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  • American Association for Cancer Research (AACR)  (4)
  • English  (4)
  • 1
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 77, No. 13_Supplement ( 2017-07-01), p. 754-754
    Abstract: Introduction: Breakthroughs in cancer research have resulted in mutation-specific targeted therapies (precision medicine). Most of these new drugs are only effective in patients with an actionable molecular profile. Thus, predictive molecular testing enables oncologists to select individual patients for the most appropriate (targeted) therapy and to reduce the burden of overtreatment. The number of clinically relevant predictive markers that are routinely analyzed is growing rapidly, resulting in the identification of rare mutations, mutations with unknown relevance and coexistence of two or more mutations in the same sample. Incorporating these into the optimal treatment for the individual patient can be complex. Methods: A total of 2461 sequential tumor biopsies were analyzed at our institute using targeted next generation sequencing (Ion Torrent platform). 230 of these patients were discussed at a weekly Molecular Tumor Board (MTB) meeting. Cases involved 170 lung and 21 colorectal carcinomas, 24 melanomas, 1 GIST and a range of other malignancies with uncommon and rare mutations. The board is composed of pulmonologists, medical oncologists, pathologists and clinical scientists in molecular pathology. The goal of the MTB is to discuss the biological and clinical relevance of rare mutations or uncommon profiles and to suggest treatment options based on registered, off-label or trial-based drugs presently available in the Netherlands. Results: In this abstract we report on four patients with an ERBB2 exon 20 mutation and 1 patient with ERBB2 amplification received anti-HER2 treatment after an MTB consensus decision. Two patients with an insertion in exon 20 of ERBB2: (c.2313_2324dup; p.(Y772_A775dup)) received first line therapy with afatinib and showed a partial response and stable disease respectively. One patient with a c.2524G & gt;A; p.(V842I) mutation received afatinib and showed stable disease for 3 months. A patient with another ERBB2 exon 20 insertion (c.2326_2327insTAT:p.(G776delinsVC)) received afatinib but had progressive disease within two months. One patient with an ERBB2 amplification by FISH and high (3+) HER2(ERBB2) expression, showed a partial response to trastuzumab. All patients had stage IV and would without genomic knowledge been treated with chemotherapy. Conclusion: Lung cancer patients with sporadic ERBB2 mutations might benefit from targeted ERBB2 therapy. For an optimal treatment decision, patients with rare mutations in general, may benefit from discussion in a multidisciplinary molecular tumor board. In the future, both the considerations for targeted therapy as well as treatment response and toxicity should be registered in an open-access database and shared with other national and international Molecular Tumor Board initiatives to allow comparison with traditional treatments. Citation Format: Arja ter Elst, Nils A. 't Hart, Anthonie J. van der Wekken, Wim Timens, Lucie B. Hijmering-Kappelle, Geke A. Hospers, Hilde Jalving, Elise M. van der Logt, Leon C. van Kempen, Sjoukje F. Oosting, Matthew R. Groves, T Jeroen Hiltermann, Anke van den Berg, Harry J. Groen, Ed Schuuring. Treatment decision-making of rare ERBB2 (HER2) mutations in lung cancer; a role for multidisciplinary molecular tumor boards [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 754. doi:10.1158/1538-7445.AM2017-754
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2017
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  • 2
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 80, No. 16_Supplement ( 2020-08-15), p. 4335-4335
    Abstract: Objective The relevance of EGFR gene amplification in patients with EGFR-mutated advanced non-small cell lung cancer (NSCLC) has not been fully elucidated. Moreover, a limited number of studies have been published on methods to estimate gene amplifications based on routinely performed targeted next generation sequencing (NGS). In this study we aimed to determine whether PCR-based targeted NGS data on tumor tissue can be used to estimate presence of gene amplifications and explored the prognostic value of EGFR gene amplification in EGFR mutated NSCLC patients. Materials and methods A total of 3,194 good quality targeted NGS data files were retrieved from 2014 to 2017. Among those, 1,729 NSCLC samples originated from 1,586 NSCLC patients of whom 134 had an EGFR mutation (8.2%). Clinical data were available for 66 of the patients. Raw sequencing data were re-analyzed using a custom designed pipeline. The presence of an amplification was based on the read depth of a given amplicon relative to a set of reference amplicons from