1
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Beasley MB. Immunohistochemistry of Lung Cancer Biomarkers. Adv Anat Pathol 2024; 31:333-343. [PMID: 38666761 DOI: 10.1097/pap.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Immunohistochemical (IHC) staining represents a comparatively inexpensive testing method that is attractive as a potential alternative to molecular sequencing methods or fluorescence in situ hybridization for pulmonary biomarker testing. While a variety of IHC tests directed at actionable genetic alterations have been developed and evaluated since the advent of targeted therapy, specific antibody clones for anaplastic lymphoma kinase, ROS-1, and potentially neurotrophic tropmyosin receptor kinase have been the primary antibodies that provide sufficiently robust results to be utilized as either a primary testing or screening method to direct targeted therapy. Antibodies for a variety of other targets such as epidermal growth factor receptors, for example, have lacked sufficient sensitivity and specificity to cover the range of mutations that may occur and are generally not recommended in lieu of molecular testing with the exception of limited resource settings. IHC is also used as a predictive marker for response to immunotherapy through evaluation of programmed death ligand 1 expression. In addition, multiple antibody-drug conjugates (ADCs) are under investigation, designed to deliver drugs directly to tumor cells through binding to specific target antigens. Some ADCs have already received accelerated FDA approval, and IHC was incorporated in many clinical trials evaluating ADC efficacy. As such, it is anticipated that ADCs may have a companion diagnostic IHC to guide patient selection.
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Affiliation(s)
- Mary Beth Beasley
- Department of Pathology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY
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2
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Wakuda K, Morita M, Sekikawa M, Morikawa N, Miura K, Doshita K, Iida Y, Kodama H, Mamesaya N, Kobayashi H, Ko R, Ono A, Kenmotsu H, Naito T, Murakami H, Muramatsu K, Kawata T, Mori K, Shimizu T, Gon Y, Takahashi T. Concordance of ALK fusion gene-rearrangement between immunohistochemistry and next-generation sequencing. Int J Clin Oncol 2024; 29:96-102. [PMID: 38183554 DOI: 10.1007/s10147-023-02451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/24/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Although various companion diagnostic tests of ALK fusion gene-rearrangement are approved, few reports have assessed the concordance of ALK fusion gene-rearrangement in two companion diagnostic tests: next-generation sequencing (NGS) testing and immunohistochemistry (IHC). METHODS The samples evaluated for gene alterations using NGS testing between May 2019 and November 2021 were included in this study. The inclusion criteria were as follows: samples were diagnosed with non-small cell lung cancer; the results of the NGS analysis were informative; and samples had residual specimens for IHC. We performed IHC on the residual specimens and retrospectively collected sample characteristics from medical records. RESULTS A total of 185 samples were analyzed using NGS. Twenty-six samples were excluded because of failure to analyze gene alterations using NGS, no residual samples, and inadequate IHC. We analyzed 159 samples. The major histological type was adenocarcinoma (115 samples). The number of surgical and transbronchial lung biopsy specimens was 59 and 56, respectively. ALK fusion gene-rearrangement was detected in four samples using NGS, and five were detected using IHC. The sensitivity and specificity of IHC referred to by NGS were 75.0% and 98.7%, respectively. The concordance rate between IHC and NGS was 98.1%. ALK rearrangement was detected in two patients using IHC but not using NGS. In addition, ALK rearrangement was detected in one patient using NGS but not using IHC. CONCLUSION Our results suggest that IHC and NGS might be complementary tests. In patients suspected of harboring ALK fusion gene-rearrangement, it should be analyzed using another diagnostic method.
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Affiliation(s)
- Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan.
| | - Meiko Morita
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Motoki Sekikawa
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Noboru Morikawa
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Keita Miura
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Yuko Iida
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Hiroaki Kodama
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Ryo Ko
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Koji Muramatsu
- Division of Pathology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Takuya Kawata
- Division of Pathology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Keita Mori
- Department of Biostatistics, Clinical Research Support Center, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo Nagaizumi-cho Suntou-gun, Shizuoka, 411-8777, Japan
| | - Tetsuo Shimizu
- Division of Respiratory Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-Kamicho, Itabashiku, Tokyo, 173-8610, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan
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3
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Tachibana T, Matsuura Y, Ninomiya H, Ichinose J, Nakao M, Okumura S, Nishio M, Ikeda N, Mun M. Optimal Treatment Strategy for Oligo-Recurrence Lung Cancer Patients with Driver Mutations. Cancers (Basel) 2024; 16:464. [PMID: 38275904 PMCID: PMC10814831 DOI: 10.3390/cancers16020464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The efficacy of local therapies for lung cancer patients with postoperative oligo-recurrence has been reported. However, whether local therapies should be chosen over molecular targeted therapies for oligo-recurrence patients with driver mutations remains controversial. Therefore, we aimed to investigate the optimal initial treatment strategy for oligo-recurrence in lung cancer patients with driver mutations. METHODS Among 2152 patients with lung adenocarcinoma who underwent surgical resection at our institute between 2008 and 2020, 66 patients with driver mutations who experienced cancer oligo-recurrence after surgery and were treated with local or molecularly targeted therapy as an initial therapy after recurrence were evaluated. Oligo-recurrence was characterized by the presence of 1 to 3 recurrent lesions. These patients were investigated, focusing on their post-recurrence therapies and prognoses. RESULTS The median follow-up period was 71 months. Local and molecular targeted therapies were administered to 41 and 25 patients, respectively. The number of recurrence lesions tended to be lower in the initial local therapy group than in the molecular targeted therapy group. In the initial local therapy group, 23 patients (56%) subsequently received molecular targeted therapies. The time from recurrence to the initiation of molecular targeted therapy was significantly longer in the local therapy group than in the molecular targeted therapy group (p < 0.001). There was no significant difference in post-recurrence overall survival (hazard ratio, 1.429; 95% confidence interval, 0.701-2.912; log-rank, p = 0.324) and post-recurrence progression-free survival (hazard ratio, 0.799; 95% confidence interval, 0.459-1.390; log-rank, p = 0.426) in the initial local ablative therapy group compared with the initial molecular targeted therapy group. CONCLUSIONS Local therapies as a first-line treatment did not show statistically significant differences in post-recurrence survival or progression-free survival compared with molecular targeted therapies. However, local therapies as an initial treatment should be considered preferably, as they can cure the recurrence and can delay the start of administration of molecular targeted therapies.
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Affiliation(s)
- Taimei Tachibana
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (T.T.); (J.I.); (M.N.); (S.O.); (M.M.)
- Department of Surgery, Tokyo Medical University, Tokyo 160-8402, Japan;
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (T.T.); (J.I.); (M.N.); (S.O.); (M.M.)
| | - Hironori Ninomiya
- Division of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan;
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (T.T.); (J.I.); (M.N.); (S.O.); (M.M.)
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (T.T.); (J.I.); (M.N.); (S.O.); (M.M.)
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (T.T.); (J.I.); (M.N.); (S.O.); (M.M.)
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan;
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo 160-8402, Japan;
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (T.T.); (J.I.); (M.N.); (S.O.); (M.M.)
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4
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Ozawa H, Matsuura Y, Hashimoto K, Ichinose J, Nakao M, Okumura S, Mun M. Prognostication Using the Japanese Risk Calculator for Lung Cancer Surgery. Clin Lung Cancer 2023; 24:743-752.e2. [PMID: 37586929 DOI: 10.1016/j.cllc.2023.07.005] [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: 10/25/2022] [Accepted: 07/21/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Various calculation models to predict surgical risk have been developed globally. These have been reported to be helpful for estimating the long-term prognosis. In Japan, a similar model for lung cancer surgery was developed in 2017; however, there have been no reports investigating its association with the long-term prognosis. The objective of this study was to assess the association of the model's predictions with the long-term prognosis. PATIENTS AND METHODS In this retrospective single-institutional study, we analyzed lung cancer patients who underwent radical lobectomy between 2010 and 2016. We calculated the predicted rates of mortality (PRM) and composite outcomes of mortality with major morbidity (PRMM) in eligible patients (N = 1054) using this model and classified them into 2 classes (class A, PRM ≥0.8% and PRMM ≥5.9%; class B, others) based on their models' predictions. We assessed the prognostic impact and clinical utility of the model's predictions. RESULTS Class A included patients with significantly poorer postoperative overall survival than class B (log-rank, P < .001; hazard ratio, 3.160; 95% confidence interval, 2.390-4.178). Time-dependent receiver operating characteristic curve analyses revealed that the model's predictions correlated strongly with 1- and 2-year overall survival and decision curve analysis showed that they had high net benefits for prediction of those. CONCLUSION The Japanese risk calculator could stratify the long-term prognosis for lung cancer patients after surgery. This model may be a valuable tool not only for multidisciplinary thoracic oncology teams to discuss treatment strategies for high-risk cases but also for them to share the decision-making process with patients.
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Affiliation(s)
- Hiroki Ozawa
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Kohei Hashimoto
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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5
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Jia X, He Q, Xing X, Yang Y, Ma Y. A Novel LOC101927967 Intergenic Region ALK Fusion Identified by NGS and Validated by IHC and FISH in a Patient with Early Stage Adenocarcinoma of Lung. Onco Targets Ther 2022; 15:251-254. [PMID: 35313528 PMCID: PMC8933637 DOI: 10.2147/ott.s347200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Xiaojing Jia
- Department of Radiotherapy, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Qianru He
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, People’s Republic of China
- Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing, People's Republic of China
- The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, People's Republic of China
| | - Xiaodan Xing
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, People’s Republic of China
- Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing, People's Republic of China
- The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, People's Republic of China
| | - Yanming Yang
- Department of Radiotherapy, The Second Hospital of Jilin University, Changchun, People’s Republic of China
- Correspondence: Yanming Yang; Yan Ma, Department of Radiotherapy, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, People’s Republic of China, Email ;
| | - Yan Ma
- Department of Radiotherapy, The Second Hospital of Jilin University, Changchun, People’s Republic of China
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6
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Pan Y, Deng C, Qiu Z, Cao C, Wu F. The Resistance Mechanisms and Treatment Strategies for ALK-Rearranged Non-Small Cell Lung Cancer. Front Oncol 2021; 11:713530. [PMID: 34660278 PMCID: PMC8517331 DOI: 10.3389/fonc.2021.713530] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022] Open
Abstract
Anaplastic lymphoma kinase (ALK) is a validated molecular target for non-small-cell lung cancer (NSCLC). The use of tyrosine kinase inhibitors (TKIs) has led to significantly improved survival benefits. However, the clinical benefits of targeting ALK using TKIs are limited due to the emergence of drug resistance. The landscape of resistance mechanisms and treatment decisions has become increasingly complex. Therefore, continued research into new drugs and combinatorial therapies is required to improve outcomes in NSCLC. In this review, we explore the resistance mechanisms of ALK TKIs in advanced NSCLC in order to provide a theoretical basis and research ideas for solving the problem of ALK drug resistance.
