1
|
Liu J, Zhao Z, Wei S, Li B, Zhao Z. Genomic features of Chinese small cell lung cancer. BMC Med Genomics 2022; 15:117. [PMID: 35596192 PMCID: PMC9123817 DOI: 10.1186/s12920-022-01255-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background Small cell lung cancer (SCLC) is an aggressive disease with poor survival. Although molecular and clinical characteristics have been established for SCLC in western patients, limited investigation has been performed for Chinese SCLC patients. Objective In this study, we investigated the genomic features of Chinese SCLC patients. Methods A total of 75 SCLC patients were enrolled. Genomic alterations in 618 selected genes were analyzed by targeted next-generation sequencing. Results Here, we showed that TP53 (77.30%) and RB1 (30.70%) were the most prevalent genes alterations, followed by KMT2D, ALK, LRP1B, EGFR, NOTCH3, AR, CREBBP, ROS1, and BRCA2. And the most common genetic alterations were enriched in the cell cycle signaling pathway (84.00%) of Chinese SCLC patients. DNA damage repair (DDR) pathway analysis showed that the most frequently enriched DDR pathways were fanconi anaemia (FA, 29.41%) and homology recombination (HR, 21.57%). Notably, 9.33% SCLC patients in our cohort had pathogenic or likely pathogenic germline gene variants. Compared with the U Cologne cohort, a higher prevalence in EGFR, AR, BRCA2, TSC1, ATXN3, MET, MSH2, ERBB3 and FOXA1 were found in our cohort; while compared to the data from the Johns Hopkins cohort, a higher mutated frequency in TP53, KMT2D, ALK, and EGFR were found in our cohort. Moreover, a significant association was found between high tumor mutation burden (TMB) and mutations involved in TP53, CREBBP, EPHA3, KMT2D, ALK and RB1. Approximately 33.33% of patients with SCLC harbored at least one actionable alteration annotated by OncoKB, of which one patient had alterations of level 1; seventeen patients had level 3; fifteen patients possessed level 4. Conclusion Our data might provide an insightful meaning in targeted therapy for Chinese SCLC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01255-3.
Collapse
Affiliation(s)
- Jun Liu
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of South China University of Technology, Guangzhou, 510000, China
| | - Zhuxiang Zhao
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of South China University of Technology, Guangzhou, 510000, China
| | - Shuquan Wei
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of South China University of Technology, Guangzhou, 510000, China
| | - Binkai Li
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of South China University of Technology, Guangzhou, 510000, China
| | - Ziwen Zhao
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of South China University of Technology, Guangzhou, 510000, China.
| |
Collapse
|
2
|
Liang X, Lin A, Wang Q, Zhang J, Luo P. Cell plasticity in patients with NSCLC: The controversial origins of transformed SCLC. Biomed Pharmacother 2022; 149:112909. [DOI: 10.1016/j.biopha.2022.112909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/02/2022] Open
|
3
|
Small Cell Lung Cancer Transformation following Treatment in EGFR-Mutated Non-Small Cell Lung Cancer. J Clin Med 2022; 11:jcm11051429. [PMID: 35268520 PMCID: PMC8911080 DOI: 10.3390/jcm11051429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 01/21/2023] Open
Abstract
EGFR-mutated lung adenocarcinoma patients who received tyrosine kinase inhibitors (TKIs) may initially respond to therapy, but over time, resistance eventually occurs. In a small population (5–10%), these patients can have a histological transformation to SCLC. Nine patients with EGFR-mutated lung adenocarcinoma who transformed to SCLC were evaluated at City of Hope. Patient clinical and pathology data, including multiple next-generation sequencing (NGS) results, clinical therapies, histology, and outcomes, were collected across multiple time points. Descriptive statistics were utilized to visualize and interpret the clinical therapeutic timeline and molecular transformation profiles for these patients. All patients received at least one line of EGFR TKI therapies prior to small cell lung cancer transformation, including erlotinib, afatinib, and osimertinib. Two patients also received chemotherapy prior to transformation (one with immunotherapy). The median months to small cell lung cancer transformation was 16 months, ranging from 4–49 months. The median overall survival (OS) was 29 months from diagnosis, with the minimum of 16 months and maximum of 62 months. The majority of patients had EGFR exon 19 deletion (n = 7, 77.8%), and no patients had a change of original oncogenic EGFR mutation over the different time points. Though a TP53 mutation was detected in eight patients (88.9%) either at the first biopsy or the subsequent biopsies, an RB1 alteration was only detected in one patient at presentation, and three patients upon subsequent biopsies (n = 4, 44.4%). Each patient had a unique molecular profile in the subsequent molecular testing post-transformation, but BRAF alterations occurred frequently, including BRAF rearrangement (n = 1), fusion (n = 1), and amplification (n = 1). Our results showed that EGFR-mutated lung adenocarcinoma to SCLC transformation patients have a unique histological, molecular, and clinical profile over multiple time points, with further heterogeneity that is not currently reported in the literature, and we suggest more work is required to better understand the molecular heterogeneity and clinical outcomes over time for this EGFR TKI resistance subtype.
