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Roeper J, Christopoulos P, Falk M, Heukamp L, Stenzinger A, Thomas M, Griesinger F. 139P The impact of TP53 mutations on EGFR mt+ NSCLC IV patients treated with 3rd generation TKI on 2nd line or further line therapy: Real-world data from two certified lung cancer centers in Germany. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Christopoulos P, Grohé C, Griesinger F, Falkenstern-Ge R, Krisam J, Brückner L, Wermke M, Misch D, Hackanson B, Faehling M, Tufman A, Janning M, Schulz C, Reck M, Hong JL, Lin H, Stenzinger A, Thomas M. 153P Real-world study of NSCLC with EGFR exon 20 insertions. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01995-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mountzios G, Samantas E, Senghas K, Zervas E, Krisam J, Samitas K, Bozorgmehr F, Kuon J, Agelaki S, Baka S, Athanasiadis I, Gaissmaier L, Elshiaty M, Daniello L, Christopoulou A, Pentheroudakis G, Lianos E, Linardou H, Kriegsmann K, Kosmidis P, El Shafie R, Kriegsmann M, Psyrri A, Andreadis C, Fountzilas E, Heussel C, Herth F, Winter H, Emmanouilidis C, Oikonomopoulos G, Meister M, Muley T, Bischoff H, Saridaki Z, Razis E, Perdikouri E, Stenzinger A, Boukovinas I, Reck M, Syrigos K, Thomas M, Christopoulos P. P75.04 Advanced Lung Cancer Inflammation Index (ALI), Neutrophil-to-Lymphocyte Ratio (NLR), and PD-(L)1 Inhibitor Efficacy in NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hofman P, Ilié M, Chamorey E, Brest P, Schiappa R, Nakache V, Antoine M, Barberis M, Begueret H, Bibeau F, Bonnetaud C, Boström P, Brousset P, Bubendorf L, Carvalho L, Cathomas G, Cazes A, Chalabreysse L, Chenard MP, Copin MC, Côté JF, Damotte D, de Leval L, Delongova P, Thomas de Montpreville V, de Muret A, Dema A, Dietmaier W, Evert M, Fabre A, Forest F, Foulet A, Garcia S, Garcia-Martos M, Gibault L, Gorkiewicz G, Jonigk D, Gosney J, Hofman A, Kern I, Kerr K, Kossai M, Kriegsmann M, Lassalle S, Long-Mira E, Lupo A, Mamilos A, Matěj R, Meilleroux J, Ortiz-Villalón C, Panico L, Panizo A, Papotti M, Pauwels P, Pelosi G, Penault-Llorca F, Pop O, Poté N, Cajal SRY, Sabourin JC, Salmon I, Sajin M, Savic-Prince S, Schildhaus HU, Schirmacher P, Serre I, Shaw E, Sizaret D, Stenzinger A, Stojsic J, Thunnissen E, Timens W, Troncone G, Werlein C, Wolff H, Berthet JP, Benzaquen J, Marquette CH, Hofman V, Calabrese F. Clinical and molecular practice of European thoracic pathology laboratories during the COVID-19 pandemic. The past and the near future. ESMO Open 2020; 6:100024. [PMID: 33399086 PMCID: PMC7780004 DOI: 10.1016/j.esmoop.2020.100024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases. Materials and methods A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID-19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019. Results Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples. Conclusions The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe. Biosafety measures used in the first wave of the COVID-19 crisis were heterogeneous in 53 European pathology laboratories. A dramatic decrease of the workload in pathology laboratories was noted. No case of healthcare workers contaminated with SARS-CoV-2 associated with samples handling was identified.
