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La Salvia A, Meyer ML, Hirsch FR, Kerr KM, Landi L, Tsao MS, Cappuzzo F. Rediscovering immunohistochemistry in lung cancer. Crit Rev Oncol Hematol 2024; 200:104401. [PMID: 38815876 DOI: 10.1016/j.critrevonc.2024.104401] [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: 01/02/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
Several observations indicate that protein expression analysis by immunohistochemistry (IHC) remains relevant in individuals with non-small-cell lung cancer (NSCLC) when considering targeted therapy, as an early step in diagnosis and for therapy selection. Since the advent of next-generation sequencing (NGS), the role of IHC in testing for NSCLC biomarkers has been forgotten or ignored. We discuss how protein-level investigations maintain a critical role in defining sensitivity to lung cancer therapies in oncogene- and non-oncogene-addicted cases and in patients eligible for immunotherapy, suggesting that IHC testing should be reconsidered in clinical practice. We also argue how a panel of IHC tests should be considered complementary to NGS and other genomic assays. This is relevant to current clinical diagnostic practice but with potential future roles to optimize the selection of patients for innovative therapies. At the same time, strict validation of antibodies, assays, scoring systems, and intra- and interobserver reproducibility is needed.
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Affiliation(s)
- Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), Rome 00161, Italy
| | - May-Lucie Meyer
- Center for Thoracic Oncology/Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fred R Hirsch
- Center for Thoracic Oncology/Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith M Kerr
- Aberdeen University School of Medicine & Aberdeen Royal Infirmary, Aberdeen, UK
| | - Lorenza Landi
- Medical Oncology, Istituto Nazionale Tumori IRCCS "Regina Elena", Rome, Italy
| | - Ming-Sound Tsao
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Federico Cappuzzo
- Medical Oncology, Istituto Nazionale Tumori IRCCS "Regina Elena", Rome, Italy.
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Osorio A, Fernandez-Trujillo L, Restrepo JG, Sua LF, Proaño C, Zuñiga-Restrepo V. Importance of Testing for ROS1 Rearrangements in Non-Small Cell Lung Cancer in the Era of Targeted Therapy in a Latin American Country. Cancer Manag Res 2024; 16:781-789. [PMID: 39010861 PMCID: PMC11249106 DOI: 10.2147/cmar.s455809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/22/2024] [Indexed: 07/17/2024] Open
Abstract
Purpose Lung cancer is the leading cause of cancer-related deaths worldwide. However, with the optimization of screening strategies and advances in treatment, mortality has been decreasing in recent years. In this study, we describe non-small cell lung cancer patients diagnosed between 2021 and 2022 at a high-complexity hospital in Latin America, as well as the immunohistochemistry techniques used to screen for ROS1 rearrangements, in the context of the recent approval of crizotinib for the treatment of ROS1 rearrangements in non-small cell lung cancer in Colombia. Methods A descriptive cross-sectional study was conducted. Sociodemographic, clinical, and molecular pathology information from non-small cell lung cancer individuals who underwent immunohistochemistry to detect ROS1 rearrangements between 2021 and 2022 at Fundación Valle del Lili (Cali, Colombia) was recorded. The clinical outcomes of confirmed ROS1 rearrangements in non-small cell lung cancer patients were reported. Results One hundred and thirty-six patients with non-small cell lung cancer were included. The median age at diagnosis was 69.8 years (interquartile range 61.9-77.7). At diagnosis, 69.8% (n = 95) were at stage IV. ROS1 immunohistochemistry was performed using the monoclonal D4D6 antibody clone in 54.4% (n = 74) of the cases, while 45.6% (n = 62) were done with the monoclonal SP384 antibody clone. Two patients were confirmed to have ROS1 rearrangements in non-small cell lung cancer using next-generation sequencing and received crizotinib. On follow-up at months 5.3 and 7.0, one patient had a partial response, and the other had oligo-progression, respectively. Conclusion Screening for ROS1 rearrangements in non-small cell lung cancer is imperative, as multiple prospective studies have shown improved clinical outcomes with tyrosine kinase inhibitors. Given the recent approval of crizotinib in Colombia, public health policies must be oriented toward early detection of driver mutations and prompt treatment. Additionally, future approvals of newly tested tyrosine kinase inhibitors should be anticipated.
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Affiliation(s)
- Alvaro Osorio
- Department of Internal Medicine, Oncology Service, Fundación Valle Del Lili, Cali, Colombia
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Liliana Fernandez-Trujillo
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
- Department of Internal Medicine, Pulmonology Service, Fundación Valle Del Lili, Cali, Colombia
| | - Juan G Restrepo
- Department of Internal Medicine, Oncology Service, Fundación Valle Del Lili, Cali, Colombia
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Luz F Sua
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
- Department of Pathology and Laboratory Medicine, Fundación Valle Del Lili, Cali, Colombia
| | - Catalina Proaño
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
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Elkhamisy FAA, Eesa AN, Elnady OM, Elnaghi KAEA, Foda AAM. Reduced expression of SOX11 in colorectal adenocarcinoma is associated with mucinous and signet ring cell types, poor survival, and lower ALK expression. Pathol Res Pract 2024; 260:155450. [PMID: 38986363 DOI: 10.1016/j.prp.2024.155450] [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: 02/03/2024] [Revised: 06/22/2024] [Accepted: 07/05/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Mucinous and signet ring cell colorectal carcinoma (m/srCRC) are challenging colorectal adenocarcinoma (CRC) types with poor prognosis. This study aimed to investigate SOX11 and ALK immunohistochemical expression in the m/srCRC group, comparing the results to those of nonmucinous CRC (nmCRC) and studying their association with different clinicopathological CRC features to better understand their significance and role. Besides, the study assesses which marker has a better predictive value for clinical practice. METHODS Tissue microarrays were prepared from 150 CRC blocks distributed equally between the m/srCRC and nmCRC groups. SOX11 and ALK immunohistochemical expressions were compared between both groups. In addition, their association with CRC clinicopathological data and survival was investigated. The Receiver Operating Characteristic (ROC) Curve analysis examined the predictive ability of SOX11 and ALK IHC expression for CRC mortality. RESULTS Both SOX11 and ALK expression were significantly reduced in m/srCRC compared to nmCRC. SOX11 is significantly associated with other prognostic clinicopathological factors (tumor size, lymph node status, overall TNM stage, grade, lymphovascular and perineural invasion) and overall survival. SOX11 significantly positively correlates with ALK expression. Using the ROC analysis, SOX11 is superior to ALK in survival prediction. CONCLUSION SOX11 can be used as a prognostic marker and is a suggested therapeutic target in mucinous and signet ring cell colorectal carcinoma through upregulation modulation.
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Affiliation(s)
| | - Ahmed Naeem Eesa
- Pathology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ola Mousa Elnady
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt
| | - Khaled Abd Elaziz Ahmed Elnaghi
- Oncology Centre, Medical Oncology unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Medical Oncology Department, Oncology Center King Abdullah Medical City, Makkah, Saudi Arabia
| | - Abd AlRahman Mohammad Foda
- Anatomic Pathology department, Faculty of Medicine, Mansoura University, Egypt; Department of Pathology, General Medicine Practice Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia
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Imyanitov EN, Preobrazhenskaya EV, Orlov SV. Current status of molecular diagnostics for lung cancer. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2024; 5:742-765. [PMID: 38966170 PMCID: PMC11220319 DOI: 10.37349/etat.2024.00244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/08/2024] [Indexed: 07/06/2024] Open
Abstract
The management of lung cancer (LC) requires the analysis of a diverse spectrum of molecular targets, including kinase activating mutations in EGFR, ERBB2 (HER2), BRAF and MET oncogenes, KRAS G12C substitutions, and ALK, ROS1, RET and NTRK1-3 gene fusions. Administration of immune checkpoint inhibitors (ICIs) is based on the immunohistochemical (IHC) analysis of PD-L1 expression and determination of tumor mutation burden (TMB). Clinical characteristics of the patients, particularly age, gender and smoking history, significantly influence the probability of finding the above targets: for example, LC in young patients is characterized by high frequency of kinase gene rearrangements, while heavy smokers often have KRAS G12C mutations and/or high TMB. Proper selection of first-line therapy influences overall treatment outcomes, therefore, the majority of these tests need to be completed within no more than 10 working days. Activating events in MAPK signaling pathway are mutually exclusive, hence, fast single-gene testing remains an option for some laboratories. RNA next-generation sequencing (NGS) is capable of detecting the entire repertoire of druggable gene alterations, therefore it is gradually becoming a dominating technology in LC molecular diagnosis.
