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Lin YS, Cao C, Cooper WA, Cheung VKY. Primary gangliocytic paraganglioma of the lung. Pathology 2024; 56:423-426. [PMID: 37863709 DOI: 10.1016/j.pathol.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/19/2023] [Accepted: 07/09/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Yee Sing Lin
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; School of Medical Science, University of New South Wales, Kensington, NSW, Australia.
| | - Christopher Cao
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Veronica Ka-Yan Cheung
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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2
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Harrison M, Jo HE, Troy LK, Nguyen B, Webster SE, Geis M, Lai S, Mulyadi E, Cooper WA, Mahar A, Teoh A, Jee A, Corte TJ. Disease Behaviour Classification: A pragmatic model for predicting outcomes in Interstitial Lung Disease. Respir Med 2024; 224:107533. [PMID: 38355019 DOI: 10.1016/j.rmed.2024.107533] [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: 06/26/2023] [Revised: 12/04/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND OBJECTIVE The interstitial lung diseases (ILD) are a heterogenous group of disorders with similar clinical presentation, but widely varying prognoses. The use of a pragmatic disease behaviour classification (DBC), first proposed in international guidelines in 2013, categorises diseases into five behavioural classes based on their predicted clinical course. This study aimed to determine the prognostic utility of the DBC in an ILD cohort. METHODS Consecutive patients presented at the weekly multidisciplinary meeting (MDM) of a specialist ILD centre were included. MDM consensus was obtained for diagnosis and DBC category (1-5). Baseline and serial clinical and physiological data were collected over the study period (median 3.9 years, range 0-5.4 years). The relationship between DBC and prognostic outcomes was explored. RESULTS 137 ILD patients, [64 (47%) female] were included with mean age 67.0 ± 1.1 years, baseline FVC% 72.7 ± 1.7, and baseline DLco% 57.8 ± 1.6%. Patients were stratified into DBC by consensus at MDM: DBC1 n = 0 (0%), DBC2 n = 16 (12%), DBC3 n = 10 (7.3%), DBC4 n = 55 (40%), and DBC5 n = 56 (41%). On univariable Cox regression, increasing DBC class was associated with poorer progression-free survival (HR 1.6, 95% CI 1.2-2.0, p < 0.001). On multivariable Cox regression, DBC remained predictive of PFS when combined with age and gender (HR 1.4, 95% CI 1.1-1.9, p = 0.011), baseline FVC% (HR 1.5, 95% CI 1.1-1.8, p = 0.003) and ILD diagnosis (HR 1.6, 95% CI 1.2-2.2, p < 0.0001). CONCLUSION DBC as determined at ILD multidisciplinary meeting may be a useful prognostic tool for the management of ILD patients.
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Affiliation(s)
- Megan Harrison
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Helen E Jo
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Lauren K Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Benjamin Nguyen
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Susanne E Webster
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Monika Geis
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Simon Lai
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ellie Mulyadi
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wendy A Cooper
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Western Sydney, Sydney, Australia
| | - Annabelle Mahar
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alan Teoh
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adelle Jee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
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3
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Cooper WA, Tan PH. Predictive and prognostic biomarkers in solid tumours. Pathology 2024; 56:145-146. [PMID: 38212231 DOI: 10.1016/j.pathol.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Campbelltown, NSW, Australia.
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Klebe S, Judge M, Brcic L, Dacic S, Galateau-Salle F, Nicholson AG, Roggli V, Nowak AK, Cooper WA. Mesothelioma in the pleura, pericardium and peritoneum: Recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2024; 84:633-645. [PMID: 38044849 DOI: 10.1111/his.15106] [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] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/19/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023]
Abstract
AIMS Mesothelioma is a rare malignancy of the serosal membranes that is commonly related to exposure to asbestos. Despite extensive research and clinical trials, prognosis to date remains poor. Consistent, comprehensive and reproducible pathology reporting form the basis of all future interventions for an individual patient, but also ensures that meaningful data are collected to identify predictive and prognostic markers. METHODS AND RESULTS This article details the International Collaboration on Cancer Reporting (ICCR) process and the development of the international consensus mesothelioma reporting data set. It describes the 'core' and 'non-core' elements to be included in pathology reports for mesothelioma of all sites, inclusive of clinical, macroscopic, microscopic and ancillary testing considerations. An international expert panel consisting of pathologists and a medical oncologist produced a set of data items for biopsy and resection specimens based on a critical review and discussion of current evidence, and in light of the changes in the 2021 WHO Classification of Tumours. The commentary focuses particularly upon new entities such as mesothelioma in situ and provides background on relevant and essential ancillary testing as well as implementation of the new requirement for tumour grading. CONCLUSION We recommend widespread and consistent implementation of this data set, which will facilitate accurate reporting and enhance the consistency of data collection, improve the comparison of epidemiological data, support retrospective research and ultimately help to improve clinical outcomes. To this end, all data sets are freely available worldwide on the ICCR website (www.iccr-cancer.org/data-sets).
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Affiliation(s)
- Sonja Klebe
- Department of Anatomical Pathology, Flinders University and SA Pathology, Adelaide, SA, Australia
| | - Meagan Judge
- International Collaboration on Cancer Reporting, Sydney, NSW, Australia
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Andrew G Nicholson
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Victor Roggli
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Anna K Nowak
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Kerr KM, Bubendorf L, Lopez-Rios F, Khalil F, Roy-Chowdhuri S, Joubert P, Hartmann A, Guerini-Rocco E, Yatabe Y, Hofman P, Cooper WA, Dacic S. Optimizing tissue stewardship in non-small cell lung cancer to support molecular characterization and treatment selection: statement from a working group of thoracic pathologists. Histopathology 2024; 84:429-439. [PMID: 37957137 DOI: 10.1111/his.15078] [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: 04/12/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 11/15/2023]
Abstract
Many patients with non-small cell lung cancer do not receive guideline-recommended, biomarker-directed therapy, despite the potential for improved clinical outcomes. Access to timely, accurate, and comprehensive molecular profiling, including targetable protein overexpression, is essential to allow fully informed treatment decisions to be taken. In turn, this requires optimal tissue management to protect and maximize the use of this precious finite resource. Here, a group of leading thoracic pathologists recommend factors to consider for optimal tissue management. Starting from when lung cancer is first suspected, keeping predictive biomarker testing in the front of the mind should drive the development of practices and procedures that conserve tissue appropriately to support molecular characterization and treatment selection.
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Affiliation(s)
- Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary and Aberdeen University Medical School, Aberdeen, UK
| | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Fernando Lopez-Rios
- Department of Pathology, 12 de Octubre University Hospital-CIBERONC, Research Institute 12 de Octubre University Hospital (i+12), Universidad Complutense, Madrid, Spain
| | | | | | - Philippe Joubert
- Québec Heart and Lung Institute-Laval University (IUCPQ-UL), Quebec, QC, Canada
| | - Arndt Hartmann
- Institute of Pathology, University Erlangen-Nürnberg, Erlangen, Germany
| | - Elena Guerini-Rocco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Paul Hofman
- Nice University Hospital, FHU OncoAge, BB-0033-00025, University Côte d'Azur, Nice, France
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
- Western Sydney University, Campbelltown, NSW, Australia
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Roden AC, Judge M, den Bakker MA, Fang W, Jain D, Marx A, Moreira AL, Rajan A, Stroebel P, Szolkowska M, Cooper WA. Dataset for reporting of thymic epithelial tumours: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2023; 83:967-980. [PMID: 37722860 DOI: 10.1111/his.15047] [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] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/11/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
AIMS Thymic epithelial tumours (TET), including thymomas and thymic carcinomas and thymic neuroendocrine neoplasms, are malignant neoplasms that can be associated with morbidity and mortality. Recently, an updated version of the World Health Organization (WHO) Classification of Thoracic Tumours 5th Edition, 2021 has been released, which included various changes to the classification of these neoplasms. In addition, in 2017 the Union for International Cancer Control (UICC) / American Joint Committee on Cancer (AJCC) published the 8th Edition Staging Manual which, for the first time, includes a TNM staging that is applicable to thymomas, thymic carcinomas, and thymic neuroendocrine neoplasms. METHODS AND RESULTS To standardize reporting of resected TET and thymic neuroendocrine neoplasms the accrediting bodies updated their reporting protocols. The International Collaboration on Cancer Reporting (ICCR), which represents a collaboration between various National Associations of Pathology, updated its 2017 histopathology reporting guide on TET and thymic neuroendocrine neoplasms accordingly. This report will highlight important changes in the reporting of TET and thymic neuroendocrine neoplasms based on the 2021 WHO, emphasize the 2017 TNM staging, and also comment on the rigour and various uncertainties for the pathologist when trying to follow that staging. CONCLUSION The ICCR dataset provides a comprehensive, standardized template for reporting of resected TET and thymic neuroendocrine neoplasms.
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Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Meagan Judge
- International Collaboration on Cancer Reporting, Sydney, NSW, Australia
| | - Michael A den Bakker
- Maasstad Hospital, Rotterdam, The Netherlands
- Academic Hospital Erasmus MC, Rotterdam, The Netherlands
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Andre L Moreira
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philipp Stroebel
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Malgorzata Szolkowska
- Department of Pathology, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, NSW, Sydney, Australia
- Institute of Medicine and Health Pathology, University of Sydney, NSW, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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7
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Cooper WA. Lessons and opportunities from improved understanding of global lung cancer histological subtypes. Lancet Oncol 2023; 24:1159-1161. [PMID: 37837980 DOI: 10.1016/s1470-2045(23)00475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia.
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8
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Dacic S, Travis W, Redman M, Saqi A, Cooper WA, Borczuk A, Chung JH, Glass C, Lopez JM, Roden AC, Sholl L, Weissferdt A, Posadas J, Walker A, Zhu H, Wijeratne MT, Connolly C, Wynes M, Bota-Rabassedas N, Sanchez-Espiridion B, Lee JJ, Berezowska S, Chou TY, Kerr K, Nicholson A, Poleri C, Schalper KA, Tsao MS, Carbone DP, Ready N, Cascone T, Heymach J, Sepesi B, Shu C, Rizvi N, Sonett J, Altorki N, Provencio M, Bunn PA, Kris MG, Belani CP, Kelly K, Wistuba I. International Association for the Study of Lung Cancer Study of Reproducibility in Assessment of Pathologic Response in Resected Lung Cancers After Neoadjuvant Therapy. J Thorac Oncol 2023; 18:1290-1302. [PMID: 37702631 DOI: 10.1016/j.jtho.2023.07.017] [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: 06/16/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Pathologic response has been proposed as an early clinical trial end point of survival after neoadjuvant treatment in clinical trials of NSCLC. The International Association for the Study of Lung Cancer (IASLC) published recommendations for pathologic evaluation of resected lung cancers after neoadjuvant therapy. The aim of this study was to assess pathologic response interobserver reproducibility using IASLC criteria. METHODS An international panel of 11 pulmonary pathologists reviewed hematoxylin and eosin-stained slides from the lung tumors of resected NSCLC from 84 patients who received neoadjuvant immune checkpoint inhibitors in six clinical trials. Pathologic response was assessed for percent viable tumor, necrosis, and stroma. For each slide, tumor bed area was measured microscopically, and pre-embedded formulas calculated unweighted and weighted major pathologic response (MPR) averages to reflect variable tumor bed proportion. RESULTS Unanimous agreement among pathologists for MPR was observed in 68 patients (81%), and inter-rater agreement (IRA) was 0.84 (95% confidence interval [CI]: 0.76-0.92) and 0.86 (95% CI: 0.79-0.93) for unweighted and weighted averages, respectively. Overall, unweighted and weighted methods did not reveal significant differences in the classification of MPR. The highest concordance by both methods was observed for cases with more than 95% viable tumor (IRA = 0.98, 95% CI: 0.96-1) and 0% viable tumor (IRA = 0.94, 95% CI: 0.89-0.98). The most common reasons for discrepancies included interpretations of tumor bed, presence of prominent stromal inflammation, distinction between reactive and neoplastic pneumocytes, and assessment of invasive mucinous adenocarcinoma. CONCLUSIONS Our study revealed excellent reliability in cases with no residual viable tumor and good reliability for MPR with the IASLC recommended less than or equal to 10% cutoff for viable tumor after neoadjuvant therapy.
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Affiliation(s)
- Sanja Dacic
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - William Travis
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary Redman
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Anjali Saqi
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Health and Medicine, University of Sydney, Sydney, Australia; Faculty of Medicine, University of Western Sydney, Sydney, Australia
| | - Alain Borczuk
- Department of Anatomic/Clinical Pathology, Northwell Health, Greenvale, New York
| | - Jin-Haeng Chung
- Department of Pathology and Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Carolyn Glass
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Javier Martin Lopez
- Department of Pathology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Lynette Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juan Posadas
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Angela Walker
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hu Zhu
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Manuja T Wijeratne
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Casey Connolly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Murry Wynes
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Neus Bota-Rabassedas
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beatriz Sanchez-Espiridion
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sabina Berezowska
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Keith Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen University Medical School, Aberdeen, United Kingdom
| | - Andrew Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Claudia Poleri
- Independent Consultant in Thoracic Pathology, Buenos Aires, Argentina
| | - Kurt A Schalper
- Department of Pathology and Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ming-Sound Tsao
- Department of Pathology, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - David P Carbone
- Comprehensive Cancer Center, Division of Medical Oncology, The Ohio State University, Columbus, USA
| | - Neal Ready
- Department of Medicine, Duke Medical Center, Durham, North Carolina
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Catherine Shu
- Division of Hematology and Oncology, Columbia University Medical Center, New York, New York
| | - Naiyer Rizvi
- Division of Hematology and Oncology, Columbia University Medical Center, New York, New York
| | - Josuha Sonett
- Thoracic Surgery Department, Columbia University New York-Presbyterian Hospital, New York, New York
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York
| | - Mariano Provencio
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Paul A Bunn
- Medical Oncology, Colorado University School of Medicine, Aurora, Colorado
| | - Mark G Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, New York
| | - Chandra P Belani
- Penn State Hershey Medical Center, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Karen Kelly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Ignacio Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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McKenzie CA, Gupta R, Jackett L, Anderson L, Chen V, Dahlstrom JE, Dray M, Farshid G, Hemmings C, Karim R, Kench JG, Klebe S, Kramer N, Kumarasinghe P, Maclean F, Morey A, Nguyen MA, O'Toole S, Rowbotham B, Salisbury ELC, Scolyer RA, Stewart K, Waring L, Cooper CL, Cooper WA. Looking beyond workforce parity: addressing gender inequity in pathology. Pathology 2023; 55:760-771. [PMID: 37573162 DOI: 10.1016/j.pathol.2023.07.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/14/2023]
Abstract
While women pathologists have made up over one-third of pathologists in the Australian workforce for over 15 years and at least 50% since 2019, they are under-represented in senior leadership roles, scientific publications, grant recipients, editorial boards, key presentations, and professional awards. This is not unique to pathology and is seen in the broader medical and academic community. Barriers to gender equity and equality in pathology, medicine and academia include gender stereotypes, gender-based discrimination, structural and organisational barriers as well as broader social and cultural barriers. A diverse leadership reflective of the whole professional body and the broader community is important for optimal health outcomes. It is the responsibility and moral duty of individuals and organisations to address any gender disparities, inequities, and inequalities by monitoring, identifying, and acting on gender biases and systemic barriers that hinder appropriate levels of representation by women.
