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Hofman P, Berezowska S, Kazdal D, Mograbi B, Ilié M, Stenzinger A, Hofman V. Current challenges and practical aspects of molecular pathology for non-small cell lung cancers. Virchows Arch 2024; 484:233-246. [PMID: 37801103 PMCID: PMC10948551 DOI: 10.1007/s00428-023-03651-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
The continuing evolution of treatment options in thoracic oncology requires the pathologist to regularly update diagnostic algorithms for management of tumor samples. It is essential to decide on the best way to use tissue biopsies, cytological samples, as well as liquid biopsies to identify the different mandatory predictive biomarkers of lung cancers in a short turnaround time. However, biological resources and laboratory member workforce are limited and may be not sufficient for the increased complexity of molecular pathological analyses and for complementary translational research development. In this context, the surgical pathologist is the only one who makes the decisions whether or not to send specimens to immunohistochemical and molecular pathology platforms. Moreover, the pathologist can rapidly contact the oncologist to obtain a new tissue biopsy and/or a liquid biopsy if he/she considers that the biological material is not sufficient in quantity or quality for assessment of predictive biomarkers. Inadequate control of algorithms and sampling workflow may lead to false negative, inconclusive, and incomplete findings, resulting in inappropriate choice of therapeutic strategy and potentially poor outcome for patients. International guidelines for lung cancer treatment are based on the results of the expression of different proteins and on genomic alterations. These guidelines have been established taking into consideration the best practices to be set up in clinical and molecular pathology laboratories. This review addresses the current predictive biomarkers and algorithms for use in thoracic oncology molecular pathology as well as the central role of the pathologist, notably in the molecular tumor board and her/his participation in the treatment decision-making. The perspectives in this setting will be discussed.
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Affiliation(s)
- Paul Hofman
- Côte d'Azur University, FHU OncoAge, IHU RespirERA, Laboratory of Clinical and Experimental Pathology, BB-0033-00025, Louis Pasteur Hospital, 30 avenue de la voie romaine, BP69, 06001, Nice cedex 01, France.
- Côte d'Azur University, IRCAN, Inserm, CNRS 7284, U1081, Nice, France.
| | - Sabina Berezowska
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniel Kazdal
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Centers for Personalized Medicine (ZPM), Heidelberg, Germany
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Baharia Mograbi
- Côte d'Azur University, FHU OncoAge, IHU RespirERA, Laboratory of Clinical and Experimental Pathology, BB-0033-00025, Louis Pasteur Hospital, 30 avenue de la voie romaine, BP69, 06001, Nice cedex 01, France
- Côte d'Azur University, IRCAN, Inserm, CNRS 7284, U1081, Nice, France
| | - Marius Ilié
- Côte d'Azur University, FHU OncoAge, IHU RespirERA, Laboratory of Clinical and Experimental Pathology, BB-0033-00025, Louis Pasteur Hospital, 30 avenue de la voie romaine, BP69, 06001, Nice cedex 01, France
- Côte d'Azur University, IRCAN, Inserm, CNRS 7284, U1081, Nice, France
| | - Albrecht Stenzinger
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Centers for Personalized Medicine (ZPM), Heidelberg, Germany
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Véronique Hofman
- Côte d'Azur University, FHU OncoAge, IHU RespirERA, Laboratory of Clinical and Experimental Pathology, BB-0033-00025, Louis Pasteur Hospital, 30 avenue de la voie romaine, BP69, 06001, Nice cedex 01, France
- Côte d'Azur University, IRCAN, Inserm, CNRS 7284, U1081, Nice, France
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Hofman V, Goffinet S, Bontoux C, Long-Mira E, Lassalle S, Ilié M, Hofman P. A Real-World Experience from a Single Center (LPCE, Nice, France) Highlights the Urgent Need to Abandon Immunohistochemistry for ROS1 Rearrangement Screening of Advanced Non-Squamous Non-Small Cell Lung Cancer. J Pers Med 2023; 13:jpm13050810. [PMID: 37240980 DOI: 10.3390/jpm13050810] [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: 03/20/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The detection of ROS1 rearrangements in metastatic non-squamous non-small cell lung carcinoma (NS-NSCLC) permits administration of efficient targeted therapy. Detection is based on a testing algorithm associated with ROS1 immunohistochemistry (IHC) screening followed by ROS1 FISH and/or next generation sequencing (NGS) to confirm positivity. However, (i) ROS1 rearrangements are rare (1-2% of NS-NSCLC), (ii) the specificity of ROS1 IHC is not optimal, and (iii) ROS1 FISH is not widely available, making this algorithm challenging to interpret time-consuming. We evaluated RNA NGS, which was used as reflex testing for ROS1 rearrangements in NS-NSCLC with the aim of replacing ROS1 IHC as a screening method. ROS1 IHC and RNA NGS were prospectively performed in 810 NS-NSCLC. Positive results were analyzed by ROS1 FISH. ROS1 IHC was positive in 36/810 (4.4%) cases that showed variable staining intensity while NGS detected ROS1 rearrangements in 16/810 (1.9%) cases. ROS1 FISH was positive in 15/810 (1.8%) of ROS1 IHC positive cases and in all positive ROS1 NGS cases. Obtaining both ROS1 IHC and ROS1 FISH reports took an average of 6 days, while obtaining ROS1 IHC and RNA NGS reports took an average of 3 days. These results showed that systematic screening for the ROS1 status using IHC must be replaced by NGS reflex testing.