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Affiliation(s)
- Evgeny N. Imyanitov
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, 197758 St.-Petersburg, Russia
- Department of Clinical Genetics, St.-Petersburg State Pediatric Medical University, 194100 St.-Petersburg, Russia
- I.V. Kurchatov Complex for Medical Primatology, National Research Centre “Kurchatov Institute”, 354376 Sochi, Russia
| | - Elena V. Preobrazhenskaya
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, 197758 St.-Petersburg, Russia
- Department of Clinical Genetics, St.-Petersburg State Pediatric Medical University, 194100 St.-Petersburg, Russia
| | - Sergey V. Orlov
- I.V. Kurchatov Complex for Medical Primatology, National Research Centre “Kurchatov Institute”, 354376 Sochi, Russia
- Department of Oncology, I.P. Pavlov St.-Petersburg State Medical University, 197022 St.-Petersburg, Russia
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Tóth LJ, Mokánszki A, Méhes G. The rapidly changing field of predictive biomarkers of non-small cell lung cancer. Pathol Oncol Res 2024; 30:1611733. [PMID: 38953007 PMCID: PMC11215025 DOI: 10.3389/pore.2024.1611733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024]
Abstract
Lung cancer is a leading cause of cancer-related death worldwide in both men and women, however mortality in the US and EU are recently declining in parallel with the gradual cut of smoking prevalence. Consequently, the relative frequency of adenocarcinoma increased while that of squamous and small cell carcinomas declined. During the last two decades a plethora of targeted drug therapies have appeared for the treatment of metastasizing non-small cell lung carcinomas (NSCLC). Personalized oncology aims to precisely match patients to treatments with the highest potential of success. Extensive research is done to introduce biomarkers which can predict the effectiveness of a specific targeted therapeutic approach. The EGFR signaling pathway includes several sufficient targets for the treatment of human cancers including NSCLC. Lung adenocarcinoma may harbor both activating and resistance mutations of the EGFR gene, and further, mutations of KRAS and BRAF oncogenes. Less frequent but targetable genetic alterations include ALK, ROS1, RET gene rearrangements, and various alterations of MET proto-oncogene. In addition, the importance of anti-tumor immunity and of tumor microenvironment has become evident recently. Accumulation of mutations generally trigger tumor specific immune defense, but immune protection may be upregulated as an aggressive feature. The blockade of immune checkpoints results in potential reactivation of tumor cell killing and induces significant tumor regression in various tumor types, such as lung carcinoma. Therapeutic responses to anti PD1-PD-L1 treatment may correlate with the expression of PD-L1 by tumor cells. Due to the wide range of diagnostic and predictive features in lung cancer a plenty of tests are required from a single small biopsy or cytology specimen, which is challenged by major issues of sample quantity and quality. Thus, the efficacy of biomarker testing should be warranted by standardized policy and optimal material usage. In this review we aim to discuss major targeted therapy-related biomarkers in NSCLC and testing possibilities comprehensively.
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Affiliation(s)
- László József Tóth
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Ilié M, Goffinet S, Rignol G, Lespinet-Fabre V, Lalvée S, Bordone O, Zahaf K, Bonnetaud C, Washetine K, Lassalle S, Long-Mira E, Heeke S, Hofman V, Hofman P. Shifting from Immunohistochemistry to Screen for ALK Rearrangements: Real-World Experience in a Large Single-Center Cohort of Patients with Non-Small-Cell Lung Cancer. Cancers (Basel) 2024; 16:2219. [PMID: 38927925 PMCID: PMC11201761 DOI: 10.3390/cancers16122219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
The identification of ALK fusions in advanced non-small-cell lung carcinoma (aNSCLC) is mandatory for targeted therapy. The current diagnostic approach employs an algorithm using ALK immunohistochemistry (IHC) screening, followed by confirmation through ALK FISH and/or next-generation sequencing (NGS). Challenges arise due to the infrequency of ALK fusions (3-7% of aNSCLC), the suboptimal specificity of ALK IHC and ALK FISH, and the growing molecular demands placed on small tissue samples, leading to interpretative, tissue availability, and time-related issues. This study investigates the effectiveness of RNA NGS as a reflex test for identifying ALK fusions in NSCLC, with the goal of replacing ALK IHC in the systematic screening process. The evaluation included 1246 NSCLC cases using paired techniques: ALK IHC, ALK FISH, and ALK NGS. ALK IHC identified 51 positive cases (4%), while RNA NGS detected ALK alterations in 59 cases (4.8%). Of the 59 ALK-positive cases identified via NGS, 53 (89.8%) were confirmed to be positive. This included 51 cases detected via both FISH and IHC, and 2 cases detected only via FISH, as they were completely negative according to IHC. The combined reporting time for ALK IHC and ALK FISH averaged 13 days, whereas ALK IHC and RNA NGS reports were obtained in an average of 4 days. These results emphasize the advantage of replacing systematic ALK IHC screening with RNA NGS reflex testing for a more comprehensive and accurate assessment of ALK status.
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Affiliation(s)
- Marius Ilié
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
| | - Samantha Goffinet
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
| | - Guylène Rignol
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
| | - Virginie Lespinet-Fabre
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
| | - Salomé Lalvée
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
| | - Olivier Bordone
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
| | - Katia Zahaf
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
| | - Christelle Bonnetaud
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
| | - Kevin Washetine
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
| | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
| | - Elodie Long-Mira
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
| | - Simon Heeke
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Véronique Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France; (M.I.); (S.G.); (G.R.); (V.L.-F.); (S.L.); (K.Z.); (C.B.); (K.W.); (S.L.); (E.L.-M.); (V.H.)
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice University Hospital, FHU OncoAge, IHU RespirERA, 06000 Nice, France;
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Peng Y, Ernani V, Liu D, Guo Q, Hopps M, Cappelleri JC, Gupta R, de Andrade M, Chen J, Yi ES, Yang P. Lung adenocarcinoma patients with ROS1-rearranged tumors by sex and smoking intensity. Heliyon 2024; 10:e28285. [PMID: 38560203 PMCID: PMC10981064 DOI: 10.1016/j.heliyon.2024.e28285] [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: 11/29/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Background ROS1 rearrangements (ROS1+) define a distinct molecular subset of lung adenocarcinomas. ROS1 + tumors are known to occur more in never-smokers, but the frequency and outcome of ROS1 positivity by sex and smoking intensity are not clearly documented. Patients and methods This patient cohort study included all never- (<100 cigarettes lifetime) and light- (100 cigarettes-20 pack-years) smokers, and a sample of heavy-smokers. ROS1 + rates by sex and smoking intensity were compared within and beyond our study. Survival outcomes were analyzed using Kaplan-Meier curves and Cox proportional hazards models. Results Of the 571 total patients, ROS1 + was detected in 24 (4.2%): 6.4% in men and 3.0% in women; 5.1% in never-, 5.7% in light-, and 1.8% in heavy-smokers (P=0.05). Among the 209 stage IIIB-IV patients, men had much higher ROS1 + rate (11.1%) not only than women (1.7%, P=0.004) in our study, but also than men (0.4%-1.8%) in 8 published studies (Ps = 0.0019-0.0001). ROS1+ rates were similar between never- (9.3%) and light-smokers (8.1%) and significantly lower in heavy-smokers (1.2%, P=0.017), a finding confirmed by 6 published studies (Ps = 0.041-0.0001). Overall survival of ROS1 + patients were significantly better than the ROS1- (P=0.023) mainly due to targeted therapy. Among patients who exhibited resistance to crizotinib, follow-up treatment of entrectinib and lorlatinib showed remarkable survival benefits. Conclusions The ROS1 + rates were higher in men than in women, and similar in never- and light-smokers, more pronounced in stage IIIB-IV patients. Newer-generation ALK/ROS1-targeted drugs showed efficacy in a cohort of crizotinib resistant ROS1 + patients. These results, when validated, could assist efficiently accruing ROS1 + patients.
