EGFR and K-Ras mutations in women with lung adenocarcinoma: implications for treatment strategy definition

Pre-treatment Neutrophil-to-Lymphocyte Ratio significantly affects progression free survival in positive EGFR mutation advanced lung adenocarcinoma with EGFR-TKI treatment in Bali, Indonesia

Introduction: Today, recommendations about initial Response Evaluation Criteria in Solid Tumor (RECIST) and its frequency still vary, while early diagnosis of progression affects patient's prognosis and subsequent treatment options. Methods: This study aims to examine Progression Free Survival (PFS) of positive EGFR mutations advanced lung adenocarcinoma receiving Tyrosine Kinase Inhibitor (TKI) and factors that influence it. This was an observational study with retrospective cohort design conducted at Prof IGNG Ngoerah Hospital from January to December 2021. Sample was data from Epidermal Growth Factor Receptor (EGFR) positive mutation advanced lung adenocarcinoma patient who were treated with EGFR-TKI at Prof IGNG Ngoerah Hospital, Denpasar, Bali from January 2017 to February 2021. Total sample was 63. Results: Median PFS was 12 months (95% CI 10.28-13.71) and minimum PFS was 3 months. In univariate analysis, Hazard Ration (HR) of older age, smoker, distant metastasis, brain metastasis, increased Neutrophil-to-Lymphocyte Ration (NLR), and exon 21 mutation to shorter PFS was 0.99 (95% CI 0.95-1.02); 1.03 (95% CI 0.57-1.85); 1.45 (95% CI 0.85-2.49); 2.14 (95% CI 1.02-4.49); 1.08 (95% CI 1.03-1.13); and 1.21 (95% CI 0.67-2.18). Multivariate analysis showed only increased NLR affected PFS significantly with HR 1.06 (95% CI 1.007-1.13). Conclusion: Median PFS of EGFR positive mutation advanced lung adenocarcinoma patients who received TKI was 12 months and minimum value was 3 months. Increased age, smoking, distant metastases, brain metastases, and exon 21 mutations were not associated with PFS. NLR significantly affected PFS.

Computed tomography and clinical features associated with epidermal growth factor receptor mutation status in stage I/II lung adenocarcinoma

Background

The relationship between epidermal growth factor receptor (EGFR) gene mutation status, preoperative computed tomography (CT), and clinical features in patients with small peripheral lung adenocarcinoma (<3 cm) was investigated.

Methods

We included 209 patients who underwent surgical resection for stage I or II lung adenocarcinoma at Nanjing General Hospital between December 2010 and May 2016. 171 cases of patients underwent a pretreatment chest CT. Eleven different CT descriptors were assessed. Multiple logistic regression analyses were performed to identify independent risk factors for the prediction of EGFR mutation. Receiver operating characteristic analysis was used to evaluate the performance of the logistic regression model.

Results

EGFR mutation was determined in 126 patients (60.3%) and appeared more frequently in women (P = 0.025), never‐smokers (P < 0.001), and patients with a carcinoembryonic antigen level <2.6 ng/ml (P = 0.045). Papillary predominant adenocarcinomas (P = 0.014), intermediate/low pathologic grade tumors (P = 0.003), tumors in the upper lobe (P = 0.028), and showing ground‐glass opacity (GGO) or mixed GGO on CT (P = 0.039) also more frequently harbored EGFR mutations. GGO on CT, acinar or papillary predominant adenocarcinoma, and non‐smoker were identified in multivariable analyses as significantly independent risk factors. The multiple logistic regression model showed high predictive power for identifying EGFR mutations. The CT features were similar between the L858R and 19 deletion mutations.

Conclusions

Combined CT and clinical features may be helpful for determining the presence of EGFR mutations in patients with small peripheral lung adenocarcinoma, particularly in patients where mutational profiling is not available or possible.