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Affiliation(s)
- Yue Pan
- Department of Oncology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao Deng
- Department of Oncology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenhua Qiu
- Department of Oncology, Second Xiangya Hospital, Central South University, Changsha, China
| | | | - Fang Wu
- Department of Oncology, Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Cancer Mega-Data Intelligent Application and Engineering Research Centre, Changsha, China.,Hunan Key Laboratory of Tumor Models and Individualized Medicine, Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Early Diagnosis and Precise Treatment of Lung Cancer, Second Xiangya Hospital, Central South University, Changsha, China
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Status quo of ALK testing in lung cancer: results of an EQA scheme based on in-situ hybridization, immunohistochemistry, and RNA/DNA sequencing. Virchows Arch 2021; 479:247-255. [PMID: 34173019 PMCID: PMC8364534 DOI: 10.1007/s00428-021-03106-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022]
Abstract
With this external quality assessment (EQA) scheme, we aim to investigate the diagnostic performance of the currently available methods for the detection of ALK alterations in non-small cell lung cancer on a national scale, namely, in situ hybridization (ISH), immunohistochemistry (IHC), and RNA/DNA sequencing (NGS). The EQA scheme cohort consisted of ten specimens, including four ALK positive and six ALK negative samples, which were thoroughly pretested using IHC, ISH, and RNA/DNA NGS. Unstained tumor sections were provided to the 57 participants, and the results were retrieved via an online questionnaire. ISH was used by 29, IHC by 38, and RNA/DNA sequencing by 19 participants. Twenty-eight institutions (97%) passed the ring trial using ISH, 33 (87%) by using IHC, and 18 (95%) by using NGS. The highest sensitivity and interrater agreement (Fleiss ‘ kappa) was observed for RNA/DNA sequencing (99%, 0.975), followed by ISH (94%, 0.898) and IHC (92%, 0.888). However, the proportion of samples that were not evaluable due to bad tissue quality was also higher for RNA/DNA sequencing (4%) compared with ISH (0.7%) and IHC (0.5%). While all three methods produced reliable results between the different institutions, the highest sensitivity and concordance were observed for RNA/DNA sequencing. These findings encourage the broad implementation of this method in routine diagnostic, although the application might be limited by technical capacity, economical restrictions, and tissue quality of formalin-fixed samples.
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8
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Zito Marino F, Alì G, Facchinetti F, Righi L, Fontanini G, Rossi G, Franco R. Fusion proteins in lung cancer: addressing diagnostic problems for deciding therapy. Expert Rev Anticancer Ther 2021; 21:887-900. [PMID: 33715580 DOI: 10.1080/14737140.2021.1903875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Gene fusions are frequent chromosomal aberrations in solid tumors. In Lung cancer (LC) several druggable-fusions involving tyrosine kinase receptor genes have been described, including ALK, ROS1, RET and NTRK. In non-small cell lung cancer, testing for targetable fusions has become a part of routine clinical practice, greatly impacting therapeutic choice for patients with these aberrations. Although substantial technologies for gene fusion detection have been implemented over time including; cytogenetic, Fluorescence in situ hybridization (FISH), Immunohistochemistry (IHC), Retro-transcription Real-Time PCR (RT-qPCR), to Next Generation Sequencing (NGS), nCounter system (Nanostring technology), several critical issues remain. To date, only the companion diagnostic tests FISH and IHC for ALK-rearrangements and NGS for ROS1-rearrangments were approved. Other fusion approved tests are currently unavailable.Areas covered: In this review, we explore current diagnostic problems of gene fusion detection relative to the technologies available, in order to clarify future standardization of analyses which determine therapeutic choices.Expert opinion: The establishment of a gold standard, an effective diagnostic algorithm, and a standardized interpretation for the analysis of each druggable-fusions in lung cancer is essential for adequate therapeutic management.
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Affiliation(s)
- Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Greta Alì
- Department of Surgical Pathology, Medical, Molecular, and Critical Area, University of Pisa, Pisa, Italy
| | - Francesco Facchinetti
- Université Paris-Saclay, Institut Gustave Roussy, INSERM, Biomarqueurs prédictifs et nouvelles stratégies thérapeutiques en oncologie, Villejuif, France.,Medical Oncology Unit, University Hospital of Parma, Italy
| | - Luisella Righi
- Department of Oncology, University of Turin, Pathology Division, San Luigi Hospital, University of Turin, Turin, Italy
| | - Gabriella Fontanini
- Department of Surgical Pathology, Medical, Molecular, and Critical Area, University of Pisa, Pisa, Italy
| | - Giulio Rossi
- Operative Unit of Pathologic Anatomy, Azienda Della Romagna, Teaching Hospital S. Maria Delle Croci, Ravenna, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
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9
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Akhavanfard S, Nohr E, AlNajjar M, Haughn M, Hashimoto S, Deeg C, Pfau R, Brundler MA, Reshmi SC. 5' ALK Amplification in Neuroblastoma: A Case Report. Case Rep Oncol 2021; 14:585-591. [PMID: 33976638 PMCID: PMC8077488 DOI: 10.1159/000512187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022] Open
Abstract
Neuroblastoma is the most common cancer in infants younger than 12 months of age, occurring with an incidence of 1 in 100,000 children. The clinical outcome of neuroblastoma ranges from spontaneous regression to treatment-resistant progression and/or metastasis, and accounts for 8-10% of childhood cancer deaths. Segmental chromosomal aberrations, as well as MYCN and ALK amplification, are among factors contributing to an unfavorable genomic profile and high-risk disease classification. Here, we describe a 5-year-old male who presented with a large right renal neuroblastoma tumor having lung and liver metastases. Fluorescence in situ hybridization analysis indicated the presence of >20 copies of the 5' region of the ALK gene in 26% of cells examined. Subsequent copy number assessment did not confirm ALK amplification, but revealed a gain of exons 2-5 of ALK, consistent with increased copy number for the 5' region of the ALK gene. Subsequent array analysis showed the presence of other unfavorable prognostic genomic features, including segmental gain of the 17q region and amplification of the long arm of chromosome 12 harboring CDK4 and MDM2, both reported to be poor prognostic indicators in patients with atypical clinical features in neuroblastoma. Taken together, this report illustrates the importance of careful interpretation of aberrant FISH findings and subsequent use of orthogonal methods to clarify the presence of genomic alterations to successfully determine potential treatment targets.
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Affiliation(s)
- Sara Akhavanfard
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Erik Nohr
- Department of Pathology and Laboratory Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Mohammad AlNajjar
- Departments of Oncology and Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Mollie Haughn
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sayaka Hashimoto
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carol Deeg
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ruthann Pfau
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Marie-Anne Brundler
- Department of Pathology and Laboratory Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Shalini C Reshmi
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University, Columbus, Ohio, USA
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10
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Zito Marino F, Brunelli M, Rossi G, Calabrese G, Caliò A, Nardiello P, Martignoni G, Squire JA, Cheng L, Massi D, Franco R. Multitarget fluorescence in situ hybridization diagnostic applications in solid and hematological tumors. Expert Rev Mol Diagn 2021; 21:161-173. [PMID: 33593207 DOI: 10.1080/14737159.2021.1887733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Multitarget FISH (mFISH) is a technique allowing for simultaneous detection of multiple targets sequences on the same slide through the choice of spectrally distinct fluorophore labels. The mFISH could represent a useful tool in the field of precision oncology.Areas covered: This review discusses the potential applications of mFISH technology in the molecular diagnosis of different solid and hematological tumors, including non-small cell lung cancers, melanomas, renal cell carcinomas, bladder carcinomas, germ cell tumors, and multiple myeloma, as commonly required in the clinical practice.Expert Opinion: In this emerging era of the tailored therapies and newer histo-molecular classifications, there are increasing numbers of predictive and diagnostic biomarkers required for effective clinical care. The mFISH approach may have several applications in the common clinical practice, improving the molecular diagnosis in terms of time, cost and preservation of biomaterial for tumors with a limited amount of tumor available. The mFISH provides several advantages compared to other high-throughput technologies; however, it requires high level of expertise required to interpret complex results.
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Affiliation(s)
- Federica Zito Marino
- Department of Mental and Physic Health and Preventive Medicine, Pathology Unit, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Matteo Brunelli
- Department of Pathology, University of Verona, Verona, Italy
| | - Giulio Rossi
- Pathology Unit, Ospedale Santa Maria Delle Croci, Ravenna, Italy
| | | | - Anna Caliò
- Department of Pathology, University of Verona, Verona, Italy
| | - Pamela Nardiello
- Section of Pathology, Department of Health Sciences, University of Florence Florence, Italy
| | - Guido Martignoni
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Jeremy A Squire
- Departments of Genetics, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniela Massi
- Section of Pathology, Department of Health Sciences, University of Florence Florence, Italy
| | - Renato Franco
- Department of Mental and Physic Health and Preventive Medicine, Pathology Unit, University of Campania Luigi Vanvitelli, Napoli, Italy
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11
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Dagogo-Jack I, Ritterhouse LL. The role of plasma genotyping in ALK- and ROS1-rearranged lung cancer. Transl Lung Cancer Res 2020; 9:2557-2570. [PMID: 33489818 PMCID: PMC7815348 DOI: 10.21037/tlcr-2019-cnsclc-09] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/11/2020] [Indexed: 01/04/2023]
Abstract
Several subsets of non-small cell lung cancer (NSCLC) are defined by the presence of oncogenic rearrangements that result in constitutive activation of a chimeric fusion protein. In NSCLCs that harbor ALK or ROS1 rearrangements, aberrant signaling from these fusion proteins can be overcome by potent and selective tyrosine kinase inhibitors (TKIs). These targeted therapies can induce durable responses and significantly improve prognostic outcomes. Historically, analysis of tissue biopsies was the primary approach to identifying key activating rearrangements. In recent years, non-invasive genotyping of tumor-derived nucleic acids in the circulation has gained ground as a strategy for determining the genetic composition of NSCLCs at diagnosis and throughout the disease course based on prospective and retrospective studies validating the utility of plasma analysis in heterogeneous populations of patients with metastatic NSCLC. Notably, these practice-changing studies predominantly included patients with NSCLCs with oncogenic mutations. Compared to other types of molecular alterations such as mutations and insertions/deletions, oncogenic rearrangements are more complex as they incorporate a variety of fusion partners and diverse breakpoints. Because of this structural complexity, detecting oncogenic rearrangements with plasma assays is more challenging than identifying disease-defining point mutations. In this review, we discuss technical aspects of plasma genotyping strategies and summarize findings from studies exploring plasma genotyping (including ctDNA analysis and profiling of nucleic acids contained in other plasma components) in two rearrangement-driven NSCLC subsets (ALK-rearranged and ROS1-rearranged).
