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Outcome of Patients With Resected Early-Stage Non-small Cell Lung Cancer and EGFR Mutations: Results From the IFCT Biomarkers France Study. Clin Lung Cancer 2023; 24:1-10. [PMID: 36180314 DOI: 10.1016/j.cllc.2022.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Molecular profile of resected stage I-II non-small cell lung cancer (NSCLC) would help refine prognosis and personalize induction or adjuvant strategies. We sought to report the molecular profile of resected stage I-II NSCLC and analyzed the impact of epidermal growth factor receptor (EGFR) mutations on outcomes in a Western population. PATIENTS AND METHODS Surgical cases were identified from Biomarkers France study, a nationwide prospective study including NSCLC patients screened for EGFR, HER2, KRAS, BRAF, PIK3CA, ALK alterations from 2012 to 2013. Among surgical patients, clinical charts of the largest centers were reviewed in order to analyze the prognostic impact of EGFR mutations. RESULTS In the BMF database (n = 17.636), surgical patients (n = 854) were characterized by a higher proportion of EGFR mutations than nonsurgical patients (12.9% vs. 10.2%, P = .025), while the other molecular alterations did not differ. The proportion of EGFR mutations was 27% in women undergoing surgery. In the study group (n = 293; EGFR wild type, n = 235; usual mutation, n = 50; rare mutation, n = 8), after a median follow-up of 67 months, 215 patients (74.4%) had not relapsed. No difference was found between EGFR-mutant and EGFR-wt tumors regarding recurrence site, disease-free survival, and overall survival. The 5-year disease-free survival and overall survival after surgical resection of stage I-II EGFR-mutated tumors were 65% and 75%, respectively. CONCLUSION In resected stage I to II NSCLC, EGFR mutations were found in 12.9% of cases, associated with a 5-year overall survival of 75%, with no impact on recurrence site, disease-free survival, and overall survival.
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Raina N, Khan S, Soundhararajan R, Shahid M, Srinivasan H, Islam A. Understanding the nano colloid-protein interaction in crowded milieu. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.119794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ghareeb WM, Draz E, Madbouly K, Hussein AH, Faisal M, Elkashef W, Emile MH, Edelhamre M, Kim SH, Emile SH. Deep Neural Network for the Prediction of KRAS Genotype in Rectal Cancer. J Am Coll Surg 2022; 235:482-493. [PMID: 35972169 DOI: 10.1097/xcs.0000000000000277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND KRAS mutation can alter the treatment plan after resection of colorectal cancer. Despite its importance, the KRAS status of several patients remains unchecked because of the high cost and limited resources. This study developed a deep neural network (DNN) to predict the KRAS genotype using hematoxylin and eosin (H&E)-stained histopathological images. STUDY DESIGN Three DNNs were created (KRAS_Mob, KRAS_Shuff, and KRAS_Ince) using the structural backbone of the MobileNet, ShuffleNet, and Inception networks, respectively. The Cancer Genome Atlas was screened to extract 49,684 image tiles that were used for deep learning and internal validation. An independent cohort of 43,032 image tiles was used for external validation. The performance was compared with humans, and a virtual cost-saving analysis was done. RESULTS The KRAS_Mob network (area under the receiver operating curve [AUC] 0.8, 95% CI 0.71 to 0.89) was the best-performing model for predicting the KRAS genotype, followed by the KRAS_Shuff (AUC 0.73, 95% CI 0.62 to 0.84) and KRAS_Ince (AUC 0.71, 95% CI 0.6 to 0.82) networks. Combing the KRAS_Mob and KRAS_Shuff networks as a double prediction approach showed improved performance. KRAS_Mob network accuracy surpassed that of two independent pathologists (AUC 0.79 [95% CI 0.64 to 0.93], 0.51 [95% CI 0.34 to 0.69], and 0.51 (95% CI 0.34 to 0.69]; p < 0.001 for all comparisons). CONCLUSION The DNN has the potential to predict the KRAS genotype directly from H&E-stained histopathological slide images. As an algorithmic screening method to prioritize patients for laboratory confirmation, such a model might possibly reduce the number of patients screened, resulting in significant test-related time and economic savings.
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Affiliation(s)
- Waleed M Ghareeb
- From the Gastrointestinal Surgery Unit (Ghareeb, Hussein), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
- Laboratory of Applied Artificial Intelligence in Medical Disciplines (Ghareeb, Draz, Hussein), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
| | - Eman Draz
- Laboratory of Applied Artificial Intelligence in Medical Disciplines (Ghareeb, Draz, Hussein), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
- Department of Surgery, and Department of Human Anatomy and Embryology (Draz), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
- Key Laboratory of Stem Cell Engineering and Regenerative Medicine, Department of Human Anatomy and Histoembryology, Fujian Medical University, 350122, Fujian Province, Fuzhou City, P.R. China (Draz)
| | - Khaled Madbouly
- Colorectal Surgery Unit, Alexandria University, Faculty of Medicine, Alexandria, Egypt (Madbouly)
| | - Ahmed H Hussein
- From the Gastrointestinal Surgery Unit (Ghareeb, Hussein), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
- Laboratory of Applied Artificial Intelligence in Medical Disciplines (Ghareeb, Draz, Hussein), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
| | - Mohammed Faisal
- Surgical Oncology Unit (Faisal), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
- General Surgery Department, Sahlgrenska University Hospital, Gothenburg, Sweden (Faisal)
| | - Wagdi Elkashef
- Department of Pathology, Faculty of Medicine (Elkashef, M Hany Emile), Mansoura University, Mansoura, Egypt
| | - Mona Hany Emile
- Department of Pathology, Faculty of Medicine (Elkashef, M Hany Emile), Mansoura University, Mansoura, Egypt
| | - Marcus Edelhamre
- the Department of Surgery, Helsingborg Hospital, University of Lund, 25187 Helsingborg, Sweden (Edelhamre)
| | - Seon Hahn Kim
- From the Gastrointestinal Surgery Unit (Ghareeb, Hussein), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
- Laboratory of Applied Artificial Intelligence in Medical Disciplines (Ghareeb, Draz, Hussein), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
