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Isaksson J, Berglund A, Louie K, Willén L, Hamidian A, Edsjö A, Enlund F, Planck M, Vikström A, Johansson M, Hallqvist A, Wagenius G, Botling J. KRAS G12C Mutant Non-Small Cell Lung Cancer Linked to Female Sex and High Risk of CNS Metastasis: Population-based Demographics and Survival Data From the National Swedish Lung Cancer Registry. Clin Lung Cancer 2023; 24:507-518. [PMID: 37296038 DOI: 10.1016/j.cllc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Real-world data on demographics related to KRAS mutation subtypes are crucial as targeted drugs against the p.G12C variant have been approved. METHOD We identified 6183 NSCLC patients with reported NGS-based KRAS status in the Swedish national lung cancer registry between 2016 and 2019. Following exclusion of other targetable drivers, three cohorts were studied: KRAS-G12C (n = 848), KRAS-other (n = 1161), and driver negative KRAS-wild-type (wt) (n = 3349). RESULTS The prevalence of KRAS mutations and the p.G12C variant respectively was 38%/16% in adenocarcinoma, 28%/13% in NSCLC-NOS and 6%/2% in squamous cell carcinoma. Women were enriched in the KRAS-G12C (65%) and KRAS-other (59%) cohorts versus KRAS-wt (48%). A high proportion of KRAS-G12C patients in stage IV (28%) presented with CNS metastasis (vs. KRAS-other [19%] and KRAS-wt [18%]). No difference in survival between the mutation cohorts was seen in stage I-IIIA. In stage IV, median overall survival (mOS) from date of diagnosis was shorter for KRAS-G12C and KRAS-other (5.8 months/5.2 months) vs. KRAS wt (6.4 months). Women had better outcome in the stage IV cohorts, except in KRAS-G12C subgroup where mOS was similar between men and women. Notably, CNS metastasis did not impact survival in stage IV KRAS-G12C, but was associated with poorer survival, as expected, in KRAS-other and KRAS-wt. CONCLUSION The KRAS p.G12C variant is a prevalent targetable driver in Sweden and significantly associated with female sex and presence of CNS metastasis. We show novel survival effects linked to KRAS p.G12C mutations in these subgroups with implications for clinical practice.
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Affiliation(s)
- Johan Isaksson
- Department of Immunology Genetics and Pathology, Science for life laboratory, Uppsala University, Uppsala, Sweden; Center for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | | | | | - Linda Willén
- Center for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden; Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - Anders Edsjö
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Region Skåne, Sweden; Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Maria Planck
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anders Vikström
- Department of Pulmonary Medicine, Linköping University Hospital, Linköping, Sweden
| | - Mikael Johansson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Andreas Hallqvist
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Wagenius
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Botling
- Department of Immunology Genetics and Pathology, Science for life laboratory, Uppsala University, Uppsala, Sweden; Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Zhang C, Wang K, Lin J, Wang H. Non-small-cell lung cancer patients harboring TP53/KRAS co-mutation could benefit from a PD-L1 inhibitor. Future Oncol 2022; 18:3031-3041. [PMID: 36065989 DOI: 10.2217/fon-2022-0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore the association between TP53 mutation and atezolizumab in non-small-cell lung cancer (NSCLC) patients. Materials & methods: Patients with NSCLC from the POPLAR and OAK studies were included. Kaplan-Meier analysis was performed to detect progression-free survival (PFS) and overall survival (OS). PFS and OS were compared using multivariate Cox regression analysis. Results: OS was significantly longer with atezolizumab compared with docetaxel among TP53/KRAS co-mutant NSCLC patients (hazard ratio [HR]: 0.014; 95% CI: 0.000-0.721). There is no significant OS difference between atezolizumab versus docetaxel for TP53-mutant NSCLC patients (HR: 0.831; 95% CI: 0.473-1.458). There is no significant OS difference between atezolizumab versus docetaxel for KRAS-mutant NSCLC patients (HR: 1.354; 95% CI: 0.528-3.472). Conclusion: PD-L1 inhibitors may bring OS benefits for patients with NSCLC harbored TP53/KRAS co-mutation.