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Affiliation(s)
- Catriona A McKenzie
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Vivien Chen
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Haematology Concord Repatriation and General Hospital, Sydney, NSW, Australia
| | - Jane E Dahlstrom
- ACT Pathology Canberra Health Services, Canberra, ACT, Australia; Australian National University, Canberra, ACT, Australia
| | | | - Gelareh Farshid
- SA Pathology, Adelaide, SA, Australia; University of Adelaide, Adelaide, SA, Australia
| | - Chris Hemmings
- Department of Anatomic Pathology Canterbury Health Laboratories, Christchurch, New Zealand; Department of Pathology and Biomedical Science University of Otago, Christchurch, New Zealand
| | - Rooshdiya Karim
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - James G Kench
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sonja Klebe
- SA Pathology, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia
| | | | | | - Fiona Maclean
- Douglass Hanly Moir Pathology Sonic Healthcare, Sydney, NSW, Australia; Macquarie University, Sydney, NSW, Australia
| | - Adrienne Morey
- ACT Pathology Canberra Health Services, Canberra, ACT, Australia; Australian National University, Canberra, ACT, Australia
| | - Minh Anh Nguyen
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sandra O'Toole
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Beverley Rowbotham
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia; The University of Queensland, Brisbane, Qld, Australia
| | - Elizabeth L C Salisbury
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia; ICPMR Westmead Hospital, NSW Health Pathology, Westmead, NSW, Australia
| | - Richard A Scolyer
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Caroline L Cooper
- The University of Queensland, Brisbane, Qld, Australia; Pathology Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
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10
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Fernando CD, Jayasekara WSN, Inampudi C, Kohonen-Corish MRJ, Cooper WA, Beilharz TH, Josephs TM, Garama DJ, Gough DJ. A STAT3 protein complex required for mitochondrial mRNA stability and cancer. Cell Rep 2023; 42:113033. [PMID: 37703176 DOI: 10.1016/j.celrep.2023.113033] [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] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/16/2023] [Accepted: 08/10/2023] [Indexed: 09/15/2023] Open
Abstract
Signal transducer and activator of transcription 3 (STAT3) is a potent transcription factor necessary for life whose activity is corrupted in diverse diseases, including cancer. STAT3 biology was presumed to be entirely dependent on its activity as a transcription factor until the discovery of a mitochondrial pool of STAT3, which is necessary for normal tissue function and tumorigenesis. However, the mechanism of this mitochondrial activity remained elusive. This study uses immunoprecipitation and mass spectrometry to identify a complex containing STAT3, leucine-rich pentatricopeptide repeat containing (LRPPRC), and SRA stem-loop-interacting RNA-binding protein (SLIRP) that is required for the stability of mature mitochondrially encoded mRNAs and transport to the mitochondrial ribosome. Moreover, we show that this complex is enriched in patients with lung adenocarcinoma and that its deletion inhibits the growth of lung cancer in vivo, providing therapeutic opportunities through the specific targeting of the mitochondrial activity of STAT3.
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Affiliation(s)
- C Dilanka Fernando
- Department of Molecular Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| | - W Samantha N Jayasekara
- Department of Molecular Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| | - Chaitanya Inampudi
- Department of Molecular Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
| | - Maija R J Kohonen-Corish
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; Faculty of Science, UTS Sydney, Ultimo, NSW 2007, Australia
| | - Wendy A Cooper
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia
| | - Traude H Beilharz
- Development and Stem Cells Program and the Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC 3800, Australia
| | - Tracy M Josephs
- Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; ARC Centre for Cryo-Electron Microscopy of Membrane Proteins, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
| | - Daniel J Garama
- Department of Molecular Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia.
| | - Daniel J Gough
- Department of Molecular Translational Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia; Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia.
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11
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Chu GJ, Linton A, Kao S, Klebe S, Adelstein S, Yeo D, Rasko JEJ, Cooper WA. High mesothelin expression by immunohistochemistry predicts improved survival in pleural mesothelioma. Histopathology 2023; 83:202-210. [PMID: 37040900 PMCID: PMC10952516 DOI: 10.1111/his.14916] [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: 11/06/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Abstract
AIMS Mesothelin (MSLN) is a cancer-associated antigen that is overexpressed in malignancies such as mesothelioma, pancreatic and ovarian cancer. It is also a target for novel personalised therapies, including antibodies, antibody-drug conjugates and chimeric antigen receptor T cells. Immunohistochemistry may predict those who would best respond to anti-mesothelin therapies and guide decisions in therapeutic strategy. This study aimed to assess the intensity and distribution of MSLN immunostaining in mesothelioma, and to determine the prognostic value of MSLN expression by histochemical-score (H-score). METHODS AND RESULTS The MN1 anti-MSLN antibody was used to stain a formalin-fixed paraffin-embedded tissue microarray of histologically confirmed mesothelioma from 75 consecutive patients who had undergone pleurectomy with or without decortication. MSLN positivity, the staining intensity, distribution of staining and H-score were evaluated. The correlation of H-score with prognosis was investigated. Sixty-six per cent of epithelioid tumours were MSLN-positive (with expression in > 5% tumour cells). Of MSLN-expressing epithelioid tumours, 70.4% had moderate (2+) or strong (3+) intensity MSLN immunostaining, although only 37% of samples had staining in ≥ 50% of tumour cells. In multivariate analysis, MSLN H-score as a continuous variable and an H-score ≥ 33 were independent predictors of improved survival (P = 0.04 and P < 0.001, respectively). CONCLUSIONS MSLN expression was more heterogenous in epithelioid mesothelioma than reported previously. Therefore, it would be appropriate to perform an immunohistochemical assessment of MSLN expression to stratify and assess patient suitability for mesothelin-targeted personalised therapies, such as chimeric antigen receptor T cells.
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Affiliation(s)
- Gerard J Chu
- Gene and Stem Cell Therapy Program Centenary InstituteUniversity of SydneySydneyNSWAustralia
- Department of Clinical Immunology and AllergyRoyal Prince Alfred HospitalCamperdownNSWAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
| | - Anthony Linton
- Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
- Department of Medical OncologyConcord HospitalConcordNSWAustralia
- Asbestos Diseases Research InstituteConcordNSWAustralia
| | - Steven Kao
- Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
- Asbestos Diseases Research InstituteConcordNSWAustralia
- Department of Medical OncologyChris O'Brien LifehouseCamperdownNSWAustralia
| | - Sonja Klebe
- Asbestos Diseases Research InstituteConcordNSWAustralia
- Department of Anatomical PathologyFlinders University and SA PathologyAdelaideSAAustralia
| | - Stephen Adelstein
- Department of Clinical Immunology and AllergyRoyal Prince Alfred HospitalCamperdownNSWAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
| | - Dannel Yeo
- Gene and Stem Cell Therapy Program Centenary InstituteUniversity of SydneySydneyNSWAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
- Cell and Molecular Therapies, Royal Prince Alfred HospitalCamperdownNSWAustralia
| | - John E J Rasko
- Gene and Stem Cell Therapy Program Centenary InstituteUniversity of SydneySydneyNSWAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
- Cell and Molecular Therapies, Royal Prince Alfred HospitalCamperdownNSWAustralia
| | - Wendy A Cooper
- Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health PathologyRoyal Prince Alfred HospitalCamperdownNSWAustralia
- School of MedicineWestern Sydney UniversitySydneyNSWAustralia
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12
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Cooper WA, John T. Rethinking Biomarkers for Combination Chemoimmunotherapy. J Thorac Oncol 2023; 18:841-843. [PMID: 37348991 DOI: 10.1016/j.jtho.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; School of Medicine, University of Western Sydney, Sydney, Australia.
| | - Thomas John
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
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13
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Nguyen MA, Colebatch AJ, Van Beek D, Tierney G, Gupta R, Cooper WA. NTRK fusions in solid tumours: what every pathologist needs to know. Pathology 2023:S0031-3025(23)00128-9. [PMID: 37330338 DOI: 10.1016/j.pathol.2023.05.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/19/2023]
Abstract
Fusions involving the Neurotrophic tropomyosin receptor kinase (NTRK) gene family (NTRK1, NTRK2 and NTRK3) are targetable oncogenic alterations that are found in a diverse range of tumours. There is an increasing demand to identify tumours which harbour these fusions to enable treatment with selective tyrosine kinase inhibitors such as larotrectinib and entrectinib. NTRK fusions occur in a wide range of tumours including rare tumours such as infantile fibrosarcoma and secretory carcinomas of the salivary gland and breast, as well as at low frequencies in more common tumours including melanoma, colorectal, thyroid and lung carcinomas. Identifying NTRK fusions is a challenging task given the different genetic mechanisms underlying NTRK fusions, their varying frequency across different tumour types, complicated by other factors such as tissue availability, optimal detection methods, accessibility and costs of testing methods. Pathologists play a key role in navigating through these complexities by determining optimal approaches to NTRK testing which has important therapeutic and prognostic implications. This review provides an overview of tumours harbouring NTRK fusions, the importance of identifying these fusions, available testing methods including advantages and limitations, and generalised and tumour-specific approaches to testing.
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Affiliation(s)
- Minh Anh Nguyen
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew J Colebatch
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Diana Van Beek
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Geraldine Tierney
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia.
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14
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Yu SL, Hsiao YJ, Cooper WA, Choi YL, Avilés-Salas A, Chou TY, Coudry R, Raskin GA, Fox SB, Huang CC, Jeon YK, Ko YH, Ku WH, Kwon GY, Leslie C, Lin MC, Lou PJ, Scapulatempo-Neto C, Mendoza Ramírez S, Savelov N, Shim HS, Lara Torres CO, Cunha IW, Zavalishina L, Chen YM. The Ring Study: an international comparison of PD-L1 diagnostic assays and their interpretation in non-small cell lung cancer, head and neck squamous cell cancer and urothelial cancer. Pathology 2023; 55:19-30. [PMID: 36319485 DOI: 10.1016/j.pathol.2022.07.016] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
PD-L1 immunohistochemistry has been approved as a diagnostic assay for immunotherapy. However, an international comparison across multiple cancers is lacking. This study aimed to assess the performance of PD-L1 diagnostic assays in non-small cell lung cancer (NSCLC), head and neck squamous cell cancer (HNSCC) and urothelial cancer (UC). The excisional specimens of NSCLC, HNSCC and UC were assayed by Ventana SP263 and scored at three sites in each country, including Australia, Brazil, Korea, Mexico, Russia and Taiwan. All slides were rotated to two other sites for interobserver scoring. The same cohort of NSCLC was assessed with Dako 22C3 pharmDx PD-L1 for comparison. The PD-L1 immunopositivity was scored according to the approved PD-L1 scoring algorithms which were the percentage of PD-L1-expressing tumour cell (TC) and tumour proportion score (TPS) by Ventana SP263 and Dako 22C3 staining, respectively. In NSCLC, the comparison demonstrated the comparability of the SP263 and 22C3 assays (cut-off of 1%, κ=0.71; 25%, κ=0.75; 50%, κ=0.81). The interobserver comparisons showed moderate to almost perfect agreement for SP263 in TC staining at 25% cut-off (NSCLC, κ=0.72 to 0.86; HNSCC, κ=0.60 to 0.82; UC, κ=0.68 to 0.91) and at 50% cut-off for NSCLC (κ=0.64 to 0.90). Regarding the immune cell (IC) scoring in UC, there was a lower correlation (concordance correlation coefficient=0.10 to 0.68) and poor to substantial agreements at the 1%, 5%, 10% and 25% cut-offs (κ= -0.04 to 0.76). The interchangeability of SP263 and 22C3 in NSCLC might be acceptable, especially at the 50% cut-off. In HNSCC, the performance of SP263 is comparable across five countries. In UC, there was low concordance of IC staining, which may affect treatment decisions. Overall, the study showed the reliability and reproducibility of SP263 in NSCLC, HNSCC and UC.
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Affiliation(s)
- Sung-Liang Yu
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yi-Jing Hsiao
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan.
| | - Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | | | - Teh-Ying Chou
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Renata Coudry
- Department of Pathology, Sirio Libanes Hospital and United Health Group Brazil, Sao Paulo, Brazil.
| | - Grigory A Raskin
- A.M. Granov Russian Scientific Center of Radiological and Surgical Technologies, St Petersburg, Russia.
| | - Stephen B Fox
- Molecular Pathology Laboratory, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Vic, Australia
| | - Chao-Cheng Huang
- Biobank and Tissue Bank and Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Young-Hyeh Ko
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wen-Hui Ku
- Taipei Institute of Pathology, Taipei, Taiwan
| | - Ghee-Young Kwon
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Mei-Chun Lin
- National Taiwan University Cancer Center, Taipei, Taiwan; Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Cristovam Scapulatempo-Neto
- Pathology and Molecular Diagnostics, Diagnósticos da América, DASA, São Paulo, Brazil; Molecular Oncology Research Center, Hospital de Amor de Barretos, Barretos, Brazil
| | | | | | - Hyo-Sup Shim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Isabela Werneck Cunha
- Institute of Anatomical Pathology, Rede D'Or São Luiz Hospitals Network, Rio de Janeiro and São Paulo, Brazil; D'Or Institute for Research and Education, Rio de Janeiro and São Paulo, Brazil
| | - Larisa Zavalishina
- Pathology Department of the Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Yan-Ming Chen
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
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15
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Maleszewski JJ, Basso C, Burke A, Castonguay M, Leduc C, Tavora F, Sheppard M, Suri R, Judge M, Cooper WA. Dataset for the reporting of neoplasms of the heart, pericardium, and great vessels: recommendations from the International Collaboration on Cancer Reporting (ICCR). Virchows Arch 2023; 482:303-309. [PMID: 36512082 DOI: 10.1007/s00428-022-03473-7] [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: 10/31/2022] [Revised: 10/31/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) was founded by major pathology organizations from around the world to produce internationally standardized and evidence-based datasets for pathologists' reporting of cancer. Its goal is to improve cancer patient outcomes worldwide and to advance international benchmarking in cancer management. The ICCR cancer dataset development schedule is aligned with revisions of the WHO Classification of Tumours ("Blue Book") series, and in 2015 ICCR developed an initial series of thoracic datasets including a dataset for neoplasms of the heart, pericardium, and great vessels. This edition has now been updated to align with the 2021 WHO Blue Book series. An expert panel was convened to review and revise the dataset. While the majority of ICCR datasets are focused on malignant tumors, the scope of this dataset includes a number of benign tumors and tumor-like entities because of the rarity of cardiac malignancies and the serious implications of even histologically benign lesions. Due to the rarity of cardiac tumors, evidence in support of reporting elements is limited.
