1
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Moulson R, Law J, Sacher A, Liu G, Shepherd FA, Bradbury P, Eng L, Iczkovitz S, Abbie E, Elia-Pacitti J, Ewara EM, Mokriak V, Weiss J, Pettengell C, Leighl NB. Real-World Outcomes of Patients with Advanced Epidermal Growth Factor Receptor-Mutated Non-Small Cell Lung Cancer in Canada Using Data Extracted by Large Language Model-Based Artificial Intelligence. Curr Oncol 2024; 31:1947-1960. [PMID: 38668049 PMCID: PMC11049467 DOI: 10.3390/curroncol31040146] [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: 01/15/2024] [Revised: 02/09/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Real-world evidence for patients with advanced EGFR-mutated non-small cell lung cancer (NSCLC) in Canada is limited. This study's objective was to use previously validated DARWENTM artificial intelligence (AI) to extract data from electronic heath records of patients with non-squamous NSCLC at University Health Network (UHN) to describe EGFR mutation prevalence, treatment patterns, and outcomes. Of 2154 patients with NSCLC, 613 had advanced disease. Of these, 136 (22%) had common sensitizing EGFR mutations (cEGFRm; ex19del, L858R), 8 (1%) had exon 20 insertions (ex20ins), and 338 (55%) had EGFR wild type. One-year overall survival (OS) (95% CI) for patients with cEGFRm, ex20ins, and EGFR wild type tumours was 88% (83, 94), 100% (100, 100), and 59% (53, 65), respectively. In total, 38% patients with ex20ins received experimental ex20ins targeting treatment as their first-line therapy. A total of 57 patients (36%) with cEGFRm received osimertinib as their first-line treatment, and 61 (39%) received it as their second-line treatment. One-year OS (95% CI) following the discontinuation of osimertinib was 35% (17, 75) post-first-line and 20% (9, 44) post-second-line. In this real-world AI-generated dataset, survival post-osimertinib was poor in patients with cEGFR mutations. Patients with ex20ins in this cohort had improved outcomes, possibly due to ex20ins targeting treatment, highlighting the need for more effective treatments for patients with advanced EGFRm NSCLC.
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Affiliation(s)
- Ruth Moulson
- Pentavere, 460 College Street, Toronto, ON M6G 1A1, Canada; (R.M.)
| | - Jennifer Law
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Adrian Sacher
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Frances A. Shepherd
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Penelope Bradbury
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | - Lawson Eng
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
| | | | | | | | | | | | - Jessica Weiss
- Pentavere, 460 College Street, Toronto, ON M6G 1A1, Canada; (R.M.)
| | | | - Natasha B. Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
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Fleming KE, Hupel A, Mithoowani H, Lulic-Kuryllo T, Valdes M. Biomarker Turnaround Times and Impact on Treatment Decisions in Patients with Advanced Non-Small Cell Lung Carcinoma at a Large Canadian Community Hospital with an Affiliated Regional Cancer Centre. Curr Oncol 2024; 31:1515-1528. [PMID: 38534948 PMCID: PMC10969576 DOI: 10.3390/curroncol31030115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Timely reporting of molecular biomarkers is critical in guiding optimal treatment decisions in patients with advanced non-small cell lung carcinoma (NSCLC). Any delays along the tissue or treatment pathway may be associated with suboptimal treatment/outcomes and a reduced quality of life. For many centres, biomarkers are tested off-site. Methods: A retrospective chart review of 123 patients with advanced NSCLC seen between 1 June 2021 and 30 June 2022 was conducted. With a focus on core biomarkers (PD L1, EGFR, and ALK), the outcome variables were as follows: total turnaround time (total TAT), divided into pre-laboratory, laboratory, and post-laboratory time intervals, as well as time to treatment decision (TOTD) and time to optimal systemic therapy decision (TOTSD). Results: At first consult, only 20.3% of patients had all core biomarker results available. The median total TAT was significantly longer for non-squamous (non-SCC) than squamous cell carcinoma (SCC) specimens (36.5 versus 22 days, p < 0.001). The median pre-laboratory time for the entire cohort was 5 calendar days. The median laboratory testing time was greater for non-SCC compared to the SCC specimens (23 versus 12 days, p < 0.001). The median time from consult to TOTD was 19 calendar days for the entire cohort. Conclusions: This study emphasizes the need for the expansion of regional resources to meet the clinical needs of advanced NSCLC patients treated at a regional cancer centre which uses an off-site molecular laboratory.
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Affiliation(s)
- Katelyn E. Fleming
- Office of Innovation & Research, Grand River Hospital, Kitchener, ON N2G 1G3, Canada
| | - Ava Hupel
- Office of Innovation & Research, Grand River Hospital, Kitchener, ON N2G 1G3, Canada
| | - Hamid Mithoowani
- Department of Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Tea Lulic-Kuryllo
- Office of Innovation & Research, Grand River Hospital, Kitchener, ON N2G 1G3, Canada
| | - Mario Valdes
- Department of Oncology, Grand River Regional Cancer Centre, Kitchener, ON N2G 1G3, Canada
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Wang P, Sun S, Lam S, Lockwood WW. New insights into the biology and development of lung cancer in never smokers-implications for early detection and treatment. J Transl Med 2023; 21:585. [PMID: 37653450 PMCID: PMC10472682 DOI: 10.1186/s12967-023-04430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
Lung cancer is the leading cause of cancer deaths worldwide. Despite never smokers comprising between 10 and 25% of all cases, lung cancer in never smokers (LCNS) is relatively under characterized from an etiological and biological perspective. The application of multi-omics techniques on large patient cohorts has significantly advanced the current understanding of LCNS tumor biology. By synthesizing the findings of multi-omics studies on LCNS from a clinical perspective, we can directly translate knowledge regarding tumor biology into implications for patient care. Primarily focused on never smokers with lung adenocarcinoma, this review details the predominance of driver mutations, particularly in East Asian patients, as well as the frequency and importance of germline variants in LCNS. The mutational patterns present in LCNS tumors are thoroughly explored, highlighting the high abundance of the APOBEC signature. Moreover, this review recognizes the spectrum of immune profiles present in LCNS tumors and posits how it can be translated to treatment selection. The recurring and novel insights from multi-omics studies on LCNS tumor biology have a wide range of clinical implications. Risk factors such as exposure to outdoor air pollution, second hand smoke, and potentially diet have a genomic imprint in LCNS at varying degrees, and although they do not encompass all LCNS cases, they can be leveraged to stratify risk. Germline variants similarly contribute to a notable proportion of LCNS, which warrants detailed documentation of family history of lung cancer among never smokers and demonstrates value in developing testing for pathogenic variants in never smokers for early detection in the future. Molecular driver subtypes and specific co-mutations and mutational signatures have prognostic value in LCNS and can guide treatment selection. LCNS tumors with no known driver alterations tend to be stem-like and genes contributing to this state may serve as potential therapeutic targets. Overall, the comprehensive findings of multi-omics studies exert a wide influence on clinical management and future research directions in the realm of LCNS.
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Affiliation(s)
- Peiyao Wang
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, BC, Canada
- Interdisciplinary Oncology Program, University of British Columbia, Vancouver, BC, Canada
| | - Sophie Sun
- Department of Medical Oncology, British Columbia Cancer Agency Vancouver, Vancouver, BC, Canada
| | - Stephen Lam
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, BC, Canada
| | - William W Lockwood
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, BC, Canada.
