1
|
Andrikou K, Ulivi P, Petracci E, Azzali I, Bertolini F, Alberti G, Bettelli S, Calistri D, Chiadini E, Capelli L, Cravero P, Guaitoli G, Zanelli F, Burgio MA, Pagano M, Verlicchi A, Martinelli E, Di Emidio K, Dominici M, Pinto C, Delmonte A. Rare Driver Mutations in Advanced, Oncogene-Addicted Non-Small Cell Lung Cancer: A North Italian, Real-World, Registry Experience. Diagnostics (Basel) 2024; 14:1024. [PMID: 38786322 PMCID: PMC11119107 DOI: 10.3390/diagnostics14101024] [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: 03/25/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
The real-world, retrospective, NEROnE registry investigated the impact of next-generation sequencing (NGS) in advanced non-small-cell lung cancer (NSCLC) patients (pts) at three oncology units in the north of Italy between January 2020 and December 2022. We focused on the clinical characterization and outcomes of NSCLC with rare molecular alterations: EGFR exon 20 insertion, non-activating EGFR mutations, BRAF V600E and non-V600, ROS1 and RET rearrangements, MET, ErbB2, and FGFR mutations. Overall, these represented 6.4% (62/970) of the pts analysed with NGS in the daily practice. The most heavily represented rare alterations were ROS1 rearrangement (15 pts-24%) and MET exon 14 skipping mutation (11 pts-18%). No associations were found with the demographic and clinical features. Forty-nine pts received targeted therapies, of which 38.8% were first- and 9.8% were second-line. The remaining pts received chemotherapy and/or immunotherapy. In terms of the clinical outcomes, although not statistically significant, a tendency toward shorter OS was seen when therapies other than specific targeted therapies were used (HR: 1.84, 95% CI: 0.79-4.33, p = 0.158). The pts with co-mutations (19.4%) seemed to receive an advantage from the front-line chemotherapy-based regimen. Finally, an NLR score (a well-known inflammatory index) ≥ 4 seemed to be related to shorter OS among the pts treated with immunotherapy alone or in combination with chemotherapy (HR: 2.83, 95% CI: 1.08-7.40, p = 0.033). Prospective evaluations need to be performed to clarify whether these indexes may help to identify patients with oncogene-addicted NSCLC who could benefit from immunotherapy.
Collapse
Affiliation(s)
- Kalliopi Andrikou
- Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST), 47014 Meldola, Italy; (K.A.); (P.C.); (M.A.B.); (A.V.); (A.D.)
| | - Paola Ulivi
- Bioscience Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST), 47014 Meldola, Italy; (D.C.); (E.C.); (L.C.)
| | - Elisabetta Petracci
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (E.P.); (I.A.)
| | - Irene Azzali
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (E.P.); (I.A.)
| | - Federica Bertolini
- Oncology Department, Modena University Hospital, 41125 Modena, Italy; (F.B.); (G.G.); (E.M.); (K.D.E.); (M.D.)
| | - Giulia Alberti
- Medical Oncology, IRCCS Arcispedale Santa Maria Nuova, 42123 Reggio Emilia, Italy; (G.A.); (F.Z.); (M.P.); (C.P.)
| | - Stefania Bettelli
- Biomolecular Pathology Unit, Azienda Ospedaliera Unica di Modena, 41125 Modena, Italy;
| | - Daniele Calistri
- Bioscience Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST), 47014 Meldola, Italy; (D.C.); (E.C.); (L.C.)
| | - Elisa Chiadini
- Bioscience Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST), 47014 Meldola, Italy; (D.C.); (E.C.); (L.C.)
| | - Laura Capelli
- Bioscience Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST), 47014 Meldola, Italy; (D.C.); (E.C.); (L.C.)
| | - Paola Cravero
- Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST), 47014 Meldola, Italy; (K.A.); (P.C.); (M.A.B.); (A.V.); (A.D.)
| | - Giorgia Guaitoli
- Oncology Department, Modena University Hospital, 41125 Modena, Italy; (F.B.); (G.G.); (E.M.); (K.D.E.); (M.D.)
| | - Francesca Zanelli
- Medical Oncology, IRCCS Arcispedale Santa Maria Nuova, 42123 Reggio Emilia, Italy; (G.A.); (F.Z.); (M.P.); (C.P.)
| | - Marco Angelo Burgio
- Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST), 47014 Meldola, Italy; (K.A.); (P.C.); (M.A.B.); (A.V.); (A.D.)
