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Shreenivas A, Janku F, Gouda MA, Chen HZ, George B, Kato S, Kurzrock R. ALK fusions in the pan-cancer setting: another tumor-agnostic target? NPJ Precis Oncol 2023; 7:101. [PMID: 37773318 PMCID: PMC10542332 DOI: 10.1038/s41698-023-00449-x] [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: 04/02/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023] Open
Abstract
Anaplastic lymphoma kinase (ALK) alterations (activating mutations, amplifications, and fusions/rearrangements) occur in ~3.3% of cancers. ALK fusions/rearrangements are discerned in >50% of inflammatory myofibroblastic tumors (IMTs) and anaplastic large cell lymphomas (ALCLs), but only in ~0.2% of other cancers outside of non-small cell lung cancer (NSCLC), a rate that may be below the viability threshold of even large-scale treatment trials. Five ALK inhibitors -alectinib, brigatinib, ceritinb, crizotinib, and lorlatinib-are FDA approved for ALK-aberrant NSCLCs, and crizotinib is also approved for ALK-aberrant IMTs and ALCL, including in children. Herein, we review the pharmacologic tractability of ALK alterations, focusing beyond NSCLC. Importantly, the hallmark of approved indications is the presence of ALK fusions/rearrangements, and response rates of ~50-85%. Moreover, there are numerous reports of ALK inhibitor activity in multiple solid and hematologic tumors (e.g., histiocytosis, leiomyosarcoma, lymphoma, myeloma, and colorectal, neuroendocrine, ovarian, pancreatic, renal, and thyroid cancer) bearing ALK fusions/rearrangements. Many reports used crizotinib or alectinib, but each of the approved ALK inhibitors have shown activity. ALK inhibitor activity is also seen in neuroblastoma, which bear ALK mutations (rather than fusions/rearrangements), but response rates are lower (~10-20%). Current data suggests that ALK inhibitors have tissue-agnostic activity in neoplasms bearing ALK fusions/rearrangements.
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Affiliation(s)
- Aditya Shreenivas
- Medical College of Wisconsin (MCW) Cancer Center, Milwaukee, WI, USA.
| | | | - Mohamed A Gouda
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui-Zi Chen
- Medical College of Wisconsin (MCW) Cancer Center, Milwaukee, WI, USA
| | - Ben George
- Medical College of Wisconsin (MCW) Cancer Center, Milwaukee, WI, USA
| | - Shumei Kato
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Razelle Kurzrock
- Medical College of Wisconsin (MCW) Cancer Center, Milwaukee, WI, USA.
- University of Nebraska, Omaha, NE, USA.
- Worldwide Innovative Network (WIN) for Personalized Cancer Therapy, Chevilly-Larue, France.
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Wan Y, Qian Y, Wang Y, Fang F, Wu G. Prognostic value of Beclin 1, EGFR and ALK in non-squamous non-small cell lung cancer. Discov Oncol 2022; 13:127. [PMID: 36401689 PMCID: PMC9675885 DOI: 10.1007/s12672-022-00586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is one of the most malignant tumors. The study was carried out to investigate the prognostic value of Beclin 1, EGFR and ALK for this cancer. Patients diagnosed with non-squamous NSCLC and admitted to our hospital from January 2011 to September 2016 were analyzed. Expression of Beclin 1 and mutation of EGFR and ALK were assessed using polymerase chain reaction (PCR) and fluorescent in situ hybridization (FISH) and analyzed for their relationship with demographic and clinical characteristics of the patients. Multivariate Cox regression models were applied to analyze the risk factors associated with survival and receiver response curves (ROC) were plotted to determine the prognostic value of Beclin 1, EGFR and ALK for patients with non-squamous NSCLC. Compared with adjacent normal tissue, Beclin 1 expression was elevated in the cancer tissue significantly; assessments of EGFR and ALK mutations showed that out of the 480 patients, 233 (48.5%) and 75 (12.6%) patients had EGFR and ALK mutations. Univariate analysis revealed that Beclin 1 level, EGFR and ALK mutations were associated with lymph node metastasis, TNM stage, tumor differentiation and prognosis, but not with gender, age and smoking status. The Kaplan-Meier survival analysis indicated that low Beclin 1 expression and positive EGFR and ALK rearrangements were associated with higher survival rate and longer progress-free survival (PFS). Multivariate Cox regression analysis showed that Beclin 1, EGFR, ALK mutations, tumor differentiation grade, TNM stage and lymph node metastasis were independently associated with PFS. ROC analysis showed that Beclin 1, EGFR and ALK were significant predictors for PFS; the areas under curve (AUC) for Beclin 1, EGFR and ALK were 0.812 (P = 0.018, cut-off value: 1.2), 0.781 (P = 0.011, cut-off value: 15%) and 0.722 (P = 0.010, cut-off value: 11%), respectively, suggesting that they have significant prognostic value for lung cancer patients. Our data indicate that Beclin 1, EGFR and ALK genes are associated with the prognosis of patients with non-squamous NSCLC. High Beclin 1 expression and negative EGFR and ALK mutations predict a poor prognosis with PFS.
