1
|
Wu J, Meng H, Zhou L, Wang M, Jin S, Ji H, Liu B, Jin P, Du C. Habitat radiomics and deep learning fusion nomogram to predict EGFR mutation status in stage I non-small cell lung cancer: a multicenter study. Sci Rep 2024; 14:15877. [PMID: 38982267 PMCID: PMC11233600 DOI: 10.1038/s41598-024-66751-1] [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: 01/28/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024] Open
Abstract
Develop a radiomics nomogram that integrates deep learning, radiomics, and clinical variables to predict epidermal growth factor receptor (EGFR) mutation status in patients with stage I non-small cell lung cancer (NSCLC). We retrospectively included 438 patients who underwent curative surgery and completed driver-gene mutation tests for stage I NSCLC from four academic medical centers. Predictive models were established by extracting and analyzing radiomic features in intratumoral, peritumoral, and habitat regions of CT images to identify EGFR mutation status in stage I NSCLC. Additionally, three deep learning models based on the intratumoral region were constructed. A nomogram was developed by integrating representative radiomic signatures, deep learning, and clinical features. Model performance was assessed by calculating the area under the receiver operating characteristic (ROC) curve. The established habitat radiomics features demonstrated encouraging performance in discriminating between EGFR mutant and wild-type, with predictive ability superior to other single models (AUC 0.886, 0.812, and 0.790 for the training, validation, and external test sets, respectively). The radiomics-based nomogram exhibited excellent performance, achieving the highest AUC values of 0.917, 0.837, and 0.809 in the training, validation, and external test sets, respectively. Decision curve analysis (DCA) indicated that the nomogram provided a higher net benefit than other radiomics models, offering valuable information for treatment.
Collapse
Affiliation(s)
- Jingran Wu
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Hao Meng
- Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Lin Zhou
- Department of Thoracic Surgery, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, 512025, China
| | - Meiling Wang
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Shanxiu Jin
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Hongjuan Ji
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, 110840, China
| | - Bona Liu
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, 110840, China.
| | - Peng Jin
- Department of Oncology, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China.
| | - Cheng Du
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, 110840, China.
| |
Collapse
|
2
|
Radhakrishnan V, Kaifi JT, Suvilesh KN. Circulating Tumor Cells: How Far Have We Come with Mining These Seeds of Metastasis? Cancers (Basel) 2024; 16:816. [PMID: 38398206 PMCID: PMC10887304 DOI: 10.3390/cancers16040816] [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: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Circulating tumor cells (CTCs) are cancer cells that slough off from the tumor and circulate in the peripheral blood and lymphatic system as micro metastases that eventually results in macro metastases. Through a simple blood draw, sensitive CTC detection from clinical samples has proven to be a useful tool for determining the prognosis of cancer. Recent technological developments now make it possible to detect CTCs reliably and repeatedly from a simple and straightforward blood test. Multicenter trials to assess the clinical value of CTCs have demonstrated the prognostic value of these cancer cells. Studies on CTCs have filled huge knowledge gap in understanding the process of metastasis since their identification in the late 19th century. However, these rare cancer cells have not been regularly used to tailor precision medicine and or identify novel druggable targets. In this review, we have attempted to summarize the milestones of CTC-based research from the time of identification to molecular characterization. Additionally, the need for a paradigm shift in dissecting these seeds of metastasis and the possible future avenues to improve CTC-based discoveries are also discussed.
Collapse
Affiliation(s)
- Vijay Radhakrishnan
- Department of Surgery, Ellis Fischel Cancer Center, Roy Blunt NextGen Precision Health Institute, University of Missouri, Columbia, MO 65212, USA; (V.R.); (J.T.K.)
| | - Jussuf T. Kaifi
- Department of Surgery, Ellis Fischel Cancer Center, Roy Blunt NextGen Precision Health Institute, University of Missouri, Columbia, MO 65212, USA; (V.R.); (J.T.K.)
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO 65201, USA
| | - Kanve N. Suvilesh
- Department of Surgery, Ellis Fischel Cancer Center, Roy Blunt NextGen Precision Health Institute, University of Missouri, Columbia, MO 65212, USA; (V.R.); (J.T.K.)
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO 65201, USA
| |
Collapse
|
3
|
Liu M, Li X, Zhang H, Ren F, Liu J, Li Y, Dong M, Zhao H, Xu S, Liu H, Chen J. Apatinib added when NSCLC patients get slow progression with EGFR-TKI: A prospective, single-arm study. Cancer Med 2023; 12:21735-21741. [PMID: 38033095 PMCID: PMC10757148 DOI: 10.1002/cam4.6737] [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: 06/02/2023] [Revised: 09/17/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) acquired resistance was an inevitably events in NSCLC treatment. AIMS Intending to overcome the acquired resistance of EGFR-TKI. MATERIALS & METHODS A clinical trial was, we enrolled 12 patients who were slowly progressing on first-generation EGFR-TKI, and added apatinib when the patients got slow progression. RESULTS Seven patients were included in the efficacy analysis. The median PFS2 of apatinib combined with EGFR-TKI was 8.2 months (95% CI, 7.3 m-NA), and the total PFS reached 20.9 months (95% CI, 17.3 m-NA) when plus PFS1. All the adverse events were manageable. The median PFS was significantly longer for circulating tumor DNA (ctDNA)-cleared patients (8.4 months; 95% CI, 8.2-NA) than for those ctDNA not cleared (7.1 months; 95% CI, 6.9-NA) (p = 0.0082). DISCUSSION The addition of apatinib did improve the duration of first-generation EGFR-TKI use, and the duration was better than the first-line use of third-generation EGFR-TKI. CONCLUSION The addition of apatinib when the patients got slow progression after initial EGFR-TKI therapy may be a good treatment option and the side effects are controllable. It is possible to monitor treatment efficacy using ctDNA.
Collapse
Affiliation(s)
- Minghui Liu
- Department of Lung Cancer SurgeryTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Xin Li
- Department of Lung Cancer SurgeryTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Hongbing Zhang
- Department of Lung Cancer SurgeryTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Fan Ren
- Department of Lung Cancer SurgeryTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Jinghao Liu
- Department of Lung Cancer SurgeryTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Yongwen Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor MicroenvironmentTianjin Lung Cancer Institute, Tianjin Medical University General HospitalTianjinChina
| | - Ming Dong
- Department of Lung Cancer SurgeryTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Honglin Zhao
- Department of Lung Cancer SurgeryTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Song Xu
- Department of Lung Cancer SurgeryTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor MicroenvironmentTianjin Lung Cancer Institute, Tianjin Medical University General HospitalTianjinChina
| | - Jun Chen
- Department of Lung Cancer SurgeryTianjin Medical University General HospitalTianjinPeople's Republic of China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor MicroenvironmentTianjin Lung Cancer Institute, Tianjin Medical University General HospitalTianjinChina
| |
Collapse
|
4
|
Wang L, Fu H, Song L, Wu Z, Yu J, Guo Q, Chen C, Yang X, Zhang J, Wang Q, Duan Y, Yang Y. Overcoming AZD9291 Resistance and Metastasis of NSCLC via Ferroptosis and Multitarget Interference by Nanocatalytic Sensitizer Plus AHP-DRI-12. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2204133. [PMID: 36420659 DOI: 10.1002/smll.202204133] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/03/2022] [Indexed: 06/16/2023]
Abstract
The acquired resistance to Osimertinib (AZD9291) greatly limits the clinical benefit of patients with non-small cell lung cancer (NSCLC), whereas AZD9291-resistant NSCLCs are prone to metastasis. It's challenging to overcome AZD9291 resistance and suppress metastasis of NSCLC simultaneously. Here, a nanocatalytic sensitizer (VF/S/A@CaP) is proposed to deliver Vitamin c (Vc)-Fe(II), si-OTUB2, ASO-MALAT1, resulting in efficient inhibition of tumor growth and metastasis of NSCLC by synergizing with AHP-DRI-12, an anti-hematogenous metastasis inhibitor by blocking the amyloid precursor protein (APP)/death receptor 6 (DR6) interaction designed by our lab. Fe2+ released from Vc-Fe(II) generates cytotoxic hydroxyl radicals (•OH) through Fenton reaction. Subsequently, glutathione peroxidase 4 (GPX4) is consumed to sensitize AZD9291-resistant NSCLCs with high mesenchymal state to ferroptosis due to the glutathione (GSH) depletion caused by Vc/dehydroascorbic acid (DHA) conversion. By screening NSCLC patients' samples, metastasis-related targets (OTUB2, LncRNA MALAT1) are confirmed. Accordingly, the dual-target knockdown plus AHP-DRI-12 significantly suppresses the metastasis of AZD9291-resistant NSCLC. Such modality leads to 91.39% tumor inhibition rate in patient-derived xenograft (PDX) models. Collectively, this study highlights the vulnerability to ferroptosis of AZD9291-resistant tumors and confirms the potential of this nanocatalytic-medicine-based modality to overcome critical AZD9291 resistance and inhibit metastasis of NSCLC simultaneously.
Collapse
Affiliation(s)
- Liting Wang
- State Key Laboratory of Oncogenes and Related Genes, Renji Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Hao Fu
- State Key Laboratory of Oncogenes and Related Genes, Renji Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Liwei Song
- Shanghai Pulmonary Tumor Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Zhihua Wu
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Jian Yu
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Qianqian Guo
- State Key Laboratory of Oncogenes and Related Genes, Renji Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Chuanrong Chen
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Xupeng Yang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Jiali Zhang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Quan Wang
- State Key Laboratory of Oncogenes and Related Genes, Renji Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Yourong Duan
- State Key Laboratory of Oncogenes and Related Genes, Renji Hospital, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200032, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200032, China
| | - Yunhai Yang
- Shanghai Pulmonary Tumor Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| |
Collapse
|
5
|
Fan X, Zou X, Liu C, Peng S, Zhang S, Zhou X, Zhu J, Zhu W. Identify miRNA-mRNA regulation pairs to explore potential pathogenesis of lung adenocarcinoma. Aging (Albany NY) 2022; 14:8357-8373. [PMID: 36260870 DOI: 10.18632/aging.204341] [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: 01/19/2022] [Accepted: 10/10/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE MicroRNA (miRNA) function via base-pairing with complementary sequences within mRNA molecules. This study aims to identify critical miRNA-mRNA regulation pairs contributing to lung adenocarcinoma (LUAD) pathogenesis. PATIENTS AND METHODS MiRNA and mRNA microarray and RNA-sequencing datasets were downloaded from gene expression omnibus (GEO) and the cancer genome atlas (TCGA) databases. Differential miRNAs (DE-miRNAs) and mRNAs (DE-mRNAs) were screened by the GEO2R tool and R packages. DAVID, DIANA, and Hiplot tools were used to perform gene enrichment analysis. The pairs of miRNA-mRNA were screened from the experimentally validated miRNA-target interactions databases (miRTarBase and TarBase). External validation was carried out in 30 pairs of LUAD tissues by quantitative reverse transcription and polymerase chain reaction (qRT-PCR). The diagnostic value of the miRNA-mRNA regulation pairs was evaluated by receiver operating characteristic curve (ROC) and decision curve analysis (DCA). Biological function assay was were also performed to confirm the function of miRNA-mRNA axis in LUAD progression. The study also performed the clinical, survival and tumor-associated phenotypic analysis of miRNA-mRNA pairs. RESULTS A total of 7 miRNA and 13 mRNA expression datasets from GEO were analyzed, and 11 DE-miRNAs (5 down-regulated and 6 up-regulated in LUAD tissues) and 128 DE-mRNAs (30 up-regulated and 98 down-regulated in LUAD tissues) were identified. The pairs of miR-1-3p(down) and CENPF(up) and miR-126-5p(down) and UGT8(up) were verified in the external validation cohort (30 LUAD vs. 30 NC) using qRT-PCR. Areas under the ROC curve of the two miRNA-mRNA regulation pairs panel were 0.973 in TCGA-LUAD and 0.771 in the external validation. The DCA also showed that the miRNA-mRNA regulation pairs had an excellent diagnostic performance distinguishing LUAD from normal controls. The expression of the regulation pairs is different in different ages, TNM stages, and gender. The overexpression of miR-1-3p and miR-126-5p significantly inhibited the proliferation and migration of LUAD cells. Correlation analysis showed that CENPF correlated with prognosis and tumor immunity. CONCLUSIONS The research identified potential miRNA-mRNA regulation pairs, providing a new idea for exploring the genesis and development of LUAD.
Collapse
Affiliation(s)
- Xingchen Fan
- Department of Geriatrics, The First People's Hospital of Lianyungang, The Affiliated Lianyungang Hospital of Xuzhou Medical University, The Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang 222002, P.R. China
| | - Xuan Zou
- First Clinical College of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Cheng Liu
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Shuang Peng
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Shiyu Zhang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Xin Zhou
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Jun Zhu
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Xuanwu, Nanjing 210009, P.R. China
| | - Wei Zhu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| |
Collapse
|
6
|
Texture Analysis of Enhanced MRI and Pathological Slides Predicts EGFR Mutation Status in Breast Cancer. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1376659. [PMID: 35663041 PMCID: PMC9162871 DOI: 10.1155/2022/1376659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022]
Abstract
Objective Image texture information was extracted from enhanced magnetic resonance imaging (MRI) and pathological hematoxylin and eosin- (HE-) stained images of female breast cancer patients. We established models individually, and then, we combine the two kinds of data to establish model. Through this method, we verified whether sufficient information could be obtained from enhanced MRI and pathological slides to assist in the determination of epidermal growth factor receptor (EGFR) mutation status in patients. Methods We obtained enhanced MRI data from patients with breast cancer before treatment and selected diffusion-weighted imaging (DWI), T1 fast-spin echo (T1 FSE), and T2 fast-spin echo (T2 FSE) as the data sources for extracting texture information. Imaging physicians manually outlined the 3D regions of interest (ROIs) and extracted texture features according to the gray level cooccurrence matrix (GLCM) of the images. For the HE staining images of the patients, we adopted a specific normalization algorithm to simulate the images dyed with only hematoxylin or eosin and extracted textures. We extracted texture features to predict the expression of EGFR. After evaluating the predictive power of each model, the models from the two data sources were combined for remodeling. Results For enhanced MRI data, the modeling of texture information of T1 FSE had a good predictive effect for EGFR mutation status. For pathological images, eosin-stained images can achieve a better prediction effect. We selected these two classifiers as the weak classifiers of the final model and obtained good results (training group: AUC, 0.983; 95% CI, 0.95-1.00; accuracy, 0.962; specificity, 0.936; and sensitivity, 0.979; test group: AUC, 0.983; 95% CI, 0.94-1.00; accuracy, 0.943; specificity, 1.00; and sensitivity, 0.905). Conclusion The EGFR mutation status of patients with breast cancer can be well predicted based on enhanced MRI data and pathological data. This helps hospitals that do not test the EGFR mutation status of patients with breast cancer. The technology gives clinicians more information about breast cancer, which helps them make accurate diagnoses and select suitable treatments.
