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Lee CL, Cremona M, Farrelly A, Workman JA, Kennedy S, Aslam R, Carr A, Madden S, O’Neill B, Hennessy BT, Toomey S. Preclinical evaluation of the CDK4/6 inhibitor palbociclib in combination with a PI3K or MEK inhibitor in colorectal cancer. Cancer Biol Ther 2023; 24:2223388. [PMID: 37326340 PMCID: PMC10281467 DOI: 10.1080/15384047.2023.2223388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Studies have demonstrated the efficacy of Palbociclib (CDK 4/6 inhibitor), Gedatolisib (PI3K/mTOR dual inhibitor) and PD0325901 (MEK1/2 inhibitor) in colorectal cancer (CRC), however single agent therapeutics are often limited by the development of resistance. METHODS We compared the anti-proliferative effects of the combination of Gedatolisib and Palbociclib and Gedatolisib and PD0325901 in five CRC cell lines with varying mutational background and tested their combinations on total and phosphoprotein levels of signaling pathway proteins. RESULTS The combination of Palbociclib and Gedatolisib was superior to the combination of Palbociclib and PD0325901. The combination of Palbociclib and Gedatolisib had synergistic anti-proliferative effects in all cell lines tested [CI range: 0.11-0.69] and resulted in the suppression of S6rp (S240/244), without AKT reactivation. The combination of Palbociclib and Gedatolisib increased BAX and Bcl-2 levels in PIK3CA mutated cell lines. The combination of Palbociclib and Gedatolisib caused MAPK/ERK reactivation, as seen by an increase in expression of total EGFR, regardless of the mutational status of the cells. CONCLUSION This study shows that the combination of Palbociclib and Gedatolisib has synergistic anti-proliferative effects in both wild-type and mutated CRC cell lines. Separately, the phosphorylation of S6rp may be a promising biomarker of responsiveness to this combination.
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Affiliation(s)
- Cha Len Lee
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mattia Cremona
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Angela Farrelly
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Julie A. Workman
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sean Kennedy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Razia Aslam
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aoife Carr
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian O’Neill
- Department of Radiation Oncology, St. Luke’s Radiation Oncology Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Bryan T. Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Strickler JH, Yoshino T, Stevinson K, Eichinger CS, Giannopoulou C, Rehn M, Modest DP. Prevalence of KRAS G12C Mutation and Co-mutations and Associated Clinical Outcomes in Patients With Colorectal Cancer: A Systematic Literature Review. Oncologist 2023; 28:e981-e994. [PMID: 37432264 PMCID: PMC10628573 DOI: 10.1093/oncolo/oyad138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/20/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE A systematic literature review was conducted to estimate the global prevalence of Kirsten rat sarcoma virus gene (KRAS) mutations, with an emphasis on the clinically significant KRAS G12C mutation, and to estimate the prognostic significance of these mutations in patients with colorectal cancer (CRC). DESIGN Relevant English-language publications in the Embase, MEDLINE, and the Cochrane Library databases (from 2009 to 2021) and congress presentations (from 2016 to 2021) were reviewed. Eligible studies were those that reported the prevalence and clinical outcomes of the KRAS G12C mutation in patients with CRC. RESULTS A total of 137 studies (interventional [n = 8], post hoc analyses of randomized clinical trials [n = 6], observational [n = 122], and longitudinal [n =1]) were reviewed. Sixty-eight studies reported the prevalence of KRAS mutations (KRASm) in 42 810 patients with CRC. The median global prevalence of KRASm was 38% (range, 13.3%-58.9%) and that of the KRAS G12C mutation (KRAS G12C) 3.1% (range, 0.7%-14%). Available evidence suggests that KRASm are possibly more common in tumors that develop on the right side of the colon. Limited evidence suggests a lower objective response rate and inferior disease-free/relapse-free survival in patients with KRAS G12C compared with patients with KRASwt or other KRASm. CONCLUSION Our analysis reveals that KRAS G12C is prevalent in 3% of patients with CRC. Available evidence suggests a poor prognosis for patients with KRAS G12C. Right-sided tumors were more likely to harbor KRASm; however, their role in determining clinical outcomes needs to be investigated further.
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Affiliation(s)
- John H Strickler
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kendall Stevinson
- Health Economics and Outcomes Researc, Amgen Inc., Thousand Oaks, CA, USA
| | | | | | - Marko Rehn
- Global Medical Affairs, Amgen Inc., Thousand Oaks, CA, USA
| | - Dominik Paul Modest
- Department for Hematology, Oncology and Cancer Immunology (CVK), Charité Universitätsmedizin Berlin, Berlin, Germany
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Huang S, Ye J, Gao X, Huang X, Huang J, Lu L, Lu C, Li Y, Luo M, Xie M, Lin Y, Liang R. Progress of research on molecular targeted therapies for colorectal cancer. Front Pharmacol 2023; 14:1160949. [PMID: 37614311 PMCID: PMC10443711 DOI: 10.3389/fphar.2023.1160949] [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: 02/07/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies, accounting for approximately 10% of global cancer incidence and mortality. Approximately 20% of patients with CRC present metastatic disease (mCRC) at the time of diagnosis. Moreover, up to 50% of patients with localized disease eventually metastasize. mCRC encompasses a complex cascade of reactions involving multiple factors and processes, leading to a diverse array of molecular mechanisms. Improved comprehension of the pathways underlying cancer cell development and proliferation, coupled with the accessibility of relevant targeted agents, has propelled advancements in CRC treatment, ultimately leading to enhanced survival rates. Mutations in various pathways and location of the primary tumor in CRC influences the efficacy of targeted agents. This review summarizes available targeted agents for different CRC pathways, with a focus on recent advances in anti-angiogenic and anti-epidermal growth factor receptor agents, BRAF mutations, and human epidermal growth factor receptor 2-associated targeted agents.
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Affiliation(s)
- Shilin Huang
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jiazhou Ye
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xing Gao
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xi Huang
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Julu Huang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Lu Lu
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Cheng Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yongqiang Li
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Min Luo
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Mingzhi Xie
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yan Lin
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Rong Liang
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
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4
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Xue WH, Li XW, Ding YQ, Wu N, Pei BB, Ma XY, Xie J, Yang WH. Efficacy and safety of third-line or later-line targeted treatment for patients with metastatic colorectal cancer: a meta-analysis. Front Oncol 2023; 13:1165040. [PMID: 37324019 PMCID: PMC10265471 DOI: 10.3389/fonc.2023.1165040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Targeted therapy has been standardized in front-line therapies for metastatic colorectal cancer (mCRC), while explicit recommendations for third- or later-line are still lacking. This study evaluated the efficacy and safety of combining targeted therapy with chemotherapy in the third- or later-line treatment for mCRC via meta-analysis, providing evidence-based guidance for clinical or research practice. Comprehensive retrieval of related studies was conducted according to the PRISMA guideline. Studies were stratified with patient characteristics and pharmacological classification of the drugs. For the data available for quantitative analysis, pooled overall response rate, disease control rate, hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS), and adverse events rate with respective 95% confidence intervals (CIs) were calculated. A total of 22 studies (1,866 patients) were included in this meta-analysis. Data from 17 studies (1,769 patients) involving targets of epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) were extracted for meta-analyses. The overall response rates for monotherapy and combined therapy were 4% (95% CI: 3%, 5%) and 20% (95% CI: 11%, 29%). The pooled HRs (combined therapy vs. mono) for OS and PFS were 0.72 (95% CI: 0.53, 0.99) and 0.34 (95% CI: 0.26, 0.45). Another five studies were included in narrative depiction, involving targets of BRAF, HER-2, ROS1, and NTRK. The findings of this meta-analysis indicate that VEGF and EGFR inhibitors manifest promising clinical response rates and prolonged survival in the treatment of mCRC with acceptable adverse events.
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Affiliation(s)
- Wen-Hui Xue
- Department of Digestive Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xue-Wei Li
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ya-Qian Ding
- Department of Digestive Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Na Wu
- Department of Digestive Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Bei-Bei Pei
- Department of Digestive Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiao-Yan Ma
- Department of Digestive Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jun Xie
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wen-Hui Yang
- Department of Gastroenterology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
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Precision Medicine for the Treatment of Colorectal Cancer: the Evolution and Status of Molecular Profiling and Biomarkers. CURRENT COLORECTAL CANCER REPORTS 2021. [DOI: 10.1007/s11888-021-00466-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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6
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Ahmad R, Singh JK, Wunnava A, Al-Obeed O, Abdulla M, Srivastava SK. Emerging trends in colorectal cancer: Dysregulated signaling pathways (Review). Int J Mol Med 2021; 47:14. [PMID: 33655327 PMCID: PMC7834960 DOI: 10.3892/ijmm.2021.4847] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most frequently detected type of cancer, and the second most common cause of cancer‑related mortality globally. The American Cancer Society predicted that approximately 147,950 individuals would be diagnosed with CRC, out of which 53,200 individuals would succumb to the disease in the USA alone in 2020. CRC‑related mortality ranks third among both males and females in the USA. CRC arises from 3 major pathways: i) The adenoma‑carcinoma sequence; ii) serrated pathway; and iii) the inflammatory pathway. The majority of cases of CRC are sporadic and result from risk factors, such as a sedentary lifestyle, obesity, processed diets, alcohol consumption and smoking. CRC is also a common preventable cancer. With widespread CRC screening, the incidence and mortality from CRC have decreased in developed countries. However, over the past few decades, CRC cases and mortality have been on the rise in young adults (age, <50 years). In addition, CRC cases are increasing in developing countries with a low gross domestic product (GDP) due to lifestyle changes. CRC is an etiologically heterogeneous disease classified by tumor location and alterations in global gene expression. Accumulating genetic and epigenetic perturbations and aberrations over time in tumor suppressor genes, oncogenes and DNA mismatch repair genes could be a precursor to the onset of colorectal cancer. CRC can be divided as sporadic, familial, and inherited depending on the origin of the mutation. Germline mutations in APC and MLH1 have been proven to play an etiological role, resulting in the predisposition of individuals to CRC. Genetic alterations cause the dysregulation of signaling pathways leading to drug resistance, the inhibition of apoptosis and the induction of proliferation, invasion and migration, resulting in CRC development and metastasis. Timely detection and effective precision therapies based on the present knowledge of CRC is essential for successful treatment and patient survival. The present review presents the CRC incidence, risk factors, dysregulated signaling pathways and targeted therapies.
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Affiliation(s)
- Rehan Ahmad
- Colorectal Research Chair, Department of Surgery, King Saud University College of Medicine, Riyadh 11472, Saudi Arabia
| | - Jaikee Kumar Singh
- Department of Biosciences, Manipal University Jaipur, Jaipur, Rajasthan 303007, India
| | - Amoolya Wunnava
- Department of Biosciences, Manipal University Jaipur, Jaipur, Rajasthan 303007, India
| | - Omar Al-Obeed
- Colorectal Research Chair, Department of Surgery, King Saud University College of Medicine, Riyadh 11472, Saudi Arabia
| | - Maha Abdulla
- Colorectal Research Chair, Department of Surgery, King Saud University College of Medicine, Riyadh 11472, Saudi Arabia
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Cohen R, Pudlarz T, Delattre JF, Colle R, André T. Molecular Targets for the Treatment of Metastatic Colorectal Cancer. Cancers (Basel) 2020; 12:E2350. [PMID: 32825275 PMCID: PMC7563268 DOI: 10.3390/cancers12092350] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
Over the past years, colorectal cancer (CRC) was subtyped according to its molecular and genetic characteristics, allowing the development of therapeutic strategies, based on predictive biomarkers. Biomarkers such as microsatellite instability (MSI), RAS and BRAF mutations, HER2 amplification or NTRK fusions represent major tools for personalized therapeutic strategies. Moreover, the routine implementation of molecular predictive tests provides new perspectives and challenges for the therapeutic management of CRC patients, such as liquid biopsies and the reintroduction of anti-EGFR monoclonal antibodies. In this review, we summarize the current landscape of targeted therapies for metastatic CRC patients, with a focus on new developments for EGFR blockade and emerging biomarkers (MSI, HER2, NTRK).
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Affiliation(s)
- Romain Cohen
- Department of Medical Oncology, Hôpital Saint-Antoine, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75012 Paris, France; (T.P.); (J.-F.D.); (R.C.); (T.A.)