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Affiliation(s)
- Yanhui Wan
- Department of Thoracic Surgery, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Futian Road , Shenzhen, 518000, China.
| | - Youhui Qian
- Department of Thoracic Surgery, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Futian Road , Shenzhen, 518000, China
| | - Youyu Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Futian Road , Shenzhen, 518000, China
| | - Fuyuan Fang
- Department of Thoracic Surgery, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Futian Road , Shenzhen, 518000, China
| | - Guodong Wu
- Department of Thoracic Surgery, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Futian Road , Shenzhen, 518000, China
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Kang S, Woo J, Kim S. A Systematic Review of Companion Diagnostic Tests by Immunohistochemistry for the Screening of Alectinib-Treated Patients in ALK-Positive Non-Small Cell Lung Cancer. Diagnostics (Basel) 2022; 12:diagnostics12051297. [PMID: 35626451 PMCID: PMC9140374 DOI: 10.3390/diagnostics12051297] [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: 04/18/2022] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Companion diagnostic tests and targeted therapy changed the management of non-small cell lung cancer by diagnosing genetic modifications and enabling individualized treatment. The purpose of this systematic review is to assess the clinical applicability of companion diagnostic tests (IHC method) by comparing the effects of alectinib and crizotinib in patients with ALK-positive NSCLC. We searched for literature up to March 2022 in PubMed, Web of Science, Cochrane, and Google Scholar. The inclusion criteria were randomized controlled trials comparing the effectiveness of alectinib and crizotinib using an IHC-based companion diagnostic test. The primary outcome was progression-free survival (PFS). The secondary outcomes were objective response rate (ORR), duration of response (DOR), and overall survival (OS). PFS was longer in alectinib (68.4 [61.0, 75.9]) than crizotinib (48.7 [40.4, 56.9]). This indicated that alectinib had a superior efficacy to that of crizotinib (HR range 0.15–0.47). In all secondary outcomes, alectinib was better than crizotinib. Particularly for the ORR, the odds ratio (OR) confirmed that alectinib had a lower risk rate (OR: 2.21, [1.46–3.36], p = 0.0002, I2 = 39%). Therefore, the companion diagnostic test (immunohistochemistry) is an effective test to determine whether to administer alectinib to ALK-positive NSCLC patients.
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Affiliation(s)
- Sulim Kang
- Department of Medical Industry, Dongguk University-Seoul, 26, Pil-dong 3-ga, Jung-gu, Seoul 04620, Korea; (S.K.); (J.W.)
| | - Jaehyun Woo
- Department of Medical Industry, Dongguk University-Seoul, 26, Pil-dong 3-ga, Jung-gu, Seoul 04620, Korea; (S.K.); (J.W.)
| | - Sungmin Kim
- Department of Medical Industry, Dongguk University-Seoul, 26, Pil-dong 3-ga, Jung-gu, Seoul 04620, Korea; (S.K.); (J.W.)
