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Tóth LJ, Mokánszki A, Méhes G. The rapidly changing field of predictive biomarkers of non-small cell lung cancer. Pathol Oncol Res 2024; 30:1611733. [PMID: 38953007 PMCID: PMC11215025 DOI: 10.3389/pore.2024.1611733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024]
Abstract
Lung cancer is a leading cause of cancer-related death worldwide in both men and women, however mortality in the US and EU are recently declining in parallel with the gradual cut of smoking prevalence. Consequently, the relative frequency of adenocarcinoma increased while that of squamous and small cell carcinomas declined. During the last two decades a plethora of targeted drug therapies have appeared for the treatment of metastasizing non-small cell lung carcinomas (NSCLC). Personalized oncology aims to precisely match patients to treatments with the highest potential of success. Extensive research is done to introduce biomarkers which can predict the effectiveness of a specific targeted therapeutic approach. The EGFR signaling pathway includes several sufficient targets for the treatment of human cancers including NSCLC. Lung adenocarcinoma may harbor both activating and resistance mutations of the EGFR gene, and further, mutations of KRAS and BRAF oncogenes. Less frequent but targetable genetic alterations include ALK, ROS1, RET gene rearrangements, and various alterations of MET proto-oncogene. In addition, the importance of anti-tumor immunity and of tumor microenvironment has become evident recently. Accumulation of mutations generally trigger tumor specific immune defense, but immune protection may be upregulated as an aggressive feature. The blockade of immune checkpoints results in potential reactivation of tumor cell killing and induces significant tumor regression in various tumor types, such as lung carcinoma. Therapeutic responses to anti PD1-PD-L1 treatment may correlate with the expression of PD-L1 by tumor cells. Due to the wide range of diagnostic and predictive features in lung cancer a plenty of tests are required from a single small biopsy or cytology specimen, which is challenged by major issues of sample quantity and quality. Thus, the efficacy of biomarker testing should be warranted by standardized policy and optimal material usage. In this review we aim to discuss major targeted therapy-related biomarkers in NSCLC and testing possibilities comprehensively.
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Affiliation(s)
- László József Tóth
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Cheung CC, Smith AC, Albadine R, Bigras G, Bojarski A, Couture C, Cutz JC, Huang WY, Ionescu D, Itani D, Izevbaye I, Karsan A, Kelly MM, Knoll J, Kwan K, Nasr MR, Qing G, Rashid-Kolvear F, Sekhon HS, Spatz A, Stockley T, Tran-Thanh D, Tucker T, Waghray R, Wang H, Xu Z, Yatabe Y, Torlakovic EE, Tsao MS. Canadian ROS proto-oncogene 1 study (CROS) for multi-institutional implementation of ROS1 testing in non-small cell lung cancer. Lung Cancer 2021; 160:127-135. [PMID: 34509095 DOI: 10.1016/j.lungcan.2021.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Patients with non-small cell lung cancer (NSCLC) harboring ROS proto-oncogene 1 (ROS1) gene rearrangements show dramatic response to the tyrosine kinase inhibitor (TKI) crizotinib. Current best practice guidelines recommend that all advanced stage non-squamous NSCLC patients be also tested for ROS1 gene rearrangements. Several studies have suggested that ROS1 immunohistochemistry (IHC) using the D4D6 antibody may be used to screen for ROS1 fusion positive lung cancers, with assays showing high sensitivity but moderate to high specificity. A break apart fluorescence in situ hybridization (FISH) test is then used to confirm the presence of ROS1 gene rearrangement. The goal of Canadian ROS1 (CROS) study was to harmonize ROS1 laboratory developed testing (LDT) by using IHC and FISH assays to detect ROS1 rearranged lung cancers across Canadian pathology laboratories. Cell lines expressing different levels of ROS1 (high, low, none) were used to calibrate IHC protocols after which participating laboratories ran the calibrated protocols on a reference set of 24 NSCLC cases (9 ROS1 rearranged tumors and 15 ROS1 non-rearranged tumors as determined by FISH). Results were compared using a centralized readout. The stained slides were evaluated for the cellular localization of staining, intensity of staining, the presence of staining in non-tumor cells, the presence of non-specific staining (e.g. necrosis, extracellular mater, other) and the percent positive cells. H-score was also determined for each tumor. Analytical sensitivity and specificity harmonization was achieved by using low limit of detection (LOD) as either any positivity in the U118 cell line or H-score of 200 with the HCC78 cell line. An overall diagnostic sensitivity and specificity of up to 100% and 99% respectively was achieved for ROS1 IHC testing (relative to FISH) using an adjusted H-score readout on the reference cases. This study confirms that LDT ROS1 IHC assays can be highly sensitive and specific for detection of ROS1 rearrangements in NSCLC. As NSCLC can demonstrate ROS1 IHC positivity in FISH-negative cases, the degree of the specificity of the IHC assay, especially in highly sensitive protocols, is mostly dependent on the readout cut-off threshold. As ROS1 IHC is a screening assay for a rare rearrangements in NSCLC, we recommend adjustment of the readout threshold in order to balance specificity, rather than decreasing the overall analytical and diagnostic sensitivity of the protocols.
