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Leman R, Muller E, Legros A, Goardon N, Chentli I, Atkinson A, Tranchant A, Castera L, Krieger S, Ricou A, Boulouard F, Joly F, Boucly R, Dumont A, Basset N, Coulet F, Chevalier LM, Rouleau E, Leitner K, González-Martin A, Gargiulo P, Lück HJ, Genestie C, Ray-Coquard I, Pujade-Lauraine E, Vaur D. Validation of the Clinical Use of GIScar, an Academic-developed Genomic Instability Score Predicting Sensitivity to Maintenance Olaparib for Ovarian Cancer. Clin Cancer Res 2023; 29:4419-4429. [PMID: 37756555 PMCID: PMC10618649 DOI: 10.1158/1078-0432.ccr-23-0898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/12/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The optimal application of maintenance PARP inhibitor therapy for ovarian cancer requires accessible, robust, and rapid testing of homologous recombination deficiency (HRD). However, in many countries, access to HRD testing is problematic and the failure rate is high. We developed an academic HRD test to support treatment decision-making. EXPERIMENTAL DESIGN Genomic Instability Scar (GIScar) was developed through targeted sequencing of a 127-gene panel to determine HRD status. GIScar was trained from a noninterventional study with 250 prospectively collected ovarian tumor samples. GIScar was validated on 469 DNA tumor samples from the PAOLA-1 trial evaluating maintenance olaparib for newly diagnosed ovarian cancer, and its predictive value was compared with Myriad Genetics MyChoice (MGMC). RESULTS GIScar showed significant correlation with MGMC HRD classification (kappa statistics: 0.780). From PAOLA-1 samples, more HRD-positive tumors were identified by GIScar (258) than MGMC (242), with a lower proportion of inconclusive results (1% vs. 9%, respectively). The HRs for progression-free survival (PFS) with olaparib versus placebo were 0.45 [95% confidence interval (CI), 0.33-0.62] in GIScar-identified HRD-positive BRCA-mutated tumors, 0.50 (95% CI, 0.31-0.80) in HRD-positive BRCA-wild-type tumors, and 1.02 (95% CI, 0.74-1.40) in HRD-negative tumors. Tumors identified as HRD positive by GIScar but HRD negative by MGMC had better PFS with olaparib (HR, 0.23; 95% CI, 0.07-0.72). CONCLUSIONS GIScar is a valuable diagnostic tool, reliably detecting HRD and predicting sensitivity to olaparib for ovarian cancer. GIScar showed high analytic concordance with MGMC test and fewer inconclusive results. GIScar is easily implemented into diagnostic laboratories with a rapid turnaround.
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Affiliation(s)
- Raphaël Leman
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Université, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Etienne Muller
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Université, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Angelina Legros
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
| | - Nicolas Goardon
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Université, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Imène Chentli
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
| | - Alexandre Atkinson
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Université, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Aurore Tranchant
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
| | - Laurent Castera
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Université, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Sophie Krieger
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Université, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Agathe Ricou
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Université, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Flavie Boulouard
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Université, UNICAEN, FHU G4 Génomique, Rouen, France
| | - Florence Joly
- Clinical Research, Centre François Baclesse, Caen, France
| | - Romain Boucly
- Unité d'Oncologie Moléculaire Humaine, Centre Oscar Lambret, Lille, France
| | - Aurélie Dumont
- Unité d'Oncologie Moléculaire Humaine, Centre Oscar Lambret, Lille, France
| | - Noémie Basset
- Département de Génétique Médicale, UF d'Onco-Angiogénétique et Génomique des Tumeurs Solides, Hôpital Pitié Salpêtrière APHP, Paris, France
- Sorbonne Université, Paris, France
| | - Florence Coulet
- Département de Génétique Médicale, UF d'Onco-Angiogénétique et Génomique des Tumeurs Solides, Hôpital Pitié Salpêtrière APHP, Paris, France
- Sorbonne Université, Paris, France
| | - Louise-Marie Chevalier
- Unité de Génomique Fonctionnelle, Institut de Cancérologie de l'Ouest, Angers, France
