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Baelen J, Dewaele B, Debiec-Rychter M, Sciot R, Schöffski P, Hompes D, Sinnaeve F, Wafa H, Vanden Bempt I. Optical Genome Mapping for Comprehensive Cytogenetic Analysis of Soft-Tissue and Bone Tumors for Diagnostic Purposes. J Mol Diagn 2024; 26:374-386. [PMID: 38395407 DOI: 10.1016/j.jmoldx.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/21/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Soft-tissue and bone tumors represent a heterogeneous group of tumors encompassing more than 100 histologic subtypes today. Identifying genetic aberrations increasingly is important in these tumors for accurate diagnosis. Although gene mutations typically are detected by second-generation sequencing, the identification of structural variants (SVs) and copy number alterations (CNAs) remains challenging and requires various cytogenetic techniques including karyotyping, fluorescence in situ hybridization, and arrays, each with important limitations. Optical Genome Mapping (OGM), a non-sequencing-based technique for high-resolution detection of SVs and CNAs, was applied in a retrospective series of diagnostic soft-tissue and bone tumor samples. Sample preparation was successful in 38 of 53 cases, with the highest success rate in nonadipocytic soft-tissue tumors (24 of 27 cases; 89%). In 32 of 35 cases carrying a diagnostic SV or CNA, OGM identified the aberration (91%), including a POU2AF3::EWSR1 fusion in a round cell sarcoma and a translocation t(1;5)(p22;p15) in a myxoinflammatory fibroblastic sarcoma. Interestingly, OGM shed light on the genomic complexity underlying the various aberrations. In five samples, OGM showed that chains of rearrangements generated the diagnostic fusion, three of which involved chromoplexy. In addition, in nine samples, chromothripsis was causal to the formation of giant marker/ring/double-minute chromosomes. Finally, compared with standard-of-care cytogenetics, OGM revealed additional aberrations, requiring further investigation of their potential clinical relevance.
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Affiliation(s)
- Jef Baelen
- Department of Human Genetics, KU Leuven, University Hospitals Leuven, Leuven, Belgium.
| | - Barbara Dewaele
- Department of Human Genetics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Maria Debiec-Rychter
- Department of Human Genetics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Raphael Sciot
- Department of Imaging and Pathology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Daphne Hompes
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Friedl Sinnaeve
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hazem Wafa
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Isabelle Vanden Bempt
- Department of Human Genetics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
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Elst L, Philips G, Vandermaesen K, Bassez A, Lodi F, Vreeburg MTA, Brouwer OR, Schepers R, Van Brussel T, Mohanty SK, Parwani AV, Spans L, Vanden Bempt I, Jacomen G, Baldewijns M, Lambrechts D, Albersen M. Single-cell Atlas of Penile Cancer Reveals TP53 Mutations as a Driver of an Aggressive Phenotype, Irrespective of Human Papillomavirus Status, and Provides Clues for Treatment Personalization. Eur Urol 2024:S0302-2838(24)02266-8. [PMID: 38670879 DOI: 10.1016/j.eururo.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND OBJECTIVE TP53 loss-of-function (TP53LOF) mutations might be a driver of poor prognosis and chemoresistance in both human papillomavirus (HPV)-independent (HPV-) and HPV-associated (HPV+) penile squamous cell carcinoma (PSCC). Here, we aim to describe transcriptomic differences in the PSCC microenvironment stratified by TP53LOF and HPV status. METHODS We used single-cell RNA sequencing (scRNA-seq) and T-cell receptor sequencing to obtain a comprehensive atlas of the cellular architecture of PSCC. TP53LOF and HPV status were determined by targeted next-generation sequencing and sequencing HPV-DNA reads. Six HPV+ TP53 wild type (WT), six HPV- TP53WT, and four TP53LOF PSCC samples and six controls were included. Immunohistochemistry and hematoxylin-eosin confirmed the morphological context of the observed signatures. Prognostic differences between patient groups were validated in 541 PSCC patients using Kaplan-Meier survival estimates. KEY FINDINGS AND LIMITATIONS Patients with aberrant p53 staining fare much worse than patients with either HPV- or HPV+ tumors and WT p53 expression. Using scRNA-seq, we revealed 65 cell subtypes within 83 682 cells. TP53LOF tumors exhibit a partial epithelial-to-mesenchymal transition, immune-excluded, angiogenic, and morphologically invasive environment, underlying their aggressive phenotype. HPV- TP53WT tumors show stemness and immune exhaustion. HPV+ TP53WT tumors mirror normal epithelial maturation with upregulation of antibody-drug-conjugate targets and activation of innate immunity. Inherent to the scRNA-seq analysis, low sample size is a limitation and validation of signatures in large PSCC cohorts is needed. CONCLUSIONS AND CLINICAL IMPLICATIONS This first scRNA-seq atlas offers unprecedented in-depth insights into PSCC biology underlying prognostic differences based on TP53 and HPV status. Our findings provide clues for testing novel biomarker-driven therapies in PSCC. PATIENT SUMMARY Here, we analyzed tissues of penile cancer at the level of individual cells, which helps us understand why patients who harbor a deactivating mutation in the TP53 gene do much worse than patients lacking such a mutation. Such an analysis may help us tailor future therapies based on TP53 gene mutations and human papillomavirus status of these tumors.
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Affiliation(s)
- Laura Elst
- Center for Cancer Biology, Laboratory of Translational Genetics, VIB-KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Gino Philips
- Center for Cancer Biology, Laboratory of Translational Genetics, VIB-KU Leuven, Leuven, Belgium
| | - Kaat Vandermaesen
- Center for Cancer Biology, Laboratory of Translational Genetics, VIB-KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Ayse Bassez
- Center for Cancer Biology, Laboratory of Translational Genetics, VIB-KU Leuven, Leuven, Belgium
| | - Francesca Lodi
- Center for Cancer Biology, Laboratory of Translational Genetics, VIB-KU Leuven, Leuven, Belgium
| | - Manon T A Vreeburg
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Oscar R Brouwer
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Rogier Schepers
- Center for Cancer Biology, Laboratory of Translational Genetics, VIB-KU Leuven, Leuven, Belgium
| | - Thomas Van Brussel
- Center for Cancer Biology, Laboratory of Translational Genetics, VIB-KU Leuven, Leuven, Belgium
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India; Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Anil V Parwani
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Lien Spans
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | | | - Gerd Jacomen
- Laboratory of Pathological Anatomy, AZ Sint-Maarten, Mechelen, Belgium
| | | | - Diether Lambrechts
- Center for Cancer Biology, Laboratory of Translational Genetics, VIB-KU Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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De Schepper M, Koorman T, Richard F, Christgen M, Vincent-Salomon A, Schnitt SJ, van Diest PJ, Zels G, Mertens F, Maetens M, Vanden Bempt I, Harbeck N, Nitz U, Gräser M, Kümmel S, Gluz O, Weynand B, Floris G, Derksen PW, Desmedt C. Integration of pathological criteria and immunohistochemical evaluation for invasive lobular carcinoma diagnosis: recommendations from the European Lobular Breast Cancer Consortium. Mod Pathol 2024:100497. [PMID: 38641322 DOI: 10.1016/j.modpat.2024.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
Invasive lobular carcinoma (ILC) is the second most frequent type of breast cancer (BC) and its peculiar morphology is mainly driven by inactivation of CDH1, the gene coding for E-cadherin cell adhesion protein. ILC-specific therapeutic and disease-monitoring approaches are gaining momentum in the clinic, increasing the importance of accurate ILC diagnosis. Several essential and desirable morphological diagnostic criteria are currently defined by the World Health Organization, the routine use of immunohistochemistry (IHC) for E-cadherin is not recommended. Disagreement in the diagnosis of ILC has been repeatedly reported, but inter-pathologist agreement increases with the use of E-cadherin IHC. In this study, we aimed to harmonize the pathological diagnosis of ILC by comparing five commonly used E-cadherin antibody clones (NCH-38, EP700Y, Clone 36, NCL-L-E-cad [Clone 36B5], and ECH-6). We determined their biochemical specificity for the E-cadherin protein and IHC staining performance according to type and location of mutation on the CDH1 gene. Western blot analysis on mouse cell lines with conditional E-cadherin expression revealed a reduced specificity of EP700Y and NCL-L-E-cad for E-cadherin, with cross-reactivity of Clone 36 to P-cadherin. The use of IHC improved inter-pathologist agreement both for ILC as well as for lobular carcinoma in situ and atypical lobular hyperplasia. The E-cadherin IHC staining pattern was associated with variant allele frequency and likelihood of non-sense mediated RNA decay but not with the type or position of CDH1 mutations. Based on these results, we make recommendations for the indication for E-cadherin staining, choice of antibodies, and their interpretation in order to standardize ILC diagnosis in current pathology practice.
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Affiliation(s)
- Maxim De Schepper
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium; Department of Pathology, University Hospitals Leuven, UH Leuven, Leuven, Belgium
| | - Thijs Koorman
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - François Richard
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - Anne Vincent-Salomon
- Institut Curie, PSL Research University, Diagnostic and Theranostic Medicine Division, Paris, France
| | - Stuart J Schnitt
- Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gitte Zels
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium; Department of Pathology, University Hospitals Leuven, UH Leuven, Leuven, Belgium
| | - Freya Mertens
- Department of Pathology, University Hospitals Leuven, UH Leuven, Leuven, Belgium
| | - Marion Maetens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - Nadia Harbeck
- West German Study Group, Mönchengladbach, Germany; Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| | - Ulrike Nitz
- West German Study Group, Mönchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany
| | - Monika Gräser
- West German Study Group, Mönchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany; Department of Gynecology, University Medical Center Hamburg, Germany
| | - Sherko Kümmel
- West German Study Group, Mönchengladbach, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany; Clinics Essen-Mitte, Breast Unit, Essen, Germany
| | - Oleg Gluz
- West German Study Group, Mönchengladbach, Germany; Ev. Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany; University Clinics Cologne, Women's Clinic and Breast Center, Cologne, Germany
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, UH Leuven, Leuven, Belgium
| | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, UH Leuven, Leuven, Belgium.
| | - Patrick Wb Derksen
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium.
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Freiberger SN, Ikenberg K, van Egmond D, Claerhout S, van Wezel T, Bempt IV, van Rossem JN, Mueller SA, Clement PM, Poorten VV, Cohen D, Hauben E, Rupp NJ. Molecular analysis using SalvGlandDx improves risk of malignancy estimation and diagnosis of salivary gland cytopathology: An exploratory multicenter study. Cancer Cytopathol 2024. [PMID: 38563876 DOI: 10.1002/cncy.22814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Diagnosis of salivary gland neoplasms is challenging, especially on cytological specimens acquired by fine-needle aspiration. The recently implemented standardized Milan system for reporting salivary gland cytopathology provides an estimated risk of malignancy (ROM); yet, for two of the categories, the diagnosis of the lesion remains unclear. However, a precise diagnosis is desirable for optimal patient management, including planning of surgery and imaging procedures. METHODS Cytological specimens (n = 106) were subjected to molecular analysis using the SalvGlandDx panel. The risk of malignancy was calculated for each detected alteration based on the diagnosis of the resection specimen. By taking into account the molecular alterations, their associated ROM, the clinical and cytological features, and the current literature, the Milan category was evaluated. RESULTS Of n = 63 technically valid cases, 76% revealed a molecular alteration. A total of 94% of these molecularly altered cases could be assigned to a different Milan category when additionally taking molecular results into account. In only 2% of the salivary gland neoplasms of uncertain malignant potential, in which a molecular alteration was detected, the classification remained salivary gland neoplasms of uncertain malignant potential. CONCLUSION Molecular analysis of cytological specimens provides a benefit in classifying salivary gland neoplasms on fine-needle aspiration. It can improve the ROM estimation and thus help to assign cases of formerly unknown malignant potential to clearly benign or malignant categories.
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Affiliation(s)
- Sandra N Freiberger
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Kristian Ikenberg
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Demi van Egmond
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Sofie Claerhout
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jeroen N van Rossem
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Simon A Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul M Clement
- Department of Oncology, Section Experimental Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Esther Hauben
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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5
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Koshyk O, Dehner CA, van den Hout MFCM, Bempt IV, Sciot R, Huang HY, Agaimy A, Din NU, Klubíčková N, Mosaieby E, Skálová A, Michalová K, Schöffski P, Oliveira AM, Halling KC, Gupta S, Gross JM, Nin JWM, Michal M, Folpe AL, Kosemehmetoglu K, Torres-Mora J, Michal M. EWSR1::POU2AF3(COLCA2) Sarcoma: An Aggressive, Polyphenotypic Sarcoma With a Head and Neck Predilection. Mod Pathol 2023; 36:100337. [PMID: 37742928 DOI: 10.1016/j.modpat.2023.100337] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
EWSR1::POU2AF3 (COLCA2) sarcomas are a recently identified group of undifferentiated round/spindle cell neoplasms with a predilection for the head and neck region. Herein, we report our experience with 8 cases, occurring in 5 men and 3 women (age range, 37-74 years; median, 60 years). Tumors involved the head/neck (4 cases), and one each the thigh, thoracic wall, fibula, and lung. Seven patients received multimodal therapy; 1 patient was treated only with surgery. Clinical follow-up (8 patients; range, 4-122 months; median, 32 months) showed 5 patients with metastases (often multifocal, with a latency ranging from 7 to 119 months), and 3 of them also with local recurrence. The median local recurrence-free and metastasis-free survival rates were 24 months and 29 months, respectively. Of the 8 patients, 1 died of an unknown cause, 4 were alive with metastatic disease, 1 was alive with unresectable local disease, and 2 were without disease. The tumors were composed of 2 morphologic subgroups: (1) relatively bland tumors consisting of spindled to stellate cells with varying cellularity and fibromyxoid stroma (2 cases) and (2) overtly malignant tumors composed of nests of "neuroendocrine-appearing" round cells surrounded by spindled cells (6 cases). Individual cases in the second group showed glandular, osteogenic, or rhabdomyoblastic differentiation. Immunohistochemical results included CD56 (4/4 cases), GFAP (5/8), SATB2 (4/6), keratin (AE1/AE3) (5/8), and S100 protein (4/7). RNA sequencing identified EWSR1::POU2AF3 gene fusion in all cases. EWSR1 gene rearrangement was confirmed by fluorescence in situ hybridization in 5 cases. Our findings confirm the head/neck predilection and aggressive clinical behavior of EWSR1::POU2AF3 sarcomas and widen the morphologic spectrum of these rare lesions to include relatively bland spindle cell tumors and tumors with divergent differentiation.
