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Knapp B, Govindan A, Patel SS, Pepin K, Wu N, Devarakonda S, Buchowski JM. Outcomes in Patients with Spinal Metastases Managed with Surgical Intervention. Cancers (Basel) 2024; 16:438. [PMID: 38275879 PMCID: PMC10813971 DOI: 10.3390/cancers16020438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Spinal metastases are a significant cause of morbidity in patients with advanced cancer, and management often requires surgical intervention. Although prior studies have identified factors that influence outcomes with surgery, the ability of these factors to predict outcomes remains unclear in the era of contemporary therapies, and there is a need to better identify patients who are likely to benefit from surgery. METHODS We performed a single-center, retrospective analysis to evaluate risk factors for poor outcomes in patients with spinal metastases treated with surgery. The primary outcome was mortality at 180 days. RESULTS A total of 128 patients were identified. Age ≥ 65 years at surgery (p = 0.0316), presence of extraspinal metastases (p = 0.0110), and ECOG performance scores >1 (p = 0.0397) were associated with mortality at 180 days on multivariate analysis. These factors and BMI ≤ 30 mg/kg2 (p = 0.0008) were also associated with worse overall survival. CONCLUSIONS Age > 65, extraspinal metastases, and performance status scores >1 are factors associated with mortality at 180 days in patients with spinal metastases treated with surgery. Patients with these factors and BMI ≤ 30 mg/kg2 had worse overall survival. Our results support multidisciplinary discussions regarding the benefits and risks associated with surgery in patients with these risk factors.
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Affiliation(s)
- Brendan Knapp
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (B.K.)
| | - Ashwin Govindan
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (B.K.)
| | - Shalin S. Patel
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kymberlie Pepin
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (B.K.)
| | - Ningying Wu
- Biostatistics Shared Resource, Division of Public Health Sciences, Department of Surgery, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Siddhartha Devarakonda
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (B.K.)
| | - Jacob M. Buchowski
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Semenkovich NP, Badiyan SN, Samson PP, Stowe HB, Wang YE, Star R, Devarakonda S, Govindan R, Waqar SN, Robinson CG, Vlacich G, Pellini B, Chaudhuri AA. Pre-radiotherapy ctDNA liquid biopsy for risk stratification of oligometastatic non-small cell lung cancer. NPJ Precis Oncol 2023; 7:100. [PMID: 37783809 PMCID: PMC10545784 DOI: 10.1038/s41698-023-00440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023] Open
Abstract
The optimal treatment paradigm for patients with oligometastatic non-small cell lung cancer (NSCLC) remains unclear. Some patients with oligometastatic disease experience prolonged remission after locally consolidative radiation therapy (RT), while others harbor micrometastatic disease (below limits of detection by imaging) and benefit from systemic therapy. To risk-stratify and identify the patients most likely to benefit from locally consolidative RT, we performed a multi-institutional cohort study of 1487 patients with oligometastatic NSCLC undergoing liquid biopsy analysis of circulating tumor DNA (ctDNA). In total, 1880 liquid biopsies were performed and approximately 20% of patients (n = 309) had ctDNA measured prior to RT and after their diagnosis of oligometastatic disease. Patients with undetectable ctDNA (pathogenic or likely pathogenic variants in plasma using the Tempus xF assay) before RT had significantly improved progression-free survival (PFS) (P = 0.004) and overall survival (OS) (P = 0.030). ctDNA maximum variant allele frequency (VAF) pre-RT and ctDNA mutational burden pre-RT were both significantly inversely correlated with PFS (maximum VAF P = 0.008, mutational burden P = 0.003) and OS (maximum VAF P = 0.007, mutational burden P = 0.045). These findings were corroborated by multivariate Cox proportional hazards models that included eight additional clinical and genomic parameters. Overall, these data suggest that in patients with oligometastatic NSCLC, pre-RT ctDNA can potentially identify the patients most likely to benefit from locally consolidative RT and experience prolonged PFS and OS. Similarly, ctDNA may be useful to identify undiagnosed micrometastatic disease where it may be appropriate to prioritize systemic therapies.
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Affiliation(s)
- Nicholas P Semenkovich
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Shahed N Badiyan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Hayley B Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Siddhartha Devarakonda
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ramaswamy Govindan
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Saiama N Waqar
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory Vlacich
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Bruna Pellini
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Aadel A Chaudhuri
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA.
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3
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Karlow JA, Pehrsson EC, Xing X, Watson M, Devarakonda S, Govindan R, Wang T. Non-small Cell Lung Cancer Epigenomes Exhibit Altered DNA Methylation in Smokers and Never-smokers. Genomics Proteomics Bioinformatics 2023; 21:991-1013. [PMID: 37742993 PMCID: PMC10928376 DOI: 10.1016/j.gpb.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 02/11/2023] [Accepted: 03/14/2023] [Indexed: 09/26/2023]
Abstract
Epigenetic alterations are widespread in cancer and can complement genetic alterations to influence cancer progression and treatment outcome. To determine the potential contribution of DNAmethylation alterations to tumor phenotype in non-small cell lung cancer (NSCLC) in both smoker and never-smoker patients, we performed genome-wide profiling of DNA methylation in 17 primary NSCLC tumors and 10 matched normal lung samples using the complementary assays, methylated DNA immunoprecipitation sequencing (MeDIP-seq) and methylation sensitive restriction enzyme sequencing (MRE-seq). We reported recurrent methylation changes in the promoters of several genes, many previously implicated in cancer, including FAM83A and SEPT9 (hypomethylation), as well as PCDH7, NKX2-1, and SOX17 (hypermethylation). Although many methylation changes between tumors and their paired normal samples were shared across patients, several were specific to a particular smoking status. For example, never-smokers displayed a greater proportion of hypomethylated differentially methylated regions (hypoDMRs) and a greater number of recurrently hypomethylated promoters, including those of ASPSCR1, TOP2A, DPP9, and USP39, all previously linked to cancer. Changes outside of promoters were also widespread and often recurrent, particularly methylation loss over repetitive elements, highly enriched for ERV1 subfamilies. Recurrent hypoDMRs were enriched for several transcription factor binding motifs, often for genes involved in signaling and cell proliferation. For example, 71% of recurrent promoter hypoDMRs contained a motif for NKX2-1. Finally, the majority of DMRs were located within an active chromatin state in tissues profiled using the Roadmap Epigenomics data, suggesting that methylation changes may contribute to altered regulatory programs through the adaptation of cell type-specific expression programs.
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Affiliation(s)
- Jennifer A Karlow
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA; The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Erica C Pehrsson
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA; The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Xiaoyun Xing
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA; The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mark Watson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Siddhartha Devarakonda
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ramaswamy Govindan
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ting Wang
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA; The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO 63108, USA.
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Ashok Kumar P, Karimi M, Basnet A, Seymour L, Kratzke R, Brambilla E, Le-Chevalier T, Soria JC, Olaussen KA, Devarakonda S, Govindan R, Tsao MS, Shepherd FA, Michiels S, Graziano S. Association of Molecular Profiles and Mutational Status With Distinct Histological Lung Adenocarcinoma Subtypes. An Analysis of the LACE-Bio Data. Clin Lung Cancer 2023; 24:528-540. [PMID: 37438216 DOI: 10.1016/j.cllc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/14/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Adjuvant chemotherapy (AC) is indicated for stage II and stage III lung adenocarcinomas (ADC). Using the LACE Bio II database, we analyzed the distribution of various mutations across the subtypes of ADCs and studied the prognostic and predictive roles of PD-L1, TMB, and Tumor Infiltrating Lymphocytes (TILs). MATERIALS AND METHODS Clinical and genomic data from the LACE Bio II data were extracted. Patients were divided into ADC subtypes, in which the grouping was done based on their known clinical behavior (Lepidic [LEP], Acinar/Papillary [ACI or PAP], Micropapillary/Solid [MIP or SOL], Mucinous [MUC] and Others). Kaplan-Meier (KM) and log-rank test were used to compare survival based on PD-L1, TMB, TILs and combinations of TMB with PD-L1 and TILs. Adjusted Hazard Ratios (HR) were analyzed with Overall Survival (OS), Disease-Free Survival (DFS) and Lung Cancer-Specific Survival (LCSS) as endpoints. RESULTS A total of 375 ADC patients were identified. MIP/SOL was the subtype most commonly positive for various biomarkers. PD-L1 Negative/high TMB was associated with better outcomes in terms of OS (HR = 0.46 [0.23-0.89], P = .021) and DFS (HR = 0.52 [0.30-0.90], P = .02), relative to PD-L1 Negative/low TMB. High TMB predicted worse outcome with AC use in terms of OS (ratio of hazard ratio rHR = 2.75 [1.07-7.04], P = .035). Marked TILs had better outcome with AC for DFS (rHR = 0.22 [0.06-0.87], P = .031 and LCSS (rHR = 0.08 [0.01-0.66], P = .019) respectively. There was also a beneficial effect of AC among patients with Marked TILs/low TMB in terms of DFS (rHR = 0.06 [0.01-0.53], P = .011). CONCLUSION High TMB has a prognostic role in resectable lung ADC. The high TMB group had a poor outcome with AC, suggesting that this group may be better served with immune checkpoint therapy.
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Affiliation(s)
| | - Maryam Karimi
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, Villejuif, France
| | - Alina Basnet
- Division of Hematology-Oncology, SUNY Upstate Medical University, Syracuse, NY
| | - Lesley Seymour
- Canadian Cancer Trials Group and Queen's University, Kingston, ON, Canada
| | - Robert Kratzke
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Elizabeth Brambilla
- Department of Pathology, University Grenoble Alpes, INSERM, Grenoble, France
| | | | - Jean-Charles Soria
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Ken André Olaussen
- Université Paris-Saclay, Faculté de médecine, Gustave Roussy, Inserm U981, Villejuif, France
| | - Siddhartha Devarakonda
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Ramaswamy Govindan
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Division of Medical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Stefan Michiels
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, Villejuif, France
| | - Stephen Graziano
- Division of Hematology-Oncology, SUNY Upstate Medical University, Syracuse, NY
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5
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Semenkovich NP, Samson PP, Badiyan SN, Vlacich G, Stowe HB, Wang YE, Star R, Devarakonda S, Govindan R, Waqar SN, Robinson CG, Pellini B, Chaudhuri AA. Pre-radiotherapy ctDNA liquid biopsy for risk stratification of oligometastatic non-small cell lung cancer. Res Sq 2023:rs.3.rs-2688927. [PMID: 36993328 PMCID: PMC10055612 DOI: 10.21203/rs.3.rs-2688927/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The optimal treatment for patients with oligometastatic non-small cell lung cancer (NSCLC) remains unclear. Some patients with oligometastatic disease can experience prolonged remission after locally consolidative radiation therapy (RT), while others harbor micrometastatic disease (below current limits of detection by imaging) that may benefit from further prioritization of systemic therapy. To better risk-stratify this population and identify the patients most likely to benefit from locally consolidative radiation therapy, we performed a multi-institutional cohort study of patients with oligometastatic NSCLC undergoing liquid biopsy analysis of circulating tumor DNA (ctDNA). Among this real-world cohort of 1,487 patients undergoing analysis (using the Tempus xF assay), a total of 1,880 ctDNA liquid biopsies along with paired clinical data were obtained across various timepoints. Approximately 20% (n=309) of patients had ctDNA obtained prior to RT and after their diagnosis of oligometastatic disease. Samples were de-identified and analyzed for mutational burden and variant frequencies of detectable deleterious (or likely deleterious) mutations in plasma. Patients with undetectable ctDNA before RT had significantly improved progression-free survival and overall survival compared to patients with detectable ctDNA prior to RT. In patients that received RT, 598 pathogenic (or likely deleterious) variants were identified. ctDNA mutational burden pre-RT and ctDNA maximum variant allele frequency (VAF) pre-RT were both significantly inversely correlated with both progression-free (P = 0.0031 for mutational burden, P = 0.0084 for maximum VAF) and overall survival (P = 0.045 for mutational burden, P = 0.0073 for maximum VAF). Patients without detectable ctDNA prior to RT had significantly improved progression-free survival (P = 0.004) and overall survival (P = 0.03) compared to patients with detectable ctDNA prior to RT. These data suggest that in patients with oligometastatic NSCLC, pre-radiotherapy ctDNA analysis can potentially identify the patients most likely to benefit from locally consolidative RT and experience prolonged progression-free and overall survival. Similarly, ctDNA may be useful to identify those patients with undiagnosed micrometastatic disease, in whom it may be appropriate to prioritize systemic therapy.
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Affiliation(s)
- Nicholas P. Semenkovich
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Pamela P. Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Shahed N. Badiyan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Gregory Vlacich
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Hayley B. Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Siddhartha Devarakonda
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ramaswamy Govindan
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Saiama N. Waqar
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Clifford G. Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Bruna Pellini
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Aadel A. Chaudhuri
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri
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Cotto KC, Feng YY, Ramu A, Richters M, Freshour SL, Skidmore ZL, Xia H, McMichael JF, Kunisaki J, Campbell KM, Chen THP, Rozycki EB, Adkins D, Devarakonda S, Sankararaman S, Lin Y, Chapman WC, Maher CA, Arora V, Dunn GP, Uppaluri R, Govindan R, Griffith OL, Griffith M. Integrated analysis of genomic and transcriptomic data for the discovery of splice-associated variants in cancer. Nat Commun 2023; 14:1589. [PMID: 36949070 PMCID: PMC10033906 DOI: 10.1038/s41467-023-37266-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 12/30/2020] [Accepted: 03/08/2023] [Indexed: 03/24/2023] Open
Abstract
Somatic mutations within non-coding regions and even exons may have unidentified regulatory consequences that are often overlooked in analysis workflows. Here we present RegTools ( www.regtools.org ), a computationally efficient, free, and open-source software package designed to integrate somatic variants from genomic data with splice junctions from bulk or single cell transcriptomic data to identify variants that may cause aberrant splicing. We apply RegTools to over 9000 tumor samples with both tumor DNA and RNA sequence data. RegTools discovers 235,778 events where a splice-associated variant significantly increases the splicing of a particular junction, across 158,200 unique variants and 131,212 unique junctions. To characterize these somatic variants and their associated splice isoforms, we annotate them with the Variant Effect Predictor, SpliceAI, and Genotype-Tissue Expression junction counts and compare our results to other tools that integrate genomic and transcriptomic data. While many events are corroborated by the aforementioned tools, the flexibility of RegTools also allows us to identify splice-associated variants in known cancer drivers, such as TP53, CDKN2A, and B2M, and other genes.