- Université Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, Angers, France
| | - Etienne Rouleau
- Service de Génétique des Tumeurs, Gustave Roussy, Villejuif, France
| | - Katharina Leitner
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
- AGO Austria, Vienna, Austria
| | - Antonio González-Martin
- Department of Medical Oncology and Program in Solid Tumors-Cima, Cancer Center Clinica Universidad de Navarra, Madrid, Spain
- GEICO, Cádiz, Spain
| | - Piera Gargiulo
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
- MITO, Italy
| | - Hans-Joachim Lück
- Gynäkologisch-Onkologische Praxis Hannover, Hannover, Germany
- AGO, Wiesbaden, Germany
| | | | - Isabelle Ray-Coquard
- Association de Recherche Cancers Gynécologiques (ARCAGY), Paris, France
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens et du sein (GINECO), France
| | - Eric Pujade-Lauraine
- Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens et du sein (GINECO), France
| | - Dominique Vaur
- Laboratoire de Biologie et de Génétique du Cancer, Centre François Baclesse, Caen, France
- Inserm U1245, Cancer Brain and Genome, Normandie Université, UNICAEN, FHU G4 Génomique, Rouen, France
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Guiu Lahaye S, Balmana Gelpi J, Gauthier L, Bigot F, Goncalves A, Frenel JS, Bachelot T, Dalenc F, Mailliez A, Chakiba C, Genet D, Dohollou N, Desmoulins I, Canon JLR, Guyonneau C, Buisson A, Chevalier LM, Delaloge S, Follana P. DOLAF: An international multicenter phase II trial of durvalumab (MEDI4736) plus olaparib plus fulvestrant in patients with metastatic or locally advanced ER-positive, HER2-negative breast cancer selected using criteria that predict sensitivity to olaparib. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps1116] [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
TPS1116 Background: PARP inhibitors have documented clinical activity in patients with HER2 negative breast cancer (BC) and a germline pathogenic variant (PV) in BRCA1 or BRCA2. Defects in other genes involved in homologous recombination DNA repair (HRR) or mismatch repair pathway (microsatellite instability MSI) have been associated with preclinical cellular sensitivity to PARP inhibitors. Several preclinical and clinical studies have suggested synergy between immune checkpoint blockade and PARP inhibitors. Indeed, tumors with deficiency in HRR have higher mutagenic potential and produce a larger number of neoantigens. Around 60% of BC with a germline PV in BRCA1/ 2 are ER+/HER2- tumors, and the ER-pathway remains a key target of their therapy. The combination of PARP inhibitors with endocrine therapy has shown to be superior to monotherapy. Methods: DOLAF is an open-label, international, multicentric, phase II trial assessing the combination of olaparib, fulvestrant, and durvalumab in ER+/HER2- metastatic or locally advanced BC with somatic or germline PV in BRCA1, BRCA2 or other genes implicated in the HRR pathway (ATM, BARD1, BRIP1, CDK12, CHEK1, CHEK2, FANCA, FAND2, FANCL, MRE11A, NBN, PALB2, PPP2R2A, RAD51B, RAD51C, RAD51D and RAD54L) or in MSI status or other actionable genes ( AKT1, ESR1, FGFR1, FGFR2, FGFR3, and PIK3CA) all based on central tumor NGS. Further an amendment in May 2021, patients with only alterations in these other actionable genes can no longer be included. Patients must have received 1 prior line of endocrine therapy for their metastatic BC, including CDK4/6 inhibitor and maximum of 1 line of chemotherapy in the metastatic setting. Patients receive olaparib (twice daily at 300 mg), fulvestrant (2 intramuscular injections of 250 mg every 28 days) and durvalumab (1500 mg intravenous every 4 weeks). The primary objective is to evaluate the progression-free survival rate at 24 weeks. Secondary endpoints include safety, overall survival, objective response rate, in the overall population and in the germline BRCA mutated population. With an optimum two-stage Simon design, α = 2.5%, β = 5%, p0 (probability of inefficiency maximum) = 50%, p1 (probability of minimum efficiency) = 65%, it is necessary to include 158 patients. The strategy could be considered sufficiently effective if there are at least 87 patients without progression at 24 weeks. Given the lack of safety data from this association, a safety run-in phase including 6 patients has been completed without DLT. As of December 31, 2021, 266 patients have been screened of whom 102 have been treated. The first interim analysis occured in November 2021 after the inclusion of 64 evaluable patients. IDMC suggested that the trial continue as planned. Clinical trial information: NCT04053322.