- Department of Medical Biotechnology, Dongguk University, Bio Medi Campus, 32, Dongguk-ro, Ilsandong-gu, Goyang-si 10326, Gyeonggi-do, Korea
- Correspondence:
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Hao J, Wang J, Wei P, Liu J, Su P, Xing A, Jing H. Anaplastic lymphoma kinase fusion protein expression is associated with a favorable prognosis in resected invasive mucinous lung adenocarcinoma: A retrospective study from two Chinese tertiary hospitals. J Cancer Res Ther 2022; 18:445-451. [DOI: 10.4103/jcrt.jcrt_2334_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Batra U, Nathany S, Sharma M, Pasricha S, Bansal A, Jain P, Mehta A. IHC versus FISH versus NGS to detect ALK gene rearrangement in NSCLC: all questions answered? J Clin Pathol 2021; 75:405-409. [PMID: 33753563 DOI: 10.1136/jclinpath-2021-207408] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/04/2022]
Abstract
AIMS Anaplastic lymphoma kinase (ALK) rearranged non-small cell lung carcinoma (NSCLC) is a distinct molecular subtype and rapid approval of ALK tyrosine kinase inhibitors (TKIs) has necessitated rapid and sensitive diagnostic modalities for the detection of this alteration. Gene rearrangements can be identified using many techniques including fluorescence in situ hybridisation (FISH), reverse transcriptase-PCR, next-generation sequencing (NGS) and immunohistochemistry (IHC) for fusion oncoprotein expression. We aimed to determine the concordance between IHC, FISH and NGS for ALK biomarker detection, and determine differences in sensitivity, and survival outcomes. METHODS We analysed the concordance between IHC using D5F3 monoclonal antibody, FISH (break-apart) and NGS using a custom panel containing 71 different ALK variants. RESULTS Among 71 cases included in this study, FISH was evaluable in 58 cases. The concordance of ALK IHC with FISH was 75.9% and that with NGS was 84.5%. The sensitivities of FISH and NGS were 75.6% and 87.5%, respectively. The median progression-free survival of ALK IHC-positive and FISH-negative group was 5.5 months and that of both positive was 9.97 months. CONCLUSION Although NGS offers a better throughput and visualisation, IHC still remains the quintessential screening tool in upfront diagnosis of ALK rearranged NSCLC.
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Affiliation(s)
- Ullas Batra
- Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Shrinidhi Nathany
- Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mansi Sharma
- Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sunil Pasricha
- Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Abhishek Bansal
- Radiology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Jain
- Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anurag Mehta
- Laboratory Services, Transfusion Medicine and Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Mok T, Peters S, Camidge DR, Noé J, Gadgeel S, Ignatius Ou SH, Kim DW, Konopa K, Pozzi E, Liu T, Loftin IR, Williams C, Shaw AT. Outcomes According to ALK Status Determined by Central IHC or FISH in Patients with ALK-Positive NSCLC Enrolled in the Phase III ALEX Study. J Thorac Oncol 2020; 16:S1556-0864(20)30815-7. [PMID: 34756882 DOI: 10.1016/j.jtho.2020.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION We retrospectively examined progression-free survival (PFS) and response by ALK fluorescence in-situ hybridization (FISH) status in patients with advanced ALK immunohistochemistry (IHC)-positive non-small-cell lung cancer (NSCLC) in the ALEX study. METHODS 303 treatment-naïve patients were randomized to receive twice-daily alectinib 600 mg or crizotinib 250 mg. ALK status was assessed centrally using Ventana ALK (D5F3) CDx IHC and Vysis ALK Break Apart FISH Probe Kit. Primary endpoint: investigator-assessed PFS. Secondary endpoints of interest: objective response rate (ORR) and duration. RESULTS Investigator-assessed PFS was significantly prolonged with alectinib versus crizotinib in ALK IHC-positive/FISH-positive tumors (n = 203, 67%) (HR 0.37, 95% CI: 0.25-0.56) and ALK IHC-positive/FISH-uninformative tumors (n = 61, 20%) (HR 0.39, 95% CI: 0.20-0.78), but not ALK IHC-positive/FISH-negative tumors (n = 39, 13%) (HR 1.33, 95% CI: 0.6-3.2). ORRs were higher with alectinib versus crizotinib in ALK IHC-positive/FISH-positive tumors 90.6% versus 81.4%; stratified odds ratio [OR] 2.22, 95% CI: 0.97-5.07) and ALK IHC-positive/FISH-uninformative tumors (96.0% versus 75.0%; OR 9.29, 95% CI: 1.05-81.88), but not ALK IHC-positive/FISH-negative tumors (28.6% versus 44.4%; OR 0.45, 95% CI: 0.12-1.74). Next-generation sequencing (NGS) was performed in 35/39 patients with ALK IHC-positive/FISH-negative tumors; no ALK fusion was identified in 20/35 (57.1%) patients by NGS, but 10/20 (50.0%) had partial response/stable disease. CONCLUSION Outcomes of patients with ALK IHC-positive/FISH-positive and ALK IHC-positive/FISH-uninformative NSCLC were similar to the overall ALEX population. These results suggest that Ventana ALK IHC is a standard testing method for selecting patients for treatment with alectinib.
