The presence of HER2 exon 20 insertion in patients with central nervous system metastases from non-small lung cancer — a potential application in classification for therapy

 WSTĘP: HER2 (ErbB2/neu) jest białkiem należącym do rodziny receptorów HER (EGFR, HER2, HER3 i HER4), posiadających w swej części wewnątrzkomórkowej aktywność kinazy tyrozynowej. Nadekspresja EGFR i HER2 występuje w wielu typach nowotworów, ale to mutacje w genach kodujących te receptory uwrażliwiają chorych na niedrobnokomórkowego raka płuca (NSCLC) na działanie inhibitorów kinaz tyrozynowych EGFR i HER2.MATERIAŁ I METODY: Wykorzystano technikę PCR oraz analizę długości fragmentów amplifikowanego DNA w celu zidentyfikowania u 150 chorych insercji 12 par zasad w obrębie eksonu 20 genu HER2 w przerzutach NDRP do mózgu.WYNIKI: W guzie z wykrytą mutacją HER2 nie stwierdzono mutacji EGFR ani BRAF. Insercja w eksonie 20 genu HER2 została wykryta u 77-letniego niepalącego mężczyzny chorego na niskozróżnicowanego raka gruczołowego (0,67% wszystkich chorych oraz 1,5% chorych na raka gruczołowego). U tego chorego nie zidentyfikowano innych nieprawidłowości genetycznych.WNIOSKI: W literaturze opisano, że u chorych posiadających mutację w genie HER2 mogą okazać się skuteczne inhibitory specyficzne w stosunku do kinaz tyrozynowych obu receptorów: EGFR i HER2 (np. afatynib). Dlatego też identyfikacja nowych mutacji kierujących w komórkach NSCLC wydaje się kluczem do właściwej kwalifikacji do terapii ukierunkowanych molekularnie. INTRODUCTION: HER2 (ErbB2/neu) is a member of the ErbB family of four structurally related receptors of tyrosine kinase activity. Overexpression of ErbB-1 (EGFR) and HER2 is found in many human cancers, but the presence of these genes mutations determines the effectiveness of EGFR and HER2 tyrosine kinase inhibitors in the therapy of non-small cell lung cancer (NSCLC).MATERIAL AND METHODS: To search for insertions of the HER2 gene in exon 20 in 150 brain metastases of non-small cell lung cancer patients, we used a PCR technique based on analysis of amplified DNA fragment lengths. We also compared the HER2 mutational status with clinicopathologic features and the presence of EGFR and BRAF mutations.RESULTS: HER2 mutation was present in one male, non-smoking patient with low differentiated adenocarcinoma (0.67% of all patients and 1.5% of patients with adenocarcinoma). The mutations of EGFR and BRAF genes were not found in HER2-mutated patient.CONCLUSIONS: The literature data suggests that patients with HER2 mutations may be sensitive to tyrosine kinase inhibitors of both EGFR and HER2 receptors (e.g. afatinib). Therefore, the identification of new driver mutations in NSCLC can improve the quality of patient care by enabling the use of correct molecularly targeted therapies

Czy stosujemy spersonalizowane leczenie raka płuca? Wykorzystanie badań molekularnych w planowaniu wielu linii leczenia u chorego na gruczolakoraka płuca

W wielodyscyplinarnym podejściu do leczenia chorych na raka płuca coraz większą rolę odgrywają terapie ukierunkowane molekularnie, które można zastosować w genetycznie wyselekcjonowanej grupie chorych. Personalizacja leczenia zwiększa liczbę opcji terapeutycznych, wydłuża przeżycie chorych oraz zmniejsza ryzyko wystąpienia efektów ubocznych terapii, mogących zagrażać życiu. W niniejszym opracowaniu przenalizowano proces leczenia 57-letniego mężczyzny chorego na gruczolakoraka płuca, u którego wykryto mutację aktywującą w genie EGFR. Oprócz diagnostycznej segmentektomii oraz paliatywnej hemipelwektomii i radioterapii przerzutu do stawu biodrowego, a także operacji cytoredukcyjnej guza pierwotnego, u chorego zastosowano sześć linii leczenia systemowego opartych zarówno na nowoczesnych terapiach ukierunkowanych molekularnie i immunoterapeutykach, jak i standardowych cytostatykach, co pozwoliło uzyskać trzyletnie przeżycie pacjenta. Niezależnie od dobrego stanu ogólnego i dobrej tolerancji leczenia uporczywość kontynuowania terapii mimo braku dłuższej stabilizacji choroby pozostaje dyskusyjna

The correlation of mutations and expressions of genes within the PI3K/Akt/mTOR pathway in breast cancer : a preliminary study

