Chẩn đoán đột biến gen EGFR trong ung thư phổi không tế bào nhỏ với các mẫu bệnh phẩm dịch khoang cơ thể

2021 ◽  
Author(s):  
Son Lam Nguyen
Keyword(s):  
Cerebrospinal Fluid ◽  
Pleural Fluid ◽  
Egfr Mutation ◽  
Gene Mutations ◽  
Body Cavity ◽  
Small Cell ◽  
Egfr Mutations ◽  
Small Cell Lung ◽  
Paraffin Block ◽  
Exon 19 Deletion

TÓM TẮT Đặt vấn đề: Dựa vào tính chất các mẫu dịch khoang cơ thể có hiện diện các mảnh DNA lơ lửng giúp thực hiện chẩn đoán đột biến EGFR. Từ nguyên lý này, chúng tôi thực hiện nghiên cứu với các mục tiêu sau: Khảo sát tỉ lệ dương tính đột biến EGFR trong các mẫu dịch khoang cơ thể; và hảo sát tỉ lệ chẩn đoán đột biến gen EGFR trong mẫu bệnh phẩm mô học đúc khối parafin với mẫu dịch khoang cơ thể trên cùng một bệnh nhân. Phương pháp nghiên cứu: Hồi cứu, thống kê mô tả cắt ngang. Các trường hợp ung thư phổi không tế bào nhỏ được chẩn đoán đột biến EGFR bằng mẫu bệnh phẩm đúc khối paraffine với Test EGFR Version 1 và mẫu bệnh phẩm dịch các khoang cơ thể (Dịch màng phổi, dịch màng tim, dịch màng bụng, dịch não tủy) với Test EGFR Version 2. Kết quả: Có 117 ca bệnh trong nghiên cứu: Kết quả chẩn đoán đột biến gen EGFR trên mẫu mô học đúc khối paraffine: (+) 49 ca # 41,88%, tương đương với các thống kê ở trong nước và thế giới (Châu Á). Đa số vẫn là hai loại đột biến nhạy thuốc TKIs Exon 19 Deletion và Exon 21 L858R (53% và 23%). Kết quả chẩn đoán đột biến EGFR trên các mẫu dịch khoang cơ thể: Đa số mẫu dịch khoang cơ thể thực hiện chẩn đoán đột biến EGFR là dịch màng phổi (91 ca # 77,77%). Tỉ lệ phát hiện đột biến trong mẫu dịch màng phổi và dịch não tủy cao nhất (29,67% & 83,33%). So sánh tỉ lệ phát hiện đột biến EGFR trên mẫu dịch khoang cơ thể (35 /117 ca # 29,91%) với tỉ lệ phát hiện trên mẫu mô học thấp hơn có ý nghĩa thống kê (29,91% ↔ 41,88% với P = 0,0125). So sánh với các nghiên cứu khác trên thế giới cho thấy đa số các nghiên cứu cho kết quả cao hơn so với nghiên cứu tại bệnh viện Phạm Ngọc Thạch. Kết luận: Khảo sát chẩn đoán đột biến EGFR trong dịch các khoang cơ thể, đặc biệt trong các mẫu dịch có quá ít tế bào ác tính, kết quả dương tính 29,91%. Tỉ lệ cao nhất trong dịch màng phổi và dịch não tủy. Tuy nhiên, khả năng phát hiện đột biến EGFR trong các dịch khoang cơ thể thấp hơn so với trên các bệnh phẩm mô học (29.91% < 41,88%). Và đô tương đồng giữa hai loại bệnh phẩm này là 71,42%. Cần nâng cao kỹ thuật thực hiện chẩn đoán đột biến EGFR trong mẫu dịch khoang cơ thể với các phương pháp có độ nhạy cao hơn: ddPCR, NGS… ABSTRACT DIAGNOSTIC EGFR GENE MUTATIONS IN NON SMALL CELL LUNG CANCER WITH SPECIMENS OF BODY CAVITY FLUIDS Introduction: Based on the nature of the body cavity fluid samples, there is the presence of suspended DNA fragments that help to make an EGFR mutation diagnosis. From this principle, we have conducted this research with the following objectives: Investigate the positive rate of EGFR mutations in body cavity fluid samples, and explore the diagnosis rate of EGFR gene mutations in paraffin block histology samples with body cavity fluid samples in the same patients. Methods: In a retrospective study, cases of NSCLC were diagnosed with EGFR mutations by paraffin block histological specimens with Test EGFR Version 1 and body cavity fluid samples (pleural fluid, pericardial fluid, peritoneal fluid, cerebrospinal fluid) with Test EGFR Version 2. Results: There are 117 cases in the research: Results of EGFR mutation diagnosis on paraffin block histology: (+) 49 cases # 41.88%, equivalent to statistics in Vietnam and the World (Asia). The majority are still two types of drug - sensitive mutants TKIs: Exon 19 Deletion and Exon 21 L858R (53% and 23%). Results of diagnosis of EGFR mutation in samples of body cavity fluids: Most samples of body cavity performing diagnosis of EGFR mutation were pleural fluid (91 cases # 77.77%). The highest rate of detection of mutations in pleural and cerebrospinal fluid samples (29.67% & 83.33%). Comparing the rate of detection of EGFR mutation in body fluid samples (35/117 cases # 29.91%) with the statistically lower rate of detection in histological samples (29.91%-41, 88% with P = 0.0125). Compared with other studies in the world, most studies have higher results than those at Pham Ngoc Thach Hospital. Conclusion: Survey on the diagnosis of EGFR mutations in body cavity fluid samples, especially in fluid samples with too few malignant cells, showed positive results of 29.91%. The highest percentage is in pleural fluid and cerebrospinal fluid. However, the ability to detect EGFR mutations in body cavity fluid samples was lower than in histological specimens (29.91% < 41.88%). And the similarity between these two samples is 71.42%. Therefore, it is necessary to improve the technique of performing EGFR mutation diagnosis in body cavity fluid samples with more sensitive methods: ddPCR, NGS... Keywords: Non small cell lung cancer (NSCLC), Formalin - Fixed Paraffin - Embedded Tissue (FFPET), Body cavity fluids, Cell Free DNA, Cellular DNA.

