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van Schaik LF, Engelhardt EG, Wilthagen EA, Steeghs N, Fernández Coves A, Joore MA, van Harten WH, Retèl VP. Factors for a broad technology assessment of comprehensive genomic profiling in advanced cancer, a systematic review. Crit Rev Oncol Hematol 2024; 202:104441. [PMID: 39002790 DOI: 10.1016/j.critrevonc.2024.104441] [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: 04/15/2024] [Revised: 06/12/2024] [Accepted: 07/06/2024] [Indexed: 07/15/2024] Open
Abstract
Comprehensive Genomic Profiling (CGP) allows for the identification of many targets. Reimbursement decision-making is, however, challenging because besides the health benefits of on-label treatments and costs, other factors related to diagnostic and treatment pathways may also play a role. The aim of this study was to identify which other factors are relevant for the technology assessment of CGP and to summarize the available evidence for these factors. After a scoping search and two expert sessions, five factors were identified: feasibility, test journey, wider implications of diagnostic results, organisation of laboratories, and "scientific spillover". Subsequently, a systematic search identified 83 studies collecting mainly evidence for the factors "test journey" and "wider implications of diagnostic results". Its nature was, however, of limited value for decision-making. We recommend the use of comparative strategies, uniformity in outcome definitions, and the inclusion of a comprehensive set of factors in future evidence generation.
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Affiliation(s)
- L F van Schaik
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, P.O. Box 90103, Amsterdam 1006 BE, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - E G Engelhardt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, P.O. Box 90103, Amsterdam 1006 BE, the Netherlands.
| | - E A Wilthagen
- Scientific Information Service, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam CX 1066, the Netherlands.
| | - N Steeghs
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam CX 1066, the Netherlands.
| | - A Fernández Coves
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), P. Debyelaan 25, Oxford Building, P.O. Box 5800a, Maastricht, Limburg, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - M A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), P. Debyelaan 25, Oxford Building, P.O. Box 5800a, Maastricht, Limburg, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - W H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, P.O. Box 90103, Amsterdam 1006 BE, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands.
| | - V P Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, P.O. Box 90103, Amsterdam 1006 BE, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
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2
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Li J, Jia Z, Dong L, Cao H, Huang Y, Xu H, Xie Z, Jiang Y, Wang X, Liu J. DNA damage response in breast cancer and its significant role in guiding novel precise therapies. Biomark Res 2024; 12:111. [PMID: 39334297 PMCID: PMC11437670 DOI: 10.1186/s40364-024-00653-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
DNA damage response (DDR) deficiency has been one of the emerging targets in treating breast cancer in recent years. On the one hand, DDR coordinates cell cycle and signal transduction, whose dysfunction may lead to cell apoptosis, genomic instability, and tumor development. Conversely, DDR deficiency is an intrinsic feature of tumors that underlies their response to treatments that inflict DNA damage. In this review, we systematically explore various mechanisms of DDR, the rationale and research advances in DDR-targeted drugs in breast cancer, and discuss the challenges in its clinical applications. Notably, poly (ADP-ribose) polymerase (PARP) inhibitors have demonstrated favorable efficacy and safety in breast cancer with high homogenous recombination deficiency (HRD) status in a series of clinical trials. Moreover, several studies on novel DDR-related molecules are actively exploring to target tumors that become resistant to PARP inhibition. Before further clinical application of new regimens or drugs, novel and standardized biomarkers are needed to develop for accurately characterizing the benefit population and predicting efficacy. Despite the promising efficacy of DDR-related treatments, challenges of off-target toxicity and drug resistance need to be addressed. Strategies to overcome drug resistance await further exploration on DDR mechanisms, and combined targeted drugs or immunotherapy will hopefully provide more precise or combined strategies and expand potential responsive populations.