- Interdisciplinary Oncology Program, University of British Columbia, Vancouver, BC, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
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Silver A, Ho C, Ye Q, Zhang J, Janzen I, Li J, Martin M, Wu L, Wang Y, Lam S, MacAulay C, Melosky B, Yuan R. Prediction of Disease Progression to Upfront Pembrolizumab Monotherapy in Advanced Non-Small-Cell Lung Cancer with High PD-L1 Expression Using Baseline CT Disease Quantification and Smoking Pack Years. Curr Oncol 2023; 30:5546-5559. [PMID: 37366902 DOI: 10.3390/curroncol30060419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Health Canada approved pembrolizumab in the first-line setting for advanced non-small-cell lung cancer with PD-L1 ≥ 50% and no EGFR/ALK aberration. The keynote 024 trial showed 55% of such patients progress with pembrolizumab monotherapy. We propose that the combination of baseline CT and clinical factors can help identify those patients who may progress. In 138 eligible patients from our institution, we retrospectively collected their baseline variables, including baseline CT findings (primary lung tumor size and metastatic site), smoking pack years, performance status, tumor pathology, and demographics. The treatment response was assessed via RECIST 1.1 using the baseline and first follow-up CT. Associations between the baseline variables and progressive disease (PD) were tested by logistic regression analyses. The results showed 46/138 patients had PD. The baseline CT "number of involved organs" by metastasis and smoking pack years were independently associated with PD (p < 0.05), and the ROC analysis showed a good performance of the model that integrated these variables in predicting PD (AUC: 0.79). This pilot study suggests that the combination of baseline CT disease and smoking PY can identify who may progress on pembrolizumab monotherapy and can potentially facilitate decision-making for the optimal first-line treatment in the high PD-L1 cohort.
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Affiliation(s)
- Ali Silver
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Cheryl Ho
- BC Cancer, Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
- Department of Medical Oncology, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Qian Ye
- Department of Statistics, Faculty of Science, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA
| | - Ian Janzen
- Integrative Oncology, BC Cancer Research Centre, 675 West 10th Avenue Vancouver, BC V5Z 1L3, Canada
| | - Jessica Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Montgomery Martin
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
- BC Cancer, Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Lang Wu
- Department of Statistics, Faculty of Science, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Ying Wang
- BC Cancer, Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
- Department of Medical Oncology, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Stephen Lam
- BC Cancer, Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
- Integrative Oncology, BC Cancer Research Centre, 675 West 10th Avenue Vancouver, BC V5Z 1L3, Canada
- Department of Respirology, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Calum MacAulay
- Integrative Oncology, BC Cancer Research Centre, 675 West 10th Avenue Vancouver, BC V5Z 1L3, Canada
| | - Barbara Melosky
- BC Cancer, Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
- Department of Medical Oncology, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Ren Yuan
- Department of Radiology, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
- BC Cancer, Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
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Sheffield BS, Eaton K, Emond B, Lafeuille MH, Hilts A, Lefebvre P, Morrison L, Stevens AL, Ewara EM, Cheema P. Cost Savings of Expedited Care with Upfront Next-Generation Sequencing Testing versus Single-Gene Testing among Patients with Metastatic Non-Small Cell Lung Cancer Based on Current Canadian Practices. Curr Oncol 2023; 30:2348-2365. [PMID: 36826141 PMCID: PMC9955559 DOI: 10.3390/curroncol30020180] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
This study assessed the total costs of testing, including the estimated costs of delaying care, associated with next-generation sequencing (NGS) versus single-gene testing strategies among patients with newly diagnosed metastatic non-small cell lung cancer (mNSCLC) from a Canadian public payer perspective. A decision tree model considered testing for genomic alterations using tissue biopsy NGS or single-gene strategies following Canadian guideline recommendations. Inputs included prevalence of mNSCLC, the proportion that tested positive for each genomic alteration, rebiopsy rates, time to test results, testing/medical costs, and costs of delaying care based on literature, public data, and expert opinion. Among 1,000,000 hypothetical publicly insured adult Canadians (382 with mNSCLC), the proportion of patients that tested positive for a genomic alteration with an approved targeted therapy was 38.0% for NGS and 26.1% for single-gene strategies. The estimated mean time to appropriate targeted therapy initiation was 5.1 weeks for NGS and 9.2 weeks for single-gene strategies. Based on literature, each week of delayed care cost CAD 406, translating to total mean per-patient costs of CAD 3480 for NGS and CAD 5632 for single-gene strategies. NGS testing with mNSCLC in current Canadian practice resulted in more patients with an identified mutation, shorter time to appropriate targeted therapy initiation, and lower total testing costs compared to single-gene strategies.
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Affiliation(s)
| | | | - Bruno Emond
- Analysis Group, Inc., Montréal, QC H3B 0G7, Canada
| | | | | | | | - Laura Morrison
- Analysis Group, Inc., Montréal, QC H3B 0G7, Canada
- Correspondence: ; Tel.: +514-871-3303
| | | | | | - Parneet Cheema
- William Osler Health System, Brampton, ON L6R 3J7, Canada
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Irodi A, Bhalla AS, Robinson Vimala L, Yadav T, Adithan S, Bhujade H, Sanghavi P, Kale A, Garg M, Jaykar David Livingstone YK, Das SK, H. GM, Sasidharan B, Thangakunam B, Pavamani S, Isiah R, Joel A, Bhat TA. Imaging Recommendations for Diagnosis, Staging, and Management of Lung Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AbstractGlobally and in India, lung cancer is one of the leading malignancies in terms of incidence and mortality. Smoking and environmental pollution are the common risk factors for developing lung cancer. Traditionally, lung cancer is divided into small cell and nonsmall cell types, with nonsmall cell carcinomas including squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.In this review article, we describe the imaging recommendations and findings in the diagnosis, staging, and management of lung cancer, including the imaging of treatment-related complications.
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Affiliation(s)
- Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | | | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, India
| | - Subathra Adithan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
| | - Parang Sanghavi
- Department of Radiology, Picture this by Jankharia, Mumbai, Maharashtra, India
| | - Alok Kale
- Radiology and Imaging Science Department, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Mandeep Garg
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
| | | | | | - Geethi M. H.
- Division of Radiation Oncology, RCC, Thiruvananthapuram, Kerala, India
| | - Balukrishna Sasidharan
- Department of Radiation Oncology, Ida B. Scudder Cancer Centre Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Simon Pavamani
- Department of Radiation Oncology, Ida B. Scudder Cancer Centre Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajesh Isiah
- Department of Radiation Oncology, Ida B. Scudder Cancer Centre Christian Medical College, Vellore, Tamil Nadu, India
| | - Anjana Joel
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tameem Ahmad Bhat
- Radiology, Shri Mata Vaishno Devi Narayana Superspeciality Hospital, Jammu, India
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Hilzenrat RA, Yip S, Melosky B, Ho C, Laskin J, Sun S, Choi JJ, McGuire AL. Disparate Time-to-Treatment and Varied Incidence of Actionable Non-Small Cell Lung Cancer Molecular Alterations in British Columbia: A Historical Cohort Study. Curr Oncol 2022; 30:145-156. [PMID: 36661661 PMCID: PMC9858228 DOI: 10.3390/curroncol30010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background: non-small cell lung cancer (NSCLC) outcomes remain suboptimal for early-stage disease despite emerging advances in systemic therapy for the peri-operative period. Next-generation sequencing (NGS) identifies driver mutations for which targeted therapies have been developed that improve survival. The BC lung cancer screening program, which was initiated in May 2022, is expected to identify people with early and late stages of NSCLC. It is crucial to first understand the molecular epidemiology and patterns of time to initiate treatment across its five health authorities (HA) to optimize the delivery of care for NSCLC in BC. In this way, we may harness the benefits of targeted therapy for more people with NSCLC as novel advances in therapy continue to emerge. Objective: to compare (a) the frequency of actionable NSCLC molecular alterations among HAs and (b) the time to treatment initiation. Methods: a retrospective observational study was conducted with prospectively collected data from the BC CGL Database. Adults with late stage NSCLC who underwent targeted NGS were included for the time period from May 2020 to June 2021. Demographics, actionable molecular alterations, PDL-1 expression, and time to treatment across HAs were examined. Using appropriate statistical tests for comparison among HAs, p>0.05 was deemed significant. Results: 582 patients underwent NGS/IHC and analysis during the study period. The mean age was 71 (10.1), and 326 (56%) patients were female. A significantly higher proportion of all EGFRm+ were identified within Vancouver Coastal Health (VCHA) and Fraser Health Authority (FHA) compared to the other health authorities (p < 0.001). This also holds true for common sensitizing EGFRm+ alone (p < 0.001) and for sensitizing EGFRm+ when adjusted for females and smoker status (OR 0.75; 95% CI 0.62, 0.92; p = 0.005). Patients residing within the Northern, Interior, and Island HAs were less likely to receive treatment at the same rate as those in VCHA and FHA HAs. Conclusion: actionable NSCLC driver mutations are present in all regional HAs, with disparity noted in time to initiate treatment between HAs. This provides evidence for the importance of molecular testing for patients in all BC HAs to guide personalized and timely NSCLC treatment.