A novel mutant-enriched liquidchip for detection of circulating EGFR mutations in advanced non-small cell lung cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e14526-e14526
Author(s):  
S. Lu ◽  
H. Yang ◽  
X. Ye ◽  
X. Xu ◽  
Z. Li ◽  
...  
Keyword(s):  
Egfr Mutation ◽  
Direct Sequencing ◽  
Small Cell ◽  
Egfr Mutations ◽  
Wild Type ◽  
Small Cell Lung ◽  
Exon 19 Deletion ◽  
L858r Mutation ◽  
Nsclc Patients ◽  
Exon 19

e14526 Background: We developed a novel technology, Mutant-enriched liquidchip (MEL), which integrates the sensitive mutant enriched PCR and quantitative high throughput liquidchip (suspension array), to detect circulating EGFR mutations (Exon 19 deletion and exon 21 L858R mutation) in patients with advanced non-small cell lung cancer (NSCLC). Methods: To enrich mutant EGFR, a unique restriction site is introduced into the mutation alleles so that the wild type sequence can be selectively removed by restriction digestion, and the undigested mutated DNA is amplified by PCR. The product is then hybridized to complementary probes (including 15 types of exon 19 deletion and exon 21 L858R mutation) which had been conjugated to beads coding with different fluorescent dye, followed by measuring through Luminex 200 system. Plasmid DNA mixture with different EGFR genotypes was applied to determine the sensitivity and accuracy of MEL. Afterwards, the MEL was validated in 49 patients whose EGFR genotypes of tissue specimen had been tested with direct sequencing The circulating genomic DNA was obtained from serum sample of other 201 Chinese stage IIIB or IV NSCLC patients without EGFR-TKI administration, and the EGFR mutation status was analyzed by using of MEL. Results: The results shows that MEL is capable of detecting as few as 20 copies of mutant EGFR alleles with a sensitivity limit of at least mutant/wild-type ratio of 0.1%. It also shows that MEL can not only confirm EGFR mutations status in tissue specimens already known by direct sequencing (13/49), but also detect mutations in some of those showing wild type by sequencing (16/49). Overall, 54% of patients had circulating EGFR mutation. 34% of patients had an exon 19 deletion and 29.6% had L858R. 63.1% of mutations were found in females and 67.6% in never-smokers. Conclusions: This novel MEL method allows for highly sensitive and reproducible detection of human somatic mutations in heterogeneous specimens, and could be applicable to test EGFR mutations non-invasively in advanced NSCLC patients for predicting response to targeted therapy. No significant financial relationships to disclose.