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Mosele F, Remon J, Mateo J, Westphalen CB, Barlesi F, Lolkema MP, Normanno N, Scarpa A, Robson M, Meric-Bernstam F, Wagle N, Stenzinger A, Bonastre J, Bayle A, Michiels S, Bièche I, Rouleau E, Jezdic S, Douillard JY, Reis-Filho JS, Dienstmann R, André F. Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers: a report from the ESMO Precision Medicine Working Group. Ann Oncol 2020; 31:1491-1505. [PMID: 32853681 DOI: 10.1016/j.annonc.2020.07.014] [Citation(s) in RCA: 594] [Impact Index Per Article: 148.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
Next-generation sequencing (NGS) allows sequencing of a high number of nucleotides in a short time frame at an affordable cost. While this technology has been widely implemented, there are no recommendations from scientific societies about its use in oncology practice. The European Society for Medical Oncology (ESMO) is proposing three levels of recommendations for the use of NGS. Based on the current evidence, ESMO recommends routine use of NGS on tumour samples in advanced non-squamous non-small-cell lung cancer (NSCLC), prostate cancers, ovarian cancers and cholangiocarcinoma. In these tumours, large multigene panels could be used if they add acceptable extra cost compared with small panels. In colon cancers, NGS could be an alternative to PCR. In addition, based on the KN158 trial and considering that patients with endometrial and small-cell lung cancers should have broad access to anti-programmed cell death 1 (anti-PD1) antibodies, it is recommended to test tumour mutational burden (TMB) in cervical cancers, well- and moderately-differentiated neuroendocrine tumours, salivary cancers, thyroid cancers and vulvar cancers, as TMB-high predicted response to pembrolizumab in these cancers. Outside the indications of multigene panels, and considering that the use of large panels of genes could lead to few clinically meaningful responders, ESMO acknowledges that a patient and a doctor could decide together to order a large panel of genes, pending no extra cost for the public health care system and if the patient is informed about the low likelihood of benefit. ESMO recommends that the use of off-label drugs matched to genomics is done only if an access programme and a procedure of decision has been developed at the national or regional level. Finally, ESMO recommends that clinical research centres develop multigene sequencing as a tool to screen patients eligible for clinical trials and to accelerate drug development, and prospectively capture the data that could further inform how to optimise the use of this technology.
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Bozorgmehr F, Fischer J, Bischof M, Atmaca A, Wetzel S, Faehling M, Bottke D, Wermke M, Troost E, Schmidtke-Schrezenmeier G, Wiegel T, van Laak V, Stupavsky A, Engel-Riedel W, Ingenhoff E, Reinmuth N, Krisam J, Stenzinger A, Thomas M, Rieken S. LBA58 ORR in patients receiving nivolumab plus radiotherapy in advanced non-small cell lung cancer: First results from the FORCE trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Christopoulos P, Kirchner M, Roeper J, Saalfeld F, Janning M, Bozorgmehr F, Magios N, Kazdal D, Volckmar AL, Brückner LM, Bochtler T, Kriegsmann M, Endris V, Penzel R, Kriegsmann K, Eichhorn M, Herth FJF, Heussel CP, El Shafie RA, Schneider MA, Muley T, Meister M, Faehling M, Fischer JR, Heukamp L, Schirmacher P, Bischoff H, Wermke M, Loges S, Griesinger F, Stenzinger A, Thomas M. Risk stratification of EGFR + lung cancer diagnosed with panel-based next-generation sequencing. Lung Cancer 2020; 148:105-112. [PMID: 32871455 DOI: 10.1016/j.lungcan.2020.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/24/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Panel-based next-generation sequencing (NGS) is increasingly used for the diagnosis of EGFR-mutated non-small-cell lung cancer (NSCLC) and could improve risk assessment in combination with clinical parameters. MATERIALS AND METHODS To this end, we retrospectively analyzed the outcome of 400 tyrosine kinase inhibitor (TKI)-treated EGFR+ NSCLC patients with validation of results in an independent cohort (n = 130). RESULTS EGFR alterations other than exon 19 deletions (non-del19), TP53 co-mutations, and brain metastases at baseline showed independent associations of similar strengths with progression-free (PFS hazard ratios [HR] 2.1-2.3) and overall survival (OS HR 1.7-2.2), in combination defining patient subgroups with distinct outcome (EGFR+NSCLC risk Score, "ENS", p < 0.001). Co-mutations beyond TP53 were rarely detected by our multigene panel (<5%) and not associated with clinical endpoints. Smoking did not affect outcome independently, but was associated with non-del19 EGFR mutations (p < 0.05) and comorbidities (p < 0.001). Laboratory parameters, like the blood lymphocyte-to-neutrophil ratio and serum LDH, correlated with the metastatic pattern (p < 0.01), but had no independent prognostic value. Reduced ECOG performance status (PS) was associated with comorbidities (p < 0.05) and shorter OS (p < 0.05), but preserved TKI efficacy. Non-adenocarcinoma histology was also associated with shorter OS (p < 0.05), but rare (2-3 %). The ECOG PS and non-adenocarcinoma histology could not be validated in our independent cohort, and did not increase the range of prognostication alongside the ENS. CONCLUSIONS EGFR variant, TP53 status and brain metastases predict TKI efficacy and survival in EGFR+ NSCLC irrespective of other currently available parameters ("ENS"). Together, they constitute a practical and reproducible approach for risk stratification of newly diagnosed metastatic EGFR+ NSCLC.