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Affiliation(s)
- Olena Koshyk
- Department of Pathology, Charles University, Faculty of Medicine in Plzeň, Czech Republic; Medical Laboratory CSD, Ltd, Kyiv, Ukraine
| | - Carina A Dehner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mari F C M van den Hout
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Isabelle Vanden Bempt
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Hsuan-Ying Huang
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Nasir Ud Din
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Natálie Klubíčková
- Department of Pathology, Charles University, Faculty of Medicine in Plzeň, Czech Republic; Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Elaheh Mosaieby
- Department of Pathology, Charles University, Faculty of Medicine in Plzeň, Czech Republic; Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Alena Skálová
- Department of Pathology, Charles University, Faculty of Medicine in Plzeň, Czech Republic; Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Květoslava Michalová
- Department of Pathology, Charles University, Faculty of Medicine in Plzeň, Czech Republic; Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Department of Oncology, KU Leuven, Laboratory of Experimental Oncology, Leuven, Belgium
| | - Andre M Oliveira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kevin C Halling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - John M Gross
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Johanna W M Nin
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michal Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzeň, Czech Republic; Bioptical Laboratory, Ltd, Plzeň, Czech Republic
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Jorge Torres-Mora
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Michael Michal
- Department of Pathology, Charles University, Faculty of Medicine in Plzeň, Czech Republic; Bioptical Laboratory, Ltd, Plzeň, Czech Republic.
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Renier R, De Haes P, Bosisio F, Bempt IV, Woei-A-Jin FSH. Vulvar Langerhans cell histiocytosis: Clinicopathologic characteristics, mutational profile, and treatment of 4 patients in a single-center cohort. JAAD Case Rep 2023; 36:78-81. [PMID: 37250013 PMCID: PMC10220460 DOI: 10.1016/j.jdcr.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Ruben Renier
- KU Leuven, Department of Dermatology, Leuven, Belgium
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7
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Vancanneyt J, Wilmsen B, Luyten C, Verslype C, Van Cutsem E, Roskams T, Tejpar S, Vanden Bempt I, Dekervel J. Therapeutic yield of extensive molecular profiling in cholangiocarcinoma: a retrospective single-center study. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04840-w. [PMID: 37184679 DOI: 10.1007/s00432-023-04840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Current available systemic therapies for advanced cholangiocarcinoma (CCA) are of limited effectiveness and prognosis is poor. Recently, introduction of next-generation sequencing (NGS) technologies led to a better understanding of the genetic pathophysiology and, consequently, identification of molecular alterations for targeted treatment. AIM To determine the proportion of actionable alterations using extensive molecular profiling in a routine diagnostic setting and to study the effect of targeted treatment on disease control. METHODS Results of extensive molecular testing by either FoundationOne NGS or an in-house developed 96 cancer gene panel were retrospectively collected from patients with locally advanced or metastatic CCA diagnosed between 01/12/2018 and 01/08/2021 in a single center. Gene variants were classified according to ESCAT and correlated with efficacy endpoints. RESULTS Of 125 patients included, 65 patients had an intrahepatic CCA (iCCA). FGFR2 fusions and IDH1/BAP1 mutations were more frequent in iCCA, while KRAS and SMAD4 mutations were predominant in extrahepatic CCA (eCCA). Targetable alterations (ESCAT tiers I-IV) were identified in 73,6% of patients. Overall survival was significantly better for higher tiers regardless of treatment. Thirteen patients (10.4%) received targeted treatment based on molecular profiling, with a median progression-free survival (PFS) of 7.3 months. CONCLUSIONS Extensive molecular characterization led to the identification of targetable and potentially targetable alterations in a significant proportion of patients with locally advanced or metastatic CCA. We confirmed the association between higher ESCAT tier and benefit of a targeted treatment. Molecular analysis should therefore be considered in all patients fit enough for systemic treatment.
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Affiliation(s)
- Justine Vancanneyt
- Department of Gastroenterology, University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium.
| | - Bie Wilmsen
- Department of Digestive Oncology, University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Caroline Luyten
- Department of Digestive Oncology, University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Chris Verslype
- Department of Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Eric Van Cutsem
- Department of Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Tania Roskams
- Department of Pathology, University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Sabine Tejpar
- Department of Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Isabelle Vanden Bempt
- Department of Human Genetics, University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Jeroen Dekervel
- Department of Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
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8
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Mennens F, Van Herck Y, Sciot R, Vanden Bempt I, Boecxstaens V, Garmyn M, Bechter O. Melanoma cell plasticity poses diagnostic challenges: a case series. Melanoma Res 2022; 32:428-439. [PMID: 36125893 DOI: 10.1097/cmr.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Phenotype switching is an emerging concept in melanoma research and deals with the cancer cell plasticity. In this paper, we present five cases of patients with metastatic malignant melanoma where the tumor underwent dramatic morphological and immunohistochemical changes thereby mimicking other types of malignancies. The diagnosis of melanoma in all these cases was based on the mutational profile of the tumor assessed by next-generation sequencing compared to the primary lesion or local regional lymph nodes. These cases highlight the importance of thorough diagnostic measures in patients with metastatic melanoma who show progressive disease and where basic pathological assessment shows a diagnostic discrepancy.
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Affiliation(s)
| | | | | | | | | | - Maria Garmyn
- Dermatology, University Hospitals Leuven, Leuven, Belgium
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9
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Decraene B, Antoranz A, Verbeke T, Vanmechelen M, Nazari P, Solie L, Dubroja N, Derweduwe M, Spans L, Bempt IV, Sciot R, De Smet F, De Vleeschouwer S. TMIC-37. SINGLE-CELL CHARACTERIZATION OF THE IMMUNE LANDSCAPE OF EXTREME LONG-TERM SURVIVORS WITH MALIGNANT GLIOMA. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Glioblastoma Multiforme (GBM) remains the most common malignant primary brain tumor with a dismal prognosis that rarely exceeds beyond two years despite extensive therapy, which consists of maximal safe surgical resection, radiotherapy and/or chemotherapy. Recently, it has become clear that GBM is not one homogeneous entity and that both intra-and intertumoral heterogeneity contribute significantly to differences in tumoral behavior which may consequently be responsible for differences in survival. Strikingly and despite its dismal prognosis, small fractions of GBM patients seem to display extreme extended survival compared to the large majority of patients. The underlying mechanisms for this peculiarity remain largely unknown however, even though emerging data suggest that both cancer cell-autonomous and microenvironmental factors and their interplay probably play an important role. We used high-dimensional, multiplexed immunohistochemistry to spatially, and cytometry by time-of-flight to quantitively, characterize the cell constitution and interactions within the tumor microenvironment (TME) in 21 extreme long-term survivors (living over 10 year) and 42 deeply matched controls and therefore short-term survivors (living under 1.5 year) on a single cell level. For all tumors (epi)genetic data was also collected. We identified a high level of both inter-and intrapatient heterogeneity defined by several distinct tumoral niches, as well as described interactions within these niches and with the surrounding infiltrating immune cells of the TME in GBM. Finally, by linking patient characteristics with the heterogeneous immune composition we are able to create an immune stratification that can be linked to patient survival in GBM. Therefore, this study is an essential initial step towards strategies to alter the TME in a favorable way with a personalized modulation strategy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Raf Sciot
- University Hospitals Leuven & KU Leuven , Leuven , USA
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10
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Elst L, Van Rompuy AS, Roussel E, Spans L, Vanden Bempt I, Necchi A, Ross J, Jacob JM, Baietti MF, Leucci E, Albersen M. Establishment and Characterization of Advanced Penile Cancer Patient-derived Tumor Xenografts: Paving the Way for Personalized Treatments. Eur Urol Focus 2022; 8:1787-1794. [PMID: 35537937 DOI: 10.1016/j.euf.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Systemic treatments for penile squamous cell carcinoma (pSCC) are toxic and inefficient. Patient-based preclinical models are essential to study novel treatments. OBJECTIVE To establish a library of patient-derived tumor xenograft (PDX) models of human papillomavirus-positive (HPV+) and -negative (HPV-) pSCC and characterize these at the genomic and histological levels. DESIGN, SETTING, AND PARTICIPANTS Eighteen tumor samples from 14 patients with recurrent or metastatic pSCC were implanted in nude mice. A biobank of PDX tumors was established after passaging of patient samples (F0) for three generations (F1, F2, F3) and was characterized using histopathology and targeted next-generation sequencing (tNGS). Single-nucleotide polymorphism fingerprinting was used to confirm PDX genealogy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The engraftment rate, overall growth rate, and pSCC histomorphology were checked for each PDX generation. Staining for p40 (a pSCC marker) and p16 (a surrogate for HPV infection) was performed for F0 samples. The mutational profile according to a validated panel of 96 cancer genes was determined for F0 and F3 samples and compared to a larger tNGS database. RESULTS AND LIMITATIONS Including a previously established pilot model, 11 out of 18 tumor samples (61%) successfully engrafted in F1. The mean time from implantation in F1 to completion of F3 was 36 wk (standard deviation 18). Histological fidelity was demonstrated across generations. The patient mutational profiles were preserved in F3 and were representative of 277 pSCC samples in the Foundation Medicine database. The rapid progression of pSCC in patients from our selected high-risk cohort impeded the use of PDXs as avatars. CONCLUSIONS We successfully established the first library of 11 PDX models of HPV- and HPV+ pSCC. Our PDX models showed high engraftment rates and histological and genomic fidelity to the tumor tissue of origin. These models may help in paving the way towards the development of novel treatments. PATIENT SUMMARY We established 11 animal models based on tumor tissue from patients with penile cancer. These models could play a vital role in selection of novel treatments according to genetic mutations. In the future, therapies with confirmed preclinical effects may have a profound impact on the development of personalized treatments in penile cancer.
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Affiliation(s)
- Laura Elst
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Eduard Roussel
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lien Spans
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | | | - Andrea Necchi
- San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jeffrey Ross
- Foundation Medicine, Cambridge, MA, USA; Upstate Medical University, Syracuse, NY, USA
| | | | - Maria-Francesca Baietti
- Trace, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Laboratory of RNA Cancer Biology, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Eleonora Leucci
- Trace, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Laboratory of RNA Cancer Biology, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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11
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Messiaen J, Antoranz A, Van Herck Y, Verhaaren B, Nazari P, Sebastian I, Milli G, Bosisio F, Pey J, Bempt IV, Sciot R, Jacobs S, De Smet F. HGG-56. Spatial mapping of the tumor micro-environment in pediatric glioma. Neuro Oncol 2022. [PMCID: PMC9165297 DOI: 10.1093/neuonc/noac079.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
High-grade glioma are the main cause of cancer-related death in children. The highly heterogeneous composition of the tumor cells and their interactions with the tumor micro-environment (TME), contribute substantially to the poor response to treatment and the high levels of morbidity and mortality. Here, we used high-dimensional, multiplexed immunohistochemistry to map the single-cell tissue architecture of 26 pediatric glioma samples covering 8 histologic diagnoses, allowing us to determine the spatial distribution of the various tumoral subtypes and how these interact with their local immune-microenvironment. Overall, this analysis showed that tumor grade anti-correlated with the amount of infiltrating cytotoxic T-lymphocytes (CTLs), which were typically more exhausted in the higher grade tumors. In addition, tumor associated macrophages were primarily infiltrating from the blood and presented an M2-like anti-inflammatory phenotype which became more extended with tumor grade. Using the spatial information, possible cell-cell interactions could be determined. In lower grade glioma, we observed an increased activation level of CTLs that were closely located to neighboring T-helper cells. In pediatric glioblastoma, on the other hand, CTLs, even though they were located close to a T-helper cell, could only minimally be activated, and showed more extended exhaustion when residing further away. Additionally, the activation of the CTLs was associated to the distance to the closest PD-L1 positive macrophage in pilocytic astrocytoma and desmoplastic infantile ganglioglioma. In conclusion, with the use of multiplex immunohistochemistry, we are able to study the tumor and TME of pediatric glioma in depth on a single-cell and spatial level, which allows us to further study the heterogeneous landscape of these tumors.
