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Tønnesen EMT, Stougaard M, Meldgaard P, Lade-Keller J. Prognostic value of KRAS mutations, TP53 mutations and PD-L1 expression among lung adenocarcinomas treated with immunotherapy. J Clin Pathol 2023; 77:54-60. [PMID: 36410939 DOI: 10.1136/jcp-2022-208574] [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: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022]
Abstract
AIMS The aim of this study was to investigate the association between oncogenic alterations and programmed cell death ligand 1 (PD-L1) expression in lung adenocarcinomas, as well as the prognostic value of KRAS and/or TP53 mutations in patients treated with immunotherapy. METHODS This study is a retrospective cohort study of 519 patients with lung adenocarcinomas analysed for mutations and PD-L1 expression. Data were collected from electronic pathology record system, next-generation sequencing system, and clinical databases. Association between mutations and PD-L1 expression was investigated, as well as survival statistics of the 65 patients treated with immunotherapy. RESULTS 41% of the samples contained a KRAS mutation, predominantly together with mutations in TP53 (41%) or STK11 (10%). Higher expression of PD-L1 was seen among patients with KRAS mutations (p=0.002) and EGFR wild type (p=0.006). For patients treated with immunotherapy, there was no statistically significant difference for overall survival (OS) and progression-free survival (PFS) according to KRAS mutation status, TP53 mutation status or PD-L1 expression. The HR for concomitant mutations in TP53 and KRAS was 0.78 (95% CI 0.62 to 0.99) for OS and 0.43 (0.21 to 0.88) for PFS. Furthermore, concomitant TP53 and KRAS mutations predicted a better PFS (p=0.015) and OS (p=0.029) compared with no mutations or a single mutation in either TP53 or KRAS. CONCLUSION Mutations in TP53 together with KRAS may serve as a potential biomarker for survival benefits with immunotherapy.
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Affiliation(s)
- Ea Maria Tønning Tønnesen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
- Department of Pathology, Viborg Regional Hospital, Viborg, Denmark
| | - Magnus Stougaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Meldgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Johanne Lade-Keller
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Soo R, Mery L, Bardot A, Kanesvaran R, Keong TC, Pongnikorn D, Prasongsook N, Hutajulu SH, Irawan C, Manan AA, Thiagarajan M, Sripan P, Peters S, Storm H, Bray F, Stahel R. Diagnostic work-up and systemic treatment for advanced non-squamous non-small-cell lung cancer in four Southeast Asian countries. ESMO Open 2022; 7:100560. [PMID: 35988454 PMCID: PMC9588878 DOI: 10.1016/j.esmoop.2022.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Lung cancer is the second most common cancer and leading cause of cancer mortality worldwide. Recent advances in molecular testing and targeted therapy have improved survival among patients with metastatic non-small-cell lung cancer (NSCLC). We sought to quantify and describe molecular testing among metastatic non-squamous NSCLC cases in selected Southeast Asian countries and describe first-line therapy chosen. PATIENTS AND METHODS A retrospective study was conducted based on incident lung cancer cases diagnosed between 2017 and 2019 in Lampang (Thailand), Penang (Malaysia), Singapore and Yogyakarta (Indonesia). Cases (n = 3413) were defined using the International Classification of Diseases for Oncology third edition. In Singapore, a clinical series obtained from the National Cancer Centre was used to identify patients, while corresponding population-based cancer registries were used elsewhere. Tumor and clinical information were abstracted by chart review according to a predefined study protocol. Molecular testing of epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) gene rearrangement, ROS1 gene rearrangement and BRAF V600 mutation was recorded. RESULTS Among 2962 cases with a specified pathological diagnosis (86.8%), most patients had non-squamous NSCLC (75.8%). For cases with staging information (92.1%), the majority presented with metastatic disease (71.3%). Overall, molecular testing rates in the 1528 patients with stage IV non-squamous NSCLC were 67.0% for EGFR, 42.3% for ALK, 39.1% for ROS1, 7.8% for BRAF and 36.1% for PD-L1. Among these patients, first-line systemic treatment included chemotherapy (25.9%), targeted therapy (35.6%) and immunotherapy (5.9%), with 31% of patients having no record of antitumor treatment. Molecular testing and the proportion of patients receiving treatment were highly heterogenous between the regions. CONCLUSIONS This first analysis of data from a clinically annotated registry for lung cancer from four settings in Southeast Asia has demonstrated the feasibility of integrating clinical data within population-based cancer registries. Our study results identify areas where further development could improve patient access to optimal treatment.
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Affiliation(s)
- R Soo
- Department of Hematology-Oncology, National University Hospital, Singapore, Singapore
| | - L Mery
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - A Bardot
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - R Kanesvaran
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - T C Keong
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - D Pongnikorn
- Cancer Registry Unit, Lampang Cancer Hospital, Lampang, Thailand
| | - N Prasongsook
- Medical Oncology Division, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - S H Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - C Irawan
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - A Ab Manan
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - M Thiagarajan
- Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - P Sripan
- Research Institute for Health Sciences, Chiang Mai University, Chiangmai, Thailand
| | - S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - H Storm
- Danish Cancer Society, Copenhagen, Denmark
| | - F Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - R Stahel
- ETOP IBCSG Partners Foundation, Bern, Switzerland.
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Ehrenstein V, Eriksen K, Taylor A, Servidio L, Jakobsen E. Characteristics and overall survival of patients with early-stage non-small cell lung cancer: A cohort study in Denmark. Cancer Med 2022; 12:30-37. [PMID: 35719062 PMCID: PMC9844620 DOI: 10.1002/cam4.4946] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 01/26/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) accounts for the majority of all lung cancer diagnoses, and approximately 35% of patients with NSCLC are diagnosed at an early stage (I-IIIA). This study aimed to describe epidermal growth factor receptor (EGFR) testing, patient characteristics, and overall survival (OS) among patients with early-stage NSCLC in Denmark. Patients with early-stage NSCLC registered in the Danish Lung Cancer Registry in 2013-2018 were followed through 2019. We described EGFR testing, descriptively summarised patient characteristics, and calculated OS by EGFR testing and mutation status. The association between EGFR mutation (EGFRm) and all-cause mortality was estimated using Cox proportional-hazards regression, in subgroups defined by stage at diagnosis, age at diagnosis, comorbidity, and receipt of surgery. In 2013-2018, 21,282 patients with NSCLC were registered in the Danish Lung Cancer Registry, of whom 8758 were diagnosed at an early stage. Of those, 4071 (46%) were tested for EGFRm at diagnosis. Median OS was 5.7 years among patients with EGFRm-positive status (n = 361) and 4.4 years among patients with EGFRm-negative status (n = 3710). EGFRm-positive status was associated with lower all-cause mortality in all subgroups. This study contributes to population-based evidence on the epidemiology of early-stage NSCLC treated in routine clinical practice.
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Affiliation(s)
- Vera Ehrenstein
- Department of Clinical EpidemiologyAarhus UniversityAarhusDenmark
| | - Katrine Eriksen
- Department of Clinical EpidemiologyAarhus UniversityAarhusDenmark
| | | | | | - Erik Jakobsen
- Department of Thoracic SurgeryOdense University HospitalOdenseDenmark
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Eide IJZ, Nilssen Y, Lund-Iversen M, Brustugun OT. Factors affecting outcome in resected EGFR-mutated lung cancer. Acta Oncol 2022; 61:749-756. [PMID: 35473448 DOI: 10.1080/0284186x.2022.2066984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Long-term data on disease trajectory of EGFR-mutated early-stage non-small cell lung cancer (NSCLC) is still limited. This is relevant in the context of the recently approved introduction of adjuvant EGFR-targeting therapy, specifically osimertinib in resected stage II-III EGFR-mutated NSCLC. METHODS Long-term data on patients with resected adenocarcinoma of the lung and known EGFR-status were analysed with focus on site of relapse and detailed cause of death. Patients resected in the period 2006 to 2018 were included. RESULTS Of 503 patients (286 (57%) females, median age 67.3 years), 62 (12%) harboured an EGFR-mutation, 286 (57%) were in stage I. After a median follow-up of 8.0 years, 241 (48%) patients relapsed. Recurrence occurred in 30% and 53% of EGFR-positive stage IA and IB patients, respectively. Median overall survival was longer in EGFR-mutated versus non-mutated patients (128 versus 88 months). The recurrence rate, time to recurrence and rate of brain metastases was not different between EGFR-mutated and non-mutated groups. Median time from recurrence to death was longer in EGFR-mutated patients (31 months) compared with non-mutated patients (15 months). More patients without EGFR-mutation succumbed to non-cancer related death (18%) compared to patients with EGFR-mutations (8%). CONCLUSIONS The recurrence pattern in EGFR-mutated and non-mutated NSCLC-patients is similar and the rate is high in early stages. Time from recurrence to death and overall survival is longer in the EGFR-mutated group, due to lower risk of non-lung cancer deaths, and efficient treatment upon relapse.
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Affiliation(s)
- Inger Johanne Zwicky Eide
- Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Yngvar Nilssen
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | | | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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5
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Carroll R, Bortolini M, Calleja A, Munro R, Kong S, Daumont MJ, Penrod JR, Lakhdari K, Lacoin L, Cheung WY. Trends in treatment patterns and survival outcomes in advanced non-small cell lung cancer: a Canadian population-based real-world analysis. BMC Cancer 2022; 22:255. [PMID: 35264135 PMCID: PMC8908553 DOI: 10.1186/s12885-022-09342-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND As part of the multi-country I-O Optimise research initiative, this population-based study evaluated real-world treatment patterns and overall survival (OS) in patients treated for advanced non-small cell lung cancer (NSCLC) before and after public reimbursement of immuno-oncology (I-O) therapies in Alberta province, Canada. METHODS This study used data from the Oncology Outcomes (O2) database, which holds information for ~ 4.5 million residents of Alberta. Eligible patients were adults newly diagnosed with NSCLC between January 2010 and December 2017 and receiving first-line therapy for advanced NSCLC (stage IIIB or IV) either in January 2010-March 2016 (pre-I-O period) or April 2016-June 2019 (post-I-O period). Time periods were based on the first public reimbursement of I-O therapy in Alberta (April 2017), with a built-in 1-year lag time before this date to allow progression to second-line therapy, for which the I-O therapy was indicated. Kaplan-Meier methods were used to estimate OS. RESULTS Of 2244 analyzed patients, 1501 (66.9%) and 743 (33.1%) received first-line treatment in the pre-I-O and post-I-O periods, respectively. Between the pre-I-O and post-I-O periods, proportions of patients receiving chemotherapy decreased, with parallel increases in proportions receiving I-O therapies in both the first-line (from < 0.5% to 17%) and second-line (from 8% to 47%) settings. Increased use of I-O therapies in the post-I-O period was observed in subgroups with non-squamous (first line, 15%; second line, 39%) and squamous (first line, 25%; second line, 65%) histology. First-line use of tyrosine kinase inhibitors also increased among patients with non-squamous histology (from 26% to 30%). In parallel with these evolving treatment patterns, median OS increased from 10.2 to 12.1 months for all patients (P < 0.001), from 11.8 to 13.7 months for patients with non-squamous histology (P = 0.022) and from 7.8 to 9.4 months for patients with squamous histology (P = 0.215). CONCLUSIONS Following public reimbursement, there was a rapid and profound adoption of I-O therapies for advanced NSCLC in Alberta, Canada. In addition, OS outcomes were significantly improved for patients treated in the post-I-O versus pre-I-O periods. These data lend support to the emerging body of evidence for the potential real-world benefits of I-O therapies for treatment of patients with advanced NSCLC.
