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Edsjö A, Holmquist L, Geoerger B, Nowak F, Gomon G, Alix-Panabières C, Ploeger C, Lassen U, Le Tourneau C, Lehtiö J, Ott PA, von Deimling A, Fröhling S, Voest E, Klauschen F, Dienstmann R, Alshibany A, Siu LL, Stenzinger A. Precision cancer medicine: Concepts, current practice, and future developments. J Intern Med 2023; 294:455-481. [PMID: 37641393 DOI: 10.1111/joim.13709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Precision cancer medicine is a multidisciplinary team effort that requires involvement and commitment of many stakeholders including the society at large. Building on the success of significant advances in precision therapy for oncological patients over the last two decades, future developments will be significantly shaped by improvements in scalable molecular diagnostics in which increasingly complex multilayered datasets require transformation into clinically useful information guiding patient management at fast turnaround times. Adaptive profiling strategies involving tissue- and liquid-based testing that account for the immense plasticity of cancer during the patient's journey and also include early detection approaches are already finding their way into clinical routine and will become paramount. A second major driver is the development of smart clinical trials and trial concepts which, complemented by real-world evidence, rapidly broaden the spectrum of therapeutic options. Tight coordination with regulatory agencies and health technology assessment bodies is crucial in this context. Multicentric networks operating nationally and internationally are key in implementing precision oncology in clinical practice and support developing and improving the ecosystem and framework needed to turn invocation into benefits for patients. The review provides an overview of the diagnostic tools, innovative clinical studies, and collaborative efforts needed to realize precision cancer medicine.
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Affiliation(s)
- Anders Edsjö
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden
- Division of Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Genomic Medicine Sweden (GMS), Kristianstad, Sweden
| | - Louise Holmquist
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden
- Genomic Medicine Sweden (GMS), Kristianstad, Sweden
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- INSERM U1015, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | | | - Georgy Gomon
- Department of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Catherine Alix-Panabières
- Laboratory of Rare Human Circulating Cells, University Medical Center of Montpellier, Montpellier, France
- CREEC, MIVEGEC, University of Montpellier, Montpellier, France
| | - Carolin Ploeger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Centers for Personalized Medicine (ZPM), Heidelberg, Germany
| | - Ulrik Lassen
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France
- INSERM U900 Research Unit, Saint-Cloud, France
- Faculty of Medicine, Paris-Saclay University, Paris, France
| | - Janne Lehtiö
- Department of Oncology Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Patrick A Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Fröhling
- Division of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Emile Voest
- Department of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frederick Klauschen
- Institute of Pathology, Charite - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- BIFOLD - Berlin Institute for the Foundations of Learning and Data, Berlin, Germany
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Munich Partner Site, Heidelberg, Germany
| | | | | | - Lillian L Siu
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Centers for Personalized Medicine (ZPM), Heidelberg, Germany
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2
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Brugières L, Cozic N, Houot R, Rigaud C, Sibon D, Arfi-Rouche J, Bories P, Cottereau AS, Delmer A, Ducassou S, Garnier N, Lamant L, Leruste A, Millot F, Moalla S, Morschhauser F, Nolla M, Pagnier A, Reguerre Y, Renaud L, Schmitt A, Simonin M, Verschuur A, Hoog Labouret N, Mahier Ait Oukhatar C, Vassal G. Efficacy and safety of crizotinib in ALK-positive systemic anaplastic large-cell lymphoma in children, adolescents, and adult patients: results of the French AcSé-crizotinib trial. Eur J Cancer 2023; 191:112984. [PMID: 37549532 DOI: 10.1016/j.ejca.2023.112984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The French phase II AcSé-crizotinib trial aimed to evaluate the safety and efficacy of crizotinib in patients with ALK, ROS1, and MET-driven malignancies, including ALK-positive anaplastic large-cell lymphoma (ALK+ ALCL). METHODS ALK+ ALCL patients 12 months or older with measurable disease and no standard care options available received crizotinib twice daily at 165 mg/m2 in children and adolescents and 250 mg in adults. The primary end-point was the response rate at 8 weeks. RESULTS Twenty-eight patients were enroled between February 2014 and March 2018. Three patients who were not treated were excluded from the analysis. The median age was 19 years. The median previous line of chemotherapy was two. In the 24 patients with an evaluable response, the response rate at 8 weeks was 67% (95% CI: 47-82%). All patients discontinued crizotinib after a median treatment duration of 3.7 months: eight for progression, two for adverse events (AEs) related to prior treatments, and 15 by choice, including six for allogeneic stem-cell transplantation. The median follow-up was 45 months. Nine patients experienced an event: eight relapses (seven after crizotinib discontinuation and one after dose reduction), and one died in complete remission. The median duration of response was 43.3 months (95% CI: 8.3-not reached). The 3-year progression-free and overall survival rates were 40% (95% CI: 23-59%) and 63% (95% CI: 43-79%). Grade 3 or 4 treatment-related AEs occurred in 32% of patients. CONCLUSION Crizotinib shows efficacy and an acceptable safety profile in ALK+ ALCL relapsed/refractory patients. However, a large proportion of patients experience a relapse after crizotinib discontinuation. Future studies will assess if prolonged ALK inhibitor exposure has curative potential without consolidation.
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Affiliation(s)
- Laurence Brugières
- Department of Children and Adolescent Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France.
| | - Nathalie Cozic
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018 INSERM, Labeled Ligue Contre le Cancer, Université Paris-Saclay, Villejuif, France
| | - Roch Houot
- Department of Hematology, CHU de Rennes, Université de Rennes, Rennes, France
| | - Charlotte Rigaud
- Department of Children and Adolescent Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - David Sibon
- Lymphoid Malignancies Department, Henri Mondor University Hospital, AP-HP, Creteil, France
| | - Julia Arfi-Rouche
- Department of Radiology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Pierre Bories
- Institut Universitaire du Cancer - Oncopole, Toulouse, France
| | - Anne S Cottereau
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, University of Paris, Paris, France
| | - Alain Delmer
- Department of Hematology, University Hospital of Reims and UFR Médecine, Reims, France
| | | | - Nathalie Garnier
- Institut d'Hematologie et d'Oncologie Pediatrique, Hospices Civils de Lyon, Lyon, France
| | - Laurence Lamant
- Department of Pathology, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France Université Toulouse III-Paul Sabatier; UMR1037 CRCT, Toulouse, France
| | - Amaury Leruste
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | | | - S Moalla
- Institut Universitaire du Cancer - Oncopole, Toulouse, France
| | - Franck Morschhauser
- ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, CHU Lille, Lille, France
| | - Marie Nolla
- Pediatric Hematology-Immunology, CHU Toulouse Purpan, France
| | - Anne Pagnier
- Pediatric Immunology Hematology and Oncology, CHU Grenoble Alpes, France
| | - Yves Reguerre
- CHU de Saint Denis de La Réunion Service d'Oncologie et d'Hématologie Pédiatrique, Saint Denis, France
| | - Loic Renaud
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Hemato-Oncologie, DMU DHI; Université de Paris, Paris, France
| | - Anne Schmitt
- Hématologie, Institut Bergonié, Bordeaux, France
| | - Mathieu Simonin
- Department of Pediatric Hematology and Oncology, Assistance Publique-Hôpitaux de Paris Armand Trousseau Hospital, Sorbonne Université, Paris, France
| | - Arnaud Verschuur
- Department of Pediatric Hematology-Oncology, La Timone University Hospital, APHM, Marseille, France
| | | | | | - Gilles Vassal
- Department of Children and Adolescent Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
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Kazzi AI, Diniz PH, Mano M, Nogueira-Rodrigues A. Challenging Outlook of Caring for Adolescents and Young Adults With Cancer in Brazil: Results of a Nationwide Survey. JCO Glob Oncol 2023; 9:e2300078. [PMID: 37561979 PMCID: PMC10581624 DOI: 10.1200/go.23.00078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE The global burden of cancer in adolescents and young adults (AYAs) emerges as a major public health issue, in which remarkable challenges and unmet needs are evident. Because of sociodemographic inequalities, initiatives to change this scenario need to be expanded globally, particularly to low-middle-income countries (LMICs). This study aimed to gain information about the standards of AYA cancer care in Brazil from the physician's perspective. METHODS Physicians involved in AYA cancer care were invited to answer a national online survey. The questions covered several aspects from health care's demographics to specialized services availability, such as fertility and genetic counseling. The availability of a specialized AYA cancer care facility was the primary study end point, and the findings were stratified by region and treatment setting (public v private). RESULTS Among the physicians who responded (N = 249), 90% reported no access to a specialized AYA service. Only 20% had access to a fertility specialist, and 30% to a survivorship program in their institutions. Even external referrals to medical specialties were challenging, with 24% of the physicians reporting challenges. Despite the potential cardiotoxicity related to treatments, 43% of the respondents reported to refer patients for cardio-oncologists hardly ever. Furthermore, 36% of physicians had never enrolled AYA patients into clinical trials and 42% had never ordered a genetic test. Lack of specialized human resources was particularly evident in Northern Brazil, and delays in cancer diagnoses were frequent. CONCLUSION This first study addresses standards of AYA cancer care across Brazil. Importantly, the data disclose significant infrastructural gaps, implying that major investments in training and infrastructure are urgently needed. These data may mirror other LMICs reality.
