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Kloker LD, Sidiras M, Flaadt T, Brecht IB, Deinzer CKW, Groß T, Benzler K, Zender L, Lauer UM. Clinical management of NUT carcinoma (NC) in Germany: Analysis of survival, therapy response, tumor markers and tumor genome sequencing in 35 adult patients. Lung Cancer 2024; 189:107496. [PMID: 38301600 DOI: 10.1016/j.lungcan.2024.107496] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/03/2024]
Abstract
NUT carcinomas (NC) are very rare and highly aggressive tumors, molecularly defined by an aberrant gene fusion involving the NUTM1 gene. NCs preferentially arise intrathoracically or in the head and neck region, having a highly adverse prognosis with almost no long-term survivors. Here, we report on a cohort of 35 adult NC patients who were evaluated at University Hospital Tuebingen in an eight year time span, i.e. between 2016 and 2023. Primary objectives were overall survival (OS) and influence of primary tumor locations, fusion gene types and staging on OS. Secondary objectives were patient baseline characteristics, risk factors, tumor markers, treatment decisions and responses to therapy comparing thoracic vs non-thoracic origins. Further, data from tumor genome sequencing were analyzed. In this monocentric German cohort, 54 % of patients had thoracic tumors and 65 % harbored a BRD4-NUTM1 fusion gene. Median OS was 7.5 months, being significantly dependent on primary tumor location and nodal status. Initial misdiagnosis was a problem in 31 % of the cases. Surgery was the first treatment in most patients (46 %) and 80 % were treated with polychemotherapies, showing longer progression free survival (PFS) with ifosfamide-based than with platinum-based regimens. Patients treated with an immune checkpoint inhibitor (ICI) in addition to first-line chemotherapy tended to have longer OS. Initial LDH levels could be identified as a prognostic measure for survival prognosis. Sequencing data highlight aberrant NUTM1 fusion genes as unique tumor driver genes. This is the largest adult European cohort of this orphan tumor disease, showing epidemiologic and molecular features as well as relevant clinical data. Awareness to prevent misdiagnosis, fast contact to a specialized nation-wide center and referral to clinical studies are essential as long-term survival is rarely achieved with any of the current therapeutic regimes.
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Affiliation(s)
- Linus D Kloker
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany.
| | - Mirjana Sidiras
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany
| | - Tim Flaadt
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital, Tuebingen, Germany
| | - Ines B Brecht
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital, Tuebingen, Germany
| | - Christoph K W Deinzer
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany
| | - Thorben Groß
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany
| | - Katrin Benzler
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany
| | - Lars Zender
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany; DFG Cluster of Excellence 2180 'Image-guided and Functional Instructed Tumor Therapy', University of Tuebingen, Tuebingen, Germany; National Center for Tumor Diseases (NCT), NCT Tuebingen, a partnership between DKFZ and the University Hospital Tuebingen, Germany
| | - Ulrich M Lauer
- Department of Medical Oncology and Pneumology, Medical University Hospital, Tuebingen, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Tuebingen, Germany; National Center for Tumor Diseases (NCT), NCT Tuebingen, a partnership between DKFZ and the University Hospital Tuebingen, Germany
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