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Klümper N, Ralser DJ, Ellinger J, Roghmann F, Albrecht J, Below E, Alajati A, Sikic D, Breyer J, Bolenz C, Zengerling F, Erben P, Schwamborn K, Wirtz RM, Horn T, Nagy D, Toma M, Kristiansen G, Büttner T, Hahn O, Grünwald V, Darr C, Erne E, Rausch S, Bedke J, Schlack K, Abbas M, Zschäbitz S, Schwab C, Mustea A, Adam P, Manseck A, Wullich B, Ritter M, Hartmann A, Gschwend J, Weichert W, Erlmeier F, Hölzel M, Eckstein M. Membranous NECTIN-4 expression frequently decreases during metastatic spread of urothelial carcinoma and is associated with enfortumab vedotin resistance. Clin Cancer Res 2022; 29:1496-1505. [PMID: 36534531 PMCID: PMC10102834 DOI: 10.1158/1078-0432.ccr-22-1764] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/06/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Background: The antibody-drug conjugate enfortumab vedotin (EV) releases a cytotoxic agent into tumor cells via binding to the membrane receptor NECTIN-4. EV has been recently approved for patients with metastatic urothelial carcinoma (mUC) without prior assessment of the tumor receptor status as ubiquitous NECTIN-4 expression is assumed. Objective: To determine the prevalence of membranous NECTIN-4 protein expression in primary tumors (PRIM) and patient-matched distant metastases (MET). Main Outcomes and Measures: Membranous NECTIN-4 protein expression was measured (H-score) by immunohistochemistry (IHC) in PRIM and corresponding MET (N=137) and in a multicenter EV-treated cohort (N=47). Progression-free survival (PFS) after initiation of EV treatment was assessed for the NECTIN-4 negative/weak (H-score 0-99) versus moderate/strong (H-score 100-300) subgroup. The specificity of the NECTIN-4 IHC staining protocol was validated by establishing CRISPR-Cas9-induced polyclonal NECTIN-4 knockouts. Results: In our cohort, membranous NECTIN-4 expression significantly decreased during metastatic spread (Wilcoxon matched pairs P<0.001, median H-score=40, interquartile range (IQR): 0-140), with 39.4% of MET lacking membranous NECTIN-4 expression. In our multicenter EV cohort, absence or weak membranous NECTIN-4 expression (34.0% of the cohort) was associated with a significantly shortened PFS on EV (Log-rank P<0.001). Conclusion: Membranous NECTIN-4 expression is frequently decreased or absent in mUC tissue. Of note, the clinical benefit of EV strongly depends on membranous NECTIN-4 expression. Thus, our results are of highest clinical relevance and argue for a critical reconsideration of the current practice and suggest that the NECTIN-4 receptor status should be determined (ideally in a metastatic/ progressive lesion) before initiation of EV.
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Affiliation(s)
| | | | | | | | | | | | | | - Danijel Sikic
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes Breyer
- Caritas Hospital St. Josef, University of Regensburg, Regensburg, Bavaria, Germany
| | | | | | - Philipp Erben
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | | | - Thomas Horn
- Technische Universität München, Munich, Germany
| | - Dora Nagy
- University Medical Center Bonn (UKB), Bonn, Germany
| | | | | | | | - Oliver Hahn
- Universitätsmedizin Göttingen, Göttingen, Germany
| | | | | | - Eva Erne
- Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | | | - Jens Bedke
- University Hospital Tuebingen, Tuebingen, Germany
| | | | | | | | - Constantin Schwab
- Heidelberg University Hospital, Heidelberg, Baden-Wuerttemberg, Germany
| | | | | | | | - Bernd Wullich
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangern, Germany
| | | | - Arndt Hartmann
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | | | - Markus Eckstein
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Dokter M, Talarico G, Armbrust S, Below E, Bockholdt B. [Fatal flecainide intoxication in a 17-year-old girl]. Anaesthesist 2018; 67:359-361. [PMID: 29594407 DOI: 10.1007/s00101-018-0434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 10/17/2022]
Abstract
A 17-year-old girl was found vomiting and somnolent at home and was taken to a hospital. The girl initially presented with ventricular tachycardia with broad QRS complexes which was very difficult to control. During the course a subsequent cardiogenic shock developed and despite exhaustion of all therapeutic options the fatal outcome could not be averted. The medicolegal autopsy revealed no evidence of any form of violence but the signs of medical treatment. Furthermore, no pathology of internal organs was detected. The toxicological analyses revealed a lethal intoxication with flecainide as the cause of death. The investigations of the police indicated that the girl took flecainide in suicidal intention.
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Affiliation(s)
- M Dokter
- Institut für Rechtsmedizin, Universitätsmedizin Greifswald, Kuhstraße 30, 17489, Greifswald, Deutschland.
| | - G Talarico
- Institut für Rechtsmedizin, Universitätsmedizin Greifswald, Kuhstraße 30, 17489, Greifswald, Deutschland
| | - S Armbrust
- Klinik für Kinder- und Jugendmedizin, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Neubrandenburg, Deutschland
| | - E Below
- Institut für Rechtsmedizin, Universitätsmedizin Greifswald, Kuhstraße 30, 17489, Greifswald, Deutschland
| | - B Bockholdt
- Institut für Rechtsmedizin, Universitätsmedizin Greifswald, Kuhstraße 30, 17489, Greifswald, Deutschland
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