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Affiliation(s)
- Ana I.M. Kazzi
- Grupo Oncoclínicas, Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Max Mano
- Grupo Oncoclínicas, Belo Horizonte, Brazil
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Horgan D, Hamdi Y, Lal JA, Nyawira T, Meyer S, Kondji D, Francisco NM, De Guzman R, Paul A, Bernard B, Reddy Nallamalla K, Park WY, Triapthi V, Tripathi R, Johns A, Singh MP, Phipps ME, Dube F, Rasheed HMA, Kozaric M, Pinto JA, Doral Stefani S, Aponte Rueda ME, Fujita Alarcon R, Barrera-Saldana HA. Framework for Adoption of Next-Generation Sequencing (NGS) Globally in the Oncology Area. Healthcare (Basel) 2023; 11:healthcare11030431. [PMID: 36767006 PMCID: PMC9914369 DOI: 10.3390/healthcare11030431] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Radical new possibilities of improved treatment of cancer are on offer from an advanced medical technology already demonstrating its significance: next-generation sequencing (NGS). This refined testing provides unprecedentedly precise diagnoses and permits the use of focused and highly personalized treatments. However, across regions globally, many cancer patients will continue to be denied the benefits of NGS as long as some of the yawning gaps in its implementation remain unattended. The challenges at the regional and national levels are linked because putting the solutions into effect is highly dependent on cooperation between regional- and national-level cooperation, which could be hindered by shortfalls in interpretation or understanding. The aim of the paper was to define and explore the necessary conditions for NGS and make recommendations for effective implementation based on extensive exchanges with policy makers and stakeholders. As a result, the European Alliance for Personalised Medicine (EAPM) developed a maturity framework structured around demand-side and supply-side issues to enable interested stakeholders in different countries to self-evaluate according to a common matrix. A questionnaire was designed to identify the current status of NGS implementation, and it was submitted to different experts in different institutions globally. This revealed significant variability in the different aspects of NGS uptake. Within different regions globally, to ensure those conditions are right, this can be improved by linking efforts made at the national level, where patients have needs and where care is delivered, and at the global level, where major policy initiatives in the health field are underway or in preparation, many of which offer direct or indirect pathways for building those conditions. In addition, in a period when consensus is still incomplete and catching up is needed at a political level to ensure rational allocation of resources-even within individual countries-to enable the best ways to make the necessary provisions for NGS, a key recommendation is to examine where closer links between national and regional actions could complement, support, and mutually reinforce efforts to improve the situation for patients.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India
- Correspondence:
| | - Yosr Hamdi
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis 1002, Tunisia
- Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Jonathan A. Lal
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India
- Department of Genetics and Cell Biology, GROW School of Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Institute for Public Health Genomics, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Teresia Nyawira
- National Commission for Science, Technology and Innovation in Kenya (NACOSTI), Nairobi 00100, Kenya
| | | | - Dominique Kondji
- Health & Development Communication, Building Capacity for Better Health in Africa, Yaounde P.O. Box 2032, Cameroon
| | - Ngiambudulu M. Francisco
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde (National Institute for Health Research), Luanda 3635, Angola
| | - Roselle De Guzman
- Oncology and Pain Management Section, Manila Central University—Filemon D. Tanchoco Medical Foundation Hospital, Caloocan 1400, Philippines
| | - Anupriya Paul
- Department of Mathematics and Statistics, Faculty of Science, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India
| | - Branka Bernard
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
- Mediterranean Institute for Life Sciences, 21000 Split, Croatia
| | | | - Woong-Yang Park
- Samsung Medical Center, Samsung Genome Institute, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Vijay Triapthi
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India
| | - Ravikant Tripathi
- Department Health Government of India, Ministry of Labor, New Delhi 110001, India
| | - Amber Johns
- Cancer Division, Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Sydney 2010, Australia
| | - Mohan P. Singh
- Center of Biotechnology, University of Allahabad, Allahabad 211002, India
| | - Maude E. Phipps
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia
| | - France Dube
- Precision Medicine and Breast Cancer Department, Astra Zeneca, 1800 Concord Pike, Wilmington, DE 19803, USA
| | | | - Marta Kozaric
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
| | - Joseph A. Pinto
- Center for Basic and Translational Research, Auna Ideas, Lima 15036, Peru
| | | | | | - Ricardo Fujita Alarcon
- Centro de Genética y Biología Molecular, Universidad de San Martín de Porres, Lima 15024, Peru
| | - Hugo A. Barrera-Saldana
- Innbiogem SC/Vitagenesis SA at National Laboratory for Services of Research, Development, and Innovation for the Pharma and Biotech Industries (LANSEIDI) of CONACyT Vitaxentrum Group, Monterrey 64630, Mexico
- Schools of Medicine and Biology, Autonomous University of Nuevo Leon, Monterrey 66451, Mexico
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Véron M, Chevret S, Grob JJ, Beylot-Barry M, Saiag P, Fléchon A, You B, Maubec E, Jouary T, Toulemonde E, Jamme P, Gambotti L, Lamrani-Ghaouti A, Dupuy A, Lebbe C, Seguin NB, Houede N, Leccia MT, Le Du F, de Pontville M, Gaudy-Marquestre C, Guillot B, Simon C, Marabelle A, Mortier L. Safety and efficacy of nivolumab, an anti-PD1 immunotherapy, in patients with advanced basal cell carcinoma, after failure or intolerance to sonic Hedgehog inhibitors: UNICANCER AcSé NIVOLUMAB trial. Eur J Cancer 2022; 177:103-111. [PMID: 36335780 DOI: 10.1016/j.ejca.2022.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common human malignancy. In most cases, BCC has slow progression and can be definitively cured by surgery or radiotherapy. However, in rare cases, it can become locally advanced or, even more rarely, metastatic. The alternative recommended treatments are Sonic Hedgehog pathway inhibitors; however, the response is often short-lived. METHODS This was a phase 2 basket study (NCT03012581) evaluating the efficacy and safety of nivolumab in a cohort of 32 advanced BCC patients, enrolled after failure of Sonic Hedgehog inhibitors, including 29 laBCC (91%) and 3 mBCC (9%). RESULTS Compared to previously published studies, our population consisted of severe patients with a poor prognosis because they had already received multiple lines of treatment: all patients received previous Sonic Hedgehog inhibitors, 53% of patients already had chemotherapy and 75% radiotherapy. At 12 weeks, we reported 3.1% of complete responses, 18.8% of partial responses, and 43.8% of stable diseases. The best response rate to nivolumab reached 12.5% of complete responses (four patients), 18.8% of partial responses (three patients), and 43.8% of stable diseases (14 patients). Adverse events (AE) were mostly grade 2 or 3, slightly different to the adverse events observed in the treatment of metastatic melanoma (higher rate of diabetes, no thyroid dysfunction). CONCLUSION Nivolumab is a relevant therapeutic option for patients with advanced relapsing/refractory BCC.
