J Thorac Oncol. 2019 Jul 16. pii: S1556-0864(19)30560-X. [Epub ahead of print]
Frauke Goeman,
Francesca De Nicola,
Stefano Scalera,
Francesca Sperati,
Enzo Gallo,
Ludovica Ciuffreda,
Matteo Pallocca,
Laura Pizzuti,
Eriseld Krasniqi,
Giacomo Barchiesi,
Patrizia Vici,
Maddalena Barba,
Simonetta Buglioni,
Beatrice Casini,
Paolo Visca,
Edoardo Pescarmona,
Marco Mazzotta,
Ruggero De Maria,
Maurizio Fanciulli,
Gennaro Ciliberto,
Marcello Maugeri-Saccà.
INTRODUCTION: Molecular characterization studies revealed recurrent KEAP1/NFE2L2 alterations in non-small cell lung cancer (NSCLC). These genes encode two interacting proteins (stress response pathway, SRP) that mediate a cytoprotective response to oxidative stress and xenobiotics. Nevertheless, whether KEAP1/NFE2L2 mutations impact on clinical outcomes is unclear.
METHODS: We performed amplicon-based next-generation sequencing to characterize the SRP in metastatic NSCLC patients (IRE cohort, N=88) treated with first-line chemotherapy. Mutations in the DNA damage response (TP53, ATM and ATR) were concomitantly analyzed. In lung adenocarcinoma (LAC), we also determined the expression of pATR and pATM. Two independent cohorts (MSKCC and TCGA) containing data from ∼1,400 advanced LAC were used to assess the reproducibility of the results.
RESULTS: In the IRE cohort, patients whose tumors carried mutations in the KEAP1/NFE2L2 pathway had significantly shorter progression-free survival (PFS) and overall survival (OS) then their wild-type counterparts (log-rank p=0.006 and p=0.018, respectively). This association was driven by LAC where KEAP1/NFE2L2 mutations were overrepresented in fast progressors and associated with an increased risk of disease progression and death. LACs carrying KEAP1/NFE2L2 mutations were characterized by elevated expression of pATR and pATM, in association with a pattern of mutual exclusivity with TP53 alterations. The relationship between KEAP1/NFE2L2 mutations and shorter survival was validated in the MSKCC cohort (N=1,256, log-rank p<0.001) and in the TCGA cohort (N=162, log-rank p=0.039).
CONCLUSIONS: These findings suggest that mutant SRP represents a negative prognostic/predictive factor in metastatic LAC, and that KEAP1/NFE2L2 mutations may define a molecular subtype of chemo-resistant and rapidly progressing LAC.
Keywords: Fast Progressors; KEAP1/NFE2L2,Stress Response Pathway; Lung Adenocarcinoma