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Rüschoff J, Kumar G, Badve S, Jasani B, Krause E, Rioux-Leclercq N, Rojo F, Martini M, Cheng L, Tretiakova M, Mitchell C, Anders RA, Robert ME, Fahy D, Pyle M, Le Q, Yu L, Glass B, Baxi V, Babadjanova Z, Pratt J, Brutus S, Karasarides M, Hartmann A. Scoring PD-L1 Expression in Urothelial Carcinoma: An International Multi-Institutional Study on Comparison of Manual and Artificial Intelligence Measurement Model (AIM-PD-L1) Pathology Assessments. Virchows Arch 2024; 484:597-608. [PMID: 38570364 DOI: 10.1007/s00428-024-03795-8] [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: 01/10/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
Assessing programmed death ligand 1 (PD-L1) expression on tumor cells (TCs) using Food and Drug Administration-approved, validated immunoassays can guide the use of immune checkpoint inhibitor (ICI) therapy in cancer treatment. However, substantial interobserver variability has been reported using these immunoassays. Artificial intelligence (AI) has the potential to accurately measure biomarker expression in tissue samples, but its reliability and comparability to standard manual scoring remain to be evaluated. This multinational study sought to compare the %TC scoring of PD-L1 expression in advanced urothelial carcinoma, assessed by either an AI Measurement Model (AIM-PD-L1) or expert pathologists. The concordance among pathologists and between pathologists and AIM-PD-L1 was determined. The positivity rate of ≥ 1%TC PD-L1 was between 20-30% for 8/10 pathologists, and the degree of agreement and scoring distribution for among pathologists and between pathologists and AIM-PD-L1 was similar both scored as a continuous variable or using the pre-defined cutoff. Numerically higher score variation was observed with the 22C3 assay than with the 28-8 assay. A 2-h training module on the 28-8 assay did not significantly impact manual assessment. Cases exhibiting significantly higher variability in the assessment of PD-L1 expression (mean absolute deviation > 10) were found to have patterns of PD-L1 staining that were more challenging to interpret. An improved understanding of sources of manual scoring variability can be applied to PD-L1 expression analysis in the clinical setting. In the future, the application of AI algorithms could serve as a valuable reference guide for pathologists while scoring PD-L1.
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Affiliation(s)
- Josef Rüschoff
- Discovery Life Sciences and Pathology Nordhessen, Kassel, Germany.
| | | | - Sunil Badve
- Emory University School of Medicine, Atlanta, GA, USA
| | - Bharat Jasani
- Discovery Life Sciences and Pathology Nordhessen, Kassel, Germany
- University of Cardiff, Cardiff, Wales, UK
| | | | | | - Federico Rojo
- IIS-Fundacion Jimenez Diaz CIBERONC (Madrid), Madrid, Spain
| | | | - Liang Cheng
- Brown University Warren Alpert Medical School and the Legorreta Cancer Center at Brown University, Providence, RI, USA
| | | | | | | | | | | | | | | | | | | | - Vipul Baxi
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | | | | | - Arndt Hartmann
- Comprehensive Cancer Center EMN, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany.
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Jasani B, Taniere P, Schildhaus HU, Blighe K, Parry S, Wilkinson D, Atkey N, Clare-Antony S, McCabe C, Quinn C, Dodson A. Global Ring Study to Investigate the Comparability of Total Assay Performance of Commercial Claudin 18 Antibodies for Evaluation in Gastric Cancer. J Transl Med 2024; 104:100284. [PMID: 37949357 DOI: 10.1016/j.labinv.2023.100284] [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: 07/28/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
Claudin 18.2 (CLDN18.2), the dominant isoform of CLDN18 in gastric tissues, is a highly specific tight junction protein of the gastric mucosa with variably retained expressions in gastric and gastroesophageal junction cancers. Additionally, CLDN18.2-targeted treatment with zolbetuximab, in combination with chemotherapy, has recently been assessed in 2 phase-III studies of patients with HER2-negative, locally advanced, unresectable, or metastatic gastric or gastroesophageal junction adenocarcinoma. These trials used the investigational VENTANA CLDN18 (43-14A) RxDx immunohistochemistry (IHC) assay on the Ventana BenchMark platform to identify patients eligible for CLDN18.2-targeted treatment. We report the findings of a global ring study evaluating the analytical comparability of concordance of the results of 3 CLDN18 antibodies (Ventana, LSBio, and Novus) stained on 3 IHC-staining platforms (Ventana, Dako, and Leica). A tissue microarray (TMA), comprising 15 gastric cancer cases, was stained by 27 laboratories across 11 countries. Each laboratory stained the TMAs using at least 2 of the 3 evaluated CLDN18 antibodies. Stained TMAs were assessed and scored using an agreed IHC-scoring algorithm, and the results were collated for statistical analysis. The data confirmed a high level of concordance for the VENTANA CLDN18 (43-14A; Ventana platform only) and LSBio antibodies on both the Dako and Leica platforms, with accuracy, precision, sensitivity, and specificity rates all reaching a minimum acceptable ≥85% threshold and good-to-excellent levels of concordance as measured by Cohen's kappa coefficient. The Novus antibody showed the highest level of variability against the reference central laboratory results for the same antibody/platform combinations. It also failed to meet the threshold for accuracy and sensitivity when used on either the Dako or Leica platform. These results demonstrated the reliability of IHC testing for CLDN18 expression in gastric tumor samples when using commercially available platforms with an appropriate methodology and primary antibody selection.
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Affiliation(s)
- Bharat Jasani
- Discovery Life Sciences (DLS) Biomarker Services GmbH, Kassel, Germany
| | - Philippe Taniere
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Kevin Blighe
- Clinical Bioinformatics Research Ltd, London, UK
| | - Suzanne Parry
- UK National External Quality Assessment Scheme for Immunocytochemistry & In-Situ Hybridisation, London, UK
| | - Dawn Wilkinson
- UK National External Quality Assessment Scheme for Immunocytochemistry & In-Situ Hybridisation, London, UK
| | | | | | | | | | - Andrew Dodson
- UK National External Quality Assessment Scheme for Immunocytochemistry & In-Situ Hybridisation, London, UK
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Dabbs DJ, Chiriboga LA, Jasani B, Kinloch MA, Miller KD, Nielsen S, Szabolcs MJ, Torlakovic E, Bogen S, Parry S, 't Hart NA. In Support of Magnani and Taylor. Arch Pathol Lab Med 2024; 148:11. [PMID: 38157868 DOI: 10.5858/arpa.2023-0446-le] [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] [Accepted: 09/26/2023] [Indexed: 01/03/2024]
Affiliation(s)
- David J Dabbs
- Department of Pathology, PreludeDx, Laguna Hills, California
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Luis A Chiriboga
- Department of Pathology & Center for Biospecimen Research and Development, NYU Grossman School of Medicine, New York, New York
| | - Bharat Jasani
- Institute of Cancer & Genetics and Department of Cancer Pathology, Cardiff University, Cardiff, Wales, United Kingdom
| | - Mary A Kinloch
- Department of Pathology and Laboratory Medicine, University of Saskatchewan & Saskatoon Health Authority, Saskatoon, Saskatchewan, Canada
| | - Keith D Miller
- Department of Pathology, Institute of Biomedical Science, The Cancer Institute, University College, London Research, London, United Kingdom
| | - Søren Nielsen
- NordiQC, Aalborg, Denmark
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Matthias J Szabolcs
- Department of Pathology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Emina Torlakovic
- Department of Pathology, University of Saskatchewan & Saskatoon Health Authority, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Steve Bogen
- Department of Pathology, Boston Cell Standards & Tufts Medical Center, Boston, Massachusetts
| | - Suzanne Parry
- Department of Immunocytochemistry and In-Situ Hybridisation, UK NEQAS-ICC/ISH, London, United Kingdom
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4
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Mairinger E, Wessolly M, Buderath P, Borchert S, Henrich L, Mach P, Steinborn J, Kimming R, Jasani B, Schmid KW, Bankfalvi A, Mairinger FD. Tumor cell cytoplasmic metallothionein expression associates with differential tumor immunogenicity and prognostic outcome in high-grade serous ovarian carcinoma. Front Oncol 2023; 13:1252700. [PMID: 38023247 PMCID: PMC10663300 DOI: 10.3389/fonc.2023.1252700] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background The underlying mechanism of high T-cell presence as a favorable prognostic factor in high-grade serous ovarian carcinoma (HGSOC) is not yet understood. In addition to immune cells, various cofactors are essential for immune processes. One of those are metallothioneins (MTs), metal-binding proteins comprising various isoforms. MTs play a role in tumor development and drug resistance. Moreover, MTs influence inflammatory processes by regulating zinc homeostasis. In particular, T-cell function and polarization are particularly susceptible to changes in zinc status. The aim of the present study was to investigate a possible role of MT-mediated immune response and its association with prognostic outcome in ovarian cancer. Methods A retrospective study was conducted on a clinically well-characterized cohort of 24 patients with HGSOC treated at the University Hospital of Essen. Gene expression patterns for anti-cancer immunogenicity-related targets were performed using the NanoString nCounter platform for digital gene expression analysis with the appurtenant PanCancer Immune Profiling panel, consisting of 770 targets and 30 reference genes. Tumor-associated immunohistochemical MT protein expression was evaluated using a semi-quantitative four-tier Immunohistochemistry (IHC) scoring. Results MT immunoexpression was detected in 43% (10/23) of all HGSOC samples. MT immunoexpression levels showed a significant association to survival, leading to prolonged progression-free and overall survival in positively stained tumors. Furthermore, T-cell receptor signaling gene signature showed a strong activation in MT-positive tumors. Activated downstream signaling cascades resulting in elevated interferon-gamma expression with a shift in the balance between T helper cells (TH1 and TH2) could be observed in the MT-positive subgroup. In addition, a higher expression pattern of perforin and several granzymes could be detected, overall suggestive of acute, targeted anti-cancer immune response in MT-positive samples. Conclusion This is the first study combining broad, digital mRNA screening of anti-tumor immune response-associated genes and their relation to MT-I/II in ovarian cancer. MT overexpression is associated with molecular characteristics of an anti-cancer immune response and is a strong prognostic marker in ovarian HGSOC. The observed immune cell activation associated with tumor MT expression comprises but is not limited to T cells and natural killer cells.
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Affiliation(s)
- Elena Mairinger
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Michael Wessolly
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - Paul Buderath
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - Sabrina Borchert
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Larissa Henrich
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Pawel Mach
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - Julia Steinborn
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Rainer Kimming
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - Bharat Jasani
- Department of Pathology, Targos - A Discovery Life Sciences Company, Kassel, Germany
| | | | - Agnes Bankfalvi
- Institute of Pathology, University Hospital Essen, Essen, Germany
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Richman SD, Hemmings G, Roberts H, Gallop N, Dodds R, Wilkinson L, Davis J, White R, Yates E, Jasani B, Brown L, Maughan TS, Butler R, Quirke P, Adams R. FOCUS4 biomarker laboratories: from the benefits to the practical and logistical issues faced during 6 years of centralised testing. J Clin Pathol 2023; 76:548-554. [PMID: 35256486 PMCID: PMC7614788 DOI: 10.1136/jclinpath-2022-208233] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/03/2022]
Abstract
AIMS FOCUS4 was a phase II/III umbrella trial, recruiting patients with advanced or metastatic colorectal cancer, between 2014 and 2020. Molecular profiling of patients' formalin-fixed, paraffin-embedded tumour blocks was undertaken at two centralised biomarker laboratories (Leeds and Cardiff), and the results fed directly to the Medical Research Council Clinical Trials Unit, and used for subsequent randomisation. Here the laboratories discuss their experiences. METHODS Following successful tumour content assessment, blocks were sectioned for DNA extraction and immunohistochemistry (IHC). Pyrosequencing was initially used to determine tumour mutation status (KRAS, NRAS, BRAF and PIK3CA), then from 2018 onwards, next-generation sequencing was employed to allow the inclusion of TP53. Protein expression of MLH1, MSH2, MSH6, PMS2 and pTEN was determined by IHC. An interlaboratory comparison programme was initiated, allowing sample exchanges, to ensure continued assay robustness. RESULTS 1291 tumour samples were successfully analysed. Assay failure rates were very low; 1.9%-3.3% for DNA sequencing and 0.9%-1.3% for IHC. Concordance rates of >98% were seen for the interlaboratory comparisons, where a result was obtained by both laboratories. CONCLUSIONS Practical and logistical problems were identified, including poor sample quality and difficulties with sample anonymisation. The often last-minute receipt of a sample for testing and a lack of integration with National Health Service mutation analysis services were challenging. The laboratories benefitted from both pretrial validations and interlaboratory comparisons, resulting in robust assay development and provided confidence during the implementation of new sequencing technologies. We conclude that our centralised approach to biomarker testing in FOCUS4 was effective and successful.
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Affiliation(s)
- Susan D Richman
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Gemma Hemmings
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Helen Roberts
- All Wales Molecular Genetics Laboratory, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | - Niall Gallop
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Rachel Dodds
- All Wales Molecular Genetics Laboratory, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | | | - Jonathan Davis
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Rhian White
- All Wales Molecular Genetics Laboratory, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | - Emma Yates
- MRC Clinical Trials Unit at UCL, London, UK
| | | | | | - Tim S Maughan
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Rachel Butler
- All Wales Molecular Genetics Laboratory, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, UK
| | - Philip Quirke
- Leeds Institute on Medical Research, University of Leeds, Leeds, UK
| | - Richard Adams
- Velindre Cancer Centre, Cardiff University, Cardiff, UK
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Robert ME, Rüschoff J, Jasani B, Graham RP, Badve SS, Rodriguez-Justo M, Kodach LL, Srivastava A, Wang HL, Tang LH, Troncone G, Rojo F, Van Treeck BJ, Pratt J, Shnitsar I, Kumar G, Karasarides M, Anders RA. Erratum to High Interobserver Variability Among Pathologists Using Combined Positive Score to Evaluate PD-L1 Expression in Gastric, Gastroesophageal Junction, and Esophageal Adenocarcinoma [Modern Pathology 36(5) (2023) 100154]. Mod Pathol 2023; 36:100238. [PMID: 37327723 DOI: 10.1016/j.modpat.2023.100238] [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: 06/18/2023]
Affiliation(s)
- Marie E Robert
- Yale University School of Medicine, New Haven, Connecticut.
| | | | | | | | - Sunil S Badve
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Hanlin L Wang
- University of California Los Angeles, Los Angeles, California
| | - Laura H Tang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Federico Rojo
- IIS-Fundacion Jimenez Diaz CIBERONC (Madrid), Madrid, Spain
| | | | | | | | | | | | - Robert A Anders
- Johns Hopkins University, Convergence Institute, Baltimore, Maryland; Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, Maryland.