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8
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Randomised phase II study of panitumumab plus irinotecan versus cetuximab plus irinotecan in patients with KRAS wild-type metastatic colorectal cancer refractory to fluoropyrimidine, irinotecan and oxaliplatin (WJOG 6510G). Eur J Cancer 2020; 135:11-21. [PMID: 32526634 DOI: 10.1016/j.ejca.2020.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/26/2020] [Accepted: 04/04/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cetuximab has been shown to be clinically active when given in combination with irinotecan in patients with irinotecan-refractory metastatic colorectal cancer (mCRC). However, it has remained unclear whether panitumumab is effective when combined with irinotecan. We compared efficacies of both regimens in this randomised phase II study. PATIENTS AND METHODS Patients with wild-type KRAS exon 2 mCRC previously treated with fluorouracil-, oxaliplatin- and irinotecan-based chemotherapies were randomised (1:1) to either panitumumab plus irinotecan (panitumumab arm) or cetuximab plus irinotecan (cetuximab arm). The primary end-point was progression-free survival (PFS). The planned sample size was 120, expecting a hazard ratio (HR) of 1.0 with non-inferiority margin of 1.3 (one-sided alpha error 0.2 and power 0.7). Major secondary end-points were overall survival (OS), response rate and safety. RESULTS From December 2011 to September 2014, 121 patients were enrolled, and 61 and 59 patients were randomised to the panitumumab and cetuximab arms, respectively (1 patient excluded). Most patients (97%) had received prior chemotherapies containing bevacizumab. The median PFS was 5.42 months in the panitumumab arm and 4.27 months in the cetuximab arm (HR = 0.64, 95% confidence interval [CI] = 0.44-0.94, P < 0.001 for non-inferiority, P = 0.058 for superiority), and median OS was 14.85 and 11.53 months (HR = 0.66, 95% CI = 0.44-1.00, P = 0.050 for superiority), respectively. The incidence of grade 3 or 4 hypomagnesaemia was higher in the panitumumab arm than that in the cetuximab arm (17% vs. 7%). CONCLUSION Panitumumab may be non-inferior to cetuximab in combination with irinotecan in survival of patients with irinotecan-refractory mCRC.
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9
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Morales ASR, Joy JK, Zbona DM. Administration sequence for multi-agent oncolytic regimens. J Oncol Pharm Pract 2020; 26:933-942. [DOI: 10.1177/1078155219895070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The existence of a multitude of oncolytics regimens containing two or more agents (combination) outlines the need to define their most adequate sequence of administration. However, limited resources are currently available to specify a particular sequence, presenting challenges potentially impacting on patient safety, and Pharmacy & Infusion Nursing workflows. Methods A comprehensive literature search was performed leading to the compilation of a document containing drug administration sequencing instructions for our Nursing, Pharmacy, and Oncology providers to follow. Regimens prioritized in our literature review represented regimens selected as part of our approved Clinical Pathways, regimens inquiries from Pharmacy or Nursing, as well as less frequently used regimens. We stratified the regimens by tumor type and arranged them alphabetically by indication. Results A table was compiled containing all the supporting literature for the recommended drug administration sequences. If, in certain instances, no literature support was identified outlining rationale such as enhanced management of adverse effects, a specific institutional decision was made by our enterprise Medical Oncology Committee with recommendations from Pharmacy experts. The primary guiding principles for outlining our recommendations were the following: administration of vesicant agents first; administration of biologic agents first; administration of taxanes prior to platinum agents; and duration of infusion (shorter infusions prioritized). Conclusion This guideline is not exhaustive. The compilation provided here is intended to be utilized as guidance for oncolytics administration sequence. We will continue to review and incorporate treatment sequencing recommendations for additional regimens.
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Affiliation(s)
| | - Jamie K Joy
- Cancer Treatment Centers of America Global, Boca Raton, FL, USA
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10
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Petrelli F, Perego G, Ghidini A, Ghidini M, Borgonovo K, Scolari C, Nozza R, Rampulla V, Costanzo A, Varricchio A, Rausa E, Pietrantonio F, Zaniboni A. A systematic review of salvage therapies in refractory metastatic colorectal cancer. Int J Colorectal Dis 2020; 35:783-794. [PMID: 32219509 DOI: 10.1007/s00384-020-03571-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Established that the only approved agents in previously treated metastatic colorectal cancer (CRC) are trifluoridine/tipiracil and regorafenib, we conducted a systematic review of all the published phase 2-3 trials, with the scope to evaluate the benefit of any later-line regimens in refractory metastatic CRC. METHODS Phase 2-3 studies that enrolled patients with stage IV disease receiving salvage therapies for refractory CRC were identified using electronic databases (Pubmed, EMBASE, and Cochrane Library). Clinical outcomes were pooled using a point estimates for the weighted values of median overall survival (OS), progression-free survival (PFS), response rate (ORR), stable disease rate (SD), and 6-month and 1-year OS. RESULTS Overall, 7556 patients were included from 67 studies (n = 70 arms). Overall, the pooled ORR and SD were 15.4% (95% CI 13-18%) and 36.9% (95% CI 33.5-40.6%). Median PFS, 6-month and 1-year OS, and median OS were 3.2 (95% CI 2.9-3.3) months, 65.4% (95% CI 61.9-68.8%), 36% (95% CI 32.3-39.9%) and 8.8 (95% CI 8.3-9.2) months. Overall survival was different in the monochemotherapy, polychemotherapy, chemotherapy + targeted therapy, and targeted therapy alone arms (7.6, 9.5, 10.3, and 7.9 months, respectively, P for difference = 0.01). Median PFS were respectively 2.3, 3.9, 3.8, and 2.6, respectively (P for difference < 0.01). CONCLUSIONS Overall, combination therapy (polychemotherapy with or without targeted agents) is associated with a higher control of disease and better outcome than approved agents. Treatment, if possible, should be personalized according to the patients' conditions, physician preference and molecular profile of disease.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
| | | | | | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Karen Borgonovo
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | | | - Renata Nozza
- Pharmacy Unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | - Antonio Costanzo
- Surgical Oncology Unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | | | - Filippo Pietrantonio
- Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
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11
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García-Foncillas J, Sunakawa Y, Aderka D, Wainberg Z, Ronga P, Witzler P, Stintzing S. Distinguishing Features of Cetuximab and Panitumumab in Colorectal Cancer and Other Solid Tumors. Front Oncol 2019; 9:849. [PMID: 31616627 PMCID: PMC6763619 DOI: 10.3389/fonc.2019.00849] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/19/2019] [Indexed: 12/27/2022] Open
Abstract
Cetuximab and panitumumab are two distinct monoclonal antibodies (mAbs) targeting the epidermal growth factor receptor (EGFR), and both are widely used in combination with chemotherapy or as monotherapy to treat patients with RAS wild-type metastatic colorectal cancer. Although often considered interchangeable, the two antibodies have different molecular structures and can behave differently in clinically relevant ways. More specifically, as an immunoglobulin (Ig) G1 isotype mAb, cetuximab can elicit immune functions such as antibody-dependent cell-mediated cytotoxicity involving natural killer cells, T-cell recruitment to the tumor, and T-cell priming via dendritic cell maturation. Panitumumab, an IgG2 isotype mAb, does not possess these immune functions. Furthermore, the two antibodies have different binding sites on the EGFR, as evidenced by mutations on the extracellular domain that can confer resistance to one of the two therapeutics or to both. We consider a comparison of the properties of these two antibodies to represent a gap in the literature. We therefore compiled a detailed, evidence-based educational review of the known molecular, clinical, and functional differences between the two antibodies and concluded that they are distinct therapeutic agents that should be considered individually during treatment planning. Available data for one agent can only partly be extrapolated to the other. Looking to the future, the known immune activity of cetuximab may provide a rationale for this antibody as a combination partner with investigational chemotherapy plus immunotherapy regimens for colorectal cancer.
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Affiliation(s)
- Jesús García-Foncillas
- Cancer Institute, University Hospital Fundacion Jimenez Diaz, Autonomous University of Madrid, Madrid, Spain
| | - Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Dan Aderka
- Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Zev Wainberg
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | | | - Sebastian Stintzing
- Department of Hematology, Oncology, and Tumor Immunology (CCM) Charité Universitaetsmedizin, Berlin, Germany
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12
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A phase 2 study of panitumumab with irinotecan as salvage therapy in chemorefractory KRAS exon 2 wild-type metastatic colorectal cancer patients. Br J Cancer 2019; 121:378-383. [PMID: 31363167 PMCID: PMC6738054 DOI: 10.1038/s41416-019-0537-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 07/11/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Targeted agents are standard treatment for RAS wild-type metastatic colorectal cancer in the first- and second-line settings. This phase 2 study determined the benefit of targeting the epidermal growth factor receptor (EGFR) with panitumumab plus irinotecan in irinotecan-refractory patients. METHODS KRAS exon-2 wild-type patients failing prior irinotecan received panitumumab (6 mg/kg) and irinotecan (180 mg/m²) every 2 weeks. The primary endpoint was the overall response rate (ORR). Secondary endpoints included safety, progression-free survival (PFS) and overall survival (OS). KRAS exon-2 status was evaluated centrally, along with NRAS, BRAF mutations, epiregulin, amphiregulin, PTEN and EGFR copy number status, and correlated with efficacy. RESULTS Sixty-one patients were treated. Among the 46 wild-type RAS patients, the ORR was 15.2% (seven partial responses), with median PFS of 3.8 months (95% CI 2.7-4.3) and median OS of 12.5 months (95% CI 6.7-15.9). Wild-type BRAF patients showed a 13.0% response rate. No significant correlations between response and baseline biomarker expression were identified. Common grade 3-4 adverse events were diarrhoea and rash (18.0% each), hypomagnesaemia and asthenia (8.2% each). CONCLUSIONS The addition of panitumumab to irinotecan as salvage therapy is feasible but has limited activity in irinotecan-refractory metastatic colorectal cancer. No biomarkers predictive of response were identified.
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13
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Clinical Pharmacokinetics and Pharmacodynamics of the Epidermal Growth Factor Receptor Inhibitor Panitumumab in the Treatment of Colorectal Cancer. Clin Pharmacokinet 2019; 57:455-473. [PMID: 28853050 PMCID: PMC5856878 DOI: 10.1007/s40262-017-0590-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite progress in the treatment of metastatic colorectal cancer (mCRC) in the last 15 years, it is still a condition with a relatively low 5-year survival rate. Panitumumab, a fully human monoclonal antibody directed against the epidermal growth factor receptor (EGFR), is able to prolong survival in patients with mCRC. Panitumumab is used in different lines of therapy in combination with chemotherapy, and as monotherapy for the treatment of wild-type (WT) RAS mCRC. It is administered as an intravenous infusion of 6 mg/kg every 2 weeks and has a t½ of approximately 7.5 days. Elimination takes place via two different mechanisms, and immunogenicity rates are low. Only RAS mutations have been confirmed as a negative predictor of efficacy with anti-EGFR antibodies. Panitumumab is generally well tolerated and has a manageable toxicity profile, despite a very high prevalence of dermatologic side effects. This article presents an overview of the clinical pharmacokinetics and pharmacodynamics of panitumumab, including a description of the studies that led to its approval in the different lines of therapy of mCRC.
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14
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Yoshihiro T, Kusaba H, Makiyama A, Kobayashi K, Uenomachi M, Ito M, Doi Y, Mitsugi K, Aikawa T, Takayoshi K, Esaki T, Shimokawa H, Tsuchihashi K, Ariyama H, Akashi K, Baba E. Efficacy and safety of ramucirumab plus modified FOLFIRI for metastatic colorectal cancer. Int J Clin Oncol 2019; 24:508-515. [PMID: 30604155 DOI: 10.1007/s10147-018-01391-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/27/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dose modification of chemotherapy for metastatic colorectal cancer (MCRC) is often needed, especially in second-line and later-line treatments due to adverse events of previous treatment and poor patient condition. No study has focused on ramucirumab plus modified dose of FOLFIRI for MCRC, and whether low relative dose intensity (RDI) affects treatment efficacy has not been clarified. METHODS MCRC patients who received ramucirumab plus FOLFIRI, which consisted of 150 mg/m2 of irinotecan, at six institutions were retrospectively analyzed. RESULTS A total of 43 patients were assessed. Median age was 63 years, and 22 patients (51%) were women. Twenty-six patients (60%) were given ramucirumab plus FOLFIRI as second-line therapy, and 17 (40%) as third or later-line. The median relative dose intensity (RDI) of irinotecan was 60.6%, which is lower than that in the pivotal phase 3 study (RAISE), and other agents showed the same trend. Median progression-free survival was 4.8 [95% confidence interval (CI) 3.2-5.7] months for all patients, 5.4 (95% CI 3.5-7.2) months for second-line patients, and 2.8 (95% CI 1.6-5.8) months for third or later-line patients. Median overall survival was 17.3 (95% CI 11.5-22.4) months for all patients. Patients with irinotecan RDI less than 60% showed similar treatment efficacy. Hematological toxicities of grade 3 or worse were observed in 21 patients, but all were manageable. CONCLUSION Low RDI did not compromise the treatment efficacy of ramucirumab plus modified FOLFIRI for MCRC patients.