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Affiliation(s)
- Roy Avraham Hilzenrat
- Department of Surgery, Division of Thoracic Surgery, Vancouver Coastal Health, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Stephen Yip
- Cancer Genetics & Genomic Laboratory, BC Cancer—Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Barbara Melosky
- Department of Medicine, Division of Medical Oncology, BC Cancer Vancouver Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Cheryl Ho
- Department of Medicine, Division of Medical Oncology, BC Cancer Vancouver Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Janessa Laskin
- Department of Medicine, Division of Medical Oncology, BC Cancer Vancouver Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Sophie Sun
- Department of Medicine, Division of Medical Oncology, BC Cancer Vancouver Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - James J. Choi
- Department of Surgery, Division of Thoracic Surgery, Vancouver Coastal Health, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Anna L. McGuire
- Department of Surgery, Division of Thoracic Surgery, Vancouver Coastal Health, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Vancouver Coastal Health Research Institute, 2635 Laurel Street, Vancouver, BC V5Z 1M9, Canada
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Consensus Recommendations to Optimize Testing for New Targetable Alterations in Non-Small Cell Lung Cancer. Curr Oncol 2022; 29:4981-4997. [PMID: 35877256 PMCID: PMC9318743 DOI: 10.3390/curroncol29070396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) has historically been associated with a poor prognosis and low 5-year survival, but the use of targeted therapies in NSCLC has improved patient outcomes over the past 10 years. The pace of development of new targeted therapies is accelerating, with the associated need for molecular testing of new targetable alterations. As the complexity of biomarker testing in NSCLC increases, there is a need for guidance on how to manage the fluid standard-of-care in NSCLC, identify pragmatic molecular testing requirements, and optimize result reporting. An expert multidisciplinary working group with representation from medical oncology, pathology, and clinical genetics convened via virtual meetings to create consensus recommendations for testing of new targetable alterations in NSCLC. The importance of accurate and timely testing of all targetable alterations to optimize disease management using targeted therapies was emphasized by the working group. Therefore, the panel of experts recommends that all targetable alterations be tested reflexively at NSCLC diagnosis as part of a comprehensive panel, using methods that can detect all relevant targetable alterations. In addition, comprehensive biomarker testing should be performed at the request of the treating clinician upon development of resistance to targeted therapy. The expert multidisciplinary working group also made recommendations for reporting to improve clarity and ease of interpretation of results by treating clinicians and to accommodate the rapid evolution in clinical actionability of these alterations. Molecular testing of all targetable alterations in NSCLC is the key for treatment decision-making and access to new therapies. These consensus recommendations are intended as a guide to further optimize molecular testing of new targetable alterations.
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In Silico Investigation of Some Compounds from the N-Butanol Extract of Centaurea tougourensis Boiss. & Reut. CRYSTALS 2022. [DOI: 10.3390/cryst12030355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Bioinformatics as a newly emerging discipline is considered nowadays a reference to characterize the physicochemical and pharmacological properties of the actual biocompounds contained in plants, which has helped the pharmaceutical industry a lot in the drug development process. In this study, a bioinformatics approach known as in silico was performed to predict, for the first time, the physicochemical properties, ADMET profile, pharmacological capacities, cytotoxicity, and nervous system macromolecular targets, as well as the gene expression profiles, of four compounds recently identified from Centaurea tougourensis via the gas chromatography–mass spectrometry (GC–MS) approach. Thus, four compounds were tested from the n-butanol (n-BuOH) extract of this plant, named, respectively, Acridin-9-amine, 1,2,3,4-tetrahydro-5,7-dimethyl- (compound 1), 3-[2,3-Dihydro-2,2-dimethylbenzofuran-7-yl]-5-methoxy-1,3,4-oxadiazol-2(3H)-one (compound 2), 9,9-Dimethoxybicyclo[3.3.1]nona-2,4-dione (compound 3), and 3-[3-Bromophenyl]-7-chloro-3,4-dihydro-10-hydroxy-1,9(2H,10H)-acridinedione (compound 4). The insilico investigation revealed that the four tested compounds could be a good candidate to regulate the expression of key genes and may also exert significant cytotoxic effects against several tumor celllines. In addition, these compounds could also be effective in the treatment of some diseases related to diabetes, skin pathologies, cardiovascular, and central nervous system disorders. The bioactive compounds of plant remain the best alternative in the context of the drug discovery and development process.
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Salas C, Martín-López J, Martínez-Pozo A, Hernández-Iglesias T, Carcedo D, Ruiz de Alda L, García JF, Rojo F. Real-world biomarker testing rate and positivity rate in NSCLC in Spain: Prospective Central Lung Cancer Biomarker Testing Registry (LungPath) from the Spanish Society of Pathology (SEAP). J Clin Pathol 2022; 75:193-200. [PMID: 33722840 PMCID: PMC8862081 DOI: 10.1136/jclinpath-2020-207280] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 01/09/2023]
Abstract
AIM The aim of this study was to describe the testing rate and frequency of molecular alterations observed in the Lung Cancer Biomarker Testing Registry (LungPath). METHODS A descriptive study of NSCLC biomarker determinations collected from March 2018 to January 2019, from 38 Spanish hospitals, was carried out. Only adenocarcinoma and not otherwise specified histologies were included for epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), c-ros oncogene 1 (ROS1) and programmed death ligand-1 (PD-L1) expression. The testing rate and the positivity rate were calculated. Multivariate logistic regression was used to explore the joint relationship between independent explanatory factors and both testing and positivity rates. Two models were adjusted: one with sample type and histology as independent factors, and the other adding the testing rate or the positivity rate of the other biomarkers. RESULTS 3226 patient samples were analysed, where EGFR, ALK, ROS1 and PD-L1 information was collected (a total of 12 904 determinations). Overall, 9118 (71.4%) determinations were finally assessed. EGFR (91.4%) and ALK (80.1%) were the mainly tested biomarkers. Positivity rates for EGFR, ALK, ROS1 and PD-L1 were 13.6%, 3.4%, 2.0% and 49.2%, respectively. Multivariate models showed a lower testing rate for ALK in surgical pieces, fine-needle aspiration or other types of samples versus biopsies. CONCLUSIONS Despite the high testing rate in EGFR and ALK in NSCLC, the real-world evidence obtained from the LungPath demonstrates that ROS1 and PD-L1 were not determined in a significant portion of patients. LungPath provides crucial information to improve the coverage in molecular testing in lung cancer, to monitor the positivity rate and the introduction of new biomarker testing in clinical practice.
