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Gieszer B, Megyesfalvi Z, Dulai V, Papay J, Kovalszky I, Timar J, Fillinger J, Harko T, Pipek O, Teglasi V, Regos E, Papp G, Szallasi Z, Laszlo V, Renyi-Vamos F, Galffy G, Bodor C, Dome B, Moldvay J. EGFR variant allele frequency predicts EGFR-TKI efficacy in lung adenocarcinoma: a multicenter study. Transl Lung Cancer Res 2021; 10:662-674. [PMID: 33718012 PMCID: PMC7947383 DOI: 10.21037/tlcr-20-814] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Although lung adenocarcinoma (LADC) with sensitizing mutations of the epidermal growth factor receptor (EGFR) is highly sensitive to EGFR tyrosine kinase inhibitors (EGFR-TKIs), in most cases disease progression inevitably occurs. Our aim was to investigate the predictive and prognostic significance of adjusted tumoral EGFR variant allele frequency (EGFR-aVAF) in the above setting. Methods Eighty-nine Caucasian advanced-stage LADC patients with known exon-specific EGFR mutations undergoing EGFR-TKI treatment were included. The correlations of EGFR-aVAF with clinicopathological variables including progression-free and overall survival (PFS and OS, respectively) were retrospectively analyzed. Results Of 89 EGFR-mutant LADC patients, 46 (51.7%) had exon 19 deletion, while 41 (46.1%) and 2 (2.2%) patients had exon 21- and exon 18-point mutations, respectively. Tumoral EGFR-aVAF was significantly higher in patients harboring EGFR exon 19 mutations than in those with exon 21-mutant tumors (P<0.001). Notably, patients with EGFR exon 19 mutant tumors demonstrated significantly improved PFS (P=0.003) and OS (P=0.02) compared to patients with exon 21 mutations. Irrespective of specific exon mutations, a statistically significant positive linear correlation was found between EGFR-aVAF of tumoral tissue and PFS (r=0.319; P=0.002). High (≥70%) EGFR-aVAF was an independent predictor of longer PFS [vs. low (<70%) EGFR-aVAF; median PFSs were 52 vs. 26 weeks, respectively; P<0.001]. Additionally, patients with high EGFR-aVAF also had significantly improved OS than those with low EGFR-aVAF (P=0.011). Conclusions Our study suggests that high (≥70%) EGFR-aVAF of tumoral tissue predicts benefit from EGFR-TKI treatment in advanced LADC and, moreover, that exon 19 EGFR mutation is associated with high EGFR-aVAF and improved survival outcomes.
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Affiliation(s)
- Balazs Gieszer
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary
| | - Zsolt Megyesfalvi
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Viktoria Dulai
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Judit Papay
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Ilona Kovalszky
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Jozsef Timar
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Janos Fillinger
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Tunde Harko
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Orsolya Pipek
- Department of Physics of Complex Systems, Eotvos Lorand University, Budapest, Hungary
| | - Vanda Teglasi
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Eszter Regos
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Gergo Papp
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Zoltan Szallasi
- MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Budapest, Hungary.,Computational Health Informatics Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Viktoria Laszlo
- National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ferenc Renyi-Vamos
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Gabriella Galffy
- Torokbalint County Institute of Pulmonology, Torokbalint, Hungary
| | - Csaba Bodor
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Balazs Dome
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary.,Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Judit Moldvay
- National Koranyi Institute of Pulmonology, Budapest, Hungary.,MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Budapest, Hungary
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Beyond Conventional: The New Horizon of Anti-Angiogenic microRNAs in Non-Small Cell Lung Cancer Therapy. Int J Mol Sci 2020; 21:ijms21218002. [PMID: 33121202 PMCID: PMC7663714 DOI: 10.3390/ijms21218002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022] Open
Abstract
GLOBOCAN 2018 identified lung cancer as the leading oncological pathology in terms of incidence and mortality rates. Angiogenesis is a key adaptive mechanism of numerous malignancies that promotes metastatic spread in view of the dependency of cancer cells on nutrients and oxygen, favoring invasion. Limitation of the angiogenic process could significantly hamper the disease advancement through starvation of the primary tumor and impairment of metastatic spread. This review explores the basic molecular mechanisms of non-small cell lung cancer (NSCLC) angiogenesis, and discusses the influences of the key proangiogenic factors-the vascular endothelial growth factor-A (VEGF-A), basic fibroblast growth factor (FGF2), several matrix metalloproteinases (MMPs-MMP-2, MMP-7, MMP-9) and hypoxia-and the therapeutic implications of microRNAs (miRNAs, miRs) throughout the entire process, while also providing critical reviews of a number of microRNAs, with a focus on miR-126, miR-182, miR-155, miR-21 and let-7b. Finally, current conventional NSCLC anti-angiogenics-bevacizumab, ramucirumab and nintedanib-are briefly summarized through the lens of evidence-based medicine.