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Affiliation(s)
- Kelsy C Cotto
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
| | - Yang-Yang Feng
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
| | - Avinash Ramu
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Megan Richters
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
| | - Sharon L Freshour
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
| | - Zachary L Skidmore
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
| | - Huiming Xia
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua F McMichael
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
| | - Jason Kunisaki
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA
| | - Katie M Campbell
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy Hung-Po Chen
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Emily B Rozycki
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Douglas Adkins
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Siddhartha Devarakonda
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Sumithra Sankararaman
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Yiing Lin
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - William C Chapman
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher A Maher
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Vivek Arora
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Gavin P Dunn
- Department of Neurosurgery, Mass General Hospital, Boston, MA, USA
- Center for Brain Tumor Immunology and Immunotherapy, Mass General Hospital, Boston, MA, USA
| | - Ravindra Uppaluri
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ramaswamy Govindan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Obi L Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
| | - Malachi Griffith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
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7
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Patel B, Pepin K, Li S, Davies S, Rohatgi A, Herzog B, Ward J, Baggstrom M, Waqar S, Morgensztern D, Govindan R, Devarakonda S. PP01.28 Tumor Engraftment is Prognostic for Disease Recurrence in Resected Non-Small Cell Lung Cancer. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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8
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Singareddy A, Flanagan ME, Samson PP, Waqar SN, Devarakonda S, Ward JP, Herzog BH, Rohatgi A, Robinson CG, Gao F, Govindan R, Puri V, Morgensztern D. Trends in Stage I Lung Cancer. Clin Lung Cancer 2023; 24:114-119. [PMID: 36504141 DOI: 10.1016/j.cllc.2022.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/26/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The American Cancer Society has recently reported an increase in the percentage of patients with localized lung cancer from 2004 to 2018, coinciding with the initial lung cancer screening guidelines issued in 2013. We conducted a National Cancer Database (NCDB) study to further evaluate the trends in stage I according to patient and tumor characteristics. METHODS We selected patients with lung cancer from the NCDB Public Benchmark Report diagnosed between 2010 and 2017. Patients with stages I to IV according to the AJCC seventh edition were evaluated according to the year of diagnosis, histology, age, sex, race, and insurance. RESULTS Among the 1,447,470 patients identified in the database, 56,382 (3.9%) were excluded due to stage 0 or unknown, or incorrect histology, leaving 1,391,088 patients eligible. The percentage of patients with stage I increased from 23.5% in 2010 to 29.1% in 2017 for all lung cancers, from 25.9% to 31.8% in non-small-cell lung cancer (NSCLC), and from 5.0% to 5.4% in small-cell lung cancer (SCLC). Patients younger than 70 years, males and blacks had lower percentages of stage I compared to older patients, females, and nonblacks respectively. Patients with no insurance had the lowest percentage of stage I. CONCLUSIONS There has been a significant increase in the percentage of stage I lung cancer at diagnosis from 2010 to 2017, which occurred mostly in NSCLC. Although the staging shift was observed in all subsets of patients, there were noticeable imbalances according to demographic factors.
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Affiliation(s)
- Aashray Singareddy
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Mary Ellen Flanagan
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Saiama N Waqar
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Siddhartha Devarakonda
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey P Ward
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Brett H Herzog
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Anjali Rohatgi
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Feng Gao
- Siteman Cancer Center Biostatistics Core, Division of Public Health Sciences, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Comprehensive Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Ramaswamy Govindan
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Daniel Morgensztern
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO.
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9
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Rajan A, Gray JE, Devarakonda S, Birhiray R, Korchin B, Menius E, Donahue RN, Schlom J, Gulley JL. Phase 1 trial of CV301 in combination with anti-PD-1 therapy in nonsquamous non-small cell lung cancer. Int J Cancer 2023; 152:447-457. [PMID: 36054490 PMCID: PMC10690498 DOI: 10.1002/ijc.34267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/14/2022] [Revised: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
CV301, a poxviral-based vaccine, has been evaluated in a phase 1 clinical trial (NCT02840994) and shown to be safe and immunologically active (phase 1a). Preclinical data support a combination of CV301 with programmed death-1 inhibitors, which has been evaluated in the phase 1b part of this trial and is reported here. Patients with advanced nonsquamous non-small cell lung cancer (NSCLC) without actionable genomic alterations received two priming doses of modified vaccinia Ankara-BN-CV301 (MVA) 4 weeks apart, followed by boosting doses of fowlpox-CV301 (FPV) at increasing time intervals for a maximum of 17 doses in combination with nivolumab for cohort 1 (C1) and 15 doses in combination with pembrolizumab for cohort 2 (C2). The primary objective was evaluation of safety and tolerability. Between October 2017 and September 14, 2018, patients were enrolled (C1: 4; median age: 64 years). Mean treatment duration was 332 days in C1 and 289 days in C2. CTCAE ≥grade 3 adverse events (AEs) were observed in four (100%) patients in C1 and three (37.5%) patients in C2. There was one death on trial. Immune-related AEs (irAEs) fulfilling criteria for a dose-limiting toxicity included 1 case of pneumonitis. Among 11 evaluable patients, 1 (9%) had a complete response, 1 (9%) had a partial response and 9 (82%) had stable disease. We conclude that CV301 administered with PD-1 inhibitors is safe and clinically active in patients with advanced NSCLC. The frequency or severity of AEs is not increased, including irAEs for each component of the combination.
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Affiliation(s)
- Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jhanelle E Gray
- Thoracic Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Ruemu Birhiray
- Medical Oncology, Investigative Clinical Research of Indiana, Indianapolis, Indiana, USA
| | | | - Erika Menius
- Bavarian Nordic, Morrisville, North Carolina, USA
| | - Renee N Donahue
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeffrey Schlom
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James L Gulley
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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10
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Sponagel J, Devarakonda S, Rubin JB, Luo J, Ippolito JE. De novo serine biosynthesis from glucose predicts sex-specific response to antifolates in non-small cell lung cancer cell lines. iScience 2022; 25:105339. [PMID: 36325067 PMCID: PMC9619300 DOI: 10.1016/j.isci.2022.105339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related death. Intriguingly, males with non-small cell lung cancer (NSCLC) have a higher mortality rate than females. Here, we investigated the role of serine metabolism as a predictive marker for sensitivity to the antifolate pemetrexed in male and female NSCLC cell lines. Using [13C6] glucose tracing in NSCLC cell lines, we found that a subset of male cells generated significantly more serine from glucose than female cells. Higher serine biosynthesis was further correlated with increased sensitivity to pemetrexed in male cells only. Concordant sex differences in metabolic gene expression were evident in NSCLC and pan-cancer transcriptome datasets, suggesting a potential mechanism with wide-reaching applicability. These data were further validated by integrating antifolate drug cytotoxicity and metabolic pathway transcriptome data from pan-cancer cell lines. Together, these findings highlight the importance of considering sex differences in cancer metabolism to improve treatment for all patients.
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Affiliation(s)
- Jasmin Sponagel
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Siddhartha Devarakonda
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joshua B. Rubin
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience Washington University School of Medicine, St Louis, MO 63110, USA
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
- Siteman Cancer Center Biostatistics Shared Resource, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Joseph E. Ippolito
- Department of Radiology Washington University School of Medicine, St Louis, MO 63110, USA
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St Louis, MO 63110, USA
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11
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Herzog BH, Waqar SN, Devarakonda S, Ward JP, Gao F, Govindan R, Morgensztern D. Ramucirumab plus atezolizumab in patients with stage IV non-small cell lung cancer previously treated with immune checkpoint inhibitors. Lung Cancer 2022; 173:101-106. [PMID: 36179540 PMCID: PMC10401890 DOI: 10.1016/j.lungcan.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/19/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The treatment options for patients with stage IV non-small cell lung cancer (NSCLC) who develop tumor progression after platinum-based chemotherapy and immune checkpoint inhibitors (ICIs) are limited. The combination of ICI with inhibitors of vascular endothelial growth receptor (VEGFR) signaling has shown promising results in previously untreated patients. MATERIALS AND METHODS In this single institution phase II study, patients with advanced stage NSCLC previously treated with at least one line including ICI received ramucirumab 10 mg/kg and atezolizumab 1,200 mg intravenously every 21 days until tumor progression or intolerable toxicity. The primary endpoint was overall response rate (ORR) by the RECIST 1.1 criteria according to the investigator assessment. Secondary endpoints included clinical benefit rate (CBR), overall survival (OS), progression-free survival (PFS) and tolerability. RESULTS Twenty-one patients were enrolled between June 2019 and April 2021. The median age was 67 (range 42-82), 17 (81 %) were female, and 15 (71 %) had non-squamous histology. The median number of prior systemic treatment lines and prior ICI lines were 3 (range 2-8) and 1 (range 1-3), respectively. One patient achieved a complete response for an ORR of 4.8 % while 16 (76.2 %) had stable disease with a CBR of 80.9 %. The median PFS was 3.4 months, and the median OS was 16.5 months. The most common adverse events included hypertension (86 %), proteinuria (67 %), and nausea (52 %). Grade 3 or 4 events were seen in 9 (43 %) of patients, with hypertension being the most common (33 %) of the grade 3 or 4 events. CONCLUSIONS Although the primary endpoint of ORR was not met, the combination of ramucirumab plus atezolizumab was associated with a high CBR and the OS was better than expected in heavily pretreated patients. Therefore, further investigation with ICI plus VEGF inhibition is warranted.
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Affiliation(s)
- Brett H Herzog
- Alvin Siteman Cancer Center and Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Saiama N Waqar
- Alvin Siteman Cancer Center and Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Siddhartha Devarakonda
- Alvin Siteman Cancer Center and Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jeffrey P Ward
- Alvin Siteman Cancer Center and Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Feng Gao
- Cancer Center Biostatistics Core, Division of Public Health Sciences, Department of Surgery at Barnes-Jewish Hospital and Alvin Siteman Cancer Center, USA
| | - Ramaswamy Govindan
- Alvin Siteman Cancer Center and Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Daniel Morgensztern
- Alvin Siteman Cancer Center and Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
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12
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Herzog B, Waqar S, Devarakonda S, Ward J, Govindan R, Morgensztern D. EP08.01-013 Ramucirumab plus Atezolizumab in Patients with Stage IV NSCLC Previously Treated with Immune Checkpoint Blockade. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Karlow JA, Devarakonda S, Xing X, Jang HS, Govindan R, Watson M, Wang T. Developmental Pathways Are Epigenetically Reprogrammed during Lung Cancer Brain Metastasis. Cancer Res 2022; 82:2692-2703. [PMID: 35706127 PMCID: PMC9357144 DOI: 10.1158/0008-5472.can-21-4160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/04/2021] [Revised: 04/13/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023]
Abstract
Non-small cell lung cancer (NSCLC) is one of the most commonly diagnosed and deadliest cancers worldwide, with roughly half of all patients initially presenting with both primary and metastatic disease. While the major events in the metastatic cascade have been identified, a mechanistic understanding of how NSCLC routinely and successfully colonizes the brain is largely unknown. Recent studies have begun demonstrating the role of epigenetic misregulation during tumorigenesis and metastasis, including widespread changes in DNA methylation and histone modifications. To better understand the role of altered DNA methylation in NSCLC metastasis to the brain, we measured DNA methylation during disease progression for 12 patients, globally profiling the methylation status of normal lung, primary lung tumor, and brain metastasis samples. The variation in methylation was similar during metastatic spread and primary tumorigenesis but less coordinated across genomic features during metastasis. The greatest recurrent changes during metastatic progression were methylation gains in DNA methylation valleys (DMV) harboring the constitutive heterochromatin mark H3K9me3 as well as bivalent marks H3K27me3 and H3K4me1. In a lymph node-derived cancer cell line, EZH2 binding within DMVs was lost, accompanied by an increase in DNA methylation, exemplifying epigenetic switching. The vast majority of the differentially methylated region-associated DMVs harbored developmental genes, suggesting that altered epigenetic regulation of developmentally important genes may confer a selective advantage during metastatic progression. The characterization of epigenetic changes during NSCLC brain metastasis identified recurrent methylation patterns that may be prognostic biomarkers and contributors to disease progression. SIGNIFICANCE Altered DNA methylation in lung cancer brain metastases corresponds with loss of EZH2 occupancy at developmental genes, which could promote stem-like phenotypes permissive of dissemination and survival in different microenvironments.