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Affiliation(s)
- Ibiayi Dagogo-Jack
- Department of Medicine and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren L. Ritterhouse
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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12
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Ding S, Wang R, Peng S, Luo X, Zhong L, Yang H, Ma Y, Chen S, Wang W. Targeted therapies for RET-fusion cancer: Dilemmas and breakthrough. Biomed Pharmacother 2020; 132:110901. [PMID: 33125973 DOI: 10.1016/j.biopha.2020.110901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/04/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022] Open
Abstract
Genomic profiling has revolutionized treatment options for patients with oncogene-driven cancers, such as epidermal growth factor receptor (EGFR) mutant carcinoma. Rearranged during transfection (RET) rearrangement, as one of the main activated oncogenes, has been well studied and found to be involved in the malignant behavior of carcinogenesis, resulting in acquired resistance to EGFR tyrosine kinase inhibitors and inducing an intrinsic resistance to immunotherapy. Thus, targeted therapies have been investigated against RET arrangement cancers, including several multi-kinase inhibitors and selective RET inhibitors. However, modest efficacy, a relatively high rate of toxicity, and poor effectiveness against brain metastasis are common limitations of multi-targeted novel molecular inhibitors. A promising prospect was shown recently in selective RET inhibitors in several ongoing clinical trials. In this review, we reviewed the concurrent dilemmas of targeted therapies against RET arrangement cancer from preclinical and clinical studies and proposed several clinical considerations for clinical practice prospectively.
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Affiliation(s)
- SiJie Ding
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Rong Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - ShunLi Peng
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Xiaoqing Luo
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - LongHui Zhong
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Hong Yang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China; Department of Oncology, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, PR China
| | - YueYun Ma
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - ShiYu Chen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Wei Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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13
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Prognostic impact and distinctive characteristics of surgically resected anaplastic lymphoma kinase-rearranged lung adenocarcinoma. J Thorac Cardiovasc Surg 2020; 163:441-451.e1. [PMID: 33131892 DOI: 10.1016/j.jtcvs.2020.09.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/06/2020] [Accepted: 09/18/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Anaplastic lymphoma kinase (ALK) rearrangement is a representative lung cancer with driver mutation because of the efficacy of ALK-tyrosine kinase inhibitors. ALK-tyrosine kinase inhibitors are extensively used for ALK-rearranged lung cancer, whereas the therapeutic benefit of surgery remains unclear. Thus, we aimed to assess the clinical benefit of surgery in ALK-rearranged lung cancer and to elucidate the oncologic characteristics of ALK-rearranged lung cancer through surgically resected cases. METHODS We retrospectively evaluated 1925 lung adenocarcinoma cases surgically resected between 1996 and 2017 at our institute. Moreover, 75 ALK-rearranged and 75 non-ALK-rearranged cases were extracted using propensity score matching. The survival rates, prognostic factors, and post-recurrence state were assessed. RESULTS Multivariable analysis revealed that ALK rearrangement was an independent prognostic factor for improved cancer-specific survival (hazard ratio, 0.2; 95% confidence interval, 0.05-0.88; P = .033). In the matched cohort, the 5-year cancer-specific survival rates after surgery in the ALK-rearranged and non-ALK-rearranged groups were 97% and 77%, respectively. The ALK-rearranged group had a significantly better cancer-specific survival than did the non-ALK-rearranged group (log-rank test; P = .003). With respect to post-recurrence state, oligo-recurrence was highly frequent in the ALK-rearranged group, and post-recurrence survival was significantly improved by administration of either ALK-tyrosine kinase inhibitors (log-rank test; P = .011) or local ablative therapies (log-rank test; P = .035). CONCLUSIONS Surgically resected ALK-rearranged lung adenocarcinoma has excellent long-term outcome. Not only ALK-tyrosine kinase inhibitors but also a combination of local and systemic therapies may be important treatment strategies for ALK-rearranged lung adenocarcinoma even in the post-recurrence state.
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15
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Clinicopathological Features of ALK Expression in 9889 Cases of Non-small-Cell Lung Cancer and Genomic Rearrangements Identified by Capture-Based Next-Generation Sequencing: A Chinese Retrospective Analysis. Mol Diagn Ther 2020; 23:395-405. [PMID: 30840206 DOI: 10.1007/s40291-019-00389-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The clinicopathological features and genomic rearrangements of anaplastic lymphoma kinase (ALK) fusion cases have not been fully identified. OBJECTIVE Our objective was to explore the status of ALK in non-small-cell lung cancer (NSCLC) specimens, to explore the relationships between ALK status and clinicopathological features and to identify genomic rearrangements via capture-based next-generation sequencing (NGS). METHODS We tested 9889 NSCLC specimens for ALK status using the Ventana anti-ALK (D5F3) antibody. Clinicopathological features were analyzed and genomic rearrangements identified using capture-based NGS in 76 ALK-positive cases. RESULTS In total, 485 specimens (4.90%) tested positive for ALK. The positivity rate was higher for adenocarcinoma samples than for non-adenocarcinoma samples (6.03 vs. 1.47%; p < 0.001) and for biopsies/cell blocks than for surgical specimens (7.00 vs. 4.16%; p < 0.001). Patient age, patient sex, specimen type, specimen histotype, and patient smoking history were all significantly correlated with ALK status. Genomic rearrangements were detected in 98.68% (75/76) of the ALK-positive samples; 89.33% (67/75) carried the canonical EML4-ALK, and the remaining samples carried only noncanonical ALK rearrangements. Four of these noncanonical ALK fusion samples were identified as carrying EML4-ALK transcripts at the RNA level. A novel fusion variant, SRD5A2-ALK, was revealed. CONCLUSIONS Younger patients with NSCLC, especially those aged < 30 years, were more likely to test positive for ALK. Positive ALK test results were more common in patients with invasive mucinous adenocarcinoma and solid-predominant invasive adenocarcinoma than in patients with other histotypes. Samples that carried only noncanonical ALK rearrangements may also have carried the canonical EML4-ALK, which was not detected by capture-based NGS. EML4-ALK transcripts might result from rare splicing mechanisms without genomic rearrangements.
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16
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Kunimasa K, Hirotsu Y, Amemiya K, Nagakubo Y, Goto T, Miyashita Y, Kakizaki Y, Tsutsui T, Otake S, Kobayashi H, Higuchi R, Inomata K, Kumagai T, Mochizuki H, Nakamura H, Nakatsuka SI, Nishino K, Imamura F, Kumagai T, Oyama T, Omata M. Genome analysis of peeling archival cytology samples detects driver mutations in lung cancer. Cancer Med 2020; 9:4501-4511. [PMID: 32351019 PMCID: PMC7333826 DOI: 10.1002/cam4.3089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTIONS When tumor tissue samples are unavailable to search for actionable driver mutations, archival cytology samples can be useful. We investigate whether archival cytology samples can yield reliable genomic information compared to corresponding formalin-fixed paraffin-embedded (FFPE) tumor samples. PATIENTS AND METHODS Pretreatment class V archival cytology samples with adequate tumor cells were selected from 172 lung cancer patients. The genomic profiles of the primary lung tumors have been analyzed through whole-exome regions of 53 genes. We compared the genomic profiles based on the oncogenicity and variant allele frequency (VAF) between the archival cytology and the corresponding primary tumors. We also analyzed the genomic profiles of serial cytological samples during the treatment of EGFR-TKI. RESULTS A total of 43 patients were analyzed with the paired samples for DNA mutations and other three patients were analyzed for their fusion genes. A total of 672 mutations were detected. Of those, 106 mutations (15.8%) were shared with both samples. Sixty of seventy-seven (77.9%) shared mutations were oncogenic or likely oncogenic mutations with VAF ≧10%. As high as 90% (9/10) actionable driver mutations and ALK and ROS1 fusion genes were successfully detected from archival cytology samples. Sequential analysis revealed the dynamic changes in EGFR-TKI-resistant mutation (EGFR p.T790M) during the course of treatment. CONCLUSION Archival cytology sample with adequate tumor cells can yield genetic information compared to the primary tumors. If tumor tissue samples are unavailable, we can use archival cytology samples to search for actionable driver mutations.
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Affiliation(s)
- Kei Kunimasa
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.,Genome Analysis Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Yosuke Hirotsu
- Genome Analysis Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Kenji Amemiya
- Genome Analysis Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Yuki Nagakubo
- Genome Analysis Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Taichiro Goto
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.,Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Yoshihiro Miyashita
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Yumiko Kakizaki
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Toshiharu Tsutsui
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Sotaro Otake
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Hiroaki Kobayashi
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Rumi Higuchi
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Kie Inomata
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Takashi Kumagai
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Hitoshi Mochizuki
- Genome Analysis Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Harumi Nakamura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Shin-Ichi Nakatsuka
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toshio Oyama
- Department of Pathology, Yamanashi Central Hospital, Yamanashi, Japan
| | - Masao Omata
- Genome Analysis Center, Yamanashi Central Hospital, Yamanashi, Japan.,The University of Tokyo, Tokyo, Japan
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17
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Pan T, Li YG, Li KY, Chen C, Xu K, Yuan DY, Zou B, Meng Z. Identification of a novel fusion gene, TRIM52-RACK1, in oral squamous cell carcinoma. Mol Cell Probes 2020; 52:101568. [PMID: 32251686 DOI: 10.1016/j.mcp.2020.101568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Abstract
Gene fusion is caused by the linkage of previously separate genes or sequences. Recently, an increasing number of novel fusion genes have been identified and associated with tumor progression, and several of them have been suggested as promising targets for tumor therapy. However, there are hardly any studies reporting the association of fusion genes with the progression of oral squamous cell carcinoma (OSCC). In this study, we identified a total of 11 fused genes in OSCC cells. We further analyzed the structure of one fused gene, TRIM52-RACK1, and detected its function in tumor progression in vitro. We found that TRIM52-RACK1 was caused by a deletion of 181,257,187-181,247,386 at 5q35.3 and it promoted OSCC cell proliferation, migration, and invasion. Therefore, TRIM52-RACK1 can be a promising target for tumor therapy in OSCC.
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Affiliation(s)
- Tao Pan
- Key Lab of Precision Biomedicine & Department of Stomatology, Liaocheng People's Hospital, College of Stomatology, Shandong First Medical University, China
| | - Yong-Guo Li
- Key Lab of Precision Biomedicine & Department of Stomatology, Liaocheng People's Hospital, College of Stomatology, Shandong First Medical University, China; Medical College, Liaocheng University, China
| | - Ke-Yi Li
- Key Lab of Precision Biomedicine & Department of Stomatology, Liaocheng People's Hospital, College of Stomatology, Shandong First Medical University, China; Medical College, Liaocheng University, China
| | - Cheng Chen
- Key Lab of Precision Biomedicine & Department of Stomatology, Liaocheng People's Hospital, College of Stomatology, Shandong First Medical University, China; Medical College, Liaocheng University, China
| | - Kai Xu
- Key Lab of Precision Biomedicine & Department of Stomatology, Liaocheng People's Hospital, College of Stomatology, Shandong First Medical University, China; Medical College, Liaocheng University, China
| | - Dao-Ying Yuan
- Key Lab of Precision Biomedicine & Department of Stomatology, Liaocheng People's Hospital, College of Stomatology, Shandong First Medical University, China; Medical College, Liaocheng University, China
| | - Bo Zou
- Key Lab of Precision Biomedicine & Department of Stomatology, Liaocheng People's Hospital, College of Stomatology, Shandong First Medical University, China.
| | - Zhen Meng
- Key Lab of Precision Biomedicine & Department of Stomatology, Liaocheng People's Hospital, College of Stomatology, Shandong First Medical University, China; Medical College, Liaocheng University, China.
