Department of Radiation Oncology, Stanford University, Stanford, California.
Stanford Cancer Institute, Stanford, California.
Cancer Discov. 2020 Dec;10(12):1826-1841. doi: 10.1158/2159-8290.CD-20-0282. Epub 2020 Oct 18.
Tumor genotyping is not routinely performed in localized non-small cell lung cancer (NSCLC) due to lack of associations of mutations with outcome. Here, we analyze 232 consecutive patients with localized NSCLC and demonstrate that and mutations are predictive of high rates of local recurrence (LR) after radiotherapy but not surgery. Half of LRs occurred in tumors with mutations, indicating that they are major molecular drivers of clinical radioresistance. Next, we functionally evaluate mutations in our radiotherapy cohort and demonstrate that only pathogenic mutations are associated with radioresistance. Furthermore, expression of NFE2L2 target genes does not predict LR, underscoring the utility of tumor genotyping. Finally, we show that glutaminase inhibition preferentially radiosensitizes -mutant cells via depletion of glutathione and increased radiation-induced DNA damage. Our findings suggest that genotyping for mutations could facilitate treatment personalization and provide a potential strategy for overcoming radioresistance conferred by these mutations. SIGNIFICANCE: This study shows that mutations in and predict for LR after radiotherapy but not surgery in patients with NSCLC. Approximately half of all LRs are associated with these mutations and glutaminase inhibition may allow personalized radiosensitization of -mutant tumors..
肿瘤基因分型在局部非小细胞肺癌(NSCLC)中通常不进行,因为突变与结局之间缺乏关联。在这里,我们分析了 232 例连续的局部 NSCLC 患者,结果表明 和 突变可预测放疗后局部复发(LR)的高发生率,但不能预测手术。一半的 LR 发生在 突变的肿瘤中,这表明它们是临床放射抵抗的主要分子驱动因素。接下来,我们在我们的放疗队列中对 突变进行了功能评估,并证实只有致病性突变与放射抵抗有关。此外,NFE2L2 靶基因的表达不能预测 LR,这突出了肿瘤基因分型的实用性。最后,我们表明谷氨酰胺酶抑制通过耗尽谷胱甘肽和增加辐射诱导的 DNA 损伤,优先放射敏化 突变细胞。我们的研究结果表明,针对 突变的基因分型可以促进治疗个体化,并为克服这些突变赋予的放射抵抗提供一种潜在策略。意义:本研究表明,在 NSCLC 患者中, 和 突变可预测放疗后而非手术后的 LR。所有 LR 的一半左右与这些突变有关,谷氨酰胺酶抑制可能允许对 突变肿瘤进行个性化的放射增敏。
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