Epidermal Growth Factor Receptor Mutations in Plasma DNA Samples Predict Tumor Response in Chinese Patients With Stages IIIB to IV Non–Small-Cell Lung Cancer

2009 ◽  
Vol 27 (16) ◽  
pp. 2653-2659 ◽  
Author(s):  
Hua Bai ◽  
Li Mao ◽  
hang Shu Wang ◽  
Jun Zhao ◽  
Lu Yang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Egfr Mutation ◽  
Tumor Response ◽  
Growth Factor Receptor ◽  
Small Cell ◽  
Egfr Mutations ◽  
Plasma Samples ◽  
Plasma Dna ◽  
Small Cell Lung ◽  
Epidermal Growth

Purpose Mutations in the epidermal growth factor receptor (EGFR) kinase domain can predict tumor response to tyrosine kinase inhibitors (TKIs) in non–small-cell lung cancer (NSCLC). However, obtaining tumor tissues for mutation analysis is challenging. We hypothesized that plasma-based EGFR mutation analysis is feasible and has value in predicting tumor response in patients with NSCLC. Patients and Methods Plasma DNA samples and matched tumors from 230 patients with stages IIIB to IV NSCLC were analyzed for EGFR mutations in exons 19 and 21 by using denaturing high-performance liquid chromatography. We compared the mutations in the plasma samples and the matched tumors and determined an association between EGFR mutation status and the patients' clinical outcomes prospectively. Results In 230 patients, we detected 81 EGFR mutations in 79 (34.3%) of the patients' plasma samples. We detected the same mutations in 63 (79.7%) of the matched tumors. Sixteen plasma (7.0%) and fourteen tumor (6.1%) samples showed unique mutations. The mutation frequencies were significantly higher in never-smokers and in patients with adenocarcinomas (P = .012 and P = .009, respectively). In the 102 patients who failed platinum-based treatment and who were treated with gefitinib, 22 (59.5%) of the 37 with EGFR mutations in the plasma samples, whereas only 15 (23.1%) of the 65 without EGFR mutations, achieved an objective response (P = .002). Patients with EGFR mutations had a significantly longer progression-free survival time than those without mutations (P = .044) in plasma. Conclusion EGFR mutations can be reliably detected in plasma DNA of patients with stages IIIB to IV NSCLC and can be used as a biomarker to predict tumor response to TKIs.

EGFR mutation analysis in histologic and cytologic specimens of non-small cell lung cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7176-7176 ◽  
Author(s):  
H. Sakai ◽  
K. Akagi ◽  
J. Sudoh ◽  
S. Yoneda ◽  
H. Komagata ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Mutation Analysis ◽  
Cell Lung Cancer ◽  
Egfr Mutation ◽  
Kinase Inhibitor ◽  
Small Cell ◽  
Egfr Mutations ◽  
Polymorphism Analysis ◽  
Small Cell Lung