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Affiliation(s)
- Robert Carroll
- Centre for Observational Research & Data Sciences, Bristol Myers Squibb, Uxbridge, UK
| | | | | | | | - Shiying Kong
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Khalid Lakhdari
- Health Economics and Market Access Oncology, Bristol Myers Squibb, Saint-Laurent, QC, Canada
| | | | - Winson Y Cheung
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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AlQahtani SH, AlOgaiel AM, AlMosa KN, Alenazi SH, AlHasan MK, AlObaidan RH, Aldokheel BD, AlSaleh K, Arafah M, Ali Khan I, AlOtaiby M. Frequency of Epidermal Growth Factor Receptor and T790M Mutations Among Patients With Non-Small Cell Lung Carcinoma: A Hospital-Based Study in the King Khalid University Hospital (KKUH) Since 2009-2017. Cureus 2021; 13:e19816. [PMID: 34963835 PMCID: PMC8695663 DOI: 10.7759/cureus.19816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
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Factors Influencing Concordance of PD-L1 Expression between Biopsies and Cytological Specimens in Non-Small Cell Lung Cancer. Diagnostics (Basel) 2021; 11:diagnostics11101927. [PMID: 34679625 PMCID: PMC8534501 DOI: 10.3390/diagnostics11101927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/07/2021] [Accepted: 10/16/2021] [Indexed: 02/06/2023] Open
Abstract
PD-L1 expression assessed by immunohistochemical staining is used for the selection of immunotherapy in non-small cell lung cancer (NSCLC). Appropriate validation of PD-L1 expression in cytology specimens is important as cytology is often the only diagnostic material in NSCLC. In a previous study comprising two different cohorts of paired biopsies and cytological specimens, we found a fairly good cyto-histological correlation of PD-L1 expression in one, whereas only a moderate correlation was found in the other cohort. Therefore, that cohort with additional new cases was now further investigated for the impact of preanalytical factors on PD-L1 concordance in paired biopsies and cytological specimens. A total of 100 formalin-fixed paraffin-embedded cell blocks from 19 pleural effusions (PE), 17 bronchial brushes (BB), and 64 bronchoalveolar lavage (BAL) and concurrent matched biopsies from 80 bronchial biopsies and 20 transthoracic core biopsies from NSCLC patients were stained using the PD-L1 28-8 assay. Using the cutoffs ≥1%, ≥5%, ≥10%, and ≥50% positive tumour cells, the overall agreement between histology and cytology was 77-85% (κ 0.51-0.70) depending on the applied cutoff value. The concordance was better for BALs (κ 0.53-0.81) and BBs (κ 0.55-0.85) than for PEs (κ -0.16-0.48), while no difference was seen for different types of biopsies or histological tumour type. A high number of tumour cells (>500) in biopsies was associated with better concordance at the ≥50% cutoff. In conclusion, the study results suggest that PEs may be less suitable for evaluation of PD-L1 due to limited cyto-histological concordance, while a high amount of tumour cells in biopsies may be favourable when regarding cyto-histological PD-L1 concordance.
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8
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Yang X, Zhong J, Yu Z, Zhuo M, Zhang M, Chen R, Xia X, Zhao J. Genetic and treatment profiles of patients with concurrent Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) mutations. BMC Cancer 2021; 21:1107. [PMID: 34654390 PMCID: PMC8520304 DOI: 10.1186/s12885-021-08824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background EGFR and ALK alternations often contribute to human malignancies, including lung cancer. EGFR and ALK mutations are usually sensitive to EGFR-tyrosine kinase inhibitors (TKIs) and ALK-TKIs. Although generally mutually exclusive, these mutations do co-exist in rare cases. This study investigated the frequencies, clinical characteristics, therapeutic efficacies, and genetic profiles of lung cancer patients with EGFR and ALK co-mutations. Methods Patients with concurrent EGFR and ALK mutations were included in this study, which analyzed mutation profiles and treatment histories. SPSS20.0 were used for survival analysis. Results Among 271 ALK-positive (ALK-pos) and 2975 EGFR-positive (EGFR-pos) patients in our database, nine (2.6% of ALK-pos and 0.2% of EGFR-pos) patients had concurrent EGFR and ALK mutations (including three exon19 Indel + EML4-ALK, two exon19 Indel + STRN-ALK, two L858R + L1152R, one L858R + EML4-ALK, and one G719C + S768I + STRN-ALK). Eight patients had at least one type of EGFR-TKIs treatment. The median progression free survival (PFS) of these patients on first-generation EGFR-TKIs was 14.5 months (95% CI: 11 - NR). Of these eight patients, one who progressed on Gefitinib and subsequently on Osimertinib had a T790M + C797G. The other seven EGFR-TKIs resistance patients had no known resistance mutations. No patients had ALK mutations before treatment, so ALK mutations may have developed as resistance mechanisms during EGFR-TKIs therapies. EGFR-TKIs-treated patients with EGFR/ALK L1152R mutations generally had a shorter PFS than patients with other mutation combinations. Conclusions ALK and EGFR mutations coincide at a relatively low frequency in lung cancer patients. ALK mutations developed either synchronously or heterochronously with EGFR mutations. Two ALK mutations (L1152R and STRN-ALK) may co-exist with EGFR mutations at a higher frequency than others. Most EGFR/ALK co-alteration patients (other than the EGFR/ALK L1152R type) can benefit from first line EGFR-TKIs. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08824-2.
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Affiliation(s)
- Xiaodan Yang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, No.52, Fucheng Road, Haidian district, Beijing, China
| | - Jia Zhong
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuo Yu
- Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| | - Minglei Zhuo
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, No.52, Fucheng Road, Haidian district, Beijing, China
| | - Min Zhang
- GenePlus-Beijing, Beijing, 102206, China
| | | | | | - Jun Zhao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, No.52, Fucheng Road, Haidian district, Beijing, China.
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Koomen BM, Vreuls W, de Boer M, de Ruiter EJ, Hoelters J, Vink A, Willems SM. False-negative programmed death-ligand 1 immunostaining in ethanol-fixed endobronchial ultrasound-guided transbronchial needle aspiration specimens of non-small-cell lung cancer patients. Histopathology 2021; 79:480-490. [PMID: 33772818 PMCID: PMC8519150 DOI: 10.1111/his.14373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/06/2021] [Accepted: 03/27/2021] [Indexed: 12/22/2022]
Abstract
AIMS Programmed death-ligand 1 (PD-L1) immunostaining is used to predict which non-small-cell lung cancer (NSCLC) patients will respond best to treatment with programmed cell death protein 1/PD-L1 inhibitors. PD-L1 immunostaining is sometimes performed on alcohol-fixed cytological specimens instead of on formalin-fixed paraffin-embedded (FFPE) biopsies or resections. We studied whether ethanol prefixation of clots from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) results in diminished PD-L1 immunostaining as compared with formalin fixation. METHODS AND RESULTS FFPE cell blocks from EBUS-TBNA specimens of 54 NSCLC patients were identified. For each case, paired samples were available, consisting of clots directly immersed in formalin and clots prefixed in Fixcyt (50% ethanol). Serial sections were immunostained for PD-L1 by use of the standardised SP263 assay and the 22C3 antibody as a laboratory-developed test (LDT). PD-L1 positivity was determined with two cut-offs (1% and 50%). Concordance of PD-L1 positivity between the formalin-fixed (gold standard) and ethanol-prefixed material was assessed. When the 22C3 LDT was used, 30% and 36% of the ethanol-prefixed specimens showed false-negative results at the 1% and 50% cut-offs, respectively (kappa 0.64 and 0.68). When SP263 was used, 22% of the ethanol-prefixed specimens showed false-negative results at the 1% cut-off (kappa 0.67). At the 50% cut-off, concordance was higher (kappa 0.91), with 12% of the ethanol-prefixed specimens showing false-negative results. CONCLUSION Ethanol fixation of EBUS-TBNA specimens prior to formalin fixation can result in a considerable number of false-negative PD-L1 immunostaining results when a 1% cut-off is used and immunostaining is performed with SP263 or the 22C3 LDT. The same applies to use of the 50% cut-off when immunostaining is performed with the 22C3 LDT.
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Affiliation(s)
- Bregje M Koomen
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Willem Vreuls
- Department of PathologyCanisius‐Wilhelmina HospitalNijmegenthe Netherlands
| | - Mirthe de Boer
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Emma J de Ruiter
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Juergen Hoelters
- Department of PulmonologyCanisius‐Wilhelmina HospitalNijmegenthe Netherlands
| | - Aryan Vink
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Stefan M Willems
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtthe Netherlands
- Department of Pathology and Medical BiologyUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
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Tønnesen E, Lade-Keller J, Stougaard M. Frequently used quantitative polymerase chain reaction-based methods overlook potential clinically relevant genetic alterations in epidermal growth factor receptor compared with next-generation sequencing: a retrospective clinical comparison of 1839 lung adenocarcinomas. Hum Pathol 2021; 115:67-75. [PMID: 34153308 DOI: 10.1016/j.humpath.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS The aim of the study was to investigate the advantage of implementing next-generation sequencing (NGS) compared with quantitative polymerase chain reaction (qPCR) when performing routine molecular diagnostics in adenocarcinomas of the lung. METHODS The study is a retrospective cross-sectional observational study of 1839 cytological and histological adenocarcinoma biopsies investigated for gene mutations from 2016 to 2018 at the Department of Pathology at Aarhus University Hospital. A total of 1169 samples were analyzed by qPCR for the presence of EGFR hotspot mutations from 2016 to 2017. A total of 670 samples were analyzed with NGS for the presence of EGFR mutations and other gene mutations in 2018. RESULTS The average frequency of EGFR mutations in the study population was 11.5%, with the highest frequency found in 2018, where NGS was implemented (10.8% in 2016, 11.5% in 2017, and 12.2% in 2018). Possible therapy resistance markers such as EGFR exon 20 mutations were found more commonly after NGS implementation, the difference being statistically significant (P = .015). In addition, NGS (2018) showed that 40.6% of the samples had KRAS mutations and 6.0% had BRAF mutations, mutations not commonly investigated in lung adenocarcinomas when qPCR is the method of choice. Among the EGFR-mutated samples analyzed with NGS, 13 contained a concurrent EGFR mutation, whereas three and two contained a concurrent KRAS and BRAF mutations, respectively. CONCLUSIONS With the implementation in a clinical setting, NGS identifies more uncommon but potentially clinically important EGFR mutations, unique combinations of EGFR mutations, and concurrent mutations in KRAS and BRAF.