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Affiliation(s)
- Yanmei Peng
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, AZ, 85259, USA
- Department of Oncology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Vinicius Ernani
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, AZ, 85054, USA
| | - Dan Liu
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, AZ, 85259, USA
- Division of Pulmonary & Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610064, China
| | - Qian Guo
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, AZ, 85259, USA
- Department of Medical Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Markay Hopps
- Vaccine R&D, Pfizer Inc, New York, NY, 10017, USA
| | | | - Ruchi Gupta
- Division of Biostatistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Mariza de Andrade
- Division of Biostatistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jun Chen
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, AZ, 85259, USA
- The Second Affiliated Hospital of Dalian Medical University, Shahekou District, Dalian, 116023, China
| | - Eunhee S. Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ping Yang
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, AZ, 85259, USA
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Melchior L, Hirschmann A, Hofman P, Bontoux C, Concha A, Mrabet-Dahbi S, Vannuffel P, Watkin E, Putzová M, Scarpino S, Cayre A, Martin P, Stoehr R, Hartmann A. Multicenter evaluation of an automated, multiplex, RNA-based molecular assay for detection of ALK, ROS1, RET fusions and MET exon 14 skipping in NSCLC. Virchows Arch 2024; 484:677-686. [PMID: 38492039 PMCID: PMC11062995 DOI: 10.1007/s00428-024-03778-9] [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: 12/03/2023] [Revised: 01/31/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
The current study assessed the performance of the fully automated RT-PCR-based Idylla™ GeneFusion Assay, which simultaneously covers the advanced non-small cell lung carcinoma (aNSCLC) actionable ALK, ROS1, RET, and MET exon 14 rearrangements, in a routine clinical setting involving 12 European clinical centers. The Idylla™ GeneFusion Assay detects fusions using fusion-specific as well as expression imbalance detection, the latter enabling detection of uncommon fusions not covered by fusion-specific assays. In total, 326 archival aNSCLC formalin-fixed paraffin-embedded (FFPE) samples were included of which 44% were resected specimen, 46% tissue biopsies, and 9% cytological specimen. With a total of 179 biomarker-positive cases (i.e., 85 ALK, 33 ROS1, 20 RET fusions and 41 MET exon 14 skipping), this is one of the largest fusion-positive datasets ever tested. The results of the Idylla™ GeneFusion Assay were compared with earlier results of routine reference technologies including fluorescence in situ hybridization, immunohistochemistry, reverse-transcription polymerase chain reaction, and next-generation sequencing, establishing a high sensitivity/specificity of 96.1%/99.6% for ALK, 96.7%/99.0% for ROS1, 100%/99.3% for RET fusion, and 92.5%/99.6% for MET exon 14 skipping, and a low failure rate (0.9%). The Idylla™ GeneFusion Assay was found to be a reliable, sensitive, and specific tool for routine detection of ALK, ROS1, RET fusions and MET exon 14 skipping. Given its short turnaround time of about 3 h, it is a time-efficient upfront screening tool in FFPE samples, supporting rapid clinical decision making. Moreover, expression-imbalance-based detection of potentially novel fusions may be easily verified with other routine technologies without delaying treatment initiation.
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Affiliation(s)
- Linea Melchior
- Department of Pathology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
- , Copenhagen, Denmark.
| | - Astrid Hirschmann
- Department of Pathology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- Hospital-integrated Biobank (BB-0033-00025), Hôpital Pasteur, Nice, France
- FHU OncoAge, IHU RespirERA, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Christophe Bontoux
- Laboratory of Clinical and Experimental Pathology, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- Hospital-integrated Biobank (BB-0033-00025), Hôpital Pasteur, Nice, France
- FHU OncoAge, IHU RespirERA, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Angel Concha
- Complejo Hospitalario de A Coruña, Corunna, Spain
| | | | | | | | | | - Stefania Scarpino
- Department of Clinical and Molecular Medicine, Pathology Unit, St. Andrea University Hospital, University of Rome La Sapienza, Rome, Italy
| | - Anne Cayre
- UF de Pathologie, Centre Jean Perrin, INSERM U1240, Clermont-Ferrand, France
| | - Paloma Martin
- Molecular Pathology Group, Department of Pathology, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Robert Stoehr
- Institute of Pathology, University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen EMN, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen EMN, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
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Rosebush MS, Smith MH, Cordell KG, Callahan N, Zaid W, Gagan J, Bishop JA. Reticular Myxoid Odontogenic Neoplasm with Novel STRN::ALK Fusion: Report of 2 Cases in 3-Year-Old Males. Head Neck Pathol 2024; 18:26. [PMID: 38526831 DOI: 10.1007/s12105-024-01633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024]
Abstract
Odontogenic tumors represent a collection of entities ranging from hamartomas to destructive benign and malignant neoplasms. Occasionally, pathologists encounter gnathic lesions which clearly exhibit an odontogenic origin but do not fit within the confines of established diagnoses. Here, we describe two such odontogenic tumors, both affecting 3-year-old males. Each case presented as a destructive, radiolucent mandibular lesion composed of mesenchymal cells, some with unique multi-lobed nuclei, frequently arranged in a reticular pattern and supported by a myxoid stroma with focal laminations. Production of odontogenic hard tissues was also seen. Because of their unique microscopic features, both cases were investigated by next-generation sequencing and found to harbor the same STRN::ALK oncogene fusion. To our knowledge, these cases represent the first report of an odontogenic tumor with a STRN::ALK gene rearrangement. We propose the possibility that this neoplasm could be separate from other known odontogenic tumors. Both patients were treated with surgical resection and reconstruction. The prognosis of patients with this entity is currently uncertain but shall become more apparent over time as more cases are identified and followed.
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Affiliation(s)
- Molly S Rosebush
- Louisiana State University Health Sciences Center New Orleans, 1100 Florida Avenue, New Orleans, LA, 70119, USA.
| | | | - Kitrina G Cordell
- Louisiana State University Health Sciences Center New Orleans, 1100 Florida Avenue, New Orleans, LA, 70119, USA
| | | | - Waleed Zaid
- Louisiana State University Health Sciences Center New Orleans, 1100 Florida Avenue, New Orleans, LA, 70119, USA
| | - Jeffrey Gagan
- The University of Texas Southwestern Medical Center, Dallas, USA
| | - Justin A Bishop
- The University of Texas Southwestern Medical Center, Dallas, USA
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10
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Pepe F, Russo G, Venuta A, Scimone C, Nacchio M, Pisapia P, Goteri G, Barbisan F, Chiappetta C, Pernazza A, Campagna D, Giordano M, Perrone G, Sabarese G, Altimari A, de Biase D, Tallini G, Calistri D, Chiadini E, Capelli L, Santinelli A, Gulini AE, Pierpaoli E, Badiali M, Murru S, Murgia R, Guerini Rocco E, Venetis K, Fusco N, Morotti D, Gianatti A, Furlan D, Rossi G, Melocchi L, Russo M, De Luca C, Palumbo L, Simonelli S, Maffè A, Francia di Celle P, Venesio T, Scatolini M, Grosso E, Orecchia S, Fassan M, Balistreri M, Zulato E, Reghellin D, Lazzari E, Santacatterina M, Piredda ML, Riccardi M, Laurino L, Roz E, Longo D, Romeo DP, Fazzari C, Moreno-Manuel A, Puglia GD, Prjibelski AD, Shafranskaya D, Righi L, Listì A, Vitale D, Iaccarino A, Malapelle U, Troncone G. Non-Small Cell Lung Cancer Testing on Reference Specimens: An Italian Multicenter Experience. Oncol Ther 2024; 12:73-95. [PMID: 38200361 PMCID: PMC10881930 DOI: 10.1007/s40487-023-00252-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Biomarker testing is mandatory for the clinical management of patients with advanced non-small cell lung cancer (NSCLC). Myriads of technical platforms are now available for biomarker analysis with differences in terms of multiplexing capability, analytical sensitivity, and turnaround time (TAT). We evaluated the technical performance of the diagnostic workflows of 24 representative Italian institutions performing molecular tests on a series of artificial reference specimens built to mimic routine diagnostic samples. METHODS Sample sets of eight slides from cell blocks of artificial reference specimens harboring exon 19 EGFR (epidermal growth factor receptor) p.E746_AT50del, exon 2 KRAS (Kirsten rat sarcoma viral oncogene homologue) p.G12C, ROS1 (c-ros oncogene 1)-unknown gene fusion, and MET (MET proto-oncogene, receptor tyrosine kinase) Δ exon 14 skipping were distributed to each participating institution. Two independent cell block specimens were validated by the University of Naples Federico II before shipment. Methodological and molecular data from reference specimens were annotated. RESULTS Overall, a median DNA concentration of 3.3 ng/µL (range 0.1-10.0 ng/µL) and 13.4 ng/µL (range 2.0-45.8 ng/µL) were obtained with automated and manual technical procedures, respectively. RNA concentrations of 5.7 ng/µL (range 0.2-11.9 ng/µL) and 9.3 ng/µL (range 0.5-18.0 ng/µL) were also detected. KRAS exon 2 p.G12C, EGFR exon 19 p.E736_A750del hotspot mutations, and ROS1 aberrant transcripts were identified in all tested cases, whereas 15 out of 16 (93.7%) centers detected MET exon 14 skipping mutation. CONCLUSIONS Optimized technical workflows are crucial in the decision-making strategy of patients with NSCLC. Artificial reference specimens enable optimization of diagnostic workflows for predictive molecular analysis in routine clinical practice.