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Affiliation(s)
- Julie Messiaen
- Department of Pediatrics, University Hospitals Leuven , Leuven , Belgium
- Laboratory for Precision Cancer Medicine, Translational cell- and tissue research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Asier Antoranz
- Laboratory for Precision Cancer Medicine, Translational cell- and tissue research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Yannick Van Herck
- Department of Oncology, University Hospitals Leuven , Leuven , Belgium
- Department of Oncology, KU Leuven , Leuven , Belgium
| | - Ben Verhaaren
- Department of Radiology, University Hospitals Leuven , Leuven , Belgium
| | - Pouya Nazari
- Laboratory for Precision Cancer Medicine, Translational cell- and tissue research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Ivey Sebastian
- Laboratory for Precision Cancer Medicine, Translational cell- and tissue research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Giorgia Milli
- Translational cell- and tissue research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Francesca Bosisio
- Translational cell- and tissue research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
- Department of Pathology, University Hospitals Leuven , Leuven , Belgium
| | - Jon Pey
- Laboratory for Precision Cancer Medicine, Translational cell- and tissue research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Isabelle Vanden Bempt
- Department of Human Genetics, University Hospitals Leuven , Leuven , Belgium
- Department of Human Genetics, KU Leuven , Leuven , Belgium
| | - Raf Sciot
- Translational cell- and tissue research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
- Department of Pathology, University Hospitals Leuven , Leuven , Belgium
| | - Sandra Jacobs
- Department of Pediatric Hematology-Oncology, Department of Pediatrics, University Hospitals Leuven , Leuven , Belgium
- Department of Pediatric Oncology, KU Leuven , Leuven , Belgium
| | - Frederik De Smet
- Laboratory for Precision Cancer Medicine, Translational cell- and tissue research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
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12
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Messiaen J, Claeys A, Shetty A, Spans L, Derweduwe M, Uyttebroeck A, Depreitere B, Bempt IV, Sciot R, Ligon K, Jones D, Jacobs S, De Smet F. OTHR-39. Extraneural spreading of a diffuse leptomeningeal glioneuronal tumor in a child: patient-derived models show sensitivity to vinblastin and trametinib. Neuro Oncol 2022. [PMCID: PMC9164998 DOI: 10.1093/neuonc/noac079.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Diffuse leptomeningeal glioneuronal tumors (DLGNT) are rare neoplasms of the central nervous system. We describe the generation of patient-derived models from a DLGNT that metastasized to the peritoneal cavity via a ventriculoperitoneal shunt in a child. The original tumor contained a KIAA1549:BRAF fusion with a chromosome 1p deletion and corresponded with methylation subclass DLGNT-MC-2 From a sample of ascitic fluid, metastatic tumoral cells could be extracted and expanded ex vivo into a long-term cell culture model. This patient-derived cell line (PDCL) showed mixed morphological phenotypes and expressed MAP2 and SYP. The KIAA1549:BRAF fusion was preserved and the PDCL still corresponded to the original methylation subclass DLGNT-MC-2. Whole-genome sequencing showed additional mutations potentially contributing to the malignant behavior of the tumor. Cytotoxic assays performed on the PDCL indicated high sensitivity to vinblastine and trametinib (MEK-inhibitor) and intermediate sensitivity to DRD/ClpP-modulators. The PDCL underwent viral transduction to induce GFP-fLux positivity and was intraperitoneally injected into immunocompromised mice. A mouse model could be generated, with the growth of a peritoneal tumor in a localized manner. The cells grown from the mouse tumor were again put into culture and were afterwards subjected to the same treatments as the PDCL. This confirmed a similar profile, with high sensitivity to vinblastin and trametinib and an intermediate sensitivity to the DRD/ClpP-modulators. In conclusion, we were able to generate patient-derived models from a metastatic DLGNT, which recapitulate the molecular characteristics of the original tumor. The models showed high sensitivity to vinblastin and targeted therapy with MEK-inhibition, but further studies are necessary to define the adequate treatment for this kind of tumor.
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Affiliation(s)
- Julie Messiaen
- Department of Pediatrics, University Hospitals Leuven , Leuven , Belgium
- Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Annelies Claeys
- Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Aniket Shetty
- Center for Patient Derived Models, Dana-Farber Cancer Institute , Boston, MA , USA
| | - Lien Spans
- Department of Human Genetics, University Hospitals Leuven , Leuven , Belgium
| | - Marleen Derweduwe
- Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
| | - Anne Uyttebroeck
- Department of Pediatric Oncology, KU Leuven , Leuven , Belgium
- Department of Pediatric Hematology-Oncology, Department of Pediatrics, University Hospitals Leuven , Leuven , Belgium
| | - Bart Depreitere
- Research Group Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven , Leuven , Belgium
- Department of Neurosurgery, University Hospitals Leuven , Leuven , Belgium
| | - Isabelle Vanden Bempt
- Department of Human Genetics, KU Leuven , Leuven , Belgium
- Department of Human Genetics, University Hospitals Leuven , Leuven , Belgium
| | - Raf Sciot
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
- Department of Pathology, University Hospitals Leuven , Leuven , Belgium
| | - Keith Ligon
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School , Boston, MA , USA
- Center for Patient Derived Models, Dana-Farber Cancer Institute , Boston, MA , USA
| | - David Jones
- Hopp Children′s Cancer Center at the NCT Heidelberg (KiTZ) , Heidelberg , Germany
- Division of Pediatric Neuro-oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Sandra Jacobs
- Department of Pediatric Oncology, KU Leuven , Leuven , Belgium
- Department of Pediatric Hematology-Oncology, Department of Pediatrics, University Hospitals Leuven , Leuven , Belgium
| | - Frederik De Smet
- Laboratory for Precision Cancer Medicine, Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven , Leuven , Belgium
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13
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Claerhout S, Lehnert S, Borght SV, Spans L, Dooms C, Wauters E, Vansteenkiste J, Weynand B, Deraedt K, Bourgain C, Bempt IV. Targeted RNA sequencing for upfront analysis of actionable driver alterations in non-small cell lung cancer. Lung Cancer 2022; 166:242-249. [DOI: 10.1016/j.lungcan.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 10/19/2022]
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14
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Bos S, Daniëls L, Michaux L, Vanden Bempt I, Vermeer S, Woei-A-Jin FSH, Schöffski P, Weynand B, Sciot R, Declercq S, Ceulemans LJ, Godinas L, Verleden GM, Van Raemdonck DE, Dupont LJ, Vos R. Case Report: An Unusual Course of Angiosarcoma After Lung Transplantation. Front Immunol 2022; 12:789851. [PMID: 35046948 PMCID: PMC8761760 DOI: 10.3389/fimmu.2021.789851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
A 35-year-old woman underwent bilateral lung transplantation for primary ciliary dyskinesia and developed vascular tumors over a slow time course. Initial presentation of non-specific vascular tumors in the lungs and liver for up to 6 years after transplantation evolved toward bilateral ovarian angiosarcoma. Tumor analysis by haplotyping and human leukocyte antigen typing showed mixed donor chimerism, proving donor origin of the tumoral lesions. In retrospect, the donor became brain dead following neurosurgical complications for a previously biopsy-proven cerebral hemangioma, which is believed to have been a precursor lesion of the vascular malignancy in the recipient. Donor-transmitted tumors should always be suspected in solid organ transplant recipients in case of uncommon disease course or histology, and proper tissue-based diagnosis using sensitive techniques should be pursued.
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Affiliation(s)
- Saskia Bos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Liesbeth Daniëls
- Histocompatibility and Immunogenetics Laboratory (HILA), Red Cross-Flanders, Mechelen, Belgium
| | - Lucienne Michaux
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | | | - Sascha Vermeer
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Fj Sherida H Woei-A-Jin
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Sabine Declercq
- Department of Pathology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Laurent Godinas
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Dirk E Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Lieven J Dupont
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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15
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Messiaen J, Nasari P, Van Herck Y, Verhaaren B, Sebastian I, Milli G, Bosisio F, Pey J, De Vleeschouwer S, De Vloo P, Depreitere B, Vanden Bempt I, Sciot R, Antoranz A, Jacobs S, De Smet F. PATH-21. THE SINGLE-CELL PATHOLOGY LANDSCAPE OF PEDIATRIC GLIOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
High-grade glioma are the main cause of cancer-related death in children. Despite extensive research, their prognosis remains poor with very few treatment options. This can be attributed to the highly heterogeneous and plastic nature of glioma tumor cells and their interactions with the microenvironment, although quantitative data are still largely missing. Here, we used high-dimensional, multiplexed immunohistochemistry to map the spatial, single-cell tissue architecture of 31 pediatric glioma samples covering 9 histologic diagnoses. This novel approach allowed us to map the spatial distribution of the various tumoral subtypes, which typically occur in specific tumoral niches, and how these interact with their local immune-microenvironment. Finally, by aligning these findings to the clinical data of the patients and comparing these to adult glioblastoma, we are now able to more precisely describe the heterogeneous landscape of pediatric glioma at single-cell resolution.
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16
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Hoogstrate Y, Ghisai SA, de Wit M, de Heer I, Draaisma K, van Riet J, van de Werken HJG, Bours V, Buter J, Vanden Bempt I, Eoli M, Franceschi E, Frenel JS, Gorlia T, Hanse MC, Hoeben A, Kerkhof M, Kros JM, Leenstra S, Lombardi G, Lukacova S, Robe PA, Sepulveda JM, Taal W, Taphoorn M, Vernhout RM, Walenkamp AME, Watts C, Weller M, de Vos FYF, Jenster GW, van den Bent M, French PJ. The EGFRvIII transcriptome in glioblastoma, a meta-omics analysis. Neuro Oncol 2021; 24:429-441. [PMID: 34608482 PMCID: PMC8917407 DOI: 10.1093/neuonc/noab231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background EGFR is among the genes most frequently altered in glioblastoma, with exons 2-7 deletions (EGFRvIII) being among its most common genomic mutations. There are conflicting reports about its prognostic role and it remains unclear whether and how it differs in signaling compared with wildtype EGFR. Methods To better understand the oncogenic role of EGFRvIII, we leveraged 4 large datasets into 1 large glioblastoma transcriptome dataset (n = 741) alongside 81 whole-genome samples from 2 datasets. Results The EGFRvIII/EGFR expression ratios differ strongly between tumors and range from 1% to 95%. Interestingly, the slope of relative EGFRvIII expression is near-linear, which argues against a more positive selection pressure than EGFR wildtype. An absence of selection pressure is also suggested by the similar survival between EGFRvIII-positive and -negative glioblastoma patients. EGFRvIII levels are inversely correlated with pan-EGFR (all wildtype and mutant variants) expression, which indicates that EGFRvIII has a higher potency in downstream pathway activation. EGFRvIII-positive glioblastomas have a lower CDK4 or MDM2 amplification incidence than EGFRvIII-negative (P = .007), which may point toward crosstalk between these pathways. EGFRvIII-expressing tumors have an upregulation of “classical” subtype genes compared to those with EGFR-amplification only (P = 3.873e−6). Genomic breakpoints of the EGFRvIII deletions have a preference toward the 3′-end of the large intron-1. These preferred breakpoints preserve a cryptic exon resulting in a novel EGFRvIII variant and preserve an intronic enhancer. Conclusions These data provide deeper insights into the complex EGFRvIII biology and provide new insights for targeting EGFRvIII mutated tumors.
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Affiliation(s)
- Youri Hoogstrate
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
- Cancer Computational Biology Center, Erasmus MC, Rotterdam, The Netherlands
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
- Corresponding Author: Youri Hoogstrate, PhD, Department of Neurology, Erasmus MC, PO Box 2040, 3000CA Rotterdam, the Netherlands ()
| | | | - Maurice de Wit
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Iris de Heer
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Kaspar Draaisma
- Department of Neurosurgery, UMC Utrecht, Utrecht, The Netherlands
| | - Job van Riet
- Cancer Computational Biology Center, Erasmus MC, Rotterdam, The Netherlands
| | - Harmen J G van de Werken
- Cancer Computational Biology Center, Erasmus MC, Rotterdam, The Netherlands
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Vincent Bours
- Department of Human Genetics, Université de Liège, Liège, Belgium
| | - Jan Buter
- Department of Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Marica Eoli
- Unit of Molecular Neuro-Oncology, Besta-IRCCS, Milan, Italy
| | - Enrico Franceschi
- IRCCS Istituto Scienze Neurologiche di Bologna, Nervous System Medical Oncology Department, Bologna, Italy
| | | | | | - Monique C Hanse
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Ann Hoeben
- Department of Medical Oncology, Maastricht UMC+, Maastricht, The Netherlands
| | - Melissa Kerkhof
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan M Kros
- Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
| | - Sieger Leenstra
- Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands
| | | | - Slávka Lukacova
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Pierre A Robe
- Department of Neurosurgery, UMC Utrecht, Utrecht, The Netherlands
| | | | - Walter Taal
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Martin Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - René M Vernhout
- Department of Radiotherapy, Erasmus MC, Rotterdam, The Netherlands
| | | | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Filip Y F de Vos
- Department of Medical Oncology, UMC Utrecht, Utrecht, The Netherlands
| | - Guido W Jenster
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Pim J French
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
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17
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Marin-Bejar O, Rogiers A, Dewaele M, Femel J, Karras P, Pozniak J, Bervoets G, Van Raemdonck N, Pedri D, Swings T, Demeulemeester J, Borght SV, Lehnert S, Bosisio F, van den Oord JJ, Bempt IV, Lambrechts D, Voet T, Bechter O, Rizos H, Levesque MP, Leucci E, Lund AW, Rambow F, Marine JC. Evolutionary predictability of genetic versus nongenetic resistance to anticancer drugs in melanoma. Cancer Cell 2021; 39:1135-1149.e8. [PMID: 34143978 DOI: 10.1016/j.ccell.2021.05.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/17/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
Therapy resistance arises from heterogeneous drug-tolerant persister cells or minimal residual disease (MRD) through genetic and nongenetic mechanisms. A key question is whether specific molecular features of the MRD ecosystem determine which of these two distinct trajectories will eventually prevail. We show that, in melanoma exposed to mitogen-activated protein kinase therapeutics, emergence of a transient neural crest stem cell (NCSC) population in MRD concurs with the development of nongenetic resistance. This increase relies on a glial cell line-derived neurotrophic factor-dependent signaling cascade, which activates the AKT survival pathway in a focal adhesion kinase (FAK)-dependent manner. Ablation of the NCSC population through FAK inhibition delays relapse in patient-derived tumor xenografts. Strikingly, all tumors that ultimately escape this treatment exhibit resistance-conferring genetic alterations and increased sensitivity to extracellular signal-regulated kinase inhibition. These findings identify an approach that abrogates the nongenetic resistance trajectory in melanoma and demonstrate that the cellular composition of MRD deterministically imposes distinct drug resistance evolutionary paths.