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Affiliation(s)
| | - Judith Balmana Gelpi
- Clinical Cancer Genetics and Breast Cancer Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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- Department of Biopathology, Centre Léon BERARD, Lyon, France
| | | | | | - Philippe Follana
- GINECO and Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
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Billaud A, Chevalier LM, Augereau P, Frenel JS, Passot C, Campone M, Morel A. Functional pre-therapeutic evaluation by genome editing of variants of uncertain significance of essential tumor suppressor genes. Genome Med 2021; 13:174. [PMID: 34749799 PMCID: PMC8576946 DOI: 10.1186/s13073-021-00976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Targeted therapies in oncology are promising but variants of uncertain significance (VUS) limit their use for clinical management and necessitate functional testing in vitro. Using BRCA1 and BRCA2 variants, which have consequences on PARP inhibitor sensitivity, and POLE variants, potential biomarkers of immunotherapy response, we developed a rapid functional assay based on CRISPR-Cas9 genome editing to determine the functional consequences of these variants having potentially direct implications on patients' access to targeted therapies. METHODS We first evaluated the functional impact of 26 BRCA1 and 7 BRCA2 variants by editing and comparing NGS results between the variant of interest and a silent control variant. Ten of these variants had already been classified as benign or pathogenic and were used as controls. Finally, we extended this method to the characterization of POLE VUS. RESULTS For the 23 variants that were unclassified or for which conflicting interpretations had been reported, 15 were classified as functionally normal and 6 as functionally abnormal. Another two variants were found to have intermediate consequences, both with potential impacts on splicing. We then compared these scores to the patients' responses to PARP inhibitors when possible. Finally, to prove the application of our method to the classification of variants from other tumor suppressor genes, we exemplified with three POLE VUS. Among them, two were classified with an intermediate functional impact and one was functionally abnormal. Eventually, four POLE variants previously classified in databases were also evaluated. However, we found evidence of a discordance with the classification, variant p.Leu424Val being found here functionally normal. CONCLUSIONS Our new rapid functional assay can be used to characterize the functional implication of BRCA1 and BRCA2 variants, giving patients whose variants were evaluated as functionally abnormal access to PARP inhibitor treatment. Retrospective analysis of patients' responses to PARP inhibitors, where accessible, was consistent with our functional score evaluation and confirmed the accuracy of our protocol. This method could potentially be extended to the classification of VUS from all essential tumor suppressor genes and can be performed within a timeframe compatible with clinical applications, thereby having a direct theranostic impact.
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Affiliation(s)
- Amandine Billaud
- Université d'Angers, Inserm, CRCINA, SFR ICAT, F-49000, Angers, France
- Institut de Cancérologie de l'Ouest Nantes-Angers, F-49000, Angers, France
| | - Louise-Marie Chevalier
- Université d'Angers, Inserm, CRCINA, SFR ICAT, F-49000, Angers, France
- Institut de Cancérologie de l'Ouest Nantes-Angers, F-49000, Angers, France
| | - Paule Augereau
- Institut de Cancérologie de l'Ouest Nantes-Angers, F-49000, Angers, France
| | - Jean-Sebastien Frenel
- Institut de Cancérologie de l'Ouest Nantes-Angers, F-49000, Angers, France
- Université de Nantes, Inserm, CRCINA, F-44000, Nantes, France
| | - Christophe Passot
- Institut de Cancérologie de l'Ouest Nantes-Angers, F-49000, Angers, France
| | - Mario Campone
- Institut de Cancérologie de l'Ouest Nantes-Angers, F-49000, Angers, France
- Université de Nantes, Inserm, CRCINA, F-44000, Nantes, France
| | - Alain Morel
- Université d'Angers, Inserm, CRCINA, SFR ICAT, F-49000, Angers, France.
- Institut de Cancérologie de l'Ouest Nantes-Angers, F-49000, Angers, France.