Collapse
|
4
|
Vendrell JA, Quantin X, Aussel A, Solassol I, Serre I, Solassol J. EGFR-dependent mechanisms of resistance to osimertinib determined by ctDNA NGS analysis identify patients with better outcome. Transl Lung Cancer Res 2022; 10:4084-4094. [PMID: 35004240 PMCID: PMC8674606 DOI: 10.21037/tlcr-21-679] [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: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 12/25/2022]
Abstract
Background Osimertinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) that is highly selective for EGFRT790M subclones in patients with EGFRsensitizing non-small cell lung cancer (NSCLC). Unfortunately, all patients develop resistance through EGFR-dependent or EGFR-independent pathways. Recently, circulating tumoral DNA (ctDNA) analysis has highlighted the usefulness of plasma genotyping for exploring patient survival outcomes after disease progression under osimertinib. Methods Plasma samples from patients treated with osimertinib as a second-line therapy were collected and the presence of molecular alterations of acquired resistance was evaluated after relapse under osimertinib using ctDNA molecular profiling by next-generation sequencing (NGS) assays. The clinical implications of these genomic alterations for the efficiency of the third-generation TKI were further assessed. Results Our ctDNA molecular profiling of plasma samples highlighted large number of actionable genomic alterations. According to ctDNA NGS results, patients were classified as having developed an EGFR-dependent or EGFR-independent mechanism of resistance. Thus, patients who developed an EGFR-dependent mechanism of resistance responded longer to osimertinib (13.8 vs. 4.6 months; P<10−4) and have a better post-osimertinib clinical outcome than EGFR-independent resistant patients. Moreover, the development of an EGFR-dependent mechanism of osimertinib resistance was identified as the best fit to determine patients’ clinical outcome compared with EGFRT790M status alone (P=0.003). Conclusions Our study highlights the potential of ctDNA NGS to rapidly select the appropriate drug after osimertinib failure and to determine clinical outcomes of patients. We suggest that ctDNA NGS should be more intensively used in clinical practice to follow patients under third-generation TKIs.
Collapse
Affiliation(s)
- Julie A Vendrell
- CHU Montpellier, Department of Pathology and Onco-biology, Univ Montpellier, Montpellier, France
| | - Xavier Quantin
- IRCM, INSERM, Univ Montpellier, ICM, Montpellier, France
| | - Audrey Aussel
- CHU Montpellier, Department of Pathology and Onco-biology, Univ Montpellier, Montpellier, France
| | | | - Isabelle Serre
- CHU Montpellier, Department of Pathology and Onco-biology, Univ Montpellier, Montpellier, France
| | - Jérôme Solassol
- CHU Montpellier, Department of Pathology and Onco-biology, Univ Montpellier, Montpellier, France.,IRCM, INSERM, Univ Montpellier, ICM, Montpellier, France
| |
Collapse
|
5
|
Gregorc V, Lazzari C, Mandalá M, Ippati S, Bulotta A, Cangi MG, Khater A, Viganò MG, Mirabile A, Pecciarini L, Ogliari FR, Arrigoni G, Grassini G, Veronesi G, Doglioni C. Intratumoral Cellular Heterogeneity: Implications for Drug Resistance in Patients with Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13092023. [PMID: 33922215 PMCID: PMC8122731 DOI: 10.3390/cancers13092023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary The number of druggable tumor-specific molecular alterations in the treatment of non-small cell lung cancer (NSCLC) has grown significantly in the past decade. Emerging technologies such as liquid biopsy and single-cell methods allow for studying targetable drivers and develop personalized treatments. However, although new therapies confer prolonged disease control and high tumor response rates, most patients eventually progress on targeted treatments. Intratumoral heterogeneity is a frequent event in NSCLC, driving the tumor cells to develop adaptive or new resistance mechanisms within the drug environment. This review summarizes the current and upcoming research on the biological role of tumor heterogeneity, highlighting the link between early and acquired drug resistance and tumoral heterogeneity in targetable driver mutated NSCLC. Abstract Tailored therapies based on the identification of molecular targets currently represent a well-established therapeutic scenario in the treatment of non-small cell lung cancer (NSCLC) patients. However, while aiming to improve patients’ response to therapy, development of resistance is frequently observed in daily clinical practice. Intratumoral heterogeneity is a frequent event in NSCLC, responsible for several critical issues in patients’ diagnosis and treatment. Advances in single-cell sequencing technologies have allowed in-depth profiling of tumors and attributed intratumoral heterogeneity to genetic, epigenetic, and protein modification driven diversities within cancer cell populations. This review highlights current research on the biological role of tumor heterogeneity and its impact on the development of acquired resistance in NSCLC patients.