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Affiliation(s)
- Tony Mok
- State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Hong Kong.
| | | | | | | | - Shirish Gadgeel
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Krzysztof Konopa
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Ting Liu
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Alice T Shaw
- Massachusetts General Hospital, Boston, Massachusetts
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Keppens C, von der Thüsen J, Pauwels P, Ryska A, 't Hart N, Schuuring E, Miller K, Thunnissen E, Zwaenepoel K, Dequeker EMC. Staining Performance of ALK and ROS1 Immunohistochemistry and Influence on Interpretation in Non-Small-Cell Lung Cancer. J Mol Diagn 2020; 22:1438-1452. [PMID: 33011443 DOI: 10.1016/j.jmoldx.2020.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/15/2020] [Accepted: 09/16/2020] [Indexed: 01/02/2023] Open
Abstract
Selection of non-small-cell lung cancer patients for treatment relies on the detection of expression of anaplastic lymphoma kinase (ALK) and ROS proto-oncogene 1 (ROS1) protein by immunohistochemistry (IHC). We evaluated staining performance for different IHC protocols and laboratory characteristics, and their influence on ALK and ROS1 interpretation during external quality assessment schemes between 2015 and 2018. Participants received five formalin-fixed, paraffin-embedded cases for staining by their routine protocol, whereafter at least two pathologists scored them simultaneously under a multihead microscope and awarded a graded expert staining score (ESS) from 1 to 5 points based on staining quality. European Conformity in Vitro Diagnostic kits (such as D5F3) revealed a better ALK ESS compared with laboratory-developed tests. ESS was indifferent to the applied antibody dilution or a recent protocol change. Lower ESSs were observed for higher antibody incubation times and temperatures. ESS for various ROS1 protocols were largely similar. Overall, for both markers, ESS improved over time and for repeated external quality assessment participation but was independent of laboratory setting or experience. Except for ROS1, ESS positively correlated with laboratory accreditation. IHC stains with lower ESS correlated with increased error rates in ALK and ROS1 interpretation and analysis failures. Laboratory characteristics differently affected staining quality and interpretation, and laboratories should assess both aspects, and less common protocols need improvement in staining performance.
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Affiliation(s)
- Cleo Keppens
- Biomedical Quality Assurance Research Unit, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Jan von der Thüsen
- Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Patrick Pauwels
- Department of Pathology, University Hospital Antwerp, Edegem, Belgium; Centre for Oncological Research, University of Antwerp, Edegem, Belgium
| | - Ales Ryska
- Department of Pathology, Charles University Medical Faculty Hospital, Hradec Kralove, Czech Republic
| | - Nils 't Hart
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Pathology, Isala Klinieken, Zwolle, the Netherlands
| | - Ed Schuuring
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Keith Miller
- UK National External Quality Assessment Scheme for Immunocytochemistry and in Situ Hybridisation, University College London Cancer Institute, London, United Kingdom
| | - Erik Thunnissen
- Department of Pathology, Vrije Universiteit Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Karen Zwaenepoel
- Department of Pathology, University Hospital Antwerp, Edegem, Belgium; Centre for Oncological Research, University of Antwerp, Edegem, Belgium
| | - Elisabeth M C Dequeker
- Biomedical Quality Assurance Research Unit, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium.