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Affiliation(s)
- Francesco Pepe
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Gianluca Russo
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Alessandro Venuta
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Claudia Scimone
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Mariantonia Nacchio
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Gaia Goteri
- Pathological Anatomy Institute, Polytechnic University of Marche Region, Ancona, Italy
| | - Francesca Barbisan
- Pathological Anatomy Institute, Polytechnic University of Marche Region, Ancona, Italy
| | | | - Angelina Pernazza
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino-Sapienza University, Latina, Italy
| | - Domenico Campagna
- Department of Pathology, San Giovanni-Addolorata Hospital, 00184, Rome, Italy
| | - Marco Giordano
- Department of Pathology, San Giovanni-Addolorata Hospital, 00184, Rome, 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, Rome, Italy
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
| | - Giovanna Sabarese
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
| | - Annalisa Altimari
- Molecular Pathology, University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Dario de Biase
- Pharmacy and Biotechnology (FaBiT), Molecular Pathology Laboratory, University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Molecular Pathology, University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
- Pharmacy and Biotechnology (FaBiT), Molecular Pathology Laboratory, University of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniele Calistri
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - Elisa Chiadini
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - Laura Capelli
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - Alfredo Santinelli
- Anatomic Pathology Azienda Sanitaria Territoriale Pesaro-Urbino, Pesaro, Italy
| | - Anna Elisa Gulini
- Anatomic Pathology Azienda Sanitaria Territoriale Pesaro-Urbino, Pesaro, Italy
| | - Elisa Pierpaoli
- Anatomic Pathology Azienda Sanitaria Territoriale Pesaro-Urbino, Pesaro, Italy
| | - Manuela Badiali
- Laboratory of Genetics and Genomics-Pediatric Hospital A.Cao-ASL8, Cagliari, Italy
| | - Stefania Murru
- Laboratory of Genetics and Genomics-Pediatric Hospital A.Cao-ASL8, Cagliari, Italy
| | - Riccardo Murgia
- Experimental Medicine Unit, Department of Biomedical Sciences, University of Cagliari, 09124, Cagliari, Italy
| | - Elena Guerini Rocco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Konstantinos Venetis
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Denise Morotti
- Pathology Unit and Medical Genetics Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Gianatti
- Pathology Unit and Medical Genetics Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Daniela Furlan
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Giulio Rossi
- Department of Anatomical Pathology, Fondazione Poliambulanza, 25124, Brescia, Italy
| | - Laura Melocchi
- Department of Anatomical Pathology, Fondazione Poliambulanza, 25124, Brescia, Italy
| | - Maria Russo
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Caterina De Luca
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Lucia Palumbo
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Saverio Simonelli
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Antonella Maffè
- Genetics and Molecular Biology Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Paola Francia di Celle
- Molecular Pathology, AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
| | - Tiziana Venesio
- Candiolo Cancer Institute, FPO-IRCCS, 10060, Candiolo, Italy
| | - Maria Scatolini
- Molecular Oncology Lab, Fondazione Edo ed Elvo Tempia, Biella, Italy
| | - Enrico Grosso
- Molecular Oncology Lab, Fondazione Edo ed Elvo Tempia, Biella, Italy
| | - Sara Orecchia
- Pathology Division, S. Antonio and Biagio Hospital, Alessandria, Italy
| | - Matteo Fassan
- Department of Medicine-DIMED, University of Padua, Padua, Veneto, Italy
- Veneto Institute of Oncology-IOV-IRCCS, Padua, Italy
| | | | | | | | - Elena Lazzari
- Department of Pathology, San Bortolo Hospital, Vicenza, Italy
| | | | | | - Manuela Riccardi
- Department of Pathology, Azienda Ulss3 Serenissima, Ospedale dell'Angelo, Venice, Italy
| | - Licia Laurino
- Department of Pathology, Azienda Ulss3 Serenissima, Ospedale dell'Angelo, Venice, Italy
| | - Elena Roz
- Pathology Unit, La Maddalena Clinic for Cancer, Palermo, Italy
| | - Domenico Longo
- UOSD di Anatomia Patologica dell'Azienda Ospedaliera Papardo, Messina, Italy
| | | | - Carmine Fazzari
- UOSD di Anatomia Patologica dell'Azienda Ospedaliera Papardo, Messina, Italy
| | - Andrea Moreno-Manuel
- Molecular Oncology Laboratory, Fundación Investigación Hospital General Universitario de Valencia, 46014, Valencia, Spain
- TRIAL Mixed Unit, Centro Investigación Príncipe Felipe-Fundación Investigación Hospital General Universitario de Valencia, 46014, Valencia, Spain
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029, Madrid, Spain
| | - Giuseppe Diego Puglia
- Institute for Agricultural and Forest Systems in the Mediterranean, National Research Council (ISAFOM-CNR), 95128, Catania, Italy
| | - Andrey D Prjibelski
- Center for Algorithmic Biotechnology, Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Daria Shafranskaya
- Center for Algorithmic Biotechnology, Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Luisella Righi
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, TO, Italy
| | - Angela Listì
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, TO, Italy
| | - Domenico Vitale
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy.
| | - Giancarlo Troncone
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
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Parvaresh H, Roozitalab G, Golandam F, Behzadi P, Jabbarzadeh Kaboli P. Unraveling the Potential of ALK-Targeted Therapies in Non-Small Cell Lung Cancer: Comprehensive Insights and Future Directions. Biomedicines 2024; 12:297. [PMID: 38397899 PMCID: PMC10887432 DOI: 10.3390/biomedicines12020297] [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: 01/06/2024] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
Background and Objective: This review comprehensively explores the intricate landscape of anaplastic lymphoma kinase (ALK), focusing specifically on its pivotal role in non-small cell lung cancer (NSCLC). Tracing ALK's discovery, from its fusion with nucleolar phosphoprotein (NPM)-1 in anaplastic large cell non-Hodgkin's lymphoma (ALCL) in 1994, the review elucidates the subsequent impact of ALK gene alterations in various malignancies, including inflammatory myofibroblastoma and NSCLC. Approximately 3-5% of NSCLC patients exhibit complex ALK rearrangements, leading to the approval of six ALK-tyrosine kinase inhibitors (TKIs) by 2022, revolutionizing the treatment landscape for advanced metastatic ALK + NSCLC. Notably, second-generation TKIs such as alectinib, ceritinib, and brigatinib have emerged to address resistance issues initially associated with the pioneer ALK-TKI, crizotinib. Methods: To ensure comprehensiveness, we extensively reviewed clinical trials on ALK inhibitors for NSCLC by 2023. Additionally, we systematically searched PubMed, prioritizing studies where the terms "ALK" AND "non-small cell lung cancer" AND/OR "NSCLC" featured prominently in the titles. This approach aimed to encompass a spectrum of relevant research studies, ensuring our review incorporates the latest and most pertinent information on innovative and alternative therapeutics for ALK + NSCLC. Key Content and Findings: Beyond exploring the intricate details of ALK structure and signaling, the review explores the convergence of ALK-targeted therapy and immunotherapy, investigating the potential of immune checkpoint inhibitors in ALK-altered NSCLC tumors. Despite encouraging preclinical data, challenges observed in trials assessing combinations such as nivolumab-crizotinib, mainly due to severe hepatic toxicity, emphasize the necessity for cautious exploration of these novel approaches. Additionally, the review explores innovative directions such as ALK molecular diagnostics, ALK vaccines, and biosensors, shedding light on their promising potential within ALK-driven cancers. Conclusions: This comprehensive analysis covers molecular mechanisms, therapeutic strategies, and immune interactions associated with ALK-rearranged NSCLC. As a pivotal resource, the review guides future research and therapeutic interventions in ALK-targeted therapy for NSCLC.
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Affiliation(s)
- Hannaneh Parvaresh
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad 9177948974, Iran
- Division of Cancer Discovery Network, Dr. Parham Academy, Taichung 40602, Taiwan; (G.R.)
| | - Ghazaal Roozitalab
- Division of Cancer Discovery Network, Dr. Parham Academy, Taichung 40602, Taiwan; (G.R.)