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Affiliation(s)
- Jennifer A. Karlow
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Current address: Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Current address: Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Siddhartha Devarakonda
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Xiaoyun Xing
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Hyo Sik Jang
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Current address: Department of Epigenetics, Van Andel Institute, Grand Rapids, MI 49503, USA
| | - Ramaswamy Govindan
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mark Watson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ting Wang
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO 63108, USA
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14
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Villalona-Calero MA, Patnaik A, Maki RG, O'Neil B, Abbruzzese JL, Dagogo-Jack I, Devarakonda S, Wahlroos S, Lin CC, Fujiwara Y, Terbuch A, Postel-Vinay S, Goebeler ME, Addeo A, Prenen H, Arkenau T, Sacher AG, Liu C, Kormany W, Rodon Ahnert J. Design and rationale of a phase 1 dose-escalation study of AMG 193, a methylthioadenosine (MTA)-cooperative PRMT5 inhibitor, in patients with advanced methylthioadenosine phosphorylase (MTAP)-null solid tumors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps3167] [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
TPS3167 Background: Protein arginine methyltransferase 5 (PRMT5) is an emerging target for cancer treatment. MTAP homozygous deletion occurs in 15% of cancers and often coincides with deletion of the tumor suppressor gene CDKN2A, leading to buildup of its substrate MTA. MTA shares close structural similarity to S-adenosyl methionine (SAM), the substrate methyl donor for PRMT5. By competing with SAM, MTA partially inhibits PRMT5. Thus, MTAP-null cancers are susceptible to further PRMT5 inhibition (Kryukov Science 2016). Current direct/indirect PRMT5 inhibitors (PRMT5i) showed preliminary anticancer activity, albeit with considerable toxicities due to their indiscriminate activities. AMG 193 is an MTA-cooperative PRMT5i that preferentially targets the MTA-bound state of PRMT5 that is enriched in MTAP-null tumors and represents a novel strategy to increase the therapeutic margin of this class of inhibitors. AMG 193 potently inhibits MTAP-null cancer cell lines and patient-derived xenografts. Methods: NCT05094336 is a first-in-human (FIH), multicenter, open-label, phase 1/1b/2 trial evaluating the safety, tolerability, pharmacokinetics (PK), pharmacodynamics, and efficacy of AMG 193 in patients with advanced MTAP-null solid tumors. Eligible patients (≥ 18 years) with histologically confirmed locally advanced/metastatic solid tumors not amenable to curative treatment with surgery and/or radiation, homozygous MTAP and/or CDKN2A deletion (by local next generation sequencing), or MTAP protein loss in tumors (by central immunohistochemistry), measurable disease, ECOG PS 0‒1, adequate hematopoietic, renal, liver, pulmonary, cardiac, coagulation function and glucose control will be included. The study will be conducted in 3 parts, each with subparts. Here, we describe Part 1a/b (dose exploration). Five dose levels are planned. Treatment continues until progression or withdrawal. The primary objectives are to evaluate the safety and tolerability of AMG 193 monotherapy; endpoints include dose-limiting toxicities, treatment-emergent adverse events, serious adverse events, electrocardiograms, laboratory abnormalities, and vital signs. Secondary objectives include the characterization of the PK parameters of AMG 193 including Cmax, Tmax, and AUC after single or multiple doses. This study is expected to enroll approximately 30 patients in Part 1a/b. This is the first FIH trial open for enrollment for this new class of PRMT5i and enrollment is ongoing. Clinical trial information: NCT05094336.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chia-Chi Lin
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | - Maria-Elisabeth Goebeler
- Translational Oncology/Early Clinical Trial Unit (ECTU), Medizinische Klinik II, University Hospital Würzburg, Würzburg, Germany
| | | | - Hans Prenen
- University Hospital Antwerp (UZ Antwerp), Antwerp, Belgium
| | - Tobias Arkenau
- Sarah Cannon Research Institute UK Limited, London, United Kingdom
| | - Adrian G. Sacher
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Singareddy A, Flanagan ME, Samson PP, Waqar SN, Devarakonda S, Ward JP, Herzog B, Rohatgi A, Robinson CG, Govindan R, Puri V, Morgensztern D. Trends in stage I lung cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10508] [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
10508 Background: The American Cancer Society has recently reported an increase in the percentage of patients with localized lung cancer from 2004 to 2018 with a corresponding improvement in survival for all patients combined. We analyzed the recent trends in stage distribution for lung cancer including tumor and demographic factors. Methods: We selected patients with lung cancer from the National Cancer Database (NCDB) public benchmark report diagnosed between 2010 and 2017. Patients with unknown stage were excluded. Stage distribution using the AJCC 7th edition of the TNM system was evaluated according to year of diagnosis, histology, age, gender, race, insurance and income. Results: Among the 1,447,470 patients from 1,384 hospitals identified in the database, 56,382 (3.9%) were excluded due to unknown stage or incorrect histology, leaving 1,391,088 patients eligible. The percentage of patients with stage I progressively increased from 23.5% in 2010 to 29.1% in 2017 while stage IV decreased from 45.5% to 43.1% during the same period (Table). The increased in percentages of stage I from 2010 to 2017 were 25.9% to 31.8% in non-small cell lung cancer (NSCLC) and 5.0% to 5.4% in small cell lung cancer (SCLC). Although the increased percentage of stage I lung cancer was observed in all subsets of patients, there were significant imbalances according to demographic and socio-economic factors. In the year 2017, the major gaps in stage I included insurance (31.4% for Medicare, 26.4% for private insurance, and 12.9% for uninsured), income (32.4% for the highest annual income and 25.4% for the lowest) and race (29.9% in whites and 24.3% in blacks). Conclusions: There has been a significant increase in the percentage of stage I lung cancer at diagnosis from 2010 to 2017 which occurred mostly in NSCLC. Disparities in diagnosis and access to treatment may account for the differences in the percentage of patients with stage I among selected demographic populations. The staging trends and recent treatment improvements may lead to better survival for lung cancer. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Jeffrey P. Ward
- Barnes-Jewish Hospital/Washington University in St. Louis, St. Louis, MO
| | - Brett Herzog
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | - Varun Puri
- Washington University School of Medicine, St. Louis, MO
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16
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Dumbrava EE, Hanna GJ, Cote GM, Stinchcombe T, Johnson ML, Chen C, Devarakonda S, Shah N, Xu F, Doebele RC, Gounder MM. A phase 2 study of the MDM2 inhibitor milademetan in patients with TP53-wild type and MDM2-amplified advanced or metastatic solid tumors (MANTRA-2). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps3165] [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
TPS3165 Background: Murine double minute 2 (MDM2) is a potent negative regulator of the tumor suppressor p53. MDM2 induces degradation of p53 and promotes tumorigenesis in solid tumors, and preclinical models have shown that inhibition of MDM2 can restore p53 tumor suppressor activity in TP53-wild type (WT), MDM2-amplified tumors. We performed a mutual exclusivity analysis of patients with solid tumors (n = 42,125; AACR Project GENIE) and found that the frequency of co-occurring TP53 mutations decreased with increasing MDM2 copy number. An MDM2 copy number of 12 was chosen as the threshold. An estimated 1.1% of solid tumors meet this molecular criteria, excluding glioblastomas, dedifferentiated liposarcomas, and intimal sarcomas where this signature is enriched. Milademetan (RAIN-32), an oral, selective MDM2 inhibitor, inhibits growth of TP53-WT/ MDM2-amplified cell lines and patient-derived xenograft models from varying tumor types. Furthermore, tumor regression was observed in 3/3 non-liposarcoma patients with MDM2 copy number > 12 in a phase 1 trial of milademetan. MANTRA-2 (RAIN-3202) is a phase 2, multicenter, single-arm, open-label, basket trial designed to evaluate the efficacy or clinical benefit of milademetan in TP53-WT solid tumors with MDM2 amplification (copy number ≥ 12). Methods: Eligible patients must be ≥ 18 years of age with histologically and/or cytologically confirmed locally advanced, incurable or metastatic solid tumors refractory to standard therapy. Local testing demonstrating TP53 WT and MDM2 amplification is required, defined as a MDM2 copy number ≥ 12 or 6-fold increase. Patients with well-differentiated/de-differentiated liposarcomas, intimal sarcomas, or primary central nervous system tumors are excluded. Prior treatment with an MDM2 inhibitor is not permitted. Patients receive milademetan 260 mg orally once daily on Days 1–3 and 15–17 of a 28-day cycle. Tumor response is evaluated by RECIST v1.1 at Weeks 8, 16, 24, and 32, and then every 12 weeks. Primary endpoint: objective response rate. Secondary endpoints include: duration of response; progression-free survival; growth modulation index; disease control rate; overall survival; safety; health-related quality of life scores. Exploratory endpoints include: biomarkers in blood and/or tumor tissue; pharmacodynamics; pharmacokinetics. Enrollment of 65 patients is planned to ensure that 57 patients have centrally confirmed TP53 WT and MDM2 copy number ≥ 12. The trial opened in November 2021 and is actively enrolling patients. Clinical trial information: NCT05012397.
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Affiliation(s)
| | | | | | - Tom Stinchcombe
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC
| | | | | | | | | | - Feng Xu
- Rain Therapeutics, Inc., Newark, CA
| | | | - Mrinal M. Gounder
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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17
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Michuda J, Park BH, Cummings AL, Devarakonda S, O'Neil B, Islam S, Parsons J, Ben-Shachar R, Breschi A, Blackwell KL, Chen JL, Dudley J, Stumpe M, Guinney J, Cohen EE. Use of clinical RNA-sequencing in the detection of actionable fusions compared to DNA-sequencing alone. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3077] [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
3077 Background: While targeted DNA-seq can detect clinically actionable fusions in tumor tissue samples, technical and analytical challenges may give rise to false negatives. RNA-based, whole-exome sequencing provides a complementary method for fusion detection, and may improve the identification of actionable variants. In this study, we quantify this benefit using a large, real-world clinical dataset to assess actionable fusions detected from RNA in conjunction with DNA profiling. Methods: Using the Tempus Research Database, we retrospectively analyzed a de-identified dataset of ̃80K samples (77.4K patients) profiled with the Tempus xT assay (both DNA-seq with fusion detection in 21 genes and whole exome capture RNA-seq). Only patients that had successful RNA- and DNA-seq were included. Fusions were detected using the Tempus bioinformatic and clinical workflow. Candidate fusions were filtered based on read support thresholds, fusion annotation ( i.e., breakpoints, reading frame, conserved domains), and manual review. OncoKB was used to select fusion alterations in levels 1 and 2 and to identify those indication-matched to targeted therapies. Results: We identified 2118 level 1 and 2 fusion events across 1945 patients across 20 different cancer types. Most fusions were observed in non-small cell lung cancer (NSCLC) (25%) and biliary cancer (9%) samples. Of the 2118 fusion events, 29.1% (616) were detected only through RNA-seq while 4.8% (101) of the events were identifiable only through DNA-seq. Notably, 69.4% of fusions in low-grade glioma and 58.2% in sarcomas were detected only by RNA-seq. When evaluating specific gene fusion events, RNA-seq consistently improved the detection of fusions compared to DNA-seq alone (Table) across all cancer types. A total of 1106 fusions were classified as targetable by OncoKB indication-matched therapies with 19% (214) of these identifiable through RNA-seq alone, 5% (54) by DNA-seq alone, and 76% (838) identifiable through RNA- and DNA-seq. Overall, fusions identified through RNA-seq alone led to a 24% increase in the number of patients who were eligible to receive matched therapies (214 / 892). This included imatinib for patients with CML/BLCL (69.8%), crizotinib for NSCLC (40.3%) and entrectinib for NTRK and ROS1 fusions (32.5%). Conclusions: The addition of RNA-seq to DNA-seq significantly increased the detection of fusion events and ability to match patients to targeted therapies. Results support consideration of combined RNA-DNA-seq for standard-of-care fusion calling. [Table: see text]
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Affiliation(s)
| | - Ben Ho Park
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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18
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Sproat MR, Hofherr ML, Devarakonda S. Successful use of Sotorasib in a Patient with End-Stage Renal Disease on Dialysis with Metastatic Lung Adenocarcinoma: A Case Report. Clin Lung Cancer 2022; 23:e339-e341. [DOI: 10.1016/j.cllc.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
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19
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Knapp B, Mezquita L, Devarakonda S, Aldea M, Waqar SN, Pepin K, Ward JP, Botticella A, Howarth K, Knape C, Morris C, Govindan R, Besse B, Morgensztern D. Exploring the Feasibility of Utilizing Limited Gene Panel Circulating Tumor DNA Clearance as a Biomarker in Patients With Locally Advanced Non-Small Cell Lung Cancer. Front Oncol 2022; 12:856132. [PMID: 35419282 PMCID: PMC9000093 DOI: 10.3389/fonc.2022.856132] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/28/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Circulating tumor DNA (ctDNA) testing may identify patients at high risk for recurrence following chemoradiation (CRT) for locally advanced non-small cell lung cancer (LA-NSCLC). We evaluated the feasibility of ctDNA testing on a readily available commercial fixed-gene panel to predict outcomes in patients with LA-NSCLC. Methods Plasma of 43 patients was collected at CRT initiation (pre-CRT), completion (post-CRT1), quarterly follow up for 12 months (post-CRT2, 3, 4, 5 respectively) after CRT, and at disease progression. ctDNA analysis was performed using InVisionFirst®-Lung to detect mutations in 36 cancer-related genes. ctDNA clearance was defined as absence of pre-CRT variants at post-CRT1. Patients without detectable pre-CRT variants or no post-CRT1 samples were excluded. Results Twenty eight of 43 patients (65%) had detectable variants pre-CRT. Nineteen of 43 patients (44%) had detectable pre-CRT variants and post-CRT1 samples and were included in analysis. Median age at diagnosis was 65 years (43-82), and most patients had stage IIIB disease (10/19, 53%). Two patients died from non-cancer related causes before post-CRT2 and were excluded from further analysis. All three patients who did not clear ctDNA had tumor relapse with a median time to relapse of 74 days (30-238), while 50% (7/14) of those who cleared ctDNA have remained disease free. Progression free survival was longer in patients who cleared ctDNA compared to those who did not (median 567 vs 74 d, p = 0.01). Conclusions Although it is feasible to use ctDNA testing on a limited gene panel to identify patients with LA-NSCLC who are at high risk for disease recurrence following CRT, further studies will be necessary to optimize these assays before they can be used to inform clinical care in patients with lung cancer.