Reproducibility of the EGFR immunohistochemistry scores for tumor samples from patients with advanced non-small cell lung cancer

Epidermal growth factor receptor (EGFR) is overexpressed in >60% of non-small cell lung cancer (NSCLC) cases. In combination with radiotherapy or chemotherapy, first-line treatments with antibodies against EGFR, including cetuximab and necitumumab, have demonstrated benefits by increasing overall survival (OS), particularly in patients who overexpress EGFR. The present study evaluated the interobserver agreement among three senior pathologists, who were blinded to the clinical outcomes and assessed tumor samples from 85 patients with NSCLC using the H-score method. EGFR immunohistochemistry was performed using a qualitative immunohistochemical kit. The reported (mean ± standard deviation) H-scores from each pathologist were 111±102, 127±103 and 128.53±104.03. The patients with average H-scores ≥1, ≥100, ≥200 and between 250-300 were 85.9, 54.1, 28.2 and 12.9, respectively. Patients who had an average H-score >100 had a shorter OS time compared with those with lower scores. Furthermore, patients with EGFR mutations who were treated with EGFR-tyrosine kinase inhibitors (TKIs) and had an average H-score >100 had a longer OS time compared with those with an average H-score <100. The interobserver concordance for the total H-scores were 0.982, 0.980 and 0.988, and for a positive H-score ≥200, the interobserver concordance was 0.773, 0.710 and 0.675, respectively. The determination of EGFR expression by the H-score method is highly reproducible among pathologists and is a prognostic factor associated with a poor OS in all patients. Additionally, the results of the present study suggest that patients with EGFR mutations that are treated with EGFR-TKIs and present with a high H-score have a longer OS time.

[Value of Immunohistochemical Methods in Detecting EML4-ALK Fusion Mutations: A Meta-analysis]

背景与目的

棘皮动物微管相关蛋白4(echinoderm microtubule-associated protein 4, EML4)与间变性淋巴瘤激酶(anaplastic lymphatic tumor kinase, ALK)重排形成的融合基因存在于大约5%的非小细胞肺癌(non-small cell lung cancer, NSCLC)患者中，是继表皮生长因子受体(epidermal growth factor receptor, EGFR)、K-ras之后又一新型靶点基因。有数据显示携带EML4-ALK融合基因的NSCLC患者接受ALK抑制剂治疗后，其疾病控制的有效率可达80%，探索和建立能够准确快速检测出NSCLC患者EML4-ALK融合突变的方法，是筛选出适合治疗的优势人群的关键。本研究分析免疫组化法(immunohistochemistry, IHC)检测EML4-ALK融合基因突变的敏感度与特异度，评价该方法准确性及临床应用价值，从而为肺癌患者"个体化分子治疗"提供依据。

方法

通过Pubmed数据库检索所有符合检索条件的文献，末次检索日期为2015年2月25日，根据纳入和排除标准进行进一步筛选，采用诊断试验meta分析方法，比较特异性抗体免疫组化法与"金标准"荧光原位杂交(fluorescence in situ hybridization, FISH)法的敏感度、特异度，以明确特异性抗体IHC作为筛查方法的可行性。

结果

本文11篇文献纳入meta分析，EML4-ALK融合基因免疫组化累计病例3, 234例，诊断比值比(diagnositic odds ratio, DOR)为1, 135.00(95%CI: 337.10-3, 821.46)；综合受试者工作特征曲线(summary receiver operating characteristic curve, SROC)下面积为0.992, 3(SEAUC=0.003, 2)，Q^*统计量为0.964, 4 (SEQ^*=0.008, 7)。

结论

特异性抗体IHC法检测EML4-ALK融合基因的方法可行，具有高特异度和敏感度，可作为一种简单快速的筛查方法，具有临床应用价值。

Hyperphosphorylation of ribosomal protein S6 predicts unfavorable clinical survival in non-small cell lung cancer

Background

Ribosomal protein S6 (rpS6), a component of the 40S ribosomal subunit, is involved in multiple cellular bioactivities. However, its clinicopathological significance in non-small cell lung cancer (NSCLC) is poorly understood.