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Affiliation(s)
- Chenyue Zhang
- Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Kai Wang
- Key Laboratory of Epigenetics & Oncology, the Research Center for Preclinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Jiamao Lin
- Department of Internal Medicine Oncology, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Haiyong Wang
- Department of Internal Medicine Oncology, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
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3
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Hsu J, Annunziata JF, Burns E, Bernicker EH, Olsen RJ, Thomas JS. Molecular Signatures of KRAS-Mutated Lung Adenocarcinoma: Analysis of Concomitant EGFR, ALK, STK11, and PD-L1 Status. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2022; 15:2632010X221102054. [PMID: 35634237 PMCID: PMC9134433 DOI: 10.1177/2632010x221102054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 04/22/2022] [Indexed: 12/12/2022]
Abstract
Background KRAS mutations are the most common oncogenic driver mutations of non-small cell lung cancer (NSCLC) in the Western world. Mutations of the KRAS gene are most prevalent in the patient population of current and former cigarette smokers. With the recent pivotal approval of a targeted inhibitor therapy for patients with KRAS p.G12C mutated and pretreated NSCLC, analysis of the heterogeneity of KRAS mutations and concomitant molecular alterations in patients with these tumors at all clinical stages is indicated. Methods In this retrospective analysis, patient pathology records were reviewed for all cases receiving a pathologic diagnosis of NSCLC within our hospital system. All data were collected with IRB approval. Cases of indeterminate tumor type favoring a non-lung primary, as well as non-adenocarcinoma NSCLC (eg, squamous) were excluded from the cohort. In this hospital system, molecular testing for KRAS mutations is part of a molecular biomarker panel that is reflex ordered at initial diagnosis by the pathologist and may be performed as a single gene test or as a solid organ cancer hotspot panel by next generation sequencing. For each patient, KRAS mutational status and specific KRAS mutations, if present, were collated. Additional information assessed for this study included patient demographics (age, gender, and smoking history), tumor staging if available, PD-L1 expression levels by immunohistochemistry (IHC), and the presence of other genetic alterations (EGFR, ALK, and STK11). Results Between January 1, 2017 and January 1, 2019, there were 276 patients diagnosed with NSCLC of all stages who had KRAS mutational analysis performed in our hospital system and who met the criteria for inclusion into the study cohort. A KRAS driver mutation was detected in 29% of these patients. The most frequently identified KRAS mutation was p.G12C (38%), followed by p.G12D (21%) and p.G12V (13%). KRAS-mutated lung adenocarcinoma was significantly associated with current or former patient smoking status in this cohort (29/202 (14%) smokers and 1/74 (1%) non-smokers; P = .0006). PD-L1 expression of at least 1% by IHC was present in 43% of KRAS-mutated lung adenocarcinomas and 45% of non-KRAS-mutated adenocarcinomas. In this study, KRAS mutations were not found to co-occur with gene alterations in EGFR, ALK, or STK11. In 48% of cases, at least one genetic alteration (KRAS, ALK, EGFR, or STK11) was identified. Conclusions In this study cohort, KRAS-mutated lung adenocarcinoma demonstrated significant mutational heterogeneity, which is consistent with previously published studies. KRAS mutational status was also significantly associated with a current or former smoking history. Notably, p.G12C was the most frequently identified KRAS mutation in this cohort, with a frequency of 38%. This finding is particularly relevant given the recent approval of a KRAS p.G12C-specific targeted inhibitor therapy and the continued development of additional KRAS targeted therapies that may prove effective in treating NSCLC. These findings also highlight the necessity of considering molecular testing for KRAS mutations in patients with NSCLC and a smoking history, as this population most frequently harbors KRAS mutations and may benefit from these emerging targeted therapies.
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Affiliation(s)
- Jim Hsu
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | | | - Ethan Burns
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
| | - Eric H Bernicker
- Houston Methodist Cancer Center, Houston Methodist Hospital, Houston, TX, USA
| | - Randall J Olsen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Jessica S Thomas
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
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Palma G, Khurshid F, Lu K, Woodward B, Husain H. Selective KRAS G12C inhibitors in non-small cell lung cancer: chemistry, concurrent pathway alterations, and clinical outcomes. NPJ Precis Oncol 2021; 5:98. [PMID: 34845311 PMCID: PMC8630042 DOI: 10.1038/s41698-021-00237-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/22/2021] [Indexed: 12/30/2022] Open
Abstract
Cancers harboring mutations in the Kirsten rat sarcoma homolog (KRAS) gene have been associated with poor prognosis and lack of targeted therapies. KRAS mutations occur in approximately one in four patients diagnosed with non-small cell lung cancer (NSCLC) with KRAS G12C mutations harbored at approximately 11-16%. Research into KRAS-driven tumors and analytical chemistry have borne a new class of selective small molecules against the KRAS G12C isoform. Phase II data for sotorasib (AMG510) has demonstrated a 37.1% overall response rate (ORR). Adagrasib (MRTX849) has demonstrated a 45% ORR in an early study. While single agent efficacy has been seen, initial data suggest combination approaches are an opportunity to improve outcomes. Here, we present perspectives on the initial progress in targeting KRAS G12C, examine co-mutations evident in KRAS G12C NSCLC, and comment on potential future combinatorial approaches including SHP2, SOS1, MEK, EGFR, mTOR, CDK, and checkpoint blockade which are currently being evaluated in clinical trials. As of May 28, 2021, sotorasib has achieved US FDA approval for patients with KRAS G12C mutant lung cancer after one line of a prior therapy.
