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Tsiouda T, Domvri K, Boutsikou E, Bikos V, Kyrka K, Papadaki K, Pezirkianidou P, Porpodis K, Cheva A. Prognostic Value of KRAS Mutations in Relation to PDL1 Expression and Immunotherapy Treatment in Adenocarcinoma and Squamous Cell Carcinoma Patients: A Greek Cohort Study. J Pers Med 2024; 14:457. [PMID: 38793038 PMCID: PMC11121847 DOI: 10.3390/jpm14050457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Factors that could predict which patients will benefit from Immune Checkpoint Inhibitors (ICIs) are not fully understood. This study aimed to investigate the prognostic value of KRAS biomarker in patients with advanced non-small cell lung cancer (NSCLC) in relation to clinical characteristics, treatment response and PDL1 expression. PATIENTS AND METHODS The study included 100 patients with NSCLC who received immunotherapy with or without chemotherapy as 1st line treatment. In biopsy samples, the PDL1 biomarker expression rate and somatic mutations of KRAS gene were determined. RESULTS The mean age of the patients was 67 ± 8 years. Patients were all male and 66% were found with adenocarcinoma whereas 34% with squamous cell carcinoma. The KRAS G12C mutation was found with the highest percentage (73%). In the Kaplan-Meier survival analysis, patients with PDL1 > 49% in combination with a negative KRAS result had a median overall survival of 40 months compared to patients with a positive KRAS result (9 months, p < 0.05). In addition, patients diagnosed with adenocarcinoma, PDL1 < 49% and negative KRAS result had a median overall survival of 39 months compared to patients with a positive result (28 months, p < 0.05). CONCLUSIONS Our study suggests that the presence of KRAS mutations in advanced NSCLC patients has a poor prognostic value, regardless of their PDL1 expression values, after receiving immunotherapy as first-line treatment.
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Affiliation(s)
- Theodora Tsiouda
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 540 07 Thessaloniki, Greece; (T.T.); (E.B.); (V.B.); (K.K.); (K.P.); (P.P.)
| | - Kalliopi Domvri
- Laboratory of Histology-Embryology, Medical School, Aristotle University, 541 24 Thessaloniki, Greece
- Laboratory of Pathology, “G. Papanikolaou” General Hospital, Exohi, 570 10 Thessaloniki, Greece
| | - Efimia Boutsikou
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 540 07 Thessaloniki, Greece; (T.T.); (E.B.); (V.B.); (K.K.); (K.P.); (P.P.)
| | - Vasileios Bikos
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 540 07 Thessaloniki, Greece; (T.T.); (E.B.); (V.B.); (K.K.); (K.P.); (P.P.)
| | - Krystallia Kyrka
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 540 07 Thessaloniki, Greece; (T.T.); (E.B.); (V.B.); (K.K.); (K.P.); (P.P.)
| | - Konstantina Papadaki
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 540 07 Thessaloniki, Greece; (T.T.); (E.B.); (V.B.); (K.K.); (K.P.); (P.P.)
| | - Persefoni Pezirkianidou
- Pulmonary-Oncology Department, ‘Theageneio’ Cancer Hospital, 540 07 Thessaloniki, Greece; (T.T.); (E.B.); (V.B.); (K.K.); (K.P.); (P.P.)
