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Riedel R, Fassunke J, Scheel AH, Scheffler M, Heydt C, Nogova L, Michels S, Fischer RN, Eisert A, Scharpenseel H, John F, Ruge L, Schaufler D, Siemanowski J, Ihle MA, Wagener-Ryczek S, Pappesch R, Rehker J, Bunck A, Kobe C, Keil F, Merkelbach-Bruse S, Büttner R, Wolf J. MET Fusions in NSCLC: Clinicopathologic Features and Response to MET Inhibition. J Thorac Oncol 2024; 19:160-165. [PMID: 37429463 DOI: 10.1016/j.jtho.2023.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION MET fusions have been described only rarely in NSCLC. Thus, data on patient characteristics and treatment response are limited. We here report histopathologic data, patient demographics, and treatment outcome including response to MET tyrosine kinase inhibitor (TKI) therapy in MET fusion-positive NSCLC. METHODS Patients with NSCLC and MET fusions were identified mostly by RNA sequencing within the routine molecular screening program of the national Network Genomic Medicine, Germany. RESULTS We describe a cohort of nine patients harboring MET fusions. Among these nine patients, two patients had been reported earlier. The overall frequency was 0.29% (95% confidence interval: 0.15-0.55). The tumors were exclusively adenocarcinoma. The cohort was heterogeneous in terms of age, sex, or smoking status. We saw five different fusion partner genes (KIF5B, TRIM4, ST7, PRKAR2B, and CAPZA2) and several different breakpoints. Four patients were treated with a MET TKI leading to two partial responses, one stable disease, and one progressive disease. One patient had a BRAF V600E mutation as acquired resistance mechanism. CONCLUSIONS MET fusions are very rare oncogenic driver events in NSCLC and predominantly seem in adenocarcinomas. They are heterogeneous in terms of fusion partners and breakpoints. Patients with MET fusion can benefit from MET TKI therapy.
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Affiliation(s)
- Richard Riedel
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Jana Fassunke
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Andreas H Scheel
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Carina Heydt
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Lucia Nogova
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Sebastian Michels
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Rieke N Fischer
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Anna Eisert
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Heather Scharpenseel
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Felix John
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Lea Ruge
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Diana Schaufler
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany
| | - Janna Siemanowski
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Michaela A Ihle
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Svenja Wagener-Ryczek
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Roberto Pappesch
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Jan Rehker
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Anne Bunck
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Radiology, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Felix Keil
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Sabine Merkelbach-Bruse
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, University of Cologne, Cologne, Germany; Lung Cancer Group Cologne, Cologne, Germany.
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Riedel R, Fassunke J, Tumbrink HL, Scheel AH, Heydt C, Hieggelke L, Scheffler M, Heimsoeth A, Nogova L, Michels S, Weber JP, Fischer RN, Eisert A, Westphal T, Schaufler D, Siemanowski J, Ihle MA, Wagener-Ryczek S, Castiglione R, Pappesch R, Rehker J, Jürgens J, Stoelben E, Bunck A, Kobe C, Merkelbach-Bruse S, Sos ML, Büttner R, Wolf J. Resistance to MET inhibition in MET-dependent NSCLC and therapeutic activity after switching from type I to type II MET inhibitors. Eur J Cancer 2023; 179:124-135. [PMID: 36521334 DOI: 10.1016/j.ejca.2022.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/30/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Resistance to MET inhibition occurs inevitably in MET-dependent non-small cell lung cancer and the underlying mechanisms are insufficiently understood. We describe resistance mechanisms in patients with MET exon 14 skipping mutation (METΔex14), MET amplification, and MET fusion and report treatment outcomes after switching therapy from type I to type II MET inhibitors. MATERIALS AND METHODS Pre- and post-treatment biopsies were analysed by NGS (next generation sequencing), digital droplet PCR (polymerase chain reaction), and FISH (fluorescense in situ hybridization). A patient-derived xenograft model was generated in one case. RESULTS Of 26 patients with MET tyrosine kinase inhibitor treatment, eight had paired pre- and post-treatment biopsies (Three with MET amplification, three with METΔex14, two with MET fusions (KIF5B-MET and PRKAR2B-MET).) In six patients, mechanisms of resistance were detected, whereas in two cases, the cause of resistance remained unclear. We found off-target resistance mechanisms in four cases with KRAS mutations and HER2 amplifications appearing. Two patients exhibited second-site MET mutations (p.D1246N and p. Y1248H). Three patients received type I and type II MET tyrosine kinase inhibitors sequentially. In two cases, further progressive disease was seen hereafter. The patient with KIF5B-MET fusion received three different MET inhibitors and showed long-lasting stable disease and a repeated response after switching therapy, respectively. CONCLUSION Resistance to MET inhibition is heterogeneous with on- and off-target mechanisms occurring regardless of the initial MET aberration. Switching therapy between different types of kinase inhibitors can lead to repeated responses in cases with second-site mutations. Controlled clinical trials in this setting with larger patient numbers are needed, as evidence to date is limited to preclinical data and case series.
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Affiliation(s)
- Richard Riedel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Jana Fassunke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Hannah L Tumbrink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Translational Genomics, Germany
| | - Andreas H Scheel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Carina Heydt
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Lena Hieggelke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Matthias Scheffler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Alena Heimsoeth
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Translational Genomics, Germany
| | - Lucia Nogova
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Sebastian Michels
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Jan-Phillip Weber
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Rieke N Fischer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Anna Eisert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Theresa Westphal
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Diana Schaufler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany
| | - Janna Siemanowski
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Michaela A Ihle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Svenja Wagener-Ryczek
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | | | - Roberto Pappesch
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Jan Rehker
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Jessica Jürgens
- Lung Clinic Merheim, Hospital of the City of Cologne, University of Witten-Herdecke, Germany
| | - Erich Stoelben
- Lung Clinic Merheim, Hospital of the City of Cologne, University of Witten-Herdecke, Germany
| | - Anne Bunck
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Radiology, Germany
| | - Carsten Kobe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Nuclear Medicine, Germany
| | - Sabine Merkelbach-Bruse
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany
| | - Martin L Sos
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Translational Genomics, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne, Germany
| | - Reinhard Büttner
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department of Pathology, Molecular Pathology, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne, Germany
| | - Jürgen Wolf
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology, Department I of Internal Medicine, Germany; Lung Cancer Group, Cologne, Germany.