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Affiliation(s)
- Clara Salas
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain,External Quality Asessment (GCP) of the Spanish Society of Pathology (SEAP), Madrid, Spain
| | | | - Antonio Martínez-Pozo
- External Quality Asessment (GCP) of the Spanish Society of Pathology (SEAP), Madrid, Spain,Pathology Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Federico Rojo
- External Quality Asessment (GCP) of the Spanish Society of Pathology (SEAP), Madrid, Spain,IIS-Fundacion Jimenez Diaz University Hospital CIBERONC, Madrid, Spain
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11
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Husereau D, Sullivan T, Feilotter HE, Gomes MM, Juergens R, Sheffield BS, Kassam S, Stockley TL, Jacobs P. Optimizing the delivery of genetic and advanced diagnostic testing in the province of Ontario: challenges and implications for laboratory technology assessment and management in decentralized healthcare systems. J Med Econ 2022; 25:993-1004. [PMID: 35850613 DOI: 10.1080/13696998.2022.2101807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIMS The Canadian province of Ontario provides full coverage for its residents (pop.14.8 M) for hospital-based diagnostic testing. Historical governance of the healthcare system and a legacy scheme of health technology assessment (HTA) and financing has led to a suboptimal approach of adopting advanced diagnostic technology (i.e. protein expression, cytogenetic, and molecular/genetic) for guiding therapeutic decisions. The aim of this research is to explore systemic barriers and provide guidance to improve patient and care provider experiences by reducing delays and inequity of access to testing, while benefitting laboratory innovators and maximizing system efficiency. MATERIALS AND METHODS A mixed-methods approach including literature review, semi-structured interviews, and a multi-stakeholder forum involving patient representatives (n = 1), laboratory leaders (n = 6), physicians (n = 5), Ministry personnel (n = 4), administrators (n = 3), extra-provincial experts, and researchers (n = 7), as well as pharmaceutical (n = 5) and diagnostic companies (n = 2). The forum considered evidence of good practices in adoption, implementation, and financing laboratory services and identified barriers as well as feasible options for improving advanced diagnostic testing in Ontario. RESULTS Overarching challenges identified included: barriers to define what is needed; need for a clear approach to adoption; and the need for more oversight and coordination. Recommendations to address these included a shift to an anticipatory system of test adoption, creating a fit-for-purpose system of health technology management that consolidates existing evaluation processes, and modernizing the governance and financing of testing so that it is managed at a care-delivery level. CONCLUSIONS The proposals for change in Ontario highlight the role that HTA, governance, and financing of health technology play along the continuum of a health technology life cycle within a healthcare system where decision-making is highly decentralized. Resource availability and capacity were not a concern - instead, solutions require higher levels of coordination and system integration along with innovative approaches to HTA.
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Affiliation(s)
- Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Terrence Sullivan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | | | - Marcio M Gomes
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ontario, Canada
- Anatomical Pathologist, The Ottawa Hospital, Ottawa, Canada
| | - Rosalyn Juergens
- Division of Medical Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | | | - Shaqil Kassam
- Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Canada
| | - Tracy L Stockley
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Philip Jacobs
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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12
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Desmeules P, Boudreau DK, Bastien N, Boulanger MC, Bossé Y, Joubert P, Couture C. Performance of an RNA-based Next-Generation Sequencing Assay for Combined Detection of Clinically Actionable Fusions and Hotspot Mutations in Non-Small Cell Lung Cancer. JTO Clin Res Rep 2022; 3:100276. [PMID: 35252895 PMCID: PMC8888203 DOI: 10.1016/j.jtocrr.2022.100276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction With its expanding list of approved and emerging therapeutic indications, NSCLC is the exemplar tumor type requiring upfront assessment of several biomarkers to guide clinical management. Next-generation sequencing allows identification of different types of molecular alterations, each with specific analytical challenges. Library preparation using parallel DNA and RNA workflows can overcome most of them, but it increases complexity of laboratory operations, turnaround time, and costs. We describe the performance characteristics of a 15-gene RNA panel on the basis of anchored multiplex polymerase chain reaction for combined detection of clinically relevant oncogenic fusion transcripts and hotspot small variants. Methods Formalin-fixed, paraffin-embedded NSCLC clinical samples (N = 58) were used along cell lines and commercial controls to validate the assay’s analytical performance, followed by an exploratory prospective cohort (N = 87). Results The raw assay sensitivity for hotspot mutations and fusions was 83% and 93%, respectively, reaching 100% after filtering for key assay metrics. Those include quantity and quality of input of nucleic acid and sequencing metric from primers on housekeeping genes included in the assay. In the prospective cohort, driver alterations were identified in most cases (≥58%). Conclusions This ultrafocused RNA–next-generation sequencing assay offers an advantageous option with single unified workflow for simultaneous detection of clinically relevant hotspot mutations and fusions in NSCLC, focusing on actionable gene targets.
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Affiliation(s)
- Patrice Desmeules
- Service of Anatomic Pathology and Cytology, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
- Corresponding author. Address for correspondence: Patrice Desmeules, MD, MSc, Service of Anatomic Pathology and Cytology, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Quebec City, QC G1V 4G5, Canada.
| | - Dominique K. Boudreau
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
| | - Nathalie Bastien
- Service of Anatomic Pathology and Cytology, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
| | - Marie-Chloé Boulanger
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
| | - Yohan Bossé
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
| | - Philippe Joubert
- Service of Anatomic Pathology and Cytology, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
| | - Christian Couture
- Service of Anatomic Pathology and Cytology, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec City, Québec, Canada
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13
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Cheema PK, Banerji SO, Blais N, Chu QSC, Desmeules P, Juergens RA, Leighl NB, Sheffield BS, Wheatley-Price PF, Melosky BL. Canadian Consensus Recommendations on the Management of MET-Altered NSCLC. Curr Oncol 2021; 28:4552-4576. [PMID: 34898564 PMCID: PMC8628757 DOI: 10.3390/curroncol28060386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/29/2022] Open
Abstract
In Canada, the therapeutic management of patients with advanced non-small cell lung cancer (NSCLC) with rare actionable mutations differs between provinces, territories, and individual centres based on access to molecular testing and funded treatments. These variations, together with the emergence of several novel mesenchymal-epithelial transition (MET) factor-targeted therapies for the treatment of NSCLC, warrant the development of evidence-based consensus recommendations for the use of these agents. A Canadian expert panel was convened to define key clinical questions, review evidence, discuss practice recommendations and reach consensus on the treatment of advanced MET-altered NSCLC. Questions addressed by the panel include: 1. How should the patients most likely to benefit from MET-targeted therapies be identified? 2. What are the preferred first-line and subsequent therapies for patients with MET exon 14 skipping mutations? 3. What are the preferred first-line and subsequent therapies for advanced NSCLC patients with de novo MET amplification? 4. What is the preferred therapy for patients with advanced epidermal growth factor receptor (EGFR)-mutated NSCLC with acquired MET amplification progressing on EGFR inhibitors? 5. What are the potential strategies for overcoming resistance to MET inhibitors? Answers to these questions, along with the consensus recommendations herein, will help streamline the management of MET-altered NSCLC in routine practice, assist clinicians in therapeutic decision-making, and help ensure optimal outcomes for NSCLC patients with MET alterations.