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3
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Shen L, Lin J, Wang B, Xu H, Zhao K, Zhang L. [Computed tomography findings, clinicopathological features, genetic characteristics and prognosis of in situ and minimally invasive lung adenocarcinomas]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:1107-1112. [PMID: 31640952 DOI: 10.12122/j.issn.1673-4254.2019.09.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the computed tomography findings, clinicopathological features, genetic characteristics and prognosis of in situ adenocarcinoma (AIS) and minimally invasive adenocarcinoma (MIA) of the lung. METHODS We retrospectively analyzed the data including computed tomography (CT) images, histopathological findings, Ki-67 immunostaining, and genetic mutations in patients with lung adenocarcinoma undergoing surgery at our hospital between 2014 and 2019. RESULTS Of the total of 480 patients with lung adenocarcinoma we reviewed, 73 (15.2%) had AIS (n=28) or MIA (n=45) tumors. The age of the patients with MIA was significantly younger than that of patients with AIS (P < 0.02). CT scans identified pure ground-glass nodules in 46.4% of AIS cases and in 44.4% of MIA cases. Multiple GGOs were more common in MIA than in AIS cases (P < 0.05), and bluured tumor margins was less frequent in AIS cases (P < 0.05). No significant difference was found in EGFR mutations between MIA and AIS cases. A Ki-67 labeling index (LI) value ≥2.8% did not differentiate MIA from AIS. The follow-up time in MIA group was significantly shorter than that in AIS group, but no recurrence or death occurred. CONCLUSIONS Despite similar surgical outcomes and favorable survival outcomes, the patients with AIS and MIA show differences in terms of age, CT findings, EGFR mutations and Ki-67 LI.
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Affiliation(s)
- Leilei Shen
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Jixing Lin
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Bailin Wang
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Hengliang Xu
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Kai Zhao
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
| | - Lianbin Zhang
- Department of Thoracic Surgery, Hainan Hospital of General Hospital of PLA, Sanya 572000, China
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Dong Y, Zhang D, Cai M, Luo Z, Zhu Y, Gong L, Lei Y, Tan X, Zhu Q, Han S. SPOP regulates the DNA damage response and lung adenocarcinoma cell response to radiation. Am J Cancer Res 2019; 9:1469-1483. [PMID: 31392082 PMCID: PMC6682716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/20/2019] [Indexed: 06/10/2023] Open
Abstract
Speckle-type POZ protein (SPOP) plays an important role in maintaining genome stability. Disability or mutation of the SPOP gene has been reported to contribute to prostate cancer incidence and prognosis. However, the functions of SPOP in lung cancer remain poorly understood, especially in lung adenocarcinoma (LUAD). Here, we found that SPOP affects the LUAD cell response to radiation by regulating the DNA damage response (DDR) pathway. SPOP is widely expressed in lung cancer cell lines, and SPOP protein levels are upregulated when cells experience DNA damage. SPOP knockdown affects DDR repair kinetics, apoptosis and cell cycle checkpoints that are induced by IR (ionizing radiation). Furthermore, we found that SPOP positively regulates the expression of DDR factors Rad51 and Ku80. Taken together, these data indicate the essential roles of SPOP in the DDR signaling pathways and LUAD cell response to radiation.