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Affiliation(s)
- Tomoyasu Yoshihiro
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hitoshi Kusaba
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Akitaka Makiyama
- Department of Hematology/Oncology, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Kazuma Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masato Uenomachi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mamoru Ito
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yasuhiro Doi
- Department of Medical Oncology, Hamanomachi Hospital, Fukuoka, Japan
| | - Kenji Mitsugi
- Department of Medical Oncology, Hamanomachi Hospital, Fukuoka, Japan
| | - Tomomi Aikawa
- Department of Gastrointestinal and Medical Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kotoe Takayoshi
- Department of Gastrointestinal and Medical Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Taito Esaki
- Department of Gastrointestinal and Medical Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Hozumi Shimokawa
- Department of Medical Oncology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kenji Tsuchihashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroshi Ariyama
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Eishi Baba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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15
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Gbolahan O, O’Neil B. Update on systemic therapy for colorectal cancer: biologics take sides. Transl Gastroenterol Hepatol 2019; 4:9. [PMID: 30976712 PMCID: PMC6414333 DOI: 10.21037/tgh.2019.01.12] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 12/13/2022] Open
Abstract
Over the last decade, progress in the management of metastatic colorectal cancer (CRC) has focused on the development of biologic therapy in addition to the back bone of combination chemotherapy. Anti-epidermal growth factor receptor (EGFR) antibodies and agents targeting angiogenesis are widely used in the clinic, and more recently, in a subset of patients with mismatch repair (MMR) deficient cancer, immunotherapy with immune check point inhibitors have been integrated into clinical practice. The major challenge with the use of these biologic therapies is determining predictive biomarkers to optimize patient selection. In this review, we discuss the most recent updates in the use of biologic therapy in CRC. We review data on the role of primary tumor location (PTL) (sidedness) as predictive biomarker and recent advances in treatment of CRC with BRAF mutation.
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Affiliation(s)
- Olumide Gbolahan
- Department of Hematology and Oncology, University of Alabama, Birmingham School of Medicine, Birmingham, AL, USA
| | - Bert O’Neil
- Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA
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16
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Hu Y, Tao SY, Deng JM, Hou ZK, Liang JQ, Huang QG, Li LH, Li HB, Chen YM, Yi H, Chen XL, Liu H. Prognostic Value of NRAS Gene for Survival of Colorectal Cancer Patients: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2018; 19:3001-3008. [PMID: 30484984 PMCID: PMC6318417 DOI: 10.31557/apjcp.2018.19.11.3001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 10/20/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: NRAS gene is associated with malignant proliferation and metastasis of colorectal cancer (CRC). But its prognostic value on CRC is still unknown. The objective of this study is to perform a meta-analysis to obtain its prognostic value on survival of CRC patients. Methods: The systematic review and meta-analysis was designed, undertaken and reported using items from the PRISMA statement. Relevant articles were identified through PubMed (containing Medline), Embase, Web of Science databases and Google scholar search engines from their inception up to October 3, 2016. The articles about NRAS on prognosis of CRC patients were enrolled. The association between NRAS and CRC survival time (including overall survival [OS], progression-free survival [PFS], and disease-free survival [DFS]) was evaluated using hazard ratio (HR) with its corresponding 95% confidence interval (CI). Results: A total of fifteen articles were included. High-expression of NRAS was significantly associated with poor OS (HR: 1.36, 95% CI: 1.15–1.61), and poor PFS (HR: 1.75, 95% CI: 1.04–2.94). The combined HR of NRAS on DFS was 0.87 (95% CI: 0.37–2.03). Subgroup analysis showed that NRAS was significantly associated with poor OS for patients from Western countries (HR: 1.38, 95% CI: 1.09–1.73), but not for those from Asian countries. Conclusions: This meta-analysis demonstrate that NRAS gene could predict the poor prognosis for the CRC patients. More large-sample cohort studies are needed to further confirm this conclusion.
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Affiliation(s)
- Yue Hu
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuang-You Tao
- Spleen and Stomach Institute, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie-Min Deng
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zheng-Kun Hou
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia-Qi Liang
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiu-Gu Huang
- The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liang-Hui Li
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui-Biao Li
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi-Ming Chen
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hua Yi
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin-Lin Chen
- School of Basic Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui Liu
- The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
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17
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Arnold D, Prager GW, Quintela A, Stein A, Moreno Vera S, Mounedji N, Taieb J. Beyond second-line therapy in patients with metastatic colorectal cancer: a systematic review. Ann Oncol 2018; 29:835-856. [PMID: 29452346 PMCID: PMC5913602 DOI: 10.1093/annonc/mdy038] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The optimal chemotherapeutic regimen for use beyond the second line for patients with metastatic colorectal cancer (mCRC) remains unclear. Materials and methods We systematically searched the Cochrane Database of Systematic Reviews, EMBASE and Medline for records published between January 2002 and May 2017, and cancer congress databases for records published between January 2014 and June 2017. Eligible studies evaluated the efficacy, safety and patient-reported outcomes of monotherapies or combination therapies at any dose and number of treatment cycles for use beyond the second line in patients with mCRC. Studies were assessed for design and quality, and a qualitative data synthesis was conducted to understand the impact of treatment on overall survival and other relevant cancer-related outcomes. Results The search yielded 938 references of which 68 were included for qualitative synthesis. There was limited evidence to support rechallenge with chemotherapy, targeted therapy or both. Compared with placebo, an overall survival benefit for trifluridine/tipiracil (also known as TAS-102) or regorafenib has been shown for patients previously treated with conventional chemotherapy and targeted therapy. There was no evidence to suggest a difference in efficacy between these treatments. Patient choice and quality of life at this stage of treatment should also be considered when choosing an appropriate therapy. Conclusions These findings support the introduction of an approved agent such as trifluridine/tipiracil or regorafenib beyond the second line before any rechallenge in patients with mCRC who have failed second-line treatment.
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Affiliation(s)
- D Arnold
- Instituto CUF de Oncologia, Lisbon, Portugal; Asklepios Tumorzentrum Hamburg, Hamburg, Germany.
| | - G W Prager
- Medical University Vienna, Department of Medicine I and Comprehensive Cancer Centre Vienna, Vienna, Austria
| | - A Quintela
- Instituto CUF de Oncologia, Lisbon, Portugal
| | - A Stein
- University Hamburg, Hubertus Wald Tumor Center and Department for Hematology and Oncology, Hamburg, Germany
| | - S Moreno Vera
- Servier Global Medical Affairs, Oncology, Suresnes, France
| | - N Mounedji
- Servier Global Medical Affairs, Oncology, Suresnes, France
| | - J Taieb
- Georges Pompidou European Hospita, Paris Descartes University, Gastroenterology and Digestive Oncology, Paris, France
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18
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Akiyoshi K, Hamaguchi T, Yoshimura K, Takahashi N, Honma Y, Iwasa S, Takashima A, Kato K, Yamada Y, Onodera H, Takeshita S, Yasui H, Sakai G, Akatsuka S, Ogawa K, Horita Y, Nagai Y, Shimada Y. A Prospective, Multicenter Phase II Study of the Efficacy and Feasibility of 15-minute Panitumumab Infusion Plus Irinotecan for Oxaliplatin- and Irinotecan-refractory, KRAS Wild-type Metastatic Colorectal Cancer (Short Infusion of Panitumumab Trial). Clin Colorectal Cancer 2017; 17:e83-e89. [PMID: 29169974 DOI: 10.1016/j.clcc.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 09/25/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In some recently updated clinical guidelines, the fully humanized monoclonal antibody panitumumab, combined with irinotecan, has been recommended as an optional third-line chemotherapy for KRAS wild-type metastatic colorectal cancer (mCRC). The present prospective, multicenter phase II study evaluated the effectiveness and safety of short 15-minute panitumumab infusions. PATIENTS AND METHODS From January 2011 to December 2011, patients with KRAS wild-type mCRC were enrolled at 8 centers. The key eligibility criteria were age ≥ 20 years and resistance or intolerance to irinotecan, fluoropyrimidine, and oxaliplatin. All patients received 6 mg/kg of panitumumab and 150 mg/m2 or the previous tolerated dose of irinotecan, biweekly, until disease progression or unacceptable toxicity. The initial panitumumab infusion was 60 minutes, followed by a 30-minute infusion and then 15-minute infusions. The primary endpoint was the confirmed response rate using Response Evaluation Criteria In Solid Tumors, version 1.0. The secondary endpoints were progression-free survival, overall survival, and toxicity. The trial is registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN no. 000004647). RESULTS Of the 43 patients, the median age was 62 years (range, 32-75 years), 58% were male, and the Eastern Cooperative Oncology Group performance status was 0 to 1. The total response rate was 37.2% (95% confidence interval [CI], 23.0-53.3), and the confirmed response rate was 18.6% (95% CI, 8.4-33.4). The median progression-free and overall survival were 5.8 months (95% CI, 3.3-8.4 months) and 13.6 months (95% CI, 10.8-16.5 months), respectively. The most frequent grade 3/4 toxicities were anorexia (12%), leukopenia (9%), and neutropenia (9%). Nine patients did not reach the 15-minute infusion, primarily because of disease progression. No infusion-related reactions were observed. CONCLUSION The short 15-minute panitumumab infusion regimen was well tolerated, without compromising safety or efficacy in patients with KRAS wild-type, oxaliplatin- and irinotecan-refractory mCRC.
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Affiliation(s)
- Kohei Akiyoshi
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan; Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Tetsuya Hamaguchi
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan; Department of Gastroenterological Oncology, Comprehensive Cancer Center, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University, Ishikawa, Japan
| | - Naoki Takahashi
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshitaka Honma
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Iwasa
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Atsuo Takashima
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Kato
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhide Yamada
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hisashi Onodera
- Department of General Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Shigeyuki Takeshita
- Department of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Hisateru Yasui
- Medical Oncology Division, Kyoto Medical Center, Kyoto, Japan
| | - Gen Sakai
- Division of Gastroenterology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Sotaro Akatsuka
- Department of Oncology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Kohei Ogawa
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Yosuke Horita
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Yushi Nagai
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Shimada
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
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19
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Silkin SV, Startsev SS, Krasnova ME, Raskin GA, Mitiushkina NV, Iyevleva AG, Sokolenko AP, Imyanitov EN. Complete Clinical Response of BRAF-Mutated Cholangiocarcinoma to Vemurafenib, Panitumumab, and Irinotecan. J Gastrointest Cancer 2017; 47:502-505. [PMID: 26687137 DOI: 10.1007/s12029-015-9792-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | | | | | - Grigory A Raskin
- Russian Research Centre for Radiology and Surgical Technologies, St.-Petersburg, 197758, Russia
| | - Natalia V Mitiushkina
- Laboratory of Molecular Oncology, N.N. Petrov Institute of Oncology, Pesochny-2, 197758, St.-Petersburg, Russia
| | - Aglaya G Iyevleva
- Laboratory of Molecular Oncology, N.N. Petrov Institute of Oncology, Pesochny-2, 197758, St.-Petersburg, Russia.,Saint-Petersburg State Pediatric Medical University, St.-Petersburg, 194100, Russia
| | - Anna P Sokolenko
- Laboratory of Molecular Oncology, N.N. Petrov Institute of Oncology, Pesochny-2, 197758, St.-Petersburg, Russia.,Saint-Petersburg State Pediatric Medical University, St.-Petersburg, 194100, Russia
| | - Evgeny N Imyanitov
- Laboratory of Molecular Oncology, N.N. Petrov Institute of Oncology, Pesochny-2, 197758, St.-Petersburg, Russia. .,Saint-Petersburg State Pediatric Medical University, St.-Petersburg, 194100, Russia. .,Medical Faculty, Saint Petersburg State University, Saint-Petersburg, 199034, Russia. .,I.I. Mechnikov North-Western State Medical University, Saint-Petersburg, 191015, Russia.
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20
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Chen Q, Cheng M, Wang Z, Zhao S. The efficacy and safety of panitumumab plus irrinotecan-based chemotherapy in the treatment of metastatic colorectal cancer: A meta-analysis. Medicine (Baltimore) 2016; 95:e5284. [PMID: 27977573 PMCID: PMC5268019 DOI: 10.1097/md.0000000000005284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Panitumumab, a fully human monoclonal antibody targeting epidermal growth factor receptor, is used in combination with chemotherapy for patients with metastatic colorectal cancer (mCRC). However, the effects of panitumumab in combination with irrinotecan-based chemotherapy remain uncertain. Therefore, we conducted this meta-analysis to assess the efficacy and safety of combination treatment of panitumumab plus chemotherapy in the treatment of mCRC. METHODS By searching electronic databases (PubMed, Embase, and Web of Science), all clinical trials which assessed the effects of panitumumab plus irrinotecan-based chemotherapy in mCRC would be included. Main outcome measures included progression-free survival (PFS), overall survival (OS), overall response rate (ORR), and adverse events. Pooled estimates were calculated by a fixed-effects model or random-effects model, according to the heterogeneity among the included studies. RESULTS Eleven trials with a total number of 1338 patients met the inclusion criteria and were included in this meta-analysis. The combination treatment of panitumumab and irrinotecan-based chemotherapy was associated with a median PFS of 5.83 months, OS of 11.15 months, and ORR of 33%. Subgroup analysis showed that, in the first-line and second-line treatment, the combination therapy for PFS was 9.27 and 5.01 months, for OS was 8.87 and 11.68 months, and for ORR was 61% and 26%, respectively. In the wild-type and mutant KRAS populations, the combination therapy for PFS was 5.76 and 5.27 months, for OS was 11.15 and 10.64 months, and for ORR was 37% and 18%, respectively. Moreover, combination therapy also induced an incidence of 56% treatment-related adverse events. CONCLUSION Panitumumab plus irrinotecan-based chemotherapy is effective and well-tolerated in the treatment of patients with mCRC, especially in those with wild-type KRAS tumors.