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Elgaafary S, Hlevnjak M, Schulze M, Thewes V, Seitz J, Fremd C, Michel L, Beck K, Pfütze K, Richter D, Wolf S, Pixberg C, Hutter B, Ishaque N, Hirsch S, Gieldon L, Stenzinger A, Springfeld C, Kreutzfeld S, Horak P, Smetanay K, Mavratzas A, Brors B, Kirsten R, Trumpp A, Schütz F, Fröhling S, Sinn HP, Jäger D, Zapatka M, Lichter P, Schneeweiss A. Dauerhaftes Ansprechen auf Olaparib und endokrine Therapie bei einer Patientin mit metastasiertem luminalem Mammakarzinom und gBRCA-Mutation. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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Görtz M, Radtke J, Hatiboglu G, Schütz V, Tosev G, Güttlein M, Leichsenring J, Stenzinger A, Bonekamp D, Schlemmer H, Hohenfellner M, Nyarangi-Dix J. The value of PSA density in PI-RADS 3 lesions on multiparametric MRI - a strategy to avoid unnecessary prostate biopsies. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Stenzinger A, Endris V, Budczies J, Merkelbach-Bruse S, Dietmaier W, Siebolts U, Maas J, Merino D, Stewart M, Allen J, Glimm H, Thiemann M, Aust D, Hummel M, Moch H, Jung A, Haller F, Weichert W, Dietel M. Harmonization and standardization of panel-based tumour mutational burden (TMB) measurement: Real-world results and recommendations of the QuIP study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Horak P, Kreutzfeldt S, Mock A, Heining C, Heilig C, Möhrmann L, Uhrig S, Hübschmann D, Beck K, Richter D, Schlenk R, Klink B, Hutter B, Weichert W, Stenzinger A, Schröck E, Brors B, Glimm H, Fröhling S. Comprehensive genomic and transcriptomic profiling in advanced-stage cancers and rare malignancies: Clinical results from the MASTER trial of the German Cancer Consortium. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mock A, Heilig C, Kreutzfeldt S, Hübschmann D, Heining C, Schröck E, Brors B, Stenzinger A, Jäger D, Schlenk R, Glimm H, Fröhling S, Horak P. Community-driven development of a modified progression-free survival ratio for precision oncology trials. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Christopoulos P, Volckmar AL, Bozorgmehr F, Magios N, Kuon J, Kirchner M, Kazdal D, Endris V, Bochtler T, Herth F, Heussel CP, Winter H, Muley T, Meister M, Fischer J, Rieken S, Faehling M, Bischoff H, Stenzinger A, Thomas M. Real-world implementation of sequential targeted therapies for EGFR-mutated NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kazdal D, Allgäuer M, Budczies J, Kriegsmann M, Leichsenring J, Volckmar A, Kirchner M, Neumann O, Brandt R, Rempel E, Tala S, Harms A, Plögler C, Von Winterfeld M, Penzel R, Schirmacher P, Endris V, Stenzinger A. P1.04-13 Delineating Spatial Heterogeneity of Tumor Mutational Burden (TMB) Counts in Pulmonary Adenocarcinoma. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ortiz-Brüchle N, Muders M, Toma M, Esposito I, Hartmann A, Stöhr R, Reis H, Wild P, Köllermann J, Bremmer F, Leichsenring J, Stenzinger A, Merkelbach-Bruse S, Kirfel S, Perner S, Hartmann N, Roth W, Jung A, Kirchner T, Schwamborn K, Pfarr N, Dahl E, Knüchel R, Gaisa NT. [Status of the availability and use of next generation sequencing (NGS) in bladder cancer-a questionnaire within the uropathology working group]. Urologe A 2019; 59:318-325. [PMID: 31541269 DOI: 10.1007/s00120-019-01046-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Technical advancement and availability of high-throughput analysis has advanced molecular subtyping of most cancers. Thus, new possibilities for precision oncology have emerged. AIM Therefore, we aimed to collect data regarding availability and use of next generation sequencing (NGS) for urothelial cancer within the uropathology working group of the German Society of Pathology. METHODS We collected data by questionnaires and additionally asked for sequencing results of bladder cancers in the participating institutions. RESULTS A total of 13 university-affiliated institutes of pathology took part in the survey. All university institutes offer NGS-based molecular panel diagnostics and provide panels covering between 15 and 170 genes. Altogether, only 20 bladder cancers were sequenced in routine diagnostics and for 10 cancers potential targeted treatment options were available. DISCUSSION So far, despite availability of NGS diagnostics at university institutes of pathology, only few bladder cancer samples have been sequenced. Based on current data from the molecular subtyping of bladder cancers, we recommend a step-by-step protocol with basic immunohistochemistry analysis and subsequent subtype-dependent analyses, e.g., alterations of the fibroblast growth factor receptors (FGFR) or comprehensive gene panel analyses.