- Surgical Oncology Unit (Faisal), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
- Department of Surgery, and Department of Human Anatomy and Embryology (Draz), Faculty of Medicine, Suez Canal University Hospitals, Ismaila, Egypt
- Key Laboratory of Stem Cell Engineering and Regenerative Medicine, Department of Human Anatomy and Histoembryology, Fujian Medical University, 350122, Fujian Province, Fuzhou City, P.R. China (Draz)
- Colorectal Surgery Unit, Alexandria University, Faculty of Medicine, Alexandria, Egypt (Madbouly)
- General Surgery Department, Sahlgrenska University Hospital, Gothenburg, Sweden (Faisal)
- Department of Pathology, Faculty of Medicine (Elkashef, M Hany Emile), Mansoura University, Mansoura, Egypt
- Colorectal Surgery Unit, General Surgery Department (S Hany Emile), Mansoura University, Mansoura, Egypt
- the Department of Surgery, Helsingborg Hospital, University of Lund, 25187 Helsingborg, Sweden (Edelhamre)
| | - Sameh Hany Emile
- Colorectal Surgery Unit, General Surgery Department (S Hany Emile), Mansoura University, Mansoura, Egypt
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Next-Generation Sequencing Targeted Panel in Routine Care for Metastatic Colon Cancers. Cancers (Basel) 2021; 13:cancers13225750. [PMID: 34830904 PMCID: PMC8616114 DOI: 10.3390/cancers13225750] [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: 10/07/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The place of Next-Generation-Sequencing (NGS) targeted panel in routine practice in digestive oncology should be addressed. The aim of our retrospective study was to assess the results and impact of NGS panel for metastatic colorectal cancer (mCRC) patients. In total, 210 patients with mCRC were included. Based on our findings, a major advantage of the NGS panel over single gene techniques is that, beyond the classical hotspots, it allows for an exhaustive search for molecular abnormalities in routinely recommended genes. In addition, routine NGS is a way to detect amplifications associated with resistance to anti-EGFR therapies and low-prevalence mutations in actionable genes, providing patients with the opportunity to access innovative targeted therapies. In conclusion, NGS targeted panel in mCRC is feasible in routine practice. Nevertheless, panels need to be regularly updated and in-depth studies are needed to better analyse the prognostic factors. Abstract In digestive oncology, the clinical impact of targeted next-generation sequencing (NGS) in routine practice should be addressed. In this work, we studied the impact of a 22-gene NGS amplicon-based panel with Ion Torrent Proton Sequencing, prospectively performed in routine practice. We analyzed the results of extended molecular testing, beyond RAS and BRAF, in metastatic colorectal cancer (mCRC) patients in a single-center, retrospective, observational study of consecutive mCRC patients followed up at the Georges Pompidou European Hospital between January 2016 and December 2018. Overall, 210 patients with mCRC were included. Median follow-up was 25.4 months (IQR: 14.9–39.5). The three most frequently mutated genes were: TP53 (63%), KRAS (41%) and PIK3CA (19%). A positive association was found between overall survival and performance status (PS) ≥ 2 (HR: 4.91 (1.84–13.1); p = 0.001) and differentiation (HR: 4.70 (1.51–14.6); p = 0.007) in multivariate analysis. The NGS panel enabled five patients to access a targeted therapy not currently registered for CRC. In conclusion, targeted NGS panels in mCRC are feasible in routine practice, but need to be regularly updated and in-depth studies are needed to better analyze the prognostic factors.
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Bachet JB, Bouché O, Taieb J, Dubreuil O, Garcia ML, Meurisse A, Normand C, Gornet JM, Artru P, Louafi S, Bonnetain F, Thirot-Bidault A, Baumgaertner I, Coriat R, Tougeron D, Lecomte T, Mary F, Aparicio T, Marthey L, Taly V, Blons H, Vernerey D, Laurent-Puig P. RAS mutation analysis in circulating tumor DNA from patients with metastatic colorectal cancer: the AGEO RASANC prospective multicenter study. Ann Oncol 2019; 29:1211-1219. [PMID: 29438522 DOI: 10.1093/annonc/mdy061] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background RAS mutations are currently sought for in tumor samples, which takes a median of almost 3 weeks in western European countries. This creates problems in clinical situations that require urgent treatment and for inclusion in therapeutic trials that need RAS status for randomization. Analysis of circulating tumor DNA might help to shorten the time required to determine RAS mutational status before anti-epidermal growth factor receptor antibody therapy for metastatic colorectal cancer. Here we compared plasma with tissue RAS analysis in a large prospective multicenter cohort. Patients and methods Plasma samples were collected prospectively from chemotherapy-naive patients and analyzed centrally by next-generation sequencing (NGS) with the colon lung cancer V2 Ampliseq panel and by methylation digital PCR (WIF1 and NPY genes). Tumoral RAS status was determined locally, in parallel, according to routine practice. For a minimal κ coefficient of 0.7, reflecting acceptable concordance (precision ± 0.07), with an estimated 5% of non-exploitable data, 425 subjects were necessary. Results From July 2015 to December 2016, 425 patients were enrolled. For the 412 patients with available paired plasma and tumor samples, the κ coefficient was 0.71 [95% confidence interval (CI), 0.64-0.77] and accuracy was 85.2% (95% CI, 81.4% to 88.5%). In the 329 patients with detectable ctDNA (at least one mutation or one methylated biomarker), the κ coefficient was 0.89 (95% CI, 0.84-0.94) and accuracy was 94.8% (95% CI, 91.9% to 97.0%). The absence of liver metastases was the main clinical factor associated with inconclusive circulating tumor DNA results [odds ratio = 0.11 (95% CI, 0.06-0.21)]. In patients with liver metastases, accuracy was 93.5% with NGS alone and 97% with NGS plus the methylated biomarkers. Conclusion This prospective trial demonstrates excellent concordance between RAS status in plasma and tumor tissue from patients with colorectal cancer and liver metastases, thus validating plasma testing for routine RAS mutation analysis in these patients. Clinical Trial registration Clinicaltrials.gov, NCT02502656.