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21
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Cohen R, Svrcek M, Dreyer C, Cervera P, Duval A, Pocard M, Fléjou JF, de Gramont A, André T. New Therapeutic Opportunities Based on DNA Mismatch Repair and BRAF Status in Metastatic Colorectal Cancer. Curr Oncol Rep 2016; 18:18. [PMID: 26861657 DOI: 10.1007/s11912-016-0504-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recently, colorectal cancer (CRC) subtyping consortium identified four consensus molecular subtypes (CMS1-4). CMS1 is enriched for deficient mismatch repair (dMMR) and BRAF (V600E) tumors. Intriguingly, this subtype has better relapse-free survival but worse overall survival after relapse compared with the other subtypes. Growing evidence is accumulating on the benefit of specific therapeutic strategies such as immune checkpoint inhibition therapy in dMMR tumors and mitogen-activated protein kinase (MAPK) pathway targeted therapy in tumors harboring BRAF (V600E) mutation. After reviewing dMMR prognostic value, immune checkpoints as major targets for dMMR carcinomas will be highlighted. Following, BRAF (V600E) prognostic impact will be reviewed and therapeutic strategies with the combination of cytotoxic agents and especially the combinations of BRAF and MAPK inhibitors will be discussed.
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Affiliation(s)
- Romain Cohen
- Department of Medical Oncology, Hospital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012, Paris, France
| | - Magali Svrcek
- Department of Pathology, Hospital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, Paris, 75012, France.,University Pierre et Marie Curie (UMPC), Paris VI, 4 Place Jussieu, Paris, 75005, France
| | - Chantal Dreyer
- Department of Medical Oncology, Hospital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012, Paris, France
| | - Pascale Cervera
- Department of Pathology, Hospital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, Paris, 75012, France.,University Pierre et Marie Curie (UMPC), Paris VI, 4 Place Jussieu, Paris, 75005, France
| | - Alex Duval
- INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe "Instabilité des Microsatellites et Cancers," Equipe labellisée par la Ligue Nationale contre le Cancer, 184 rue du Faubourg Saint-Antoine, Paris, 75012, France
| | - Marc Pocard
- GERCOR, Oncology Multidisciplinary Group, 151 rue du Faubourg Saint Antoine, Paris, 75011, France.,Departement of Digestive and Oncologic Surgery, Hospital Lariboisière, APHP, 2 rue Ambroise Paré, Paris, 75010, France
| | - Jean-François Fléjou
- Department of Pathology, Hospital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, Paris, 75012, France.,University Pierre et Marie Curie (UMPC), Paris VI, 4 Place Jussieu, Paris, 75005, France
| | - Aimery de Gramont
- GERCOR, Oncology Multidisciplinary Group, 151 rue du Faubourg Saint Antoine, Paris, 75011, France.,Department of Medical Oncology, Institut Hospitalier Franco-Britannique, 4 rue Kléber, 92300, Levallois-Perret, France
| | - Thierry André
- Department of Medical Oncology, Hospital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012, Paris, France. .,University Pierre et Marie Curie (UMPC), Paris VI, 4 Place Jussieu, Paris, 75005, France. .,INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe "Instabilité des Microsatellites et Cancers," Equipe labellisée par la Ligue Nationale contre le Cancer, 184 rue du Faubourg Saint-Antoine, Paris, 75012, France. .,GERCOR, Oncology Multidisciplinary Group, 151 rue du Faubourg Saint Antoine, Paris, 75011, France.
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22
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Massalou D, Benizri E, Chevallier A, Duranton-Tanneur V, Pedeutour F, Benchimol D, Béréder JM. Peritoneal carcinomatosis of colorectal cancer: novel clinical and molecular outcomes. Am J Surg 2016; 213:377-387. [PMID: 27816197 DOI: 10.1016/j.amjsurg.2016.03.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/17/2016] [Accepted: 03/29/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this study was to identify the prognostic impact of parameters in peritoneal carcinomatosis from colorectal cancer. METHODS We collected data from patients treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy for peritoneal carcinomatosis secondary to colorectal cancer. RESULTS Ninety-one procedures were performed. In univariate analysis, an increased peritoneal cancer index was associated with decreased survival (P < .001). The presence of signet ring cells was associated to a decrease in survival from 45.8 to 12.1 months (P < .001). Microsatellite sequences instability status was the only molecular prognostic factor correlated with an increase in median disease-free survival: 12.4 vs 24.9 months (P = .01). The presence of a mucinous component was associated with a decreased of survival from 51.9 to 35.1 months (P = .02). CONCLUSIONS Clinical factors were affecting the survival of patients. The absence of signet ring cells and mucinous component and the presence of microsatellite sequences instability may be favorable prognostic factors.
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Affiliation(s)
- Damien Massalou
- Department of General Surgery and Digestive Cancerology, Nice University Hospital, 151 route de St. Antoine de Ginestière, Nice, 06200, France; Acute Care Surgery Unit, Emergency Department and Intensive Care, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Emmanuel Benizri
- Department of General Surgery and Digestive Cancerology, Nice University Hospital, 151 route de St. Antoine de Ginestière, Nice, 06200, France.
| | - Anne Chevallier
- Central Laboratory of Pathology, Laboratory Department, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Valérie Duranton-Tanneur
- Laboratory of Solid Tumor Genetics, Laboratory Department, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Florence Pedeutour
- Laboratory of Solid Tumor Genetics, Laboratory Department, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Daniel Benchimol
- Department of General Surgery and Digestive Cancerology, Nice University Hospital, 151 route de St. Antoine de Ginestière, Nice, 06200, France
| | - Jean-Marc Béréder
- Department of General Surgery and Digestive Cancerology, Nice University Hospital, 151 route de St. Antoine de Ginestière, Nice, 06200, France
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Prognostic and Predictive Value of RAS Gene Mutations in Colorectal Cancer: Moving Beyond KRAS Exon 2. Drugs 2016; 75:1739-56. [PMID: 26347132 DOI: 10.1007/s40265-015-0459-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The advent of anti-EGFR (epidermal growth factor receptor) therapy resulted in significant progress in the treatment of metastatic colorectal cancer patients. However, many patients do not respond to this therapy or develop acquired resistance within a few months after the start of treatment. Since 2008, anti-EGFR therapy is restricted to KRAS wild-type patients as it has been shown that KRAS exon 2-mutated patients do not respond to this therapy. Still, up to 60 % of KRAS exon 2 wild-type patients show primary resistance to this treatment. Recently, several studies investigating the predictive and prognostic role of RAS mutations other than in KRAS exon 2 demonstrated that patients with these mutations are not responding to therapy. However, the role of these mutations has long been questioned as The National Comprehensive Cancer Network Guidelines in Oncology and the European Medicines Agency indications had already been changed in order to restrict anti-EGFR therapy to all RAS wild-type colorectal cancer patients, while the Food and Drug Administration guidelines remained unchanged. Recently, the Food and Drug Administration guidelines have also been changed, which implies the importance of RAS mutations beyond KRAS exon 2 in colorectal cancer. In this review, we discuss the most important studies regarding the predictive and prognostic role of RAS mutations other than in KRAS exon 2 in order to demonstrate the importance of these RAS mutations in patients with metastatic colorectal cancer treated with anti-EGFR therapy.
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Multicenter phase II study of combination therapy with cetuximab and S-1 in patients with KRAS exon 2 wild-type unresectable colorectal cancer previously treated with irinotecan, oxaliplatin, and fluoropyrimidines (KSCC 0901 study). Cancer Chemother Pharmacol 2016; 78:585-93. [PMID: 27468920 DOI: 10.1007/s00280-016-3109-4] [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: 03/02/2016] [Accepted: 07/13/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Anti-epidermal growth factor receptor antibody therapy alone or in combination with irinotecan is recognized as a standard third-line treatment for KRAS wild-type unresectable metastatic colorectal cancer. However, in some cases, it is difficult to administer irinotecan after third-line treatment. Therefore, we examined the efficacy and safety of the combination of cetuximab and S-1 in patients with KRAS wild-type unresectable metastatic colorectal cancer who were previously treated with irinotecan, oxaliplatin, and fluoropyrimidines. METHODS The study was designed as a phase II, non-randomized, open-label, multicenter trial. Cetuximab was initially administered at 400 mg/m(2), followed by weekly infusion at 250 mg/m(2). S-1 was administered at a fixed dose of 80 mg/m(2) orally twice daily for 28 days followed by a 14-day break, resulting in a 6-week treatment course. The primary endpoint was progression-free survival (PFS). The secondary endpoints were the overall response rate (ORR), overall survival (OS), disease control rate (DCR), time to treatment failure, dose intensity, safety, and BRAF mutation status. RESULTS Thirty-seven patients were eligible. The median PFS was 5.5 months, the median OS was 13.5 months, the ORR was 29.7 %, and the DCR was 73.0 %. The relative dose intensity was 86.8 % for cetuximab and 88.1 % for S-1. Grade 3-4 adverse events that occurred in >10 % of the patient population included rash, dry skin, diarrhea, paronychia, anorexia, fatigue, mucositis, and neutropenia. CONCLUSIONS Combination therapy with cetuximab and S-1 was effective and well tolerated in patients with irinotecan-, oxaliplatin-, and fluoropyrimidine-refractory metastatic colorectal cancer.
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A phase I study of the combination of panitumumab and bevacizumab in KRAS wild-type colorectal cancer patients previously treated with fluoropyrimidine, oxaliplatin, irinotecan and bevacizumab. Cancer Chemother Pharmacol 2016; 78:567-75. [PMID: 27438067 DOI: 10.1007/s00280-016-3111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The clinical benefit of combination treatment with panitumumab and bevacizumab (PB) based on bevacizumab beyond progression (BBP) after the failure of second-line chemotherapy remains unclear. We assessed the tolerability and efficacy of PB as BBP in Japanese patients with metastatic colorectal cancer (mCRC). METHODS This phase I study comprised two parts: (1) PB part to estimate the recommended PB dose, (2) CPB part to investigate the safety of PB with irinotecan (CPB). Three panitumumab doses (4, 5, and 6 mg/kg at Levels -1, 0 and 1, respectively) were set for the PB part, starting with Level 0. Bevacizumab was administered at a fixed dose of 5 mg/kg, regardless of panitumumab dose levels. All drugs were administered on day 1 and repeated every 2 weeks. RESULTS No dose-limiting toxicities were observed at Levels 0 (n = 3) and 1 (n = 3) for the PB part, determining the recommended dose as Level 1. During the whole treatment course at Level 1, grade 3 acneiform rash was observed in two patients with a partial response. For six patients (irinotecan biweekly, 150 mg/m(2) n = 3, 120 mg/m(2) n = 3) enrolled in the CPB part, grade 3 toxicities were leukopenia/neutropenia (n = 1), mucositis (n = 1), diarrhea (n = 1), rash acneiform (n = 1) and thromboembolic event (n = 1), and two of six patients achieved partial responses. CONCLUSION Recommended doses for the PB regimen in mCRC were panitumumab 6 mg/kg and bevacizumab 5 mg/kg. PB and CPB showed manageable toxicities in KRAS wild-type patients previously managed with standard treatment, including bevacizumab.
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Nishi T, Hamamoto Y, Nagase M, Denda T, Yamaguchi K, Amagai K, Miyata Y, Yamanaka Y, Yanai K, Ishikawa T, Kuroki Y, Fujii H. Phase II trial of panitumumab with irinotecan as salvage therapy for patients with advanced or recurrent colorectal cancer (TOPIC study). Oncol Lett 2016; 11:4049-4054. [PMID: 27313739 DOI: 10.3892/ol.2016.4532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/01/2016] [Indexed: 12/19/2022] Open
Abstract
Little is known about the clinical impact of salvage panitumumab with irinotecan for metastatic colorectal cancer (mCRC) patients. The present study conducted a single-arm, multicenter phase II trial for mCRC with skin toxicity prevention program. The subjects were mCRC patients with wild-type KRAS, who showed resistance to fluoropyrimidine, oxaliplatin and irinotecan. Panitumumab was administered at a dose of 6 mg/kg every 2 weeks by intravenous infusion over 60 min, and irinotecan was administered at a dose of 100-180 mg/m2 every 2 weeks by intravenous infusion over 90 min, depending on the preceding treatment dose. To prevent skin toxicities, a moisturizer was applied and oral antibiotics (100 mg minocycline twice daily) were initiated for 6 weeks. The primary endpoint was the response rate (RR) determined by independent reviewers. Secondary endpoints were the disease control rate (DCR), progression-free survival (PFS) time, overall survival (OS) time and adverse events. A total of 35 patients were enrolled between October 2010 and March 2012. The median age was 61 years (range, 41-76 years), with 25 male and 10 female patients. The initial irinotecan dose was 150 mg/m2 in 19 patients and 180 mg/m2 in 1 patient. The remaining patients were treated with ≤120 mg/m2. A central review indicated a partial response in 8 patients (22.9%) and stable disease in 6 patients (17.1%), with an RR of 22.9% (95% confidence interval, 12.1-39.0) and a DCR of 40%. The RR of the patients with standard-dose irinotecan (150 or 180 mg/m2) was 30%, although that of low-dose irinotecan (100-120 mg/m2) was 13%. The median PFS time was 2.7 months, and the median OS time was 6.3 months. A grade 3 or above acne-like rash developed in 25.7% of patients. In conclusion, panitumumab and irinotecan as salvage therapy for mCRC KRAS wild-type patients with skin toxicity prevention exhibits limited efficacy. In particular, the effect of low-dose irinotecan with panitumumab appears to be clinically insignificant. Routine use of skin toxicity prevention is currently under evaluation.