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa 7461686688, Iran
| | - Fatemeh Golandam
- Division of Cancer Discovery Network, Dr. Parham Academy, Taichung 40602, Taiwan; (G.R.)
- Department of Pharmacy, Mashhad University of Medical Science, Mashhad 9177948974, Iran
| | - Payam Behzadi
- Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran 37541-374, Iran;
| | - Parham Jabbarzadeh Kaboli
- Division of Cancer Discovery Network, Dr. Parham Academy, Taichung 40602, Taiwan; (G.R.)
- Graduate Institute of Biomedical Sciences, Institute of Biochemistry and Molecular Biology, China Medical University, Taichung 407, Taiwan
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12
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Hofman V, Goffinet S, Bontoux C, Long-Mira E, Lassalle S, Ilié M, Hofman P. A Real-World Experience from a Single Center (LPCE, Nice, France) Highlights the Urgent Need to Abandon Immunohistochemistry for ROS1 Rearrangement Screening of Advanced Non-Squamous Non-Small Cell Lung Cancer. J Pers Med 2023; 13:jpm13050810. [PMID: 37240980 DOI: 10.3390/jpm13050810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The detection of ROS1 rearrangements in metastatic non-squamous non-small cell lung carcinoma (NS-NSCLC) permits administration of efficient targeted therapy. Detection is based on a testing algorithm associated with ROS1 immunohistochemistry (IHC) screening followed by ROS1 FISH and/or next generation sequencing (NGS) to confirm positivity. However, (i) ROS1 rearrangements are rare (1-2% of NS-NSCLC), (ii) the specificity of ROS1 IHC is not optimal, and (iii) ROS1 FISH is not widely available, making this algorithm challenging to interpret time-consuming. We evaluated RNA NGS, which was used as reflex testing for ROS1 rearrangements in NS-NSCLC with the aim of replacing ROS1 IHC as a screening method. ROS1 IHC and RNA NGS were prospectively performed in 810 NS-NSCLC. Positive results were analyzed by ROS1 FISH. ROS1 IHC was positive in 36/810 (4.4%) cases that showed variable staining intensity while NGS detected ROS1 rearrangements in 16/810 (1.9%) cases. ROS1 FISH was positive in 15/810 (1.8%) of ROS1 IHC positive cases and in all positive ROS1 NGS cases. Obtaining both ROS1 IHC and ROS1 FISH reports took an average of 6 days, while obtaining ROS1 IHC and RNA NGS reports took an average of 3 days. These results showed that systematic screening for the ROS1 status using IHC must be replaced by NGS reflex testing.
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Affiliation(s)
- Véronique Hofman
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Samantha Goffinet
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
| | - Christophe Bontoux
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Elodie Long-Mira
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Marius Ilié
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
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13
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Guillard M, Caumont C, Marcorelles P, Merlio JP, Cappellen D, Uguen A. Performances of the Idylla GeneFusion Assay: contribution to a rapid diagnosis of targetable gene fusions in tumour samples. J Clin Pathol 2023:jcp-2023-208798. [PMID: 37185257 DOI: 10.1136/jcp-2023-208798] [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: 01/24/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
AIMS We aimed to evaluate the performances of the Idylla GeneFusion Assay (IGFA) designed to detect, in a single, rapid and fully automated assay, ALK, ROS1, RET, NTRK1, NTRK2 and NTRK3 gene fusions and MET exon 14 skipping in cancer samples. METHODS Based on a set of tumours enriched in cases with gene fusions, we applied the IGFA to tumour areas of various sizes and tumour cell contents. IGFA results were compared with those obtained with other methods (immunohistochemistry, fluorescent in situ hybridisation, DNA and RNA next-generation sequencing). RESULTS We selected 68 tumours: 49 cases with known gene fusions (8 ALK, 8 ROS1, 5 RET, 7 NTRK1, 3 NTRK2 and 6 NTRK3 ones) or MET exon 14 skipping mutations (12 cases) and 19 cases with no fusion and no MET mutation. We performed 128 IGFA tests on distinct tissue areas. The global sensitivity and specificity of the IGFA were, respectively, 62.82% and 99.2% with variations between molecular targets and tissue areas. Of note, 72.5% sensitivity and 98.79% specificity were obtained in 37 tissue areas fulfilling the manufacturer's recommendations (ie, at least 10% of tumour cells in at least 20 mm² of tissue area). The rate of non-conclusive results was higher in small samples with low percentages of tumour cells. CONCLUSIONS The IGFA could contribute to the rapid detection of targetable gene fusions and mutations, especially in context of rapidly growing cancers requiring urgent therapeutic choices.
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Affiliation(s)
- Matthieu Guillard
- Service d'Anatomie et Cytologie Pathologiques, CHRU Brest, Brest, France
| | - Charline Caumont
- Service de Biologie des Tumeurs, CHU Bordeaux, Pessac, France
- BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, Université de Bordeaux, Pessac, France
| | - Pascale Marcorelles
- Service d'Anatomie et Cytologie Pathologiques, CHRU Brest, Brest, France
- LBAI, UMR1227 INSERM, Université de Bretagne Occidentale, Brest, France
| | - Jean-Philippe Merlio
- Service de Biologie des Tumeurs, CHU Bordeaux, Pessac, France
- BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, Université de Bordeaux, Pessac, France
| | - David Cappellen
- Service de Biologie des Tumeurs, CHU Bordeaux, Pessac, France
- BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, Université de Bordeaux, Pessac, France
| | - Arnaud Uguen
- Service d'Anatomie et Cytologie Pathologiques, CHRU Brest, Brest, France
- LBAI, UMR1227 INSERM, Université de Bretagne Occidentale, Brest, France
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Isla D, Lozano MD, Paz-Ares L, Salas C, de Castro J, Conde E, Felip E, Gómez-Román J, Garrido P, Belén Enguita A. [New update to the guidelines on testing predictive biomarkers in non-small-cell lung cancer: a National Consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2023; 56:97-112. [PMID: 37061248 DOI: 10.1016/j.patol.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 04/17/2023]
Abstract
Non-small cell lung cancer (NSCLC) presents the greatest number of identified therapeutic targets, some of which have therapeutic utility. Currently, detecting EGFR, BRAF, KRAS and MET mutations, ALK, ROS1, NTRK and RET translocations, and PD-L1 expression in these patients is considered essential. The use of next-generation sequencing (NGS) facilitates precise molecular diagnosis and allows the detection of other emerging mutations, such as the HER2 mutation and predictive biomarkers for immunotherapy responses. In this consensus, a group of experts in the diagnosis and treatment of NSCLC selected by the Spanish Society of Pathology (SEAP) and the Spanish Society of Medical Oncology (SEOM) have evaluated currently available information and propose a series of recommendations to optimize the detection and use of biomarkers in daily clinical practice.
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Affiliation(s)
- Dolores Isla
- Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Sociedad Española de Oncología Médica (SEOM), Zaragoza, España
| | - María D Lozano
- Clínica Universidad de Navarra, Sociedad Española de Citología (SEC), Sociedad Española de Anatomía Patológica (SEAP), Pamplona, España
| | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, Sociedad Española de Oncología Médica (SEOM), Madrid, España
| | - Clara Salas
- Hospital Universitario Puerta de Hierro, Sociedad Española de Anatomía Patológica (SEAP), Madrid, España
| | - Javier de Castro
- Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Sociedad Española de Oncología Médica (SEOM), Madrid, España
| | - Esther Conde
- Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital Universitario 12 de Octubre (i+12), Sociedad Española de Anatomía Patológica (SEAP), Madrid, España
| | - Enriqueta Felip
- Hospital Universitario Vall d'Hebron, Sociedad Española de Oncología Médica (SEOM), Barcelona, España
| | - Javier Gómez-Román
- Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Sociedad Española de Anatomía Patológica (SEAP), Santander, España
| | - Pilar Garrido
- Hospital Universitario Ramón y Cajal, Sociedad Española de Oncología Médica (SEOM), Madrid, España
| | - Ana Belén Enguita
- Hospital Universitario 12 de Octubre, Sociedad Española de Anatomía Patológica (SEAP), Madrid, España.