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Affiliation(s)
- Parneet K. Cheema
- Medical Oncology/Hematology, William Osler Health System, Brampton, ON L6R 3J7, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Shantanu O. Banerji
- CancerCare Manitoba Research Institute, Department of Medical Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Normand Blais
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada;
| | - Quincy S.-C. Chu
- Cross Cancer Institute, Alberta Health Services, Edmonton, AB T6G 1Z2, Canada;
| | - Patrice Desmeules
- Service d’Anatomopathologie et de Cytologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 0A6, Canada;
| | - Rosalyn A. Juergens
- Department of Medical Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Natasha B. Leighl
- Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Brandon S. Sheffield
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada;
| | - Paul F. Wheatley-Price
- Department of Medicine, The Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Barbara L. Melosky
- Department of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC V5Z 4E6, Canada;
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Kim J, Xu Z, Marignani PA. Single-cell RNA sequencing for the identification of early-stage lung cancer biomarkers from circulating blood. NPJ Genom Med 2021; 6:87. [PMID: 34654834 PMCID: PMC8519939 DOI: 10.1038/s41525-021-00248-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023] Open
Abstract
Lung cancer accounts for more than half of the new cancers diagnosed world-wide with poor survival rates. Despite the development of chemical, radiological, and immunotherapies, many patients do not benefit from these therapies, as recurrence is common. We performed single-cell RNA-sequencing (scRNA-seq) analysis using Fluidigm C1 systems to characterize human lung cancer transcriptomes at single-cell resolution. Validation of scRNA-seq differentially expressed genes (DEGs) through quantitative real time-polymerase chain reaction (qRT-PCR) found a positive correlation in fold-change values between C-X-C motif chemokine ligand 1 (CXCL1) and 2 (CXCL2) compared with bulk-cell level in 34 primary lung adenocarcinomas (LUADs) from Stage I patients. Furthermore, we discovered an inverse correlation between chemokine mRNAs, miR-532-5p, and miR-1266-3p in early-stage primary LUADs. Specially, miR-532-5p was quantifiable in plasma from the corresponding LUADs. Collectively, we identified markers of early-stage lung cancer that were validated in primary lung tumors and circulating blood.
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Affiliation(s)
- Jinhong Kim
- grid.55602.340000 0004 1936 8200Department of Biochemistry and Molecular Biology, Faculty of Medicine, Dalhousie University, Room 9F1, 5850 College Street, Halifax, Nova Scotia B3H1X5 Canada
| | - Zhaolin Xu
- grid.55602.340000 0004 1936 8200Department of Pathology, Faculty of Medicine, Dalhousie University, Room 734C, 5788 University Avenue, Halifax, Nova Scotia B3H1V8 Canada
| | - Paola A. Marignani
- grid.55602.340000 0004 1936 8200Department of Biochemistry and Molecular Biology, Faculty of Medicine, Dalhousie University, Room 9F1, 5850 College Street, Halifax, Nova Scotia B3H1X5 Canada ,grid.55602.340000 0004 1936 8200Department of Pathology, Faculty of Medicine, Dalhousie University, Room 734C, 5788 University Avenue, Halifax, Nova Scotia B3H1V8 Canada
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15
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Stock-Martineau S, Laurie K, McKinnon M, Zhang T, Wheatley-Price P. Evolution of Systemic Treatment Uptake and Survival in Advanced Non-Small Cell Lung Cancer. ACTA ACUST UNITED AC 2020; 28:60-68. [PMID: 33704175 PMCID: PMC7816185 DOI: 10.3390/curroncol28010008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
Abstract
Background: Non-small cell lung cancer (NSCLC) commonly presents at advanced stage. We previously reported systemic treatment uptake in stage IV NSCLC climbing from 55% (2009–2012) to 62% (2015–2017). Since then, first-line immunotherapy and 2nd/3rd generation tyrosine kinase inhibitors (TKIs) have emerged as standards of care. We explored whether treatment rates continued to rise and studied outcomes. Methods: We reviewed all cases of de novo stage IIIB/IIIC/IV NSCLC seen in out-patient medical oncology consultation at our institution between 2009–2012 (cohort A), 2015–2017 (cohort B), and June–December 2018 (cohort C). We compared rates of systemic treatment, molecular testing, targeted therapy, and immune checkpoint inhibitor (ICI) use. We compared survival in the overall, treated/untreated, younger and elderly population in cohort A vs. cohort B + C (=cohort D). Results: Cohorts A, B, and C included 528, 463, and 93 patients, respectively. Overall, 66% received any systemic therapy in cohort C, compared to 62% in cohort B and 55% in cohort A. Across three time periods, first-line chemotherapy rates fell (93, 76, 46%) while rates of first-line targeted therapy (5, 16, 15%) and ICI (0, 2, 36%) rose. Among molecular subtypes, first-line targeted treatment in EGFR-positive patients (63, 94, 100%) and anaplastic lymphoma kinase (ALK)-positive patients (0, 91, 100%) rose. Survival improved in all subgroups in cohort D vs. cohort A, except for patients ≥ 70 years and the untreated population. Conclusions: Systemic treatment rose across three time periods, reflecting the introduction of rapid diagnostic pathways, reflex molecular testing, ICI, and targeted therapies. Survival outcomes of advanced NSCLC patients have significantly improved.
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Affiliation(s)
| | - Katie Laurie
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; (K.L.); (M.M.); (T.Z.)
| | - Mathieu McKinnon
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; (K.L.); (M.M.); (T.Z.)
| | - Tinghua Zhang
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; (K.L.); (M.M.); (T.Z.)
| | - Paul Wheatley-Price
- Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; (K.L.); (M.M.); (T.Z.)
- Correspondence: ; Tel.: +1-613-798-5555 (ext. 79859)
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16
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Cheema PK, Gomes M, Banerji S, Joubert P, Leighl NB, Melosky B, Sheffield BS, Stockley T, Ionescu DN. Consensus recommendations for optimizing biomarker testing to identify and treat advanced EGFR-mutated non-small-cell lung cancer. Curr Oncol 2020; 27:321-329. [PMID: 33380864 PMCID: PMC7755440 DOI: 10.3747/co.27.7297] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The advent of personalized therapy for non-small-cell lung carcinoma (nsclc) has improved patient outcomes. Selection of appropriate targeted therapy for patients with nsclc now involves testing for multiple biomarkers, including EGFR. EGFR mutation status is required to optimally treat patients with nsclc, and thus timely and accurate biomarker testing is necessary. However, in Canada, there are currently no standardized processes or methods in place to ensure consistent testing implementation. That lack creates challenges in ensuring that all appropriate biomarkers are tested for each patient and that the medical oncologist receives the results for making informed treatment decisions in a timely way. An expert multidisciplinary working group was convened to create consensus recommendations about biomarker testing in advanced nsclc in Canada, with a primary focus on EGFR testing. Recognizing that there are biomarkers beyond EGFR that require timely identification, the expert multidisciplinary working group considered EGFR testing in the broader context of integration into complex lung biomarker testing. Primarily, the panel of experts recommends that all patients with nonsquamous nsclc, regardless of stage, should undergo comprehensive reflex biomarker testing at diagnosis with targeted next-generation sequencing. The panel also considered the EGFR testing algorithm and the challenges associated with the pre-analytic, analytic, and post-analytic elements of testing. Strategies for funding testing by reducing silos of single biomarker testing for EGFR and for optimally implementing the recommendations presented here and educating oncology professionals about them are also discussed.