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Affiliation(s)
- Véronique Hofman
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Samantha Goffinet
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
| | - Christophe Bontoux
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Elodie Long-Mira
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Sandra Lassalle
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Marius Ilié
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, FHU OncoAge, Pasteur Hospital, 06000 Nice, France
- Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, 06000 Nice, France
- Team 4, IRCAN Inserm U1081, CNRS 7284, Université Côte d'Azur, 06100 Nice, France
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Analytical validation of automated multiplex chromogenic immunohistochemistry for diagnostic and predictive purpose in non-small cell lung cancer. Lung Cancer 2022; 166:1-8. [DOI: 10.1016/j.lungcan.2022.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 12/12/2022]
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Zhou H, Xu B, Xu J, Zhu G, Guo Y. Novel MRPS9-ALK Fusion Mutation in a Lung Adenocarcinoma Patient: A Case Report. Front Oncol 2021; 11:670907. [PMID: 34168990 PMCID: PMC8217641 DOI: 10.3389/fonc.2021.670907] [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: 03/18/2021] [Accepted: 05/10/2021] [Indexed: 12/25/2022] Open
Abstract
Anaplastic lymphoma kinase (ALK) rearrangements account for approximately 5-6% of non-small-cell lung cancer (NSCLC) patients. In this study, a case of lung adenocarcinoma harboring a novel MRPS9-ALK fusion is reported. The patient responded well to the first and second generation of ALK-tyrosine kinase inhibitors (ALK-TKIs) (crizotinib then alectinib), as her imaging findings and clinical symptoms significantly improved. At last follow-up, over 21 months of overall survival (OS) has been achieved since ALK-TKI treatment. The progression-free survival (PFS) is already ten months since alectinib. The adverse effects were manageable. The case presented here provides first clinical evidence of the efficacy of ALK-TKIs in NSCLC patients with MRPS9-ALK fusion.
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Affiliation(s)
- Huamiao Zhou
- Department of Oncology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Binyue Xu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jili Xu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Guomeng Zhu
- Department of Oncology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Yong Guo
- Department of Oncology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
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What Is New in Biomarker Testing at Diagnosis of Advanced Non-Squamous Non-Small Cell Lung Carcinoma? Implications for Cytology and Liquid Biopsy. JOURNAL OF MOLECULAR PATHOLOGY 2021. [DOI: 10.3390/jmp2020015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The discovery and clinical validation of biomarkers predictive of the response of non-squamous non-small-cell lung carcinomas (NS-NSCLC) to therapeutic strategies continue to provide new data. The evaluation of novel treatments is based on molecular analyses aimed at determining their efficacy. These tests are increasing in number, but the tissue specimens are smaller and smaller and/or can have few tumor cells. Indeed, in addition to tissue samples, complementary cytological and/or blood samples can also give access to these biomarkers. To date, it is recommended and necessary to look for the status of five genomic molecular biomarkers (EGFR, ALK, ROS1, BRAFV600, NTRK) and of a protein biomarker (PD-L1). However, the short- and more or less long-term emergence of new targeted treatments of genomic alterations on RET and MET, but also on others’ genomic alteration, notably on KRAS, HER2, NRG1, SMARCA4, and NUT, have made cellular and blood samples essential for molecular testing. The aim of this review is to present the interest in using cytological and/or liquid biopsies as complementary biological material, or as an alternative to tissue specimens, for detection at diagnosis of new predictive biomarkers of NS-NSCLC.
