＜Clinical and Reseach Applications of Biomarkers in Lung Cancer＞
David CL Lam, Department of Medicine, University of Hong Kong
・Cancer Biomarkers→Diagnosis, Therapeutics, Prognosis estimation
2004 EGFR-TKIとEGFR mutation
2005 EGFR-TKI acquired T790M mutation
2007 ALK rearrangement dicsovered
2009 IPASS key open
2010 Crizotinib approved
2014 Ceritinib approved
2015 anti PD-1 antibody approved
AZD9291 approved
・Treatment selection
past: TNM classification
PS
present: Histology
Bevacizumab indication
molecular biology
・analysis method
EGFR: direct sequence, PCR
ALK: FISH, PCR, IHC
ROS1: FISH etc.
・gefitinib: WJOG3405
NEJ002
erlotinib: EURTAC
OPTIMAL
afatinib: LUX-Lung 3
LUX-Lung 6
それぞれ、TKIとChemotherapyのPFSを比較。
・EGFR-TKI resistance variance
T790M
c-Met amplifiation
Thress et al, Lung Cancer, 2015, EGFRm detection on plasma DNA
Paz-Ares et al, NEJM 2015 (AZD9291 for T790M mutation)
Sequist et al, NEJM 2015 (CO1686 for T790M mutation)
Soria et al, J Thorac Oncol 2015 abst.#3287 (IMPRESS trial about beyond PD EGFR-TKI)
Janjigian et al, Cancer Discovery 1036-1045, 2014 (afatinib + cetuximab)
・原発巣と転移巣でgenomic biomarker statusはほぼ一致する
Vignot et al, J Clin Oncol 2167-2172, 2013
・IGNITE study ELCC 2015
・ALK rearrangement analysis
IHC: screenig
FISH: confirmatory