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Pinquie F, Cortot AB, Chevalier LM, Morel A, Sandrini J, Guguen C, Morvan B, Molinier O. A Case Report of Successful Treatment With Crizotinib to Overcome Resistance to Osimertinib in an EGFR Mutated Non-Small-Cell Lung Cancer Patient Harboring an Acquired MET Exon 14 Mutation. Clin Lung Cancer 2021; 23:e131-e134. [PMID: 34548228 DOI: 10.1016/j.cllc.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/29/2021] [Accepted: 06/03/2021] [Indexed: 11/03/2022]
Affiliation(s)
- François Pinquie
- Department of Respiratory Diseases, Le Mans Hospital Center, 72000 Le Mans, France
| | - Alexis B Cortot
- Department of Thoracic Oncology, Lille University Hospital, CNRS, Inserm, Institut Pasteur de Lille, Canther, F-59000, Lille, France
| | - Louise-Marie Chevalier
- Angers University, Inserm, 49000 Angers, France; Department of Oncogenomic, Cancer Center Paul Papin, 49000 Angers, France
| | - Alain Morel
- Angers University, Inserm, 49000 Angers, France; Department of Oncogenomic, Cancer Center Paul Papin, 49000 Angers, France
| | - Jérémy Sandrini
- Department of Pathology, Le Mans Hospital Center, 72000 Le Mans, France
| | - Camille Guguen
- Department of Respiratory Diseases, Le Mans Hospital Center, 72000 Le Mans, France
| | - Benjamin Morvan
- Department of Pathology, Le Mans Hospital Center, 72000 Le Mans, France
| | - Olivier Molinier
- Department of Respiratory Diseases, Le Mans Hospital Center, 72000 Le Mans, France.
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Chevalier LM, Billaud A, Fronteau S, Dauvé J, Patsouris A, Verriele V, Morel A. Somatic mRNA Analysis of BRCA1 Splice Variants Provides a Direct Theranostic Impact on PARP Inhibitors. Mol Diagn Ther 2021; 24:233-243. [PMID: 32124385 DOI: 10.1007/s40291-020-00452-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The identification of pretherapeutic somatic BRCA variants can have considerable clinical impact given that they affect response to the new poly (ADP-ribose) polymerase (PARP)-targeted therapy. One major issue with this type of testing is the identification of splicing variants of uncertain significance (VUS) on degraded somatic messenger RNA. It is therefore important to be able to quickly characterize these splice variants. OBJECTIVE As part of PARP inhibitor targeted therapy, we have investigated a method for the direct confirmation of potential pathogenic somatic splice variants of BRCA1 found in fixed tumor samples. Previously these VUS have commonly only been tested by in silico analysis. METHODS Five BRCA1 variants affecting splicing were characterized from formalin-fixed, paraffin-embedded (FFPE) ovarian carcinoma tissues by next-generation sequencing (NGS). Three patient samples had already been functionally characterized and were used as controls. Total somatic RNA from samples was extracted, reverse-transcribed, and amplified with several primer pairs encompassing the target exon. The polymerase chain reaction (PCR) products were analyzed by capillary gel electrophoresis to assess possible changes in size due to splicing alterations. Finally, we confirmed our results by cloning, followed by Sanger sequencing, and analyzed the expression of the aberrant forms. RESULTS Our molecular approach made it possible to visualize the splicing outcomes of three variants (c.5194-2A>G, c.5434C>G, and c.547+1G>A) already identified and present in databases and/or identified with prediction tools (ClinVar, UMD, ARUP Utah database, and Human Splice Finder splices sites prediction) and to confirm their exon skipping consequences, their expression in tumors, and thus their pathogenicity. The c.4484+5G>A variant was not found in databases and was predicted to have no impact on splicing, but was found to display altered processing in tumor tissue. This variant also had a major detrimental impact on transcriptional expression. CONCLUSION In a break from purely in silico approaches, we propose a simple and rapid pretherapeutic functional analysis of somatic BRCA1 variants potentially involved in splicing alterations. This approach will allow more ovarian cancer patients to benefit from new therapies targeting PARP.