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7
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Robert ME, Rüschoff J, Jasani B, Graham RP, Badve SS, Rodriguez-Justo M, Kodach LL, Srivastava A, Wang HL, Tang LH, Troncone G, Rojo F, Van Treeck BJ, Pratt J, Shnitsar I, Kumar G, Karasarides M, Anders RA. High Interobserver Variability among Pathologists Using Combined Positive Score to Evaluate PD-L1 Expression in Gastric, Gastroesophageal Junction and Esophageal Adenocarcinoma. Mod Pathol 2023; 36:100154. [PMID: 36925069 DOI: 10.1016/j.modpat.2023.100154] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/17/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
Reliable, reproducible methods to interpret programmed death ligand-1 (PD-L1) expression on tumor cells (TC) and immune cells (IC) are needed for pathologists to inform decisions associated with checkpoint inhibitor therapies. Our international study compared interpathologist agreement of PD-L1 expression using combined positive score (CPS) under standardized conditions on samples from patients with gastric/gastroesophageal junction/esophageal adenocarcinoma. Tissue sections from 100 adenocarcinoma pre-treatment biopsies were stained in a single laboratory using the PD-L1 IHC 28-8 and 22C3(Agilent) pharmDx immunohistochemical assays. PD-L1 CPS was evaluated by 12 pathologists on scanned whole slide images of these biopsies before and after a 2-hour CPS training session by Agilent. Additionally, pathologists determined PD-L1 positive TC, IC, and total viable TC on a single tissue fragment from 35 of 100 biopsy samples. Scoring agreement among pathologists was assessed using the intraclass correlation coefficient (ICC). Interobserver variability for CPS for 100 biopsies was high with only fair agreement among pathologists both pre- (range 0.45 to 0.55) and post-training (range 0.56 to 0.57) for both assays. For the 35 single biopsy samples, poor/fair agreement was also observed for the total number viable TC (ICC 0.09), number of PD-L1 positive IC (ICC 0.19), number of PD-L1 positive TC (ICC 0.54), and calculated CPS (ICC 0.14), while calculated TC score (positive TC/Total TC) showed excellent agreement (ICC 0.82). Retrospective histologic review of samples with the poorest interpathologist agreement revealed (1) ambiguous identification of positively staining stromal cells, (2) faint or variable intensity of staining, (3) difficulty in distinguishing membranous from cytoplasmic tumor staining, and (4) cautery and crush artifact, as possible confounding factors. These results emphasize the need for objective techniques to standardize the interpretation of PD-L1 expression when using the CPS methodology on gastric/gastroesophageal junction cancer biopsies to accurately identify patients most likely to benefit from immune checkpoint inhibitor therapy.
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Affiliation(s)
| | | | | | | | - Sunil S Badve
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Hanlin L Wang
- University of California Los Angeles, Los Angeles, CA, USA
| | - Laura H Tang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Federico Rojo
- IIS-Fundacion Jimenez Diaz CIBERONC (Madrid), Madrid, Spain
| | | | | | | | | | | | - Robert A Anders
- John Hopkins University,; Convergence Institute,; Bloomberg∼Kimmel Intitute for Cancer Immunotherapy Baltimore, MD, USA.
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Jasani B, Schildhaus HU, Dodson A, Parry S, Clare-Antony S, Atkey N, Taniere P. 7P Global ring study determining reproducibility & comparability of CLDN18 testing assays in gastric cancer. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100973] [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] [Indexed: 04/05/2023] Open
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9
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Nuti S, Zhang Y, Zerrouki N, Roach C, Bänfer G, Kumar GL, Manna E, Diezko R, Kersch K, Rüschoff J, Jasani B. High interobserver and intraobserver reproducibility among pathologists assessing PD-L1 CPS across multiple indications. Histopathology 2022; 81:732-741. [PMID: 35993150 DOI: 10.1111/his.14775] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/15/2022] [Revised: 07/18/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022]
Abstract
AIMS A common concern among pathologists scoring PD-L1 immunohistochemical staining is interobserver and intraobserver variability. We assessed interobserver and intraobserver reproducibility of PD-L1 scoring among trained pathologists using combined positive score (CPS; tumour cell and tumour-associated immune cell staining). METHODS AND RESULTS Data were collected for 2 years (2017-2019) from 456 pathologists worldwide. Digital training encompassed unique, tumour-specific training and test sets. Samples were stained using PD-L1 IHC 22C3 pharmDx and evaluated at specific CPS cut-offs for gastric cancer (GC), cervical cancer (CC), urothelial cancer (UC), oesophageal cancer (OC), and head and neck squamous cell carcinoma (HNSCC). Pathologists underwent expert-to-peer training and scored 20 blinded samples on day 1 and 25 blinded samples on day 2 (including 15 of the day 1 samples). Interobserver and intraobserver reproducibility were assessed. For GC (120 observers) and CC (32 observers) samples assessed at CPS ≥1, average interobserver agreement was 91.5% and 91.0%, respectively, and average intraobserver agreement was 90.2% and 96.6%, respectively. For UC (139 observers) and OC (52 observers) samples measured at CPS ≥10, average interobserver agreement was 93.4% and 93.7%, respectively, and average intraobserver agreement was 92.0% and 92.5%, respectively. For HNSCC samples (113 observers), average interobserver agreement was 94.1% at CPS ≥1 and 86.5% at CPS ≥20; intraobserver agreement was 94.7% at CPS ≥1 and 90.5% at CPS ≥20. CONCLUSION The consistently high interobserver and intraobserver concordance rates support the effectiveness of face-to-face training of many global pathologists for scoring PD-L1 CPS across multiple indications at several specific cut-offs.
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Affiliation(s)
- Shanthy Nuti
- Biomarkers and Diagnostics, Oncology, Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc., Rahway, NJ, USA
| | - Yiwei Zhang
- Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Nabila Zerrouki
- Biomarkers and Diagnostics, Oncology, Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc., Rahway, NJ, USA
| | - Charlotte Roach
- Companion Diagnostics, R&D, Agilent Technologies, Inc., Carpinteria, CA, USA
| | - Gudrun Bänfer
- Training & Consulting, Targos Molecular Pathology GmbH, Kassel, Germany
| | - George L Kumar
- Scientific Affairs, Targos Inc, San Bruno, CA, USA.,Current affiliation: Bristol Myers Squibb, Princeton, NJ, USA
| | - Edward Manna
- CDx Pathology, Agilent Technologies, Inc., Carpinteria, CA, USA
| | - Rolf Diezko
- Training & Consulting, Targos Molecular Pathology GmbH, Kassel, Germany
| | - Kristopher Kersch
- Companion Diagnostics, Agilent Technologies, Inc., Carpinteria, CA, USA
| | - Josef Rüschoff
- Department of Pathology, Targos Molecular Pathology GmbH, Kassel, Germany.,Current affiliation: Discovery Life Sciences, Kassel, Germany
| | - Bharat Jasani
- Department of Pathology, Targos Molecular Pathology GmbH, Kassel, Germany.,Current affiliation: Discovery Life Sciences, Kassel, Germany
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10
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Yeung T, Shahroor M, Jain A, Weisz D, Jasani B. Efficacy and safety of high versus standard dose ibuprofen for patent ductus arteriosus treatment in preterm infants: A systematic review and meta-analysis. J Neonatal Perinatal Med 2022; 15:501-510. [PMID: 35404294 DOI: 10.3233/npm-210968] [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] [Indexed: 06/14/2023]
Abstract
BACKGROUND Several small randomized controlled trials (RCTs) and observational studies have compared high (15-20/7.5-10/7.5-10 mg/kg/dose) versus standard dose (10/5/5 mg/kg/dose) ibuprofen for patent ductus arteriosus (PDA) closure, with limited evidence on efficacy and safety. OBJECTIVE To systematically review and meta-analyze studies of high versus standard dose ibuprofen for the closure of PDA in preterm infants. METHODS Databases were searched for RCTs and observational studies assessing high compared to standard dose of ibuprofen for PDA closure for preterm infants until August 2021. The primary outcome was failure of PDA closure after the first course of ibuprofen. The secondary outcomes were the failure of PDA closure after a second course of ibuprofen, rates of PDA ligation, all-cause mortality prior to hospital discharge, bronchopulmonary dysplasia, necrotizing enterocolitis, bleeding disorders, oliguria, and serum creatinine after treatment. RESULTS There were 6 studies with 369 patients (3 RCT, N = 190; 3 observational studies, N = 179). Compared to standard dose, high dose ibuprofen did not significantly decrease the failure rate of PDA closure in preterm infants after the first course (Relative risk (RR) 0.74, 95% confidence interval (CI) 0.53 -1.03, 6 studies, N = 369). High dose ibuprofen significantly decreased the rates of PDA ligation compared to standard dose (RR 0.33, 95% CI 0.16 -0.70, 5 studies, N = 309). INTERPRETATION Based on low-grade evidence, high dose ibuprofen may more effectively reduce rates of PDA ligation compared to standard dose with no increase in adverse effects, neonatal morbidities and mortality.
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Affiliation(s)
- T Yeung
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- Windsor Regional Hospital, Windsor, Canada
- Mount Sinai Hospital, Toronto, Canada
| | - M Shahroor
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- Sunny brook Health Sciences Centre, Toronto, Canada
| | - A Jain
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
| | - D Weisz
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- Sunny brook Health Sciences Centre, Toronto, Canada
| | - B Jasani
- Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
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11
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Schöniger S, Degner S, Zhang Q, Schandelmaier C, Aupperle-Lellbach H, Jasani B, Schoon HA. Tumor Infiltrating Lymphocytes in Pet Rabbit Mammary Carcinomas: A Study with Relevance to Comparative Pathology. Animals (Basel) 2020; 10:ani10081437. [PMID: 32824521 PMCID: PMC7459912 DOI: 10.3390/ani10081437] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023] Open
Abstract
Simple Summary The interaction between tumors and immune cells influences tumor fate, i.e., regression, growth, or even metastases. The evaluation of tumor infiltrating lymphocytes (TILs) in human breast cancer has prognostic value. Pet rabbits develop spontaneous mammary carcinomas and have an immune system that is comparable with that of humans, so that they have the potential to provide an animal model for human breast cancer. To further substantiate this similarity, this study examined TILs in 107 pet rabbit mammary carcinomas according to criteria established for human breast cancer. For TIL evaluation routinely stained microscopic sections were examined by light microscopy. Relevant histological and immunohistochemical tumor characteristics were obtained from a data base. Results showed that increased presence of stromal TILs was statistically associated with histological tumor features indicative of a less aggressive biological behavior, i.e., reduced tumor cell proliferation and a lower histological grade. The expression by tumor cells of calponin, a presumed tumor suppressor protein, was also associated with their reduced proliferation and a higher percentage of stromal TILs. Data suggest that higher percentages of stromal TILs may have the potential to serve as favorable prognostic indicator in rabbit mammary carcinomas and support the value of pet rabbits for comparative research. Abstract Tumor infiltrating lymphocytes (TILs) serve as prognostic biomarker in human breast cancer. Rabbits have the potential to act as animal model for human breast cancer, and close similarities exist between the rabbit and human immune system. The aim of this study is to characterize TILs in pet rabbit mammary carcinomas and to statistically correlate results with histological and immunohistochemical tumor characteristics. Microscopic evaluation of TILs was performed in hematoxylin and eosin stained sections of 107 rabbit mammary carcinomas according to international guidelines for human breast cancer. Data on histological features of malignancy, estrogen and progesterone receptor status and calponin expression were obtained from the data base. This study revealed a statistical association between stromal TILs in the central tumor (CT) and infiltrative margin. Higher maximal percentages of stromal TILs at the CT were statistically correlated with decreased mitotic count and lower tumor grade. An increased number of calponin positive tumor cells was statistically associated with a lower mitotic count and a higher percentage of stromal TILs. Results suggest that higher percentages of stromal TILs are useful biomarkers that may point toward a favorable prognosis in rabbit mammary carcinomas and support the concept of the use of rabbits for translational research.
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Affiliation(s)
- Sandra Schöniger
- Targos Molecular Pathology GmbH, Germaniastrasse 7, 34119 Kassel, Germany;
- Correspondence:
| | - Sophie Degner
- Institute of Veterinary Pathology, University of Leipzig, An den Tierkliniken, 04109 Leipzig, Germany; (S.D.); (H.-A.S.)
| | - Qian Zhang
- Institute of Anatomy, Experimental Neurobiology, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany;
| | - Claudia Schandelmaier
- Laboklin GmbH & Co. KG, Steubenstrasse 4, 97688 Bad Kissingen, Germany; (C.S.); (H.A.-L.)
| | | | - Bharat Jasani
- Targos Molecular Pathology GmbH, Germaniastrasse 7, 34119 Kassel, Germany;
| | - Heinz-Adolf Schoon
- Institute of Veterinary Pathology, University of Leipzig, An den Tierkliniken, 04109 Leipzig, Germany; (S.D.); (H.-A.S.)
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12
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Jasani B, Bänfer G, Fish R, Waelput W, Sucaet Y, Barker C, Whiteley JL, Walker J, Hovelinck R, Diezko R. Evaluation of an online training tool for scoring programmed cell death ligand-1 (PD-L1) diagnostic tests for lung cancer. Diagn Pathol 2020; 15:37. [PMID: 32303234 PMCID: PMC7164334 DOI: 10.1186/s13000-020-00953-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/06/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Numerous studies indicate that higher tumour programmed cell death ligand-1 (PD-L1) expression is associated with greater response to anti-programmed cell death-1 (PD-1)/PD-L1 immunotherapy in non-small cell lung cancer (NSCLC). In the era of precision medicine, there is a need to provide reliable, standardised training for pathologists to improve their accuracy of interpretation and scoring, as the results are used directly to inform clinical decisions. Here we present findings regarding reader reproducibility of PD-L1 tumour cell (TC) staining scoring for NSCLC using a PD-L1 e-trainer tool as part of a PD-L1 immunohistochemistry reader training course. METHODS The PD-L1 training course was developed based on the use of VENTANA PD-L1 (SP263) and Dako PD-L1 IHC PharmDx 22C3 stained NSCLC samples in combination with a PD-L1 e-trainer tool. Five-hundred formalin-fixed, paraffin-embedded archival samples were obtained from commercial sources and stained for PD-L1. Slides were scored by two expert pathologists, then scanned to produce digital images and re-scored. Thirty-three cases were selected and sorted into three sets: a training set and two self-assessment tests (pre-test and 'competence' test). Participants (all selected board-certified pathologists) received face-to-face training including use of an e-trainer tool. Statistical analyses were performed using the competence test set. Overall percentage agreement (OPA) was assessed between the participant pathologists' registered scores and the reference scores assigned by expert pathologists at clinically relevant PD-L1 cut-offs (≥1%, ≥25% and ≥ 50%). RESULTS Seven sessions were held and 69 participant pathologists completed the training. Inter-reader concordance indicated high OPA (85-95%) for PD-L1 TC scoring at clinically relevant cut-offs, with Fleiss' Kappa > 0.5. CONCLUSIONS Use of this web-based training tool incorporated into classroom-style training was associated with an overall moderately good level of inter-reader reproducibility at key cut-offs for TC PD-L1 expression testing in NSCLC. Overall, the online training tool offers a means of standardised training for practising pathologists in a clinical setting.