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Affiliation(s)
- Jiayi Li
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China
| | - Ziqi Jia
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Dong
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Heng Cao
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yansong Huang
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China
| | - Hengyi Xu
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhixuan Xie
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China
| | - Yiwen Jiang
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China
| | - Xiang Wang
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jiaqi Liu
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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3
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Philips AO, Panda SS, Cyriac S, Moharana L, Kilaru S, Kolluri S, Rathnam K, Saju S, Raju HS, Kayal S, Biswajit D, Sehrawat A, Sundriyal D, Jose AT, Raju S, Paul P, Ganesan P. Real-World Experiences of Next-Generation Sequencing in Oncology: From an Indian Multicenter Registry and Collaborative Centers. Indian J Med Paediatr Oncol 2024. [DOI: 10.1055/s-0044-1779275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Abstract
Background The integration of next-generation sequencing (NGS) in guiding personalized therapy for oncology faces the challenges, primarily, of cost and drug accessibility. Limited data from Indian academic centers accentuate the need for comprehensive insights into the real-world applications of NGS in oncology.
Methods The Network of Oncology Clinical Trials in India (NOCI), accessible at www.noci-india.com, compiled data on patients who underwent NGS for solid organ cancers from January 1, 2018, to December 31, 2021. This study aimed to elucidate the testing indications, sample types analyzed, and the resultant impact on patient care.
Results Analysis of data from six centers included 278 subjects, with 24 specimens (9%) excluded due to quality test failure. Tissue constituted 59.7% of specimens, blood 38.5%, and both 1.8%. Predominantly, NGS was employed for identifying BRCA1/2 mutations (56%) and for targeted therapy in non-small-cell lung cancer (NSCLC; 28%). Only 41 (16%) patients with other cancers underwent multigene NGS panels in pursuit of targetable mutations. Among them, 13 exhibited targetable mutations, and 3 received treatment based on NGS findings.
Conclusion This study underscores that the majority of NGS applications focused on screening for BRCA1/2 mutations and identifying targetable mutations in NSCLC. However, among those undergoing NGS for advanced cancers, only a limited number received personalized therapy. The findings underscore the challenges of utilizing NGS in off-label indications within resource-constrained settings.
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Affiliation(s)
| | - Soumya Surath Panda
- Department of Medical Oncology, Institute of Medical Sciences and Sum Hospital, Odhisha, India
| | - Sunu Cyriac
- Department of Medical Oncology, Amala Institute of Medical Sciences, Kerala, India
| | - Lalatendu Moharana
- Department of Medical Oncology, Institute of Medical Sciences and Sum Hospital, Odhisha, India
| | - Sindhu Kilaru
- Department of Medical Oncology, Institute of Medical Sciences and Sum Hospital, Odhisha, India
| | - Spoorty Kolluri
- Department of Medical Oncology, Institute of Medical Sciences and Sum Hospital, Odhisha, India
| | - Krishnakumar Rathnam
- Department of Medical Oncology, Meenakshi Mission Medical College and Research Center, Madurai, India
| | - S.V. Saju
- Department of Medical Oncology, Meenakshi Mission Medical College and Research Center, Madurai, India
| | - Honey Susan Raju
- Department of Medical Oncology, Meenakshi Mission Medical College and Research Center, Madurai, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dubashi Biswajit
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Amit Sehrawat
- Department of Medical Oncology, All India Institute of Medical Sciences Rishikesh, India
| | - Deepak Sundriyal
- Department of Medical Oncology, All India Institute of Medical Sciences Rishikesh, India
| | - Anil T. Jose
- Department of Medical Oncology, Amala Institute of Medical Sciences, Kerala, India
| | - Sreeja Raju
- Department of Pathology, Amala Institute of Medical Sciences, Kerala, India
| | - Preethi Paul
- Department of Pathology, Christian Medical College, Ludhiana, Punjab, India
| | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Mulet Margalef N, Castillo C, Mosteiro M, Pérez X, Aguilar S, Ruíz‐Pace F, Gil M, Cuadra C, Ruffinelli JC, Martínez M, Losa F, Soler G, Teulé À, Castany R, Gallego R, Ruíz A, Garralda E, Élez E, Vivancos A, Tabernero J, Salazar R, Dienstmann R, Santos Vivas C. Genomically matched therapy in refractory colorectal cancer according to ESMO Scale for Clinical Actionability of Molecular Targets: experience of a comprehensive cancer centre network. Mol Oncol 2023; 17:1908-1916. [PMID: 37097008 PMCID: PMC10483603 DOI: 10.1002/1878-0261.13444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/02/2023] [Accepted: 04/24/2023] [Indexed: 04/26/2023] Open