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18
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Smuk G, Pajor G, Szuhai K, Morreau H, Kocsmár I, Kocsmár É, Pajor L, Kajtár B, Sárosi V, Lotz G, Tornóczky T. Attenuated isolated 3' signal: A highly challenging therapy relevant ALK FISH pattern in NSCLC. Lung Cancer 2020; 143:80-85. [PMID: 32272316 DOI: 10.1016/j.lungcan.2020.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/14/2020] [Accepted: 03/08/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Targeted therapies in the management of patients with lung cancer provide significantly better outcome compared to chemotherapy. Detection of the anaplastic lymphoma kinase (ALK) gene rearrangement has great predictive value for treatment with small molecule tyrosine kinase inhibitor (crizotinib and alectinib commonly). Fluorescent in situ hybridisation (FISH) assay is a basic diagnostic test designed for detecting ALK gene rearrangements. Although being considered as gold standard method by IASLC's guideline, it is often regarded as difficult and error prone. Our aim was to examine a unique atypical ALK FISH pattern, revealed during a systematic large-scale monitoring, which carries the great risk of misinterpretation, hence may result in loss of patients eligible for targeted therapy. MATERIALS AND METHODS Tissue and cytology samples from nearly one thousand patients with advanced stage non-small cell lung cancer (NSCLC, n = 996) were routinely examined by ALK FISH and immunohistochemistry (Ventana ALK-D5F3-CDx assay). Anchored Multiplex PCR based Next Generation Sequencing (AMP-NGS) was used to detect fusion gene transcripts in ambiguous cases. RESULTS Fifty-nine (5,9%) of the cases were positive with ALK FISH test. Three cases showed atypical pattern with a significantly reduced sized red (3') signal and complete loss of green signals. Digital signal measurement confirmed this finding, showing consistent attenuation of 3' signals throughout the tumours. In all three cases AMP-NGS and ALK IHC verified the presence of a fusion gene and expressed oncoprotein, respectively. CONCLUSION Approximately 5% of the 59 ALK positive cases exhibited atypical attenuated isolated 3' signal pattern. The immunohistochemistry and AMP-NGS examinations helped to clarify the presence of oncoprotein and the fusion gene, respectively. Our results emphasize the importance of extensive exploration of the genetic background of any unexpected FISH finding to avoid false diagnosis. This enables clinicians to indicate the adequate therapy with higher efficiency for patients suffering from NSCLC.
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Affiliation(s)
- Gábor Smuk
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary
| | - Gábor Pajor
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary
| | - Károly Szuhai
- Department of Cell and Chemical Biology, Leiden University Medical Center, Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Netherlands
| | - Ildikó Kocsmár
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Hungary
| | - Éva Kocsmár
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Hungary
| | - László Pajor
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary
| | - Béla Kajtár
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary
| | - Veronika Sárosi
- 1st Department of Internal Medicine, Medical School and Clinical Center, University of Pécs, Hungary
| | - Gábor Lotz
- 2nd Department of Pathology, Faculty of Medicine, Semmelweis University, Hungary
| | - Tamás Tornóczky
- Department of Pathology, Medical School and Clinical Center, University of Pécs, Hungary.
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Imai K, Takashima S, Fujishima S, Matsuo T, Watanabe SN, Nanjo H, Akagami Y, Nakamura R, Terata K, Wakita A, Sato Y, Motoyama S, Minamiya Y. Development of a Novel One-Step Automated Rapid in situ Hybridization for Anaplastic Lymphoma Kinase Rearrangement Using Non-Contact Alternating-Current Electric-Field Mixing. Pathobiology 2020; 87:45-50. [PMID: 32023616 DOI: 10.1159/000505631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/29/2019] [Indexed: 11/19/2022] Open
Abstract
Echinoderm microtubule-associated protein-like 4 and anaplastic lymphoma kinase (ALK) fusion gene rearrangement is a key driver mutation in non-small cell lung cancer (NSCLC). Although Break-Apart ALK fluorescence in situ hybridization (FISH) is a reliable diagnostic method for detecting ALK gene rearrangement, it is also costly and time-consuming to use as a routine screening test. Our aim was to evaluate the clinical utility of a novel one-step, automated, rapid FISH (Auto-RaFISH) method developed to facilitate hybridization. This method takes advantage of the non-contact mixing effect of an alternating-current electric field. Ten representative specimens from 85 patients diagnosed at multiple centers with primary lung cancer with identified ALK-FISH status were collected. The specimens were all tested using FISH, RaFISH, and Auto-RaFISH. With both RaFISH protocols, the ALK test was completed within 4.5 h, as compared to the 20 h needed for the standard protocol. We found 100% agreement between the standard FISH, RaFISH, and new Auto-RaFISH based on the ALK status, and all methods stained equally well. These findings suggest that Auto-RaFISH could potentially serve as an automated clinical tool for prompt determination of ALK status in NSCLC.
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Affiliation(s)
- Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan,
| | - Shinogu Takashima
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoshi Fujishima
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Tsubasa Matsuo
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Nosuke Watanabe
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Nanjo
- Department of Pathology,Akita University Hospital, Akita, Japan
| | - Yoichi Akagami
- Akita Prefectural Research and Development Center, Akita, Japan
| | - Ryuta Nakamura
- Akita Prefectural Research and Development Center, Akita, Japan
| | - Kaori Terata
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiyuki Wakita
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yusuke Sato
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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20
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Furugaki K, Mochizuki M, Kohno M, Shu S, Harada N, Yoshimura Y. Expression of C-terminal ALK, RET, or ROS1 in lung cancer cells with or without fusion. BMC Cancer 2019; 19:301. [PMID: 30943926 PMCID: PMC6446279 DOI: 10.1186/s12885-019-5527-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 03/27/2019] [Indexed: 01/19/2023] Open
Abstract
Background Genetic alterations, including mutation of epidermal growth factor receptor or v-Ki-ras2 kirsten rat sarcoma viral oncogene homolog and fusion of anaplastic lymphoma kinase (ALK), RET proto-oncogene (RET), or v-ros UR2 sarcoma virus oncogene homolog 1 (ROS1), occur in non-small cell lung cancers, and these oncogenic drivers are important biomarkers for targeted therapies. A useful technique to screen for these fusions is the detection of native carboxy-terminal (C-terminal) protein by immunohistochemistry; however, the effects of other genetic alterations on C-terminal expression is not fully understood. In this study, we evaluated whether C-terminal expression is specifically elevated by fusion with or without typical genetic alterations of lung cancer. Methods In 37 human lung cancer cell lines and four tissue specimens, protein and mRNA levels were measured by capillary western blotting and reverse transcription–PCR, respectively. Results Compared with the median of all 37 cell lines, mRNA levels at the C-terminus of all five of the fusion-positive cell lines tested (three ALK, one RET, and one ROS1) were elevated at least 2000-, 300-, or 2000-fold, respectively, and high C-terminal protein expression was detected. In an ALK fusion–positive tissue specimen, the mRNA and protein levels of C-terminal ALK were also markedly elevated. Meanwhile, in one of 36 RET fusion–negative cell lines, RET mRNA levels at the C-terminus were elevated at least 500-fold compared with the median of all 37 cell lines, and high C-terminal protein expression was detected despite the absence of RET fusion. Conclusions This study of 37 cell lines and four tissue specimens shows the detection of C-terminal ALK or ROS1 proteins could be a comprehensive method to determine ALK or ROS1 fusion, whereas not only the detection of C-terminal RET protein but also other methods would be needed to determine RET fusion. Electronic supplementary material The online version of this article (10.1186/s12885-019-5527-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Koh Furugaki
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Marie Mochizuki
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Mirei Kohno
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Sei Shu
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Naoki Harada
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Yasushi Yoshimura
- Product Research Department, Kamakura Research Laboratories, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura, Kanagawa, 247-8530, Japan.
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21
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Takeuchi K. Discovery Stories of RET Fusions in Lung Cancer: A Mini-Review. Front Physiol 2019; 10:216. [PMID: 30941048 PMCID: PMC6433883 DOI: 10.3389/fphys.2019.00216] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/20/2019] [Indexed: 12/29/2022] Open
Abstract
In 2004, a chemical inhibitor of the kinase activity of EGFR was reported to be effective in a subset of lung cancer patients with activating somatic mutations of EGFR. It remained unclear, however, whether kinase fusion genes also play a major role in the pathogenesis of lung cancers. The discovery of the EML4-ALK fusion kinase in 2007 was a breakthrough for this situation, and kinase fusion genes now form a group of relevant targetable oncogenes in lung cancer. In this mini-review article, the discovery of REarrangement during Transfection fusions, the third kinase fusion gene in lung cancer, is briefly described.
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Affiliation(s)
- Kengo Takeuchi
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.,Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
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22
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Abstract
INTRODUCTION Anaplastic lymphoma kinase (ALK) is one of the most attractive molecular targets for the treatment of patients with non-small-cell lung cancer. Treatment with ALK inhibitors is recognized as the standard-of-care for patients with ALK gene rearrangements, but it is important to appropriately select patients who will benefit from such treatment. Areas covered: In this article, we review the evidence regarding ALK testing. Immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and reverse transcription polymerase chain reaction (RT-PCR) are the representative methods for detecting ALK gene fusions. Among these diagnostic modalities, IHC in particular exhibits high sensitivity and specificity for the detection of ALK fusions when appropriately applied and interpreted. Expert commentary: Discrepancies have been reported between the results of IHC and FISH. However, it was revealed that patients with IHC-positivity and FISH-negativity may respond to alectinib, indicating that IHC can be used as a stand-alone method from a clinical standpoint for the identification of patients eligible for treatment with ALK inhibitors. In addition, differences between ALK variants have been reported to affect the prognosis and efficacy of ALK inhibitor-based treatments, and RT-PCR will likely increase in importance as a complementary tool.