There is an urgent need to seek new molecular biomarkers helpful in diagnosing and treating breast cancer. In this elaboration, we performed a molecular analysis of mutations and expression of genes within the PI3K/Akt/mTOR pathway in patients with ductal breast cancer of various malignancy levels. We recognized significant correlations between the expression levels of the studied genes. We also performed a bioinformatics analysis of the data available on the international database TCGA and compared them with our own research. Studies on mutations and expression of genes were conducted using High-Resolution Melt PCR (HRM-PCR), Allele-Specific-quantitative PCR (ASP-qPCR), Real-Time PCR molecular methods in a group of women with ductal breast cancer. Bioinformatics analysis was carried out using web source Ualcan and bc-GenExMiner. In the studied group of women, it was observed that the prevalence of mutations in the studied PIK3CA and AKT1 genes was 29.63%. It was stated that the average expression level of the PIK3CA, PIK3R1, PTEN genes in the group of breast cancer patients is lower in comparison to the control group, while the average expression level of the AKT1 and mTOR genes in the studied group was higher in comparison to the control group. It was also indicated that in the group of patients with mutations in the area of the PIK3CA and AKT1 genes, the PIK3CA gene expression level is statistically significantly lower than in the group without mutations. According to our knowledge, we demonstrate, for the first time, that there is a very strong positive correlation between the levels of AKT1 and mTOR gene expression in the case of patients with mutations and without mutations

The Overview of Perspectives of Clinical Application of Liquid Biopsy in Non-Small-Cell Lung Cancer

The standard diagnostics procedure for non-small-cell lung cancer (NSCLC) requires a pathological evaluation of tissue samples obtained by surgery or biopsy, which are considered invasive sampling procedures. Due to this fact, re-sampling of the primary tumor at the moment of progression is limited and depends on the patient’s condition, even if it could reveal a mechanism of resistance to applied therapy. Recently, many studies have indicated that liquid biopsy could be provided for the noninvasive management of NSCLC patients who receive molecularly targeted therapies or immunotherapy. The liquid biopsy of neoplastic patients harbors small fragments of circulating-free DNA (cfDNA) and cell-free RNA (cfRNA) secreted to the circulation from normal cells, as well as a subset of tumor-derived circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA). In NSCLC patients, a longitudinal assessment of genetic alterations in “druggable” genes in liquid biopsy might improve the follow-up of treatment efficacy and allow for the detection of an early progression before it is detectable in computed tomography or a clinical image. However, a liquid biopsy may be used to determine a variety of relevant molecular or genetic information for understanding tumor biology and its evolutionary trajectories. Thus, liquid biopsy is currently associated with greater hope for common diagnostic and clinical applications. In this review, we would like to highlight diagnostic challenges in the application of liquid biopsy into the clinical routine and indicate its implications on the metastatic spread of NSCLC or monitoring of personalized treatment regimens

Genetic Clonality as the Hallmark Driving Evolution of Non-Small Cell Lung Cancer

Data indicate that many driver alterations from the primary tumor of non-small cell lung cancer (NSCLC) are predominantly shared across all metastases; however, disseminating cells may also acquire a new genetic landscape across their journey. By comparing the constituent subclonal mutations between pairs of primary and metastatic samples, it is possible to derive the ancestral relationships between tumor clones, rather than between tumor samples. Current treatment strategies mostly rely on the theory that metastases are genetically similar to the primary lesions from which they arise. However, intratumor heterogeneity (ITH) affects accurate diagnosis and treatment decisions and it is considered the main hallmark of anticancer therapy failure. Understanding the genetic changes that drive the metastatic process is critical for improving the treatment strategies of this deadly condition. Application of next generation sequencing (NGS) techniques has already created knowledge about tumorigenesis and cancer evolution; however, further NGS implementation may also allow to reconstruct phylogenetic clonal lineages and clonal expansion. In this review, we discuss how the clonality of genetic alterations influence the seeding of primary and metastatic lesions of NSCLC. We highlight that wide genetic analyses may reveal the phylogenetic trajectories of NSCLC evolution, and may pave the way to better management of follow-up and treatment

Variant Allele Frequency Analysis of Circulating Tumor DNA as a Promising Tool in Assessing the Effectiveness of Treatment in Non-Small Cell Lung Carcinoma Patients

