Efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in targeted therapy of lung squamous cell carcinoma patients with EGFR mutation: a pooled analysis

[Advances of Molecular Targeted Therapy in EGFR-mutated Squamous Cell Lung Cancer]

Non-small cell lung cancer (NSCLC) is a prevalent tumour type in our country, with lung squamous carcinoma being a commonly observed NSCLC subtype besides lung adenocarcinoma. Epidermal growth factor receptor (EGFR) is a significant driver gene in lung cancer, and EGFR mutation frequency is considerably lower in lung squamous carcinoma in comparison to lung adenocarcinoma. Although targeted therapy against EGFR has demonstrated significant advancements in lung adenocarcinoma, while progress in lung squamous carcinoma has been relatively sluggish. This paper reviews recent studies on molecular targeted therapy for EGFR-mutated lung squamous carcinoma and summarises the efficacy of EGFR-tyrosine kinase inhibitors (TKIs) in treating squamous carcinoma of the lung, in order to provide a reference for treating patients with EGFR-mutated squamous carcinoma of the lung.
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The Anticancer Mechanisms of Scutellaria barbata against Lung Squamous Cell Carcinoma

Objective. Scutellaria barbata (S. barbata) is a Chinese traditional medicinal crop with anti-inflammatory as well as anticancer properties. To explore the anticancer mechanisms of functional monomers of S. barbata against lung squamous cell carcinoma (LUSC), a network pharmacology approach and molecular docking were utilized. Methods. The expression profile of genes encoding functional monomer components in S. barbata was obtained from the Traditional Chinese Medicine Systems Pharmacology platform (TCMSP) database. Expression data of LUSC-related genes were acquired from DisGeNET, GeneCards, OMIM, DrugBank, and TTD databases. The target genes of S. barbata that confer anticancer effects against LUSC were obtained by considering the intersecting genes between S. barbata target genes and LUSC-related genes. The potential regulatory pathways enriched in these intersected genes were identified using the KOBAS database, and Gene Ontology (GO) function enrichment analysis was performed using the online tool DAVID. The relationship network of S. barbata functional monomer components-action targets-disease-pathways was established using Cytoscape 3.8.2, and the protein-protein interaction network of those intersected genes was established using the STRING database. Finally, the hub genes were screened by using CytoNCA, a plug-in of Cytoscape, and hub gene expressions in LUSC were evaluated via the Gene Expression Profiling Interactive Analysis (GEPIA) database. AutoDockTools and PyMOL software were employed to verify the molecular docking on disease target proteins and drug functional molecules. Results. In S. barbata, 104 target genes and 20 hub genes encoding functional components against LUSC were screened out, six of which were significantly differentially expressed between LUSC samples and normal tissue samples in the GEPIA database. Here, GO analysis illustrated the involvement of these genes in the signal transduction and positive regulation of transcription from RNA polymerase II promoter and negative regulation of apoptosis, while KEGG pathway enrichment analysis demonstrated that these genes were mainly involved in several pathways, for instance, AGE-RAGE, PI3K-Akt, p53, and MAPK signaling pathway. There are four main functional components docking with six key target proteins, all of which have strong binding activity. Conclusions. We predicted the molecular mechanisms and signaling pathways of genes encoding functional components in S. barbata against LUSC. These discoveries offer novel understanding for further study, laying a scientific foundation for the production of synthetic monomer components of S. barbata.

EGFR-Mutated Squamous Cell Lung Cancer and Its Association With Outcomes

Background

The therapeutic efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in advanced EGFR-mutant lung squamous cell carcinoma (SCC) patients remains uncertain. Furthermore, the factors underlying the responsiveness have not been fully investigated. We therefore investigated the link between genomic profiles and EGFR-TKI efficacy.

Material and Methods

We consecutively enrolled stage IV, EGFR-mutant, and EGFR-TKI–treated patients with SCC. Patients with EGFR wild-type lung SCC and EGFR-mutant lung adenocarcinoma were consecutively enrolled as controls, and next-generation sequencing (NGS) was performed.

Results

In total, 28 EGFR-mutant lung SCC, 41 EGFR-mutant lung adenocarcinoma, and 40 EGFR wild-type lung SCC patients were included. Among the patients with EGFR mutations, shorter progression-free survival (PFS) was observed in SCC compared to adenocarcinoma (4.6 vs. 11.0 months, P<0.001). Comparison of the genomic profiles revealed that EGFR-mutant SCC patients had similar mutation characteristics to EGFR-mutant adenocarcinoma patients, but differed from those with EGFR wild-type SCC. Further exploration of EGFR-mutant SCC revealed that mutations in CREBBP (P = 0.005), ZNF217 (P = 0.016), and the Wnt (P = 0.027) pathway were negatively associated with PFS. Mutations in GRM8 (P = 0.025) were associated with improved PFS.