| | - Konstantinos Porpodis
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Exohi, 570 10 Thessaloniki, Greece;
| | - Angeliki Cheva
- Department of Pathology, AHEPA University Hospital of Thessaloniki, Aristotle University, 541 24 Thessaloniki, Greece;
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Michaelidou K, Karniadakis I, Pantelaion V, Koutoulaki C, Boukla E, Folinas K, Dimaras P, Papadaki MA, Koutsopoulos AV, Mavroudis D, Vourlakou C, Mavridis K, Agelaki S. Rapid and reliable testing for clinically actionable EGFR mutations in non-small cell lung cancer using the Idylla TM platform: a real-world two-center experience in Greece. Expert Rev Mol Diagn 2024; 24:89-98. [PMID: 38193169 DOI: 10.1080/14737159.2024.2303320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Limited information exists on epidermal growth factor receptor (EGFR) molecular epidemiology in Greece. Next-generation sequencing (NGS) is the recommended method for EGFR genotyping in NSCLC. The Idylla Biocartis platform is a fully automated system for actionable EGFR mutation detection. RESEARCH DESIGN AND METHODS We describe the prevalence of EGFR mutations in NSCLC patients in two high-volume clinical centers in Greece and compare key methods used for their determination. Eight hundred and fifty-seven FFPE samples from NSCLC patients were tested for EGFR mutations at University of Crete (UoC; n = 324) and at Evangelismos Hospital, Athens (Evangelismos; n = 503). RESULTS The prevalence of EGFR mutations was 11.1% in the whole cohort (11.5% in non-squamous). The detection rate was 11.0% by NGS, 9.8% by Sanger and 11.3% by Idylla for the whole cohort (12.0% in non-squamous). The agreement between Idylla and Sanger was 93.2%. A targetable EGFR mutation was detected in 10.0% using tissue NGS alone, and in 16.0% using concurrent Idylla ctEGFR testing. CONCLUSION The frequency of EGFR mutations was as expected for a Caucasian population. The Idylla EGFR test performance is comparable to reference methods and with a shorter TAT. Adding a concurrent plasma Idylla test to tissue NGS testing increases the detection rate of EGFR mutations in NSCLC.
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Affiliation(s)
- Kleita Michaelidou
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Crete, Greece
| | - Ioannis Karniadakis
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Crete, Greece
| | | | - Chara Koutoulaki
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Crete, Greece
| | - Eleni Boukla
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | | | - Pantelis Dimaras
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - Maria A Papadaki
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Crete, Greece
| | | | - Dimitrios Mavroudis
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Crete, Greece
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | | | - Konstantinos Mavridis
- Institute of Molecular Biology and Biotechnology (IMBB), Foundation for Research and Technology-Hellas (FORTH), Heraklion, Crete, Greece
| | - Sofia Agelaki
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Crete, Greece
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
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3
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Biomarker Testing in Older Patients Treated for an Advanced or Metastatic Non-Squamous Non-Small-Cell Lung Cancer: The French ESME Real-Life Multicenter Cohort Experience. Cancers (Basel) 2021; 14:cancers14010092. [PMID: 35008257 PMCID: PMC8750267 DOI: 10.3390/cancers14010092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Genomic and immunologic tumor biomarker testing has dramatically changed the prognosis of patients treated for advanced/metastatic non-squamous non-small-cell lung cancer (aNSCLC). In older patients, targeted therapy and immunotherapy appear attractive considering better tolerance and increased survival. However, it remains unclear whether they have access to biomarker testing techniques in the same proportion as younger patients. The aim of our retrospective study was to compare the proportion of biomarker testing performed in non-squamous aNSCLC at diagnosis between patients aged ≥70 years old and their younger counterparts. There was no significant difference between the two age groups in terms of frequency of biomarker testing. Among old patients tested, 22% of them presented an EGFR mutation. Biomarker testing is a crucial diagnostic tool for older patients with aNSCLC in whom the newer anti-EGFR agents have shown clear benefits. Abstract Background: Genomic and immunologic tumor biomarker testing has dramatically changed the prognosis of patients, particularly those treated for advanced/metastatic non-squamous non-small-cell lung cancer (aNSCLC) when access to targeted agents is available. It remains unclear whether older patients have access to therapy-predictive biomarker testing techniques in the same proportion as younger patients. This study aims to compare the proportion of biomarker testing performed in non-squamous aNSCLC at diagnosis between patients aged ≥70 years old and their younger counterparts. Methods: We conducted a retrospective analysis using the Epidemio-Strategy and Medical Economics (ESME) Advanced or Metastatic Lung Cancer Data Platform, a French multicenter real-life database. All patients with non-squamous aNSCLC diagnosed between 2015 and 2018 were selected. Biomarker testing corresponded to at least one molecular alteration and/or PD-L1 testing performed within 1 month before or 3 months after the aNSCLC diagnosis. Results: In total, 2848 patients aged ≥70 years and 6900 patients aged <70 years were included. Most patients were male. The proportion of current smokers at diagnosis was higher in the <70 years group (42% vs. 17%, p < 0.0001). There was no significant difference in the proportion of biomarker testing performed between the two groups (63% vs. 65%, p = 0.15). EGFR mutations were significantly more common in the older group (22% vs. 12%, p < 0.0001) and KRAS mutations significantly more frequent in the younger group (39% vs. 31% p < 0.0001). The distribution of other driver mutations (ALK, ROS1, BRAF V600E, HER2, and MET) was similar across age. In the multivariable analysis, factors independently associated with biomarker testing were gender, smoking status, history of COPD, stage at primary diagnosis, and histological type. Conclusions: Age is not a barrier to biomarker testing in patients with aNSCLC.