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Affiliation(s)
- Joseph J Maleszewski
- ICCR Dataset for the Reporting of Neoplasms of the Heart, Pericardium, and Great Vessels Dataset Authoring Committee, Department of Laboratory Medicine & Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA.
| | - Cristina Basso
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Allen Burke
- University of Maryland Medical Center, University of Maryland, Baltimore, MD, USA
| | - Mathieu Castonguay
- Department of Pathology, Faculty of Medicine, Dalhousie University Halifax, Halifax, NS, Canada
| | - Charles Leduc
- Department of Pathology, University of Montreal Health Center, Montreal, QC, Canada
| | - Fabio Tavora
- Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | - Mary Sheppard
- St. George's Medical School, University of London, London, UK
| | - Rakesh Suri
- Division of Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Meagan Judge
- Royal College of Pathologists of Australasia, Surry Hills, New South Wales, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, 2050, Australia.,Discipline of Pathology, School of Medicine, Western Sydney University, Penrith, NSW, Australia
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16
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Heynemann S, Prosser N, Lee J, Mahar A, Anderson L, Kao S, Cooper WA. Squamous cell carcinoma differentiation at progression as a resistance mechanism in metastatic non-small cell lung carcinoma harbouring a targetable mutation. Pathology 2022; 54:935-938. [PMID: 35570027 DOI: 10.1016/j.pathol.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Sarah Heynemann
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
| | - N Prosser
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - J Lee
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Department of Clinical Medicine, Macquarie University, Macquarie Park, NSW, Australia
| | - A Mahar
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - L Anderson
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - S Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - W A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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17
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Parker AL, Bowman E, Zingone A, Ryan BM, Cooper WA, Kohonen-Corish M, Harris CC, Cox TR. Extracellular matrix profiles determine risk and prognosis of the squamous cell carcinoma subtype of non-small cell lung carcinoma. Genome Med 2022; 14:126. [PMID: 36404344 PMCID: PMC9677915 DOI: 10.1186/s13073-022-01127-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Squamous cell carcinoma (SqCC) is a subtype of non-small cell lung cancer for which patient prognosis remains poor. The extracellular matrix (ECM) is critical in regulating cell behavior; however, its importance in tumor aggressiveness remains to be comprehensively characterized. METHODS Multi-omics data of SqCC human tumor specimens was combined to characterize ECM features associated with initiation and recurrence. Penalized logistic regression was used to define a matrix risk signature for SqCC tumors and its performance across a panel of tumor types and in SqCC premalignant lesions was evaluated. Consensus clustering was used to define prognostic matreotypes for SqCC tumors. Matreotype-specific tumor biology was defined by integration of bulk RNAseq with scRNAseq data, cell type deconvolution, analysis of ligand-receptor interactions and enriched biological pathways, and through cross comparison of matreotype expression profiles with aging and idiopathic pulmonary fibrosis lung profiles. RESULTS This analysis revealed subtype-specific ECM signatures associated with tumor initiation that were predictive of premalignant progression. We identified an ECM-enriched tumor subtype associated with the poorest prognosis. In silico analysis indicates that matrix remodeling programs differentially activate intracellular signaling in tumor and stromal cells to reinforce matrix remodeling associated with resistance and progression. The matrix subtype with the poorest prognosis resembles ECM remodeling in idiopathic pulmonary fibrosis and may represent a field of cancerization associated with elevated cancer risk. CONCLUSIONS Collectively, this analysis defines matrix-driven features of poor prognosis to inform precision medicine prevention and treatment strategies towards improving SqCC patient outcome.
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Affiliation(s)
- Amelia L. Parker
- grid.415306.50000 0000 9983 6924Matrix and Metastasis Lab, Cancer Ecosystems Program, Garvan Institute of Medical Research and The Kinghorn Cancer Centre, 384 Victoria St, Darlinghurst, NSW 2052 Australia ,grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Sydney, Sydney, 2052 Australia
| | - Elise Bowman
- grid.48336.3a0000 0004 1936 8075Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892 USA
| | - Adriana Zingone
- grid.48336.3a0000 0004 1936 8075Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892 USA
| | - Brid M. Ryan
- grid.48336.3a0000 0004 1936 8075Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892 USA ,Present address: MiNA Therapeutics, London, UK
| | - Wendy A. Cooper
- grid.413249.90000 0004 0385 0051Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia ,grid.1013.30000 0004 1936 834XSydney Medical School, University of Sydney, Sydney, NSW 2050 Australia ,grid.1029.a0000 0000 9939 5719Discipline of Pathology, School of Medicine, Western Sydney University, Liverpool, NSW 2170 Australia
| | - Maija Kohonen-Corish
- grid.417229.b0000 0000 8945 8472Woolcock Institute of Medical Research, Sydney, NSW 2037 Australia ,grid.1005.40000 0004 4902 0432Microbiome Research Centre, School of Clinical Medicine, UNSW Sydney, Sydney, 2052 Australia ,grid.415306.50000 0000 9983 6924Garvan Institute of Medical Research, Darlinghurst, NSW 2010 Australia
| | - Curtis C. Harris
- grid.48336.3a0000 0004 1936 8075Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892 USA
| | - Thomas R. Cox
- grid.415306.50000 0000 9983 6924Matrix and Metastasis Lab, Cancer Ecosystems Program, Garvan Institute of Medical Research and The Kinghorn Cancer Centre, 384 Victoria St, Darlinghurst, NSW 2052 Australia ,grid.1005.40000 0004 4902 0432School of Clinical Medicine, UNSW Sydney, Sydney, 2052 Australia
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18
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Potter AJ, Colebatch AJ, Rawson RV, Ferguson PM, Cooper WA, Gupta R, O'Toole S, Saw RPM, Ch'ng S, Menzies AM, Long GV, Scolyer RA. Pathologist initiated reflex BRAF mutation testing in metastatic melanoma: experience at a specialist melanoma treatment centre. Pathology 2022; 54:526-532. [PMID: 35249747 DOI: 10.1016/j.pathol.2021.12.290] [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] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
Testing for BRAF mutations in metastatic melanoma is pivotal to identifying patients suitable for targeted therapy and influences treatment decisions regarding single agent versus combination immunotherapy. Knowledge of BRAF V600E immunohistochemistry (IHC) results can streamline decisions during initial oncology consultations, prior to DNA-based test results. In the absence of formal guidelines that require pathologist initiated ('reflex') BRAF mutation testing, our institution developed a local protocol to perform BRAF V600E IHC on specimens from all stage III/IV melanoma patients when the status is otherwise unknown. This study was designed to evaluate the application of this protocol in a tertiary referral pathology department. A total of 408 stage III/IV melanoma patients had tissue specimens accessioned between 1 January and 31 March in three consecutive years (from 2019 to 2021), reported by 32 individual pathologists. The BRAF mutation status was established by pathologists in 87% (352/408) of cases. When a prior BRAF mutation status was previously known, as confirmed in linked electronic records (202/408), this status had been communicated by the clinician on the pathology request form in 1% of cases (3/202). Pathologists performed BRAF V600E IHC in 153 cases (74% of cases where the status was unknown, 153/206) and testing was duplicated in 5% of cases (20/408). Reflex BRAF IHC testing was omitted in 26% of cases (53/206), often on specimens with small volume disease (cytology specimens or sentinel node biopsies) despite adequate tissue for testing. Incorporating BRAF IHC testing within routine diagnostic protocols of stage III/IV melanoma was both feasible and successful in most cases. Communication of a patient's BRAF mutation status via the pathology request form will likely improve implementation of pathologist initiated BRAF mutation testing and may result in a reduction of duplicate tests. To improve pathologist reflex testing rates, we advocate for the use of an algorithmic approach to pathologist initiated BRAF mutation testing utilising both IHC and DNA-based methodologies for stage III/IV melanoma patients.
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Affiliation(s)
- Alison J Potter
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J Colebatch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Robert V Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Peter M Ferguson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Western Sydney University, Campbelltown, NSW, Australia
| | - Ruta Gupta
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sandra O'Toole
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Western Sydney University, Campbelltown, NSW, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Mater Hospital, North Sydney, NSW, Australia
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Mater Hospital, North Sydney, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Mater Hospital, North Sydney, NSW, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Mater Hospital, North Sydney, NSW, Australia; Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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19
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Walsh SL, Mackintosh JA, Calandriello L, Silva M, Sverzellati N, Larici AR, Humphries SM, Lynch DA, Jo HE, Glaspole I, Grainge C, Goh N, Hopkins PMA, Moodley Y, Reynolds PN, Zappala C, Keir G, Cooper WA, Mahar AM, Ellis S, Wells AU, Corte TJ. Deep Learning-based Outcome Prediction in Progressive Fibrotic Lung Disease Using High-resolution Computed Tomography. Am J Respir Crit Care Med 2022; 206:883-891. [PMID: 35696341 DOI: 10.1164/rccm.202112-2684oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Reliable outcome prediction in patients with fibrotic lung disease using baseline high-resolution computed tomography (HRCT) data remains challenging. OBJECTIVES To evaluate the prognostic accuracy of a deep learning algorithm (SOFIA), trained and validated in the identification of UIP-like features on HRCT (UIP probability), in a large cohort of well characterised patients with progressive fibrotic lung disease, drawn from a national registry. METHODS SOFIA and radiologist-UIP probabilities were converted to PIOPED-based UIP probability categories (UIP not included in the differential: 0-4%, low probability of UIP: 5-29%, intermediate probability of UIP: 30-69%, high probability of UIP: 70-94%, and pathognomonic for UIP:95-100%) and their prognostic utility assessed using Cox proportional hazards modelling. MEASUREMENTS AND MAIN RESULTS On multivariable analysis adjusting for age, gender, guideline based radiologic diagnosis and disease severity (using total ILD extent on HRCT, %predicted FVC, DLco or the CPI), only SOFIA-UIP probability PIOPED categories predicted survival. SOFIA-PIOPED UIP probability categories remained prognostically significant in patients considered indeterminate (n=83) by expert radiologist consensus (HR1.73, p<0.0001, 95%CI 1.40-2.14). In patients undergoing surgical lung biopsy (SLB) (n=86), after adjusting for guideline-based histologic pattern and total ILD extent on HRCT, only SOFIA-PIOPED probabilities were predictive of mortality (HR1.75, p<0.0001, 95%CI 1.37-2.25). CONCLUSIONS Deep learning-based UIP probability on HRCT provides enhanced outcome prediction in patients with progressive fibrotic lung disease when compared to expert radiologist evaluation or guideline-based histologic pattern. In principle this tool may be useful in multidisciplinary characterisation of fibrotic lung disease. The utility of this technology as a decision support system when ILD expertise is unavailable requires further investigation.
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Affiliation(s)
- Simon Lf Walsh
- Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland;
| | | | - Lucio Calandriello
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 18654, Dipartimento di Diagnostica per immagini, Roma, Italy
| | - Mario Silva
- Universita degli Studi di Parma, 9370, Section of Radiology, Department of Medicine and Surgery, Parma, Italy
| | - Nicola Sverzellati
- Department of Surgical Sciences, Ospedale Maggiore di Parma, Parma, Italy
| | - Anna Rita Larici
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 18654, Dipartimento di Diagnostica per immagini, Roma, Italy
| | | | - David A Lynch
- National Jewish Health, Radiology, Denver, Colorado, United States
| | - Helen E Jo
- Centre of Research Excellence in Pulmonary Fibrosis, Camperdown , New South Wales, Australia.,The University of Sydney, 4334, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, 2205, Department of Respiratory and Sleep Medicine, Camperdown, New South Wales, Australia
| | - Ian Glaspole
- The Alfred Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Christopher Grainge
- John Hunter Hospital, 37024, New Lambton Heights, New South Wales, Australia
| | - Nicole Goh
- Austin Health, Department of Respiratory and Sleep Medicine, Heidelberg, Victoria, Australia.,Alfred Health, 5392, Allergy, Immunology & Respiratory Medicine Department, Melbourne, Victoria, Australia
| | - Peter M A Hopkins
- The Prince Charles Hospital, 67567, Chermside, Queensland, Australia
| | - Yuben Moodley
- The University of Western Australia, Respiratory Medicine, Perth, Western Australia, Australia
| | - Paul N Reynolds
- Royal Adelaide Hospital, Thoracic Medicine, Adelaide, South Australia, Australia
| | | | - Gregory Keir
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Wendy A Cooper
- Royal Prince Alfred Hospital, 2205, Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Camperdown, New South Wales, Australia
| | - Annabelle M Mahar
- Royal Prince Alfred Hospital, 2205, Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Camperdown, New South Wales, Australia
| | - Samantha Ellis
- Alfred Health, 5392, Department of Radiology, Melbourne, Victoria, Australia
| | - Athol U Wells
- Royal Brompton Hospital, Interstitial Lung Disease Unit, London, United Kingdom of Great Britain and Northern Ireland
| | - Tamera J Corte
- Royal Prince Alfred Hospital, 2205, Department of Respiratory and Sleep Medicine, Camperdown, New South Wales, Australia
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20
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Satgunaseelan L, Strbenac D, Willet C, Chew T, Sadsad R, Wykes J, Low HTH, Cooper WA, Lee CS, Palme CE, Yang JYH, Clark JR, Gupta R. Whole Genome Duplication in Oral Squamous Cell Carcinoma in Patients Younger Than 50 years: Implications for Prognosis and Adverse Clinicopathological Factors. Genes Chromosomes Cancer 2022; 61:561-571. [PMID: 35670448 PMCID: PMC9542139 DOI: 10.1002/gcc.23076] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Oral squamous cell carcinoma (OSCC) in the young (<50 years), without known carcinogenic risk factors, is on the rise globally. Whole genome duplication (WGD) has been shown to occur at higher rates in cancers without an identifiable carcinogenic agent. We aimed to evaluate the prevalence of WGD in a cohort of OSCC patients under the age of 50 years. Methods Whole genome sequencing (WGS) was performed on 28 OSCC patients from the Sydney Head and Neck Cancer Institute (SHNCI) biobank. An additional nine cases were obtained from The Cancer Genome Atlas (TCGA). Results WGD was seen in 27 of 37 (73%) cases. Non‐synonymous, somatic TP53 mutations occurred in 25 of 27 (93%) cases of WGD and were predicted to precede WGD in 21 (77%). WGD was significantly associated with larger tumor size (p = 0.01) and was frequent in patients with recurrences (87%, p = 0.36). Overall survival was significantly worse in those with WGD (p = 0.05). Conclusions Our data, based on one of the largest WGS datasets of young patients with OSCC, demonstrates a high frequency of WGD and its association with adverse pathologic characteristics and clinical outcomes. TP53 mutations also preceded WGD, as has been described in other tumors without a clear mutagenic driver.