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Affiliation(s)
- Yiping Dong
- Department of Oncology Radiotherapy, The First Affiliated Hospital, Medical School of Xi’an Jiaotong UniversityXi’an 710061, Shaanxi, China
| | - Dan Zhang
- Department of Oncology Radiotherapy, The First Affiliated Hospital, Medical School of Xi’an Jiaotong UniversityXi’an 710061, Shaanxi, China
- Department of Cell Biology and Genetics, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science CenterXi’an 710061, Shaanxi, China
| | - Mengjiao Cai
- Department of Oncology Radiotherapy, The First Affiliated Hospital, Medical School of Xi’an Jiaotong UniversityXi’an 710061, Shaanxi, China
| | - Zhenzhen Luo
- Department of Oncology Radiotherapy, The First Affiliated Hospital, Medical School of Xi’an Jiaotong UniversityXi’an 710061, Shaanxi, China
| | - Yue Zhu
- Department of Oncology Radiotherapy, The First Affiliated Hospital, Medical School of Xi’an Jiaotong UniversityXi’an 710061, Shaanxi, China
| | - Liuyun Gong
- Department of Oncology Radiotherapy, The First Affiliated Hospital, Medical School of Xi’an Jiaotong UniversityXi’an 710061, Shaanxi, China
| | - Yutiantian Lei
- Department of Oncology Radiotherapy, The First Affiliated Hospital, Medical School of Xi’an Jiaotong UniversityXi’an 710061, Shaanxi, China
| | - Xinyue Tan
- Department of Oncology Radiotherapy, The First Affiliated Hospital, Medical School of Xi’an Jiaotong UniversityXi’an 710061, Shaanxi, China
| | - Qing Zhu
- Department of Abdominal Oncology, West China Hospital of Sichuan UniversityChengdu 610041, China
| | - Suxia Han
- Department of Oncology Radiotherapy, The First Affiliated Hospital, Medical School of Xi’an Jiaotong UniversityXi’an 710061, Shaanxi, China
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Yu KH, Berry GJ, Rubin DL, Ré C, Altman RB, Snyder M. Association of Omics Features with Histopathology Patterns in Lung Adenocarcinoma. Cell Syst 2017; 5:620-627.e3. [PMID: 29153840 PMCID: PMC5746468 DOI: 10.1016/j.cels.2017.10.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/30/2017] [Accepted: 10/19/2017] [Indexed: 12/16/2022]
Abstract
Adenocarcinoma accounts for more than 40% of lung malignancy, and microscopic pathology evaluation is indispensable for its diagnosis. However, how histopathology findings relate to molecular abnormalities remains largely unknown. Here, we obtained H&E-stained whole-slide histopathology images, pathology reports, RNA sequencing, and proteomics data of 538 lung adenocarcinoma patients from The Cancer Genome Atlas and used these to identify molecular pathways associated with histopathology patterns. We report cell-cycle regulation and nucleotide binding pathways underpinning tumor cell dedifferentiation, and we predicted histology grade using transcriptomics and proteomics signatures (area under curve >0.80). We built an integrative histopathology-transcriptomics model to generate better prognostic predictions for stage I patients (p = 0.0182 ± 0.0021) compared with gene expression or histopathology studies alone, and the results were replicated in an independent cohort (p = 0.0220 ± 0.0070). These results motivate the integration of histopathology and omics data to investigate molecular mechanisms of pathology findings and enhance clinical prognostic prediction.