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Affiliation(s)
- Marie Véron
- Department of Dermatology, Claude Huriez Hospital, University Hospital of Lille, France; University School of Medecine Henri Warembourg, Lille, France.
| | | | - Jean-Jacques Grob
- Department of Dermatology, University Hospital La Timone, Marseille, France; CARADERM Network
| | - Marie Beylot-Barry
- Department of Dermatology, University Hospital of Bordeaux & Translational Research on Oncodermatology and Rare Skin Diseases, Bordeaux Institute of Oncology, INSERM 1312, University of Bordeaux, France; CARADERM Network
| | - Philippe Saiag
- Department of Dermatology, Ambroise Paré Hospital, APHP, & EA4340, University of Versailles-SQY and University of Paris-Saclay, France; CARADERM Network
| | - Aude Fléchon
- Department of Oncology, Léon Bérard Center, Lyon, France
| | - Benoit You
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, EA3738 CICLY, Université Claude Bernard Lyon 1, Lyon, France; CARADERM Network
| | - Eve Maubec
- Department of Dermatology, Avicenne Hospital, University Hospital of Paris, France; CARADERM Network
| | - Thomas Jouary
- Department of Dermatology, University Hospital of Pau, France; CARADERM Network
| | - Elise Toulemonde
- Department of Dermatology, Claude Huriez Hospital, University Hospital of Lille, France; University School of Medecine Henri Warembourg, Lille, France
| | - Philippe Jamme
- Department of Dermatology, Claude Huriez Hospital, University Hospital of Lille, France; University School of Medecine Henri Warembourg, Lille, France
| | | | | | | | - Céleste Lebbe
- Université de Paris Cite, Dermato-Oncologie, AP-HP Hôpital Saint Louis, F-75010 Paris, INSERM U976, France; CARADERM Network
| | - Nicole Basset Seguin
- Université de Paris Cite, Dermato-Oncologie, AP-HP Hôpital Saint Louis, F-75010 Paris, INSERM U976, France; CARADERM Network
| | - Nadine Houede
- Department of Dermatology, University Hospital of Nimes, France
| | - Marie-Thérèse Leccia
- Department of Dermatology, University Hospital of Grenoble, France; CARADERM Network
| | - Fanny Le Du
- Department of Oncology, Eugène Maquis Center, Rennes, France
| | - Michel de Pontville
- Department of Dermatology, University Hospital of Caen, France; CARADERM Network
| | | | - Bernard Guillot
- Department of Dermatology, St Eloi Hospital, University Hospital of Montpellier, France; CARADERM Network
| | | | - Aurélien Marabelle
- Département D'Innovation Thérapeutique et D'Essais Précoces (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - Laurent Mortier
- Department of Dermatology, Claude Huriez Hospital, University Hospital of Lille, France; University School of Medecine Henri Warembourg, Lille, France; CARADERM Network; INSERM 41189 / ONCOTHAI
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Aparicio T, Cozic N, de la Fouchardière C, Meriaux E, Plaza J, Mineur L, Guimbaud R, Samalin E, Mary F, Lecomte T, Gomez-Roca C, Haineaux PA, Gratet A, Selves J, Menu Y, Colignon N, Johnson L, Legrand F, Vassal G. The Activity of Crizotinib in Chemo-Refractory MET-Amplified Esophageal and Gastric Adenocarcinomas: Results from the AcSé-Crizotinib Program. Target Oncol 2021; 16:381-388. [PMID: 33847874 PMCID: PMC8105218 DOI: 10.1007/s11523-021-00811-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 12/03/2022]
Abstract
Background The AcSé-crizotinib program provides extensive screening of crizotinib-targeted genomic alteration in several malignancies. We here report the results in patients with esogastric MET-amplified adenocarcinomas. Objective The objective of the study was to evaluate the efficacy and tolerability of crizotinib in patients with pretreated esogastric MET-amplified adenocarcinoma who have no alternative treatment options. Patients and Methods MET expression was evaluated by fluorescence in situ hybridization in tumor samples with immunohistochemistry scores ≥ 2+. Patients with chemo-refractory tumors showing ≥ 6 MET copies were eligible for crizotinib 250 mg twice daily. The primary efficacy outcome was the objective response rate after two cycles of crizotinib. Results MET was prospectively analyzed in 570 esogastric adenocarcinomas. Amplifications were found in 35/570 adenocarcinomas (29/523 gastric and 6/47 esophageal). Nine patients were treated with crizotinib. The objective response rate after two cycles was 33.3% (95% CI 7.5–70), the best overall response rate was 55.6% (95% CI 21.2–86.3), with median progression-free survival of 3.2 months (95% CI 1.0–5.4), and overall survival of 8.1 months (95% CI 1.7–24.6). Safety was consistent with that previously reported for crizotinib. Conclusions Large-scale screening for MET-amplified esogastric adenocarcinomas is feasible. MET amplification was observed in 5.5% of gastric and 12.8% of esophageal adenocarcinomas. Crizotinib shows encouraging results in selected patients. Thus, c-MET inhibition for MET-amplified tumors deserves further evaluation. Trial Registration Number NCT02034981. Date of Registration 14 January 2014.
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Affiliation(s)
- Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Hôpital Saint Louis, APHP, Université de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France.
| | - Nathalie Cozic
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France.,Oncostat U1018, Inserm, University Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Christelle de la Fouchardière
- Medical Oncology Department, Centre Léon Bérard, Lyon, France.,Cancer Research Center of Lyon, UMR INSERM 1052, CNRS 5286, 69373, Lyon, France
| | - Emeline Meriaux
- Institut du Cancer de l'Ouest-Centre René Gauducheau, Saint Herblain, France
| | - Jérome Plaza
- Hopitaux Privés de Metz-Hôpital Belle Isle, Metz, France
| | - Laurent Mineur
- Institut du cancer Sainte-Catherine Avignon Provence, Avignon, France
| | | | - Emmanuelle Samalin
- Medical Oncology Department, Institut du Cancer de Montpellier, Université de Montpellier, Montpellier, France
| | - Florence Mary
- Gastroenterology and Digestive Oncology, Hôpital Avicenne, AP-HP, Bobigny, France
| | - Thierry Lecomte
- Gastroenterology and Digestive Oncology, Tours University Hospital, UMR INSERM 1069, Université de Tours, Tours, France
| | - Carlos Gomez-Roca
- Institut Claudius Regaud, Toulouse, France.,IUCT-Oncopole, Toulouse, France
| | | | | | | | - Yves Menu
- Hôpital Saint Antoine, APHP, Paris, France
| | | | | | - Frédéric Legrand
- Department of Clinical Research, Institut National du Cancer, Boulogne Billancourt, France
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Hofman P, Rouleau E, Sabourin JC, Denis M, Deleuze JF, Barlesi F, Laurent-Puig P. Predictive molecular pathology in non-small cell lung cancer in France: The past, the present and the perspectives. Cancer Cytopathol 2021; 128:601-610. [PMID: 32885912 DOI: 10.1002/cncy.22318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022]
Abstract
The advent of molecular targets for novel therapeutics in oncology, notably for non-small cell lung carcinoma (NSCLC), led the French National Cancer Institute (INCa) to establish a national network of 28 hospital Molecular Genetics Centers for Cancer (MGCC) in 2007. In each University in France, laboratories were established to develop molecular biology testing to evaluate a few genomic alterations, initially a selection of genes, by using specific targeted polymerase chain reaction (PCR) assays. In a second phase, the number of studied genes was increased. In 2015, the MGCC benefited from an additional dedicated budget from the INCa to develop next-generation sequencing (NGS) technology. In the meantime, a new financial regulation for innovative testing has been established for the acts out of nomenclature. Consequently, all private and public laboratories in France have access to funding for molecular biology testing in oncology. The gene-based PCR assays or NGS tests have benefitted from reimbursement of cost testing by the INCa. Today, the laboratories consider this reimbursement to be only partial, and its use to be complex. In 2018, a strategic plan for medical genomic analyses (France Médecine Génomique 2025) was implemented to introduce more systematic sequencing into the health care pathway and oncology practice. The large panel of molecular tests should be centralized to a limited number of molecular genetic centers. This review describes the evolution of the different stages of implementation of molecular pathology testing for NSCLC patients over the last few years in France.