Collapse
|
7
|
Behel V, Choughule A, Noronha V, Patil V, Menon N, Singh A, Kumar S, Kumar R, Shah S, More S, Banavali S, Chandrani P, Prabhash K. Clinical utility of liquid biopsy (cell-free DNA) based EGFR mutation detection post treatment initiation as a disease monitoring tool in patients with advanced EGFR-mutant NSCLC. Clin Lung Cancer 2022; 23:410-418. [DOI: 10.1016/j.cllc.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 12/15/2022]
|
8
|
Hassanein SS, Ibrahim SA, Abdel-Mawgood AL. Cell Behavior of Non-Small Cell Lung Cancer Is at EGFR and MicroRNAs Hands. Int J Mol Sci 2021; 22:12496. [PMID: 34830377 PMCID: PMC8621388 DOI: 10.3390/ijms222212496] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is a complex disease associated with gene mutations, particularly mutations of Kirsten Rat Sarcoma Viral Oncogene Homolog (KRAS) and epidermal growth factor receptor (EGFR). Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) are the two major types of lung cancer. The former includes most lung cancers (85%) and are commonly associated with EGFR mutations. Several EGFR-tyrosine kinase inhibitors (EGFR-TKIs), including erlotinib, gefitinib, and osimertinib, are effective therapeutic agents in EGFR-mutated NSCLC. However, their effectiveness is limited by the development (acquired) or presence of intrinsic drug resistance. MicroRNAs (miRNAs) are key gene regulators that play a profound role in the development and outcomes for NSCLC via their role as oncogenes or oncosuppressors. The regulatory role of miRNA-dependent EGFR crosstalk depends on EGFR signaling pathway, including Rat Sarcoma/Rapidly Accelerated Fibrosarcoma/Mitogen-Activated Protein Kinase/Extracellular Signal-Regulated Kinase 1/2 (Ras/Raf/MEK/ERK1/2), Signal Transducer and Activator of Transcription (STAT), Nuclear Factor Kappa-Light-Chain-Enhancer of Activated B Cells (NF-kB), phosphoinositide 3-kinase/protein kinase B (PI3K/AKT), Janus kinase 1 (JAK1), and growth factor receptor-bound protein 2 (GRB2). Dysregulated expression of miRNAs affects sensitivity to treatment with EGFR-TKIs. Thus, abnormalities in miRNA-dependent EGFR crosstalk can be used as diagnostic and prognostic markers, as well as therapeutic targets in NSCLC. In this review, we present an overview of miRNA-dependent EGFR expression regulation, which modulates the behavior and progression of NSCLC.
Collapse
Affiliation(s)
- Sarah Sayed Hassanein
- Biotechnology Program, Basic and Applied Sciences (BAS) Institute, Egypt-Japan University of Science and Technology (E-JUST), Alexandria 21934, Egypt;
- Department of Zoology, Faculty of Science, Cairo University, Giza 12613, Egypt;
| | | | - Ahmed Lotfy Abdel-Mawgood
- Biotechnology Program, Basic and Applied Sciences (BAS) Institute, Egypt-Japan University of Science and Technology (E-JUST), Alexandria 21934, Egypt;
| |
Collapse
|
9
|
Poudel B, Desman J, Aihara G, Weidman DI, Tsang A, Kovrizhkin K, Pereira T, Arun S, Pradeep T, Matin S, Liddell RP. Adequacy of samples obtained via percutaneous core-needle rebiopsy for EGFR T790M molecular analysis in patients with non-small cell lung cancer following acquired resistance to first-line therapy: A systematic review and meta-analysis. Cancer Treat Res Commun 2021; 29:100470. [PMID: 34628209 DOI: 10.1016/j.ctarc.2021.100470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 12/23/2022]
Abstract
MICRO ABSTRACT Rebiopsies characterizing resistance mutations in patients with non-small cell lung cancer (NSCLC) can guide personalized medicine and improve overall survival rates. In this systematic review, we examine the suitability of percutaneous core-needle biopsy (PT-CNB) to obtain adequate samples for molecular characterization of the acquired resistance mutation T790M. This review provides evidence that PT-CNB can obtain samples with high adequacy, with a mutation detection rate that is in accordance with prior literature. BACKGROUND Non-small cell lung cancer (NSCLC) comprises 85% of all lung cancers and has seen improved survival rates with the rise of personalized medicine. Resistance mutations to first-line therapies, such as T790M, however, render first-line therapies ineffective. Rebiopsies characterizing resistance mutations inform therapeutic decisions, which result in prolonged survival. Given the high efficacy of percutaneous core-needle biopsy (PT-CNB), we conducted the first systematic review to analyze the ability of PT-CNB to obtain samples of high adequacy in order to characterize the acquired resistance mutation T790M in patients with NSCLC. METHODS We performed a comprehensive literature search across PubMed, Embase, and CENTRAL. Search terms related to "NSCLC," "rebiopsy," and "PT-CNB" were used to obtain results. We included all prospective and retrospective studies that satisfied our inclusion and exclusion criteria. A random effects model was utilized to pool adequacy and detection rates of the chosen articles. We performed a systematic review, meta-analysis, and meta-regression to investigate the adequacy and T790M detection rates of samples obtained via PT-CNB. RESULTS Out of the 173 studies initially identified, 5 studies met the inclusion and exclusion criteria and were chosen for our final cohort of 436 patients for meta-analysis. The pooled adequacy rate of samples obtained via PT-CNB was 86.92% (95% CI: [79.31%, 92.0%]) and the pooled T790M detection rate was 46.0% (95% CI: [26.6%, 66.7%]). There was considerable heterogeneity among studies (I2 > 50%) in both adequacy and T790M detection rates. CONCLUSION PT-CNB can obtain adequate samples for T790M molecular characterization in NSCLC lung cancer patients. Additional prospective studies are needed to corroborate the results in this review.
Collapse
Affiliation(s)
- Bibhav Poudel
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Jacob Desman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Gohta Aihara
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Deborah I Weidman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Ashley Tsang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Katherine Kovrizhkin
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Tatiana Pereira
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Siddharth Arun
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Tejus Pradeep
- Department of Ophthalmology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Shababa Matin
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Robert P Liddell
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, United States of America.
| |
Collapse
|
10
|
Qian H, Zhang Y, Xu J, He J, Gao W. Progress and application of circulating tumor cells in non-small cell lung cancer. Mol Ther Oncolytics 2021; 22:72-84. [PMID: 34514090 PMCID: PMC8408556 DOI: 10.1016/j.omto.2021.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) has the highest morbidity and mortality worldwide among malignant tumors. NSCLC is a great threat to health and well-being. Biopsy is the gold standard to diagnose lung cancer, but traditional biopsy methods cannot fully reflect the true condition of tumors. There is growing evidence that a single-point biopsy fails to reveal the complete landscape of the tumor due to intratumor heterogeneity, but it is impractical to complete multiple biopsies that are separated both spatially and temporally. Liquid biopsy heralds that a new era is coming. Circulating tumor cells (CTCs) are tumor cells that circulate in the peripheral blood after being shed from primary or metastatic tumors. CTCs constitute a considerable portion of a liquid biopsy, which contributes to the diagnosis, assessment of prognosis, and therapy of NSCLC. Herein, this review discusses the technologies for detection and enrichment of CTCs as well as clinical applications involving CTCs.
Collapse
Affiliation(s)
- Huizhu Qian
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Yue Zhang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Jing Xu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Jing He
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| | - Wen Gao
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
| |
Collapse
|
11
|
Garrido P, Paz-Ares L, Majem M, Morán T, Trigo JM, Bosch-Barrera J, Garcίa-Campelo R, González-Larriba JL, Sánchez-Torres JM, Isla D, Viñolas N, Camps C, Insa A, Juan Ó, Massuti B, Paredes A, Artal Á, López-Brea M, Palacios J, Felip E. LungBEAM: A prospective multicenter study to monitor stage IV NSCLC patients with EGFR mutations using BEAMing technology. Cancer Med 2021; 10:5878-5888. [PMID: 34296539 PMCID: PMC8419773 DOI: 10.1002/cam4.4135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The aim of LungBEAM was to determine the value of a novel epidermal growth factor receptor (EGFR) mutation test in blood based on BEAMing technology to predict disease progression in advanced non-small cell lung cancer (NSCLC) patients treated with first- or second-generation EGFR-tyrosine kinase inhibitors (EGFR-TKIs). Another goal was to monitor the dynamics of EGFR mutations, as well as to track EGFR exon 20 p.T790M (p.T790M) resistance during treatment, as critical indicators of therapeutic efficacy and patient survival. METHODS Stage IV NSCLC patients with locally confirmed EGFR-TKI sensitizing mutations (ex19del and/or L858R) in biopsy tissue who were candidates to receive first- or second-generation EGFR-TKI as first-line therapy were included. Plasma samples were obtained at baseline and every 4 weeks during treatment until a progression-free survival (PFS) event or until study completion (72-week follow-up). The mutant allele fraction (MAF) was determined for each identified mutation using BEAMing. RESULTS A total of 68 of the 110 (61.8%) patients experienced a PFS event. Twenty-six patients (23.6%) presented with an emergent p.T790M mutation in plasma at some point during follow-up, preceding radiologic progression with a median of 76 (interquartile ratio: 54-111) days. Disease progression correlated with the appearance of p.T790M in plasma with a hazard ratio (HR) of 1.94 (95% confidence interval [CI], 1.48-2.54; p < 0.001). The HR for progression in patients showing increasing plasma sensitizing mutation levels (positive MAF slope) versus patients showing either decreasing or unchanged plasma mutation levels (negative or null MAF slopes) was 3.85 (95% CI, 2.01-7.36; p < 0.001). CONCLUSION Detection and quantification of EGFR mutations in circulating tumor DNA using the highly sensitive BEAMing method should greatly assist in optimizing treatment decisions for advanced NSCLC patients.
Collapse
Affiliation(s)
- Pilar Garrido
- Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Universidad Alcalá, Madrid, Spain.,CIBERONC, Madrid, Spain
| | - Luis Paz-Ares
- CIBERONC, Madrid, Spain.,Medical Oncology Department, Hospital Universitario 12 de Octubre and i+12 Research Institute, Madrid, Spain.,Lung Cancer Group, Clinical Research Program, Spanish National Cancer Research Center (CNIO), Madrid, Spain.,Complutense University, Madrid, Spain
| | - Margarita Majem
- Medical Oncology Department, Hospital De La Santa Creu I Sant Pau, Barcelona, Spain.,Spanish Lung Cancer Group (GECP), Barcelona, Spain
| | - Teresa Morán
- Spanish Lung Cancer Group (GECP), Barcelona, Spain.,ICO Badalona, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - José Manuel Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Joaquim Bosch-Barrera
- Medical Oncology, Catalan Institute of Oncology (ICO), Dr. Josep Trueta Hospital of Girona, Girona, Spain
| | | | | | | | - Dolores Isla
- Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Núria Viñolas
- Medical Oncology Department, Hospital Clinic i Provincial, Barcelona, Spain
| | - Carlos Camps
- CIBERONC, Madrid, Spain.,Medical Oncology Department, Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Amelia Insa
- Medical Oncology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Óscar Juan
- Medical Oncology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Bartomeu Massuti
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Alfredo Paredes
- Medical Oncology Department, Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - Ángel Artal
- Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marta López-Brea
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - José Palacios
- CIBERONC, Madrid, Spain.,Pathology Department, IRYCIS Hospital Universitario Ramón y Cajal, Universidad Alcalá, Madrid, Spain
| | - Enriqueta Felip
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
12
|
Ianza A, Di Chicco A, Biagi C, Giudici F, Dicorato A, Guglielmi A, Variola F, Tomasi S, Roviello G, Generali D, Zanconati F. EGFR mutation analysis on circulating free DNA in NSCLC: a single-center experience. J Cancer Res Clin Oncol 2021; 147:2301-2307. [PMID: 34003366 PMCID: PMC8236477 DOI: 10.1007/s00432-021-03658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
Purpose Monitoring mutation status in circulating free DNA (cfDNA) during target therapy could hold significant clinical importance in non-small cell lung cancer (NSCLC). Our aim is to establish if EGFR mutational status change on cfDNA has predictive value that can impact clinical management of NSCLC patients care. Methods This study included 30 patients with EGFR-mutated NSCLC. Blood samples were collected at diagnosis (T0) and in 19 patients during therapy (T1). Results Concordance between T0 and T1 EGFR mutation status for patients evaluable for both samples (n = 19) was 79%, with a sensitivity of 100% (95% CI: 55.5–100.0) and specificity of 60.0% (95% CI: 26.2–86.8). For the patients in oncological therapy with targeted drug and with T1 sample available (n = 18), survival outcomes were evaluated. For both mutation-negative T0 and T1 patients, 12-month progression-free survival (PFS) was 66.7% (95% CI: 27.2–100.0) and 12-month overall survival (OS) was 100% (95% CI: 1.00–1.00); for patients mutated both at T0 and T1, PFS was 22.2% (95% CI: 6.5–75.4%) and OS was 55.6% (95% CI: 20.4–96.1%). Conclusion EGFR mutation status can be assessed using cfDNA for routine purposes and longitudinal assessment of plasma mutation is an easy approach to monitor the therapeutic response or resistance onset.