7176 Background: Recent studies have suggested that EGFR mutations can be used to predict tumor sensitivity to gefitinib (epidermal growth factor receptor tyrosine kinase inhibitor) in patients with non-small-cell lung cancer (NSCLC). Most previous studies of EGFR mutations have used direct sequencing to analyze surgically resected specimens. More rapid, accurate, and simple techniques for analysis of EGFR mutations in histologic or cytologic specimens (i.e., transbronchial biopsy, bronchial washing, pleural effusion, lymph node aspiration) are needed to improve outcomes. Methods: DNA was extracted from histologic or cytologic specimens of NSCLC obtained from March through October 2005. The major mutations of the EGFR gene (exons 18–21) were analyzed by our original technique for fragment analysis and polymerase-chain-reaction-restriction-fragment-length polymorphism analysis. Results: About 2 days were required for mutation analysis. Pathological analysis indicated that 64 (5 histologic and 59 cytologic specimens) of 90 specimens (11 histologic and 79 cytologic specimens) were adenocarcinomas. EGFR mutations were found in 22 of these specimens (2 histologic and 20 cytologic specimens; ex19:del 13, ex19:ins 2, ex21:L858R 7). An EGFR mutation (ex19:del) was also found in a patient with large cell carcinoma. Conclusions: Our method can efficiently detect EGFR mutations in small samples of lung cancer cells obtained from histologic or cytologic specimens. This method is useful for the identification of EGFR mutations in patients with unresectable NSCLC in whom sufficient tissue specimens are difficult to obtain. No significant financial relationships to disclose.

Neratinib, an Irreversible Pan-ErbB Receptor Tyrosine Kinase Inhibitor: Results of a Phase II Trial in Patients With Advanced Non–Small-Cell Lung Cancer

2010 ◽  
Vol 28 (18) ◽  
pp. 3076-3083 ◽  
Author(s):  
Lecia V. Sequist ◽  
Benjamin Besse ◽  
Thomas J. Lynch ◽  
Vincent A. Miller ◽  
Kwok K. Wong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Tyrosine Kinase ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Egfr Mutation ◽  
Objective Response ◽  
Resistance Mutation ◽  
Small Cell ◽  
Egfr Mutations ◽  
Small Cell Lung

PurposeEpidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have had a significant impact on non–small-cell lung cancer (NSCLC) outcomes, particularly for patients with EGFR mutations. Resistance emerges after 9 to 12 months, primarily mediated by the T790M resistance mutation. We studied neratinib, an irreversible pan-ErbB TKI that may overcome T790M.Patients and MethodsPatients with advanced NSCLC underwent EGFR sequencing of available tumor tissue at enrollment. Those with ≥ 12 weeks of prior TKI therapy were placed in arm A if they were EGFR mutation positive or arm B if they were wild-type. Arm C included TKI-naïve patients with adenocarcinoma and light smoking histories (≤ 20 pack-years). All patients received daily oral neratinib, initially at 320 mg but subsequently reduced to 240 mg because of excessive diarrhea. The primary end point was objective response rate (RR).ResultsOne-hundred sixty-seven patients were treated: 91 in arm A, 48 in arm B, and 28 in arm C. Diarrhea was the most common toxicity; grade 3 incidence was 50% at 320 mg but improved to 25% after dose reduction. The RR was 3% in arm A and zero in arms B and C. No patients with known T790M responded. Notably, three of four patients with an exon 18 G719X EGFR mutation had a partial response and the fourth had stable disease lasting 40 weeks.ConclusionNeratinib had low activity in patients with prior benefit from TKIs and in TKI-naïve patients, potentially because of insufficient bioavailability from diarrhea-imposed dose limitation. Responses were seen in patients with the rare G719X EGFR mutation, highlighting the importance of obtaining comprehensive genetic information on trials of targeted agents.

scholarly journals Rational Application of First-Line EGFR-TKIs Combined with Antiangiogenic Inhibitors in Advanced EGFR-Mutant Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-15
Author(s):  
Jie-Tao Ma ◽  
Yi-Jia Guo ◽  
Jun Song ◽  
Li Sun ◽  
Shu-Ling Zhang ◽  
...  
Keyword(s):  
Egfr Mutation ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Formula Group ◽  
Exon 19 Deletion ◽  
Egfr Mutant ◽  
Egfr Tki ◽  
Egfr Tkis