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Affiliation(s)
- Brendan Knapp
- Department of Medicine, Division of General Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Laura Mezquita
- Medical Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Siddhartha Devarakonda
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Mihaela Aldea
- Medical Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Saiama N Waqar
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Kym Pepin
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeffrey P Ward
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Angela Botticella
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Karen Howarth
- Department of Clinical Genomics, Inivata Limited, Cambridge, United Kingdom
| | - Charlene Knape
- Inivata Inc, Research Triangle Park, Durham, NC, United States
| | - Clive Morris
- Department of Clinical Genomics, Inivata Limited, Cambridge, United Kingdom
| | - Ramaswamy Govindan
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Benjamin Besse
- Medical Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Daniel Morgensztern
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, United States
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20
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Bagegni NA, Park H, Kraft K, O-Toole M, Gao F, Waqar SN, Ratner L, Morgensztern D, Devarakonda S, Amin M, Baggstrom MQ, Liang C, Selvaggi G, Wang-Gillam A. Phase 1b trial of anti-VEGF/PDGFR vorolanib combined with immune checkpoint inhibitors in patients with advanced solid tumors. Cancer Chemother Pharmacol 2022; 89:487-497. [PMID: 35247086 PMCID: PMC8956523 DOI: 10.1007/s00280-022-04406-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/31/2022] [Indexed: 12/30/2022]
Abstract
Purpose Vorolanib is a multi-target tyrosine kinase inhibitor with anti-angiogenic properties. This study aimed to evaluate the tolerability, safety and efficacy of vorolanib when added to checkpoint inhibitors (CPIs) in patients with advanced solid tumors. Methods We conducted a phase 1b study of vorolanib (300 or 400 mg orally once daily) plus pembrolizumab or nivolumab using a standard 3 + 3 design to determine the dose-limiting toxicity (DLT), maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D). The endpoints included safety, toxicity and objective response rate, according to Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1). Results Sixteen patients (9 in pembrolizumab arm, 7 in nivolumab arm) with gastrointestinal or lung cancers were enrolled. All patients had at least 1 treatment-related adverse event (TRAE). The most common TRAEs across all cohorts were lymphopenia (n = 7), leukopenia (n = 5), fatigue (n = 5), and alanine aminotransferase elevation (n = 5); most toxicities were grade (G) 1–2. DLTs were reported in 3 patients at vorolanib 400 mg dose level, with G3 aspartate aminotransferase elevation, G3 rectal hemorrhage, and G3 rash. Of 13 total response-evaluable patients, 2 patients had confirmed partial responses (1 rectal squamous cell cancer and 1 small cell lung cancer). Two patients achieved prolonged stable disease. Vorolanib 300 mg daily was determined to be the RP2D for either pembrolizumab or nivolumab. Conclusion Combination vorolanib 300 mg orally once daily plus CPI appears to be a feasible regimen with manageable toxicity and promising efficacy in select tumor types. NCT03511222. Date of Registration: April 18, 2018.
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Affiliation(s)
- Nusayba A Bagegni
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Haeseong Park
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Katlyn Kraft
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Maura O-Toole
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Feng Gao
- Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Saiama N Waqar
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Lee Ratner
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Daniel Morgensztern
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Siddhartha Devarakonda
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Manik Amin
- Division of Hematology/Oncology, Dartmouth Giesel School of Medicine, Hanover, NH, USA
| | - Maria Q Baggstrom
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Chris Liang
- Xcovery Holdings, Inc., North Palm Beach, USA
| | | | - Andrea Wang-Gillam
- Division of Oncology, Washington University in St. Louis School of Medicine, St Louis, MO, USA.
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21
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Devarakonda S, Wu N, Sankararaman S, Govindan R. Reply to G. Bi et al. J Clin Oncol 2022; 40:1260. [PMID: 35188825 DOI: 10.1200/jco.21.02945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Siddhartha Devarakonda
- Siddhartha Devarakonda, MD, Division of Oncology, Washington University School of Medicine, St Louis, MO, Siteman Cancer Center, St Louis, MO; Ningying Wu, MD, PhD, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO; Sumithra Sankararaman, PhD, Division of Oncology, Washington University School of Medicine, St Louis, MO; and Ramaswamy Govindan, MD, Division of Oncology, Washington University School of Medicine, St Louis, MO, Siteman Cancer Center, St Louis, MO
| | - Ningying Wu
- Siddhartha Devarakonda, MD, Division of Oncology, Washington University School of Medicine, St Louis, MO, Siteman Cancer Center, St Louis, MO; Ningying Wu, MD, PhD, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO; Sumithra Sankararaman, PhD, Division of Oncology, Washington University School of Medicine, St Louis, MO; and Ramaswamy Govindan, MD, Division of Oncology, Washington University School of Medicine, St Louis, MO, Siteman Cancer Center, St Louis, MO
| | - Sumithra Sankararaman
- Siddhartha Devarakonda, MD, Division of Oncology, Washington University School of Medicine, St Louis, MO, Siteman Cancer Center, St Louis, MO; Ningying Wu, MD, PhD, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO; Sumithra Sankararaman, PhD, Division of Oncology, Washington University School of Medicine, St Louis, MO; and Ramaswamy Govindan, MD, Division of Oncology, Washington University School of Medicine, St Louis, MO, Siteman Cancer Center, St Louis, MO
| | - Ramaswamy Govindan
- Siddhartha Devarakonda, MD, Division of Oncology, Washington University School of Medicine, St Louis, MO, Siteman Cancer Center, St Louis, MO; Ningying Wu, MD, PhD, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO; Sumithra Sankararaman, PhD, Division of Oncology, Washington University School of Medicine, St Louis, MO; and Ramaswamy Govindan, MD, Division of Oncology, Washington University School of Medicine, St Louis, MO, Siteman Cancer Center, St Louis, MO
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22
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Blumenschein GR, Devarakonda S, Johnson M, Moreno V, Gainor J, Edelman MJ, Heymach JV, Govindan R, Bachier C, Doger de Spéville B, Frigault MJ, Olszanski AJ, Lam VK, Hyland N, Navenot JM, Fayngerts S, Wolchinsky Z, Broad R, Batrakou D, Pentony MM, Sanderson JP, Gerry A, Marks D, Bai J, Holdich T, Norry E, Fracasso PM. Phase I clinical trial evaluating the safety and efficacy of ADP-A2M10 SPEAR T cells in patients with MAGE-A10 + advanced non-small cell lung cancer. J Immunother Cancer 2022; 10:jitc-2021-003581. [PMID: 35086946 PMCID: PMC8796260 DOI: 10.1136/jitc-2021-003581] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background ADP-A2M10 specific peptide enhanced affinity receptor (SPEAR) T cells (ADP-A2M10) are genetically engineered autologous T cells that express a high-affinity melanoma-associated antigen A10 (MAGE-A10)-specific T-cell receptor (TCR) targeting MAGE-A10+ tumors in the context of human leukocyte antigen (HLA)-A*02. ADP-0022-003 was a phase I dose-escalation trial that aimed to evaluate the safety and antitumor activity of ADP-A2M10 in non-small cell lung cancer (NSCLC) (NCT02592577). Methods Eligible patients were HLA-A*02 positive with advanced NSCLC expressing MAGE-A10. Patients underwent apheresis; T cells were isolated, transduced with a lentiviral vector containing the TCR targeting MAGE-A10, and expanded. Patients underwent lymphodepletion with varying doses/schedules of fludarabine and cyclophosphamide prior to receiving ADP-A2M10. ADP-A2M10 were administered at 0.08–0.12×109 (dose group 1), 0.5–1.2×109 (dose group 2), and 1.2–15×109 (dose group 3/expansion) transduced cells. Results Eleven patients (male, n=6; female, n=5) with NSCLC (adenocarcinoma, n=8; squamous cell carcinoma, n=3) were treated. Five, three, and three patients received cells in dose group 1, dose group 2, and dose group 3/expansion, respectively. The most frequently reported grade ≥3 adverse events were lymphopenia (n=11), leukopenia (n=10), neutropenia (n=8), anemia (n=6), thrombocytopenia (n=5), and hyponatremia (n=5). Three patients presented with cytokine release syndrome (grades 1, 2, and 4, respectively). One patient received the highest dose of lymphodepletion (fludarabine 30 mg/m2 on days –5 to –2 and cyclophosphamide 1800 mg/m2 on days −5 to −4) prior to a second infusion of ADP-A2M10 and had a partial response, subsequently complicated by aplastic anemia and death. Responses included: partial response (after second infusion; one patient), stable disease (four patients), clinical or radiographic progressive disease (five patients), and not evaluable (one patient). ADP-A2M10 were detectable in peripheral blood and in tumor tissue. Peak persistence was higher in patients who received higher doses of ADP-A2M10. Conclusions ADP-A2M10 demonstrated an acceptable safety profile and no evidence of toxicity related to off-target binding or alloreactivity. There was persistence of ADP-A2M10 in peripheral blood as well as ADP-A2M10 trafficking into the tumor. Given the discovery that MAGE-A10 and MAGE-A4 expression frequently overlap, this clinical program closed as trials with SPEAR T cells targeting MAGE-A4 are ongoing.
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Affiliation(s)
- George R Blumenschein
- Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Melissa Johnson
- Lung Cancer Research and Drug Development, Sarah Cannon Research Institute at Tennessee Oncology, Nashville, Tennessee, USA
| | - Victor Moreno
- START Madrid-FJD, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Justin Gainor
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Martin J Edelman
- Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - John V Heymach
- Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ramaswamy Govindan
- Medical Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Carlos Bachier
- Hematology, Sarah Cannon Center for Blood Cancer at TriStar Centennial, Nashville, Tennessee, USA
| | | | - Matthew J Frigault
- Bone Marrow Transplant & Cellular Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony J Olszanski
- Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Vincent K Lam
- Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | - Robyn Broad
- Adaptimmune, Milton Park, Abingdon, Oxfordshire, UK
| | | | | | | | - Andrew Gerry
- Adaptimmune, Milton Park, Abingdon, Oxfordshire, UK
| | - Diane Marks
- Adaptimmune, Philadelphia, Pennsylvania, USA
| | - Jane Bai
- Adaptimmune, Philadelphia, Pennsylvania, USA
| | - Tom Holdich
- Adaptimmune, Milton Park, Abingdon, Oxfordshire, UK
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23
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Devarakonda S, Li Y, Martins Rodrigues F, Sankararaman S, Kadara H, Goparaju C, Lanc I, Pepin K, Waqar SN, Morgensztern D, Ward J, Masood A, Fulton R, Fulton L, Gillette MA, Satpathy S, Carr SA, Wistuba I, Pass H, Wilson RK, Ding L, Govindan R. Genomic Profiling of Lung Adenocarcinoma in Never-Smokers. J Clin Oncol 2021; 39:3747-3758. [PMID: 34591593 PMCID: PMC8601276 DOI: 10.1200/jco.21.01691] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 07/09/2021] [Revised: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Approximately 10%-40% of patients with lung cancer report no history of tobacco smoking (never-smokers). We analyzed whole-exome and RNA-sequencing data of 160 tumor and normal lung adenocarcinoma (LUAD) samples from never-smokers to identify clinically actionable alterations and gain insight into the environmental and hereditary risk factors for LUAD among never-smokers. METHODS We performed whole-exome and RNA-sequencing of 88 and 69 never-smoker LUADs. We analyzed these data in conjunction with data from 76 never-smoker and 299 smoker LUAD samples sequenced by The Cancer Genome Atlas and Clinical Proteomic Tumor Analysis Consortium. RESULTS We observed a high prevalence of clinically actionable driver alterations in never-smoker LUADs compared with smoker LUADs (78%-92% v 49.5%; P < .0001). Although a subset of never-smoker samples demonstrated germline alterations in DNA repair genes, the frequency of samples showing germline variants in cancer predisposing genes was comparable between smokers and never-smokers (6.4% v 6.9%; P = .82). A subset of never-smoker samples (5.9%) showed mutation signatures that were suggestive of passive exposure to cigarette smoke. Finally, analysis of RNA-sequencing data showed distinct immune transcriptional subtypes of never-smoker LUADs that varied in their expression of clinically relevant immune checkpoint molecules and immune cell composition. CONCLUSION In this comprehensive genomic and transcriptome analysis of never-smoker LUADs, we observed a potential role for germline variants in DNA repair genes and passive exposure to cigarette smoke in the pathogenesis of a subset of never-smoker LUADs. Our findings also show that clinically actionable driver alterations are highly prevalent in never-smoker LUADs, highlighting the need for obtaining biopsies with adequate cellularity for clinical genomic testing in these patients.
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Affiliation(s)
- Siddhartha Devarakonda
- Division of Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, St Louis, MO
| | - Yize Li
- Division of Oncology, Washington University School of Medicine, St Louis, MO
- McDonnell Genome Institute, St Louis, MO
- Division of Biological and Biomedical Sciences, Washington University in St Louis, St Louis, MO
| | - Fernanda Martins Rodrigues
- Division of Oncology, Washington University School of Medicine, St Louis, MO
- McDonnell Genome Institute, St Louis, MO
- Division of Biological and Biomedical Sciences, Washington University in St Louis, St Louis, MO
| | | | | | | | | | - Kymberlie Pepin
- Division of Oncology, Washington University School of Medicine, St Louis, MO
| | - Saiama N. Waqar
- Division of Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, St Louis, MO
| | - Daniel Morgensztern
- Division of Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, St Louis, MO
| | - Jeffrey Ward
- Division of Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, St Louis, MO
| | | | | | | | - Michael A. Gillette
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Shankha Satpathy
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Steven A. Carr
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | | | - Harvey Pass
- New York University Langone Medical Center, New York, NY
| | | | - Li Ding
- Division of Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, St Louis, MO
- McDonnell Genome Institute, St Louis, MO
- Department of Genetics, Washington University in St Louis, St Louis, MO
- Department of Medicine, Washington University in St Louis, St Louis, MO
| | - Ramaswamy Govindan
- Division of Oncology, Washington University School of Medicine, St Louis, MO
- Siteman Cancer Center, St Louis, MO
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Devarakonda S, Narayanan S, Lingamdenne PE, Kandasamy S, Korula PJ. 1063 Incidence, Risk Factors, and Outcomes of ARDS in Patients with SARS-CoV-2 Infection. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.491] [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: 11/13/2022]
Abstract
Abstract
Introduction
Many asymptomatic patients are diagnosed with SARS-CoV-2 infection on screening, which might alter their expected course of illness. We wanted to study the incidence, risk factors, and ARDS outcomes in these patients admitted to our ITU.
Method
A review of all admissions (medical, surgical, and obstetric) to our ITU from May to October 2020 was done after institutional ethics approval. Age, gender, comorbidities, admission diagnosis, APACHE II score, and in-hospital course were studied. ARDS was defined as PaO2/FiO2 ≤ 300 mmHg (with PEEP or CPAP ≥ 5 cmH2O) in the absence of cardiac failure or fluid overload. Data were analyzed using Statistical Package for Social Services (SPSS) software Version 21.0 (Armonk, NY: IBM Corp).
Results
Of the 832 cases, 119 (14.3%) had SARS-CoV-2 infection. 41 of 119 (34.4%) cases developed ARDS. Among the comorbidities studied, only hypertension (OR 2.6, 95% CI 1.0-6.2) seemed to increase ARDS odds. Patients with Severe Acute Respiratory Illness (SARI) had a higher incidence of ARDS when compared to the asymptomatic ones (P < .05). Patients with sepsis (OR 5.8, 95% CI 2.4-13.7) and APACHE II score ≥10 (OR 5, 95% CI 2.0-12.3) had higher odds of developing ARDS. Age, gender, trauma, and recent surgery did not seem to increase the risk of ARDS.