Collapse
Affiliation(s)
- Anna Ianza
- Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy.
| | - A Di Chicco
- Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy
| | - C Biagi
- Azienda Sanitaria Universitaria Goriziano Isontina, Cattinara Academic Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - F Giudici
- Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy
| | - A Dicorato
- Azienda Sanitaria Universitaria Goriziano Isontina, Cattinara Academic Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - A Guglielmi
- Azienda Sanitaria Universitaria Goriziano Isontina, Cattinara Academic Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - F Variola
- Azienda Sanitaria Universitaria Goriziano Isontina, Cattinara Academic Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - S Tomasi
- Azienda Sanitaria Universitaria Goriziano Isontina, Cattinara Academic Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - G Roviello
- Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy
| | - D Generali
- Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy.,Breast Cancer Unit and Translational Research Unit, ASST Cremona, Cremona, Italy
| | - F Zanconati
- Department of Medical, Surgery and Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy.,Azienda Sanitaria Universitaria Goriziano Isontina, Cattinara Academic Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| |
Collapse
|
13
|
Garcia J, Gauthier A, Lescuyer G, Barthelemy D, Geiguer F, Balandier J, Edelstein DL, Jones FS, Holtrup F, Duruisseau M, Grolleau E, Rodriguez-Lafrasse C, Merle P, Couraud S, Payen L. Routine Molecular Screening of Patients with Advanced Non-SmallCell Lung Cancer in Circulating Cell-Free DNA at Diagnosis and During Progression Using OncoBEAM TM EGFR V2 and NGS Technologies. Mol Diagn Ther 2021; 25:239-250. [PMID: 33660188 PMCID: PMC7956937 DOI: 10.1007/s40291-021-00515-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/30/2022]
Abstract
Background and Objectives The use of ultra-sensitive diagnostic tests to detect clinically actionable somatic alterations within the gene encoding the epidermal growth factor receptor (EGFR) within circulating cell-free DNA is an important first step in determining the eligibility of patients with non-small cell lung cancer to receive tyrosine kinase inhibitors. Methods We present the clinical validation (accuracy, sensitivity, and specificity) of a highly sensitive OncoBEAMTMEGFR V2 test, which we compare to a custom next-generation sequencing assay, for the treatment of patients with non-small cell lung cancer with EGFR tyrosine kinase inhibitor therapies. The OncoBEAMTM digital-polymerase chain reaction method detects 36 different EGFR alterations in circulating cell-free DNA, whereas the next-generation sequencing assay covers major solid tumor oncodrivers. Of the 540 samples analyzed with the OncoBEAMTMEGFR V2 test, 42.4% of patients had undergone molecular testing at diagnosis (N = 229/540) and 57.7% of patients during disease progression (N = 311/540). Results The sensitivity and specificity were measured for this BEAMing assay. The number of mutant beads and mutant allelic fraction were measured for each EGFR alteration and the level of detection was established at 0.1% for a median of 2861 genome equivalent (GE) in each reaction using HD780 horizon control DNA, as well as by an internal quality reference standard. Approximately 10%, 27%, and 63% of the 540 samples contained < 1500 GE, a range of 1500–3000 GE, and > 3000 GE, which corresponded to a maximal assay sensitivity of 2.0%, 0.5–0.1%, and 0.1–0.05% mutant allelic fraction, respectively. In a routine hospital setting, 11.4% of non-small cell lung cancer tumors were positive at diagnosis for EGFR alterations, while 43.7% samples harbored EGFR mutations at progression, among which 40.3% expressed EGFR resistance mutations after first-line tyrosine kinase inhibitor treatment with first- and second-generation drugs. Conclusions The OncoBEAMTMEGFR V2 is a sensitive, robust, and accurate assay that delivers reproducible results. Next-generation sequencing and BEAMing technologies act complementarily in the routine molecular screening. We show that using a next-generation sequencing assay, despite its lower sensitivity, enables the identification of rare EGFR alterations or resistance mechanisms (mutation, deletion, insertion, and copy number variation) to orient first- and second-line treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s40291-021-00515-9.
Collapse
Affiliation(s)
- Jessica Garcia
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Hospices Civils de Lyon Cancer Institute, CIRculating CANcer (CIRCAN) Program, Pierre-Bénite, France
| | - Arnaud Gauthier
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gaëlle Lescuyer
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Hospices Civils de Lyon Cancer Institute, CIRculating CANcer (CIRCAN) Program, Pierre-Bénite, France
| | - David Barthelemy
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Hospices Civils de Lyon Cancer Institute, CIRculating CANcer (CIRCAN) Program, Pierre-Bénite, France
| | - Florence Geiguer
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Hospices Civils de Lyon Cancer Institute, CIRculating CANcer (CIRCAN) Program, Pierre-Bénite, France
| | - Julie Balandier
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Hospices Civils de Lyon Cancer Institute, CIRculating CANcer (CIRCAN) Program, Pierre-Bénite, France
| | - Daniel L Edelstein
- Life Sciences Medical Affairs and Research and Development Sysmex Inostics, GmBH, Hamburg, Germany
| | - Frederick S Jones
- Life Sciences Medical Affairs and Research and Development Sysmex Inostics, GmBH, Hamburg, Germany
| | - Frank Holtrup
- Life Sciences Medical Affairs and Research and Development Sysmex Inostics, GmBH, Hamburg, Germany
| | - Mickael Duruisseau
- Service de Pneumologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Emmanuel Grolleau
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Groupement Hospitalier Sud, Institut de Cancérologie des Hospices Civils de Lyon, Pierre-Bénite, France
| | - Claire Rodriguez-Lafrasse
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Patrick Merle
- Service de Pneumologie, Centre Hospitalier Gabriel Montpied, Clermont-Ferrand, France
| | - Sébastien Couraud
- Hospices Civils de Lyon Cancer Institute, CIRculating CANcer (CIRCAN) Program, Pierre-Bénite, France.,Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Groupement Hospitalier Sud, Institut de Cancérologie des Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738 Ciblage Thérapeutique en Oncologie, Faculté de Médecine Lyon-Sud, Université de Lyon, Oullins, France
| | - Léa Payen
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France. .,Hospices Civils de Lyon Cancer Institute, CIRculating CANcer (CIRCAN) Program, Pierre-Bénite, France. .,Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165, Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.
| |
Collapse
|
14
|
The new opportunities in medicinal chemistry of fourth-generation EGFR inhibitors to overcome C797S mutation. Eur J Med Chem 2020; 210:112995. [PMID: 33243531 DOI: 10.1016/j.ejmech.2020.112995] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 12/24/2022]
Abstract
Epidermal growth factor receptor (EGFR) is a receptor for epithelial growth factor (EGF) cell proliferation and signaling, which is related to the inhibition of tumor cell proliferation, angiogenesis, tumor invasion, metastasis, and apoptosis. Thus, it has become an important target for the treatment of non-small cell lung cancer (NSCLC). The first to the third-generation EGFR inhibitors have demonstrated powerful efficacy and brought a prospect to patients. Unfortunately, after 9-15 months of treatment, they all developed resistance without exception. As for the resistance of third-generation inhibitors, no major breakthrough has been made in this field. In this review, we discussed the recent advances in medicinal chemistry of fourth-generation EGFR-TKIs, as well as further discussed the clinical challenges and future prospects of treating patients with EGFR mutations resistant to third-generation EGFR-TKIs.
Collapse
|
15
|
Serum microRNA expression profiling revealing potential diagnostic biomarkers for lung adenocarcinoma. Chin Med J (Engl) 2020; 133:2532-2542. [PMID: 32947363 PMCID: PMC7722592 DOI: 10.1097/cm9.0000000000001100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Recent studies have demonstrated that microRNAs (miRNAs) in the blood circulation can serve as promising diagnostic markers for cancers. This four-stage study aimed at finding serum miRNAs as potential biomarkers for lung adenocarcinoma (LA) diagnosis. Methods The study was carried out between 2016 and 2017. The Exiqon miRNA qPCR panel (3 LA vs. 1 normal control [NC] pooled serum samples) was used for initial screening to acquire miRNA profiles. Thirty-five dysregulated miRNAs were further evaluated in the training (24 LA vs. 24 NCs) and testing stages (110 LA vs. 110 NCs) using quantitative real-time polymerase chain reaction assays. Results Four serum miRNAs (miR-133a-3p, miR-584-5p, miR-10b-5p, and miR-221-3p) were significantly overexpressed in LA patients compared with NCs. The diagnostic value of the four-miRNA panel was validated by an external cohort (36 LA vs. 36 NCs). The areas under the receiver operating characteristic curve of the four-miRNA panel in the training, testing, and external validation stages were 0.734, 0.803, and 0.894 respectively. Meanwhile, the expression level of miR-221-3p was much higher in LA tumor samples than that in the adjacent normal tissues (19 LA vs. 19 NCs). The expression level of miR-10b-5p was also elevated in the serum-derived exosomes samples (18 LA vs. 18 NCs). The expression of miR-133a-3p, miR-584-5p, and miR-10b-5p was significantly elevated in LA patients with epidermal growth factor receptor mutation compared with NCs. Conclusion The study established a four-miRNA signature in serum that could improve the diagnostic capability of LA.
Collapse
|
16
|
Pesapane F, Suter MB, Rotili A, Penco S, Nigro O, Cremonesi M, Bellomi M, Jereczek-Fossa BA, Pinotti G, Cassano E. Will traditional biopsy be substituted by radiomics and liquid biopsy for breast cancer diagnosis and characterisation? Med Oncol 2020; 37:29. [PMID: 32180032 DOI: 10.1007/s12032-020-01353-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
The diagnosis of breast cancer currently relies on radiological and clinical evaluation, confirmed by histopathological examination. However, such approach has some limitations as the suboptimal sensitivity, the long turnaround time for recall tests, the invasiveness of the procedure and the risk that some features of target lesions may remain undetected, making re-biopsy a necessity. Recent technological advances in the field of artificial intelligence hold promise in addressing such medical challenges not only in cancer diagnosis, but also in treatment assessment, and monitoring of disease progression. In the perspective of a truly personalised medicine, based on the early diagnosis and individually tailored treatments, two new technologies, namely radiomics and liquid biopsy, are rising as means to obtain information from diagnosis to molecular profiling and response assessment, without the need of a biopsied tissue sample. Radiomics works through the extraction of quantitative peculiar features of cancer from radiological data, while liquid biopsy gets the whole of the malignancy's biology from something as easy as a blood sample. Both techniques hopefully will identify diagnostic and prognostic information of breast cancer potentially reducing the need for invasive (and often difficult to perform) biopsies and favouring an approach that is as personalised as possible for each patient. Nevertheless, such techniques will not substitute tissue biopsy in the near future, and even in further times they will require the aid of other parameters to be correctly interpreted and acted upon.
Collapse
Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy.
| | | | - Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Silvia Penco
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Olga Nigro
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, 21100, Varese, VA, Italy
| | - Marta Cremonesi
- Radiation Research Unit, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Massimo Bellomi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Radiology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - Graziella Pinotti
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, 21100, Varese, VA, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| |
Collapse
|
17
|
Hong D, Xu K, Zhang L, Wan X, Guo Y. Radiomics Signature as a Predictive Factor for EGFR Mutations in Advanced Lung Adenocarcinoma. Front Oncol 2020; 10:28. [PMID: 32082997 PMCID: PMC7005234 DOI: 10.3389/fonc.2020.00028] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose: To develop and validate a radiomic signature to identify EGFR mutations in patients with advanced lung adenocarcinoma. Methods: This study involved 201 patients with advanced lung adenocarcinoma (140 in the training cohort and 61 in the validation cohort). A total of 396 features were extracted from manual segmentation based on enhanced and non-enhance CT imaging after image preprocessing. The Lasso algorithm was used for feature selection, 6 machine learning methods were used to construct radiomics models. Receiver operating characteristic (ROC) curve analysis was applied to evaluate the performance of the radiomic signature between different data and methods. A nomogram was developed using clinical factors and the radiomics signature, then it was analyzed based on its discriminatory ability and calibration. Decision curve analysis (DCA) was implemented to evaluate the clinical utility. Results: Ten features for contrast data and eleven features for non-contrast data were selected through LASSO algorithm. The performance of the radiomics signature for contrast images was better than that for non-contrast images in all of the 6 different machine learning methods. Finally, the best radiomics signature was built with logistic regression method based on enhanced CT imaging with an area under the curve (AUC) of 0.851 (95% CI, 0.750 to 0.951) in the validation cohort. A nomogram was developed using the radiomics signature and sex with a C-index of 0.908 (95%CI, 0.862 to 0.954) in the training cohort and 0.835 (95% CI, 0.825 to 0.845) in the validation cohort. It showed good discrimination and calibration (Hosmer-Lemeshow test, P = 0.621 for the training cohort and P = 0.605 for the validation cohort). Conclusion: Radiomics signature can help to distinguish between EGFR positive and wild type advanced lung adenocarcinomas.
Collapse
Affiliation(s)
- Duo Hong
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Ke Xu
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Lina Zhang
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoting Wan
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yan Guo
- GE Healthcare, Shanghai, China
| |
Collapse
|
18
|
Zeng Z, Wang ZY, Li YK, Ye DM, Zeng J, Hu JL, Chen PF, Xiao J, Zou J, Li ZH. Nuclear factor erythroid 2 (NF-E2)-related factor 2 (Nrf2) in non-small cell lung cancer. Life Sci 2020; 254:117325. [PMID: 31954159 DOI: 10.1016/j.lfs.2020.117325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/15/2022]
Abstract
Nuclear factor erythroid 2 (NF-E2)-related factor 2 (Nrf2) is a transcription factor that can regulate downstream target gene expression. Kelch-like ECH-associated protein 1 (Keap1) negatively regulates Nrf2 activation and translocation to target its 26S proteasomal degradation. It has been widely reported that the Keap1/Nrf2 pathway is associated with tumorigenesis, chemotherapy resistance and progression and development of non-small cell lung cancer (NSCLC). High expression of Nrf2 and low abundance of Keap1 contribute to the abnormalities and unrealistic treatment prognosis of NSCLC. Therefore, elucidating the role and potential mechanism of Nrf2 in NSCLC is essential for understanding tumorigenesis and for the development of strategies for effective clinical management. Here, we summarize current knowledge about the molecular structure and biological function of Nrf2, and we discuss the roles of Nrf2 in tumorigenesis, which will further provide a possible therapeutic strategy for NSCLC.