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3
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Scheffler M, Holzem A, Kron A, Nogova L, Ihle MA, von Levetzow C, Fassunke J, Wömpner C, Bitter E, Koleczko S, Abdulla DSY, Michels S, Fischer R, Riedel R, Weber JP, Westphal T, Gerigk U, Kern J, Kaminsky B, Randerath W, Kambartel KO, Merkelbach-Bruse S, Büttner R, Wolf J. Co-occurrence of targetable mutations in Non-small cell lung cancer (NSCLC) patients harboring MAP2K1 mutations. Lung Cancer 2020; 144:40-48. [PMID: 32361034 DOI: 10.1016/j.lungcan.2020.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/21/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND MAP2K1 mutations are rare in non-small cell lung cancer (NSCLC) and considered to be mutually exclusive from known driver mutations. Activation of the MEK1-cascade is considered pivotal in resistance to targeted therapy approaches, and MAP2K1 K57 N mutation could be linked to resistance in preclinical models. We set out this study to detect MAP2K1 mutations and potentially targetable co-mutations using a molecular multiplex approach. METHODS Between 2012 and 2018, we routinely analyzed 14.512 NSCLC patients with two next-generation sequencing (NGS) panels. In a subset of patients, fluorescence in-situ hybridization was performed to detect rearrangements or amplifications. We assessed clinical parameters and co-occurring mutations and compared treatment outcomes of different forms of systemic therapy. RESULTS We identified 66 (0.5%) patients with MAP2K1 mutations. Both adenocarcinoma (n = 62) and squamous cell carcinoma (n = 4) histology. The presence of the mutations was linked to smoking, and transversions were more common than transitions. K57 N was the most frequent MAP2K1 mutation (n = 25). Additional mutations were found in 57 patients (86.4%). Mutations of TP53 were detected in 33 patients, followed by KEAP1 mutations in 28.1%. 24 patients (36.4%) had either MAP2K1-only or a co-occurring aberration considered targetable, including EGFR mutations, a BRAF V600E mutation and ROS1 rearrangements. Outcome analyses revealed a trend toward benefit from pemetrexed treatment. CONCLUSION Our analysis shows that MAP2K1-mutated NSCLC patients might frequently present with potentially targetable aberrations. Their role in providing resistance in these subtypes and the possible therapeutic opportunities justify further analyses of this rare NSCLC subgroup.
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Affiliation(s)
- Matthias Scheffler
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Alessandra Holzem
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Anna Kron
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Lucia Nogova
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Michaela A Ihle
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Cornelia von Levetzow
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Jana Fassunke
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Claudia Wömpner
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Elisabeth Bitter
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Sophia Koleczko
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Diana S Y Abdulla
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Sebastian Michels
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Rieke Fischer
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Richard Riedel
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Jan-Philipp Weber
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Theresa Westphal
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Ulrich Gerigk
- GFO Clinics Bonn, Marien-Hospital Bonn, Bonn, Germany
| | - Jens Kern
- KWM Missio Clinic, Würzburg, Germany
| | - Britta Kaminsky
- Bethanien Hospital Solingen, Clinic for Pulmonology and Allergology, Solingen, Germany
| | - Winfried Randerath
- Bethanien Hospital Solingen, Clinic for Pulmonology and Allergology, Solingen, Germany
| | | | | | - Reinhard Büttner
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Jürgen Wolf
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany.
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4
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Kron A, Alidousty C, Scheffler M, Merkelbach-Bruse S, Seidel D, Riedel R, Ihle MA, Michels S, Nogova L, Fassunke J, Heydt C, Kron F, Ueckeroth F, Serke M, Krüger S, Grohe C, Koschel D, Benedikter J, Kaminsky B, Schaaf B, Braess J, Sebastian M, Kambartel KO, Thomas R, Zander T, Schultheis AM, Büttner R, Wolf J. Impact of TP53 mutation status on systemic treatment outcome in ALK-rearranged non-small-cell lung cancer. Ann Oncol 2019; 29:2068-2075. [PMID: 30165392 PMCID: PMC6225899 DOI: 10.1093/annonc/mdy333] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background We analyzed whether co-occurring mutations influence the outcome of systemic therapy in ALK-rearranged non-small-cell lung cancer (NSCLC). Patients and methods ALK-rearranged stage IIIB/IV NSCLC patients were analyzed with next-generation sequencing and fluorescence in situ hybridization analyses on a centralized diagnostic platform. Median progression-free survival (PFS) and overall survival (OS) were determined in the total cohort and in treatment-related sub-cohorts. Cox regression analyses were carried out to exclude confounders. Results Among 216 patients with ALK-rearranged NSCLC, the frequency of pathogenic TP53 mutations was 23.8%, while other co-occurring mutations were rare events. In ALK/TP53 co-mutated patients, median PFS and OS were significantly lower compared with TP53 wildtype patients [PFS 3.9 months (95% CI: 2.4–5.6) versus 10.3 months (95% CI: 8.6–12.0), P < 0.001; OS 15.0 months (95% CI: 5.0–24.9) versus 50.0 months (95% CI: 22.9–77.1), P = 0.002]. This difference was confirmed in all treatment-related subgroups including chemotherapy only [PFS first-line chemotherapy 2.6 months (95% CI: 1.3–4.1) versus 6.2 months (95% CI: 1.8–10.5), P = 0.021; OS 2.0 months (95% CI: 0.0–4.6) versus 9.0 months (95% CI: 6.1–11.9), P = 0.035], crizotinib plus chemotherapy [PFS crizotinib 5.0 months (95% CI: 2.9–7.2) versus 14.0 months (95% CI: 8.0–20.1), P < 0.001; OS 17.0 months (95% CI: 6.7–27.3) versus not reached, P = 0.049] and crizotinib followed by next-generation ALK-inhibitor [PFS next-generation inhibitor 5.4 months (95% CI: 0.1–10.7) versus 9.9 months (95% CI: 6.4–13.5), P = 0.039; OS 7.0 months versus 50.0 months (95% CI: not reached), P = 0.001). Conclusions In ALK-rearranged NSCLC co-occurring TP53 mutations predict an unfavorable outcome of systemic therapy. Our observations encourage future research to understand the underlying molecular mechanisms and to improve treatment outcome of the ALK/TP53 co-mutated subgroup.