Conclusions
Even though COVID-19 patients admitted with SARI and sepsis are at a higher risk of developing ARDS, further research will be needed to predict the extent to which SARS-CoV-2 infection will influence the course of their illness.
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Affiliation(s)
| | | | | | | | - P J Korula
- Christian Medical College, Vellore, India
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Devarakonda S, Korula PJ, Kandasamy S. 744 A Quality Improvement Project on Timely Removal of Central Venous Catheters. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.748] [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: 11/13/2022]
Abstract
Abstract
Introduction
Central Line-Associated Blood Stream Infections are associated with high morbidity and mortality. It is essential to ensure quality in insertion, maintenance, and timely removal of central lines. Our ICU follows a protocol to remove unused lines after five days. We have an electronic alert system to monitor these lines, and we wanted to audit its usage and improve its efficacy.
Method
This project was designed using QI methodology and was carried out in a Level III Surgical ICU. We implemented two PDSA cycles in August and December 2020. After the first cycle, an online survey was performed among ICU doctors to gauge their knowledge of the alert system and local protocols. Based on the above results, an educational session was carried out, showing a step-by-step guide to using the alert system, and a re-audit was done in December.
Results
The first cycle showed that alerts were created for only 17 (25%) of 68 lines. Also, the survey revealed that about 30% of doctors were unfamiliar with the alert system. After the intervention, adherence to the alert system increased to 65% (alerts for 41 of 63 lines). There was also a significant improvement in the mean number of central line days from 6.4 (SD = 3.1) to 4.2 (SD = 2.8) [P < .05].
Conclusions
It is crucial to monitor central lines, and simple educational sessions about local protocols can bring success in implementing sustainable change in quality. We suggest hospitals have systems to monitor the central lines and regularly audit their effectiveness.
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Affiliation(s)
| | - P J Korula
- Christian Medical College, Vellore, India
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26
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Devarakonda S, Pellini B, Verghese L, Park H, Morgensztern D, Govindan R, Suresh R, Oppelt P, Baggstrom MQ, Wu N, Waqar SN. A phase II study of everolimus in patients with advanced solid malignancies with TSC1, TSC2, NF1, NF2 or STK11 mutations. J Thorac Dis 2021; 13:4054-4062. [PMID: 34422335 PMCID: PMC8339787 DOI: 10.21037/jtd-21-195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/28/2021] [Indexed: 11/06/2022]
Abstract
Background Activation of the mTOR pathway has been implicated in the development of several malignancies and alterations in TSC1, TSC2, STK11 and NF1, can lead to the dysregulation of this pathway. Furthermore, mutations in TSC1 and NF2 are known to confer sensitivity to everolimus-an mTOR inhibitor. Based on these data, a single-arm, open label, single-institution phase II basket study was designed to assess the activity of everolimus in patients with solid malignancies whose tumors harbored mutations in TSC1, TSC2, NF1, NF2, or STK11. Methods A total of 12 patients with histologically confirmed diagnosis of advanced solid tumors (metastatic, recurrent, or unresectable) with mutations in TSC1, TSC2, NF1, NF2 or STK11 genes, who had failed at least one line of standard of care systemic therapy, were enrolled to this open label, single-arm study. Presence of mutations in TSC1, TSC2, NF1, NF2 or STK11 genes was assessed using targeted-next generation sequencing (NGS). All eligible patients were treated with everolimus at an initial dose of 10 mg orally once daily in cycles of 28 days. The primary endpoint of this study was overall response rate (ORR). Results Of 12 patients enrolled, 8 were evaluable for response at the end of 2 cycles. One complete response (CR) was observed (12.5%) and one patient (12.5%) had stable disease (SD), while six (75%) patients showed disease progression. Everolimus was overall well tolerated with anemia, decreased neutrophil and lymphocyte counts, peripheral edema and hyperglycemia representing the most common adverse events. One patient discontinued treatment due to a treatment related grade 4 pericardial effusion. Both patients with CR or SD had a diagnosis of lung adenocarcinoma with NF1 or STK11 mutations, respectively. Conclusions Although this study failed to meet its prespecified ORR threshold for success of 30% or higher, exploratory analyses suggest potential activity for everolimus in a subset of patients with lung adenocarcinomas with STK11 or NF1 mutations. Further studies are necessary to systematically explore the clinical activity of everolimus, potentially as a combination therapy, in these patients.
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Affiliation(s)
- Siddhartha Devarakonda
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Bruna Pellini
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Luke Verghese
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Haeseong Park
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel Morgensztern
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ramaswamy Govindan
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rama Suresh
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter Oppelt
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Maria Q Baggstrom
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ningying Wu
- Biostatistics Shared Resource, Public Health Science Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Saiama N Waqar
- Division of Medical Oncology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Herzog BH, Devarakonda S, Govindan R. Overcoming Chemotherapy Resistance in SCLC. J Thorac Oncol 2021; 16:2002-2015. [PMID: 34358725 DOI: 10.1016/j.jtho.2021.07.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 03/29/2021] [Revised: 07/09/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
SCLC is an aggressive form of lung cancer with a very poor prognosis. Although SCLC initially responds very well to platinum-based chemotherapy, it eventually recurs and at recurrence is nearly universally resistant to therapy. In light of the recent advances in understanding regarding the biology of SCLC, we review findings related to SCLC chemotherapy resistance. We discuss the potential clinical implications of recent preclinical discoveries in altered signaling pathways, transcriptional landscapes, metabolic vulnerabilities, and the tumor microenvironment.
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Affiliation(s)
- Brett H Herzog
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Alvin J Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Siddhartha Devarakonda
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Alvin J Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Ramaswamy Govindan
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Alvin J Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.
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Singareddy A, Waqar SN, Devarakonda S, Ward JP, Govindan R, Robinson C, Morgensztern D, Samson PP. Cause of death among patients with non-small cell lung cancer treated with postoperative radiation therapy (PORT). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e20555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
e20555 Background: The indications for post-operative radiation therapy (PORT) in locally advanced non-small cell lung cancer (NSCLC) remain undefined and a major concern is the perceived risk of increased mortality from cardiopulmonary causes. The purpose of this study was to quantify the rate of cardiopulmonary death in patients with resected NSCLC receiving PORT using a large national database. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database for lung cancer, patients with Stage IIIA or Stage IIIB NSCLC according to the 6th AJCC edition treated with surgery followed by PORT, who also received chemotherapy were identified. Cause of death was categorized as due to lung cancer, other cancer, cardiac, pulmonary, or other and reported as a percentage of total deaths at one and 2 years. Kaplan-Meier survival analysis was done to compare overall survival between Stage IIIA and IIIB patients. Results: From 2004 to 2015, 4387 patients with stage IIIA and IIIB meeting the eligibility criteria were identified. The median age at diagnosis was 65 years old, most patients were male (53%), Caucasian (83%), had adenocarcinoma (54.8%), stage IIIA disease (69%), and N2 disease (78%). The median overall survival for Stage IIIA and IIIB patients was 39 months and 27 months respectively (p < 0.001). Among the 2586 patients that died during the study period, the most common COD was lung cancer (81.3%). Cardiac and pulmonary COD occurred in 86 patients (3.3% of deaths) and 84 patients (3.2% of deaths) respectively, whereas 158 patients (6.1%) died from other cancers and 154 (5.9%) from other causes. There were 77 deaths from cardiopulmonary cause at 2 years (1.7% of patients and 2.9% of deaths). Cardiopulmonary COD was more common in patients with stage IIIB compared to IIIA disease (4.9% vs 3.3% of deaths, p < 0.001). Lung cancer was the most common COD both at 1 and 2 years (85%) whereas cardiopulmonary was the COD in 5.2% of patients at 1 year and 5.1% at 2 years. Conclusions: This analysis showed a low cardiopulmonary mortality from PORT in the first 2 years. The role for adjuvant radiotherapy remains undefined and treatment decisions for patients with resected stage III NSCLC should be guided by co-morbidities and the competing risk for death from lung cancer.
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Affiliation(s)
| | | | | | - Jeffrey P. Ward
- Barnes-Jewish Hospital/Washington University in St. Louis, St. Louis, MO
| | | | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, Saint Louis, MO
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Pellini B, Hasan S, Samson P, Earland N, Ward J, Waqar S, Baggstrom M, Robinson C, Govindan R, Devarakonda S, Morgensztern D. P49.03 Chemoradiation with Cisplatin-Etoposide versus Carboplatin-Etoposide in Limited-Stage Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Antao N, Samson P, Pellini B, Waqar S, Devarakonda S, Ward J, Govindan R, Morgensztern D. P09.26 Cause of Death in Patients with Squamous Cell Lung Cancer (SCC) Treated with Surgery. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Knapp B, Mezquita L, Devarakonda S, Aldea M, Waqar S, Pepin K, Ward J, Botticella A, Howarth K, Knape C, Morris C, Govindan R, Besse B, Morgensztern D. FP07.11 Circulating Tumor DNA (ctDNA) Clearance as a Biomarker in Patients With Locally Advanced NSCLC Following Chemoradiation. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Carrot-Zhang J, Yao X, Devarakonda S, Deshpande A, Damrauer JS, Silva TC, Wong CK, Choi HY, Felau I, Robertson AG, Castro MA, Bao L, Rheinbay E, Liu EM, Trieu T, Haan D, Yau C, Hinoue T, Liu Y, Shapira O, Kumar K, Mungall KL, Zhang H, Lee JJK, Berger A, Gao GF, Zhitomirsky B, Liang WW, Zhou M, Moorthi S, Berger AH, Collisson EA, Zody MC, Ding L, Cherniack AD, Getz G, Elemento O, Benz CC, Stuart J, Zenklusen J, Beroukhim R, Chang JC, Campbell JD, Hayes DN, Yang L, Laird PW, Weinstein JN, Kwiatkowski DJ, Tsao MS, Travis WD, Khurana E, Berman BP, Hoadley KA, Robine N, Meyerson M, Govindan R, Imielinski M. Whole-genome characterization of lung adenocarcinomas lacking alterations in the RTK/RAS/RAF pathway. Cell Rep 2021; 34:108784. [PMID: 33626341 PMCID: PMC8608252 DOI: 10.1016/j.celrep.2021.108784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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33
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Fung AS, Karimi M, Michiels S, Seymour L, Brambilla E, Le-Chevalier T, Soria JC, Kratzke R, Graziano SL, Devarakonda S, Govindan R, Tsao MS, Shepherd FA. Prognostic and predictive effect of KRAS gene copy number and mutation status in early stage non-small cell lung cancer patients. Transl Lung Cancer Res 2021; 10:826-838. [PMID: 33718025 PMCID: PMC7947394 DOI: 10.21037/tlcr-20-927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background In the current analysis, we characterize the prognostic significance of KRAS mutations with concomitant copy number aberrations (CNA) in early stage non-small cell lung cancer (NSCLC), and evaluate the ability to predict survival benefit from adjuvant chemotherapy. Methods Clinical and genomic data from the LACE (Lung Adjuvant Cisplatin Evaluation)-Bio consortium was utilized. CNAs were categorized as Gain (CN ≥2) or Neutral (Neut)/Loss; KRAS status was defined as wild type (WT) or mutant (MUT). The following groups were compared in all patients and the adenocarcinoma subgroup, and were correlated to survival endpoints using a Cox proportional hazards model: WT + Neut/Loss (reference), WT + Gain, MUT + Gain and MUT + Neut/Loss. A treatment-by-variable interaction was added to evaluate predictive effect. Results Of the 946 (399 adenocarcinoma) NSCLC patients, 41 [30] had MUT + Gain, 145 [99] MUT + Neut/Loss, 125 [16] WT + Gain, and 635 [254] WT + Neut/Loss. A non-significant trend towards worse lung cancer-specific survival (LCSS; HR =1.34; 95% CI, 0.83-2.17, P=0.232), DFS (HR =1.34; 95% CI, 0.86-2.09, P=0.202) and OS (HR =1.59; 95% CI, 0.99-2.54, P=0.055) was seen in KRAS MUT + Gain patients relative to KRAS WT + Neut/Loss patients. A negative prognostic effect of KRAS MUT + Neut/Loss was observed for LCSS (HR =1.32; 95% CI, 1.01-1.71, P=0.038) relative to KRAS WT + Neut/Loss on univariable analysis, but to a lesser extent after adjusting for covariates (HR =1.28; 95% CI, 0.97-1.68, P=0.078). KRAS MUT + Gain was associated with a greater beneficial effect of chemotherapy on DFS compared to KRAS WT + Neut/Loss patients (rHR =0.33; 95% CI, 0.11-0.99, P=0.048), with a non-significant trend also seen for LCSS (rHR =0.41; 95% CI, 0.13-1.33, P=0.138) and OS (rHR =0.40; 95% CI, 0.13-1.26, P=0.116) in the adenocarcinoma subgroup. Conclusions A small prognostic effect of KRAS mutation was identified for LCSS, and a trend towards worse LCSS, DFS and OS was noted for KRAS MUT + Gain. A potential predictive effect of concomitant KRAS mutation and copy number gain was observed for DFS in adenocarcinoma patients. These results could be driven by the small number of patients and require validation.