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Affiliation(s)
- Bharat Jasani
- Pathology Unit, Targos Molecular Pathology GmbH, Kassel, Germany
| | - Gudrun Bänfer
- Advance - Training and Consulting Unit, Targos Molecular Pathology GmbH, Kassel, Germany
| | - Rebecca Fish
- Diagnostic Development Unit, Precision Medicine, R&D Oncology, AstraZeneca, Cambridge, UK
| | - Wim Waelput
- Department of Pathology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | | | - Craig Barker
- Diagnostic Development Unit, Precision Medicine, R&D Oncology, AstraZeneca, Cambridge, UK
| | - Jessica L Whiteley
- Diagnostic Development Unit, Precision Medicine, R&D Oncology, AstraZeneca, Cambridge, UK
| | - Jill Walker
- Oncology Companion Diagnostics Unit, Precision Medicine, R&D Oncology Unit, AstraZeneca, Cambridge, UK
| | | | - Rolf Diezko
- Advance - Training and Consulting Unit, Targos Molecular Pathology GmbH, Kassel, Germany.
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13
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Koppel C, Schwellenbach H, Zielinski D, Eckstein S, Martin-Ortega M, D'Arrigo C, Schildhaus HU, Rüschoff J, Jasani B. Optimization and validation of PD-L1 immunohistochemistry staining protocols using the antibody clone 28-8 on different staining platforms. Mod Pathol 2018; 31:1630-1644. [PMID: 29946185 DOI: 10.1038/s41379-018-0071-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/05/2018] [Accepted: 04/08/2018] [Indexed: 12/13/2022]
Abstract
Several immunohistochemistry (IHC) assays have been developed to assess tumor programmed death-ligand 1 (PD-L1) expression levels in patients who are candidates for programmed death-1 (PD-1)/PD-L1 inhibitor therapy. The PD-L1 IHC 28-8 pharmDx kit is FDA-approved as a complementary diagnostic and CE-marked as an in vitro diagnostic device for nivolumab therapy in melanoma and specific lung cancer subtypes (and for squamous cell carcinoma of the head and neck/urothelial carcinoma in Europe only). Kit availability is limited outside the United States, and its use requires the Dako Autostainer Link 48 platform, which is unavailable in many laboratories. Validated laboratory-developed tests based on 28-8 concentrated antibody outside the kit are needed. This study compared the results from PD-L1 expression level analysis across four immunohistochemistry platforms (Dako Autostainer Link 48, Dako Omnis, Leica Bond-III, and Ventana BenchMark ULTRA) with the 28-8 pharmDx kit in lung cancer (multiple histologies), melanoma, and head and neck cancer (multiple histologies). Samples were prepared per protocol for each platform and stained using PD-L1 IHC 28-8 pharmDx kit on Dako Autostainer Link 48, and per protocol for each platform. The control samples (tonsil and placenta tissue; cell lines with prespecified PD-L1 expression levels) were tested to evaluate the specificity and the sensitivity of test assays. An agreement level of 0.90 with the pharmDx kit was set for each platform. Inter- and intra-assay reliability were assessed. Evaluable samples were lung cancer = 29; melanoma = 31; head and neck cancer = 30. Mean agreement was calculated for PD-L1 expression levels of ≥1%, ≥5%, ≥10%, and ≥50%. Mean overall agreement for all indications was 0.87-0.99. Inter- and intra-assay of scoring/classification repeatability was 100%. Analysis of PD-L1 expression levels using laboratory-developed immunohistochemistry assays with 28-8 antibody may be permissible if the platform is validated using reference samples with defined expression levels.
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Affiliation(s)
| | | | | | - Sina Eckstein
- Institute of Pathology, Universitätsmedizin Göttingen, Göttingen, Germany
| | | | | | | | - Josef Rüschoff
- Targos Molecular Pathology GmbH, Kassel, Germany.,Institute of Pathology Nordhessen, Kassel, Germany
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14
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Abstract
While cyclooxygenase inhibitors have been the most common medications used to facilitate earlier closure of patent ductus arteriosus in preterm infants, adverse effects and variable efficacy have highlighted a need for alternative options. Acetaminophen facilitates ductal closure via an alternate pathway of prostaglandin inhibition. Despite treatment with high doses, toxicity is uncommon in preterm infants, possibly due to immature hepatic metabolism. Pooled data from randomized clinical trials of early treatment demonstrate that acetaminophen has similar efficacy as cyclooxygenase inhibitors for PDA closure with a favorable side effect profile and without any apparent increase in adverse neonatal outcomes. Acetaminophen may therefore be an ideal first-line agent among moderately and extremely preterm infants, though there is a paucity of data from controlled trials regarding its use in infants at the border of viability (gestation age ≤25 weeks). Evidence from clinical studies of limited quality supports acetaminophen treatment as rescue therapy for infants with persistent PDA after unsuccessful cyclooxygenase inhibitor treatment, including those being considered for surgical ligation.
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Affiliation(s)
- B Jasani
- Division of Neonatology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada; Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - D E Weisz
- Department of Paediatrics, University of Toronto, Toronto, Canada; Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - P J McNamara
- Division of Neonatology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Canada.
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15
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Mairinger FD, Schmeller J, Borchert S, Wessolly M, Mairinger E, Kollmeier J, Hager T, Mairinger T, Christoph DC, Walter RFH, Eberhardt WEE, Plönes T, Wohlschlaeger J, Jasani B, Schmid KW, Bankfalvi A. Immunohistochemically detectable metallothionein expression in malignant pleural mesotheliomas is strongly associated with early failure to platin-based chemotherapy. Oncotarget 2018; 9:22254-22268. [PMID: 29854276 PMCID: PMC5976462 DOI: 10.18632/oncotarget.24962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 08/18/2017] [Accepted: 03/11/2018] [Indexed: 12/13/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a biologically highly aggressive tumor arising from the pleura with a dismal prognosis. Cisplatin is the drug of choice for the treatment of MPM, and carboplatin seems to have comparable efficacy. Nevertheless, cisplatin treatment results in a response rate of merely 14% and a median survival of less than seven months. Due to their role in many cellular processes, methallothioneins (MTs) have been widely studied in various cancers. The known heavy metal detoxifying effect of MT-I and MT-II may be the reason for heavy metal drug resistance of various cancers including MPM. Methods 105 patients were retrospectively analyzed immunohistochemically for their MT expression levels. Survival analysis was done by Cox-regression, and statistical significance determined using likelihood ratio, Wald test and Score (logrank) tests. Results Cox-regression analyses were done in a linear and logarithmic scale revealing a significant association between expression of MT and shortened overall survival (OS) in a linear (p=0.0009) and logarithmic scale (p=0.0003). Reduced progression free survival (PFS) was also observed for MT expressing tumors (linear: p=0.0134, log: p=0.0152). Conclusion Since both, overall survival and progression-free survival are negatively correlated with detectable MT expression in MPM, our results indicate a possible resistance to platin-based chemotherapy associated with MT expression upregulation, found exclusively in progressive MPM samples. Initial cell culture studies suggest promoter DNA hypomethylation and expression of miRNA-566 a direct regulator of copper transporter SLC31A1 and a putative regulator of MT1A and MT2A gene expression, to be responsible for the drug resistance.
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Affiliation(s)
- Fabian D Mairinger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Schmeller
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sabrina Borchert
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Wessolly
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elena Mairinger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jens Kollmeier
- Department of Pneumology, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Thomas Hager
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Mairinger
- Department of Pathology, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Daniel C Christoph
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Internistic Oncology, Kliniken Essen Mitte, Essen, Germany
| | - Robert F H Walter
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Ruhrlandklinik, West German Lung Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Ruhrlandklinik, West German Lung Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery and Thoracical Endoscopy, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jeremias Wohlschlaeger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Pathology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - Bharat Jasani
- Department of Pathology, Targos Molecular Pathology GmbH, Kassel, Germany
| | - Kurt Werner Schmid
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Agnes Bankfalvi
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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16
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Scheel AH, Penault-Llorca F, Hanna W, Baretton G, Middel P, Burchhardt J, Hofmann M, Jasani B, Rüschoff J. Physical basis of the 'magnification rule' for standardized Immunohistochemical scoring of HER2 in breast and gastric cancer. Diagn Pathol 2018. [PMID: 29530054 PMCID: PMC5848460 DOI: 10.1186/s13000-018-0696-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Indexed: 01/22/2023] Open
Abstract
Background Detection of HER2/neu receptor overexpression and/or amplification is a prerequisite for efficient anti-HER2 treatment of breast and gastric carcinomas. Immunohistochemistry (IHC) of the HER2 protein is the most common screening test, thus precise and reproducible IHC-scoring is of utmost importance. Interobserver variance still is a problem; in particular in gastric carcinomas the reliable differentiation of IHC scores 2+ and 1+ is challenging. Herein we describe the physical basis of what we called the ‘magnification rule’: Different microscope objectives are employed to reproducibly subdivide the continuous spectrum of IHC staining intensities into distinct categories (1+, 2+, 3+). Methods HER2-IHC was performed on 120 breast cancer biopsy specimens (n = 40 per category). Width and color-intensity of membranous DAB chromogen precipitates were measured by whole-slide scanning and digital morphometry. Image-analysis data were related to semi-quantitative manual scoring according to the magnification rule and to the optical properties of the employed microscope objectives. Results The semi-quantitative manual HER2-IHC scores are correlated to color-intensity measured by image-analysis and to the width of DAB-precipitates. The mean widths ±standard deviations of precipitates were: IHC-score 1+, 0.64 ± 0.1 μm; score 2+, 1.0 ± 0.23 μm; score 3+, 2.14 ± 0.4 μm. The width of precipitates per category matched the optical resolution of the employed microscope objective lenses: Approximately 0.4 μm (40×), 1.0 μm (10×) and 2.0 μm (5×). Conclusions Perceived intensity, width of the DAB chromogen precipitate, and absolute color-intensity determined by image-analysis are linked. These interrelations form the physical basis of the ‘magnification rule’: 2+ precipitates are too narrow to be observed with 5× microscope objectives, 1+ precipitates are too narrow for 10× objectives. Thus, the rule uses the optical resolution windows of standard diagnostic microscope objectives to derive the width of the DAB-precipitates. The width is in turn correlated with color-intensity. Hereby, the more or less subjective estimation of IHC scores based only on the staining-intensity is replaced by a quasi-morphometric measurement. The principle seems universally applicable to immunohistochemical stainings of membrane-bound biomarkers that require an intensity-dependent scoring. Electronic supplementary material The online version of this article (10.1186/s13000-018-0696-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas H Scheel
- Institute of Pathology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Frédérique Penault-Llorca
- Département de Pathologie, Centre Jean-Perrin, 58, rue Montalembert, 392, 63011, Clermont-Ferrand cedex 1, BP, France
| | - Wedad Hanna
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Gustavo Baretton
- Institute of Pathology, University Hospital Dresden, Fetscherstr, 74, 01307, Dresden, Germany
| | - Peter Middel
- Institute of Pathology Nordhessen, Germaniastraße 7, 34119, Kassel, Germany.,Institute of Pathology, University Hospital Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Judith Burchhardt
- Institute of Pathology Nordhessen, Germaniastraße 7, 34119, Kassel, Germany
| | - Manfred Hofmann
- Institute of Pathology Nordhessen, Germaniastraße 7, 34119, Kassel, Germany
| | - Bharat Jasani
- Targos Molecular Pathology GmbH, Germaniastraße 7, 34119, Kassel, Germany
| | - Josef Rüschoff
- Institute of Pathology Nordhessen, Germaniastraße 7, 34119, Kassel, Germany.,Targos Molecular Pathology GmbH, Germaniastraße 7, 34119, Kassel, Germany
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17
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Scheel AH, Baenfer G, Baretton G, Dietel M, Diezko R, Henkel T, Heukamp LC, Jasani B, Jöhrens K, Kirchner T, Lasitschka F, Petersen I, Reu S, Schildhaus HU, Schirmacher P, Schwamborn K, Sommer U, Stoss O, Tiemann M, Warth A, Weichert W, Wolf J, Büttner R, Rüschoff J. Interlaboratory concordance of PD-L1 immunohistochemistry for non-small-cell lung cancer. Histopathology 2017; 72:449-459. [PMID: 28851100 DOI: 10.1111/his.13375] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 05/07/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022]
Abstract
AIMS Programmed death ligand 1 (PD-L1) immunohistochemistry has become a mandatory diagnostic test in the treatment of lung cancer. Several research initiatives have started to harmonise the five PD-L1 immunohistochemistry assays that have been used in clinical trials. Here, we report data on interlaboratory and interassay concordance for commercial assays ('assays') and laboratory-developed tests (LDTs) at 10 German testing sites. METHODS AND RESULTS To assess interlaboratory concordance, a tissue microarray containing 21 pulmonary carcinoma specimens was centrally prepared. Pre-cut sections were stained at 10 sites by the use of assays 28-8, 22C3, SP263, and SP142, as well as 11 LDTs. Assay performance was evaluated with a second tissue microarray containing 11 cell lines with defined PD-L1 expression. Quality control was centrally performed by manual and digital analyses. The assays yielded reproducible IHC staining patterns at all sites. In agreement with previous studies, 22C3, 28-8 and SP263 showed similar staining patterns, whereas SP142 was distinct. Among the LDTs, six of 11 protocols showed staining patterns similar to those of assays 22C3 and 28-8. Interlaboratory concordance of tumour cell scoring by use of a six-step system was moderate (Light's κ = 0.43-0.69), whereas the clinically approved cut-offs of ≥1% and ≥50% showed substantial concordance (κ = 0.73-0.89). Immune cell scoring by the use of SP142 yielded moderate concordance (κ = 0.42). CONCLUSIONS The data confirm the previously described staining patterns of the assays, and show that they can be reproducibly employed at different sites. LDTs with staining results similar to those of the assays are implementable, but have to be carefully validated.
