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Dichotomous ALK-IHC Is a Better Predictor for ALK Inhibition Outcome than Traditional ALK-FISH in Advanced Non-Small Cell Lung Cancer.
Clin Cancer Res 2017; 23(15):4251-4258CC

Abstract

Purpose:

ALK rearrangement detection using FISH is the standard test to identify patients with non-small cell lung carcinoma (NSCLC) eligible for treatment with ALK inhibitors. Recently, ALK protein expression in resectable NSCLC showed predictive value. We evaluated tumor response rate and survival after crizotinib treatment of patients with advanced NSCLC with ALK activation using both dichotomous immunohistochemical (IHC) staining and FISH.

Experimental Design:

Patients with stage IV NSCLC treated with crizotinib were selected. Tumor response was assessed. ALK rearrangements were detected by FISH (Vysis ALK-break-apart FISH-Probe KIT) and IHC [Ventana ALK (D5F3) CDx assay]. Cohorts of patients with ALK-FISH-positive advanced NSCLC from four other hospitals were used for validation.

Results:

Twenty-nine consecutive patients with ALK-positive advanced NSCLC diagnosed by FISH and/or IHC on small biopsies or fine-needle aspirations (FNA) were treated with ALK inhibitors. All ALK-IHC-positive patients responded to crizotinib except three with primary resistance. No tumor response was observed in 13 ALK-FISH-positive but ALK-IHC-negative patients. This was confirmed in an external cohort of 16 patients. Receiver operator characteristic (ROC) curves for ALK-IHC and ALK-FISH compared with treatment outcome showed that dichotomous ALK-IHC outperforms ALK-FISH [tumor response area under the curve: (AUC), 0.86 vs. 0.64, P = 0.03; progression-free survival (PFS): AUC 0.86 vs. 0.36, P = 0.005; overall survival (OS): AUC, 0.78 vs. 0.41, P = 0.01, respectively].

Conclusions:

Dichotomous ALK-IHC is superior to ALK-FISH on small biopsies and FNA to predict tumor response and survival to crizotinib for patients with advanced NSCLC. Our data strongly suggest adapting the guidelines and using dichotomous ALK-IHC as standard companion diagnostic test to select patients with NSCLC who benefit from ALK-targeting therapy. Clin Cancer Res; 23(15); 4251-8. ©2017 AACR.

Authors+Show Affiliations

Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands. a.j.van.der.wekken@umcg.nl.Department of Pathology and Medical Biology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pathology and Medical Biology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pathology and Medical Biology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pathology and Medical Biology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pulmonary Diseases, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands.Department of Pulmonary Diseases, Free University Medical Centre, Amsterdam, the Netherlands.Department of Pulmonary Diseases, ZGT Almelo/Hengelo, Hengelo, the Netherlands.Department of Pathology/LabPON, ZGT Almelo/Hengelo, Hengelo, the Netherlands.Department of Pulmonary Diseases, Catharina Cancer Institute, Catharina Hospital Eindhoven, the Netherlands.Department of Pathology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pulmonary Diseases, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.Department of Pathology and Medical Biology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pathology and Medical Biology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pathology and Medical Biology, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.Department of Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28183714