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Affiliation(s)
- Laveniya Satgunaseelan
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Dario Strbenac
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia
| | - Cali Willet
- The Sydney Informatics Hub, Core Research Facilities, The University of Sydney, Sydney, NSW, Australia
| | - Tracy Chew
- The Sydney Informatics Hub, Core Research Facilities, The University of Sydney, Sydney, NSW, Australia
| | - Rosemarie Sadsad
- The Sydney Informatics Hub, Core Research Facilities, The University of Sydney, Sydney, NSW, Australia
| | - James Wykes
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Hubert T H Low
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - C Soon Lee
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Discipline of Pathology, School of Medicine, Western Sydney University, Penrith, NSW, Australia.,Genomics & Molecular Pathology Laboratory, Department of Anatomical Pathology, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, NSW, Australia
| | - Carsten E Palme
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Jean Y H Yang
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan R Clark
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia
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21
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McLean AEB, Kao SC, Barnes DJ, Wong KKH, Scolyer RA, Cooper WA, Kohonen-Corish MRJ. Corrigendum to "The emerging role of the lung microbiome and its importance in non-small cell lung cancer diagnosis and treatment" [Lung Cancer 165C (2022) 124-132]. Lung Cancer 2022; 166:252. [PMID: 35279297 DOI: 10.1016/j.lungcan.2022.02.011] [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: 10/18/2022]
Affiliation(s)
- Anna E B McLean
- Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Respiratory and Sleep Medicine, Sydney Local Health District, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Steven C Kao
- Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Asbestos Diseases Research Institute, Sydney, New South Wales, Australia
| | - David J Barnes
- Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Respiratory and Sleep Medicine, Sydney Local Health District, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Keith K H Wong
- Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Respiratory and Sleep Medicine, Sydney Local Health District, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Tissue Pathology and Diagnostic Oncology, Sydney Local Health District, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Wendy A Cooper
- Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Tissue Pathology and Diagnostic Oncology, Sydney Local Health District, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Western Sydney University, Sydney, New South Wales, Australia
| | - Maija R J Kohonen-Corish
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia; Western Sydney University, Sydney, New South Wales, Australia; University of Technology Sydney, Sydney, New South Wales, Australia; Microbiome Research Centre, St George and Sutherland Clinical School, UNSW, Sydney, New South Wales, Australia
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22
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McLean AEB, Kao SC, Barnes DJ, Wong KKH, Scolyer RA, Cooper WA, Kohonen-Corish MRJ. The emerging role of the lung microbiome and its importance in non-small cell lung cancer diagnosis and treatment. Lung Cancer 2022; 165:124-132. [PMID: 35123155 DOI: 10.1016/j.lungcan.2022.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/15/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 12/18/2022]
Abstract
Over the last 10 years, with the development of culture-free bacterial identification techniques, understanding of how the microbiome influences diseases has increased exponentially and has highlighted potential opportunities for its use as a diagnostic biomarker and interventional target in many diseases including malignancy. Initial research focused on the faecal microbiome since it contains the densest bacterial populations and many other mucosal sites, such as the lungs, were until recently thought to be sterile. However, in recent years, it has become clear that the lower airways are home to a dynamic bacterial population sustained by the migration and elimination of microbes from the gastrointestinal and upper airway tracts. As in the gut, the lung microbiome plays an important role in regulating mucosal immunity and maintaining the balance between immune tolerance and inflammation. Studies to date have all shown that the lung microbiome undergoes significant changes in the setting of pulmonary disease. In lung cancer, animal models and small patient cohort studies have suggested that microbiome dysbiosis may not only impact tumour progression and response to therapy, particularly immunotherapy, but also plays a key role in cancer pathogenesis by influencing early carcinogenic pathways. These early results have led to concerted efforts to identify microbiome signatures that represent diagnostic biomarkers of early-stage disease and to consider modulation of the lung microbiome as a potential therapeutic strategy. Lung microbiome research is in its infancy and studies to date have been small, single centre with significant methodological variation. Large, multicentre longitudinal studies are needed to establish the clinical potential of this exciting field.
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Affiliation(s)
- Anna E B McLean
- Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia; Respiratory and Sleep Medicine, Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.
| | - Steven C Kao
- Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, Australia; Asbestos Diseases Research Institute, Rhodes, Australia
| | - David J Barnes
- Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia; Respiratory and Sleep Medicine, Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Keith K H Wong
- Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia; Respiratory and Sleep Medicine, Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Richard A Scolyer
- Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia; Tissue Pathology and Diagnostic Oncology, Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Wendy A Cooper
- Faculty of Medicine and Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia; Tissue Pathology and Diagnostic Oncology, Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Western Sydney University, Campbelltown, Sydney, New South Wales, Australia
| | - Maija R J Kohonen-Corish
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia; Western Sydney University, Campbelltown, Sydney, New South Wales, Australia; University of Technology Sydney, Ultimo, New South Wales, Australia; Microbiome Research Centre, St George and Sutherland Clinical School, UNSW Sydney, Kogarah, New South Wales, Australia
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23
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Woodford R, Zhou D, Lord SJ, Marschner I, Cooper WA, Lewis CR, John T, Yang JCH, Lee CK. PD-L1 expression as a prognostic marker in patients treated with chemotherapy for metastatic non-small-cell lung cancer. Future Oncol 2022; 18:1793-1799. [PMID: 35156837 DOI: 10.2217/fon-2021-1184] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: In metastatic non-small-cell lung cancer (mNSCLC), PD-L1 expression is associated with benefit from immune checkpoint inhibitor (ICI) therapy. However, the significance of PD-L1 expression in chemotherapy-treated patients is uncertain. Methods: Using the chemotherapy control arm of first-line randomized trials, a meta-analysis of the association between efficacy outcomes and PD-L1 status was performed, stratified by assay due to inter-assay differences. Results: Across 12 trials and 4378 patients, overall survival (OS) was superior in high PD-L1 versus negative tumors and low versus negative according to 22C3/28-8 assays. When classified by SP142 assay, no significant difference in response or survival was seen between PD-L1 groups. Conclusion: In mNSCLC, high PD-L1-expressing tumors are associated with longer OS and improved objective rate when treated with chemotherapy. Inter-assay variability impacts outcome results.
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Affiliation(s)
- Rachel Woodford
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.,Cancer Care Centre, St George Hospital, Kogarah, 2217, Australia
| | - Deborah Zhou
- Chris O'Brien Lifehouse, Royal Prince Alfred Hospital, Sydney, 2050, Australia
| | - Sarah J Lord
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Ian Marschner
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology & Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, New South Wales, 2050, Australia
| | - Craig R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, 2031, Australia
| | - Thomas John
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, Taipei City, 100, Taiwan
| | - Chee Khoon Lee
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.,Cancer Care Centre, St George Hospital, Kogarah, 2217, Australia
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24
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Cooper WA, Mahar A, Myers JL, Grainge C, Corte TJ, Williamson JP, Lau EMT, Raghu G, Troy LK. In Reply. Arch Pathol Lab Med 2021; 145:1326-1327. [PMID: 34673907 DOI: 10.5858/arpa.2021-0305-le] [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] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, University of Washington, Seattle.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Annabelle Mahar
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, University of Washington, Seattle
| | - Jeffrey L Myers
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor
| | - Christopher Grainge
- Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Tamera J Corte
- Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
| | - Jonathan P Williamson
- Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.,MQ Health, Respiratory and Sleep, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Edmund M T Lau
- Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ganesh Raghu
- Division of Pulmonary, Sleep and Critical Care Medicine, University of Washington, Seattle
| | - Lauren K Troy
- Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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25
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Clynick B, Corte TJ, Jo HE, Stewart I, Glaspole IN, Grainge C, Maher TM, Navaratnam V, Hubbard R, Hopkins PMA, Reynolds PN, Chapman S, Zappala C, Keir GJ, Cooper WA, Mahar AM, Ellis S, Goh NS, De Jong E, Cha L, Tan DBA, Leigh L, Oldmeadow C, Walters EH, Jenkins RG, Moodley Y. Biomarker signatures for progressive idiopathic pulmonary fibrosis. Eur Respir J 2021; 59:13993003.01181-2021. [PMID: 34675050 DOI: 10.1183/13993003.01181-2021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/03/2021] [Indexed: 11/05/2022]
Abstract
RATIONALE Idiopathic Pulmonary Fibrosis (IPF) is a progressive lung disease in which circulatory biomarkers has the potential for guiding management in clinical practice. OBJECTIVES We assessed the prognostic role of serum biomarkers in three independent IPF cohorts, the Australian IPF Registry (AIPFR), Trent Lung Fibrosis (TLF) and Prospective Observation of Fibrosis in the Lung Clinical Endpoints (PROFILE). METHODS In the AIPFR, candidate proteins were assessed by ELISA as well as in an unbiased proteomic approach. Least absolute shrinkage and selection operator (LASSO) regression was used to restrict the selection of markers that best accounted for the progressor phenotype at one-year in AIPFR, and subsequently prospectively selected for replication in the validation TLF cohort and assessed retrospectively in PROFILE. Four significantly replicating biomarkers were aggregated into a progression index (PI) model based on tertiles of circulating concentrations. MAIN RESULTS One-hundred and eighty-nine participants were included in the AIPFR cohort, 205 participants from the TLF, and 122 participants from the PROFILE cohorts. Differential biomarker expression was observed by ELISA and replicated for osteopontin, matrix metallopeptidase-7, intercellular adhesion molecule-1 and periostin for those with a progressor phenotype at one-year. Proteomic data did not replicate. The PI in the AIPFR, TLF and PROFILE predicted risk of progression, mortality and progression-free survival. A statistical model incorporating PI demonstrated the capacity to distinguish disease progression at 12 months, which was increased beyond the clinical GAP model alone in all cohorts, and significantly so within incidence based TLF and PROFILE cohorts. CONCLUSION A panel of circulatory biomarkers can provide potentially valuable clinical assistance in the prognosis of IPF patients.
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Affiliation(s)
- Britt Clynick
- Centre of Research Excellence in Pulmonary Fibrosis, Australia .,Institute for Respiratory Health Inc, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia.,The authors wish it to be known that, in their opinion, the first two authors should be regarded as joint First Authors
| | - Tamera J Corte
- Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,The authors wish it to be known that, in their opinion, the first two authors should be regarded as joint First Authors
| | - Helen E Jo
- Centre of Research Excellence in Pulmonary Fibrosis, Australia.,The University of Sydney Central Clinical School, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Iain Stewart
- NIHR Biomedical Research Centre, Respiratory Theme, University of Nottingham, Nottingham, UK
| | - Ian N Glaspole
- Monash University, Clayton, Victoria, Australia.,Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher Grainge
- University of Newcastle, Callaghan, New South Wales, Australia.,John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | | | - Vidya Navaratnam
- NIHR Biomedical Research Centre, Respiratory Theme, University of Nottingham, Nottingham, UK.,Nottingham University Hospitals, Nottingham, UK
| | - Richard Hubbard
- NIHR Biomedical Research Centre, Respiratory Theme, University of Nottingham, Nottingham, UK
| | - Peter M A Hopkins
- University of Queensland, St Lucia, Queensland, Australia.,Prince Charles Hospital, Chermside, Queensland, Australia
| | - Paul N Reynolds
- University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sally Chapman
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Gregory J Keir
- University of Queensland, St Lucia, Queensland, Australia
| | - Wendy A Cooper
- The University of Sydney Central Clinical School, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia
| | - Annabelle M Mahar
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Samantha Ellis
- Monash University, Clayton, Victoria, Australia.,Alfred Hospital, Melbourne, Victoria, Australia
| | - Nicole S Goh
- Austin Hospital, Heidelberg, Victoria, Australia.,Institute of Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Emma De Jong
- Institute for Respiratory Health Inc, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia
| | - Lilian Cha
- Institute for Respiratory Health Inc, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia
| | - Dino B A Tan
- Institute for Respiratory Health Inc, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia
| | - Lucy Leigh
- University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christopher Oldmeadow
- University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - E Haydn Walters
- Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Alfred Hospital, Melbourne, Victoria, Australia.,University of Tasmania, Hobart, Tasmania, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - R Gisli Jenkins
- NIHR Biomedical Research Centre, Respiratory Theme, University of Nottingham, Nottingham, UK
| | - Yuben Moodley
- Centre of Research Excellence in Pulmonary Fibrosis, Australia.,Institute for Respiratory Health Inc, Nedlands, Western Australia, Australia.,University of Western Australia, Crawley, Western Australia, Australia.,Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Aggarwal C, Bubendorf L, Cooper WA, Illei P, Borralho Nunes P, Ong BH, Tsao MS, Yatabe Y, Kerr KM. Molecular testing in stage I-III non-small cell lung cancer: Approaches and challenges. Lung Cancer 2021; 162:42-53. [PMID: 34739853 DOI: 10.1016/j.lungcan.2021.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 06/15/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/08/2023]
Abstract
Precision medicine in non-small cell lung cancer (NSCLC) is a rapidly evolving area, with the development of targeted therapies for advanced disease and concomitant molecular testing to inform clinical decision-making. In contrast, routine molecular testing in stage I-III disease has not been required, where standard of care comprises surgery with or without adjuvant or neoadjuvant chemotherapy, or concurrent chemoradiotherapy for unresectable stage III disease, without the integration of targeted therapy. However, the phase 3 ADAURA trial has recently shown that the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), osimertinib, reduces the risk of disease recurrence by 80% versus placebo in the adjuvant setting for patients with stage IB-IIIA EGFR mutation-positive NSCLC following complete tumor resection with or without adjuvant chemotherapy, according to physician and patient choice. Treatment with adjuvant osimertinib requires selection of patients based on the presence of an EGFR-TKI sensitizing mutation. Other targeted agents are currently being evaluated in the adjuvant and neoadjuvant settings. Approval of at least some of these other agents is highly likely in the coming years, bringing with it in parallel, a requirement for comprehensive molecular testing for stage I-III disease. In this review, we consider the implications of integrating molecular testing into practice when managing patients with stage I-III non-squamous NSCLC. We discuss best practices, approaches and challenges from pathology, surgical and oncology perspectives.