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Zhao T, Khadka VS, Deng Y. Identification of lncRNA biomarkers for lung cancer through integrative cross-platform data analyses. Aging (Albany NY) 2020; 12:14506-14527. [PMID: 32675385 PMCID: PMC7425463 DOI: 10.18632/aging.103496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
This study was designed to identify lncRNA biomarker candidates using lung cancer data from RNA-Seq and microarray platforms separately. Lung cancer datasets were obtained from the Gene Expression Omnibus (GEO, n = 287) and The Cancer Genome Atlas (TCGA, n = 216) repositories, only common lncRNAs were used. Differentially expressed (DE) lncRNAs in tumors with respect to normal were selected from the Affymetrix and TCGA datasets. A training model consisting of the top 20 DE Affymetrix lncRNAs was used for validation in the TCGA and Agilent datasets. A second similar training model was generated using the TCGA dataset. First, a model using the top 20 DE lncRNAs from Affymetrix for training and validated using TCGA and Agilent, achieved high prediction accuracy for both training (98.5% AUC for Affymetrix) and validation (99.2% AUC for TCGA and 92.8% AUC for Agilent). A similar model using the top 20 DE lncRNAs from TCGA for training and validated using Affymetrix and Agilent, also achieved high prediction accuracy for both training (97.7% AUC for TCGA) and validation (96.5% AUC for Affymetrix and 80.9% AUC for Agilent). Eight lncRNAs were found to be overlapped from these two lists.
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Affiliation(s)
- Tianying Zhao
- Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, The University of Hawaii at Manoa, Honolulu, HI 96813, USA.,Department of Molecular Biosciences and Bioengineering, The University of Hawaii at Manoa College of Tropical Agriculture and Human Resources, Agricultural Sciences 218, Honolulu, HI 96822, USA
| | - Vedbar Singh Khadka
- Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, The University of Hawaii at Manoa, Honolulu, HI 96813, USA
| | - Youping Deng
- Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, The University of Hawaii at Manoa, Honolulu, HI 96813, USA
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Critical Assessment in Routine Clinical Practice of Liquid Biopsy for EGFR Status Testing in Non-Small-Cell Lung Cancer: A Single-Laboratory Experience (LPCE, Nice, France). Clin Lung Cancer 2019; 21:56-65.e8. [PMID: 31519454 DOI: 10.1016/j.cllc.2019.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/08/2019] [Accepted: 07/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The introduction of liquid biopsy using PCR-based assays into routine practice has had a strong impact on the treatment of EGFR-mutated lung adenocarcinoma and is now commonly used for routine testing of EGFR mutations in certain clinical settings. To assess whether the claimed benefits of PCR-based assays hold true in daily practice at a multicenter clinical institution, we assessed how treatment decisions are affected by PCR-based assays for the analysis of EGFR mutations from plasma samples in a centralized laboratory (LPCE, Nice, France). PATIENTS AND METHODS A total of 345 samples were analyzed using the US Food and Drug Administration-approved Cobas EGFR Mutation Test v2 and 103 using the Therascreen EGFR Plasma RGQ PCR Kit over 3 years (395 samples from 324 patients). Eleven plasma samples were validated independently using Cobas at 3 institutions, and 130 samples were analyzed using Stilla digital PCR. Clinical data were collected for 175 (54%) of 324 patients. RESULTS Cobas was superior to the Therascreen assay and demonstrated 100% reproducibility. Digital PCR showed only 48%, 83%, and 58% concordance with Cobas for exon 19 deletions, L858R mutations, and T790M mutations, respectively. Liquid biopsies helped inform and change treatment when resistance occurred and enabled the detection of EGFR mutations in patients when biopsy tissue results were unavailable. CONCLUSION PCR-based assays are a fast and convenient test, allowing the detection of primary and secondary EGFR mutations from plasma. Cobas proved to be a reliable test, whereas digital PCR produced too many inconclusive results to be currently recommended as a principal testing device.
