Real-world analysis of MET exon 14 mutations in non-small cell lung cancer: a retrospective study from two Swedish hospitals

BACKGROUND

Real-World evidence on mesenchymal-epithelial transition exon 14 skipping mutations (METex14) in lung cancer remains limited. With an incidence of 3-4% across histological subtypes, METex14 is now an actionable target for MET inhibitors (METi) in advanced lung cancer, demonstrating response rates between 30-70%. Yet, its role in early stages and sensitivity to immune checkpoint inhibitors (ICIs) is still under exploration.

MATERIAL AND METHODS

We conducted a retrospective analysis of the clinical data of lung cancer patients presenting with METex14 across all stages. These patients were treated at two Swedish University Hospitals: Karolinska and Skåne, between the years 2014 and 2022.

RESULTS

We identified a total of 63 patients, of which 50 met the inclusion criteria. The median overall survival (OS) with corresponding 95% confidence intervals (95% CI) according to the stage was not reached (NR) for stage I, NR for stage II, 15 months (95% CI, 5.4-24.6) for stage III, and 17 months (95% CI, 9.2-NR) for stage IV. The median OS for stage IV patients who received a METi was 17 months (95% CI, 9.5-NR) vs. 10 months (95% CI, 6.2-NR) in patients without METi (p = 0.92; Hazard Ratio [HR] = 1.07). The median OS for stage IV patients who received ICIs was 18 months (95% CI, 16.5-NR) vs. 6 months (95% CI, 2.5-NR) in patients without ICIs (p = 0.15; HR = 0.47). The median OS for stage IV patients who received chemotherapy was 17 months (95% CI, 9.7-NR) vs. 10 months (95% CI, 4.5-NR) in patients without (p = 0.97; HR = 0.98).

CONCLUSIONS

Our data suggest limited survival benefits from METi, ICIs, and chemotherapy for METex14 lung cancer patients. While not statistically significant, these findings underscore the need for larger trials for validation. Identifying effective treatments for this challenging lung cancer subtype remains a priority.

Clinical Utility of Targeted Sequencing in Lung Cancer: Experience From an Autonomous Swedish Health Care Center

OBJECTIVES

Mutation analysis by massive parallel sequencing (MPS) is routinely performed in the clinical management of lung cancer in Sweden. We describe the clinical and mutational profiles of lung cancer patients subjected to the first 1.5 years of treatment predictive MPS testing in an autonomous regional health care region.

METHODS

Tumors from all patients with lung cancer who had an MPS test from January 2015 to June 2016 in the Skåne health care region in Sweden (1.3 million citizens) were included. Six hundred eleven tumors from 599 patients were profiled using targeted sequencing with a 26-gene exon-focused panel. Data on disease patterns and characteristics of the patients subjected to testing were assembled, and correlations between mutational profiles and clinical features were analyzed.

RESULTS

MPS with the 26-gene panel revealed alterations in 92% of the 611 lung tumors, with the most frequent mutations detected in the nontargetable genes TP53 (62%) and KRAS (37%). Neither KRAS nor TP53 mutations were associated with disease pattern, chemotherapy response, progression-free survival, or overall survival in advanced-stage disease treated with platinum-based doublet chemotherapy as a first-line treatment. Among targetable genes, EGFR driver mutations were detected in 10% of the tumors, and BRAF p.V600 variants in 2.3%. For the 71 never smokers (12%), targetable alterations (EGFR mutations, BRAF p.V600, MET exon 14 skipping, or ALK/ROS1 rearrangement) were detected in 59% of the tumors.

CONCLUSION

Although the increasing importance of MPS as a predictor of response to targeted therapies is indisputable, its role in prognostics or as a predictor of clinical course in nontargetable advanced stage lung cancer requires further investigation.

Fourier-transform infrared imaging using a rapid-scan spectrometer

We present a major improvement to the Fourier-transform infrared (FTIR) imaging technique brought about by replacement of the commonly used step-scan spectrometer with a rapid-scanning spectrometer. This advancement dramatically decreases the time required for data collection without decreasing the data quality. With this new instrumental setup, an imaging data set consisting of 64x64 spectra with a 4-cm (-1) spectral resolution over a 1360-cm (-1) spectral range can be collected in 34 s. As a practical example, we demonstrate what we believe to be the first application of FTIR imaging to the screening of adsorbates on the elements of a combinatorial library containing different supported catalyst materials in the same reactant feed.

Modification of fatty acid composition of rat heart lipids by feeding cod liver oil

Modification of the fatty acid composition of cardiac phospholipids and neutral lipids was studied in rats fed a diet containing 10% cod liver oil. The results reflect the dynamic state of esterified fatty acids in neutral lipids and phospholipids of heart muscle. In cardiac neutral lipids there was a moderate but significant increase in exogenous fatty acids, 20:1(n--9), 22:1(n--11), 20:5(n--3) and 22:6(n--3), in animals fed cod liver oil, and a relative decrease in endogenous fatty acids, 16:0, 18:2(n--6 and 20:4(n--6). Increased dietary availability of 22: 6(n--3) resulted in a major increase in the content of this fatty acid in phospholipids and replacement of 18:2(n--6) and 20:4(n--6). The 22:6(n--3) was able to replace one third of 18:2(n--6): further increase in 22: 6n--3) was accompanied by a decrease in 18:0. An inverse relationship between (n--6) and (n--3) polyene fatty acids in cardiac phospholipids suggests a replacement of (n--6) acids by (n--3) fatty acids.

Role of myocardial lipids in development of cardiac necrosis

Significant alterations in fatty acyl composition of cardiac phospholipids and neutral lipids are induced by dietary cod liver oil in the rat. Increased dietary availability of docosahexaenoic acid (22:6 omega3) leads to extensive replacement of linoleic acid (18:2omega6) and arachidonic acid (20:4omega6) in phospholipids. Dietary cod liver oil (10%) reduces isoproterenol stress tolerance and results in increased development of cardiac necrosis and mortality following isoproterenol treatment. It is suggested that diminished catecholamine stress tolerance may be related to altered synthesis of prostaglandins or related products.