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Affiliation(s)
- Charu Aggarwal
- Abramson Cancer Center and Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; Western Sydney University, Campbelltown, NSW, Australia
| | - Peter Illei
- Department of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paula Borralho Nunes
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Hospital CUF Descobertas, Lisbon, Portugal
| | - Boon-Hean Ong
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Ming-Sound Tsao
- Department of Pathology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center, Tokyo, Japan
| | - Keith M Kerr
- Department of Pathology, Aberdeen University, Medical School and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
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Cooper WA, Lantuejoul S, Mino-Kenudson M. Predicting Response to Programmed Cell Death Protein-1 or Programmed Death-Ligand 1 Blockade in NSCLC-Is Multiplex Immunohistochemistry or Immunofluorescence the Answer? J Thorac Oncol 2021; 16:1247-1249. [PMID: 34304853 DOI: 10.1016/j.jtho.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; School of Medicine, Western Sydney University, Sydney, Australia.
| | - Sylvie Lantuejoul
- Institute for Advanced Biosciences, University Grenoble Alpes, Grenoble, France; Department of Biopathology, Centre Leon Berard Unicancer and Pathology Research Platform, Cancer Research Center of Lyon (CRCL), Lyon, France
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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28
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Pang JMB, Castles B, Byrne DJ, Button P, Hendry S, Lakhani SR, Sivasubramaniam V, Cooper WA, Armes J, Millar EK, Raymond W, Roberts-Thomson S, Kumar B, Burr M, Selinger C, Harvey K, Chan C, Beith J, Clouston D, O’Toole SA, Fox SB. SP142 PD-L1 Scoring Shows High Interobserver and Intraobserver Agreement in Triple-negative Breast Carcinoma But Overall Low Percentage Agreement With Other PD-L1 Clones SP263 and 22C3. Am J Surg Pathol 2021; 45:1108-1117. [PMID: 34232604 PMCID: PMC8277187 DOI: 10.1097/pas.0000000000001701] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SP142 programmed cell death ligand 1 (PD-L1) status predicts response to atezolizumab in triple-negative breast carcinoma (TNBC). Prevalence of VENTANA PD-L1 (SP142) Assay positivity, concordance with the VENTANA PD-L1 (SP263) Assay and Dako PD-L1 IHC 22C3 pharmDx assay, and association with clinicopathologic features were assessed in 447 TNBCs. SP142 PD-L1 intraobserver and interobserver agreement was investigated in a subset of 60 TNBCs, with scores enriched around the 1% cutoff. The effect of a 1-hour training video on pretraining and posttraining scores was ascertained. At a 1% cutoff, 34.2% of tumors were SP142 PD-L1 positive. SP142 PD-L1 positivity was significantly associated with tumor-infiltrating lymphocytes (P <0.01), and node negativity (P=0.02), but not with tumor grade (P=0.35), tumor size (P=0.58), or BRCA mutation (P=0.53). Overall percentage agreement (OPA) for intraobserver and interobserver agreement was 95.0% and 93.7%, respectively, among 5 pathologists trained in TNBC SP142 PD-L1 scoring. In 5 TNBC SP142 PD-L1-naive pathologists, significantly higher OPA to the reference score was achieved after video training (posttraining OPA 85.7%, pretraining OPA 81.5%, P<0.05). PD-L1 status at a 1% cutoff was assessed by SP142 and SP263 in 420 cases, and by SP142 and 22C3 in 423 cases, with OPA of 88.1% and 85.8%, respectively. The VENTANA PD-L1 (SP142) Assay is reproducible for classifying TNBC PD-L1 status by trained observers; however, it is not analytically equivalent to the VENTANA PD-L1 (SP263) Assay and Dako PD-L1 IHC 22C3 pharmDx assay.
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Affiliation(s)
| | | | | | | | | | - Sunil R. Lakhani
- University of Queensland Centre for Clinical Research
- Pathology Queensland, Brisbane
| | | | - Wendy A. Cooper
- Sydney Medical School, The University of Sydney
- Department of Tissue Pathology, Royal Prince Alfred Hospital, NSW Health Pathology
- Western Sydney University, Campbelltown
| | - Jane Armes
- Pathology Queensland, Sunshine Coast, QLD
| | - Ewan K.A. Millar
- NSW Health Pathology, St George Hospital
- St. George and Sutherland Clinical School, University of New South Wales, Kogarah
| | - Wendy Raymond
- Flinders Medical Centre, Flinders University of South Australia
- Clinpath Laboratories, Adelaide, SA, Australia
| | | | | | - Marian Burr
- Royal Melbourne Hospital
- Sir Peter MacCallum Department of Oncology, University of Melbourne
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, UK
| | | | - Kate Harvey
- The Garvan Institute of Medical Research, Darlinghurst
| | - Charles Chan
- Concord Clinical School, The University of Sydney, Sydney
- Concord Repatriation General Hospital, Concord, NSW
| | - Jane Beith
- Sydney Medical School, The University of Sydney
- Chris O’Brien Lifehouse, Camperdown
| | | | - Sandra A. O’Toole
- Sydney Medical School, The University of Sydney
- The Garvan Institute of Medical Research, Darlinghurst
- Department of Tissue Pathology, Royal Prince Alfred Hospital, NSW Health Pathology
- Western Sydney University, Campbelltown
| | - Stephen B. Fox
- Peter MacCallum Cancer Centre
- Sir Peter MacCallum Department of Oncology, University of Melbourne
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29
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Cooper WA, Mahar A, Myers JL, Grainge C, Corte TJ, Williamson JP, Vallely MP, Lai S, Mulyadi E, Torzillo PJ, Phillips MJ, Lau EMT, Raghu G, Troy LK. Cryobiopsy for Identification of Usual Interstitial Pneumonia and Other Interstitial Lung Disease Features. Further Lessons from COLDICE, a Prospective Multicenter Clinical Trial. Am J Respir Crit Care Med 2021; 203:1306-1313. [PMID: 33285079 DOI: 10.1164/rccm.202009-3688oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Rationale: Transbronchial lung cryobiopsy (TBLC) is an emerging technique for interstitial lung disease diagnosis. Good histopathologic agreement between TBLC and surgical lung biopsy (SLB) was demonstrated in the COLDICE (Cryobiopsy versus Open Lung Biopsy in the Diagnosis of Interstitial Lung Disease Alliance) study; however, diagnostic confidence was frequently lower for TBLC than SLB. Objectives: To characterize specific features of TBLC predictive of usual interstitial pneumonia (UIP) in corresponding SLB and to identify clinical indices predictive of biopsy concordance. Methods: The COLDICE study was a prospective, multicenter study investigating diagnostic agreement between TBLC and SLB. The participants underwent both procedures with blinded pathologist analysis of specimens, applying international guideline criteria. The TBLC features predictive of UIP in the paired SLB and predictive features of overall concordance were analyzed. Measurements and Main Results: A total of 65 patients (66.1 ± 9.3 yr; FVC, 84.7 ± 14.2%; DlCO, 63.4 ± 13.8%) participated in the COLDICE study. UIP was identified in 33/65 (50.8%) SLB, and 81.5% were concordant with corresponding TBLC (κ, 0.61; 95% confidence interval [CI], 0.38-0.77). The UIP guideline criteria of "predominantly subpleural or paraseptal fibrosis" was infrequently reported in TBLC (8/33, 24.2%), whereas "patchy fibrosis," "fibroblast foci," and the "absence of alternative diagnostic features" were frequently observed in TBLC. The combination of these three features strongly predicted UIP in paired SLB (odds ratio [OR], 23.4; 95% CI, 6.36-86.1; P < 0.0001). Increased numbers of TBLC samples predicted histopathologic concordance with SLB (OR, 1.8; 95% CI, 1.08-3.01; P = 0.03). The predictors of discordance included older age, family history, and radiologic asymmetry. Conclusions: Subpleural and/or paraseptal fibrosis were not essential for diagnosing UIP in TBLC, provided that other guideline criteria features were present. The diagnostic accuracy of TBLC was strengthened when increased numbers of samples were taken. Clinical trial registered with www.anzctr.org.au (ACTRN12615000718549).
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Affiliation(s)
- Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Annabelle Mahar
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology
| | - Jeffrey L Myers
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christopher Grainge
- Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Tamera J Corte
- Respiratory and Sleep Medicine, and.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
| | - Jonathan P Williamson
- Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.,Macquarie Health, Respiratory and Sleep, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Michael P Vallely
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Simon Lai
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ellie Mulyadi
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Paul J Torzillo
- Respiratory and Sleep Medicine, and.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Martin J Phillips
- Macquarie Health, Respiratory and Sleep, Macquarie University Hospital, Sydney, New South Wales, Australia.,Respiratory and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and
| | - Edmund M T Lau
- Respiratory and Sleep Medicine, and.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ganesh Raghu
- Division of Pulmonary, Sleep, and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Lauren K Troy
- Respiratory and Sleep Medicine, and.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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30
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Davis AP, Cooper WA, Boyer M, Lee JH, Pavlakis N, Kao SC. Efficacy of immunotherapy in KRAS-mutant non-small-cell lung cancer with comutations. Immunotherapy 2021; 13:941-952. [PMID: 34114474 DOI: 10.2217/imt-2021-0090] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/06/2023] Open
Abstract
KRAS-mutant non-small-cell lung cancer is the most common molecular driver of lung adenocarcinoma in western populations. No KRAS specific therapy has been approved by the US FDA until 2021. Despite significant heterogeneity in comutations, patients typically receive single-agent immunotherapy or chemoimmunotherapy as standard first-line therapy. It is unclear whether KRAS mutations predict outcomes with immunotherapy; however, there is emerging data suggesting improved outcomes in patients with a TP53 comutation and worse outcomes in patients with a STK11/LKB1 or KEAP1 comutation.
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Affiliation(s)
- Alexander P Davis
- Department of Medical Oncology, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Wendy A Cooper
- Tissue Pathology & Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia.,School of Medicine, Western Sydney University, Sydney, NSW 2571, Australia
| | - Michael Boyer
- Department of Medical Oncology, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia.,Sydney Medical School, University of Sydney, NSW 2006, Australia
| | - Jenny H Lee
- Department of Medical Oncology, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia.,Faculty of Medicine & Health, Macquarie University, NSW 2109, Australia
| | - Nick Pavlakis
- Sydney Medical School, University of Sydney, NSW 2006, Australia.,Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.,Genesis Care St Leonards, St Leonards, NSW 2065, Australia
| | - Steven C Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia.,Sydney Medical School, University of Sydney, NSW 2006, Australia.,Asbestos Disease Research Institute, Concord, NSW 2139, Australia
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Hulme KR, Mahar A, Cao C, McCaughan B, Cooper WA. Micronodular thymoma with lymphoid stroma: a clinicopathological study of five cases. Pathology 2021; 53:930-933. [PMID: 33947520 DOI: 10.1016/j.pathol.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Katherine R Hulme
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Annabelle Mahar
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Cao
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Brian McCaughan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Sydney Cardiothoracic Surgeons, Royal Prince Alfred Hospital Medical Centre, Sydney, NSW, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia.
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Paver E, O'Toole S, Cheng XM, Mahar A, Cooper WA. Updates in the molecular pathology of non-small cell lung cancer. Semin Diagn Pathol 2021; 38:54-61. [PMID: 33985831 DOI: 10.1053/j.semdp.2021.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/21/2021] [Revised: 04/04/2021] [Accepted: 04/08/2021] [Indexed: 12/21/2022]
Abstract
An understanding of the molecular pathology of non-small cell lung cancer (NSCLC) is important for pathologists as molecular characterization is now required for treatment decisions in advanced stage disease. While assessment for EGFR mutations, ALK and ROS1 fusions, and in some countries BRAF mutations, is now standard practice, other oncogenic mutations are also emerging that may impact routine clinical practice including alterations involving KRAS, NTRK, RET, MET and HER2. In addition, molecular pathology alterations of NSCLC are associated with responses to immune checkpoint therapy and are being increasingly investigated. Finally, specific molecular pathological alterations define some rarer subtypes of NSCLC such as salivary gland tumours, NUT carcinoma and SMARCA4-deficient undifferentiated tumour, and an understanding of the molecular pathology is important for their accurate diagnosis. In this review, the molecular pathology of NSCLC is discussed with a focus on clinically relevant molecular alterations.
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Affiliation(s)
- Elizabeth Paver
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sandra O'Toole
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Xin Min Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Annabelle Mahar
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia.
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Mino-Kenudson M, Le Stang N, Daigneault JB, Nicholson AG, Cooper WA, Roden AC, Moreira AL, Thunnissen E, Papotti M, Pelosi G, Motoi N, Poleri C, Brambilla E, Redman M, Jain D, Dacic S, Yatabe Y, Tsao MS, Lopez-Rios F, Botling J, Chen G, Chou TY, Hirsch FR, Beasley MB, Borczuk A, Bubendorf L, Chung JH, Hwang D, Lin D, Longshore J, Noguchi M, Rekhtman N, Sholl L, Travis W, Yoshida A, Wynes MW, Wistuba II, Kerr KM, Lantuejoul S. The International Association for the Study of Lung Cancer Global Survey on Programmed Death-Ligand 1 Testing for NSCLC. J Thorac Oncol 2021; 16:686-696. [PMID: 33662578 PMCID: PMC9260927 DOI: 10.1016/j.jtho.2020.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/03/2020] [Revised: 12/19/2020] [Accepted: 12/26/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Programmed death-ligand 1 (PD-L1) immunohistochemistry (IHC) is required to determine the eligibility for pembrolizumab monotherapy in advanced NSCLC worldwide and for several other indications depending on the country. Four assays have been approved/ Communauté Européene-In vitro Diagnostic (CV-IVD)-marked, but PD-L1 IHC seems diversely implemented across regions and laboratories with the application of laboratory-developed tests (LDTs). METHOD To assess the practice of PD-L1 IHC and identify issues and disparities, the International Association for the Study of Lung Cancer Pathology Committee conducted a global survey for pathologists from January to May 2019, comprising multiple questions on preanalytical, analytical, and postanalytical conditions. RESULT A total of 344 pathologists from 64 countries participated with 41% from Europe, 24% from North America, and 18% from Asia. Besides biopsies and resections, cellblocks were used by 75% of the participants and smears by 11%. The clone 22C3 was most often used (69%) followed by SP263 (51%). They were applied as an LDT by 40% and 30% of the users, respectively, and 76% of the participants developed at least one LDT. Half of the participants reported a turnaround time of less than or equal to 2 days, whereas 13% reported that of greater than or equal to 5 days. In addition, quality assurance (QA), formal training for scoring, and standardized reporting were not implemented by 18%, 16%, and 14% of the participants, respectively. CONCLUSIONS Heterogeneity in PD-L1 testing is marked across regions and laboratories in terms of antibody clones, IHC assays, samples, turnaround times, and QA measures. The lack of QA, formal training, and standardized reporting stated by a considerable minority identifies a need for additional QA measures and training opportunities.