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Affiliation(s)
- Andreas H Scheel
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | | | - Gustavo Baretton
- Institute of Pathology, University Hospital Dresden, Dresden, Germany
| | - Manfred Dietel
- Institute of Pathology, Charité-University Hospital Berlin, Berlin, Germany
| | - Rolf Diezko
- Targos Molecular Pathology GmbH, Kassel, Germany
| | | | | | | | - Korinna Jöhrens
- Institute of Pathology, Charité-University Hospital Berlin, Berlin, Germany
| | - Thomas Kirchner
- Institute of Pathology, LMU University Hospital Munich, Munich, Germany
| | - Felix Lasitschka
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Iver Petersen
- Institute of Pathology, University Hospital Jena, Jena, Germany
| | - Simone Reu
- Institute of Pathology, LMU University Hospital Munich, Munich, Germany
| | | | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Ulrich Sommer
- Institute of Pathology, University Hospital Dresden, Dresden, Germany
| | - Oliver Stoss
- Targos Molecular Pathology GmbH, Kassel, Germany
| | - Markus Tiemann
- Institute for Haematopathology Hamburg, Hamburg, Germany
| | - Arne Warth
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wilko Weichert
- Institute of Pathology, TUM University Hospital Munich, Munich, Germany
| | - Jürgen Wolf
- Medical Clinic I, University Hospital Cologne, Cologne, Germany
| | - Reinhard Büttner
- Institute of Pathology, University Hospital Cologne, Cologne, Germany.,Targos Molecular Pathology GmbH, Kassel, Germany
| | - Josef Rüschoff
- Targos Molecular Pathology GmbH, Kassel, Germany.,Institute of Pathology Nordhessen, Kassel, Germany
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18
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Jasani B, Patole S. Standardized feeding regimen for reducing necrotizing enterocolitis in preterm infants: an updated systematic review. J Perinatol 2017; 37:827-833. [PMID: 28358382 DOI: 10.1038/jp.2017.37] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/31/2016] [Accepted: 02/21/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A systematic review (2005) of observational studies has reported 87% reduction in the incidence of necrotizing enterocolitis (NEC) after introducing standardized feeding regimen (SFR) in preterm infants. Considering the many new studies in this field since 2005 and the continued health burden of NEC, we aimed to systematically review the incidence of NEC in preterm infants 'before' vs 'after' implementing a SFR. STUDY DESIGN PubMed, EMBASE, CINAHL and E-abstracts from the Pediatric Academic Society meetings and other pediatric and neonatal conference proceedings were searched in May 2016. Observational studies reporting incidence of NEC before and after implementing a SFR were included. Relevant data were extracted independently by two reviewers. Meta-analysis was conducted using random effects model (REM) and results rechecked with fixed effects model. RESULTS Pooled results from 15 observational studies (N=18 160) using REM showed that SFR significantly reduced the incidence of NEC (risk ratio 0.22; 95% confidence interval 0.13 to 0.36; P<0.00001; I2=74%). The results remained significant after comparing studies in two epochs (1978 to 2003 vs 2004 to 2016). CONCLUSION SFR continues to be an important tool in prevention of NEC in preterm infants.
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Affiliation(s)
- B Jasani
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, WA, Australia
| | - S Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, WA, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
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19
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Scheel AH, Bänfer G, Baretton GB, Dietel M, Diezko R, Henkel T, Heukamp LC, Jasani B, Jöhrens K, Kirchner T, Petersen I, Reu S, Schildhaus HU, Schirmacher P, Tiemann M, Warth A, Weichert W, Wolf J, Rüschoff J, Buettner R. Interlaboratory-concordance of PD-L1 IHC for NSCLC. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20508] [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: 11/20/2022] Open
Abstract
e20508 Background: Immunohistochemistry (IHC) of the PD-L1 protein has become a mandatory diagnostic test for NSCLC. We conducted a two-step round robin test to analyze interobserver- and interlaboratory-concordance of PD-L1 IHC and to compare four clinical trial assays (CTAs; 28-8, 22C3, SP264, SP142) and laboratory-developed tests (LDTs). Results of step-one showed that reproducible PD-L1 IHC scoring is feasible; here we present the data on interlaboratory concordance Methods: Interlaboratory-concordance was tested by a centrally prepared tissue-microarray containing 21 NSCLC specimens that was stained at ten sites using CTAs and LDTs. Assay-performance was assessed with a second tissue-microarray containing eleven cell-lines with defined PD-L1 expression. Slides were evaluated by central quality-control and image-analysis. Results: The four CTAs yielded reproducible IHC-stainings at all sites while the results of the LDTs were mixed: Six protocols showed appropriate IHC quality with staining patterns similar to 22C3 and 28-8 CTAs, five protocols yielded less DAB-deposits and reduced staining intensity. Interlaboratory-concordance of carcinoma cell scoring using the 6-step system was moderate (κ = 0.43-0.69) while the included cut-offs ≥1% and ≥50% showed substantial concordance for the CTAs (κ = 0.73-0.89) and moderate concordance for the LDTs (κ = 0.50). No significant differences in interlaboratory-concordance were found among the CTAs. However, differences in the resulting staining patterns were noticed: While 22C3 and 28-8 showed similar staining patterns, SP263 showed minor differences in some cases and SP142 showed distinct patterns. Conclusions: The data show that the PD-L1 CTAs can be reproducibly employed and scored at different sites. LDTs with staining patterns similar to the CTAs are possible yet have to be carefully calibrated to match the appropriate intensity-range. The choice of assay and the set-up of the IHC-protocol may strongly influence the resulting staining.
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Affiliation(s)
- Andreas H. Scheel
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | | | | | - Manfred Dietel
- Institute of Pathology, Charité University Hospital, Berlin, Germany
| | - Rolf Diezko
- Targos Molecular Pathology GmbH, Kassel, Germany
| | | | - Lukas C. Heukamp
- Haematopathology Hamburg and NEO New Oncology GmbH, Hamburg, Germany
| | | | - Korinna Jöhrens
- Institute of Pathology, Charité University Hospital, Campus Berlin-Mitte, Berlin, Germany
| | - Thomas Kirchner
- Department of Pathology, University of Munich, Muenchen, Germany
| | - Iver Petersen
- Institute of Pathology, University Hospital Jena, Jena, Germany
| | - Simone Reu
- LMU Munich, Institute of Pathology, Munich, Germany
| | | | | | | | - Arne Warth
- Translational Lung Research Center Heidelberg, Universitätsklinikum Heidelberg, Department of Pathology, Heidelberg, Germany
| | | | - Juergen Wolf
- Lung Cancer Group Cologne, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Josef Rüschoff
- Institut für Pathologie, Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany
| | - Reinhard Buettner
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
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Jasani B, Navabi N, Barrett-Lee P, Thompson A, Chester J, Mason M. Abstract P3-14-07: Intra-cellular dsRNA receptor RIG-I: A ubiquitous novel target for treatment of chemotherapy drug resistant breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-14-07] [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
INTRODUCTION: Toll-like receptor 3 (TLR3), the cell surface receptor for double stranded RNA (dsRNA), expressed in ∼40% of advanced primary breast cancers (T2/T3/N+) has been shown to be an effective therapeutic target for synthetic dsRNA poly A:U in combination with radiation and adjuvant chemotherapy, producing a significant decrease in risk of metastatic relapse (HR 1.85-2.0; 1.03-3.89; Cancer Res;71:1607).
AIM: The present pre-clinical study aimed to explore the therapeutic potential of a ubiquitously expressed intracellular dsRNA receptor, retinoic-acid-inducible gene-I (RIG-I) - a cytoplasmic pathogen recognition receptor directed at pathogen-associated molecular pattern (PAMP) motifs to differentiate viral from cellular dsRNAs. We have shown Ampligen, poly I:C12U (a synthetic dsRNA polymer designed to rapidly degrade in vivo to prevent the toxicity of long dsRNA polymers such as poly I:C) is capable of entering cells in its fragmented dsRNA oligomeric form (<1–2 kb) optimal for activation of intra-cellular RIG-I (J Exp Med 2008;205:1601–1610).
METHODOLOGY & RESULTS: Preliminary experiments with Ampligen on several human breast cancer cell lines (MCF-7 & MDA-MB 453) and normal human mammary epithelial & fibroblast cell lines (HMEC & HFC) unexpectedly showed it to consistently cause a significant loss of cell viability (CellTiter-Glo Luminescent Cell Viability Assay) in p53-deficient drug resistant (5-FU/doxorubicin) MDA-MB 453 cell line in contrast to cell growth arrest (Guava cell Cycle Assay) in p53 wild type MCF-7 cancer and the two non-neoplastic cells lines. This selective effect was confirmed using syngeneic clones of MCF-7 breast cancer cells stably transfected with a dominant negative p53 construct or vector alone: p53-function blocked (DD1) vs p53-function active (EV1) MCF-7 cell lines, respectively (J Nucl Med 2006; 47:1525–1530), and shown to be associated with RIG-I specific mRNA induction (RT-PCR) and Type I interferon pathway activation both inhibited by BX795 (selective inhibitor of IRF3 activation and IFN-b production). Decitabine (DNA demethylating drug capable of intra-cellular generation of dsRNA through transcriptional activation of Alu retrotransposons - PNAS 2012; December 10: E89–E98 ) was next tested as an alternative source of intra-cellular dsRNA, and found to produce results similar to Ampligen on DD1 and EV1. Work is in progress to examine dose response and time-course relationships of the effects Ampligen or decitabine added singly or in combination with chemotherapeutic drug (e.g. doxorubicin) on DD1 and triple negative breast cancer cell lines such as MDA-MB 453 to explore potential therapeutically most effective protocols.
PROVISIONAL CONCLUSIONS: Intra-cellular dsRNA receptor RIG-I constitutively expressed in all cells offers a more ubiquitous target compared to TLR3 for the treatment of breast cancer. Ampligen and decitabine with their selective growth inhibitory effect on drug resistant p53-deficient breast cancer cell lines, merit testing as novel drugs for treatment of p53-deficient drug resistant breast cancer e.g. triple negative breast cancer frequently (∼70%) associated with drug resistance and altered p53 status.
Citation Format: Jasani B, Navabi N, Barrett-Lee P, Thompson A, Chester J, Mason M. Intra-cellular dsRNA receptor RIG-I: A ubiquitous novel target for treatment of chemotherapy drug resistant breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-14-07.
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Affiliation(s)
- B Jasani
- Nazarbayev University School of Medicine, Astana, Kazakhstan; Velindre Cancer Centre, Velindre Hospital NHS Trust, Cardiff, Wales, United Kingdom; James Arrott Drive Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, United Kingdom; Institute of Cancer & Genetics, Cardiff University, Cardiff, Wales, United Kingdom
| | - N Navabi
- Nazarbayev University School of Medicine, Astana, Kazakhstan; Velindre Cancer Centre, Velindre Hospital NHS Trust, Cardiff, Wales, United Kingdom; James Arrott Drive Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, United Kingdom; Institute of Cancer & Genetics, Cardiff University, Cardiff, Wales, United Kingdom
| | - P Barrett-Lee
- Nazarbayev University School of Medicine, Astana, Kazakhstan; Velindre Cancer Centre, Velindre Hospital NHS Trust, Cardiff, Wales, United Kingdom; James Arrott Drive Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, United Kingdom; Institute of Cancer & Genetics, Cardiff University, Cardiff, Wales, United Kingdom
| | - A Thompson
- Nazarbayev University School of Medicine, Astana, Kazakhstan; Velindre Cancer Centre, Velindre Hospital NHS Trust, Cardiff, Wales, United Kingdom; James Arrott Drive Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, United Kingdom; Institute of Cancer & Genetics, Cardiff University, Cardiff, Wales, United Kingdom
| | - J Chester
- Nazarbayev University School of Medicine, Astana, Kazakhstan; Velindre Cancer Centre, Velindre Hospital NHS Trust, Cardiff, Wales, United Kingdom; James Arrott Drive Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, United Kingdom; Institute of Cancer & Genetics, Cardiff University, Cardiff, Wales, United Kingdom
| | - M Mason
- Nazarbayev University School of Medicine, Astana, Kazakhstan; Velindre Cancer Centre, Velindre Hospital NHS Trust, Cardiff, Wales, United Kingdom; James Arrott Drive Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, United Kingdom; Institute of Cancer & Genetics, Cardiff University, Cardiff, Wales, United Kingdom
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Richman SD, Adams R, Quirke P, Butler R, Hemmings G, Chambers P, Roberts H, James MD, Wozniak S, Bathia R, Pugh C, Maughan T, Jasani B. Pre-trial inter-laboratory analytical validation of the FOCUS4 personalised therapy trial. J Clin Pathol 2016; 69:35-41. [PMID: 26350752 PMCID: PMC4717430 DOI: 10.1136/jclinpath-2015-203097] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Received: 04/23/2015] [Accepted: 07/03/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Molecular characterisation of tumours is increasing personalisation of cancer therapy, tailored to an individual and their cancer. FOCUS4 is a molecularly stratified clinical trial for patients with advanced colorectal cancer. During an initial 16-week period of standard first-line chemotherapy, tumour tissue will undergo several molecular assays, with the results used for cohort allocation, then randomisation. Laboratories in Leeds and Cardiff will perform the molecular testing. The results of a rigorous pre-trial inter-laboratory analytical validation are presented and discussed. METHODS Wales Cancer Bank supplied FFPE tumour blocks from 97 mCRC patients with consent for use in further research. Both laboratories processed each sample according to an agreed definitive FOCUS4 laboratory protocol, reporting results directly to the MRC Trial Management Group for independent cross-referencing. RESULTS Pyrosequencing analysis of mutation status at KRAS codons12/13/61/146, NRAS codons12/13/61, BRAF codon600 and PIK3CA codons542/545/546/1047, generated highly concordant results. Two samples gave discrepant results; in one a PIK3CA mutation was detected only in Leeds, and in the other, a PIK3CA mutation was only detected in Cardiff. pTEN and mismatch repair (MMR) protein expression was assessed by immunohistochemistry (IHC) resulting in 6/97 discordant results for pTEN and 5/388 for MMR, resolved upon joint review. Tumour heterogeneity was likely responsible for pyrosequencing discrepancies. The presence of signet-ring cells, necrosis, mucin, edge-effects and over-counterstaining influenced IHC discrepancies. CONCLUSIONS Pre-trial assay analytical validation is essential to ensure appropriate selection of patients for targeted therapies. This is feasible for both mutation testing and immunohistochemical assays and must be built into the workup of such trials. TRIAL REGISTRATION NUMBER ISRCTN90061564.