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Sará L, Clavijo AS, Niño-Torres JD, Solarte LM, Vergara A, Moreno OM, Rodríguez JL, Rojas A. Discordant results for ALK based on immunohistochemistry versus fluorescence in situ hybridization in a cohort of patients diagnosed with lung adenocarcinoma. REVISTA ESPAÑOLA DE PATOLOGÍA 2023; 56:88-96. [PMID: 37061247 DOI: 10.1016/j.patol.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/01/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Anaplastic lymphoma kinase (ALK) rearrangement located on the short arm of chromosome 2, region 2 and band 3 is frequent in lung cancer patients who respond to targeted therapies with ALK inhibitors Therefore, their identification has become a standard diagnostic test in patients with advanced NSCLS, as such chromosomal alterations may lead to the activation of important signalling pathways involved in cell survival and proliferation. METHODS To investigate the ALK gene status, we performed FISH and IHC assays in 18 lung adenocarcinoma patients, 12 women and 6 men, aged between 29 and 85 years. Paraffin-embedded samples were analyzed in the Pathology Department of the Hospital Universitario San Ignacio. RESULTS Results between the two techniques in 5 patients showed discordant patterns, being positive for FISH and negative for IHC. The borderline to define ALK positivity was set at 15%, These results present experimental evidence that the techniques differ in specific situations. CONCLUSIONS Our findings show that it is advisable to investigate the ALK gene status in patients with suspected lung cancer using both FISH and IHC in combination.
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16
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Cytological Samples: An Asset for the Diagnosis and Therapeutic Management of Patients with Lung Cancer. Cells 2023; 12:cells12050754. [PMID: 36899890 PMCID: PMC10001120 DOI: 10.3390/cells12050754] [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: 01/12/2023] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Lung cancer has become the leading cause of cancer death for men and women. Most patients are diagnosed at an advanced stage when surgery is no longer a therapeutic option. At this stage, cytological samples are often the less invasive source for diagnosis and the determination of predictive markers. We assessed the ability of cytological samples to perform diagnosis, and to establish molecular profile and PD-L1 expression, which are essential for the therapeutic management of patients. METHODS We included 259 cytological samples with suspected tumor cells and assessed the ability to confirm the type of malignancy by immunocytochemistry. We summarized results of molecular testing by next generation sequencing (NGS) and PD-L1 expression from these samples. Finally, we analyzed the impact of these results in the patient management. RESULTS Among the 259 cytological samples, 189 concerned lung cancers. Of these, immunocytochemistry confirmed the diagnosis in 95%. Molecular testing by NGS was obtained in 93% of lung adenocarcinomas and non-small cell lung cancer. PD-L1 results were obtained in 75% of patients tested. The results obtained with cytological samples led to a therapeutic decision in 87% of patients. CONCLUSION Cytological samples are obtained by minimally invasive procedures and can provide enough material for the diagnosis and therapeutic management in lung cancer patients.
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17
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HUANG CONGGAI, LUO XING, WANG SHAOHUA, WAN YU, WANG JIEQIONG, TANG XIAOQIN, SCHATZ CHRISTOPH, ZHANG HUILING, HAYBAECK JOHANNES, YANG ZHIHUI. Minimally Invasive Cytopathology and Accurate Diagnosis: Technical Procedures and Ancillary Techniques. In Vivo 2023; 37:11-21. [PMID: 36593030 PMCID: PMC9843757 DOI: 10.21873/invivo.13050] [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: 11/08/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
In recent years, the demand for cytopathological accurate diagnoses has increased as expanding minimally invasive procedures obtain materials from patients with advanced cancer for diagnostic, prognostic, and predictive purposes. However, inadequate knowledge of cytopathological technical procedures and ancillary techniques by clinicians remains the most common reason for the limited availability of cytopathology. The objectives of this review were to understand the technical procedures, ancillary techniques, and application and effectiveness of various types of tests in cytopathology. Each of the many ancillary technologies described in the literature has specific advantages and limitations and laboratories select one or more methods depending on their infrastructure and expertise to achieve the goal from initial screening of the disease to the final diagnosis of the cytopathology. This paper systematically reviews the development of cytopathology, summarizes the existing problems in cytopathology and the new progress of auxiliary examination, to provide a theoretical basis for the advanced development of cytopathological diagnostic technologies and to consolidate the minimally invasive and accurate diagnosis of cytopathologies for clinicians. Cytopathology offers many advantages over other clinical examinations, particularly for minimally invasive and accurate diagnosis.
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Affiliation(s)
- CONGGAI HUANG
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - XING LUO
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - SHAOHUA WANG
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - YU WAN
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - JIEQIONG WANG
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - XIAOQIN TANG
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - CHRISTOPH SCHATZ
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - HUILING ZHANG
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
| | - JOHANNES HAYBAECK
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria,Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - ZHIHUI YANG
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China
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18
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Fintelmann FJ, Martin NA, Tahir I, Quinn EM, Allen TC, Joseph L, Nikolic B, Lee C. Optimizing molecular testing of lung cancer needle biopsy specimens: potential solutions from an interdisciplinary qualitative study. Respir Res 2023; 24:17. [PMID: 36650544 PMCID: PMC9847026 DOI: 10.1186/s12931-023-02321-9] [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: 11/20/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Molecular testing can detect actionable genomic alterations and tumor cell surface proteins in patients with non-small cell lung cancer (NSCLC). However, utilization remains suboptimal, representing missed treatment opportunities. This study aimed to identify challenges and potential solutions to obtaining percutaneous lung needle biopsy specimens for successful molecular testing in patients with advanced NSCLC. METHODS This interdisciplinary qualitative study included ten radiologists and four pathologists from academic and community settings across the United States who routinely perform and analyze percutaneous lung needle biopsies. Participants underwent semi-structured one-on-one interviews (Phase 1). Interview questionnaires were constructed based on a literature review of key lines of inquiry and conducted by professional market researchers using the theoretical domains framework. Primary barriers to molecular testing were identified using thematic analysis. Subsequently, multidisciplinary focus groups were convened to identify potential solutions (Phase 2). RESULTS Four themes emerged as barriers to molecular testing and were matched to the clinical workflow: (1) biopsy request, (2) biopsy procedure, (3) specimen analysis, and (4) communication. The nineteen potential solutions included adding a "checkbox" to indicate molecular testing in the biopsy request, leveraging pre-procedural imaging to guide biopsies, conserving tissue through appropriate allocation strategies and next generation sequencing panels instead of sequential single-gene assays, instituting reflex-molecular testing upon NSCLC diagnosis, tracking and communicating biopsy outcomes at multidisciplinary tumor boards, and improving integration of radiologists and pathologists into oncology care teams. CONCLUSIONS Potential solutions exist to increase successful molecular testing of lung needle biopsy specimens in patients with advanced NSCLC.
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Affiliation(s)
- Florian J. Fintelmann
- grid.32224.350000 0004 0386 9924Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Nikki A. Martin
- grid.443873.f0000 0004 0422 4933LUNGevity Foundation, Bethesda, MD USA
| | - Ismail Tahir
- grid.32224.350000 0004 0386 9924Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Elissa M. Quinn
- grid.497611.c0000 0004 1794 1958Blueprint Medicines, Boston, MA USA
| | | | - Lija Joseph
- grid.461527.30000 0004 0383 4123Lowell General Hospital, Lowell, MA USA
| | - Boris Nikolic
- grid.439147.c0000 0004 0628 7583Wyoming Valley Radiology Associates, Wilkes-Barre General Hospital, Wilkes-Barre, PA USA
| | - Christopher Lee
- grid.50956.3f0000 0001 2152 9905Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA USA
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19
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New update to the guidelines on testing predictive biomarkers in non-small-cell lung cancer: a National Consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology. Clin Transl Oncol 2022; 25:1252-1267. [PMID: 36571695 PMCID: PMC10119050 DOI: 10.1007/s12094-022-03046-9] [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: 11/02/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022]
Abstract
Non-small cell lung cancer (NSCLC) presents the greatest number of identified therapeutic targets, some of which have therapeutic utility. Currently, detecting EGFR, BRAF, KRAS and MET mutations, ALK, ROS1, NTRK and RET translocations, and PD-L1 expression in these patients is considered essential. The use of next-generation sequencing facilitates precise molecular diagnosis and allows the detection of other emerging mutations, such as the HER2 mutation and predictive biomarkers for immunotherapy responses. In this consensus, a group of experts in the diagnosis and treatment of NSCLC selected by the Spanish Society of Pathology and the Spanish Society of Medical Oncology have evaluated currently available information and propose a series of recommendations to optimize the detection and use of biomarkers in daily clinical practice.
