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      Detection of ALK fusion transcripts in FFPE lung cancer samples by NanoString technology

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          Abstract

          Background

          ALK-rearranged lung cancers exhibit specific pathologic and clinical features and are responsive to anti- ALK therapies. Therefore, the detection of ALK-rearrangement is fundamental for personalized lung cancer therapy. Recently, new molecular techniques, such as NanoString nCounter, have been developed to detect ALK fusions with more accuracy and sensitivity.

          Methods

          In the present study, we intended to validate a NanoString nCounter ALK-fusion panel in routine biopsies of FFPE lung cancer patients. A total of 43 samples were analyzed, 13 ALK-positive and 30 ALK-negative, as previously detected by FISH and/or immunohistochemistry.

          Results

          The NanoString panel detected the presence of the EML4-ALK, KIF5B-ALK and TFG-ALK fusion variants. We observed that all the 13 ALK-positive cases exhibited genetic aberrations by the NanoString methodology. Namely, six cases (46.15%) presented EML-ALK variant 1, two (15.38%) presented EML-ALK variant 2, two (15.38%) presented EML-ALK variant 3a, and three (23.07%) exhibited no variant but presented unbalanced expression between 5’/3’ exons, similar to other positive samples. Importantly, for all these analyses, the initial input of RNA was 100 ng, and some cases displayed poor RNA quality measurements.

          Conclusions

          In this study, we reported the great utility of NanoString technology in the assessment of ALK fusions in routine lung biopsies of FFPE specimens.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12890-017-0428-0) contains supplementary material, which is available to authorized users.

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          Most cited references23

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          Global survey of phosphotyrosine signaling identifies oncogenic kinases in lung cancer.

          Despite the success of tyrosine kinase-based cancer therapeutics, for most solid tumors the tyrosine kinases that drive disease remain unknown, limiting our ability to identify drug targets and predict response. Here we present the first large-scale survey of tyrosine kinase activity in lung cancer. Using a phosphoproteomic approach, we characterize tyrosine kinase signaling across 41 non-small cell lung cancer (NSCLC) cell lines and over 150 NSCLC tumors. Profiles of phosphotyrosine signaling are generated and analyzed to identify known oncogenic kinases such as EGFR and c-Met as well as novel ALK and ROS fusion proteins. Other activated tyrosine kinases such as PDGFRalpha and DDR1 not previously implicated in the genesis of NSCLC are also identified. By focusing on activated cell circuitry, the approach outlined here provides insight into cancer biology not available at the chromosomal and transcriptional levels and can be applied broadly across all human cancers.
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            Clinical features and outcome of patients with non-small-cell lung cancer who harbor EML4-ALK.

            The EML4-ALK fusion oncogene represents a novel molecular target in a small subset of non-small-cell lung cancers (NSCLC). To aid in identification and treatment of these patients, we examined the clinical characteristics and treatment outcomes of patients who had NSCLC with and without EML4-ALK. Patients with NSCLC were selected for genetic screening on the basis of two or more of the following characteristics: female sex, Asian ethnicity, never/light smoking history, and adenocarcinoma histology. EML4-ALK was identified by using fluorescent in situ hybridization for ALK rearrangements and was confirmed by immunohistochemistry for ALK expression. EGFR and KRAS mutations were determined by DNA sequencing. Of 141 tumors screened, 19 (13%) were EML4-ALK mutant, 31 (22%) were EGFR mutant, and 91 (65%) were wild type (WT/WT) for both ALK and EGFR. Compared with the EGFR mutant and WT/WT cohorts, patients with EML4-ALK mutant tumors were significantly younger (P < .001 and P = .005) and were more likely to be men (P = .036 and P = .039). Patients with EML4-ALK-positive tumors, like patients who harbored EGFR mutations, also were more likely to be never/light smokers compared with patients in the WT/WT cohort (P < .001). Eighteen of the 19 EML4-ALK tumors were adenocarcinomas, predominantly the signet ring cell subtype. Among patients with metastatic disease, EML4-ALK positivity was associated with resistance to EGFR tyrosine kinase inhibitors (TKIs). Patients in the EML4-ALK cohort and the WT/WT cohort showed similar response rates to platinum-based combination chemotherapy and no difference in overall survival. EML4-ALK defines a molecular subset of NSCLC with distinct clinical characteristics. Patients who harbor this mutation do not benefit from EGFR TKIs and should be directed to trials of ALK-targeted agents.
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              Fusion of a kinase gene, ALK, to a nucleolar protein gene, NPM, in non-Hodgkin's lymphoma.

