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Kerr KM, Thunnissen E, Dafni U, Finn SP, Bubendorf L, Soltermann A, Verbeken E, Biernat W, Warth A, Marchetti A, Speel EJM, Pokharel S, Quinn AM, Monkhorst K, Navarro A, Madsen LB, Radonic T, Wilson J, De Luca G, Gray SG, Cheney R, Savic S, Martorell M, Muley T, Baas P, Meldgaard P, Blackhall F, Dingemans AM, Dziadziuszko R, Vansteenkiste J, Weder W, Polydoropoulou V, Geiger T, Kammler R, Peters S, Stahel R. A retrospective cohort study of PD-L1 prevalence, molecular associations and clinical outcomes in patients with NSCLC: Results from the European Thoracic Oncology Platform (ETOP) Lungscape Project. Lung Cancer 2019; 131:95-103. [PMID: 31027705 DOI: 10.1016/j.lungcan.2019.03.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/10/2019] [Accepted: 03/14/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The PD-L1 biomarker is an important factor in selecting patients with non-small cell lung cancer for immunotherapy. While several reports suggest that PD-L1 positivity is linked to a poor prognosis, others suggest that PD-L1 positive status portends a good prognosis. METHODS PD-L1 positivity prevalence, assessed via immunohistochemistry (IHC) on tissue microarrays (TMAs), and its association with clinicopathological characteristics, molecular profiles and patient outcome- Relapse-free Survival (RFS), Time-to-Relapse (TTR) and Overall Survival (OS)- is explored in the ETOP Lungscape cohort of stage I-III non-small cell lung cancer (NSCLC). Tumors are considered positive if they have ≥1/5/25/50% neoplastic cell membrane staining. RESULTS PD-L1 expression was assessed in 2182 NSCLC cases (2008 evaluable, median follow-up 4.8 years, 54.6% still alive), from 15 ETOP centers. Adenocarcinomas represent 50.9% of the cohort (squamous cell: 42.4%). Former smokers are 53.7% (current: 31.6%, never: 10.5%). PD-L1 positivity prevalence is present in more than one third of the Lungscape cohort (1%/5% cut-offs). It doesn't differ between adenocarcinomas and squamous cell histologies, but is more frequently detected in higher stages, never smokers, larger tumors (1/5/25% cut-offs). With ≥1% cut-off it is significantly associated with IHC MET overexpression, expression of PTEN, EGFR and KRAS mutation (only for adenocarcinoma). Results for 5%, 25% and 50% cut-offs were similar, with MET being significantly associated with PD-L1 positivity both for AC (p < 0.001, 5%/25%/50% cut-offs) and SCC (p < 0.001, 5% & 50% cut-offs and p = 0.0017 for 25%). When adjusting for clinicopathological characteristics, a significant prognostic effect was identified in adenocarcinomas (adjusted p-values: 0.024/0.064/0.063 for RFS/TTR/OS 1% cut-off, analogous for 5%/25%, but not for 50%). Similar results obtained for the model including all histologies, but no effect was found for the squamous cell carcinomas. CONCLUSION PD-L1 positivity, when adjusted for clinicopathological characteristics, is associated with a better prognosis for non-metastatic adenocarcinoma patients.