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Affiliation(s)
- Louise-Marie Chevalier
- Université d'Angers, Inserm, CRCINA, 49000, Angers, France.,Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | - Amandine Billaud
- Université d'Angers, Inserm, CRCINA, 49000, Angers, France.,Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | - Sabrina Fronteau
- Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | - Jonathan Dauvé
- Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | - Anne Patsouris
- Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | | | - Alain Morel
- Université d'Angers, Inserm, CRCINA, 49000, Angers, France. .,Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France.
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Billaud A, Chevalier LM, Campone M, Morel A, Bigot F. [Genetic instability, a factor limiting the efficiency of targeted therapies in solid oncology]. Bull Cancer 2020; 107:1161-1170. [PMID: 33070953 DOI: 10.1016/j.bulcan.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
Genomic instability is one of the main properties of tumour development, promoting first the acquisition of genetic alterations and thus carcinogenesis. Then, the chronic and anarchic proliferation of cancer cells also supports and contributes to this instability allowing a continuous evolution of the tumour. The accumulation of mutations resulting from that instability contributes to tumour heterogeneity that occurs in a specific environment. The resulting diversity of oncogenic drivers further complicates the characterization of the origin of cancer cells dysfunction and consequently therapeutic decision. However, the consideration of the molecular context in oncology has initiated the development of targeted therapies. Based on the concept of oncogene addiction and synthetic lethality, these new drugs require the characterization and identification of specific tumour biomarkers. Targeted therapies have thus considerably optimized patient management, improving efficiency and quality of life while limiting the side effects observed with conventional chemotherapies. However, despite significant clinical benefits, some major limitations to their administration remain. The study of the current issues related to these new therapeutic molecules is becoming crucial for patient management towards an improvement of personalized medicine.
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Affiliation(s)
- Amandine Billaud
- Université d'Angers, Inserm, CRCINA, 49000 Angers, France; Institut de cancérologie de l'Ouest, Angers, France
| | - Louise-Marie Chevalier
- Université d'Angers, Inserm, CRCINA, 49000 Angers, France; Institut de cancérologie de l'Ouest, Angers, France
| | - Mario Campone
- Université de Nantes, Inserm, CRCINA, 44000 Nantes, France; Institut de cancérologie de l'Ouest, Angers, France
| | - Alain Morel
- Université d'Angers, Inserm, CRCINA, 49000 Angers, France; Institut de cancérologie de l'Ouest, Angers, France.
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Billaud A, Verriele V, Dauvé J, Chevalier LM, Morel A. Non-Small-Cell Lung Cancer-Sensitive Detection of the p.Thr790Met EGFR Alteration by Preamplification before PNA-Mediated PCR Clamping and Pyrosequencing. Diagnostics (Basel) 2020; 10:diagnostics10080527. [PMID: 32751202 PMCID: PMC7460542 DOI: 10.3390/diagnostics10080527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/27/2020] [Revised: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 12/24/2022] Open
Abstract
Targeted therapies and, more precisely, EGFR tyrosine kinase inhibitors (TKIs) have been a major improvement in the therapeutic management of EGFR-mutated non-small-cell lung cancers (NSCLCs). Earlier administration of these TKIs throughout tumor progression is imperative to improve patient outcomes. Consequently, studies have focused on refining the characterization of biomarkers, especially concerning the resistance mutation p.Thr790Met of EGFR. Herein, we developed peptide nucleic acid (PNA)-mediated PCR clamping followed by pyrosequencing, favoring enrichment of the mutated fraction. A preamplification step was first added to increase the amplifiable DNA fraction. Throughout the application of our method on DNA extracted from FFPE samples of 46 patients with NSCLC who had relapsed under first-generation EGFR TKI, we evaluated a sensitivity of 93.3% and a specificity of 100%. All 19 patients who were positive for the p.Thr790Met mutation with NGS were also found to be positive with our protocol. The only discordant case was a sample with no mutation detected with NGS, but which was positive with PNA. This protocol allows for the detection of the p.Thr790Met mutation with a sensitivity of 0.5% which will permit earlier detection and an improvement of therapeutic management.
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Affiliation(s)
- Amandine Billaud
- Université d’Angers, Inserm, CRCINA, F-49000 Angers, France; (A.B.); (L.-M.C.)