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Affiliation(s)
- Kun-Hsing Yu
- Biomedical Informatics Program, Stanford University, Stanford, CA 94305-5479, USA; Department of Genetics, Stanford University, Stanford, CA 94305-5120, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, USA
| | - Gerald J Berry
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
| | - Daniel L Rubin
- Biomedical Informatics Program, Stanford University, Stanford, CA 94305-5479, USA; Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, USA; Department of Radiology, Stanford University, Stanford, CA 94305-5105, USA; Department of Medicine (Biomedical Informatics Research), Stanford University, Stanford, CA 94305-5479, USA
| | - Christopher Ré
- Department of Computer Science, Stanford University, Stanford, CA 94305-9025, USA
| | - Russ B Altman
- Biomedical Informatics Program, Stanford University, Stanford, CA 94305-5479, USA; Department of Genetics, Stanford University, Stanford, CA 94305-5120, USA; Department of Computer Science, Stanford University, Stanford, CA 94305-9025, USA; Department of Bioengineering, Stanford University, Stanford, CA 94305-4125, USA
| | - Michael Snyder
- Department of Genetics, Stanford University, Stanford, CA 94305-5120, USA.
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Bhardwaj B, Revannasiddaiah S, Bhardwaj H, Balusu S, Shwaiki A. Molecular targeted therapy to improve radiotherapeutic outcomes for non-small cell lung carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:50. [PMID: 26904572 DOI: 10.3978/j.issn.2305-5839.2015.10.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Effective treatments for non-small cell lung carcinoma (NSCLC) remain elusive. The use of concurrent chemotherapy with radiotherapy (RT) has improved outcomes, but a significant proportion of NSCLC patients are too frail to be able to tolerate an intense course of concurrent chemoradiotherapy. The development of targeted therapies ignited new hope in enhancing radiotherapeutic outcomes. The use of targeted therapies against the epidermal growth factor receptor (EGFR) has offered slight but significant benefits in concurrent use with RT for certain patients in certain situations. However, despite theoretical promise, the use of anti-angiogenics, such as bevacizumab and endostatin, has not proven clinically safe or useful in combination with RT. However, many new targeted agents against new targets are being experimented for combined use with RT. It is hoped that these agents may provide a significant breakthrough in the radiotherapeutic management of NSCLC. The current review provides a brief discussion about the targets, the targeted therapies, the rationale for the use of targeted therapies in combination with RT, and a brief review of the existing data on the subject.
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Affiliation(s)
- Bhaskar Bhardwaj
- 1 Department of Internal medicine, University of Missouri, Kansas City, MO, USA ; 2 Department of Radiation Oncology, Government Medical College, Haldwani, Nanital, India ; 3 Department of Pulmonary Medicine and Critical Care, University of Oklahoma, Norman, OK, USA ; 4 Department of Internal Medicine, University of Missouri, Kansas City, MO, USA ; 5 Department of Hematology and Oncology, Saint Luke's Hospital, Kansas City, MO, USA
| | - Swaroop Revannasiddaiah
- 1 Department of Internal medicine, University of Missouri, Kansas City, MO, USA ; 2 Department of Radiation Oncology, Government Medical College, Haldwani, Nanital, India ; 3 Department of Pulmonary Medicine and Critical Care, University of Oklahoma, Norman, OK, USA ; 4 Department of Internal Medicine, University of Missouri, Kansas City, MO, USA ; 5 Department of Hematology and Oncology, Saint Luke's Hospital, Kansas City, MO, USA
| | - Himanshu Bhardwaj