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Affiliation(s)
- Gabriela Palma
- grid.266100.30000 0001 2107 4242University of California San Diego, La Jolla, CA USA
| | - Faisal Khurshid
- grid.266100.30000 0001 2107 4242University of California San Diego, La Jolla, CA USA
| | - Kevin Lu
- grid.266100.30000 0001 2107 4242University of California San Diego, La Jolla, CA USA
| | - Brian Woodward
- grid.266100.30000 0001 2107 4242University of California San Diego, La Jolla, CA USA
| | - Hatim Husain
- University of California San Diego, La Jolla, CA, USA.
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Goh KY, Lim WT. Cyclin D1 expression in KRAS mutant non-small cell lung cancer-old wine into new skins. Transl Lung Cancer Res 2021; 9:2302-2304. [PMID: 33489791 PMCID: PMC7815367 DOI: 10.21037/tlcr-20-639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kah Yee Goh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Wan-Teck Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,Office of Academic and Clinical Development, Duke-NUS Medical School, Singapore.,Institute of Molecular and Cell Biology, AStar, Proteos, Singapore
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Kras mutations increase telomerase activity and targeting telomerase is a promising therapeutic strategy for Kras-mutant NSCLC. Oncotarget 2018; 8:179-190. [PMID: 27329725 PMCID: PMC5352098 DOI: 10.18632/oncotarget.10162] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 06/06/2016] [Indexed: 01/14/2023] Open
Abstract
As shortened telomeres inhibit tumor formation and prolong life span in a KrasG12D mouse lung cancer model, we investigated the implications of telomerase in Kras-mutant NSCLC. We found that Kras mutations increased TERT (telomerase reverse transcriptase) mRNA expression and telomerase activity and telomere length in both immortalized bronchial epithelial cells (BEAS-2B) and lung adenocarcinoma cells (Calu-3). MEK inhibition led to reduced TERT expression and telomerase activity. Furthermore, telomerase inhibitor BIBR1532 shortened telomere length and inhibited mutant Kras-induced long-term proliferation, colony formation and migration capabilities of BEAS-2B and Calu-3 cells. Importantly, BIBR1532 sensitized oncogenic Kras expressing Calu-3 cells to chemotherapeutic agents. The Calu-3-KrasG12D xenograft mouse model confirmed that BIBR1532 enhanced the antitumor efficacy of paclitaxel in vivo. In addition, higher TERT expression was seen in Kras-mutant NSCLC than that with wild-type Kras. Our data suggest that Kras mutations increase telomerase activity and telomere length by activating the RAS/MEK pathway, which contributes to an aggressive phenotype of NSCLC. Kras mutations-induced lung tumorigenesis and chemoresistance are attenuated by telomerase inhibition. Targeting telomerase/telomere may be a promising therapeutic strategy for patients with Kras-mutant NSCLC.
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Kempf E, Rousseau B, Besse B, Paz-Ares L. KRAS oncogene in lung cancer: focus on molecularly driven clinical trials. Eur Respir Rev 2016; 25:71-6. [PMID: 26929424 DOI: 10.1183/16000617.0071-2015] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
KRAS mutations are the most frequent molecular abnormalities found in one out of four nonsmall cell lung cancers (NSCLC). Their incidence increases in cases of adenocarcinoma, smokers and Caucasian patients. Their negative value in terms of prognosis and responsiveness to both standard chemotherapy and targeted therapies remains under debate. Many drugs have been developed specifically for KRAS-mutated NSCLC patients. Direct inhibition of RAS activation failed to show any clinical efficacy. Inhibition of downstream targets of the mitogen-activated protein kinase (MEK) pathway is a promising strategy: phase II combinations of MEK 1/2 kinase inhibitors with chemotherapy doubled patients' clinical outcomes. One phase III trial in such a setting is ongoing. Double inhibition of MEK and epidermal growth factor receptor proteins is currently being assessed in early-phase trials. The association with mammalian target of rapamycin pathway inhibition leads to non-manageable toxicity. Other strategies, such as inhibition of molecular heat-shock proteins 90 or focal adhesion kinase are currently assessed. Abemaciclib, a cyclin-dependent kinase 4/6 inhibitor, showed promising results in a phase I trial, with a 54% disease control rate. Results of an ongoing phase III trial are warranted. Immunotherapy might be the next relevant step in KRAS-mutated NSCLC management due to the high burden of associated mutations and neo-antigens.