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Affiliation(s)
- Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, University Côte d'Azur, Nice, France.,Hospital-Related Biobank, Pasteur Hospital, University Côte d'Azur, Nice, France.,FHU OncoAge, Pasteur Hospital, University Côte d'Azur, Nice, France
| | - Etienne Rouleau
- Cancer Genetic Laboratory, Biology and Pathology Department, Gustave Roussy, Villejuif, France
| | | | - Marc Denis
- Department of Biochemistry and INSERM U1232, Nantes University Hospital, Nantes, France
| | - Jean-François Deleuze
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris Saclay, Evry, France.,Centre d'Etude du Polymorphisme Humain, Fondation Jean Dausset, Paris, France.,Centre de Référence, d'Innovation et d'Expertise (CREFIX), Paris, France
| | - Fabrice Barlesi
- Aix-Marseille University, CNRS, INSERM, CRCM, Marseille, France.,Gustave Roussy Cancer Campus, Villejuif, France
| | - Pierre Laurent-Puig
- UMR-1138, INSERM, Département de Biologie, Hôpital Européen Georges-Pompidou, Paris, France.,Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
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8
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Petit A, Lantuejoul S, Mc Leer A, Mondet J, Piolat C, Durand C, Moro-Sibilot D, Geoerger B, Vassal G, Sartelet H, Plantaz D. Precision medicine at its best: Prolonged survival in a child presenting a secondary mesothelioma treated with crizotinib. Pediatr Blood Cancer 2021; 68:e28666. [PMID: 32896951 DOI: 10.1002/pbc.28666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Audrey Petit
- Département de pédiatrie, CHU de Grenoble, La Tronche, France
| | - Sylvie Lantuejoul
- Département de biopathologie, Centre Léon Berard, CNR Mesopath, Université Grenoble Alpes, Saint-Martin-d'Hères, France
| | - Anne Mc Leer
- Service d'anatomie et cytologie pathologiques, Pôle de Biologie et Pathologie, CHU Grenoble Alpes, La Tronche, France.,UGA/INSERM U1209/CNRS 5309-Institute for Advanced Biosciences-Université Grenoble Alpes, Saint-Martin-d'Hères, France
| | - Julie Mondet
- Service d'anatomie et cytologie pathologiques, Pôle de Biologie et Pathologie, CHU Grenoble Alpes, La Tronche, France.,UGA/INSERM U1209/CNRS 5309-Institute for Advanced Biosciences-Université Grenoble Alpes, Saint-Martin-d'Hères, France
| | - Christian Piolat
- Département de chirurgie Pédiatrique, CHU de Grenoble, La Tronche, France
| | - Chantal Durand
- Département de radiologie Pédiatrique, CHU de Grenoble, La Tronche, France
| | - Denis Moro-Sibilot
- UGA/INSERM U1209/CNRS 5309-Institute for Advanced Biosciences-Université Grenoble Alpes, Saint-Martin-d'Hères, France.,Service Hospitalo Universitaire de physiologie et pneumologie, CHU de Grenoble, La Tronche, France
| | - Birgit Geoerger
- Gustave Roussy Cancer Campus, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Saint-Aubin, France
| | - Gilles Vassal
- Direction de la recherche clinique, Institut Gustave Roussy, Villejuif, France
| | - Hervé Sartelet
- Service d'anatomie et cytologie pathologiques, Pôle de Biologie et Pathologie, CHU Grenoble Alpes, La Tronche, France.,UGA/INSERM U1209/CNRS 5309-Institute for Advanced Biosciences-Université Grenoble Alpes, Saint-Martin-d'Hères, France
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9
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Basket trials: From tumour gnostic to tumour agnostic drug development. Cancer Treat Rev 2020; 90:102082. [DOI: 10.1016/j.ctrv.2020.102082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022]
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10
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Coquerelle S, Darlington M, Michel M, Durand M, Borget I, Baffert S, Marino P, Perrier L, Durand-Zaleski I. Impact of Next Generation Sequencing on Clinical Practice in Oncology in France: Better Genetic Profiles for Patients Improve Access to Experimental Treatments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:898-906. [PMID: 32762992 DOI: 10.1016/j.jval.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/11/2020] [Accepted: 03/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES We evaluated how next generation sequencing (NGS) can modify care pathways in an observational impact study in France. METHODS All patients with lung cancer, colorectal cancer, or melanoma who had NGS analyses of somatic genomic alterations done in 1 of 7 biomolecular platforms certified by the French National Cancer Institute (INCa) between 2013 and 2016 were eligible. We compared patients' pathways before and after their NGS results. Endpoints consisted of the turnaround time in obtaining results, the number of patients with at least 1 genomic alteration identified, the number of actionable alterations, the impact of the genomic multidisciplinary tumor board on care pathways, the number of changes in the treatment plan, and the survival outcome up to 1 year after NGS analyses. RESULTS 1213 patients with a request for NGS analysis were included. NGS was performed for 1155 patients, identified at least 1 genomic alteration for 867 (75%), and provided an actionable alteration for 614 (53%). Turnaround time between analyses and results was on average 8 days (Min: 0; Max: 95) for all cancer types. Before NGS analysis, 33 of 614 patients (5%) were prescribed a targeted therapy compared with 54 of 614 patients (8%) after NGS analysis. Proposition of inclusion in clinical trials with experimental treatments increased from 5% (n = 31 of 614) before to 28% (n = 178 of 614) after NGS analysis. Patients who benefited from a genotype matched treatment after NGS analysis tended to have a better survival outcome at 1 year than patients with nonmatched treatment: 258 days (±107) compared with 234 days (±106), (P = .41). CONCLUSIONS NGS analyses resulted in a change in patients' care pathways for 20% of patients (n = 232 of 1155).
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Affiliation(s)
- Séverine Coquerelle
- Unité de Recherche Clinique en Économie de la Santé d'Ile de France, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Centre of Research in Epidemiology and Statistics, Institut National de la Santé et de la Recherche Médicale-Joint Research Units, Paris, France.
| | - Meryl Darlington
- Unité de Recherche Clinique en Économie de la Santé d'Ile de France, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Morgane Michel
- Unité de Recherche Clinique en Économie de la Santé d'Ile de France, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Institut National de la Santé et de la Recherche Médicale, Epidémiologie Clinique et Evaluation Economique, Paris, France
| | - Manon Durand
- Unité de Recherche Clinique en Économie de la Santé d'Ile de France, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Isabelle Borget
- Etudes et Recherche en Economie de la Santé, Gustave Roussy Institute, Villejuif, France
| | | | - Patricia Marino
- Institut Paoli Calmettes, Sciences Economiques et Sociales de la Santé et Traitement de l'information Médicale, Marseille, France
| | - Lionel Perrier
- Université de Lyon, Centre Léon Bérard, Groupe d'Analyse de Théorie Economique, Lyon Saint-Etienne-Joint Research Units, Lyon, France
| | - Isabelle Durand-Zaleski
- Unité de Recherche Clinique en Économie de la Santé d'Ile de France, Assistance Publique Hôpitaux de Paris, Paris, France; Centre of Research in Epidemiology and Statistics, Institut National de la Santé et de la Recherche Médicale-Joint Research Units, Paris, France; Public Health Department, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
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11
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Mazieres J, Cropet C, Montané L, Barlesi F, Souquet P, Quantin X, Dubos-Arvis C, Otto J, Favier L, Avrillon V, Cadranel J, Moro-Sibilot D, Monnet I, Westeel V, Le Treut J, Brain E, Trédaniel J, Jaffro M, Collot S, Ferretti G, Tiffon C, Mahier-Ait Oukhatar C, Blay J. Vemurafenib in non-small-cell lung cancer patients with BRAFV600 and BRAFnonV600 mutations. Ann Oncol 2020; 31:289-294. [DOI: 10.1016/j.annonc.2019.10.022] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 12/21/2022] Open
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12
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Genomic profiling in oncology clinical practice. Clin Transl Oncol 2020; 22:1430-1439. [PMID: 31981077 DOI: 10.1007/s12094-020-02296-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/08/2020] [Indexed: 02/04/2023]
Abstract
The development of high-throughput technologies such as next-generation sequencing for DNA sequencing together with the decrease in their cost has led to the progressive introduction of genomic profiling in our daily practice in oncology. Nowadays, genomic profiling is part of genetic counseling, cancer diagnosis, molecular characterization, and as a biomarker of prognosis and response to treatment. Furthermore, germline or somatic genomic characterization of the tumor may provide new treatment opportunities for patients with cancer. In this review, we will summarize the clinical applications and limitations of genomic profiling in oncology clinical practice, focusing on next-generation sequencing.