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Affiliation(s)
- Yuka Kozuma
- a Department of Thoracic Oncology , National Kyushu Cancer Center , Fukuoka , Japan.,b Department of Surgery and Sciences, Graduate School of Medical Sciences , Kyushu University , Fukuoka , Japan
| | - Gouji Toyokawa
- b Department of Surgery and Sciences, Graduate School of Medical Sciences , Kyushu University , Fukuoka , Japan
| | - Takashi Seto
- a Department of Thoracic Oncology , National Kyushu Cancer Center , Fukuoka , Japan
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23
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Smuk G, Tornóczky T, Pajor L, Chudoba I, Kajtár B, Sárosi V, Pajor G. Immense random colocalization, revealed by automated high content image cytometry, seriously questions FISH as gold standard for detecting EML4-ALK fusion. Cytometry A 2018; 93:653-661. [DOI: 10.1002/cyto.a.23489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/23/2018] [Accepted: 04/13/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Gábor Smuk
- Department of Pathology; University of Pécs Medical School; Hungary
| | - Tamás Tornóczky
- Department of Pathology; University of Pécs Medical School; Hungary
| | - László Pajor
- Department of Pathology; University of Pécs Medical School; Hungary
| | | | - Béla Kajtár
- Department of Pathology; University of Pécs Medical School; Hungary
| | - Veronika Sárosi
- Department of Internal Medicine; University of Pécs Medical School; Hungary
| | - Gábor Pajor
- Department of Pathology; University of Pécs Medical School; Hungary
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24
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Lv T, Zou Q, Song Z, Liu H, Wang Q, Song Y. The correlation between crizotinib efficacy and molecular heterogeneity by next-generation sequencing in non-small cell lung cancer. J Thorac Dis 2018; 10:2948-2959. [PMID: 29997961 DOI: 10.21037/jtd.2018.05.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Non-small cell lung cancer (NSCLC) patients with EML4-ALK fusion exhibited various durations of response to crizotinib. Molecular heterogeneity is also one of the factors associated with resistance to crizotinib. This study investigated the relevance of molecular heterogeneity to the clinical efficacy of crizotinib using next-generation sequencing (NGS). Methods A total of 52 ALK-positive advanced NSCLC patients were enrolled. The genetic variation was revealed by NGS. We identified different ALK fusion types, allelic fraction (AF) and additional coexisting mutations (ACMs) and evaluated the correlation between the above three factors and clinical response to crizotinib. Results Among the group that was detected with ALK+ fusion by immunohistochemistry (IHC), patients detected as ALK- fusion by the NGS method were associated with a shorter progression-free survival (PFS) compared with ALK+ patients by NGS. Moreover, for different ALK fusion types, the median PFS of variant 1/2/3 and other uncommon variants were 305, 557, 242 and 370 days, respectively. Although there was no statistically significant difference (P=0.201), patients with ALK variant 2 appeared to display a longer PFS than other types of variants in this study. There was no significant difference in the relationship between ALK fusion AF and PFS (P=0.639). Additionally, there was no correlation between ACMs and PFS in the three groups (IHC+, IHC+/NGS-, and IHC+/NGS+, P=0.738, 0.801 and 0.550). We analysed the relationship between TP53/FAT3 and PFS in the IHC+/NGS+ group, and there was no statistically significant difference (P=0.712/0.631). Conclusions It is necessary to use multiple methods together to detect ALK fusion, and we can continue to carry out the study of the correlation between the different contents of heterogeneity of gene mutations and TKI effects using the NGS method.
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Affiliation(s)
- Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.,Nanjing University Institute of Respiratory Medicine, Nanjing 210002, China
| | - Qian Zou
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Zhengbo Song
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.,Nanjing University Institute of Respiratory Medicine, Nanjing 210002, China
| | - Qiming Wang
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
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25
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Vlajnic T, Savic S, Barascud A, Baschiera B, Bihl M, Grilli B, Herzog M, Rebetez J, Bubendorf L. Detection of ROS1-positive non-small cell lung cancer on cytological specimens using immunocytochemistry. Cancer Cytopathol 2018; 126:421-429. [DOI: 10.1002/cncy.21983] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Tatjana Vlajnic
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Spasenija Savic
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Audrey Barascud
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Betty Baschiera
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Michel Bihl
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Bruno Grilli
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Michelle Herzog
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Julien Rebetez
- Institute of Pathology; University Hospital Basel; Basel Switzerland
| | - Lukas Bubendorf
- Institute of Pathology; University Hospital Basel; Basel Switzerland
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26
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Fujishima S, Imai K, Nakamura R, Nanjo H, Saito Y, Saito H, Terata K, Sato Y, Motoyama S, Akagami Y, Minamiya Y. Novel method for rapid fluorescence in-situ hybridization of ALK rearrangement using non-contact alternating current electric field mixing. Sci Rep 2017; 7:15116. [PMID: 29118432 PMCID: PMC5678187 DOI: 10.1038/s41598-017-15515-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/27/2017] [Indexed: 12/25/2022] Open
Abstract
Echinoderm microtubule-associated protein-like 4 gene and anaplastic lymphoma kinase gene (EML4-ALK) rearrangement is a key driver mutation in non-small cell lung cancer (NSCLC). Although Break-Apart ALK fluorescence in situ hybridization (FISH) is a reliable diagnostic method for detecting ALK gene rearrangement, it is too costly and time-consuming for use as a routine screening test. Our aim was to evaluate the clinical utility of a novel rapid FISH (RaFISH) method developed to facilitate hybridization. RaFISH takes advantage of the non-contact mixing effect of an alternating current (AC) electric field. Eighty-five specimens were used from patients diagnosed with NSCLC identified immunohistochemically as ALK 0, (1/2+) or (3+). With RaFISH, the ALK test was completed within 4.5 h, as compared to 20 h needed for the standard FISH. Although RaFISH produced results more promptly, the staining and accuracy of the ALK evaluation with RaFISH was equal to the standard. We found 97.6% agreement between FISH and RaFISH based on the status of the ALK signals. These results suggest RaFISH could be used as a clinical tool to promptly determine ALK status.
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Affiliation(s)
- Satoshi Fujishima
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | | | - Hiroshi Nanjo
- Division of Clinical Pathology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshitaro Saito
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kaori Terata
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yusuke Sato
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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27
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Hida T, Nokihara H, Kondo M, Kim YH, Azuma K, Seto T, Takiguchi Y, Nishio M, Yoshioka H, Imamura F, Hotta K, Watanabe S, Goto K, Satouchi M, Kozuki T, Shukuya T, Nakagawa K, Mitsudomi T, Yamamoto N, Asakawa T, Asabe R, Tanaka T, Tamura T. Alectinib versus crizotinib in patients with ALK-positive non-small-cell lung cancer (J-ALEX): an open-label, randomised phase 3 trial. Lancet 2017; 390:29-39. [PMID: 28501140 DOI: 10.1016/s0140-6736(17)30565-2] [Citation(s) in RCA: 642] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Alectinib, a potent, highly selective, CNS-active inhibitor of anaplastic lymphoma kinase (ALK), showed promising efficacy and tolerability in the single-arm phase 1/2 AF-001JP trial in Japanese patients with ALK-positive non-small-cell lung cancer. Given those promising results, we did a phase 3 trial to directly compare the efficacy and safety of alectinib and crizotinib. METHODS J-ALEX was a randomised, open-label, phase 3 trial that recruited ALK inhibitor-naive Japanese patients with ALK-positive non-small-cell lung cancer, who were chemotherapy-naive or had received one previous chemotherapy regimen, from 41 study sites in Japan. Patients were randomly assigned (1:1) via an interactive web response system using a permuted-block method stratified by Eastern Cooperative Oncology Group performance status, treatment line, and disease stage to receive oral alectinib 300 mg twice daily or crizotinib 250 mg twice daily until progressive disease, unacceptable toxicity, death, or withdrawal. The primary endpoint was progression-free survival assessed by an independent review facility. The efficacy analysis was done in the intention-to-treat population, and safety analyses were done in all patients who received at least one dose of the study drug. The study is ongoing and patient recruitment is closed. This study is registered with the Japan Pharmaceutical Information Center (number JapicCTI-132316). FINDINGS Between Nov 18, 2013, and Aug 4, 2015, 207 patients were recruited and assigned to the alectinib (n=103) or crizotinib (n=104) groups. At data cutoff for the second interim analysis, 24 patients in the alectinib group had discontinued treatment compared with 61 in the crizotinib group, mostly due to lack of efficacy or adverse events. At the second interim analysis (data cutoff date Dec 3, 2015), an independent data monitoring committee determined that the primary endpoint of the study had been met (hazard ratio 0·34 [99·7% CI 0·17-0·71], stratified log-rank p<0·0001) and recommended an immediate release of the data. Median progression-free survival had not yet been reached with alectinib (95% CI 20·3-not estimated) and was 10·2 months (8·2-12·0) with crizotinib. Grade 3 or 4 adverse events occurred at a greater frequency with crizotinib (54 [52%] of 104) than alectinib (27 [26%] of 103). Dose interruptions due to adverse events were also more prevalent with crizotinib (77 [74%] of 104) than with alectinib (30 [29%] of 103), and more patients receiving crizotinib (21 [20%]) than alectinib (nine [9%]) discontinued the study drug because of an adverse event. No adverse events with a fatal outcome occurred in either treatment group. INTERPRETATION These results provide the first head-to-head comparison of alectinib and crizotinib and have the potential to change the standard of care for the first-line treatment of ALK-positive non-small-cell lung cancer. The dose of alectinib (300 mg twice daily) used in this study is lower than the approved dose in countries other than Japan; however, this limitation is being addressed in the ongoing ALEX study. FUNDING Chugai Pharmaceutical Co, Ltd.
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Affiliation(s)
- Toyoaki Hida
- Department of Thoracic Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hiroshi Nokihara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masashi Kondo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Azuma
- Institution Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroshige Yoshioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Fumio Imamura
- Department of Thoracic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Katsuyuki Hotta
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Miyako Satouchi
- Department of Thoracic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Toshiyuki Kozuki
- Department of Thoracic Oncology and Medicine, Shikoku Cancer Center, Matsuyama, Japan
| | - Takehito Shukuya
- Department of Respiratory Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Tetsuya Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Nobuyuki Yamamoto
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Asakawa
- Clinical Science and Strategy Department, Chugai Pharmaceutical, Tokyo, Japan
| | - Ryoichi Asabe
- Clinical Study Management Department, Chugai Pharmaceutical, Tokyo, Japan
| | - Tomohiro Tanaka
- Clinical Science and Strategy Department, Chugai Pharmaceutical, Tokyo, Japan
| | - Tomohide Tamura
- Thoracic Center, St. Luke's International Hospital, Tokyo, Japan.