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Affiliation(s)
- A Kron
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - C Alidousty
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - M Scheffler
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - S Merkelbach-Bruse
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - D Seidel
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - R Riedel
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - M A Ihle
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - S Michels
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - L Nogova
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - J Fassunke
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - C Heydt
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - F Kron
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - F Ueckeroth
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - M Serke
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Lungenklinik Hemer des Deutschen Gemeinschafts-Diakonieverbandes GmbH, Hemer, Germany
| | - S Krüger
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Florence Nightingale Hospital, Düsseldorf, Germany
| | - C Grohe
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Evangelische Lungenklinik Berlin (Paul Gerhardt Diakonie), Berlin, Germany
| | - D Koschel
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Fachkrankenhaus Coswig, Coswig, Germany
| | - J Benedikter
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Klinikum Bogenhausen, Munich, Germany
| | - B Kaminsky
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Krankenhaus Bethanien, Solingen, Germany
| | - B Schaaf
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Center, Klinikum Dortmund GmbH, Dortmund, Germany
| | - J Braess
- Network Genomic Medicine, Cologne, Germany; Department of Oncology and Hematology, Krankenhaus Barmherzige Brueder, Regensburg, Germany
| | - M Sebastian
- Network Genomic Medicine, Cologne, Germany; Department of Oncology and Hematology, University Hospital Frankfurt (Johannes-Wolfgang Goethe Institute), Frankfurt am Main, Germany
| | - K-O Kambartel
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Bethanien Hospital Moers-Lungenzentrum, Moers, Germany
| | - R Thomas
- Network Genomic Medicine, Cologne, Germany; Cologne Center for Genomics, University Hospital of Cologne, Cologne, Germany
| | - T Zander
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - A M Schultheis
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - R Büttner
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - J Wolf
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany.
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Michels S, Heydt C, van Veggel B, Deschler-Baier B, Pardo N, Monkhorst K, Rüsseler V, Stratmann J, Griesinger F, Steinhauser S, Kostenko A, Diebold J, Fassunke J, Fischer R, Engel-Riedel W, Gautschi O, Geissinger E, Haneder S, Ihle MA, Kopp HG, de Langen AJ, Martinez-Marti A, Nogova L, Persigehl T, Plenker D, Puesken M, Rodermann E, Rosenwald A, Scheel AH, Scheffler M, Spengler W, Seggewiss-Bernhardt R, Brägelmann J, Sebastian M, Vrugt B, Hellmich M, Sos ML, Heukamp LC, Felip E, Merkelbach-Bruse S, Smit EF, Büttner R, Wolf J. Genomic Profiling Identifies Outcome-Relevant Mechanisms of Innate and Acquired Resistance to Third-Generation Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Therapy in Lung Cancer. JCO Precis Oncol 2019; 3:1800210. [PMID: 32914023 PMCID: PMC7446436 DOI: 10.1200/po.18.00210] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are effective in acquired resistance (AR) to early-generation EGFR TKIs in EGFR-mutant lung cancer. However, efficacy is marked by interindividual heterogeneity. We present the molecular profiles of pretreatment and post-treatment samples from patients treated with third-generation EGFR TKIs and their impact on treatment outcomes. METHODS Using the databases of two lung cancer networks and two lung cancer centers, we molecularly characterized 124 patients with EGFR p.T790M-positive AR to early-generation EGFR TKIs. In 56 patients, correlative analyses of third-generation EGFR TKI treatment outcomes and molecular characteristics were feasible. In addition, matched post-treatment biopsy samples were collected for 29 patients with progression to third-generation EGFR TKIs. RESULTS Co-occurring genetic aberrations were found in 74.4% of EGFR p.T790-positive samples (n = 124). Mutations in TP53 were the most frequent aberrations detected (44.5%; n = 53) and had no significant impact on third-generation EGFR TKI treatment. Mesenchymal-epithelial transition factor (MET) amplifications were found in 5% of samples (n = 6) and reduced efficacy of third-generation EGFR TKIs significantly (eg, median progression-free survival, 1.0 months; 95% CI, 0.37 to 1.72 v 8.2 months; 95% CI, 1.69 to 14.77 months; P ≤ .001). Genetic changes in the 29 samples with AR to third-generation EGFR TKIs were found in EGFR (eg, p.T790M loss, acquisition of p.C797S or p.G724S) or in other genes (eg, MET amplification, KRAS mutations). CONCLUSION Additional genetic aberrations are frequent in EGFR-mutant lung cancer and may mediate innate and AR to third-generation EGFR TKIs. MET amplification was strongly associated with primary treatment failure and was a common mechanism of AR to third-generation EGFR TKIs. Thus, combining EGFR inhibitors with TKIs targeting common mechanisms of resistance may delay AR.
