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Speel EJM, Dafni U, Thunnissen E, Hendrik Rüschoff J, O'Brien C, Kowalski J, Kerr KM, Bubendorf L, Sansano I, Joseph L, Kriegsmann M, Navarro A, Monkhorst K, Bille Madsen L, Hernandez Losa J, Biernat W, Stenzinger A, Rüland A, Hillen LM, Marti N, Molina-Vila MA, Dellaporta T, Kammler R, Peters S, Stahel RA, Finn SP, Radonic T. ROS1 fusions in resected stage I-III adenocarcinoma: Results from the European Thoracic Oncology Platform Lungscape project. Lung Cancer 2024; 194:107860. [PMID: 39002492 DOI: 10.1016/j.lungcan.2024.107860] [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: 04/15/2024] [Revised: 06/10/2024] [Accepted: 06/21/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND ROS1 fusion is a relatively low prevalence (0.6-2.0%) but targetable driver in lung adenocarcinoma (LUAD). Robust and low-cost tests, such as immunohistochemistry (IHC), are desirable to screen for patients potentially harboring this fusion. The aim was to investigate the prevalence of ROS1 fusions in a clinically annotated European stage I-III LUAD cohort using IHC screening with the in vitro diagnostics (IVD)-marked clone SP384, followed by confirmatory molecular analysis in pre-defined subsets. METHODS Resected LUADs constructed in tissue microarrays, were immunostained for ROS1 expression using SP384 clone in a ready-to-use kit and Ventana immunostainers. After external quality control, analysis was performed by trained pathologists. Staining intensity of at least 2+ (any percentage of tumor cells) was considered IHC positive (ROS1 IHC + ). Subsequently, ROS1 IHC + cases were 1:1:1 matched with IHC0 and IHC1 + cases and subjected to orthogonal ROS1 FISH and RNA-based testing. RESULTS The prevalence of positive ROS1 expression (ROS1 IHC + ), defined as IHC 2+/3+, was 4 % (35 of 866 LUADs). Twenty-eight ROS1 IHC + cases were analyzed by FISH/RNA-based testing, with only two harboring a confirmed ROS1 gene fusion, corresponding to a lower limit for the prevalence of ROS1 gene fusion of 0.23 %. They represent a 7 % probability of identifying a fusion among ROS1 IHC + cases. Both confirmed cases were among the only four with sufficient material and H-score ≥ 200, leading to a 50 % probability of identifying a ROS1 gene fusion in cases with an H-score considered strongly positive. All matched ROS1 IHC- (IHC0 and IHC1 + ) cases were also found negative by FISH/RNA-based testing, leading to a 100 % probability of lack of ROS1 fusion for ROS1 IHC- cases. CONCLUSIONS The prevalence of ROS1 fusion in an LUAD stage I-III European cohort was relatively low. ROS1 IHC using SP384 clone is useful for exclusion of ROS1 gene fusion negative cases.
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Affiliation(s)
- Ernst-Jan M Speel
- Department of Pathology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, MUMC+ Maastricht, Netherlands & Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Urania Dafni
- ETOP IBCSG Partners Foundation, ETOP Statistical Center, Frontier Science Foundation-Hellas & National and Kapodistrian University of Athens, Athens, Greece
| | - Erik Thunnissen
- Department of Pathology, Amsterdam University Medical Centre, location VUmc, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | - Cathal O'Brien
- Department of Histopathology, St James's Hospital and Trinity College, Dublin, Ireland
| | - Jacek Kowalski
- Pathomorphology Department, Medical University of Gdansk, Gdansk, Poland
| | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary - NHS Grampian, Aberdeen, United Kingdom
| | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Irene Sansano
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Leena Joseph
- Department of Pathology, Lung Cancer Group Manchester, Manchester, United Kingdom
| | - Mark Kriegsmann
- Department of Histopathology, University Hospital Heidelberg, Germany
| | - Atilio Navarro
- Department of Pathology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Kim Monkhorst
- Pathology Department, NKI-AVL - Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | | | | | - Wojciech Biernat
- Pathomorphology Department, Medical University of Gdansk, Gdansk, Poland
| | | | - Andrea Rüland
- Department of Pathology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, MUMC+ Maastricht, Netherlands & Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Lisa M Hillen
- Department of Pathology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, MUMC+ Maastricht, Netherlands & Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Nesa Marti
- Translational Research Coordination, ETOP IBCSG Partners Foundation, Bern, Switzerland
| | - Miguel A Molina-Vila
- Laboratory of Oncology, Pangaea Oncology, Dexeus University Hospital, Barcelona, Spain
| | - Tereza Dellaporta
- ETOP Statistical Center, Frontier Science Foundation-Hellas, Athens, Greece
| | - Roswitha Kammler
- Translational Research Coordination, ETOP IBCSG Partners Foundation, Bern, Switzerland
| | - Solange Peters
- Oncology Department, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Rolf A Stahel
- President, ETOP IBCSG Partners Foundation, Bern, Switzerland.