the sample or relative to a set of normal control samples. Reference amplicons were selected based on low degree of variation in read depth amongst all tested samples. Amplifications were regarded significant when the ratio was ≥3 and the z score was ≥3.5. Technical validation was done by FISH and MLPA. Cox regression analysis on overall survival was done with each of the amplification parameters using SPSS. Results No amplifications were detected for the ALK, KIT, NRAS, PDGFRA, GNAQ and MAP2K1 gene loci, whereas amplifications for BRAF, ESR1, GNA11, HRAS, KRAS, MET and PIK3CA were observed at a low frequency. Depending on the amplification analysis strategy (within sample or relative to normal controls), 19% and 13% of the EGFR mutated group had an EGFR amplification, respectively. In EGFR wild type patients, amplifications were detected in 5% and 4% of the patients using the two methods, respectively. The sensitivity and specificity of the NGS based estimation of amplifications for EGFR was 94% (14/15) and 97% (34/35) respectively for both data analysis approaches. Patients with concurrent EGFR mutations and amplifications (estimated within sample) treated with EGFR-TKI had a significantly worse overall survival compared with those without concurrent EGFR amplifications (ratio, p=0.047 and z score, p=0.015). Cox regression analysis indicated a borderline significant interaction between ratio and z score (p=0.052). Conclusion Routinely obtained amplicon-based NGS data can be used to identify gene amplifications. The presence of EGFR amplifications in EGFR mutant patients is predictive of a worse overall survival. Keywords: Lung adenocarcinoma, EGFR, survival, tyrosine kinase inhibitor Citation Format: Pei Meng, Jiacong Wei, Miente Martijn Terpstra, Anke van Rijk, Menno Tamminga, Frank Scherpen, Arja ter Elst, Mohamed Z. Alimohamed, Lennart F. Johansson, T. Jeroen N. Hiltermann, Harry J. Groen, Klaas Kok, Anthonie J. van der Wekken, Anke van den Berg. Clinical value of EGFR gene amplifications detected using amplicon based targeted next generation sequencing data in lung adenocarcinoma patients [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4335.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    RVK:
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
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  • 3
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 77, No. 13_Supplement ( 2017-07-01), p. 4951-4951
    Abstract: Introduction Gastrointestinal stromal tumors (GISTs) are rare malignancies of the gastrointestinal tract. In the Netherlands, most patients with GIST are treated in five sarcoma expertise centers. GIST is known to have driver mutations in the tyrosine kinase receptors KIT and PDGFRα in respectively 80% and 10% of the patients. Mutations (single nucleotide variations, insertions and deletions) are mostly found in KIT exon 9 and 11. GIST patients with a primary KIT exon 11 mutation respond generally well to tyrosine kinase inhibitors (TKIs). The aim of this study was to evaluate treatment response by the detection of KIT exon 11 mutations in cell free DNA (cfDNA) of patients with GIST at multiple time points. Materials and methods Since Dec 2014, plasma samples of patients have been collected at every hospital visit and were put in a bio-databank for analysis of mutation detection in cfDNA. Eligibility criteria were histological diagnosis of GIST and treatment with a TKI. Patients with a known KIT exon 11 mutation, of which a baseline (before start of any TKI) sample or a recurrence/progression sample was available, were analyzed. A custom single-tube digital droplet PCR (ddPCR) drop-off assay, designed at the UMCG, was used. This assay detects 80% of the known KIT exon 11 mutations. Results Until Nov 2016, & gt;620 samples of 175 patients have been collected. From 43 patients with a KIT exon 11 mutations in the pretreatment tumor biopsy, a baseline/progression sample was available. Mutations in exon 11 were detected in cfDNA from baseline plasma of 22/43 patients, 20 with metastasized and 2 with localized disease. Of the 21 patients without detectable mutations, 11 had localized and 10 metastatic disease. Three of these patients with metastatic disease had mutations that could not be detected by our probe. Two weeks after start of TKI, an increase in mutant allelic frequency was seen in 5 (of 9 available 2 week samples) patients, while 4 weeks later the mutant allelic frequency had decreased, in parallel with decrease in tumor load on radiological imaging. Eight patients developed radiological disease recurrence (2 patients, after 4 and 20 months) or progression (6 patients, median 10 (6-24) months). This was paralleled by an increase in mutant allelic frequency in cfDNA in 6 of them (baseline median 0% (0-0.9%); at progression median 3.5% (0-30%); p= 0.028; related samples