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Affiliation(s)
- Ea Tønnesen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; Department of Pathology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | - Johanne Lade-Keller
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; Department of Pathology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Magnus Stougaard
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; Department of Pathology, Aarhus University Hospital, 8200 Aarhus N, Denmark
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11
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Gursoy P. Re-use of erlotinib in a patient using osimertinib after erlotinib, case report. J Oncol Pharm Pract 2021; 28:211-214. [PMID: 34074173 DOI: 10.1177/10781552211019108] [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: 11/17/2022]
Abstract
INTRODUCTION Most patients with non-small-cell lung cancer tumors that have epidermal growth factor receptor (EGFR) mutations have deletion mutations in exon 19 or exon 21, or both.In recent years, targeted therapies in lung cancer have increased survival, but the development of resistance to these drugs poses a major problem. Thesubstitution of methionineforthreonine at position 790 (T790M) mutation,is primarily responsible for this resistance. However, after osimertinib used in T790M positivepatients treatment options are generally limited to chemotherapy. CASE REPORT We reported the efficacy of erlotinib, which we reapplied due to the disappearance of the resistance mutation after osimertinib in a 68-year-old patient using osimertinib after erlotinib.Management and outcome: In the patient using erlotinib due to exon 19 deletion when progression was observed and T790M positivity was detected, osimertinib treatment was initiated. However, when T790M was found to be negative with rebiopsy in progression after osimertinib, a complete response was achieved by restarting erlotinib. DISCUSSION The strategy of restarting erlotinib treatment with negative T790M mutation detected in biopsies of patients with osimertinib resistance may be an acceptable treatment option.
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Affiliation(s)
- Pinar Gursoy
- Ege University School of Medicine, Tulay Aktas Oncology Hospital, Izmir, Turkey
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12
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Koomen BM, van der Starre‐Gaal J, Vonk JM, von der Thüsen JH, van der Meij JJC, Monkhorst K, Willems SM, Timens W, ’t Hart NA. Formalin fixation for optimal concordance of programmed death-ligand 1 immunostaining between cytologic and histologic specimens from patients with non-small cell lung cancer. Cancer Cytopathol 2021; 129:304-317. [PMID: 33108706 PMCID: PMC8246726 DOI: 10.1002/cncy.22383] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Immunohistochemical staining of programmed death-ligand 1 (PD-L1) is used to determine which patients with non-small cell lung cancer (NSCLC) may benefit most from immunotherapy. Therapeutic management of many patients with NSCLC is based on cytology instead of histology. In this study, concordance of PD-L1 immunostaining between cytology cell blocks and their histologic counterparts was analyzed. Furthermore, the effect of various fixatives and fixation times on PD-L1 immunoreactivity was studied. METHODS Paired histologic and cytologic samples from 67 patients with NSCLC were collected by performing fine-needle aspiration on pneumonectomy/lobectomy specimens. Formalin-fixed, agar-based or CytoLyt/PreservCyt-fixed Cellient cell blocks were prepared. Sections from cell blocks and tissue blocks were stained with SP263 (standardized assay) and 22C3 (laboratory-developed test) antibodies. PD-L1 scores were compared between histology and cytology. In addition, immunostaining was compared between PD-L1-expressing human cell lines fixed in various fixatives at increasing increments in fixation duration. RESULTS Agar cell blocks and tissue blocks showed substantial agreement (κ = 0.70 and κ = 0.67, respectively), whereas fair-to-moderate agreement was found between Cellient cell blocks and histology (κ = 0.28 and κ = 0.49, respectively). Cell lines fixed in various alcohol-based fixatives showed less PD-L1 immunoreactivity compared with those fixed in formalin. In contrast to SP263, additional formalin fixation after alcohol fixation resulted in preserved staining intensity using the 22C3 laboratory-developed test and the 22C3 pharmDx assay. CONCLUSIONS Performing PD-L1 staining on cytologic specimens fixed in alcohol-based fixatives could result in false-negative immunostaining results, whereas fixation in formalin leads to higher and more histology-concordant PD-L1 immunostaining. The deleterious effect of alcohol fixation could be reversed to some degree by postfixation in formalin.
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Affiliation(s)
- Bregje M. Koomen
- Department of PathologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | | | - Judith M. Vonk
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | | | | | - Kim Monkhorst
- Department of PathologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands
| | - Stefan M. Willems
- Department of PathologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
- Department of Pathology and Medical BiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Wim Timens
- Department of Pathology and Medical BiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Nils A. ’t Hart
- Department of PathologyIsala HospitalsZwollethe Netherlands
- Department of Pathology and Medical BiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
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Chen X, Lu J, Wu Y, Jiang X, Gu Y, Li Y, Zhao H, Jin M. Genetic features and application value of next generation sequencing in the diagnosis of synchronous multifocal lung adenocarcinoma. Oncol Lett 2020; 20:2829-2839. [PMID: 32782601 PMCID: PMC7400153 DOI: 10.3892/ol.2020.11843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/14/2020] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to elucidate the genetic features of multiple lung cancer (MLC) and identify effective molecular markers for diagnosis using next generation sequencing (NGS). The present data may also inform patient treatment and prognosis. A total of 35 lesions were obtained from 17 patients with MLC. Based on lesion histology and NGS, 13 cases of multiple primary lung cancer (MPLC) were identified and 4 cases were classified as intrapulmonary metastasis (IPM). All 4 patients with IPM exhibited an epidermal growth factor receptor (EGFR) mutation and synchronous mutation of at least one tumor suppressor gene. The frequency and percentage of EGFR mutations, accompanied with tumor suppressor genes, were significantly higher in patients with IPM compared with MPLC. Furthermore, a high EGFR-heterogeneity score and male sex were risk factors of IPM occurrence. There were significant differences in mean EGFR mutation abundance alone, mutations of tumor suppressor genes and mutations of EGFR combined with tumor suppressor genes between patients with adenocarcinoma (ADC) and adenocarcinoma in situ (AIS). In conclusion, histological characteristics combined with genetic alterations may be an effective method for the diagnosis of MPLC and IPM, and NGS may serve as a useful diagnostic tool. MLC exhibited unique molecular characteristics, including higher rates of EGFR mutations, EGFR driver mutations accompanied with tumor suppressor gene mutations and the absence of anaplastic lymphoma kinase mutations, which may help distinguish between patients with MPLC or IPM. The present study hypothesized that the mean frequency of EGFR mutations, mutations of tumor suppressor genes and mutations of both EGFR and tumor suppressor genes may serve an important role in the development of AIS to ADC. The results of the present study highlight the potential underlying mechanisms of lung ADC development, which may assist with future elucidation of effective treatments to prevent the progression of lung cancer.
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Affiliation(s)
- Xiaoyan Chen
- Department of Pathology, Capital Medical University, Affiliated Beijing Chaoyang Hospital, Beijing 100020, P.R. China.,Department of Pathology, Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia 014010, P.R. China.,Department of Pathology, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia 014010, P.R. China
| | - Jun Lu
- Department of Pathology, Capital Medical University, Affiliated Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Yingying Wu
- Department of Pathology, Capital Medical University, Affiliated Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Xingran Jiang
- Department of Pathology, Capital Medical University, Affiliated Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Yajuan Gu
- Department of Pathology, Capital Medical University, Affiliated Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Yunlong Li
- Department of Pathology, Capital Medical University, Affiliated Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Hongying Zhao
- Department of Pathology, Capital Medical University, Affiliated Beijing Chaoyang Hospital, Beijing 100020, P.R. China
| | - Mulan Jin
- Department of Pathology, Capital Medical University, Affiliated Beijing Chaoyang Hospital, Beijing 100020, P.R. China
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Zhou X, Xu X, Tian Z, Xu WY, Cui Y. Mutational profiling of lung adenocarcinoma in China detected by next-generation sequencing. J Cancer Res Clin Oncol 2020; 146:2277-2287. [DOI: 10.1007/s00432-020-03284-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022]
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15
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Daverio M, Patrucco F, Gavelli F, Airoldi C, Sciortino G, Chiaramonte C, Rena O, Balbo PE, Boldorini RL. Comparative analysis of programmed death ligand 1 expression in paired cytologic and histologic specimens of non-small cell lung cancer. Cancer Cytopathol 2020; 128:580-588. [PMID: 32463583 DOI: 10.1002/cncy.22292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/25/2020] [Accepted: 05/01/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND In advanced non-small cell lung cancer (NSCLC), cytologic specimens from transbronchial needle aspiration (TBNA) or transthoracic needle aspiration are often the only cancer tissue material available for the analysis of programmed death ligand 1 (PD-L1) expression. This study was aimed at assessing the concordance of PD-L1 expression in histologic and cytologic samples and at evaluating interobserver agreement on specimens in this setting. METHODS One hundred and thirty-eight specimens from 60 patients with NSCLC were analyzed. Histologic specimens were represented by endoscopic samples obtained with forceps (biopsies), whereas cytologic specimens were from TBNA and bronchial lavage (BL). PD-L1 expression was quantified with the immunohistochemistry (IHC)-based Ventana SP263 assay. For cytologic specimens, IHC was performed on cell block sections. Two independent pathologists who were blinded to the clinical data evaluated partial or complete membrane IHC staining. Concordance between 2 methods and between 2 pathologists was evaluated with normal and weighted Cohen's κ coefficients, overall agreement, and Bland-Altman plots. RESULTS PD-L1 expression was quantified in 138 specimens from 60 patients. Concordance between cytologic and histologic approaches was moderate (κ = 0.56; weighted κ = 0.55). Also, concordance in the biopsy-TBNA and biopsy-BL subgroups was moderate (κ = 0.43 and κ = 0.47, respectively), whereas interobserver agreement was substantial (weighted κ = 0.72). A Bland-Altman plot showed an underestimation in PD-L1 values from cytologic samples in comparison with histologic ones. CONCLUSIONS The results demonstrate that in the absence of available histologic specimens, PD-L1 positivity in cytologic samples could be a reliable data for the oncologist to consider immune checkpoint inhibitor therapy. However, a comparison of cytologic and histologic samples has shown an underestimation of PD-L1 values in cytologic samples.