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Affiliation(s)
- Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
| | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, Netherlands
| | - Urania Dafni
- Froniter Science Foundation-Hellas & University of Athens, Athens, Greece
| | - Stephen P Finn
- Department of Histopathology, St James's Hospital and Trinity College, Dublin, Ireland
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Alex Soltermann
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Eric Verbeken
- Department of Pathology, University Hospital KU Leuven, Leuven, Belgium
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - Arne Warth
- Department of Pathology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Antonio Marchetti
- Center of Predicitve Predictive Molecular Medicine, CeSI, University of Chieti-Pescara, Chieti, Italy
| | - Ernst-Jan M Speel
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sarawati Pokharel
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Anne Marie Quinn
- Wythenshawe Hospital, Department of Histopathology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Monkhorst
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Atilio Navarro
- Department of Pathology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Teodora Radonic
- Department of Pathology, VU University Medical Center, Amsterdam, Netherlands
| | - Joan Wilson
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Graziano De Luca
- Center of Predicitve Predictive Molecular Medicine, CeSI, University of Chieti-Pescara, Chieti, Italy
| | - Steven G Gray
- Department of Clinical Medicine, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Richard Cheney
- Department of Pathology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Spasenija Savic
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Miguel Martorell
- Department of Pathology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Thomas Muley
- Translational Research Unit, Thoraxklinik, University Hospital of Heidelberg, and Translational Lung Research Center (TLRC) Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Anne-Marie Dingemans
- Department of Pulmonology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Johan Vansteenkiste
- Department of Respiratory Oncology, University Hospital KU Leuven, Leuven, Belgium
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Thomas Geiger
- Translational Research Coordination, ETOP Coordinating Office, Bern, Switzerland
| | - Roswitha Kammler
- Translational Research Coordination, ETOP Coordinating Office, Bern, Switzerland
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Rolf Stahel
- Clinic of Oncology, University Hospital Zurich, Zurich, Switzerland
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Marchetti A, Barberis M, Di Lorito A, Pace MV, Di Lisio C, Felicioni L, Guerini-Rocco E, Vingiani A, D’Antuono T, Liberatore M, Filice G, De Luca G, De Marinis F, Passaro A, Guetti L, Irtelli L, Crinò L, Mucilli F, Buttitta F. ROS1 Gene Fusion in Advanced Lung Cancer in Women: A Systematic Analysis, Review of the Literature, and Diagnostic Algorithm. JCO Precis Oncol 2017; 1:1-9. [DOI: 10.1200/po.16.00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Crizotinib, a mesenchymal-epithelial transition/anaplastic lymphoma kinase/c-ros oncogene 1 (ROS1) inhibitor, has recently been approved by the US Food and Drug Administration for the treatment of patients with advanced ROS1-positive non–small-cell lung cancer (NSCLC). Therefore, interest in ROS1 testing is growing. ROS1 gene fusions affect approximately 0.5% to 2% of unselected NSCLCs. Limited data are available on the prevalence and distribution of ROS1 fusions in patients with advanced-stage NSCLC. Material and Methods A series of 727 lung adenocarcinomas from patients with stage IV disease, negative for epidermal growth factor receptor and anaplastic lymphoma kinase alterations, were tested for ROS1 fusions by fluorescent in situ hybridization analysis, with confirmation by immunohistochemistry. Results were correlated with clinicopathologic parameters and compared with data from the literature. Results ROS1 fusions were detected in 29 patients (4%), including 27 of 266 females (10.2%) and two of 461 males (0.4%; P = 1.2E-10). The mean age of patients with ROS1-positive disease was lower than that of patients with ROS1-negative disease (49.21 v 62.96 years, respectively; P = 1.1E-10). Eleven of 583 smokers (1.9%) and 18 of 144 nonsmokers (12.5%) showed ROS1 rearrangement ( P = 4.05E-7). By logistic regression analysis, ROS1 fusions were independently associated with female sex, younger age at diagnosis, and absence of smoking history, (odds ratios, 12.4, 7.9, and 3.6, respectively). These data, integrated with those reported in the literature, indicate that the prevalence of ROS1 fusions in females and in nonsmokers was higher in patients with advanced disease than in patients with operable disease (11.2% v 3.1%, P < .001; 11.6% v 2.8%, P < .001, respectively). The mean age at diagnosis was significantly lower in patients with advanced disease (49.8 years) than in patients with operable disease (55.6 years; P < .001). Conclusion Our data indicate that ROS1 fusions in patients with advanced-stage lung adenocarcinoma are more frequent in females, particularly if young and nonsmokers. A diagnostic algorithm for an accurate screening of ROS1 alterations was elaborated.
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Affiliation(s)
- Antonio Marchetti
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Massimo Barberis
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Alessia Di Lorito
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Maria Vittoria Pace
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Chiara Di Lisio
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Lara Felicioni
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Elena Guerini-Rocco
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Andrea Vingiani
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Tommaso D’Antuono
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Marcella Liberatore
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Giampaolo Filice
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Graziano De Luca
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Filippo De Marinis
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Antonio Passaro
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Luigi Guetti
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Luciana Irtelli
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Lucio Crinò
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Felice Mucilli
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
| | - Fiamma Buttitta
- Antonio Marchetti, Alessia Di Lorito, Maria Vittoria Pace, Chiara Di Lisio, Lara Felicioni, Tommaso D’Antuono, Marcella Liberatore, Giampaolo Filice, Graziano De Luca, Luigi Guetti, Luciana Irtelli, Felice Mucilli, and Fiamma Buttitta, University of Chieti-Pescara, Chieti; Massimo Barberis, Elena Guerini-Rocco, Andrea Vingiani, Filippo De Marinis, and Antonio Passaro, European Institute of Oncology, Milan; and Lucio Crinò, Istituto Oncologico Romagnolo IRCCS Meldola Forli, Meldola, Italy
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