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Affiliation(s)
- J B Bachet
- Sorbonne Universités, UPMC Université, Paris; Université Sorbonne Paris Cité, INSERM UMR-S1147 MEPPOT, CNRS SNC5014, Centre Universitaire des Saints-Pères, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris; Department of Hepato-Gastroenterology, Groupe Hospitalier Pitié Salpêtrière, Paris; AGEO (Association des Gastroentérologues Oncologues), Paris
| | - O Bouché
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Hepato-Gastroenterology, Hôpital Robert Debré, Reims
| | - J Taieb
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Digestive Oncology, Hôpital Européen Georges Pompidou, Paris
| | - O Dubreuil
- Department of Hepato-Gastroenterology, Groupe Hospitalier Pitié Salpêtrière, Paris; AGEO (Association des Gastroentérologues Oncologues), Paris
| | - M L Garcia
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Oncology, Hôpital Saint-Antoine, Paris
| | - A Meurisse
- Department of Methodology and Quality of Life in Oncology, INSERM UMR 1098, Hôpital Universitaire de Besancon, Besancon
| | - C Normand
- Université Sorbonne Paris Cité, INSERM UMR-S1147 MEPPOT, CNRS SNC5014, Centre Universitaire des Saints-Pères, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris
| | - J M Gornet
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Gastroenterology, Hôpital Saint-Louis, Paris
| | - P Artru
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Gastroenterology, Hôpital Privé Jean Mermoz, Lyon
| | - S Louafi
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Gastroenterology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Department of Gastroenterology, Groupe Hospitalier Nord Essonne, Longjumeau
| | - F Bonnetain
- Department of Methodology and Quality of Life in Oncology, INSERM UMR 1098, Hôpital Universitaire de Besancon, Besancon
| | - A Thirot-Bidault
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Gastroenterology, Hôpital Kremlin Bicêtre, Le Kremlin-Bicêtre
| | - I Baumgaertner
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Oncology, Hôpital Henri Mondor, Créteil
| | - R Coriat
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Gastroenterology, Hôpital Cochin, Paris
| | - D Tougeron
- AGEO (Association des Gastroentérologues Oncologues), Paris; Depatment of Gastroenterology, Centre Hospitalo-Universitaire de Poitiers, Poitiers
| | - T Lecomte
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Gastroenterology, Centre Hospitalo-Universitaire de Tours, Tours
| | - F Mary
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Gastroenterology, Hôpital Avicenne, Bobigny
| | - T Aparicio
- AGEO (Association des Gastroentérologues Oncologues), Paris; Department of Gastroenterology, Hôpital Saint-Louis, Paris; Department of Gastroenterology, Hôpital Avicenne, Bobigny
| | - L Marthey
- AGEO (Association des Gastroentérologues Oncologues), Paris; Depatment of Gastroenterology, Hôpital Antoine Béclère, Clamart
| | - V Taly
- Université Sorbonne Paris Cité, INSERM UMR-S1147 MEPPOT, CNRS SNC5014, Centre Universitaire des Saints-Pères, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris
| | - H Blons
- Université Sorbonne Paris Cité, INSERM UMR-S1147 MEPPOT, CNRS SNC5014, Centre Universitaire des Saints-Pères, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris; Department of Biochemistry, Hôpital Européen Georges Pompidou, Paris, France
| | - D Vernerey
- Department of Methodology and Quality of Life in Oncology, INSERM UMR 1098, Hôpital Universitaire de Besancon, Besancon
| | - P Laurent-Puig
- Université Sorbonne Paris Cité, INSERM UMR-S1147 MEPPOT, CNRS SNC5014, Centre Universitaire des Saints-Pères, Equipe Labellisée Ligue Nationale Contre le Cancer, Paris.
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Validity of Targeted Next-Generation Sequencing in Routine Care for Identifying Clinically Relevant Molecular Profiles in Non-Small-Cell Lung Cancer: Results of a 2-Year Experience on 1343 Samples. J Mol Diagn 2018; 20:550-564. [PMID: 29787863 DOI: 10.1016/j.jmoldx.2018.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/15/2018] [Accepted: 04/11/2018] [Indexed: 11/22/2022] Open
Abstract
Theranostic assays are based on single-gene testing, but the ability of next-generation sequencing (NGS) to interrogate numerous genetic alterations will progressively replace single-gene assays. Although NGS was evaluated to screen for theranostic mutations, its usefulness in clinical practice on large series of samples remains to be demonstrated. NGS performance was assessed following guidelines. TaqMan probes and NGS were compared for their ability to detect EGFR and KRAS mutations, and NGS mutation profiles were analyzed on a large series of non-small-cell lung cancers (n = 1343). The R2 correlation between expected and measured allelic ratio, using commercial samples, was >0.96. Mutation detection threshold was 2% for 10 ng of DNA input. κ Scores for TaqMan versus NGS were 0.99 (95% CI, 0.97-1.00) for EGFR and 0.98 (95% CI, 0.97-1.00) for KRAS after exclusion of rare EGFR (n = 40) and KRAS (n = 60) mutations. NGS identified 693 and 292 mutations in validated and potential oncogenic drivers, respectively. Significant associations were found between EGFR and PI3KCA or CTNNB1 and between KRAS and STK11. Potential oncogenic driver mutations or gene amplifications were more frequent in validated oncogenic driver nonmutated samples. This work is a proof of concept that targeted NGS is accessible in routine screening, including large screening, at reasonable cost. Clinical data should be collected and implemented in specific databases to make molecular data meaningful for direct patients' benefit.
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Huxley N, Crathorne L, Varley-Campbell J, Tikhonova I, Snowsill T, Briscoe S, Peters J, Bond M, Napier M, Hoyle M. The clinical effectiveness and cost-effectiveness of cetuximab (review of technology appraisal no. 176) and panitumumab (partial review of technology appraisal no. 240) for previously untreated metastatic colorectal cancer: a systematic review and economic evaluation. Health Technol Assess 2018; 21:1-294. [PMID: 28682222 DOI: 10.3310/hta21380] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Colorectal cancer is the fourth most commonly diagnosed cancer in the UK after breast, lung and prostate cancer. People with metastatic disease who are sufficiently fit are usually treated with active chemotherapy as first- or second-line therapy. Targeted agents are available, including the antiepidermal growth factor receptor (EGFR) agents cetuximab (Erbitux®, Merck Serono UK Ltd, Feltham, UK) and panitumumab (Vecitibix®, Amgen UK Ltd, Cambridge, UK). OBJECTIVE To investigate the clinical effectiveness and cost-effectiveness of panitumumab in combination with chemotherapy and cetuximab in combination with chemotherapy for rat sarcoma (RAS) wild-type (WT) patients for the first-line treatment of metastatic colorectal cancer. DATA SOURCES The assessment included a systematic review of clinical effectiveness and cost-effectiveness studies, a review and critique of manufacturer submissions, and a de novo cohort-based economic analysis. For the assessment of effectiveness, a literature search was conducted up to 27 April 2015 in a range of electronic databases, including MEDLINE, EMBASE and The Cochrane Library. REVIEW METHODS Studies were included if they were randomised controlled trials (RCTs) or systematic reviews of RCTs of cetuximab or panitumumab in participants with previously untreated metastatic colorectal cancer with RAS WT status. All steps in the review were performed by one reviewer and checked independently by a second. Narrative synthesis and network meta-analyses (NMAs) were conducted for outcomes of interest. An economic model was developed focusing on first-line treatment and using a 30-year time horizon to capture costs and benefits. Costs and benefits were discounted at 3.5% per annum. Scenario analyses and probabilistic and univariate deterministic sensitivity analyses were performed. RESULTS The searches identified 2811 titles and abstracts, of which five clinical trials were included. Additional data from these trials were provided by the manufacturers. No data were available for panitumumab plus irinotecan-based chemotherapy (folinic acid + 5-fluorouracil + irinotecan) (FOLFIRI) in previously untreated patients. Studies reported results for RAS WT subgroups. First-line treatment with anti-EGFR therapies in combination with chemotherapy appeared to have statistically significant benefits for patients who are RAS WT. For the independent economic evaluation, the base-case incremental cost-effectiveness ratio (ICER) for RAS WT patients for cetuximab plus oxaliplatin-based chemotherapy (folinic acid + 5-fluorouracil + oxaliplatin) (FOLFOX) compared with FOLFOX was £104,205 per quality-adjusted life-year (QALY) gained; for panitumumab plus FOLFOX compared with FOLFOX was £204,103 per QALY gained; and for cetuximab plus FOLFIRI compared with FOLFIRI was £122,554 per QALY gained. The ICERs were sensitive to treatment duration, progression-free survival, overall survival (resected patients only) and resection rates. LIMITATIONS The trials included RAS WT populations only as subgroups. No evidence was available for panitumumab plus FOLFIRI. Two networks were used for the NMA and model, based on the different chemotherapies (FOLFOX and FOLFIRI), as insufficient evidence was available to the assessment group to connect these networks. CONCLUSIONS Although cetuximab and panitumumab in combination with chemotherapy appear to be clinically beneficial for RAS WT patients compared with chemotherapy alone, they are likely to represent poor value for money when judged by cost-effectiveness criteria currently used in the UK. It would be useful to conduct a RCT in patients with RAS WT. STUDY REGISTRATION This study is registered as PROSPERO CRD42015016111. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Nicola Huxley
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Louise Crathorne
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Irina Tikhonova
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Simon Briscoe
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Jaime Peters
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Mary Bond
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Mark Napier
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Martin Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
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Loubière S, Drezet A, Beau-Faller M, Moro-Sibilot D, Friard S, Wislez M, Blons H, Daniel C, Westeel V, Madroszyk A, Léna H, Merle P, Mazières J, Zalcman G, Lacave R, Antoine M, Morin F, Missy P, Barlesi F, Auquier P, Cadranel J. Cost-effectiveness of KRAS, EGFR and ALK testing for decision making in advanced nonsmall cell lung carcinoma: the French IFCT-PREDICT.amm study. Eur Respir J 2018; 51:13993003.01467-2017. [DOI: 10.1183/13993003.01467-2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/31/2018] [Indexed: 11/05/2022]
Abstract
ALK rearrangement and EGFR/KRAS mutations constitute the primary biomarkers tested to provide targeted or nontargeted therapies in advanced nonsmall cell lung cancer (NSCLC) patients. Our objective was to assess the cost-effectiveness of biomarker testing for NSCLC.Between 2013 and 2014, 843 treatment-naive patients were prospectively recruited at 19 French hospitals into a longitudinal observational cohort study. Two testing strategies were compared, i.e. with “at least one biomarker status known” and “at least KRAS status known”, in addition to “no biomarker testing” as the reference strategy. The Kaplan–Meier approach was employed to assess restricted mean survival time. Direct medical costs incurred by hospitals were estimated with regard to treatment, inpatient care and biomarker testing.Compared with “no biomarker testing”, the “at least one biomarker status known” strategy yielded an incremental cost-effectiveness ratio of EUR13 230 per life-year saved, which decreased to EUR7444 per life-year saved with the “at least KRAS status known” testing strategy. In sensitivity analyses, biomarker testing strategies were less costly and more effective in 41% of iterations.In summary, molecular testing prior to treatment initiation proves to be cost-effective in advanced NSCLC management and may assist decision makers in defining conditions for further implementation of these innovations in general practice.
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Albertini AF, Raoux D, Neumann F, Rossat S, Tabet F, Pedeutour F, Duranton-Tanneur V, Kubiniek V, Vire O, Weinbreck N. [Detection of RAS genes mutation using the Cobas ® method in a private laboratory of pathology: Medical and economical study in comparison to a public platform of molecular biology of cancer]. Bull Cancer 2017; 104:662-674. [PMID: 28688743 DOI: 10.1016/j.bulcan.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 04/02/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
In France, determination of the mutation status of RAS genes for predictive response to anti-EGFR targeted treatments is carried out by public platforms of molecular biology of cancer created by the French National Cancer Institute. This study aims to demonstrate the feasibility of these analyses by a private pathology laboratory (MEDIPATH) as per the requirements of accreditation. We retrospectively studied the mutation status of KRAS and NRAS genes in 163 cases of colorectal metastatic cancer using the Cobas® technique. We compared our results to those prospectively obtained through pyrosequencing and allelic discrimination by the genetic laboratory of solid tumors at the Nice University Hospital (PACA-EST regional platform). The results of both series were identical: 98.7% positive correlation; negative correlation of 93.1%; overall correlation of 95.7% (Kappa=0.92). This study demonstrates the feasibility of molecular analysis in a private pathology laboratory. As this practice requires a high level of guarantee, its accreditation, according to the NF-EN-ISO15189 quality compliance French standard, is essential. Conducting molecular analysis in this context avoids the steps of routing the sample and the result between the pathology laboratory and the platform, which reduces the overall time of rendering the result. In conclusion, the transfer of some analysis from these platforms to private pathology laboratories would allow the platforms to be discharged from a part of routine testing and therefore concentrate their efforts to the development of new analyses constantly required to access personalized medicine.
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Affiliation(s)
- Anne-Flore Albertini
- Laboratoire Médipath, pôle d'excellence Jean-Louis, 263, Via Nova, 83600 Fréjus, France.