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Ponti G, Manfredini M, Tomasi A. Non-blood sources of cell-free DNA for cancer molecular profiling in clinical pathology and oncology. Crit Rev Oncol Hematol 2019; 141:36-42. [PMID: 31212145 DOI: 10.1016/j.critrevonc.2019.06.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/19/2018] [Accepted: 06/04/2019] [Indexed: 12/12/2022] Open
Abstract
Liquid biopsy can quantify and qualify cell-free (cfDNA) and tumour-derived (ctDNA) DNA fragments in the bloodstream. CfDNA quantification and mutation analysis can be applied to diagnosis, follow-up and therapeutic management as novel oncologic biomarkers. However, some tumor-types release a low amount of DNA into the bloodstream, hampering diagnosis through standard liquid biopsy procedures. Several tumors, as such as brain, kidney, prostate, and thyroid cancer, are in direct contact with other body fluids and may be alternative sources for cfDNA and ctDNA. Non-blood sources of cfDNA/ctDNA useful as novel oncologic biomarkers include cerebrospinal fluids, urine, sputum, saliva, pleural effusion, stool and seminal fluid. Seminal plasma cfDNA, which can be analyzed with cost-effective procedures, may provide powerful information capable to revolutionize prostate cancer (PCa) patient diagnosis and management. In the near future, cfDNA analysis from non-blood biological liquids will become routine clinical practice for cancer patient diagnosis and management.
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Affiliation(s)
- Giovanni Ponti
- Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, Division of Clinical Pathology, University of Modena & Reggio Emilia, Modena, Italy.
| | - Marco Manfredini
- Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, Dermatology Unit, University of Modena & Reggio Emilia, Modena, Italy
| | - Aldo Tomasi
- Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, Division of Clinical Pathology, University of Modena & Reggio Emilia, Modena, Italy
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VanderLaan PA. Non–small cell lung cancer predictive biomarker testing via immunocytochemistry: Ways of future past? Cancer Cytopathol 2019; 127:278-280. [DOI: 10.1002/cncy.22138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Paul A. VanderLaan
- Department of Pathology Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts
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Liquid biopsy for predictive mutational profiling of solid cancer: The pathologist’s perspective. J Biotechnol 2019; 297:66-70. [DOI: 10.1016/j.jbiotec.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
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Hofman V, Rouquette I, Long-Mira E, Piton N, Chamorey E, Heeke S, Vignaud JM, Yguel C, Mazières J, Lepage AL, Bibeau F, Begueret H, Lassalle S, Lalvée S, Zahaf K, Benzaquen J, Poudenx M, Marquette CH, Sabourin JC, Ilié M, Hofman P. Multicenter Evaluation of a Novel ROS1 Immunohistochemistry Assay (SP384) for Detection of ROS1 Rearrangements in a Large Cohort of Lung Adenocarcinoma Patients. J Thorac Oncol 2019; 14:1204-1212. [PMID: 30999109 DOI: 10.1016/j.jtho.2019.03.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/06/2019] [Accepted: 03/19/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The detection of a ROS1 rearrangement in advanced and metastatic lung adenocarcinoma (LUAD) led to a targeted treatment with tyrosine kinase inhibitors with favorable progression-free survival and overall survival of the patients. Thus, it is mandatory to screen for the ROS1 rearrangement in all these patients. ROS1 rearrangements can be detected using break-apart fluorescence in situ hybridization (FISH), which is the gold standard; however, ROS1 immunohistochemistry (IHC) can be used as a screening test because it is widely available, easy and rapid to perform, and cost-effective. METHODS We evaluated the diagnostic accuracy and interpathologist agreement of two anti-ROS1 IHC clones, SP384 (Ventana, Tucson, Arizona) and D4D6 (Cell Signaling, Danvers, Massachusetts), in a training cohort of 51 positive ROS1 FISH LUAD cases, and then in a large validation cohort of 714 consecutive cases of LUAD from six routine molecular pathology platforms. RESULTS In the two cohorts, the SP384 and D4D6 clones show variable sensitivity and specificity rates on the basis of two cutoff points greater than or equal to 1+ (all % tumor cells) and greater than or equal to 2+ (>30% stained tumor cells). In the validation cohort, the D4D6 yielded the best accuracy for the presence of a ROS1 rearrangement by FISH. Interpathologist agreement was moderate to good (interclass correlation 0.722-0.874) for the D4D6 clone and good to excellent (interclass correlation: 0.830-0.956) for the SP384 clone. CONCLUSIONS ROS1 IHC is an effective screening tool for the presence of ROS1 rearrangements. However, users must be acutely aware of the variable diagnostic performance of different anti-ROS1 antibodies before implementation into routine clinical practice.
