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Tarabay A, Boileve A, Smolenschi C, Antoun L, Valery M, Fuerea A, Perret A, Burtin P, Cosconea S, Belkhodja H, Malka D, Boige V, Hollebecque A, Ducreux M. Precision Medicine in Pancreatic Ductal Adenocarcinoma: The Impact of Targeted Therapies on Survival of Patients Harboring Actionable Mutations. Biomedicines 2023; 11:2569. [PMID: 37761010 PMCID: PMC10526242 DOI: 10.3390/biomedicines11092569] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of death by cancer worldwide. Mostly diagnosed with locally advanced or metastatic disease, patients lack treatment options. Gene alterations (GAs) are frequently observed in PDAC, some of which are considered for molecular targeted therapies (MTTs), with potential clinical benefits and improved outcomes. However, the applicability of molecular profiling (MP) for precision medicine in PDAC remains to be demonstrated. METHODS We conducted a retrospective analysis of all patients, aged ≥18 years with histologically confirmed PDAC, who underwent tumor MP between 2010 and 2020 in our institution as part of personalized medicine trials. The primary study endpoint was overall survival (OS), and (minimal follow-up was 6 months after MP). RESULTS Of 115 eligible patients, MP was successful in 102 patients (89%). KRAS mutations were the most frequent GAs, mostly G12D. Based on ESCAT classification, actionable GAs were found in 29 patients (28%), involving mainly BRCA1 or BRCA2 (5 (18%)), HER2 (5 (18%)), MTAP (5 (18%)), and FGFR (3 (11%)). Only 12 of these 29 patients (41%, or 10% of the whole population) received MTTs, with a median progression-free survival of 1.6 months. Median OS was 19 months in patients with actionable GAs treated with MTTs (n = 12 (11.8%)), 14 months in patients with actionable GAs treated with standard therapies (n = 17 (16.7%)), and 17 months in patients without actionable GAs treated with standard therapies (n = 73 (71.5%); p = 0.26). The absence of liver metastases was associated with better OS (HR = 0.471, p = 0.01). The highest OS following MTT was observed in patients with BRCA mutations treated with olaparib. INTERPRETATION Actionable GAs were found in more than a quarter of patients with advanced PDAC. Overall, targeting actionable GAs with MTTs was not associated with improved OS in this retrospective study with limited patient numbers. However, selected GA/MTT combinations (e.g., BRCA mutations/olaparib) were associated with a better outcome.
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Affiliation(s)
- Anthony Tarabay
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Alice Boileve
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Cristina Smolenschi
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Leony Antoun
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Marine Valery
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Alina Fuerea
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Audrey Perret
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Pascal Burtin
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Simona Cosconea
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Hichem Belkhodja
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - David Malka
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Valérie Boige
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
| | - Antoine Hollebecque
- Gustave Roussy, Département d’Innovation Thérapeutique et d’Essais Précoces, 94805 Villejuif, France;
| | - Michel Ducreux
- Gustave Roussy, Département de Médecine, 94805 Villejuif, France; (A.B.); (C.S.); (L.A.); (M.V.); (A.F.); (A.P.); (P.B.); (S.C.); (H.B.); (D.M.); (V.B.); (M.D.)
- Faculty of Medicine, Université Paris Saclay, 91400 Orsay, France
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Masson E, Ewers M, Paliwal S, Kume K, Scotet V, Cooper DN, Rebours V, Buscail L, Rouault K, Abrantes A, Aguilera Munoz L, Albouys J, Alric L, Amiot X, Archambeaud I, Audiau S, Bastide L, Baudon J, Bellaiche G, Bellon S, Bertrand V, Bideau K, Billiemaz K, Billioud C, Bonnefoy S, Borderon C, Bournet B, Breton E, Brugel M, Buscail L, Cadiot G, Camus M, Carpentier-Pourquier M, Chamouard P, Chaput U, Chen JM, Cholet F, Ciocan DM, Clavel C, Coffin B, Coimet-Berger L, Cosconea S, Creveaux I, Culetto A, Daboussi O, De Mestier L, Degand T, D'engremont C, Denis B, Dermine S, Drouet D'Aubigny A, Enaud R, Fabre A, Férec C, Gargot D, Gelsi E, Gentilcore E, Gincul R, Ginglinger-Favre E, Giovannini M, Gomercic C, Gondran H, Grainville T, Grandval P, Grasset D, Grimaldi S, Grimbert S, Hagege H, Heissat S, Hentic O, Herber-Mayne A, Hervouet M, Hoibian S, Jacques J, Jais B, Kaassis M, Koch S, Lacaze E, Lacroute J, Lamireau T, Laurent L, Le Guillou X, Le Rhun M, Leblanc S, Levy P, Lievre A, Lorenzo D, Maire F, Marcel K, Masson E, Mauillon J, Morgant S, Moussata D, Muller N, Nambot S, Napoleon B, Olivier A, Pagenault M, Pelletier AL, Pennec O, Pinard F, Pioche M, Prost B, Queneherve L, Rebours V, Reboux N, Rekik S, Riachi G, Rohmer B, Roquelaure B, Rosa Hezode I, Rostain F, Saurin JC, Servais L, Stan-Iuga R, Subtil C, Tanneche J, Texier C, Thomassin L, Tougeron D, Vuitton L, Wallenhorst T, Wangerme M, Zanaldi H, Zerbib F, Bhaskar S, Kikuta K, Rao GV, Hamada S, Reddy DN, Masamune A, Chandak GR, Witt H, Férec C, Chen JM. The PRSS3P2 and TRY7 deletion copy number variant modifies risk for chronic pancreatitis. Pancreatology 2023; 23:48-56. [PMID: 36517351 DOI: 10.1016/j.pan.2022.11.013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND PRSS1 and PRSS2 constitute the only functional copies of a tandemly-arranged five-trypsinogen-gene cluster (i.e., PRSS1, PRSS3P1, PRSS3P2, TRY7 and PRSS2) on chromosome 7q35. Variants in PRSS1 and PRSS2, including missense and copy number variants (CNVs), have been reported to predispose to or protect against chronic pancreatitis (CP). We wondered whether a common trypsinogen pseudogene deletion CNV (that removes two of the three trypsinogen pseudogenes, PRSS3P2 and