评估和预测接受同步放化疗及辅助替莫唑胺化疗的胶质母细胞瘤患者表皮生长因子受体 vIII 突变的意义。
Assessment and prognostic significance of the epidermal growth factor receptor vIII mutation in glioblastoma patients treated with concurrent and adjuvant temozolomide radiochemotherapy.
出版信息
Int J Cancer. 2014 May 15;134(10):2437-47. doi: 10.1002/ijc.28576.
The epidermal growth factor receptor vIII mutant (EGFRvIII) is found in ~50% of all EGFR-amplified glioblastomas and constitutes a tumor-specific therapeutic target. To assess molecular testing approaches and the prognostic role of EGFRvIII in patients treated according to current standards of care, we compared different EGFRvIII detection methods and correlated EGFRvIII status with outcome in a prospective patient cohort of the German Glioma Network. In total, 184 newly diagnosed glioblastoma patients were investigated for EGFR amplification and for expression of EGFR and EGFRvIII by immunohistochemistry. Further, the EGFRvIII status was additionally studied by multiplex ligation-dependent probe amplification (MLPA) analysis and reverse transcription-PCR (RT-PCR). Immunohistochemistry demonstrated EGFRvIII in 34 of 184 patients (18%). RT-PCR or MLPA analysis detected four additional EGFRvIII-positive patients. Overall, RT-PCR and immunohistochemistry were more sensitive for EGFRvIII detection than MLPA. EGFRvIII status was not associated with progression-free and overall survival. EGFRvIII also had no prognostic significance in the subgroup of patients who were free from progression after concomitant radiochemotherapy and thus would be eligible for the ongoing ACT IV EGFRvIII vaccination trial. Age, extent of resection and O⁶-methylguanine DNA methyltransferase (MGMT) promoter methylation status appeared to be less prognostic in EGFRvIII-positive patients. Thus, EGFRvIII positivity is not a major negative prognostic factor in glioblastoma patients treated according to current standards of care. Data from phase II EGFRvIII-targeted vaccination trials compare favorably with the present contemporary results, supporting the further exploration of EGVRvIII vaccination in newly diagnosed glioblastoma.
表皮生长因子受体 vIII 突变体(EGFRvIII)存在于约 50%的所有 EGFR 扩增的胶质母细胞瘤中,构成了肿瘤特异性的治疗靶点。为了评估分子检测方法以及 EGFRvIII 在根据当前护理标准治疗的患者中的预后作用,我们比较了不同的 EGFRvIII 检测方法,并在德国神经胶质瘤网络的前瞻性患者队列中,将 EGFRvIII 状态与结果相关联。总共对 184 例新诊断的胶质母细胞瘤患者进行了 EGFR 扩增以及 EGFR 和 EGFRvIII 的免疫组织化学检测。此外,还通过多重连接依赖性探针扩增(MLPA)分析和逆转录-PCR(RT-PCR)进一步研究了 EGFRvIII 状态。免疫组织化学显示 184 例患者中有 34 例(18%)存在 EGFRvIII。RT-PCR 或 MLPA 分析检测到另外 4 例 EGFRvIII 阳性患者。总体而言,RT-PCR 和免疫组化检测 EGFRvIII 的敏感性高于 MLPA。EGFRvIII 状态与无进展生存期和总生存期无关。在接受同期放化疗后无进展的患者亚组中,EGFRvIII 也没有预后意义,因此符合正在进行的 ACT IV EGFRvIII 疫苗试验的条件。年龄、切除范围和 O⁶-甲基鸟嘌呤 DNA 甲基转移酶(MGMT)启动子甲基化状态在 EGFRvIII 阳性患者中似乎预后较差。因此,在根据当前护理标准治疗的胶质母细胞瘤患者中,EGFRvIII 阳性不是主要的预后不良因素。来自 II 期 EGFRvIII 靶向疫苗试验的数据与目前的当代结果相比表现良好,支持在新诊断的胶质母细胞瘤中进一步探索 EGVRvIII 疫苗接种。