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Affiliation(s)
- Véronique Hofman
- Université Côte d'Azur, University Hospital Federation OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France; Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Ageing of Nice (IRCAN), University Hospital Federation OncoAge, Nice, France; Université Côte d'Azur, University Hospital Federation OncoAge, Hospital-Related Biobank (BB-0033-00025), Pasteur Hospital, Nice, France
| | | | - Elodie Long-Mira
- Université Côte d'Azur, University Hospital Federation OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France; Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Ageing of Nice (IRCAN), University Hospital Federation OncoAge, Nice, France; Université Côte d'Azur, University Hospital Federation OncoAge, Hospital-Related Biobank (BB-0033-00025), Pasteur Hospital, Nice, France
| | - Nicolas Piton
- Charles Nicolle Hospital, Department of Pathology, Rouen, France
| | - Emmanuel Chamorey
- Antoine Lacassagne Comprehensive Cancer Center, Biostatistics Unit, Nice, France
| | - Simon Heeke
- Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Ageing of Nice (IRCAN), University Hospital Federation OncoAge, Nice, France
| | - Jean Michel Vignaud
- CHU Nancy, Department of Pathology and Biobank (BB-0033-00035), Nancy, France
| | - Clémence Yguel
- CHU Nancy, Department of Pathology and Biobank (BB-0033-00035), Nancy, France
| | - Julien Mazières
- CHU Toulouse, Larrey Hospital, Université Paul Sabatier, Toulouse, France
| | | | | | | | - Sandra Lassalle
- Université Côte d'Azur, University Hospital Federation OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France; Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Ageing of Nice (IRCAN), University Hospital Federation OncoAge, Nice, France
| | - Salomé Lalvée
- Université Côte d'Azur, University Hospital Federation OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France
| | - Katia Zahaf
- Université Côte d'Azur, University Hospital Federation OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France
| | - Jonathan Benzaquen
- Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Ageing of Nice (IRCAN), University Hospital Federation OncoAge, Nice, France; Université Côte d'Azur, University Hospital Federation OncoAge, Department of Pulmonary Medicine and Thoracic Oncology, Nice, France
| | - Michel Poudenx
- Université Côte d'Azur, University Hospital Federation OncoAge, Department of Pulmonary Medicine and Thoracic Oncology, Nice, France
| | - Charles-Hugo Marquette
- Université Côte d'Azur, University Hospital Federation OncoAge, Department of Pulmonary Medicine and Thoracic Oncology, Nice, France
| | | | - Marius Ilié
- Université Côte d'Azur, University Hospital Federation OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France; Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Ageing of Nice (IRCAN), University Hospital Federation OncoAge, Nice, France; Université Côte d'Azur, University Hospital Federation OncoAge, Hospital-Related Biobank (BB-0033-00025), Pasteur Hospital, Nice, France
| | - Paul Hofman
- Université Côte d'Azur, University Hospital Federation OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France; Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Ageing of Nice (IRCAN), University Hospital Federation OncoAge, Nice, France; Université Côte d'Azur, University Hospital Federation OncoAge, Hospital-Related Biobank (BB-0033-00025), Pasteur Hospital, Nice, France.
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Hofman P. Advances in theranostic biomarkers for lung cancer from clinical to molecular pathology. J Thorac Dis 2019; 11:S1-S2. [PMID: 30775022 DOI: 10.21037/jtd.2018.10.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Paul Hofman
- Université Côte d'Azur, CHU Nice, FHU OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France.,Université Côte d'Azur, CNRS, INSERM, IRCAN, FHU OncoAge, Team 4, Nice, France.,Université Côte d'Azur, CHU Nice, FHU OncoAge, Hospital-Integrated Biobank (BB-0033-00025), Nice, France
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Hofman P. [Thoracic oncology and tumor mutational burden: Towards new challenges for the pathologist?]. Ann Pathol 2019; 39:212-220. [PMID: 30711336 DOI: 10.1016/j.annpat.2018.12.008] [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: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
Among the different promising predictive biomarkers in immuno-oncology, the tumor mutational burden (TMB) may soon impose itself in clinical routine practice, in association with PD-L1 immunohistochemistry testing. However, the TMB is used currently in clinical trials only, in particular in the thoracic oncology field. If this biomarker becomes mandatory in the near future, the pathologist will have to respond to new challenges in tight collaboration with the activity of molecular pathology platforms. Given the high incidence of lung cancer in France, this new development could have a strong impact on the daily life of the laboratories. This review addresses the different challenges which could be soon proposed to the laboratories and the pathologists due to the use of TMB assays on a daily practice.