- Institut de Cancérologie de l’Ouest Nantes-Angers, 49000 Angers, France; (V.V.); (J.D.)
| | - Veronique Verriele
- Institut de Cancérologie de l’Ouest Nantes-Angers, 49000 Angers, France; (V.V.); (J.D.)
| | - Jonathan Dauvé
- Institut de Cancérologie de l’Ouest Nantes-Angers, 49000 Angers, France; (V.V.); (J.D.)
| | - Louise-Marie Chevalier
- Université d’Angers, Inserm, CRCINA, F-49000 Angers, France; (A.B.); (L.-M.C.)
- Institut de Cancérologie de l’Ouest Nantes-Angers, 49000 Angers, France; (V.V.); (J.D.)
| | - Alain Morel
- Université d’Angers, Inserm, CRCINA, F-49000 Angers, France; (A.B.); (L.-M.C.)
- Institut de Cancérologie de l’Ouest Nantes-Angers, 49000 Angers, France; (V.V.); (J.D.)
- Correspondence: ; Tel.: +33-241-352-717
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Chevalier LM, Billaud A, Passot C, Renoult A, Bigot F, Verrièle V, Morel A. [EGFR molecular characterization in non-small cell bronchic cancer: comparative prospective study by NGS and Idylla platform technologies]. Ann Pathol 2020; 40:389-400. [PMID: 32081549 DOI: 10.1016/j.annpat.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 06/27/2019] [Revised: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Detection of genetic alterations in the EGFR tyrosine kinase domain is a major concern in the management of non-small cell lung cancer because it conditions access to tyrosine kinase inhibitors. In practice, it is possible to characterize only well-documented mutations or to sequence all relevant EGFR exons and also other targets of theranostic interest. This prospective study compares the targeted EGFR characterization on Idylla platform (Biocartis) and a more extensive one by next generation sequencing using Ion Torrent technology. MATERIAL AND METHODS A total of 100 formalin-fixed paraffin-embedded tumour samples were tested simultaneously by both techniques under the conditions recommended by the suppliers. The comparison covered all technical and practical aspects of the laboratory. RESULTS At least one EGFR mutation of interest for tyrosine kinase inhibitors for 9 and 7 samples was detected respectively by sequencing and by the Idylla system. For three samples, EGFR sensitive mutations to tyrosine kinase inhibitors were detected only by next-generation sequencing. In addition, for 37 samples, mutations of clinical interest outside EGFR were characterized by sequencing and communicated to the prescriber. CONCLUSION Idylla technology allows the rapid characterization of a majority of EGFR variants. The result can be optimized by careful analysis of the amplification curves with the Idylla Explore tool or by increasing the amount of initial material. A complementary new generation sequencing analysis for non-contributory results by Idylla should also be recommended.
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Affiliation(s)
- Louise-Marie Chevalier
- Département de Biopathologie, Institut de Cancérologie de l'Ouest, site Paul Papin, 15, rue André Boquel, 49 055 Angers cedex 02, France; CRCINA U1232, Inserm, Université de Nantes, Université d'Angers, 4, rue Larrey, Angers, France.
| | - Amandine Billaud
- Département de Biopathologie, Institut de Cancérologie de l'Ouest, site Paul Papin, 15, rue André Boquel, 49 055 Angers cedex 02, France; CRCINA U1232, Inserm, Université de Nantes, Université d'Angers, 4, rue Larrey, Angers, France.
| | - Christophe Passot
- Département de Biopathologie, Institut de Cancérologie de l'Ouest, site Paul Papin, 15, rue André Boquel, 49 055 Angers cedex 02, France.
| | - Adélaïde Renoult
- Département de Biopathologie, Institut de Cancérologie de l'Ouest, site Paul Papin, 15, rue André Boquel, 49 055 Angers cedex 02, France.
| | - Frédéric Bigot
- Département de Biopathologie, Institut de Cancérologie de l'Ouest, site Paul Papin, 15, rue André Boquel, 49 055 Angers cedex 02, France.
| | - Véronique Verrièle
- Département de Biopathologie, Institut de Cancérologie de l'Ouest, site Paul Papin, 15, rue André Boquel, 49 055 Angers cedex 02, France.
| | - Alain Morel
- Département de Biopathologie, Institut de Cancérologie de l'Ouest, site Paul Papin, 15, rue André Boquel, 49 055 Angers cedex 02, France; CRCINA U1232, Inserm, Université de Nantes, Université d'Angers, 4, rue Larrey, Angers, France.