Collapse
Affiliation(s)
- Vanesa Gregorc
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
- Correspondence:
| | - Chiara Lazzari
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Mario Mandalá
- Division of Pathological Anatomy, Papa Giovanni XXIII Hospital, 24100 Bergamo, Italy;
- Unit of Medical Oncology, University of Perugia, 06123 Perugia, Italy
| | - Stefania Ippati
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Maria Giulia Cangi
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Abdelrahman Khater
- San Raffaele Hospital, IRCCS, University Vita Salute, 20132 Milan, Italy;
| | - Maria Grazia Viganò
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Aurora Mirabile
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Lorenza Pecciarini
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Francesca Rita Ogliari
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Gianluigi Arrigoni
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Greta Grassini
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Giulia Veronesi
- Division of Thoracic Surgery, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy;
| | - Claudio Doglioni
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| |
Collapse
|
6
|
Abstract
Small-cell lung cancer (SCLC) represents about 15% of all lung cancers and is marked by an exceptionally high proliferative rate, strong predilection for early metastasis and poor prognosis. SCLC is strongly associated with exposure to tobacco carcinogens. Most patients have metastatic disease at diagnosis, with only one-third having earlier-stage disease that is amenable to potentially curative multimodality therapy. Genomic profiling of SCLC reveals extensive chromosomal rearrangements and a high mutation burden, almost always including functional inactivation of the tumour suppressor genes TP53 and RB1. Analyses of both human SCLC and murine models have defined subtypes of disease based on the relative expression of dominant transcriptional regulators and have also revealed substantial intratumoural heterogeneity. Aspects of this heterogeneity have been implicated in tumour evolution, metastasis and acquired therapeutic resistance. Although clinical progress in SCLC treatment has been notoriously slow, a better understanding of the biology of disease has uncovered novel vulnerabilities that might be amenable to targeted therapeutic approaches. The recent introduction of immune checkpoint blockade into the treatment of patients with SCLC is offering new hope, with a small subset of patients deriving prolonged benefit. Strategies to direct targeted therapies to those patients who are most likely to respond and to extend the durable benefit of effective antitumour immunity to a greater fraction of patients are urgently needed and are now being actively explored.
Collapse
Affiliation(s)
- Charles M Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Elisabeth Brambilla
- Institute for Advanced Biosciences, Université Grenoble Alpes, Grenoble, France
| | - Corinne Faivre-Finn
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Julien Sage
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Genetics, Stanford University, Stanford, CA, USA
| |
Collapse
|
7
|
Clamon G, Zeitler W, An J, Hejleh TA. Transformational Changes Between Non-Small Cell and Small Cell Lung Cancer-Biological and Clinical Relevance-A Review. Am J Clin Oncol 2020; 43:670-675. [PMID: 32889839 DOI: 10.1097/coc.0000000000000720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During the course of therapy, patients with small cell lung cancer have been noted to develop transformation to non-small cell lung cancer and conversely, patients with non-small cell lung cancer have had transformation to small cell lung cancer or other non-small cell histologies. Transformation may occur after prior tyrosine kinase inhibitors, chemotherapy, immunotherapy or radiation therapy. These changes reflect on the overlapping biology of these cell types and the clinical need for re-biopsy at times of disease progression. The optimum therapy after transformation will depend upon prior therapies received, the functional capacity of the patient, and further research to define the best therapy options.
Collapse
Affiliation(s)
- Gerald Clamon
- Department of Internal Medicine, Division of Hematology, Oncology, Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | | | | |
Collapse
|