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Affiliation(s)
- Paul Hofman
- Laboratoire de pathologie clinique et expérimentale, hôpital Pasteur, centre hospitalo-universitaire de Nice, université de Nice Sophia Antipolis, BP 69, 30, avenue de la voie romaine, 06001 Nice cedex 01, France; Biobanque hospitalière (BB-0033-00025), hôpital Pasteur, 06001 Nice cedex 01, France; FHU OncoAge, hôpital Pasteur, université Nice Côte d'Azur, 06001 Nice cedex 01, France.
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Hofman P. The challenges of evaluating predictive biomarkers using small biopsy tissue samples and liquid biopsies from non-small cell lung cancer patients. J Thorac Dis 2019; 11:S57-S64. [PMID: 30775028 DOI: 10.21037/jtd.2018.11.85] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The list of theranostic biomarkers for the care of patients with advanced stage or metastatic non-small cell lung cancer has lengthened considerably these last few years. Moreover, the advances in therapeutics will certainly increase the number and complexity of these tests performed in laboratories in the near future. In addition, the methods for investigation of biomarkers that require access to biological tissue are less and less invasive with the consequential increase in the use of small-sized tissue biopsies and cytological and blood samples. Thus, each laboratory must master the management of the biological samples according to the number and type of tests to be performed. This review will provide an update of the difference challenges facing pathologists and biologist in responding to the issues related to new treatments. These challenges concern: (I) the management of the pre-analytical phase; (II) the appropriate choice of the technological approach; (III) the performance of quality control; (IV) the mastering of the delay in obtaining the results; and (V) the economic model of the laboratory.
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Affiliation(s)
- Paul Hofman
- Université Côte d'Azur, CHU Nice, FHU OncoAge, Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France.,Université Côte d'Azur, CNRS, INSERM, IRCAN, FHU OncoAge, Team 4, Nice, France.,Université Côte d'Azur, CHU Nice, FHU OncoAge, Hospital-Integrated Biobank (BB-0033-00025), Nice, France
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15
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Heeke S, Hofman P. Tumor mutational burden assessment as a predictive biomarker for immunotherapy in lung cancer patients: getting ready for prime-time or not? Transl Lung Cancer Res 2018; 7:631-638. [PMID: 30505707 DOI: 10.21037/tlcr.2018.08.04] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The emergence of immunotherapy as a first- or second-line of treatment has revolutionized the therapeutic management of lung cancer patients. However, not all lung cancer patients receive the same benefit from this treatment, leading to limitations in the number of patients who can receive anti-PD-1/PD-L1 checkpoint inhibitors because some secondary toxicity has been associated with immunotherapy, and because some patients would benefit more from chemotherapy. In this context, the selection of patients is currently based on PD-L1 immunohistochemistry (IHC), specifically on the percentage of PD-L1 positive tumor cells. To date, this is the only validated biomarker that is used as a companion diagnostic test for immunotherapy in non-small cell carcinoma lung (NSCLC) patients. However, this biomarker is not sufficiently robust and demonstrates many challenges. For example, some patients with more than 50% PD-L1 positive tumor cells are non-responders to anti-PD-1/PD-L1 treatment, while conversely, other patients with no PD-L1 positive tumor cells are good responders. The tumor mutation burden (TMB) or tumor mutation load (TML) emerged recently as a new predictive biomarker for immunotherapy response in NSCLC. However, this biomarker needs to be validated for routine clinical use and shares similar constraints with the PD-L1 IHC biomarker. PD-L1 IHC and TMB are currently the two best predictive biomarkers that could soon be used to systematically inform treatment decisions in advanced or metastatic NSCLC patients. The aim of this review is to consider the possible integration of TMB testing in daily practice through a pros- and cons-debate, and to establish sample quality-dependent algorithms and the main current constraints for laboratories considering TMB assessments.
