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Genomic Profiling Reveals Novel Predictive Biomarkers for Chemo-Radiotherapy Efficacy and Thoracic Toxicity in Non-Small-Cell Lung Cancer

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机构: [1]Shandong Univ, Dept Radiat Oncol, Shandong First Med Univ & Shandong Acad Med Sci, Canc Canter,Shandong Canc Hosp & Inst, Jinan, Peoples R China [2]Shandong First Med Univ, Dept Ultrasound, Jinan Cent Hosp, Jinan, Peoples R China [3]Nanjing Geneseeq Technol Inc, Geneseeq Res Inst, Nanjing, Peoples R China [4]Shandong First Med Univ & Shandong Acad Med Sci, Shandong Canc Hosp & Inst, Dept Pathol, Jinan, Peoples R China [5]Hebei Med Univ, Dept Radiat Oncol, Hosp 4, Shijiazhuang, Hebei, Peoples R China [6]Zhengzhou Univ, Dept Radiat Oncol, Affiliated Canc Hosp, Zhengzhou, Peoples R China [7]Zhengzhou Univ, Dept Pathol, Affiliated Canc Hosp, Zhengzhou, Peoples R China [8]Shandong Prov Hosp, Dept Radiat Oncol, Jinan, Peoples R China [9]Jilin Univ, Dept Radiat Oncol & Therapy, Jilin Prov Key Lab Radiat Oncol & Therapy, Hosp 1, Jilin, Jilin, Peoples R China [10]Nanjing Med Univ, Sch Publ Hlth, Nanjing, Peoples R China
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关键词: non-small cell lung cancer radiotherapy radiation sensitivity biomarker genetic variation prognosis chemo-radiotherapy radiotherapy-associated toxicity

摘要:
Chemo-radiotherapy (CRT) remains the main treatment modality for non-small-cell lung cancer (NSCLC). However, its clinical efficacy is largely limited by individual variations in radio-sensitivity and radiotherapy-associated toxicity. There is an urgent need to identify genetic determinants that can explain patients' likelihood to develop recurrence and radiotherapy-associated toxicity following CRT. In this study, we performed comprehensive genomic profiling, using a 474-cancer- and radiotherapy-related gene panel, on pretreatment biopsy samples from patients with unresectable stage III NSCLCs who underwent definitive CRT. Patients' baseline clinical characteristics and genomic features, including tumor genetic, genomic and molecular pathway alterations, as well as single nucleotide polymorphisms (SNPs), were correlated with progression-free survival (PFS), overall survival (OS), and radiotherapy-associated pneumonitis and/or esophagitis development after CRT. A total of 122 patients were enrolled between 2014 and 2019, with 84 (69%) squamous cell carcinomas and 38 (31%) adenocarcinomas. Genetic analysis confirmed the association between the KEAP1-NRF2 pathway gene alterations and unfavorable survival outcome, and revealed alterations in FGFR family genes, MET, PTEN, and NOTCH2 as potential novel and independent risk factors of poor post-CRT survival. Combined analysis of such alterations led to improved stratification of the risk populations. In addition, patients with EGFR activating mutations or any oncogenic driver mutations exhibited improved OS. On the other hand, we also identified genetic markers in relation to radiotherapy-associated thoracic toxicity. SNPs in the DNA repair-associated XRCC5 (rs3835) and XRCC1 (rs25487) were associated with an increased risk of high-grade esophagitis and pneumonitis respectively. MTHFR (rs1801133) and NQO1 (rs1800566) were additional risk alleles related to higher susceptibility to pneumonitis and esophagitis overall. Moreover, through their roles in genome integrity and replicative fidelity, somatic alterations in ZNF217 and POLD1 might also serve as risk predictors of high-grade pneumonitis and esophagitis. Taken together, leveraging targeted next-generating sequencing, we identified a set of novel clinically applicable biomarkers that might enable prediction of survival outcomes and risk of radiotherapy-associated thoracic toxicities. Our findings highlight the value of pre-treatment genetic testing to better inform CRT outcomes and clinical actions in stage III unresectable NSCLCs.

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出版当年[2022]版:
大类 | 3 区 医学
小类 | 3 区 肿瘤学
最新[2025]版:
大类 | 3 区 医学
小类 | 4 区 肿瘤学
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Q2 ONCOLOGY
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Q2 ONCOLOGY

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第一作者机构: [1]Shandong Univ, Dept Radiat Oncol, Shandong First Med Univ & Shandong Acad Med Sci, Canc Canter,Shandong Canc Hosp & Inst, Jinan, Peoples R China
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通讯机构: [3]Nanjing Geneseeq Technol Inc, Geneseeq Res Inst, Nanjing, Peoples R China [10]Nanjing Med Univ, Sch Publ Hlth, Nanjing, Peoples R China
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