Conclusions

EGFR-mutant lung SCC has a worse prognosis than EGFR-mutant adenocarcinoma. Mutations in other genes, such as CREBBP, ZNF217, GRM8, or Wnt that had implications on PFS raise the possibility of understanding mechanisms of resistance to EGFR-TKI in lung SCC, which will aid identification of potential beneficial subgroups of patients with EGFR-mutant SCCs receiving EGFR-TKIs.

First-line immune checkpoint therapy in metastatic squamous cell lung cancer harboring both EGFR mutation and high expression of PD-L1: A case report

A 90-year-old female was admitted to our hospital with a history of a dry cough. Chest computed tomography (CT) scan showed a tumor shadow, and CT-guided lung biopsy revealed squamous cell carcinoma harboring an EGFR mutation. In addition, programmed death-ligand 1 (PD-L1) was highly expressed with a tumor proportion score (TPS) of >75%. Pembrolizumab therapy in the first-line setting was not effective, and the patient died at six months from the first visit. Squamous cell lung cancers (SCLCs) with both EGFR mutation and high expression of PD-L1 are very rare.

A study of ALK-positive pulmonary squamous-cell carcinoma: From diagnostic methodologies to clinical efficacy

BACKGROUND

High concordance has been observed between Ventana D5F3 ALK immunohistochemistry (IHC) and fluorescence in-situ hybridization (FISH) in lung adenocarcinoma (LADC). However, whether a similar conclusion can be applied to lung squamous-cell carcinoma (LSCC) has remained unclear. We therefore evaluated the ALK (anaplastic lymphoma kinase) status and the therapeutic effect of an ALK tyrosine kinase inhibitor (TKI) in IHC- or FISH-positive LSCC.

MATERIALS AND METHODS

A total of 2403 LSCC patients from three institutions were screened for ALK aberration by IHC. All IHC-positive cases were subjected to FISH (with an approximately equal number of negative cases as a control group) and next-generation sequencing (NGS). Clinical efficacy was evaluated for the patients who received TKI therapy.

RESULTS

In 2403 cases of LSCC, 37 cases were identified as ALK-positive by IHC. After quality control, 28 cases were succeeded by FISH (six with insufficient tissue, three with lack of signals) and 13 by NGS (24 failed due to insufficient samples or poor DNA quality); the percentage of non-diagnostic tests was 24.3% (9/37) and 64.9% (24/37), respectively. Four cases (4/2394, 0.17%) analyzed by FISH were determined as ALK-positive. For the control group (40 ALK IHC), FISH demonstrated no samples with ALK gene fusion. The concordance between ALK IHC- and ALK FISH-positive results was 14.3% (4/28). In the 13 cases studied by NGS, two cases showed ALK-EML4 fusion (consistent with two FISH-positive results), and two cases were interpreted as harboring an ALK-association gene mutation. Among four patients (two FISH-positive and two IHC-positive only cases) receiving TKI therapy, two patients had stable disease and the other two had progressive disease.

CONCLUSIONS

The positive concordance rate of ALK IHC and FISH in LSCC is far less than that reported for LADC. Therefore, ALK IHC detection in LSCC cannot be used as a diagnostic method for ALK rearrangement.

Cost-effectiveness of afatinib and erlotinib as second-line treatments for advanced squamous cell carcinoma of the lung

AIM

To investigate the cost-effectiveness of afatinib and erlotinib as second-line therapy for advanced squamous cell carcinoma of the lung.

MATERIALS & METHODS

A decision-analytic model was developed for projecting the economic outcomes. Clinical parameters and utilities were from the LUX-Lung 8 trial. Costs were mainly estimated from the Chinese health system. The outcome was the incremental cost-effectiveness ratio.

RESULTS

The afatinib strategy generated additional 0.154 quality-adjusted life-years compared with erlotinib, with incremental costs of ¥16,852. Relative to erlotinib, afatinib resulted in an incremental cost-effectiveness ratio of ¥109,429 per quality-adjusted life-year gained. The overall survival time of afatinib had a considerable impact on the model outcomes.

CONCLUSION

Afatinib is a cost-effective treatment option compared with erlotinib in patients with squamous cell carcinoma.