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Affiliation(s)
- Simon Heeke
- Université Côte d'Azur, Nice, France.,Team 4 IRCAN, Inserm U1081/CNRS 7284, Antoine Lacassagne Cancer Center, Nice, France
| | - Paul Hofman
- Université Côte d'Azur, Nice, France.,Team 4 IRCAN, Inserm U1081/CNRS 7284, Antoine Lacassagne Cancer Center, Nice, France.,Laboratory of Clinical and Experimental Pathology, Biobank BB-0033-00025, Pasteur Hospital, Nice, France.,FHU OncoAge Pasteur Hospital, Nice, France
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16
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Ilie M, Beaulande M, Hamila M, Erb G, Hofman V, Hofman P. Automated chromogenic multiplexed immunohistochemistry assay for diagnosis and predictive biomarker testing in non-small cell lung cancer. Lung Cancer 2018; 124:90-94. [PMID: 30268486 DOI: 10.1016/j.lungcan.2018.07.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The current challenge in the management of non-small cell lung cancer (NSCLC) in pathology laboratories is to combine immunohistochemistry (IHC) and molecular approaches on increasingly smaller biopsies and the need to reserve a fair amount of tumor material for molecular analyses with increasingly larger panels. The latest lung cancer classification, especially in the setting of poorly differentiated tumors, requires an IHC workup to allow for accurate diagnosis and also to preserve as much tissue as possible for molecular testing. Thus, it is recommended to reduce use of the term NSCLC not otherwise specified as much as possible and classify tumors according to their specific histologic subtype. This implies limiting the number of tissue slides despite the existence of specific and sensitive biomarkers (ALK, ROS1, BRAF V600E, PD-L1) and the obligation to distinguish lung adenocarcinoma (TTF-1 positive) from squamous cell carcinoma (p40 positive). MATERIALS AND METHODS Samples from 18 patients with NSCLC, previously characterized for histologic and genomic/immune features, were included. Two multiplexed IHC assays were developed, for diagnosis and immunophenotyping including TTF1, p40, PD-L1, and pan-Keratin antibodies, and for molecular profiling panel including ALK, ROS1 and BRAF V600E antibodies. RESULTS We developed two sensitive multiplexed IHC assays to comprehensively characterize major NSCLC histotypes and FDA-cleared predictive biomarkers, without antigenicity loss, steric interference or increased cross-reactivity. The assays rely on standard antigen retrieval and automated staining protocols, limiting the need for validation strategies. CONCLUSION Our multiplexed IHC approach provides a unique sample-sparing tool to characterize limited tissue samples in lung oncology and making it an alternative method in the clinical setting for therapeutic decision making of advanced NSCLC, provided that validation in a larger population is performed.
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Affiliation(s)
- Marius Ilie
- Laboratory of Clinical and Experimental Pathology/ Hospital-Integrated Biobank (BB-0033-00025), CHU Nice, FHU OncoAge, Université Côte d'Azur, Nice, France.
| | | | - Marame Hamila
- Laboratory of Clinical and Experimental Pathology/ Hospital-Integrated Biobank (BB-0033-00025), CHU Nice, FHU OncoAge, Université Côte d'Azur, Nice, France
| | - Gilles Erb
- EMEA-LATAM division, Roche Diagnostics France, Meylan, France
| | - Véronique Hofman
- Laboratory of Clinical and Experimental Pathology/ Hospital-Integrated Biobank (BB-0033-00025), CHU Nice, FHU OncoAge, Université Côte d'Azur, Nice, France
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology/ Hospital-Integrated Biobank (BB-0033-00025), CHU Nice, FHU OncoAge, Université Côte d'Azur, Nice, France.