Purpose. A meta-analysis of randomized controlled trials (RCTs) was conducted to compare the difference in efficacy and safety between epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) with antiangiogenic inhibitors ( A + T ) and EGFR-TKI monotherapy in patients with treatment-naïve advanced EGFR-mutant non-small-cell lung cancer (NSCLC). Methods. PubMed, Embase, Web of Science, and Cochrane electronic databases were searched for relevant RCTs. Meeting abstracts were also reviewed to identify appropriate studies. The endpoints included progression-free survival (PFS), overall survival (OS), 1- and 2-year OS rates, objective response rate (ORR), and grade ≥ 3 adverse events. All pooled outcomes were expressed using hazard ratios (HRs) or relative risk ratios (RRs). Results. Data were collected from six eligible RCTs, which included 1,244 participants (619 in the A + T group and 625 in the TKI alone group). PFS was significantly improved with A + T compared to TKI alone ( HR = 0.60 ; P < 0.01 ) regardless of EGFR mutation types (exon 19 deletion or L858R) and brain metastasis status (with or without brain metastases). There was no significant difference in median OS between the A + T and TKI alone groups ( HR = 0.933 ; P = 0.551 ) regardless of EGFR mutation type. The ORR for A + T combination therapy was significantly increased compared to TKI monotherapy in exon 19 deletion subgroups ( RR = 0.774 ; P = 0.008 ). There was no difference in the positive rates of acquired T790M mutation between the two groups ( RR = 0.967 ; P = 0.846 ). More patients in the TKI alone group received a variety of subsequent systemic treatments than those in the A + T group ( RR = 0.881 ; P = 0.002 ). Conclusion. Addition of antiangiogenic inhibitors to first-line EGFR-TKI therapy significantly reduced the risk of disease progression for patients with advanced EGFR-mutant NSCLC regardless of EGFR mutation type and brain metastasis status. The lack of OS benefit may be explained by differences in subsequent treatments rather than drug resistance mechanisms.

scholarly journals Predictors of Outcomes in Patients with EGFR-Mutated Non-Small Cell Lung Cancer Receiving EGFR Tyrosine Kinase Inhibitors: A Systematic Review and Meta-Analysis

Cancers ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 1259 ◽  
Author(s):  
Carlo Buonerba ◽  
Simona Iaccarino ◽  
Pasquale Dolce ◽  
Martina Pagliuca ◽  
Michela Izzo ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Egfr Mutation ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
Exon 19 Deletion ◽  
L858r Mutation ◽  
Egfr Mutant ◽  
Nsclc Patients ◽  
Egfr Tkis

Some commonly available patient or disease characteristics may be associated with progression-free survival (PFS) and overall survival (OS) in EGFR-mutant non-small cell lung cancer (NSCLC) patients receiving EGFR-TKIs (epidermal growth factor receptor - tyrosine kinase inhibitors). We performed a systematic review and meta-analysis of randomized control trials (RCTs) to explore differences in outcomes associated with EGFR-TKIs among subgroups of EGFR-mutant NSCLC patients. Pooled HRs for progression or death (PFS-HRs) and pooled HRs for death (OS-HRs) were compared among sub-groups defined according to baseline clinical and demographic variables as well as type of EGFR mutation. In the entire assessable population of 4465 EGFR-mutant NSCLC patients, significant interactions with PFS were found for gender (males vs. females; pooled ratio of the PFS-HRs = 1.2; 95% CI 1.12–1.56), smoking history (smokers vs. non-smokers; pooled ratio of the PFS-HRs = 1.26; 95% CI 1.05–1.51), and type of EGFR mutation (patients with exon 21 L858R mutation vs. exon 19 deletion; pooled ratio of the PFS-HRs = 1.39; 95% CI 1.18–1.63). Male patients, smokers and patients with EGFR exon 21 L858R mutation may derive less benefit from EGFR-TKIs compared to female patients, non-smokers and patients with EGFR exon 19 deletion.

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