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Affiliation(s)
- Matteo Daverio
- Medical Department, Division of Respiratory Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Filippo Patrucco
- Medical Department, Division of Respiratory Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy.,Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Giusy Sciortino
- Pathology Unit, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Claudia Chiaramonte
- Pathology Unit, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Ottavio Rena
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy.,Health Sciences Department, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Piero E Balbo
- Medical Department, Division of Respiratory Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Renzo L Boldorini
- Pathology Unit, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy.,Health Sciences Department, University of Piemonte Orientale, Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, Novara, Italy
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Niu Y, Tang D, Fan L, Gao W, Lin H. CCL25 promotes the migration and invasion of non-small cell lung cancer cells by regulating VEGF and MMPs in a CCR9-dependent manner. Exp Ther Med 2020; 19:3571-3580. [PMID: 32346420 PMCID: PMC7185084 DOI: 10.3892/etm.2020.8635] [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: 08/04/2019] [Accepted: 03/05/2020] [Indexed: 12/14/2022] Open
Abstract
The CC chemokine receptor 9 (CCR9) and its natural secreted ligand CC motif chemokine ligand 25 (CCL25) have been implicated in cancer metastasis. However, their metastatic potential in non-small cell lung cancer (NSCLC) remains unclear. In the present study, immunohistochemistry was used to detect the expression and localization of CCR9, vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-1 and MMP-7 in lung cancer tissue and adjacent normal tissue. The association between the expression of CCR9 and clinical variables was also examined. Reverse transcription-quantitative PCR and western blotting were conducted to detect the expression of VEGF-C, VEGF-D, MMP-1 and MMP-7 in lung cancer cell lines (A549 and SK-MES-1). Migration and invasion assays were conducted to examine cell migration and invasion. Survival and mutation analysis were conducted using published datasets. The expressions of CCR9, VEGF, MMP-1 and MMP-7 were upregulated in cancer tissue, compared with adjacent normal tissue (all P<0.05). Patients with lower expression of CCR9 or CCL25 had better overall survival (OS) compared with those with higher CCR9 or CCL25 expression (P<0.05 and P=0.05, respectively). Furthermore, the expressions of VEGF-C, VEGF-D, MMP-1 and MMP-7 were higher in the CCL25-treated cell lines (all P<0.05), but MMP-7 protein expression was not affected by CCL25 treatment in SK-MES-1 cells (P>0.05). Following treatment with CCL25, lung cancer cells demonstrated higher migratory and invasive potential, which could be blocked by the CCR9 antibody (P<0.05). Survival analysis demonstrated that low expression levels of both CCR9 and CCL25 mRNA indicated favorable OS in patients with NSCLC. Altogether, these results suggested that CCL25 enhanced the phenotype associated with migration and invasion in NSCLC by regulating the expression of VEGF-C, VEGF-D, MMP-1 and MMP-7.
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Affiliation(s)
- Yuxu Niu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Dongfang Tang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Liwen Fan
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Wen Gao
- Department of Thoracic Surgery, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Hui Lin
- Department of Thoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
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Eide IJZ, Helland Å, Ekman S, Mellemgaard A, Hansen KH, Cicenas S, Koivunen J, Grønberg BH, Brustugun OT. Osimertinib in T790M-positive and -negative patients with EGFR-mutated advanced non-small cell lung cancer (the TREM-study). Lung Cancer 2020; 143:27-35. [PMID: 32200138 DOI: 10.1016/j.lungcan.2020.03.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES In non-small cell lung cancer patients with acquired resistance to first- or second-generation EGFR-TKIs, osimertinib is approved in the presence of the T790 M resistance mutation. We assessed the efficacy of osimertinib in both T790M-positive and T790M-negative patients. MATERIALS AND METHODS The TREM-study is an investigator-initiated, multi-centre, single-arm, phase 2 clinical trial conducted in five Northern European countries. Patients with progression on at least one previous EGFR-TKI were assigned to treatment with 80 mg of osimertinib daily until radiological progression or death. Patients were included regardless of the presence of T790 M. The primary endpoint was objective response rate (ORR). RESULTS Of 199 included patients, 120 (60 %) were T790M-positive, 52 (26 %) were T790M-negative and 27 (14 %) had unknown T790M-status. 24 % had brain metastases and 15 % had an ECOG performance status of 2. Overall ORR was 48 % (95 % CI, 41 %-55 %), 60 % (51 %-69 %) for T790M-positive patients and 28 % (15 %-41 %) for T790M-negative patients, p < 0.001. ORR for patients with co-occurring del19 vs L858R was 61 % vs 32 %, p = 0.001. Duration of response was similar between the T790M-positive and -negative groups (11.8 vs 10.7 months, p = 0.229). Overall median progression-free survival (PFS) was 8.9 months (95 % CI, 7.4-10.5), and 10.8 vs 5.1 months for T790M-positive vs -negative patients (HR 0.62, p = 0.007). Median overall survival (OS) was 17.9 months (95 % CI, 14.4-21.3). For T790M-positive vs -negative median OS was 22.5 vs 13.4 months, (HR 0.55, p = 0.002). CONCLUSIONS This study confirms the efficacy of osimertinib for T790M-positive patients. There was also clinically significant activity of osimertinib in a proportion of T790M-negative patients. CLINICAL TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (NCT02504346).
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Affiliation(s)
- Inger Johanne Zwicky Eide
- Vestre Viken Hospital Trust, Drammen, Norway; Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
| | - Åslaug Helland
- Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; Departement of Oncology, Oslo University Hospital, Oslo, Norway; University of Oslo, Department of Clinical Medicine, Oslo, Norway
| | - Simon Ekman
- Thoracic Oncology Center, Karolinska University Hospital/Departement of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Jussi Koivunen
- Oulu University Hospital, University of Oulu, MRC Oulu, Oulu, Finland
| | - Bjørn Henning Grønberg
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Odd Terje Brustugun
- Vestre Viken Hospital Trust, Drammen, Norway; Department of Cancer Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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Evaluation of epidermal growth factor receptor mutations and thyroid transcription factor-1 status in Turkish non-small cell lung carcinoma patients: A study of 600 cases from a single center. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:143-150. [PMID: 32175155 DOI: 10.5606/tgkdc.dergisi.2020.18196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022]
Abstract
Background This study aims to investigate the frequency, distribution, and morphological/immunohistochemical features of epidermal growth factor receptor mutations and to examine the possible relationship between the material type and technical success of mutation analysis in Turkish population with non-small cell lung cancer. Methods Between September 2012 and December 2015, a total of 499 consecutive, treatment-naïve patients (437 males, 163 females; mean age 61 years; range, 30 to 84 years) with primary or metastatic non-small cell lung cancer who underwent epidermal growth factor receptor mutation testing using Sanger sequencing method were retrospectively analyzed. Archival records and hematoxylin-eosine and immunohistochemically stained sections were re-examined. The thyroid transcription factor-1 and napsin A immunohistochemical stains were performed on tissue array blocks. Results Seventy-five mutations were detected in 70 patients (14%). The success rate of testing and intact deoxyribonucleic acid fragment length were significantly higher in the cytological material, compared to tissue specimens (p<0.001). The mutation rate in adenocarcinomas was 33.9% for women and 9.4% for men. The most common mutation was L746-E750del in exon 19 (29.3%), followed by the L858R mutation in exon 21 (28%). The mutation rate was the highest in micropapillary (40%) and lowest in solid (5.4%) adenocarcinomas. All epidermal growth factor receptor mutations, except for one, were positive for the thyroid transcription factor-1. The single nucleotide polymorphism Q787Q in exon 20 was observed in 79.6% of patients. Conclusion The frequency and distribution of epidermal growth factor receptor mutations in the Turkish patients with non-small cell lung cancer are similar to the European populations. These results also demonstrate that cytological materials are highly reliable for epidermal growth factor receptor mutation testing, and the probability of detection of wild-type epidermal growth factor receptor is low in cases of thyroid transcription factor-1 negativity.
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Skov BG, Rørvig SB, Jensen THL, Skov T. The prevalence of programmed death ligand-1 (PD-L1) expression in non-small cell lung cancer in an unselected, consecutive population. Mod Pathol 2020; 33:109-117. [PMID: 31383957 DOI: 10.1038/s41379-019-0339-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/07/2019] [Accepted: 07/07/2019] [Indexed: 11/09/2022]
Abstract
Little is known about prevalence of PD-L1 expression in tumor cells of unselected patients with all stages of non-small cell lung cancer. The objective of this study is to assess the prevalence of PD-L1 positivity in patients with non-small cell lung cancer, to analyze the association between PD-L1 positivity and patients' clinicopathological characteristics, and to assess the use of immune-oncologic treatment in eligible patients. All non-small cell lung cancer patients diagnosed in a 10-month period in an unselected population of 1.7 million Caucasian inhabitants were evaluated with the PD-L1 IHC 22C3 pharmDx kit. A total of 819 patients were diagnosed with non-small cell lung cancer. Samples analyzable for PD-L1 expression were obtained from 97% of patients. In a multivariate analysis with cut-off at tumor proportion score ≥50%, lower stage was associated with lower prevalence of PD-L1 positivity with an odds ratio of 0.31 for stage I vs. stage IV. A significant difference in PD-L1 expression between squamous-cell carcinoma and adenocarcinoma was observed with odds ratio for adenocarcinoma 1.8. With cut-off tumor proportion score ≥1%, attenuated effects of the same direction were seen. For neither cut-off did type and location of material used for PD-L1 analysis, age, sex, smoking history, or performance status have statistically significant impact on the PD-L1 expression. Fifty four percent of the patients who were eligible for immune-oncologic treatment were actually treated in first-line with pembrolizumab monotherapy. In conclusion, 97% of the patients had material analyzable for PD-L1. If a patient in need of immuno-oncologic treatment has shifted stage, a negative or low positive PD-L1 test performed on a biopsy taken in a lower stage might not mirror the PD-L1 expression in the new metastatic lesion. Therefore, a re-biopsy should be considered.
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Affiliation(s)
| | - Sara Bird Rørvig
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Kuempers C, van der Linde LIS, Reischl M, Vogel W, Stellmacher F, Reck M, Heigener D, Rabe KF, Kirfel J, Perner S, Welker L. Comparison of PD-L1 expression between paired cytologic and histologic specimens from non-small cell lung cancer patients. Virchows Arch 2019; 476:261-271. [PMID: 31392467 DOI: 10.1007/s00428-019-02632-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/04/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022]
Abstract
Expression of programmed death ligand 1 assessed on histologic samples is a confirmed predictive biomarker for anti-PD-1 immunotherapy, but its evaluation is not approved for immunocytochemistry. We investigated if PD-L1 expression shows comparable results on paired cytologic and histologic tumor specimens and interobserver variability. Percentage of PD-L1-positive tumor cells of 247 paired samples of non-small cell lung cancer was evaluated by three independent investigators. Samples were compared on the basis of the continuous values and also categorized with the tumor proportion score (TPS). Concordance was defined if continuous values were both within a deviation of 10% and if categorized values were identically grouped. Interobserver variability was assessed by the standard deviation of the mean. Based on continuous values between paired samples, perfect concordance rate was approximately 53%. With categorization of PD-L1 expression based on TPS, category was identical in 74.1%. However, defining the continuous values of PD-L1 expression between paired samples within a deviation of 10% as concordant, concordance rate was 82%. Interobserver variability was significantly higher in evaluation of cytologic specimens. Evaluation of PD-L1 expression in paired histologic and cytologic tumor specimens shows comparable results if a deviation of 10% between the values is tolerated. Interobserver variability demonstrates a much more challenging interpretation of PD-L1 expression for cytologic samples.