Collapse
Affiliation(s)
- Zhi Zeng
- Department of Pathology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437000, PR China
| | - Zi-Yao Wang
- Ultrasound B Imaging Division, The First Affiliated Hospital of University of South China, Hengyang, Hunan 421001, PR China
| | - Yu-Kun Li
- Hunan Province Key Laboratory of Tumor Cellular & Molecular Pathology, Cancer Research Institute, University of South China, Hengyang, Hunan 421001, PR China
| | - Dong-Mei Ye
- Hunan Province Key Laboratory of Tumor Cellular & Molecular Pathology, Cancer Research Institute, University of South China, Hengyang, Hunan 421001, PR China
| | - Juan Zeng
- Department of Anesthesiology, The Second Affiliated Hospital of University of South China, Hengyang, Hunan 421001, PR China
| | - Jia-Li Hu
- Department of Pathology, Jiujiang University Clinic College Hospital, Jiujiang, Jiangxi 332000, PR China
| | - Pi-Feng Chen
- Department of Pediatric Surgery, Jiujiang Maternal and Child Health Hospital, Jiujiang, Jiangxi 332000, PR China
| | - Jiao Xiao
- Department of Endocrinology, The Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan 421002, PR China
| | - Juan Zou
- Hunan Province Key Laboratory of Tumor Cellular & Molecular Pathology, Cancer Research Institute, University of South China, Hengyang, Hunan 421001, PR China.
| | - Zhen-Hua Li
- Department of Cardiothoracic Surgery, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning 437000, PR China.
| |
Collapse
|
19
|
Yang Y, Chen A, Ma J, Wu A, Xu F. Effects of radioactive 125I on apoptosis of HGC-27 gastric cancer cells. Oncol Lett 2019; 18:4916-4922. [PMID: 31612002 PMCID: PMC6781667 DOI: 10.3892/ol.2019.10832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/07/2019] [Indexed: 01/01/2023] Open
Abstract
Effects of radioactive 125I particles at different doses on apoptosis of HGC-27 gastric cancer cells were investigated. HGC-27 gastric cancer cell suspension was used to establish a tumor-bearing mouse model. The model was reared for approximately 3 weeks and then divided into the control group (implanted with blank particles), the low dose group (implanted with 1.48×10-7 Bq 125I particles), the medium dose group (implanted with 2.22×10-7 Bq 125I particles) and the high dose group (implanted with 2.96×10-7 Bq 125I particles) (n=15 per group). Six nude mice were randomly sacrificed to collect the tumor tissue and measure tumor volume and mass. TUNEL (TdT-mediated dUTP nick-end labeling) was used for detecting apoptosis of tumor cells, and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) for detecting the relative expression of Bax, caspase-3 and caspase-8. On the 28th day after implantation, the apoptotic rate in the low, medium and high dose groups was significantly higher than that in the control group, which in the medium and high dose groups was significantly lower than that in the low dose group (P<0.05). On the 28th day after implantation, the relative expression of Bax, caspase-3 and caspase-8 mRNA in the control group was significantly lower than that in the low, medium and high dose groups (P<0.05), which in the low dose group was significantly higher than that in the medium and high dose groups (P<0.05). 125I particles can inhibit the growth of HGC-27 gastric cancer cell transplants and promote the expression of Bax, caspase-3 and caspase-8 mRNA in the tumor tissue. Low-dose 125I particles are significantly more effective than medium- or high-dose 125I particles.
Collapse
Affiliation(s)
- Yong Yang
- Department of Oncology, Huai'an TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Huai'an, Jiangsu 223001, P.R. China
| | - Aifei Chen
- Department of Oncology, Huai'an TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Huai'an, Jiangsu 223001, P.R. China
| | - Jun Ma
- Department of Oncology, Huai'an TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Huai'an, Jiangsu 223001, P.R. China
| | - Aiping Wu
- Department of Oncology, Huai'an TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Huai'an, Jiangsu 223001, P.R. China
| | - Fazhen Xu
- Department of Gastroenterology, Lianshui County People's Hospital, Huai'an, Jiangsu 223400, P.R. China
| |
Collapse
|
20
|
Dong H, Yin H, Zhao C, Cao J, Xu W, Zhang Y. Design, Synthesis and Biological Evaluation of Novel Osimertinib-Based HDAC and EGFR Dual Inhibitors. Molecules 2019; 24:molecules24132407. [PMID: 31261881 PMCID: PMC6651501 DOI: 10.3390/molecules24132407] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
Herein a novel series of histone deacetylases (HDACs) and epidermal growth factor receptor (EGFR) dual inhibitors were designed and synthesized based on the structure of the approved EGFR inhibitor osimertinib (AZD9291). Among them, four compounds 5D, 5E, 9D and 9E exhibited more potent total HDAC inhibition than the approved HDAC inhibitor SAHA. However, these compounds only showed moderate to low inhibitory potency towards EGFR with compounds 5E and 9E possessing IC50 values against EGFRWT and EGFRT790M in the micromolar range. 3-[4,5-dimethyl-2-thiazolyl]-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay revealed the potent antiproliferative activities of compounds 5D, 5E, 9D and 9E, among which 9E was even more potent against HeLa, MDA-MB-231, MDA-MB-468, HT-29 and KG-1 cell lines than SAHA and AZD9291. Further selectivity profile of 9E showed that this compound was not active against other 13 cancer-related kinases and two epigenetic targets lysine specific demethylase 1 (LSD1) and bromodomain-containing protein 4 (BRD4). These results support further structural modification of 9E to improve its EGFR inhibitory activity, which will lead to more potent and balanced HDAC and EGFR dual inhibitors as anticancer agents.
Collapse
Affiliation(s)
- Hang Dong
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Shandong University, 44 West Wenhua Road, Ji'nan 250012, China
| | - Hao Yin
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Shandong University, 44 West Wenhua Road, Ji'nan 250012, China
| | - Chunlong Zhao
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Shandong University, 44 West Wenhua Road, Ji'nan 250012, China
| | - Jiangying Cao
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Shandong University, 44 West Wenhua Road, Ji'nan 250012, China
| | - Wenfang Xu
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Shandong University, 44 West Wenhua Road, Ji'nan 250012, China
| | - Yingjie Zhang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Shandong University, 44 West Wenhua Road, Ji'nan 250012, China.
| |
Collapse
|
21
|
Assi H, Tfayli A, Assaf N, Daya SA, Bidikian AH, Kawsarani D, Fermanian P, Zaatari G, Mahfouz R. Prevalence of T790M mutation among TKI-therapy resistant Lebanese lung cancer patients based on liquid biopsy analysis: a first report from a major tertiary care center. Mol Biol Rep 2019; 46:3671-3676. [PMID: 31147859 DOI: 10.1007/s11033-019-04797-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/03/2019] [Indexed: 01/16/2023]
Abstract
Lung adenocarcinoma patients have variable prognosis due to many factors. Detection of epidermal growth factor receptor (EGFR) activating mutations is one of the factors that implies the need for initiating a first-line EGFR tyrosine kinase inhibitor (TKI) treatment. However, T790M resistance mutation emergence during treatment accounts for most EGFR-TKI drug resistance. The traditional sample taken for T790M mutation analysis is tissue biopsy, but its numerous disadvantages have introduced liquid biopsy as a preferred method for testing. We studied the prevalence of T790M mutation among pulmonary adenocarcinoma patients in Lebanese patients based on liquid biopsy testing the circulating tumor DNA (ctDNA). We have reviewed the laboratory charts of 52 patients who developed resistance on treatment and referred to AUBMC for EGFR T790M Liquid Biopsy to analyze the mutational analysis results for EGFR T790M. In total, 82.6% of the tested lung cancer patients were positive for a specific EGFR mutation. Among these patients, a total 26.9% were positive for T790M, which is comparable to the international prevalence of this mutation. However, for those cases who developed resistance with circulating DNA showing an EGFR mutation, 50% were positive for T790M that is also comparable to the international literature. This is the first report from Lebanon to discuss the prevalence of T790M mutation using liquid biopsy among Lebanese population. An important landmark molecular epidemiology study that will be a reference to all oncologists in Lebanon and the region in assessing the potential for targeted therapy options in the country. In addition, the data will be of an asset to the building international literature related to this disease.
Collapse
Affiliation(s)
- Hazem Assi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Arafat Tfayli
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Assaf
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, PO BOX 11-0236, Beirut, Lebanon
| | - Sarah Abou Daya
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, PO BOX 11-0236, Beirut, Lebanon
| | - Aram H Bidikian
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Dima Kawsarani
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, PO BOX 11-0236, Beirut, Lebanon
| | - Puzant Fermanian
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, PO BOX 11-0236, Beirut, Lebanon
| | - Ghazi Zaatari
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, PO BOX 11-0236, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, PO BOX 11-0236, Beirut, Lebanon.
| |
Collapse
|
22
|
Quan X, Li X, Yin Z, Ren Y, Zhou B. p53/miR-30a-5p/ SOX4 feedback loop mediates cellular proliferation, apoptosis, and migration of non-small-cell lung cancer. J Cell Physiol 2019; 234:22884-22895. [PMID: 31124131 DOI: 10.1002/jcp.28851] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/31/2022]
Abstract
Many microRNAs (miRNAs) play vital roles in the tumorigenesis and development of cancers. In this study, we aimed to identify the differentially expressed miRNAs and their specific mechanisms in non-small-cell lung cancer (NSCLC). Based on data from the GSE56036 database, miR-30a-5p expression was identified to be downregulated in NSCLC. Further investigations showed that overexpression of miR-30a-5p inhibited cell proliferation, migration, and promoted apoptosis in NSCLC. Increase of miR-30a-5p level could induce the increase of Bax protein level and decrease of Bcl-2 protein level. In addition, chromatin immunoprecipitation assays showed that miR-30a-5p expression was induced by binding of p53 to the promoter of MIR30A. Bioinformatics prediction indicated that miR-30a-5p targets SOX4, and western blot analysis indicated that overexpression of the miRNA decreases the SOX4 protein expression level, which in turn regulated the level of p53. Thus, this study provides evidence for the existence of a p53/miR-30a-5p/SOX4 feedback loop, which likely plays a key role in the regulation of proliferation, apoptosis, and migration in NSCLC, highlighting a new therapeutic target.
Collapse
Affiliation(s)
- Xiaowei Quan
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.,Key Laboratory of Cancer Etiology and Prevention, China Medical University, Liaoning Provincial Department of Education, Liaoning, China
| | - Xuelian Li
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.,Key Laboratory of Cancer Etiology and Prevention, China Medical University, Liaoning Provincial Department of Education, Liaoning, China
| | - Zhihua Yin
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.,Key Laboratory of Cancer Etiology and Prevention, China Medical University, Liaoning Provincial Department of Education, Liaoning, China
| | - Yangwu Ren
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.,Key Laboratory of Cancer Etiology and Prevention, China Medical University, Liaoning Provincial Department of Education, Liaoning, China
| | - Baosen Zhou
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.,Key Laboratory of Cancer Etiology and Prevention, China Medical University, Liaoning Provincial Department of Education, Liaoning, China
| |
Collapse
|
23
|
She K, Fang S, Du W, Fan X, He J, Pan H, Huang L, He P, Huang J. SCD1 is required for EGFR-targeting cancer therapy of lung cancer via re-activation of EGFR/PI3K/AKT signals. Cancer Cell Int 2019; 19:103. [PMID: 31019378 PMCID: PMC6472070 DOI: 10.1186/s12935-019-0809-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/28/2019] [Indexed: 11/26/2022] Open
Abstract
Background Cancer cells are characterized by aberrant activation of lipid biosynthesis, producing saturated fatty acids and monounsaturated fatty acids via stearoyl-CoA desaturases (SCD) for regulating metabolic and signaling platforms. SCD1 overexpression functions as an oncogene in lung cancer and predicts a poor clinical outcome. This study aimed to investigate the role of SCD1 inhibition by EGFR inhibitor (Gefitinib)-based anti-tumor therapy of lung cancer both in vitro and in vivo. Methods CCK-8 assay was performed to determine cell viability. The SCD1 mRNA level was detected by qPCR. The protein levels were assessed by Western blotting. E-cadherin and N-cadherin levels were determined by immunofluorescence. Apoptosis detection was conducted by flow cytometry. Cell migration or invasion was evaluated by transwell assay. The tumor sizes and tumor volumes were calculated in nude mice by subcutaneous injection of A549 cells transfected with vector of pcDNA3.1-SCD1 or negative control. Expression of Ki-67 was detected by immunohistochemistry. Result SCD1 up-regulated expression was observed in lung cancer cell lines. Cells with overexpressed SCD1 had high IC50 values for Gefitinib in A549 and H1573 cell lines. Overexpression of SCD1 inhibited Gefitinib-induced apoptosis, decreased cell vitality and impaired ability of migration and invasion, while these effects were counteracted by A939572. Mechanistically, SCD1 promoted the activation of proliferation and metastasis-related EGFR/PI3K/AKT signaling, and up-regulated epithelial to mesenchymal transition (EMT) phenotype in the two cell lines, which was restored by SCD1 inhibition. Furthermore, in spite of EGFR inhibition, overexpression of SCD1 in vivo significantly promoted tumor growth by activating EGFR/PI3K/AKT signaling in tumor tissues, but A939572 treatment restricted SCD1-induced tumor progression and inhibited EMT phenotype of cancer cells in vivo. Conclusion These findings indicated that inhibition of oncogene SCD1 is required for targeting EGFR therapy in lung cancer.
Collapse
Affiliation(s)
- Kelin She
- 1Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Research Institute of Respiratory Disease, China Key Laboratory of Respiratory Disease, National Center for Clinical Trials on Respiratory Diseases, No. 151 Yanjiangxi Road, Guangzhou, Guangdong 510120 China.,The Central Hospital of Shaoyang City, Shaoyang, Hu'nan China
| | - Shenghua Fang
- 3Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Wei Du
- 4Department of Thoracic Surgery, Dongguan People's Hospital, Dongguan, Guangdong China
| | - Xingxing Fan
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, SAR China
| | - Jiaxi He
- 1Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Research Institute of Respiratory Disease, China Key Laboratory of Respiratory Disease, National Center for Clinical Trials on Respiratory Diseases, No. 151 Yanjiangxi Road, Guangzhou, Guangdong 510120 China
| | - Hui Pan
- 1Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Research Institute of Respiratory Disease, China Key Laboratory of Respiratory Disease, National Center for Clinical Trials on Respiratory Diseases, No. 151 Yanjiangxi Road, Guangzhou, Guangdong 510120 China
| | - Liyan Huang
- 1Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Research Institute of Respiratory Disease, China Key Laboratory of Respiratory Disease, National Center for Clinical Trials on Respiratory Diseases, No. 151 Yanjiangxi Road, Guangzhou, Guangdong 510120 China
| | - Ping He
- 6Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun Huang
- 1Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Research Institute of Respiratory Disease, China Key Laboratory of Respiratory Disease, National Center for Clinical Trials on Respiratory Diseases, No. 151 Yanjiangxi Road, Guangzhou, Guangdong 510120 China
| |
Collapse
|
24
|
Yang X, Dong X, Wang J, Li W, Gu Z, Gao D, Zhong N, Guan Y. Computed Tomography-Based Radiomics Signature: A Potential Indicator of Epidermal Growth Factor Receptor Mutation in Pulmonary Adenocarcinoma Appearing as a Subsolid Nodule. Oncologist 2019; 24:e1156-e1164. [PMID: 30936378 DOI: 10.1634/theoncologist.2018-0706] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/28/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Lung adenocarcinoma (LADC) with epidermal growth factor receptor (EGFR) mutation is considered a subgroup of lung cancer sensitive to EGFR-targeted tyrosine kinase inhibitors. We aimed to develop and validate a computed tomography (CT)-based radiomics signature for prediction of EGFR mutation status in LADC appearing as a subsolid nodule. MATERIALS AND METHODS A total of 467 eligible patients were divided into training and validation cohorts (n = 306 and 161, respectively). Radiomics features were extracted from unenhanced CT images by using Pyradiomics. A CT-based radiomics signature for distinguishing EGFR mutation status was constructed using the random forest (RF) method in the training cohort and then tested in the validation cohort. A combination of the radiomics signature with a clinical factors model was also constructed using the RF method. The performance of the model was evaluated using the area under the curve (AUC) of a receiver operating characteristic curve. RESULTS In this study, 64.2% (300/467) of the patients showed EGFR mutations. L858R mutation of exon 21 was the most common mutation type (185/301). We identified a CT-based radiomics signature that successfully discriminated between EGFR positive and EGFR negative in the training cohort (AUC = 0.831) and the validation cohort (AUC = 0.789). The radiomics signature combined with the clinical factors model was not superior to the simple radiomics signature in the two cohorts (p > .05). CONCLUSION As a noninvasive method, the CT-based radiomics signature can be used to predict the EGFR mutation status of LADC appearing as a subsolid nodule. IMPLICATIONS FOR PRACTICE Lung adenocarcinoma (LADC) with epidermal growth factor receptor (EGFR) mutation is considered a subgroup of lung cancer that is sensitive to EGFR-targeted tyrosine kinase inhibitors. However, some patients with inoperable subsolid LADC are unable to undergo tissue sampling by biopsy for molecular analysis in clinical practice. A computed tomography-based radiomics signature may serve as a noninvasive biomarker to predict the EGFR mutation status of subsolid LADCs when mutational profiling is not available or possible.