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Affiliation(s)
| | - Carina Heydt
- University Hospital of Cologne, Cologne, Germany
| | | | - Barbara Deschler-Baier
- University Hospital of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Nuria Pardo
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - Kim Monkhorst
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Jan Stratmann
- University Hospital of Frankfurt, Frankfurt, Germany
| | - Frank Griesinger
- Pius Hospital Oldenburg and Lung Cancer Network NOWEL, Oldenburg, Germany
| | | | | | | | | | | | | | | | - Eva Geissinger
- University of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | | | | | - Hans-Georg Kopp
- Robert Bosch Centrum für Tumorerkrankungen, Stuttgart, Germany
| | | | | | - Lucia Nogova
- University Hospital of Cologne, Cologne, Germany
| | | | | | | | - Ernst Rodermann
- Private practice in Hematology and Oncology, Troisdorf, Germany
| | - Andreas Rosenwald
- University of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | | | | | | | | | - Johannes Brägelmann
- University Hospital of Cologne, Cologne, Germany.,University of Cologne, Cologne, Germany
| | | | - Bart Vrugt
- University Hospital Zurich, Zurich, Switzerland
| | | | - Martin L Sos
- University Hospital of Cologne, Cologne, Germany.,University of Cologne, Cologne, Germany
| | - Lukas C Heukamp
- Hematopathology Hamburg and Lung Cancer Network NOWEL, Hamburg, Germany
| | | | | | - Egbert F Smit
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Jürgen Wolf
- University Hospital of Cologne, Cologne, Germany
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6
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Scheffler M, Ihle MA, Hein R, Merkelbach-Bruse S, Scheel AH, Siemanowski J, Brägelmann J, Kron A, Abedpour N, Ueckeroth F, Schüller M, Koleczko S, Michels S, Fassunke J, Pasternack H, Heydt C, Serke M, Fischer R, Schulte W, Gerigk U, Nogova L, Ko YD, Abdulla DSY, Riedel R, Kambartel KO, Lorenz J, Sauerland I, Randerath W, Kaminsky B, Hagmeyer L, Grohé C, Eisert A, Frank R, Gogl L, Schaepers C, Holzem A, Hellmich M, Thomas RK, Peifer M, Sos ML, Büttner R, Wolf J. K-ras Mutation Subtypes in NSCLC and Associated Co-occuring Mutations in Other Oncogenic Pathways. J Thorac Oncol 2018; 14:606-616. [PMID: 30605727 DOI: 10.1016/j.jtho.2018.12.013] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [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: 06/12/2018] [Revised: 10/31/2018] [Accepted: 12/10/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although KRAS mutations in NSCLC have been considered mutually exclusive driver mutations for a long time, there is now growing evidence that KRAS-mutated NSCLC represents a genetically heterogeneous subgroup. We sought to determine genetic heterogeneity with respect to cancer-related co-mutations and their correlation with different KRAS mutation subtypes. METHODS Diagnostic samples from 4507 patients with NSCLC were analyzed by next-generation sequencing by using a panel of 14 genes and, in a subset of patients, fluorescence in situ hybridization. Next-generation sequencing with an extended panel of 14 additional genes was performed in 101 patients. Molecular data were correlated with clinical data. Whole-exome sequencing was performed in two patients. RESULTS We identified 1078 patients with KRAS mutations, of whom 53.5% had at least one additional mutation. Different KRAS mutation subtypes showed different patterns of co-occurring mutations. Besides mutations in tumor protein p53 gene (TP53) (39.4%), serine/threonine kinase 11 gene (STK11) (19.8%), kelch like ECH associated protein 1 gene (KEAP1) (12.9%), and ATM serine/threonine kinase gene (ATM) (11.9%), as well as MNNG HOS Transforming gene (MET) amplifications (15.4%) and erb-b2 receptor tyrosine kinase 2 gene (ERBB2) amplifications (13.8%, exclusively in G12C), we found rare co-occurrence of targetable mutations in EGFR (1.2%) and BRAF (1.2%). Whole-exome sequencing of two patients with co-occurring phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha gene (PIK3CA) mutation revealed clonality of mutated KRAS in one patient and subclonality in the second, suggesting different evolutionary backgrounds. CONCLUSION KRAS-mutated NSCLC represents a genetically heterogeneous subgroup with a high frequency of co-occurring mutations in cancer-associated pathways, partly associated with distinct KRAS mutation subtypes. This diversity might have implications for understanding the variability of treatment outcome in KRAS-mutated NSCLC and for future trial design.
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Affiliation(s)
- Matthias Scheffler
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Michaela A Ihle
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Rebecca Hein
- University of Cologne, Institute of Medical Statistics, Informatics and Epidemiology, Cologne, Germany
| | | | - Andreas H Scheel
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Janna Siemanowski
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Johannes Brägelmann
- University of Cologne, Department for Translational Genomics, Cologne, Germany
| | - Anna Kron
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Nima Abedpour
- University of Cologne, Department for Translational Genomics, Cologne, Germany
| | - Frank Ueckeroth
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Merle Schüller
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Sophia Koleczko
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Sebastian Michels
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Jana Fassunke
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Helen Pasternack
- Pathology of the University Medical Center Schleswig-Holstein, Campus Luebeck and Research Center Borstel, Leibniz Center for Medicine and Biosciences
| | - Carina Heydt
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Monika Serke
- Lung Clinic Hemer, Department for Pulmonology and Thoracic Oncology, Hemer, Germany
| | - Rieke Fischer
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | | | - Ulrich Gerigk
- GFO Clinics Bonn, Marien-Hospital Bonn, Bonn, Germany
| | - Lucia Nogova
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Yon-Dschun Ko
- Evangelical Clinics of Bonn, Johanniter Hospital, Bonn, Germany
| | - Diana S Y Abdulla
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Richard Riedel
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | | | - Joachim Lorenz
- Hospital Lüdenscheid, Clinic for Pneumology, Internistic Intensive Medicine, Infectiology and Sleep Medicine, Lüdenscheid, Germany
| | - Imke Sauerland
- Hospital Lüdenscheid, Clinic for Pneumology, Internistic Intensive Medicine, Infectiology and Sleep Medicine, Lüdenscheid, Germany
| | - Winfried Randerath
- Bethanien Hospital Solingen, Clinic for Pulmonology and Allergology, Solingen, Germany
| | - Britta Kaminsky
- Bethanien Hospital Solingen, Clinic for Pulmonology and Allergology, Solingen, Germany
| | - Lars Hagmeyer
- Bethanien Hospital Solingen, Clinic for Pulmonology and Allergology, Solingen, Germany
| | - Christian Grohé
- Evangelic Lung Clinic Berlin, Department of Respiratory Diseases, Berlin, Germany
| | - Anna Eisert
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Rieke Frank
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Leonie Gogl
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Carsten Schaepers
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Alessandra Holzem
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Martin Hellmich
- University of Cologne, Institute of Medical Statistics, Informatics and Epidemiology, Cologne, Germany
| | - Roman K Thomas
- University of Cologne, Department for Translational Genomics, Cologne, Germany
| | - Martin Peifer
- University of Cologne, Department for Translational Genomics, Cologne, Germany
| | - Martin L Sos
- University of Cologne, Department for Translational Genomics, Cologne, Germany
| | - Reinhard Büttner
- University of Cologne, Cologne Institute of Pathology, Cologne, Germany
| | - Jürgen Wolf
- University Hospital of Cologne, Lung Cancer Group Cologne, Department I of Internal Medicine, Cologne, Germany.