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28
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Yamasaki M, Saito N, Hada Y, Miyamoto S, Okanobu H, Ikeda N, Daido W, Ishiyama S, Deguchi N, Taniwaki M, Ohashi N. Nivolumab Therapy for Synchronous ALK-Positive Lung Cancer and Gastric Cancer. Case Rep Oncol 2017; 10:361-367. [PMID: 28559820 PMCID: PMC5436064 DOI: 10.1159/000470830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 12/27/2022] Open
Abstract
Nivolumab is an immune checkpoint inhibitor with demonstrated efficacy against several malignant tumors. Alterations in driver oncogenes such as EGFR and ALK are a poor prognostic factor in nivolumab therapy for non-small cell lung cancer (NSCLC), whereas a smoking history is a well-known, favorable prognostic factor. However, an efficacy of nivolumab therapy for multiple primary malignant tumors (MPMTs) has not been reported, and its efficacy for driver oncogene-positive NSCLC in smokers is unclear. Herein, we report the case of a patient with a history of heavy smoking who developed synchronous ALK-positive NSCLC and gastric cancer that responded to nivolumab therapy. A 76-year-old man who was a heavy smoker presented to our hospital with symptoms of hoarseness and dysphagia. He was ultimately diagnosed with ALK-positive advanced NSCLC. An ALK inhibitor (alectinib) was administered, and the lung cancer lesions showed improvement. The alectinib therapy was continued for 5 months. Thereafter, the lesions in the left lower lobe of the lung showed regrowth. During the same period, the patient experienced epigastric pain. Gastrointestinal endoscopy examination revealed gastric cancer. He was administered nivolumab to treat both the lung cancer and the gastric cancer. Two months later, both the lung lesions and the gastric lesions had diminished in size. Nivolumab therapy might be an effective therapy for synchronous MPMTs and NSCLC in heavy smokers, even if the lung cancer possesses driver oncogene mutations.
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Affiliation(s)
- Masahiro Yamasaki
- aDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Naomi Saito
- aDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Yu Hada
- bDepartment of Gastroenterology, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Sayaka Miyamoto
- bDepartment of Gastroenterology, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Hideharu Okanobu
- bDepartment of Gastroenterology, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Naoya Ikeda
- cDepartment of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Wakako Daido
- aDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Sayaka Ishiyama
- aDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Naoko Deguchi
- aDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Masaya Taniwaki
- aDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Nobuyuki Ohashi
- aDepartment of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan.,dOhashi Clinic, Hiroshima, Japan
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29
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Nakajima N, Yoshizawa A, Kondo K, Rokutan-Kurata M, Hirata M, Furuhata A, Sumiyoshi S, Sonobe M, Menju T, Momose M, Fujimoto M, Date H, Haga H. Evaluating the effectiveness of RNA in-situ hybridization for detecting lung adenocarcinoma with anaplastic lymphoma kinase rearrangement. Histopathology 2017; 71:143-149. [PMID: 28231386 DOI: 10.1111/his.13198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
Abstract
AIMS An easy and rapid assay for detecting mRNA in formalin-fixed paraffin-embedded samples [RNA in-situ hybridization (ISH)] has been reported recently. The aim of this study was to investigate the diagnostic accuracy of RNA ISH in detecting lung adenocarcinoma (LA) with anaplastic lymphoma kinase (ALK) gene rearrangement. METHODS AND RESULTS We tested ALK RNA ISH on 11 resected LAs for which ALK fusion was confirmed by immunohistochemistry (IHC) and/or fluorescence in-situ hybridization (FISH). ALK mRNA expression was detected by RNA ISH in all 11 ALK-positive LAs, with a mean positive cell proportion of 68.4% (median, 75.3%; range, 3-98.8%), by counting 100 tumour cells at 10 different loci; RNA ISH did not detect ALK mRNA expression in the normal surrounding lung cells. Next, we explored the concordance between ALK RNA ISH and IHC/FISH tests by using tissue microarrays (TMAs) containing 294 LAs. In the TMA slides, we found five ALK-positive cases with IHC and/or FISH. The mean proportion of ALK RNA ISH-positive cells in these five cases was 75.6% (median, 82%; range, 40-94%), whereas the proportion of ALK RNA ISH-positive cells in the remaining 289 cases was 0.3% (median 0%; range, 0-15%). When the cutoff value was set at 15%, ALK RNA ISH-positive and ALK RNA ISH-negative cases were distinguishable with 100% sensitivity and specificity relative to the IHC/FISH tests. CONCLUSIONS Our findings show that RNA ISH is useful for detecting ALK rearrangement with high sensitivity and specificity relative to conventional IHC/FISH tests. Thus, RNA ISH, which is an easy and rapid assay, could be an alternative method to IHC and FISH.
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Affiliation(s)
- Naoki Nakajima
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Kyoko Kondo
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | | | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Ayako Furuhata
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Shinji Sumiyoshi
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.,Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Masanobu Momose
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.,Diagnostic Pathology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
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30
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Tamura T, Kiura K, Seto T, Nakagawa K, Maemondo M, Inoue A, Hida T, Yoshioka H, Harada M, Ohe Y, Nogami N, Murakami H, Kuriki H, Shimada T, Tanaka T, Takeuchi K, Nishio M. Three-Year Follow-Up of an Alectinib Phase I/II Study in ALK-Positive Non-Small-Cell Lung Cancer: AF-001JP. J Clin Oncol 2017; 35:1515-1521. [PMID: 28296581 PMCID: PMC5455704 DOI: 10.1200/jco.2016.70.5749] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Alectinib is an anaplastic lymphoma kinase (ALK) –specific kinase inhibitor that seems to be effective against non–small-cell lung cancer (NSCLC) with a variety of ALK mutations. The primary analysis of AF-001JP reported a promising overall response rate. To assess progression-free survival (PFS) and overall survival (OS), patients from the phase II part of AF-001JP were followed up for approximately 3 years. Patients and Methods Oral alectinib 300 mg was administered twice per day to patients with ALK inhibitor–naïve, ALK-positive NSCLC who had progressed after one or more regimens of previous chemotherapy. In this long-term follow-up, efficacy (PFS, OS), correlation between tumor shrinkage and PFS, safety of alectinib, and relief of cancer symptoms were evaluated. Results At the updated data cutoff (September 10, 2015; first patient in August 30, 2011, last patient in April 18, 2012), 25 of 46 phase II patients were still receiving alectinib. Disease progression was confirmed in 18 patients (39%); median PFS was not reached (3-year PFS rate, 62%; 95% CI, 45 to 75). Fourteen patients had brain metastases at baseline; of these, 6 remained in the study without CNS and systemic progression. Tumor shrinkage and PFS showed no correlation. The 3-year OS rate was 78% (13 events). The most common treatment-related adverse event (all grades) was increased blood bilirubin (36.2%). Most cancer symptoms were relieved early, and medication for symptoms was dramatically decreased during alectinib therapy. Conclusion Alectinib was effective in this 3-year follow-up with a favorable safety profile over a long administration period in ALK-positive NSCLC without previous ALK inhibitor treatment.
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Affiliation(s)
- Tomohide Tamura
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuyuki Kiura
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Seto
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazuhiko Nakagawa
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Makoto Maemondo
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Inoue
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Toyoaki Hida
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroshige Yoshioka
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masao Harada
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yuichiro Ohe
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naoyuki Nogami
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruyasu Murakami
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroshi Kuriki
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tadashi Shimada
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomohiro Tanaka
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kengo Takeuchi
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
| | - Makoto Nishio
- Tomohide Tamura, St Luke's International Hospital; Yuichiro Ohe, National Cancer Center Hospital; Hiroshi Kuriki, Tadashi Shimada, and Tomohiro Tanaka, Chugai Pharmaceutical; Kengo Takeuchi, Japanese Foundation for Cancer Research; Makoto Nishio, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo; Katsuyuki Kiura, Okayama University Hospital, Okayama; Takashi Seto, National Kyusyu Cancer Center, Fukuoka; Kazuhiko Nakagawa, Kindai University, Osaka-Sayama; Makoto Maemondo, Miyagi Cancer Center, Natori; Akira Inoue, Tohoku University, Sendai; Toyoaki Hida, Aichi Cancer Center, Nagoya; Hiroshige Yoshioka, Kurashiki Central Hospital, Kurashiki; Masao Harada, Hokkaido Cancer Center, Sapporo; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; and Haruyasu Murakami, Shizuoka Cancer Center, Shizuoka, Japan
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Huang JL, Zeng J, Wang F, Huang QT, Lu JB, Li XM, Chen WQ, Zhu CM, Jin JT, Lin SX. Responses to Crizotinib therapy in five patients with non-small-cell lung cancer who tested FISH negative and Ventana immunohistochemistry positive for ALK fusions. Per Med 2017; 14:99-107. [PMID: 29754556 DOI: 10.2217/pme-2016-0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM Although immunohistochemistry (IHC) and reverse transcription-PCR can detect ALK rearrangements, the ALK break-apart FISH assay is currently considered the standard method. MATERIALS & METHODS Five patients with advanced non-small-cell lung cancer, who had an ALK-negative FISH result that was later confirmed as positive by the Ventana IHC assay, were studied. Four had previously received chemotherapy or radiotherapy. All five were subsequently treated with Crizoitinib 250 mg twice daily. RESULTS & CONCLUSION Four patients had a partial response to Crizotinib and one had stable disease. IHC is an efficient technique for diagnosing ALK rearrangements in patients with non-small-cell lung cancer, and may serve as an alternative to FISH in clinical practice.
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Affiliation(s)
- Jin-Lin Huang
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jing Zeng
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Fang Wang
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qi-Tao Huang
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jia-Bin Lu
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xiao-Mei Li
- Department of Pathology, Shenzhen Baoan Maternal & Child Health Hospital, Shenzhen, China
| | - Wei-Qiang Chen
- Department of Imaging, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Chong-Mei Zhu
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jie-Tian Jin
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Su-Xia Lin
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Hida T, Nakagawa K, Seto T, Satouchi M, Nishio M, Hotta K, Takahashi T, Ohe Y, Takeda K, Tatsuno M, Asakawa T, Shimada T, Tanaka T, Tamura T. Pharmacologic study (JP28927) of alectinib in Japanese patients with ALK+ non-small-cell lung cancer with or without prior crizotinib therapy. Cancer Sci 2017; 107:1642-1646. [PMID: 27566263 PMCID: PMC5132270 DOI: 10.1111/cas.13066] [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: 05/26/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 02/02/2023] Open
Abstract
We report pharmacokinetics, efficacy and safety data for a new 150‐mg alectinib capsule in ALK+ non‐small‐cell lung cancer in a multicenter, open‐label pharmacologic study (JP28927). Eligible patients (≥20 years, locally advanced/metastatic ALK+ disease, ALK inhibitor‐naïve and ‐pretreated [including crizotinib refractory]) were randomized 1:1 to receive one of two sequences of alectinib 300 mg twice daily (comprising different schedules of 20/40‐mg and 150‐mg capsules) until investigator‐determined lack of clinical benefit. Co‐primary endpoints were: bioequivalence of alectinib 20/40 mg vs 150 mg; food effect with 150 mg; and safety. Thirty‐five patients were enrolled; median treatment duration was 13.1 months (range 1.1−15.0). Under fasting conditions, exposure of the two formulations was similar; mean AUClast ± standard deviation 3230 ± 914 h·ng/mL vs 3710 ± 1040 h·ng/mL, respectively, for 150‐mg vs 20/40‐mg capsules. Food effect with 150 mg alectinib was negligible. Treatment‐related adverse events in >20% of patients were constipation (31.4%), dysgeusia (25.7%), and decreased white blood cell and neutrophil count (22.9% each). No treatment‐related grade 4/5 events occurred. Median time to response was 1.2 months (95% CI 1.1−2.1). For the full analysis set (n = 35) and crizotinib‐failure subpopulations (n = 23), the overall response rate was 70.0% (95% CI 50.6−85.3) and 65.0% (95% CI 40.8−84.6), and median progression‐free survival was 13.9 months (95% CI 11.1−not reached) and 12.9 months (95% CI 3.9−not reached), respectively. The 150‐mg capsule had a similar exposure profile to 20/40‐mg capsules. Alectinib demonstrated promising efficacy and was well tolerated.
