Precision Medicine Applied to the Study of Endometrial Cancer: Application of NGS for Molecular Classification

Официальное название

Precision Medicine Applied to Endometrial Cancer (EC)

Обзор

In recent years, knowledge about cancer biology has expanded significantly. The study of gene expression profiles has revealed the heterogeneous nature and potential reclassification of the various tumor subtypes based on specific genetic alterations. This is of great importance since it allows a therapeutic approach more directed to the intrinsic characteristics of each tumor (precision medicine). Integrating clinicopathological information with molecular classification could provide new guidelines when approaching patients with EC, both in preoperative assessment and in adjuvant treatment and surveillance. The application of molecular classification in endometrial carcinomas shows a subgroup of patients with an excellent prognosis, corresponding to the POLEmut subgroup that could be reclassified with eventual therapeutic de-escalation. The clinical guidelines for the management of patients with endometrial cancer proposed by ESGO/ESTRO/ESP in 2020 recommend the use of this new classification, and warn that clinical management may be modified by the molecular classification in scenarios where adjuvant chemotherapy is considered (high-grade/high-risk disease).

Первичные конечные точки

• Distribution of Endometrial Cancer Molecular Subtypes Identified by Immunohistochemistry and POLE Sequencing [Срок оценки: At study inclusion (retrospective evaluation of cases from the last 5 years). Units: Percentage of patients per subtype]

Вторичные конечные точки (2)

• Association Between Molecular Subtypes and Histological Risk Categories. [Срок оценки: At study inclusion (retrospective evaluation of cases from the last 5 years).]
• Time to Recurrence by Molecular Subtype [Срок оценки: At study inclusion (retrospective evaluation of cases from the last 5 years).]

Критерии участия

Критерии включения

• Patients over 18 years of age with a diagnosis of EC diagnosed by histological biopsy and surgically treated sequentially in the participating centers in the last 5 years with clinical follow-up.
• Patients over 18 years of age, diagnosed with CE III-IV by histological biopsy, not susceptible to surgical treatment in each institution during the last 5 years in clinical follow-up. Cases with a diagnosis of carcinosarcoma (a rare subtype of endometrial carcinoma with sarcomatous transdifferentiation) are included.
• Material blocks fixed in formalin and embedded in paraffin with a tumor volume in the paraffin block of at least 1 cm3

Критерии исключения

• The following uterine neoplasms will be excluded:

• Biphasic tumors (epithelial-mesenchymal) such as adenosarcoma.
• Mesenchymal neoplasms such as endometrial stromal sarcoma and leiomyosarcomas.
• Others: primary lymphoproliferative processes of the uterine body; neuroendocrine tumors; Gestational trophoblastic disease, secondary lesions either of the genital tract (example: cervical carcinomas with extension to the endometrium) or of distant sites (breast cancer metastasis).

• Patients with synchronous endometrial and ovarian carcinoma
• For technical reasons, they will be excluded
• tumors smaller than 0.2 cm in which sufficient material cannot be obtained for immunohistochemical and molecular biology determinations.
• Tumors with severe artifacts due to poor processing, such as autolysis.
• Samples with low-quality DNA

• Patients operated on outside participating centers.
• Patients under 18 years of age.
• Patients with primary non-surgical treatments (neoadjuvant chemotherapy).

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Публикации

• Stelloo E, Nout RA, Osse EM, Jurgenliemk-Schulz IJ, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM, Nijman HW, Putter H, Bosse T, Creutzberg CL, Smit VT. Improved Risk Assessment by Integrating Molecular and Clinicopathological Factors in Early-stage Endometrial Cancer-Combined Analysis of the PORTEC Cohorts. Clin Cancer Res. 2016 Aug 15;22(16):4215-24. doi: 10.1158/1078-0432.CCR-15-2878. Epub 20 PMID 27006490
• Talhouk A, McConechy MK, Leung S, Yang W, Lum A, Senz J, Boyd N, Pike J, Anglesio M, Kwon JS, Karnezis AN, Huntsman DG, Gilks CB, McAlpine JN. Confirmation of ProMisE: A simple, genomics-based clinical classifier for endometrial cancer. Cancer. 2017 Mar 1;123(5):802-813. doi: 10.1002/cncr.30496. Epub 2017 Jan 6. PMID 28061006
• Hoang LN, Kinloch MA, Leo JM, Grondin K, Lee CH, Ewanowich C, Kobel M, Cheng A, Talhouk A, McConechy M, Huntsman DG, McAlpine JN, Soslow RA, Gilks CB. Interobserver Agreement in Endometrial Carcinoma Histotype Diagnosis Varies Depending on The Cancer Genome Atlas (TCGA)-based Molecular Subgroup. Am J Surg Pathol. 2017 Feb;41(2):245-252. doi: 10.1097/PAS.0000000000000764. PMID 28079598
• Kobel M, Nelson GS. Letter in response to: McAlpine J, Leon-Castillo A, Bosse T. The rise of a novel classification system for endometrial carcinoma; integration of molecular subclasses. J Pathol 2018; 244: 538-549. J Pathol. 2018 Jun;245(2):249-250. doi: 10.1002/path.5068. Epub 2018 Apr 16. No abstract available. PMID 29512840
• Cancer Genome Atlas Research Network; Kandoth C, Schultz N, Cherniack AD, Akbani R, Liu Y, Shen H, Robertson AG, Pashtan I, Shen R, Benz CC, Yau C, Laird PW, Ding L, Zhang W, Mills GB, Kucherlapati R, Mardis ER, Levine DA. Integrated genomic characterization of endometrial carcinoma. Nature. 2013 May 2;497(7447):67-73. doi: 10.1038/nature12113. PMID 23636398
• Bendifallah S, Canlorbe G, Collinet P, Arsene E, Huguet F, Coutant C, Hudry D, Graesslin O, Raimond E, Touboul C, Darai E, Ballester M. Just how accurate are the major risk stratification systems for early-stage endometrial cancer? Br J Cancer. 2015 Mar 3;112(5):793-801. doi: 10.1038/bjc.2015.35. Epub 2015 Feb 12. PMID 25675149
• Imai K, Kato H, Katayama K, Nakanishi K, Kawano A, Iura A, Konnai K, Onose R, Hirahara F, Miyagi E. A preoperative risk-scoring system to predict lymph node metastasis in endometrial cancer and stratify patients for lymphadenectomy. Gynecol Oncol. 2016 Aug;142(2):273-7. doi: 10.1016/j.ygyno.2016.06.004. Epub 2016 Jun 15. PMID 27268220
• Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983 Feb;15(1):10-7. doi: 10.1016/0090-8258(83)90111-7. PMID 6822361

Идентификаторы

NCT: NCT07006103 · 6760

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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