El-Deiry Wafik S, Vijayvergia Namrata, Xiu Joanne, Scicchitano Angelique, Lim Bora, Yee Nelson S, Harvey Harold A, Gatalica Zoran, Reddy Sandeep
a Fox Chase Cancer Center ; Philadelphia , PA , 19111 , USA.
c Penn State Hershey Cancer Institute ; Hershey , PA , 17033 , USA.
Cancer Biol Ther. 2015;16(12):1726-37. doi: 10.1080/15384047.2015.1113356.
Metastatic colorectal cancer (mCRC) carries a poor prognosis with an overall 5-year survival of 13.1%. Therapies guided by tumor profiling have suggested benefit in advanced cancer. We used a multiplatform molecular profiling (MP) approach to identify key molecular changes that may provide therapeutic options not typically considered in mCRC. We evaluated 6892 mCRC referred to Caris Life Sciences by MP including sequencing (Sanger/NGS), immunohistochemistry (IHC) and in-situ hybridization (ISH). mCRC metastases to liver, brain, ovary or lung (n = 1507) showed differential expression of markers including high protein expression of TOPO1 (52%) and/or low RRM1 (57%), TS (71%) and MGMT (39%), suggesting possible benefit from irinotecan, gemcitabine, 5FU/capecitabine and temozolomide, respectively. Lung metastases harbored a higher Her2 protein expression than the primary colon tumors (4% vs. 1.8%, p = 0.028). Brain and lung metastases had higher KRAS mutations than other sites (65% vs 59% vs 47%, respectively, p = 0.07, <0.01), suggesting poor response to anti-EGFR therapies. BRAF-mutated CRC (n = 455) showed coincident high protein expression of RRM1 (56%), TS (53%) and low PDGFR (22%) as compared with BRAF wild-type tumors. KRAS-mutated mCRC had higher protein expression of c-MET (47% vs. 36%) and lower MGMT (56% vs. 63%), suggesting consideration of c-MET inhibitors and temozolomide. KRAS-mutated CRC had high TUBB3 (42% vs. 33%) and low Her2 by IHC (0.5%) and HER2 by FISH (3%, p <0.05). CRC primaries had a lower incidence of PIK3CA and BRAF mutations in rectal cancer versus colon cancer (10% and 3.3%, respectively). MP of 6892 CRCs identified significant differences between primary and metastatic sites and among BRAF/KRAS sub-types. Our findings are hypothesis generating and need to be examined in prospective studies. Specific therapies may be considered for different actionable targets in mCRC as revealed by MP.
转移性结直肠癌(mCRC)预后较差,总体5年生存率为13.1%。以肿瘤分析为指导的治疗方法已显示对晚期癌症有益。我们采用多平台分子分析(MP)方法来识别可能提供mCRC中通常未考虑的治疗选择的关键分子变化。我们通过MP评估了6892例转诊至卡里斯拉生命科学公司的mCRC,包括测序(桑格测序/二代测序)、免疫组织化学(IHC)和原位杂交(ISH)。转移至肝脏、脑、卵巢或肺的mCRC(n = 1507)显示出标志物的差异表达,包括TOPO1高蛋白表达(52%)和/或低RRM1(57%)、TS(71%)和MGMT(39%),分别提示可能从伊立替康、吉西他滨、5-氟尿嘧啶/卡培他滨和替莫唑胺中获益。肺转移灶中Her2蛋白表达高于原发性结肠肿瘤(4%对1.8%,p = 0.028)。脑转移和肺转移灶的KRAS突变高于其他部位(分别为65%对59%对47%,p = 0.07,<0.01),提示对抗表皮生长因子受体(EGFR)治疗反应不佳。与BRAF野生型肿瘤相比,BRAF突变的结直肠癌(n = 455)显示RRM1(56%)、TS(53%)高蛋白表达且PDGFR低表达(22%)。KRAS突变的mCRC中c-MET蛋白表达较高(47%对36%)且MGMT较低(56%对63%),提示可考虑使用c-MET抑制剂和替莫唑胺。KRAS突变的结直肠癌通过免疫组织化学检测TUBB3高表达(42%对33%)且Her2低表达(0.5%),通过荧光原位杂交检测HER2低表达(3%,p <0.05)。结直肠癌原发灶中PIK3CA和BRAF突变在直肠癌中的发生率低于结肠癌(分别为10%和3.3%)。对6892例结直肠癌的MP分析确定了原发部位和转移部位之间以及BRAF/KRAS亚型之间的显著差异。我们的发现仅为提出假设,需要在前瞻性研究中进行检验。如MP所揭示的,对于mCRC中不同的可操作靶点可考虑采用特定治疗方法。
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