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20
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Comparison between Immunocytochemistry, FISH and NGS for ALK and ROS1 Rearrangement Detection in Cytological Samples. Int J Mol Sci 2022; 23:ijms231810556. [PMID: 36142468 PMCID: PMC9502752 DOI: 10.3390/ijms231810556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
The detection of ROS1 and ALK rearrangements is performed for advanced-stage non-small cell lung cancer. Several techniques can be used on cytological samples, such as immunocytochemistry (ICC), fluorescence in situ hybridization (FISH) and, more recently, next-generation sequencing (NGS), which is gradually becoming the gold standard. We performed a retrospective study to compare ALK and ROS1 rearrangement results from immunocytochemistry, FISH and NGS methods from 131 cytological samples. Compared to NGS, the sensitivity and specificity of ICC were 0.79 and 0.91, respectively, for ALK, and 1 and 0.87 for ROS1. Regarding FISH, the sensitivity and specificity were both at 1 for ALK and ROS1 probes. False-positive cases obtained by ICC were systematically corrected by FISH. When using ICC and FISH techniques, results are very close to NGS. The false-positive cases obtained by ICC are corrected by FISH, and the true-positive cases are confirmed. NGS has the potential to improve the detection of ALK and ROS1 rearrangements in cytological samples; however, the cost of this technique is still much higher than the sequential use of ICC and FISH.
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21
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Alternative Treatment Options to ALK Inhibitor Monotherapy for EML4-ALK-Driven Lung Cancer. Cancers (Basel) 2022; 14:cancers14143452. [PMID: 35884511 PMCID: PMC9325236 DOI: 10.3390/cancers14143452] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
EML4-ALK is an oncogenic fusion protein that accounts for approximately 5% of NSCLC cases. Targeted inhibitors of ALK are the standard of care treatment, often leading to a good initial response. Sadly, some patients do not respond well, and most will develop resistance over time, emphasizing the need for alternative treatments. This review discusses recent advances in our understanding of the mechanisms behind EML4-ALK-driven NSCLC progression and the opportunities they present for alternative treatment options to ALK inhibitor monotherapy. Targeting ALK-dependent signalling pathways can overcome resistance that has developed due to mutations in the ALK catalytic domain, as well as through activation of bypass mechanisms that utilise the same pathways. We also consider evidence for polytherapy approaches that combine targeted inhibition of these pathways with ALK inhibitors. Lastly, we review combination approaches that use targeted inhibitors of ALK together with chemotherapy, radiotherapy or immunotherapy. Throughout this article, we highlight the importance of alternative breakpoints in the EML4 gene that result in the generation of distinct EML4-ALK variants with different biological and pathological properties and consider monotherapy and polytherapy approaches that may be selective to particular variants.
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22
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Febbraro M, Gheware A, Kennedy T, Jain D, de Moraes FY, Juergens R. Barriers to Access: Global Variability in Implementing Treatment Advances in Lung Cancer. Am Soc Clin Oncol Educ Book 2022; 42:1-7. [PMID: 35427189 DOI: 10.1200/edbk_351021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Globally, lung cancer is the second most-diagnosed cancer and is the leading cause of cancer death. Advances in science and technology have contributed to improvements in primary cancer prevention, cancer diagnosis, and cancer therapy, leading to an increase in survival and improvement in quality of life. Many of these advances have been seen in high-income countries. Accessibility, availability, and affordability are key domains in barriers to access of care between countries and within countries. The impact of these domains, as they relate to molecular testing, radiation therapy, and systemic therapy, are discussed.
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Affiliation(s)
- Michela Febbraro
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Department of Medical Oncology, Juravinski Cancer Center, Hamilton, Ontario, Canada
| | - Atish Gheware
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Thomas Kennedy
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rosalyn Juergens
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Department of Medical Oncology, Juravinski Cancer Center, Hamilton, Ontario, Canada
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23
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Rojo F, Conde E, Torres H, Cabezón-Gutiérrez L, Bautista D, Ramos I, Carcedo D, Arrabal N, García JF, Galán R, Nadal E. Clinical and economic impact of 'ROS1-testing' strategy compared to a 'no-ROS1-testing' strategy in advanced NSCLC in Spain. BMC Cancer 2022; 22:292. [PMID: 35303812 PMCID: PMC8933896 DOI: 10.1186/s12885-022-09397-4] [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: 11/22/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Detection of the ROS1 rearrangement is mandatory in patients with advanced or metastatic non-small cell lung cancer (NSCLC) to allow targeted therapy with specific inhibitors. However, in Spanish clinical practice ROS1 determination is not yet fully widespread. The aim of this study is to determine the clinical and economic impact of sequentially testing ROS1 in addition to EGFR and ALK in Spain. Methods A joint model (decision-tree and Markov model) was developed to determine the cost-effectiveness of testing ROS1 strategy versus a no-ROS1 testing strategy in Spain. Distribution of ROS1 techniques, rates of testing, positivity, and invalidity of biomarkers included in the analysis (EGFR, ALK, ROS1 and PD-L1) were based on expert opinion and Lungpath real-world database. Treatment allocation depending on the molecular testing results was defined by expert opinion. For each treatment, a 3-states Markov model was developed, where progression-free survival (PFS) and overall survival (OS) curves were parameterized using exponential extrapolations to model transition of patients among health states. Only medical direct costs were included (€ 2021). A lifetime horizon was considered and a discount rate of 3% was applied for both costs and effects. Both deterministic and probabilistic sensitivity analyses were performed to address uncertainty. Results A target population of 8755 patients with advanced NSCLC (non-squamous or never smokers squamous) entered the model. Over a lifetime horizon, the ROS1 testing scenario produced additional 157.5 life years and 121.3 quality-adjusted life years (QALYs) compared with no-ROS1 testing scenario. Total direct costs were increased up to € 2,244,737 for ROS1 testing scenario. The incremental cost-utility ratio (ICUR) was 18,514 €/QALY. Robustness of the base-case results were confirmed by the sensitivity analysis. Conclusions Our study shows that ROS1 testing in addition to EGFR and ALK is a cost-effective strategy compared to no-ROS1 testing, and it generates more than 120 QALYs in Spain over a lifetime horizon. Despite the low prevalence of ROS1 rearrangements in NSCLC patients, the clinical and economic consequences of ROS1 testing should encourage centers to test all advanced or metastatic NSCLC (non-squamous and never-smoker squamous) patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09397-4.
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Affiliation(s)
- Federico Rojo
- Hospital Universitario Fundación Jiménez Diaz - CIBERONC, Madrid, Spain
| | - Esther Conde
- Hospital Universiario 12 de Octubre-CIBERONC, Madrid, Spain
| | - Héctor Torres
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - David Carcedo
- Hygeia Consulting, S.A, Madrid, Spain. .,Hygeia Consulting, Barcelona, Spain.
| | | | | | | | - Ernest Nadal
- Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Spain
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24
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Kazdal D, Hofman V, Christopoulos P, Ilié M, Stenzinger A, Hofman P. Fusion-positive non-small cell lung carcinoma: Biological principles, clinical practice, and diagnostic implications. Genes Chromosomes Cancer 2022; 61:244-260. [PMID: 34997651 DOI: 10.1002/gcc.23022] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 12/11/2022] Open
Abstract
Based on superior efficacy and tolerability, targeted therapy is currently preferred over chemotherapy and/or immunotherapy for actionable gene fusions that occur in late-stage non-small cell lung carcinoma (NSCLC). Consequently, current clinical practice guidelines mandate testing for ALK, ROS1, NTRK, and RET gene fusions in all patients with newly diagnosed advanced non-squamous NSCLC (NS-NSCLC). Gene fusions can be detected using different approaches, but today RNA next-generation sequencing (NGS) or combined DNA/RNA NGS is the method of choice. The discovery of other gene fusions (involving, eg, NRG1, NUT, FGFR1, FGFR2, MET, BRAF, EGFR, SMARC fusions) and their partners has increased progressively in recent years, leading to the development of new and promising therapies and mandating the development and implementation of comprehensive detection methods. The purpose of this review is to focus on recent data concerning the main gene fusions identified in NSCLC, followed by the discussion of major challenges in this domain.
