HER2 expression and markers of phosphoinositide-3-kinase pathway activation define a favorable subgroup of metastatic pulmonary adenocarcinomas.
OBJECTIVES
Pulmonary adenocarcinomas (ADC) can be sub-grouped based on dominant oncogenic drivers. EGFR mutations define an entity of metastatic ADC with favorable prognosis and high susceptibility to EGFR tyrosine kinase inhibition. In contrast, the clinical impact of additional ERBB family members in ADC is less defined. To this end we prospectively studied HER2 expression, gene amplification, and mutation in relation to outcome of patients with advanced or metastatic ADC.


MATERIALS AND METHODS
Diagnostic tumor biopsies from 193 sequential patients with stage III/IV ADC were prospectively studied for HER2 expression by immunohistochemistry (IHC). Cases with IHC scores 2+ or 3+ were analyzed by HER2 chromogenic in situ hybridization (CISH), and sequencing of HER2 exons 20 and 23. Additional prospectively determined biomarkers included PTEN, cMET, pAKT, and pERK expression, KRAS, EGFR, BRAF and PIK3CA mutations, and ALK fluorescence ISH (FISH).


RESULTS AND CONCLUSION
HER2-IHC was feasible in 176 (91.2%) cases. Of 53 (30%) cases with IHC scores 2+/3+, 45 (85%) could be studied by CISH and 34 (64%) by sequencing. The lower number of HER2-mutational analyses resulted from exhaustion of tumor tissue and DNA following mutational analysis of KRAS, EGFR, BRAF and PIK3CA. HER2 amplification was detected in 4 cases (2.3%), while no mutation was found. HER2 expression correlated with expression of pAKT and cMET. Expression of HER2 and pAKT was associated with favorable overall survival in stage IV disease. HER2-expressing ADC more frequently harbored KRAS mutations, while HER2 expression was absent in all 4 cases with BRAF mutation. HER2-IHC was not predictive of HER2 gene amplification or mutation, which both were rare events in prospectively studied patients with advanced or metastatic ADC. Expression of HER2 and pAKT define a population of patients with stage IV ADC with a distinct disease course, who could benefit from specifically tailored pharmacotherapies.
['Reis|H|H|', 'Herold|T|T|', 'Ting|S|S|', 'Worm|K|K|', 'Huber|U|U|', 'Christoph|D C|DC|', 'Eberhardt|W E|WE|', 'Kostbade|K|K|', 'Kasper|S|S|', 'Stamatis|G|G|', 'Welter|S|S|', 'Darwiche|K|K|', 'Karpf-Wissel|R|R|', 'Theegarten|D|D|', 'Schmid|K W|KW|', 'Schuler|M|M|', 'Wiesweg|M|M|']
D000230:Adenocarcinoma D000368:Aged D014408:Biomarkers, Tumor D004252:DNA Mutational Analysis D005260:Female D005784:Gene Amplification D015870:Gene Expression D006801:Humans D053208:Kaplan-Meier Estimate D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D019869:Phosphatidylinositol 3-Kinases D016016:Proportional Hazards Models D011446:Prospective Studies D051057:Proto-Oncogene Proteins c-akt D018719:Receptor, ErbB-2 D015398:Signal Transduction
HER2 Prospective study Biomarker Lung adenocarcinoma NSCLC PI3K