TRY7) might be associated with CP causation/predisposition. METHODS We analyzed the common PRSS3P2 and TRY7 deletion CNV in a total of 1536 CP patients and 3506 controls from France, Germany, India and Japan by means of quantitative fluorescent multiplex polymerase chain reaction. RESULTS We demonstrated that the deletion CNV variant was associated with a protective effect against CP in the French, German and Japanese cohorts whilst a trend toward the same association was noted in the Indian cohort. Meta-analysis under a dominant model yielded a pooled odds ratio (OR) of 0.68 (95% confidence interval (CI) 0.52-0.89; p = 0.005) whereas an allele-based meta-analysis yielded a pooled OR of 0.84 (95% CI 0.77-0.92; p = 0.0001). This protective effect is explicable by reference to the recent finding that the still functional PRSS3P2/TRY7 pseudogene enhancers upregulate pancreatic PRSS2 expression. CONCLUSIONS The common PRSS3P2 and TRY7 deletion CNV was associated with a reduced risk for CP. This finding provides additional support for the emerging view that dysregulated PRSS2 expression represents a discrete mechanism underlying CP predisposition or protection.
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Affiliation(s)
- Emmanuelle Masson
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France; Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | - Maren Ewers
- Paediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany
| | - Sumit Paliwal
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Virginie Scotet
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Vinciane Rebours
- Pancreatology and Digestive Oncology Department, Beaujon Hospital, APHP - Clichy, Université Paris Cité, Paris, France
| | - Louis Buscail
- Department of Gastroenterology and Pancreatology, CHU Rangueil and University of Toulouse, Toulouse, France
| | - Karen Rouault
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France; Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
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- Hôpital d'instruction des Armées Percy, Clamart, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seema Bhaskar
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Giriraj Ratan Chandak
- Genomic Research on Complex Diseases (GRC Group), CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Heiko Witt
- Paediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising, Germany
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - Jian-Min Chen
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France.
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Deffieux T, Gennisson JL, Bousquet L, Corouge M, Cosconea S, Amroun D, Tripon S, Terris B, Mallet V, Sogni P, Tanter M, Pol S. Investigating liver stiffness and viscosity for fibrosis, steatosis and activity staging using shear wave elastography. J Hepatol 2015; 62:317-24. [PMID: 25251998 DOI: 10.1016/j.jhep.2014.09.020] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 09/10/2014] [Accepted: 09/15/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Quantitative shear wave elastography was shown to be an effective tool for the non-invasive diagnosis and staging of chronic liver diseases. The liver shear modulus, estimated from the propagation velocity of shear waves, is correlated to the degree of fibrosis and can therefore be used for the non-invasive staging of fibrosis. METHODS We performed a clinical prospective study in a total of 120 patients with various chronic liver diseases to compare the accuracy of supersonic shear imaging (SSI), a technique based on acoustic radiation and ultrafast ultrasound imaging, to 1D transient elastography (FibroScan) for the staging and grading of fibrosis as assessed by liver biopsy. Since shear wave propagation spectroscopy can also provide additional mechanical information on soft tissues, such as viscosity, we also investigated those new mechanical parameters as possible predictors of fibrosis, steatosis, and disease activity. RESULTS SSI was successfully performed in 98.3% of patients and it was shown to be as accurate as FibroScan for the staging of fibrosis both for the whole population (N=120) and for the subgroup with viral hepatitis (n=70) (AUC=0.85 [0.77-0.96] and 0.89 [0.81-0.97] for significant fibrosis, AUC=0.90 [0.83-0.97] and 0.87 [0.75-0.98] for cirrhosis, with respect to SSI [n=68/70] and FibroScan [n=66/68]). Viscosity could also be used to stage the degree of fibrosis (AUC=0.76 [0.64-0.87] for significant fibrosis and AUC=0.87 [0.74-0.99] for cirrhosis), for the subgroup of patients with viral hepatitis (n=67/70) but was a poor predictor of disease activity and steatosis levels. CONCLUSIONS Supersonic shear imaging is a robust technique for the staging of liver fibrosis. Liver viscosity was found to be correlated with fibrosis but not to steatosis or disease activity.
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Affiliation(s)
- Thomas Deffieux
- Institut Langevin, ESPCI ParisTech, PSL University, CNRS UMR7587, INSERM U979, Paris, France.
| | - Jean-Luc Gennisson
- Institut Langevin, ESPCI ParisTech, PSL University, CNRS UMR7587, INSERM U979, Paris, France
| | - Laurence Bousquet
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Marion Corouge
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Simona Cosconea
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Dalila Amroun
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Simona Tripon
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Benoit Terris
- Service d'anatomo-pathologie, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Vincent Mallet
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Philippe Sogni
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
| | - Mickael Tanter
- Institut Langevin, ESPCI ParisTech, PSL University, CNRS UMR7587, INSERM U979, Paris, France
| | - Stanislas Pol
- Liver Unit, Hôpital Cochin, APHP, INSERM U1016, Université Paris-Descartes, Paris, France
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