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Affiliation(s)
- Toyoaki Hida
- Department of Thoracic Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Kyusyu Cancer Center, Fukuoka, Japan
| | - Miyako Satouchi
- Department of Thoracic Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Katsuyuki Hotta
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Toshiaki Takahashi
- Department of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.,National Cancer Center East, Chiba, Japan
| | - Koji Takeda
- Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Masahiro Tatsuno
- Translational Clinical Research Science & Strategy Department, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Takashi Asakawa
- Clinical Science & Strategy Department, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Tadashi Shimada
- Clinical Science & Strategy Department, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Tomohiro Tanaka
- Clinical Science & Strategy Department, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Tomohide Tamura
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.,Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
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Reguart N, Teixidó C, Giménez-Capitán A, Paré L, Galván P, Viteri S, Rodríguez S, Peg V, Aldeguer E, Viñolas N, Remon J, Karachaliou N, Conde E, Lopez-Rios F, Nadal E, Merkelbach-Bruse S, Büttner R, Rosell R, Molina-Vila MA, Prat A. Identification of ALK, ROS1, and RET Fusions by a Multiplexed mRNA-Based Assay in Formalin-Fixed, Paraffin-Embedded Samples from Advanced Non-Small-Cell Lung Cancer Patients. Clin Chem 2017; 63:751-760. [PMID: 28073897 DOI: 10.1373/clinchem.2016.265314] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/13/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anaplastic lymphoma receptor tyrosine kinase (ALK), ROS proto-oncogene 1, receptor tyrosine kinase (ROS1), and ret proto-oncogene (RET) fusions are present in 5%-7% of patients with advanced non-small-cell lung cancer (NSCLC); their accurate identification is critical to guide targeted therapies. FISH and immunohistochemistry (IHC) are considered the gold standards to determine gene fusions, but they have limitations. The nCounter platform is a potentially useful genomic tool for multiplexed detection of gene fusions, but has not been validated in the clinical setting. METHODS Formalin-fixed, paraffin embedded (FFPE) samples from 108 patients with advanced NSCLC were analyzed with an nCounter-based assay and the results compared with FISH, IHC, and reverse transcription PCR (RT-PCR). Data on response to fusion kinase inhibitors was retrospectively collected in a subset of 29 patients. RESULTS Of 108 FFPE samples, 98 were successfully analyzed by nCounter (91%), which identified 55 fusion-positive cases (32 ALK, 21 ROS1, and 2 RET). nCounter results were highly concordant with IHC for ALK (98.5%, CI = 91.8-99.7), while 11 discrepancies were found compared with FISH (87.5% concordance, CI = 79.0-92.9). For ROS1, nCounter showed similar agreement with IHC and FISH (87.2% and 85.9%), but a substantial number of samples were positive only by 1 or 2 techniques. Of the 25 patients deriving clinical benefit from fusion kinase inhibitors, 24 were positive by nCounter and 22 by FISH. CONCLUSIONS nCounter compares favorably with IHC and FISH and can be used for identifying patients with advanced NSCLC positive for ALK/ROS1/RET fusion genes.
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Affiliation(s)
- Noemí Reguart
- Medical Oncology, Hospital Clínic, Barcelona, Spain; .,Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Teixidó
- Pangaea Biotech, Laboratory of Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Ana Giménez-Capitán
- Pangaea Biotech, Laboratory of Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Laia Paré
- Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Patricia Galván
- Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Pangaea Biotech, Laboratory of Oncology, Quirón Dexeus University Hospital, Barcelona, Spain.,Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO)
| | - Santiago Viteri
- Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Sonia Rodríguez
- Pangaea Biotech, Laboratory of Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Vicente Peg
- Pangaea Biotech, Laboratory of Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Erika Aldeguer
- Pangaea Biotech, Laboratory of Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | | | - Jordi Remon
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Niki Karachaliou
- Pangaea Biotech, Laboratory of Oncology, Quirón Dexeus University Hospital, Barcelona, Spain.,Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain.,University Hospital Sagrat Cor, Barcelona, Spain
| | - Esther Conde
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Fernando Lopez-Rios
- Laboratorio de Dianas Terapéuticas, Centro Integral Oncológico Clara Campal, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Ernest Nadal
- Medical Oncology Service, Catalan Institute of Oncology, L'Hospitalet, Spain
| | | | - Reinhard Büttner
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Rafael Rosell
- Pangaea Biotech, Laboratory of Oncology, Quirón Dexeus University Hospital, Barcelona, Spain.,Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain.,Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Germans Trias i Pujol Health Sciences Institute and Hospital, Badalona, Barcelona, Spain
| | - Miguel A Molina-Vila
- Pangaea Biotech, Laboratory of Oncology, Quirón Dexeus University Hospital, Barcelona, Spain;
| | - Aleix Prat
- Medical Oncology, Hospital Clínic, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Li W, Zhang J, Guo L, Chuai S, Shan L, Ying J. Combinational Analysis of FISH and Immunohistochemistry Reveals Rare Genomic Events in ALK Fusion Patterns in NSCLC that Responds to Crizotinib Treatment. J Thorac Oncol 2017; 12:94-101. [DOI: 10.1016/j.jtho.2016.08.145] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/12/2016] [Accepted: 08/24/2016] [Indexed: 11/16/2022]
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Tsuyama N, Sakamoto K, Sakata S, Dobashi A, Takeuchi K. Anaplastic large cell lymphoma: pathology, genetics, and clinical aspects. J Clin Exp Hematop 2017; 57:120-142. [PMID: 29279550 PMCID: PMC6144189 DOI: 10.3960/jslrt.17023] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/19/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022] Open
Abstract
Anaplastic large cell lymphoma (ALCL) was first described in 1985 as a large-cell neoplasm with anaplastic morphology immunostained by the Ki-1 antibody, which recognizes CD30. In 1994, the nucleophosmin (NPM)-anaplastic lymphoma kinase (ALK) fusion receptor tyrosine kinase was identified in a subset of patients, leading to subdivision of this disease into ALK-positive and -negative ALCL in the present World Health Organization classification. Due to variations in morphology and immunophenotype, which may sometimes be atypical for lymphoma, many differential diagnoses should be considered, including solid cancers, lymphomas, and reactive processes. CD30 and ALK are key molecules involved in the pathogenesis, diagnosis, and treatment of ALCL. In addition, signal transducer and activator of transcription 3 (STAT3)-mediated mechanisms are relevant in both types of ALCL, and fusion/mutated receptor tyrosine kinases other than ALK have been reported in ALK-negative ALCL. ALK-positive ALCL has a better prognosis than ALK-negative ALCL or other peripheral T-cell lymphomas. Patients with ALK-positive ALCL are usually treated with anthracycline-based regimens, such as combination cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) or CHOEP (CHOP plus etoposide), which provide a favorable prognosis, except in patients with multiple International Prognostic Index factors. For targeted therapies, an anti-CD30 monoclonal antibody linked to a synthetic antimitotic agent (brentuximab vedotin) and ALK inhibitors (crizotinib, alectinib, and ceritinib) are being used in clinical settings.
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ALK Immunohistochemistry for ALK Gene Rearrangement Screening in Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Int J Biol Markers 2016; 31:e413-e421. [DOI: 10.5301/jbm.5000218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/20/2022]
Abstract
Introduction The aim of this study was to investigate the diagnostic accuracy of anaplastic lymphoma kinase (ALK) immunohistochemistry (IHC) for ALK gene rearrangement in non-small cell lung cancer (NSCLC) through systematic review, meta-analysis and diagnostic test accuracy review. Methods The current study included 11,806 NSCLC cases in 42 eligible studies. We performed concordance analyses between ALK IHC and fluorescence in situ hybridization (FISH). The diagnostic accuracy of ALK IHC was analyzed based on ALK IHC criteria and antibodies. Results The overall ALK IHC results were positive in 13.2%. The overall concordance rate between ALK IHC and FISH was 0.950 (95% confidence interval [CI], 0.927-0.966). In the ALK IHC-positive and negative groups, the concordance rates were 0.805 (95% CI 0.733-0.861) and 0.985 (95% CI 0.978-0.990), respectively. The ALK FISH-positive rates were 0.009 (95% CI 0.004-0.023), 0.378 (95% CI 0.217-0.572), 0.628 (95% CI 0.420-0.796) and 0.900 (95% CI 0.840-0.939) in the ALK IHC 0, 1+, 2+ and 3+ groups, respectively. In diagnostic test accuracy review for ALK IHC, the pooled sensitivity and specificity were 0.92 (95% CI 0.89-0.94) and 0.91 (95% CI 0.90-0.91), respectively. The diagnostic odds ratio and the area under the curve on the summary receiver operating characteristic curve were 266.56 (95% CI 110.83-641.14) and 0.983, respectively. Conclusions Our results suggested that ALK IHC equivocal (score 1+ and 2+) cases should not be considered as IHC-negative in screening for ALK gene rearrangement. Additional detailed criteria for ALK IHC equivocal cases are necessary to determine how to best apply this approach in daily practice.
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Management of Resistance to Crizotinib in Anaplastic Lymphoma Kinase-Positive Non–Small-cell Lung Cancer. Clin Lung Cancer 2016; 17:474-482. [DOI: 10.1016/j.cllc.2016.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 12/20/2022]
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Hiley CT, Le Quesne J, Santis G, Sharpe R, de Castro DG, Middleton G, Swanton C. Challenges in molecular testing in non-small-cell lung cancer patients with advanced disease. Lancet 2016; 388:1002-11. [PMID: 27598680 DOI: 10.1016/s0140-6736(16)31340-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/15/2016] [Accepted: 07/25/2016] [Indexed: 12/18/2022]
Abstract
Lung cancer diagnostics have progressed greatly in the previous decade. Development of molecular testing to identify an increasing number of potentially clinically actionable genetic variants, using smaller samples obtained via minimally invasive techniques, is a huge challenge. Tumour heterogeneity and cancer evolution in response to therapy means that repeat biopsies or circulating biomarkers are likely to be increasingly useful to adapt treatment as resistance develops. We highlight some of the current challenges faced in clinical practice for molecular testing of EGFR, ALK, and new biomarkers such as PDL1. Implementation of next generation sequencing platforms for molecular diagnostics in non-small-cell lung cancer is increasingly common, allowing testing of multiple genetic variants from a single sample. The use of next generation sequencing to recruit for molecularly stratified clinical trials is discussed in the context of the UK Stratified Medicine Programme and The UK National Lung Matrix Trial.