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Affiliation(s)
- Oskar Marin-Bejar
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Aljosja Rogiers
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Michael Dewaele
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Julia Femel
- Ronald O. Perelman Department of Dermatology and Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Panagiotis Karras
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Joanna Pozniak
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Greet Bervoets
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Nina Van Raemdonck
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Dennis Pedri
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Toon Swings
- VIB Technology Watch, Technology Innovation Lab, VIB, Leuven, Belgium
| | - Jonas Demeulemeester
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven, Belgium; Cancer Genomic Laboratory, The Francis Crick Institute, London, UK
| | | | | | - Francesca Bosisio
- Laboratory of Translational Cell and Tissue Research, Department of Pathology, KU Leuven and UZ Leuven, Leuven, Belgium
| | - Joost J van den Oord
- Laboratory of Translational Cell and Tissue Research, Department of Pathology, KU Leuven and UZ Leuven, Leuven, Belgium
| | | | - Diether Lambrechts
- Laboratory of Translational Genetics, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory of Translational Genetics, Center for Human Genetics, KU Leuven, Belgium
| | - Thierry Voet
- Laboratory of Reproductive Genomics, Department of Human Genetics, KU Leuven, Leuven, Belgium; KU Leuven Institute for Single Cell Omics, LISCO, KU Leuven, Leuven, Belgium
| | - Oliver Bechter
- Department of General Medical Oncology UZ Leuven, Belgium
| | - Helen Rizos
- Macquarie University, Sydney, NSW, Australia; Melanoma Institute Australia, Sydney, NSW, Australia
| | - Mitchell P Levesque
- Department of Dermatology, University of Zürich Hospital, University of Zürich, Zürich, Switzerland
| | - Eleonora Leucci
- Laboratory for RNA Cancer Biology, Department of Oncology, LKI, KU Leuven, Leuven, Belgium; Trace PDX Platform, Department of Oncology, LKI, KU Leuven, Leuven, Belgium
| | - Amanda W Lund
- Ronald O. Perelman Department of Dermatology and Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Florian Rambow
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium.
| | - Jean-Christophe Marine
- Laboratory for Molecular Cancer Biology, Center for Cancer Biology, VIB, Leuven, Belgium; Laboratory for Molecular Cancer Biology, Department of Oncology, KU Leuven, Leuven, Belgium.
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Victoor J, Borght SV, Spans L, Lehnert S, Brems H, Laenen A, Vergote I, Van Gorp T, Van Nieuwenhuysen E, Han S, Timmerman S, Van Rompuy AS, Vanden Bempt I. Comprehensive immunomolecular profiling of endometrial carcinoma: A tertiary retrospective study. Gynecol Oncol 2021; 162:694-701. [PMID: 34253388 DOI: 10.1016/j.ygyno.2021.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Combined immunohistochemical and molecular classification using the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) independently predicts prognosis in endometrial carcinoma (EC). As next-generation sequencing (NGS) is entering clinical practice, we evaluated whether more comprehensive immunomolecular profiling (CIMP), including NGS and extended immunohistochemical analysis, could further refine the current ProMisE classification. METHODS A series of 120 consecutive ECs, classified according to ProMisE, was stained immunohistochemically for CD3, CD8, PD-L1, beta-catenin and L1CAM. An in-house 96 gene NGS panel was performed on a subset of 44 ECs, representing the 4 ProMisE subgroups (DNA polymerase epsilon catalytic subunit exonuclease domain mutated (POLEmut), mismatch repair deficient (MMRd), p53 abnormal (p53 abn) and no specific molecular profile (NSMP) ECs). Cases harboring non-hotspot POLE variants were analyzed with Illumina TruSight Oncology 500 NGS panel (TSO500) as a surrogate for whole-exome sequencing. RESULTS Eight cases harbored POLE variants, half of which were hotspots. Using TSO500, non-hotspot POLE variants were classified as pathogenic (3) or variant of unknown significance (1). POLEmut and MMRd ECs typically showed higher numbers of CD3+/CD8+ tumor-infiltrating lymphocytes and higher PD-L1 expression in tumor-infiltrating immune cells. p53 abn ECs showed significantly higher L1CAM immunoreactivity and frequently harbored gene amplifications including HER2 (25%), but typically lacked ARID1A or PTEN variants. Beta-catenin-positivity and FGFR2 variants were predominantly found in NSMP ECs. CONCLUSIONS Our data show that CIMP adds significant value to EC characterization and may help to determine pathogenicity of non-hotspot POLE variants, encountered more frequently than expected in our series. In addition, CIMP may reveal ECs benefitting from immune checkpoint inhibition and allows upfront identification of targetable alterations, such as HER2 amplification in p53 abn ECs.
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Affiliation(s)
- Jasper Victoor
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Sara Vander Borght
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Lien Spans
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Lehnert
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Brems
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- KU Leuven, Biostatistics and Statistical Bioinformatics Centre, Leuven, Belgium
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Division of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Toon Van Gorp
- Department of Gynecology and Obstetrics, Division of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Els Van Nieuwenhuysen
- Department of Gynecology and Obstetrics, Division of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sileny Han
- Department of Gynecology and Obstetrics, Division of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Timmerman
- Department of Gynecology and Obstetrics, Division of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Anne-Sophie Van Rompuy
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Translational Cell & Tissue Research, Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium.
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19
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Lenaerts L, Brison N, Maggen C, Vancoillie L, Che H, Vandenberghe P, Dierickx D, Michaux L, Dewaele B, Neven P, Floris G, Tousseyn T, Lannoo L, Jatsenko T, Bempt IV, Van Calsteren K, Vandecaveye V, Dehaspe L, Devriendt K, Legius E, Bogaert KVD, Vermeesch JR, Amant F. Comprehensive genome-wide analysis of routine non-invasive test data allows cancer prediction: A single-center retrospective analysis of over 85,000 pregnancies. EClinicalMedicine 2021; 35:100856. [PMID: 34036251 PMCID: PMC8138727 DOI: 10.1016/j.eclinm.2021.100856] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Implausible false positive results in non-invasive prenatal testing (NIPT) have been occasionally associated with the detection of occult maternal malignancies. Hence, there is a need for approaches allowing accurate prediction of whether the NIPT result is pointing to an underlying malignancy, as well as for organized programs ensuring efficient downstream clinical management of these cases. METHODS Using a data set of 88,294 NIPT performed at University Hospital Leuven (Belgium) between November 2013 and March 2020, we retrospectively evaluated the positive predictive value (PPV) of our NIPT approach for cancer detection. In this approach, whole-genome cell-free DNA (cfDNA) data from NIPT were scrutinized for the presence of (sub)chromosomal copy number alterations (CNAs) predictive for a malignancy, using an unbiased NIPT analysis pipeline coined GIPSeq. For suspected cases, the presence of a maternal cancer was evaluated via subsequent multidisciplinary clinical follow-up examinations. The cancer-specificity of the identified CNAs in cfDNA was assessed through genetic analyses of a tumor biopsy. FINDINGS Fifteen women without a cancer history were identified with a GIPSeq result suggestive of a malignant process. Their cfDNA profiles showed either genome-wide aberrations or a single trisomy 8. Upon clinical examinations, a solid or hematological cancer was identified in 4 and 7 cases, respectively. Three women were identified as having a clonal mosaicism. For one case no underlying condition was found. These numbers add to a PPV of 73%. Based on this experience, we presented a multidisciplinary care path for efficient clinical management of these cases. INTERPRETATION The presented approach for analysing NIPT results has a high PPV, yet unknown sensitivity, for detecting asymptomatic malignancies upon routine NIPT. Given the complexity of diagnosing a pregnant woman with cancer, clinical follow-up should occur in a well-designed multidisciplinary setting, such as via the care model that we presented here. FUNDING This work was supported by Research Foundation Flanders and KU Leuven funding.
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Affiliation(s)
| | - Nathalie Brison
- Center for Human Genetics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Charlotte Maggen
- Department of Oncology, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Leen Vancoillie
- Center for Human Genetics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Huiwen Che
- Department of Human Genetics, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Peter Vandenberghe
- Department of Human Genetics, KU Leuven, Herestraat 49, Leuven, Belgium
- Hematology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Daan Dierickx
- Department of Oncology, KU Leuven, Herestraat 49, Leuven, Belgium
- Hematology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Lucienne Michaux
- Center for Human Genetics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Barbara Dewaele
- Center for Human Genetics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Patrick Neven
- Department of Oncology, KU Leuven, Herestraat 49, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Giuseppe Floris
- Pathology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Imaging & Pathology, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Thomas Tousseyn
- Pathology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Imaging & Pathology, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Lore Lannoo
- Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Department of Development and Regeneration, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Tatjana Jatsenko
- Department of Human Genetics, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Isabelle Vanden Bempt
- Center for Human Genetics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Kristel Van Calsteren
- Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Department of Development and Regeneration, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Vincent Vandecaveye
- Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Imaging & Pathology, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Luc Dehaspe
- Genomics Core facility, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Koenraad Devriendt
- Center for Human Genetics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Eric Legius
- Center for Human Genetics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Kris Van Den Bogaert
- Center for Human Genetics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Joris Robert Vermeesch
- Center for Human Genetics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Herestraat 49, Leuven, Belgium
- Genomics Core facility, KU Leuven, Herestraat 49, Leuven, Belgium
- Corresponding authors.
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Herestraat 49, Leuven, Belgium
- Gynaecology and Obstetrics, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
- Academic Medical Centers Amsterdam-University of Amsterdam and The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
- Corresponding authors.
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20
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Schöffski P, Vander Borght S, Vanden Bempt I, Jentjens S, Vandecaveye V, Sciot R, De Hertogh G, Christiaens M, Wolthuis A. Curative, Organ-Sparing, Multimodal, Perioperative Treatment of a Young Patient with a Rectoanal Inflammatory Myofibroblastic Tumor. Oncol Res Treat 2021; 44:269-275. [PMID: 33895750 DOI: 10.1159/000515710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We report the case of a young female patient with a technically resectable, nonmetastatic, rectoanal, anaplastic lymphoma kinase gene (ALK)-translocated inflammatory myofibroblastic tumor (IMFT). CASE PRESENTATION The patient was successfully treated preoperatively with the tyrosine kinase inhibitor (TKI) crizotinib, to downsize the primary tumor, followed by sphincter-sparing surgery, and adjuvant radiotherapy and crizotinib. She is now in follow-up with good sphincter function and with no evidence of active disease. CONCLUSION Pre- and postoperative treatment administration of crizotinib can be given with curative intent to patients with locally advanced, nonmetastatic IMFTs to avoid mutilating surgery.
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Affiliation(s)
- Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Sara Vander Borght
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium.,Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | | | - Sander Jentjens
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Melissa Christiaens
- Department of Radiotherapy/Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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21
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Vanden Bempt I, Vander Borght S, Sciot R, Spans L, Claerhout S, Brems H, Lehnert S, Dehaspe L, Fransis S, Neuville B, Topal B, Schöffski P, Legius E, Debiec-Rychter M. Comprehensive targeted next-generation sequencing approach in the molecular diagnosis of gastrointestinal stromal tumor. Genes Chromosomes Cancer 2020; 60:239-249. [PMID: 33258138 DOI: 10.1002/gcc.22923] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 12/26/2022] Open
Abstract
Mutational analysis guides therapeutic decision making in patients with advanced-stage gastrointestinal stromal tumors (GISTs). We evaluated three targeted next-generation sequencing (NGS) assays, consecutively used over 4 years in our laboratory for mutational analysis of 162 primary GISTs: Agilent GIST MASTR, Illumina TruSight 26 and an in-house developed 96 gene panels. In addition, we investigated the feasibility of a more comprehensive approach by adding targeted RNA sequencing (Archer FusionPlex, 11 genes) in an attempt to reduce the number of Wild Type GISTs. We found KIT or PDGFRA mutations in 149 out of 162 GISTs (92.0%). Challenging KIT exon 11 alterations were initially missed by different assays in seven GISTs and typically represented deletions at the KIT intron 10-exon 11 boundary or large insertions/deletions (>24 base pairs). Comprehensive analysis led to the additional identification of driver alterations in 8/162 GISTs (4.9%): apart from BRAF and SDHA mutations (one case each), we found five GISTs harboring somatic neurofibromatosis type 1 (NF1) alterations (3.1%) and one case with an in-frame TRIM4-BRAF fusion not reported in GIST before. Eventually, no driver alteration was found in two out of 162 GISTs (1.2%) and three samples (1.9%) failed analysis. Our study shows that a comprehensive targeted NGS approach is feasible for routine mutational analysis of GIST, thereby substantially reducing the number of Wild Type GISTs, and highlights the need to optimize assays for challenging KIT exon 11 alterations.