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13
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Moro-Sibilot D, Cozic N, Pérol M, Mazières J, Otto J, Souquet PJ, Bahleda R, Wislez M, Zalcman G, Guibert SD, Barlési F, Mennecier B, Monnet I, Sabatier R, Bota S, Dubos C, Verriele V, Haddad V, Ferretti G, Cortot A, De Fraipont F, Jimenez M, Hoog-Labouret N, Vassal G. Crizotinib in c-MET- or ROS1-positive NSCLC: results of the AcSé phase II trial. Ann Oncol 2019; 30:1985-1991. [PMID: 31584608 DOI: 10.1093/annonc/mdz407] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In 2013, the French National Cancer Institute initiated the AcSé program to provide patients with secure access to targeted therapies outside of their marketed approvals. Efficacy and safety was then assessed using a two-stage Simon phase II trial design. When the study design was designed, crizotinib was approved only as monotherapy for adults with anaplastic lymphoma kinase plus non-small-cell lung cancers (NSCLC). PATIENTS AND METHODS Advanced NSCLC patients with c-MET ≥6 copies, c-MET-mutated, or ROS-1-translocated tumours were enrolled in one of the three cohorts. Patients were treated with crizotinib 250 mg twice daily. Efficacy was assessed using the objective response rate (ORR) after two cycles of crizotinib as primary outcome. Secondary outcomes included disease control rate at four cycles, best ORR, progression-free survival, overall survival, and drug tolerance. RESULTS From August 2013 to March 2018, 5606 patients had their tumour tested for crizotinib targeted molecular alterations: 252 patients had c-MET ≥6 copies, 74 c-MET-mutation, and 78 ROS-1-translocated tumour. Finally, 25 patients in the c-MET ≥6 copies cohort, 28 in the c-MET-mutation cohort, and 37 in the ROS-1-translocation cohort were treated in the phase II trial. The ORR was 16% in the c-MET ≥6 copies cohort, 10.7% in the mutated, and 47.2% in the ROS-1 cohort. The best ORR during treatment was 32% in the c-MET-≥6 copies cohort, 36% in the c-MET-mutated, and 69.4% in the ROS-1-translocation cohort. Safety data were consistent with that previously reported. CONCLUSIONS Crizotinib activity in patients with ROS1-translocated tumours was confirmed. In the c-MET-mutation and c-MET ≥6 copies cohorts, despite insufficient ORR after two cycles of crizotinib, there are signs of late response not sufficient to justify the development of crizotinib in this indication. The continued targeting of c-MET with innovative therapies appears justified. CLINICAL TRIAL NUMBER NCT02034981.
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Affiliation(s)
- D Moro-Sibilot
- Thoracic Oncology Unit, Grenoble-Alpes University Hospital, Grenoble; Intergroupe Francophone de Cancérologie Thoracique (IFCT), Paris.
| | - N Cozic
- Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, ESP, Paris-Saclay and Paris-Sud Universities, Villejuif
| | - M Pérol
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon
| | - J Mazières
- Pneumology Department, Toulouse University Hospital and Paul Sabatier University, Toulouse
| | - J Otto
- Department of Medicine, Antoine Lacassagne Cancer Centre, Nice
| | - P J Souquet
- Department of Pneumology and Thoracic Oncology, Lyon Sud Hospital Center, Hospices Civils de Lyon, Pierre Bénite
| | - R Bahleda
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif
| | - M Wislez
- Pneumology Department, Tenon Hospital, AP-HP and "Pierre and Marie Curie" University, Paris
| | - G Zalcman
- Thoracic Oncology Department-CIC INSERM 1425, Bichat University Hospital, AP-HP, Paris; Paris-Diderot University, Paris
| | | | - F Barlési
- Multidisciplinary Oncology & Therapeutic Innovations Department, APHM and Aix Marseille University, INSERM, CNRS, CRCM, Marseille
| | - B Mennecier
- Pneumology Department, Strasbourg University Hospital, Strasbourg
| | - I Monnet
- Pneumology Department, CHIC Creteil, Créteil
| | - R Sabatier
- Department of Medical Oncology, Inserm 1068, CNRS UMR7258, CRCM, Paoli-Calmettes Institute and Aix-Marseille University, Marseille
| | - S Bota
- Pneumology Department, Charles Nicolle Hospital, Rouen University Hospital, Rouen
| | - C Dubos
- Pneumology Department, François Baclesse Cancer Centre, Caen
| | - V Verriele
- Anatomy and Pathological Cytologies Department, Paul Papin Cancer Centre, ICO, Angers
| | - V Haddad
- Department of Tumour Biology, Léon Bérard Cancer Centre, Lyon
| | - G Ferretti
- Radiology and Medical Imaging Department, Grenoble-Alpes University Hospital, Grenoble
| | - A Cortot
- Department of Thoracic Oncology, Lille University Hospital and University of Lille, Lille
| | - F De Fraipont
- Molecular Genetic Unit: Hereditary Diseases and Oncology, Grenoble-Alpes University Hospital, Grenoble
| | - M Jimenez
- Research and Development UNICANCER, Paris
| | | | - G Vassal
- Clinical Research Division, Gustave Roussy Cancer Campus, Villejuif, France
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14
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Ou FS, An MW, Ruppert AS, Mandrekar SJ. Discussion of Trial Designs for Biomarker Identification and Validation Through the Use of Case Studies. JCO Precis Oncol 2019; 3:PO.19.00051. [PMID: 32190807 PMCID: PMC7079723 DOI: 10.1200/po.19.00051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 12/29/2022] Open
Abstract
With the launch of the National Cancer Institute's Precision Medicine Initiative in 2015, there has been a shift to trial designs that tailor health care solutions to individual patients by using a screening platform and by moving away from the one-trial/one-biomarker-at-a-time approach. To make precision medicine a reality, it is critical to identify and validate potential biomarkers to help select patients who will truly benefit from a targeted therapy. In this article, we discuss five trial designs: enrichment, umbrella, basket, subgroup, and window of opportunity. For each trial design, we describe the design characteristics, use ongoing or completed trials as case studies, provide any recent advances to the trial design, and discuss advantages and disadvantages of each design.
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15
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Mulero-Sánchez A, Pogacar Z, Vecchione L. Importance of genetic screens in precision oncology. ESMO Open 2019; 4:e000505. [PMID: 31231569 PMCID: PMC6555615 DOI: 10.1136/esmoopen-2019-000505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 01/05/2023] Open
Abstract
Precision oncology aims to distinguish which patients are eligible for a specific treatment in order to achieve the best possible outcome. In the last few years, genetic screens have shown their potential to find the new targets and drug combinations as well as predictive biomarkers for response and/or resistance to cancer treatment. In this review, we outline how precision oncology is changing over time and describe the different applications of genetic screens. Finally, we present some practical examples that describe the utility and the limitations of genetic screens in precision oncology.