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Affiliation(s)
- Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | | | - Andrew G Nicholson
- Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Wendy A Cooper
- Royal Prince Alfred Hospital, New South Wales (NSW) Health Pathology and University of Sydney, Camperdown, Australia
| | - Anja C Roden
- Department of Pathology, Mayo Clinic, Rochester, Minnesota
| | - Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, New York
| | - Erik Thunnissen
- Department of Pathology, VU Medical Center, Amsterdam, The Netherlands
| | - Mauro Papotti
- Anatomic Pathology, University of Turin, Turin, Italy
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Noriko Motoi
- Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Claudia Poleri
- Office of Pathology Consultants, Buenos Aires, Argentina
| | | | - Mary Redman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Deepali Jain
- All India Institute of Medical Sciences, New Delhi, India
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yasushi Yatabe
- Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Ming Sound Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Johan Botling
- Department of Immunology Genetics and Pathology, Science for Life Laboratory, Uppsala University Hospital, Uppsala, Sweden
| | - Gang Chen
- Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Teh-Ying Chou
- Taipei Veterans General Hospital, Taipei, Republic of China
| | - Fred R Hirsch
- Center for Thoracic Oncology, The Tisch Cancer Institute, New York, New York; Ichan School of Medicine, Mount Sinai Health System, New York, New York
| | - Mary Beth Beasley
- Ichan School of Medicine, Mount Sinai Health System, New York, New York
| | - Alain Borczuk
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Lukas Bubendorf
- Institute of Pathology, University of Basel, Basel, Switzerland
| | - Jin-Haeng Chung
- Seoul National University Bundang Hospital, Seoul, South Korea
| | - David Hwang
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dongmei Lin
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | | | | | | | - Lynette Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - William Travis
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Akihiko Yoshida
- Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Murry W Wynes
- International Association for the Study of Lung Cancer, Denver, Colorado
| | | | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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Liu J, Itchins M, Nagrial A, Cooper WA, De Silva M, Barnet M, Varikatt W, Sivasubramaniam V, Davis A, Gill AJ, Blinman P, Lee K, Hui R, Gao B, Pavlakis N, Clarke S, Lee J, Boyer M, Kao S. Relationship between PD-L1 expression and outcome in EGFR-mutant lung cancer patients treated with EGFR tyrosine kinase inhibitors. Lung Cancer 2021; 155:28-33. [PMID: 33721613 DOI: 10.1016/j.lungcan.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/17/2020] [Revised: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Predictive biomarkers for poor response to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is an area of ongoing research. This multicentre retrospective study sought to determine the impact of programmed death-ligand 1 (PD-L1) tumour proportional score (TPS) on outcome in EGFR TKI treated patients. MATERIALS AND METHODS Patients with Stage IIIB/IV lung adenocarcinoma harbouring a sensitising EGFR mutation treated with first-line TKI at five metropolitan hospitals were included. PD-L1 TPS was determined using the Ventana anti-PD-L1 (SP263) assay. High PD-L1 expression was defined as TPS ≥ 50 %. Determinants of progression and survival hazards were modelled using Cox regression. RESULTS A total of 186 patients were included. Mean age was 67 years, 66 % were female and 54 % were Asian. Patients with high PD-L1 expression (n = 23; 12 %) had significantly shorter progression free survival (6.6 vs 13.0 months, hazard ratio (HR) 2.6 95 % CI 1.6-4.2, p < 0.0001) and overall survival (11.5 vs 32.9 months, HR 3.3, 95 % CI 1.9-5.7, p < 0.0001) compared to patients with PD-L1 low/negative tumours. This remained significant in multivariate analyses. High PD-L1 in post-TKI progression biopsies was not associated with poorer survival. CONCLUSION In this large, real-world cohort of EGFR-mutant lung adenocarcinoma patients, high PD-L1 expression was associated with early resistance to 1st generation EGFR TKIs and shorter survival, regardless of ethnicity.
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Affiliation(s)
- Jia Liu
- Crown Princess Mary Cancer Centre, Westmead, NSW, Australia; Blacktown Hospital, Blacktown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Children's Medical Research Institute, Westmead, NSW, Australia
| | - Malinda Itchins
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Adnan Nagrial
- Crown Princess Mary Cancer Centre, Westmead, NSW, Australia; Blacktown Hospital, Blacktown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Wendy A Cooper
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, NSW, Australia; Sydney School of Medicine, Western Sydney University, NSW, Australia
| | - Madhawa De Silva
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Megan Barnet
- Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Winny Varikatt
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | | | | | - Anthony J Gill
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Prunella Blinman
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Kenneth Lee
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Anatomical Pathology, NSW Health Pathology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Rina Hui
- Crown Princess Mary Cancer Centre, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Bo Gao
- Crown Princess Mary Cancer Centre, Westmead, NSW, Australia; Blacktown Hospital, Blacktown, NSW, Australia
| | - Nick Pavlakis
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Stephen Clarke
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jenny Lee
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Michael Boyer
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Steven Kao
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
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John T, Cooper WA, Wright G, Siva S, Solomon B, Marshall HM, Fong KM. Lung Cancer in Australia. J Thorac Oncol 2021; 15:1809-1814. [PMID: 33246594 DOI: 10.1016/j.jtho.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas John
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Gavin Wright
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Shankar Siva
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Henry M Marshall
- Thoracic Research Centre, University of Queensland, Queensland, Australia; Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Kwun M Fong
- Thoracic Research Centre, University of Queensland, Queensland, Australia; Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
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Paver EC, Cooper WA, Colebatch AJ, Ferguson PM, Hill SK, Lum T, Shin JS, O'Toole S, Anderson L, Scolyer RA, Gupta R. Programmed death ligand-1 (PD-L1) as a predictive marker for immunotherapy in solid tumours: a guide to immunohistochemistry implementation and interpretation. Pathology 2020; 53:141-156. [PMID: 33388161 DOI: 10.1016/j.pathol.2020.10.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [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: 08/16/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/20/2022]
Abstract
Immunotherapy with checkpoint inhibitors is well established as an effective treatment for non-small cell lung cancer and melanoma. The list of approved indications for treatment with PD-1/PD-L1 checkpoint inhibitors is growing rapidly as clinical trials continue to show their efficacy in patients with a wide range of solid tumours. Clinical trials have used a variety of PD-L1 immunohistochemical assays to evaluate PD-L1 expression on tumour cells, immune cells or both as a potential biomarker to predict response to immunotherapy. Requests to pathologists for PD-L1 testing to guide choice of therapy are rapidly becoming commonplace. Thus, pathologists need to be aware of the different PD-L1 assays, methods of evaluation in different tumour types and the impact of the results on therapeutic decisions. This review discusses the key practical issues relating to the implementation of PD-L1 testing for solid tumours in a pathology laboratory, including evidence for PD-L1 testing, different assay types, the potential interchangeability of PD-L1 antibody clones and staining platforms, scoring criteria for PD-L1, validation, quality assurance, and pitfalls in PD-L1 assessment. This review also explores PD-L1 IHC in solid tumours including non-small cell lung carcinoma, head and neck carcinoma, triple negative breast carcinoma, melanoma, renal cell carcinoma, urothelial carcinoma, gastric and gastroesophageal carcinoma, colorectal carcinoma, hepatocellular carcinoma, and endometrial carcinoma. The review aims to provide pathologists with a practical guide to the implementation and interpretation of PD-L1 testing by immunohistochemistry.
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Affiliation(s)
- Elizabeth C Paver
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; Western Sydney University, Campbelltown, NSW, Australia
| | - Andrew J Colebatch
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Peter M Ferguson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Sean K Hill
- Gold Coast University Hospital, Southport, Qld, Australia
| | - Trina Lum
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Joo-Shik Shin
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Sandra O'Toole
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; Western Sydney University, Campbelltown, NSW, Australia
| | - Richard A Scolyer
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
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Ahmadzada T, Cooper WA, Holmes M, Mahar A, Westman H, Gill AJ, Nordman I, Yip PY, Pal A, Zielinski R, Pavlakis N, Nagrial A, Daneshvar D, Brungs D, Karikios D, Aleksova V, Burn J, Asher R, Grau GE, Hosseini-Beheshti E, Reid G, Clarke S, Kao S. Retrospective Evaluation of the Use of Pembrolizumab in Malignant Mesothelioma in a Real-World Australian Population. JTO Clin Res Rep 2020; 1:100075. [PMID: 34589956 PMCID: PMC8474198 DOI: 10.1016/j.jtocrr.2020.100075] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION We investigated the efficacy and toxicity of pembrolizumab in patients with mesothelioma from a real-world Australian population. We aimed to determine clinical factors and predictive biomarkers that could help select patients who are likely to benefit from pembrolizumab. METHOD Patients with mesothelioma who were treated with pembrolizumab as part of the Insurance and Care New South Wales compensation scheme were included. Clinical information was collected retrospectively. Tumor biomarkers such as programmed death-ligand 1 (PD-L1), BAP1, and CD3-positive (CD3+) tumor-infiltrating lymphocytes (TILs) were examined using archival formalin-fixed paraffin-embedded tumor samples. RESULTS A total of 98 patients were included with a median age of 70 years (range, 46-91 y); 92% were men; 76% had epithelioid subtype; 21% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0. Pembrolizumab was used as second-line or subsequent-line treatment in 94 patients and as first-line treatment in four patients. The overall response rate was 18%, and the disease control rate was 56%. The median progression-free survival (PFS) was 4.8 months (95% confidence interval: 3.6-6.2), and the median overall survival (OS) was 9.5 months (95% confidence interval: 6.6-13.7). Immune-related adverse events occurred in 27% of patients, of which nine (9%) were of grade 3 or higher. In the multivariable analysis, factors independently associated with longer PFS included baseline ECOG status of 0 (median PFS: 12 mo versus 4 mo, p < 0.01) and PD-L1 tumor proportion score of greater than or equal to 1% (median PFS: 6 mo versus 4 mo, p < 0.01). Baseline platelet count of less than or equal to 400 × 109/liter was independently associated with longer PFS and OS (median PFS: 6 mo versus 2 mo, p = 0.05; median OS: 10 mo versus 4 mo, p = 0.01), whereas lack of pretreatment dexamethasone was independently associated with OS but not PFS (median OS: 10 mo versus 3 mo, p = 0.01). The odds of response were higher for patients with baseline ECOG status of 0 (p = 0.02) and with greater than or equal to 5% CD3+ TILs in the tumor (p < 0.01). PD-L1 expression, BAP1 loss, and CD3+ TILs in the stroma were not significantly associated with the overall response rate. CONCLUSIONS Immunotherapy is a reasonable treatment option for patients with mesothelioma. Our results are comparable to other clinical trials investigating pembrolizumab in mesothelioma in terms of response. Good performance status assessment remains the most robust predictor for patient outcomes. CD3+ TILs in the tumor may help select patients that are likely to respond to pembrolizumab, whereas factors such as PD-L1 expression, baseline platelet count, and lack of pretreatment dexamethasone may help predict survival outcomes from pembrolizumab treatment.
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Affiliation(s)
- Tamkin Ahmadzada
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Wendy A. Cooper
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Mikaela Holmes
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Annabelle Mahar
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Helen Westman
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anthony J. Gill
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ina Nordman
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Po Yee Yip
- Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Abhijit Pal
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Drug Development Unit, Royal Marsden Hospital, Sutton, United Kingdom
| | - Rob Zielinski
- Central West Cancer Care Centre, Orange Base Hospital, Orange, New South Wales, Australia
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Adnan Nagrial
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Medical Oncology Department, Westmead Hospital, New South Wales, Australia
| | - Dariush Daneshvar
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology & Medical Research (ICPMR)–Westmead Hospital, Sydney, New South Wales, Australia
| | - Daniel Brungs
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
- Illawarra Cancer Centre, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Deme Karikios
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Vesna Aleksova
- Asbestos Diseases Research Institute, Sydney, New South Wales, Australia
| | - Juliet Burn
- Anatomical Pathology, Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Georges E. Grau
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Immunology Unit, Department of Pathology, School of Medical Sciences, The University of Sydney, Camperdown, New South Wales, Australia
- The Sydney Nano Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elham Hosseini-Beheshti
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Immunology Unit, Department of Pathology, School of Medical Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Glen Reid
- Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Stephen Clarke
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven Kao
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Asbestos Diseases Research Institute, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, New South Wales, Australia
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Itchins M, Lau B, Hudson AL, Westman H, Xia CY, Hayes SA, Howell VM, Rodriguez M, Cooper WA, Wei H, Buckland M, Li BT, Li M, Rathi V, Fox SB, Gill AJ, Clarke SJ, Boyer MJ, Pavlakis N. ALK-Rearranged Non-Small Cell Lung Cancer in 2020: Real-World Triumphs in an Era of Multigeneration ALK-Inhibitor Sequencing Informed by Drug Resistance Profiling. Oncologist 2020; 25:641-649. [PMID: 32558067 PMCID: PMC7418351 DOI: 10.1634/theoncologist.2020-0075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/02/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
Since its discovery in 2007, we have seen the lives of patients diagnosed with advanced anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancers (NSCLC) transform with the advent of molecular therapies with first-, second-, and third-generation ALK inhibitors now available in the clinic. Despite great gains in patient survival now measured in years and preserved quality of life with targeted therapies, drug resistance is unfortunately inevitably encountered in this rare and unique molecular subset of lung cancer, and patients will eventually succumb to the disease. As these patients are often young, fit, and never smokers, the clinical and scientific communities have aligned to expedite drug development and access. Drug resistance profiling and further strategies are being explored through clinical trials, including the evaluation of specific drug sequencing and combinations to overcome such resistance and promote patient longevity. The cases of this report focus on precision medicine and aim to portray the pertinent aspects to consider when treating ALK-rearranged NSCLC in 2020, an ever-shifting space. By way of case examples, this report offers valuable information to the treating clinician, including the evolution of systemic treatments and the management of oligo-progression and multisite drug resistance. With the maturation of real-world data, we are fortunate to be experiencing quality and length of life for patients with this disease surpassing prior expectations in advanced lung cancer. KEY POINTS: This report focuses on the importance of genetic analysis of serial biopsies to capture the dynamic therapeutic vulnerabilities of a patient's tumor, providing a perspective on the complexity of ALK tyrosine kinase inhibitor (ALKi) treatment sequencing. These case examples contribute to the literature on ALK-rearranged and oncogene addicted non-small cell lung cancer (NSCLC), providing a framework for care in the clinic. In oligo-progressive disease, local ablative therapy and continuation of ALKi postprogression should be considered with potential for sustained disease control. ALK G1202R kinase domain mutations (KDM), highly prevalent at resistance to second-generation ALKi resistances, may emerge in non-EML4-ALK variant 3 cases and is sensitive to third-generation lorlatinib. When in compound with one or more ALK KDMs, resistance to lorlatinib is expected. In the case of rampantly progressive disease, rebiopsy and redefining biology in a timely manner may be informative.