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Mountzios G, Koumarianou A, Bokas A, Mavroudis D, Samantas E, Fergadis EG, Linardou H, Katsaounis P, Athanasiadis E, Karamouzis MV, Pentheroudakis G, Lampaki S, Froudarakis ME, Perdikouri EIA, Somarakis A, Papageorgiou F, Paparepa Z, Nikolaou A, Syrigos KN. A Real-World, Observational, Prospective Study to Assess the Molecular Epidemiology of Epidermal Growth Factor Receptor ( EGFR) Mutations upon Progression on or after First-Line Therapy with a First- or Second-Generation EGFR Tyrosine Kinase Inhibitor in EGFR Mutation-Positive Locally Advanced or Metastatic Non-Small Cell Lung Cancer: The 'LUNGFUL' Study. Cancers (Basel) 2021; 13:cancers13133172. [PMID: 34202063 PMCID: PMC8268841 DOI: 10.3390/cancers13133172] [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: 04/25/2021] [Revised: 06/13/2021] [Accepted: 06/21/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer cases, with few patients carrying driver mutations in the gene encoding for epidermal growth factor receptor (EGFR). Advances in translational research have established EGFR tyrosine kinase inhibitors (TKIs) as the standard first-line therapy for NSCLC patients with activating EGFR mutations. The aim of our observational study was to assess the frequency of T790M acquired resistance and predictors of its presence, in patients with EGFR-mutated locally advanced or metastatic NSCLC who have progressed in the first-line EGFR-TKI treatment setting with first- or second-generation TKIs and have undergone molecular testing in tissue and/or plasma biopsy. The study highlights the challenges of performing tissue re-biopsy in routine care settings, which can lead to patients considered non-eligible for certain therapies from which they can benefit, and merits further actions from the healthcare community, in order to establish re-biopsy as a standard procedure. Abstract Background: Real-world data on the molecular epidemiology of EGFR resistance mutations at or after progression with first- or second-generation EGFR-TKIs in patients with advanced NSCLC are lacking. Methods: This ongoing observational study was carried out by 23 hospital-based physicians in Greece. The decision to perform cobas®EGFR Mutation Test v2 in tissue and/or plasma at disease progression was made before enrollment. For patients with negative/inconclusive T790M plasma-based results, tissue re-biopsy could be performed. Results: Ninety-six (96) eligible patients were consecutively enrolled (median age: 67.8 years) between July-2017 and September-2019. Of the patients, 98% were tested upon progression using plasma and 2% using tissue/cytology biopsy. The T790M mutation was detected in 16.0% of liquid biopsies. Tissue re-biopsy was performed in 22.8% of patients with a T790M-negative plasma result. In total, the T790M positivity rate was 21.9%, not differing between patients on first- or second-generation EGFR-TKI. Higher (≥2) ECOG performance status and longer (≥10 months) time to disease progression following EGFR-TKI treatment initiation were associated with T790M positivity. Conclusions: Results from plasma/tissue-cytology samples in a real-world setting, yielded a T790M positivity rate lower than previous reports. Fewer than one in four patients with negative plasma-based testing underwent tissue re-biopsy, indicating the challenges in routine care settings.