Methods

Expressions of total rpS6 (t-rpS6) and phosphorylated rpS6 (Ser235/236, p-rpS6) were detected immunohistochemically in 316 NSCLC tissues and 82 adjacent controls, followed by statistical evaluation of the relationship between proteins expressions and patients’ survivals to identify their prognostic values. Cytological experiments with overexpressing or silencing rpS6 by lentivirus in human bronchial epithelial (HBE) and NSCLC cell lines were performed to explore potential mechanisms by which rpS6 affects the clinical development of NSCLC. Additionally, specific RNA interference for Akt1, Akt2, Akt3, Akt inhibitor and subsequent cellular bioactivity tests were employed as well to investigate the upstream regulation of rpS6.

Results

Positive rates of t-rpS6 and p-rpS6 were both significantly increased in NSCLC tissues, compared with controls (82.91 vs 62.20 % for t-rpS6; 52.22 vs 21.95 % for p-rpS6; both P < 0.001). However, only hyperphosphorylation of rpS6, expressed as either elevated p-rpS6 alone or the ratio of p-rpS6 to t-rpS6 (p-rpS6/t-rpS6) no less than 0.67, was greatly associated with the unfavorable survival of NSCLC patients, especially for cases at stage I (all P < 0.001). The independent adverse prognostic value of hyperphosphorylated rpS6 was confirmed by multivariate Cox regression analysis (hazard ratios for elevated p-rpS6 alone and p-rpS6/t-rpS6 no less than 0.67 were 2.403, 4.311 respectively, both P < 0.001). Overexpression or knockdown of rpS6, along with parallel alterations of p-rpS6, led to increased or decreased cells proliferations respectively, which were dependent on redistributions of cell cycles (all P < 0.05). Cells migration and invasion also changed with rpS6 interference (all P < 0.05). Furthermore, upstream overexpression or knockdown of Akt2 or Akt2 phosphorylation inhibition, rather than Akt1 or Akt3, resulted in striking hyperphosphorylation or dephosphorylation of mTOR, p70S6K and rpS6 (all P < 0.05), without any change in total proteins expressions. Further tests showed markedly accompanied variation of cells proliferation, cell cycle distribution and invasion (all P < 0.05).

Conclusion

Hyperphosphorylation of rpS6, probably regulated by the Akt2/mTOR/p70S6K signaling pathway, is closely relevant to the progression of NSCLC and it might be served as a promising therapeutic target for NSCLC treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/s13046-015-0239-1) contains supplementary material, which is available to authorized users.

Down-regulation of let-7 microRNA increased K-ras expression in lung damage induced by radon

Radon has long been recognized as a human carcinogen leading to lung cancer, but the underlying mechanisms remain obscure. Recent studies have shown that the let-7 microRNA and K-ras play an important role in the development of various cancers. However, the exact role between let-7 and K-ras in radon induced lung damage has not been explored so far. In the present study, wistar rats and human bronchial epithelial (HBE) cells were long-term exposed to radon, and then alterations in histological pathology of rat lung tissue, ROS, antioxidant enzymes activities and clonogenic formation in HBE cells, as well as changes in let-7 and K-ras expression were determined to observe the adverse effects induced by radon. The results showed that long-term exposure to radon produced severe lung damage in rats, significantly increased ROS production and clonogenic formation ratios and decreased SOD activities in HBE cells. In addition, an obvious down-regulation of let-7 and up-regulation of K-ras were also revealed both in mRNA and in protein level in lung tissue of rats and HBE cells exposed to radon. Furthermore, a significant down-regulation of K-ras was then confirmed in both let-7b-3p and let-7a-2-3p transfected HBE cells. Taken together, the present results propose an involvement of let-7 microRNA and K-ras in radon induced lung damage both in vivo and in vitro, which may thus be of potential value in early diagnosis and therapy of radon-induced lung tumorgenesis.

Predictive value of K-ras and PIK3CA in non-small cell lung cancer patients treated with EGFR-TKIs: a systemic review and meta-analysis

Objective

A meta-analysis was performed to augment the insufficient data on the impact of mutative EGFR downstream phosphatidylinositol-3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways on the clinical efficiency of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment of non-small cell lung cancer (NSCLC) patients.

Methods

Network databases were explored in April, 2015. Papers that investigated the clinical outcomes of NSCLC patients treated with EGFR-TKIs according to the status of K-ras and/or PIK3CA gene mutation were included. A quantitative meta-analysis was conducted using standard statistical methods. Odds ratios (ORs) for objective response rate (ORR) and hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) were calculated.

