented on any SMART on FHIR-enabled EHRs, and future versions of PCM should be able to evolve in parallel with external knowledge bases.
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Affiliation(s)
- Jeremy L Warner
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Matthew J Rioth
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Kenneth D Mandl
- Boston Children's Hospital Computational Health Informatics Program, Boston, MA, USA Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Joshua C Mandel
- Boston Children's Hospital Computational Health Informatics Program, Boston, MA, USA Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | | | - Isaac S Kohane
- Boston Children's Hospital Computational Health Informatics Program, Boston, MA, USA Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA Department of Pediatric Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - Daniel Carbone
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ross Oreto
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lucy Wang
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shilin Zhu
- Department of Electrical Engineering and Information Science, University of Science and Technology of China, Hefei, China
| | - Heming Yao
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University, Nashville, TN, USA
| | - Gil Alterovitz
- Boston Children's Hospital Computational Health Informatics Program, Boston, MA, USA Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
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Patil T, Aisner DL, Noonan SA, Bunn PA, Purcell WT, Carr LL, Camidge DR, Doebele RC. Malignant pleural disease is highly associated with subsequent peritoneal metastasis in patients with stage IV non-small cell lung cancer independent of oncogene status. Lung Cancer 2016; 96:27-32. [PMID: 27133746 DOI: 10.1016/j.lungcan.2016.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/17/2016] [Accepted: 03/20/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Peritoneal metastasis from lung cancer is an uncommon clinical event and there are limited data on what factors predict peritoneal progression. This study retrospectively investigated whether patterns of metastatic spread and oncogene status in patients with advanced non-small cell lung cancer (NSCLC) are associated with peritoneal metastasis. METHODS Patients with metastatic non-squamous NSCLC (n=410) were identified at the University of Colorado Cancer Center. Sites of metastatic disease and baseline oncogene status (EGFR, ALK, KRAS, or triple negative) were documented via a retrospective chart review. In patients with EGFR mutations who developed peritoneal disease, we documented the presence of known resistance mechanisms. Median time to peritoneal metastasis, time from peritoneal disease to death, and overall survival were collected. RESULTS Eight percent (33/410) patients in this study developed peritoneal metastasis. Malignant pleural disease at baseline was significantly associated with subsequent peritoneal spread. There was no association between oncogene status and peritoneal metastasis. Three patients with EGFR mutations who developed peritoneal metastasis had documented resistance to tyrosine kinase inhibitors (TKIs) in the ascitic fluid. Median time from stage IV disease to peritoneal metastasis was 16.5 months (range 0.6-108 months). There were no differences in overall survival between patients who developed peritoneal metastasis and those who did not. CONCLUSIONS Malignant pleural disease is highly associated with peritoneal metastasis in patients with advanced NSCLC. The underlying mechanism is not clear. The presence of resistance mutations in ascitic fluid implies that poor drug penetration is unlikely to be the dominant mechanism. Despite being a late clinical finding, there were no differences in overall survival between patients who developed peritoneal metastasis and those who did not. Additional studies exploring treatment related factors in patients with malignant pleural disease that can reduce risk of peritoneal metastasis are warranted.