| | - Stephen P Finn
- Department of Histopathology, St James's Hospital and Trinity College, Dublin, Ireland
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Centre, location VUmc, Cancer Center Amsterdam, Amsterdam, Netherlands
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Alt NJ, Muster J, Ziegler DA, Bendrich S, Donath S, Hille A, Anczykowski MZ, Zwerenz CM, Braulke F, von Hammerstein-Equord A, Overbeck TR, Treiber H, Guhlich M, El Shafie R, Rieken S, Leu M, Dröge LH. Outcomes of Multimodal Treatment in Elderly Patients with Localized Non-Small Lung Cancer from a Radiation Oncology Point of View: Special Focus on Low-Dose Cisplatin. Cancers (Basel) 2024; 16:327. [PMID: 38254817 PMCID: PMC10814481 DOI: 10.3390/cancers16020327] [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: 12/07/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Identification of the optimal treatment strategy is challenging in elderly with localized non-small cell lung cancer (NSCLC). Concurrent chemotherapy with low-dose cisplatin represents an option for elderly. Outcomes (1) in elderly (≥70 years, n = 158) vs. younger patients (n = 188) and (2), independently of age, in definitive radiochemotherapy, with low-dose cisplatin (n = 125) vs. cisplatin/vinorelbine (n = 76) were studied. Elderly included more males, had a lower Karnofsky index, more comorbidities, and lower stages. Low-dose cisplatin patients (vs. cisplatin/vinorelbine) had higher age, more comorbidities, and lower stages. We observed reduced dermatitis and dysphagia and increased anemia and thrombocytopenia in elderly vs. younger patients, without increased ≥grade 3 toxicities. Low-dose cisplatin was less toxic than cisplatin/vinorelbine. Survival outcomes were lower in elderly vs. younger and comparable between low-dose cisplatin and cisplatin/vinorelbine. In elderly, gender, Karnofsky index, stage, and multimodal treatment (including additional surgery/systemic therapy) were identified as prognostic factors. In conclusion, we found evidence for an acceptable toxicity profile and the need for improvement of outcomes in elderly with localized NSCLC. Multimodal strategies (including additional surgery/systemic treatment) showed favorable outcomes and should be reasonably considered in elderly who are deemed fit enough. Low-dose cisplatin should be discussed on an individual basis due to favorable toxicity and outcomes.
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Affiliation(s)
- Niklas Josua Alt
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Julian Muster
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - David Alexander Ziegler
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Stephanie Bendrich
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Sandra Donath
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Andrea Hille
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Mahalia Zoe Anczykowski
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Carla Marie Zwerenz
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Friederike Braulke
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Alexander von Hammerstein-Equord
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
- Department of Cardio-Thoracic and Vascular Surgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Tobias Raphael Overbeck
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Hannes Treiber
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Manuel Guhlich
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Rami El Shafie
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Stefan Rieken
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Martin Leu
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
| | - Leif Hendrik Dröge
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (N.J.A.); (D.A.Z.); (S.B.); (S.D.); (A.H.); (M.Z.A.); (C.M.Z.); (M.G.); (R.E.S.); (S.R.); (M.L.)
- Göttingen Comprehensive Cancer Center (G-CCC), University Medical Center Göttingen, Von-Bar-Str. 2/4, 37075 Göttingen, Germany; (F.B.); (A.v.H.-E.); (T.R.O.); (H.T.)
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