Collapse
Affiliation(s)
- Xinguan Yang
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, Guangzhou, People's Republic of China
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People's Republic of China
| | - Xiao Dong
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, Guangzhou, People's Republic of China
| | - Jiao Wang
- 12 Sigma Technologies, San Diego, California, USA
| | - Weiwei Li
- 12 Sigma Technologies, San Diego, California, USA
| | - Zhuoran Gu
- 12 Sigma Technologies, San Diego, California, USA
| | - Dashan Gao
- 12 Sigma Technologies, San Diego, California, USA
| | - Nanshan Zhong
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, Guangzhou, People's Republic of China
| | - Yubao Guan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Diseases, Guangzhou, People's Republic of China
| |
Collapse
|
25
|
Chen W, Hang Y, Xu W, Wu J, Chen L, Chen J, Mao Y, Song J, Song J, Wang H. BLACAT1 predicts poor prognosis and serves as oncogenic lncRNA in small-cell lung cancer. J Cell Biochem 2019; 120:2540-2546. [PMID: 30203450 DOI: 10.1002/jcb.27548] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 01/24/2023]
Abstract
Bladder cancer-associated transcript 1 (BLACAT1) is a novel identified long noncoding RNA (lncRNA) in bladder cancer, and has been suggested to function as an oncogenic lncRNA in several types of human cancer. However, its involvement in the progression of small-cell lung cancer (SCLC) remained unknown. The aim of our study was to investigate the clinical value and biological function in SCLC. In our results, BLACAT1 expression was increased in SCLC tissues and cell lines compared with paired adjacent normal tissues and bronchial epithelial cell lines, respectively. In addition, BLACAT1 high-expression was obviously associated with advanced clinical stage, large tumor size, more lymph node metastasis, present distant metastasis, and poor prognosis. Furthermore, multivariate analysis indicated that high-expression of BLACAT1 acted as an independent poor prognostic factor for overall survival in SCLC cases. The loss-of-function studies suggested that of BLACAT1 suppressed SCLC cell proliferation, migration, and invasion, and induced G0/G1 phase arrest. In conclusion, BLACAT1 is associated with the malignant status and prognosis in patients with SCLC, and functions as an oncogenic lncRNA in regulating cell proliferation and motility, suggesting BLACAT1 may act as a potential target for SCLC prevention and treatment.
Collapse
Affiliation(s)
- Weiwei Chen
- Department of Radiotherapy, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Ye Hang
- Department of Radiotherapy, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Weiwei Xu
- Department of Radiotherapy, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Jixiang Wu
- Department of Cardiothoracic Surgery, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Longyun Chen
- Department of Radiotherapy, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Jinzhong Chen
- Department of Radiotherapy, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Yixiang Mao
- Department of Radiotherapy, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Jin Song
- Department of Radiotherapy, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Jianxiang Song
- Department of Cardiothoracic Surgery, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| | - Hanhua Wang
- Department of Radiotherapy, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University, The Sixth Affiliated Hospital of Nantong University, Yancheng, Jiangsu, China
| |
Collapse
|
26
|
Zheng CC, Hu HF, Hong P, Zhang QH, Xu WW, He QY, Li B. Significance of integrin-linked kinase (ILK) in tumorigenesis and its potential implication as a biomarker and therapeutic target for human cancer. Am J Cancer Res 2019; 9:186-197. [PMID: 30755822 PMCID: PMC6356918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023] Open
Abstract
Integrin-linked kinase (ILK), which is an ankyrin repeat-containing serine/threonine protein kinase, interacts with integrin β1 and the β3 cytoplasmic domain and phosphorylates integrin β1. ILK has multiple functions in cells, such as cell-extracellular matrix interactions, cell cycle, apoptosis, cell proliferation and cell motility, which are associated with the interacting partners of ILK and downstream signaling pathways. Upregulation of ILK is frequently observed in cancer tissues compared to corresponding normal tissues. Emerging evidence has demonstrated that ILK plays an important role in biological processes associated with tumorigenesis, including cancer cell proliferation, angiogenesis, metastasis, and drug resistance. Furthermore, inhibition of ILK expression and activity using siRNA or chemical inhibitors has shown a significant suppressive effect on cancer development and progression, implicating the potential of ILK as a target for cancer treatment. In this review, we summarized the functional role of ILK in tumorigenesis, with the expectation that targeting ILK could provide more evidence for cancer therapy.
Collapse
Affiliation(s)
- Can-Can Zheng
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan UniversityGuangzhou 510632, China
| | - Hui-Fang Hu
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan UniversityGuangzhou 510632, China
| | - Pan Hong
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan UniversityGuangzhou 510632, China
| | - Qi-Hua Zhang
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan UniversityGuangzhou 510632, China
| | - Wen Wen Xu
- Institute of Biomedicine, Guangdong Provincial Key Laboratory of Bioengineering Medicine, National Engineering Research Center of Genetic Medicine, Jinan UniversityGuangzhou 510632, China
| | - Qing-Yu He
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan UniversityGuangzhou 510632, China
| | - Bin Li
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan UniversityGuangzhou 510632, China
| |
Collapse
|
27
|
Madic J, Jovelet C, Lopez J, André B, Fatien J, Miran I, Honoré A, Mezquita L, Besse B, Lacroix L, Droniou M. EGFR C797S, EGFR T790M and EGFR sensitizing mutations in non-small cell lung cancer revealed by six-color crystal digital PCR. Oncotarget 2018; 9:37393-37406. [PMID: 30647840 PMCID: PMC6324771 DOI: 10.18632/oncotarget.26446] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Detection of EGFR sensitizing and p.T790M and p.C797S resistance mutations is particularly important for non-small cell lung cancer (NSCLC) patient therapy management. Non-invasive blood-based monitoring of these mutations may pave the way to a fine-tuned personalized treatment. Digital PCR has emerged as an extremely sensitive method to detect rare mutations, however its major limitation is the number of hotspots that can be simultaneously differentiated. Methods We developed a 6-color digital PCR assay for the detection and quantification of 19 most prevalent EGFR sensitizing and resistance mutations and evaluated this assay on 82 tumor and plasma samples from NSLC patients. Results Limits of detection (LOD) for the 6-color digital PCR assay were assessed on serial dilutions of DNA standards. We found that the 6-color assay enabled detection of mutant fractions as low as 1 mutant in 1025 wild-type molecules, depending on the mutation targeted, when assayed in a background of 10 000 wild-type DNA copies. EGFR mutant allelic fraction was also measured on tumor and plasma samples by 6-color digital PCR, and displayed a highly significant correlation with next generation sequencing and 3-color digital PCR. Lastly, the 6-color digital PCR assay was performed on several longitudinal plasma samples from four patients and revealed levels of sensitizing and resistance EGFR mutations that reflected well the course of the disease. Conclusion This 6-color Crystal digital PCR assay could represent a robust solution using digital PCR for the monitoring of EGFR mutations.
Collapse
Affiliation(s)
- Jordan Madic
- Stilla Technologies, 1 Mail du Professeur Georges Mathé, Villejuif, France
| | - Cécile Jovelet
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Julien Lopez
- Stilla Technologies, 1 Mail du Professeur Georges Mathé, Villejuif, France
| | - Barbara André
- Stilla Technologies, 1 Mail du Professeur Georges Mathé, Villejuif, France
| | - Jean Fatien
- Ecole Polytechnique, Route de Saclay, Palaiseau, France
| | - Isabelle Miran
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Aurélie Honoré
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Laura Mezquita
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Benjamin Besse
- Département d'Oncologie Médicale, Gustave Roussy, Villejuif, France
| | - Ludovic Lacroix
- Plateforme de Génomique, Module de Biopathologie Moléculaire et Centre de Ressources Biologiques, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France.,Département de Biologie et Pathologie Médicales, Institut Gustave Roussy, Villejuif, France
| | - Magali Droniou
- Stilla Technologies, 1 Mail du Professeur Georges Mathé, Villejuif, France
| |
Collapse
|
28
|
Zhou C, Yuan Z, Ma W, Qi L, Mahavongtrakul A, Li Y, Li H, Gong J, Fan RR, Li J, Molmen M, Clark TA, Pavlick D, Frampton GM, Forcier B, Moore EH, Shelton DK, Cooke M, Ali SM, Miller VA, Gregg JP, Stephens PJ, Li T. Clinical utility of tumor genomic profiling in patients with high plasma circulating tumor DNA burden or metabolically active tumors. J Hematol Oncol 2018; 11:129. [PMID: 30400986 PMCID: PMC6219073 DOI: 10.1186/s13045-018-0671-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This retrospective study was undertaken to determine if the plasma circulating tumor DNA (ctDNA) level and tumor biological features in patients with advanced solid tumors affected the detection of genomic alterations (GAs) by a plasma ctDNA assay. METHOD Cell-free DNA (cfDNA) extracted from frozen plasma (N = 35) or fresh whole blood (N = 90) samples were subjected to a 62-gene hybrid capture-based next-generation sequencing assay FoundationACT. Concordance was analyzed for 51 matched FoundationACT and FoundationOne (tissue) cases. The maximum somatic allele frequency (MSAF) was used to estimate the amount of tumor fraction of cfDNA in each sample. The detection of GAs was correlated with the amount of cfDNA, MSAF, total tumor anatomic burden (dimensional sum), and total tumor metabolic burden (SUVmax sum) of the largest ten tumor lesions on PET/CT scans. RESULTS FoundationACT detected GAs in 69 of 81 (85%) cases with MSAF > 0. Forty-two of 51 (82%) cases had ≥ 1 concordance GAs matched with FoundationOne, and 22 (52%) matched to the National Comprehensive Cancer Network (NCCN)-recommended molecular targets. FoundationACT also detected 8 unique molecular targets, which changed the therapy in 7 (88%) patients who did not have tumor rebiopsy or sufficient tumor DNA for genomic profiling assay. In all samples (N = 81), GAs were detected in plasma cfDNA from cancer patients with high MSAF quantity (P = 0.0006) or high tumor metabolic burden (P = 0.0006) regardless of cfDNA quantity (P = 0.2362). CONCLUSION This study supports the utility of using plasma-based genomic assays in cancer patients with high plasma MSAF level or high tumor metabolic burden.
Collapse
Affiliation(s)
- Cathy Zhou
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Zilong Yuan
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijie Ma
- Division of Hematology and Oncology, Department of Internal Medicine University of California Davis School of Medicine, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA
| | - Lihong Qi
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Angelique Mahavongtrakul
- Division of Hematology and Oncology, Department of Internal Medicine University of California Davis School of Medicine, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA
| | - Ying Li
- Division of Hematology and Oncology, Department of Internal Medicine University of California Davis School of Medicine, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA
- Currently Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | - Hong Li
- Division of Hematology and Oncology, Department of Internal Medicine University of California Davis School of Medicine, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA
- Currently Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Jay Gong
- Division of Hematology and Oncology, Department of Internal Medicine University of California Davis School of Medicine, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA
| | - Reggie R Fan
- Division of Hematology and Oncology, Department of Internal Medicine University of California Davis School of Medicine, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA
| | - Jin Li
- Department of Public Health Sciences, University of California, Davis, CA, USA
- Currently Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | | | | | | | | | | | - Elizabeth H Moore
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - David K Shelton
- Department of Radiology, University of California Davis School of Medicine, Sacramento, CA, USA
| | | | - Siraj M Ali
- Foundation Medicine, Inc., Cambridge, MA, USA
| | | | - Jeffrey P Gregg
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
- Department of Pathology and Laboratory Medicine and Genomic Shared Resource, University of California Davis School of Medicine, Sacramento, CA, USA
| | | | - Tianhong Li
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
- Division of Hematology and Oncology, Department of Internal Medicine University of California Davis School of Medicine, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA.
- Department of Internal Medicine, Veterans Affairs Northern California Health Care System, Mather, CA, USA.
| |
Collapse
|
29
|
Tian Y, Zhao J, Ren P, Wang B, Zhao C, Shi C, Wei B, Ma J, Guo Y. Different subtypes of EGFR exon19 mutation can affect prognosis of patients with non-small cell lung adenocarcinoma. PLoS One 2018; 13:e0201682. [PMID: 30383772 PMCID: PMC6211626 DOI: 10.1371/journal.pone.0201682] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/07/2018] [Indexed: 12/22/2022] Open
Abstract
Aims In this study, we determined whether different subtypes of epidermal growth factor receptor (EGFR) exon19 mutation are associated with the therapeutic effect of EGFR-tyrosine kinase inhibitors (TKIs) on advanced non-small cell lung adenocarcinoma. Methods A total of 122 patients with stage III or IV non-small cell lung adenocarcinoma were retrospectively reviewed. Clinical characteristics of these patients, including progression-free survival (PFS) outcome for EGFR-TKI treatment, were analyzed. Results According to the mutation pattern, we classified the in-frame deletions detected on EGFR Exon19 into three different types: codon deletion (CD), with a deletion of one or more original codons; codon substitution and skipping (CSS), with a deletion of one or two nucleotides but the residues could be translated into a new amino acid without changing following amino acid sequence; CD or CSS plus single nucleotide variant (SNV) (CD/CSS+SNV), exclude CD or CSS, there’s another SNV nearby the deletion region. The clinical characteristics of three groups were analyzed and as a result, no significant difference was found. By comparing the average number of missing bases and amino acids of the three mutation subtypes, it could be discovered that the number of missing bases and amino acids of the three mutation subtypes is diverse, and group CSS> group CD> group CD/CSS+SNV. Finally, survival analysis was performed between three groups of patients. The median PFS of group CD, group CSS and group CD/CSS+SNV was 11 months, 9 months and 14 months respectively. There was a distinct difference in the PFS between group CSS and group CD/CSS+SNV (P = 0.035<0.05), and the PFS of group CD/CSS+SNV was longer. Conclusions Different mutation subtypes of EGFR exon19 can predict the therapeutic effect of EGFR-TKIs on advanced non-small cell lung adenocarcinoma.