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Affiliation(s)
- Isabelle Vanden Bempt
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Sara Vander Borght
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Lien Spans
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Sofie Claerhout
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Hilde Brems
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Stefan Lehnert
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Luc Dehaspe
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Sabine Fransis
- Department of Pathology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Bart Neuville
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Baki Topal
- Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, and Department of Oncology, KU Leuven, Laboratory of Experimental Oncology, Leuven, Belgium.,Department of Oncology, KU Leuven, Laboratory of Experimental Oncology, Leuven, Belgium
| | - Eric Legius
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Maria Debiec-Rychter
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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22
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Messiaen J, Uyttebroeck A, Depreitere B, Bempt IV, Sciot R, Jacobs SA. RARE-56. PERITONEAL SEEDING OF A DIFFUSE LEPTOMENINGEAL GLIONEURONAL TUMOR IN A CHILD. Neuro Oncol 2020. [PMCID: PMC7715907 DOI: 10.1093/neuonc/noaa222.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Diffuse leptomeningeal glioneuronal tumors (DLGNT) are rare neoplasms of the central nervous system and have been included in the 2016 update of the WHO classification. This is the first description of a DLGNT disseminating to the peritoneal cavity via a ventriculoperitoneal shunt (VPS) in a child. We describe an 11-year old girl who received a VPS for a Dandy-Walker malformation at the age of seven, and was diagnosed with a spinal pilocytic astrocytoma with leptomeningeal metastases six months later. She received chemotherapy (SIOP-LGG protocol) with partial response, and had progressive disease eight months after therapy cessation. Following a novel biopsy, the diagnosis was revised to a DLGNT, with a KIAA1549-BRAF fusion and loss of 1p. She received vinblastine, but was clinically progressive and craniospinal radiotherapy was initiated. 13 months later, she suddenly presented with ascites. The inferior vena cava was compressed due to the ascites, and an abdominal drain was placed, with massive fluid release. Abdominal MRI indicated an omental cake and peritoneal contrast enhancement. Bone metastases were suspected in the iliac and femoral bones. Anatomopathological examination of the ascites showed an atypical cell population, with irregular, hyperchromatic and enlarged nuclei resembling the primary tumor. The cells were positive for synaptophysin, MAP2 and weakly positive for S100. Pan-NTRK staining was negative. The diagnosis of a metastatic localization of the DLGNT was made, due to seeding of tumoral cells via the VPS. Treatment with a MEK-inhibitor was initiated, but was stopped due to progressive disease and she died 3 weeks later.
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Affiliation(s)
- Julie Messiaen
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Isabelle Vanden Bempt
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Raf Sciot
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Sandra A Jacobs
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
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23
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Gheysen M, Vander Borght S, Lehnert S, Vanslembrouck R, Vanden Bempt I, Schöffski P. An Unexpected Response to Imatinib in a "Wild-Type" Gastrointestinal Stromal Tumor. Oncol Res Treat 2020; 43:470-473. [PMID: 32640452 DOI: 10.1159/000508536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and the most frequent sarcomas in some geographic regions. In patients with metastatic GIST, the tyrosine kinase inhibitor imatinib is the first-line standard of care. Mutations in KIT or specific platelet-derived growth factor receptor alpha (PDGFRA) gene aberrations in the tumor cells predict a favorable response to this agent, while tumors without KIT or PDGFRA mutations ("wild-type" GISTs) are usually resistant to such treatment. Next-generation sequencing (NGS) is commonly used for mutational analysis of GISTs. CASE PRESENTATION We present a case of an unexpected response to imatinib treatment in a GIST that was initially called "wild-type" based on routine NGS. A spectacular response to empirical imatinib treatment triggered further genetic analysis and led to the identification of a 45-bp duplication in KIT exon 11 undetectable by routine NGS. CONCLUSION Negative findings on routine NGS testing for KIT alterations do not exclude the presence of actionable drug targets, as in the case of larger or complex gene insertions or deletions. Updating the NGS bioinformatics pipeline to ensure identification of larger deletions or insertions or additional Sanger sequencing is warranted in NGS driver-negative GISTs in order to allow accurate detection of actionable mutations.
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Affiliation(s)
- Mathilde Gheysen
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium,
| | - Sara Vander Borght
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Lehnert
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Laboratory of Experimental Oncology, Leuven, Belgium
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24
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Schöffski P, Mir O, Kasper B, Papai Z, Blay JY, Italiano A, Benson C, Kopeckova K, Ali N, Dileo P, LeCesne A, Menge F, Cousin S, Wardelmann E, Wozniak A, Marreaud S, Litiere S, Zaffaroni F, Nzokirantevye A, Vanden Bempt I, Gelderblom H. Activity and safety of the multi-target tyrosine kinase inhibitor cabozantinib in patients with metastatic gastrointestinal stromal tumour after treatment with imatinib and sunitinib: European Organisation for Research and Treatment of Cancer phase II trial 1317 'CaboGIST'. Eur J Cancer 2020; 134:62-74. [PMID: 32470848 DOI: 10.1016/j.ejca.2020.04.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumour (GIST) is commonly treated with tyrosine kinase inhibitors (TKIs), but most patients ultimately develop secondary resistance. Cabozantinib, a multi-targeted TKI inhibitor, has activity in patient-derived GIST mouse xenograft models and can overcome compensatory MET signalling occurring on TKI treatment. European Organisation for Treatment of Cancer (EORTC) 1317 'CaboGIST' assessed the safety and activity of cabozantinib in patients with GIST who had progressed on imatinib and sunitinib. METHODS In this multi-center, open label, single arm phase II study, eligible GIST patients received oral cabozantinib (60 mg) once daily. Primary end-point was the progression-free survival rate at 12 weeks assessed by the local investigator per Response Evaluation Criteria in Solid Tumours 1·1. If at least 21 of the first 41 eligible and evaluable patients were progression-free at week 12, the activity of cabozantinib was sufficient to warrant further exploration according to the A'Hern one-stage study design. FINDINGS A total of 50 eligible patients started treatment between 02/2017 and 08/2018, including four (8%) still continuing cabozantinib at clinical cut-off (09/2019). The number of 3-weekly treatment cycles ranged from 1 to 30. Among the first 41 eligible and evaluable patients, 24 were progression-free at week 12 (58·5%, 95% confidence interval [CI] 42·0-74·0%). Among all 50 patients, 30 were progression-free at week 12 (60%, 95% CI 45-74%). Seven patients achieved a partial response (14%, 95% CI 6-27%), and 34 had stable disease (68%, 95% CI 53-80%) as best response. Progression was seen in eight patients (16%, 95% CI 7-29%), and one was not evaluable. Disease control was achieved in 41 patients (82%, 95% CI 69-91%). Median progression-free survival was 5·5 months (95% CI 3·6-6·9). The most common adverse events were diarrhoea (76%), palmar-plantar erythrodysesthesia syndrome (60%), fatigue (50%), hypertension (42%), weight loss (40%) and oral mucositis (30%), with 32 (64%) patients requiring dose reductions, 27 (54%) having treatment interruptions and no cabozantinib-related deaths observed. INTERPRETATION EORTC 1317 met its primary end-point, with 24/41 patients being progression-free at week 12 of treatment. The objective response was 14% with an encouraging disease control rate of 82%. Results of this trial confirm preclinical findings and warrant further exploration of cabozantinib in GIST. CLINICAL TRIAL NUMBERS EORTC 1317, NCT02216578, EudraCT 2014-000501-13.
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Affiliation(s)
- Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, and Department of Oncology, KU Leuven, Laboratory of Experimental Oncology, Leuven, Belgium.
| | - Olivier Mir
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, Mannheim, Germany
| | | | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, NETSARC+, LYRICAN, and Université Claude Bernard Lyon I, Lyon, France
| | | | | | | | - Nasim Ali
- Clatterbridge Cancer Centre, Wirral, United Kingdom
| | - Palma Dileo
- Sarcoma Unit, University College London, United Kingdom
| | - Axel LeCesne
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Franka Menge
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, Mannheim, Germany
| | | | | | - Agnieszka Wozniak
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, and Department of Oncology, KU Leuven, Laboratory of Experimental Oncology, Leuven, Belgium
| | - Sandrine Marreaud
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Saskia Litiere
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Facundo Zaffaroni
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | | | - Isabelle Vanden Bempt
- Department of Human Genetics, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
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25
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Slembrouck L, Bempt IV, Wildiers H, Smeets A, Van Limbergen E, Moerman P, Weltens C, Punie K, Hoste G, Van Nieuwenhuysen E, Han S, Nevelsteen I, Jongen L, Neven P, Floris G. Abstract P3-07-14: Multigene signatures based risk estimates in early ER+/HER2- breast cancer: The predictive value of inexpensive statistical models and changes in adjuvant chemotherapy use. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-07-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Multigene signatures (MGS) select women with estrogen receptor positive human epidermal growth factor receptor 2 negative (ER+/HER2-) breast cancers where adjuvant chemotherapy (aCT) can be avoided. However, MGS are expensive and not always reimbursed. We investigated the predictive value of six inexpensive statistical models in tumors with low or high risk of relapse based on MGS and investigated the change in decision to add chemotherapy following MGS results. Patients and Methods In this retrospective study, we evaluated patients diagnosed with primary operable ER+/HER2- lymph node negative or positive breast cancer diagnosed at University Hospitals Leuven between 2013 and 2018. Tumor tissue of the patients was analyzed by MammaPrint® (MP) (n=25), OncotypeDX® (ODX) (n=44) or Prosigna® (n=57) as there was uncertainty about benefit of aCT during multidisciplinary meeting (MDM). Magee equations (ME), Memorial Sloan Kettering simplified score (MSK), Breast Cancer Recurrence Score Estimator (BCRSE), OncotypeDXCalculator (ODXC), new Adjuvant! Online (nAOL) and PREDICT v2.0 were computed. TAILORx cut-offs were used for ODX. A 85% cut-off was used for the probability of a low (0-25) or high risk (26-100) ODX recurrence score for ODXC and a 5% cut-off was used for 10-year survival benefit with aCT for nAOL and PREDICT. Results All ME- and BCRSE-high cases were classified by MGS as high or intermediate and not as MGS-low risk (Table 1). None of the low risk classifications by ME and nAOL resulted in MGS-high risk with ODX. High risk classification with nAOL showed strong concordance with all MGS-high risk results. A switch in chemotherapy recommendation based on MDM decisions, was observed in 46% (58/126) of patients after MGS results. Following MGS testing, aCT was given to 57 patients which resulted in 17% relative and 10% absolute reduction. Conclusion Inexpensive statistical models based on clinico-pathological parameters can be useful in selecting patients that may need MGS testing. The use of MGS resulted in a substantial decisional switch and reduction in aCT-use.
Table 1 Predictive value of inexpensive statistical models in MGS tested tumors.MGS high risk (n=53)MGS low risk (n=52)ODX (n=17)MP (n=11)Prosigna (n=25)ODX (n=27)MP (n=14)Prosigna (n=11)MSK high (n=32)1038150ME high (n=7)411000BCRSE high (n=6)311000ODXC high (n=4)110010nAOL high (n=105)1772423123PREDICT high (n=47)7512850MSK low (n=37)3361145ME low (n=9)012202BCRSE low (n=50)3310967ODXC low (n=67)35131469nAOL low (n=21)041428PREDICT low (n=79)1061319911
Citation Format: Laurence Slembrouck, Isabelle Vanden Bempt, Hans Wildiers, Ann Smeets, Erik Van Limbergen, Philippe Moerman, Caroline Weltens, Kevin Punie, Griet Hoste, Els Van Nieuwenhuysen, Sileny Han, Ines Nevelsteen, Lynn Jongen, Patrick Neven, Giuseppe Floris. Multigene signatures based risk estimates in early ER+/HER2- breast cancer: The predictive value of inexpensive statistical models and changes in adjuvant chemotherapy use [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-07-14.
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Affiliation(s)
| | - Isabelle Vanden Bempt
- 2KU Leuven – University of Leuven, University Hospitals Leuven, Department of Human Genetics, Leuven, Belgium
| | - Hans Wildiers
- 3KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of General Medical Oncology, Leuven, Belgium
| | - Ann Smeets
- 4KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of Surgical Oncology, Leuven, Belgium
| | - Erik Van Limbergen
- 5KU Leuven - University of Leuven, Department of Oncology and KU Leuven – University of Leuven, University Hospitals Leuven, Department of Radiotherapy Oncology, Leuven, Belgium
| | - Philippe Moerman
- 6KU Leuven - University of Leuven, Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research and University Hospitals Leuven, Department of Pathology, Leuven, Belgium
| | - Caroline Weltens
- 5KU Leuven - University of Leuven, Department of Oncology and KU Leuven – University of Leuven, University Hospitals Leuven, Department of Radiotherapy Oncology, Leuven, Belgium
| | - Kevin Punie
- 3KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of General Medical Oncology, Leuven, Belgium
| | - Griet Hoste
- 7KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, Leuven, Belgium
| | - Els Van Nieuwenhuysen
- 7KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, Leuven, Belgium
| | - Sileny Han
- 8KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, Leuven, Belgium
| | - Ines Nevelsteen
- 4KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of Surgical Oncology, Leuven, Belgium
| | - Lynn Jongen
- 1KU Leuven - University of Leuven, Department of Oncology, Leuven, Belgium
| | - Patrick Neven
- 8KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, Leuven, Belgium
| | - Giuseppe Floris
- 6KU Leuven - University of Leuven, Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research and University Hospitals Leuven, Department of Pathology, Leuven, Belgium
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26
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Slembrouck L, Renders D, Borght SV, Neven P, Floris G, Spans L, Wildiers H, Punie K, Smeets A, Nevelsteen I, Vergote I, Vanderstichele A, Bempt IV. Abstract P5-06-28: Optimization and validation of PIK3CA mutation detection with droplet digital PCR in liquid biopsies of patients with metastatic breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-06-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Approximately 40% of oestrogen receptor positive (ER+) metastatic breast cancer harbour PIK3CA hotspot mutations, leading to an over-activated PI3K pathway. The PI3Kα-selective inhibitor, alpelisib, is FDA approved and currently available in early access program for patients with ER+ HER2-negative metastatic disease, if an activating PIK3CA mutation is confirmed. Mutational analysis on liquid biopsies may increase the number of eligible patients given the challenges of tissue procurement in metastatic setting. We optimized and validated ddPCR assays for PIK3CA hotspot mutations in cell-free DNA (cfDNA) of metastatic breast cancer patients. Patients and Methods We prospectively collected two blood samples (cfDNA Collection tubes, Roche Diagnostics) of 20 metastatic breast cancer patients at progression (N=12) or during therapy (N=8). PIK3CA mutation status was previously demonstrated by Next Generation Sequencing (NGS) performed in 4 patients on primary tumor tissue and in 16 patients on metastatic tumor tissue; 8 patients tested positive and 12 negative. Tumors were ER+ HER2-negative, triple-negative and HER2-positive in 14, 5 and one patients, respectively. After plasma-isolation, cfDNA was manually extracted with Cobas® cfDNA Sample Preparation Kit (2mL plasma) and semi-automatically with Maxwell® RSC ccfDNA Plasma Kit (2mL and 4mL plasma). Inter-run variability, intra-run variability, precision and robustness of the assays, and concordance between NGS and ddPCR for the detection of PIK3CA hotspot mutations on tumor tissue and in plasma, respectively, were assessed. Results All 20 samples were successfully processed with ddPCR. The highest cfDNA yield was obtained by Maxwell 4mL extraction method (median: 0.483 ng/µL; range: 0.140 - 10.500 ng/µL). The per-mutation sensitivity and specificity was 87.5% and 95.8%, respectively. Two samples showed discordant results between PIK3CA mutations detected by NGS on tumor tissue and by ddPCR in plasma. One sample tested positive for p.(H1047R) on tumor tissue, and for p.(E542K), p.(E545K) and p.(H1047R) in cfDNA. The other switched between p.(E545K) mutation on tumor tissue and p.(E542K) in cfDNA. Tumor tissue of samples for which the results of the NGS test were discordant with the ddPCR test on plasma, was tested again using ddPCR on the tissue. This still showed discordances in PIK3CA mutations which can be explained by tumor heterogeneity and the lower detection limit of ddPCR versus NGS. Conclusion Detection of PIK3CA hotspot mutations with ddPCR in cfDNA is feasible. We observed good concordance between NGS and ddPCR for the detection of PIK3CA hotspot mutations on tumor tissue and in plasma, respectively. In 10% of cases, discordant PIK3CA mutation status in tissue versus plasma was detected. Further investigation of different metastatic lesions in these cases is ongoing.