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Affiliation(s)
- Susan D Richman
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James Hospital, Leeds, UK
| | - Richard Adams
- Institute of Cancer & Genetics, Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Phil Quirke
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James Hospital, Leeds, UK
| | - Rachel Butler
- Cardiff and Vale UHB-Medical Genetics University Hospital of Wales, Heath Park, Cardiff, UK
| | - Gemma Hemmings
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James Hospital, Leeds, UK
| | - Phil Chambers
- Department of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, St James Hospital, Leeds, UK
| | - Helen Roberts
- Cardiff and Vale UHB-Medical Genetics University Hospital of Wales, Heath Park, Cardiff, UK
| | - Michelle D James
- Cardiff and Vale UHB- Histopathology University Hospital of Wales, Heath Park, Cardiff, UK
| | - Sue Wozniak
- Cardiff and Vale UHB- Histopathology University Hospital of Wales, Heath Park, Cardiff, UK
| | | | | | - Timothy Maughan
- Gray Laboratories, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Bharat Jasani
- Institute of Cancer and Genetics, Heath Park, Cardiff, UK
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22
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Campbell L, Jasani B, Griffiths DFR, Gumbleton M. Phospho-4e-BP1 and eIF4E overexpression synergistically drives disease progression in clinically confined clear cell renal cell carcinoma. Am J Cancer Res 2015; 5:2838-2848. [PMID: 26609489 PMCID: PMC4633910] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/04/2015] [Indexed: 06/05/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC), the most aggressive and lethal form of renal cell carcinoma accounts for over 90% of metastasis that occur following curative surgery for clinically confined disease. High relapse rates have prompted the evaluation of targeted therapies for the prevention or delay of metastatic disease in high-risk patients, with biomarkers offering significant potential to guide and improve patient management in this setting. In this current study we examined the value of the 4E-BP1/eIF4E axis for prognostic significance and risk stratification in patients with clinically confined ccRCC. This axis is a critical convergence point for many signalling pathways that are targeted by current therapies for the treatment of advanced RCC. Immunohistochemistry for phosphorylated 4E-BP1 (p4E-BP1) and total eIF4E was performed on tissue microarrays containing tumour cores from 135 patients with localised ccRCC. For both biomarkers 39% of all evaluable cores stained positive, with a strong correlation observed between the presence of p4E-BP1 and the overexpression of eIF4E within the same tumour (P = 0.005). Further, the combined expression of p4E-BP1 and eIF4E was associated with significantly worse disease-free survival of 2.9 vs 5.7 yrs compared to patients whose tumours expressed only one, or neither, of the biomarkers (P < 0.001). Cox-regression analysis confirmed the ability of the p4EBP1/eIF4E signature to independently identify high-risk patients with a Hazard Ratio of 4.2 (CI = 2.1-8.6; P < 0.001), compared to 3.3 for tumour grade 3 and 4, and 2.3 for tumour stage 3 and 4. These data show the powerful prognostic value of the p4E-BP1/eIF4E signature for potential management of patients with clinically confined ccRCC, and in addition provides insights into the possible key synergistic determinants of disease progression and treatment response.
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Affiliation(s)
- Lee Campbell
- Experimental Therapeutics, School of Pharmacy and Pharmaceutical Sciences, Cardiff UniversityCardiff, CF10 3NB, UK
- Cancer Research Wales, Velindre Cancer CentreCardiff, CF14 2TL, UK
| | - Bharat Jasani
- School of Medicine, Cardiff UniversityHeath Park, Cardiff, CF14 4YS, UK
| | | | - Mark Gumbleton
- Experimental Therapeutics, School of Pharmacy and Pharmaceutical Sciences, Cardiff UniversityCardiff, CF10 3NB, UK
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Hutchinson RA, Adams RA, McArt DG, Salto-Tellez M, Jasani B, Hamilton PW. Epidermal growth factor receptor immunohistochemistry: new opportunities in metastatic colorectal cancer. J Transl Med 2015; 13:217. [PMID: 26149458 PMCID: PMC4492076 DOI: 10.1186/s12967-015-0531-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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] [Received: 01/24/2015] [Accepted: 05/12/2015] [Indexed: 02/06/2023] Open
Abstract
The treatment of cancer is becoming more precise, targeting specific oncogenic drivers with targeted molecular therapies. The epidermal growth factor receptor has been found to be over-expressed in a multitude of solid tumours. Immunohistochemistry is widely used in the fields of diagnostic and personalised medicine to localise and visualise disease specific proteins. To date the clinical utility of epidermal growth factor receptor immunohistochemistry in determining monoclonal antibody efficacy has remained somewhat inconclusive. The lack of an agreed reproducible scoring criteria for epidermal growth factor receptor immunohistochemistry has, in various clinical trials yielded conflicting results as to the use of epidermal growth factor receptor immunohistochemistry assay as a companion diagnostic. This has resulted in this test being removed from the licence for the drug panitumumab and not performed in clinical practice for cetuximab. In this review we explore the reasons behind this with a particular emphasis on colorectal cancer, and to suggest a way of resolving the situation through improving the precision of epidermal growth factor receptor immunohistochemistry with quantitative image analysis of digitised images complemented with companion molecular morphological techniques such as in situ hybridisation and section based gene mutation analysis.
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Affiliation(s)
- Ryan A Hutchinson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
- Waring Laboratory, Department of Pathology, Centre for Translational Pathology, University of Melbourne, Parkville, 3010, VIC, Australia.
| | - Richard A Adams
- Institute of Cancer and Genetics, Cardiff University School of Medicine, Institute of Medical Genetics Building, Heath Park, Cardiff, CF14 4XN, UK.
| | - Darragh G McArt
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
| | - Manuel Salto-Tellez
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
| | - Bharat Jasani
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, 010000, Kazakhstan.
| | - Peter W Hamilton
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
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Brunelli M, Nottegar A, Bogina G, Caliò A, Cima L, Eccher A, Vicentini C, Marcolini L, Scarpa A, Pedron S, Brunello E, Knuutila S, Sapino A, Marchiò C, Bria E, Molino A, Carbognin L, Tortora G, Jasani B, Miller K, Merdol I, Zanatta L, Laurino L, Wirtanen T, Zamboni G, Marconi M, Chilosi M, Manfrin E, Martignoni G, Bonetti F. Monosomy of chromosome 17 in breast cancer during interpretation of HER2 gene amplification. Am J Cancer Res 2015; 5:2212-2221. [PMID: 26328251 PMCID: PMC4548332] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 06/11/2015] [Indexed: 06/04/2023] Open
Abstract
Monosomy of chromosome 17 may affect the assessment of HER2 amplification. Notably, the prevalence ranges from 1% up to 49% due to lack of consensus in recognition. We sought to investigate the impact of monosomy of chromosome 17 to interpretation of HER2 gene status. 201 breast carcinoma were reviewed for HER2 gene amplification and chromosome 17 status. FISH analysis was performed by using double probes (LSI/CEP). Absolute gene copy number was also scored per each probe. HER2 FISH test was repeated on serial tissue sections, ranging in thickness from 3 to 20 µm. Ratio was scored and subsequently corrected by monosomy after gold control test using the aCGH method to overcome false interpretation due to artefactual nuclear truncation. HER2 immunotests was performed on all cases. 26/201 cases were amplified (13%). Single signals per CEP17 were revealed in 7/201 (3.5%) cases. Five out of 7 cases appeared monosomic with aCGH (overall, 5/201, 2.5%) and evidenced single signals in >60% of nuclei after second-look on FISH when matching both techniques. Among 5, one case showed amplification with a pattern 7/1 (HER2/CEP17>2) of copies (3+ at immunotest); three cases revealed single signals per both probes (LSI/CEP=1) and one case revealed a 3:1 ratio; all last 4 cases showed 0/1+ immunoscore. We concluded that: 1) monosomy of chromosome 17 may be observed in 2.5% of breast carcinoma; 2) monosomy of chromosome 17 due to biological reasons rather than nuclear truncation was observed when using the cut-off of 60% of nuclei harboring single signals; 3) the skewing of the ratio due to single centromeric 17 probe may lead to false positive evaluation; 4) breast carcinomas showing a 3:1 ratio (HER2/CEP17) usually show negative 0/1+ immunoscore and <6 gene copy number at FISH.
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Affiliation(s)
- Matteo Brunelli
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Alessia Nottegar
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Giuseppe Bogina
- Anatomic Pathology, Sacro Cuore Don Calabria HospitalNegrar, Italy
| | - Anna Caliò
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Luca Cima
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | | | - Lisa Marcolini
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Aldo Scarpa
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
- ARC-NET Applied Research Centre, University of VeronaItaly
| | - Serena Pedron
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Eleonora Brunello
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Sakari Knuutila
- Department of Pathology, Laboratory of Molecular Cytogenetic, University of HelsinkiFinland
| | - Anna Sapino
- Department of Medical Sciences, Anatomic Pathology, University and Hospital TrustTurin, Italy
| | - Caterina Marchiò
- Department of Medical Sciences, Anatomic Pathology, University and Hospital TrustTurin, Italy
| | - Emilio Bria
- Medical Oncology, University and Hospital TrustVerona, Italy
| | | | - Luisa Carbognin
- Medical Oncology, University and Hospital TrustVerona, Italy
| | | | - Bharat Jasani
- Institute of Cancer & Genetics, Pathology, Cardiff UniversityUnited Kingdom
| | - Keith Miller
- UK NEQAS, University College of LondonUnited Kingdom
| | | | - Lucia Zanatta
- Anatomic Pathology, S. Maria di Ca’ Foncello HospitalTreviso, Italy
| | - Licia Laurino
- Anatomic Pathology, S. Maria di Ca’ Foncello HospitalTreviso, Italy
| | - Tiina Wirtanen
- Department of Pathology, Laboratory of Molecular Cytogenetic, University of HelsinkiFinland
- Department of Pathology, HUSLab, University Central HospitalHelsinki, Finland
| | - Giuseppe Zamboni
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
- Anatomic Pathology, Sacro Cuore Don Calabria HospitalNegrar, Italy
| | - Marcella Marconi
- Anatomic Pathology, Sacro Cuore Don Calabria HospitalNegrar, Italy
| | - Marco Chilosi
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Erminia Manfrin
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Guido Martignoni
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
| | - Franco Bonetti
- Department of Pathology and Diagnostic, Anatomic Pathology, University and Hospital TrustVerona, Italy
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Ng T, Weitsman G, Barber P, Lawler K, Rowley M, Elshtein G, Rodriguez-justo M, Jasani B, Pugh SA, Bridgewater JA, Primrose JN, Fisher D, Adams RA, Maughan T, Vojnovic B, Coolen A. Use of FLIM histology-based HER2-HER3 heterodimer quantification and a Bayesian latent class proportional hazards model to predict cetuximab response in the COIN and new EPOC trials. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14535] [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
Affiliation(s)
- Tony Ng
- Kings College London, London, United Kingdom
| | | | - Paul Barber
- University of Oxford, Oxford, United Kingdom
| | | | - Mark Rowley
- King's College London, London, United Kingdom
| | | | | | - Bharat Jasani
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | | | - John Neil Primrose
- University Surgery, University of Southampton, Southampton, United Kingdom
| | - David Fisher
- University College London, London, United Kingdom
| | | | - Tim Maughan
- University of Oxford, Oxford, United Kingdom
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Jasani B, Campbell F, Jones P, Gilbert J, Dowd J, Miller K, Ibrahim M, Ellis I, Hurley E, Falzon M, Peter BL, Starczynski J. Abstract P5-10-03: Audit of the accuracy of immunohistochemical (IHC) testing of HER2 negative status of breast cancer in the United Kingdom. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p5-10-03] [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: The analysis of the level and distribution of HER2 protein expressed by cancer cells (HER2 status) is of great clinical value in the management of breast cancer patients both for the determination of the prognosis of disease and for identification of those patients who are eligible for anti-HER2 therapy. Accurate assessment of the HER2 status is essential for identifying patients which will benefit from HER2 targeted therapy. HER2 status in the UK is established using a two tier strategy with IHC as the initial test and subsequent reflex of equivocal results to in situ hybridization (ISH). IHC staining of the HER2 protein is graded as 0, 1+, 2+ or 3+ dependent upon the intensity of staining, cellular localisation and the percentage
of cells positive in accordance with CAP/ASCO and UK guidelines. HER2 3+ cases are considered as positive, with HER2 2+ cases (equivocal) retested by ISH to ascertain the gene amplification status. Cases that are scored as 0 and 1+ by IHC have no additional testing and are classed as negative. The literature indicates that a subset of these IHC negative cases show HER2 gene amplification by FISH (range 1.1-11.5%). The aim of this audit is to evaluate the discordance rate of HER2 IHC negative,
FISH positive breast cancer in the UK, with a secondary objective to resolve if this is related to the choice of antibody and assay platform used.
Materials and methods: This audit selected a total of 600 sequential cases reported as HER2 negative on IHC, from three UK reference centres receiving cases from 29 different hospitals. The cases were given a unique identifying number and annonymised. Each of the three centres used a different IHC method for frontline HER2 testing with centre one using HercepTestTM (DAKO), centre two Pathway 4B5 (Roche), and centre three, Oracle (Leica Microsystems). HER2 gene amplification status was determined using dual colour FISH analysis, PathVysion (ABBOTT) fluorescence ISH (FISH)
in a single centre to provide standardised methodology and assessment. HER2 was classed as amplified when the HER2/CEP 17 ratio was two or greater in accordance with UK guidelines. All cases which showed discordance between IHC and FISH were re-tested with each of the HER2 IHC platforms to discover whether these are truly discordant results or if the discrepancy is a consequence of the choice of antibody.
Results: 16/600 (2.8%) unequivocal HER2 gene amplification (mean ratio >2.0) whilst 8/600 (1.2%) had borderline amplification status(mean ratio = or <2.0). The overall assay specific discordance rates were 3.0% (HercepTest), 2.5% (4B5) and 3.0% (Oracle), respectively.
Conclusion: The observed level of discordance is well within the range of discordance rates reported by previous studies. The discrepancies could be due to inadequate quality fixation and/or inadequate sensitivity of the assay platforms used, or under scoring. A detailed analysis of possible assay related source of discrepancy is currently underway by repeating the analyses of the 24 discordant cases using like for like three assay platforms at an independent expert centre.
Citation Format: Bharat Jasani, Fiona Campbell, Phillapa Jones, Jane Gilbert, James Dowd, Keith Miller, Merdol Ibrahim, Ian Ellis, Emma Hurley, Mary Falzon, Barrett-Lee Peter, Jane Starczynski. Audit of the accuracy of immunohistochemical (IHC) testing of HER2 negative status of breast cancer in the United Kingdom [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-10-03.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mary Falzon
- 8University College London Hospitals NHS Foundation Trust
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Maughan TS, Meade AM, Adams RA, Richman SD, Butler R, Fisher D, Wilson RH, Jasani B, Taylor GR, Williams GT, Sampson JR, Seymour MT, Nichols LL, Kenny SL, Nelson A, Sampson CM, Hodgkinson E, Bridgewater JA, Furniss DL, Roy R, Pope MJ, Pope JK, Parmar M, Quirke P, Kaplan R. A feasibility study testing four hypotheses with phase II outcomes in advanced colorectal cancer (MRC FOCUS3): a model for randomised controlled trials in the era of personalised medicine? Br J Cancer 2014; 110:2178-86. [PMID: 24743706 PMCID: PMC4007241 DOI: 10.1038/bjc.2014.182] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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] [Received: 11/21/2013] [Revised: 02/27/2014] [Accepted: 03/13/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Molecular characteristics of cancer vary between individuals. In future, most trials will require assessment of biomarkers to allocate patients into enriched populations in which targeted therapies are more likely to be effective. The MRC FOCUS3 trial is a feasibility study to assess key elements in the planning of such studies. PATIENTS AND METHODS Patients with advanced colorectal cancer were registered from 24 centres between February 2010 and April 2011. With their consent, patients' tumour samples were analysed for KRAS/BRAF oncogene mutation status and topoisomerase 1 (topo-1) immunohistochemistry. Patients were then classified into one of four molecular strata; within each strata patients were randomised to one of two hypothesis-driven experimental therapies or a common control arm (FOLFIRI chemotherapy). A 4-stage suite of patient information sheets (PISs) was developed to avoid patient overload. RESULTS A total of 332 patients were registered, 244 randomised. Among randomised patients, biomarker results were provided within 10 working days (w.d.) in 71%, 15 w.d. in 91% and 20 w.d. in 99%. DNA mutation analysis was 100% concordant between two laboratories. Over 90% of participants reported excellent understanding of all aspects of the trial. In this randomised phase II setting, omission of irinotecan in the low topo-1 group was associated with increased response rate and addition of cetuximab in the KRAS, BRAF wild-type cohort was associated with longer progression-free survival. CONCLUSIONS Patient samples can be collected and analysed within workable time frames and with reproducible mutation results. Complex multi-arm designs are acceptable to patients with good PIS. Randomisation within each cohort provides outcome data that can inform clinical practice.