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Affiliation(s)
- Antonio Mulero-Sánchez
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ziva Pogacar
- Division of Molecular Carcinogenesis, Oncode Institute, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Loredana Vecchione
- Charite Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
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16
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Salgado R, Solit DB, Rimm DL, Bogaerts J, Canetta R, Lively T, Lyerly K, Span PN, Bateman-House A, Makady A, Bergmann L, Nagai S, Smith C, Robson M, Savage M, Voest E, Sweeney C, Lambin P, Thomas M, Harris L, Lacombe D, Massard C. Addressing the dichotomy between individual and societal approaches to personalised medicine in oncology. Eur J Cancer 2019; 114:128-136. [PMID: 31060925 DOI: 10.1016/j.ejca.2019.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/28/2019] [Indexed: 11/28/2022]
Abstract
Academic, industry, regulatory leaders and patient advocates in cancer clinical research met in November 2018 at the Innovation and Biomarkers in Cancer Drug Development meeting in Brussels to address the existing dichotomy between increasing calls for personalised oncology approaches based on individual molecular profiles and the need to make resource and regulatory decisions at the societal level in differing health-care delivery systems around the globe. Novel clinical trial designs, the utility and limitations of real-world evidence (RWE) and emerging technologies for profiling patient tumours and tumour-derived DNA in plasma were discussed. While randomised clinical trials remain the gold standard approach to defining clinical utility of local and systemic therapeutic interventions, the broader adoption of comprehensive tumour profiling and novel trial designs coupled with RWE may allow patient and physician autonomy to be appropriately balanced with broader assessments of safety and overall societal benefit.
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Affiliation(s)
- Roberto Salgado
- Department of Pathology GZA-ZNA, Antwerp, Belgium; Division of Research, Peter Mac Callum Cancer Center, Melbourne, Australia.
| | - David B Solit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David L Rimm
- Dept. of Pathology, Yale University School of Medicine, New Haven, CT, USA; Dept. of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | | | - Paul N Span
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Amr Makady
- The National Healthcare Institute (ZIN), Diemen, the Netherlands
| | - L Bergmann
- Medical Clinic II, University Hospital Frankfurt, Germany; Ambulantes Krebszentrum Frankfurt, Germany
| | - Sumimasa Nagai
- Translational Research Center, The University of Tokyo Hospital and PMDA, Tokyo, Japan
| | - Chris Smith
- CRUK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Emile Voest
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Philippe Lambin
- The D-Lab & The M-Lab, Department of Precision Medicine, GROW Research Institute for Oncology, Maastricht, The Netherlands
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17
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DuBois SG, Corson LB, Stegmaier K, Janeway KA. Ushering in the next generation of precision trials for pediatric cancer. Science 2019; 363:1175-1181. [DOI: 10.1126/science.aaw4153] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cancer treatment decisions are increasingly based on the genomic profile of the patient’s tumor, a strategy called “precision oncology.” Over the past few years, a growing number of clinical trials and case reports have provided evidence that precision oncology is an effective approach for at least some children with cancer. Here, we review key factors influencing pediatric drug development in the era of precision oncology. We describe an emerging regulatory framework that is accelerating the pace of clinical trials in children as well as design challenges that are specific to trials that involve young cancer patients. Last, we discuss new drug development approaches for pediatric cancers whose growth relies on proteins that are difficult to target therapeutically, such as transcription factors.
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18
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Rochigneux P, Thomassin-Piana J, Laibe S, Brunelle S, Salem N, Escudier B, Vassal G, Gravis G. Long-term efficacy of crizotinib in a metastatic papillary renal carcinoma with MET amplification: a case report and literature review. BMC Cancer 2018; 18:1159. [PMID: 30466410 PMCID: PMC6251103 DOI: 10.1186/s12885-018-5049-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/06/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Papillary renal cell carcinoma (pRCC) is the 2nd most frequent histological type of kidney cancer and accounts for approximately 15% of all renal cell carcinoma. It has a poorer prognosis than clear cell RCC (ccRCC) with a lack of standard treatments. CASE PRESENTATION We report the case of a 51 year old man with a metastatic pRCC (hepatic dome and left colonic peritoneal carcinomatosis) progressive after sunitinib, with a MET amplification. The patient was enrolled in the UNICANCER-sponsored AcSé crizotinib trial (NCT02034981), designed to give an access to crizotinib for patients with tumors harboring a genomic alteration on one of the biological targets of the drug. With 2nd line crizotinib (250 mg twice/day), the patient had a very good tolerance, a partial response in the target lesions using RECIST 1.1, and a 19 months' clinical efficacy. CONCLUSIONS In metastatic pRCC with a MET amplification, crizotinib maybe a potential met-inhibitory therapeutic option.
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Affiliation(s)
- Philippe Rochigneux
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd de Sainte-Marguerite, 13009, Marseille, France.
- UCLA David Geffen School of Medicine, Los Angeles, USA.
| | | | - Sophy Laibe
- Department of Cytogenetics and Molecular Genetics, Institut Paoli-Calmettes, Marseille, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, Marseille, France
| | - Naji Salem
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
| | - Bernard Escudier
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Gilles Vassal
- Direction of Clinical Research, Gustave Roussy Cancer Center, Villejuif, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Bd de Sainte-Marguerite, 13009, Marseille, France
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Abstract
INTRODUCTION In recent years, the therapeutic management of selected patients with cancer has shifted toward the 'precision medicine' approach based on patient's mechanisms of tumorigenesis, and their baseline characteristics and comorbidities. Complete tumor and cell-free DNA profiling using next-generation sequencing, proteomic and RNA analysis, and immune mechanisms should to be taken into consideration and accurate bioinformatic analysis is essential to optimize patient's treatment. Areas covered: The challenges and opportunities of conducting clinical trials in precision oncology are summarized. Expert commentary: Precision medicine has significantly changed the diagnostic and therapeutic landscape of cancer. Successful implementation of precision medicine requires translational and bioinformatics infrastructure to support optimization of treatment selection. Targeted therapy, immunotherapy, T-cell therapy alone or in combination with cytotoxic or other effective therapeutic strategies and innovative clinical trials with adaptive design should be offered to all patients. Data sharing and 'N-of-1' models hold the promise to optimize the treatment of individual patients and expedite drug approval for rare alterations and tumor types. Artificial intelligence will facilitate accurate utilization of sequencing data to perform algorithm analysis. Collaboration of healthcare providers with pharmaceutical and biotechnical companies, scientific organizations, and governmental regulatory agencies have a crucial role in curing cancer.
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Affiliation(s)
- Elena Fountzilas
- a Department of Investigational Cancer Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Apostolia M Tsimberidou
- a Department of Investigational Cancer Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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20
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Garinet S, Laurent-Puig P, Blons H, Oudart JB. Current and Future Molecular Testing in NSCLC, What Can We Expect from New Sequencing Technologies? J Clin Med 2018; 7:E144. [PMID: 29890761 PMCID: PMC6024886 DOI: 10.3390/jcm7060144] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022] Open
Abstract
Recent changes in lung cancer care, including new approvals in first line and the introduction of high-throughput molecular technologies in routine testing led us to question ourselves on how deeper molecular testing may be helpful for the optimal use of targeted drugs. In this article, we review recent results in the scope of personalized medicine in lung cancer. We discuss biomarkers that have a therapeutic predictive value in lung cancer with a focus on recent changes and on the clinical value of large scale sequencing strategies. We review the use of second- and third-generation EGFR and ALK inhibitors with a focus on secondary resistance alterations. We discuss anti-BRAF and anti-MEK combo, emerging biomarkers as NRG1 and NTRKs fusions and immunotherapy. Finally, we discuss the different technical issues of comprehensive molecular profiling and show how large screenings might refine the prediction value of individual markers. Based on a review of recent publications (2012⁻2018), we address promising approaches for the treatment of patients with lung cancers and the technical challenges associated with the identification of new predictive markers.
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Affiliation(s)
- Simon Garinet
- INSERM UMR-S1147, Paris Sorbonne Cite University, 75270 Paris Cedex 06, France.
- Department of Biochemistry, Unit of Pharmacogenetics and Molecular Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France.
| | - Pierre Laurent-Puig
- INSERM UMR-S1147, Paris Sorbonne Cite University, 75270 Paris Cedex 06, France.