Citation Format: Laurence Slembrouck, Demi Renders, Sara Vander Borght, Patrick Neven, Giuseppe Floris, Lien Spans, Hans Wildiers, Kevin Punie, Ann Smeets, Ines Nevelsteen, Ignace Vergote, Adriaan Vanderstichele, Isabelle Vanden Bempt. Optimization and validation of PIK3CA mutation detection with droplet digital PCR in liquid biopsies of patients with metastatic breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-06-28.
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Affiliation(s)
| | - Demi Renders
- 2KU Leuven – University of Leuven, University Hospitals Leuven, Department of Human Genetics, Leuven, Belgium
| | - Sara Vander Borght
- 3KU Leuven - University Hospitals Leuven, Department of Pathology, Leuven, Belgium
| | - Patrick Neven
- 4KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, Leuven, Belgium
| | - Giuseppe Floris
- 5KU Leuven - University Hospitals Leuven, Department of Pathology and KU Leuven - University of Leuven, Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research, Leuven, Belgium
| | - Lien Spans
- 2KU Leuven – University of Leuven, University Hospitals Leuven, Department of Human Genetics, Leuven, Belgium
| | - Hans Wildiers
- 6KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of General Medical Oncology, Leuven, Belgium
| | - Kevin Punie
- 6KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of General Medical Oncology, Leuven, Belgium
| | - Ann Smeets
- 7KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of Surgical Oncology, Leuven, Belgium
| | - Ines Nevelsteen
- 7KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of Surgical Oncology, Leuven, Belgium
| | - Ignace Vergote
- 4KU Leuven - University of Leuven, Department of Oncology and KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, Leuven, Belgium
| | - Adriaan Vanderstichele
- 8KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, Leuven, Belgium
| | - Isabelle Vanden Bempt
- 2KU Leuven – University of Leuven, University Hospitals Leuven, Department of Human Genetics, Leuven, Belgium
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27
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Libbrecht L, Bempt IV, Schubert T, Sciot R, Galant C. Next generation sequencing for GNAS uncovers CD34 as a sensitive marker for intramuscular myxoma. Ann Diagn Pathol 2019; 43:151409. [PMID: 31726379 DOI: 10.1016/j.anndiagpath.2019.151409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/08/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intramuscular myxoma is a soft tissue myxoid tumor with a broad morphological differential diagnosis and recent developments have led to the identification of markers that can exclude some, but not all, differential diagnostic entities. However, a sensitive confirmatory marker for intramuscular myxoma has not been clearly identified. Since there is some evidence that mutations in the GNAS gene could be such a marker, we evaluated our results of next-generation sequencing testing for GNAS mutations performed in recent years on our series of intramuscular myxoma. MATERIALS AND METHODS Next-generation sequencing was performed on 10 cases of intramuscular myxoma diagnosed between 2015 and 2019, using either the TruSight Tumor 26 panel or an in-house developed 97 cancer gene panel. Additionally, immunohistochemistry for CD34 was performed on all cases. RESULTS All intramuscular myxomas showed a diffuse and strong expression of CD34 and a GNAS mutation was found in 88% of cases, making this a very sensitive positive test for the diagnosis of intramuscular myxoma. CONCLUSIONS Under the condition that contemporary next-generation sequencing is applied as testing method, searching for GNAS mutations is a very sensitive confirmatory test for the diagnosis of intramuscular myxoma, obviating the necessity to perform tests that exclude other entities by the virtue of their negative result. The molecular tests results also identified strong and diffuse CD34 expression as a sensitive, albeit non-specific, marker for intramuscular myxoma.
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Affiliation(s)
- Louis Libbrecht
- Department of Pathology, University Hospital Saint-Luc, Brussels, Belgium.
| | | | - Thomas Schubert
- Department of Orthopedic Surgery, University Hospital Saint-Luc, Brussels, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Christine Galant
- Department of Pathology, University Hospital Saint-Luc, Brussels, Belgium
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28
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Slembrouck L, Darrigues L, Laurent C, Mittempergher L, Delahaye LJ, Vanden Bempt I, Vander Borght S, Vliegen L, Sintubin P, Raynal V, Bohec M, Reyes C, Rapinat A, Helsmoortel C, Jongen L, Hoste G, Neven P, Wildiers H, Smeets A, Nevelsteen I, Punie K, Van Nieuwenhuysen E, Han S, Vincent Salomon A, Laas Faron E, Cynober T, Gentien D, Baulande S, Snel MH, Witteveen AT, Neijenhuis S, Glas AM, Reyal F, Floris G. Decentralization of Next-Generation RNA Sequencing-Based MammaPrint® and BluePrint® Kit at University Hospitals Leuven and Curie Institute Paris. Transl Oncol 2019; 12:1557-1565. [PMID: 31513983 PMCID: PMC6742807 DOI: 10.1016/j.tranon.2019.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022] Open
Abstract
A previously developed and centrally validated MammaPrint® (MP) and BluePrint® (BP) targeted RNA next-generation sequencing (NGS) kit was implemented and validated in two large academic European hospitals. Additionally, breast cancer molecular subtypes by MP and BP RNA sequencing were compared with immunohistochemistry (IHC). Patients with early breast cancer diagnosed at University Hospitals Leuven and Curie Institute Paris were prospectively included between September 2017 and January 2018. Formalin-fixed paraffin-embedded tissue sections were analyzed with MP and BP NGS technology at the beta sites and with both NGS and microarray technology at Agendia. Raw NGS data generated on Illumina MiSeq instruments at the beta sites were interpreted and compared with NGS and microarray data at Agendia. MP and BP NGS molecular subtypes were compared to surrogate IHC breast cancer subtypes. Equivalence of MP and BP indices was determined by Pearson's correlation coefficient. Acceptable limits were defined a priori, based on microarray data generated at Agendia between 2012 and 2016. The concordance, the Negative Percent Agreement and the Positive Percent Agreement were calculated based on the contingency tables and had to be equal to or higher than 90%. Out of 124 included samples, 48% were MP Low and 52% High Risk with microarray. Molecular subtypes were BP luminal, HER2 or basal in 82%, 8% and 10% respectively. Concordance between MP microarray at Agendia and MP NGS at the beta sites was 91.1%. Concordance of MP High and Low Risk classification between NGS at the beta sites and NGS at Agendia was 93.9%. Concordance of MP and BP molecular subtyping using NGS at the beta sites and microarray at Agendia was 89.5%. Concordance between MP and BP NGS subtyping, and IHC was 71.8% and 76.6%, for two IHC surrogate models. The MP/BP NGS kit was successfully validated in a decentralized setting.
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Affiliation(s)
- Laurence Slembrouck
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium.
| | - Lauren Darrigues
- Curie Institute, Department of Surgery, Paris Descartes University, F-75248, France
| | - Cecile Laurent
- Curie Institute, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Paris Descartes University, INSERM, U932 Immunity and Cancer, Paris, F-75248, France
| | - Lorenza Mittempergher
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Leonie Jmj Delahaye
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Isabelle Vanden Bempt
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Human Genetics, B-3000 Leuven, Belgium
| | - Sara Vander Borght
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Human Genetics, B-3000 Leuven, Belgium; KU Leuven - University Hospitals Leuven, Department of Pathology, B-3000 Leuven, Belgium
| | - Liesbet Vliegen
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Human Genetics, B-3000 Leuven, Belgium
| | - Petra Sintubin
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Human Genetics, B-3000 Leuven, Belgium
| | - Virginie Raynal
- Curie Institute, PSL Research University, Genomics of Excellence (ICGex) Platform, Paris, F-75248, France
| | - Mylene Bohec
- Curie Institute, PSL Research University, Genomics of Excellence (ICGex) Platform, Paris, F-75248, France
| | - Cécile Reyes
- Curie Institute, PSL Research University, Translational Research Department, Genomics Platform, Paris, F-75248, France
| | - Audrey Rapinat
- Curie Institute, PSL Research University, Translational Research Department, Genomics Platform, Paris, F-75248, France
| | - Céline Helsmoortel
- KU Leuven - University of Leuven, University Hospitals Leuven, Genomics Core, B-3000 Leuven, Belgium
| | - Lynn Jongen
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium
| | - Griet Hoste
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, B-3000 Leuven, Belgium
| | - Patrick Neven
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, B-3000 Leuven, Belgium
| | - Hans Wildiers
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of General Medical Oncology, B-3000 Leuven, Belgium
| | - Ann Smeets
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Surgical Oncology, B-3000 Leuven, Belgium
| | - Ines Nevelsteen
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Surgical Oncology, B-3000 Leuven, Belgium
| | - Kevin Punie
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of General Medical Oncology, B-3000 Leuven, Belgium
| | - Els Van Nieuwenhuysen
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, B-3000 Leuven, Belgium
| | - Sileny Han
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, B-3000 Leuven, Belgium
| | | | - Enora Laas Faron
- Curie Institute, Department of Surgery, Paris Descartes University, F-75248, France
| | - Timothé Cynober
- Curie Institute, Administration and General Services, Paris, F-75248, France
| | - David Gentien
- Curie Institute, PSL Research University, Translational Research Department, Genomics Platform, Paris, F-75248, France
| | - Sylvain Baulande
- Curie Institute, PSL Research University, Genomics of Excellence (ICGex) Platform, Paris, F-75248, France
| | - Mireille Hj Snel
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Anke T Witteveen
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Sari Neijenhuis
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Annuska M Glas
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Fabien Reyal
- Curie Institute, Department of Surgery, Paris Descartes University, F-75248, France; Curie Institute, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Paris Descartes University, INSERM, U932 Immunity and Cancer, Paris, F-75248, France
| | - Giuseppe Floris
- KU Leuven - University Hospitals Leuven, Department of Pathology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research
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Slembrouck L, Floris G, Wildiers H, Smeets A, Limbergen EV, Moerman P, Weltens C, Punie K, Hoste G, Nieuwenhuysen EV, Han S, Nevelsteen I, Jongen L, Neven P, Bempt IV. Abstract 1406: Multigene signatures based risk estimates in ER+/HER2- breast cancers: The predictive value of inexpensive statistical models and changes in adjuvant chemotherapy use. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Multigene signatures (MGS) select women with estrogen receptor positive human epidermal growth factor receptor 2 negative (ER+/HER2-) breast cancers where adjuvant chemotherapy (aCT) can be avoided. However, MGS are expensive and not always reimbursed. We investigated the predictive value of five inexpensive statistical models in tumors with low or high risk of relapse based on MGS and investigated the change in decision to add chemotherapy following MGS results.
Patients and Methods In this retrospective study, we evaluated patients diagnosed with primary operable ER+/HER2- lymph node negative or positive breast cancer diagnosed at University Hospitals Leuven between 2013 and 2018. Patients were analyzed by MammaPrint® (MP) (n=24), OncotypeDX® (ODX) (n=44) or Prosigna®(n=57) as there was uncertainty about benefit of aCT during multidisciplinary meeting (MDM). Magee equations (ME), Memorial Sloan Kettering simplified score (MSK), Breast Cancer Recurrence Score Estimator (BCRSE), new Adjuvant! Online (nAOL) and PREDICT v2.0 were computed. TAILORx cut-offs were used for ODX. A 5% cut-off was used for 10-year survival benefit with aCT for nAOL and PREDICT.