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7
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Alidousty C, Baar T, Martelotto LG, Heydt C, Wagener S, Fassunke J, Duerbaum N, Scheel AH, Frank S, Holz B, Binot E, Kron A, Merkelbach‐Bruse S, Ihle MA, Wolf J, Buettner R, Schultheis AM. Genetic instability and recurrent MYC amplification in ALK-translocated NSCLC: a central role of TP53 mutations. J Pathol 2018; 246:67-76. [PMID: 29885057 PMCID: PMC6120547 DOI: 10.1002/path.5110] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/30/2018] [Accepted: 06/05/2018] [Indexed: 12/12/2022]
Abstract
The anaplastic lymphoma kinase (ALK) rearrangement defines a distinct molecular subtype of non-small cell lung cancer (NSCLC). Despite the excellent initial efficacy of ALK inhibitors in patients with ALK+ lung cancer, resistance occurs almost inevitably. To date, there is no reliable biomarker allowing the identification of patients at higher risk of relapse. Here, we analysed a subset of 53 ALK+ tumours with and without TP53 mutation and ALK+ NSCLC cell lines by NanoString nCounter technology. We found that the co-occurrence of early TP53 mutations in ALK+ NSCLC can lead to chromosomal instability: 24% of TP53-mutated patients showed amplifications of known cancer genes such as MYC (14%), CCND1 (10%), TERT (5%), BIRC2 (5%), ORAOV1 (5%), and YAP1 (5%). MYC-overexpressing ALK+ TP53-mutated cells had a proliferative advantage compared to wild-type cells. ChIP-Seq data revealed MYC-binding sites within the promoter region of EML4, and MYC overexpression in ALK+ TP53-mutated cells resulted in an upregulation of EML4-ALK, indicating a potential MYC-dependent resistance mechanism in patients with increased MYC copy number. Our study reveals that ALK+ NSCLC represents a more heterogeneous subgroup of tumours than initially thought, and that TP53 mutations in that particular cancer type define a subset of tumours that harbour chromosomal instability, leading to the co-occurrence of pathogenic aberrations. © 2018 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
| | - Till Baar
- University of Cologne, Faculty of Medicine, Institute of Medical Statistics and Computational BiologyCologneGermany
| | | | - Carina Heydt
- University Hospital Cologne, Institute of PathologyCologneGermany
| | - Svenja Wagener
- University Hospital Cologne, Institute of PathologyCologneGermany
| | - Jana Fassunke
- University Hospital Cologne, Institute of PathologyCologneGermany
| | - Nicolai Duerbaum
- University Hospital Cologne, Institute of PathologyCologneGermany
| | - Andreas H Scheel
- University Hospital Cologne, Institute of PathologyCologneGermany
| | - Sandra Frank
- University Hospital Cologne, Institute of PathologyCologneGermany
| | - Barbara Holz
- University Hospital Cologne, Institute of PathologyCologneGermany
| | - Elke Binot
- University Hospital Cologne, Institute of PathologyCologneGermany
| | - Anna Kron
- Network Genomic MedicineCologneGermany
| | | | - Michaela A Ihle
- University Hospital Cologne, Institute of PathologyCologneGermany
| | - Jürgen Wolf
- Network Genomic MedicineCologneGermany
- Lung Cancer Group Cologne, Department I for Internal MedicineUniversity Hospital of CologneCologneGermany
- Center for Integrated Oncology Cologne BonnGermany
| | - Reinhard Buettner
- University Hospital Cologne, Institute of PathologyCologneGermany
- Network Genomic MedicineCologneGermany
- Lung Cancer Group Cologne, Department I for Internal MedicineUniversity Hospital of CologneCologneGermany
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8
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Frank R, Scheffler M, Merkelbach-Bruse S, Ihle MA, Kron A, Rauer M, Ueckeroth F, König K, Michels S, Fischer R, Eisert A, Fassunke J, Heydt C, Serke M, Ko YD, Gerigk U, Geist T, Kaminsky B, Heukamp LC, Clement-Ziza M, Büttner R, Wolf J. Clinical and Pathological Characteristics of KEAP1- and NFE2L2-Mutated Non-Small Cell Lung Carcinoma (NSCLC). Clin Cancer Res 2018; 24:3087-3096. [PMID: 29615460 DOI: 10.1158/1078-0432.ccr-17-3416] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/22/2018] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
Purpose:KEAP1 and NFE2L2 mutations are associated with impaired prognosis in a variety of cancers and with squamous cell carcinoma formation in non-small cell lung cancer (NSCLC). However, little is known about frequency, histology dependence, molecular and clinical presentation as well as response to systemic treatment in NSCLC.Experimental Design: Tumor tissue of 1,391 patients with NSCLC was analyzed using next-generation sequencing (NGS). Clinical and pathologic characteristics, survival, and treatment outcome of patients with KEAP1 or NFE2L2 mutations were assessed.Results:KEAP1 mutations occurred with a frequency of 11.3% (n = 157) and NFE2L2 mutations with a frequency of 3.5% (n = 49) in NSCLC patients. In the vast majority of patients, both mutations did not occur simultaneously. KEAP1 mutations were found mainly in adenocarcinoma (AD; 72%), while NFE2L2 mutations were more common in squamous cell carcinoma (LSCC; 59%). KEAP1 mutations were spread over the whole protein, whereas NFE2L2 mutations were clustered in specific hotspot regions. In over 80% of the patients both mutations co-occurred with other cancer-related mutations, among them also targetable aberrations like activating EGFR mutations or MET amplification. Both patient groups showed different patterns of metastases, stage distribution and performance state. No patient with KEAP1 mutation had a response on systemic treatment in first-, second-, or third-line setting. Of NFE2L2-mutated patients, none responded to second- or third-line therapy.Conclusions:KEAP1- and NFE2L2-mutated NSCLC patients represent a highly heterogeneous patient cohort. Both are associated with different histologies and usually are found together with other cancer-related, partly targetable, genetic aberrations. In addition, both markers seem to be predictive for chemotherapy resistance. Clin Cancer Res; 24(13); 3087-96. ©2018 AACR.