- 1 Department of Internal medicine, University of Missouri, Kansas City, MO, USA ; 2 Department of Radiation Oncology, Government Medical College, Haldwani, Nanital, India ; 3 Department of Pulmonary Medicine and Critical Care, University of Oklahoma, Norman, OK, USA ; 4 Department of Internal Medicine, University of Missouri, Kansas City, MO, USA ; 5 Department of Hematology and Oncology, Saint Luke's Hospital, Kansas City, MO, USA
| | - Sree Balusu
- 1 Department of Internal medicine, University of Missouri, Kansas City, MO, USA ; 2 Department of Radiation Oncology, Government Medical College, Haldwani, Nanital, India ; 3 Department of Pulmonary Medicine and Critical Care, University of Oklahoma, Norman, OK, USA ; 4 Department of Internal Medicine, University of Missouri, Kansas City, MO, USA ; 5 Department of Hematology and Oncology, Saint Luke's Hospital, Kansas City, MO, USA
| | - Ali Shwaiki
- 1 Department of Internal medicine, University of Missouri, Kansas City, MO, USA ; 2 Department of Radiation Oncology, Government Medical College, Haldwani, Nanital, India ; 3 Department of Pulmonary Medicine and Critical Care, University of Oklahoma, Norman, OK, USA ; 4 Department of Internal Medicine, University of Missouri, Kansas City, MO, USA ; 5 Department of Hematology and Oncology, Saint Luke's Hospital, Kansas City, MO, USA
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Revannasiddaiah S, Joshi SC, Pandey KC, Rastogi M, Sharma M, Gupta M. The results with the addition of metronomic cyclophosphamide to palliative radiotherapy for the treatment of non-small cell lung carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:305. [PMID: 26697465 DOI: 10.3978/j.issn.2305-5839.2015.11.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND A considerable proportion of non-small cell lung carcinoma (NSCLC) patients are ineligible for radical therapies. Many are frail not to tolerate intravenous palliative chemotherapy either. These patients often receive palliative radiotherapy (RT), or supportive care alone. We intend to compare outcomes with palliative RT alone, versus palliative RT plus oral low dose metronomic cyclophosphamide. METHODS Data was mined from 139 eligible NSCLC patient records. Comparisons were made between 65 patients treated from January 2011 to March 2013 with palliative RT (20-30 Gray in 5-10 fractions) alone, versus 74 patients treated from April 2013 to December 2014 with palliative RT plus oral metronomic cyclophosphamide (50 mg once daily from day of initiation of RT until at least the day of disease progression). Response was assessed after 1-month post-RT by computed tomography. Patients with complete or partial response were recorded as responders. For the determination of progression free survival (PFS), progression would be declared in case of increase in size of lesions, development of new lesions, or development of effusions. The proportions of responders were compared with the Fisher exact test, and the PFS curves were compared with the log-rank test. RESULTS Differences in response rates were statistically insignificant. The PFS was significantly higher when metronomic chemotherapy was added to RT in comparison to treatment with RT alone (mean PFS 3.1 vs. 2.55 months; P=0.0501). Further histological sub-group analysis revealed that the enhanced outcomes with addition of metronomic cyclophosphamide to RT were limited to patients with adenocarcinoma histology (3.5 vs. 2.4 months; P=0.0053), while there was no benefit for those with squamous cell histology (2.6 vs. 2.6 months; P=1). At the dose of oral cyclophosphamide used, there was no recorded instance of any measurable hematological toxicity. CONCLUSIONS For pulmonary adenocarcinoma patients, the treatment with palliative RT plus oral metronomic cyclophosphamide is better than that with palliative RT alone. However, for pulmonary squamous cell carcinoma the addition of oral metronomic cyclophosphamide to palliative RT offered no benefit. Further studies with similar and different metronomic chemotherapy agents are justifiable.