Results All ME- and BCRSE-high cases were classified by MGS as high or intermediate and not as MGS-low risk, as shown in Table 1. None of the low risk classifications by ME and nAOL resulted in MGS-high risk with ODX. High risk classification with nAOL showed strong concordance with all MGS-high risk results. Chemotherapy switch according to MGS results was observed in 46% (57/125) of patients. Following MGS testing, aCT was given to 56 patients which resulted in 19% relative and 10% absolute reduction.
Conclusion Inexpensive statistical models based on pathologic parameters can be useful to select patients who may need MGS testing. Integration of MGS into MDM decisions, resulted in a substantial decisional switch and reduction in aCT administration.
Table 1Predictive value of inexpensive statistical models in MGS tested tumors.MGS high risk (n=52)MGS low risk (n=52)ODX (n=17)MP (n=10)Prosigna (n=25)ODX (n=27)MP (n=14)Prosigna (n=11)MSK high59% (10/17)30% (3/10)32% (8/25)4% (1/27)36% (5/14)0% (0/11)ME high24% (4/17)10% (1/10)4% (1/25)0% (0/27)0% (0/14)0% (0/11)BCRSE high0% (0/17)10% (1/10)4% (1/25)0% (0/27)0% (0/14)0% (0/11)nAOL high100% (17/17)60% (6/10)96% (24/25)85% (23/27)86% (12/14)27% (3/11)PREDICT high47% (8/17)40% (4/10)48% (12/25)26% (7/27)36% (5/14)0% (0/11)MSK low18% (3/17)30% (3/10)24% (6/25)41% (11/27)29% (4/14)46% (5/11)ME low0% (0/17)10% (1/10)8% (2/25)7% (2/27)0% (0/14)18% (2/11)BCRSE low18% (3/17)30% (3/10)40% (10/25)26% (7/27)43% (6/14)64% (7/11)nAOL low0% (0/17)40% (4/10)4% (1/25)15% (4/27)14% (2/14)73% (8/11)PREDICT low53% (9/17)60% (6/10)52% (13/25)74% (20/27)64% (9/14)100% (11/11)
Citation Format: Laurence Slembrouck, Giuseppe Floris, Hans Wildiers, Ann Smeets, Erik Van Limbergen, Philippe Moerman, Caroline Weltens, Kevin Punie, Griet Hoste, Els Van Nieuwenhuysen, Sileny Han, Ines Nevelsteen, Lynn Jongen, Patrick Neven, Isabelle Vanden Bempt. Multigene signatures based risk estimates in ER+/HER2- breast cancers: The predictive value of inexpensive statistical models and changes in adjuvant chemotherapy use [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1406.
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Affiliation(s)
| | - Giuseppe Floris
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Erik Van Limbergen
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Philippe Moerman
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Caroline Weltens
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Kevin Punie
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Griet Hoste
- 3University Hospitals Leuven, Leuven, Belgium
| | | | - Sileny Han
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Ines Nevelsteen
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Lynn Jongen
- 1KU Leuven - University of Leuven, Leuven, Belgium
| | - Patrick Neven
- 2KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
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Hoste G, Slembrouck L, Jongen L, Punie K, Matton T, Vander Borght S, Vanden Bempt I, Menten J, Wildiers H, Floris G, Arteaga C, Neven P. Correction to: Unexpected Benefit from Alpelisib and Fulvestrant in a Woman with Highly Pre-treated ER-Positive, HER2-Negative PIK3CA Mutant Metastatic Breast Cancer. Clin Drug Investig 2019; 39:113. [PMID: 30637612 DOI: 10.1007/s40261-019-00748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Dr. Arteaga serves on an Advisory Board for Novartis and was a consultant for AstraZeneca from 2015 to 2016. All other authors declare that they have no competing interests.
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Affiliation(s)
- Griet Hoste
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - Laurence Slembrouck
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Lynn Jongen
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Kevin Punie
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Tom Matton
- Department of Radiology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium
| | - Sara Vander Borght
- Department of Pathology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium.,Department of Human Genetics, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Isabelle Vanden Bempt
- Department of Human Genetics, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Johan Menten
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium.,Department of Radiotherapy, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Hans Wildiers
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Giuseppe Floris
- Department of Radiology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium.,Department of Imaging and Pathology, Laboratory of Translational Cell and Tissue Research, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Carlos Arteaga
- University of Texas Southwestern Medical Center, Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Patrick Neven
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium.,Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
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Hoste G, Slembrouck L, Jongen L, Punie K, Matton T, Vander Borght S, Vanden Bempt I, Menten J, Wildiers H, Floris G, Arteaga C, Neven P. Unexpected Benefit from Alpelisib and Fulvestrant in a Woman with Highly Pre-treated ER-Positive, HER2-Negative PIK3CA Mutant Metastatic Breast Cancer. Clin Drug Investig 2018; 38:1071-1075. [PMID: 30187361 DOI: 10.1007/s40261-018-0696-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We present the case of a postmenopausal patient with a secondary metastatic ER-positive, HER2-negative breast cancer who was successfully treated with fulvestrant and alpelisib following six lines of therapy. The tumour showed two uncommon PIK3CA mutations, and with the combination of alpelisib and fulvestrant the patient went from ECOG grade 3, before the start of this therapy, to ECOG grade 1 during treatment until progressive disease after 6 months. This unexpected benefit emphasizes the importance of performing a Next Generation Sequencing (NGS)-based assay to screen for several cancer genes in the metastatic setting, even after more than four lines of therapy and a high ECOG grade. Moreover, the use of alpelisib may be beneficial for uncommon PIK3CA mutations.
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Affiliation(s)
- Griet Hoste
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - Laurence Slembrouck
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Lynn Jongen
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Kevin Punie
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Tom Matton
- Department of Radiology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium
| | - Sara Vander Borght
- Department of Pathology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium.,Department of Human Genetics, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Isabelle Vanden Bempt
- Department of Human Genetics, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Johan Menten
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium.,Department of Radiotherapy, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Hans Wildiers
- Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium.,Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Giuseppe Floris
- Department of Radiology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium.,Department of Imaging and Pathology, Laboratory of Translational Cell and Tissue Research, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Carlos Arteaga
- University of Texas Southwestern Medical Center, Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Patrick Neven
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium.,Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium
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Schats KA, Van Vré EA, De Schepper S, Boeckx C, Schrijvers DM, Waelput W, Fransen E, Vanden Bempt I, Neyns B, De Meester I, Kockx MM. Validated programmed cell death ligand 1 immunohistochemistry assays (E1L3N and SP142) reveal similar immune cell staining patterns in melanoma when using the same sensitive detection system. Histopathology 2016; 70:253-263. [PMID: 27496355 DOI: 10.1111/his.13056] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/28/2016] [Accepted: 08/03/2016] [Indexed: 12/16/2022]
Abstract
AIMS Tumour cell and/or immune cell programmed cell death ligand 1 (PD-L1) expression is considered as a potential biomarker for anti-PD1 and anti-PD-L1 immunotherapy. Currently, different PD-L1 assays are used. This study aims to compare the staining patterns of two PD-L1 antibody clones in melanoma metastases and correlate them with PD-L1 mRNA expression. METHODS AND RESULTS The immunohistochemistry assays were optimized and validated independently on a Ventana Benchmark Ultra (Ventana Medical Systems Inc., Tucson, AZ, USA) (E1L3N) and XT (SP142), using the same detection system. In total, 46 melanoma metastases were stained with both validated immunohistochemistry assays. Stained slides were digitized for qualitative and semi-quantitative evaluation; done by pathologist and semi-automated software analysis. A subset of 21 melanoma metastases was selected for quantification of the PD-L1 mRNA expression. Accuracy and precision criteria were met for both assays. PD-L1 protein and mRNA expression showed remarkably good Spearman's coefficients of 0.90 (E1L3N) and 0.87 (SP142). Despite the remarkable correlation between both PD-L1 assays in expression patterns and quantification values (ρ > 0.90), E1L3N showed significantly more tumour cell staining than SP142. CONCLUSIONS E1L3N and SP142 IHC assays were optimized and validated successfully and independently for sensitive and accurate PD-L1 detection. Concordance was best for immune cell scoring, while E1L3N tended to detect more tumour cells. Determination of the clinically relevant cut-off values for immune cell versus tumour cell detection requires further research.
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Affiliation(s)
- Kelly A Schats
- Department of Immunohistochemistry, HistoGeneX, Antwerp, Belgium.,Department of Medical Biochemistry, University of Antwerp, Antwerp, Belgium
| | - Emily A Van Vré
- Department of Immunohistochemistry, HistoGeneX, Antwerp, Belgium
| | | | - Carolien Boeckx
- Department of Immunohistochemistry, HistoGeneX, Antwerp, Belgium
| | | | - Wim Waelput
- Department of Pathology, Universitair Ziekenhuis, Brussels, Belgium.,Department of Molecular Pathology, HistoGeneX, Antwerp, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | | | - Bart Neyns
- Medical Oncology, Universitair Ziekenhuis, Brussels, Belgium
| | - Ingrid De Meester
- Department of Medical Biochemistry, University of Antwerp, Antwerp, Belgium
| | - Mark M Kockx
- Department of Molecular Pathology, HistoGeneX, Antwerp, Belgium
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Janku F, Claes B, Huang HJ, Falchook GS, Devogelaere B, Kockx M, Bempt IV, Reijans M, Naing A, Fu S, Piha-Paul SA, Hong DS, Holley VR, Tsimberidou AM, Stepanek VM, Patel SP, Kopetz ES, Subbiah V, Wheler JJ, Zinner RG, Karp DD, Luthra R, Roy-Chowdhuri S, Sablon E, Meric-Bernstam F, Maertens G, Kurzrock R. BRAF mutation testing with a rapid, fully integrated molecular diagnostics system. Oncotarget 2016; 6:26886-94. [PMID: 26330075 PMCID: PMC4694960 DOI: 10.18632/oncotarget.4723] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/17/2015] [Indexed: 01/07/2023] Open
Abstract
Fast and accurate diagnostic systems are needed for further implementation of precision therapy of BRAF-mutant and other cancers. The novel IdyllaTMBRAF Mutation Test has high sensitivity and shorter turnaround times compared to other methods. We used Idylla to detect BRAF V600 mutations in archived formalin-fixed paraffin-embedded (FFPE) tumor samples and compared these results with those obtained using the cobas 4800 BRAF V600 Mutation Test or MiSeq deep sequencing system and with those obtained by a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory employing polymerase chain reaction–based sequencing, mass spectrometric detection, or next-generation sequencing. In one set of 60 FFPE tumor samples (15 with BRAF mutations per Idylla), the Idylla and cobas results had an agreement of 97%. Idylla detected BRAF V600 mutations in two additional samples. The Idylla and MiSeq results had 100% concordance. In a separate set of 100 FFPE tumor samples (64 with BRAF mutation per Idylla), the Idylla and CLIA-certified laboratory results demonstrated an agreement of 96% even though the tests were not performed simultaneously and different FFPE blocks had to be used for 9 cases. The IdyllaTMBRAF Mutation Test produced results quickly (sample to results time was about 90 minutes with about 2 minutes of hands on time) and the closed nature of the cartridge eliminates the risk of PCR contamination. In conclusion, our observations demonstrate that the Idylla test is rapid and has high concordance with other routinely used but more complex BRAF mutation–detecting tests.
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Affiliation(s)
- Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Helen J Huang
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gerald S Falchook
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Sarah Cannon Research Institute at HealthONE, Denver, CO 80218, USA
| | | | | | | | | | - Aung Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Veronica R Holley
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vanda M Stepanek
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sapna P Patel
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - E Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennifer J Wheler
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ralph G Zinner
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rajyalakshmi Luthra
- Molecular Diagnostics Laboratory, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Razelle Kurzrock
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Center for Personalized Cancer Therapy, Moores Cancer Center, The University of California San Diego, La Jolla, CA 92093, USA
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Sillekens P, Bellon E, Vandenbroucke I, Van Brussel M, Torremans A, Kockx M, Vanden Bempt I, Sablon E, Maertens GG. Evaluation of a sensitive and fully automated extended KRAS test for detection of 21 mutations in 6 codons in KRAS exons 2, 3 and 4. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e22147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Boeckx C, Weyn C, Vanden Bempt I, Deschoolmeester V, Wouters A, Specenier P, Van Laer C, Van den Weyngaert D, Kockx M, Vermorken JB, Peeters M, Pauwels P, Lardon F, Baay M. Mutation analysis of genes in the EGFR pathway in Head and Neck cancer patients: implications for anti-EGFR treatment response. BMC Res Notes 2014; 7:337. [PMID: 24899223 PMCID: PMC4067106 DOI: 10.1186/1756-0500-7-337] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/29/2014] [Indexed: 11/14/2022] Open
Abstract
Background Targeted therapy against the Epidermal Growth Factor Receptor (EGFR) is among the most promising molecular therapeutics for Head and Neck Squamous Cell Carcinoma (HNSCC). However, drug resistance limits the clinical efficacy of anti-EGFR monoclonal antibodies and no predictive biomarker has entered the clinic yet. Methods A retrospective clinical study was performed utilizing pathological specimens from 52 newly diagnosed HNSCC patients. These patients were screened for mutations in EGFR and KRAS. Tyrosine kinase mutations in EGFR and KRAS mutations were evaluated by high resolution melting analysis (HRMA), whereas EGFRvIII was determined using one-step real-time PCR. Finally, patient samples were screened for HPV-DNA by GP5+/6+ PCR. Survival analysis was performed using Kaplan-Meier analysis and significance was calculated using log-rank statistic. Results In our study population no EGFRvIII mutations were present. However, two silent mutations were found; T785T in exon 20 and R836R in exon 21 of the EGFR gene. Additionally, HRMA revealed an abnormal KRAS melting pattern in 7.0% of the samples. However, the KRAS StripAssay could confirm only one sample with a G12S mutation and none of these samples could be confirmed by direct sequencing. HPV DNA was present in 3/25 larynx and 9/27 oropharynx tumors. Conclusion The low rate of EGFR and KRAS mutations in this Belgian HNSCC population suggests that these genes will probably not play a major role in predicting response to anti-EGFR therapy in HNSCC. Hence, other predictive markers need to be discovered in order to optimize EGFR targeting therapy.