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Affiliation(s)
- P K Cheema
- William Osler Health System, University of Toronto, Brampton, ON
| | - M Gomes
- The Ottawa Hospital Research Institute and Department of Pathology, University of Ottawa, Ottawa, ON
| | - S Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, and Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - P Joubert
- Princess Margaret Cancer Centre, Toronto, ON
| | - N B Leighl
- Department of Pathology, Quebec Heart and Lung Institute, Université Laval, Quebec City, QC
| | - B Melosky
- BC Cancer-Vancouver Centre, Vancouver, BC
| | - B S Sheffield
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON
| | - T Stockley
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - D N Ionescu
- BC Cancer, Department of Pathology, Vancouver, BC
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17
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Black PC, Alimohamed NS, Berman D, Blais N, Eigl B, Karakiewicz PI, Kassouf W, Kulkarni GS, Ong M, Spatz A, Sridhar SS, Stockley T, van der Kwast T, Hew H, Park-Wyllie L, North SA. Optimizing management of advanced urothelial carcinoma: A review of emerging therapies and biomarker-driven patient selection. Can Urol Assoc J 2020; 14:E373-E382. [PMID: 32209217 DOI: 10.5489/cuaj.6458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Advanced urothelial carcinoma has been challenging to treat due to limited treatment options, poor response rates, and poor long-term survival. New treatment options hold the promise of improved outcomes for these patients. METHODS A multidisciplinary working group drafted a management algorithm for advanced urothelial carcinoma using "consensus development conference" methodology. A targeted literature search identified new and emerging treatments for inclusion in the management algorithm. Published clinical data were considered during the algorithm development process, as well as the risks and benefits of the treatment options. Biomarkers to guide patient selection in clinical trials for new treatments were incorporated into the algorithm. RESULTS The advanced urothelial carcinoma management algorithm includes newly approved first-line anti-programmed death receptor-1 (PD1)/ programmed death-ligand 1 (PD-L1) therapies, a newly approved anti-fibroblast growth factor receptors (FGFR) therapy, and an emerging anti-Nectin 4 therapy, which have had encouraging results in phase 2 trials for second-line and third-line therapy, respectively. This algorithm also incorporates suggestions for biomarker testing of PD-L1 expression and FGFR gene alterations. CONCLUSIONS Newly approved and emerging therapies are starting to cover an unmet need for more treatment options, better response rates, and improved overall survival in advanced urothelial carcinoma. The management algorithm provides guidance on how to incorporate these new options, and their associated biomarkers, into clinical practice.
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Affiliation(s)
- Peter C Black
- Department of Urologic Sciences, University of British, Columbia, Vancouver, BC, Canada
| | | | - David Berman
- Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Normand Blais
- Division of Medical Oncology/Hematology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Bernhard Eigl
- BC Cancer Vancouver Cancer Centre, Vancouver, BC, Canada
| | - Pierre I Karakiewicz
- Service d'urologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Girish S Kulkarni
- Departments of Surgery (Urology), Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael Ong
- Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Alan Spatz
- Departments of Pathology and Oncology at McGill University, Montreal, QC, Canada
| | - Srikala S Sridhar
- Departments of Medical Oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Tracy Stockley
- Department of Clinical Laboratory Genetics, University Health Network, Toronto, ON, Canada
| | | | - Huong Hew
- Medical Affairs, Janssen Inc, Toronto, ON, Canada
| | | | - Scott A North
- Division of Medical Oncology, University of Alberta, Edmonton, AB, Canada
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Cell-Free Circulating Tumour DNA Blood Testing to Detect EGFR T790M Mutation in People With Advanced Non-Small Cell Lung Cancer: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2020; 20:1-176. [PMID: 32206157 PMCID: PMC7082730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cell-free circulating tumour DNA blood testing (also called liquid biopsy) can determine if a person with advanced non-small cell lung cancer (NSCLC) whose disease is progressing has developed the epidermal growth factor receptor (EGFR) T790M resistance mutation. Identifying this resistance mutation can help physicians choose appropriate treatment (i.e., osimertinib if positive and chemotherapy if negative). Tissue biopsy is typically used to look for the resistance mutation, but this is an invasive test that might not be feasible if the patient is too ill. We conducted a health technology assessment of liquid biopsy for people with advanced NSCLC, which included an evaluation of the diagnostic accuracy, clinical utility, safety, cost-effectiveness, and the budget impact of publicly funding liquid biopsy, as well as an evaluation of patient preferences and values. METHODS We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using Risk of Bias in Systematic Reviews (ROBIS), Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2), Risk of Bias Among Non-randomized Studies (RoBANS), and the Cochrane risk of bias (ROB) tool and assessed quality of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and conducted short-term and long-term cost-effectiveness and cost-utility analyses comparing liquid biopsy as a triage test, liquid biopsy alone, and tissue biopsy alone from a public payer perspective. We also analyzed the budget impact of publicly funding liquid biopsy for people in Ontario with advanced NSCLC. To assess the potential value of liquid biopsy, we spoke with people with lung cancer and people with an understanding of the process of liquid biopsy. RESULTS We included 19 studies (within a published systematic review) to examine diagnostic test accuracy and 12 studies to examine clinical utility. In patients with advanced NSCLC, liquid biopsy to detect the EGFR T790M resistance mutation demonstrated a positive and negative predictive value of 89% and 61%, respectively, a sensitivity of 68%, and specificity of 86%. No studies examined the clinical utility of liquid biopsy as a triage test. When NSCLC was treated appropriately, progression-free survival was similar in patients with and without the resistance mutation, as ascertained by liquid biopsy.We estimated that it costs about $700 to conduct a liquid biopsy and $2,500 to conduct a tissue biopsy. Our analyses showed that, when considering costs and effects directly related to testing, liquid biopsy (as a triage test, which means patients who test negative undergo a follow-up tissue biopsy, or alone, which means using only liquid biopsy) was less costly than tissue biopsy alone and led to fewer tissue biopsies. Using liquid biopsy as a triage test produced the most correct treatment decisions and greatest number of people who were given osimertinib.When considering long-term costs (i.e., treatment and care) and effects (i.e., life-years and quality-adjusted life-years [QALYs]), liquid biopsy as a triage test was the most effective and most costly strategy followed by liquid biopsy alone. Tissue biopsy alone was the least effective and least costly strategy. The incremental cost-effectiveness ratios (ICERs) of liquid biopsy as a triage test compared with liquid biopsy alone and of liquid biopsy alone compared with tissue biopsy alone were greater than $100,000 per QALY. However, this result was largely driven by the cost of osimertinib, which was used more often when liquid biopsy was used as a triage test.We estimated that the total annual budget impact of publicly funding liquid biopsy as a triage test in Ontario over the next 5 years would range from approximateily $60,000 in year 1 to $3 million in year 5.People with lung cancer with whom we spoke said that liquid biopsy would likely be an appropriate test for people with NSCLC given their frail condition and because it would avoid the pain and anxiety associated with tissue biopsy. CONCLUSIONS As a minimally invasive test, liquid biopsy identifies a high proportion of people with the EGFR T790M resistance mutation. This identification could better guide treatment for people with advanced NSCLC. However, its relatively low negative predictive value means it is best used as a triage test (i.e., followed by tissue biopsy if the liquid biopsy does not identify a resistance mutation). Liquid biopsy as a triage test is likely more effective than tissue biopsy alone. However, owing to the high cost of treatment, liquid biopsy may not be cost-effective. We estimated that publicly funding liquid biopsy as a triage test in Ontario would result in additional costs (related to more patients being treated) of between $0.06 million and $3 million over the next 5 years.