| | - Delphine Raoux
- Laboratoire Médipath, pôle d'excellence Jean-Louis, 263, Via Nova, 83600 Fréjus, France
| | - Frédéric Neumann
- Laboratoire Médipath, pôle d'excellence Jean-Louis, 263, Via Nova, 83600 Fréjus, France
| | - Stéphane Rossat
- Laboratoire Médipath, pôle d'excellence Jean-Louis, 263, Via Nova, 83600 Fréjus, France
| | - Farid Tabet
- Laboratoire Médipath, pôle d'excellence Jean-Louis, 263, Via Nova, 83600 Fréjus, France
| | - Florence Pedeutour
- CHU de Nice, faculté de médecine, laboratoire de génétique somatique des tumeurs solides, 22, avenue de Valombrose, 06107 Nice cedex 02, France
| | - Valérie Duranton-Tanneur
- CHU de Nice, faculté de médecine, laboratoire de génétique somatique des tumeurs solides, 22, avenue de Valombrose, 06107 Nice cedex 02, France
| | - Valérie Kubiniek
- CHU de Nice, faculté de médecine, laboratoire de génétique somatique des tumeurs solides, 22, avenue de Valombrose, 06107 Nice cedex 02, France
| | - Olivier Vire
- Laboratoire Médipath, pôle d'excellence Jean-Louis, 263, Via Nova, 83600 Fréjus, France
| | - Nicolas Weinbreck
- Laboratoire Médipath, pôle d'excellence Jean-Louis, 263, Via Nova, 83600 Fréjus, France
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10
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The cost of molecular-guided therapy in oncology: a prospective cost study alongside the MOSCATO trial. Genet Med 2016; 19:683-690. [DOI: 10.1038/gim.2016.174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/21/2016] [Indexed: 12/28/2022] Open
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11
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Clinical Outcomes of Patients with Rare and Heavily Pretreated Solid Tumors Treated according to the Results of Tumor Molecular Profiling. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4627214. [PMID: 27525268 PMCID: PMC4972920 DOI: 10.1155/2016/4627214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/25/2016] [Accepted: 04/10/2016] [Indexed: 12/26/2022]
Abstract
Patients with heavily pretreated advanced cancer or with rare tumors are difficult to treat. Molecular profiling (MP) of tumors to identify biomarkers that predict potential outcomes with individual therapies is an emerging strategy to guide treatment decisions. Patients with rare tumors for which standard-of-care therapy was unavailable or more common tumors for which standard-of-care options had been exhausted underwent MP at a single Australian center. Data regarding treating physicians' choice of therapy, MP results and recommendations, and patient outcomes were collected. Seven patients had received prior standard first-line therapy (PST), 16 had rare tumors, and 31 had been heavily pretreated (HPT; ≥2 prior lines). Most treatments suggested by MP (541/594; 91.1%) were common chemotherapy drugs available in generic formulations. MP-guided therapy recommendations differed from physician's recommendations in 48 patients (88.9%). MP-guided therapy produced clinical benefit (improved QOL and/or performance status, symptoms, bodyweight, or RECIST) in 19/31 (61.3%), 11/16 (68.8%), and 3/7 (42.9%) patients with HPTs, rare tumors, and PSTs, respectively, and had a PFS ratio ≥1.3 in 22/37 evaluable patients (59.5%; 95% confidence interval 44–76%). The null hypothesis that ≤15% of these patients would have a PFS ratio ≥1.3 was rejected (one-sided p < 0.0001). In conclusion, using MP to guide therapy selection is feasible in clinical practice and may improve patient outcomes.
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12
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Plun-Favreau J, Immonen-Charalambous K, Steuten L, Strootker A, Rouzier R, Horgan D, Lawler M. Enabling Equal Access to Molecular Diagnostics: What Are the Implications for Policy and Health Technology Assessment? Public Health Genomics 2016; 19:144-52. [PMID: 27237607 DOI: 10.1159/000446532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Molecular diagnostics can offer important benefits to patients and are a key enabler of the integration of personalised medicine into health care systems. However, despite their promise, few molecular diagnostics are embedded into clinical practice (especially in Europe) and access to these technologies remains unequal across countries and sometimes even within individual countries. If research translation and the regulatory environments have proven to be more challenging than expected, reimbursement and value assessment remain the main barriers to providing patients with equal access to molecular diagnostics. Unclear or non-existent reimbursement pathways, together with the lack of clear evidence requirements, have led to significant delays in the assessment of molecular diagnostics technologies in certain countries. Additionally, the lack of dedicated diagnostics budgets and the siloed nature of resource allocation within certain health care systems have significantly delayed diagnostics commissioning. This article will consider the perspectives of different stakeholders (patients, health care payers, health care professionals, and manufacturers) on the provision of a research-enabled, patient-focused molecular diagnostics platform that supports optimal patient care. Through the discussion of specific case studies, and building on the experience from countries that have successfully integrated molecular diagnostics into clinical practice, this article will discuss the necessary evolutions in policy and health technology assessment to ensure that patients can have equal access to appropriate molecular diagnostics.
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13
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Barlesi F, Mazieres J, Merlio JP, Debieuvre D, Mosser J, Lena H, Ouafik L, Besse B, Rouquette I, Westeel V, Escande F, Monnet I, Lemoine A, Veillon R, Blons H, Audigier-Valette C, Bringuier PP, Lamy R, Beau-Faller M, Pujol JL, Sabourin JC, Penault-Llorca F, Denis MG, Lantuejoul S, Morin F, Tran Q, Missy P, Langlais A, Milleron B, Cadranel J, Soria JC, Zalcman G. Routine molecular profiling of patients with advanced non-small-cell lung cancer: results of a 1-year nationwide programme of the French Cooperative Thoracic Intergroup (IFCT). Lancet 2016; 387:1415-1426. [PMID: 26777916 DOI: 10.1016/s0140-6736(16)00004-0] [Citation(s) in RCA: 673] [Impact Index Per Article: 84.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The molecular profiling of patients with advanced non-small-cell lung cancer (NSCLC) for known oncogenic drivers is recommended during routine care. Nationally, however, the feasibility and effects on outcomes of this policy are unknown. We aimed to assess the characteristics, molecular profiles, and clinical outcomes of patients who were screened during a 1-year period by a nationwide programme funded by the French National Cancer Institute. METHODS This study included patients with advanced NSCLC, who were routinely screened for EGFR mutations, ALK rearrangements, as well as HER2 (ERBB2), KRAS, BRAF, and PIK3CA mutations by 28 certified regional genetics centres in France. Patients were assessed consecutively during a 1-year period from April, 2012, to April, 2013. We measured the frequency of molecular alterations in the six routinely screened genes, the turnaround time in obtaining molecular results, and patients' clinical outcomes. This study is registered with ClinicalTrials.gov, number NCT01700582. FINDINGS 18,679 molecular analyses of 17,664 patients with NSCLC were done (of patients with known data, median age was 64·5 years [range 18-98], 65% were men, 81% were smokers or former smokers, and 76% had adenocarcinoma). The median interval between the initiation of analysis and provision of the written report was 11 days (IQR 7-16). A genetic alteration was recorded in about 50% of the analyses; EGFR mutations were reported in 1947 (11%) of 17,706 analyses for which data were available, HER2 mutations in 98 (1%) of 11,723, KRAS mutations in 4894 (29%) of 17,001, BRAF mutations in 262 (2%) of 13,906, and PIK3CA mutations in 252 (2%) of 10,678; ALK rearrangements were reported in 388 (5%) of 8134 analyses. The median duration of follow-up at the time of analysis was 24·9 months (95% CI 24·8-25·0). The presence of a genetic alteration affected first-line treatment for 4176 (51%) of 8147 patients and was associated with a significant improvement in the proportion of patients achieving an overall response in first-line treatment (37% [95% CI 34·7-38·2] for presence of a genetic alteration vs 33% [29·5-35·6] for absence of a genetic alteration; p=0·03) and in second-line treatment (17% [15·0-18·8] vs 9% [6·7-11·9]; p<0·0001). Presence of a genetic alteration was also associated with improved first-line progression-free survival (10·0 months [95% CI 9·2-10·7] vs 7·1 months [6·1-7·9]; p<0·0001) and overall survival (16·5 months [15·0-18·3] vs 11·8 months [10·1-13·5]; p<0·0001) compared with absence of a genetic alteration. INTERPRETATION Routine nationwide molecular profiling of patients with advanced NSCLC is feasible. The frequency of genetic alterations, acceptable turnaround times in obtaining analysis results, and the clinical advantage provided by detection of a genetic alteration suggest that this policy provides a clinical benefit. FUNDING French National Cancer Institute (INCa).