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Affiliation(s)
- Emmanuelle Kempf
- Dept of Medical Oncology, Virgen del Rocio Teaching Hospital, Instituto de Biomedicina de Sevilla - IBIS, Seville, Spain Dept of Medical Oncology, Pharmacology Unit, AP-HP, Henri Mondor Teaching Hospital, Créteil, France
| | - Benoît Rousseau
- Dept of Medical Oncology, Pharmacology Unit, AP-HP, Henri Mondor Teaching Hospital, Créteil, France Université Paris-Est, VIC DHU, Inserm U 955, Team 18, UPEC, Créteil, France
| | - Benjamin Besse
- Dept of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France Paris-Sud University, Inserm U981, Paris, France
| | - Luis Paz-Ares
- Dept of Medical Oncology, Virgen del Rocio Teaching Hospital, Instituto de Biomedicina de Sevilla - IBIS, Seville, Spain
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8
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Survival outcome according to KRAS mutation status in newly diagnosed patients with stage IV non-small cell lung cancer treated with platinum doublet chemotherapy. Oncotarget 2016; 6:30287-94. [PMID: 26471290 PMCID: PMC4745798 DOI: 10.18632/oncotarget.4711] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/24/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction Mutations (MT) of the KRAS gene are the most common mutation in non-small cell lung cancer (NSCLC), seen in about 20–25% of all adenocarcinomas. Effect of KRAS MT on response to cytotoxic chemotherapy is unclear. Methods We undertook a single-institution retrospective analysis of 93 consecutive patients with stage IV NSCLC adenocarcinoma with known KRAS and EGFR MT status to determine the association of KRAS MT with survival. All patients were treated between January 1, 2008 and December 31, 2011 with standard platinum based chemotherapy at the University of Pennsylvania. Overall and progression free survival were analyzed using Kaplan-Meier and Cox proportional hazard methods. Results All patients in this series received platinum doublet chemotherapy, and 42 (45%) received bevacizumab. Overall survival and progression free survival for patients with KRAS MT was no worse than for patients with wild type KRAS. Median overall survival for patients with KRAS MT was 19 months (mo) vs. 15.6 mo for KRAS WT, p = 0.34, and progression-free survival was 6.2 mo in patients with KRAS MT vs. 7mo in patients with KRAS WT, p = 0.51. In multivariable analysis including age, race, gender, and ECOG PS, KRAS MT was not associated with overall survival (HR 1.12, 95% CI 0.58–2.16, p = 0.74) or progression free survival (HR 0.80, 95% CI 0.48–1.34, p = 41). Of note, receipt of bevacizumab was associated with improved overall survival only in KRAS WT patients (HR 0.34, p = 0.01). Conclusions KRAS MT are not associated with inferior progression-free and overall survival in advanced NSCLC patients treated with standard first-line platinum-based chemotherapy.
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Quéré G, Descourt R, Robinet G, Autret S, Raguenes O, Fercot B, Alemany P, Uguen A, Férec C, Quintin-Roué I, Le Gac G. Mutational status of synchronous and metachronous tumor samples in patients with metastatic non-small-cell lung cancer. BMC Cancer 2016; 16:210. [PMID: 26968843 PMCID: PMC4788951 DOI: 10.1186/s12885-016-2249-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/03/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUNDS Despite reported discordance between the mutational status of primary lung cancers and their metastases, metastatic sites are rarely biopsied and targeted therapy is guided by genetic biomarkers detected in the primary tumor. This situation is mostly explained by the apparent stability of EGFR-activating mutations. Given the dramatic increase in the range of candidate drugs and high rates of drug resistance, rebiopsy or liquid biopsy may become widespread. The purpose of this study was to test genetic biomarkers used in clinical practice (EGFR, ALK) and candidate biomarkers identified by the French National Cancer Institute (KRAS, BRAF, PIK3CA, HER2) in patients with metastatic non-small-cell lung cancer for whom two tumor samples were available. METHODS A retrospective study identified 88 tumor samples collected synchronously or metachronously, from the same or two different sites, in 44 patients. Mutation analysis used SNaPshot (EGFR, KRAS, BRAF missense mutations), pyrosequencing (EGFR and PIK3CA missense mutations), sizing assays (EGFR and HER2 indels) and IHC and/or FISH (ALK rearrangements). RESULTS About half the patients (52%) harbored at least one mutation. Five patients had an activating mutation of EGFR in both the primary tumor and the metastasis. The T790M resistance mutation was detected in metastases in 3 patients with acquired resistance to EGFR tyrosine kinase inhibitors. FISH showed discordance in ALK status between a small biopsy sample and the surgical specimen. KRAS mutations were observed in 36% of samples, six patients (14%) having discordant genotypes; all discordances concerned sampling from different sites. Two patients (5%) showed PI3KCA mutations. One metastasis harbored both PI3KCA and KRAS mutations, while the synchronously sampled primary tumor was mutation free. No mutations were detected in BRAF and HER2. CONCLUSIONS This study highlighted noteworthy intra-individual discordance in KRAS mutational status, whereas EGFR status was stable. Intratumoral heterogeneity for ALK rearrangement suggests a limitation of single-biopsy analysis for therapeutic strategy with crizotinib.