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Affiliation(s)
- Malinda Itchins
- Department of Medical Oncology, Royal North Shore HospitalSt LeonardsNew South WalesAustralia
- Bill Walsh Translational Research Laboratory, Kolling InstituteSt LeonardsNew South WalesAustralia
- Northern Clinical School, Faculty of Medicine and Health, University of SydneySt LeonardsNew South WalesAustralia
| | - Brandon Lau
- Chris O'Brien LifehouseCamperdownNew South WalesAustralia
| | - Amanda L. Hudson
- Bill Walsh Translational Research Laboratory, Kolling InstituteSt LeonardsNew South WalesAustralia
- Northern Clinical School, Faculty of Medicine and Health, University of SydneySt LeonardsNew South WalesAustralia
| | - Helen Westman
- Department of Medical Oncology, Royal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Cathy Yi Xia
- Department of Medical Oncology, Royal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Sarah A. Hayes
- Bill Walsh Translational Research Laboratory, Kolling InstituteSt LeonardsNew South WalesAustralia
- Northern Clinical School, Faculty of Medicine and Health, University of SydneySt LeonardsNew South WalesAustralia
| | - Viive M. Howell
- Bill Walsh Translational Research Laboratory, Kolling InstituteSt LeonardsNew South WalesAustralia
- Northern Clinical School, Faculty of Medicine and Health, University of SydneySt LeonardsNew South WalesAustralia
| | - Michael Rodriguez
- Bill Walsh Translational Research Laboratory, Kolling InstituteSt LeonardsNew South WalesAustralia
- Northern Clinical School, Faculty of Medicine and Health, University of SydneySt LeonardsNew South WalesAustralia
- Department of Anatomical Pathology, Douglas Hanly MoirMacquarie ParkNew South WalesAustralia
| | - Wendy A. Cooper
- Central Clinical School, School of Medicine, University of SydneySt LeonardsNew South WalesAustralia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred HospitalSydneyNew South WalesAustralia
- School of Medicine, Western Sydney UniversitySydneyNew South WalesAustralia
| | - Heng Wei
- Brain and Mind Centre, University of SydneySt LeonardsNew South WalesAustralia
| | - Michael Buckland
- Brain and Mind Centre, University of SydneySt LeonardsNew South WalesAustralia
- Department of Neuropathology, Royal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Bob T. Li
- Northern Clinical School, Faculty of Medicine and Health, University of SydneySt LeonardsNew South WalesAustralia
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical CollegeNew YorkNew YorkUSA
| | - Mark Li
- Resolution BioscienceRedmondWashingtonUSA
| | - Vivek Rathi
- Department of Anatomical Pathology, St Vincent's, Victoria ParadeFitzroyVictoriaAustralia
| | - Stephen B. Fox
- Department of Pathology, Peter MacCallum Cancer Centre, and University of MelbourneVictoriaAustralia
| | - Anthony J. Gill
- Department of Anatomical Pathology, Royal North Shore HospitalSt LeonardsNew South WalesAustralia
- Northern Clinical School, Faculty of Medicine and Health, University of SydneySt LeonardsNew South WalesAustralia
| | - Stephen J. Clarke
- Department of Medical Oncology, Royal North Shore HospitalSt LeonardsNew South WalesAustralia
- Bill Walsh Translational Research Laboratory, Kolling InstituteSt LeonardsNew South WalesAustralia
- Northern Clinical School, Faculty of Medicine and Health, University of SydneySt LeonardsNew South WalesAustralia
| | - Michael J. Boyer
- Chris O'Brien LifehouseCamperdownNew South WalesAustralia
- Department of Pathology, Peter MacCallum Cancer Centre, and University of MelbourneVictoriaAustralia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore HospitalSt LeonardsNew South WalesAustralia
- Bill Walsh Translational Research Laboratory, Kolling InstituteSt LeonardsNew South WalesAustralia
- Northern Clinical School, Faculty of Medicine and Health, University of SydneySt LeonardsNew South WalesAustralia
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Moreira AL, Ocampo PSS, Xia Y, Zhong H, Russell PA, Minami Y, Cooper WA, Yoshida A, Bubendorf L, Papotti M, Pelosi G, Lopez-Rios F, Kunitoki K, Ferrari-Light D, Sholl LM, Beasley MB, Borczuk A, Botling J, Brambilla E, Chen G, Chou TY, Chung JH, Dacic S, Jain D, Hirsch FR, Hwang D, Lantuejoul S, Lin D, Longshore JW, Motoi N, Noguchi M, Poleri C, Rekhtman N, Tsao MS, Thunnissen E, Travis WD, Yatabe Y, Roden AC, Daigneault JB, Wistuba II, Kerr KM, Pass H, Nicholson AG, Mino-Kenudson M. A Grading System for Invasive Pulmonary Adenocarcinoma: A Proposal From the International Association for the Study of Lung Cancer Pathology Committee. J Thorac Oncol 2020; 15:1599-1610. [PMID: 32562873 DOI: 10.1016/j.jtho.2020.06.001] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION A grading system for pulmonary adenocarcinoma has not been established. The International Association for the Study of Lung Cancer pathology panel evaluated a set of histologic criteria associated with prognosis aimed at establishing a grading system for invasive pulmonary adenocarcinoma. METHODS A multi-institutional study involving multiple cohorts of invasive pulmonary adenocarcinomas was conducted. A cohort of 284 stage I pulmonary adenocarcinomas was used as a training set to identify histologic features associated with patient outcomes (recurrence-free survival [RFS] and overall survival [OS]). Receiver operating characteristic curve analysis was used to select the best model, which was validated (n = 212) and tested (n = 300, including stage I-III) in independent cohorts. Reproducibility of the model was assessed using kappa statistics. RESULTS The best model (area under the receiver operating characteristic curve [AUC] = 0.749 for RFS and 0.787 for OS) was composed of a combination of predominant plus high-grade histologic pattern with a cutoff of 20% for the latter. The model consists of the following: grade 1, lepidic predominant tumor; grade 2, acinar or papillary predominant tumor, both with no or less than 20% of high-grade patterns; and grade 3, any tumor with 20% or more of high-grade patterns (solid, micropapillary, or complex gland). Similar results were seen in the validation (AUC = 0.732 for RFS and 0.787 for OS) and test cohorts (AUC = 0.690 for RFS and 0.743 for OS), confirming the predictive value of the model. Interobserver reproducibility revealed good agreement (k = 0.617). CONCLUSIONS A grading system based on the predominant and high-grade patterns is practical and prognostic for invasive pulmonary adenocarcinoma.
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Affiliation(s)
- Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, New York.
| | - Paolo S S Ocampo
- Department of Pathology, New York University Langone Health, New York, New York
| | - Yuhe Xia
- Department of Biostatistics, New York University Langone Health, New York, New York
| | - Hua Zhong
- Department of Biostatistics, New York University Langone Health, New York, New York
| | | | - Yuko Minami
- Department of Pathology, Ibarakihigashi National Hospital, Tokai, Japan
| | - Wendy A Cooper
- Department of Pathology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Giuseppe Pelosi
- Department of Pathology, University of Milan, Milan Italy; IRCCS MultiMedica, Milan Italy
| | | | - Keiko Kunitoki
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dana Ferrari-Light
- Department of Surgery, New York University Langone Health, New York, New York
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mary Beth Beasley
- Department of Pathology, Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - Alain Borczuk
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Johan Botling
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University Hospital, Uppsala, Sweden
| | - Elisabeth Brambilla
- Department of Anatomic Pathology and Cytology, Université Grenoble Alpes, Grenoble, France
| | - Gang Chen
- Department fo Pathology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Teh-Ying Chou
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Fred R Hirsch
- Center for Thoracic Oncology, The Tisch Cancer Institute, New York, New York
| | - David Hwang
- Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Dongmei Lin
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - John W Longshore
- Carolinas Pathology Group, Atrium Health, Charlotte, North Carolina
| | - Noriko Motoi
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Claudia Poleri
- Office of Pathology Consultants, Buenos Aires, Argentina
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ming-Sound Tsao
- University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Ignacio I Wistuba
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Harvey Pass
- Department of Surgery, New York University Langone Health, New York, New York
| | - Andrew G Nicholson
- Department of Pathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Sholl LM, Hirsch FR, Hwang D, Botling J, Lopez-Rios F, Bubendorf L, Mino-Kenudson M, Roden AC, Beasley MB, Borczuk A, Brambilla E, Chen G, Chou TY, Chung JH, Cooper WA, Dacic S, Lantuejoul S, Jain D, Lin D, Minami Y, Moreira A, Nicholson AG, Noguchi M, Papotti M, Pelosi G, Poleri C, Rekhtman N, Tsao MS, Thunnissen E, Travis W, Yatabe Y, Yoshida A, Daigneault JB, Zehir A, Peters S, Wistuba II, Kerr KM, Longshore JW. The Promises and Challenges of Tumor Mutation Burden as an Immunotherapy Biomarker: A Perspective from the International Association for the Study of Lung Cancer Pathology Committee. J Thorac Oncol 2020; 15:1409-1424. [PMID: 32522712 DOI: 10.1016/j.jtho.2020.05.019] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/11/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022]
Abstract
Immune checkpoint inhibitor (ICI) therapies have revolutionized the management of patients with NSCLC and have led to unprecedented improvements in response rates and survival in a subset of patients with this fatal disease. However, the available therapies work only for a minority of patients, are associated with substantial societal cost, and may lead to considerable immune-related adverse events. Therefore, patient selection must be optimized through the use of relevant biomarkers. Programmed death-ligand 1 protein expression by immunohistochemistry is widely used today for the selection of programmed cell death protein 1 inhibitor therapy in patients with NSCLC; however, this approach lacks robust sensitivity and specificity for predicting response. Tumor mutation burden (TMB), or the number of somatic mutations derived from next-generation sequencing techniques, has been widely explored as an alternative or complementary biomarker for response to ICIs. In theory, a higher TMB increases the probability of tumor neoantigen production and therefore, the likelihood of immune recognition and tumor cell killing. Although TMB alone is a simplistic surrogate of this complex interplay, it is a quantitative variable that can be relatively readily measured using currently available sequencing techniques. A large number of clinical trials and retrospective analyses, employing both tumor and blood-based sequencing tools, have evaluated the performance of TMB as a predictive biomarker, and in many cases reveal a correlation between high TMB and ICI response rates and progression-free survival. Many challenges remain before the implementation of TMB as a biomarker in clinical practice. These include the following: (1) identification of therapies whose response is best informed by TMB status; (2) robust definition of a predictive TMB cut point; (3) acceptable sequencing panel size and design; and (4) the need for robust technical and informatic rigor to generate precise and accurate TMB measurements across different laboratories. Finally, effective prediction of response to ICI therapy will likely require integration of TMB with a host of other potential biomarkers, including tumor genomic driver alterations, tumor-immune milieu, and other features of the host immune system. This perspective piece will review the current clinical evidence for TMB as a biomarker and address the technical sequencing considerations and ongoing challenges in the use of TMB in routine practice.
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Affiliation(s)
- Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Fred R Hirsch
- Center for Thoracic Oncology, The Tisch Cancer Institute, New York, New York; Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - David Hwang
- Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Johan Botling
- Department of Immunology Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anja C Roden
- Department of Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mary Beth Beasley
- Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - Alain Borczuk
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | | | - Gang Chen
- Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | | | - Jin-Haeng Chung
- Seoul National University Bundang Hospital, Seoul, South Korea
| | | | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sylvie Lantuejoul
- Université Grenoble Alpes, Grenoble, France; Centre Léon Bérard Unicancer, Lyon, France
| | - Deepali Jain
- All India Institute of Medical Sciences, New Delhi, India
| | - Dongmei Lin
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Yuko Minami
- Ibarakihigashi National Hospital, Tokai, Japan
| | - Andre Moreira
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Andrew G Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Giuseppe Pelosi
- University of Milan, Milan Italy; Department of Oncology and Hemato-Oncology, Istituto di Ricovero e Cura a Carattere Scientifico MultiMedica, Milan Italy
| | - Claudia Poleri
- Oggice of Pathology Consultants, Buenos Aires, Argentina
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, Netherlands
| | - William Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Ahmet Zehir
- Oggice of Pathology Consultants, Buenos Aires, Argentina
| | - Solange Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | | | - Keith M Kerr
- Department of Pathology, Aberdffn Royal Infirmary, Aberdffn, United Kingdom
| | - John W Longshore
- Carolinas Pathology Group, Atrium Health, Charlotte, North Carolina
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Lau EMT, Grainge C, Williamson JP, Corte TJ, Cooper WA, Phillips MJ, Torzillo PJ, Vallely MP, Raghu G, Troy LK. Methodologies of COLDICE and Cryo-PID studies: details make the difference. Ann Transl Med 2020; 8:781. [PMID: 32647706 PMCID: PMC7333101 DOI: 10.21037/atm-20-3769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Edmund M. T. Lau
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Jonathan P. Williamson
- Liverpool Hospital, Liverpool, NSW, Australia
- Macquarie University Hospital, Sydney, NSW, Australia
| | - Tamera J. Corte
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Wendy A. Cooper
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Paul J. Torzillo
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | | | - Lauren K. Troy
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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42
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Clynick B, Jo HE, Corte TJ, Glaspole IN, Grainge C, Hopkins PMA, Reynolds PN, Chapman S, Walters EH, Zappala C, Keir GJ, Cooper WA, Mahar AM, Ellis S, Goh NS, Baltic S, Ryan M, Tan DBA, Moodley YP. Circulating RNA differences between patients with stable and progressive idiopathic pulmonary fibrosis. Eur Respir J 2020; 56:13993003.02058-2019. [PMID: 32381494 DOI: 10.1183/13993003.02058-2019] [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] [Received: 10/22/2019] [Accepted: 04/08/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Britt Clynick
- Institute for Respiratory Health, Nedlands, Australia.,University of Western Australia, Crawley, Australia
| | - Helen E Jo
- University of Sydney, Camperdown, Australia.,Royal Prince Alfred Hospital, Camperdown, Australia
| | - Tamera J Corte
- University of Sydney, Camperdown, Australia.,Royal Prince Alfred Hospital, Camperdown, Australia
| | - Ian N Glaspole
- Monash University, Clayton, Australia.,Alfred Hospital, Melbourne, Australia
| | - Christopher Grainge
- University of Newcastle, Callaghan, Australia.,John Hunter Hospital, New Lambton Heights, Australia
| | - Peter M A Hopkins
- University of Queensland, St Lucia, Australia.,Prince Charles Hospital, Chermside, Australia
| | - Paul N Reynolds
- University of Adelaide, Adelaide, Australia.,Royal Adelaide Hospital, Adelaide, Australia
| | | | - E Haydn Walters
- Alfred Hospital, Melbourne, Australia.,University of Tasmania, Hobart, Australia.,University of Melbourne, Parkville, Australia.,Royal Hobart Hospital, Hobart, Australia
| | | | | | - Wendy A Cooper
- University of Sydney, Camperdown, Australia.,Royal Prince Alfred Hospital, Camperdown, Australia.,Western Sydney University, Sydney, Australia
| | - Annabelle M Mahar
- University of Sydney, Camperdown, Australia.,Royal Prince Alfred Hospital, Camperdown, Australia
| | | | - Nicole S Goh
- Austin Hospital, Heidelberg, Australia.,Institute of Breathing and Sleep, Heidelberg, Australia
| | - Svetlana Baltic
- Institute for Respiratory Health, Nedlands, Australia.,University of Western Australia, Crawley, Australia
| | - Marisa Ryan
- Institute for Respiratory Health, Nedlands, Australia.,University of Western Australia, Crawley, Australia
| | - Dino B A Tan
- Institute for Respiratory Health, Nedlands, Australia.,University of Western Australia, Crawley, Australia
| | - Yuben P Moodley
- Institute for Respiratory Health, Nedlands, Australia.,University of Western Australia, Crawley, Australia.,Fiona Stanley Hospital, Murdoch, Australia
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43
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Patten HW, Graves JP, Cooper WA, Eriksson J, Pfefferlé D. Identification of an Optimized Heating and Fast Ion Generation Scheme for the Wendelstein 7-X Stellarator. Phys Rev Lett 2020; 124:155001. [PMID: 32357043 DOI: 10.1103/physrevlett.124.155001] [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] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/24/2019] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Abstract
A Doppler shifted resonance minority species ion cyclotron range of frequency (ICRF) scheme for heating neutral beam ions has been identified and optimized for the Wendelstein 7-X stellarator. Compared with more conventional methods, the synergetic scheme increases the normalized core collisional power transfer to the background plasma, and induces larger concentrations of energetic ions. Simulations in the intricate 3D magnetic stellarator geometry reveal an energetic distribution function that is only weakly anisotropic, and is thus relevant to fast ion and alpha particle driven Alfvén eigenmode experimental preparation. Quasilinear theory and simulations of the Joint European Torus indicate that the excellent confinement properties are due to increased velocity diffusion from ICRF interaction along the magnetic field lines. Agreement is found between SCENIC simulations and Joint European Torus experimental measurements for the total neutron rate and the energy distribution of the fast ions.