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Affiliation(s)
- Tomohiro Nishi
- Kawasaki Municipal Ida Hospital, Kawasaki Comprehensive Care Center, Kawasaki, Kanagawa 211-0012, Japan; Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi 320-0834, Japan
| | - Yasuo Hamamoto
- Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi 320-0834, Japan; Keio Cancer Center, Keio University Hospital, School of Medicine, Tokyo 160-8582, Japan
| | - Michitaka Nagase
- Department of Clinical Oncology, Jichi Medical University Hospital, Shimotsuke, Tochigi 329-0498, Japan; Department of Chemotherapy, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi 453-8511, Japan
| | - Tadamichi Denda
- Division of Gastroenterology, Chiba Cancer Center, Chiba 260-8717, Japan
| | - Kensei Yamaguchi
- Division of Gastroenterology, Saitama Cancer Center, Saitama 362-0806, Japan
| | - Kenji Amagai
- Department of Gastroenterology, Ibaraki Central Hospital, Kasama, Ibaraki 309-1793, Japan
| | - Yoshinori Miyata
- Department of Medical Oncology, Saku Central Hospital, Saku, Nagano 384-0301, Japan
| | - Yasuhiro Yamanaka
- Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi 320-0834, Japan
| | - Kai Yanai
- Department of Clinical Oncology, Jichi Medical University Hospital, Shimotsuke, Tochigi 329-0498, Japan
| | - Tsutomu Ishikawa
- Department of Diagnostic Radiology, Dokkyo Medical University, Tochigi 321-0293, Japan
| | - Yoshifumi Kuroki
- Department of Diagnostic Imaging, Fukuoka University, Fukuoka 815-0032, Japan
| | - Hirofumi Fujii
- Department of Clinical Oncology, Jichi Medical University Hospital, Shimotsuke, Tochigi 329-0498, Japan
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Van Krieken JHJM, Rouleau E, Ligtenberg MJL, Normanno N, Patterson SD, Jung A. RAS testing in metastatic colorectal cancer: advances in Europe. Virchows Arch 2016; 468:383-96. [PMID: 26573425 PMCID: PMC4830882 DOI: 10.1007/s00428-015-1876-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 12/22/2022]
Abstract
Personalized medicine shows promise for maximizing efficacy and minimizing toxicity of anti-cancer treatment. KRAS exon 2 mutations are predictive of resistance to epidermal growth factor receptor-directed monoclonal antibodies in patients with metastatic colorectal cancer. Recent studies have shown that broader RAS testing (KRAS and NRAS) is needed to select patients for treatment. While Sanger sequencing is still used, approaches based on various methodologies are available. Few CE-approved kits, however, detect the full spectrum of RAS mutations. More recently, "next-generation" sequencing has been developed for research use, including parallel semiconductor sequencing and reversible termination. These techniques have high technical sensitivities for detecting mutations, although the ideal threshold is currently unknown. Finally, liquid biopsy has the potential to become an additional tool to assess tumor-derived DNA. For accurate and timely RAS testing, appropriate sampling and prompt delivery of material is critical. Processes to ensure efficient turnaround from sample request to RAS evaluation must be implemented so that patients receive the most appropriate treatment. Given the variety of methodologies, external quality assurance programs are important to ensure a high standard of RAS testing. Here, we review technical and practical aspects of RAS testing for pathologists working with metastatic colorectal cancer tumor samples. The extension of markers from KRAS to RAS testing is the new paradigm for biomarker testing in colorectal cancer.
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Affiliation(s)
- J Han J M Van Krieken
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands.
| | | | - Marjolijn J L Ligtenberg
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, INT-Fondazione Pascale, Naples, Italy
| | - Scott D Patterson
- Amgen Inc., Thousand Oaks, CA, USA
- Gilead Sciences, Inc., Foster City, CA, USA
| | - Andreas Jung
- Institute of Pathology, University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Liu J, Hu J, Cheng L, Ren W, Yang M, Liu B, Xie L, Qian X. Biomarkers predicting resistance to epidermal growth factor receptor-targeted therapy in metastatic colorectal cancer with wild-type KRAS. Onco Targets Ther 2016; 9:557-65. [PMID: 26869800 PMCID: PMC4734822 DOI: 10.2147/ott.s86966] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
EGFR pathway is an important therapeutic target in human tumors, including metastatic colorectal cancer (mCRC). The advent of EGFR-targeted monoclonal antibodies panitumumab and cetuximab has generated promise for the treatment of mCRC and has largely improved patients' progression-free survival (PFS) and overall survival (OS). However, treatment with anti-EGFR monoclonal antibodies is only effective in a subset of mCRC patients with wild-type KRAS. This indicates that there are other factors affecting the efficacy of anti-EGFR monoclonal antibodies. Existing studies have demonstrated that among colorectal cancer patients with wild-type KRAS, harboring mutations of BRAF, PIK3CA, NRAS, or PTEN-null may demonstrate resistance to anti-EGFR-targeted therapy, and biomarkers detection can provide better-personalized treatment for mCRC patients. How to identify and reverse the secondary resistance to anti-EGFR monoclonal antibody therapy is also another great challenge to improve the anti-EGFR efficacy in wild-type KRAS mCRC patients. Finally, both of the molecular mechanisms of response and acquired resistance would be important for the directions of future research. This review focuses on how to further improve the predictive value of anti-EGFR therapies and how to also try and avoid futile treatment for wild-type KRAS colorectal cancer patients.
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Affiliation(s)
- Jiang Liu
- The Comprehensive Cancer Center of Drum-Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Jing Hu
- The Comprehensive Cancer Center of Drum-Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Lei Cheng
- The Comprehensive Cancer Center of Drum-Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Wei Ren
- The Comprehensive Cancer Center of Drum-Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Mi Yang
- The Comprehensive Cancer Center of Drum-Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Baorui Liu
- The Comprehensive Cancer Center of Drum-Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Li Xie
- The Comprehensive Cancer Center of Drum-Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Xiaoping Qian
- The Comprehensive Cancer Center of Drum-Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, People's Republic of China
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Yonesaka K, Takegawa N, Satoh T, Ueda H, Yoshida T, Takeda M, Shimizu T, Chiba Y, Okamoto I, Nishio K, Tamura T, Nakagawa K. Combined Analysis of Plasma Amphiregulin and Heregulin Predicts Response to Cetuximab in Metastatic Colorectal Cancer. PLoS One 2015; 10:e0143132. [PMID: 26569500 PMCID: PMC4646631 DOI: 10.1371/journal.pone.0143132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 10/30/2015] [Indexed: 12/27/2022] Open
Abstract
Background Amphiregulin, a ligand of the epidermal growth factor receptor (EGFR), is associated with the efficacy of cetuximab, an antibody against EGFR, as treatment for colorectal cancer (CRC). In contrast, the HER3 ligand heregulin correlates with cetuximab resistance. In this study, we evaluated how the combined levels of circulating amphiregulin and heregulin affect clinical outcomes in patients who receive cetuximab as therapy against advanced CRC. Methods Plasma levels of amphiregulin and heregulin were measured by enzyme-linked immunosorbent assay in 50 patients with CRC in a training cohort, and in 10 patients in a validation cohort. The combined expression was then assessed with clinical outcome after receiver operating characteristics analysis. Results Overall response rate was 26%, and median progression-free survival was 110 days in the training cohort. Patients with high amphiregulin and low heregulin had significantly higher objective response rate at 58% and significantly longer progression-free survival of 216 days. This result was confirmed in the validation cohort. Conclusion A subgroup of CRC patients with high amphiregulin and low heregulin respond to cetuximab therapy better than other patients.
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Affiliation(s)
- Kimio Yonesaka
- Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka, Japan
- * E-mail:
| | - Naoki Takegawa
- Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Taroh Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroto Ueda
- Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Takeshi Yoshida
- Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Toshio Shimizu
- Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kinki University Faculty of Medicine, Osaka, Japan
| | - Isamu Okamoto
- Center for Clinical and Translational Research, Kyushu University, Fukuoka, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Takao Tamura
- Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka, Japan
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Lakomy R, Rogowski W, Piko B, Mihaylova Z, Pritzova E, Kvocekova L. Prospective noninterventional study on the use of panitumumab monotherapy in patients with recurrent or progressive colorectal cancer: the VECTIS study. Cancer Manag Res 2015; 7:311-8. [PMID: 26566372 PMCID: PMC4627397 DOI: 10.2147/cmar.s86796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Epidermal growth factor receptor-targeted monoclonal antibodies are active as monotherapy beyond second-line treatment. Skin toxicities (STs) are common during treatment, and a positive association between ST severity and patient outcome has been reported. This study collected information on panitumumab monotherapy use in patients with KRAS exon 2 wild-type metastatic colorectal cancer in clinical practice. Methods This open-label, prospective, observational, noninterventional study included adult patients who had failed prior chemotherapy with 5-fluorouracil, oxaliplatin, and irinotecan. Patients received panitumumab monotherapy (6 mg/kg every 2 weeks) for ≤18 cycles. Effectiveness was assessed as disease control rate (DCR), tumor response, and freedom from progression. The incidence of ST and other adverse drug reactions (ADRs) was recorded, as were Eastern Cooperative Oncology Group performance status (ECOG PS) and quality of life. The KRAS analysis process was also evaluated. Findings The full analysis set included 632 patients (64.6% male; mean age, 62.3 years), who completed a mean of 9.6 panitumumab cycles. ST, mainly grade 1/2, occurred in 84.3% of patients, 82.7% of whom required treatment. Nonskin ADRs occurred in 3.5% of patients. By the end of treatment, the DCR was 58.9% overall, and was 53.8% and 62.7%, respectively in patients with ST grade 0/1 and grade 2/3. Significant associations were observed between maximum ST grade and best response (P=0.0009), DCR (P=0.0046), tumor response (P=0.0002), and freedom from progression (P=0.0084). At the end of the study, 67.4% of the patients had an ECOG PS of 0/1. Quality of life was rated as “very good” or “good” in 70.3% of patients. Mean time to obtain KRAS results was 18.2 days; satisfaction with different aspects of KRAS testing was “very good” or “good” in 80%–97% of patients. Conclusion Panitumumab monotherapy showed adequate effectiveness and safety in patients with heavily pretreated KRAS exon 2 wild-type metastatic colorectal cancer. The most common ADR was grade 1/2 ST.
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Affiliation(s)
- Radek Lakomy
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic ; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Wojciech Rogowski
- Department of Chemotherapy, Warmia and Masuria Oncology Center, Olsztyn, Poland
| | - Bela Piko
- Pándy Kálmán County Hospital, Gyula, Hungary
| | - Zh Mihaylova
- Department of Medical Oncology, Military Medical Academy, Sofia, Bulgaria
| | - Eva Pritzova
- F.D. Roosevelt Teaching Hospital with Policlinic, Banska Bystrica, Slovak Republic
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Cohen R, Cervera P, Svrcek M, Dumont C, Garcia ML, Chibaudel B, de Gramont A, Pocard M, Duval A, Fléjou JF, André T. [DNA mismatch repair and BRAF status in colorectal cancer: Interest for the therapeutic management?]. Bull Cancer 2015; 102:S72-81. [PMID: 26118880 DOI: 10.1016/s0007-4551(15)31220-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 12/19/2022]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in France. Recently, colorectal cancer subtyping consortium (CRCSC) identified 4 consensus molecular subtypes (CMS). CMS1 is enriched for CRC with deficient DNA mismatch repair system (dMMR) and tumors with mutated BRAF. Intriguingly, CMS1 is characterized by better relapse-free survival but worse survival after relapse, compared with the other subtypes. In this review, we provide a comprehensive overview of prognostic and predictive impacts of MMR and BRAF status. We highlight immune checkpoints inhibitors as potentially future therapeutics for CRC with deficient MMR. We also focus on the management of BRAF mutant metastatic CRC, with a particular interest on targeted therapies.