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Affiliation(s)
- Fabrice Barlesi
- Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille University, Centre d'Investigation Clinique, Marseille, France.
| | - Julien Mazieres
- Hôpital Larrey, Centre Hospitalier Universitaire, Université Paul Sabatier, Toulouse, France
| | - Jean-Philippe Merlio
- Centre Hospitalier Universitaire de Bordeaux, Pôle Biologie et Anatomie Pathologique, Pessac, France; Université de Bordeaux, Histologie et Pathologie Moléculaires des Tumeurs, Bordeaux, France
| | | | - Jean Mosser
- Centre Hospitalier Universitaire de Rennes, Département de Génomique et Génétique Moléculaire, Plateforme INCA, Rennes, France
| | - Hervé Lena
- Hôpital Pontchaillou, Service de Pneumologie, Centre Hospitalier Universitaire, Rennes, France
| | - L'Houcine Ouafik
- Assistance Publique Hôpitaux de Marseille, Service de Transfert d'Oncologie Biologique, Aix Marseille University, Marseille, France
| | - Benjamin Besse
- Gustave Roussy, Cancer Campus, Villejuif, France; University Paris-Sud, Châtenay-Malabry, France
| | - Isabelle Rouquette
- Institut Universitaire du Cancer de Toulouse, Oncopôle, Service d'Anatomie Pathologique, Toulouse, France
| | - Virginie Westeel
- Université de Franche-Comté, EA3181, Centre Hospitalier Universitaire Jean Minjoz, Service de Pneumologie, Besançon, France
| | - Fabienne Escande
- Centre Hospitalier Universitaire de Lille, Département de Biochimie et Biologie Moléculaire, Centre de Biologie Pathologie, Lille, France
| | - Isabelle Monnet
- Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie et de Pathologie Professionnelle, Créteil, France
| | - Antoinette Lemoine
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Paris-Sud, Service d'Oncogénétique- Oncomolpath, Université Paris 11, Villejuif, France
| | - Rémi Veillon
- Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Respiratoires, Pessac, France
| | - Hélène Blons
- UMR-S1147, INSERM, Université Paris Descartes, Assistance Publique Hôpitaux de Paris Département de Biologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Pierre-Paul Bringuier
- Hôpital Edouard Herriot, Service d'Anatomie et de Cytologie Pathologique, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon Cancer Research Center, UMR 1057 INSERM, Lyon, France
| | - Régine Lamy
- Centre Hospitalier de Bretagne Sud, Service d'Oncologie Médicale, Lorient, France
| | - Michèle Beau-Faller
- Centre Hospitalier Universitaire de Hautepierre, Laboratoire de Biochimie et de Biologie Moléculaire & Plate-forme de Génomique des Cancers, Strasbourg, France
| | - Jean-Louis Pujol
- Centre Hospitalier Universitaire de Montpellier, Unité d'Oncologie Thoracique, Pôle Cœur Poumon, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Jean-Christophe Sabourin
- Centre Hospitalier Universitaire de Rouen, Département d'Anatomie et de Cytologie Pathologiques, Rouen, France
| | | | - Marc G Denis
- Centre Hospitalier Universitaire de Nantes, Laboratoire de Biochimie, Nantes, France
| | - Sylvie Lantuejoul
- Centre Hospitalier Universitaire A Michallon, Département d'Anatomie et Cytologie Pathologiques DACP, Institut de Biologie et de Pathologie, Université Joseph Fourier-INSERM U 823, Institut Albert Bonniot, Grenoble, France
| | - Franck Morin
- Clinical Research Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Quân Tran
- Clinical Research Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Pascale Missy
- Clinical Research Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Alexandra Langlais
- Biostatistics Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Bernard Milleron
- Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Sorbonne Universités, UPMC Université Paris 06, Paris, France
| | - Jacques Cadranel
- Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Sorbonne Universités, UPMC Université Paris 06, Paris, France
| | - Jean-Charles Soria
- Gustave Roussy, Cancer Campus, Villejuif, France; University Paris-Sud, Châtenay-Malabry, France
| | - Gérard Zalcman
- Centre Hospitalier Universitaire de Caen, Service de Pneumologie et Oncologie Thoracique, Centre de Recherche Clinique, Université de Caen-Basse Normandie, Caen, France
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Van Krieken JHJM, Rouleau E, Ligtenberg MJL, Normanno N, Patterson SD, Jung A. RAS testing in metastatic colorectal cancer: advances in Europe. Virchows Arch 2016; 468:383-96. [PMID: 26573425 PMCID: PMC4830882 DOI: 10.1007/s00428-015-1876-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 12/22/2022]
Abstract
Personalized medicine shows promise for maximizing efficacy and minimizing toxicity of anti-cancer treatment. KRAS exon 2 mutations are predictive of resistance to epidermal growth factor receptor-directed monoclonal antibodies in patients with metastatic colorectal cancer. Recent studies have shown that broader RAS testing (KRAS and NRAS) is needed to select patients for treatment. While Sanger sequencing is still used, approaches based on various methodologies are available. Few CE-approved kits, however, detect the full spectrum of RAS mutations. More recently, "next-generation" sequencing has been developed for research use, including parallel semiconductor sequencing and reversible termination. These techniques have high technical sensitivities for detecting mutations, although the ideal threshold is currently unknown. Finally, liquid biopsy has the potential to become an additional tool to assess tumor-derived DNA. For accurate and timely RAS testing, appropriate sampling and prompt delivery of material is critical. Processes to ensure efficient turnaround from sample request to RAS evaluation must be implemented so that patients receive the most appropriate treatment. Given the variety of methodologies, external quality assurance programs are important to ensure a high standard of RAS testing. Here, we review technical and practical aspects of RAS testing for pathologists working with metastatic colorectal cancer tumor samples. The extension of markers from KRAS to RAS testing is the new paradigm for biomarker testing in colorectal cancer.