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Affiliation(s)
- Carol C Cheung
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adam C Smith
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roula Albadine
- Department of Pathology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gilbert Bigras
- Laboratory Medicine Department, University of Alberta, Edmonton, AB, Canada
| | - Anna Bojarski
- Department of Pathology and Laboratory Medicine, Health Sciences North, Sudbury, ON, Canada
| | - Christian Couture
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City, QC, Canada
| | - Jean-Claude Cutz
- Department of Pathology and Molecular Medicine, McMaster University Health Sciences Centre and McMaster University, Hamilton, ON, Canada
| | - Weei-Yuan Huang
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Science Center, ON, Canada
| | - Diana Ionescu
- Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, BC, Canada
| | - Doha Itani
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Pathology, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Iyare Izevbaye
- Laboratory Medicine Department, University of Alberta, Edmonton, AB, Canada
| | - Aly Karsan
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Margaret M Kelly
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joan Knoll
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Keith Kwan
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michel R Nasr
- Department of Pathology, Shared Health Manitoba, University of Manitoba, Winnipeg, MB, Canada; Department of Pathology SUNY Upstate Medical University, Syracuse, NY, USA
| | - Gefei Qing
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, AB, Canada, and Calgary Laboratory Services, Calgary, AB, Canada
| | - Fariboz Rashid-Kolvear
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, AB, Canada, and Calgary Laboratory Services, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, Johns Hopkins Medicine, Johns Hopkins All Children's Hospital, Baltimore, MD, USA
| | - Harmanjatinder S Sekhon
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and ORLA, University of Ottawa, Ottawa, ON, Canada
| | - Alan Spatz
- Divisions of Pathology and Molecular Genetics, McGill University Health Center and McGill University, Montreal, QC, Canada
| | - Tracy Stockley
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Danh Tran-Thanh
- Department of Pathology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Tracy Tucker
- Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, BC, Canada
| | - Ranjit Waghray
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hangjun Wang
- Divisions of Pathology and Molecular Genetics, McGill University Health Center and McGill University, Montreal, QC, Canada
| | - Zhaolin Xu
- Dept. of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center, Tokyo, Japan
| | - Emina E Torlakovic
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan and Saskatchewan Health Authority, Saskatoon, SK, Canada.