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Affiliation(s)
- Gilles Quéré
- CHRU de Brest, Institut de Cancérologie et d'Hématologie, Brest, France
| | - Renaud Descourt
- CHRU de Brest, Institut de Cancérologie et d'Hématologie, Brest, France
| | - Gilles Robinet
- CHRU de Brest, Institut de Cancérologie et d'Hématologie, Brest, France
| | - Sandrine Autret
- CHRU de Brest, Hôpital Morvan, Bat 5 bis, Laboratoire de Génétique Moléculaire et d'Histocompatibilité, 2 Avenue Foch, 29200, Brest, France.,Plateforme de Génétique Moléculaire des Cancers (INCa), Brest, France
| | - Odile Raguenes
- CHRU de Brest, Hôpital Morvan, Bat 5 bis, Laboratoire de Génétique Moléculaire et d'Histocompatibilité, 2 Avenue Foch, 29200, Brest, France.,Plateforme de Génétique Moléculaire des Cancers (INCa), Brest, France
| | - Brigitte Fercot
- CHRU de Brest, Hôpital Morvan, Bat 5 bis, Laboratoire de Génétique Moléculaire et d'Histocompatibilité, 2 Avenue Foch, 29200, Brest, France.,Plateforme de Génétique Moléculaire des Cancers (INCa), Brest, France
| | - Pierre Alemany
- Plateforme de Génétique Moléculaire des Cancers (INCa), Brest, France.,CHRU de Brest, Service d'Anatomopathologie, Brest, France
| | - Arnaud Uguen
- Plateforme de Génétique Moléculaire des Cancers (INCa), Brest, France.,Inserm U1078, Université de Brest, SFR SnInBioS, Brest, France.,CHRU de Brest, Service d'Anatomopathologie, Brest, France
| | - Claude Férec
- CHRU de Brest, Hôpital Morvan, Bat 5 bis, Laboratoire de Génétique Moléculaire et d'Histocompatibilité, 2 Avenue Foch, 29200, Brest, France.,Plateforme de Génétique Moléculaire des Cancers (INCa), Brest, France.,Inserm U1078, Université de Brest, SFR SnInBioS, Brest, France
| | - Isabelle Quintin-Roué
- Plateforme de Génétique Moléculaire des Cancers (INCa), Brest, France.,CHRU de Brest, Service d'Anatomopathologie, Brest, France
| | - Gérald Le Gac
- CHRU de Brest, Hôpital Morvan, Bat 5 bis, Laboratoire de Génétique Moléculaire et d'Histocompatibilité, 2 Avenue Foch, 29200, Brest, France. .,Plateforme de Génétique Moléculaire des Cancers (INCa), Brest, France. .,Inserm U1078, Université de Brest, SFR SnInBioS, Brest, France.
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10
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Pulmonary mucinous adenocarcinomas: architectural patterns in correlation with genetic changes, prognosis and survival. Virchows Arch 2015; 467:675-686. [DOI: 10.1007/s00428-015-1852-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/10/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
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11
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Bar J, Damianovich M, Hout Siloni G, Dar E, Cohen Y, Perelman M, Ben Nun A, Simansky D, Yellin A, Urban D, Onn A. Genetic mutation screen in early non--small-cell lung cancer (NSCLC) specimens. Clin Lung Cancer 2013; 15:159-65. [PMID: 24370118 DOI: 10.1016/j.cllc.2013.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 10/19/2013] [Accepted: 11/08/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Testing for genetic abnormalities in epithelial growth factor receptor (EGFR), anaplastic lymphoma receptor tyrosine kinase (ALK), and potentially additional genes is a critical tool in the care of advanced NSCLC. There is conflicting evidence for the role of such tests in early NSCLC. We report a single-institute Sequenom testing for a wide range of mutations and their clinical correlations in early-resected NSCLC specimens. MATERIALS AND METHODS Early NSCLC paraffin-embedded, formalin-fixed (FFPE) specimens were collected, DNA extracted, and using Sequenom-based matrix-assisted laser desorption/ionization-time of flight analysis, mutations in 22 oncogenes and tumor suppressor genes were evaluated. Clinical data was collected retrospectively. RESULTS The technique was found to be feasible. Thirty-six of 96 patients (37.5%) had any genetic abnormality identified, and 8 (8.3%) had 2 or more mutations. Kirsten rat sarcoma viral oncogene homolog (KRAS) and EGFR were the most common genes to appear mutated (15.6%); phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) was the gene to be found most commonly in tumors with co-mutations. Transversions were found mostly in KRAS gene mutations and to be nonprognostic. No difference in the spectrum of mutations was found between squamous-cell and non-squamous-cell lung cancers. Ever-smokers showed a trend for worse prognosis, with a similar spectrum of mutations. CONCLUSION Sequenom-based mutation screen is feasible using FFPE samples. More than a third of the patients were found to harbor some genetic abnormality, and 8% were found to have more than a single mutated gene. Wide-range gene screens using large sample depositories are required for further insight into the important genes at play in early NSCLC.