| | - Maria Pagano
- Medical Oncology, IRCCS Arcispedale Santa Maria Nuova, 42123 Reggio Emilia, Italy; (G.A.); (F.Z.); (M.P.); (C.P.)
| | - Alberto Verlicchi
- Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST), 47014 Meldola, Italy; (K.A.); (P.C.); (M.A.B.); (A.V.); (A.D.)
| | - Enrica Martinelli
- Oncology Department, Modena University Hospital, 41125 Modena, Italy; (F.B.); (G.G.); (E.M.); (K.D.E.); (M.D.)
| | - Katia Di Emidio
- Oncology Department, Modena University Hospital, 41125 Modena, Italy; (F.B.); (G.G.); (E.M.); (K.D.E.); (M.D.)
| | - Massimo Dominici
- Oncology Department, Modena University Hospital, 41125 Modena, Italy; (F.B.); (G.G.); (E.M.); (K.D.E.); (M.D.)
| | - Carmine Pinto
- Medical Oncology, IRCCS Arcispedale Santa Maria Nuova, 42123 Reggio Emilia, Italy; (G.A.); (F.Z.); (M.P.); (C.P.)
| | - Angelo Delmonte
- Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST), 47014 Meldola, Italy; (K.A.); (P.C.); (M.A.B.); (A.V.); (A.D.)
| |
Collapse
|
2
|
Nistal-Villan E, Rius-Rocabert S, Llinares-Pinel F. Oncolytic virotherapy in lung cancer. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2023; 379:221-239. [PMID: 37541725 DOI: 10.1016/bs.ircmb.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Lung tumors are one of the most aggressive threats affecting humans. Current therapeutic approaches have improved patients' survival; however, further efforts are required to increase effectiveness and protection against tumor relapse and metastasis. Immunotherapy presents an alternative to previous treatments that focuses on stimulating of the patient's immune system to destroy tumor cells. Viruses can be used as part of the immune therapeutic approach as agents that could selectively infect tumor cells, triggering an immune response against the infection and against the tumor cells. Some viruses have been selected for specifically infecting and destroying cancer cells, activating the immune response, enhancing access, amplifying the cytotoxicity against the tumor cells, and improving the long-term memory that can prevent tumor relapse. Oncolytic virotherapy can then be used as a strategy to target the destruction of transformed cells at the tumor site and act in locations distant from the primary targeted tumor site. Some of the current challenges in lung cancer treatment can be addressed using traditional therapies combined with oncolytic virotherapy. Defining the best combination, including the choice of the right settings will be at the next frontier in lung cancer treatment.
Collapse
Affiliation(s)
- Estanislao Nistal-Villan
- Microbiology Section, Departamento CC, Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain; Instituto de Medicina Molecular Aplicada (IMMA) Nemesio Díez, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Boadilla del Monte, Spain.
| | - Sergio Rius-Rocabert
- Microbiology Section, Departamento CC, Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain; Instituto de Medicina Molecular Aplicada (IMMA) Nemesio Díez, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Boadilla del Monte, Spain
| | - Francisco Llinares-Pinel
- Microbiology Section, Departamento CC, Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, Spain
| |
Collapse
|
3
|
Hou D, Zheng X, Song W, Liu X, Wang S, Zhou L, Tao X, Lv L, Sun Q, Jin Y, Zhang Z, Ding L, Wu N, Zhao S. Radiomic-signature changes after early treatment improve the prediction of progression-free survival in patients with advanced anaplastic lymphoma kinase-positive non-small cell lung cancer. Acta Radiol 2023; 64:1194-1204. [PMID: 35971221 DOI: 10.1177/02841851221119621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prognosis of lung cancer varies widely, even in cases wherein the tumor stage, genetic mutation, and treatment regimens are the same. Thus, an effective means for risk stratification of patients with lung cancer is needed. PURPOSE To develop and validate a combined model for predicting progression-free survival and risk stratification in patients with advanced anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) treated with ensartinib. MATERIAL AND METHODS We analyzed 203 tumor lesions in 114 patients and evaluated average radiomic feature measures from all lesions at baseline and changes in these features after early treatment (Δradiomic features). Combined models were developed by integrating clinical with radiomic features. The prediction performance and clinical value of the proposed models were evaluated using receiver operating characteristic analysis, calibration curve, decision curve analysis (DCA), and Kaplan-Meier survival analysis. RESULTS Both the baseline and delta combined models achieved predictive efficacy with a high area under the curve. The calibration curve and DCA indicated the high accuracy and clinical usefulness of the combined models for tumor progression prediction. In the Kaplan-Meier analysis, the delta and baseline combined models, Δradiomic signature, and two selected clinical features could distinguish patients with a higher progression risk within 42 weeks. The delta combined model had the best performance. CONCLUSION The combination of clinical and radiomic features provided a prognostic value for survival and progression in patients with NSCLC receiving ensartinib. Radiomic-signature changes after early treatment could be more valuable than those at baseline alone.