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Affiliation(s)
- Rieke Frank
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Network Genomic Medicine (Lung Cancer), Cologne, Germany
| | - Matthias Scheffler
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Network Genomic Medicine (Lung Cancer), Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Michaela A Ihle
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Anna Kron
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Michael Rauer
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster for Cellular Stress Responses in Aging-Associated Diseases (CECAD) Research Center and Systems Biology of Ageing Cologne, University of Cologne, Cologne, Germany
| | - Frank Ueckeroth
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Katharina König
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Michels
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Network Genomic Medicine (Lung Cancer), Cologne, Germany
| | - Rieke Fischer
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Network Genomic Medicine (Lung Cancer), Cologne, Germany
| | - Anna Eisert
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Network Genomic Medicine (Lung Cancer), Cologne, Germany
| | - Jana Fassunke
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Carina Heydt
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Monika Serke
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Department for Pulmonology and Thoracic Oncology, Lung Clinic Hemer, Hemer, Germany
| | - Yon-Dschun Ko
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Johanniter Hospital, Evangelical Clinics of Bonn, Bonn, Germany
| | - Ulrich Gerigk
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Marien-Hospital Bonn, GFO Clinics Bonn, Bonn, Germany
| | - Thomas Geist
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Center Practice for Lung and Bronchial Diseases, Düsseldorf, Germany
| | - Britta Kaminsky
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Clinic for Pulmonology and Allergology, Bethanien Hospital Solingen, Solingen, Germany
| | - Lukas C Heukamp
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Mathieu Clement-Ziza
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster for Cellular Stress Responses in Aging-Associated Diseases (CECAD) Research Center and Systems Biology of Ageing Cologne, University of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Network Genomic Medicine (Lung Cancer), Cologne, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany. .,Network Genomic Medicine (Lung Cancer), Cologne, Germany
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9
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Holzem A, Nogova L, Ihle MA, Wompner C, Bitter E, Michels SYF, Fischer RN, Kron A, Gerigk U, Kern J, Kaminsky B, Randerath W, Lorenz J, Kambartel KO, Merkelbach-Bruse S, Büttner R, Scheffler M, Wolf J. Co-occurrence of targetable aberrations in non-small cell lung cancer patients harboring MAP2K1 mutations. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
e20059 Background: MAP2K1 mutations are rare in non-small cell lung cancer (NSCLC) and considered to be mutually exclusive with known driver mutations. Activation of the MEK1-cascade might play a pivotal role in resistance to targeted inhibition of BRAF V600E, EML4-ALK and EGFR T790M. So far, however, only MAP2K1 K57N could be identified and linked functionally to resistance in preclinical models. Clinical trials combining specific inhibitors for predefined NSCLC subgroups with MEK inhibitors are ongoing. We sought to characterize frequency and type of MAP2K1-mutated NSCLC regarding curated targetable aberrations. Methods: Tumor tissue collected consecutively from 4590 NSCLC patients within the German Network Genomic Medicine (NGM) between 07/2014 and 07/2015 was analyzed for MAP2K1 mutations using next-generation sequencing (NGS) with a set of 102 amplicons in 14 genes. Clinical and molecular characteristics of these patients were determined and compared with an internal control group of NSCLC patients and an independent control group of The Cancer Genome Atlas (TCGA). Results: We identified 21 (0.5%) patients with MAP2K1 mutations. They were frequently found in adenocarcinomas (n = 20) and were significantly associated with smoking. The most common MAP2K1 mutation was K57N. Most of the patients (n = 16) had additional oncogenic driver aberrations, including mutations in ALK, EGFR or BRAF, ROS1 rearrangements and MET amplification. TP53 mutations were found in 11 patients. In only five patients (23.8%) MAP2K1 occurred exclusively. TCGA analysis revealed additional 10 patients with MAP2K1 mutations, whereof 9 had additional TP53 mutations and one had BRAF mutation. Whereof most patients in our cohort had stage IV NSCLC, all patients in TCGA were systemic treatment naive. Compared with local stages in TCGA, our findings strongly suggest that targetable co-occurring mutations might occur more frequently in advanced stage NSCLC patients. Conclusions: MAP2K1 mutations co-occur frequently with targetable aberrations in smoking stage IV patients. Combination of targeted therapy against known driver aberrations with MEK inhibitors might be a promising therapeutic approach for such patients.
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Affiliation(s)
| | - Lucia Nogova
- Lung Cancer Group Cologne, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Michaela A. Ihle
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Claudia Wompner
- Lung Cancer Group Cologne, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Elisabeth Bitter
- Lung Cancer Group Cologne, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | | | - Rieke Nila Fischer
- Lung Cancer Group Cologne, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Anna Kron
- University Hospital Cologne, Cologne, Germany
| | - Ulrich Gerigk
- Evangelische Kliniken Johanniter-und Waldkrankenhaus Bonn GmbH, Bonn, Germany
| | - Jens Kern
- University Hospital Würzburg Comprehensive Cancer Center Mainfranken, Wuerzburg, Germany
| | | | - Winfried Randerath
- Krankenhaus Bethanien, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen, Germany
| | | | | | - Sabine Merkelbach-Bruse
- Institute for Pathology, University Hospital of Cologne, Center for Integrated Oncology, Cologne, Germany
| | - Reinhard Büttner
- University Hospital Cologne, Institute of Pathology, Cologne, Germany
| | - Matthias Scheffler
- Lung Cancer Group Cologne, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Juergen Wolf
- Lung Cancer Group Cologne, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
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10
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Ortiz-Cuaran S, Scheffler M, Plenker D, Dahmen L, Scheel AH, Fernandez-Cuesta L, Meder L, Lovly CM, Persigehl T, Merkelbach-Bruse S, Bos M, Michels S, Fischer R, Albus K, König K, Schildhaus HU, Fassunke J, Ihle MA, Pasternack H, Heydt C, Becker C, Altmüller J, Ji H, Müller C, Florin A, Heuckmann JM, Nuernberg P, Ansén S, Heukamp LC, Berg J, Pao W, Peifer M, Buettner R, Wolf J, Thomas RK, Sos ML. Heterogeneous Mechanisms of Primary and Acquired Resistance to Third-Generation EGFR Inhibitors. Clin Cancer Res 2016; 22:4837-4847. [PMID: 27252416 DOI: 10.1158/1078-0432.ccr-15-1915] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 05/21/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify novel mechanisms of resistance to third-generation EGFR inhibitors in patients with lung adenocarcinoma that progressed under therapy with either AZD9291 or rociletinib (CO-1686). EXPERIMENTAL DESIGN We analyzed tumor biopsies from seven patients obtained before, during, and/or after treatment with AZD9291 or rociletinib (CO-1686). Targeted sequencing and FISH analyses were performed, and the relevance of candidate genes was functionally assessed in in vitro models. RESULTS We found recurrent amplification of either MET or ERBB2 in tumors that were resistant or developed resistance to third-generation EGFR inhibitors and show that ERBB2 and MET activation can confer resistance to these compounds. Furthermore, we identified a KRASG12S mutation in a patient with acquired resistance to AZD9291 as a potential driver of acquired resistance. Finally, we show that dual inhibition of EGFR/MEK might be a viable strategy to overcome resistance in EGFR-mutant cells expressing mutant KRAS CONCLUSIONS: Our data suggest that heterogeneous mechanisms of resistance can drive primary and acquired resistance to third-generation EGFR inhibitors and provide a rationale for potential combination strategies. Clin Cancer Res; 22(19); 4837-47. ©2016 AACR.