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Affiliation(s)
- Jair Bar
- Institute of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel.
| | - Maya Damianovich
- Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Goni Hout Siloni
- Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Erel Dar
- Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yoram Cohen
- Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Marina Perelman
- Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Alon Ben Nun
- Thoracic Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - David Simansky
- Thoracic Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Alon Yellin
- Thoracic Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Damien Urban
- Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia
| | - Amir Onn
- Institute of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel
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Lechner M, Frampton GM, Fenton T, Feber A, Palmer G, Jay A, Pillay N, Forster M, Cronin MT, Lipson D, Miller VA, Brennan TA, Henderson S, Vaz F, O'Flynn P, Kalavrezos N, Yelensky R, Beck S, Stephens PJ, Boshoff C. Targeted next-generation sequencing of head and neck squamous cell carcinoma identifies novel genetic alterations in HPV+ and HPV- tumors. Genome Med 2013; 5:49. [PMID: 23718828 PMCID: PMC4064312 DOI: 10.1186/gm453] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/15/2013] [Accepted: 05/29/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Human papillomavirus positive (HPV+) head and neck squamous cell carcinoma (HNSCC) is an emerging disease, representing a distinct clinical and epidemiological entity. Understanding the genetic basis of this specific subtype of cancer could allow therapeutic targeting of affected pathways for a stratified medicine approach. METHODS Twenty HPV+ and 20 HPV- laser-capture microdissected oropharyngeal carcinomas were used for paired-end sequencing of hybrid-captured DNA, targeting 3,230 exons in 182 genes often mutated in cancer. Copy number alteration (CNA) profiling, Sequenom MassArray sequencing and immunohistochemistry were used to further validate findings. RESULTS HPV+ and HPV- oropharyngeal carcinomas cluster into two distinct subgroups. TP53 mutations are detected in 100% of HPV negative cases and abrogation of the G1/S checkpoint by CDKN2A/B deletion and/or CCND1 amplification occurs in the majority of HPV- tumors. CONCLUSION These findings strongly support a causal role for HPV, acting via p53 and RB pathway inhibition, in the pathogenesis of a subset of oropharyngeal cancers and suggest that studies of CDK inhibitors in HPV- disease may be warranted. Mutation and copy number alteration of PI3 kinase (PI3K) pathway components appears particularly prevalent in HPV+ tumors and assessment of these alterations may aid in the interpretation of current clinical trials of PI3K, AKT, and mTOR inhibitors in HNSCC.