Collapse
Affiliation(s)
- Yingying Tian
- Department of Molecular Pathology, Henan Cancer Hospital, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou, China
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Jiuzhou Zhao
- Department of Molecular Pathology, Henan Cancer Hospital, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Pengfei Ren
- Department of Molecular Pathology, Henan Cancer Hospital, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Bo Wang
- Department of Molecular Pathology, Henan Cancer Hospital, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Chengzhi Zhao
- Department of Molecular Pathology, Henan Cancer Hospital, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Chao Shi
- Department of Molecular Pathology, Henan Cancer Hospital, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Bing Wei
- Department of Molecular Pathology, Henan Cancer Hospital, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Jie Ma
- Department of Molecular Pathology, Henan Cancer Hospital, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Yongjun Guo
- Department of Molecular Pathology, Henan Cancer Hospital, The Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou, China
- * E-mail:
| |
Collapse
|
30
|
Jia Y, Li X, Zhao C, Jiang T, Zhao S, Zhang L, Liu X, Shi J, Qiao M, Luo J, Liu S, Han R, Chen X, Zhou C. Impact of serum vascular endothelial growth factor and interleukin-6 on treatment response to epidermal growth factor receptor tyrosine kinase inhibitors in patients with non-small-cell lung cancer. Lung Cancer 2018; 125:22-28. [DOI: 10.1016/j.lungcan.2018.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/14/2018] [Accepted: 08/29/2018] [Indexed: 12/22/2022]
|
31
|
Poh ME, Liam CK, Rajadurai P, Chai CS. Epithelial-to-mesenchymal transition (EMT) causing acquired resistance to afatinib in a patient with epidermal growth factor receptor ( EGFR)-mutant lung adenocarcinoma. J Thorac Dis 2018; 10:E560-E563. [PMID: 30174934 DOI: 10.21037/jtd.2018.06.122] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report the first case of epithelial-to-mesenchymal transition (EMT) as the cause of acquired resistance to the second-generation EGFR-tyrosine kinase inhibitor (TKI), afatinib in a patient with advanced non-small cell lung cancer (NSCLC) harboring a sensitizing EGFR mutation. Patients with EGFR-mutant NSCLC inevitably develop acquired resistance while on EGFR-TKI treatment. EMT which renders cancer cells more invasive and migratory is one of the mechanisms of acquired resistance to EGFR-TKIs and correlates with a poor prognosis. Possible therapeutic strategies in patients with EMT include blocking M2 muscarinic receptor signalling, targeting EMT with histone deacetylase inhibitors such as entinostat and MEK-inhibitors such as selumetinib, inhibition of microRNAs, immunotherapy and inhibiting fibroblast growth factor receptor-1.
Collapse
Affiliation(s)
- Mau-Ern Poh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| |
Collapse
|
32
|
Wang XH, Cui YX, Wang ZM, Liu J. Down-regulation of FOXR2 inhibits non-small cell lung cancer cell proliferation and invasion through the Wnt/β-catenin signaling pathway. Biochem Biophys Res Commun 2018; 500:229-235. [PMID: 29634928 DOI: 10.1016/j.bbrc.2018.04.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 04/06/2018] [Indexed: 02/08/2023]
Abstract
Forkhead box R2 (FOXR2), a new member of the FOX family, is an important player in a wide range of cellular processes such as proliferation, migration, differentiation and apoptosis. Recently, FOXR2 has been reported to be implicated in cancer development. However, the biological functions of FOXR2 in non-small cell lung cancer (NSCLC) remain unclear. In this study, we investigated the specific role of FOXR2 in NSCLC. The results showed that down-regulation of FOXR2 significantly inhibited NSCLC cell proliferation and invasion in vitro and suppressed NSCLC cell growth and metastasis in vivo. In addition, the decrease in FOXR2 expression markedly reduced the protein levels of β-catenin, cyclinD1 and c-Myc and hence inactivated the Wnt/β-catenin pathway in NSCLC cells. Taken together, we concluded that FOXR2 might be considered as a promising therapeutic target for NSCLC treatment.
Collapse
Affiliation(s)
- Xin-Hua Wang
- Department of Clinical Laboratory, Linyi City Central Hospital, Linyi, 276400, China
| | - Yan-Xiang Cui
- Department of Clinical Laboratory, Traditional Chinese Medical Hospital of Huangdao District, Qingdao, 266000, China
| | - Zhen-Min Wang
- Department of Clinical Laboratory, Linyi City Central Hospital, Linyi, 276400, China
| | - Jian Liu
- Department of Clinical Laboratory, Linyi City Central Hospital, Linyi, 276400, China.
| |
Collapse
|
33
|
Hu F, Mao X, Zhang Y, Zheng X, Gu P, Wang H, Zhang X. Reliability of using circulating tumor cells for detecting epidermal growth factor receptor mutation status in advanced non-small-cell lung cancer patients: a meta-analysis and systematic review. Onco Targets Ther 2018; 11:1373-1384. [PMID: 29559795 PMCID: PMC5857158 DOI: 10.2147/ott.s158479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the clinical value of circulating tumor cells as a surrogate to detect epidermal growth factor receptor mutation in advanced non-small-cell lung cancer (NSCLC) patients. Methods We searched the electronic databases, and all articles meeting predetermined selection criteria were included in this study. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated. The evaluation indexes of the diagnostic performance were the summary receiver operating characteristic curve and area under the summary receiver operating characteristic curve. Results Eight eligible publications with 255 advanced NSCLC patients were included in this meta-analysis. Taking tumor tissues as reference, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of circulating tumor cells for detecting the epidermal growth factor receptor mutation status were found to be 0.82 (95% confidence interval [CI]: 0.50–0.95), 0.95 (95% CI: 0.24–1.00), 16.81 (95% CI: 0.33–848.62), 0.19 (95% CI: 0.06–0.64), and 86.81 (95% CI: 1.22–6,154.15), respectively. The area under the summary receiver operating characteristic curve was 0.92 (95% CI: 0.89–0.94). The subgroup analysis showed that the factors of blood volume, histological type, EGFR-tyrosine kinase inhibitor therapy, and circulating tumor cell and tissue test methods for EGFR accounted for the significant difference of the pooled specificity. No significant difference was found between the pooled sensitivity of the subgroup. Conclusion Our meta-analysis confirmed that circulating tumor cells are a good surrogate for detecting epidermal growth factor receptor mutation when tumor tissue is unavailable in advanced NSCLC patients, but more precise techniques are needed to improve their clinical efficiency.
Collapse
Affiliation(s)
- Fang Hu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaowei Mao
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yujun Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaoxuan Zheng
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Ping Gu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Huimin Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xueyan Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| |
Collapse
|
34
|
Nishikawa S, Kimura H, Koba H, Yoneda T, Watanabe S, Sakai T, Hara J, Sone T, Kasahara K, Nakao S. Selective gene amplification to detect the T790M mutation in plasma from patients with advanced non-small cell lung cancer (NSCLC) who have developed epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) resistance. J Thorac Dis 2018; 10:1431-1439. [PMID: 29707292 DOI: 10.21037/jtd.2018.01.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The epidermal growth factor receptor (EGFR) T790M mutation is associated with resistance to EGFR tyrosine kinase inhibitors (EGFR-TKIs) in non-small cell lung cancer (NSCLC). However, tissues for the genotyping of the EGFR T790M mutation can be difficult to obtain in a clinical setting. The aims of this study were to evaluate a blood-based, non-invasive approach to detecting the EGFR T790M mutation in advanced NSCLC patients using the PointMan™ EGFR DNA enrichment kit, which is a novel method for the selective amplification of specific genotype sequences. Methods Blood samples were collected from NSCLC patients who had activating EGFR mutations and who were resistant to EGFR-TKI treatment. Using cell-free DNA (cfDNA) from plasma, EGFR T790M mutations were amplified using the PointMan™ enrichment kit, and all the reaction products were confirmed using direct sequencing. The concentrations of plasma DNA were then determined using quantitative real-time PCR. Results Nineteen patients were enrolled, and 12 patients (63.2%) were found to contain EGFR T790M mutations in their cfDNA, as detected by the kit. T790M mutations were detected in tumor tissues in 12 cases, and 11 of these cases (91.7%) also exhibited the T790M mutation in cfDNA samples. The concentrations of cfDNA were similar between patients with the T790M mutation and those without the mutation. Conclusions The PointMan™ kit provides a useful method for determining the EGFR T790M mutation status in cfDNA.
Collapse
Affiliation(s)
- Shingo Nishikawa
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hideharu Kimura
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hayato Koba
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Taro Yoneda
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Satoshi Watanabe
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Tamami Sakai
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Johsuke Hara
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Takashi Sone
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kazuo Kasahara
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Shinji Nakao
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| |
Collapse
|
35
|
Zhou X, Wen W, Shan X, Zhu W, Xu J, Guo R, Cheng W, Wang F, Qi LW, Chen Y, Huang Z, Wang T, Zhu D, Liu P, Shu Y. A six-microRNA panel in plasma was identified as a potential biomarker for lung adenocarcinoma diagnosis. Oncotarget 2018; 8:6513-6525. [PMID: 28036284 PMCID: PMC5351649 DOI: 10.18632/oncotarget.14311] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/13/2016] [Indexed: 12/21/2022] Open
Abstract
Differently expressed microRNAs (miRNAs) in the plasma of lung adenocarcinoma (LA) patients might serve as biomarkers for LA detection. MiRNA expression profiling was performed using Exiqon panels followed by the verification (30 LA VS. 10 healthy controls (HCs)) with quantitative reverse transcription polymerase chain reaction (qRT-PCR) in the screening phase. Identified miRNAs were confirmed through training (42 LA VS. 32 HCs) and testing stages (66 LA VS. 62 HCs) by using qRT-PCR based absolute quantification methods. A total of six up-regulated plasma miRNAs (miR-19b-3p, miR-21-5p, miR-221-3p, miR-409-3p, miR-425-5p and miR-584-5p) were identified. The six-miRNA panel could discriminate LA patients from HCs with areas under the receiver operating characteristic curve of 0.72, 0.74 and 0.84 for the training, testing and the external validation stage (33 LA VS. 30 HCs), respectively. All the miRNAs identified except miR-584-5p were significantly up-regulated in LA tissues. MiR-19-3p, miR-21-5p, miR-409-3p and miR-425-5p showed high expression in arterial plasma with borderline significance. Additionally, miR-19-3p, miR-21-5p and miR-221-3p were significantly up-regulated in exosomes extracted from LA peripheral plasma samples. In conclusion, we identified a six-miRNA panel in peripheral plasma which might give assistance to the detection of LA at least for Asian population to a certain extent.
Collapse
Affiliation(s)
- Xin Zhou
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Wei Wen
- Department of Thoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Xia Shan
- Department of Respiration, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 210000, PR China
| | - Wei Zhu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Jing Xu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Renhua Guo
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Wenfang Cheng
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Fang Wang
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University,Nanjing 210029, PR China
| | - Lian-Wen Qi
- State Key Laboratory of Natural Medicines and Department of Pharmacognosy, China Pharmaceutical University, Nanjing, 210009, China
| | - Yan Chen
- Department of Emergency, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Zebo Huang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Tongshan Wang
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China
| | - Danxia Zhu
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Ping Liu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China.,Cancer Center of Nanjing Medical University, Nanjing 210029, China
| | - Yongqian Shu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, PR China.,Cancer Center of Nanjing Medical University, Nanjing 210029, China
| |
Collapse
|
36
|
Wu S, Zhu L, Tu L, Chen S, Huang H, Zhang J, Ma S, Zhang S. AZD9291 Increases Sensitivity to Radiation in PC-9-IR Cells by Delaying DNA Damage Repair after Irradiation and Inducing Apoptosis. Radiat Res 2018; 189:283-291. [PMID: 29332537 DOI: 10.1667/rr14682.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AZD9291 is a novel, irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), which is administered orally. It has been proven effective in non-small cell lung cancer (NSCLC) patients, with both EGFR-sensitizing and EGFR T790M mutations in preclinical models. However, the potential therapeutic effects of AZD9291 combined with other modalities, including ionizing radiation, are not well understood. The presence of AZD9291 significantly increases the cell-killing effects of radiation in PC-9-IR cells with a secondary EGFR mutation (T790M), which was developed from NSCLC PC-9 cells (human lung adenocarcinoma cell with EGFR 19 exon 15 bp deletion) after chronic exposure to increasing doses of gefitinib, and in H1975 cells (human lung adenocarcinoma cell with EGFR exon 20 T790M mutation de novo), but not in PC-9 cells or in H460 cells (human lung adenocarcinoma cell with wild-type EGFR). In PC-9-IR cells, AZD9291 remarkably decreases phosphorylation levels of EGFR, extracellular regulated protein kinase (ERK), and protein kinase B (AKT). AZD9291 increases sensitivity to radiation in PC-9-IR cells by delaying deoxyribonucleic acid (DNA) damage repair after irradiation and inducing apoptosis, and enhances tumor growth inhibition when combined with radiation in PC-9-IR xenografts. Our findings suggest a potential therapeutic effect of AZD9291 as a radiation sensitizer in lung cancer cells with an acquired EGFR T790M mutation, providing a rationale for a clinical trial using the combination of AZD9291 and radiation in NSCLCs harboring acquired T790M mutation.