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Affiliation(s)
- Sandra Ortiz-Cuaran
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany
| | - Dennis Plenker
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany. Molecular Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Llona Dahmen
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Andreas H Scheel
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Lynnette Fernandez-Cuesta
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany. Genetic Cancer Susceptibility Group, Section of Genetics, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Lydia Meder
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | | | | | - Sabine Merkelbach-Bruse
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Marc Bos
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Sebastian Michels
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany
| | - Rieke Fischer
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany
| | - Kerstin Albus
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | | | | | - Jana Fassunke
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Michaela A Ihle
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Helen Pasternack
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany. Pathology of the University Hospital of Luebeck and Leibniz Research Center Borstel, Lübeck and Borstel, Germany
| | - Carina Heydt
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Christian Becker
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Hongbin Ji
- Key Laboratory of Systems Biology, CAS Center for Excellence in Molecular Cell Science, Innovation Center for Cell Signaling Network, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Science, Shanghai, China. School of Life Science and Technology, Shanghai Tech University, Shanghai, China
| | - Christian Müller
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Alexandra Florin
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | | | - Peter Nuernberg
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Sascha Ansén
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany
| | - Lukas C Heukamp
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany. NEO New Oncology AG, Cologne, Germany
| | - Johannes Berg
- Institute for Theoretical Physics. University of Cologne, Cologne, Germany
| | - William Pao
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Martin Peifer
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany. Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Reinhard Buettner
- Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany.
| | - Jürgen Wolf
- Department I of Internal Medicine, Lung Cancer Group Cologne and Network Genomic Medicine (Lung Cancer), Center for Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Cologne, Germany.
| | - Roman K Thomas
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, Cologne, Germany. Institute of Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany.
| | - Martin L Sos
- Molecular Pathology, Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany.
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Scheffler M, Ihle MA, Hein R, Merkelbach-Bruse S, Braegelmann J, Scheel AH, Michels SYF, Ueckeroth F, Eisert A, Gogl L, Frank R, Fischer RN, Koleczko S, Schaepers C, Kostenko A, Kron F, Hellmich M, Sos ML, Buettner R, Wolf J. Genetic heterogeneity of KRAS-mutated NSCLC: Co-occurrence of potentially targetable aberrations and evolutionary background. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matthias Scheffler
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Michaela A. Ihle
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Rebecca Hein
- Institute of Medical Statistics, Informatics, and Epidemiology, University of Cologne, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Institute for Pathology, University Hospital of Cologne, Center for Integrated Oncology, Cologne, Germany
| | | | - Andreas H. Scheel
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Yves Friedrich Michels
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Frank Ueckeroth
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Anna Eisert
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Center for Integrated Oncology (CIO) Köln Bonn, Cologne, Germany
| | - Leonie Gogl
- Lung Cancer Group Cologne, Departement I of Internal Medicine, University Hospital of Cologne, Center for Integrated oncology (CIO) Köln Bonn, Cologne, Germany
| | - Rieke Frank
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Center for Integrated Oncology (CIO) Köln Bonn, Cologne, Germany
| | - Rieke Nila Fischer
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Sophia Koleczko
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Carsten Schaepers
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Anna Kostenko
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Florian Kron
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Martin L. Sos
- Department of Translational Genomics, University of Cologne, Cologne, Germany
| | - Reinhard Buettner
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Juergen Wolf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
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12
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Castiglione R, Ihle MA, Heydt C, Schultheis AM, Merkelbach-Bruse S, Mauch C, Büttner R. The impact of sequencing on diagnosis and treatment of malignant melanoma. Expert Rev Mol Diagn 2016; 16:423-33. [PMID: 26822148 DOI: 10.1586/14737159.2016.1147958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Melanoma is one of the clinically most important cancer types considering its high mortality rate and that it is commonly diagnosed in relatively young people. With the advent of targeted therapies and, more recently, immune checkpoint inhibitors, more treatment options are available resulting in higher patient survival rates. However, the successful application of these targeted therapies critically depends on the reliable detection of molecular aberrations. Today, massively parallel sequencing techniques enable us to analyze large sets of genes in a relatively short time. It has allowed increased knowledge of acquired somatic mutations in melanoma and has helped to identify new targets for personalized therapy, and potentially may help to predict response to immune therapies. Described here are the development of sequencing techniques, how their improvement has changed diagnosis, prognosis and management of malignant melanoma and the future perspectives of melanoma diagnostics in the routine clinical setting.
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Affiliation(s)
| | - Michaela A Ihle
- a Institute of Pathology , University Hospital Cologne , Cologne , Germany
| | - Carina Heydt
- a Institute of Pathology , University Hospital Cologne , Cologne , Germany
| | - Anne M Schultheis
- a Institute of Pathology , University Hospital Cologne , Cologne , Germany
| | | | - Cornelia Mauch
- b Clinic for Dermatology , University Hospital Cologne , Cologne , Germany
| | - Reinhard Büttner
- a Institute of Pathology , University Hospital Cologne , Cologne , Germany
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13
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Schmitz K, Koeppen H, Binot E, Fassunke J, Künstlinger H, Ihle MA, Heydt C, Wardelmann E, Büttner R, Merkelbach-Bruse S, Rüschoff J, Schildhaus HU. MET gene copy number alterations and expression of MET and hepatocyte growth factor are potential biomarkers in angiosarcomas and undifferentiated pleomorphic sarcomas. PLoS One 2015; 10:e0120079. [PMID: 25844809 PMCID: PMC4386816 DOI: 10.1371/journal.pone.0120079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/19/2015] [Indexed: 11/19/2022] Open
Abstract
Soft tissue sarcomas are a heterogeneous group of tumors with many different subtypes. In 2014 an estimated 12,020 newly diagnosed cases and 4,740 soft tissue sarcoma related deaths can be expected in the United States. Many soft tissue sarcomas are associated with poor prognosis and therapeutic options are often limited. The evolution of precision medicine has not yet fully reached the clinical treatment of sarcomas since therapeutically tractable genetic changes have not been comprehensively studied so far. We analyzed a total of 484 adult-type malignant mesenchymal tumors by MET fluorescence in situ hybridization and MET and hepatocyte growth factor immunohistochemistry. Eleven different entities were included, among them the most common and clinically relevant subtypes and tumors with specific translocations or complex genetic changes. MET protein expression was observed in 2.6% of the cases, all of which were either undifferentiated pleomorphic sarcomas or angiosarcomas, showing positivity rates of 14% and 17%, respectively. 6% of the tumors showed hepatocyte growth factor overexpression, mainly seen in undifferentiated pleomorphic sarcomas and angiosarcomas, but also in clear cell sarcomas, malignant peripheral nerve sheath tumors, leiomyosarcomas and gastrointestinal stromal tumors. MET and hepatocyte growth factor overexpression were significantly correlated and may suggest an autocrine activation in these tumors. MET FISH amplification and copy number gain were present in 4% of the tumors (15/413). Two samples, both undifferentiated pleomorphic sarcomas, fulfilled the criteria for high level amplification of MET, one undifferentiated pleomorphic sarcoma reached an intermediate level copy number gain, and 12 samples of different subtypes were categorized as low level copy number gains for MET. Our findings indicate that angiosarcomas and undifferentiated pleomorphic sarcomas rather than other frequent adult-type sarcomas should be enrolled in screening programs for clinical trials with MET inhibitors. The screening methods should include both in situ hybridization and immunohistochemistry.