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Affiliation(s)
- C Kuempers
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160 (Building 50), 23538, Luebeck, Germany
| | - L I S van der Linde
- Cytologic Laboratory, LungenClinic Grosshansdorf, Wöhrendamm 80, 22927, Großhansdorf, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Gießen, Germany
| | - M Reischl
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - W Vogel
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160 (Building 50), 23538, Luebeck, Germany
- Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - F Stellmacher
- Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - M Reck
- Cytologic Laboratory, LungenClinic Grosshansdorf, Wöhrendamm 80, 22927, Großhansdorf, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Gießen, Germany
| | - D Heigener
- Helios Klinikum Schleswig, Schleswig, Germany
| | - K F Rabe
- Cytologic Laboratory, LungenClinic Grosshansdorf, Wöhrendamm 80, 22927, Großhansdorf, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Gießen, Germany
| | - J Kirfel
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160 (Building 50), 23538, Luebeck, Germany
| | - S Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160 (Building 50), 23538, Luebeck, Germany.
- Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.
| | - L Welker
- Cytologic Laboratory, LungenClinic Grosshansdorf, Wöhrendamm 80, 22927, Großhansdorf, Germany.
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Gießen, Germany.
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Kumari N, Singh S, Haloi D, Mishra SK, Krishnani N, Nath A, Neyaz Z. Epidermal Growth Factor Receptor Mutation Frequency in Squamous Cell Carcinoma and Its Diagnostic Performance in Cytological Samples: A Molecular and Immunohistochemical Study. World J Oncol 2019; 10:142-150. [PMID: 31312281 PMCID: PMC6615915 DOI: 10.14740/wjon1204] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/10/2019] [Indexed: 01/11/2023] Open
Abstract
Background Epidermal growth factor receptor (EGFR) mutation is the most frequent mutation tested in lung cancer for targeted therapy in the era of personalized medicine. Knowledge about EGFR mutation is constantly expanding regarding its frequency, clinicopathological association, advancements in testing methodology and sample requirement. We investigated EGFR mutation frequency in non-small cell lung cancer (NSCLC) in North Indian patients and evaluated its diagnostic performance in cytological samples. Methods Molecular EGFR testing was done in 250 cases of NSCLC by both real-time polymerase chain reaction (PCR) (Therascreen) and mutation-specific EGFR immunohistochemistry (IHC). Thirty cases had both cytology samples and biopsy including 20 pleural effusions and 10 fine-needle aspirates. EGFR mutation concordance between pleural effusion and biopsy was studied. Results EGFR mutation was overall 31.6% in NSCLC with 36.5% in adenocarcinoma and 15% in squamous cell carcinoma. L858R mutation accounted for 50.7% and DEL19 for 39.3% of total EGFR mutations. Complex mutations were seen in 2% of cases. Sensitivity of mutation-specific EGFR IHC was 48.3% and specificity was 92.3%. L858R showed higher sensitivity (55% vs. 33.3%) but similar specificity (93.2% vs. 91.3%) compared to DEL19. EGFR mutation was successful in 95% of pleural effusion and showed 83.3% concordance with tissue biopsy. Conclusions EGFR mutation frequency in North Indian patients was comparable to that of Asia-Pacific region and showed a similar pattern of histological distribution. EGFR mutation in squamous cell carcinomas is increasingly recognized which was 15% in our study. Mutation-specific EGFR IHC shows variable but generally low sensitivity and considering its significant pre- and post-analytical variables, it should be highly discouraged in patient management. Cytological samples may not only serve as suitable alternative but may be complementary to tissue biopsies.
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Affiliation(s)
- Niraj Kumari
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Shalini Singh
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Dhanjit Haloi
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Shravan Kumar Mishra
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Narendra Krishnani
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Zafar Neyaz
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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Wu YL, Xu CR, Hu CP, Feng J, Lu S, Huang Y, Li W, Hou M, Shi JH, Märten A, Fan J, Peil B, Zhou C. Afatinib versus gemcitabine/cisplatin for first-line treatment of Chinese patients with advanced non-small-cell lung cancer harboring EGFR mutations: subgroup analysis of the LUX-Lung 6 trial. Onco Targets Ther 2018; 11:8575-8587. [PMID: 30584317 PMCID: PMC6280988 DOI: 10.2147/ott.s160358] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction Non-small-cell lung cancer (NSCLC) is the leading cause of cancer death in China. Four epidermal growth factor receptor (EGFR)-targeted tyrosine kinase inhibitors – afatinib, erlotinib, icotinib, and gefitinib – are available for first-line treatment of NSCLC in China; however, there are few data to guide treatment choice. The Phase III LUX-Lung 6 trial compared afatinib with platinum-based chemotherapy for first-line treatment of patients from Southeast Asia with EGFR mutation-positive advanced NSCLC. This post hoc analysis assessed the findings from LUX-Lung 6 in Chinese patients. Clinical trial registration ClinicalTrials.gov: NCT01121393. Materials and methods Previously untreated patients with EGFR mutation-positive stage IIIB/IV lung adenocarcinoma were randomized 2:1 to receive afatinib or ≤6 cycles of gemcitabine/ cisplatin. The key outcomes were progression-free survival (PFS; primary), objective response rate, disease control rate, overall survival (OS), duration of response and disease control, patient-reported outcomes, and safety. Three hundred and twenty-seven patients from mainland China were treated (89.8% of overall LUX-Lung 6 population; afatinib 217, gemcitabine/cisplatin 110). Results PFS was significantly longer with afatinib than gemcitabine/cisplatin (median 11.0 versus 5.6 months; hazard ratio [HR], 0.30 [95% CI, 0.21, 0.43]; P,0.0001). Overall, there was no significant difference in OS between treatment arms; however, in a subgroup analysis, afatinib significantly improved OS versus gemcitabine/cisplatin in patients with an EGFR Del19 mutation (median 31.6 versus 16.3 months; HR, 0.61 [95% CI, 0.41, 0.91]; P=0.0146). Afatinib was well tolerated, with most treatment-related adverse events (TRAEs) being of grade 1 or 2 severity. The most common grade 3/4 TRAEs with afatinib were rash/acne (15.9%/0.5%), stomatitis (6.1%/0%), and diarrhea (5.6%/0%). TRAEs leading to permanent discontinuation were reported in 12 patients (5.6%) receiving afatinib and 43 (41.7%) receiving gemcitabine/cisplatin. Afatinib significantly improved PFS compared with standard first-line chemotherapy in Chinese patients with EGFR mutation-positive NSCLC and demonstrated a manageable safety profile. Conclusion The findings support the rationale for using afatinib as a first-line treatment option for this patient population.
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Affiliation(s)
- Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China,
| | - Chong-Rui Xu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China,
| | - Cheng-Ping Hu
- Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jifeng Feng
- Department of Internal Medicine, Jiangsu Provincial Tumor Hospital, Nanjing, Jiangsu, China
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yunchao Huang
- Department of Thoracic Surgery, Yunnan Tumor Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, Yunnan, China
| | - Wei Li
- Department of Hematology & Oncology, Cancer Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Mei Hou
- Lung Cancer Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian Hua Shi
- Department of Oncology, Lin Yi Tumor Hospital, Linyi, Shandong, China
| | - Angela Märten
- Department of Oncology, Boehringer Ingelheim GmbH, Ingelheim, Germany
| | - Jean Fan
- Department of Oncology, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Barbara Peil
- Department of Oncology, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Yangpu District, Shanghai, China
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Wang X, Zhong D. [Advances in Double Mutations of EGFR and ALK Gene in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:686-691. [PMID: 30201068 PMCID: PMC6136996 DOI: 10.3779/j.issn.1009-3419.2018.09.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Molecular target therapy is one of the most popular field of non-small cell lung cancer (NSCLC) treatmnet. Epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearragement are the most important two oncogenic drivers in NSCLC, early studies suggested that EGFR mutations and ALK rearrangements are mutually exclusive, but isolated cases or small sample research with concomitant EGFR and ALK alterations have been constantly reported. The co-occurrence of EGFR mutations and anaplastic lymphoma kinase (ALK) rearrangements constitutes a rare molecular, the frequency of EGFR/ALK co-alterations was about 1%, however, little has been known about clinicopathologic feature and treatment. This review summarized published case report, EGFR and ALK alterations are common in female, Asian origin, never smoker, IV stage, and denocarcinomas. First-line treatment can choose EGFR or ALK tyrosine kinase inhibitors (TKIs). However, studies about the origin and resistance mechanism in EGFR/ALK co-alterations are little, require more experimental and clinical research.
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Affiliation(s)
- Xin Wang
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
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24
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Grenda A, Jarosz B, Krawczyk P, Kucharczyk T, Wojas-Krawczyk K, Reszka K, Krukowska K, Nicoś M, Pankowski J, Bryl M, Ramlau R, Kuźnar-Kamińska B, Grodzki T, Szczęsna A, Siemiątkowska K, Szumiło J, Batura-Gabryel H, Palonka M, Milanowski J. Discrepancies between ALK protein disruption and occurrence of ALK gene rearrangement in Polish NSCLC patients. J Thorac Dis 2018; 10:4994-5009. [PMID: 30233874 PMCID: PMC6129873 DOI: 10.21037/jtd.2018.07.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/27/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangement are predisposed to molecularly targeted therapies. Proper diagnostic is crucial for quick and correct patients qualification to optimal treatment method. Genetic tests to detect predictive factors could be performed sequentially. After excluding EGFR mutations, abnormal ALK protein expression should be tested using immunohistochemistry (IHC) method. In patients with disrupted ALK expression, the rearrangement of the ALK gene should be confirmed by FISH method. Despite few years of experience in analysis of these predictive factors, there are still problems in interpretation of diagnostic tests results. Especially, some recommendations for ALK IHC diagnosis are not precise. METHODS Mutations in EGFR gene were examined using real-time PCR technique in 1,108 formalin-fixed paraffin-embedded (FFPE) tissues, 398 FFPE cell-blocks and 470 cytological specimens of NSCLC. The disrupted ALK protein expression was analysed in 1,100 samples including 782 histological and 306 cytological (cell-blocks) samples using IHC. Twelve materials (1.1%) were non-diagnostic in IHC. ALK gene rearrangement using FISH method was analysed in IHC positive cases. RESULTS The frequency of EGFR mutations was 8.6%. EGFR mutations occurred significantly more often in females (P=0.00001, χ2=62.732) and in adenocarcinoma cases (P=0.0002, χ2=14.222). The exon 19 deletions (49%) and exon 21 Leu858Arg substitution (38%) were the most common, rare EGFR mutations occurred in 13% of patients. Any expression of abnormal ALK protein was detected in 202 cases (18.57%). ALK gene rearrangement was confirmed in 49 cases (4.5%). ALK gene rearrangement is significantly more common in female than in male (P=0.0105, χ2=6.541). In patients with ALK gene rearrangement, the median percentage of nuclei with ALK rearrangement was only 25.5%. The polysomy (≥4 gene copy number per nuclei) of ALK gene was observed in 39 cases (21.4% of patients with diagnostic result of FISH examination). Median number of ALK gene copy per nuclei was 2.9±0.77. Significant positive correlation between percentage of cells with abnormal ALK expression in IHC test and percentage of nuclei with ALK rearrangement in FISH method was detected (R=0.617, P<0.00001). Significant negative correlation between the number of copies of ALK gene and the percentage of cells with expression of abnormal ALK was observed (R=-0.2004, P<0.05). ALK gene rearrangement was significantly more frequently observed in the material with coarse-grained cytoplasmic and membranous IHC staining than in materials with light cytoplasmic stippling. The occurrence of cytoplasmic stippling correlated with the increase of ALK gene copy number. CONCLUSIONS We indicated that diagnosis of ALK disruption in NSCLC patients should be notably careful using IHC and FISH methods. Recommendations for ALK diagnosis should include the way of interpretation of cases with low percentage of cells with abnormal ALK protein expression in IHC test, character of IHC reaction, and cases with ALK gene polysomy in FISH method.