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Affiliation(s)
- Carolien Boeckx
- Center for Oncological Research (CORE) Antwerp, Laboratory of Cancer Research and Clinical Oncology, University of Antwerp, Wilrijk, Belgium.
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Van Belle V, Van Calster B, Brouckaert O, Vanden Bempt I, Pintens S, Harvey V, Murray P, Naume B, Wiedswang G, Paridaens R, Moerman P, Amant F, Leunen K, Smeets A, Drijkoningen M, Wildiers H, Christiaens MR, Vergote I, Van Huffel S, Neven P. Qualitative Assessment of the Progesterone Receptor and HER2 Improves the Nottingham Prognostic Index Up to 5 Years After Breast Cancer Diagnosis. J Clin Oncol 2010; 28:4129-34. [DOI: 10.1200/jco.2009.26.4200] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo investigate whether the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) can improve the Nottingham Prognostic Index (NPI) in the classification of patients with primary operable breast cancer for disease-free survival (DFS).Patients and MethodsThe analysis is based on 1,927 patients with breast cancer treated between 2000 and 2005 at the University Hospitals, Leuven. We compared performances of NPI with and without ER, PR and/or HER2. Validation was done on two external data sets containing 862 and 2,805 patients from Oslo (Norway) and Auckland (New Zealand), respectively.ResultsIn the Leuven cohort, median follow-up was 66 months, and 13.7% of patients experienced a breast cancer–related event. Positive staining for ER, PR, and HER2 was detected, respectively, in 86.9%, 75.5%, and 11.9% of patients. Based on multivariate Cox regression modeling, the improved NPI (iNPI) was derived as NPI − PR positivity + HER2 positivity. Validation results showed a risk group reclassification of 20% to 30% of patients when using iNPI with its optimal risk boundaries versus NPI, in a majority of patients to more appropriate risk groups. An additional 10% of patients were classified into the extreme risk groups, where clinical actions are less ambiguous. Survival curves of reclassified patients resembled more closely those for patients in the same iNPI group than those for patients in the same NPI group.ConclusionThe addition of PR and HER2 to NPI increases its 5-year prognostic accuracy. The iNPI can be considered as a clinically useful tool for stratification of patients with breast cancer receiving standard of care.
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Affiliation(s)
- Vanya Van Belle
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Ben Van Calster
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Olivier Brouckaert
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Isabelle Vanden Bempt
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Saskia Pintens
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Vernon Harvey
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Paula Murray
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Björn Naume
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Gro Wiedswang
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Robert Paridaens
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Philippe Moerman
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Frederic Amant
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Karin Leunen
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Ann Smeets
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Maria Drijkoningen
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Hans Wildiers
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Marie-Rose Christiaens
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Ignace Vergote
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Sabine Van Huffel
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Patrick Neven
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
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Van Loo P, Tousseyn T, Vanhentenrijk V, Dierickx D, Malecka A, Vanden Bempt I, Verhoef G, Delabie J, Marynen P, Matthys P, De Wolf-Peeters C. T-cell/histiocyte-rich large B-cell lymphoma shows transcriptional features suggestive of a tolerogenic host immune response. Haematologica 2009; 95:440-8. [PMID: 19797726 DOI: 10.3324/haematol.2009.009647] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Gene expression profiling has successfully identified the prognostic significance of the host response in lymphomas. The aggressive T-cell/histiocyte-rich large B-cell lymphoma and the indolent nodular lymphocyte-predominant Hodgkin's lymphoma are both characterized by a paucity of tumor cells embedded in an overwhelming background. The tumor cells of both lymphomas share several characteristics, while the cellular composition of their microenvironment is clearly different. DESIGN AND METHODS We collected 33 cases of T-cell/histiocyte-rich large B-cell lymphoma and 56 cases of nodular lymphocyte-predominant Hodgkin's lymphoma and performed microarray gene expression profiling on ten cases of each lymphoma, to obtain a better understanding of the lymphoma host response. By quantitative reverse transcriptase polymerase chain reaction we verified that these 20 selected cases were representative of the entire population of T-cell/histiocyte-rich large B-cell and nodular lymphocyte-predominant Hodgkin's lymphomas. RESULTS We observed that the microenvironment in nodular lymphocyte-predominant Hodgkin's lymphoma is molecularly very similar to a lymph node characterized by follicular hyperplasia, while the microenvironment in T-cell/histiocyte-rich large B-cell lymphoma is clearly different. The T-cell/histiocyte-rich large B-cell lymphoma signature is hallmarked by up-regulation of CCL8, interferon-gamma, indoleamine 2,3 dioxygenase, VSIG4 and Toll-like receptors. These features may be responsible for the recruitment and activation of T cells, macrophages and dendritic cells, characterizing the stromal component of this lymphoma, and may point towards innate immunity and a tumor tolerogenic immune response in T-cell/histiocyte-rich large B-cell lymphoma. CONCLUSIONS The gene expression profile of T-cell/histiocyte-rich large B-cell lymphoma, in comparison with that of nodular lymphocyte-predominant Hodgkin's lymphoma, shows features suggestive of a distinct tolerogenic host immune response that may play a key role in the aggressive behavior of this lymphoma, and that may serve as a potential target for future therapy.
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Affiliation(s)
- Peter Van Loo
- Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium
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Vanden Bempt I, Van Loo P, Drijkoningen M, Neven P, Smeets A, Christiaens MR, Paridaens R, De Wolf-Peeters C. Polysomy 17 in breast cancer: clinicopathologic significance and impact on HER-2 testing. J Clin Oncol 2008; 26:4869-74. [PMID: 18794552 DOI: 10.1200/jco.2007.13.4296] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Polysomy 17 is frequently found in breast cancer and may complicate the interpretation of HER-2 testing results. We investigated the impact of polysomy 17 on HER-2 testing and studied its clinicopathologic significance in relation to HER2 gene amplification. PATIENTS AND METHODS In 226 patients with primary invasive breast carcinoma, HER2 gene and chromosome 17 copy numbers were determined by dual-color fluorescent in situ hybridization (FISH). The interpretation of FISH results was based on either absolute HER2 gene copy number or the ratio HER2/chromosome 17. Results were correlated with HER-2 protein expression on immunohistochemistry (IHC), HER2 mRNA expression by reverse transcriptase polymerase chain reaction (RT-PCR), and with various clinicopathologic parameters. RESULTS All cases with an equivocal HER-2 result by FISH, either by absolute HER2 copy number (44 of 226 patients; 19.5%) or by the ratio HER2/chromosome 17 (three of 226 patients; 1.3%), displayed polysomy 17. On its own, polysomy 17 was not associated with HER-2 overexpression on IHC or increased HER2 mRNA levels by RT-PCR. Moreover, and in contrast with HER2 gene amplification, polysomy 17 was not associated with high tumor grade, hormone receptor negativity, or reduced disease-free survival. CONCLUSION Polysomy 17 affects HER-2 testing in breast cancer and is a major cause of equivocal results by FISH. We show that tumors displaying polysomy 17 in the absence of HER2 gene amplification resemble more HER-2-negative than HER-2-positive tumors. These findings highlight the need for clinical trials to investigative whether polysomy 17 tumors benefit from HER-2-targeted therapy.
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39
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Neven P, Brouckaert O, Van Belle V, Vanden Bempt I, Hendrickx W, Cho H, Deraedt K, Van Calster B, Van Huffel S, Moerman P, Amant F, Leunen K, Smeets A, Wildiers H, Paridaens R, Vergote I, Christiaens MR. In early-stage breast cancer, the estrogen receptor interacts with correlation between human epidermal growth factor receptor 2 status and age at diagnosis, tumor grade, and lymph node involvement. J Clin Oncol 2008; 26:1768-9; author reply 1769-71. [PMID: 18519273 DOI: 10.1200/jco.2007.15.6141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vanden Bempt I, Drijkoningen M, De Wolf-Peeters C. The complexity of genotypic alterations underlying HER2-positive breast cancer: an explanation for its clinical heterogeneity. Curr Opin Oncol 2007; 19:552-7. [PMID: 17906451 DOI: 10.1097/cco.0b013e3282f0ad8e] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW We discuss recent findings on the genotypic alterations associated with HER2-positive breast cancer in an attempt to clarify the clinical heterogeneity observed among these tumors. RECENT FINDINGS Molecular genetic analysis supports the distinctive nature of HER2-positive breast cancer, which is primarily driven by HER2 gene amplification. Depending on the amplicon size, a variety of genes can be coamplified and overexpressed together with HER2, some of which may contribute to tumorigenesis; the amplicon size may even predict response to trastuzumab therapy. HER2 gene amplification may further destabilize the tumor genome, facilitating the generation of additional genomic aberrations including aneuploidy. The latter might imply polysomy 17, a phenomenon that should be discriminated from true HER2 gene amplification: polysomy 17 in the absence of HER2 gene amplification is not associated with HER2 overexpression nor with the clinical characteristics of HER2-positive breast cancer. SUMMARY HER2 gene amplification is a complex event: it includes coamplification of other, potentially oncogenic genes and facilitates the generation of additional genomic aberrations. Further studies on these genotypic findings will be helpful to better identify the patients that might benefit from trastuzumab therapy.
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Affiliation(s)
- Isabelle Vanden Bempt
- Department of Pathology, University Hospital of the Katholieke Universiteit Leuven, Leuven, Belgium.
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Verlinden L, Vanden Bempt I, Eelen G, Drijkoningen M, Verlinden I, Marchal K, De Wolf-Peeters C, Christiaens MR, Michiels L, Bouillon R, Verstuyf A. The E2F-regulated gene Chk1 is highly expressed in triple-negative estrogen receptor /progesterone receptor /HER-2 breast carcinomas. Cancer Res 2007; 67:6574-81. [PMID: 17638866 DOI: 10.1158/0008-5472.can-06-3545] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We previously showed that checkpoint kinase 1 (Chk1) and Claspin, two DNA-damage checkpoint proteins, were down-regulated by 1,25-dihydroxyvitamin D(3), a known inhibitor of cell proliferation. In the present study, we aimed to investigate the transcriptional regulation of Chk1 and Claspin and to study their expression levels in human breast cancer tissue. Transient transfection experiments in MCF-7 breast cancer cells showed that promoter activities of Chk1 and Claspin were regulated by the E2F family of transcription factors. Subsequently, transcript levels of Chk1, Claspin, and E2F1 were determined by quantitative reverse transcriptase-PCR analysis in 103 primary invasive breast carcinomas and were compared with several clinicopathologic variables in breast cancer. A strong correlation was found between Chk1 and Claspin transcript levels. Transcript levels of Chk1, Claspin, and E2F1 were highest in histologic grade 3 tumors and in tumors in which the expression of estrogen receptor (ER) and progesterone receptor (PR) was lost. Moreover, Chk1 expression was significantly elevated in grade 3 breast carcinomas showing a triple-negative ER-/PR-/HER-2- phenotype compared with other grade 3 tumors. Further research is warranted to validate the use of Chk1 inhibitors in triple-negative breast carcinomas for which treatment strategies are limited at present.
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Affiliation(s)
- Lieve Verlinden
- Laboratorium voor Experimentele Geneeskunde en Endocrinologie and CMPG/ESAT, Katholieke Universiteit Leuven, Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
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Vanden Bempt I, Vanhentenrijk V, Drijkoningen M, De Wolf-Peeters C. Comparative expressed sequence hybridization reveals differential gene expression in morphological breast cancer subtypes. J Pathol 2006; 208:486-94. [PMID: 16402338 DOI: 10.1002/path.1911] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this study, comparative expressed sequence hybridization (CESH) has been used to compare gene expression patterns in three morphologically different breast cancer subtypes: classic-type invasive lobular carcinoma (ILC), poorly differentiated ERBB2-negative invasive ductal carcinoma-not otherwise specified (IDC-NOS), and poorly differentiated ERBB2-positive IDC-NOS. CESH allows global detection of chromosomal regions with differential gene expression in a way similar to that of comparative genomic hybridization (CGH). Eight cases of each breast cancer subtype were included in the study. For each subtype, two pools of four cases each were constructed. CESH was used to compare both pools within the same morphological subtype, followed by a comparison of pools belonging to different subtypes. This revealed three chromosomal regions that were differentially expressed in ductal and lobular carcinomas, including relative overexpression at 8q13-q23 and 16q22, and relative underexpression at 8p21-p22. In addition, an expression signature characterized by relative overexpression at 3q24-q26.3, 14q23-31, 17q12, and 20q12-13 was identified for ERBB2-positive IDC-NOS. In summary, CESH analysis highlights chromosomal regions of differential gene expression that are associated with morphologically defined breast cancer subtypes and suggests that regions on chromosome 8 are of interest in the discrimination between ductal and lobular carcinomas. In addition, using CESH, it was possible to identify an ERBB2 expression signature, comprising four chromosomal regions with potential significance in the aggressive behaviour of ERBB2-positive IDC-NOS.
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MESH Headings
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/pathology
- Chromosomes, Human, Pair 8
- Diagnosis, Differential
- Female
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Genes, erbB-2
- Humans
- In Situ Hybridization/methods
- Oligonucleotide Array Sequence Analysis
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Affiliation(s)
- Isabelle Vanden Bempt
- Department of Pathology, University Hospital of KU Leuven, Minderbroedersstraat 12, 3000 Leuven, Belgium.
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