| | - Ming-Sound Tsao
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Nong L, Zhang Z, Xiong Y, Zheng Y, Li X, Li D, He Q, Li T. Comparison of next-generation sequencing and immunohistochemistry analysis for targeted therapy-related genomic status in lung cancer patients. J Thorac Dis 2019; 11:4992-5003. [PMID: 32030215 DOI: 10.21037/jtd.2019.12.25] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Some drugs that target molecular pathways are available for the targeted treatment of lung cancer. Multiple tests are needed to detect the status of the known molecular targets to determine whether the patients can respond to the drugs. An integrated platform for various gene alteration detection including both mutations and rearrangements is necessary for patients, especially those without enough tissue. Methods In our study, detections of EGFR mutations, ALK rearrangement, ROS1 rearrangement, and alterations of other nine important lung cancer-related genes were integrated into a single next-generation sequencing (NGS) platform. The NGS analysis was performed in 107 cases of non-small cell lung cancer (NSCLC). Meanwhile, hot spots such as EGFR L858R, EGFR E746-A750Del mutations and gene rearrangement of ALK and ROS1 were detected by immunohistochemical (IHC) staining. Results NGS could explore various gene mutations and gene rearrangements with a reduced experiment time and lower amounts of tumor tissues than multiple IHC staining experiments. NGS results were more informative and reliable than IHC staining for EGFR gene alterations, especially for the exon 19 region. NGS could also increase the positive rate of ALK rearrangement and decrease the false positive results of ROS1 rearrangements detected by IHC staining. Conclusions NGS is effective for confirmation the status of various important lung cancer-related gene alterations. Furthermore, NGS is necessary for the confirmation of the IHC results of ALK and ROS1 rearrangements.
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Affiliation(s)
- Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | | | - Yan Xiong
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Yalin Zheng
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Xin Li
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Dong Li
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Qiye He
- Singlera Genomics Inc., Shanghai 201318, China
| | - Ting Li
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
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Rossi G, Jocollé G, Conti A, Tiseo M, Zito Marino F, Donati G, Franco R, Bono F, Barbisan F, Facchinetti F. Detection of ROS1 rearrangement in non-small cell lung cancer: current and future perspectives. LUNG CANCER (AUCKLAND, N.Z.) 2017; 8:45-55. [PMID: 28740441 PMCID: PMC5508815 DOI: 10.2147/lctt.s120172] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ROS1 rearrangement characterizes a small subset (1%-2%) of non-small cell lung cancer and is associated with slight/never smoking patients and adenocarcinoma histology. Identification of ROS1 rearrangement is mandatory to permit targeted therapy with specific inhibitors, demonstrating a significantly better survival when compared with conventional chemotherapy. Detection of ROS1 rearrangement is based on in situ (immunohistochemistry, fluorescence in situ hybridization) and extractive non-in situ assays. While fluorescence in situ hybridization still represents the gold standard in clinical trials, this technique may fail to recognize rearrangements of ROS1 with some gene fusion partner. On the other hand, immunohistochemistry is the most cost-effective screening technique, but it seems to be characterized by low specificity. Extractive molecular assays are expensive and laborious methods, but they specifically recognize almost all ROS1 fusions using a limited amount of mRNA even from formalin-fixed, paraffin-embedded tumor tissues. This review is a discussion on the present and futuristic diagnostic scenario of ROS1 identification in lung cancer.
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Affiliation(s)
| | - Genny Jocollé
- Oncology Unit, Azienda USL Valle d’Aosta, Regional Hospital “Parini”, Aosta
| | | | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma
| | - Federica Zito Marino
- Pathology Unit, Istituto Nazionale Tumori Fondazione G. Pascale
- Pathology Unit, Luigi Vanvitelli University of Campania, Naples
| | - Giovanni Donati
- Unit of Thoracic and Senology Surgery, Azienda USL Valle d’Aosta, Regional Hospital “Parini”, Aosta
| | - Renato Franco
- Pathology Unit, Istituto Nazionale Tumori Fondazione G. Pascale
- Pathology Unit, Luigi Vanvitelli University of Campania, Naples
| | - Francesca Bono
- Unit of Pathologic Anatomy, San Gerardo Hospital, IRCCS, Monza
| | - Francesca Barbisan
- Pathology Unit, University Hospital, Azienda Ospedali Riuniti, Ancona, Italy
| | - Francesco Facchinetti
- Medical Oncology Unit, University Hospital of Parma, Parma
- INSERM, U981, Gustave Roussy Cancer Campus, Villejuif, France
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