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9
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Paolini L, Adam C, Beauvillain C, Preisser L, Blanchard S, Pignon P, Seegers V, Chevalier LM, Campone M, Wernert R, Verrielle V, Raro P, Ifrah N, Lavoué V, Descamps P, Morel A, Catros V, Tcherkez G, Lenaers G, Bocca C, Kouassi Nzoughet J, Procaccio V, Delneste Y, Jeannin P. Lactic Acidosis Together with GM-CSF and M-CSF Induces Human Macrophages toward an Inflammatory Protumor Phenotype. Cancer Immunol Res 2020; 8:383-395. [PMID: 31924656 DOI: 10.1158/2326-6066.cir-18-0749] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 07/12/2019] [Accepted: 01/03/2020] [Indexed: 11/16/2022]
Abstract
In established tumors, tumor-associated macrophages (TAM) orchestrate nonresolving cancer-related inflammation and produce mediators favoring tumor growth, metastasis, and angiogenesis. However, the factors conferring inflammatory and protumor properties on human macrophages remain largely unknown. Most solid tumors have high lactate content. We therefore analyzed the impact of lactate on human monocyte differentiation. We report that prolonged lactic acidosis induces the differentiation of monocytes into macrophages with a phenotype including protumor and inflammatory characteristics. These cells produce tumor growth factors, inflammatory cytokines, and chemokines as well as low amounts of IL10. These effects of lactate require its metabolism and are associated with hypoxia-inducible factor-1α stabilization. The expression of some lactate-induced genes is dependent on autocrine M-CSF consumption. Finally, TAMs with protumor and inflammatory characteristics (VEGFhigh CXCL8+ IL1β+) are found in solid ovarian tumors. These results show that tumor-derived lactate links the protumor features of TAMs with their inflammatory properties. Treatments that reduce tumor glycolysis or tumor-associated acidosis may help combat cancer.
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Affiliation(s)
- Léa Paolini
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France
| | - Clément Adam
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France
| | - Céline Beauvillain
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France.,Laboratoire d'Immunologie et Allergologie, CHU d'Angers, Angers, France
| | - Laurence Preisser
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France
| | - Simon Blanchard
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France.,Laboratoire d'Immunologie et Allergologie, CHU d'Angers, Angers, France
| | - Pascale Pignon
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France
| | - Valérie Seegers
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France.,Institut de Cancérologie de l'Ouest, Angers, France
| | - Louise-Marie Chevalier
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France.,Institut de Cancérologie de l'Ouest, Angers, France
| | - Mario Campone
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France.,Institut de Cancérologie de l'Ouest, Angers, France
| | | | | | - Pedro Raro
- Institut de Cancérologie de l'Ouest, Angers, France
| | - Norbert Ifrah
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France.,Service des Maladies du Sang, CHU d'Angers, Angers, France
| | - Vincent Lavoué
- Service de Gynécologie-obstétrique, CHU de Rennes, Rennes, France.,UMR INSERM 1242, Université de Rennes, Rennes, France
| | | | - Alain Morel
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France.,Institut de Cancérologie de l'Ouest, Angers, France
| | - Véronique Catros
- CHU de Rennes, Rennes, France; UMR INSERM 991, Rennes, France; CRB Santé de Rennes, Rennes, France
| | - Guillaume Tcherkez
- Research School of Biology, ANU Joint College of Sciences, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Guy Lenaers
- Université d'Angers, Inserm U1083, CNRS U6015, Institut MitoVasc, Angers, France
| | - Cinzia Bocca
- Université d'Angers, Inserm U1083, CNRS U6015, Institut MitoVasc, Angers, France
| | | | - Vincent Procaccio
- Université d'Angers, Inserm U1083, CNRS U6015, Institut MitoVasc, Angers, France.,Département de Biochimie et Génétique, CHU d'Angers, Angers, France
| | - Yves Delneste
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France.,Laboratoire d'Immunologie et Allergologie, CHU d'Angers, Angers, France
| | - Pascale Jeannin
- Université d'Angers, CHU d'Angers, Inserm U1232, CRCINA, Angers, France. .,Laboratoire d'Immunologie et Allergologie, CHU d'Angers, Angers, France
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10
