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Mao X, Liu J, Hu F, Niu Y, Pan F, Fu X, Jiang L. Serum NSE is Early Marker of Transformed Neuroendocrine Tumor After EGFR-TKI Treatment of Lung Adenocarcinoma. Cancer Manag Res 2022; 14:1293-1302. [PMID: 35386183 PMCID: PMC8978576 DOI: 10.2147/cmar.s349082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Transformation to a lung neuroendocrine tumor (LNET) is a mechanism of resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI). Serum neuron-specific enolase (NSE) is a useful marker in the detection of LNET. Therefore, we explored the clinical significance of serum NSE levels in the detection of transformed neuroendocrine tumors after EGFR-TKI therapy. Methods We report a cohort of 5 cases in our treatment group. The characteristics of the patients, pathological diagnoses, immunohistochemistry with molecular detection, laboratory examination, and treatment histories are analyzed. The tumor markers of serum NSE were analyzed. Additionally, we reviewed the publications reporting the tumor markers before and after LNET transformation during EGFR-TKI therapy. Results Most patients are female (3/5), aged <60 years old (4/5), nonsmokers (4/5) and harbor the EGFR 19 exon deletion (4/5). The median time of LNET transformation was 19 months (range: 12–31 months). The clinical characteristics were similar to those reported in previous studies. Laboratory examination revealed an increased NSE level before the LNET is defined. Sixteen publications were reviewed. Of those, 86.67% (13/15) publications showed an increased level of NSE when the LNET transformation was defined. Conclusion Adenocarcinoma tumors in non-smokers, young patients harboring the EGFR 19 exon deletion tended to transform to LNETs after EGFR-TKI therapy. Combining our findings and a review of the literature, we suggest that serum NSE may be a useful tumor marker to predict neuroendocrine tumor transformation.
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Affiliation(s)
- Xiaowei Mao
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jiabing Liu
- Department of Radiation Oncology, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People’s Republic of China
| | - Fang Hu
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People’s Republic of China
| | - Yanjie Niu
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People’s Republic of China
| | - Feng Pan
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People’s Republic of China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People’s Republic of China
| | - Liyan Jiang
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People’s Republic of China
- Correspondence: Liyan Jiang; Xiaolong Fu, Email ;
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Woo CG, Son SM, Lee HC, Han HS, Lee KH, Kim D, Kim EG, Lee OJ. Histologic Changes in Non-Small Cell Lung Cancer Under Various Treatments: A Comparison of Histology and Mutation Status in Serial Samples. Cancer Res Treat 2021; 54:737-743. [PMID: 34583457 PMCID: PMC9296944 DOI: 10.4143/crt.2021.773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/20/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose Histologic change is a resistant mechanism in lung cancer. The most common histological change is the switch from adenocarcinoma (AdenoCa) to small cell carcinoma (SCC) against to tyrosine kinase inhibitors (TKI). However, it is not clear whether other treatment modalities are involved in the histologic changes. Materials and Methods We investigated histological changes in eight cases after various treatments, and compared the molecular profiles between primary tumors and changed tumors using exome sequencing where tissue was available. Results Three cases of AdenoCa that were changed into SCC retained the initial mutations after TKI and/or surgical treatment. After treatment with TKI and immunotherapy, an EGFR (epidermal growth factor receptor)-mutant AdenoCa changed to squamous cell carcinoma (SqCa). SqCa in a patient treated with surgery was changed into combined AdenoCa and SqCa. These two cases showed the same genetic variations between the two distinct non–small cell carcinomas (NSCC). Three patients experienced two histologic changes, which the changed tumors returned to its original subtype or changed to a combined tumor after treatments. Four cases showed combined histology in the first or second change. Conclusion The histology of NSCC can be changed to a single pattern or combined subtypes after various treatment modalities, and the phenotypic changes seem not fixed. Therefore, additional morphologic changes may occur regardless of their genetic status and types of treatments. To refine the new treatment strategy, consecutive repeated biopsies in progressive disease or recurrent tumor are necessary.
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Affiliation(s)
- Chang Gok Woo
- Departments of Pathology, Chungbuk National University Hospital, Cheongju, Korea.,Departments of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Myoung Son
- Departments of Pathology, Chungbuk National University Hospital, Cheongju, Korea.,Departments of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ho-Chang Lee
- Departments of Pathology, Chungbuk National University Hospital, Cheongju, Korea.,Departments of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hye Sook Han
- Division of Hematology-Oncology, Departments of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ki Hyeong Lee
- Division of Hematology-Oncology, Departments of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dohun Kim
- Departments of Thoracic and Cardiovascular surgery, Chungbuk National University Hospital, Cheongju, Korea.,Departments of Thoracic and Cardiovascular surgery, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eung-Gook Kim
- Departments of Biochemistry, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ok-Jun Lee
- Departments of Pathology, Chungbuk National University Hospital, Cheongju, Korea.,Departments of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
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Jin CB, Yang L. Histological transformation of non-small cell lung cancer: Clinical analysis of nine cases. World J Clin Cases 2021; 9:4617-4626. [PMID: 34222428 PMCID: PMC8223818 DOI: 10.12998/wjcc.v9.i18.4617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/11/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Histological transformation is one of the numerous mechanisms of acquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Given its rarity, the underlying transformational mechanisms, clinical features, and therapeutic prognoses are only studied through limited case reports.