Collapse
Affiliation(s)
- Donghui Hou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Xiaomin Zheng
- Department of Endocrinology, Chui Yang Liu Hospital affiliated to Tsinghua University, Beijing, PR China
| | - Wei Song
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Xiaoqing Liu
- Department of Pulmonary Oncology, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Sicong Wang
- Life Sciences, GE Healthcare, Beijing, PR China
| | - Lina Zhou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Xiuli Tao
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Lv Lv
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Qi Sun
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, PR China
| | - Yujing Jin
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Zewei Zhang
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Lieming Ding
- 576287Betta Pharmaceuticals Co., Ltd, Hangzhou, PR China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Shijun Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| |
Collapse
|
4
|
Gao P, Tang K, Hao Y, Li W, Lv X, Li D, Jia Y. Case Report: Patient With Lung Adenocarcinoma With ALK-HLA-DRB1 Rearrangement Shows Impressive Progression-Free Survival After Sequential Crizotinib and Ceritinib Treatment. Front Oncol 2022; 12:762338. [PMID: 35280798 PMCID: PMC8914946 DOI: 10.3389/fonc.2022.762338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
The anaplastic lymphoma kinase (ALK) gene rearrangement is a driving mutation that underlies about 5-6% of non-small cell lung cancer (NSCLC) cases. Lung cancers that are ALK gene rearrangement-positive can be effectively treated with ALK inhibitors. However, the response of patients with rarer ALK gene rearrangements to ALK inhibitors remains unknown. Herein, we described a case of lung adenocarcinoma carrying ALK-HLA-DRB1 fusion in a 48-year-old nonsmoking woman. A similar case of ALK-HLA-DRB1 rearrangement in NSCLC has not been described previously neither in NSCLC nor in other disease. The patient achieved a progression-free survival of 18 months after sequential therapy consisting of crizotinib and then ceritinib during the follow-up. These findings provide basis for the application of ALK inhibitors in patients carrying the rare ALK-HLA-DRB1 fusion.
Collapse
Affiliation(s)
- Peng Gao
- Department of Respiratory and Critical Care Medicine, Second Hospital of Jilin University, Changchun, China
- *Correspondence: Peng Gao,
| | - Kangning Tang
- Department of Respiratory and Critical Care Medicine, Second Hospital of Jilin University, Changchun, China
| | - Yuqiu Hao
- Department of Respiratory and Critical Care Medicine, Second Hospital of Jilin University, Changchun, China
| | - Wei Li
- Department of Respiratory and Critical Care Medicine, Second Hospital of Jilin University, Changchun, China
| | - Xuejiao Lv
- Department of Respiratory and Critical Care Medicine, Second Hospital of Jilin University, Changchun, China
| | - Dapeng Li
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Jilin Medical College, Jilin, China
| | - Yuxi Jia
- Department of Orthopedics Application Demonstration Center of Precision Medicine Molecular Diagnosis, the Second Hospital of Jilin University, Changchun, China
| |
Collapse
|
5
|
Targeting anaplastic lymphoma kinase (ALK) gene alterations in neuroblastoma by using alkylating pyrrole-imidazole polyamides. PLoS One 2021; 16:e0257718. [PMID: 34591871 PMCID: PMC8483358 DOI: 10.1371/journal.pone.0257718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/08/2021] [Indexed: 12/28/2022] Open
Abstract
Anaplastic lymphoma kinase (ALK) aberration is related to high-risk neuroblastomas and is an important therapeutic target. As acquired resistance to ALK tyrosine kinase inhibitors is inevitable, novel anti-ALK drug development is necessary in order to overcome potential drug resistance against ATP-competitive kinase inhibitors. In this study, to overcome ALK inhibitor resistance, we examined the growth inhibition effects of newly developed ALK-targeting pyrrole-imidazole polyamide CCC-003, which was designed to directly bind and alkylate DNA within the F1174L-mutated ALK gene. CCC-003 suppressed cell proliferation in ALK-mutated neuroblastoma cells. The expression of total and phosphorylated ALK was downregulated by CCC-003 treatment but not by treatment with a mismatch polyamide without any binding motif within the ALK gene region. CCC-003 preferentially bound to the DNA sequence with the F1174L mutation and significantly suppressed tumor progression in a human neuroblastoma xenograft mouse model. Our data suggest that the specific binding of CCC-003 to mutated DNA within the ALK gene exerts its anti-tumor activity through a mode of action that is distinct from those of other ALK inhibitors. In summary, our current study provides evidence for the potential of pyrrole-imidazole polyamide ALK inhibitor CCC-003 for the treatment of neuroblastoma thus offering a possible solution to the problem of tyrosine kinase inhibitor resistance.