- Department of Biochemistry, Unit of Pharmacogenetics and Molecular Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France.
| | - Hélène Blons
- INSERM UMR-S1147, Paris Sorbonne Cite University, 75270 Paris Cedex 06, France.
- Department of Biochemistry, Unit of Pharmacogenetics and Molecular Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France.
| | - Jean-Baptiste Oudart
- Department of Biochemistry, Unit of Pharmacogenetics and Molecular Oncology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France.
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21
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Validity of Targeted Next-Generation Sequencing in Routine Care for Identifying Clinically Relevant Molecular Profiles in Non-Small-Cell Lung Cancer: Results of a 2-Year Experience on 1343 Samples. J Mol Diagn 2018; 20:550-564. [PMID: 29787863 DOI: 10.1016/j.jmoldx.2018.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/15/2018] [Accepted: 04/11/2018] [Indexed: 11/22/2022] Open
Abstract
Theranostic assays are based on single-gene testing, but the ability of next-generation sequencing (NGS) to interrogate numerous genetic alterations will progressively replace single-gene assays. Although NGS was evaluated to screen for theranostic mutations, its usefulness in clinical practice on large series of samples remains to be demonstrated. NGS performance was assessed following guidelines. TaqMan probes and NGS were compared for their ability to detect EGFR and KRAS mutations, and NGS mutation profiles were analyzed on a large series of non-small-cell lung cancers (n = 1343). The R2 correlation between expected and measured allelic ratio, using commercial samples, was >0.96. Mutation detection threshold was 2% for 10 ng of DNA input. κ Scores for TaqMan versus NGS were 0.99 (95% CI, 0.97-1.00) for EGFR and 0.98 (95% CI, 0.97-1.00) for KRAS after exclusion of rare EGFR (n = 40) and KRAS (n = 60) mutations. NGS identified 693 and 292 mutations in validated and potential oncogenic drivers, respectively. Significant associations were found between EGFR and PI3KCA or CTNNB1 and between KRAS and STK11. Potential oncogenic driver mutations or gene amplifications were more frequent in validated oncogenic driver nonmutated samples. This work is a proof of concept that targeted NGS is accessible in routine screening, including large screening, at reasonable cost. Clinical data should be collected and implemented in specific databases to make molecular data meaningful for direct patients' benefit.
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22
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Human epidermal receptor family inhibitors in patients with ERBB3 mutated cancers: Entering the back door. Eur J Cancer 2018; 92:1-10. [DOI: 10.1016/j.ejca.2017.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/17/2022]
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23
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Fountzilas E, Said R, Tsimberidou AM. Expanded access to investigational drugs: balancing patient safety with potential therapeutic benefits. Expert Opin Investig Drugs 2018; 27:155-162. [PMID: 29353505 PMCID: PMC6291242 DOI: 10.1080/13543784.2018.1430137] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction: Expanded access is the use of an investigational product by patients with serious medical conditions without participation in a clinical trial. It is a complicated process involving the collaboration of many parties and pharmaceutical companies. Ongoing efforts focus on accelerating expanded access procedures in the best interest of patients with cancer. Areas covered: We review the regulatory and ethical challenges encountered in efforts to optimize expanded access. Expert opinion: In the era of personalized medicine, patients may benefit from novel therapeutic agents that demonstrate encouraging results in early studies. However, drug approval is a lengthy and cumbersome procedure that might exceed the time frame of a life-threatening disease. Expanded access provides options to patients with unmet needs. It may provide informative safety and efficacy data to the manufacturers and the scientific and regulatory organizations. Ongoing efforts are being made by global governmental and scientific committees, regulatory agencies, and patient organizations to address the ethical and regulatory issues and to optimize the expanded access process. Their goal is to expand access to promising novel drugs for individual patients and to accelerate the necessary procedures while preserving patient safety.
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Affiliation(s)
- Elena Fountzilas
- a MD Anderson Cancer Center, Department of Investigational Cancer Therapeutics , The University of Texas , Houston , TX , USA
| | - Rabih Said
- b The University of Balamand, Department of Internal Medicine/Oncology Division , St George Hospital University Medical Center, Youssef Sursok Street, St. George Health Complex , Beirut , Lebanon
| | - Apostolia M Tsimberidou
- a MD Anderson Cancer Center, Department of Investigational Cancer Therapeutics , The University of Texas , Houston , TX , USA
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24
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Cabel L, Fuerea A, Lacroix L, Baldini C, Martin P, Hollebecque A, Postel-Vinay S, Varga A, Balheda R, Gazzah A, Michot JM, Marabelle A, Rouleau E, Solary E, De Baere T, Angevin E, Armand JP, Michiels S, Scoazec JY, Ammari S, André F, Soria JC, Massard C, Verlingue L. Efficacy of histology-agnostic and molecularly-driven HER2 inhibitors for refractory cancers. Oncotarget 2018. [PMID: 29515767 PMCID: PMC5839398 DOI: 10.18632/oncotarget.24188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A targeted therapy is recommended in case of ERBB2 alteration for breast and gastric carcinomas, but miscellaneous other tumor types are ERBB2-altered at low prevalence. Broadening the administration of HER2 inhibitors across tumor types and genomic alterations could benefit to patients with refractory metastatic tumors. Targeted next-generation-sequencing (tNGS) and comparative genomic hybridization array (CGH) have been performed on fresh tumor biopsies of patients included in the MOSCATO-01 and ongoing MOSCATO-02 trials to administrate HER2 inhibitors in case of ERBB2 pathogenic mutation of amplification. Between December 2011 and January 2017 a molecular analysis was performed for 934 patients (759 CGH and 912 tNGS). A novel ERBB2 alteration has been found in 4.7% (n = 44/934), including 1.5% (n = 14/912) ERBB2 mutations, and 4% (n = 30/759) ERBB2 amplifications. A matched HER2 inhibitor was administrated to 70% (31/44) of patients and consisted in trastuzumab plus chemotherapy for 90% of them (28/31). On the 31 evaluable patients, 1 complete response (CR), 10 partial response (PR) and 2 stable disease (SD) >24 weeks were observed accounting for a clinical benefit rate (CBR) of 42% (n = 13/31, 95% CI 25–61%). Besides breast and oesogastric carcinomas, 19 patients affected by 8 different tumor types had a CBR of 25% for ERBB2 mutations (n = 2/8, 95% CI 3%–65%, with 2 PR) and 64% for ERBB2 amplifications (n = 7/11, 95% CI 31%–89%; with 1 CR, 4 PR, 2 SD). ERBB2 genomic alterations were diffuse across metastatic tumor types and signs of efficacy emerged for HER2 targeted treatments, especially in case of ERBB2 amplifications or a p.S310Y ERBB2 mutation.