Abstract
Efficiency of expanded genomic profiling (EGP) programmes in terms of final inclusion of patients in genomically matched therapies is still unknown. Fit patients with advanced and refractory colorectal cancer (CRC) were selected for an EGP programme. Next-generation sequencing (NGS) analysis from formalin-fixed paraffin-embedded tumour samples was performed. The purpose was to describe the prevalence of genomic alterations defined by the ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT), as well as the percentage of patients finally included in genomically guided clinical trials. In total, 187 patients were recruited. Mutational profile was obtained in 177 patients (10 patients were failure due to insufficient tumour sample), copy number alterations in 41 patients and fusions in 31 patients. ESCAT-defined alterations were detected in 28.8% of the intention-to-analyse population. BRAF V600E was clustered in ESCAT I, with a prevalence of 3.7%, KRAS G12C and ERBB2 amplification were clustered in ESCAT II, whose prevalence was 4.2% and 1.6%, respectively. Most alterations were classified in ESCAT III (mutations in ERBB2, PIK3CA or FGFR genes and MET amplification) and IV (mutations in BRAF non-V600E, ERBB3, FBXW7, NOTCH, RNF43), with a single prevalence under 5%, except for PIK3CA mutation (9%). The final rate of inclusion into genomically guided clinical trials was 2.7%, including therapies targeting BRAF V600E or RNF43 mutations in two patients each, and ERBB2 mutation in one patient. In conclusion, EGP programmes in patients with advanced CRC are feasible and identify a subset of patients with potentially druggable genomic alterations. However, further efforts must be made to increase the rate of patients treated with genomically guided therapies.
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Affiliation(s)
- Núria Mulet Margalef
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
- Badalona Applied Research Group in Oncology, B‐ARGOSpain
| | - Carmen Castillo
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Miguel Mosteiro
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Xavier Pérez
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Susana Aguilar
- Molecular Pre‐Screening ProgramVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | - Fiorella Ruíz‐Pace
- Oncology Data Science GroupVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | - Marta Gil
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Carmen Cuadra
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | | | - Mercedes Martínez
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Ferran Losa
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Gema Soler
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Àlex Teulé
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Roser Castany
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Rosa Gallego
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Andrea Ruíz
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
| | - Elena Garralda
- Research Unit for Molecular Therapy of Cancer (UITM)Vall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | - Elena Élez
- Department of Medical OncologyVall d'Hebron Hospital Campus and Vall d'Hebron Institute of OncologyBarcelonaSpain
| | - Ana Vivancos
- Cancer Genomics GroupVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | - Josep Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology (VHIO)IOB‐Quiron, UVic‐UCC, CIBERONCBarcelonaSpain
| | - Ramon Salazar
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
- Oncobell Program (IDIBELL), Facultat de Medicina i Ciències de la SalutUniversitat de Barcelona CIBERONCSpain
| | - Rodrigo Dienstmann
- Oncology Data Science GroupVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | - Cristina Santos Vivas
- Medical Oncology DepartmentInstitut Català d'OncologiaL'Hospitalet de LlobregatSpain
- Oncobell Program (IDIBELL), Facultat de Medicina i Ciències de la SalutUniversitat de Barcelona CIBERONCSpain
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5
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Nibid L, Sabarese G, Righi D, Rossi SM, Merlini G, Crucitti P, Vincenzi B, Tonini G, Perrone G. Feasibility of Comprehensive Genomic Profiling (CGP) in Real-Life Clinical Practice. Diagnostics (Basel) 2023; 13:diagnostics13040782. [PMID: 36832270 PMCID: PMC9955416 DOI: 10.3390/diagnostics13040782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