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Affiliation(s)
- T S Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
| | - A M Meade
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - R A Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - S D Richman
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - R Butler
- University Hospital of Wales, Cardiff CF14 4XW, UK
| | - D Fisher
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - R H Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast BT9 7AE, UK
| | - B Jasani
- Institute of Cancer and Genetics, Cardiff University, Cardiff CF14 4XN, UK
| | - G R Taylor
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - G T Williams
- Institute of Cancer and Genetics, Cardiff University, Cardiff CF14 4XN, UK
| | - J R Sampson
- Institute of Cancer and Genetics, Cardiff University, Cardiff CF14 4XN, UK
| | - M T Seymour
- St James's Institute of Oncology, University of Leeds, Leeds LS9 7TF, UK
| | - L L Nichols
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - S L Kenny
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - A Nelson
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - C M Sampson
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - E Hodgkinson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | | | - D L Furniss
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | - R Roy
- Department of Oncology, Castle Hill Hospital, East Riding of Yorkshire HU16 5JQ, UK
| | - M J Pope
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - J K Pope
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - P Quirke
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - R Kaplan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
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Eccles SA, Aboagye EO, Ali S, Anderson AS, Armes J, Berditchevski F, Blaydes JP, Brennan K, Brown NJ, Bryant HE, Bundred NJ, Burchell JM, Campbell AM, Carroll JS, Clarke RB, Coles CE, Cook GJR, Cox A, Curtin NJ, Dekker LV, dos Santos Silva I, Duffy SW, Easton DF, Eccles DM, Edwards DR, Edwards J, Evans DG, Fenlon DF, Flanagan JM, Foster C, Gallagher WM, Garcia-Closas M, Gee JMW, Gescher AJ, Goh V, Groves AM, Harvey AJ, Harvie M, Hennessy BT, Hiscox S, Holen I, Howell SJ, Howell A, Hubbard G, Hulbert-Williams N, Hunter MS, Jasani B, Jones LJ, Key TJ, Kirwan CC, Kong A, Kunkler IH, Langdon SP, Leach MO, Mann DJ, Marshall JF, Martin LA, Martin SG, Macdougall JE, Miles DW, Miller WR, Morris JR, Moss SM, Mullan P, Natrajan R, O’Connor JPB, O’Connor R, Palmieri C, Pharoah PDP, Rakha EA, Reed E, Robinson SP, Sahai E, Saxton JM, Schmid P, Smalley MJ, Speirs V, Stein R, Stingl J, Streuli CH, Tutt ANJ, Velikova G, Walker RA, Watson CJ, Williams KJ, Young LS, Thompson AM. Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer. Breast Cancer Res 2013; 15:R92. [PMID: 24286369 PMCID: PMC3907091 DOI: 10.1186/bcr3493] [Citation(s) in RCA: 275] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 09/12/2013] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Breast cancer remains a significant scientific, clinical and societal challenge. This gap analysis has reviewed and critically assessed enduring issues and new challenges emerging from recent research, and proposes strategies for translating solutions into practice. METHODS More than 100 internationally recognised specialist breast cancer scientists, clinicians and healthcare professionals collaborated to address nine thematic areas: genetics, epigenetics and epidemiology; molecular pathology and cell biology; hormonal influences and endocrine therapy; imaging, detection and screening; current/novel therapies and biomarkers; drug resistance; metastasis, angiogenesis, circulating tumour cells, cancer 'stem' cells; risk and prevention; living with and managing breast cancer and its treatment. The groups developed summary papers through an iterative process which, following further appraisal from experts and patients, were melded into this summary account. RESULTS The 10 major gaps identified were: (1) understanding the functions and contextual interactions of genetic and epigenetic changes in normal breast development and during malignant transformation; (2) how to implement sustainable lifestyle changes (diet, exercise and weight) and chemopreventive strategies; (3) the need for tailored screening approaches including clinically actionable tests; (4) enhancing knowledge of molecular drivers behind breast cancer subtypes, progression and metastasis; (5) understanding the molecular mechanisms of tumour heterogeneity, dormancy, de novo or acquired resistance and how to target key nodes in these dynamic processes; (6) developing validated markers for chemosensitivity and radiosensitivity; (7) understanding the optimal duration, sequencing and rational combinations of treatment for improved personalised therapy; (8) validating multimodality imaging biomarkers for minimally invasive diagnosis and monitoring of responses in primary and metastatic disease; (9) developing interventions and support to improve the survivorship experience; (10) a continuing need for clinical material for translational research derived from normal breast, blood, primary, relapsed, metastatic and drug-resistant cancers with expert bioinformatics support to maximise its utility. The proposed infrastructural enablers include enhanced resources to support clinically relevant in vitro and in vivo tumour models; improved access to appropriate, fully annotated clinical samples; extended biomarker discovery, validation and standardisation; and facilitated cross-discipline working. CONCLUSIONS With resources to conduct further high-quality targeted research focusing on the gaps identified, increased knowledge translating into improved clinical care should be achievable within five years.
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Affiliation(s)
- Suzanne A Eccles
- The Institute of Cancer Research, 15 Cotswold Road, London SM2 5MG, UK
| | - Eric O Aboagye
- Imperial College London, Exhibition Rd, London SW7 2AZ, UK
| | - Simak Ali
- Imperial College London, Exhibition Rd, London SW7 2AZ, UK
| | | | - Jo Armes
- Kings College London, Strand, London WC2R 2LS, UK
| | | | - Jeremy P Blaydes
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Keith Brennan
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Nicola J Brown
- University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Helen E Bryant
- University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Nigel J Bundred
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | | | | | - Jason S Carroll
- Cancer Research UK, Cambridge Research Institute/University of Cambridge, Trinity Lane, Cambridge CB2 1TN, UK
| | - Robert B Clarke
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Charlotte E Coles
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Gary JR Cook
- Kings College London, Strand, London WC2R 2LS, UK
| | - Angela Cox
- University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Nicola J Curtin
- Newcastle University, Claremont Road, Newcastle upon Tyne NE1 7RU, UK
| | | | | | - Stephen W Duffy
- Queen Mary University of London, Mile End Road, London E1 4NS, UK
| | - Douglas F Easton
- Cancer Research UK, Cambridge Research Institute/University of Cambridge, Trinity Lane, Cambridge CB2 1TN, UK
| | - Diana M Eccles
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Dylan R Edwards
- University of East Anglia, Earlham Road, Norwich NR4 7TJ, UK
| | - Joanne Edwards
- University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - D Gareth Evans
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Deborah F Fenlon
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | | | - Claire Foster
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | | | | | - Julia M W Gee
- University of Cardiff, Park Place, Cardiff CF10 3AT, UK
| | - Andy J Gescher
- University of Leicester, University Road, Leicester LE1 4RH, UK
| | - Vicky Goh
- Kings College London, Strand, London WC2R 2LS, UK
| | - Ashley M Groves
- University College London, Gower Street, London WC1E 6BT, UK
| | | | - Michelle Harvie
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Bryan T Hennessy
- Royal College of Surgeons Ireland, 123, St Stephen’s Green, Dublin 2, Ireland
| | | | - Ingunn Holen
- University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Sacha J Howell
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Anthony Howell
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | | | | | | | - Bharat Jasani
- University of Cardiff, Park Place, Cardiff CF10 3AT, UK
| | - Louise J Jones
- Queen Mary University of London, Mile End Road, London E1 4NS, UK
| | - Timothy J Key
- University of Oxford, Wellington Square, Oxford OX1 2JD, UK
| | - Cliona C Kirwan
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Anthony Kong
- University of Oxford, Wellington Square, Oxford OX1 2JD, UK
| | - Ian H Kunkler
- University of Edinburgh, South Bridge, Edinburgh EH8 9YL, UK
| | - Simon P Langdon
- University of Edinburgh, South Bridge, Edinburgh EH8 9YL, UK
| | - Martin O Leach
- The Institute of Cancer Research, 15 Cotswold Road, London SM2 5MG, UK
| | - David J Mann
- Imperial College London, Exhibition Rd, London SW7 2AZ, UK
| | - John F Marshall
- Queen Mary University of London, Mile End Road, London E1 4NS, UK
| | - Lesley Ann Martin
- The Institute of Cancer Research, 15 Cotswold Road, London SM2 5MG, UK
| | - Stewart G Martin
- University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | | | | | | | | | - Sue M Moss
- Queen Mary University of London, Mile End Road, London E1 4NS, UK
| | - Paul Mullan
- Queen’s University Belfast, University Road, Belfast BT7 1NN, UK
| | - Rachel Natrajan
- The Institute of Cancer Research, 15 Cotswold Road, London SM2 5MG, UK
| | | | | | - Carlo Palmieri
- The University of Liverpool, Brownlow Hill, Liverpool L69 7ZX, UK
| | - Paul D P Pharoah
- Cancer Research UK, Cambridge Research Institute/University of Cambridge, Trinity Lane, Cambridge CB2 1TN, UK
| | - Emad A Rakha
- University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Elizabeth Reed
- Princess Alice Hospice, West End Lane, Esher KT10 8NA, UK
| | - Simon P Robinson
- The Institute of Cancer Research, 15 Cotswold Road, London SM2 5MG, UK
| | - Erik Sahai
- London Research Institute, 44 Lincoln’s Inn Fields, London WC2A 3LY, UK
| | - John M Saxton
- University of East Anglia, Earlham Road, Norwich NR4 7TJ, UK
| | - Peter Schmid
- Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex BN1 9PX, UK
| | | | | | - Robert Stein
- University College London, Gower Street, London WC1E 6BT, UK
| | - John Stingl
- Cancer Research UK, Cambridge Research Institute/University of Cambridge, Trinity Lane, Cambridge CB2 1TN, UK
| | | | | | | | | | - Christine J Watson
- Cancer Research UK, Cambridge Research Institute/University of Cambridge, Trinity Lane, Cambridge CB2 1TN, UK
| | - Kaye J Williams
- University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Leonie S Young
- Royal College of Surgeons Ireland, 123, St Stephen’s Green, Dublin 2, Ireland
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Hutchinson R, Salto-Tellez M, Hamilton P, Jasani B, Adams R. Automated Quantification of MRC COIN Trial EGFR Immunohistochemistry. Am J Clin Pathol 2013. [DOI: 10.1093/ajcp/140.suppl1.230] [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] [Indexed: 11/14/2022] Open
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Brunelli M, Manfrin E, Bria E, Massari F, Tortora G, Brunello E, Carbognin L, Nottegar A, Furlanetto J, Molino A, Fiorio E, Chilosi M, Jasani B, Vergine M, Marcolini L, Filippini D, Scarpa A, Martignoni G, Bonetti F. HER2/neu gene determination in women screened for breast carcinoma: how screening programs reduce the skyrocketing cost of targeted therapy. Anticancer Res 2013; 33:3705-3710. [PMID: 24023299] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Few data on Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast carcinomas have been reported for screen-detected breast carcinoma. Assessing the impact of a targeted intervention with anti-HER2 inhibitors on costs is required in order to plan for better strategies in screening programs. A total of 54,472 women were screened and 323 cases were found to be invasive cancer. We performed immunophenotypical-fluorescent in situ hybridization (FISH) analysis. Among 153 evaluable breast carcinomas, tumours displayed a 3+ scoring status 3+ in 16 (10%), 2+ in 12 (8%), 1+ in 29 (19%) and 0 in 96 (63%) of cases, respectively. All 3+ HER2+ cases and 2/12 2+ (17%) cases exhibited HER2/neu gene amplification, the remaining cases did not. In contrast to the higher incidence reported at the population level, 20-30% HER2-positive cases for metastatic carcinomas, and only 11% of the screen-detected breast carcinomas displayed HER2/neu gene amplification. Breast cancer detection by screening programs hijacks the skyrocketing cost of the use of targeted therapy in HER2-positive carcinoma.
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Affiliation(s)
- Matteo Brunelli
- Department of Pathology and Diagnostics, University of Verona, P.le L. Scuro n. 10, 37134 Verona, Italy.
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Carney WP, Bernhardt D, Jasani B. Circulating HER2 Extracellular Domain: A Specific and Quantitative Biomarker of Prognostic Value in all Breast Cancer Patients? Biomark Cancer 2013; 5:31-9. [PMID: 24179396 PMCID: PMC3791951 DOI: 10.4137/bic.s12389] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The HER2 oncoprotein has emerged as an essential biomarker in the treatment of breast cancer patients. Once the primary breast cancer is removed, there is an increasing need to detect breast cancer recurrence as early as possible with the hope that earlier intervention with new anti-HER2 therapies will improve quality of life and increase overall survival. Numerous publications have shown that increasing blood levels of circulating HER2 is an early indicator of progression, particularly in HER2-positive patients and that the rise and fall parallels the clinical course of disease and independent of therapy. Many studies show that the HER2 status of the primary tumor may not fully and accurately reflect the HER2 status of recurrent cancer. Thus, elevated serum HER2 levels may be an early signal of the emergence of a HER2-positive metastatic tumor and therefore alert the physician to re-assess HER2 status using a tissue test.