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Affiliation(s)
- Anna Grenda
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Bożena Jarosz
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Paweł Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Kucharczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Kamila Wojas-Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | | | - Kinga Krukowska
- Genetics and Immunology Laboratory Genim LLC, Lublin, Poland
| | - Marcin Nicoś
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | | | - Maciej Bryl
- E.J. Zeyland Greatpoland Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - Rodryg Ramlau
- Department of Oncology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Kuźnar-Kamińska
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Grodzki
- Department of Thoracic Surgery, Regional Hospital for Lung Diseases, Szczecin-Zdunowo, Poland
| | - Aleksandra Szczęsna
- Mazovian Centre for Treatment of Lung Diseases and Tuberculosis, Otwock, Poland
| | - Krystyna Siemiątkowska
- Department of Pathomorphology, Kuyavian-Pomeranian Center of Pulmonology, Bydgoszcz, Poland
| | - Justyna Szumiło
- Department of Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Halina Batura-Gabryel
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Palonka
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
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Abstract
Brain metastases (BM) are the most commonly diagnosed type of central nervous system tumor in the United States. Estimates of the frequency of BM vary significantly, as there is no nationwide reporting system for metastases. BM may be the first sign of a previously undiagnosed cancer, or occur years or decades after the primary cancer was diagnosed. Incidence of BM varies significantly by primary cancer site. Lung, breast, and melanoma continue to be the leading cause of BM. These tumors are increasingly more common as new therapeutics, advanced imaging, and improved screening have led to lengthened survival after primary diagnosis for cancer patients. BM are difficult to treat, and for most individuals the diagnosis of BM generally portends a poor prognosis.
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Affiliation(s)
- Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Christina Huang Wright
- Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
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Jakobsen JN, Santoni-Rugiu E, Grauslund M, Melchior L, Sørensen JB. Concomitant driver mutations in advanced EGFR-mutated non-small-cell lung cancer and their impact on erlotinib treatment. Oncotarget 2018; 9:26195-26208. [PMID: 29899852 PMCID: PMC5995236 DOI: 10.18632/oncotarget.25490] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022] Open
Abstract
Background Patients with EGFR-mutated non-small-cell lung cancer benefit from EGFR tyrosine kinase inhibitors (TKIs) like erlotinib. However, the efficacy may be impaired by driver mutations in other genes. Methods Five hundred and fourteen consecutive patients with NSCLC of all stages were tested for EGFR-mutations by cobas® EGFR Mutation Test. Fluorescent in situ hybridization (FISH) for MET-amplification, immunohistochemistry (IHC) for MET- and ALK-expression, and Next Generation Sequencing (NGS) for concomitant driver mutations were performed on EGFR-mutated tumor samples from erlotinib-treated patients. Results Thirty-six patients (7%) had EGFR-mutations, including 2 with intrinsic resistance mutation p.T790M together with the p.L858R sensitizing mutation and 1 harboring the p.G719C/S768I double-mutation. Twenty-three patients had either locally advanced or advanced disease and received first-line erlotinib-treatment. Concomitant driver mutations were found in 15/21 (71%) of NGS-analyzed TKI-treated NSCLCs, involving in 67% of cases TP53, in 13% CTNNB1, and in 7% KRAS, MET, SMAD4, PIK3CA, FGFR1, FGFR3, NRAS, DDR2, and ERBB4. No ALK-expression was found, whereas MET-overexpression and MET-amplification were observed in 5 and 4 patients, respectively. Objective responses occurred in 17/23 patients (74%), 4 did not respond (17%), and 2 harboring a SMAD4-mutation (p.R135*(stop)) and a FGFR3-mutation (p.D785fs*31), respectively, displayed mixed response with simultaneously progressing and responding tumors (8.7%). Thus, EGFR-mutated tumors harboring co-mutations were not less likely to respond. Conclusion Co-mutations in other cancer-driver genes (oncogenes or tumor suppressor genes) were frequent in EGFR-mutated NSCLCs and few cases harbored concomitant activating and resistance EGFR-mutations before TKI-treatment. Most co-mutations did not impact the response to first-line erlotinib-treatment, but may represent potential additional therapeutic targets.
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Affiliation(s)
- Jan Nyrop Jakobsen
- Department of Oncology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Eric Santoni-Rugiu
- Department of Pathology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Morten Grauslund
- Department of Pathology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Linea Melchior
- Department of Pathology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Jens Benn Sørensen
- Department of Oncology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
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27
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Erlotinib in routine clinical practice for first-line maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC). J Cancer Res Clin Oncol 2018; 144:1375-1383. [PMID: 29687154 DOI: 10.1007/s00432-018-2649-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The controlled phase III trial SATURN demonstrated that maintenance therapy with erlotinib after the first-line platinum-based chemotherapy prolonged progression-free survival (PFS) and overall survival (OS) of non-small cell lung cancer (NSCLC) patients with advanced, non-progressive disease. We conducted the non-interventional study SATURN NIS to investigate the effectiveness and tolerability of erlotinib maintenance in daily clinical practice. METHODS This single-arm NIS screened 290 patients with locally advanced or metastatic NSCLC (stage IIIB or IV) and stable disease after standard platinum-based first-line chemotherapy in 95 institutions across Germany. Erlotinib was dosed and administered corresponding to the terms of the marketing authorization at the time of recruitment. The main effectiveness endpoint was subjects' OS at 1 year. Subgroup analyses of survival estimates of OS and PFS were performed. RESULTS 272 patients were eligible for analysis (median age 66 years, 37.1% females, 99.6% Caucasian, median ECOG performance status 1, 61.8% adenocarcinoma, 96.3% of patients with stable disease). Maintenance therapy with erlotinib resulted in median OS comparable to that of the SATURN phase III trial 10.4 months [95% CI: (8.8; 12.5) vs. 11.9 months]. The 1-year survival rate was 45.6% [95% CI: (37.5%; 53.6%)]. No new safety signals were observed. As expected, patients with epidermal growth factor receptor (EGFR) mutations derived a greater benefit concerning OS and PFS than EGFR-wild-type patients. Moreover, a significant association of OS and PFS and the smoking status was observed. CONCLUSIONS The results of this non-interventional study support the current clinical practice of erlotinib switch maintenance in EGFR-mutation-positive patients.
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Yang W, Gao Y, Li X, Zhang J, Liu T, Feng X, Pan H, Yang X, Xie S, Feng X, Lv Z, Wang Y, Chen Z, He J. Postoperative survival of EGFR-TKI-targeted therapy in non-small cell lung cancer patients with EGFR 19 or 21 mutations: a retrospective study. World J Surg Oncol 2017; 15:197. [PMID: 29110716 PMCID: PMC5674232 DOI: 10.1186/s12957-017-1251-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 09/26/2017] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this retrospective study is to identify epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer patients and to compare the long-term postoperative outcomes in different EGFR-TKI-targeted therapy effects between the different EGFR mutation groups. Methods A total of 2094 postoperative non-small cell lung cancer (NSCLC) patients with EGFR gene detection were collected in the Department of Pathology in the Cancer Hospital Chinese Academy of Medical Sciences from January 2003 to January 2014. Three hundred sixty-three patients were treated with EGFR tyrosine kinase inhibitor (TKI) after surgery: 184 harbored the exon 19 deletion mutation and 179 cases carried the exon 21 L858R point mutation. The end points included progression-free survival (PFS), overall survival (OS), and the response rate. Results OS was increased in the EGFR exon 19 deletion group compared with the exon 21 L858R point mutation group (92 vs. 65 months; P < 0.001). But the median PFS did not differ between two groups (12 vs 14 months). The objective response rate (ORR) in 19 deletion group was increased compared with L858R mutation patients (28.35 vs. 22.73%). The disease control rate (DCR) of patients with 19 deletion benefited more from targeted therapy, compared with L858R group (93.71 vs. 84.31%, P = 0.014). In 19 deletion group, a high ORR and DCR were noted in patients treated with icotinib, 16 out of 18 achieved stable disease (SD), and the DCR in this population was 100%. Conclusions EGFR subtypes could influence the postoperative survival of NSCLC patients with TKI-targeted therapy.
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Affiliation(s)
- Wenjing Yang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yibo Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Xuelian Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
| | - Jing Zhang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Tiejun Liu
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xiaoli Feng
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Pan
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
| | - Xiaofan Yang
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
| | - Shuanghua Xie
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoshuang Feng
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhangyan Lv
- Program Office for Cancer Screening in Urban China, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yonggang Wang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Zhaoli Chen
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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29
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Aguiar F, Fernandes G, Queiroga H, Machado JC, Cirnes L, Souto Moura C, Hespanhol V. Overall Survival Analysis and Characterization of an EGFR Mutated Non-Small Cell Lung Cancer (NSCLC) Population. Arch Bronconeumol 2017; 54:10-17. [PMID: 29079040 DOI: 10.1016/j.arbres.2017.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/09/2017] [Accepted: 07/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with activating somatic mutations in the Epidermal Growth Factor Receptor (EGFR) have better clinical outcomes when treated with Tyrosine Kinase Inhibitors (TKI) over chemotherapy. However, the impact of the use of TKIs on overall survival outside clinical trials is not well established. OBJECTIVE To characterize and analyze the overall survival of a Caucasian population with NSCLC and EGFR mutations. METHODS A retrospective cohort analysis of patients with NSCLC screened for EGFR mutations (exons 18-21) between October 2009 and July 2013 was conducted. Clinical and pathological characteristics, mutational EGFR status, treatment and overall survival were evaluated. RESULTS From the 285 patients which performed screening for EGFR mutations, 54 (18.9%) had mutations, 25 (46.3%) of which in exon 19 and 20 of which (37.0%) in exon 21. The occurrence of mutations was associated with female sex and non-smoking habits (both, P<.001). The median survival of the global population was 12.0 months, with a better overall survival in mutated than non-mutated patients (20.0 vs 11.0 months, respectively; P=.007). CONCLUSION These data contribute for a better knowledge of our lung cancer population concerning the mutational status and clinical outcomes, confirming a better overall survival for the patients with EGFR TKI sensible mutations.