Collapse
|
6
|
Schokrpur S, Hilburn V, Giustini N, Bazhenova L. An overview of alectinib hydrochloride as a treatment option for ALK positive non-small cell lung cancer. Expert Opin Pharmacother 2021; 22:1815-1824. [PMID: 34225542 DOI: 10.1080/14656566.2021.1948014] [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: 10/20/2022]
Abstract
Introduction: Alectinib is a second-generation inhibitor of anaplastic lymphoma kinase (ALK) and RET. Phase III clinical trials have established its superiority to crizotinib in the first-line ALK inhibitor-naïve setting. Studies also support its use over chemotherapy in the post-crizotinib setting. It is currently one of several FDA- and EMA-approved ALK inhibitors, and it is listed as a preferred initial therapy for treatment-naïve ALK-positive non-small cell lung cancer (NSCLC).Areas covered: Herein, the authors provide the reader with details of the chemical structure, pharmacologic properties, resistance mutations, phase I, II, and III clinical trials, and safety profile of alectinib. Furthermore, the authors provide the reader with the expert opinion and future perspectives on the drug.Expert opinion: Alectinib compares favorably to other second-generation ALK inhibitors with regards to safety, tolerability, and efficacy. Based on currently available data, it is an appropriate first-line option. Ongoing studies will better resolve the ideal sequencing of ALK inhibitors in the treatment of ALK-positive NSCLC.
Collapse
Affiliation(s)
- Shiruyeh Schokrpur
- Division of Hematology, Oncology University of California San Diego Moores Cancer Center, San Diego, California, USA
| | - Van Hilburn
- Division of Pharmacy, University of California San Diego, San Diego, California, USA
| | - Nicholas Giustini
- Division of Hematology, Oncology University of California San Diego Moores Cancer Center, San Diego, California, USA
| | - Lyudmila Bazhenova
- Division of Hematology, Oncology University of California San Diego Moores Cancer Center, San Diego, California, USA
| |
Collapse
|
7
|
Tabbò F, Reale ML, Bironzo P, Scagliotti GV. Resistance to anaplastic lymphoma kinase inhibitors: knowing the enemy is half the battle won. Transl Lung Cancer Res 2021; 9:2545-2556. [PMID: 33489817 PMCID: PMC7815358 DOI: 10.21037/tlcr-20-372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anaplastic lymphoma kinase (ALK) translocations are responsible of neoplastic transformation in a limited subset of non-small cell lung cancer (NSCLC) patients. In recent years outcomes of these patients improved due to the development and clinical availability of specific and extremely active targeted therapies [i.e., next-generation Tyrosine Kinase Inhibitors (TKI)]: ALK+ patients are now reaching impressive results when treated with more potent inhibitors upfront with an average median progression-free survival (mPFS) around 35 months. However, under drug pressure, cancer cells develop resistance and patients eventually progress. Multiple mechanisms of intrinsic or acquired resistance have been extensively characterized. Less potent ALK inhibitors (ALKi)—like crizotinib—usually tend to induce a large spectrum of secondary intra-kinase mutations; however, these alterations may be observed also after sequential administration of multiple ALKi. Noteworthy, neoplastic cells may evade ALK targeting through a myriad of different mechanisms involving cell-stroma interaction, activation of parallel signaling pathways, intracellular downstream adaptation and histological reshaping, as relevant molecular events. Often these phenomena are restricted to a limited number of cases or even can be patient-specific, thus hindering the development of therapeutic strategies largely applicable. Consequently, the recognition of specific resistance mechanisms seldom translates in clinical opportunities. Management of ALK+ patients is drastically changed and deciphering the molecular biology underlying this disease during treatment is of paramount relevance. The bedrock of resistance to TKI is that, after the diagnosis, we face with a different disease that needs to be re-characterized through tissue or/and liquid biopsies. Understanding molecular pathways driving the resistant phenotype will give us the chance to know what we are dealing with and, rather than choose an empirical approach, will help us to properly define the best targeted treatment for these patients.