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Affiliation(s)
- Andrea S Fung
- Cancer Centre of Southeastern Ontario and Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Maryam Karimi
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, Villejuif, France
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, Villejuif, France
| | - Lesley Seymour
- Canadian Cancer Trials Group and Queen's University, Kingston, ON, Canada
| | - Elisabeth Brambilla
- Department of Pathology, Institut Albert Bonniot, Hopital Albert Michallon, Grenoble, France
| | | | - Jean-Charles Soria
- Institut Gustave Roussy, Department of Medical Oncology, Villejuif, France
| | - Robert Kratzke
- Department of Medical Oncology, University of Minnesota, Minneapolis, MN, USA
| | | | - Siddhartha Devarakonda
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ramaswamy Govindan
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, ON, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Medicine, Division of Medical Oncology, University Health Network, Toronto, ON, Canada
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34
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Carrot-Zhang J, Yao X, Devarakonda S, Deshpande A, Damrauer JS, Silva TC, Wong CK, Choi HY, Felau I, Robertson AG, Castro MAA, Bao L, Rheinbay E, Liu EM, Trieu T, Haan D, Yau C, Hinoue T, Liu Y, Shapira O, Kumar K, Mungall KL, Zhang H, Lee JJK, Berger A, Gao GF, Zhitomirsky B, Liang WW, Zhou M, Moorthi S, Berger AH, Collisson EA, Zody MC, Ding L, Cherniack AD, Getz G, Elemento O, Benz CC, Stuart J, Zenklusen JC, Beroukhim R, Chang JC, Campbell JD, Hayes DN, Yang L, Laird PW, Weinstein JN, Kwiatkowski DJ, Tsao MS, Travis WD, Khurana E, Berman BP, Hoadley KA, Robine N, Meyerson M, Govindan R, Imielinski M. Whole-genome characterization of lung adenocarcinomas lacking the RTK/RAS/RAF pathway. Cell Rep 2021; 34:108707. [PMID: 33535033 PMCID: PMC8009291 DOI: 10.1016/j.celrep.2021.108707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/08/2020] [Accepted: 01/08/2021] [Indexed: 12/13/2022] Open
Abstract
RTK/RAS/RAF pathway alterations (RPAs) are a hallmark of lung adenocarcinoma (LUAD). In this study, we use whole-genome sequencing (WGS) of 85 cases found to be RPA(-) by previous studies from The Cancer Genome Atlas (TCGA) to characterize the minority of LUADs lacking apparent alterations in this pathway. We show that WGS analysis uncovers RPA(+) in 28 (33%) of the 85 samples. Among the remaining 57 cases, we observe focal deletions targeting the promoter or transcription start site of STK11 (n = 7) or KEAP1 (n = 3), and promoter mutations associated with the increased expression of ILF2 (n = 6). We also identify complex structural variations associated with high-level copy number amplifications. Moreover, an enrichment of focal deletions is found in TP53 mutant cases. Our results indicate that RPA(-) cases demonstrate tumor suppressor deletions and genome instability, but lack unique or recurrent genetic lesions compensating for the lack of RPAs. Larger WGS studies of RPA(-) cases are required to understand this important LUAD subset.
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Affiliation(s)
- Jian Carrot-Zhang
- Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Xiaotong Yao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA; New York Genome Center, New York, NY, USA; Tri-institutional Ph.D. Program in Computational Biology and Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine and Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Siddhartha Devarakonda
- Section of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA; Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Aditya Deshpande
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA; New York Genome Center, New York, NY, USA; Tri-institutional Ph.D. Program in Computational Biology and Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine and Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey S Damrauer
- Department of Genetics, Computational Medicine Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tiago Chedraoui Silva
- Center for Bioinformatics and Functional Genomics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christopher K Wong
- Department of Biomolecular Engineering, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Hyo Young Choi
- University of Tennessee Health Science Center, UTHSC Center for Cancer Research, TN, USA
| | - Ina Felau
- National Cancer Institute, Bethesda, MD, USA
| | - A Gordon Robertson
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Mauro A A Castro
- Bioinformatics and Systems Biology Laboratory, Federal University of Paraná, Curitiba, PR, Brazil
| | - Lisui Bao
- Ben May Department for Cancer Research, University of Chicago, Chicago, IL, USA
| | - Esther Rheinbay
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Eric Minwei Liu
- Caryl and Israel Englander Institute for Precision Medicine and Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Tuan Trieu
- Caryl and Israel Englander Institute for Precision Medicine and Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - David Haan
- Department of Biomolecular Engineering, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Christina Yau
- University of California, San Francisco, San Francisco, CA, USA; Buck Institute for Research on Aging, Novato, CA, USA
| | | | - Yuexin Liu
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ofer Shapira
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kiran Kumar
- Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Karen L Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Hailei Zhang
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Ashton Berger
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Galen F Gao
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Binyamin Zhitomirsky
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Wen-Wei Liang
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO, USA
| | - Meng Zhou
- Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Alice H Berger
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Li Ding
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA; McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO, USA
| | - Andrew D Cherniack
- Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Gad Getz
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Olivier Elemento
- Tri-institutional Ph.D. Program in Computational Biology and Medicine, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine and Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | | | - Josh Stuart
- Department of Biomolecular Engineering, University of California, Santa Cruz, Santa Cruz, CA, USA
| | | | - Rameen Beroukhim
- Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jason C Chang
- Thoracic Pathology, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua D Campbell
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA, USA
| | - D Neil Hayes
- University of Tennessee Health Science Center, UTHSC Center for Cancer Research, TN, USA
| | - Lixing Yang
- Ben May Department for Cancer Research, University of Chicago, Chicago, IL, USA
| | | | - John N Weinstein
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Ming S Tsao
- Department of Pathology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - William D Travis
- Thoracic Pathology, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ekta Khurana
- Caryl and Israel Englander Institute for Precision Medicine and Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Benjamin P Berman
- Center for Bioinformatics and Functional Genomics, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University, Jerusalem, Israel
| | - Katherine A Hoadley
- Department of Genetics, Computational Medicine Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Matthew Meyerson
- Dana-Farber Cancer Institute, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Ramaswamy Govindan
- Section of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA; Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA.
| | - Marcin Imielinski
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA; New York Genome Center, New York, NY, USA; Caryl and Israel Englander Institute for Precision Medicine and Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
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Knapp BJ, Devarakonda S, Govindan R. Bone metastases in non-small cell lung cancer: a narrative review. J Thorac Dis 2021; 14:1696-1712. [PMID: 35693589 PMCID: PMC9186248 DOI: 10.21037/jtd-21-1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/17/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Brendan J. Knapp
- Division of General Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Siddhartha Devarakonda
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ramaswamy Govindan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Haspel RL, Genzen JR, Wagner J, Lockwood CM, Fong K, Adesina AM, Browning L, Chabot-Richards D, Cushman-Vokoun AM, D’Angelo AR, DeFrances MC, Devarakonda S, Fernandes H, Fernandez P, Gupta R, Hurwitz ME, Lindeman NI, Nobori A, Nohr E, Payton J, Saylor B, Sobel ME, Stringer KF, Vanderbilt CM, Young M, Adesina AM, Browning L, Chabot-Richards D, Cushman-Vokoun AM, D’Angelo AR, DeFrances MC, Devarakonda S, Fernandes H, Fernandez P, Gupta R, Hurwitz ME, Lindeman NI, Nobori A, Nohr E, Payton J, Saylor B, Sobel ME, Stringer KF, Vanderbilt CM, Young M. Integration of Genomic Medicine in Pathology Resident Training. Am J Clin Pathol 2020; 154:784-791. [PMID: 32696061 DOI: 10.1093/ajcp/aqaa094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/13/2022] Open
Abstract
OBJECTIVES To assess current pathology resident training in genomic and molecular pathology. METHODS The Training Residents in Genomics (TRIG) Working Group has developed survey questions for the pathology Resident In-Service Examination (RISE) since 2012. Responses to these questions, as well as knowledge questions, were analyzed. RESULTS A total of 2,529 residents took the 2019 RISE. Since 2013, there has been an increase in postgraduate year 4 (PGY4) respondents indicating training in genomic medicine (58% to approximately 80%) but still less than almost 100% each year for molecular pathology. In 2019, PGY4 residents indicated less perceived knowledge and ability related to both genomic and traditional molecular pathology topics compared with control areas. Knowledge question results supported this subjective self-appraisal. CONCLUSIONS The RISE is a powerful tool for assessing the current state and also trends related to resident training in genomic pathology. The results show progress but also the need for improvement in not only genomic pathology but traditional molecular pathology training as well.
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Affiliation(s)
- Richard L Haspel
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - Jay Wagner
- American Society for Clinical Pathology (ASCP), Chicago, IL
| | - Christina M Lockwood
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle
| | - Karen Fong
- American Society for Clinical Pathology (ASCP), Chicago, IL
| | - Adekunle M Adesina
- Department of Pathology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Devon Chabot-Richards
- Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque
| | | | - Alix R D’Angelo
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans
| | - Marie C DeFrances
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Helen Fernandes
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Pedro Fernandez
- Department of Anatomical Pathology, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Ruta Gupta
- NSW Health Pathology, Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Neal I Lindeman
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - Alexander Nobori
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA
| | - Erik Nohr
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Calgary, Canada
| | - Jaqueline Payton
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Benjamin Saylor
- Department of Pathology, University of Alabama at Birmingham
| | - Mark E Sobel
- American Society for Investigative Pathology, Bethesda, MD
| | - Keith F Stringer
- Department of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Chad M Vanderbilt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin Young
- Cytopathology Department, Royal Free Hospital, London, UK
| | - Adekunle M Adesina
- Department of Pathology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Devon Chabot-Richards
- Department of Pathology, TriCore Reference Laboratories and the University of New Mexico, Albuquerque
| | | | - Alix R D’Angelo
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans
| | - Marie C DeFrances
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Helen Fernandes
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Pedro Fernandez
- Department of Anatomical Pathology, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Ruta Gupta
- NSW Health Pathology, Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Neal I Lindeman
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - Alexander Nobori
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA
| | - Erik Nohr
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Calgary, Canada
| | - Jaqueline Payton
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Benjamin Saylor
- Department of Pathology, University of Alabama at Birmingham
| | - Mark E Sobel
- American Society for Investigative Pathology, Bethesda, MD
| | - Keith F Stringer
- Department of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Chad M Vanderbilt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin Young
- Cytopathology Department, Royal Free Hospital, London, UK
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Ireland AS, Micinski AM, Kastner DW, Guo B, Wait SJ, Spainhower KB, Conley CC, Chen OS, Guthrie MR, Soltero D, Qiao Y, Huang X, Tarapcsak S, Devarakonda S, Chalishazar MD, Gertz J, Moser JC, Marth G, Puri S, Witt BL, Spike BT, Oliver TG. Abstract PO-120: MYC drives temporal evolution of small cell lung cancer subtypes by reprogramming neuroendocrine fate. Cancer Res 2020. [DOI: 10.1158/1538-7445.tumhet2020-po-120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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
Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine tumor that is treated clinically as a single disease with poor outcomes. However, SCLC is recently recognized to comprise multiple molecular subsets with unique therapeutic vulnerabilities. Four distinct subtypes of SCLC have been defined based on expression of lineage-related transcription factors: ASCL1, NEUROD1, POU2F3 or YAP1. The origins of these subtypes remain unknown. We use mouse and human SCLC models with a time-series analysis of single-cell transcriptome profiling to reveal that the oncogene MYC drives the dynamic evolution of SCLC subtypes by activation of Notch signaling. MYC cooperates with Notch signaling to promote a temporal shift from an ASCL1-to-NEUROD1-to-YAP1-positive state from a neuroendocrine cell of origin, whereas MYC promotes POU2F3+ tumors from a distinct cell type. SCLC molecular subtypes are therefore not distinct, but rather represent dynamic stages of MYC-driven tumor evolution. Treatment-naive human SCLC exhibits intratumoral heterogeneity in SCLC subtypes, suggesting this dynamic evolution occurs in patient tumors. These findings demonstrate that genetics, cell of origin, and tumor cell plasticity determine SCLC subtype. Given the reported unique therapeutic vulnerabilities of each subtype, we postulate that SCLC tumors represent a “moving therapeutic target” that may require more general, combinatorial, or plasticity-directed therapeutic approaches to combat this transcriptional flexibility. We anticipate that molecular subsets of other cancer types may also represent dynamic stages of tumor evolution.
Citation Format: Abbie S. Ireland, Alexi M. Micinski, David W. Kastner, Bingqian Guo, Sarah J. Wait, Kyle B. Spainhower, Christopher C. Conley, Opal S. Chen, Matthew R. Guthrie, Danny Soltero, Yi Qiao, Xiaomeng Huang, Szabolcs Tarapcsak, Siddhartha Devarakonda, Milind D. Chalishazar, Jason Gertz, Justin C. Moser, Gabor Marth, Sonam Puri, Benjamin L. Witt, Benjamin T. Spike, Trudy G. Oliver. MYC drives temporal evolution of small cell lung cancer subtypes by reprogramming neuroendocrine fate [abstract]. In: Proceedings of the AACR Virtual Special Conference on Tumor Heterogeneity: From Single Cells to Clinical Impact; 2020 Sep 17-18. Philadelphia (PA): AACR; Cancer Res 2020;80(21 Suppl):Abstract nr PO-120.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Yi Qiao
- 1University of Utah, Salt Lake City, UT,
| | | | | | | | | | | | | | | | - Sonam Puri
- 1University of Utah, Salt Lake City, UT,
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38
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Abstract
In a recent Nature article, Middleton et al. report the National Lung Matrix trial results where patients with previously treated non-small cell lung cancer (NSCLC) are assigned to personalized therapy based on the results of a 28-gene next-generation sequencing panel test.
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Affiliation(s)
- Siddhartha Devarakonda
- Alvin Siteman Cancer Center at Washington University, Washington University School of Medicine, 660 S Euclid Box 8056, St. Louis, MO, USA
| | - Ramaswamy Govindan
- Alvin Siteman Cancer Center at Washington University, Washington University School of Medicine, 660 S Euclid Box 8056, St. Louis, MO, USA
| | - Daniel Morgensztern
- Alvin Siteman Cancer Center at Washington University, Washington University School of Medicine, 660 S Euclid Box 8056, St. Louis, MO, USA.