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Affiliation(s)
| | - Gabriela Fernandes
- Pneumology Department, Centro Hospitalar de São João, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal
| | - Henrique Queiroga
- Pneumology Department, Centro Hospitalar de São João, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal
| | - José Carlos Machado
- Faculdade de Medicina da Universidade do Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
| | - Luís Cirnes
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Ipatimup - Institute of Molecular Pathology and Immunology of the University of Porto, Portugal
| | | | - Venceslau Hespanhol
- Pneumology Department, Centro Hospitalar de São João, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal
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Gu W, Zhu Y, Ye D. Beyond chemotherapy for advanced disease-the role of EGFR and PD-1 inhibitors. Transl Androl Urol 2017; 6:848-854. [PMID: 29184782 PMCID: PMC5673798 DOI: 10.21037/tau.2017.03.92] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Penile squamous cell carcinoma (SCC) is a rare malignancy with limited treatment options when the tumor is unresectable and/or chemorefractory. Triplet systemic chemotherapy regimens including taxane and cisplatin are recommended, but the response duration can be short and the treatment-related toxicity high. Only a small proportion of patients survive 1 year or longer with the current standard treatment paradigm. Beyond chemotherapy, the use of novel targeted agents, either alone or in combination with traditional chemotherapeutic agents, has appeared to have promising efficacy in patients with platinum-refractory penile cancer. The frequent overexpression of PD-L1 in advanced penile SCC indicates the potential efficacy of PD-1 inhibitors. Upcoming clinical trials using the immune check-point inhibitors may provide exciting landscape and change the paradigm for patients in the future.
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Affiliation(s)
- Weijie Gu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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31
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Paired Comparison of PD-L1 Expression on Cytologic and Histologic Specimens From Malignancies in the Lung Assessed With PD-L1 IHC 28-8pharmDx and PD-L1 IHC 22C3pharmDx. Appl Immunohistochem Mol Morphol 2017; 25:453-459. [DOI: 10.1097/pai.0000000000000540] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Castellanos E, Feld E, Horn L. Driven by Mutations: The Predictive Value of Mutation Subtype in EGFR -Mutated Non–Small Cell Lung Cancer. J Thorac Oncol 2017; 12:612-623. [DOI: 10.1016/j.jtho.2016.12.014] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 12/21/2022]
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33
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Skov BG, Clementsen P, Larsen KR, Sørensen JB, Mellemgaard A. The prevalence of ALK rearrangement in pulmonary adenocarcinomas in an unselected Caucasian population from a defined catchment area: impact of smoking. Histopathology 2017; 70:889-895. [DOI: 10.1111/his.13148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Birgit G Skov
- Department of Pathology; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Paul Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES); Rigshospitalet and the Capital Region of Denmark; Copenhagen Denmark
| | - Klaus R Larsen
- Department of Respiratory Medicine; Bispebjerg University Hospital; Copenhagen Denmark
| | - Jens B Sørensen
- Department of Oncology; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
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34
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Li K, Yang M, Liang N, Li S. Determining EGFR-TKI sensitivity of G719X and other uncommon EGFR mutations in non-small cell lung cancer: Perplexity and solution (Review). Oncol Rep 2017; 37:1347-1358. [PMID: 28184913 PMCID: PMC5364853 DOI: 10.3892/or.2017.5409] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/19/2017] [Indexed: 01/20/2023] Open
Abstract
Mutations in epidermal growth factor receptor (EGFR) play critical roles in the pathogenesis of non-small cell lung cancer (NSCLC), and they are highly associated with sensitivity to tyrosine kinase inhibitors (TKIs). While the pathogenic and pharmacological characteristics of common mutations in EGFR have been thoroughly investigated, those of uncommon mutations remain to be elucidated. Traditional approaches to study common mutations by randomized controlled trials are not feasible for uncommon mutations owing to their rarity. Therefore, by systematically reviewing laboratory and clinical studies of the G719X mutation, one of the uncommon mutations, we concluded that the G719X mutation was intermediately sensitive to TKIs, with an average response rate of 35.1% (47/134). Moreover, accordingly, we proposed a comprehensive model to investigate uncommon mutations in EGFR. The model involves both basic and clinical components, composed of structural analyses, functional alterations, cell viabilities and animal models with various types of clinical studies. In this review, we systematically reviewed studies of the G719X mutation and put forward a research model that could be generalized to explore uncommon mutations in diseases associated with gene mutations.
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Affiliation(s)
- Kaidi Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Maojun Yang
- Key Laboratory for Protein Sciences of Ministry of Education, Tsinghua-Peking Center for Life Sciences, School of Life Sciences, Tsinghua University, Beijing 100084, P.R. China
| | - Naixin Liang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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35
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Lung cancer mutation profile of EGFR, ALK, and KRAS: Meta-analysis and comparison of never and ever smokers. Lung Cancer 2016; 102:122-134. [DOI: 10.1016/j.lungcan.2016.10.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/15/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023]
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36
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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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37
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Mäki-Nevala S, Sarhadi VK, Rönty M, Kettunen E, Husgafvel-Pursiainen K, Wolff H, Knuuttila A, Knuutila S. Hot spot mutations in Finnish non-small cell lung cancers. Lung Cancer 2016; 99:102-10. [DOI: 10.1016/j.lungcan.2016.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/07/2016] [Accepted: 06/27/2016] [Indexed: 12/22/2022]
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38
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Bansal P, Rusthoven C, Boumber Y, Gan GN. The role of local ablative therapy in oligometastatic non-small-cell lung cancer: hype or hope. Future Oncol 2016; 12:2713-2727. [PMID: 27467543 DOI: 10.2217/fon-2016-0219] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In recent years, the emergence of the oligometastatic state has called into question whether patients found to have a limited or low metastatic tumor burden may benefit from locally ablative therapy (LAT). In the past two decades, stereotactic body radiation therapy has been increasingly used to safely deliver LAT and provide high local control in nonoperable non-small-cell lung cancer patients. Mostly retrospective analyses suggest that using LAT for oligometastatic disease in non-small-cell lung cancer offers excellent local control and may provide an improvement in progression-free survival. Any meaningful improvement in cancer-specific survival remains debatable. We examine the role of integrating LAT in this patient population and the rationale behind its use in combination with targeted therapy and immunotherapy.
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Affiliation(s)
- Pranshu Bansal
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico School of Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA.,Hematology/Oncology Fellowship Program, University of New Mexico School of Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA
| | - Yanis Boumber
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico School of Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA.,Cancer Genetics, Epigenetics & Genomics Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA
| | - Gregory N Gan
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico School of Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA.,Section of Radiation Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA.,Cancer Therapeutics: Technology, Discovery & Targeted Delivery Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA
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Bansal P, Osman D, Gan GN, Simon GR, Boumber Y. Recent Advances in Targetable Therapeutics in Metastatic Non-Squamous NSCLC. Front Oncol 2016; 6:112. [PMID: 27200298 PMCID: PMC4854869 DOI: 10.3389/fonc.2016.00112] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/19/2016] [Indexed: 11/13/2022] Open
Abstract
Lung adenocarcinoma is the most common subtype of non-small cell lung cancer (NSCLC). With the discovery of epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) rearrangements, and effective targeted therapies, therapeutic options are expanding for patients with lung adenocarcinoma. Here, we review novel therapies in non-squamous NSCLC, which are directed against oncogenic targets, including EGFR, ALK, ROS1, BRAF, MET, human epidermal growth factor receptor 2 (HER2), vascular endothelial growth factor receptor 2 (VEGFR2), RET, and NTRK. With the rapidly evolving molecular testing and development of new targeted agents, our ability to further personalize therapy in non-squamous NSCLC is rapidly expanding.
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Affiliation(s)
- Pranshu Bansal
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA; Hematology/Oncology Fellowship Program, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Diaa Osman
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA; Hematology/Oncology Fellowship Program, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Gregory N Gan
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA; Section of Radiation Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - George R Simon
- Department of Thoracic and Head/Neck Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Yanis Boumber
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA; Cancer Genetics, Epigenetics, and Genomics Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
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40
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Sag SO, Gorukmez O, Ture M, Gorukmez O, Deligonul A, Sahinturk S, Topak A, Gulten T, Kurt E, Yakut T. Spectrum of EGFR gene mutations and ALK rearrangements in lung cancer patients in Turkey. SPRINGERPLUS 2016; 5:482. [PMID: 27217997 PMCID: PMC4837752 DOI: 10.1186/s40064-016-2150-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/12/2016] [Indexed: 01/05/2023]
Abstract
The EGFR gene and ALK rearrangements are two genetic drivers of non-small cell lung cancer (NSCLC). The frequency of EGFR mutations and ALK rearrangement varies according to not only ethnicity but also gender, smoking status and the histological type of NSCLC. In the present study, we demonstrated the distribution of EGFR mutations in 132 NSCLC patients by using a pyrosequencing technique and the distribution of ALK rearrangements in 51 NSCLC patients by using fluorescent in situ hybridization technique in Turkey. Additionally, we compared the clinicopathological data of NSCLC patients with the mutation status of EGFR in their cancerous tissues. Both EGFR mutations and ALK rearrangements were identified in 19 (14.39 %) and 1 (1.96 %) patients, respectively. We found EGFR mutations in codon 861, 719 and 858 with the ratios of 10.52 % (2/19), 10.52 % (2/19) and 31.58 % (6/19), respectively, and deletion of exon 19 in 47.37 % (9/19) of the patients. We found the frequency of EGFR mutations to be significantly higher in female patients and nonsmokers (p = 0.043, p = 0.027, respectively). Consequently, we found EGFR mutations to be more frequent in female patients and nonsmokers. Future studies on larger patient groups would provide more accurate data to exhibit the relationship between EGFR mutations and ALK rearrangements and the clinicopathological status.
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Affiliation(s)
- Sebnem Ozemri Sag
- Department of Medical Genetics, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa Turkey
| | - Ozlem Gorukmez
- Department of Medical Genetics, Sevket Yılmaz Education and Research Hospital, 16310 Yıldırım, Bursa Turkey
| | - Mehmet Ture
- Department of Medical Genetics, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa Turkey
| | - Orhan Gorukmez
- Department of Medical Genetics, Sevket Yılmaz Education and Research Hospital, 16310 Yıldırım, Bursa Turkey
| | - Adem Deligonul
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa Turkey
| | - Serdar Sahinturk
- Department of Medical Genetics, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa Turkey
| | - Ali Topak
- Department of Medical Genetics, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa Turkey
| | - Tuna Gulten
- Department of Medical Genetics, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa Turkey
| | - Ender Kurt
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa Turkey
| | - Tahsin Yakut
- Department of Medical Genetics, Faculty of Medicine, Uludag University, 16059 Görükle, Bursa Turkey
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41
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McKay C, Burke T, Cao X, Abernethy AP, Carbone DP. Treatment Patterns for Advanced Non-Small-cell Lung Cancer After Platinum-containing Therapy in U.S. Community Oncology Clinical Practice. Clin Lung Cancer 2016; 17:449-460.e7. [PMID: 27157534 DOI: 10.1016/j.cllc.2016.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Knowledge of the real-world treatment patterns for non-small-cell lung cancer (NSCLC) can identify quality-of-care gaps and guide resource allocation needs. Our objective was to describe the treatment patterns for advanced NSCLC after first-line chemotherapy in the era before the approval of immunotherapeutic agents. MATERIALS AND METHODS The present was a retrospective observational study of adult patients with advanced NSCLC (stage IIIB/IV or metastatic recurrence) who had completed a platinum-containing regimen, with an appropriate tyrosine kinase inhibitor if positive for epidermal growth factor receptor mutation or anaplastic lymphoma kinase translocation. Eligible patients initiated second-line chemotherapy from November 2012 through October 2014, recorded in an oncology record system for U.S. community clinics. RESULTS Of 6867 patients with advanced NSCLC, 4188 (61%) initiated and 2707 (39%) completed platinum therapy, with a tyrosine kinase inhibitor, if appropriate. Subsequently 1889 of 2707 (70%) received second-line chemotherapy, including 1173 within the study period (844 [72%] nonsquamous, 275 [23%] squamous, and 54 [5%] not otherwise specified). The mean ± standard deviation patient age was 66 ± 10 years; 54% were male. Of the 94 different second-line regimens, docetaxel was the most common, prescribed to 14% of the patients overall and 14% and 16% of the nonsquamous and squamous cohorts, respectively. The median duration was 64 days (range, 1-455 days) and 48 days (range, 1-210 days) for the nonsquamous and squamous cohorts, respectively. The median duration by regimen category was 15 to 85 days (overall range, 1-953 days). CONCLUSION These findings show the diversity, short treatment duration, and lack of efficacy of second-line chemotherapy regimens for NSCLC in the community oncology setting.