Collapse
Affiliation(s)
- Fabrizio Tabbò
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
| | - Giorgio V Scagliotti
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
| |
Collapse
|
8
|
Tabbò F, Passiglia F, Novello S. Upfront Management of ALK-Rearranged Metastatic Non-small Cell Lung Cancer: One Inhibitor Fits All? Curr Oncol Rep 2021; 23:10. [PMID: 33387080 DOI: 10.1007/s11912-020-00989-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Anaplastic lymphoma kinase (ALK) rearrangements represent a seldom event in non-small cell lung cancer (NSCLC). Given the oncogene alteration, ALK targeting represents the main therapeutic strategy. Here, we review evidence regarding ALK inhibitors (ALKi): clinical activity, safety profiles, financial costs, and biomarkers of efficacy. RECENT FINDINGS During the past 10 years, multiple ALKi have been developed, and four different compounds are currently available as upfront options for ALK+ NSCLC patients: crizotinib, ceritinib, alectinib, and brigatinib. Second-generation (2G) ALKi demonstrated superior clinical activity in terms of median progression-free survival (mPFS), objective response rate (ORR), intracranial disease control, and duration of response (DOR) when compared with crizotinib. 2G ALKi represent the current gold-standard first-line treatment for ALK-rearranged metastatic NSCLC. Among all available options, in our opinion, alectinib has likely the best profile of clinical activity and safety, thus emerging as the best upfront therapy. More insights will come from ongoing trials and analysis of biomarkers.
Collapse
Affiliation(s)
- Fabrizio Tabbò
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, TO, Italy.
| |
Collapse
|
9
|
Zhao S, Hou D, Zheng X, Song W, Liu X, Wang S, Zhou L, Tao X, Lv L, Sun Q, Jin Y, Ding L, Mao L, Wu N. MRI radiomic signature predicts intracranial progression-free survival in patients with brain metastases of ALK-positive non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:368-380. [PMID: 33569319 PMCID: PMC7867779 DOI: 10.21037/tlcr-20-361] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Intracranial progression is considered an important cause of treatment failure in anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) patients. Recent advances in targeted therapy and radiomics have generated considerable interest for the exploration of prognostic imaging biomarkers to predict the clinical course. Here, we developed a magnetic resonance imaging (MRI) radiomic signature that can stratify survival and intracranial progression. Methods We analyzed 87 brain metastatic lesions in 24 ALK-positive NSCLC patients undergoing ALK-inhibitor ensartinib therapy and divided them into training (n=61) and validation (n=26) sets. Radiomic features were extracted and screened from contrast-enhanced MR images. Combined with these selected features, the Rad-score was calculated with multivariate logistic regression. The predictive model and Rad-score performance were assessed in the training set and validated in the validation set; decision curve analysis was performed with the combined training and validation sets to estimate Rad-score’s patient-stratification ability. Results The prediction model constructed with nine selected radiomic features could predict intracranial progression within 51 weeks (AUC =0.84 and 0.85 in the training and validation sets, respectively), while clinical and regular MRI characteristics were independent of progression (P>0.05). The decision-curve analysis showed that the radiomic prediction model was clinically useful. The Kaplan-Meier analysis showed that the progression-free survival (PFS) difference between the high- and low-risk groups distinguished by the Rad-score was significant (P=0.017). Conclusions Radiomics may provide prognostic information and improve pretreatment risk stratification in ALK-positive NSCLC patients with brain metastases undergoing ensartinib treatment, allowing follow-up and treatment to be tailored to the patient’s individual risk profile.