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Affiliation(s)
- Matthias Lechner
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6BT, UK ; Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK
| | - Garrett M Frampton
- Foundation Medicine, One Kendall Square, Suite B3501, Cambridge, MA 02139, USA
| | - Tim Fenton
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6BT, UK
| | - Andrew Feber
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6BT, UK
| | - Gary Palmer
- Foundation Medicine, One Kendall Square, Suite B3501, Cambridge, MA 02139, USA
| | - Amrita Jay
- Department of Histopathology, University College London Hospitals NHS Trust, Rockefeller Building, University Street, London, WC1E 6JJ, UK
| | - Nischalan Pillay
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6BT, UK
| | - Martin Forster
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6BT, UK ; Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK
| | - Maureen T Cronin
- Foundation Medicine, One Kendall Square, Suite B3501, Cambridge, MA 02139, USA
| | - Doron Lipson
- Foundation Medicine, One Kendall Square, Suite B3501, Cambridge, MA 02139, USA
| | - Vincent A Miller
- Foundation Medicine, One Kendall Square, Suite B3501, Cambridge, MA 02139, USA
| | - Timothy A Brennan
- Foundation Medicine, One Kendall Square, Suite B3501, Cambridge, MA 02139, USA
| | - Stephen Henderson
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6BT, UK
| | - Francis Vaz
- Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK
| | - Paul O'Flynn
- Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK
| | - Nicholas Kalavrezos
- Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK
| | - Roman Yelensky
- Foundation Medicine, One Kendall Square, Suite B3501, Cambridge, MA 02139, USA
| | - Stephan Beck
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6BT, UK
| | - Philip J Stephens
- Foundation Medicine, One Kendall Square, Suite B3501, Cambridge, MA 02139, USA
| | - Chris Boshoff
- UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6BT, UK
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Luo SY, Lam DC. Oncogenic driver mutations in lung cancer. TRANSLATIONAL RESPIRATORY MEDICINE 2013; 1:6. [PMID: 27234388 PMCID: PMC6733434 DOI: 10.1186/2213-0802-1-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/19/2013] [Indexed: 12/12/2022]
Abstract
Lung cancer is a heterogeneous and complex disease. Genomic and transcriptomic profiling of lung cancer not only further our knowledge about cancer initiation and progression, but could also provide guidance on treatment decisions. The fact that targeted treatment is most successful in a subset of tumors indicates the need for better classification of clinically related molecular tumor phenotypes based on better understanding of the mutations in relevant genes, especially in those oncogenic driver mutations. EGFR gene mutations, KRAS gene mutations, EML4-ALK rearrangements and altered MET signaling are widely recognized alterations that play important roles in both the biological mechanisms and the clinical sensitivity to treatment in lung cancer. In this article, we reviewed the discovery of the clinical values of these oncogenic driver mutations and the clinical studies revealing the prognostic and predictive values of these biomarkers for clinical sensitivity and resistance to anti-EGFR therapy or other targeted therapies. These form the basis of personalized treatment in lung cancer based on biomarker profiles of individual tumor, leading to therapeutic advancement and betterment.
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Affiliation(s)
- Susan Y Luo
- Department of Medicine, University of Hong Kong, 102 Pokfulam Road, Hong Kong, SAR, China
| | - David Cl Lam
- Department of Medicine, University of Hong Kong, 102 Pokfulam Road, Hong Kong, SAR, China.
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14
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Stinn W, Buettner A, Weiler H, Friedrichs B, Luetjen S, van Overveld F, Meurrens K, Janssens K, Gebel S, Stabbert R, Haussmann HJ. Lung inflammatory effects, tumorigenesis, and emphysema development in a long-term inhalation study with cigarette mainstream smoke in mice. Toxicol Sci 2013; 131:596-611. [PMID: 23104432 PMCID: PMC3551427 DOI: 10.1093/toxsci/kfs312] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/17/2012] [Indexed: 12/14/2022] Open
Abstract
Cigarette smoking is the leading cause of lung cancer and chronic obstructive pulmonary disease, yet there is little mechanistic information available in the literature. To improve this, laboratory models for cigarette mainstream smoke (MS) inhalation-induced chronic disease development are needed. The current study investigated the effects of exposing male A/J mice to MS (6h/day, 5 days/week at 150 and 300 mg total particulate matter per cubic meter) for 2.5, 5, 10, and 18 months in selected combinations with postinhalation periods of 0, 4, 8, and 13 months. Histopathological examination of step-serial sections of the lungs revealed nodular hyperplasia of the alveolar epithelium and bronchioloalveolar adenoma and adenocarcinoma. At 18 months, lung tumors were found to be enhanced concentration dependently (up to threefold beyond sham exposure), irrespective of whether MS inhalation had been performed for the complete study duration or was interrupted after 5 or 10 months and followed by postinhalation periods. Morphometric analysis revealed an increase in the extent of emphysematous changes after 5 months of MS inhalation, which did not significantly change over the following 13 months of study duration, irrespective of whether MS exposure was continued or not. These changes were found to be accompanied by a complex pattern of transient and sustained pulmonary inflammatory changes that may contribute to the observed pathogeneses. Data from this study suggest that the A/J mouse model holds considerable promise as a relevant model for investigating smoking-related emphysema and adenocarcinoma development.