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Affiliation(s)
- Crispin T Hiley
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK; Division of Cancer Studies, King's College London, London, UK
| | - John Le Quesne
- Department of Cancer Studies, University of Leicester, Leicester, UK
| | - George Santis
- Department of Respiratory Medicine and Allergy, King's College London, UK
| | | | - David Gonzalez de Castro
- Centre for Molecular Pathology, Royal Marsden Hospital, Sutton, UK; School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Charles Swanton
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London, UK; CRUK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK.
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Hirsch FR, Suda K, Wiens J, Bunn PA. New and emerging targeted treatments in advanced non-small-cell lung cancer. Lancet 2016; 388:1012-24. [PMID: 27598681 DOI: 10.1016/s0140-6736(16)31473-8] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/20/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022]
Abstract
Targeted therapies are substantially changing the management of lung cancers. These treatments include drugs that target driver mutations, those that target presumed important molecules in cancer cell proliferation and survival, and those that inhibit immune checkpoint molecules. This area of research progresses day by day, with novel target discoveries, novel drug development, and use of novel combination treatments. Researchers and clinicians have also extensively investigated the predictive biomarkers and the molecular mechanisms underlying inherent or acquired resistance to these targeted therapies. We review recent progress in the development of targeted treatments for patients with advanced non-small-cell lung cancer, especially focusing on data from published clinical trials.
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Affiliation(s)
- Fred R Hirsch
- Department of Medicine, Division of Medical Oncology and Department of Pathology, University of Colorado Cancer Center, Aurora, CO, USA; International Association for the Study of Lung Cancer, Aurora, CO, USA.
| | - Kenichi Suda
- Department of Medicine, Division of Medical Oncology and Department of Pathology, University of Colorado Cancer Center, Aurora, CO, USA
| | - Jacinta Wiens
- International Association for the Study of Lung Cancer, Aurora, CO, USA
| | - Paul A Bunn
- Department of Medicine, Division of Medical Oncology and Department of Pathology, University of Colorado Cancer Center, Aurora, CO, USA
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Kerr K, López-Ríos F. Precision medicine in NSCLC and pathology: how does ALK fit in the pathway? Ann Oncol 2016; 27 Suppl 3:iii16-iii24. [DOI: 10.1093/annonc/mdw302] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Mattsson JSM, Brunnström H, Jabs V, Edlund K, Jirström K, Mindus S, la Fleur L, Pontén F, Karlsson MG, Karlsson C, Koyi H, Brandén E, Botling J, Helenius G, Micke P, Svensson MA. Inconsistent results in the analysis of ALK rearrangements in non-small cell lung cancer. BMC Cancer 2016; 16:603. [PMID: 27495736 PMCID: PMC4974795 DOI: 10.1186/s12885-016-2646-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/28/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Identification of targetable EML4-ALK fusion proteins has revolutionized the treatment of a minor subgroup of non-small cell lung cancer (NSCLC) patients. Although fluorescence in situ hybridization (FISH) is regarded as the gold standard for detection of ALK rearrangements, ALK immunohistochemistry (IHC) is often used as screening tool in clinical practice. In order to unbiasedly analyze the diagnostic impact of such a screening strategy, we compared ALK IHC with ALK FISH in three large representative Swedish NSCLC cohorts incorporating clinical parameters and gene expression data. METHODS ALK rearrangements were detected using FISH on tissue microarrays (TMAs), including tissue from 851 NSCLC patients. In parallel, ALK protein expression was detected using IHC, applying the antibody clone D5F3 with two different protocols (the FDA approved Ventana CDx assay and our in house Dako IHC protocol). Gene expression microarray data (Affymetrix) was available for 194 patients. RESULTS ALK rearrangements were detected in 1.7 % in the complete cohort and 2.0 % in the non-squamous cell carcinoma subgroup. ALK protein expression was observed in 1.8 and 1.4 % when applying the Ventana assay or the in house Dako protocol, respectively. The specificity and accuracy of IHC was high (> 98 %), while the sensitivity was between 69 % (Ventana) and 62 % (in house Dako protocol). Furthermore, only 67 % of the ALK IHC positive cases were positive with both IHC assays. Gene expression analysis revealed that 6/194 (3 %) tumors showed high ALK gene expression (≥ 6 AU) and of them only three were positive by either FISH or IHC. CONCLUSION The overall frequency of ALK rearrangements based on FISH was lower than previously reported. The sensitivity of both IHC assays was low, and the concordance between the FISH and the IHC assays poor, questioning current strategies to screen with IHC prior to FISH or completely replace FISH by IHC.
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Affiliation(s)
- Johanna S M Mattsson
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden.
| | - Hans Brunnström
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Pathology, Regional Laboratories Region Skåne, SE-221 85, Lund, Sweden
| | - Verena Jabs
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Karolina Edlund
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at Dortmund TU, Dortmund, Germany
| | - Karin Jirström
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Stephanie Mindus
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Linnéa la Fleur
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Mats G Karlsson
- Department of Research and Education, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle hospital, Gävle; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Eva Brandén
- Department of Respiratory Medicine, Gävle hospital, Gävle; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Johan Botling
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Gisela Helenius
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick Micke
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85, Uppsala, Sweden
| | - Maria A Svensson
- Clinical Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Bioanalysis of alectinib and metabolite M4 in human plasma, cross-validation and impact on PK assessment. Bioanalysis 2016; 8:1465-79. [DOI: 10.4155/bio-2016-0068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Alectinib is a novel anaplastic lymphoma kinase (ALK) inhibitor for treatment of patients with ALK-positive non-small-cell lung cancer who have progressed on or are intolerant to crizotinib. To support clinical development, concentrations of alectinib and metabolite M4 were determined in plasma from patients and healthy subjects. Methods: LC–MS/MS methods were developed and validated in two different laboratories: Chugai used separate assays for alectinib and M4 in a pivotal Phase I/II study while Roche established a simultaneous assay for both analytes for another pivotal study and all other studies. Conclusion: Cross-validation assessment revealed a bias between the two bioanalytical laboratories, which was confirmed with the clinical PK data between both pivotal studies using the different bioanalytical methods.
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Cortinovis D, Abbate M, Bidoli P, Capici S, Canova S. Targeted therapies and immunotherapy in non-small-cell lung cancer. Ecancermedicalscience 2016; 10:648. [PMID: 27433281 PMCID: PMC4929979 DOI: 10.3332/ecancer.2016.648] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Indexed: 01/23/2023] Open
Abstract
Non-small-cell lung cancer is still considered a difficult disease to manage because of its aggressiveness and resistance to common therapies. Chemotherapy remains the gold standard in nearly 80% of lung cancers, but clinical outcomes are discouraging, and the impact on median overall survival (OS) barely reaches 12 months. At the end of the last century, the discovery of oncogene-driven tumours completely changed the therapeutic landscape in lung cancers, harbouring specific gene mutations/translocations. Epidermal growth factors receptor (EGFR) common mutations first and anaplastic lymphoma kinase (ALK) translocations later led new insights in lung cancer biology knowledge. The use of specific tyrosine kinases inhibitors overturned the biological behaviour of EGFR mutation positive tumours and became a preclinical model to understand the heterogeneity of lung cancers and the mechanisms of drug resistance. In this review, we summarise the employment of targeted agents against the most representative biomolecular alterations and provide some criticisms of the therapeutic strategies.
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Affiliation(s)
- D Cortinovis
- Medical Oncology Unit, AOU San Gerardo, via Giambattista Pergolesi 33, 20900 Monza, Italy
| | - M Abbate
- Medical Oncology Unit, AOU San Gerardo, via Giambattista Pergolesi 33, 20900 Monza, Italy
| | - P Bidoli
- Medical Oncology Unit, AOU San Gerardo, via Giambattista Pergolesi 33, 20900 Monza, Italy
| | - S Capici
- Medical Oncology Unit, AOU San Gerardo, via Giambattista Pergolesi 33, 20900 Monza, Italy
| | - S Canova
- Medical Oncology Unit, AOU San Gerardo, via Giambattista Pergolesi 33, 20900 Monza, Italy
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Abstract
INTRODUCTION Anaplastic lymphoma kinase (ALK) rearrangements are present in about 5% of advanced non-small-cell lung cancer (NSCLC) patients. Despite the initial response, after a median of 1-2 years, ALK-positive patients developed an acquired resistance to the ALK-inhibitor crizotinib. Among the most promising second-generation ALK-inhibitors, alectinib is being investigated in crizotinib-naïve and -resistant ALK-positive NSCLC patients. AREAS COVERED The current state-of-the-art of ALK-inhibitors treatment, and in particular the role of alectinib in this setting, is reviewed and discussed. A structured search of bibliographic databases for peer-reviewed research literature and of main meetings using a focused review question was undertaken. Expert commentary: Alectinib reports promising results with a good safety profile, becoming a potentially very important option for ALK-translocated NSCLC patients. The preliminary results from the J-ALEX phase III randomized trial performed in ALK-rearranged NSCLC Japanese patients showed a better activity and tolerability of alectinib versus crizotinib.
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Affiliation(s)
- Antonio Rossi
- a Division of Medical Oncology , "S.G. Moscati" Hospital , Avellino , Italy
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Conde E, Hernandez S, Prieto M, Martinez R, Lopez-Rios F. Profile of Ventana ALK (D5F3) companion diagnostic assay for non-small-cell lung carcinomas. Expert Rev Mol Diagn 2016; 16:707-13. [PMID: 27031368 DOI: 10.1586/14737159.2016.1172963] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The development of several ALK inhibitors means that the importance of accurately identifying ALK-positive lung cancer has never been greater. Therefore, it is crucial that ALK testing assays become more standardized. The aim of this review is to comment on the recently FDA-approved VENTANA ALK (D5F3) Companion Diagnostic (CDx) Assay. This kit provides high sensitivity and specificity for the detection of ALK rearrangements and seamless integration into the laboratory workflow, with a fully automated analytical phase and fast interpretation. The use of controls increases the sensitivity and specificity and a dichotomous scoring approach enhances reproducibility.
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Affiliation(s)
- Esther Conde
- a Laboratorio de Dianas Terapéuticas , Hospital Universitario HM Sanchinarro , Madrid , Spain.,b Faculty of Medicine , Universidad San Pablo-CEU , Madrid , Spain
| | - Susana Hernandez
- a Laboratorio de Dianas Terapéuticas , Hospital Universitario HM Sanchinarro , Madrid , Spain
| | - Mario Prieto
- a Laboratorio de Dianas Terapéuticas , Hospital Universitario HM Sanchinarro , Madrid , Spain.,b Faculty of Medicine , Universidad San Pablo-CEU , Madrid , Spain
| | - Rebeca Martinez
- a Laboratorio de Dianas Terapéuticas , Hospital Universitario HM Sanchinarro , Madrid , Spain
| | - Fernando Lopez-Rios
- a Laboratorio de Dianas Terapéuticas , Hospital Universitario HM Sanchinarro , Madrid , Spain.,b Faculty of Medicine , Universidad San Pablo-CEU , Madrid , Spain
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