Collapse
Affiliation(s)
- Shijun Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Donghui Hou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaomin Zheng
- Department of Endocrinology, Chui Yang Liu Hospital affiliated to Tsinghua University, Beijing, China
| | - Wei Song
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaoqing Liu
- Department of Pulmonary Oncology, the Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Sicong Wang
- GE Healthcare, Life Sciences, Beijing, China
| | - Lina Zhou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuli Tao
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lv Lv
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yujing Jin
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lieming Ding
- Betta Pharmaceuticals Co., Ltd., Hangzhou, China
| | - Li Mao
- Betta Pharmaceuticals Co., Ltd., Hangzhou, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
10
|
Wu X, Zhou H, He Z, Zhang Z, Feng W, Zhao J, Chen H, Wang S, Wang W, Wang Q. Coexistence of a novel CCNY-ALK and ATIC-ALK double-fusion in one patient with ALK-positive NSCLC and response to crizotinib: a case report. Transl Lung Cancer Res 2020; 9:2494-2499. [PMID: 33489809 PMCID: PMC7815378 DOI: 10.21037/tlcr-20-1049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anaplastic lymphoma kinase (ALK) rearrangement, one of the common oncogene rearrangements in the mutational history of lung adenocarcinoma, occurs in approximately 5% of non-small cell lung cancer (NSCLC) patients who could be effectively treated with ALK tyrosine kinase inhibitors (TKIs). The earlier phase III PROFILE 1014 study has shown that crizotinib, a first-generation ALK-TKI, significantly improved progression-free survival (PFS) compared with platinum-based chemotherapy in patients with previously untreated advanced ALK-positive NSCLC. Thus, clinicians must screen potential candidates for this driver alteration to guide ALK inhibitor therapy with a molecular testing platform capable of capturing all ALK fusions. Echinoderm microtubule-associated proteins, including the EML4 gene, are the most common ALK rearrangement partner. With the widespread use of the next-generation sequencing (NGS) techniques, which could approach enable the simultaneous screening of multiple genetic alterations, increasingly ALK rearrangement partners have been documented. However, the concurrent two ALK rearrangements within the same patient have rarely previously been reported. Here, we describe a novel CCNY-ALK (C1:A20) and ATIC-ALK (A7:A20), coexisting in the same case with poorly differentiated NSCLC and providing evidence of its sensitivity to ALK inhibitors. The newly identified rearrangement partners can be added to the list of ALK rearrangements that occurred in ALK-positive NSCLC, as it could lead to prolonged disease control. Also, while different ALK rearrangement variants might bring differing clinical outcomes, we discuss the impact of the co-mutations of these two ALK rearrangements on the sensitivity to ALK inhibitors. However, the impact of co-mutations on the pathogenesis of NSCLC should be further studied to supply more theoretical insight that co-mutations present for personalized anti-cancer therapy.
Collapse
Affiliation(s)
- Xuan Wu
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Hanqiong Zhou
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Zhen He
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Zhe Zhang
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Wen Feng
- Department of Pathology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jiuzhou Zhao
- Department of Molecular Pathology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Haiyang Chen
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Shuai Wang
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Wei Wang
- Henan Medical Association, Zhengzhou, China
| | - Qiming Wang
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| |
Collapse
|
11
|
Inagaki M, Ichimura H, Usui S, Iguchi K, Ishibashi O, Nakamura R, Inage Y, Suzuki H, Kiyoshima M, Kamiyama K, Kimura M, Yoshida S, Sakai M, Kobayashi N, Furukawa K, Satoh H, Hizawa N, Sato Y. A population-based study of outcomes in patients with surgically resected non-small cell lung cancer with anaplastic lymphoma kinase-rearranged mutations: A matched-pair study. Mol Clin Oncol 2020; 14:11. [PMID: 33282286 PMCID: PMC7709561 DOI: 10.3892/mco.2020.2173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/21/2020] [Indexed: 12/04/2022] Open
Abstract
The present study aimed to evaluate clinical outcomes in patients with surgically resected non-small cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK)-rearranged mutations. A matched-pair analysis in completely resected ALK-rearranged NSLC patients and those with neither ALK nor epidermal growth factor receptor (EGFR) mutations diagnosed at 11 institutes was performed between April 2008 and March 2019. A total of 51 patients with surgically resected ALK-rearranged NSCLC were included. Women constituted 68.6%, and smokers 29.4%. The median age was 65 years. In matched-pair analysis, disease-free survival and overall survival did not differ between patients with ALK-rearranged mutations and those without mutations. Post-recurrence survival in patients with ALK mutations was longer than that of patients with neither ALK nor epidermal growth factor receptor mutations. ALK genetic testing should be performed, even in elderly patients with NSCLC. Favorable prognosis might be expected after appropriate treatment for patients with recurrent ALK-mutated disease.