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Elkrief A, Joubert P, Florescu M, Tehfe M, Blais N, Routy B. Therapeutic landscape of metastatic non-small-cell lung cancer in Canada in 2020. ACTA ACUST UNITED AC 2020; 27:52-60. [PMID: 32218661 DOI: 10.3747/co.27.5953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the most commonly diagnosed cancer in Canada and remains associated with high mortality. Nevertheless, recent advances in the fields of immuno-oncology and precision medicine have led to significant improvements in clinical outcome in metastatic non-small-cell lung cancer (nsclc). Those improvements were facilitated by a greater understanding of the biologic classification of nsclc, which catalyzed discoveries of novel therapies. Here, we present a comprehensive review of the recent avalanche of practice-changing trials in metastatic nsclc, and we offer an approach to the management of this disease from a Canadian perspective. We begin with an overview of the pathologic and molecular characterization of metastatic nsclc. Next, we review the indications for currently approved immune checkpoint inhibitors, and we provide an approach to the management of disease with a driver mutation. Finally, we address future avenues in both diagnostics and therapeutics for patients with advanced and metastatic nsclc.
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Affiliation(s)
- A Elkrief
- Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal.,Cedars Cancer Centre, McGill University Health Centre, Montreal.,Centre de recherche du Centre hospitalier de l'Universtité de Montréal, Montreal
| | - P Joubert
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City
| | - M Florescu
- Centre de recherche du Centre hospitalier de l'Universtité de Montréal, Montreal.,Division of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - M Tehfe
- Centre de recherche du Centre hospitalier de l'Universtité de Montréal, Montreal.,Division of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - N Blais
- Centre de recherche du Centre hospitalier de l'Universtité de Montréal, Montreal.,Division of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - B Routy
- Centre de recherche du Centre hospitalier de l'Universtité de Montréal, Montreal.,Division of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC
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Fiset PO, Labbé C, Young K, Craddock KJ, Smith AC, Tanguay J, Pintilie M, Wang R, Torlakovic E, Cheung C, da Cunha Santos G, Ko HM, Boerner SL, Hwang DM, Leighl NB, Tsao MS. Anaplastic lymphoma kinase 5A4 immunohistochemistry as a diagnostic assay in lung cancer: A Canadian reference testing center's results in population-based reflex testing. Cancer 2019; 125:4043-4051. [PMID: 31390053 DOI: 10.1002/cncr.32422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND The presence of anaplastic lymphoma kinase (ALK) rearrangement predicts response to ALK tyrosine kinase inhibitor (TKI) therapy. Fluorescence in situ hybridization (FISH) was the initial reference standard to detect ALK rearrangement, but immunohistochemistry (IHC) using D5F3 has gained acceptance as an alternative diagnostic method. ALK IHC assays using other ALK antibodies have also been used as screening methods, but data supporting their utility as diagnostic tests have not been widely reported. METHODS Data from reflexive clinical ALK IHC test using the 5A4 clone concurrent with epidermal growth factor receptor (EGFR) mutation testing were analyzed. ALK IHC results were reported as negative (-), equivocal, or positive (+), with equivocal or positive staining validated by FISH break-apart probe testing. Treatment outcomes were reviewed for ALK IHC+ patients. RESULTS Between 2012 and 2015, 146 (2.5%) cases were reported as ALK IHC+, 188 (3.2%) were reported as equivocal, and 5624 (94.4%) were reported as ALK IHC-. Of the ALK IHC+ cases, 131/143(91.6%) were ALK FISH+. Excluding 6 cases in which FISH was inconclusive or not performed, the positive predictive value was 95.6%, and the negative predictive value was 100%. Most specimens (n = 5352 [89.6%]) were also successfully tested for EGFR. Clinical responses to ALK TKIs were noted in 49 ALK IHC+ patients, with a median progression-free survival of 9.9 months. CONCLUSIONS ALK 5A4 IHC can serve as a robust diagnostic test for ALK-rearranged lung cancer and is associated with treatment response and survival. Optimized tissue allocation resulted in high success rates of combined reflex EGFR and ALK testing.
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Affiliation(s)
- Pierre O Fiset
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Catherine Labbé
- Division of Hematology and Oncology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Kelvin Young
- Division of Hematology and Oncology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth J Craddock
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Pathology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Adam C Smith
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Tanguay
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Melania Pintilie
- Department of Biostatistics, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - Ri Wang
- Department of Biostatistics, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Emina Torlakovic
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Carol Cheung
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Gilda da Cunha Santos
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Hyang-Mi Ko
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Scott L Boerner
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - David M Hwang
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Division of Hematology and Oncology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Laboratory Medicine Program, Department of Pathology, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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21
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Bebb DG, Agulnik J, Albadine R, Banerji S, Bigras G, Butts C, Couture C, Cutz JC, Desmeules P, Ionescu DN, Leighl NB, Melosky B, Morzycki W, Rashid-Kolvear F, Lab C, Sekhon HS, Smith AC, Stockley TL, Torlakovic E, Xu Z, Tsao MS. Crizotinib inhibition of ROS1-positive tumours in advanced non-small-cell lung cancer: a Canadian perspective. Curr Oncol 2019; 26:e551-e557. [PMID: 31548824 PMCID: PMC6726257 DOI: 10.3747/co.26.5137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The ros1 kinase is an oncogenic driver in non-small-cell lung cancer (nsclc). Fusion events involving the ROS1 gene are found in 1%-2% of nsclc patients and lead to deregulation of a tyrosine kinase-mediated multi-use intracellular signalling pathway, which then promotes the growth, proliferation, and progression of tumour cells. ROS1 fusion is a distinct molecular subtype of nsclc, found independently of other recognized driver mutations, and it is predominantly identified in younger patients (<50 years of age), women, never-smokers, and patients with adenocarcinoma histology. Targeted inhibition of the aberrant ros1 kinase with crizotinib is associated with increased progression-free survival (pfs) and improved quality-of-life measures. As the sole approved treatment for ROS1-rearranged nsclc, crizotinib has been demonstrated, through a variety of clinical trials and retrospective analyses, to be a safe, effective, well-tolerated, and appropriate treatment for patients having the ROS1 rearrangement. Canadian physicians endorse current guidelines which recommend that all patients with nonsquamous advanced nsclc, regardless of clinical characteristics, be tested for ROS1 rearrangement. Future integration of multigene testing panels into the standard of care could allow for efficient and cost-effective comprehensive testing of all patients with advanced nsclc. If a ROS1 rearrangement is found, treatment with crizotinib, preferably in the first-line setting, constitutes the standard of care, with other treatment options being investigated, as appropriate, should resistance to crizotinib develop.