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Carrot-Zhang J, Devarakonda S, Robine N, Yao X, Silva TC, Damrauer J, Deshpande A, Tsao MS, Yao C, Wong C, Bao L, Choi HY, Felau I, Zenklusen JC, Robertson G, Trieua T, Liang WW, Zhou M, Rheinbay E, Hayes N, Khurana E, Ding L, Laird P, Elemento O, Weinstein J, Kwiatkowski D, Benz C, Stuart J, Yang L, Castro M, Travis W, Hoadley K, Berman B, Meyerson M, Govindan R, Imielinski M. Abstract 5895: Whole-genome characterization of lung adenocarcinomas lacking alterations in RTK/RAS/RAF/MAPK pathway. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Lung adenocarcinomas (LUAD) are typically characterized by genetic activation of the receptor tyrosine kinase (RTK)/RAS/RAF/MAP kinase (MAPK) pathway. A minority of LUAD cases (20-25%) lack apparent genetic alterations in this pathway, and thus are ineligible for most targeted therapies. These candidate “oncogene negative” LUADs may harbor novel classes of oncogenic drivers or represent a biologically distinct class of tumors. To characterize the genomic landscape of oncogene-negative LUADs, we nominated 98 cases that were found to lack an activating RTK/RAS/RAF/MAPK pathway alteration in a TCGA study utilizing whole exome sequencing, microarray, and transcriptome data. We profiled these tumors with high-depth whole genome sequencing (WGS), with the goal of identifying noncoding and structural variant driver DNA alterations in both known and novel loci. Of the 98 cases, 20 harbored somatic KRAS mutations that had been missed in the prior WES and transcriptome studies because of insufficient coverage, including 8 cases with the recently targetable p.G12C mutation. 16 samples harbored oncogenic or loss-of-function structural variants in FGFR1, MAPK1, EGFR, NF1, RASA1, ARAF, NTRK2 and NRG1. 5 other samples with SNV or indels in EGFR, ERBB2 and SOS1 were reclassified as oncogene positive. Thus via comprehensive genomic analysis, we confirmed that 57 of the 98 WGS cases did not harbor any detectable alterations in genes encoding any known RTK/RAS/RAF/MAPK members, representing 13% cases chosen as “lung adenocarcinomas” for the TCGA study. Among the 57 confirmed oncogene-negative LUADs, we identified focal deletions targeting the promoter and transcription start site of tumor suppressor genes STK11, KEAP1 and SMARCA4 in 10 samples. Expression and methylation profiling suggested an enrichment of the TP53-deficient phenotype, including cell cycle and FOXM1 deregulation, among the oncogene-negative samples. Moreover, novel promoter mutations associated with increased expression were identified in ILF2, which regulates DNA damage response pathways. Finally, a subset of confirmed oncogene-negative LUADs harbored increased expression of neuroendocrine markers, suggesting that these oncogene-negative samples may either be mis-diagnosed as LUAD or represent LUAD with mixed features of other subtypes of lung cancer; indeed, 14 of the 57 confirmed oncogene-negative cases show histological features of large cell neuroendocrine lung carcinoma. This would suggest that 10% of the cases in this study are both lung adenocarcinoma and “oncogene-negative” to date. Our results provide some of the first comprehensive genomic characterization of oncogene-negative LUADs, implicating TP53 and structural variants in the pathogenesis of this common and difficult to treat entity.
Citation Format: Jian Carrot-Zhang, Siddhartha Devarakonda, Nicolas Robine, Xiaotong Yao, Tiago C. Silva, Jeff Damrauer, Aditya Deshpande, Ming-Sound Tsao, Christina Yao, Chris Wong, Lisui Bao, Hyo Young Choi, Ina Felau, Jean C. Zenklusen, Gordon Robertson, Tuan Trieua, Wei-Wei Liang, Meng Zhou, Esther Rheinbay, Neil Hayes, Ekta Khurana, Li Ding, Peter Laird, Olivier Elemento, John Weinstein, David Kwiatkowski, Chris Benz, Josh Stuart, Lixing Yang, Mauro Castro, William Travis, Katherine Hoadley, Ben Berman, TCGA Analysis Network, Matthew Meyerson, Ramaswamy Govindan, Marcin Imielinski. Whole-genome characterization of lung adenocarcinomas lacking alterations in RTK/RAS/RAF/MAPK pathway [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5895.
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Affiliation(s)
| | | | | | - Xiaotong Yao
- 4Weill Cornell Medical College of Cornell University, NY
| | | | | | | | | | | | - Chris Wong
- 9University of California, Santa Cruz, CA
| | | | | | | | | | | | - Tuan Trieua
- 4Weill Cornell Medical College of Cornell University, NY
| | | | - Meng Zhou
- 14Dana Farber Cancer Institute, Boston, MA
| | | | | | - Ekta Khurana
- 4Weill Cornell Medical College of Cornell University, NY
| | - Li Ding
- 2Washington University School of Medicine, MO
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40
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Ireland AS, Micinski AM, Kastner DW, Guo B, Wait SJ, Spainhower KB, Conley CC, Chen OS, Guthrie MR, Soltero D, Qiao Y, Huang X, Tarapcsák S, Devarakonda S, Chalishazar MD, Gertz J, Moser JC, Marth G, Puri S, Witt BL, Spike BT, Oliver TG. MYC Drives Temporal Evolution of Small Cell Lung Cancer Subtypes by Reprogramming Neuroendocrine Fate. Cancer Cell 2020; 38:60-78.e12. [PMID: 32473656 PMCID: PMC7393942 DOI: 10.1016/j.ccell.2020.05.001] [Citation(s) in RCA: 216] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/23/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023]
Abstract
Small cell lung cancer (SCLC) is a neuroendocrine tumor treated clinically as a single disease with poor outcomes. Distinct SCLC molecular subtypes have been defined based on expression of ASCL1, NEUROD1, POU2F3, or YAP1. Here, we use mouse and human models with a time-series single-cell transcriptome analysis to reveal that MYC drives dynamic evolution of SCLC subtypes. In neuroendocrine cells, MYC activates Notch to dedifferentiate tumor cells, promoting a temporal shift in SCLC from ASCL1+ to NEUROD1+ to YAP1+ states. MYC alternatively promotes POU2F3+ tumors from a distinct cell type. Human SCLC exhibits intratumoral subtype heterogeneity, suggesting that this dynamic evolution occurs in patient tumors. These findings suggest that genetics, cell of origin, and tumor cell plasticity determine SCLC subtype.
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Affiliation(s)
- Abbie S Ireland
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Alexi M Micinski
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - David W Kastner
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Bingqian Guo
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Sarah J Wait
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Kyle B Spainhower
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Christopher C Conley
- Huntsman Cancer Institute Bioinformatic Analysis Shared Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Opal S Chen
- Huntsman Cancer Institute High-Throughput Genomics Shared Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Matthew R Guthrie
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Danny Soltero
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Yi Qiao
- Utah Center for Genetic Discovery, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Xiaomeng Huang
- Utah Center for Genetic Discovery, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Szabolcs Tarapcsák
- Utah Center for Genetic Discovery, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Siddhartha Devarakonda
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Milind D Chalishazar
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Jason Gertz
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Justin C Moser
- HonorHealth Research Institute, Scottsdale, AZ 85254, USA
| | - Gabor Marth
- Utah Center for Genetic Discovery, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Sonam Puri
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Benjamin L Witt
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA; ARUP Laboratories at University of Utah, Salt Lake City, UT 84108, USA
| | - Benjamin T Spike
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Trudy G Oliver
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA.
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Fung AS, Karimi M, Michiels S, Seymour L, Brambilla E, Le Chevalier T, Soria JC, Kratzke RA, Graziano SL, Devarakonda S, Govindan R, Tsao MS, Shepherd FA. Prognostic and predictive effect of KRAS gene copy number and mutation status in early stage non-small cell lung cancer (NSCLC) patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21080] [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
e21080 Background: The prognostic and predictive role of KRAS mutations and gene copy number aberrations (CNA) in early stage NSCLC is unclear. In this study, we characterize the prognostic effect of KRAS mutation status and concomitant CN gain in early stage NSCLC, and determine the ability to predict survival benefit from adjuvant chemotherapy. We hypothesize that concomitant KRAS mutations and CN gain will be prognostic of worse survival compared to KRAS mutations alone. Methods: Clinical and genomic data from The LACE (Lung Adjuvant Cisplatin Evaluation)-BIO consortium was utilized. CNA were categorized as Gain or Neutral (Neut)/Loss; mutation status was defined as wild type (WT) or mutant (MUT). WT+Neut/Loss (reference), WT+Gain, MUT+Gain and MUT+Neut/Loss groups were compared in all patients and the adenocarcinoma subgroup. Primary endpoint was lung-cancer-specific survival (LCSS); secondary endpoints were DFS and OS. Survival curves were assessed using Kaplan-Meier and log-rank tests. Concomitant KRAS CNA and mutation status was correlated to endpoints using a Cox proportional hazards model stratified by trial and adjusted for treatment, age, gender, histology, WHO performance status, surgery type, tumor and nodal stage. A treatment-by-variable interaction was added to evaluate predictive effect. Results: 946 (399 adenocarcinoma) patients had complete KRAS mutation, CNA and clinical data: 41 (30) MUT+Gain, 145 (99) MUT+Neut/Loss, 125 (16) WT+Gain, 635 (254) WT+Neut/Loss. There was a negative prognostic effect of KRAS MUT+Neut/Loss for LCSS (HR = 1.32 [1.01-1.71]) on univariable analysis, and to a lesser extent after adjusting for covariates (HR = 1.28 [0.97-1.68]). A similar non-significant trend was observed in KRAS MUT+Gain patients for LCSS (HR = 1.34 [0.83-2.17]), DFS (HR = 1.34 [0.86-2.09]) and OS (HR = 1.59 [0.99-2.54]). There was no significant predictive effect in the overall population; however, a potential predictive effect of KRAS for OS was seen in the adenocarcinoma subgroup (interaction p = 0.046). KRAS MUT+Gain was associated with a beneficial effect of chemotherapy on DFS (HR = 0.33 [0.11-0.99], p = 0.048), with a non-significant trend also seen for LCSS (HR = 0.41 [0.13-1.33]) and OS (HR = 0.40 [0.13-1.26]). Conclusions: A small prognostic effect of KRAS mutation was identified for LCSS. A potential predictive effect of concomitant KRAS mutation status and CNA was observed for DFS in adenocarcinoma patients. These results could be driven by the small number of patients and require further validation.
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Affiliation(s)
| | - Maryam Karimi
- Institut Gustave Roussy, Service de Biostatistique et d’Epidémiologie, Villejuif, France
| | | | | | | | | | | | | | | | - Siddhartha Devarakonda
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | | | - Ming-Sound Tsao
- Princess Margaret Hospital, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Frances A. Shepherd
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada
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42
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Affiliation(s)
- Siddhartha Devarakonda
- Section of Medical Oncology, Division of Oncology, Washington University School of Medicine, St Louis, Missouri
- Siteman Cancer Center, St Louis, Missouri
| | - Ramaswamy Govindan
- Section of Medical Oncology, Division of Oncology, Washington University School of Medicine, St Louis, Missouri
- Siteman Cancer Center, St Louis, Missouri
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43
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Rajan A, Gray J, Devarakonda S, Gurtler J, Birhiray R, Paschold E, Dasgupta A, Heery C, Pico-Navarro C, Piechatzek M, Wagner E, Menius E, Donahue R, Schlom J, Gulley J. Phase I trial of CV301 in combination with anti-PD-1 therapy in non-squamous NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Devarakonda S, Sankararaman S, Herzog BH, Gold KA, Waqar SN, Ward JP, Raymond VM, Lanman RB, Chaudhuri AA, Owonikoko TK, Li BT, Poirier JT, Rudin CM, Govindan R, Morgensztern D. Circulating Tumor DNA Profiling in Small-Cell Lung Cancer Identifies Potentially Targetable Alterations. Clin Cancer Res 2019; 25:6119-6126. [PMID: 31300452 DOI: 10.1158/1078-0432.ccr-19-0879] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 03/19/2019] [Revised: 05/15/2019] [Accepted: 07/02/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Patients with SCLC rarely undergo biopsies at relapse. When pursued, tissue obtained can be inadequate for molecular testing, posing a challenge in identifying potentially targetable alterations in a clinically meaningful time frame. We examined the feasibility of circulating tumor DNA (ctDNA) testing in identifying potentially targetable alterations in SCLC. EXPERIMENTAL DESIGN ctDNA test results were prospectively collected from patients with SCLC between 2014 and 2017 and analyzed. ctDNA profiles of SCLC at diagnosis and relapse were also compared. RESULTS A total of 609 samples collected from 564 patients between 2014 and 2017 were analyzed. The median turnaround time for test results was 14 days. Among patients with data on treatment status, there were 61 samples from 59 patients and 219 samples from 206 patients collected at diagnosis and relapse, respectively. The number of mutations or amplifications detected per sample did not differ by treatment status. Potentially targetable alterations in DNA repair, MAPK and PI3K pathways, and genes such as MYC and ARID1A were identifiable through ctDNA testing. Furthermore, our results support that it may be possible to reconstruct the clonal relationship between detected variants through ctDNA testing. CONCLUSIONS Patients with relapsed SCLC rarely undergo biopsies for molecular testing and often require prompt treatment initiation. ctDNA testing is less invasive and capable of identifying alterations in relapsed disease in a clinically meaningful timeframe. ctDNA testing on an expanded gene panel has the potential to advance our knowledge of the mechanisms underlying treatment resistance in SCLC and aid in the development of novel treatment strategies.
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Affiliation(s)
- Siddhartha Devarakonda
- Washington University School of Medicine, Saint Louis, Missouri
- Alvin J. Siteman Cancer Center, Saint Louis, Missouri
| | | | - Brett H Herzog
- Washington University School of Medicine, Saint Louis, Missouri
| | - Kathryn A Gold
- University of California San Diego School of Medicine, La Jolla, California
| | - Saiama N Waqar
- Washington University School of Medicine, Saint Louis, Missouri
- Alvin J. Siteman Cancer Center, Saint Louis, Missouri
| | - Jeffrey P Ward
- Washington University School of Medicine, Saint Louis, Missouri
- Alvin J. Siteman Cancer Center, Saint Louis, Missouri
| | | | | | - Aadel A Chaudhuri
- Washington University School of Medicine, Saint Louis, Missouri
- Alvin J. Siteman Cancer Center, Saint Louis, Missouri
| | | | - Bob T Li
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - John T Poirier
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ramaswamy Govindan
- Washington University School of Medicine, Saint Louis, Missouri
- Alvin J. Siteman Cancer Center, Saint Louis, Missouri
| | - Daniel Morgensztern
- Washington University School of Medicine, Saint Louis, Missouri.