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Budczies J, Allgäuer M, Litchfield K, Rempel E, Christopoulos P, Kazdal D, Endris V, Thomas M, Fröhling S, Peters S, Swanton C, Schirmacher P, Stenzinger A. Optimizing panel-based tumor mutational burden (TMB) measurement. Ann Oncol 2019; 30:1496-1506. [PMID: 31268125 DOI: 10.1093/annonc/mdz205] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Panel sequencing based estimates of tumor mutational burden (psTMB) are increasingly replacing whole exome sequencing (WES) tumor mutational burden as predictive biomarker of immune checkpoint blockade (ICB). DESIGN A mathematical law describing psTMB variability was derived using a random mutation model and complemented by the contributions of non-randomly mutated real-world cancer genomes and intratumoral heterogeneity through simulations in publicly available datasets. RESULTS The coefficient of variation (CV) of psTMB decreased inversely proportional with the square root of the panel size and the square root of the TMB level. In silico simulations of all major commercially available panels in the TCGA pan-cancer cohort confirmed the validity of this mathematical law and demonstrated that the CV was 35% for TMB = 10 muts/Mbp for the largest panels of size 1.1-1.4 Mbp. Accordingly, misclassification rates (gold standard: WES) to separate 'TMBhigh' from 'TMBlow' using a cut-point of 199 mutations were 10%-12% in TCGA-LUAD and 17%-19% in TCGA-LUSC. A novel three-tier psTMB classification scheme which accounts for the likelihood of misclassification is proposed. Simulations in two WES datasets of immunotherapy treated patients revealed that small gene panels were poor predictors of ICB response. Moreover, we noted substantial intratumoral variance of psTMB scores in the TRACERx 100 cohort and identified indel burden as independent marker complementing missense mutation burden. CONCLUSIONS A universal mathematical law describes accuracy limitations inherent to psTMB, which result in substantial misclassification rates. This scenario can be controlled by two measures: (i) a panel design that is based on the mathematical law described in this article: halving the CV requires a fourfold increase in panel size, (ii) a novel three-tier TMB classification scheme. Moreover, inclusion of indel burden can complement TMB reports. This work has substantial implications for panel design, TMB testing, clinical trials and patient management.
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Leichsenring J, Kazdal D, Ploeger C, Allgäuer M, Endris V, Volckmar AL, Neumann O, Kirchner M, Penzel R, Rempel E, Budczies J, Schirmacher P, Fröhling S, Stenzinger A. [From panel diagnostics to comprehensive genomic analysis : Infobesity or empowerment?]. DER PATHOLOGE 2019; 40:235-242. [PMID: 31089797 DOI: 10.1007/s00292-019-0608-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Precision oncology is obtaining a central role in the therapy of malignant diseases. The indication for targeted therapy is based on the identification of molecular targets for which next-generation sequencing (NGS) is commonly used nowadays. All approved predictive biomarkers and molecular targets, including gene fusions and copy number alterations, can be identified depending on panel design and method applied. Some clinical scenarios, however, may require more holistic genomic approaches, such as whole-genome/whole-exome and transcriptome analysis, which must be embedded in a clinical trial. Here, key aspects and applications of each method are summarized and discussed.