Wilcoxon signed rank test). Summary and conclusion KIT exon 11 mutations in cfDNA could be detected in 74% of the patients with metastatic disease. Disease progression or recurrence, coincides with a rise of mutant alleles detected in the plasma. In conclusion, mutation detection in cfDNA of GIST patients with metastatic disease is feasible. Our study will be extended to include the monitoring of early progression based on cfDNA, which may guide early treatment adaptations. Citation Format: Pieter A. Boonstra, Arja ter Elst, Marco Tibbesma, Ron H. Mathijssen, Florence Atrafi, Frits van Coevorden, Sheima Farag, Neeltje Steeghs, Ingrid M. Desar, Winette T. van der Graaf, Hans Gelderblom, Boudewijn van Etten, Jelle Overbosch, Albert J. Suurmeijer, Jourik A. Gietema, Ed Schuuring, Anna K. Reyners. Dynamics of KIT exon 11 mutations in cell free plasma DNA of patients treated for advanced gastrointestinal stromal tumors: Results from the Dutch GIST bio-databank [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4951. doi:10.1158/1538-7445.AM2017-4951
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    RVK:
    RVK:
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2017
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    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 4
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 77, No. 13_Supplement ( 2017-07-01), p. 2718-2718
    Abstract: Purpose: To evaluate treatment response following the Multidisciplinary Molecular Tumor Board (MTB) decisions which focused on EGFR exon 20 mutations in lung adenocarcinoma. Methods: Molecular studies were routinely performed using the Ion Torrent sequencing platform for histologically or cytologically diagnosed lung adenocarcinoma. Since October 2014 patients with rare (prevalence & lt;1%) or combinations of rare mutations were discussed at the MTB of the University Medical Center Groningen. More common, known sensitive EGFR, BRAF V600E, as well as KRAS, and PIK3CA mutations were excluded. To predict the best therapy for a subset of patients with EGFR exon 20 insertion mutations the literature is reviewed and molecular models were built using SWISS-MODEL, is used to predict protein tertiary structure (https://swissmodel.expasy.org/interactive/wcurbt/models/). Summary of data: Over a period of 2 years 1389 samples were tested. A total of 170 (12.2%) rare mutations were detected in lung cancer. Among these rare mutations we observed 16 EGFR exon 20 insertions and other mutations like e.g: p.T790M, p.D761N, p.D770delinsGY, p.S768_D770dup, p.V769_D770insSFL, p.N771_H773dup, p.T790S. Using an in silico modeling of protein responses with TKI were predicted to be likely in EGFR T790M mutations and p.S768_V769delinsIL, but not in p. D770delinsGY, p.S768_D770dup, p.V769_D770insSFL, and p.N771_H773dup mutations. Eight patients with an exon 20 mutation were treated with an EGFR TKI. One patient (p.D761N) had a partial response on erlotinib 300mg daily. On afatinib monotherapy 2 out of 3 pts had stable disease (PFS 3-11 months). On afatinib/cetuximab treatment 1 out of 2 pts (p.D770delinsGY) had a partial response and the other patient had stable disease (p.S768_D770dup) (PFS 11 and 4 months, resp.). Two evaluable patients were treated with osimertinib: the first patient initially progressed on afatinib (p.V769_D770insSFL). The protein model predicted no response, since we predicted hindrance of osimertinib. The model predicted no response on osimertinib in the second patient as well, and during treatment a stable disease for 4 months was observed (p.N771_H773dup). This molecular information from the weekly MTB meeting was delivered within 2 weeks to the treating physician. Feedback on treatment outcome helped to further improve treatment predictions. Conclusion: The Molecular Tumor Board is an effective multidisciplinary team to discuss rare mutations. Our pilot data show that the evaluation of the use and effectiveness of a theoretical model concerning protein structures is not possible yet, however, did provide a clear insight in protein structures in a mutated EGFR receptor supporting decision making of treatment options. Citation Format: Anthonie J. van der Wekken, Matthew R. Groves, Arja ter Elst, Nils A. 't Hart, Lucie B. Hijmering-Kappelle, Thijo J. Hiltermann, Anke van den Berg, Wim Timens, Ed Schuuring, Harry J. Groen. Molecular Tumor Board treatment predictions on rare EGFR exon 20 mutations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2718. doi:10.1158/1538-7445.AM2017-2718
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    RVK:
    RVK:
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2017
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    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
    Location Call Number Limitation Availability
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