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Affiliation(s)
- Tejas Patil
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Dara L Aisner
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sinead A Noonan
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Paul A Bunn
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - William T Purcell
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Laurie L Carr
- National Jewish Division of Oncology, Denver, CO, United States
| | - D Ross Camidge
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert C Doebele
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
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Sholl LM, Aisner DL, Varella-Garcia M, Berry LD, Dias-Santagata D, Wistuba II, Chen H, Fujimoto J, Kugler K, Franklin WA, Iafrate AJ, Ladanyi M, Kris MG, Johnson BE, Bunn PA, Minna JD, Kwiatkowski DJ. Multi-institutional Oncogenic Driver Mutation Analysis in Lung Adenocarcinoma: The Lung Cancer Mutation Consortium Experience. J Thorac Oncol 2016; 10:768-777. [PMID: 25738220 DOI: 10.1097/jto.0000000000000516] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Molecular genetic analyses of lung adenocarcinoma have recently become standard of care for treatment selection. The Lung Cancer Mutation Consortium was formed to enable collaborative multi-institutional analyses of 10 potential oncogenic driver mutations. Technical aspects of testing and clinicopathologic correlations are presented. METHODS Mutation testing in at least one of the eight genes (epidermal growth factor receptor [EGFR], KRAS, ERBB2, AKT1, BRAF, MEK1, NRAS, and PIK3CA) using SNaPshot, mass spectrometry, Sanger sequencing+/- peptide nucleic acid and/or sizing assays, along with anaplastic lymphoma kinase (ALK) and/or MET fluorescence in situ hybridization, were performed in six labs on 1007 patients from 14 institutions. RESULTS In all, 1007 specimens had mutation analysis performed, and 733 specimens had all 10 genes analyzed. Mutation identification rates did not vary by analytic method. Biopsy and cytology specimens were inadequate for testing in 26% and 35% of cases compared with 5% of surgical specimens. Among the 1007 cases with mutation analysis performed, EGFR, KRAS, ALK, and ERBB2 alterations were detected in 22%, 25%, 8.5%, and 2.4% of cases, respectively. EGFR mutations were highly associated with female sex, Asian race, and never-smoking status; and less strongly associated with stage IV disease, presence of bone metastases, and absence of adrenal metastases. ALK rearrangements were strongly associated with never-smoking status and more weakly associated with presence of liver metastases. ERBB2 mutations were strongly associated with Asian race and never-smoking status. Two mutations were seen in 2.7% of samples, all but one of which involved one or more of PIK3CA, ALK, or MET. CONCLUSION Multi-institutional molecular analysis across multiple platforms, sample types, and institutions can yield consistent results and novel clinicopathological observations.
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Affiliation(s)
- Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dara L Aisner
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Marileila Varella-Garcia
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Lynne D Berry
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Dora Dias-Santagata
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Heidi Chen
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Junya Fujimoto
- Department of Translational Molecular Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Kelly Kugler
- Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Wilbur A Franklin
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marc Ladanyi
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark G Kris
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bruce E Johnson
- Department of Medicine, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Paul A Bunn
- Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Lung Cancer Mutation Consortium, University of Colorado Cancer Center, Aurora, Colorado
| | | | - David J Kwiatkowski
- Department of Medicine, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Akabane H, Sullivan RJ. The Future of Molecular Analysis in Melanoma: Diagnostics to Direct Molecularly Targeted Therapy. Am J Clin Dermatol 2016; 17:1-10. [PMID: 26518880 DOI: 10.1007/s40257-015-0159-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Melanoma is a malignancy of pigment-producing cells that is driven by a variety of genetic mutations and aberrations. In most cases, this leads to upregulation of the mitogen-activated protein kinase (MAPK) pathway through activating mutations of upstream mediators of the pathway including BRAF and NRAS. With the advent of effective MAPK pathway inhibitors, including the US FDA-approved BRAF inhibitors vemurafenib and dabrafenib and MEK inhibitor trametinib, molecular analysis has become an integral part of the care of patients with metastatic melanoma. In this article, the key molecular targets and strategies to inhibit these targets therapeutically are presented, and the techniques of identifying these targets, in both tissue and blood, are discussed.
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Affiliation(s)
- Hugo Akabane
- Department of Medicine, Metrowest Medical Center, Framingham, MA, USA
| | - Ryan J Sullivan
- Center for Melanoma, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, 02114, USA.