In advanced or metastatic settings, Comprehensive Genomic Profiling (CGP) allows the evaluation of thousands of gene alterations with the goal of offering new opportunities for personalized treatment in solid tumors. This study evaluated the CGP Success Rate in a real-life cohort of 184 patients enrolled in a prospective clinical trial. CGP data were compared with the routine molecular testing strategy adopted in-house. Sample age, tumor area, and the percentage of tumor nuclei were recorded for CGP analysis. We found that 150/184 (81.5%) samples resulted in satisfying CGP reports. The CGP Success Rate was higher in samples from surgical specimens (96.7%) and in specimens that had been stored (sample age) for less than six months (89.4%). Among the inconclusive CGP reports, 7/34 (20.6%) were optimal samples, according to CGP sample requirements. Moreover, with the in-house molecular testing approach, we could obtain clinically relevant molecular data in 25/34 (73.5%) samples that had inconclusive CGP reports. In conclusion, despite the fact that CGP offers specific therapeutical options in selected patients, our data suggest that the standard molecular testing strategy should not be replaced in routine molecular profiling.
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Affiliation(s)
- Lorenzo Nibid
- Research Unit of Anatomical Pathology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
- Correspondence: (L.N.); (G.P.)
| | - Giovanna Sabarese
- Research Unit of Anatomical Pathology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Daniela Righi
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Silvia Maria Rossi
- Research Unit of Anatomical Pathology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Giorgia Merlini
- Research Unit of Anatomical Pathology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
| | - Pierfilippo Crucitti
- Research Unit of General Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
- Thoracic Surgery Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Bruno Vincenzi
- Research Unit of Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
- Medical Oncology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Giuseppe Tonini
- Research Unit of Oncology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
- Medical Oncology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Giuseppe Perrone
- Research Unit of Anatomical Pathology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128 Roma, Italy
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
- Correspondence: (L.N.); (G.P.)
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6
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Pinet S, Durand S, Perani A, Darnaud L, Amadjikpe F, Yon M, Darbas T, Vergnenegre A, Egenod T, Simonneau Y, Le Brun-Ly V, Pestre J, Venat L, Thuillier F, Chaunavel A, Duchesne M, Fermeaux V, Guyot A, Lacorre S, Bessette B, Lalloué F, Durand K, Deluche E. Clinical management of molecular alterations identified by high throughput sequencing in patients with advanced solid tumors in treatment failure: Real-world data from a French hospital. Front Oncol 2023; 13:1104659. [PMID: 36923436 PMCID: PMC10009270 DOI: 10.3389/fonc.2023.1104659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
Background In the context of personalized medicine, screening patients to identify targetable molecular alterations is essential for therapeutic decisions such as inclusion in clinical trials, early access to therapies, or compassionate treatment. The objective of this study was to determine the real-world impact of routine incorporation of FoundationOne analysis in cancers with a poor prognosis and limited treatment options, or in those progressing after at least one course of standard therapy. Methods A FoundationOneCDx panel for solid tumor or liquid biopsy samples was offered to 204 eligible patients. Results Samples from 150 patients were processed for genomic testing, with a data acquisition success rate of 93%. The analysis identified 2419 gene alterations, with a median of 11 alterations per tumor (range, 0-86). The most common or likely pathogenic variants were on TP53, TERT, PI3KCA, CDKN2A/B, KRAS, CCDN1, FGF19, FGF3, and SMAD4. The median tumor mutation burden was three mutations/Mb (range, 0-117) in 143 patients with available data. Of 150 patients with known or likely pathogenic actionable alterations, 13 (8.6%) received matched targeted therapy. Sixty-nine patients underwent Molecular Tumor Board, which resulted in recommendations in 60 cases. Treatment with genotype-directed therapy had no impact on overall survival (13 months vs. 14 months; p = 0.95; hazard ratio = 1.04 (95% confidence interval, 0.48-2.26)]. Conclusions This study highlights that an organized center with a Multidisciplinary Molecular Tumor Board and an NGS screening system can obtain satisfactory results comparable with those of large centers for including patients in clinical trials.