Results

Mutation in K-ras significantly predicted poor ORR [OR =0.22; 95% confidence interval (CI), 0.13-0.35], shorter PFS (HR =1.56; 95% CI, 1.27-1.92), and shorter OS (HR =1.59; 95% CI, 1.33-1.91) in NSCLC patients treated with EGFR-TKIs. Mutant PIK3CA significantly predicted shorter OS (HR =1.83; 95% CI, 1.05-3.20), showed poor ORR (OR =0.70; 95% CI, 0.22-2.18), and shorter PFS (HR =1.79; 95% CI, 0.91-3.53) in NSCLC patients treated with EGFR-TKIs.

Conclusion

K-ras mutation adversely affected the clinical response and survival of NSCLC patients treated with EGFR-TKIs. PIK3CA mutation showed similar trends. In addition to EGFR, adding K-ras and PIK3CA as routine gene biomarkers in clinical genetic analysis is valuable to optimize the effectiveness of EGFR-TKI regimens and identify optimal patients who will benefit from EGFR-TKI treatment.

Carfilzomib demonstrates broad anti-tumor activity in pre-clinical non-small cell and small cell lung cancer models

BACKGROUND

Carfilzomib (CFZ) is a proteasome inhibitor that selectively and irreversibly binds to its target and has been approved in the US for treatment of relapsed and refractory multiple myeloma. Phase 1B studies of CFZ reported signals of clinical activity in solid tumors, including small cell lung cancer (SCLC). The aim of this study was to investigate the activity of CFZ in lung cancer models.

METHODS

A diverse panel of human lung cancer cell lines and a SHP77 small cell lung cancer xenograft model were used to investigate the anti-tumor activity of CFZ.

RESULTS

CFZ treatment inhibited both the constitutive proteasome and the immunoproteasome in lung cancer cell lines. CFZ had marked anti-proliferative activity in A549, H1993, H520, H460, and H1299 non-small cell lung cancer (NSCLC) cell lines, with IC50 values after 96 hour exposure from <1.0 nM to 36 nM. CFZ had more variable effects in the SHP77 and DMS114 SCLC cell lines, with IC50 values at 96 hours from <1 nM to 203 nM. Western blot analysis of CFZ-treated H1993 and SHP77 cells showed cleavage of poly ADP ribose polymerase (PARP) and caspase-3, indicative of apoptosis, and induction of microtubule-associated protein-1 light chain-3B (LC3B), indicative of autophagy. In SHP77 flank xenograft tumors, CFZ monotherapy inhibited tumor growth and prolonged survival, while no additive or synergistic anti-tumor efficacy was observed for CFZ + cisplatin (CDDP).

CONCLUSIONS

CFZ demonstrated anti-proliferative activity in lung cancer cell lines in vitro and resulted in a significant survival advantage in mice with SHP77 SCLC xenografts, supporting further pre-clinical and clinical investigations of CFZ in NSCLC and SCLC.

RASAL2 promotes lung cancer metastasis through epithelial-mesenchymal transition

It was reported that genetically-engineered RASAL2 knockout mice are prone to development of several sporadic tumor, including lung adenocarcinoma. However, a causative relationship between RASAL2 deficiency and lung adenocarcinoma development still remains unknown. In the present study, RASAL2 level was determined in patients with lung adenocarcinoma and control subjects in an attempt to explore its potential clinical diagnostic and prognostic value. Low RASAL2 expression levels were found in 71% (37 of 52) of lung adenocarcinoma, which were correlated with lymph node metastasis in lung adenocarcinoma. Moreover, Low RASAL2 expression levels were correlated with reduced overall survival (OS) in lung adenocarcinoma. We find that inactivation of RASAL2 promotes lung cancer cell migration through the induction of epithelial mesenchymal transition (EMT) and promoted lung metastasis in nude mice. Our results suggest that the down-regulation of RASAL2 promotes metastatic progression of lung adenocarcinoma, hence it could serve as a potential target for the development of lung cancer therapies.