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Smith CG, Fisher D, Claes B, Maughan TS, Idziaszczyk S, Peuteman G, Harris R, James MD, Meade A, Jasani B, Adams RA, Kenny S, Kaplan R, Lambrechts D, Cheadle JP. Somatic profiling of the epidermal growth factor receptor pathway in tumors from patients with advanced colorectal cancer treated with chemotherapy ± cetuximab. Clin Cancer Res 2013; 19:4104-13. [PMID: 23741067 PMCID: PMC3732482 DOI: 10.1158/1078-0432.ccr-12-2581] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To study the somatic molecular profile of the EGF receptor (EGFR) pathway in advanced colorectal cancer, its relationship to prognosis, the site of the primary and metastases, and response to cetuximab. EXPERIMENTAL DESIGN We used Sequenom and Pyrosequencing for high-throughput somatic profiling of the EGFR pathway in 1,976 tumors from patients with advanced colorectal cancer from the COIN trial (oxaliplatin and fluoropyrimidine chemotherapy ± cetuximab). Correlations between mutations, clinicopathologic, response, and survival data were carried out. RESULTS Sequenom and Pyrosequencing had 99.0% (9,961/10,063) genotype concordance. We identified 13 different KRAS mutations in 42.3% of advanced colorectal cancers, 2 BRAF mutations in 9.0%, 4 NRAS mutations in 3.6%, and 5 PIK3CA mutations in 12.7%. 4.2% of advanced colorectal cancers had microsatellite instability (MSI). KRAS and PIK3CA exon 9, but not exon 20, mutations cooccurred (P = 8.9 × 10(-4)) as did MSI and BRAF mutations (P = 5.3 × 10(-10)). KRAS mutations were associated with right colon cancers (P = 5.2 × 10(-5)) and BRAF mutations with right (P = 7.2 × 10(-5)) and transverse colon (P = 9.8 × 10(-6)) cancers. KRAS mutations were associated with lung-only metastases (P = 2.3 × 10(-4)), BRAF mutations with peritoneal (P = 9.2 × 10(-4)) and nodal-only (P = 3.7 × 10(-5)) metastases, and MSI (BRAF(WT)) with nodal-only metastases (P = 2.9 × 10(-4)). MSI (BRAF(WT)) was associated with worse survival (HR = 1.89, 95% CI 1.30-2.76, P = 8.5 × 10(-4)). No mutations, subsets of mutations, or MSI status were associated with response to cetuximab. CONCLUSIONS Our data support a functional cooperation between KRAS and PIK3CA in colorectal tumorigenesis and link somatic profiles to the sites of metastases. MSI was associated with poor prognosis in advanced disease, and no individual somatic profile was associated with response to cetuximab in COIN.
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Affiliation(s)
- Christopher G. Smith
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - David Fisher
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Bart Claes
- Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, B3000, Belgium
| | - Timothy S. Maughan
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, OX3 7DQ, UK
| | - Shelley Idziaszczyk
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Gilian Peuteman
- Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, B3000, Belgium
| | - Rebecca Harris
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Michelle D. James
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Angela Meade
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Bharat Jasani
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Richard A. Adams
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Sarah Kenny
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Richard Kaplan
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Diether Lambrechts
- Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, B3000, Belgium
| | - Jeremy P. Cheadle
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
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Brunello E, Bogina G, Bria E, Vergine M, Zamboni G, Pedron S, Daniele I, Furlanetto J, Carbognin L, Marconi M, Manfrin E, Ibrahim M, Miller K, Tortora G, Molino A, Jasani B, Beccari S, Bonetti F, Chilosi M, Martignoni G, Brunelli M. The identification of a small but significant subset of patients still targetable with anti-HER2 inhibitors when affected by triple negative breast carcinoma. J Cancer Res Clin Oncol 2013; 139:1563-8. [PMID: 23892410 DOI: 10.1007/s00432-013-1479-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 07/04/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Triple (ER-, PR-, HER2-) negative breast carcinoma lack targeted therapies, making this group of tumors difficult to treat. By definition, the lack of HER2 expression means a case scoring 0 or 1+ after immunophenotypical analysis and makes the patients avoiding therapeutical chances with anti-HER2 inhibitors. We sought to recruit from a group of triple negative breast carcinoma, patients eligible for effective personalized targeted therapy with anti-HER therapies on the basis of their HER2 gene status. METHODS 135 patients diagnosed with IHC triple negative breast carcinoma were studied. Whole tissue sections were used for in situ hybridization analysis. RESULTS 8/100 (8 %) of ductal-type triple negative breast carcinoma presented Her-2/neu gene amplification versus 2/35 (5.7 %) non-ductal triple negative breast carcinoma. Three cases showed a ratio 2.5. One case showed Her-2/neu heterogeneous gene amplification, ratio 2.3. The other six showed from 7 to 8 absolute Her-2/neu gene copy number. Two cases staged pT1c, and eight cases staged pT2. Eight cases graded G3 and two cases G2. CONCLUSION (1) Eight percentage of ductal and 5.7 % non-ductal-type triple negative breast carcinoma present Her-2/neu gene amplification, (2) the standard diagnostic flowchart "do not FISH in 0-1+ (HER2-) breast carcinoma" should be replaced by "do FISH in triple (ER-, PR-, HER2-) negative breast carcinoma," to avoid loss of therapeutical chances in a cohort of such a patients, (3) we demonstrated the identification of a small but significant subset of patients targetable with anti-HER2 inhibitors, giving patients affected by (ex)triple negative breast carcinoma new personalized therapeutical chances.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents/therapeutic use
- Apocrine Glands/metabolism
- Apocrine Glands/pathology
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Cohort Studies
- Female
- Follow-Up Studies
- Gene Amplification
- Humans
- Immunoenzyme Techniques
- In Situ Hybridization, Fluorescence
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/antagonists & inhibitors
- Receptor, ErbB-2/genetics
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Trastuzumab
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Affiliation(s)
- Eleonora Brunello
- Department of Pathology and Diagnostic, University of Verona, P.le Scuro n. 10, 37134, Verona, Italy
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Jasani B, Butel JS. Can SV40 infect and immortalize human B-lymphocytes and mesothelial cells as a natural pathogen? Leuk Res 2013; 37:607-8. [DOI: 10.1016/j.leukres.2013.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 11/27/2022]
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Jasani B, Kabra N, Nanavati RN. Oral paracetamol in treatment of closure of patent ductus arteriosus in preterm neonates. J Postgrad Med 2013; 59:312-4. [DOI: 10.4103/0022-3859.123164] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Adams RA, Fisher D, Farragher S, Jasani B, Smith CG, James MD, Cheadle J, Nichols LL, Meade AM, Kaplan RS, Wilson RH, Wasan H, Maughan T. Use of epiregulin (EREG) and amphiregulin (AREG) gene expression to predict response to cetuximab (cet) in combination with oxaliplatin (Ox) and 5FU in the first-line treatment of advanced colorectal cancer (aCRC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.30_suppl.32] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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
32 Background: Previous data suggests the EGF ligands EREG/AREG may predict outcome of KRAS wt patients (pts) treated with cet in the chemo-refractory setting but this finding has not been previously reported from first line randomised trials. Methods: FFPE samples from primary tumours of pts in Arms A&B of the COIN trial of Ox fluoropyrimidine (Fp) +/- cet were analysed for EGFR IHC, KRAS/NRAS/BRAF mutation and EREG/AREG expression by RT-PCR. Ligand levels were assessed against baseline data, prognostic markers as uni/multivariate analyses and as predictive markers in wild type (wt) and mutant (mt) cohorts and separately by Fp backbone [capecitabine (CapOx) or 5FU (FOLFOX)]. Tests for interaction were performed with EREG/AREG continuous, using Flexible Parametric survival analysis. Results: 952/1630 (57%) of pts were evaluable for all parameters. High EREG/AREG levels were associated with KRAS wt (p<0.005), BRAF wt, absence of MSI and with primary tumour in left colon/rectum, presence of liver metastases, post randomisation radical surgery, high CEA (p<0.05) and ALKP. In the control arm, high EREG/AREG conferred a better prognosis among KRAS wt pts in a multivariate analysis. High EREG predicted for OS benefit from cet. treatment in KRAS wt pts, (n=525, p=0.017) and, separately, in pts treated with FOLFOX (n=310, p=0.021), with greatest effect in the “combined” subgroup (KRAS wt + FOLFOX, n=176, p=0.0042). Conversely a trend towards disbenefit was observed in KRAS wt pts treated with XELOX (n=349, p=0.14). Conclusions: The data suggest a prognostic effect of EREG/AREG in aCRC. The original hypothesis, that KRAS wt patients with high EREG expression have improved outcome with cet, is limited to patients treated with FOLFOX in the first-line setting. This data further suggests that capecitabine in combination with oxaliplatin and cetuximab produces a sub-optimal outcome.
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Affiliation(s)
| | - David Fisher
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | | | - Bharat Jasani
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | | | | | - Laura L. Nichols
- Medical Research Council Clinical Trials Unit, London, United Kingdom
| | - Angela M. Meade
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | - Richard S. Kaplan
- Medical Research Council Clinical Trials Unit, London, United Kingdom
| | | | | | - Tim Maughan
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom
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Chan DSY, Campbell F, Edwards P, Jasani B, Williams GT, Lewis WG. Relative Prognostic Value of Human Epidermal Growth Factor Receptor 2 (HER2) Expression in Operable Oesophagogastric Cancer. ISRN Surg 2012; 2012:804891. [PMID: 22900205 PMCID: PMC3412097 DOI: 10.5402/2012/804891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/14/2012] [Indexed: 12/21/2022]
Abstract
Aims. The aim of this study was to determine the prognostic significance of HER2 receptor expression in operable oesophagogastric adenocarcinoma.
Methods. Eighty-five consecutive patients diagnosed with oesophagogastric adenocarcinoma [18 oesophageal (OC), 32 junctional (JC) and 35 gastric (GC)] undergoing potentially curative resection were studied retrospectively. Immunohistochemistry was used to determine HER2 status at endoscopic biopsy and resection specimen. The primary outcome measure was survival.
Results. Twenty (24%) patients had HER2 positive tumours which was commoner in JC (14/32, 44% versus 2/18, 11% in OC and 4/35, 11% in GC, P = 0.003). The sensitivity, specificity, positive and negative predictive values of HER2 status at endoscopic biopsy were 56%, 93%, 63%, 91% respectively (weighted Kappa = 0.504, P < 0.0001). Five-year survival in OC HER2 positive negative was 100% and 36% (P = 0.167) compared with 14% and 44% (P = 0.0726) in JC and 50% and 46% (P = 0.942) in GC respectively. Conclusions. Endoscopic biopsy had a high specificity and negative predictive value in determining HER2 status. Patients with JC had a significantly higher rate of HER2 overexpression and this was associated with a nonsignificant poorer survival trend. A larger study is needed to confirm these findings because of the implications for neoadjuvant and adjuvant chemotherapy regimens.
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Affiliation(s)
- David S Y Chan
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
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Abstract
CONTEXT Despite asbestos being identified as the single most important cause of malignant mesothelioma, the tumor is known to occur in only 10% to 20% of heavily exposed individuals. In addition, about 20% of the patients have no history of asbestos exposure even after detailed assessment. Therefore, there has been speculation for some time that asbestos alone may not be sufficient to cause mesothelioma and that other factors may be involved either as cocarcinogens or as independent mechanisms of cancer causation. OBJECTIVE To give a brief review of nonasbestos fiber erionite and therapeutic radiation as 2 established examples of asbestos-independent mechanisms, of the potential emerging role of man-made fibers such as carbon nanotubes, and of polyoma virus SV40 (simian virus 40) as a potential example of the cocarcinogenic mode of involvement. DATA SOURCES Relevant recent literature has been surveyed to portray and provide the evidence in favor of the examples. CONCLUSIONS Erionite has emerged as the most important example of nonasbestos-mediated cause of mesothelioma in regions such as Turkey where exposure to this type of fiber is highly prevalent. Recently, the polyoma virus SV40 has been unexpectedly discovered as an effective cocarcinogen of asbestos in the causation of animal mesothelioma, though despite considerable research, its potential role in human mesothelioma remains unproven.
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Affiliation(s)
- Bharat Jasani
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, United Kingdom.
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Starczynski J, Atkey N, Connelly Y, O’Grady T, Campbell FM, di Palma S, Wencyk P, Jasani B, Gandy M, Bartlett J. HER2 gene amplification in breast cancer: a rogues' gallery of challenging diagnostic cases: UKNEQAS interpretation guidelines and research recommendations. Am J Clin Pathol 2012; 137:595-605. [PMID: 22431536 DOI: 10.1309/ajcpatbz2jfn1qqc] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
International and national guidelines highlight the importance of accuracy, reproducibility, and quality control of in situ hybridization (ISH) methods for testing breast carcinomas. However, few guidelines cover the reporting of ISH cases with "unusual" signal patterns, including, eg, heterogeneity and loss of chromosome enumeration probe or gene signals. These cases are, in fact, relatively frequent, and there is a need for developing evidence- or consensus-based reporting guidelines to ensure consistency of treatment. Following an audit of cases from a single center (including >1,700 cases) we show that approximately 10% of ISH results reflect unusual signal patterns. We illustrate the most common of these patterns and provide reporting guidelines for diagnosticians and recommendations for future research. Our goal is to ensure that in the future such "rogues" are reported in a consistent manner that, ultimately, will be supported by molecular and biochemical evidence.
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Maughan T, Wilson RH, Williams GT, Seymour MT, Richman SD, Quirke P, Pope J, Pope M, Parmar M, Nelson A, Meade AM, Nichols LL, Jasani B, Hodgkinson E, Fisher D, Butler R, Bridgewater JA, Adams RA, Kaplan RS. FOCUS 3: A study to determine the feasibility of molecular selection of therapy using K-RAS, B-RAF, and topo-1 in patients with advanced colorectal cancer (ACRC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.563] [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: 11/20/2022] Open
Abstract
563 Background: Molecular characteristics of cancer vary between individuals. In future increasing numbers of trials will require assessment of biomarkers in order to allocate patients into enriched populations in which targeted therapies are more likely to be effective. The FOCUS 3 trial is a feasibility study to assess whether tumour samples could be collected from referring hospitals’ pathology departments, sent to designated reference laboratories for biomarker evaluation, and results provided to oncologists within 10 working days. Methods: Patients with ACRC, fit for chemotherapy, were registered from 24 centres between 02.10 and 04.11. Following consent, paraffin embedded tumour samples were sent to Cardiff or Leeds for analysis of topoisomerase 1 (topo-1) by immunohistochemistry and of KRAS and BRAF mutation status, and results were forwarded to the MRC CTU. Patients were classified into 1 of 4 molecular strata, which determined the set of 2 hypothesis driven experimental therapies they could be randomised to in addition to control chemotherapy (irinotecan + 5FU). At this stage eligibility was reconfirmed and consent for randomisation obtained. Results: 332 patients were registered to participate in FOCUS 3. Biomarker results were provided to oncologists within 10 working days (wd) in 71%, within 15 wd in 91% and within 20 wd in 99% patients. A 4 stage suite of patient information sheets (PIS) was designed and implemented to avoid patient overload; separate information sheets were provided to patients at stages during the consent process and patient understanding was assessed. 93% of eligible patients gave consent to randomisation. KRAS mutation was detected in 88 (36%), BRAF in 15 (6%), 2 patients had both mutations and 133 were double wildtype. 77% of patients were high (2-3), 19% low (0-1) and 4% inconclusive for topo-1. Tumour response and toxicity results for the 244 randomised patients will be presented. Conclusions: Patient samples can be collected and analysed at designated reference laboratories within acceptable timeframes. Multi-arm designs can be made acceptable to patients through good PIS, ensured by patient and carer input into their design.