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Affiliation(s)
- Sandra Pinet
- Medical Oncology Department, Dupuytren University Hospital, Limoges, France
| | - Stéphanie Durand
- The National Institute for Health and Medical Research (INSERM) U1308 - CAPTuR "Control Of Cell Activation, Tumor Progression and Therapeutic Resistance", Faculty of Medicine, University of Limoges, Limoges, France
| | - Alexandre Perani
- Cytogenetic, Medical Genetic and Reproductive Biology, Dupuytren University Hospital, Limoges, France
| | - Léa Darnaud
- Department of Pathology, Dupuytren University Hospital, Limoges, France
| | - Fifame Amadjikpe
- Department of Pathology, Dupuytren University Hospital, Limoges, France
| | - Mathieu Yon
- Department of Pathology, Dupuytren University Hospital, Limoges, France
| | - Tiffany Darbas
- Medical Oncology Department, Dupuytren University Hospital, Limoges, France
| | | | - Thomas Egenod
- Chest Department, Dupuytren University Hospital, Limoges, France
| | | | - Valérie Le Brun-Ly
- Medical Oncology Department, Dupuytren University Hospital, Limoges, France
| | - Julia Pestre
- Medical Oncology Department, Dupuytren University Hospital, Limoges, France
| | - Laurence Venat
- Medical Oncology Department, Dupuytren University Hospital, Limoges, France
| | - Frédéric Thuillier
- Medical Oncology Department, Dupuytren University Hospital, Limoges, France
| | - Alain Chaunavel
- The National Institute for Health and Medical Research (INSERM) U1308 - CAPTuR "Control Of Cell Activation, Tumor Progression and Therapeutic Resistance", Faculty of Medicine, University of Limoges, Limoges, France.,Department of Pathology, Dupuytren University Hospital, Limoges, France
| | - Mathilde Duchesne
- Department of Pathology, Dupuytren University Hospital, Limoges, France.,Research Unit (UR) 20218 - NEURIT "Neuropathies et Innovations Thérapeutiques", Faculty of Medicine, University of Limoges, Limoges, France
| | | | - Anne Guyot
- Department of Pathology, Dupuytren University Hospital, Limoges, France
| | - Sylvain Lacorre
- Department of Pathology, Dupuytren University Hospital, Limoges, France
| | - Barbara Bessette
- The National Institute for Health and Medical Research (INSERM) U1308 - CAPTuR "Control Of Cell Activation, Tumor Progression and Therapeutic Resistance", Faculty of Medicine, University of Limoges, Limoges, France
| | - Fabrice Lalloué
- The National Institute for Health and Medical Research (INSERM) U1308 - CAPTuR "Control Of Cell Activation, Tumor Progression and Therapeutic Resistance", Faculty of Medicine, University of Limoges, Limoges, France
| | - Karine Durand
- The National Institute for Health and Medical Research (INSERM) U1308 - CAPTuR "Control Of Cell Activation, Tumor Progression and Therapeutic Resistance", Faculty of Medicine, University of Limoges, Limoges, France.,Department of Pathology, Dupuytren University Hospital, Limoges, France
| | - Elise Deluche
- Medical Oncology Department, Dupuytren University Hospital, Limoges, France.,The National Institute for Health and Medical Research (INSERM) U1308 - CAPTuR "Control Of Cell Activation, Tumor Progression and Therapeutic Resistance", Faculty of Medicine, University of Limoges, Limoges, France
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7
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Caputo V, De Falco V, Ventriglia A, Famiglietti V, Martinelli E, Morgillo F, Martini G, Corte CMD, Ciardiello D, Poliero L, De Vita F, Orditura M, Fasano M, Franco R, Caraglia M, Avitabile A, Scalamogna R, Marchi B, Ciardiello F, Troiani T, Napolitano S. Comprehensive genome profiling by next generation sequencing of circulating tumor DNA in solid tumors: a single academic institution experience. Ther Adv Med Oncol 2022; 14:17588359221096878. [PMID: 35547096 PMCID: PMC9082754 DOI: 10.1177/17588359221096878] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 04/07/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Recently, new evidence of the next-generation sequencing (NGS) liquid biopsy utility in clinical practice has been developed. This assay is emerging as a new promising tool to use as a noninvasive biomarker for cancer mutation profiling. Additional data supporting the clinical validity of cell free DNA (cfDNA) based testing is necessary to inform optimal use of these assays in the clinic. Materials and methods: A total of 398 cancer patients were analyzed by FoundationOne Liquid Analysis (F1LA), a genomic profiling assay and by standard NGS diagnostic ThermoFisher platform. The association between diagnostic technique was