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Affiliation(s)
- H W Patten
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Swiss Plasma Center (SPC), CH-1015 Lausanne, Switzerland
| | - J P Graves
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Swiss Plasma Center (SPC), CH-1015 Lausanne, Switzerland
| | - W A Cooper
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Swiss Plasma Center (SPC), CH-1015 Lausanne, Switzerland
| | - J Eriksson
- Department of Physics and Astronomy, Uppsala University, SE-75120 Uppsala, Sweden
| | - D Pfefferlé
- University of Western Australia, 6009 Crawley, Australia
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44
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Mahar A, Cooper WA, Myers JL, Grainge C, Corte TJ, Williamson JP, Vallely MP, Torzillo PJ, Phillips MJ, Raghu G, Lau EM, Troy LK. Cryobiopsy versus surgical lung biopsy in the diagnosis of interstitial lung disease (coldice study): Is bigger always better? Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.065] [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: 10/25/2022]
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45
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Troy LK, Grainge C, Corte TJ, Williamson JP, Vallely MP, Cooper WA, Mahar A, Myers JL, Lai S, Mulyadi E, Torzillo PJ, Phillips MJ, Jo HE, Webster SE, Lin QT, Rhodes JE, Salamonsen M, Wrobel JP, Harris B, Don G, Wu PJC, Ng BJ, Oldmeadow C, Raghu G, Lau EMT, Arnold D, Cao C, Cashmore A, Cleary S, Evans TJ, French B, Geis M, Glenn L, Hibbert M, Ing A, James A, Meredith G, Merry C, Pudipeddi A, Saghaie T, Thomas R, Thomson C, Twaddell S. Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study. The Lancet Respiratory Medicine 2020; 8:171-181. [DOI: 10.1016/s2213-2600(19)30342-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 10/25/2022]
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Hendry S, Byrne DJ, Christie M, Steinfort DP, Irving LB, Wagner CA, Ellwood T, Cooper WA, Fox SB. Adequate tumour cellularity is essential for accurate PD-L1 immunohistochemistry assessment on cytology cell-block specimens. Cytopathology 2020; 31:90-95. [PMID: 31808243 DOI: 10.1111/cyt.12795] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/15/2019] [Accepted: 12/02/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES PD-L1 immunohistochemistry (IHC) is an essential predictive biomarker for patients with non-small cell lung cancer (NSCLC), required to inform treatment decisions regarding anti-PD-1 immune checkpoint inhibitor therapy. This study aims to investigate the concordance between PD-L1 IHC assessed on NSCLC cytology and histology specimens and to determine the impactce of tumour cellularity. METHODS Matched cytology and histology NSCLC specimens were retrieved from the archives of the Royal Melbourne Hospital and the Royal Prince Alfred Hospital. PD-L1 IHC was performed concurrently on both specimens at the Peter MacCallum Cancer Centre using the SP263 assay kit on the Ventana Benchmark Ultra staining platform and scored by two experienced pathologists. RESULTS Overall agreement between matched cytology and histology specimens was good (intraclass correlation coefficient = 0.653, n = 58); however, markedly increased when the analysis was limited to cell-blocks with >100 tumour cells (intraclass correlation coefficient = 0.957, n = 29). Specificity at both 1% and 50% cut-offs was high regardless of cellularity; however, sensitivity decreased in samples with <100 tumour cells. CONCLUSIONS PD-L1 IHC on cytology cell-block specimens in NSCLC is an acceptable alternative to histological specimens, provided adequate tumour cells are present. Clinicians and pathologists should be mindful of the risk of false negative PD-L1 IHC in samples with low tumour cellularity, to avoid excluding patients from potentially beneficial treatment.
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Affiliation(s)
- Shona Hendry
- Department of Pathology at Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Pathology at St Vincent's Hospital, Melbourne, VIC, Australia
| | - David J Byrne
- Department of Pathology at Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael Christie
- Department of Pathology at Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Daniel P Steinfort
- Department of Respiratory & Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine (RMH), University of Melbourne, Melbourne, VIC, Australia
| | - Louis B Irving
- Department of Respiratory & Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Carrie-Anne Wagner
- Department of Respiratory & Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Timothy Ellwood
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Wendy A Cooper
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Stephen B Fox
- Department of Pathology at Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Medical Oncology at the University of Melbourne, Melbourne, VIC, Australia
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47
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Lantuejoul S, Sound-Tsao M, Cooper WA, Girard N, Hirsch FR, Roden AC, Lopez-Rios F, Jain D, Chou TY, Motoi N, Kerr KM, Yatabe Y, Brambilla E, Longshore J, Papotti M, Sholl LM, Thunnissen E, Rekhtman N, Borczuk A, Bubendorf L, Minami Y, Beasley MB, Botling J, Chen G, Chung JH, Dacic S, Hwang D, Lin D, Moreira A, Nicholson AG, Noguchi M, Pelosi G, Poleri C, Travis W, Yoshida A, Daigneault JB, Wistuba II, Mino-Kenudson M. PD-L1 Testing for Lung Cancer in 2019: Perspective From the IASLC Pathology Committee. J Thorac Oncol 2019; 15:499-519. [PMID: 31870882 DOI: 10.1016/j.jtho.2019.12.107] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/29/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022]
Abstract
The recent development of immune checkpoint inhibitors (ICIs) has led to promising advances in the treatment of patients with NSCLC and SCLC with advanced or metastatic disease. Most ICIs target programmed cell death protein 1 (PD-1) or programmed death ligand 1 (PD-L1) axis with the aim of restoring antitumor immunity. Multiple clinical trials for ICIs have evaluated a predictive value of PD-L1 protein expression in tumor cells and tumor-infiltrating immune cells (ICs) by immunohistochemistry (IHC), for which different assays with specific IHC platforms were applied. Of those, some PD-L1 IHC assays have been validated for the prescription of the corresponding agent for first- or second-line treatment. However, not all laboratories are equipped with the dedicated platforms, and many laboratories have set up in-house or laboratory-developed tests that are more affordable than the generally expensive clinical trial-validated assays. Although PD-L1 IHC test is now deployed in most pathology laboratories, its appropriate implementation and interpretation are critical as a predictive biomarker and can be challenging owing to the multiple antibody clones and platforms or assays available and given the typically small size of samples provided. Because many articles have been published since the issue of the IASLC Atlas of PD-L1 Immunohistochemistry Testing in Lung Cancer, this review by the IASLC Pathology Committee provides updates on the indications of ICIs for lung cancer in 2019 and discusses important considerations on preanalytical, analytical, and postanalytical aspects of PD-L1 IHC testing, including specimen type, validation of assays, external quality assurance, and training.
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Affiliation(s)
- Sylvie Lantuejoul
- Centre Léon Bérard Unicancer, Lyon, France; Université Grenoble Alpes, Grenoble, France
| | - Ming Sound-Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Nicolas Girard
- Institut Curie, Paris, and Université Claude Bernard, Lyon, France
| | - Fred R Hirsch
- Center for Thoracic Oncology, The Tisch Cancer Institute, New York, New York; Ichan School of Medicine, Mount Sinai Health System, New York, New York
| | | | | | - Deepali Jain
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | | | | | | | | | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, Netherlands
| | | | | | - Lukas Bubendorf
- Institute of Pathology, University of Basel, Basel, Switzerland
| | - Yuko Minami
- Ibarakihigashi National Hospital, Tokai, Japan
| | - Mary Beth Beasley
- Ichan School of Medicine, Mount Sinai Health System, New York, New York
| | | | - Gang Chen
- Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jin-Haeng Chung
- Seoul National University Bundang Hospital, Seoul, South Korea
| | - Sanja Dacic
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David Hwang
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dongmei Lin
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Andre Moreira
- New York University School of Medicine, New York, New York
| | - Andrew G Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, London, and National Heart and Lung Institute, Imperial College, United Kingdom
| | | | | | - Claudia Poleri
- Office of Pathology Consultants, Buenos Aires, Argentina
| | - William Travis
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Mari Mino-Kenudson
- Department of Pathology, Harvard Medical School, Boston, Massachusetts; Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
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48
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Pavlakis N, Cooper C, John T, Kao S, Klebe S, Lee CK, Leong T, Millward M, O'Byrne K, Russell PA, Solomon B, Cooper WA, Fox S. Australian consensus statement for best practice ROS1 testing in advanced non-small cell lung cancer. Pathology 2019; 51:673-680. [PMID: 31668406 DOI: 10.1016/j.pathol.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/28/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022]
Abstract
Lung cancer is the most commonly diagnosed malignancy and the leading cause of death from cancer globally. Diagnosis of advanced non-small cell lung cancer (NSCLC) is associated with 5-year relative survival of 3.2%. ROS proto-oncogene 1 (ROS1) is an oncogenic driver of NSCLC occurring in up to 2% of cases and commonly associated with younger age and a history of never or light smoking. Results of an early trial with the tyrosine kinase inhibitor (TKI) crizotinib that inhibits tumours that harbour ROS1 rearrangements have shown an objective response rate (ORR) of 72% (95% CI 58-83%), median progression free survival (PFS) of 19.3 months (95% CI 15.2-39.1 months) and median overall survival (OS) of 51.4 months (95% CI 29.3 months to not reached). Therefore, with the availability of highly effective ROS1-targeted TKI therapy, upfront molecular testing for ROS1 status alongside EGFR and ALK testing is recommended for all patients with NSCLC. We review the tissue requirements for ROS1 testing by immunohistochemistry (IHC) and fluorescent in situ hybridisation (FISH) and we present a testing algorithm for advanced NSCLC and consider how the future of pathology testing for ROS1 may evolve.
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Affiliation(s)
- Nick Pavlakis
- Royal North Shore Hospital, St Leonards, and Sydney University, Camperdown, NSW, Australia.
| | - Caroline Cooper
- Pathology Queensland, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Thomas John
- Olivia Newton-John Cancer Research Institute, Heidelberg, Vic, Australia
| | - Steven Kao
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Sonja Klebe
- SA Pathology, and Flinders University at Flinders Medical Centre, Bedford Park, SA, Australia
| | | | | | | | - Ken O'Byrne
- Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Prudence A Russell
- St Vincent's Hospital, University of Melbourne, Melbourne, Vic, Australia
| | | | - Wendy A Cooper
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Stephen Fox
- Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
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49
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Jo HE, Corte TJ, Glaspole I, Grainge C, Hopkins PMA, Moodley Y, Reynolds PN, Chapman S, Walters EH, Zappala C, Allan H, Keir GJ, Cooper WA, Mahar AM, Ellis S, Macansh S, Goh NS. Gastroesophageal reflux and antacid therapy in IPF: analysis from the Australia IPF Registry. BMC Pulm Med 2019; 19:84. [PMID: 31053121 PMCID: PMC6499965 DOI: 10.1186/s12890-019-0846-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/11/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Gastroesophageal reflux disease (GORD) is highly prevalent in idiopathic pulmonary fibrosis (IPF) and may play a role in its pathogenesis. Recent IPF treatment guidelines suggest that all patients with IPF be considered for antacid therapy. However, emerging evidence suggests that antacid therapy does not improve IPF patient outcomes and may increase the risk of pulmonary infection. METHODS Using prospectively collected data from the Australian IPF Registry including use of antacid therapy, GORD diagnosis and GORD symptoms, the relationship of these GORD variables to survival and disease progression was assessed. The severity of GORD symptoms using the frequency scale for symptoms of GORD (FSSG) and its relationships to outcomes was also assessed for the first time in an IPF cohort. RESULTS Five hundred eighty-seven (86%) of the 684 patients in the Australian IPF Registry were eligible for inclusion. Patients were mostly male (69%), aged 71.0 ± 8.5 years with moderate disease (FVC 81.7 ± 21.5%; DLco 48.5 ± 16.4%). Most patients were taking antacids (n = 384; 65%), though fewer had a diagnosis of GORD (n = 243, 41.4%) and typical GORD symptoms were even less common (n = 171, 29.1%). The mean FSSG score was 8.39 ± 7.45 with 43% (n = 251) having a score > 8. Overall, there was no difference in survival or disease progression, regardless of antacid treatment, GORD diagnosis or GORD symptoms. CONCLUSIONS Neither the use of antacid therapy nor the presence of GORD symptoms affects longer term outcomes in IPF patients. This contributes to the increasing evidence that antacid therapy may not be beneficial in IPF patients and that GORD directed therapy should be considered on an individual basis to treat the symptoms of reflux.
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Affiliation(s)
- Helen E Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia.
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia.
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
| | - Ian Glaspole
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- Department of Allergy and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Grainge
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter M A Hopkins
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Yuben Moodley
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Paul N Reynolds
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sally Chapman
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - E Haydn Walters
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- University of Tasmania, Hobart, TAS, Australia
| | - Christopher Zappala
- Department of Thoracic Medicine, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | | | - Gregory J Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Wendy A Cooper
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Tissue pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Annabelle M Mahar
- Tissue pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Samantha Ellis
- Department of Radiology, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Nicole S Goh
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory Medicine, Austin Hospital, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
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Brunetti D, Graves JP, Lazzaro E, Mariani A, Nowak S, Cooper WA, Wahlberg C. Excitation Mechanism of Low-n Edge Harmonic Oscillations in Edge Localized Mode-Free, High Performance, Tokamak Plasmas. Phys Rev Lett 2019; 122:155003. [PMID: 31050499 DOI: 10.1103/physrevlett.122.155003] [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] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/01/2019] [Indexed: 06/09/2023]
Abstract
The excitation mechanism for low-n edge harmonic oscillations in quiescent H-mode regimes is identified analytically. We show that the combined effect of diamagnetic and poloidal magnetohydrodynamic flows, with the constraint of a Doppler-like effect of the ion flow, leads to the stabilization of short wavelength modes, allowing low-n perturbation to grow. The analysis, performed in tokamak toroidal geometry, includes the effects of large edge pressure gradients, associated with the local flattening of the safety factor and diamagnetic flows, sheared parallel and E×B rotation, and a vacuum region between plasma and the ideal metallic wall. The separatrix also is modeled analytically.
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Affiliation(s)
- D Brunetti
- Istituto di Fisica del Plasma IFP-CNR, Via R. Cozzi 53, 20125 Milano, Italy
| | - J P Graves
- École Polytechnique Fédérale de Lausanne (EPFL), Swiss Plasma Center (SPC), CH-1015 Lausanne, Switzerland
| | - E Lazzaro
- Istituto di Fisica del Plasma IFP-CNR, Via R. Cozzi 53, 20125 Milano, Italy
| | - A Mariani
- Istituto di Fisica del Plasma IFP-CNR, Via R. Cozzi 53, 20125 Milano, Italy
| | - S Nowak
- Istituto di Fisica del Plasma IFP-CNR, Via R. Cozzi 53, 20125 Milano, Italy
| | - W A Cooper
- École Polytechnique Fédérale de Lausanne (EPFL), Swiss Plasma Center (SPC), CH-1015 Lausanne, Switzerland
| | - C Wahlberg
- Department of Physics and Astronomy, P.O. Box 516, Uppsala University, SE-751 20 Uppsala, Sweden
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