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Affiliation(s)
- Caroline McKay
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ.
| | - Thomas Burke
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ
| | - Xiting Cao
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ
| | | | - David P Carbone
- Medical Oncology, The James, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Koh YW, Kim HJ, Kwon HY, Han JH, Lee CK, Lee MS, Kim CJ, Baek MJ, Jeong D. Q787Q EGFR Polymorphism as a Prognostic Factor for Lung Squamous Cell Carcinoma. Oncology 2016; 90:289-98. [DOI: 10.1159/000444495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/04/2016] [Indexed: 11/19/2022]
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43
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Alexander M, Evans SM, Stirling RG, Wolfe R, Officer A, MacManus M, Solomon B, Burbury K, Ball D. The Influence of Comorbidity and the Simplified Comorbidity Score on Overall Survival in Non-Small Cell Lung Cancer-A Prospective Cohort Study. J Thorac Oncol 2016; 11:748-757. [PMID: 26851495 DOI: 10.1016/j.jtho.2016.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We addressed the uncertainty of comorbidity as a prognosticator by evaluating comorbidity and the Simplified Comorbidity Score (SCS) as predictors of overall survival in non-small cell lung cancer (NSCLC). METHODS A prospective study included patients in whom NSCLC was diagnosed at an Australian cancer hospital between 2012 and 2014. Patients were assessed for SCS at recruitment and followed up every 3 months until death. RESULTS The cohort included 633 patients; their median age was 67 years (range 28-93), 63% were male, and 86% were ever-smokers. The median SCS at enrolment was 8 (range 0-19); 20% had an SCS higher than 9, and 11% had an SCS of 0. An SCS higher than 9 was associated with male sex, age older than 75 years, an Eastern Cooperative Oncology Group performance status of 2 or higher, and fewer cancer treatments. The 1-year overall survival rate was 62% (95% confidence interval: 58-66). In multivariate analysis, the strongest associations with mortality were metastatic disease (hazard ratio [HR] = 2.8, p < 0.01), Eastern Cooperative Oncology Group performance status of 2 or higher (HR = 2.0, p < 0.01), male sex (HR = 1.6, p < 0.01), more than 10% weight loss at diagnosis (HR = 1.5, p < 0.01), and age older than 75 years (HR = 1.5, p = 0.01). An SCS higher than 9 was not associated with overall survival (HR = 1.0, p = 0.8), and the effect of continuous SCS (HR = 1.1, p < 0.01) was explained by smoking status. CONCLUSIONS In this cohort of patients with NSCLC the SCS was not a clinically significant predictor of overall survival over and above basic patient and disease factors.
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Affiliation(s)
- Marliese Alexander
- Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Australia; Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Sue M Evans
- Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Australia
| | - Robert G Stirling
- Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Australia; Department of Allergy Immunology and Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Australia
| | - Ann Officer
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Radiation Oncology (Lung Service), Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael MacManus
- Department of Radiation Oncology (Lung Service), Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Kate Burbury
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David Ball
- Department of Radiation Oncology (Lung Service), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
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Krawczyk P, Reszka K, Ramlau R, Powrózek T, Pankowski J, Wojas-Krawczyk K, Kalinka-Warzocha E, Szczęsna A, Nicoś M, Jarosz B, Szyszka-Barth K, Bryl M, Adamowicz K, Szumiło J, Milanowski J. Prevalence of rare EGFR gene mutations in nonsmall-cell lung cancer: a multicenter study on 3856 Polish Caucasian patients. Ann Oncol 2015; 27:358-9. [PMID: 26578740 DOI: 10.1093/annonc/mdv553] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin
| | - K Reszka
- GENIM Ltd. Institute of Genetics and Immunology, Lublin
| | - R Ramlau
- Department of Clinical Oncology, Medical University of Poznan, Poznan
| | - T Powrózek
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin
| | - J Pankowski
- Department of Pathology, Specialist Pulmonary Hospital of Sokolowski, Zakopane
| | - K Wojas-Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin
| | | | - A Szczęsna
- Regional Centre of Oncology, M. Kopernik Hospital, Lodz
| | - M Nicoś
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin
| | - B Jarosz
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin
| | - K Szyszka-Barth
- Department of Clinical Oncology, Medical University of Poznan, Poznan
| | - M Bryl
- E.J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan
| | | | - J Szumiło
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - J Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin
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Lee SH, Kim WS, Choi YD, Seo JW, Han JH, Kim MJ, Kim L, Lee GK, Lee CH, Oh MH, Kim GY, Sung SH, Lee KY, Chang SH, Rho MS, Kim HK, Jung SH, Jang SJ. Analysis of Mutations in Epidermal Growth Factor Receptor Gene in Korean Patients with Non-small Cell Lung Cancer: Summary of a Nationwide Survey. J Pathol Transl Med 2015; 49:481-8. [PMID: 26459407 PMCID: PMC4696529 DOI: 10.4132/jptm.2015.09.14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/13/2015] [Accepted: 09/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background: Analysis of mutations in the epidermal growth factor receptor gene (EGFR) is important for predicting response to EGFR tyrosine kinase inhibitors. The overall rate of EGFR mutations in Korean patients is variable. To obtain comprehensive data on the status of EGFR mutations in Korean patients with lung cancer, the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists initiated a nationwide survey. Methods: We obtained 1,753 reports on EGFR mutations in patients with lung cancer from 15 hospitals between January and December 2009. We compared EGFR mutations with patient age, sex, history of smoking, histologic diagnosis, specimen type, procurement site, tumor cell dissection, and laboratory status. Results: The overall EGFR mutation rate was 34.3% in patients with non-small cell lung cancer (NSCLC) and 43.3% in patients with adenocarcinoma. EGFR mutation rate was significantly higher in women, never smokers, patients with adenocarcinoma, and patients who had undergone excisional biopsy. EGFR mutation rates did not differ with respect to patient age or procurement site among patients with NSCLC. Conclusions EGFR mutation rates and statuses were similar to those in published data from other East Asian countries.
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Affiliation(s)
- Sang Hwa Lee
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Yoo Duk Choi
- Chonnam National University Medical School, Gwangju, Korea
| | - Jeong Wook Seo
- Seoul National University College of Medicine, Seoul, Korea
| | - Joung Ho Han
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Yeungnam University College of Medicine, Daegu, Korea
| | - Lucia Kim
- Inha University College of Medicine, Incheon, Korea
| | | | - Chang Hun Lee
- Busan National University School of Medicine, Busan, Korea
| | - Mee Hye Oh
- Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Gou Young Kim
- Kyung Hee University School of Medicine, Seoul, Korea
| | - Sun Hee Sung
- Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyo Young Lee
- Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | | | - Mee Sook Rho
- Dong-A University College of Medicine, Busan, Korea
| | | | - Soon Hee Jung
- Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Se Jin Jang
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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46
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Berg J, Fjellbirkeland L, Suhrke P, Jebsen P, Lund-Iversen M, Kleinberg L, Helgeland L, Brustugun OT, Helland Å. EGFR mutation testing of lung cancer patients - Experiences from Vestfold Hospital Trust. Acta Oncol 2015; 55:149-55. [PMID: 26313507 DOI: 10.3109/0284186x.2015.1062537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with advanced stage lung cancer and somatic mutations in the epithelial growth factor receptor (EGFR) gene are currently treated with tyrosine-kinase inhibitors. The Norwegian Lung Cancer Group (NLCG) recommended EGFR testing of all patients with non-small cell lung carcinoma (NSCLC) from June 2010. From March 2013, testing of squamous cell carcinomas was terminated. We have analysed how these recommendation were followed at a medium-sized Norwegian hospital and we present data on mutation frequency, retesting and possible explanations for missing test results. MATERIAL AND METHODS All pathology reports for patients diagnosed with NSCLC at Vestfold Hospital Trust were examined for the period June 2010 to December 2013. Mutation analyses were done at the Department of Pathology, Oslo University Hospital. RESULTS Material was sent for EGFR analysis for 256 of the 304 eligible patients diagnosed in the period. Material from 48 patients was never sent for EGFR testing, of which five samples consisted of too few tumour cells. For the rest, no obvious reason for omitting EGFR mutation analyses was identified. During the first six months of our study period, material from 25 of 66 NSCLC patients (38%) was not tested, whereas only six of the 118 patients (5%) in 2013 were not tested. For 34 patients, the first tissue specimen contained too few tumour cells and a new sample was sent for EGFR analyses for 11 of these. EGFR mutation was detected in 7.1% of the analysed NSCLC and in 9.4% of adenocarcinomas. DISCUSSION Especially for patients with advanced stages of NSCLC, EGFR mutation status is necessary for treatment stratification. Our results show that the guidelines were followed increasingly over time for patients diagnosed with NSCLC at the Vestfold Hospital Trust. The establishment of interdisciplinary meetings has improved the diagnostic routines.
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Affiliation(s)
- Janna Berg
- a Department of Medicine , Vestfold Hospital Trust , Tønsberg , Norway
| | - Lars Fjellbirkeland
- b Department of Pulmonology , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Pål Suhrke
- c Department of Pathology , Vestfold Hospital Trust , Tønsberg , Norway
| | - Peter Jebsen
- d Department of Pathology , Oslo University Hospital , Oslo , Norway
| | | | - Lilach Kleinberg
- d Department of Pathology , Oslo University Hospital , Oslo , Norway
| | - Lars Helgeland
- e Department of Pathology , Haukeland Universitetssykehus , Haukeland , Norway
| | - Odd Terje Brustugun
- f Department of Genetics/Oncology , Oslo University Hospital , Oslo , Norway
| | - Åslaug Helland
- f Department of Genetics/Oncology , Oslo University Hospital , Oslo , Norway
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