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Affiliation(s)
- D G Bebb
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - J Agulnik
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - R Albadine
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - S Banerji
- Manitoba: Department of Medical Oncology, University of Manitoba, Winnipeg (Banerji)
| | - G Bigras
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - C Butts
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - C Couture
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - J C Cutz
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - P Desmeules
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - D N Ionescu
- British Columbia: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (Ionescu); BC Cancer-Vancouver Centre, Vancouver (Melosky)
| | - N B Leighl
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - B Melosky
- British Columbia: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (Ionescu); BC Cancer-Vancouver Centre, Vancouver (Melosky)
| | - W Morzycki
- Nova Scotia: Queen Elizabeth iiHealth Sciences Centre and Dalhousie University, Halifax (Morzycki, Xu)
| | - F Rashid-Kolvear
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
- Manitoba: Department of Medical Oncology, University of Manitoba, Winnipeg (Banerji)
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
- British Columbia: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (Ionescu); BC Cancer-Vancouver Centre, Vancouver (Melosky)
- Nova Scotia: Queen Elizabeth iiHealth Sciences Centre and Dalhousie University, Halifax (Morzycki, Xu)
- Saskatchewan: Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority and University of Saskatchewan, Saskatoon (Torlakovic)
| | - Clin Lab
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - H S Sekhon
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - A C Smith
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - T L Stockley
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - E Torlakovic
- Saskatchewan: Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority and University of Saskatchewan, Saskatoon (Torlakovic)
| | - Z Xu
- Nova Scotia: Queen Elizabeth iiHealth Sciences Centre and Dalhousie University, Halifax (Morzycki, Xu)
| | - M S Tsao
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
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22
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PD-L1 testing on the EBUS-FNA cytology specimens of non-small cell lung cancer. Lung Cancer 2019; 136:1-5. [PMID: 31421256 DOI: 10.1016/j.lungcan.2019.07.033] [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: 01/08/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The FDA approved PD-L1 tests for anti-PD-L1 immunotherapy are for surgical or histology specimens. It is not clear if cytology specimens could be used for PD-L1 testing to guide immunotherapy. In this study, we assess the suitability of EBUS-FNA cytology specimens for the testing of PD-L1. MATERIALS AND METHODS Consecutive patients with Non-small cell lung cancer (NSCLC) underwent EBUS procedure between January 1, 2017 and March 31, 2018 for PD-L1 testing were included. The cell blocks of EBUS-FNA cytology specimens were used for PD-L1 testing using Dako 22C3 phamDx antibody according to the Dako protocol. PD-L1 protein expression in tumor cells is determined by using Tumor Proportion Score (TPS). RESULTS AND CONCLUSION Of the 265 EBUS-FNA specimens from 262 patients sent for testing, 230 (86.8%) were adequate for PD-L1 testing. Of the 34 NSCLC patients with both histology and EBUS-FNA cytology specimens tested for PD-L1, the results from different specimen types had a concordance of 91.3%. The PD-L1 results from 16 paired specimens from the same anatomic site had 100% agreement. The rates of PD-L1 TPS ≥ 50% were significantly higher in the metastatic tumors in the lymph nodes than in the lung primary lesions. Therefore, EBUS-FNA cytology specimen is suitable for PD-L1 testing in patients with advanced NSCLC. The metastatic tumors in mediastinal lymph nodes appear to have higher PD-L1 expression than primary lesions.
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23
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Yip S, Christofides A, Banerji S, Downes MR, Izevbaye I, Lo B, MacMillan A, McCuaig J, Stockley T, Yousef GM, Spatz A. A Canadian guideline on the use of next-generation sequencing in oncology. Curr Oncol 2019; 26:e241-e254. [PMID: 31043833 PMCID: PMC6476432 DOI: 10.3747/co.26.4731] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rapid advancements in next-generation sequencing (ngs) technology have created an unprecedented opportunity to decipher the molecular profile of tumours to more effectively prevent, diagnose, and treat cancer. Oncologists now have the option to order molecular tests that can guide treatment decisions. However, to date, most oncologists have received limited training in genomics, and they are now faced with the challenge of understanding how such tests and their interpretation align with patient management. Guidance on how to effectively use ngs technology is therefore needed to aid oncologists in applying the results of genomic tests. The Canadian guideline presented here describes best practices and unmet needs related to ngs-based testing for somatic variants in oncology, including clinical application, assay and sample selection, bioinformatics and interpretation of reports performed by laboratories, patient communication, and clinical trials.
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Affiliation(s)
- S Yip
- Cancer Genetics and Genomics Lab, BC Cancer, Vancouver, BC
| | | | - S Banerji
- Department of Medical Oncology, CancerCare Manitoba, Winnipeg, MB
| | - M R Downes
- Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - I Izevbaye
- Division of Molecular Pathology, Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, AB
| | - B Lo
- Molecular Diagnostics, The Ottawa Hospital, Ottawa, ON
| | - A MacMillan
- Provincial Medical Genetics Program, St. John's, NL
| | - J McCuaig
- Princess Margaret Cancer Centre, Toronto, ON
| | - T Stockley
- Department of Laboratory Medicine and Pathobiology, University of Toronto and University Health Network, Toronto, ON
| | - G M Yousef
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON
| | - A Spatz
- Departments of Pathology and Oncology, McGill University, McGill University Health Centre and Lady Davis Institute, Montreal, QC
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24
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Melosky B, Cheema P, Agulnik J, Albadine R, Bebb DG, Blais N, Burkes R, Butts C, Card PB, Chan AMY, Hirsh V, Ionescu DN, Juergens R, Morzycki W, Poonja Z, Sangha R, Tehfe M, Tsao MS, Vincent M, Xu Z, Liu G. Canadian perspectives: update on inhibition of ALK-positive tumours in advanced non-small-cell lung cancer. Curr Oncol 2018; 25:317-328. [PMID: 30464681 PMCID: PMC6209554 DOI: 10.3747/co.25.4379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Inhibition of the anaplastic lymphoma kinase (alk) oncogenic driver in advanced non-small-cell lung carcinoma (nsclc) improves survival. In 2015, Canadian thoracic oncology specialists published a consensus guideline about the identification and treatment of ALK-positive patients, recommending use of the alk inhibitor crizotinib in the first line. New scientific literature warrants a consensus update. Methods Clinical trials of alk inhibitor were reviewed to assess benefits, risks, and implications relative to current Canadian guidance in patients with ALK-positive nsclc. Results Randomized phase iii trials have demonstrated clinical benefit for single-agent alectinib and ceritinib used in treatment-naïve patients and as second-line therapy after crizotinib. Phase ii trials have demonstrated activity for single-agent brigatinib and lorlatinib in further lines of therapy. Improved responses in brain metastases were observed for all second- and next/third-generation alk tyrosine kinase inhibitors in patients progressing on crizotinib. Canadian recommendations are therefore revised as follows:■ Patients with advanced nonsquamous nsclc have to be tested for the presence of an ALK rearrangement.■ Treatment-naïve patients with ALK-positive disease should initially be offered single-agent alectinib or ceritinib, or both sequentially.■ Crizotinib-refractory patients should be treated with single-agent alectinib or ceritinib, or both sequentially.■ Further treatments could include single-agent brigatinib or lorlatinib, or both sequentially.■ Patients progressing on alk tyrosine kinase inhibitors should be considered for pemetrexed-based chemotherapy.■ Other systemic therapies should be exhausted before immunotherapy is considered. Summary Multiple lines of alk inhibition are now recommended for patients with advanced nsclc with an ALK rearrangement.
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Affiliation(s)
- B Melosky
- BC Cancer-Vancouver Centre, Vancouver, BC
| | - P Cheema
- William Osler Health System, University of Toronto, Brampton, ON
| | - J Agulnik
- Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QC
| | - R Albadine
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - D G Bebb
- Tom Baker Cancer Centre and University of Calgary, Calgary, AB
| | - N Blais
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - R Burkes
- Mount Sinai Hospital, Toronto, ON
| | - C Butts
- Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - P B Card
- Kaleidoscope Strategic, Inc., Toronto, ON
| | - A M Y Chan
- Tom Baker Cancer Centre and University of Calgary, Calgary, AB
| | - V Hirsh
- Royal Victoria Hospital, McGill University Health Centre, Montreal, QC
| | | | - R Juergens
- Juravinski Cancer Centre, McMaster University, Hamilton, ON
| | - W Morzycki
- qeii Health Sciences Centre, Halifax, NS
| | - Z Poonja
- BC Cancer-Vancouver Island Center, Victoria, BC
| | - R Sangha
- Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - M Tehfe
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - M S Tsao
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON
| | - M Vincent
- University of Western Ontario, London, ON
| | - Z Xu
- qeii Health Sciences Centre, Halifax, NS
| | - G Liu
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON
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