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Hu X, Cui Q, Wang M. A Novel CAMKMT Exon3-ALK Exon20 Fusion Variant was Identified in a Primary Pulmonary Mucinous Adenocarcinoma. J Thorac Oncol 2019; 14:e11-e12. [DOI: 10.1016/j.jtho.2018.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 11/15/2022]
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Scattone A, Catino A, Schirosi L, Caldarola L, Tommasi S, Lacalamita R, Montagna ES, Galetta D, Serio G, Zito FA, Mangia A. Discordance between FISH, IHC, and NGS Analysis of ALK Status in Advanced Non-Small Cell Lung Cancer (NSCLC): a Brief Report of 7 Cases. Transl Oncol 2018; 12:389-395. [PMID: 30529852 PMCID: PMC6280637 DOI: 10.1016/j.tranon.2018.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Anaplastic lymphoma kinase (ALK) rearrangement represents a landmark in the targeted therapy of non–small cell lung cancer (NSCLC). Immunohistochemistry (IHC) is a sensitive and specific method to detect ALK protein expression, possibly an alternative to fluorescence in situ hybridization (FISH). In this study, the concordance of FISH and IHC to determine ALK status was evaluated, particularly focusing on discordant cases. MATERIALS AND METHODS: ALK status was tested by FISH and the IHC validated method (Ventana ALK (D5F3) CDx Assay) in 95 NSCLCs. Discordant cases were analyzed also by next-generation sequencing (NGS). The response to crizotinib of treated patients was recorded. RESULTS: Seven (7.3%) discordant cases were ALK FISH positive and IHC negative. They showed coexistent split signals pattern, with mean percentage of 15.4%, and 5′ deletions pattern, with mean percentage 31.7%. Two cases had also gene amplification pattern. In three cases (42.8 %), the polysomy was observed. The NGS assay confirmed IHC results. In these patients, the treatment with crizotinib was ineffective. CONCLUSIONS: In our discordant cases, a coexistent complex pattern (deleted, split, and amplified/polysomic) of ALK gene was observed by FISH analysis. These complex rearranged cases were not detectable by IHC, and it could be speculated that more complex biological mechanisms could modulate protein expression. These data highlight the role of IHC and underscore the complexity of the genetic pattern of ALK. It could be crucial to consider these findings in order to best select patients for anti-ALK treatment in daily clinical practice.
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Affiliation(s)
- Anna Scattone
- Pathology Department, IRCCS Istituto Tumori "Giovanni Paolo II" di Bari, viale Orazio Flacco 65, 70124 Bari, Italy
| | - Annamaria Catino
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II" di Bari, viale Orazio Flacco 65, 70124 Bari, Italy
| | - Laura Schirosi
- Pathology Department, IRCCS Istituto Tumori "Giovanni Paolo II" di Bari, viale Orazio Flacco 65, 70124 Bari, Italy.
| | - Lucia Caldarola
- Pathology Department, Hospital "SS Annunziata", via Bruno 1, 74121 Taranto, Italy
| | - Stefania Tommasi
- Molecular Genetic Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II" di Bari, viale Orazio Flacco 65, 70124 Bari, Italy
| | - Rosanna Lacalamita
- Molecular Genetic Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II" di Bari, viale Orazio Flacco 65, 70124 Bari, Italy
| | - Elisabetta Sara Montagna
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II" di Bari, viale Orazio Flacco 65, 70124 Bari, Italy
| | - Domenico Galetta
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II" di Bari, viale Orazio Flacco 65, 70124 Bari, Italy
| | - Gabriella Serio
- Pathology Department, DETO, University of Bari, piazza Giulio Cesare, Bari 70124, Italy
| | - Francesco Alfredo Zito
- Pathology Department, IRCCS Istituto Tumori "Giovanni Paolo II" di Bari, viale Orazio Flacco 65, 70124 Bari, Italy
| | - Anita Mangia
- Functional Biomorphology Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II" di Bari, viale Orazio Flacco 65, 70124 Bari, Italy
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Grocholski S, Banerji S, Qing G, Dawe DE. Benefit of crizotinib in a lung cancer patient with discordant ALK testing results. Cancer Treat Res Commun 2018; 15:13-16. [PMID: 30207282 DOI: 10.1016/j.ctarc.2018.02.002] [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: 04/23/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 11/16/2022]
Abstract