Collapse
Affiliation(s)
- Masaharu Inagaki
- Department of Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki 3000028, Japan
| | - Hideo Ichimura
- Divisions of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki 3170077, Japan
| | - Shingo Usui
- Division of Thoracic Surgery, Ibarakihigashi Hospital, Tokai-mura, Ibaraki 3191113, Japan
| | - Kesato Iguchi
- Division of Respiratory Medicine and Thoracic Surgery, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki 3100015, Japan
| | - Osamu Ishibashi
- Division of Respiratory Medicine and Thoracic Surgery, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki 3100015, Japan
| | - Ryota Nakamura
- Division of Thoracic Surgery, Mito Medical Center, Mito, Ibaraki 3113193, Japan
| | - Yoshihisa Inage
- Division of Thoracic Surgery, Mito Medical Center, Mito, Ibaraki 3113193, Japan
| | - Hisashi Suzuki
- Respiratory Center, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki 3091703, Japan
| | - Moriyuki Kiyoshima
- Respiratory Center, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki 3091703, Japan
| | - Koichi Kamiyama
- Division of Thoracic Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki 3002622, Japan
| | - Masaki Kimura
- Division of Thoracic Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki 3002622, Japan
| | - Susumu Yoshida
- Division of Thoracic Surgery, Ibaraki Seinan Medical Center Hospital, Sakai-machi, Ibaraki 3060433, Japan
| | - Mitsuaki Sakai
- Division of Thoracic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki 3058558, Japan
| | - Naohiro Kobayashi
- Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 3058575, Japan
| | - Kinya Furukawa
- Division of Thoracic Surgery, Tokyo Medical University, Ibaraki Medical Center, Ami-machi, Ibaraki 3113193, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine and Thoracic Surgery, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Ibaraki 3100015, Japan
| | - Nobuyuki Hizawa
- Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 3058575, Japan
| | - Yukio Sato
- Faculty of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 3058575, Japan
| |
Collapse
|
12
|
Zhou S, Liu W, Zhou C, Zhang L, Xie L, Xu Z, Wang L, Zhao Y, Guo L, Chen J, Ding L, Mao L, Tao Y, Zhang C, Ding S, Shao F. Mass balance, metabolic disposition, and pharmacokinetics of [ 14C]ensartinib, a novel potent anaplastic lymphoma kinase (ALK) inhibitor, in healthy subjects following oral administration. Cancer Chemother Pharmacol 2020; 86:719-730. [PMID: 33044566 DOI: 10.1007/s00280-020-04159-0] [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: 04/30/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Ensartinib is a novel, potent and highly selective inhibitor of anaplastic lymphoma kinase (ALK) that has promising clinical activity and low toxicity in patients with ALK-positive non-small cell lung cancer. This study was conducted to investigate the pharmacokinetics, metabolism and excretion of ensartinib following a single 200 mg/100 μCi oral dose of radiolabeled ensartinib to healthy subjects. METHODS Six healthy male subjects were enrolled and administrated an oral suspension in a fasted state. Blood, urine and feces were collected. Radioactivity concentrations were measured by liquid scintillation counting and plasma concentrations of ensartinib by liquid chromatography-tandem mass spectrometry. Both techniques were applied for metabolite profiling and characterization. RESULTS The mean total recovery was 101.21% of the radiolabeled dose with 91.00% and 10.21% excreted in feces and urine, respectively. Unchanged ensartinib was the predominant drug-related component in urine and feces, representing 4.39% and 38.12% of the administered dose, respectively. Unchanged ensartinib and its metabolite M465 were the major circulating components, accounting for the same 27.45% of the plasma total radioactivity (AUC0-24h pool), while other circulating metabolites were minor, accounting for less than 10%. Mean Cmax, AUC0-∞, T1/2 and Tmax values for ensartinib in plasma were 185 ng/mL, 3827 h ng/mL, 18.3 h and 3.25 h, respectively. The total radioactivity in plasma was cleared with terminal half-life of 27.2 h. Treatment with ensartinib was well tolerated, and no serious adverse events were reported. CONCLUSION It was well tolerated in the six healthy male subjects following a single oral administration of 200 mg/100 μCi dose of ensartinib. Besides unchanged ensartinib, metabolite of M465 was the predominant circulating drug-related component. The drug was primarily eliminated in feces. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT03804541.
Collapse
Affiliation(s)
- Sufeng Zhou
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, #300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wei Liu
- Nulear Medicine Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Chen Zhou
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, #300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lingling Zhang
- Lab Testing Division, Department of DMPK Service, WuXi AppTec Co. Ltd., Nanjing, 210038, China
| | - Lijun Xie
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, #300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Zhaoqiang Xu
- Nulear Medicine Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Lu Wang
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, #300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yuqing Zhao
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, #300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lian Guo
- Lab Testing Division, Department of DMPK Service, WuXi AppTec Co. Ltd., Nanjing, 210038, China
| | - Juan Chen
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, #300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lieming Ding
- Betta Pharmaceuticals Co., Ltd., Hangzhou, 311100, China
| | - Li Mao
- Betta Pharmaceuticals Co., Ltd., Hangzhou, 311100, China
| | - Yi Tao
- Lab Testing Division, Department of DMPK Service, WuXi AppTec Co. Ltd., Nanjing, 210038, China
| | - Chen Zhang
- Nulear Medicine Department, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Sijia Ding
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, #300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Feng Shao
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, #300 Guangzhou Road, Nanjing, 210029, Jiangsu, China. .,Department of Clinical Pharmacology, Pharmacy College, Nanjing Medical University, Nanjing, 211166, China.