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Affiliation(s)
- Romain Cohen
- Service d'oncologie médicale, Hôpitaux universitaires de l'Est Parisien (AP-HP), Site Saint-Antoine 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France; Groupe coopérateur multidisciplinaire en oncologie (GERCOR), Paris, France
| | - Pascale Cervera
- Service d'oncologie médicale, Hôpitaux universitaires de l'Est Parisien (AP-HP), Site Saint-Antoine 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Magali Svrcek
- Service d'oncologie médicale, Hôpitaux universitaires de l'Est Parisien (AP-HP), Site Saint-Antoine 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France; Inserm, Unité mixte de recherche scientifique 938, Centre de recherche Saint-Antoine, Équipe Instabilité des microsatellites et cancers, Équipe labellisée par la Ligue nationale contre le cancer, Paris, France
| | - Clément Dumont
- Service d'oncologie médicale, Hôpitaux universitaires de l'Est Parisien (AP-HP), Site Saint-Antoine 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Marie-Line Garcia
- Service d'oncologie médicale, Hôpitaux universitaires de l'Est Parisien (AP-HP), Site Saint-Antoine 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France
| | - Benoist Chibaudel
- Groupe coopérateur multidisciplinaire en oncologie (GERCOR), Paris, France; Institut hospitalier franco-britannique, 4 rue Kléber, 92300 Levallois-Perret, France
| | - Aimery de Gramont
- Groupe coopérateur multidisciplinaire en oncologie (GERCOR), Paris, France; Institut hospitalier franco-britannique, 4 rue Kléber, 92300 Levallois-Perret, France
| | - Marc Pocard
- Hôpital Lariboisière, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, CART, Inserm U965, Paris, France
| | - Alex Duval
- Inserm, Unité mixte de recherche scientifique 938, Centre de recherche Saint-Antoine, Équipe Instabilité des microsatellites et cancers, Équipe labellisée par la Ligue nationale contre le cancer, Paris, France
| | - Jean-François Fléjou
- Service d'oncologie médicale, Hôpitaux universitaires de l'Est Parisien (AP-HP), Site Saint-Antoine 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France; Université Pierre et Marie Curie (UPMC), Paris VI, Paris, France
| | - Thierry André
- Service d'oncologie médicale, Hôpitaux universitaires de l'Est Parisien (AP-HP), Site Saint-Antoine 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France; Université Pierre et Marie Curie (UPMC), Paris VI, Paris, France.
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Peeters M, Oliner KS, Price TJ, Cervantes A, Sobrero AF, Ducreux M, Hotko Y, André T, Chan E, Lordick F, Punt CJA, Strickland AH, Wilson G, Ciuleanu TE, Roman L, Van Cutsem E, He P, Yu H, Koukakis R, Terwey JH, Jung AS, Sidhu R, Patterson SD. Analysis of KRAS/NRAS Mutations in a Phase III Study of Panitumumab with FOLFIRI Compared with FOLFIRI Alone as Second-line Treatment for Metastatic Colorectal Cancer. Clin Cancer Res 2015; 21:5469-79. [PMID: 26341920 DOI: 10.1158/1078-0432.ccr-15-0526] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/25/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE We evaluated the influence of RAS mutation status on the treatment effect of panitumumab in a prospective-retrospective analysis of a randomized, multicenter phase III study of panitumumab plus fluorouracil, leucovorin, and irinotecan (FOLFIRI) versus FOLFIRI alone as second-line therapy in patients with metastatic colorectal cancer (mCRC; ClinicalTrials.gov, NCT0039183). EXPERIMENTAL DESIGN Outcomes were from the study's primary analysis. RAS mutations beyond KRAS exon 2 (KRAS exons 3, 4; NRAS exons 2, 3, 4; BRAF exon 15) were detected by bidirectional Sanger sequencing in wild-type KRAS exon 2 tumor specimens. Progression-free survival (PFS) and overall survival (OS) were coprimary endpoints. RESULTS The RAS ascertainment rate was 85%; 18% of wild-type KRAS exon 2 tumors harbored other RAS mutations. For PFS and OS, the hazard ratio (HR) for panitumumab plus FOLFIRI versus FOLFIRI alone more strongly favored panitumumab in the wild-type RAS population than in the wild-type KRAS exon 2 population [PFS HR, 0.70 (95% confidence interval [CI], 0.54-0.91); P = 0.007 vs. 0.73 (95% CI, 0.59-0.90); P = 0.004; OS HR, 0.81 (95% CI, 0.63-1.03); P = 0.08 vs. 0.85 (95% CI, 0.70-1.04); P = 0.12]. Patients with RAS mutations were unlikely to benefit from panitumumab. Among RAS wild-type patients, the objective response rate was 41% in the panitumumab-FOLFIRI group versus 10% in the FOLFIRI group. CONCLUSIONS Patients with RAS mutations were unlikely to benefit from panitumumab-FOLFIRI and the benefit-risk of panitumumab-FOLFIRI was improved in the wild-type RAS population compared with the wild-type KRAS exon 2 population. These findings support RAS testing for patients with mCRC. Clin Cancer Res; 21(24); 5469-79. ©2015 AACR.See related commentary by Salazar and Ciardiello, p. 5415.
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Affiliation(s)
- Marc Peeters
- Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
| | | | - Timothy J Price
- Queen Elizabeth Hospital and University of Adelaide, Woodville, Australia
| | - Andrés Cervantes
- Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | | | - Michel Ducreux
- Institut Gustave Roussy, Villejuif, and Paris-Sud University, Le Kremlin Bicêtre, Paris, France
| | | | - Thierry André
- Hôpital Saint Antoine and Université Pierre et Marie Curie (UMPC; Paris VI), Paris, France
| | - Emily Chan
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | - Tudor E Ciuleanu
- Institutul Oncologic Ion Chiricuta and University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - Laslo Roman
- Leningrad Regional Oncology Dispensary, Saint Petersburg, Russia
| | | | - Pei He
- Amgen Inc., Thousand Oaks, California, USA
| | - Hua Yu
- Amgen Inc., Thousand Oaks, California, USA
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Del Prete M, Giampieri R, Faloppi L, Bianconi M, Bittoni A, Andrikou K, Cascinu S. Panitumumab for the treatment of metastatic colorectal cancer: a review. Immunotherapy 2015; 7:721-38. [PMID: 26250414 DOI: 10.2217/imt.15.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In recent years, the treatment of metastatic colorectal cancer (mCRC) has evolved significantly with the increase of new therapeutic options, leading to an improved median survival for these patients. In particular, the identification of molecular targets in tumor cells has led to the introduction of biological drugs for the treatment of mCRC. Panitumumab is a fully human monoclonal antibody that binds the EGF receptor of tumor cells and inhibits downstream cell signaling with antitumor effect on inhibition of tumor growth. Its use has been approved by randomized clinical trials as monotherapy in chemorefractory patients or combined with chemotherapy in the treatment of RAS wild-type mCRC, where it demonstrated a significant improvement in survival and response rate. The purpose of this review is to analyze the use and efficacy profile of panitumumab, particularly focusing on recently reported data on its use, and future perspectives in patients with mCRC.
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Affiliation(s)
- M Del Prete
- Medical Oncology, AOU Ospedali Riuniti-Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy
| | - R Giampieri
- Medical Oncology, AOU Ospedali Riuniti-Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy
| | - L Faloppi
- Medical Oncology, AOU Ospedali Riuniti-Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy
| | - M Bianconi
- Medical Oncology, AOU Ospedali Riuniti-Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy
| | - A Bittoni
- Medical Oncology, AOU Ospedali Riuniti-Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy
| | - K Andrikou
- Medical Oncology, AOU Ospedali Riuniti-Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy
| | - S Cascinu
- Medical Oncology, AOU Ospedali Riuniti-Università Politecnica delle Marche, via Conca 71, 60126 Ancona, Italy
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Al-Shamsi HO, Alhazzani W, Wolff RA. Extended RAS testing in metastatic colorectal cancer-Refining the predictive molecular biomarkers. J Gastrointest Oncol 2015; 6:314-21. [PMID: 26029459 DOI: 10.3978/j.issn.2078-6891.2015.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 01/26/2015] [Indexed: 12/20/2022] Open
Abstract
Mutations of exon 2 of Kirsten rat sarcoma viral oncogene homologue (KRAS) (exon 2 codons 12/13) lead to constitutive activation of the EGFR (epidermal growth factor receptor) mediated signal transduction pathway and been shown to be a negative predictive biomarker for EGFR-directed monoclonal antibodies among patients with colorectal cancer (CRC). As selection of patients is very important for administration of anti-EGFR therapy, this lone biomarker has proved to be insufficient for selecting the appropriate patients as more patients lacking exon 2 KRAS mutation were resistant to anti-EGFR therapy. The results of various randomized clinical trials have confirmed the presence of other RAS mutation including additional RAS mutations (KRAS exons 3/4 and NRAS exon 1/2/3/4). Extended RAS analysis should be considered before initiating anti-EGFR therapy to patients of metastatic CRC. This can help in proper selection of patients leading to tailored individualistic treatment, decreasing cost of treatment and the adverse effects related to use of monoclonal antibody therapy. The new evidence is supporting the need to make 'Extended RAS' analysis essential before start of treatment with anti-EGFR monoclonal antibody therapy. Prior to this the Extended RAS testing should be standardized.
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Affiliation(s)
- Humaid O Al-Shamsi
- 1 Department of Gastrointestinal Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA ; 2 Department of Gastroenterology, Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Waleed Alhazzani
- 1 Department of Gastrointestinal Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA ; 2 Department of Gastroenterology, Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert A Wolff
- 1 Department of Gastrointestinal Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA ; 2 Department of Gastroenterology, Internal Medicine, McMaster University, Hamilton, Ontario, Canada
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Perkins G, Pilati C, Blons H, Laurent-Puig P. Beyond KRAS status and response to anti-EGFR therapy in metastatic colorectal cancer. Pharmacogenomics 2015; 15:1043-52. [PMID: 24956256 DOI: 10.2217/pgs.14.66] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In patients with metastatic colorectal cancer, overall survival has improved over the last decade mainly due to the use of effective targeted therapies such as anti-EGFR. However, survival improvement is linked to proper selection of patients expected to benefit from these treatments. KRAS codons 12 and 13 mutation status was the first validated molecular biomarker for anti-EGFR antibodies. Today, rare KRAS alterations and NRAS mutations were implemented, defining the 'RAS' status as the new validated marker of response to anti-EGFR antibodies. Moreover, other biomarkers are under investigation to screen for other targets and help with patients selection. Here, we reviewed these promising biomarkers: mutations in the RAS-MAPK and PI3K-AKT pathways genes, MET activation, HER/ErbB receptors activation (EGFR, HER2 and HER3), EGFR ligands, antibody-dependent cell-mediated cytotoxicity) and miRNAs. Further data are needed to define their impact for the treatment of patients with metastatic colorectal cancer.
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Affiliation(s)
- Geraldine Perkins
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)-S1147, Personalized Medicine, Pharmacogenomics, Therapeutic Optimization, University Paris Descartes, 45 rue des Saints Pères, Paris 75006, France
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Anti-EGFR Resistance in Colorectal Cancer: Current Knowledge and Future Perspectives. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-014-0242-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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de Gramont A, Watson S, Ellis LM, Rodón J, Tabernero J, de Gramont A, Hamilton SR. Pragmatic issues in biomarker evaluation for targeted therapies in cancer. Nat Rev Clin Oncol 2014; 12:197-212. [PMID: 25421275 DOI: 10.1038/nrclinonc.2014.202] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Predictive biomarkers are becoming increasingly important tools in drug development and clinical research. The importance of using both guidelines for specimen acquisition and analytical methods for biomarker measurements that are standardized has become recognized widely as an important issue, which must be addressed in order to provide high-quality, validated assays. Herein, we review the major challenges in biomarker validation processes, including pre-analytical (sample-related), analytical, and post-analytical (data-related) aspects of assay development. Recommendations for improving biomarker assay development and method validation are proposed to facilitate the use of predictive biomarkers in clinical trials and the practice of oncology.
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Affiliation(s)
- Armand de Gramont
- New Drug Evaluation Laboratory, Centre of Experimental Therapeutics, Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Sarah Watson
- INSERM U830, Genetics and Biology of Paediatric Tumours Group, Institut Curie, France
| | - Lee M Ellis
- Departments of Surgical Oncology, and Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, USA
| | - Jordi Rodón
- Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO) and Universitat Autonoma de Barcelona (UAB), Spain
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO) and Universitat Autonoma de Barcelona (UAB), Spain
| | - Aimery de Gramont
- Medical Oncology Department, Institut Hospitalier Franco-Britannique, France
| | - Stanley R Hamilton
- Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, USA
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Chang KC, Marton MJ. Past, current and future approaches to querying MAPK pathway activation: status and clinical implications. Per Med 2014; 11:745-760. [PMID: 29764047 DOI: 10.2217/pme.14.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
MAPK pathway activation related to cancer development has drawn a great deal of attention in the field of personalized medicine in recent years. Many different approaches and assays have been developed to query the activation of this pathway and to develop life-saving treatments. The goal of this review article is threefold. First, to provide a brief overview of the many mutation assays that have been used to detect MAPK pathway activation, and to compare pros and cons of these assay platforms. Second, to focus on one custom-designed multiplexing mutation assay that is currently used to support an ongoing clinical trial and to show the novel features of this assay and its relevance in addressing unmet clinical needs. Third, to provide future perspectives of these MAPK pathway gene mutation detection efforts and to suggest how what we have learned from past and current approaches should guide future developments.