Crizotinib is a first line treatment for patients with non-small cell lung cancer (NSCLC) harboring translocations in anaplastic lymphoma kinase (ALK). The current gold standard for determining ALK status is fluorescence in-situ hybridisation (FISH), but immunohistochemistry (IHC) is becoming increasingly popular due to lower cost. There are currently few reports on clinical outcomes with crizotinib therapy in patients who have tested negative by FISH and positive by IHC. A 53 year old lifelong non-smoking, physically active male with newly diagnosed Stage IV NSCLC presented with shortness of breath on exertion one month prior to referral. Staging CT scan failed to show a discreet lung lesion, but the left lower lobe was collapsed due to pleural effusion. Pleural fluid showed adenocarcinoma and IHC was positive for an ALK mutation, while FISH was negative. Pre-treatment PET-CT showed hypermetabolic, enlarged lymph nodes in the mediastinum and retroperitoneum. Partially due to patient concerns about cytotoxic chemotherapy toxicity, crizotinib therapy was instituted. Repeat CT conducted two months after crizotinib initiation showed a decrease in lymphadenopathy at all sites compared to the PET-CT. Furthermore, the patient showed clinical improvement, with less drainage through his PleurX catheter and stability of his excellent performance status. After 12 months on crizotinib CT showed ongoing improvement in lymphadenopathy. His bloodwork has been stable, and he denies significant drug toxicity. This case illustrates a sustained response to crizotinib therapy in a patient with an ALK translocation identified by IHC, but with negative FISH testing. The literature suggests that the population with these discordant results could be up to 19% of ALK positive NSCLC. Patients in this subgroup who are receiving crizotinib should be identified and outcome data pooled. However, in the interim, oncologists may wish to consider targeted therapy for these discordant patients.
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Affiliation(s)
- Steven Grocholski
- Rady Faculty of Health Sciences, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Shantanu Banerji
- Rady Faculty of Health Sciences, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Cancer Care Manitoba, Department of Hematology and Medical Oncology, Winnipeg, MB, Canada
| | - Gefei Qing
- Rady Faculty of Health Sciences, Department of Pathology, University of Manitoba, Winnipeg, MB, Canada
| | - David E Dawe
- Rady Faculty of Health Sciences, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; Cancer Care Manitoba, Department of Hematology and Medical Oncology, Winnipeg, MB, Canada.
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Yang J, Pyo JS, Kang G. Clinicopathological significance and diagnostic approach of ROS1 rearrangement in non-small cell lung cancer: a meta-analysis: ROS1 in non-small cell lung cancer. Int J Biol Markers 2018; 33:1724600818772194. [PMID: 29874982 DOI: 10.1177/1724600818772194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE The aim of this study was to investigate the rate of ROS1 rearrangement and concordance between ROS1 immunohistochemistry (IHC) and molecular tests in non-small cell lung cancer (NSCLC). METHODS The study included 10,898 NSCLC cases from 21 eligible studies. ROS1 rearrangement rates were evaluated in NSCLC by a meta-analysis, including subgroup analyses. In addition, we performed a concordance analysis and a diagnostic test accuracy review of ROS1 IHC in NSCLC. RESULTS The estimated overall rate of ROS1 rearrangement and IHC positivity was 2.4% (95% confidence interval (CI) 1.5, 3.7). In the subgroup analysis, which was based on tumor subtype, the rate of ROS1 rearrangement and IHC positivity was 2.9% (95% CI 1.9, 4.5) and 0.6% (95% CI 0.3, 1.2) in adenocarcinoma and non-adenocarcinoma, respectively. The overall concordance rate between ROS1 IHC and molecular tests was 93.4% (95% CI 78.3, 98.2). In ROS1 IHC positive and negative cases, the concordance rates were 79.0% (95% CI 43.3, 94.9) and 97.0% (95% CI 83.3, 99.5), respectively. The pooled sensitivity and the specificity of ROS1 IHC were 0.90 (95% CI 0.70, 0.99) and 0.82 (95% CI 0.79, 0.84), respectively. The diagnostic odds ratio and the area under the curve of the summary receiver operating characteristic curve were 118.01 (95% CI 11.81, 1179.67) and 0.9417, respectively. CONCLUSION The rates of ROS1 rearrangement differed by tumor histologic subtype in NSCLC. ROS1 IHC may be useful for the detection of ROS1 rearrangement in NSCLC. Detailed criteria for evaluating ROS1 IHC are needed before it can be applied in daily practice.