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Tu M, Chia D, Wei F, Wong D. Liquid biopsy for detection of actionable oncogenic mutations in human cancers and electric field induced release and measurement liquid biopsy (eLB). Analyst 2016; 141:393-402. [PMID: 26645892 PMCID: PMC4701580 DOI: 10.1039/c5an01863c] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Oncogenic activations by mutations in key cancer genes such as EGFR and KRAS are frequently associated with human cancers. Molecular targeting of specific oncogenic mutations in human cancer is a major therapeutic inroad for anti-cancer drug therapy. In addition, progressive developments of oncogene mutations lead to drug resistance. Therefore, the ability to detect and continuously monitor key actionable oncogenic mutations is important to guide the use of targeted molecular therapies to improve long-term clinical outcomes in cancer patients. Current oncogenic mutation detection is based on direct sampling of cancer tissue by surgical resection or biopsy. Oncogenic mutations were recently shown to be detectable in circulating bodily fluids of cancer patients. This field of investigation, termed liquid biopsy, permits a less invasive means of assessing the oncogenic mutation profile of a patient. This paper will review the analytical strategies used to assess oncogenic mutations from biofluid samples. Clinical applications will also be discussed.
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Affiliation(s)
- Michael Tu
- School of Dentistry, University of California, Los Angeles, CA, USA.
| | - David Chia
- Department of Pathology, UCLA David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Fang Wei
- School of Dentistry, University of California, Los Angeles, CA, USA.
| | - David Wong
- School of Dentistry, University of California, Los Angeles, CA, USA.
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Fisher KE, Zhang L, Wang J, Smith GH, Newman S, Schneider TM, Pillai RN, Kudchadkar RR, Owonikoko TK, Ramalingam SS, Lawson DH, Delman KA, El-Rayes BF, Wilson MM, Sullivan HC, Morrison AS, Balci S, Adsay NV, Gal AA, Sica GL, Saxe DF, Mann KP, Hill CE, Khuri FR, Rossi MR. Clinical Validation and Implementation of a Targeted Next-Generation Sequencing Assay to Detect Somatic Variants in Non-Small Cell Lung, Melanoma, and Gastrointestinal Malignancies. J Mol Diagn 2016; 18:299-315. [PMID: 26801070 DOI: 10.1016/j.jmoldx.2015.11.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/05/2015] [Accepted: 11/19/2015] [Indexed: 12/30/2022] Open
Abstract
We tested and clinically validated a targeted next-generation sequencing (NGS) mutation panel using 80 formalin-fixed, paraffin-embedded (FFPE) tumor samples. Forty non-small cell lung carcinoma (NSCLC), 30 melanoma, and 30 gastrointestinal (12 colonic, 10 gastric, and 8 pancreatic adenocarcinoma) FFPE samples were selected from laboratory archives. After appropriate specimen and nucleic acid quality control, 80 NGS libraries were prepared using the Illumina TruSight tumor (TST) kit and sequenced on the Illumina MiSeq. Sequence alignment, variant calling, and sequencing quality control were performed using vendor software and laboratory-developed analysis workflows. TST generated ≥500× coverage for 98.4% of the 13,952 targeted bases. Reproducible and accurate variant calling was achieved at ≥5% variant allele frequency with 8 to 12 multiplexed samples per MiSeq flow cell. TST detected 112 variants overall, and confirmed all known single-nucleotide variants (n = 27), deletions (n = 5), insertions (n = 3), and multinucleotide variants (n = 3). TST detected at least one variant in 85.0% (68/80), and two or more variants in 36.2% (29/80), of samples. TP53 was the most frequently mutated gene in NSCLC (13 variants; 13/32 samples), gastrointestinal malignancies (15 variants; 13/25 samples), and overall (30 variants; 28/80 samples). BRAF mutations were most common in melanoma (nine variants; 9/23 samples). Clinically relevant NGS data can be obtained from routine clinical FFPE solid tumor specimens using TST, benchtop instruments, and vendor-supplied bioinformatics pipelines.