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Affiliation(s)
- Ken Cn Chang
- Molecular Biomarkers & Diagnostics, Merck & Co, Inc., Rahway, NJ, USA
| | - Matthew J Marton
- Molecular Biomarkers & Diagnostics, Merck & Co, Inc., Rahway, NJ, USA
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Mi K, Kalady MF, Quintini C, Khorana AA. Integrating systemic and surgical approaches to treating metastatic colorectal cancer. Surg Oncol Clin N Am 2014; 24:199-214. [PMID: 25444476 DOI: 10.1016/j.soc.2014.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multiple new treatment options for metastatic colorectal cancer have been developed over the past 2 decades, including conventional chemotherapy and agents directed against vascular endothelial growth factor and epidermal growth factor receptor. Combination regimens, integrated with surgical approaches, have led to an increase in median survival, and a minority of patients with resectable disease can survive for years. Clinical decision-making therefore requires a strategic, biomarker-based multidisciplinary approach to maximize life expectancy and quality of life. This review describes systemic approaches to the treatment of patients with metastatic colorectal cancer, including integration with liver resection, other liver-directed therapies, and primary resection.
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Affiliation(s)
- Kaihong Mi
- Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Matthew F Kalady
- Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Digestive Disease Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Cristiano Quintini
- Digestive Disease Institute, HPB and Liver Transplant Program, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Alok A Khorana
- Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Devon KM, Lerner-Ellis JP, Ganai S, Angelos P. Ethics and genomic medicine, how to navigate decisions in surgical oncology. J Surg Oncol 2014; 111:18-23. [DOI: 10.1002/jso.23771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/22/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Karen M. Devon
- Department of Surgery; University of Toronto; Toronto Ontario Canada
- Department of Surgery; Women's College Hospital; Toronto Ontario Canada
- Department of Surgery; University Health Network; Toronto Ontario Canada
| | - Jordan P. Lerner-Ellis
- Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
- Department of Pathology and Laboratory Medicine; Mount Sinai Hospital; Toronto Ontario Canada
- Ontario Institute for Cancer Research; Toronto Ontario Canada
| | - Sabha Ganai
- Department of Gastrointestinal Oncology; Simmons Cancer Institute at SIU; Springfield Illinois
- Department of Surgery; Southern Illinois University School of Medicine; Springfield Illinois
| | - Peter Angelos
- Department of; Surgery and Surgical Ethics; Chicago Illinois
- Department of Endocrine Surgery; Chicago Illinois
- MacLean Center for Clinical Medical Ethics; Chicago Illinois
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Gasparini G, Buttitta F, D'Andrea MR, Tumolo S, Buonadonna A, Pavese I, Cordio S, De Tursi M, Mosconi S, Stumbo L, Felicioni L, Marchetti A. Optimizing single agent panitumumab therapy in pre-treated advanced colorectal cancer. Neoplasia 2014; 16:751-6. [PMID: 25246275 PMCID: PMC4234870 DOI: 10.1016/j.neo.2014.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE To improve the selection of advanced colorectal cancer patients to panitumumab by optimizing the assessment of RAS (KRAS-NRAS) mutations. EXPERIMENTAL DESIGN Using a centralized pyrosequencing RAS assay, we analyzed the tumors of 94 patients, wild-type for KRAS mutations (codons 12 to 13) by Sanger sequencing (SS), treated with panitumumab. RESULTS By SS analysis, 94 (62%) of 152 patients were wild-type and their objective response rate to panitumumab was 17%. We first optimized the KRAS test, by performing an accurate tissue-dissection step followed by pyrosequencing, a more sensitive method, and found further mutations in 12 (12.8%) cases. Secondly, tumors were subjected to RAS extension analysis (KRAS, exons 3 to 4; NRAS exons 2 to 4) by pyrosequencing that allowed to identify several rare mutations: KRAS codon 61, 5.3%; codon 146, 5.3%; NRAS, 9.5%. Overall, RAS mutation rate was 32.9%. All patients with additional RAS mutations had progressive or stable disease, except 3 patients with mutations at codon 61 of KRAS or NRAS who experienced partial (2 cases) or complete response. By excluding from the analysis 11 cases with mutations at codons 61, no patient was responsive to treatment (P=.021). RAS wild-type versus RAS mutated cases had a significantly better time to progression (P=.044), that resulted improved (p=.004) by excluding codon 61 mutations. CONCLUSION This study shows that by optimizing the RAS test it is possible to significantly improve the identification of patients who do not gain benefit of panitumumab. Prospective studies are warranted to determine the clinical significance of rare mutations.
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Affiliation(s)
| | - Fiamma Buttitta
- Center of Predictive Molecular Medicine, University-Foundation, CeSI Biotech Chieti, Italy
| | | | | | - Angela Buonadonna
- Oncology Unit B IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | - Ida Pavese
- Oncology Unit Ospedale Villa San Pietro Fatebenefratelli, Rome, Italy
| | | | - Michele De Tursi
- Oncology Unit Department of Clinical and Experimental Science, University of Chieti, Chieti, Italy
| | | | - Luciano Stumbo
- Department of Oncology, San Filippo Neri Hospital, Rome, Italy
| | - Lara Felicioni
- Center of Predictive Molecular Medicine, University-Foundation, CeSI Biotech Chieti, Italy
| | - Antonio Marchetti
- Center of Predictive Molecular Medicine, University-Foundation, CeSI Biotech Chieti, Italy
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The Role of Predictive Molecular Biomarkers for the Treatment of Metastatic Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-014-0246-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Jeong WJ, Cha PH, Choi KY. Strategies to overcome resistance to epidermal growth factor receptor monoclonal antibody therapy in metastatic colorectal cancer. World J Gastroenterol 2014; 20:9862-9871. [PMID: 25110417 PMCID: PMC4123368 DOI: 10.3748/wjg.v20.i29.9862] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/14/2014] [Accepted: 04/16/2014] [Indexed: 02/06/2023] Open
Abstract
Administration of monoclonal antibodies (mAbs) against epidermal growth factor receptor (EGFR) such as cetuximab and panitumumab in combination with conventional chemotherapy substantially prolongs survival of patients with metastatic colorectal cancer (mCRC). However, the efficacy of these mAbs is limited due to genetic variation among patients, in particular K-ras mutations. The discovery of K-ras mutation as a predictor of non-responsiveness to EGFR mAb therapy has caused a major change in the treatment of mCRC. Drugs that inhibit transformation caused by oncogenic alterations of Ras and its downstream components such as BRAF, MEK and AKT seem to be promising cancer therapeutics as single agents or when given with EGFR inhibitors. Although multiple therapeutic strategies to overcome EGFR mAb-resistance are under investigation, our understanding of their mode of action is limited. Rational drug development based on stringent preclinical data, biomarker validation, and proper selection of patients is of paramount importance in the treatment of mCRC. In this review, we will discuss diverse approaches to overcome the problem of resistance to existing anti-EGFR therapies and potential future directions for cancer therapies related to the mutational status of genes associated with EGFR-Ras-ERK and PI3K signalings.
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Imamura Y, Lochhead P, Yamauchi M, Kuchiba A, Qian ZR, Liao X, Nishihara R, Jung S, Wu K, Nosho K, Wang YE, Peng S, Bass AJ, Haigis KM, Meyerhardt JA, Chan AT, Fuchs CS, Ogino S. Analyses of clinicopathological, molecular, and prognostic associations of KRAS codon 61 and codon 146 mutations in colorectal cancer: cohort study and literature review. Mol Cancer 2014; 13:135. [PMID: 24885062 PMCID: PMC4051153 DOI: 10.1186/1476-4598-13-135] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 05/07/2014] [Indexed: 12/14/2022] Open
Abstract
Background KRAS mutations in codons 12 and 13 are established predictive biomarkers for anti-EGFR therapy in colorectal cancer. Previous studies suggest that KRAS codon 61 and 146 mutations may also predict resistance to anti-EGFR therapy in colorectal cancer. However, clinicopathological, molecular, and prognostic features of colorectal carcinoma with KRAS codon 61 or 146 mutation remain unclear. Methods We utilized a molecular pathological epidemiology database of 1267 colon and rectal cancers in the Nurse’s Health Study and the Health Professionals Follow-up Study. We examined KRAS mutations in codons 12, 13, 61 and 146 (assessed by pyrosequencing), in relation to clinicopathological features, and tumor molecular markers, including BRAF and PIK3CA mutations, CpG island methylator phenotype (CIMP), LINE-1 methylation, and microsatellite instability (MSI). Survival analyses were performed in 1067 BRAF-wild-type cancers to avoid confounding by BRAF mutation. Cox proportional hazards models were used to compute mortality hazard ratio, adjusting for potential confounders, including disease stage, PIK3CA mutation, CIMP, LINE-1 hypomethylation, and MSI. Results KRAS codon 61 mutations were detected in 19 cases (1.5%), and codon 146 mutations in 40 cases (3.2%). Overall KRAS mutation prevalence in colorectal cancers was 40% (=505/1267). Of interest, compared to KRAS-wild-type, overall, KRAS-mutated cancers more frequently exhibited cecal location (24% vs. 12% in KRAS-wild-type; P < 0.0001), CIMP-low (49% vs. 32% in KRAS-wild-type; P < 0.0001), and PIK3CA mutations (24% vs. 11% in KRAS-wild-type; P < 0.0001). These trends were evident irrespective of mutated codon, though statistical power was limited for codon 61 mutants. Neither KRAS codon 61 nor codon 146 mutation was significantly associated with clinical outcome or prognosis in univariate or multivariate analysis [colorectal cancer-specific mortality hazard ratio (HR) = 0.81, 95% confidence interval (CI) = 0.29-2.26 for codon 61 mutation; colorectal cancer-specific mortality HR = 0.86, 95% CI = 0.42-1.78 for codon 146 mutation]. Conclusions Tumors with KRAS mutations in codons 61 and 146 account for an appreciable proportion (approximately 5%) of colorectal cancers, and their clinicopathological and molecular features appear generally similar to KRAS codon 12 or 13 mutated cancers. To further assess clinical utility of KRAS codon 61 and 146 testing, large-scale trials are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shuji Ogino
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave,, Room M422, 02215 Boston, MA, USA.
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Schirripa M, Cremolini C, Loupakis F, Morvillo M, Bergamo F, Zoratto F, Salvatore L, Antoniotti C, Marmorino F, Sensi E, Lupi C, Fontanini G, De Gregorio V, Giannini R, Basolo F, Masi G, Falcone A. Role of NRAS mutations as prognostic and predictive markers in metastatic colorectal cancer. Int J Cancer 2014; 136:83-90. [PMID: 24806288 DOI: 10.1002/ijc.28955] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/25/2014] [Indexed: 02/06/2023]
Abstract
NRAS mutations occur in 3-5% of colorectal cancer. Differently from KRAS and BRAF mutations, the role of NRAS mutations as prognostic and predictive markers in metastatic colorectal cancer (mCRC) has been investigated to a lesser extent. A retrospective series suggested the role of NRAS mutations as predictors of resistance to anti-EGFR monoclonal antibodies (MoAbs) in chemo-refractory patients with mCRC. In our study, KRAS codons 12, 13, 61 and BRAF codon 600 mutational status were evaluated in mCRCs referred to our Institution from 2009 to 2012. NRAS codons 12, 13 and 61 mutational status was analyzed in KRAS/BRAF wt patients. We collected pathological and clinical features in the overall population and outcome data in a subset of NRAS mutated chemo-refractory patients treated with anti-EGFR MoAbs in advanced lines. NRAS was mutated in 47/786 (6%) mCRCs. NRAS and KRAS mutated tumors did not show significant differences in terms of clinical and pathological characteristics, except for a lower prevalence of mucinous histology (p = 0.012) and lung metastases (p = 0.012) among NRAS mutated tumors. In the uni- and multivariate model, NRAS mutations were associated with shorter overall survival (OS) compared to all wt patients (median OS 25.6 vs 42.7 months; univ: HR = 1.91, 95% CI 1.39-3.86, p = 0.0013; multiv: HR = 1.75, 95% CI 1.1.3-2.72, p = 0.013). None of the chemo-refractory NRAS mutated patients evaluable for response to anti-EGFRs achieved response. In conclusion, NRAS mutations have a relevant incidence in patients with mCRC and showed an association with specific clinical and pathological features. NRAS mutations affect mCRC patients' prognosis and predict lack of response to anti-EGFRs.