Citation

van der Wekken, A J., et al. "Dichotomous ALK-IHC Is a Better Predictor for ALK Inhibition Outcome Than Traditional ALK-FISH in Advanced Non-Small Cell Lung Cancer." Clinical Cancer Research : an Official Journal of the American Association for Cancer Research, vol. 23, no. 15, 2017, pp. 4251-4258.
van der Wekken AJ, Pelgrim R, 't Hart N, et al. Dichotomous ALK-IHC Is a Better Predictor for ALK Inhibition Outcome than Traditional ALK-FISH in Advanced Non-Small Cell Lung Cancer. Clin Cancer Res. 2017;23(15):4251-4258.
van der Wekken, A. J., Pelgrim, R., 't Hart, N., Werner, N., Mastik, M. F., Hendriks, L., ... Groen, H. J. M. (2017). Dichotomous ALK-IHC Is a Better Predictor for ALK Inhibition Outcome than Traditional ALK-FISH in Advanced Non-Small Cell Lung Cancer. Clinical Cancer Research : an Official Journal of the American Association for Cancer Research, 23(15), pp. 4251-4258. doi:10.1158/1078-0432.CCR-16-1631.
van der Wekken AJ, et al. Dichotomous ALK-IHC Is a Better Predictor for ALK Inhibition Outcome Than Traditional ALK-FISH in Advanced Non-Small Cell Lung Cancer. Clin Cancer Res. 2017 Aug 1;23(15):4251-4258. PubMed PMID: 28183714.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dichotomous ALK-IHC Is a Better Predictor for ALK Inhibition Outcome than Traditional ALK-FISH in Advanced Non-Small Cell Lung Cancer. AU - van der Wekken,A J, AU - Pelgrim,R, AU - 't Hart,N, AU - Werner,N, AU - Mastik,M F, AU - Hendriks,L, AU - van der Heijden,E H F M, AU - Looijen-Salamon,M, AU - de Langen,A J, AU - Staal-van den Brekel,J, AU - Riemersma,S, AU - van den Borne,B E, AU - Speel,E J M, AU - Dingemans,A-M C, AU - Hiltermann,T J N, AU - van den Berg,A, AU - Timens,W, AU - Schuuring,E, AU - Groen,H J M, Y1 - 2017/02/09/ PY - 2016/07/11/received PY - 2016/09/05/revised PY - 2017/02/01/accepted PY - 2017/2/12/pubmed PY - 2018/6/20/medline PY - 2017/2/11/entrez SP - 4251 EP - 4258 JF - Clinical cancer research : an official journal of the American Association for Cancer Research JO - Clin. Cancer Res. VL - 23 IS - 15 N2 - Purpose: ALK rearrangement detection using FISH is the standard test to identify patients with non-small cell lung carcinoma (NSCLC) eligible for treatment with ALK inhibitors. Recently, ALK protein expression in resectable NSCLC showed predictive value. We evaluated tumor response rate and survival after crizotinib treatment of patients with advanced NSCLC with ALK activation using both dichotomous immunohistochemical (IHC) staining and FISH.Experimental Design: Patients with stage IV NSCLC treated with crizotinib were selected. Tumor response was assessed. ALK rearrangements were detected by FISH (Vysis ALK-break-apart FISH-Probe KIT) and IHC [Ventana ALK (D5F3) CDx assay]. Cohorts of patients with ALK-FISH-positive advanced NSCLC from four other hospitals were used for validation.Results: Twenty-nine consecutive patients with ALK-positive advanced NSCLC diagnosed by FISH and/or IHC on small biopsies or fine-needle aspirations (FNA) were treated with ALK inhibitors. All ALK-IHC-positive patients responded to crizotinib except three with primary resistance. No tumor response was observed in 13 ALK-FISH-positive but ALK-IHC-negative patients. This was confirmed in an external cohort of 16 patients. Receiver operator characteristic (ROC) curves for ALK-IHC and ALK-FISH compared with treatment outcome showed that dichotomous ALK-IHC outperforms ALK-FISH [tumor response area under the curve: (AUC), 0.86 vs. 0.64, P = 0.03; progression-free survival (PFS): AUC 0.86 vs. 0.36, P = 0.005; overall survival (OS): AUC, 0.78 vs. 0.41, P = 0.01, respectively].Conclusions: Dichotomous ALK-IHC is superior to ALK-FISH on small biopsies and FNA to predict tumor response and survival to crizotinib for patients with advanced NSCLC. Our data strongly suggest adapting the guidelines and using dichotomous ALK-IHC as standard companion diagnostic test to select patients with NSCLC who benefit from ALK-targeting therapy. Clin Cancer Res; 23(15); 4251-8. ©2017 AACR. SN - 1078-0432 UR - https://www.unboundmedicine.com/medline/citation/28183714/Dichotomous_ALK_IHC_Is_a_Better_Predictor_for_ALK_Inhibition_Outcome_than_Traditional_ALK_FISH_in_Advanced_Non_Small_Cell_Lung_Cancer_ L2 - http://clincancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=28183714 DB - PRIME DP - Unbound Medicine ER -