Collapse
Affiliation(s)
- Shenghai Wu
- a Department of Laboratory, Hangzhou First People's Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lucheng Zhu
- b Department of Oncology, Hangzhou First People's Hospital of Nanjing Medical University, Hangzhou, China
| | - Linglan Tu
- c Centre of Molecular Medicine, Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Sumei Chen
- d Department of Oncology, Hangzhou Cancer Hospital, Hangzhou, China; and
| | - Haixiu Huang
- b Department of Oncology, Hangzhou First People's Hospital of Nanjing Medical University, Hangzhou, China
| | - Jingjing Zhang
- b Department of Oncology, Hangzhou First People's Hospital of Nanjing Medical University, Hangzhou, China
| | - Shenglin Ma
- e Department of Oncology, Hangzhou First People's Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shirong Zhang
- b Department of Oncology, Hangzhou First People's Hospital of Nanjing Medical University, Hangzhou, China
| |
Collapse
|
37
|
Ai B, Liu H, Huang Y, Peng P. Circulating cell-free DNA as a prognostic and predictive biomarker in non-small cell lung cancer. Oncotarget 2018; 7:44583-44595. [PMID: 27323821 PMCID: PMC5190120 DOI: 10.18632/oncotarget.10069] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/29/2016] [Indexed: 01/15/2023] Open
Abstract
Circulating cell-free DNA (cfDNA), which can be obtained from plasma or serum by non-invasive procedures, has showed great potential to predict treatment response and survival for cancer patients. Several studies have assessed the prognostic and predictive value of cfDNA in non-small cell lung cancer (NSCLC). However, these studies were often small and reported varying results. To address this issue, a meta-analysis was carried out. A total of 22 studies involving 2518 patients were subjected to the final analysis. Our results indicated that NSCLC patients with higher cfDNA concentration had shorter median progression-free survival (PFS) and overall survival (OS) time. In addition, high levels of cfDNA were significantly associated with poor PFS (hazard ratio or HR, 1.32; 95% CI, 1.02-1.71) and OS (HR, 1.64; 95% CI, 1.26-2.15). With respect to tumor specific mutations, we failed to reveal significant differences for PFS (HR, 1.30; 95% CI, 0.66-2.56) and OS (HR, 1.05; 95% CI, 0.49-2.25) when NSCLC patients were grouped according to KRAS genotype detected in cfDNA. However, NSCLC patients which harbored EGFR activating mutation in cfDNA had a greater chance of response to EGFR-TKIs (odds ratio or OR, 1.96; 95% CI, 1.59-2.42). No significant publication bias was detected in this study. In conclusion, cfDNA could act as a prognostic and predictive biomarker for patients with NSCLC.
Collapse
Affiliation(s)
- Bo Ai
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - Huiquan Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - Yu Huang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - Ping Peng
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| |
Collapse
|
38
|
Wang CG, Zeng DX, Huang JA, Jiang JH. Effective assessment of low times MET amplification in pleural effusion after epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) acquired resistance: Cases report. Medicine (Baltimore) 2018; 97:e9021. [PMID: 29505507 PMCID: PMC5943108 DOI: 10.1097/md.0000000000009021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE The mechanism of the first-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) acquired resistance included T790M mutation, cellular-mesenchymal to epithelial transition factor (MET) or EGFR amplification, PIK3CA mutation, and transformation to small cell lung cancer. MET amplification accounted for only about 5% of the resistance cases. PATIENTS CONCERNS Few report detected MET amplification in pleural effusion. Here, we reported 2 lung adenocarcinoma cases with MET amplification in pleural effusion rapidly responded to crizotinib after EGFR-TKIs acquired resistance. DIAGNOSES Biopsy via bronchoscopy, next-generation sequencing (NGS) in pleural effusion. INTERVENTIONS EGFR-TKIs (Icotinib), MET inhibitor crizotinib. OUTCOMES After a progression-free survival of 9 months and 23months, respectively, both cases progressed accompanying with pleural effusion. Results of NGS in pleural effusion showed MET amplification (2-3 times) in both cases. The 2 patients were treated with a MET inhibitor crizotinib and rapidly responded. CONCLUSION MET amplification in pleural effusion could predict a perfect response to crizotinib after EGFR-TKIs acquired resistance, even only a low times gene amplification.
Collapse
|
39
|
Chen Y, Guo W, Fan J, Chen Y, Zhang X, Chen X, Luo P. The applications of liquid biopsy in resistance surveillance of anaplastic lymphoma kinase inhibitor. Cancer Manag Res 2017; 9:801-811. [PMID: 29263703 PMCID: PMC5724713 DOI: 10.2147/cmar.s151235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
With the clinical promotion of precision medicine and individualized medical care, molecular targeted medicine has been used to treat non-small cell lung cancer (NSCLC) patients and proved to be significantly effective. Anaplastic lymphoma kinase (ALK) inhibitor is one of the most important specific therapeutic agents for patients with ALK-positive NSCLC. It can extend the survival of patients. However, resistance to the ALK inhibitor inevitably develops in the application process. So, the real-time resistance surveillance is particularly important, and liquid biopsy is one of the most potential inspection methods. Circulating tumor cells, circulating free tumor DNA and exosome in body fluid are used as the main detection biomarkers to reflect the occurrence of resistance in real time through sequencing or counting and then to guide the follow-up treatment.
Collapse
Affiliation(s)
- Yating Chen
- Department of Respiratory, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Wenjie Guo
- Department of Respiratory, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Junsheng Fan
- Department of Respiratory, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Yuqing Chen
- Department of Respiratory, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiaoli Zhang
- Department of Respiratory, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xin Chen
- Department of Respiratory, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Peng Luo
- Department of Respiratory, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
40
|
Wu K, Yu S, Liu Q, Bai X, Zheng X, Wu K. The clinical significance of CXCL5 in non-small cell lung cancer. Onco Targets Ther 2017; 10:5561-5573. [PMID: 29200871 PMCID: PMC5702175 DOI: 10.2147/ott.s148772] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
As a CXC-type chemokine, ENA78/CXCL5 is an important attractant for granulocytes by binding to its receptor CXCR2. Recent studies proved that CXCL5/CXCR2 axis plays an oncogenic role in many human cancers. However, the exact clinical significance of CXCL5 in lung cancer has not been well defined. Here, we found that the serum protein expression of CXCL5 was significantly increased in non-small cell lung cancer (NSCLC) compared with that in healthy volunteers. Immunohistochemistry staining revealed that CXCL5 protein was higher in various lung cancer tissues compared with normal tissues. Moreover, CXCL5 expression correlated with histological grade, tumor size, and TNM stage in NSCLC. Elevated CXCL5 protein abundance predicted poor overall survival in adenocarcinoma patients. Further meta-analysis demonstrated that CXCL5 mRNA expression was also positively associated with tumor stage, lymph node metastasis, and worse survival. Kaplan–Meier plot analyses indicated high CXCL5 was associated with short overall survival and progression-free survival. Together, these results indicated that CXCL5 may be a potential biomarker for NSCLC.
Collapse
Affiliation(s)
- Kongju Wu
- Medical School of Pingdingshan University, Pingdingshan, Henan
| | - Shengnan Yu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Qian Liu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xianguang Bai
- Medical School of Pingdingshan University, Pingdingshan, Henan
| | - Xinhua Zheng
- Medical School of Pingdingshan University, Pingdingshan, Henan
| | - Kongming Wu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| |
Collapse
|
41
|
Pi C, Zhang MF, Peng XX, Zhang YC, Xu CR, Zhou Q. Liquid biopsy in non-small cell lung cancer: a key role in the future of personalized medicine? Expert Rev Mol Diagn 2017; 17:1089-1096. [PMID: 29057681 DOI: 10.1080/14737159.2017.1395701] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Liquid biopsies, especially the analysis of circulating tumor DNA (ctDNA), as a novel and non-invasive method for the diagnosis and monitoring of non-small cell lung cancer (NSCLC) have already been implemented in clinical settings. The majority of ctDNA is released from apoptotic or necrotic tumor cells, thus reflecting the genetic profile of a tumor. Numerous studies have reported a high concordance in mutation profiles derived from liquid biopsy and tissue biopsy, especially in driver genes. Liquid biopsy could overcome the clonal heterogeneity of tumour biopsy, as it provides a single snapshot of a tumour tissue. Moreover, non-invasiveness is the biggest advantage for liquid biopsy, and the procedure can be repeatedly performed during the treatment for the purpose of monitoring. Therefore, ctDNA could act as a potential complementary method for tissue biopsies in diagnosis, prognostic, treatment response and resistance. Areas covered: This review summarizes the recent advancements in liquid biopsy with a focus on NSCLC, including its applications and technologies associated with assessing ctDNA. The authors conclude the review by discussing the challenges associated with liquid biopsy. Expert commentary: The analysis of ctDNA represents a promising method for liquid biopsy, which will be a novel and potentially complementary method in diagnosis, treatment and prognostic in NSCLC at all stages.
Collapse
Affiliation(s)
- Can Pi
- a Guangdong Lung Cancer Institute , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangdong , PR China.,b The Second School of Clinical Medicine , Southern Medical University , Guangdong , PR China
| | - Ming-Feng Zhang
- a Guangdong Lung Cancer Institute , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangdong , PR China.,b The Second School of Clinical Medicine , Southern Medical University , Guangdong , PR China
| | - Xiao-Xiao Peng
- a Guangdong Lung Cancer Institute , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangdong , PR China.,c School of Medicine , South China University of Technology , Guangzhou , China
| | - Yi-Chen Zhang
- a Guangdong Lung Cancer Institute , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangdong , PR China.,b The Second School of Clinical Medicine , Southern Medical University , Guangdong , PR China
| | - Chong-Rui Xu
- a Guangdong Lung Cancer Institute , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangdong , PR China
| | - Qing Zhou
- a Guangdong Lung Cancer Institute , Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangdong , PR China.,b The Second School of Clinical Medicine , Southern Medical University , Guangdong , PR China
| |
Collapse
|
42
|
Zhang YC, Zhou Q, Wu YL. The emerging roles of NGS-based liquid biopsy in non-small cell lung cancer. J Hematol Oncol 2017; 10:167. [PMID: 29061113 PMCID: PMC5654124 DOI: 10.1186/s13045-017-0536-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/17/2017] [Indexed: 12/25/2022] Open
Abstract
The treatment paradigm of non-small cell lung cancer (NSCLC) has evolved into oncogene-directed precision medicine. Identifying actionable genomic alterations is the initial step towards precision medicine. An important scientific progress in molecular profiling of NSCLC over the past decade is the shift from the traditional piecemeal fashion to massively parallel sequencing with the use of next-generation sequencing (NGS). Another technical advance is the development of liquid biopsy with great potential in providing a dynamic and comprehensive genomic profiling of NSCLC in a minimally invasive manner. The integration of NGS with liquid biopsy has been demonstrated to play emerging roles in genomic profiling of NSCLC by increasing evidences. This review summarized the potential applications of NGS-based liquid biopsy in the diagnosis and treatment of NSCLC including identifying actionable genomic alterations, tracking spatiotemporal tumor evolution, dynamically monitoring response and resistance to targeted therapies, and diagnostic value in early-stage NSCLC, and discussed emerging challenges to overcome in order to facilitate clinical translation in future.
Collapse
Affiliation(s)
- Yi-Chen Zhang
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, People's Republic of China.
| |
Collapse
|
43
|
Fassunke J, Ihle MA, Lenze D, Lehmann A, Hummel M, Vollbrecht C, Penzel R, Volckmar AL, Stenzinger A, Endris V, Jung A, Lehmann U, Zeugner S, Baretton G, Kreipe H, Schirmacher P, Kirchner T, Dietel M, Büttner R, Merkelbach-Bruse S. EGFR T790M mutation testing of non-small cell lung cancer tissue and blood samples artificially spiked with circulating cell-free tumor DNA: results of a round robin trial. Virchows Arch 2017; 471:509-520. [DOI: 10.1007/s00428-017-2226-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/22/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023]
|
44
|
MicroRNA-330-3p promotes cell invasion and metastasis in non-small cell lung cancer through GRIA3 by activating MAPK/ERK signaling pathway. J Hematol Oncol 2017. [PMID: 28629431 PMCID: PMC5477161 DOI: 10.1186/s13045-017-0493-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Brain metastasis (BM) is associated with poor prognosis in patients with non-small cell lung cancer (NSCLC). Recent studies demonstrated that microRNA-330-3p (miR-330-3p) was involved in NSCLC brain metastasis (BM). However, the exact parts played by miR-330-3p in BM of NSCLC remain unknown. Discovery and development of biomarkers and elucidation of the mechanism underlying BM in NSCLC is critical for effective prophylactic interventions. Here, we evaluated the expression and biological effects of miR-330-3p in NSCLC cells and explored the underlying mechanism of miR-330-3p in promoting cell migration and invasion in NSCLC. Methods Stable over-expression and knockdown of miR-330-3p in NSCLC cells was constructed with lentivirus. Expression levels of miR-330-3p in NSCLC cells were quantified by quantitive real-time PCR (qRT-PCR). The effects of miR-330-3p on NSCLC cells were investigated using assays of cell viability, migration, invasion, cell cycle, apoptosis, western blotting, immunohistochemical, and immunofluorescence staining. A xenograft nude mouse model and in situ brain metastasis model were used to observe tumor growth and brain metastasis. The potential target of miR-330-3p in NSCLC cells was explored using the luciferase reporter assay, qRT-PCR, and western blotting. The miR-330-3p targets were identified using bioinformatics analysis and verified by luciferase reporter assay. The correlation between GRIA3 and DNA methyltransferase (DNMT) 1 and DNMT3A was tested by RT-PCR, western blotting, and co-immunoprecipitation (IP). Results miR-330-3p was significantly up-regulated in NSCLC cell lines. MTT assay, transwell migration, and invasion assays showed that miR-330-3p promoted the growth, migration, and invasion of NSCLC cells in vitro and induced tumor growth and metastasis in vivo. Luciferase reporter assays showed that GRIA3 was a target of miR-330-3p. qRT-PCR and western blotting exhibited that miR-330-3p promoted the growth, invasion, and migration of NSCLC cells by activating mitogen-activated protein kinase (MAPK)/extracellular-regulated protein kinases (ERK) signaling pathway. Furthermore, miR-330-3p up-regulated the total DNA methylation in NSCLC cells, and co-IP-demonstrated GRIA3 was directly related with DNMT1 and DNMT3A. Conclusions miR-330-3p promoted the progression of NSCLC and might be a potential target for the further research of NSCLC brain metastasis. Electronic supplementary material The online version of this article (doi:10.1186/s13045-017-0493-0) contains supplementary material, which is available to authorized users.