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Affiliation(s)
- Luc Cabel
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Alina Fuerea
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Ludovic Lacroix
- Laboratory of Translational Research and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655 Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France.,Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Capucine Baldini
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Patricia Martin
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Antoine Hollebecque
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France.,Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Sophie Postel-Vinay
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Andrea Varga
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Rastilav Balheda
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Anas Gazzah
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Jean-Marie Michot
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Aurélien Marabelle
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Etienne Rouleau
- Laboratory of Translational Research and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655 Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France.,Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Eric Solary
- Inserm Unit UMR 1170, Université Paris Saclay, Université Paris-Sud, Gustave Roussy, Villejuif, France
| | - Thierry De Baere
- Department of Interventional Radiology, Gustave Roussy, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Eric Angevin
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Jean-Pierre Armand
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Épidémiologie, Gustave Roussy, Villejuif, France
| | - Jean Yves Scoazec
- Laboratory of Translational Research and Biological Resource Center, AMMICA, INSERM US23/CNRS UMS3655 Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France.,Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Samy Ammari
- Department of Radiology, Gustave Roussy, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Fabrice André
- Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France.,Inserm Unit U981, Université Paris Saclay, Université Paris-Sud, Gustave Roussy, Villejuif, France
| | - Jean-Charles Soria
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France.,Inserm Unit U981, Université Paris Saclay, Université Paris-Sud, Gustave Roussy, Villejuif, France
| | - Christophe Massard
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
| | - Loic Verlingue
- Drug Development Department (DITEP), Gustave Roussy Department of Medical Oncology, Faculté de Medicine Paris-Sud XI, Villejuif, France
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25
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Added Value of Whole-Exome and Transcriptome Sequencing for Clinical Molecular Screenings of Advanced Cancer Patients With Solid Tumors. Cancer J 2018; 24:153-162. [DOI: 10.1097/ppo.0000000000000322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Pace J, Ghinea N, Kerridge I, Lipworth W. Accelerated Access to Medicines: An Ethical Analysis. Ther Innov Regul Sci 2017; 51:157-163. [DOI: 10.1177/2168479016674043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Ray-Coquard I, Trama A, Seckl MJ, Fotopoulou C, Pautier P, Pignata S, Kristensen G, Mangili G, Falconer H, Massuger L, Sehouli J, Pujade-Lauraine E, Lorusso D, Amant F, Rokkones E, Vergote I, Ledermann JA. Rare ovarian tumours: Epidemiology, treatment challenges in and outside a network setting. Eur J Surg Oncol 2017; 45:67-74. [PMID: 29108961 DOI: 10.1016/j.ejso.2017.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/26/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE OF THE REVIEW More than 50% of all gynaecological cancers can be classified as rare tumours (defined as an annual incidence of <6 per 100,000) and such tumours represent an important challenge for clinicians. RECENT FINDINGS Rare cancers account for more than one fifth of all new cancer diagnoses, more than any of the single common cancers alone. Reviewing the RARECAREnet database, some of the tumours occur infrequently, whilst others because of their natural history have a high prevalence, and therefore appear to be more common, although their incidence is also rare. Harmonization of medical practice, guidelines and novel trials are needed to identify rare tumours and facilitate the development of new treatments. Ovarian tumours are the focus of this review, but we comment on other rare gynaecological tumours, as the diagnosis and treatment challenges faced are similar. FUTURE This requires European collaboration, international partnerships, harmonization of treatment and collaboration to overcome the regulatory barriers to conduct international trials. Whilst randomized trials can be done in many tumour types, there are some for which conducting even single arm studies may be challenging. For these tumours alternative study designs, robust collection of data through national registries and audits could lead to improvements in the treatment of rare tumours. In addition, concentring the care of patients with rare tumours into a limited number of centres will help to build expertise, facilitate trials and improve outcomes.
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Affiliation(s)
- I Ray-Coquard
- Dpt of Medical Oncology, Centre Leon Berard, University Claude Bernard LyonI, Lyon, France.
| | - AnnaLisa Trama
- AnnaLisa Trama, Fondazione IRCCS istituto nazionale dei tumori Milan, Italy
| | - M J Seckl
- Charing Cross Hospital, Campus of Imperial College London, Fulham Palace Rd, W68RF London, UK
| | - C Fotopoulou
- Dept of Surgery and Cancer, Imperial College London, UK
| | - P Pautier
- Medical Oncology, Dpt Gustave Roussy Institution, Villejuif, France
| | - S Pignata
- Medical Oncology, Department of Urology and Gynecology, Istituto Nazionale Tumori - IRCSS - Fondazione G. Pascale, Naples Italy
| | - G Kristensen
- Dept of Gynecologic Oncology, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
| | - G Mangili
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
| | - H Falconer
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/University Hospital, 171 76 Stockholm, Sweden
| | - L Massuger
- Department of Obstetrics and Gynaecology, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, European Competence Center for Ovarian Cancer, Campus Virchow Klinikum, Medical University of Berlin, Germany
| | | | - D Lorusso
- Gynecologic Oncology Unit, Fondazione IRCCS istituto nazionale dei tumori Milan, Italy
| | - F Amant
- Center Gynaecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute, University of Amsterdam & Gynaecologic Oncology KU Leuven, The Netherlands
| | - E Rokkones
- Dept. of Gynaecological Oncology, The Norwegian Radium Hospital, Division of Cancer Medicine Oslo University Hospital, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - I Vergote
- Gynaecological Oncologist, University Hospital Leuven, European Union, Herestraat 49, B-3000 Leuven, Belgium
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28
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Rossing M, Yde CW, Sehested A, Østrup O, Scheie D, Dangouloff-Ros V, Geoerger B, Vassal G, Nysom K. Genomic diagnostics leading to the identification of a TFG-ROS1 fusion in a child with possible atypical meningioma. Cancer Genet 2017; 212-213:32-37. [PMID: 28449809 DOI: 10.1016/j.cancergen.2017.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/14/2017] [Accepted: 03/18/2017] [Indexed: 11/17/2022]
Abstract
Meningiomas are rare in children. They are highly complex, harboring unique clinical and pathological characteristics, and many occur in patients with neurofibromatosis type 2. Hereby, we present a case of a two-year-old boy presented with a diagnostically challenging intraventricular tumor. It was incompletely resected 6 times over 14 months but kept progressing and was ultimately deemed unresectable. Histologically, the tumor was initially classified as schwannoma, but extensive international review concluded it was most likely an atypical meningioma, WHO grade II. Comprehensive genomic profiling revealed a TFG-ROS1 fusion, suggesting that ROS1-signaling pathway alterations were driving the tumor growth. In light of this new information, the possibility of a diagnosis of inflammatory myofibroblastic tumor was considered; however the histopathological results were not conclusive. This specific molecular finding allowed the potential use of precision medicine and the patient was enrolled in the AcSé phase 2 trial with crizotinib (NCT02034981), leading to a prolonged partial tumor response which is persisting since 14 months. This case highlights the value of precision cancer medicine in children.
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Affiliation(s)
- Maria Rossing
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Christina Westmose Yde
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Olga Østrup
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Birgit Geoerger
- Department of Paediatrics and Adolescent Oncology, Vectorology and Anticancer Therapies, UMR 8203, CNRS, Univ. Paris-Sud, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Gilles Vassal
- Department of Paediatrics and Adolescent Oncology, Vectorology and Anticancer Therapies, UMR 8203, CNRS, Univ. Paris-Sud, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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29
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[New molecular classification of colorectal cancer, pancreatic cancer and stomach cancer: Towards "à la carte" treatment?]. Bull Cancer 2016; 103:643-50. [PMID: 27345450 DOI: 10.1016/j.bulcan.2016.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/21/2022]
Abstract
This review reports 3 of recently published molecular classifications of the 3 main gastro-intestinal cancers: gastric, pancreatic and colorectal adenocarcinoma. In colorectal adenocarcinoma, 6 independent classifications were combined to finally hold 4 molecular sub-groups, Consensus Molecular Subtypes (CMS 1-4), linked to various clinical, molecular and survival data. CMS1 (14% MSI with immune activation); CMS2 (37%: canonical with epithelial differentiation and activation of the WNT/MYC pathway); CMS3 (13% metabolic with epithelial differentiation and RAS mutation); CMS4 (23%: mesenchymal with activation of TGFβ pathway and angiogenesis with stromal invasion). In gastric adenocarcinoma, 4 groups were established: subtype "EBV" (9%, high frequency of PIK3CA mutations, hypermetylation and amplification of JAK2, PD-L1 and PD-L2), subtype "MSI" (22%, high rate of mutation), subtype "genomically stable tumor" (20%, diffuse histology type and mutations of RAS and genes encoding integrins and adhesion proteins including CDH1) and subtype "tumors with chromosomal instability" (50%, intestinal type, aneuploidy and receptor tyrosine kinase amplification). In pancreatic adenocarcinomas, a classification in four sub-groups has been proposed, stable subtype (20%, aneuploidy), locally rearranged subtype (30%, focal event on one or two chromosoms), scattered subtype (36%,<200 structural variation events), and unstable subtype (14%,>200 structural variation events, defects in DNA maintenance). Although currently away from the care of patients, these classifications open the way to "à la carte" treatment depending on molecular biology.
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