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Affiliation(s)
- J Han J M Van Krieken
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands.
| | | | - Marjolijn J L Ligtenberg
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, INT-Fondazione Pascale, Naples, Italy
| | - Scott D Patterson
- Amgen Inc., Thousand Oaks, CA, USA
- Gilead Sciences, Inc., Foster City, CA, USA
| | - Andreas Jung
- Institute of Pathology, University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Dequeker EM, Keppens C, Egele C, Delen S, Lamy A, Lemoine A, Sabourin JC, Andrieu C, Ligtenberg M, Fetique D, Tops B, Descarpentries C, Blons H, Denoux Y, Aube C, Penault-Llorca F, Hofman P, Leroy K, Le Marechal C, Doucet L, Duranton-Tanneur V, Pedeutour F, Soubeyran I, Côté JF, Emile JF, Vignaud JM, Monhoven N, Haddad V, Laurent-Puig P, van Krieken H, Nowak F, Lonchamp E, Bellocq JP, Rouleau E. Three Rounds of External Quality Assessment in France to Evaluate the Performance of 28 Platforms for Multiparametric Molecular Testing in Metastatic Colorectal and Non-Small Cell Lung Cancer. J Mol Diagn 2016; 18:205-14. [DOI: 10.1016/j.jmoldx.2015.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/29/2015] [Accepted: 09/23/2015] [Indexed: 12/31/2022] Open
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16
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Piton N, Lonchamp E, Nowak F, Sabourin JC. Real-Life Distribution of KRAS and NRAS Mutations in Metastatic Colorectal Carcinoma from French Routine Genotyping. Cancer Epidemiol Biomarkers Prev 2015; 24:1416-8. [DOI: 10.1158/1055-9965.epi-15-0059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022] Open
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17
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Atsumi J, Hanami T, Enokida Y, Ogawa H, Delobel D, Mitani Y, Kimura Y, Soma T, Tagami M, Takase Y, Ichihara T, Takeyoshi I, Usui K, Hayashizaki Y, Shimizu K. Eprobe-mediated screening system for somatic mutations in the KRAS locus. Oncol Rep 2015; 33:2719-27. [PMID: 25823645 PMCID: PMC4431451 DOI: 10.3892/or.2015.3883] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/03/2015] [Indexed: 12/21/2022] Open
Abstract
Activating mutations in the Kirsten rat sarcoma viral oncogene homolog (KRAS) loci are largely predictive of resistance to epidermal growth factor receptor (EGFR) therapy in colorectal cancer (CRC). A highly sensitive detection system for the KRAS gene mutations is urgently needed; however, conventional methods have issues with feasibility and cost performance. Here, we describe a novel detection system using a fluorescence ‘Eprobe’ capable of detecting low level KRAS gene mutations, via real-time PCR, with high sensitivity and simple usability. We designed our Eprobes to be complementary to wild-type (WT) KRAS or to the commonly mutated codons 12 and 13. The WT Eprobe binds strongly to the WT DNA template and suppresses amplification by blocking annealing of the primer during PCR. Eprobe-PCR with WT Eprobe shows high sensitivity (0.05–0.1% of plasmid DNA, 1% of genomic DNA) for the KRAS mutation by enrichment of the mutant type (MT) amplicon. Assay performance was compared to Sanger sequencing using 92 CRC samples. Discrepancies were analyzed by mutation genotyping via Eprobe-PCR with full match Eprobes for 7 prevalent mutations and the next generation sequencing (NGS). Significantly, the Eprobe system had a higher sensitivity for detecting KRAS mutations in CRC patient samples; these mutations could not be identified by Sanger sequencing. Thus, the Eprobe approach provides for highly sensitive and convenient mutation detection and should be useful for diagnostic applications.
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Affiliation(s)
- Jun Atsumi
- Departments of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takeshi Hanami
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Kanagawa, Japan
| | - Yasuaki Enokida
- Departments of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroomi Ogawa
- Departments of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Diane Delobel
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Kanagawa, Japan
| | - Yasumasa Mitani
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Kanagawa, Japan
| | - Yasumasa Kimura
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Kanagawa, Japan
| | - Takahiro Soma
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Kanagawa, Japan
| | - Michihira Tagami
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Kanagawa, Japan
| | - Yoshiaki Takase
- Departments of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tatsuo Ichihara
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Kanagawa, Japan
| | - Izumi Takeyoshi
- Departments of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kengo Usui
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Kanagawa, Japan
| | - Yoshihide Hayashizaki
- RIKEN Preventive Medicine and Diagnosis Innovation Program, Yokohama, Kanagawa, Japan
| | - Kimihiro Shimizu
- Departments of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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18
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Gordon BL, Finnerty BM, Aronova A, Fahey TJ. Genomic medicine for cancer diagnosis. J Surg Oncol 2015; 111:24-30. [DOI: 10.1002/jso.23778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Benjamin L. Gordon
- Research Fellow, Department of Surgery; Weill Cornell Medical College/New York Presbyterian Hospital; NY New York
| | - Brendan M. Finnerty
- Research Fellow, Department of Surgery; Weill Cornell Medical College/New York Presbyterian Hospital; NY New York
| | - Anna Aronova
- Research Fellow, Department of Surgery; Weill Cornell Medical College/New York Presbyterian Hospital; NY New York
| | - Thomas J. Fahey
- Chief of Endocrine Surgery and Professor of Surgery, Department of Surgery; Weill Cornell Medical College/New York Presbyterian Hospital; NY New York
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19
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Blons H, Emile JF, Le Malicot K, Julié C, Zaanan A, Tabernero J, Mini E, Folprecht G, Van Laethem JL, Thaler J, Bridgewater J, Nørgård-Petersen L, Van Cutsem E, Lepage C, Zawadi MA, Salazar R, Laurent-Puig P, Taieb J. Prognostic value of KRAS mutations in stage III colon cancer: post hoc analysis of the PETACC8 phase III trial dataset. Ann Oncol 2014; 25:2378-2385. [PMID: 25294886 DOI: 10.1093/annonc/mdu464] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The prognostic value of KRAS mutations in colon adenocarcinoma is controversial. We examined this question as an ancillary study of the PETACC8 phase III trial. PATIENTS AND METHODS We analyzed the prognostic impact of KRAS exon 2 mutations in stage III colon cancer patients (n = 1657) receiving adjuvant FOLFOX ± cetuximab therapy included in the PETACC8 trial. Patients with BRAF-mutated cancers were excluded and, as no difference was found for time to recurrence (TTR) and disease-free survival (DFS) between treatment arms, both were pooled for analysis. Associations with TTR and DFS were analyzed using a Cox proportional hazards model. RESULTS KRAS mutations were found in 638 of 1657 tumors and linked to shorter TTR (P < 0.001). However, when specific mutations were compared with wild-type, codon 12 mutations [hazard ratio (HR) 1.67, 95% confidence interval (CI) 1.35-2.04; P < 0.001] but not codon 13 (HR 1.23, 95% CI 0.85-1.79; P = 0.26) were significantly associated with shorter TTR, independently of other covariates. The interaction test showed that, regarding tumor location (distal versus proximal), KRAS genotype affects differently on recurrence (P = 0.02) and DFS (P = 0.042). Subgroup analysis showed that KRAS only affected TTR and DFS in distal tumors (n = 1043; 692 wild type; 351 mutated), with an increased risk of relapse (HR 1.96, 95% CI 1.51-2.56; P < 0.0001) for KRAS codon 12 mutations and a borderline significance for codon 13 mutations (HR 1.59, 95% CI 1.00-2.56; P = 0.051). CONCLUSION KRAS exon 2 mutations are independent predictors of shorter TTR in patients with resected stage III distal colon cancers receiving adjuvant therapy. Future clinical trials in the adjuvant setting should consider both the tumor location and KRAS mutations as important stratification factors. CLINICAL TRIAL NUMBER This is an ancillary study of the PETACC8 trial: EUDRACT 2005-003463-23.
