There are no validated molecular tools to allow patient selection for adjuvant chemotherapy after complete resection of non–small-cell lung cancer. Immunohistochemistry biomarkers shown in one trial to have a prognostic/predictive effect on overall survival were tested. The majority of the promising biomarkers could not be validated, and none were predictive of benefit. Immunohistochemistry assays from single trials may be misleading. Background: Complete resection of non–small-cell lung cancer (NSCLC) offers the potential for cure after surgery and adjuvant chemotherapy. Patients may not benefit and may experience severe toxicity. There are no validated molecular tools to allow better patient selection. Materials and Methods: The LACE-Bio (LACE [Lung Adjuvant Cisplatin Evaluation]) project includes 4 trials (International Adjuvant Lung Cancer Trial [IALT], Adjuvant Navelbine International Trialist Association [ANITA], JBR10, and Cancer and Leukemia Group B (CALGB)-9633). Immunohistochemistry biomarkers shown in one trial to have a prognostic/predictive effect on overall survival were tested. Results: The majority of the promising biomarkers could not be validated; the prognostic effect of tumor infiltrating lymphocytes and β-tubulin was confirmed. Potential causes include tissue fixation, storage, the use of tissue microarrays, and varying reagent/antibody batches. Conclusions: Immunohistochemistry assays from single trials may be misleading and require validation before being used for patient selection. LACE-Bio-2 is evaluating potential genomic biomarkers that may allow more precise selection of patients with NSCLC for adjuvant chemotherapy in NSCLC.
Bibliographical noteFunding Information:
We have now implemented LACE-Bio2, investigating the utility of genomic-based biomarkers, funded in part by a National Institutes of Health RO-1 grant ( http://grantome.com/grant/NIH/R01-CA165958-02 ). Initial results suggest chromosomal instability and high nonsynonymous TMB (> 8 mutations/Mb) may have a prognostic effect, and we have identified new candidate prognostic markers. 38,39
This work was supported by the Canadian Cancer Society Research Institute [grant # 015469 and # 021039 ], Institut National du Cancer (INCA) funding to J.-C. Soria, E. Brambilla (PNES and PHRC, Direction de la Recherche Clinique du CHUGA Grenoble), Ligue Nationale Contre le Cancer funding to the Meta-analysis Unit, and an unrestricted educational grant from Sanofi (France). The authors acknowledge Nicolas Lemaire for immunohistochemical technique.
- Adjuvant chemotherapy