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Patsouris A, Augereau P, Frenel JS, Robert M, Gourmelon C, Bourbouloux E, Berton-Rigaud D, Chevalier LM, Campone M. Benefits versus risk profile of buparlisib for the treatment of breast cancer. Expert Opin Drug Saf 2019; 18:553-562. [PMID: 31159599 DOI: 10.1080/14740338.2019.1623877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Activation of phosphoinositide 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathways occurs in 70% of breast cancer, including PIK3CA activating mutations, PTEN loss and AKT mutation. It is associated with poor prognosis and resistance to anti-HER2 and endocrine therapy. PI3K inhibitors are promising anticancer targets that can reverse resistance to these therapies. Buparlisib (BKM-120) is an orally active pan-PI3K inhibitor evaluated in different solid tumors as monotherapy or in combination. Areas covered: This article reviews preclinical data, clinical studies that have evaluated the efficacy and safety profiles of buparlisib as a monotherapy or in combination with targeted therapy (including endocrine and anti-HER2 therapy) or cytotoxics. The authors cover completed and ongoing studies to evaluate the benefit vs risk profile of buparlisib. Expert opinion: Targeting PI3K showed efficacy in BC. Buparlisib, a pan PI3K inhibitor, presents manageable but not negligible toxicity with an activity/toxicity ratio in favor of the use of emerging second generation, α-selective PI3K inhibitors for ongoing and future trials.
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Affiliation(s)
- Anne Patsouris
- a Unité INSERM 1232, Equipe 12, CRCINA , ICO Nantes-Angers , Nantes , France
| | - Paule Augereau
- b Departement of medical oncology , ICO Nantes-Angers , Nantes , France
| | | | - Marie Robert
- b Departement of medical oncology , ICO Nantes-Angers , Nantes , France
| | - Carole Gourmelon
- b Departement of medical oncology , ICO Nantes-Angers , Nantes , France
| | | | | | | | - Mario Campone
- d Unité INSERM 1232, Equipe 8 CRCINA , ICO Nantes-Angers , Nantes , France
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11
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Esseltine DW, Freeman CR, Chevalier LM, Smith R, O'Gorman AM, Dubé J, Whitehead VM, Nogrady MB. Computed tomography brain scans in long term survivors of childhood acute lymphoblastic leukemia. Med Pediatr Oncol 1981; 9:429-38. [PMID: 6795432 DOI: 10.1002/mpo.2950090504] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
There have been varying frequencies cited for the occurrence of abnormal brain CT scans in leukemic patients and conflicting evidence about the significance of these abnormalities and their relationship to sanctuary therapy. Our study of CT brain scans in 26 long survivors of acute lymphoblastic leukemia showed an overall prevalence of 35% abnormal scans. There was no statistically significant difference between the number of abnormal scans in patients given radiotherapy as part of their CNS prophylaxis and those receiving only intrathecal methotrexate. Because the children in each treatment group were evenly matched with respect to other treatment variables possibly relevant to the causation of abnormal brain scans, a strong case is made for more rigorous design of such studies, preferably in a prospective fashion, looking simultaneously at other parameters of brain structure and function.
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12
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Freeman CR, Gledhill R, Chevalier LM, Whitehead VM, Esseltine DL. Osteogenic sarcoma following treatment with megavoltage radiation and chemotherapy for bone tumors in children. Med Pediatr Oncol 1980; 8:375-82. [PMID: 6779103 DOI: 10.1002/mpo.2950080409] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
While osteogenic sarcoma has been well-recognized as a late complication of exposure to high doses of ionizing radiation in the orthovoltage energy range, it has been less frequently reported in patients treated with megavoltage radiation. This potential complication should, however, not be dismissed as an occurrence to be seen only after high-dose orthovoltage radiation. We have recently seen two children who developed osteogenic sarcoma following treatment with megavoltage radiation and combination chemotherapy for primary bone tumors. The implications in regard to aggressive multimodality treatment for pediatric malignancies are discussed.
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