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Affiliation(s)
- H Blons
- UMR-S1147, INSERM, Paris; Paris Descartes University, Paris; APHP Department of Biology, Georges Pompidou Hospital, Paris
| | - J F Emile
- Department of Pathology, APHP Ambroise Paré Hospital, Boulogne-Billancourt; Paris-Ouest University, Versailles Saint-Quentin
| | - K Le Malicot
- Department of Statistics, Fédération Francophone de Cancérologie Digestive, Dijon
| | - C Julié
- Department of Pathology, APHP Ambroise Paré Hospital, Boulogne-Billancourt
| | - A Zaanan
- APHP Department of Hepatogastroenterology and GI Oncology, Georges Pompidou Hospital, Paris, France
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - E Mini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Folprecht
- 1st Medical Department, University Hospital Carl Gustav Carus, Dresden, Germany
| | - J L Van Laethem
- Deptartment of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - J Thaler
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - J Bridgewater
- UCL Cancer Institute, University College London, London, UK
| | | | - E Van Cutsem
- Department of Digestive Oncology, University Hospitals and KULeuven, Leuven, Belgium
| | - C Lepage
- Department of Hepato-Gastroenterology, Dijon University Hospital and INSERM U 866, Dijon
| | - M A Zawadi
- GI Oncology, Les Oudairies Hospital, La Roche sur Yon, France
| | - R Salazar
- Catalan Institute of Oncology (IDIBELL), Barcelona, Spain
| | - P Laurent-Puig
- UMR-S1147, INSERM, Paris; Paris Descartes University, Paris; APHP Department of Biology, Georges Pompidou Hospital, Paris
| | - J Taieb
- APHP Department of Hepatogastroenterology and GI Oncology, Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris.
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20
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Scott RJ, Fox SB, Desai J, Grieu F, Amanuel B, Garrett K, Harraway J, Cheetham G, Pattle N, Haddad A, Byron K, Rudzki B, Waring P, Iacopetta B. KRASmutation testing of metastatic colorectal cancer in Australia: Where are we at? Asia Pac J Clin Oncol 2014; 10:261-5. [DOI: 10.1111/ajco.12201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 01/24/2023]
Affiliation(s)
- Rodney J. Scott
- Hunter Area Pathology Service; Newcastle New South Wales Australia
| | - Stephen B. Fox
- Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Jayesh Desai
- Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Fabienne Grieu
- Department of Molecular Anatomic Pathology, PathWest QEII; Nedlands Western Australia Australia
| | - Benhur Amanuel
- Department of Molecular Anatomic Pathology, PathWest QEII; Nedlands Western Australia Australia
| | - Kerryn Garrett
- St John of God Pathology; Subiaco Western Australia Australia
| | - James Harraway
- Sullivan Nicolaides Pathology; Brisbane Queensland Australia
| | | | | | - Afaf Haddad
- Dorevitch Pathology; Melbourne Victoria Australia
| | - Keith Byron
- Healthscope Pathology; Clayton Victoria Australia
| | - Barney Rudzki
- Department of Pathology, University of Melbourne; Melbourne Victoria Australia
| | - Paul Waring
- Department of Pathology, University of Melbourne; Melbourne Victoria Australia
| | - Barry Iacopetta
- School of Surgery; University of Western Australia; Nedlands Western Australia Australia
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Emile JF, Tisserand J, Bergougnoux L, Nowak F, Faucher G, Surel S, Lamy A, Lecorre D, Helias-Rodzewicz Z, Hofman P, Sabourin JC, Laurent-Puig P. Improvement of the quality of BRAF testing in melanomas with nationwide external quality assessment, for the BRAF EQA group. BMC Cancer 2013; 13:472. [PMID: 24119386 PMCID: PMC3852250 DOI: 10.1186/1471-2407-13-472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/01/2013] [Indexed: 11/15/2022] Open
Abstract
Background Knowledge about tumour gene mutation status is essential for the treatment of increasing numbers of cancer patients, and testing quality has a major impact on treatment response and cost. In 2012, 4,629 tests for BRAF p.V600 were performed in France, in patients with melanomas. Methods Two batches of unstained melanoma sections were sent, in May and November 2012, to the 46 laboratories supported by the French National Institute of Cancer (INCa). An external quality assessment (EQA) evaluated mutation status, response times and compliance with INCa recommendations. Results All the French laboratories involved in testing participated in the EQA. Fourteen different methods were used to detect BRAF mutations, most consisting of combinations of in-house techniques. False responses were noted in 25/520 cases (4.8%), 11 of which concerned confusion between p.V600E and p.V600K. Thus, 2.7% of responses would have led to inappropriate treatment. Within six months, mean response times decreased from 22 to 12 days (P<0.001), and the percentage of samples evaluated by a pathologist for tumour cell content increased, from 75.2% to 96.9% (P<0.001). Conclusion Despite the use of non-certified methods, the false response rate was low. Nationwide EQA can improve the quality of molecular pathology tests on tumours.
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