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Affiliation(s)
- Swaroop Revannasiddaiah
- 1 Department of Radiation Oncology, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 2 Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 3 Department of Radiation Oncology, HealthCare Global- Bangalore Institute of Oncology, Bengaluru, India ; 4 Department of Radiation Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India
| | - Subhash Chandra Joshi
- 1 Department of Radiation Oncology, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 2 Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 3 Department of Radiation Oncology, HealthCare Global- Bangalore Institute of Oncology, Bengaluru, India ; 4 Department of Radiation Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India
| | - Kailash Chandra Pandey
- 1 Department of Radiation Oncology, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 2 Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 3 Department of Radiation Oncology, HealthCare Global- Bangalore Institute of Oncology, Bengaluru, India ; 4 Department of Radiation Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India
| | - Madhup Rastogi
- 1 Department of Radiation Oncology, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 2 Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 3 Department of Radiation Oncology, HealthCare Global- Bangalore Institute of Oncology, Bengaluru, India ; 4 Department of Radiation Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India
| | - Mukesh Sharma
- 1 Department of Radiation Oncology, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 2 Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 3 Department of Radiation Oncology, HealthCare Global- Bangalore Institute of Oncology, Bengaluru, India ; 4 Department of Radiation Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India
| | - Manoj Gupta
- 1 Department of Radiation Oncology, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 2 Department of Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India ; 3 Department of Radiation Oncology, HealthCare Global- Bangalore Institute of Oncology, Bengaluru, India ; 4 Department of Radiation Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India
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Vollbrecht C, Werner R, Walter RFH, Christoph DC, Heukamp LC, Peifer M, Hirsch B, Burbat L, Mairinger T, Schmid KW, Wohlschlaeger J, Mairinger FD. Mutational analysis of pulmonary tumours with neuroendocrine features using targeted massive parallel sequencing: a comparison of a neglected tumour group. Br J Cancer 2015; 113:1704-11. [PMID: 26645239 PMCID: PMC4701994 DOI: 10.1038/bjc.2015.397] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 12/15/2022] Open
Abstract
Background: Lung cancer is the leading cause of cancer-related deaths worldwide. The typical and atypical carcinoid (TC and AC), the large-cell neuroendocrine carcinoma (LCNEC) and the small-cell lung cancers (SCLC) are subgroups of pulmonary tumours that show neuroendocrine differentiations. With the rising impact of molecular pathology in routine diagnostics the interest for reliable biomarkers, which can help to differentiate these subgroups and may enable a more personalised treatment of patients, grows. Methods: A collective of 70 formalin-fixed, paraffin-embedded (FFPE) pulmonary neuroendocrine tumours (17 TCs, 17 ACs, 19 LCNECs and 17 SCLCs) was used to identify biomarkers by high-throughput sequencing. Using the Illumina TruSeq Amplicon-Cancer Panel on the MiSeq instrument, the samples were screened for alterations in 221 mutation hot spots of 48 tumour-relevant genes. Results: After filtering >26 000 detected variants by applying strict algorithms, a total of 130 mutations were found in 29 genes and 49 patients. Mutations in JAK3, NRAS, RB1 and VHL1 were exclusively found in SCLCs, whereas the FGFR2 mutation was detected in LCNEC only. KIT, PTEN, HNF1A and SMO were altered in ACs. The SMAD4 mutation corresponded to the TC subtype. We prove that the frequency of mutations increased with the malignancy of tumour type. Interestingly, four out of five ATM-mutated patients showed an additional alteration in TP53, which was by far the most frequently altered gene (28 out of 130; 22%). We found correlations between tumour type and IASLC grade for ATM- (P=0.022; P=0.008) and TP53-mutated patients (P<0.001). Both mutated genes were also associated with lymph node invasion and distant metastasis (P⩽0.005). Furthermore, PIK3CA-mutated patients with high-grade tumours showed a reduced overall survival (P=0.040) and the mutation frequency of APC and ATM in high-grade neuroendocrine lung cancer patients was associated with progression-free survival (PFS) (P=0.020). Conclusions: The implementation of high-throughput sequencing for the analysis of the neuroendocrine lung tumours has revealed that, even if these tumours encompass several subtypes with varying clinical aggressiveness, they share a number of molecular features. An improved understanding of the biology of neuroendocrine tumours will offer the opportunity for novel approaches in clinical management, resulting in a better prognosis and prediction of therapeutic response.
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Affiliation(s)
| | - Robert Werner
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Robert Fred Henry Walter
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Ruhrlandklinik, West German Lung Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | | | - Martin Peifer
- Department of Translational Genomics, Cologne Center of Genomics, University of Cologne, Cologne, Germany
| | - Burkhard Hirsch
- Institute of Pathology, Molecular Diagnostics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lina Burbat
- Institute of Pathology, Molecular Diagnostics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Mairinger
- Institute of Pathology, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Kurt Werner Schmid
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jeremias Wohlschlaeger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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