Clinical and epidemiological study of EGFR mutations and EML4-ALK fusion genes among Indian patients with adenocarcinoma of the lung

Background

Mutation in the tyrosine kinase domain of epidermal growth factor receptor (EGFR) is a common feature observed in lung adenocarcinoma. A fusion gene between echinoderm microtubule-associated protein-like 4 (EML4) and the intracellular domain of anaplastic lymphoma kinase (ALK), named EML4-ALK, has been identified in a subset of non-small-cell lung cancer (NSCLC) tumors. The objective of this study was to determine the prevalence of EGFR mutations and EML4-ALK fusions in Indian patients with NSCLC (adenocarcinoma) as well as evaluate their clinical characteristics.

Patients and methods

Patients with NSCLC, adenocarcinoma histology, whose tumors had been tested for EGFR mutational status, were considered for this study. ALK gene rearrangement was detected by fluorescence in situ hybridization using the Vysis ALK Break Apart Rearrangement Probe Kit. ALK mutation was tested in samples that were negative for EGFR mutation.

Results

A total of 500 NSCLC adenocarcinoma patients were enrolled across six centers. There were 337 (67.4%) men and 163 (32.6%) women with a median age of 58 years. One hundred and sixty-four (32.8%) blocks were positive for EGFR mutations, whereas 336 (67.2%) were EGFR wild-type. Of the 336 EGFR-negative blocks, EML4-ALK fusion gene was present in 15 (4.5%) patients, whereas 321 (95.5%) tumors were EML4-ALK negative. The overall incidence of EML4-ALK fusion gene was 3% (15/500).

Conclusion

The incidence of EGFR mutations (33%) in this Indian population is close to the reported incidence in Asian patients. EML4-ALK gene fusions are present in lung adenocarcinomas from Indian patients, and the 3% incidence of EML4-ALK gene fusion in EGFR mutation-negative cases is similar to what has been observed in other Western and Asian populations. The mutual exclusivity of EML4-ALK and EGFR mutations suggests implementation of biomarker testing for tumors harboring ALK rearrangements in order to identify patients that can benefit from newer targeted therapies.

Binding of Rigid Dendritic Ruthenium Complexes to Carbon Nanotubes

Single-walled carbon nanotubes (SWNTs) bind strongly to rigid ruthenium metallodendrimers. High valence ions effectively coagulate these nanotubes from stable dispersions in N,N-dimethylforamide. While ruthenium salts and small [Ru(diimine)(3)](2+) complexes also coagulate the nanotubes, they require much higher concentrations and are easily extracted from the nanotubes with acetonitrile. Enantiomerically pure ruthenium metallodendrimer [Lambda(6)Delta(3)Lambda-Ru(10)](20+)[PF(6)(-)](20) is shown to bind strongly and specifically to the SWNTs. Most of the nanotube's ends are functionalized with this large (5.8 nm), optically active, rigid supramolecular complex. We study the binding capacity with UV-vis and atomic absorption spectroscopy. Imaging the functionalized nanotubes with scanning electron microscopy and atomic force microscopy (AFM) yields direct confirmation of end functionalization. Statistical analysis of the AFM images shows the morphology of the functionalized ends is consistent with the nanotubes binding to one of the endo- or exoreceptors around the dendrimer. Implications of these results toward efficient nanomanufacturing of carbon nanotube devices are discussed.