              The 2;5 chromosomal translocation occurs in most anaplastic large-cell non-Hodgkin's lymphomas arising from activated T lymphocytes. This rearrangement was shown to fuse the NPM nucleolar phosphoprotein gene on chromosome 5q35 to a previously unidentified protein tyrosine kinase gene, ALK, on chromosome 2p23. In the predicted hybrid protein, the amino terminus of nucleophosmin (NPM) is linked to the catalytic domain of anaplastic lymphoma kinase (ALK). Expressed in the small intestine, testis, and brain but not in normal lymphoid cells, ALK shows greatest sequence similarity to the insulin receptor subfamily of kinases. Unscheduled expression of the truncated ALK may contribute to malignant transformation in these lymphomas.
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                Author and article information

                Contributors
                adriane.feijo@gmail.com
                zanon.maicon@gmail.com
                drybiomedic@gmail.com
                escremim@gmail.com
                maremorini@hotmail.com
                maressa.ferreira@gmail.com
                iberesoares@bol.com.br
                joseelias@gmail.com
                pedrodemarchi@yahoo.com.br
                cristovamscapula@gmail.com
                +551733216600 , ruireis.hcb@gmail.com
                Journal
                BMC Pulm Med
                BMC Pulm Med
                BMC Pulmonary Medicine
                BioMed Central (London )
                1471-2466
                26 May 2017
                26 May 2017
                2017
                : 17
                : 86
                Affiliations
                [1 ]ISNI 0000 0004 0615 7498, GRID grid.427783.d, Molecular Oncology Research Center, , Barretos Cancer Hospital, ; Rua Antenor Duarte Villela, 1331, Barretos, CEP 14784-400 São Paulo Brazil
                [2 ]ISNI 0000 0004 0615 7498, GRID grid.427783.d, Department of Pathology, , Barretos Cancer Hospital, ; Rua Antenor Duarte Villela 1331, Barretos, CEP 14784-400 São Paulo Brazil
                [3 ]ISNI 0000 0004 0615 7498, GRID grid.427783.d, Department of Thoracic Surgery, , Barretos Cancer Hospital, ; Rua Antenor Duarte Villela 1331, Barretos, CEP 14784-400 São Paulo Brazil
                [4 ]ISNI 0000 0004 0615 7498, GRID grid.427783.d, Department of Clinical Oncology, , Barretos Cancer Hospital, ; Rua Antenor Duarte Villela 1331, Barretos, CEP 14784-400 Sao Paulo Brazil
                [5 ]ISNI 0000 0001 2159 175X, GRID grid.10328.38, Life and Health Sciences Research Institute (ICVS), Health Sciences School, , University of Minho, ; Braga, 4710-057 Portugal
                [6 ]ISNI 0000 0001 2159 175X, GRID grid.10328.38, , ICVS/3B’s-PT Government Associate Laboratory, ; Braga/Guimarães, 4710-057 Portugal
                Article
                428
                10.1186/s12890-017-0428-0
                5446704
                28549458
                3f18fdac-591f-42fa-93bf-4cb60184da39
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 March 2017
                : 19 May 2017
                Funding
                Funded by: MCTI/FINEP/MS/SCTIE/DECIT (BIOPLAT (1302/13))
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Respiratory medicine
                alk,alk fusions,nanostring,ffpe
                Respiratory medicine
                alk, alk fusions, nanostring, ffpe

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