Despite the different possible paths of treatment, lung cancer remains one of the leading causes of death in oncological patients. New tools guiding the therapeutic process are under scientific investigation, and one of the promising indicators of the effectiveness of therapy in patients with NSCLC is variant allele frequency (VAF) analysis. VAF is a metric characterized as the measurement of the specific variant allele proportion within a genomic locus, and it can be determined using methods based on NGS or PCR. It can be assessed using not only tissue samples but also ctDNA (circulating tumor DNA) isolated from liquid biopsy. The non-invasive characteristic of liquid biopsy enables a more frequent collection of material and increases the potential of VAF analysis in monitoring therapy. Several studies have been performed on patients with NSCLC to evaluate the possibility of VAF usage. The research carried out so far demonstrates that the evaluation of VAF dynamics may be useful in monitoring tumor progression, remission, and recurrence during or after treatment. Moreover, the use of VAF analysis appears to be beneficial in making treatment decisions. However, several issues require better understanding and standardization before VAF testing can be implemented in clinical practice. In this review, we discuss the difficulties in the application of ctDNA VAF analysis in clinical routine, discussing the diagnostic and methodological challenges in VAF measurement in liquid biopsy. We highlight the possible applications of VAF-based measurements that are under consideration in clinical trials in the monitoring of personalized treatments for patients with NSCLC

Failure of Immunotherapy—The Molecular and Immunological Origin of Immunotherapy Resistance in Lung Cancer

Immune checkpoint inhibitors (ICIs) have a huge impact on clinical treatment results in non-small cell lung cancer (NSCLC). Blocking antibodies targeting programmed cell death protein 1 (PD-1), programmed cell death protein ligand 1 (PD-L1) or CTLA-4 (cytotoxic T cell antigen 4) have been developed and approved for the treatment of NSCLC patients. However, a large number of patients develop resistance to this type of treatment. Primary and secondary immunotherapy resistance are distinguished. No solid biomarkers are available that are appropriate to predict the unique sensitivity to immunotherapy. Knowledge of predictive markers involved in treatment resistance is fundamental for planning of new treatment combinations. Scientists focused research on the use of immunotherapy as an essential treatment in combination with other therapy strategies, which could increase cancer immunogenicity by generating tumor cells death and new antigen release as well as by targeting other immune checkpoints and tumor microenvironment. In the present review, we summarize the current knowledge of molecular bases underlying immunotherapy resistance and discuss the capabilities and the reason of different therapeutic combinations

The effect of different concentrations of anti-PD-1 and anti-PD-L1 antibodies on the activity of immune system cells in patients with non-small cell lung cancer

Introduction. The last century abounded in numerous scientific discoveries that allowed us to understand the operation and functioning of one of the most complex human systems, i.e. the immune system. One of the most important discoveries was the work of Prof. James Alison and Prof. Tasuko Honjo on the development of anti-cancer therapy inhibiting negative immune regulation (PD-1 and CTLA-4 molecules). Knowledge of these molecules’ action and their huge role in inhibiting immune system activity, e.g. during cancer growth, created the basis for the development of specific monoclonal antibodies, without which clinicians from many specialties cannot imagine modern cancer therapies. However, side effects of these therapies are still quite troublesome.To minimize them, it would be necessary to reduce the dose while still maintaining the effective level of anticancer activity of immune system cells.  Material and methods. In this study, 24-hour culture of PBMCs isolated from blood and bronchoaspirate with various concentrations of nivolumab or atezolizumab was performed. Expression of the individual activation markers on cultured cells was compared to the expression of these markers on cells not subjected to cell culture.  Results and conclusions. The outcomes of our research may indicate that individualized dosages of anti-PD-1 and anti-PD-L1 antibodies may contribute to the effective activation of immune system cells while minimizing the side effects of the therapy

Molecular Classification of Endometrial Cancer and Its Impact on Therapy Selection

Endometrial cancer (EC) accounts for 90% of uterine cancer cases. It is considered not only one of the most common gynecological malignancies but also one of the most frequent cancers among women overall. Nowadays, the differentiation of EC subtypes is based on immunohistochemistry and molecular techniques. It is considered that patients’ prognosis and the implementation of the appropriate treatment depend on the cancer subtype. Patients with pathogenic variants in POLE have the most favorable outcome, while those with abnormal p53 protein have the poorest. Therefore, in patients with POLE mutation, the de-escalation of postoperative treatment may be considered, and patients with abnormal p53 protein should be subjected to intensive adjuvant therapy. Patients with a DNA mismatch repair (dMMR) deficiency are classified in the intermediate prognosis group as EC patients without a specific molecular profile. Immunotherapy has been recognized as an effective treatment method in patients with advanced or recurrent EC with a mismatch deficiency. Thus, different adjuvant therapy approaches, including targeted therapy and immunotherapy, are being proposed depending on the EC subtype, and international guidelines, such as those published by ESMO and ESGO/ESTRO/ESP, include recommendations for performing the molecular classification of all EC cases. The decision about adjuvant therapy selection has to be based not only on clinical data and histological type and stage of cancer, but, following international recommendations, has to include EC molecular subtyping. This review describes how molecular classification could support more optimal therapeutic management in endometrial cancer patients