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Affiliation(s)
- Tim Maughan
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Richard H. Wilson
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Geraint T Williams
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Matthew T. Seymour
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Susan D. Richman
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Philip Quirke
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Janet Pope
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Malcolm Pope
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Mahesh Parmar
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Annmarie Nelson
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Angela M. Meade
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Laura L Nichols
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Bharat Jasani
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Elizabeth Hodgkinson
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - David Fisher
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Rachel Butler
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - John A. Bridgewater
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Richard A. Adams
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
| | - Richard S. Kaplan
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cardiff University, Cardiff, United Kingdom; University of Leeds, Leeds, United Kingdom; Velindre Cancer Centre, Cardiff, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Wales Cancer Trials Unit, Cardiff, United Kingdom; Medical Research Council Clinical Trials Unit, London, United Kingdom; School of Medicine, Cardiff
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Kalhan A, Gharibi B, Vazquez M, Jasani B, Neal J, Kidd M, Modlin IM, Pfragner R, Rees DA, Ham J. Adenosine A2A and A2B receptor expression in neuroendocrine tumours: potential targets for therapy. Purinergic Signal 2011; 8:265-74. [PMID: 22119961 DOI: 10.1007/s11302-011-9280-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/04/2011] [Indexed: 12/26/2022] Open
Abstract
The clinical management of neuroendocrine tumours is complex. Such tumours are highly vascular suggesting tumour-related angiogenesis. Adenosine, released during cellular stress, damage and hypoxia, is a major regulator of angiogenesis. Herein, we describe the expression and function of adenosine receptors (A(1), A(2A), A(2B) and A(3)) in neuroendocrine tumours. Expression of adenosine receptors was investigated in archival human neuroendocrine tumour sections and in two human tumour cell lines, BON-1 (pancreatic) and KRJ-I (intestinal). Their function, with respect to growth and chromogranin A secretion was carried out in vitro. Immunocytochemical data showed that A(2A) and A(2B) receptors were strongly expressed in 15/15 and 13/18 archival tumour sections. Staining for A(1) (4/18) and A(3) (6/18) receptors was either very weak or absent. In vitro data showed that adenosine stimulated a three- to fourfold increase in cAMP levels in BON-1 and KRJ-1 cells. The non-selective adenosine receptor agonist (adenosine-5'N-ethylcarboxamide, NECA) and the A(2A)R agonist (CGS21680) stimulated cell proliferation by up to 20-40% which was attenuated by A(2B) (PSB603 and MRS1754) and A(2A) (SCH442416) receptor selective antagonists but not by the A(1) receptor antagonist (PSB36). Adenosine and NECA stimulated a twofold increase in chromogranin A secretion in BON-1 cells. Our data suggest that neuroendocrine tumours predominantly express A(2A) and A(2B) adenosine receptors; their activation leads to increased proliferation and secretion of chromogranin A. Targeting adenosine signal pathways, specifically inhibition of A(2) receptors, may thus be a useful addition to the therapeutic management of neuroendocrine tumours.
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Affiliation(s)
- A Kalhan
- Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
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Bartlett JMS, Starczynski J, Atkey N, Kay E, O'Grady A, Gandy M, Ibrahim M, Jasani B, Ellis IO, Pinder SE, Walker RA. HER2 testing in the UK: recommendations for breast and gastric in-situ hybridisation methods. J Clin Pathol 2011; 64:649-53. [PMID: 21690244 DOI: 10.1136/jcp.2011.089847] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
These guidelines supplement existing guidelines on HER2 testing by immunohistochemistry and in-situ hybridisation(ISH) methods in the UK. They provide a specific focus on aspects of guidance relevant to HER2 ISH testing methods, both fluorescent and chromogenic. They are formulated to give advice on methodology, interpretation and quality control for ISH-based testing of HER2 status in common tumour types, including both breast and gastric tumours. The aim is to ensure that all ISH-based testing is accurate, reliable and timely.
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Maughan TS, Adams RA, Smith CG, Meade AM, Seymour MT, Wilson RH, Idziaszczyk S, Harris R, Fisher D, Kenny SL, Kay E, Mitchell JK, Madi A, Jasani B, James MD, Bridgewater J, Kennedy MJ, Claes B, Lambrechts D, Kaplan R, Cheadle JP. Addition of cetuximab to oxaliplatin-based first-line combination chemotherapy for treatment of advanced colorectal cancer: results of the randomised phase 3 MRC COIN trial. Lancet 2011; 377:2103-14. [PMID: 21641636 PMCID: PMC3159415 DOI: 10.1016/s0140-6736(11)60613-2] [Citation(s) in RCA: 731] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the Medical Research Council (MRC) COIN trial, the epidermal growth factor receptor (EGFR)-targeted antibody cetuximab was added to standard chemotherapy in first-line treatment of advanced colorectal cancer with the aim of assessing effect on overall survival. METHODS In this randomised controlled trial, patients who were fit for but had not received previous chemotherapy for advanced colorectal cancer were randomly assigned to oxaliplatin and fluoropyrimidine chemotherapy (arm A), the same combination plus cetuximab (arm B), or intermittent chemotherapy (arm C). The choice of fluoropyrimidine therapy (capecitabine or infused fluouroracil plus leucovorin) was decided before randomisation. Randomisation was done centrally (via telephone) by the MRC Clinical Trials Unit using minimisation. Treatment allocation was not masked. The comparison of arms A and C is described in a companion paper. Here, we present the comparison of arm A and B, for which the primary outcome was overall survival in patients with KRAS wild-type tumours. Analysis was by intention to treat. Further analyses with respect to NRAS, BRAF, and EGFR status were done. The trial is registered, ISRCTN27286448. FINDINGS 1630 patients were randomly assigned to treatment groups (815 to standard therapy and 815 to addition of cetuximab). Tumour samples from 1316 (81%) patients were used for somatic molecular analyses; 565 (43%) had KRAS mutations. In patients with KRAS wild-type tumours (arm A, n=367; arm B, n=362), overall survival did not differ between treatment groups (median survival 17·9 months [IQR 10·3-29·2] in the control group vs 17·0 months [9·4-30·1] in the cetuximab group; HR 1·04, 95% CI 0·87-1·23, p=0·67). Similarly, there was no effect on progression-free survival (8·6 months [IQR 5·0-12·5] in the control group vs 8·6 months [5·1-13·8] in the cetuximab group; HR 0·96, 0·82-1·12, p=0·60). Overall response rate increased from 57% (n=209) with chemotherapy alone to 64% (n=232) with addition of cetuximab (p=0·049). Grade 3 and higher skin and gastrointestinal toxic effects were increased with cetuximab (14 vs 114 and 67 vs 97 patients in the control group vs the cetuximab group with KRAS wild-type tumours, respectively). Overall survival differs by somatic mutation status irrespective of treatment received: BRAF mutant, 8·8 months (IQR 4·5-27·4); KRAS mutant, 14·4 months (8·5-24·0); all wild-type, 20·1 months (11·5-31·7). INTERPRETATION This trial has not confirmed a benefit of addition of cetuximab to oxaliplatin-based chemotherapy in first-line treatment of patients with advanced colorectal cancer. Cetuximab increases response rate, with no evidence of benefit in progression-free or overall survival in KRAS wild-type patients or even in patients selected by additional mutational analysis of their tumours. The use of cetuximab in combination with oxaliplatin and capecitabine in first-line chemotherapy in patients with widespread metastases cannot be recommended. FUNDING Cancer Research UK, Cancer Research Wales, UK Medical Research Council, Merck KGgA.
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Affiliation(s)
| | | | | | - Angela M Meade
- Medical Research Council Clinical Trials Unit, London, UK
| | | | | | | | | | - David Fisher
- Medical Research Council Clinical Trials Unit, London, UK
| | - Sarah L Kenny
- Medical Research Council Clinical Trials Unit, London, UK
| | - Edward Kay
- Medical Research Council Clinical Trials Unit, London, UK
| | | | - Ayman Madi
- School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - M John Kennedy
- ICORG, All Ireland Co-operative Oncology Research Group, Dublin, Ireland
| | - Bart Claes
- VIB Vesalius Research Center, University of Leuven, Leuven, Belgium
| | | | - Richard Kaplan
- Medical Research Council Clinical Trials Unit, London, UK
- Correspondence to: Prof Richard Kaplan, MRC Clinical Trials Unit, London NW1 2DA, UK
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Maughan T, Wilson RH, Williams GT, Seymour MT, Richman S, Quirke P, Pope M, Pope J, Parmar M, Nelson A, Meade AM, Kenny SL, Jasani B, Hodgkinson E, Fisher D, Butler R, Bridgewater JA, Adams RA, Kaplan RS. Developing a biomarker-stratified trial design in advanced colorectal cancer: The MRC FOCUS 3 feasibility study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Adams R, Hembrough TA, Thyparambil S, Krizman D, Darfler M, Jasani B, Maughan T, Kaplan RS, Burrows J. Multiplexed quantitation of growth factor receptors and pathway activation in FFPE tumor tissue from the COIN trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14117] [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] [Indexed: 11/20/2022] Open
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Hembrough T, Thyparambil S, Krizman D, Darfler M, Wei Y, Taylor P, Tong J, Pham NA, Jasani B, Adams R, Tsao MS, Moran M, Burrows J. Abstract 4919: Multiplexed EGFR signaling pathway analysis in FFPE tissue using quantitative mass spectrometry. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-4919] [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
The epidermal growth factor receptor (EGFR) is a drug target for both small molecule and antibody therapeutics and has been approved in non small-cell lung carcinoma (NSCLC) and colorectal carcinoma (CRC) among other indications. These drugs block receptor signaling though blockade of the tyrosine kinase domain, or through inhibition of ligand binding. Current genomic tests measure receptor amplification, RNA levels, the mutation status of receptor or pathway molecules (EGFR or kRAS mutations) but no current assay can directly assess the activation state of the EGFR or its downstream signaling pathway components. Indeed, the EGFR mutation positive NSCLC tumors (thought to be constitutively active) show a high response rate to TKI therapy, but the many non responders (50% or more) demonstrate the limitation of genomic analysis.
Since activation of EGFR is necessary for the response to these targeted agents, it is critical to measure what levels of receptor activation and downstream signaling determines tumor responsiveness to EGFR targeted therapies in these patients. For this reason, we have developed a panel of new diagnostic assays which measure the activation of the EGFR and key downstream signaling proteins through quantitation of the phosphorylation state of these proteins. These assays are based on the Liquid Tissue®-SRM technology platform. This approach enables relative and absolute quantification of proteins and their phosphorylation status directly in formalin fixed paraffin embedded (FFPE) tissue.
We preclinically validated the multiplexed Liquid Tissue® phospho-SRM assay on formalin fixed EGF stimulated A431 cells. We followed up these in vitro studies with phospho-SRM analysis of FFPE NSCLC xenograft explants where extensive independent histopathologic and molecular characterization had been performed, allowing us to benchmark our phospho-SRM analysis with standard diagnostic analyses.
We have now extended these quantitation studies by measuring the expression of EGFR and phospho-EGFR in FFPE tissues obtained from relevant human clinical trial cohorts – Gefitinib treated NSCLC and Cetuximab treated CRC. It is hoped that we will be able to correlate EGFR expression, activation and signaling in these tumors with responsiveness to EGFR targeted therapy, and to validate this assay for use as a companion diagnostic to guide therapy in both NSCLC and CRC.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4919. doi:10.1158/1538-7445.AM2011-4919
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Affiliation(s)
| | | | | | | | - Yuhong Wei
- 2Hospital for Sick Kids, Toronto, Ontario, Canada
| | - Paul Taylor
- 2Hospital for Sick Kids, Toronto, Ontario, Canada
| | - Jiefei Tong
- 2Hospital for Sick Kids, Toronto, Ontario, Canada
| | - Nhu-An Pham
- 3Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Ming-Sound Tsao
- 3Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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Adams RA, James MD, Smith CG, Wilson RH, Fisher D, Kenny SL, Kaplan RS, Stoerkel S, Maughan TS, Jasani B. Epidermal growth factor receptor (EGFR) as a predictive and prognostic marker in patients with advanced colorectal cancer (aCRC): The MRC COIN trial experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
359 Background: KRAS mutation has been shown to be a more effective (though negative) biomarker for selection of patients for EGFR targeted therapy in aCRC. However, positive EGFR immunohistochemistry (IHC) remains a license requirement and was an inclusion criterion in most trials to date. The MRC COIN trial recruited 2445 pts into 3 arms of oxaliplatin + fluoropyrimidine +/- cetuximab without prior EGFR assessment. This trial provides a unique opportunity to definitively examine the role of EGFR IHC as prognostic and predictive marker and potentially the evidence required to remove this assessment from the license for this drug. Methods: Formalin-fixed paraffin embedded (FFPE) tissue was stained retrospectively for EGFR using Dako kit in a national reference lab. Results were assessed by 3 reviewers (BJ, SS, RA) using digital imaging software in a blinded fashion, then by BJ/SS providing consensus for discrepancies. EGFR scoring was assessed as a prognostic variable in association with selected patient, tumor and biochemical data. Cut off points examined for +ve vs -ve tumours, in terms of total tumour cells demonstrating membrane staining, were: 0% vs >0%; <10% vs ≥10%; <20% vs ≥20%. Results: EGFR IHC was adequately assessed for 1621 pts (66% of randomised), 22% were negative (0%) and 78% positive (>0%), balanced across arms. EGFR was not prognostic for PFS within KRAS wt pts at the standardized cut off point 0% vs >0% HR=1.11 95% CI 0.91-1.36 p=0.31 but was at <10% vs ≥10% (HR=1.27 95% CI 1.07-1.52 p=0.008) this was robust to other prognostic variables. No effect was seen for overall response or survival. There was no prognostic effect for the KRAS mutant group. In the 1065 assessable pts randomised to +/- cetuximab, no evidence of EGFR IHC as a predictive marker for response or survival outcomes was observed for the addition of cetuximab to chemotherapy (OS HR=1.11 95% CI 0.70-1.75 p=0.66; PFS HR=0.95 95% CI 0.64-1.43 p=0.82). Conclusions: Extensive assessment of samples from this trial suggest a role for EGFR IHC as a prognostic marker in KRAS wt aCRC but refute the predictive value embedded within the licence for cetuximab used in combination with chemo in first-line therapy. [Table: see text]
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Affiliation(s)
- R. A. Adams
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
| | - M. D. James
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
| | - C. G. Smith
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
| | - R. H. Wilson
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
| | - D. Fisher
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
| | - S. L. Kenny
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
| | - R. S. Kaplan
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
| | - S. Stoerkel
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
| | - T. S. Maughan
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
| | - B. Jasani
- School of Medicine, Cardiff University, Cardiff, United Kingdom; Cardiff University, Cardiff, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Clinical Trials Unit, Medical Research Council, London, United Kingdom; Institute of Pathology, HELIOS Klinikum Wuppertal, Wuppertal, Germany
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Searchfield L, Price SA, Betton G, Jasani B, Riccardi D, Griffiths DFR. Glutathione S-transferases as molecular markers of tumour progression and prognosis in renal cell carcinoma. Histopathology 2011; 58:180-90. [DOI: 10.1111/j.1365-2559.2010.03733.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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