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Affiliation(s)
- Jungho Yang
- 1 Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Soo Pyo
- 2 Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Guhyun Kang
- 3 Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
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Metro G, Giannarelli D, Sidoni A, Chiari R, Bellezza G. Anaplastic lymphoma kinase immunohistochemistry scores do not predict sensitivity to crizotinib in fluorescence in situ hybridization-positive non-small cell lung cancer patients. Int J Biol Markers 2018; 33:1724600818754763. [PMID: 29683065 DOI: 10.1177/1724600818754763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Giulio Metro
- 1 Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | - Angelo Sidoni
- 3 Section of Anatomic Pathology and Histology, Department of Experimental Medicine, University of Perugia Medical School, Perugia, Italy
| | - Rita Chiari
- 1 Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Guido Bellezza
- 3 Section of Anatomic Pathology and Histology, Department of Experimental Medicine, University of Perugia Medical School, Perugia, Italy
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Gao Q, Jiang X, Huang C. [Clinical Advanced in Early-stage ALK-positive Non-small Cell Lung Cancer Patients]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:124-129. [PMID: 28228224 PMCID: PMC5972973 DOI: 10.3779/j.issn.1009-3419.2017.02.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
肺癌是我国癌症死亡最主要的原因。其中非小细胞肺癌(non-small cell lung cancer, NSCLC)占肺癌患者的85%,且大部分患者初诊时即为晚期。针对晚期NSCLC患者,分子靶向治疗成为人们关注的热点。棘皮动物微管相关蛋白-间变淋巴瘤激酶(echinoderm microtubule-associated protein-like 4 gene and the anaplastic lymphoma kinase gene, EML4-ALK)是NSCLC最常见的分子靶点之一,其特异性的小分子酪氨酸激酶抑制剂(tyrosine kinase inhibitors, TKIs)已被批准应用于ALK阳性晚期NSCLC患者的治疗。然而,ALK融合基因对早期NSCLC患者预后的影响,以及ALK阳性的早期NSCLC患者应用TKIs的必要性等问题尚不明确。本文主要围绕ALK阳性NSCLC患者的检测进展,早期ALK阳性NSCLC患者的临床病理特征、预后、ALK-TKIs应用必要性等情况做一简要综述。
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Affiliation(s)
- Qiongqiong Gao
- Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xiangli Jiang
- Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Chun Huang
- Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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Abstract
The rise of genomically targeted therapies and immunotherapy has revolutionized the practice of oncology in the last 10–15 years. At the same time, new technologies and the electronic health record (EHR) in particular have permeated the oncology clinic. Initially designed as billing and clinical documentation systems, EHR systems have not anticipated the complexity and variety of genomic information that needs to be reviewed, interpreted, and acted upon on a daily basis. Improved integration of cancer genomic data with EHR systems will help guide clinician decision making, support secondary uses, and ultimately improve patient care within oncology clinics. Some of the key factors relating to the challenge of integrating cancer genomic data into EHRs include: the bioinformatics pipelines that translate raw genomic data into meaningful, actionable results; the role of human curation in the interpretation of variant calls; and the need for consistent standards with regard to genomic and clinical data. Several emerging paradigms for integration are discussed in this review, including: non-standardized efforts between individual institutions and genomic testing laboratories; “middleware” products that portray genomic information, albeit outside of the clinical workflow; and application programming interfaces that have the potential to work within clinical workflow. The critical need for clinical-genomic knowledge bases, which can be independent or integrated into the aforementioned solutions, is also discussed.
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Affiliation(s)
- Jeremy L Warner
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA. .,Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37232, USA. .,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
| | - Sandeep K Jain
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37232, USA.,Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
| | - Mia A Levy
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, 37232, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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