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Affiliation(s)
- Kevin E Fisher
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; Department of Pathology, Texas Children's Hospital, Houston, Texas; Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas.
| | - Linsheng Zhang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jason Wang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; Department of Pathology, University of Texas Southwestern and Children's Medical Center, Dallas, Texas
| | - Geoffrey H Smith
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Scott Newman
- Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, Georgia
| | - Thomas M Schneider
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Rathi N Pillai
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Ragini R Kudchadkar
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Taofeek K Owonikoko
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - David H Lawson
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Keith A Delman
- Winship Cancer Institute, Emory University, Atlanta, Georgia; Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bassel F El-Rayes
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - H Clifford Sullivan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Annie S Morrison
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Serdar Balci
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - N Volkan Adsay
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Anthony A Gal
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gabriel L Sica
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Debra F Saxe
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Karen P Mann
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Charles E Hill
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Fadlo R Khuri
- Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Michael R Rossi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
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Pirazzoli V, Ayeni D, Meador CB, Sanganahalli BG, Hyder F, de Stanchina E, Goldberg SB, Pao W, Politi K. Afatinib plus Cetuximab Delays Resistance Compared to Single-Agent Erlotinib or Afatinib in Mouse Models of TKI-Naïve EGFR L858R-Induced Lung Adenocarcinoma. Clin Cancer Res 2016; 22:426-35. [PMID: 26341921 PMCID: PMC4715986 DOI: 10.1158/1078-0432.ccr-15-0620] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/18/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE The EGFR tyrosine kinase inhibitors (TKIs), erlotinib and afatinib, have transformed the treatment of advanced EGFR-mutant lung adenocarcinoma. However, almost all patients who respond develop acquired resistance on average approximately 1 year after starting therapy. Resistance is commonly due to a secondary mutation in EGFR (EGFR(T790M)). We previously found that the combination of the EGFR TKI afatinib and the EGFR antibody cetuximab could overcome EGFR(T790M)-mediated resistance in preclinical models. This combination has shown a 29% response rate in a clinical trial in patients with acquired resistance to first-generation TKIs. An outstanding question is whether this regimen is beneficial when used as first-line therapy. EXPERIMENTAL DESIGN Using mouse models of EGFR-mutant lung cancer, we tested whether the combination of afatinib plus cetuximab delivered upfront to mice with TKI-naïve EGFR(L858R)-induced lung adenocarcinomas delayed tumor relapse and drug-resistance compared with single-agent TKIs. RESULTS Afatinib plus cetuximab markedly delayed the time to relapse and incidence of drug-resistant tumors, which occurred in only 63.6% of the mice, in contrast to erlotinib or afatinib treatment where 100% of mice developed resistance. Mechanisms of tumor escape observed in afatinib plus cetuximab resistant tumors include the EGFR(T790M) mutation and Kras mutations. Experiments in cell lines and xenografts confirmed that the afatinib plus cetuximab combination does not suppress the emergence of EGFR(T790M). CONCLUSIONS These results highlight the potential of afatinib plus cetuximab as an effective treatment strategy for patients with TKI-naïve EGFR-mutant lung cancer and indicate that clinical trial development in this area is warranted.
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Affiliation(s)
- Valentina Pirazzoli
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Deborah Ayeni
- Experimental Pathology Graduate Program, Graduate School of Arts and Sciences, Yale University, New Haven, Connecticut. Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Catherine B Meador
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Basavaraju G Sanganahalli
- Department of Diagnostic Radiology and Magnetic Resonance Research Center, Yale University School of Medicine, New Haven, Connecticut
| | - Fahmeed Hyder
- Department of Diagnostic Radiology and Magnetic Resonance Research Center, Yale University School of Medicine, New Haven, Connecticut. Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, Connecticut
| | - Elisa de Stanchina
- Antitumor Assessment Core, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarah B Goldberg
- Department of Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - William Pao
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee. Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Katerina Politi
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut. Department of Pathology, Yale University School of Medicine, New Haven, Connecticut. Department of Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut.