evaluated using a Poisson regression model. FoundationOne Liquid (F1L) and FoundationOne Liquid CDx (F1LCDx) detect 70 and 324 cancer-related genes alterations, respectively, including genomic signatures tumor fraction, blood tumor mutational burden (only for the 324 genes version), and microsatellite instability high status. Both assays used a single DNA extraction method to obtain cfDNA. The real-life clinical impact and feasibility of F1L and F1LCDx were evaluated across different solid tumors in our department. Results: Between 1 January 2019 and 28 February 2021, 398 samples of different tumor types from 398 patients were analyzed (overall success rate: 92%, in FoundationOne Liquid CDx Analysis success rate: 97%). Most frequent molecular alterations were TP53 (74), APC (40), DNMT3A (39), KRAS (23). The comprehensive clinical impact of F1LA compared with standard diagnostic was 64.7% versus 22.1% [risk ratio (RR) = 2.94; p < 0.001] and the potential clinical impact was 58.6% versus 11.0% (RR = 5.32; p < 0.001), respectively. Furthermore, some clinical cases were selected, in which F1LA detected actionable alterations offering an unexpected therapeutic choice. Conclusions: Although additional studies are needed to better select patients and setting, NGS F1LA is a useful, noninvasive, and repeatable assay to guide therapeutic choice in oncology. It provides a snapshot of cancer heterogeneity profile that could be incorporated in routinely clinical practice.
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Affiliation(s)
- Vincenza Caputo
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Vincenzo De Falco
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Anna Ventriglia
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Vincenzo Famiglietti
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Erika Martinelli
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Floriana Morgillo
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Giulia Martini
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Carminia Maria Della Corte
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Davide Ciardiello
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
- Oncology Unit, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Luca Poliero
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Ferdinando De Vita
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Michele Orditura
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Morena Fasano
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Michele Caraglia
- Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | | | | | | | - Fortunato Ciardiello
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Teresa Troiani
- Full Professor, Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Via S. Pansini 5, Napoli 80131, Italy
| | - Stefania Napolitano
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Via S. Pansini 5, Napoli 80131, Italy
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8
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Di Liello R, Piccirillo MC, Arenare L, Gargiulo P, Schettino C, Gravina A, Perrone F. Master Protocols for Precision Medicine in Oncology: Overcoming Methodology of Randomized Clinical Trials. Life (Basel) 2021; 11:1253. [PMID: 34833129 PMCID: PMC8618758 DOI: 10.3390/life11111253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 01/06/2023] Open
Abstract
Randomized clinical trials are considered the milestones of clinical research in oncology, and guided the development and approval of new compounds so far. In the last few years, however, molecular and genomic profiling led to a change of paradigm in therapeutic algorithms of many cancer types, with the spread of different biomarker-driven therapies (or targeted therapies). This scenario of "personalized medicine" revolutionized therapeutic strategies and the methodology of the supporting clinical research. New clinical trial designs are emerging to answer to the unmet clinical needs related to the development of these targeted therapies, overcoming the "classical" structure of randomized studies. Innovative trial designs able to evaluate more than one treatment in the same group of patients or many groups of patients with the same treatment (or both) are emerging as a possible future standard in clinical trial methodology. These are identified as "master protocols", and include umbrella, basket and platform trials. In this review, we described the main characteristics of these new trial designs, focusing on the opportunities and limitations of their use in the era of personalized medicine.