- Alvin J. Siteman Cancer Center, Saint Louis, Missouri
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45
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Abstract
The genomic and host factors that drive the progression of pre-invasive lesions in non-small cell lung cancer are poorly understood. Studying these factors can advance our knowledge of lung cancer biology, aid in the development of better screening strategies and improve patient outcomes.
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Affiliation(s)
- Siddhartha Devarakonda
- Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, United States.,Siteman Cancer Center, St. Louis, MO, 63110, United States
| | - Ramaswamy Govindan
- Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, United States. .,Siteman Cancer Center, St. Louis, MO, 63110, United States.
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Maakaron J, Zhao Q, Puto M, Von Derau R, Robinson J, Brammer J, Penza S, Baiocchi R, Christian B, Maddocks K, Saad A, Wall S, Benson D, Efebera Y, Rosko A, Ayyappan S, Grieselhuber N, Vasu S, Larkin K, Epperla N, Devarakonda S, Choe H, Chaudhry M, Blaser B, Blachly J, Bhatnagar B, Alinari L, Mims A, Jaglowski S, William B. PHASE I DOSE-ESCALATION STUDY OF VENETOCLAX PLUS BEAM FOLLOWED BY AUTOLOGOUS STEM CELL TRANSPLANT (ASCT) FOR CHEMORESISTANT, RELAPSED/REFRACTORY, OR HIGH-RISK NON-HODGKIN'S LYMPHOMA (NHL); PRELIMINARY RESULTS. Hematol Oncol 2019. [DOI: 10.1002/hon.213_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. Maakaron
- Hematology; The Ohio State University; Columbus United States
| | - Q. Zhao
- Hematology; The Ohio State University; Columbus United States
| | - M. Puto
- Hematology; The Ohio State University; Columbus United States
| | - R. Von Derau
- Hematology; The Ohio State University; Columbus United States
| | - J. Robinson
- Hematology; The Ohio State University; Columbus United States
| | - J. Brammer
- Hematology; The Ohio State University; Columbus United States
| | - S. Penza
- Hematology; The Ohio State University; Columbus United States
| | - R. Baiocchi
- Hematology; The Ohio State University; Columbus United States
| | - B. Christian
- Hematology; The Ohio State University; Columbus United States
| | - K. Maddocks
- Hematology; The Ohio State University; Columbus United States
| | - A. Saad
- Hematology; The Ohio State University; Columbus United States
| | - S. Wall
- Hematology; The Ohio State University; Columbus United States
| | - D. Benson
- Hematology; The Ohio State University; Columbus United States
| | - Y. Efebera
- Hematology; The Ohio State University; Columbus United States
| | - A. Rosko
- Hematology; The Ohio State University; Columbus United States
| | - S. Ayyappan
- Hematology; The Ohio State University; Columbus United States
| | - N. Grieselhuber
- Hematology; The Ohio State University; Columbus United States
| | - S. Vasu
- Hematology; The Ohio State University; Columbus United States
| | - K. Larkin
- Hematology; The Ohio State University; Columbus United States
| | - N. Epperla
- Hematology; The Ohio State University; Columbus United States
| | - S. Devarakonda
- Hematology; The Ohio State University; Columbus United States
| | - H. Choe
- Hematology; The Ohio State University; Columbus United States
| | - M. Chaudhry
- Hematology; The Ohio State University; Columbus United States
| | - B. Blaser
- Hematology; The Ohio State University; Columbus United States
| | - J. Blachly
- Hematology; The Ohio State University; Columbus United States
| | - B. Bhatnagar
- Hematology; The Ohio State University; Columbus United States
| | - L. Alinari
- Hematology; The Ohio State University; Columbus United States
| | - A. Mims
- Hematology; The Ohio State University; Columbus United States
| | - S. Jaglowski
- Hematology; The Ohio State University; Columbus United States
| | - B.M. William
- Hematology; The Ohio State University; Columbus United States
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Devarakonda S, Govindan R. Targeting Resistance to Targeted Therapies: Combating a Resilient Foe. Clin Cancer Res 2018; 24:6112-6114. [PMID: 30352903 DOI: 10.1158/1078-0432.ccr-18-3178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 11/16/2022]
Abstract
While the advent of third-generation therapies has dramatically changed the treatment paradigm for EGFR-mutated lung cancer, resistance to these agents inevitably emerges. Understanding resistance mechanisms and their genomic underpinnings is crucial for developing innovative strategies that are capable of meaningfully prolonging patient survival.See related article by Le et al., p. 6195.
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Affiliation(s)
- Siddhartha Devarakonda
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, St. Louis, Missouri
| | - Ramaswamy Govindan
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri. .,Siteman Cancer Center, St. Louis, Missouri
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Devarakonda S, Rotolo F, Tsao MS, Lanc I, Brambilla E, Masood A, Olaussen KA, Fulton R, Sakashita S, McLeer-Florin A, Ding K, Le Teuff G, Shepherd FA, Pignon JP, Graziano SL, Kratzke R, Soria JC, Seymour L, Govindan R, Michiels S. Tumor Mutation Burden as a Biomarker in Resected Non-Small-Cell Lung Cancer. J Clin Oncol 2018; 36:2995-3006. [PMID: 30106638 PMCID: PMC6804865 DOI: 10.1200/jco.2018.78.1963] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [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] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The survival benefit with adjuvant chemotherapy for patients with resected stage II-III non-small-cell lung cancer (NSCLC) is modest. Efforts to develop prognostic or predictive biomarkers in these patients have not yielded clinically useful tests. We report findings from the Lung Adjuvant Cisplatin Evaluation (LACE)-Bio-II study, in which we analyzed next-generation sequencing and long-term outcomes data from > 900 patients with early-stage NSCLC treated prospectively in adjuvant landmark clinical trials. We used a targeted gene panel to assess the prognostic and predictive effect of mutations in individual genes, DNA repair pathways, and tumor mutation burden (TMB). METHODS A total of 908 unmatched, formalin-fixed, paraffin-embedded, resected lung cancer tumor specimens were sequenced using a targeted panel of 1,538 genes. Stringent filtering criteria were applied to exclude germline variants and artifacts related to formalin fixation. Disease-free survival, overall survival, and lung cancer-specific survival (LCSS) were assessed in Cox models stratified by trial and adjusted for treatment, age, sex, performance score, histology, type of surgery, and stage. RESULTS Nonsynonymous mutations were identified in 1,515 genes in 908 tumor samples. High nonsynonymous TMB (> 8 mutations/Mb) was prognostic for favorable outcomes (ie, overall survival, disease-free survival, and LCSS) in patients with resected NSCLC. LCSS benefit with adjuvant chemotherapy was more pronounced in patients with low nonsynonymous TMBs (≤ 4 mutations/Mb). Presence of mutations in DNA repair pathways, tumor-infiltrating lymphocytes, TP53 alteration subtype, and intratumor heterogeneity was neither prognostic nor predictive. Statistically significant effect of mutations in individual genes was difficult to determine due to high false-discovery rates. CONCLUSION High nonsynonymous TMB was associated with a better prognosis in patients with resected NSCLC. In addition, the benefit of adjuvant chemotherapy on LCSS was more pronounced in patients with low nonsynonymous TMBs. Studies are warranted to confirm these findings.
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Affiliation(s)
- Siddhartha Devarakonda
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Federico Rotolo
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Ming-Sound Tsao
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Irena Lanc
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Elisabeth Brambilla
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Ashiq Masood
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Ken A. Olaussen
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Robert Fulton
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Shingo Sakashita
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Anne McLeer-Florin
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Keyue Ding
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Gwénaël Le Teuff
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Frances A. Shepherd
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Jean-Pierre Pignon
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Stephen L. Graziano
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Robert Kratzke
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Jean-Charles Soria
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Lesley Seymour
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Ramaswamy Govindan
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
| | - Stefan Michiels
- Siddhartha Devarakonda, Irena Lanc, and Ramaswamy Govindan, Washington University School of Medicine; Siddhartha Devarakonda and Ramaswamy Govindan, Siteman Cancer Center; Robert Fulton, Washington University School of Medicine, St. Louis; Ashiq Masood, University of Missouri Kansas City, Kansas City, MO; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, and Stefan Michiels, Université Paris-Saclay; Federico Rotolo, Ken A. Olaussen, Gwénaël Le Teuff, Jean-Pierre Pignon, Jean-Charles Soria, and Stefan Michiels, Gustave Roussy Cancer Campus, Villejuif; Elisabeth Brambilla and Anne McLeer-Florin, Centre Hospitalier Universitaire de Grenoble, La Tronche, France; Ming-Sound Tsao, Shingo Sakashita, and Frances A. Shepherd, Princess Margaret Cancer Centre and University of Toronto, Toronto; Keyue Ding and Lesley Seymour, Queen's University Kingston, Ontario, Canada; Stephen L. Graziano, State University of New York Upstate Medical University, Syracuse, NY; Robert Kratzke, University of Minnesota Medical School, Minneapolis, MN
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49
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Wagner AH, Devarakonda S, Skidmore ZL, Krysiak K, Ramu A, Trani L, Kunisaki J, Masood A, Waqar SN, Spies NC, Morgensztern D, Waligorski J, Ponce J, Fulton RS, Maggi LB, Weber JD, Watson MA, O'Conor CJ, Ritter JH, Olsen RR, Cheng H, Mukhopadhyay A, Can I, Cessna MH, Oliver TG, Mardis ER, Wilson RK, Griffith M, Griffith OL, Govindan R. Recurrent WNT pathway alterations are frequent in relapsed small cell lung cancer. Nat Commun 2018; 9:3787. [PMID: 30224629 PMCID: PMC6141466 DOI: 10.1038/s41467-018-06162-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/13/2018] [Indexed: 12/27/2022] Open
Abstract
Nearly all patients with small cell lung cancer (SCLC) eventually relapse with chemoresistant disease. The molecular mechanisms driving chemoresistance in SCLC remain un-characterized. Here, we describe whole-exome sequencing of paired SCLC tumor samples procured at diagnosis and relapse from 12 patients, and unpaired relapse samples from 18 additional patients. Multiple somatic copy number alterations, including gains in ABCC1 and deletions in MYCL, MSH2, and MSH6, are identifiable in relapsed samples. Relapse samples also exhibit recurrent mutations and loss of heterozygosity in regulators of WNT signaling, including CHD8 and APC. Analysis of RNA-sequencing data shows enrichment for an ASCL1-low expression subtype and WNT activation in relapse samples. Activation of WNT signaling in chemosensitive human SCLC cell lines through APC knockdown induces chemoresistance. Additionally, in vitro-derived chemoresistant cell lines demonstrate increased WNT activity. Overall, our results suggest WNT signaling activation as a mechanism of chemoresistance in relapsed SCLC.
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Affiliation(s)
- Alex H Wagner
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Siddhartha Devarakonda
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA
| | - Zachary L Skidmore
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Kilannin Krysiak
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Avinash Ramu
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Lee Trani
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Jason Kunisaki
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Ashiq Masood
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA
- Saint Luke's Health System, Kansas City, MO, USA
| | - Saiama N Waqar
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA
| | - Nicholas C Spies
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Daniel Morgensztern
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA
| | - Jason Waligorski
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Jennifer Ponce
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Robert S Fulton
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Leonard B Maggi
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA
- ICCE Institute, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jason D Weber
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA
- ICCE Institute, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Mark A Watson
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA
| | - Christopher J O'Conor
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jon H Ritter
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Rachelle R Olsen
- Department of Oncological Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Haixia Cheng
- Department of Oncological Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Anandaroop Mukhopadhyay
- Department of Oncological Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Ismail Can
- Department of Oncological Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Melissa H Cessna
- Intermountain Healthcare BioRepository and Department of Pathology, Intermountain Healthcare, Salt Lake City, UT, 84103, USA
| | - Trudy G Oliver
- Department of Oncological Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, 84112, USA
| | - Elaine R Mardis
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard K Wilson
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Malachi Griffith
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA.
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Obi L Griffith
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO, 63108, USA.
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Ramaswamy Govindan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- Alvin J Siteman Cancer Center, Washington University, St. Louis, MO, 63110, USA.
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50
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Waqar SN, Samson PP, Robinson CG, Bradley J, Devarakonda S, Du L, Govindan R, Gao F, Puri V, Morgensztern D. Non-small-cell Lung Cancer With Brain Metastasis at Presentation. Clin Lung Cancer 2018; 19:e373-e379. [PMID: 29526531 PMCID: PMC6990432 DOI: 10.1016/j.cllc.2018.01.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [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: 10/02/2017] [Revised: 01/15/2018] [Accepted: 01/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data on the prevalence of brain metastases at presentation in patients with non-small-cell lung cancer (NSCLC) are limited. We queried the National Cancer Data Base to determine prevalence, clinical risk factors, and outcomes of patients with NSCLC presenting with brain metastases. PATIENTS AND METHODS Patients with NSCLC diagnosed between 2010 and 2012 were identified using the National Cancer Data Base. The risk of brain metastases for individual variables was summarized by odds ratios and calculated using logistic regression analysis. The Kaplan-Meier product limit method was used to calculate the median and 1-, 2-, and 3-year overall survival (OS). RESULTS Brain metastases were observed in 47,546 (10.4%) of the 457,481 patients with NSCLC overall. The prevalence of brain metastases was much higher (26%) in patients with stage IV disease at presentation. On multivariate analysis, younger age, adenocarcinoma or large cell histology, tumor size > 3 cm, tumor grade ≥ II, and node-positive disease were associated with brain metastases. The prevalence of brain metastases ranged from as low as 0.57% in patients with only 1 risk factor to as high as 22% in patients with all 5 risk factors. The median and 1-, 2-, and 3-year OS for patients with brain metastases were 6 months and 29.9%, 14.3%, and 8.4%, respectively, with the 3-year OS increasing to 36.2% in those with T1/2 and N0/1 undergoing surgery for the primary site. CONCLUSIONS In patients with NSCLC, the risk of brain metastases at presentation may be calculated based on 5 clinical variables. Selected patients with brain metastases at presentation may achieve prolonged benefit.
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Affiliation(s)
- Saiama N Waqar
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Cliff G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Siddhartha Devarakonda
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Lingling Du
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Ramaswamy Govindan
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Feng Gao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Daniel Morgensztern
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
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