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50
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Weitzel KW, Alexander M, Bernhardt BA, Calman N, Carey DJ, Cavallari LH, Field JR, Hauser D, Junkins HA, Levin PA, Levy K, Madden EB, Manolio TA, Odgis J, Orlando LA, Pyeritz R, Wu RR, Shuldiner AR, Bottinger EP, Denny JC, Dexter PR, Flockhart DA, Horowitz CR, Johnson JA, Kimmel SE, Levy MA, Pollin TI, Ginsburg GS. The IGNITE network: a model for genomic medicine implementation and research. BMC Med Genomics 2016; 9:1. [PMID: 26729011 PMCID: PMC4700677 DOI: 10.1186/s12920-015-0162-5] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/17/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients, clinicians, researchers and payers are seeking to understand the value of using genomic information (as reflected by genotyping, sequencing, family history or other data) to inform clinical decision-making. However, challenges exist to widespread clinical implementation of genomic medicine, a prerequisite for developing evidence of its real-world utility. METHODS To address these challenges, the National Institutes of Health-funded IGNITE (Implementing GeNomics In pracTicE; www.ignite-genomics.org ) Network, comprised of six projects and a coordinating center, was established in 2013 to support the development, investigation and dissemination of genomic medicine practice models that seamlessly integrate genomic data into the electronic health record and that deploy tools for point of care decision making. IGNITE site projects are aligned in their purpose of testing these models, but individual projects vary in scope and design, including exploring genetic markers for disease risk prediction and prevention, developing tools for using family history data, incorporating pharmacogenomic data into clinical care, refining disease diagnosis using sequence-based mutation discovery, and creating novel educational approaches. RESULTS This paper describes the IGNITE Network and member projects, including network structure, collaborative initiatives, clinical decision support strategies, methods for return of genomic test results, and educational initiatives for patients and providers. Clinical and outcomes data from individual sites and network-wide projects are anticipated to begin being published over the next few years. CONCLUSIONS The IGNITE Network is an innovative series of projects and pilot demonstrations aiming to enhance translation of validated actionable genomic information into clinical settings and develop and use measures of outcome in response to genome-based clinical interventions using a pragmatic framework to provide early data and proofs of concept on the utility of these interventions. Through these efforts and collaboration with other stakeholders, IGNITE is poised to have a significant impact on the acceleration of genomic information into medical practice.
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Affiliation(s)
- Kristin Wiisanen Weitzel
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida (UF) College of Pharmacy, Gainesville, FL, USA.
| | - Madeline Alexander
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Barbara A Bernhardt
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Neil Calman
- Institute for Family Health, New York, NY, USA.
| | - David J Carey
- Weis Center for Research, Geisinger Health System, Danville, PA, USA.
| | - Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida (UF) College of Pharmacy, Gainesville, FL, USA.
| | - Julie R Field
- Institute for Clinical and Translational Research, School of Medicine, Vanderbilt University, Nashville, TN, USA.
| | | | - Heather A Junkins
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Phillip A Levin
- Bay West Endocrinology Associates and MODEL Clinical Research, Baltimore, MD, USA.
| | - Kenneth Levy
- Department of Medicine, Indiana University School of Medicine, Indiana, IN, USA.
| | - Ebony B Madden
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Teri A Manolio
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Jacqueline Odgis
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Lori A Orlando
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, 101 Science Dr, Rm 2111, CIEMAS Bldg, Durham, NC, 27708, USA.
| | - Reed Pyeritz
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - R Ryanne Wu
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, 101 Science Dr, Rm 2111, CIEMAS Bldg, Durham, NC, 27708, USA.
| | - Alan R Shuldiner
- University of Maryland School of Medicine, Baltimore, MD, USA.
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA.
| | - Erwin P Bottinger
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Joshua C Denny
- Departments of Biomedical Informatics and Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Paul R Dexter
- Department of Medicine, Indiana University School of Medicine, Indiana, IN, USA.
| | - David A Flockhart
- Department of Medicine, Indiana University School of Medicine, Indiana, IN, USA.
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida (UF) College of Pharmacy, Gainesville, FL, USA.
| | - Stephen E Kimmel
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Clinical Epidemiology and Biostatistics, Center for Therapeutic Effectiveness Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Mia A Levy
- Departments of Biomedical Informatics and Medicine, Division of Hematology and Oncology, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Toni I Pollin
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Geoffrey S Ginsburg
- Duke Center for Applied Genomics and Precision Medicine, Duke University Medical Center, 101 Science Dr, Rm 2111, CIEMAS Bldg, Durham, NC, 27708, USA.
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