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Affiliation(s)
- Walter Stinn
- *Philip Morris Research Laboratories GmbH, 51149 Cologne, Germany
| | - Ansgar Buettner
- *Philip Morris Research Laboratories GmbH, 51149 Cologne, Germany
| | - Horst Weiler
- *Philip Morris Research Laboratories GmbH, 51149 Cologne, Germany
| | | | - Sonja Luetjen
- *Philip Morris Research Laboratories GmbH, 51149 Cologne, Germany
| | | | - Kris Meurrens
- †Philip Morris Research Laboratories bvba, 3001 Leuven, Belgium
| | - Kris Janssens
- *Philip Morris Research Laboratories GmbH, 51149 Cologne, Germany
| | - Stephan Gebel
- *Philip Morris Research Laboratories GmbH, 51149 Cologne, Germany
| | - Regina Stabbert
- ‡Philip Morris International R&D, Neuchâtel, Switzerland; and
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15
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Alexander RE, Lopez-Beltran A, Montironi R, MacLennan GT, Post KM, Bilbo SA, Jones TD, Huang W, Rao Q, Sen JD, Meehan K, Cornwell A, Miravalle L, Cheng L. KRAS mutation is present in a small subset of primary urinary bladder adenocarcinomas. Histopathology 2012; 61:1036-42. [PMID: 22804747 DOI: 10.1111/j.1365-2559.2012.04309.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS To determine whether KRAS mutations occur in primary bladder adenocarcinoma. METHODS AND RESULTS Twenty-six cases of primary urinary bladder adenocarcinoma were analysed. DNA was extracted from formalin-fixed, paraffin-embedded tissue and amplified with shifted termination assay technology, which recognizes wild-type or mutant target sequences and selectively extends detection primers with labelled nucleotides. A mutation in KRAS was found in three (11.5%) of 26 primary bladder adenocarcinomas. Two of these three cases exhibited a G13D mutation, whereas the remaining case contained a mutation in G12V. None of the ten cases of urothelial carcinoma with glandular differentiation displayed KRAS mutation. Colonic adenocarcinoma contained a KRAS mutation in 18 (33%) of 55 cases. There was no distinct difference with regard to grade, stage or outcome according to the limited clinicopathological data available. However, the two youngest patients, aged 32 and 39 years, in our study group, with a mean population age of 61 years, were found to have mutations in KRAS. CONCLUSIONS KRAS mutations are present in a small subset of primary urinary bladder adenocarcinomas. Future clinical trials for treatment of bladder adenocarcinoma, employing targeted therapies similar to those used for treatment of colon cancer, may also benefit from the predictive implications of KRAS mutational testing.
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Affiliation(s)
- Riley E Alexander
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
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16
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An SJ, Chen ZH, Su J, Zhang XC, Zhong WZ, Yang JJ, Zhou Q, Yang XN, Huang L, Guan JL, Nie Q, Yan HH, Mok TS, Wu YL. Identification of enriched driver gene alterations in subgroups of non-small cell lung cancer patients based on histology and smoking status. PLoS One 2012; 7:e40109. [PMID: 22768234 PMCID: PMC3387024 DOI: 10.1371/journal.pone.0040109] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 06/01/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Appropriate patient selection is needed for targeted therapies that are efficacious only in patients with specific genetic alterations. We aimed to define subgroups of patients with candidate driver genes in patients with non-small cell lung cancer. METHODS Patients with primary lung cancer who underwent clinical genetic tests at Guangdong General Hospital were enrolled. Driver genes were detected by sequencing, high-resolution melt analysis, qPCR, or multiple PCR and RACE methods. RESULTS 524 patients were enrolled in this study, and the differences in driver gene alterations among subgroups were analyzed based on histology and smoking status. In a subgroup of non-smokers with adenocarcinoma, EGFR was the most frequently altered gene, with a mutation rate of 49.8%, followed by EML4-ALK (9.3%), PTEN (9.1%), PIK3CA (5.2%), c-Met (4.8%), KRAS (4.5%), STK11 (2.7%), and BRAF (1.9%). The three most frequently altered genes in a subgroup of smokers with adenocarcinoma were EGFR (22.0%), STK11 (19.0%), and KRAS (12.0%). We only found EGFR (8.0%), c-Met (2.8%), and PIK3CA (2.6%) alterations in the non-smoker with squamous cell carcinoma (SCC) subgroup. PTEN (16.1%), STK11 (8.3%), and PIK3CA (7.2%) were the three most frequently enriched genes in smokers with SCC. DDR2 and FGFR2 only presented in smokers with SCC (4.4% and 2.2%, respectively). Among these four subgroups, the differences in EGFR, KRAS, and PTEN mutations were statistically significant. CONCLUSION The distinct features of driver gene alterations in different subgroups based on histology and smoking status were helpful in defining patients for future clinical trials that target these genes. This study also suggests that we may consider patients with infrequent alterations of driver genes as having rare or orphan diseases that should be managed with special molecularly targeted therapies.
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Affiliation(s)
- She-Juan An
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi-Hong Chen
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Su
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xu-Chao Zhang
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin-Ji Yang
- Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ling Huang
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ji-Lin Guan
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiang Nie
- Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tony S. Mok
- Department of Clinical Oncology, the Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong, P. R. China
- * E-mail: (TSM); (YLW)
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Division of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- * E-mail: (TSM); (YLW)
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