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Peters S, Dafni U, Boyer M, De Ruysscher D, Faivre-Finn C, Felip E, Garrido P, Girard N, Guckenberger M, Haanen J, Le Pechoux C, Mornex F, Ozsahin M, Paz-Ares L, Planchard D, Raben D, Ramalingam S, Reck M, Smit E, Stahel R, Stenzinger A, Swanton C, Vallone S, Garassino MC. Position of a panel of international lung cancer experts on the approval decision for use of durvalumab in stage III non-small-cell lung cancer (NSCLC) by the Committee for Medicinal Products for Human Use (CHMP). Ann Oncol 2019; 30:161-165. [PMID: 30624547 DOI: 10.1093/annonc/mdy553] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
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Chan TA, Yarchoan M, Jaffee E, Swanton C, Quezada SA, Stenzinger A, Peters S. Development of tumor mutation burden as an immunotherapy biomarker: utility for the oncology clinic. Ann Oncol 2019; 30:44-56. [PMID: 30395155 PMCID: PMC6336005 DOI: 10.1093/annonc/mdy495] [Citation(s) in RCA: 1558] [Impact Index Per Article: 311.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Treatment with immune checkpoint blockade (ICB) with agents such as anti-programmed cell death protein 1 (PD-1), anti-programmed death-ligand 1 (PD-L1), and/or anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) can result in impressive response rates and durable disease remission but only in a subset of patients with cancer. Expression of PD-L1 has demonstrated utility in selecting patients for response to ICB and has proven to be an important biomarker for patient selection. Tumor mutation burden (TMB) is emerging as a potential biomarker. However, refinement of interpretation and contextualization is required. Materials and methods In this review, we outline the evolution of TMB as a biomarker in oncology, delineate how TMB can be applied in the clinic, discuss current limitations as a diagnostic test, and highlight mechanistic insights unveiled by the study of TMB. We review available data to date studying TMB as a biomarker for response to ICB by tumor type, focusing on studies proposing a threshold for TMB as a predictive biomarker for ICB activity. Results High TMB consistently selects for benefit with ICB therapy. In lung, bladder and head and neck cancers, the current predictive TMB thresholds proposed approximate 200 non-synonymous somatic mutations by whole exome sequencing (WES). PD-L1 expression influences response to ICB in high TMB tumors with single agent PD-(L)1 antibodies; however, response may not be dependent on PD-L1 expression in the setting of anti-CTLA4 or anti-PD-1/CTLA-4 combination therapy. Disease-specific TMB thresholds for effective prediction of response in various other malignancies are not well established. Conclusions TMB, in concert with PD-L1 expression, has been demonstrated to be a useful biomarker for ICB selection across some cancer types; however, further prospective validation studies are required. TMB determination by selected targeted panels has been correlated with WES. Calibration and harmonization will be required for optimal utility and alignment across all platforms currently used internationally. Key challenges will need to be addressed before broader use in different tumor types.
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Christopoulos P, Kohlhäufl J, Bozorgmehr F, Kuon J, Schneider M, Neumann O, Liersch S, Heussel C, Winter H, Herth F, Rieken S, Muley T, Meister M, Bischoff H, Lasitschka F, Stenzinger A, Thomas M. Clinical and laboratory predictors of immune checkpoint inhibitor efficacy in non-small cell lung cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy493.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Christopoulos P, Kirchner M, Bozorgmehr F, Endris V, Elsayed M, Budczies J, Ristau J, Penzel R, Herth F, Heussel C, Eichhorn M, Muley T, Meister M, Fischer J, Rieken S, Lasitschka F, Bischoff H, Sotillo R, Schirmacher P, Thomas M, Stenzinger A. Identification of a highly lethal V3+TP53+subset in ALK+lung adenocarcinoma. Int J Cancer 2018; 144:190-199. [DOI: 10.1002/ijc.31893] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/11/2018] [Indexed: 12/24/2022]
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Christopoulos P, Kirchner M, Bozorgmehr F, Endris V, Elsayed M, Magios N, Volckmar AL, Penzel R, Herth F, Heussel C, Winter H, Muley T, Meister M, Fischer J, Rieken S, Lasitschka F, Bischoff H, Schirmacher P, Thomas M, Stenzinger A. TP53 mutations impair overall survival of TKI-treated patients with oncogene-driven NSCLC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stenzinger A, Allen J, Maas J, Stewart M, Merino D, Dietel M. Tumor mutational burden (TMB) standardization initiative: Establishing a consistent methodology for TMB measurement in clinical samples. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Apostolidis L, Kreutzfeldt S, Oles M, Gieldon L, Heining C, Horak P, Hutter B, Fröhlich M, Klink B, Lamping M, Uhrig S, Stenzinger A, Winkler E, Wiedenmann B, Jäger D, Schröck E, Keilholz U, Pavel M, Glimm H, Fröhling S. Prospective genome and transcriptome sequencing in advanced-stage neuroendocrine neoplasms. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nientiedt C, Tolstov Y, Volckmar AL, Endris V, Bonekamp D, Haberkorn U, Jäger D, Sültmann H, Stenzinger A, Hohenfellner M, Grüllich C, Duensing S. PARP inhibition in BRCA2-mutated prostate cancer. Ann Oncol 2018; 28:189-191. [PMID: 27687312 DOI: 10.1093/annonc/mdw445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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