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Affiliation(s)
- Raimondo Di Liello
- Oncologia Medica, Dipartimento di Medicina di Precisione, Università degli Studi della Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Napoli, Italy;
| | - Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, Via M. Semmola, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (A.G.); (F.P.)
| | - Laura Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, Via M. Semmola, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (A.G.); (F.P.)
| | - Piera Gargiulo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, Via M. Semmola, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (A.G.); (F.P.)
| | - Clorinda Schettino
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, Via M. Semmola, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (A.G.); (F.P.)
| | - Adriano Gravina
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, Via M. Semmola, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (A.G.); (F.P.)
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, Via M. Semmola, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (A.G.); (F.P.)
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9
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Multiple Acquired Mutations Captured by Liquid Biopsy in the EGFR Addicted Metastatic Colorectal Cancer. Clin Colorectal Cancer 2021; 20:354-358. [PMID: 34454840 DOI: 10.1016/j.clcc.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023]
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10
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Fasano M, Della Corte CM, Di Liello R, Barra G, Sparano F, Viscardi G, Iacovino ML, Paragliola F, Famiglietti V, Ciaramella V, Cimmino F, Capasso M, Iolascon A, Sforza V, Morabito A, Maiello E, Ciardiello F, Morgillo F. Induction of natural killer antibody-dependent cell cytotoxicity and of clinical activity of cetuximab plus avelumab in non-small cell lung cancer. ESMO Open 2021; 5:e000753. [PMID: 32912860 PMCID: PMC7484864 DOI: 10.1136/esmoopen-2020-000753] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background Antibody-dependent cell-mediated cytotoxicity (ADCC) may mediate antitumour activity of IgG1-isotype monoclonal antibody (mAb), suggesting as potential treatment combination of IgG1-mAbs, anti-epidermal growth factor receptor cetuximab and anti-programmed death-ligand-1 avelumab. Methods We evaluated ADCC induction in lung cancer cells by lactate dehydrogenase (LDH) release assay. Antitumour activity and safety of cetuximab plus avelumab were explored in a single-arm proof-of-concept study in pre-treated non-small cell lung cancer (NSCLC) patients (pt) (Cetuximab-AVElumab-lung, CAVE-Lung). Search for predictive biomarkers of response was done. Results Avelumab plus cetuximab induced ADCC in NSCLC cells in vitro in presence of natural killers (NK) from healthy donors (HD) or NSCLC pt, as effectors. Sixteen relapsed NSCLC pt were treated with avelumab plus cetuximab. Antitumour activity was observed in 6/16 pt, defined by progression free survival (PFS) ≥8 months, with 4 of them still on treatment at data lock time (range, 14–19 months). Of note, 3/6 responders had received as previous line anti-programmed death-1 therapy. In responders, clinical benefit was accompanied by significant increase in LDH release over baseline at the first radiological evaluation (8 weeks) (p=0.01) and by early skin toxicity; while in the 10 non-responders, that had PFS ≤5 months, LDH release tends to reduce. Baseline circulating DNA levels were higher in non-responders compared with responders and HD (p=0.026) and decrease in responders during therapy. Mutations in DNA damage responsive family genes were found in responders. Conclusion Cetuximab and avelumab activates NSCLC pt NK cells. Ex vivo evaluation of ADCC, circulating DNA levels and early skin toxicity may predict response to cetuximab plus avelumab in NSCLC. EUDRACT 2017-004195-58
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Affiliation(s)
- Morena Fasano
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | | | - Raimondo Di Liello
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | - Giusi Barra
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | - Francesca Sparano
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | - Giuseppe Viscardi
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | - Maria Lucia Iacovino
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | - Fernando Paragliola
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | - Vincenzo Famiglietti
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | - Vincenza Ciaramella
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | - Flora Cimmino
- Department of Molecular Medicine and Biotechnologies, CEINGE Advanced Biotechnologies, Napoli, Campania, Italy
| | - Mario Capasso
- Department of Molecular Medicine and Biotechnologies, CEINGE Advanced Biotechnologies, Napoli, Campania, Italy
| | - Achille Iolascon
- Department of Molecular Medicine and Biotechnologies, CEINGE Advanced Biotechnologies, Napoli, Campania, Italy
| | - Vincenzo Sforza
- Department of Thoracic Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Alessandro Morabito
- Department of Thoracic Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Evaristo Maiello
- Medical Oncology and Immunotherapy Division, Istituto Toscano Tumori, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy
| | - Floriana Morgillo
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Campania, Italy.