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Affiliation(s)
- Daniel Kazdal
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Heidelberg, Germany.,German Center for Lung Research (DZL), Heidelberg, Germany
| | - Véronique Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Université Côte d'Azur, FHU OncoAge, Nice, France.,Centre Antoine Lacassagne Cancer Center, Université Côte d'Azur, CNRS, INSERM, IRCAN, FHU OncoAge, Nice, France.,Hospital-Integrated Biobank BB-0033-00025, Université Côte d'Azur, CHU Nice, FHU OncoAge, Nice, France
| | - Petros Christopoulos
- Translational Lung Research Center (TLRC) Heidelberg, Heidelberg, Germany.,German Center for Lung Research (DZL), Heidelberg, Germany.,Thoraxklinik and National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Marius Ilié
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Université Côte d'Azur, FHU OncoAge, Nice, France.,Centre Antoine Lacassagne Cancer Center, Université Côte d'Azur, CNRS, INSERM, IRCAN, FHU OncoAge, Nice, France.,Hospital-Integrated Biobank BB-0033-00025, Université Côte d'Azur, CHU Nice, FHU OncoAge, Nice, France
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,German Center for Lung Research (DZL), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Université Côte d'Azur, FHU OncoAge, Nice, France.,Centre Antoine Lacassagne Cancer Center, Université Côte d'Azur, CNRS, INSERM, IRCAN, FHU OncoAge, Nice, France.,Hospital-Integrated Biobank BB-0033-00025, Université Côte d'Azur, CHU Nice, FHU OncoAge, Nice, France
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25
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Direct identification of ALK and ROS1 fusions in non-small cell lung cancer from hematoxylin and eosin-stained slides using deep learning algorithms. Mod Pathol 2022; 35:1882-1887. [PMID: 36057739 PMCID: PMC9708557 DOI: 10.1038/s41379-022-01141-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022]
Abstract
Anaplastic lymphoma kinase (ALK) and ROS oncogene 1 (ROS1) gene fusions are well-established key players in non-small cell lung cancer (NSCLC). Although their frequency is relatively low, their detection is important for patient care and guides therapeutic decisions. The accepted methods used for their detection are immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) assay, as well as DNA and RNA-based sequencing methodologies. These assays are expensive, time-consuming, and require technical expertise and specialized equipment as well as biological specimens that are not always available. Here we present an alternative detection method using a computer vision deep learning approach. An advanced convolutional neural network (CNN) was used to generate classifier models to detect ALK and ROS1-fusions directly from scanned hematoxylin and eosin (H&E) whole slide images prepared from NSCLC tumors of patients. A two-step training approach was applied, with an initial unsupervised training step performed on a pan-cancer sample cohort followed by a semi-supervised fine-tuning step, which supported the development of a classifier with performances equal to those accepted for diagnostic tests. Validation of the ALK/ROS1 classifier on a cohort of 72 lung cancer cases who underwent ALK and ROS1-fusion testing at the pathology department at Sheba Medical Center displayed sensitivities of 100% for both genes (six ALK-positive and two ROS1-positive cases) and specificities of 100% and 98.6% respectively for ALK and ROS1, with only one false-positive result for ROS1-alteration. These results demonstrate the potential advantages that machine learning solutions may have in the molecular pathology domain, by allowing fast, standardized, accurate, and robust biomarker detection overcoming many limitations encountered when using current techniques. The integration of such novel solutions into the routine pathology workflow can support and improve the current clinical pipeline.
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Moayed-Alaei L, Vargas AC, Adybeik D, Maclean F, Moir D. Analysing the morphological spectrum of Epithelioid fibrous histiocytoma and the immunohistochemical performance of the ALK D5F3 and ALK1 clones. Hum Pathol 2021; 120:46-56. [DOI: 10.1016/j.humpath.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 11/04/2022]
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27
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Cheng Y, Zhang T, Xu Q. Therapeutic advances in non-small cell lung cancer: Focus on clinical development of targeted therapy and immunotherapy. MedComm (Beijing) 2021; 2:692-729. [PMID: 34977873 PMCID: PMC8706764 DOI: 10.1002/mco2.105] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023] Open
Abstract
Lung cancer still contributes to nearly one-quarter cancer-related deaths in the past decades, despite the rapid development of targeted therapy and immunotherapy in non-small cell lung cancer (NSCLC). The development and availability of comprehensive genomic profiling make the classification of NSCLC more precise and personalized. Most treatment decisions of advanced-stage NSCLC have been made based on the genetic features and PD-L1 expression of patients. For the past 2 years, more than 10 therapeutic strategies have been approved as first-line treatment for certain subgroups of NSCLC. However, some major challenges remain, including drug resistance and low rate of overall survival. Therefore, we discuss and review the therapeutic strategies of NSCLC, and focus on the development of targeted therapy and immunotherapy in advanced-stage NSCLC. Based on the latest guidelines, we provide an updated summary on the standard treatment for NSCLC. At last, we discussed several potential therapies for NSCLC. The development of new drugs and combination therapies both provide promising therapeutic effects on NSCLC.
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Affiliation(s)
- Yuan Cheng
- Laboratory of Aging Research and Cancer Drug TargetState Key Laboratory of Biotherapy and Cancer CenterNational Clinical Research Center for GeriatricsWest China HospitalSichuan UniversityChengduChina
| | - Tao Zhang
- Laboratory of Aging Research and Cancer Drug TargetState Key Laboratory of Biotherapy and Cancer CenterNational Clinical Research Center for GeriatricsWest China HospitalSichuan UniversityChengduChina
| | - Qing Xu
- Department of OncologyShanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
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Aleksakhina SN, Imyanitov EN. Cancer Therapy Guided by Mutation Tests: Current Status and Perspectives. Int J Mol Sci 2021; 22:ijms222010931. [PMID: 34681592 PMCID: PMC8536080 DOI: 10.3390/ijms222010931] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/11/2022] Open
Abstract
The administration of many cancer drugs is tailored to genetic tests. Some genomic events, e.g., alterations of EGFR or BRAF oncogenes, result in the conformational change of the corresponding proteins and call for the use of mutation-specific compounds. Other genetic perturbations, e.g., HER2 amplifications, ALK translocations or MET exon 14 skipping mutations, cause overproduction of the entire protein or its kinase domain. There are multilocus assays that provide integrative characteristics of the tumor genome, such as the analysis of tumor mutation burden or deficiency of DNA repair. Treatment planning for non-small cell lung cancer requires testing for EGFR, ALK, ROS1, BRAF, MET, RET and KRAS gene alterations. Colorectal cancer patients need to undergo KRAS, NRAS, BRAF, HER2 and microsatellite instability analysis. The genomic examination of breast cancer includes testing for HER2 amplification and PIK3CA activation. Melanomas are currently subjected to BRAF and, in some instances, KIT genetic analysis. Predictive DNA assays have also been developed for thyroid cancers, cholangiocarcinomas and urinary bladder tumors. There is an increasing utilization of agnostic testing which involves the analysis of all potentially actionable genes across all tumor types. The invention of genomically tailored treatment has resulted in a spectacular improvement in disease outcomes for a significant portion of cancer patients.
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Affiliation(s)
- Svetlana N. Aleksakhina
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, 197758 Saint-Petersburg, Russia;
- Department of Medical Genetics, St.-Petersburg Pediatric Medical University, 194100 Saint-Petersburg, Russia
| | - Evgeny N. Imyanitov
- Department of Tumor Growth Biology, N.N. Petrov Institute of Oncology, 197758 Saint-Petersburg, Russia;
- Department of Medical Genetics, St.-Petersburg Pediatric Medical University, 194100 Saint-Petersburg, Russia
- Correspondence: ; Tel.: +7-812-439-95-28
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What Is New in Biomarker Testing at Diagnosis of Advanced Non-Squamous Non-Small Cell Lung Carcinoma? Implications for Cytology and Liquid Biopsy. JOURNAL OF MOLECULAR PATHOLOGY 2021. [DOI: 10.3390/jmp2020015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The discovery and clinical validation of biomarkers predictive of the response of non-squamous non-small-cell lung carcinomas (NS-NSCLC) to therapeutic strategies continue to provide new data. The evaluation of novel treatments is based on molecular analyses aimed at determining their efficacy. These tests are increasing in number, but the tissue specimens are smaller and smaller and/or can have few tumor cells. Indeed, in addition to tissue samples, complementary cytological and/or blood samples can also give access to these biomarkers. To date, it is recommended and necessary to look for the status of five genomic molecular biomarkers (EGFR, ALK, ROS1, BRAFV600, NTRK) and of a protein biomarker (PD-L1). However, the short- and more or less long-term emergence of new targeted treatments of genomic alterations on RET and MET, but also on others’ genomic alteration, notably on KRAS, HER2, NRG1, SMARCA4, and NUT, have made cellular and blood samples essential for molecular testing. The aim of this review is to present the interest in using cytological and/or liquid biopsies as complementary biological material, or as an alternative to tissue specimens, for detection at diagnosis of new predictive biomarkers of NS-NSCLC.
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