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17
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Inamura K, Shigematsu Y, Ninomiya H, Nakashima Y, Kobayashi M, Saito H, Takahashi K, Futaya E, Okumura S, Ishikawa Y, Kanda H. CSF1R-Expressing Tumor-Associated Macrophages, Smoking and Survival in Lung Adenocarcinoma: Analyses Using Quantitative Phosphor-Integrated Dot Staining. Cancers (Basel) 2018; 10:cancers10080252. [PMID: 30065206 PMCID: PMC6115958 DOI: 10.3390/cancers10080252] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/16/2018] [Accepted: 07/27/2018] [Indexed: 12/12/2022] Open
Abstract
CSF1R-expressing tumor-associated macrophages (TAMs) induce a tumor-promoting microenvironment by regulating immunity. Evidence demonstrates that the expression and single nucleotide polymorphisms of CSF1R relate with survival and risk of lung cancer in never smokers. However, no previous studies have examined the association of CSF1R expression in TAMs with mortality or whether the prognostic association differs according to smoking status in lung adenocarcinoma. Quantitative phosphor-integrated dot staining was used to precisely assess CSF1R expression in TAMs. Using 195 consecutive cases of lung adenocarcinoma, we examined the association of CSF1R expression with mortality and whether the prognostic association differs according to smoking status. We observed high expression levels of CSF1R in TAMs in 65 of 195 (33%) cases of lung adenocarcinoma. High expression levels of CSF1R were associated with high lung cancer-specific mortality (log-rank p = 0.037; hazard ratio (HR) = 1.61, 95% confidence interval (CI) = 1.02−2.52, p = 0.043). This prognostic association differed according to smoking status (p for interaction = 0.049, between never-smoking and ever-smoking patients). The association between high expression levels of CSF1R and lung cancer-specific mortality was stronger in never-smoking patients (log-rank p = 0.0027; HR = 2.90, 95% CI = 1.41−6.11, p = 0.0041) than in ever-smoking patients (log-rank p = 0.73; HR = 1.11, 95% CI = 0.59−2.00, p = 0.73). The findings suggest that CSF1R-expressing TAMs may exert stronger tumor-promoting immunity in never-smoking patients with lung adenocarcinoma and serve as a therapeutic target in precision immunotherapies.
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Affiliation(s)
- Kentaro Inamura
- Division of Pathology, The Cancer Institute, Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Yasuyuki Shigematsu
- Division of Pathology, The Cancer Institute, Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Hironori Ninomiya
- Division of Pathology, The Cancer Institute, Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Yasuhiro Nakashima
- Division of Pathology, The Cancer Institute, Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Maki Kobayashi
- Division of Pathology, The Cancer Institute, Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Haruyuki Saito
- Bio Advanced Technology Division, Corporate R&D Headquarters, Konica Minolta, Inc., 1 Sakura-machi, Hino, Tokyo 191-8511, Japan.
| | - Katsuhiro Takahashi
- Bio Advanced Technology Division, Corporate R&D Headquarters, Konica Minolta, Inc., 1 Sakura-machi, Hino, Tokyo 191-8511, Japan.
| | - Etsuko Futaya
- Bio Advanced Technology Division, Corporate R&D Headquarters, Konica Minolta, Inc., 1 Sakura-machi, Hino, Tokyo 191-8511, Japan.
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Yuichi Ishikawa
- Division of Pathology, The Cancer Institute, Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Hiroaki Kanda
- Division of Pathology, The Cancer Institute, Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
- Department of Pathology, Saitama Cancer Center, 780 Komuro, Ina, Kitaadachi-gun, Saitama 362-0806, Japan.
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Immunohistochemistry for Diagnosis of Metastatic Carcinomas of Unknown Primary Site. Cancers (Basel) 2018; 10:cancers10040108. [PMID: 29621151 PMCID: PMC5923363 DOI: 10.3390/cancers10040108] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 01/05/2023] Open
Abstract
Immunohistochemistry has become an essential ancillary examination for the identification and classification of carcinomas of unknown primary site (CUPs). Over the last decade, the diagnostic accuracy of organ- or tumour-specific immunomarkers and the clinical validation of effective immunohistochemical panels has improved significantly. When dealing with small sample sizes, diagnostic accuracy is crucial, particularly in the current era of targeted molecular and immune-based therapies. Effective systematic use of appropriate immunohistochemical panels enables accurate classification of most of the undifferentiated carcinomas as well as careful preservation of tissues for potential molecular or other ancillary tests. This review discusses the algorithmic approach to the diagnosis of CUPs using CK7 and CK20 staining patterns. It outlines the most frequently used tissue-specific antibodies, provides some pitfalls essential in avoiding potential diagnostic errors and discusses the complementary tools, such as molecular tumour profiling and mutation-specific antibodies, for the improvement of diagnosis and prediction of the treatment response.
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