| |
Collapse
|
13
|
Qiao M, Zhao C, Liu Q, Wang Y, Shi J, Ng TL, Zhou F, Li X, Jiang T, Yang S, Gao G, Xiong A, Li J, Li W, Wu F, Chen X, Su C, Ren S, Zhou C, Zhang J. Impact of ALK variants on brain metastasis and treatment response in advanced NSCLC patients with oncogenic ALK fusion. Transl Lung Cancer Res 2020; 9:1452-1463. [PMID: 32953517 PMCID: PMC7481619 DOI: 10.21037/tlcr-19-346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background To investigate the impact of ALK variants on the features of brain metastases (BM), the outcome of chemotherapy and targeted therapy using crizotinib, as well as the progression pattern in patients with ALK fusion. Methods Patients with ALK fusion were retrospectively collected from January 2013 to July 2017 in Shanghai Pulmonary Hospital. ALK rearrangements were identified via ARMS-PCR. ALK variants were identified via Sanger Sequencing. Results A total of 135 patients and 41 with brain metastasis were identified. Radiological features showed that the patients with ALK variant 1 had a larger BM size compared with patients with ALK non-variant 1 (median tumor size: 16.89 vs. 11.01 mm, P=0.031). Similar time to treatment failure (TTF) was observed in patients with ALK variant 1 and non-variant 1 who received first-line crizotinib (median TTF: 15.7 vs. 13.8 months, HR =0.75, P=0.34). Patients with ALK variant 1 who had baseline BM had significantly shorter TTF than non-variant 1 with baseline BM when treated with first-line crizotinib (median TTF: 9.1 vs. 14.9 months, HR =2.68, P=0.037). In patients treated with chemotherapy, ALK variant 1 was associated with inferior TTF (median TTF: 5.6 vs. 8.1 months, HR =1.66, P=0.039). Progression pattern was similar between ALK variant 1 and non-variant 1. Conclusions Patients with ALK variant 1 and baseline BM had inferior TTF on first-line crizotinib treatment and presented with more aggressive radiological features. Patients with ALK non-variant 1 had better clinical outcome on first-line chemotherapy.
Collapse
Affiliation(s)
- Meng Qiao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chao Zhao
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qian Liu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingyun Shi
- Department of Imaging, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Terry L Ng
- Division of Medical Oncology, University of Ottawa, Ottawa, Canada
| | - Fei Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuo Yang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guanghui Gao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Anwen Xiong
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiayu Li
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Li
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fengying Wu
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoxia Chen
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Zhang
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| |
Collapse
|
14
|
Tang Z, Chen H, Hong L, Tang G, Toruner GA, Wang W, Roy Chowdhuri S, Yin W, Jung HS, Gu J, Routbort MJ, Zhang J, Khoury JD, Medeiros LJ. Inconsistent Intersample ALK FISH Results in Patients with Lung Cancer: Analysis of Potential Causes. Cancers (Basel) 2020; 12:cancers12071903. [PMID: 32674491 PMCID: PMC7409019 DOI: 10.3390/cancers12071903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022] Open
Abstract
ALK FISH analyses of multiple specimens occasionally yield inconsistent intersample results in lung cancer patients, posing clinical challenges requiring intensive analysis of all potential causative pre- and post- analytic factors. In this study, 19 patients (8M/11F) with inconsistent intersample ALK FISH results were analyzed, representing 4.9% of patients assessed ≥ twice in our institution. Fifteen patients received ALK tyrosine kinase inhibitor(s) (TKIs). Nine patients died, and ten were alive for 8 to 74-month follow-ups (median, 40 months). Through strict and stringent laboratory and case-review policies, all postanalytic factors were excluded. Correlating clinical information, ALK results obtained by RNA sequencing (RNA-seq) and other concurrent tests, several pre-analytic factors were determined. A suboptimal specimen was likely the cause in three patients, supported by the failure of one or more concurrent tests or discrepant results between FISH and RNA-seq. ALK inhibition by TKIs might have been responsible for the change of ALK status from positive to negative in eight patients. Other potential explanations include the existence of multiple primary lung cancer lesions, tumor heterogeneity, and the clonal evolution of tumor cells, related or not to ALK TKI therapy. This study is helpful for both pathologists and clinicians encountering inconsistent and/or discrepant intersample results.
Collapse
|