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Affiliation(s)
- Marta Schirripa
- Unit of Medical Oncology 2, University Hospital of Pisa, Pisa, Italy
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Xie L, Ge X, Tan H, Xie L, Zhang Y, Hart T, Yang X, Bourne PE. Towards structural systems pharmacology to study complex diseases and personalized medicine. PLoS Comput Biol 2014; 10:e1003554. [PMID: 24830652 PMCID: PMC4022462 DOI: 10.1371/journal.pcbi.1003554] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Genome-Wide Association Studies (GWAS), whole genome sequencing, and high-throughput omics techniques have generated vast amounts of genotypic and molecular phenotypic data. However, these data have not yet been fully explored to improve the effectiveness and efficiency of drug discovery, which continues along a one-drug-one-target-one-disease paradigm. As a partial consequence, both the cost to launch a new drug and the attrition rate are increasing. Systems pharmacology and pharmacogenomics are emerging to exploit the available data and potentially reverse this trend, but, as we argue here, more is needed. To understand the impact of genetic, epigenetic, and environmental factors on drug action, we must study the structural energetics and dynamics of molecular interactions in the context of the whole human genome and interactome. Such an approach requires an integrative modeling framework for drug action that leverages advances in data-driven statistical modeling and mechanism-based multiscale modeling and transforms heterogeneous data from GWAS, high-throughput sequencing, structural genomics, functional genomics, and chemical genomics into unified knowledge. This is not a small task, but, as reviewed here, progress is being made towards the final goal of personalized medicines for the treatment of complex diseases.
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Affiliation(s)
- Lei Xie
- Department of Computer Science, Hunter College, The City University of New York, New York, New York, United States of America
- Ph.D. Program in Computer Science, Biology, and Biochemistry, The Graduate Center, The City University of New York, New York, New York, United States of America
- * E-mail:
| | - Xiaoxia Ge
- Department of Computer Science, Hunter College, The City University of New York, New York, New York, United States of America
| | - Hepan Tan
- Department of Computer Science, Hunter College, The City University of New York, New York, New York, United States of America
| | - Li Xie
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Yinliang Zhang
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Thomas Hart
- Department of Biological Sciences, Hunter College, The City University of New York, New York, New York, United States of America
| | - Xiaowei Yang
- School of Public Health, Hunter College, The City University of New York, New York, New York, United States of America
| | - Philip E. Bourne
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, United States of America
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47
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von Einem JC, Heinemann V, von Weikersthal LF, Vehling-Kaiser U, Stauch M, Hass HG, Decker T, Klein S, Held S, Jung A, Kirchner T, Haas M, Holch J, Michl M, Aubele P, Boeck S, Schulz C, Giessen C, Stintzing S, Modest DP. Left-sided primary tumors are associated with favorable prognosis in patients with KRAS codon 12/13 wild-type metastatic colorectal cancer treated with cetuximab plus chemotherapy: an analysis of the AIO KRK-0104 trial. J Cancer Res Clin Oncol 2014; 140:1607-14. [PMID: 24816724 PMCID: PMC4131148 DOI: 10.1007/s00432-014-1678-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/28/2014] [Indexed: 02/06/2023]
Abstract
Purpose AIO KRK-0104 investigated first-line therapy of metastatic colorectal cancer (mCRC) with cetuximab, capecitabine and irinotecan versus cetuximab, capecitabine and oxaliplatin. This analysis investigated the impact of primary tumor location on outcome of patients. Patients and methods Left-sided primary tumors were defined as tumors from rectum to left flexure, while tumors in the remaining colon were regarded right sided. Overall survival (OS), progression-free survival (PFS) and response rate were correlated with primary tumor location. A Cox regression model was used to evaluate interaction between primary tumor location and KRAS mutation. Results Of 146 patients of the AIO KRK-0104 trial, 100 patients presented left-sided (of those 68 KRAS codon 12/13 wild-type) and 46 patients right-sided primary tumors (of those 27 KRAS codon 12/13 wild-type). Left-sided tumors were associated with significantly longer OS (p = 0.016, HR = 0.63) and PFS (p = 0.02, HR = 0.67) as compared to right-sided tumors. These effects were present in the KRAS codon 12/13 wild-type population (HR OS: 0.42; HR PFS: 0.54), while no impact of primary tumor location was evident in patients with KRAS codon 12/13 mutant tumors (HR OS: 1.3; HR PFS: 1.01). A significant interaction of KRAS status and primary tumor location concerning OS and PFS was observed. Conclusion Our findings suggest that primary tumor location and KRAS codon 12/13 mutational status interact on the outcome of patients with mCRC receiving cetuximab-based first-line therapy. Left-sided primary tumor location might be a predictor of cetuximab efficacy.
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Affiliation(s)
- J C von Einem
- Department of Medicine III, University Hospital Grosshadern, University of Munich, Munich, Germany,
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48
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Stremitzer S, Sebio A, Stintzing S, Lenz HJ. Panitumumab safety for treating colorectal cancer. Expert Opin Drug Saf 2014; 13:843-51. [PMID: 24766434 DOI: 10.1517/14740338.2014.915024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Panitumumab is a human IgG2 mAb against the EGFR, inhibiting tumor cell proliferation, survival and angiogenesis. It has demonstrated clinical efficacy in metastatic colorectal cancer (CRC) in combination with chemotherapy in first- and second-line settings and as monotherapy in third-line setting. Recently, mutations in the RAS genes have been shown to be predictive of lack of efficacy, panitumumab should be restricted to patients with RAS wild-type (wt) tumors. AREAS COVERED This review focuses on main efficacy results of panitumumab in metastatic CRC in first-, second- and third-line settings in combination with chemotherapy or as monotherapy. Additionally, we have covered safety aspects of this agent in these indications, especially in K-RAS and all RAS wt patients. These safety aspects refer to the most common toxicities (i.e., acne-like skin rash, diarrhea and hypomagnesaemia). EXPERT OPINION Panitumumab adds to the armamentarium of effective agents in the treatment of metastatic CRC. Due to its human origin, panitumumab is a well-tolerated agent with low rates of infusional reactions. Skin toxicity is frequent and should be pre-emptively treated. Other common toxicities related to panitumumab treatment, such as diarrhea and hypomagnesaemia, should be closely monitored to ensure early treatment or substitution.
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Affiliation(s)
- Stefan Stremitzer
- University of Southern California, Keck School of Medicine, Norris Comprehensive Cancer Center, Division of Medical Oncology , 1441 Eastlake Avenue, Los Angeles, CA, 90033 , USA +1 323 865 3967 ; +1 323 865 0061 ;
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49
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Manceau G, Imbeaud S, Thiébaut R, Liébaert F, Fontaine K, Rousseau F, Génin B, Le Corre D, Didelot A, Vincent M, Bachet JB, Chibaudel B, Bouché O, Landi B, Bibeau F, Leroy K, Penault-Llorca F, Van Laethem JL, Demetter P, Tejpar S, Rossi S, Mosakhani N, Osterlund P, Ristamäki R, Sarhadi V, Knuutila S, Boige V, André T, Laurent-Puig P. Hsa-miR-31-3p expression is linked to progression-free survival in patients with KRAS wild-type metastatic colorectal cancer treated with anti-EGFR therapy. Clin Cancer Res 2014; 20:3338-47. [PMID: 24771647 DOI: 10.1158/1078-0432.ccr-13-2750] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To identify microRNAs (miRNA) that predict response to anti-EGFR antibodies in patients with wild-type KRAS metastatic colorectal cancer (mCRC). EXPERIMENTAL DESIGN miRNA profiling was performed in a training set of 87 patients with mCRC refractory to chemotherapy treated with anti-EGFR antibodies. This included 33 fresh-frozen (FF) and 35 formalin-fixed paraffin-embedded (FFPE) samples retrospectively collected and 19 prospectively collected FF samples. An independent validation cohort consisting of 19 FF and 26 FFPE prospectively collected samples from patients with mCRC treated with anti-EGFR antibodies was used to confirm our findings. RESULTS After screening the expression of 1,145 miRNAs in FF samples from the training set, we identified that hsa-miR-31-3p expression level was significantly associated with progression-free survival (PFS). Statistical models based on miRNA expression discriminated between high and low risk of progression for both FF and FFPE samples. These models were confirmed in the validation cohort for both FF [HR, 4.1; 95% confidence interval (CI), 1.1-15.3; P < 0.04] and FFPE samples (HR, 2.44; 95% CI, 1.1-5.4; P = 0.028). The percentage of variation of RECIST criteria in the validation series was significantly associated with the expression level of hsa-miR-31-3p (r(2) = 0.49; P = 0.0035) and risk status determined by hsa-miR-31-3p expression level (P = 0.02, Kruskal-Wallis rank test). Nomograms were built and validated to predict PFS-depending on hsa-miR-31-3p expression level. Following in vitro studies, we identified 47 genes regulated by hsa-miR-31-3p. CONCLUSION Hsa-miR-31-3p seems to be a new mCRC biomarker whose expression level allows for the identification of patients with wild-type KRAS mCRC who are more likely to respond to anti-EGFR therapy.
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Affiliation(s)
- Gilles Manceau
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, FinlandAuthors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpit
| | - Sandrine Imbeaud
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Raphaële Thiébaut
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - François Liébaert
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Karine Fontaine
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Francis Rousseau
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Bérengère Génin
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Delphine Le Corre
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Audrey Didelot
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Marc Vincent
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Jean-Baptiste Bachet
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Benoist Chibaudel
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Olivier Bouché
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Bruno Landi
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Frédéric Bibeau
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Karen Leroy
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Frédérique Penault-Llorca
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Jean-Luc Van Laethem
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Pieter Demetter
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Sabine Tejpar
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Simona Rossi
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Neda Mosakhani
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Pia Osterlund
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Raija Ristamäki
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Virinder Sarhadi
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Sakari Knuutila
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, FinlandAuthors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpit
| | - Valérie Boige
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, FinlandAuthors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpit
| | - Thierry André
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Pierre Laurent-Puig
- Authors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, service d'Hépato-Gastro-Entérologie et d'Oncologie Digestive; Université Paris-Est Créteil; Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Department of Medicine, Institut Gustave Roussy, Villejuif; and Department of Biology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou, Paris; Université de Reims Champagne-Ardenne; Centre Hospitalier Universitaire de Reims, Reims; Service d'Anatomo-Pathologie, Centre Val d'Aurelle Paul-Lamarque, Montpellier; Université Clermont-Ferrand, Centre Jean Perrin, Clermont-Ferrand, France; Department of Gastroenterology, GI Cancer Unit; Department of Pathological Anatomy, Erasme University Hospital, Brussels; Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium; Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland; Haartman Institute, University of Helsinki; Department of Oncology, Helsinki University Central Hospital and Helsinki University; HUSLAB, Department of Pathology and Genetic Laboratory, Helsinki; and Department of Oncology and Radiotherapy, Turku University Hospital, Turku, FinlandAuthors' Affiliations: Université Paris Sorbonne Cité; INSERM UMR-S775 Bases Moléculaires de la réponse aux xénobiotiques; INSERM UMR-S674 Genomique Fonctionnelle des Tumeurs; Integragen S.A., Evry; Université Pierre et Marie Curie; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière; Université Pierre et Marie Curie; Assistance Publique-Hôpit
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Pant S, Weiner R, Marton MJ. Navigating the rapids: the development of regulated next-generation sequencing-based clinical trial assays and companion diagnostics. Front Oncol 2014; 4:78. [PMID: 24860780 PMCID: PMC4029014 DOI: 10.3389/fonc.2014.00078] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/28/2014] [Indexed: 12/11/2022] Open
Abstract
Over the past decade, next-generation sequencing (NGS) technology has experienced meteoric growth in the aspects of platform, technology, and supporting bioinformatics development allowing its widespread and rapid uptake in research settings. More recently, NGS-based genomic data have been exploited to better understand disease development and patient characteristics that influence response to a given therapeutic intervention. Cancer, as a disease characterized by and driven by the tumor genetic landscape, is particularly amenable to NGS-based diagnostic (Dx) approaches. NGS-based technologies are particularly well suited to studying cancer disease development, progression and emergence of resistance, all key factors in the development of next-generation cancer Dxs. Yet, to achieve the promise of NGS-based patient treatment, drug developers will need to overcome a number of operational, technical, regulatory, and strategic challenges. Here, we provide a succinct overview of the state of the clinical NGS field in terms of the available clinically targeted platforms and sequencing technologies. We discuss the various operational and practical aspects of clinical NGS testing that will facilitate or limit the uptake of such assays in routine clinical care. We examine the current strategies for analytical validation and Food and Drug Administration (FDA)-approval of NGS-based assays and ongoing efforts to standardize clinical NGS and build quality control standards for the same. The rapidly evolving companion diagnostic (CDx) landscape for NGS-based assays will be reviewed, highlighting the key areas of concern and suggesting strategies to mitigate risk. The review will conclude with a series of strategic questions that face drug developers and a discussion of the likely future course of NGS-based CDx development efforts.
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Affiliation(s)
- Saumya Pant
- Merck Research Laboratories, Molecular Biomarkers and Diagnostics , Rahway, NJ , USA
| | - Russell Weiner
- Merck Research Laboratories, Molecular Biomarkers and Diagnostics , Rahway, NJ , USA
| | - Matthew J Marton
- Merck Research Laboratories, Molecular Biomarkers and Diagnostics , Rahway, NJ , USA
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