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Affiliation(s)
- Katja Schmitz
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Institute of Pathology, University Hospital Göttingen, Göttingen, Germany
| | - Hartmut Koeppen
- Genentech Inc., South San Francisco, California, United States of America
| | - Elke Binot
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Jana Fassunke
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Helen Künstlinger
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Michaela A. Ihle
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Carina Heydt
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Eva Wardelmann
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Reinhard Büttner
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | | | | | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Institute of Pathology, University Hospital Göttingen, Göttingen, Germany
- * E-mail:
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14
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Ortiz-Cuarán S, Schöttle J, Dahmen I, Peifer M, Wieczoreck C, Koker M, Ihle MA, Florin A, Pinther B, Heukamp LC, Ullrich RT, Thomas RK. Abstract 1690: Attacking EGFR mutant lung cancer by combined EGFR and c-Met inhibition. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In lung adenocarcinomas, targeted therapy with the EGFR tyrosine kinase inhibitors (TKIs) erlotinib and gefitinib is associated with longer progression free survival (PFS). However, despite the initial success, all patients progress with a median PFS of 12 to 16 months. Acquired resistance is driven by the occurrence of a secondary EGFR mutation (T790M) in about 50% of the cases and by c-Met amplification in 5 to 10 % of the cases. We report the activity of a new reversible and ATP-competitive c-Met inhibitor, EMD1214063, in the setting of primary lung adenocarcinomas harboring EGFR activating mutations and in two models of acquired resistance. EMD1214063 showed to be specifically active in c-Met amplified and c-Met dependent cells in a large panel of genotypically characterized lung cancer cell lines. In the context of acquired resistance, we studied the effect of EMD1214063 alone and in combination of afatinib, an irreversible EGFR TKI, in PC9 cells (EGFR Exon19del), H1975 cells (EGFR L858R and T790M), HCC827 (EGFR Exon19del, not c-Met amplified) and in HCC827GR cells (EGFR Exon19del and c-Met amplified). Treatment of HCC827GR cells with EMD1214063 resulted in substantial growth inhibition and induced apoptosis. The in vitro results showed a significant synergistic effect of the combination of EMD121039 and afatinib in the induction of growth inhibition in the context of c-Met amplification and EGFR T790M mutation. Combination treatment robustly suppressed expression of downstream pErk and pAkt, showing efficient suppression of PI3K and MAPK signaling. To determine whether the antitumor activity of the combination observed in vitro might also be apparent in vivo, we injected these cells in nude mice to elicit the formation of solid tumors. Mice were treated with EMD121043 (25mg/kg), afatinib (10mg/kg) or the combination of both. In H1975 xenografts only the combination therapy could significantly reduce tumor growth, thus confirming the results obtained in vitro. In the c-Met amplified setting, we treated mice harboring HCC827, HCC827GR and mixed xenografts. HCC827-driven tumors strongly responded to both afatinib monotherapy and to the combination, leading to complete remission within 40 days of therapy. HCC827/HCC827GR mixed xenografts containing 0.1%, 1% and 10% of HCC827GR cells partially responded to afatinib monotherapy; however, growth was completely abolished by combination therapy. Treatment with EMD1214063 led to significant growth reduction in mice harboring HCC827GR tumors. In this model, only the combination therapy led to massive tumor shrinkage. Assessment of cell proliferation in vivo by [18F]FLT-PET showed a decline in FLT-uptake of 40% in both the combination therapy and the EMD1214063 monotherapy. In conclusion, the combination of EMD1214063 and afatinib promote tumor regression in erlotinib acquired resistant lung cancers driven by EGFR L858R/T790M or EGFR Exon19 del/c-Met amplification.
Citation Format: Sandra Ortiz-Cuarán, Jakob Schöttle, Ilona Dahmen, Martin Peifer, Caroline Wieczoreck, Mirjam Koker, Michaela A. Ihle, Alexandra Florin, Berit Pinther, Lukas C. Heukamp, Roland T. Ullrich, Roman K. Thomas. Attacking EGFR mutant lung cancer by combined EGFR and c-Met inhibition. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1690. doi:10.1158/1538-7445.AM2014-1690
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Affiliation(s)
- Sandra Ortiz-Cuarán
- 1University of Cologne, Department of Translational Genomics, Cologne, Germany
| | - Jakob Schöttle
- 1University of Cologne, Department of Translational Genomics, Cologne, Germany
| | - Ilona Dahmen
- 1University of Cologne, Department of Translational Genomics, Cologne, Germany
| | - Martin Peifer
- 1University of Cologne, Department of Translational Genomics, Cologne, Germany
| | - Caroline Wieczoreck
- 2University of Cologne, Max-Planck-Institute for Neurological Research, Cologne, Germany
| | - Mirjam Koker
- 1University of Cologne, Department of Translational Genomics, Cologne, Germany
| | - Michaela A. Ihle
- 3Institute of Pathology, University Hospital Medical School, Cologne, Germany
| | - Alexandra Florin
- 3Institute of Pathology, University Hospital Medical School, Cologne, Germany
| | - Berit Pinther
- 1University of Cologne, Department of Translational Genomics, Cologne, Germany
| | - Lukas C. Heukamp
- 3Institute of Pathology, University Hospital Medical School, Cologne, Germany
| | - Roland T. Ullrich
- 2University of Cologne, Max-Planck-Institute for Neurological Research, Cologne, Germany
| | - Roman K. Thomas
- 1University of Cologne, Department of Translational Genomics, Cologne, Germany
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