Collapse
|
45
|
Li X, Liu Y, Shi W, Xu H, Hu H, Dong Z, Zhu G, Sun Y, Liu B, Gao H, Tang C, Liu X. Droplet digital PCR improved the EGFR mutation diagnosis with pleural fluid samples in non-small-cell lung cancer patients. Clin Chim Acta 2017; 471:177-184. [PMID: 28602964 DOI: 10.1016/j.cca.2017.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/01/2017] [Accepted: 06/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Droplet digital polymerase chain reaction (ddPCR) is a promising method for analyzing minor amounts of nucleic acid. However, its application has not been reported in pleural fluid, which is an ideal sample source for epidermal growth factor receptor (EGFR) mutation analysis in non-small-cell lung cancer (NSCLC) patients. METHODS The extracted DNA from supernatants of pleural fluid was selected from our sample bank and re-analyzed by our previously established ddPCR assay. The results were compared with the former outcomes detected by direct sequencing or the amplification-refractory mutation system (ARMS). RESULTS A total of 95 samples were selected, and 64 and 31 of them had been performed with direct sequencing and ARMS tests, respectively. The EGFR mutation detection rate of ddPCR was significantly elevated, compared with both direct sequencing (75.4% vs. 43.8%, P<0.0001) and ARMS (61.3% vs. 38.7%, P=0.016). Compared with ARMS, Fisher's exact test showed that EGFR-positive patients who were redefined by ddPCR had higher objective response rates (ORRs): 57.9% vs. 16.7%, P=0.032. Compared with direct sequencing results, Kaplan-Meier curves demonstrated that EGFR-positive patients who were redefined by ddPCR had longer progression-free survival (PFS): 8.0 vs. 2.0months, P=0.0001. CONCLUSION We have demonstrated the clinical value of ddPCR in pleural fluid samples. The experience obtained from the present study is practical and favorable for the proper application of this new assay.
Collapse
Affiliation(s)
- Xiaoyan Li
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie, Beijing, China
| | - Yi Liu
- Translational Medicine Center, Laboratory of Oncology, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie, Beijing, China.
| | - Weiwei Shi
- Department of Oncology, the General Hospital of PLA, No. 28 Fuxing Road, Beijing, China
| | - Huayan Xu
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie, Beijing, China
| | - Haixu Hu
- Translational Medicine Center, Laboratory of Oncology, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie, Beijing, China
| | | | | | - Yun Sun
- Translational Science, Asia & Emerging Markets Innovative Medicine, AstraZeneca R&D, Shanghai, China
| | - Bing Liu
- Translational Medicine Center, Laboratory of Oncology, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie, Beijing, China
| | - Hongjun Gao
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie, Beijing, China
| | - Chuanhao Tang
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie, Beijing, China; Department of Oncology, Peking University International Hospital, Zhongguancun Life Science Park, Beijing, China.
| | - Xiaoqing Liu
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie, Beijing, China.
| |
Collapse
|
46
|
Efimova O, Berse B, Denhalter DW, DuVall SL, Filipski KK, Icardi M, Kelley MJ, Lynch JA. Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration. BMC Med Inform Decis Mak 2017; 17:71. [PMID: 28558785 PMCID: PMC5450357 DOI: 10.1186/s12911-017-0475-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current clinical guidelines recommend epidermal growth factor receptor (EGFR) mutational testing in patients with metastatic non-small cell lung cancer (NSCLC) to predict the benefit of the tyrosine kinase inhibitor erlotinib as first-line treatment. Proteomic (VeriStrat) testing is recommended for patients with EGFR negative or unknown status when erlotinib is being considered. Departure from this clinical algorithm can increase costs and may result in worse outcomes. We examined EGFR and proteomic testing among patients with NSCLC within the Department of Veterans Affairs (VA). We explored adherence to guidelines and the impact of test results on treatment decisions and cost of care. METHODS Proteomic and EGFR test results from 2013 to 2015 were merged with VA electronic health records and pharmacy data. Chart reviews were conducted. Cases were categorized based on the appropriateness of testing and treatment. RESULTS Of the 69 patients with NSCLC who underwent proteomic testing, 33 (48%) were EGFR-negative and 36 (52%) did not have documented EGFR status. We analyzed 138 clinical decisions surrounding EGFR/proteomic testing and erlotinib treatment. Most decisions (105, or 76%) were concordant with clinical practice guidelines. However, for 24 (17%) decisions documentation of testing or justification of treatment was inadequate, and 9 (7%) decisions represented clear departures from guidelines. CONCLUSION EGFR testing, the least expensive clinical intervention analyzed in this study, was significantly underutilized or undocumented. The records of more than half of the patients lacked information on EGFR status. Our analysis illustrated several clinical scenarios where the timing of proteomic testing and erlotinib diverged from the recommended algorithm, resulting in excessive costs of care with no documented improvements in health outcomes.
Collapse
Affiliation(s)
- Olga Efimova
- Department of Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
| | - Brygida Berse
- Boston University School of Medicine, 715 Albany Street, Boston, MA, 02118, USA.,Veterans Healthcare Administration Bedford, 200 Springs Rd, Bedford, MA, 01730, USA.,RTI International, 307 Waverley Oaks Rd, Waltham, MA, 02452, USA
| | - Daniel W Denhalter
- Department of Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.,University of Utah, 30 2000 E, Salt Lake City, UT, 84112, USA
| | - Scott L DuVall
- Department of Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.,University of Utah, 30 2000 E, Salt Lake City, UT, 84112, USA
| | - Kelly K Filipski
- National Cancer Institute, NIH, 9609 Medical Center Dr, Rockville, MD, 20850, USA
| | - Michael Icardi
- University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Iowa City VA Medical Center, 601 Highway 6 West, Iowa City, IA, 52246-2208, USA
| | - Michael J Kelley
- Durham VA Medical Center, 508 Fulton St, Durham, NC, 27705, USA.,Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA
| | - Julie A Lynch
- Department of Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA. .,RTI International, 307 Waverley Oaks Rd, Waltham, MA, 02452, USA. .,University of Utah, 30 2000 E, Salt Lake City, UT, 84112, USA. .,University of Massachusetts College of Nursing & Health Sciences, 100 Morrissey Blvd, Boston, MA, 02125, USA.
| |
Collapse
|
47
|
Liu D, Wang S, Bindeman W. Clinical applications of PD-L1 bioassays for cancer immunotherapy. J Hematol Oncol 2017; 10:110. [PMID: 28514966 PMCID: PMC5436438 DOI: 10.1186/s13045-017-0479-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/09/2017] [Indexed: 12/11/2022] Open
Abstract
Programmed death ligand 1 (PD-L1) has emerged as a biomarker that can help to predict responses to immunotherapies targeted against PD-L1 and its receptor (PD-1). Companion tests for evaluating PD-L1 expression as a biomarker of response have been developed for many cancer immunotherapy agents. These assays use a variety of detection platforms at different levels (protein, mRNA), employ diverse biopsy and surgical samples, and have disparate positivity cutoff points and scoring systems, all of which complicate the standardization of clinical decision-making. This review summarizes the current understanding and ongoing investigations regarding PD-L1 expression as a potential biomarker for clinical outcomes of anti-PD-1/PD-L1 immunotherapy.
Collapse
Affiliation(s)
- Delong Liu
- Department of Oncology, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Shuhang Wang
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing, China
| | - Wendy Bindeman
- Department of Immunology, Mayo Clinic, Rochester, MN, 55905, USA
| |
Collapse
|
48
|
Saito S, Espinoza-Mercado F, Liu H, Sata N, Cui X, Soukiasian HJ. Current status of research and treatment for non-small cell lung cancer in never-smoking females. Cancer Biol Ther 2017; 18:359-368. [PMID: 28494184 DOI: 10.1080/15384047.2017.1323580] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide with over 1 million deaths each year. The overall prognosis of lung cancer patients remains unsatisfactory, with a 5-year overall survival rate of less than 15%. Although most lung cancers are a result of smoking, approximately 25% of lung cancer cases worldwide are not attributable to tobacco use. Notably, more than half of the lung cancer cases in women occur in non-smokers. Among non-small-cell lung cancer (NSCLC) cases, cigarette-smokers have a greater association with squamous cell carcinoma than adenocarcinoma, which is more common in non-smokers. These findings imply that specific molecular and pathological features may associate with lung adenocarcinoma arising in non-smoker female patients. Over the past decade, whole genome sequencing and other '-omics' technologies led to the discovery of pathogenic mutations that drive tumor cell formation. These technological developments may enable tailored patient treatments throughout the course of their disease, potentially leading to improved patient outcomes. Some clinical and laboratory studies have shown success outcomes using epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKI) in patients with EGFR mutations and ALK rearrangements, respectively. In fact, these 2 mutations are predominantly present in female non-smokers with adenocarcinoma. Immunotherapy has also recently emerged as a major therapeutic modality in NSCLC. In this review, we summarize the current understanding of NSCLC biology and new therapeutic molecular targets, focusing on the pathogenesis of non-smoker female NSCLC patients.
Collapse
Affiliation(s)
- Shin Saito
- a Department of Surgery , Jichi Medical University , Yakushiji, Shimotsuke-City , Tochigi , Japan
| | - Fernando Espinoza-Mercado
- b Department of Surgery, Division of Thoracic Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Hui Liu
- c College of Medical Laboratory Techniques, Tianjin Medical University , Tianjin , China
| | - Naohiro Sata
- a Department of Surgery , Jichi Medical University , Yakushiji, Shimotsuke-City , Tochigi , Japan
| | - Xiaojiang Cui
- d Department of Surgery , Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Harmik J Soukiasian
- b Department of Surgery, Division of Thoracic Surgery , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| |
Collapse
|
49
|
Yang M, Topaloglu U, Petty WJ, Pagni M, Foley KL, Grant SC, Robinson M, Bitting RL, Thomas A, Alistar AT, Desnoyers RJ, Goodman M, Albright C, Porosnicu M, Vatca M, Qasem SA, DeYoung B, Kytola V, Nykter M, Chen K, Levine EA, Staren ED, D’Agostino RB, Petro RM, Blackstock W, Powell BL, Abraham E, Pasche B, Zhang W. Circulating mutational portrait of cancer: manifestation of aggressive clonal events in both early and late stages. J Hematol Oncol 2017; 10:100. [PMID: 28472989 PMCID: PMC5418716 DOI: 10.1186/s13045-017-0468-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/20/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Solid tumors residing in tissues and organs leave footprints in circulation through circulating tumor cells (CTCs) and circulating tumor DNAs (ctDNA). Characterization of the ctDNA portraits and comparison with tumor DNA mutational portraits may reveal clinically actionable information on solid tumors that is traditionally achieved through more invasive approaches. METHODS We isolated ctDNAs from plasma of patients of 103 lung cancer and 74 other solid tumors of different tissue origins. Deep sequencing using the Guardant360 test was performed to identify mutations in 73 clinically actionable genes, and the results were associated with clinical characteristics of the patient. The mutation profiles of 37 lung cancer cases with paired ctDNA and tumor genomic DNA sequencing were used to evaluate clonal representation of tumor in circulation. Five lung cancer cases with longitudinal ctDNA sampling were monitored for cancer progression or response to treatments. RESULTS Mutations in TP53, EGFR, and KRAS genes are most prevalent in our cohort. Mutation rates of ctDNA are similar in early (I and II) and late stage (III and IV) cancers. Mutation in DNA repair genes BRCA1, BRCA2, and ATM are found in 18.1% (32/177) of cases. Patients with higher mutation rates had significantly higher mortality rates. Lung cancer of never smokers exhibited significantly higher ctDNA mutation rates as well as higher EGFR and ERBB2 mutations than ever smokers. Comparative analysis of ctDNA and tumor DNA mutation data from the same patients showed that key driver mutations could be detected in plasma even when they were present at a minor clonal population in the tumor. Mutations of key genes found in the tumor tissue could remain in circulation even after frontline radiotherapy and chemotherapy suggesting these mutations represented resistance mechanisms. Longitudinal sampling of five lung cancer cases showed distinct changes in ctDNA mutation portraits that are consistent with cancer progression or response to EGFR drug treatment. CONCLUSIONS This study demonstrates that ctDNA mutation rates in the key tumor-associated genes are clinical parameters relevant to smoking status and mortality. Mutations in ctDNA may serve as an early detection tool for cancer. This study quantitatively confirms the hypothesis that ctDNAs in circulation is the result of dissemination of aggressive tumor clones and survival of resistant clones. This study supports the use of ctDNA profiling as a less-invasive approach to monitor cancer progression and selection of appropriate drugs during cancer evolution.
Collapse
Affiliation(s)
- Meng Yang
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, 300060 Tianjin, China
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Umit Topaloglu
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - W. Jeffrey Petty
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Matthew Pagni
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Kristie L. Foley
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Stefan C. Grant
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Mac Robinson
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Rhonda L. Bitting
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Alexandra Thomas
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Angela T. Alistar
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Rodwige J. Desnoyers
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Michael Goodman
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Carol Albright
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Mercedes Porosnicu
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Mihaela Vatca
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Shadi A. Qasem
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Laboratory Medicine and Pathology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Barry DeYoung
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Laboratory Medicine and Pathology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Ville Kytola
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Institute for Biosciences and Medical Technology, University of Tampere, 33520 Tampere, Finland
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Matti Nykter
- Institute for Biosciences and Medical Technology, University of Tampere, 33520 Tampere, Finland
| | - Kexin Chen
- Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, 300060 Tianjin, China
| | - Edward A. Levine
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of General Surgery-Section of Surgical Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Edgar D. Staren
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of General Surgery-Section of Surgical Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Ralph B. D’Agostino
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Robin M. Petro
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - William Blackstock
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Bayard L. Powell
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Edward Abraham
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Boris Pasche
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Department of Internal Medicine-Section of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Wei Zhang
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157 USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Cancer Genomics and Precision Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157 USA
| |
Collapse
|
50
|
Tian Y, Liu Q, Wu K, Chu Q, Chen Y, Wu K. Meta-analysis comparing the efficacy of nedaplatin-based regimens between squamous cell and non-squamous cell lung cancers. Oncotarget 2017; 8:62330-62338. [PMID: 28977948 PMCID: PMC5617508 DOI: 10.18632/oncotarget.17499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 04/17/2017] [Indexed: 11/25/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) consists of several subtypes, including adenocarcinoma, squamous cell lung cancer, large cell lung cancer, and other rarer types. Platinum-based regimens are currently the standard for treatment of advanced NSCLC. Nedaplatin is reportedly associated with a high response rate in squamous cell lung cancer. However, the relevant studies are small and mainly descriptive. The purpose of this meta-analysis was therefore to compare the efficacy of nedaplatin in squamous cell lung cancer with that in non-squamous cell lung cancer. Studies concerning nedaplatin-based regimens in NSCLC patients were retrieved from PubMed and EMBASE. The response rate for nedaplatin-based regimens in squamous cell lung cancer (ORR: 55.6%, 95% CI: 52.5-58.7%) was higher (OR: 1.55, 95% CI: 1.17-2.05) than that for non-squamous cell lung cancer (ORR: 34.4%, 95% CI: 32.3-36.5%). In addition, Taxane plus nedaplatin produced a longer overall and progress-free survival than CPT-11 or gemcitabine plus nedaplatin. To verify these findings, future well-controlled clinical studies will be needed.
Collapse
Affiliation(s)
- Yijun Tian
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Qian Liu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Kongju Wu
- Medical School of Pingdingshan University, Pingdingshan, P.R. China
| | - Qian Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Yuan Chen
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Kongming Wu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| |
Collapse
|