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11
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Inagaki C, Maeda D, Hatake K, Sato Y, Hashimoto K, Sakai D, Yachida S, Nonomura N, Satoh T. Clinical Utility of Next-Generation Sequencing-Based Panel Testing under the Universal Health-Care System in Japan: A Retrospective Analysis at a Single University Hospital. Cancers (Basel) 2021; 13:1121. [PMID: 33807840 PMCID: PMC7961835 DOI: 10.3390/cancers13051121] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022] Open
Abstract
Next-generation sequencing (NGS) assay is part of routine care in Japan owing to its reimbursement by Japan's universal health-care system; however, reimbursement is limited to patients who finished standard treatment. We retrospectively investigated 221 patients who underwent Foundation One CDX (F1CDx) at our hospital. Every F1CDx result was assessed at the molecular tumor board (MTB) for treatment recommendation. Based on patients' preferences, presumed germline findings were also assessed at the MTB and disclosed at the clinic. In total, 204 patients underwent F1CDx and 195 patients completed the analysis; however, 13.8% of them could not receive the report due to disease progression. Among 168 patients who received the results, 41.6% had at least one actionable alteration, and 3.6% received genomically matched treatment. Presumed germline findings were nominated in 24 patients, and 16.7% of them contacted a geneticist counselor. The NGS assay should be performed earlier in the clinical course to maximize the clinical benefit. Broader reimbursement for the NGS assay would enhance the delivery of precision oncology to patients. Access to clinical trials affects the number of patients who benefit from NGS. Additionally, the disclosure of presumed germline findings is feasible in clinical practice.
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Affiliation(s)
- Chiaki Inagaki
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan;
| | - Daichi Maeda
- Department of Clinical Genomics, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan;
| | - Kazue Hatake
- Center for Cancer Genomics and Personalized Medicine, Osaka University Hospital, Osaka 565-0871, Japan; (K.H.); (D.S.); (S.Y.); (N.N.)
| | - Yuki Sato
- Department of Genetic Counseling, Osaka University Hospital, Osaka 565-0871, Japan; (Y.S.); (K.H.)
| | - Kae Hashimoto
- Department of Genetic Counseling, Osaka University Hospital, Osaka 565-0871, Japan; (Y.S.); (K.H.)
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Daisuke Sakai
- Center for Cancer Genomics and Personalized Medicine, Osaka University Hospital, Osaka 565-0871, Japan; (K.H.); (D.S.); (S.Y.); (N.N.)
| | - Shinichi Yachida
- Center for Cancer Genomics and Personalized Medicine, Osaka University Hospital, Osaka 565-0871, Japan; (K.H.); (D.S.); (S.Y.); (N.N.)
- Department of Cancer Genome Informatics, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Norio Nonomura
- Center for Cancer Genomics and Personalized Medicine, Osaka University Hospital, Osaka 565-0871, Japan; (K.H.); (D.S.); (S.Y.); (N.N.)
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Taroh Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan;
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