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Affiliation(s)
- Giannis Mountzios
- Fourth Oncology Department and Clinical Trials Unit, Henry Dunant Hospital Center, 11526 Athens, Greece
- Correspondence: ; Tel.: +30-6983519989; Fax: +30-2106972274
| | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Alexandros Bokas
- First Department of Clinical Oncology, Theagenio Cancer Hospital, 54007 Thessaloniki, Greece;
| | - Dimitrios Mavroudis
- Department of Medical Oncology, University Hospital of Heraklion, 71110 Crete, Greece;
| | | | | | - Helena Linardou
- 4th Oncology Department & Comprehensive Clinical Trials Center, Metropolitan Hospital, 18547 Athens, Greece;
| | | | | | - Michalis V. Karamouzis
- Molecular Oncology Unit, Department of Biological Chemistry Medical School, 11525 Athens, Greece;
| | - George Pentheroudakis
- Department of Medical Oncology, Medical School University of Ioannina, 45500 Ioannina, Greece;
| | - Sofia Lampaki
- Pulmonary Department, General Hospital ‘G. Papanikolaou’, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece;
| | - Marios E. Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Eleni-Isidora A. Perdikouri
- Oncology Department, General Hospital ‘Papageorgiou’, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Alvertos Somarakis
- Medical Affairs Department, AstraZeneca, 15123 Athens, Greece; (A.S.); (A.N.)
| | | | - Zoe Paparepa
- Clinical Operations, AstraZeneca, 15123 Athens, Greece;
| | - Aristeidis Nikolaou
- Medical Affairs Department, AstraZeneca, 15123 Athens, Greece; (A.S.); (A.N.)
| | - Konstantinos N. Syrigos
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, 11527 Athens, Greece;
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5
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Papanikolaou V, Chrysovergis A, Mastronikolis S, Tsiambas E, Ragos V, Peschos D, Spyropoulou D, Pantos P, Niotis A, Mastronikolis N, Kyrodimos E. Impact of K-Ras Over-expression in Laryngeal Squamous Cell Carcinoma. In Vivo 2021; 35:1611-1615. [PMID: 33910843 DOI: 10.21873/invivo.12418] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM Oncogene up-regulation combined with suppressor gene down-regulation is a crucial genetic combination that promotes cell neoplastic phenotype and progressively malignant transformation in solid malignancies, including laryngeal squamous cell carcinoma (LSCC). Among oncogenes, the Kirsten ras oncogene homolog (K-Ras) is involved in LSCC onset and progression. PATIENTS AND METHODS Sixty (n=60) primary LSCC tissue sections were analyzed by immunohistochemistry (IHC). Digital image analysis (DIA) was also implemented for measuring K-Ras protein expression levels. RESULTS High K-Ras protein expression levels were observed in 20/60 (33.3%) LSCC tissue sections, whereas the rest of the cases (n=40; 66.7%) demonstrated low expression. Overall K-Ras expression was borderline significantly associated to the grade of the examined malignancies (p=0.048), whereas no other strong statistical correlations were identified. A progressive K-Ras overexpression was observed in all grades of the examined cases. CONCLUSION K-Ras over expression is correlated to a progressive dedifferentiation in LSCC.
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Affiliation(s)
| | | | | | | | - Vasileios Ragos
- Department of Maxillofacial Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios Peschos
- Department of Physiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Despoina Spyropoulou
- Department of Radiation Oncology, Medical School, University of Patras, Patras, Greece
| | - Pavlos Pantos
- 1 ENT Department, Hippocration Hospital, University of Athens, Athens, Greece
| | | | | | - Efthymios Kyrodimos
- 1 ENT Department, Hippocration Hospital, University of Athens, Athens, Greece
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6
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Cavagna R, Escremim de Paula F, Sant'Anna D, Santana I, da Silva VD, da Silva ECA, Bacchi CE, Miziara JE, Dias JM, De Marchi P, Leal LF, Reis RM. Frequency of KRAS p.Gly12Cys Mutation in Brazilian Patients With Lung Cancer. JCO Glob Oncol 2021; 7:639-645. [PMID: 33956502 PMCID: PMC8162527 DOI: 10.1200/go.20.00615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/08/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Rodrigo Cavagna
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Débora Sant'Anna
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - Iara Santana
- Molecular Diagnostic Laboratory, Barretos Cancer Hospital, Barretos, Brazil
- Department of Pathology, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | - José E. Miziara
- Department of Thoracic Surgery, Barretos Cancer Hospital, Barretos, Brazil
| | - Josiane M. Dias
- Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Pedro De Marchi
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil
- Oncoclinicas, Rio de Janeiro, Brazil
| | - Leticia F. Leal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Barretos School of Health Sciences, Dr Paulo Prata—FACISB, Barretos, Brazil
| | - Rui M. Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Molecular Diagnostic Laboratory, Barretos Cancer Hospital, Barretos, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
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