AIM To analyze the clinical characteristics and underlying mechanisms in non-small cell lung cancer (SCLC) patients with histological transformation after treatment with EGFR-TKIs.
METHODS We retrospectively investigated nine patients diagnosed with non-SCLC transforming to SCLC, large-cell neuroendocrine carcinoma (LCNEC), or squamous cell carcinoma on re-biopsy after first- or third-generation EGFR-TKIs.
RESULTS The median age of nine patients was 60 years. Among them, six patients had the EGFR 19del mutation, one had the L858R mutation, and one had wild-type EGFR. The level of plasma NSE was measured in six patients with SCLC or LCNEC transformation when transformation occurred, and five patients had elevated plasma NSE levels. All patients received standard chemotherapy after transformation with the exception of one patient who received chemotherapy and anlotinib.
CONCLUSION Tumor re-biopsy should be performed routinely when EGFR-TKI therapy fails in lung cancer patients to avoid ignoring histological transformation and to select a subsequent therapeutic strategy. The transformed tumor retained the original EGFR mutation, indicating that histological transformation represents an evolution from the initial tumor.
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Affiliation(s)
- Cai-Bao Jin
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan 430000, Hubei Province, China
| | - Ling Yang
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan 430000, Hubei Province, China
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Xie Z, Gu Y, Lin X, Ouyang M, Qin Y, Zhang J, Liu J, Mai S, Zhou C. Unexpected favorable outcome to etoposide and cisplatin in a small cell lung cancer transformed patient: a case report. Cancer Biol Ther 2019; 20:1172-1175. [PMID: 31161851 PMCID: PMC6741564 DOI: 10.1080/15384047.2019.1617561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer can benefit significantly from EGFR tyrosine-kinase inhibitors (TKIs) treatment, but almost every patient will inevitably develop resistance. The transformation to small cell lung cancer (SCLC) has been described as an EGFR-TKI resistance often associated with aggressive clinical course and poor prognosis. In this study, we report an unexpected favorable response to etoposide and cisplatin (EP) from an EGFR-mutant patient who developed SCLC transformation at disease progression after the administration of erlotinib with a progression-free survivalof 7.7 months. At disease progression (PD) after erlotinib, rebiopsy showed typical SCLC histology accompanied by positive expressions of CD56, TTF-1, CK7, and synaptophysin. Subsequently, he was switched to standard SCLC treatment regimen EP in combination with erlotinib due to the retention of EGFR 19 del and achieved PR four cycles after the treatment. His disease progressed again 7.7 months after the initiation of EP treatment, with an enlargement of both primary and metastatic lesions. Collectively, this case illustrated the transformation from adenocarcinoma to SCLC and the subsequent durable benefit from standard treatment for SCLC.
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Affiliation(s)
- Zhanhong Xie
- Department of Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Yingying Gu
- Department of Pathology, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Xinqing Lin
- Department of Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Ming Ouyang
- Department of Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Yinyin Qin
- Department of Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Jiexia Zhang
- Department of Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Junjun Liu
- Burning Rock Biotech , Guangzhou , China
| | - Suiyi Mai
- Burning Rock Biotech , Guangzhou , China
| | - Chengzhi Zhou
- Department of Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
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Taniguchi Y, Horiuchi H, Morikawa T, Usui K. Small-Cell Carcinoma Transformation of Pulmonary Adenocarcinoma after Osimertinib Treatment: A Case Report. Case Rep Oncol 2018; 11:323-329. [PMID: 29928211 PMCID: PMC6006630 DOI: 10.1159/000489603] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 01/01/2023] Open
Abstract
There are various mechanisms underlying the resistance of EGFR-mutant lung adenocarcinoma to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). We herein report a case of pulmonary adenocarcinoma with EGFR mutation (exon 19 deletion and T790M) that acquired resistance to osimertinib treatment because of transformation into small-cell lung carcinoma (SCLC). A 67-year-old ex-smoking woman was diagnosed with left upper lobe adenocarcinoma of clinical stage IIIA (cT2bN2M0). She was treated with chemoradiotherapy (cisplatin and vinorelbine plus radiation), gefitinib, cisplatin, and pemetrexed followed by pemetrexed maintenance therapy and erlotinib. Since a sample extracted from the metastatic lung tumor taken obtained via a transbronchial lung biopsy was found to be positive for the T790M mutation at the time of disease progression during erlotinib treatment, she received osimertinib treatment for 15 months until progressive disease. She developed resistance to osimertinib due to the histologic transformation to SCLC. Although the standard chemotherapy of carboplatin and etoposide for SCLC was administered, she died due to metastatic liver failure.
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Affiliation(s)
- Yuri Taniguchi
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Hajime Horiuchi
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kazuhiro Usui
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
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