Subtypes Of Lung Carcinoma Research Articles

Abstract LB282: Therapeutic efficacy and dosimetry for a 177-lutetium radiolabeled minibody targeting DLL3 in a preclinical model of small cell lung cancer

Abstract Small cell lung cancer (SCLC) is the most aggressive subtype of lung carcinoma with a 5-year survival rate below 7%. While the addition of anti-PD-1 antibody treatment has improved SCLC patient outcomes, nearly all patients relapse, indicating an unmet need for more efficacious therapeutics. Delta-like ligand 3 (DLL3) is an inhibitory Notch ligand that is over-expressed on the surface of SCLC tumor cells. Due to this, DLL3 has become a target of interest for SCLC treatment and several agents are in preclinical and clinical evaluation using different strategies such as antibody-drug conjugates, bispecific T cell engagers, and DLL3-targeting CAR-T. Minibodies are antibody fragments that provide optimal pharmacokinetics for the delivery of radioactive payloads. Their molecular weight of 80 kDa allows for rapid tumor uptake and faster circulation clearance than full-length antibodies. These scaffolds also present deeper tumor penetration relative to full-length antibodies, and higher target specificity and retention at the tumor site, with respect to small molecules. We hypothesized that a minibody targeting DLL3 (IAB57) would be a valid approach for radiopharmaceutical therapy (RPT) of SCLC and tested its efficacy in a preclinical model of SCLC. We conjugated the IAB57 minibody with DOTAGA and radiolabeled the protein with the β-emitter 177-Lu. Nu/J female mice were inoculated subcutaneously with the non-encapsulated lung carcinoma cell line SHP77, and the tumor size was measured 3 times per week until it reached 100-150 mm3. 24-hour biodistribution results revealed a tumor uptake of 18.8% injected dose per gram (%ID/gr). Mice were treated with 13.3 MBq and 13.6 MBq doses of 177-Lu-DOTAGA-IAB57 7 days apart to determine if there was a therapeutic effect and improved animal survival. A subgroup of mice was not treated and was considered controls. A time course biodistribution was performed to assess organs dosimetry. The dosimetry results were extrapolated to human organ exposure showing kidneys and liver uptakes of 2.2 and 4.6 Gy which is 10 times and 7 times below published exposure thresholds (23 Gy and 32 Gy respectively). Exposure at bone marrow (b.m., 0.1 Gy), spleen (1.5 Gy) and lungs (0.4 Gy) were 20 times, 27 times and 68 times below published toxicity thresholds (b.m.: 2 Gy; spleen: 40 Gy; lungs: 27 Gy). The RPT data showed a significant decrease in tumor size beginning on day 11 in the treated group compared to the control group. The decreased tumor size also coincided with a doubling in the survival rate. Overall, these results indicate that the IAB57 minibody targeting DLL3 is a promising and effective agent for RPT treatment of SCLC via β-emitting radionuclides. Citation Format: Kelley C. Atkinson, Leticia M. De Souza Cordeiro, Fang Jia, Argin Aivazian, Gareth E. Smith, Ian Wilson, Alessandro Mascioni. Therapeutic efficacy and dosimetry for a 177-lutetium radiolabeled minibody targeting DLL3 in a preclinical model of small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB282.

Abstract 7088: MALDI-IHC high-plex protein biomarker imaging for fast, non-iterative identification of lung carcinoma subtypes

Abstract Lung cancer is the second most common cancer worldwide, with over 2.2 million new cases in 2020 and is the leading cause of cancer-related deaths worldwide. Most lung cancer (80-85%) is non-small cell (NSCLC), comprising mostly adenocarcinoma and squamous cell carcinoma, while roughly 10-15% of lung cancer is small cell lung cancer (SCLC), also termed neuroendocrine lung cancer. Subtype identification is critical for determining treatment, and with limited samples, it is critical to get the most data possible from each tissue section. NSCLC subtypes can be treated with chemotherapy or targeted drugs, whereas SCLC tends to respond best to a combination of chemotherapy and radiation. While there have been many improvements in the detection and treatment of lung carcinoma, the immuno-histochemical (IHC) confirmation of subtype remains a prolonged and often iterative process. To overcome this limitation, we have developed a new IHC approach which uses antibodies labeled with novel photocleavable mass-tags combined with matrix assisted laser desorption ionization (MALDI) mass spectrometry imaging. The approach, termed MALDI-IHC, provides fast (1 hr/cm2 imaging time) and highly multiplexed IHC (100+-plex) without the need for iterative cycling procedures. Here, we present a 20+-plex panel for the determination of subtype in lung cancer. An antibody panel comprised of established clinical biomarkers was developed to differentiate between the lung carcinoma subtypes and provide potentially prognostic information. This included markers for adenocarcinoma (TTF-1, Napsin A), squamous cell carcinoma (p40, CK5), and small cell lung cancer (CD56, Chromogranin A and Synaptophysin), as well as general carcinoma markers for t cells, b cells, macrophages, and fibroblasts These markers were first validated individually by immunofluorescence and then compared to MALDI-IHC on annotated tissues. Here we present an overview of the antibody validation for the 20+-plex lung carcinoma panel. Biomarker presence and peak signal intensity for the various subtypes was then determined using pathologist classified tissues for normal lung, adenocarcinoma, squamous cell carcinoma and small cell lung cancer. We report application of the MALDI-IHC approach to the simultaneous determination of lung carcinoma subtypes on a 99-core human lung tissue microarray (TMA) comprised of normal, normal adjacent, cancer adjacent, and cancerous tissues. Moreover, because MALDI-IHC is a non-destructive process, it can be followed by conventional H&E staining on the same tissue section for accurate co-registration of traditional pathology annotations with the highly multiplexed MALDI-IHC results. In the future, even larger, 100+-plex antibody panels can be used for precision medicine on a wide range of cancers, in order to determine the molecular subtypes and guide treatment paths. Citation Format: Catherine A. Kita, Kristina Schwamborn, Gargey Yagnik, Kenneth J. Rothschild, Mark J. Lim. MALDI-IHC high-plex protein biomarker imaging for fast, non-iterative identification of lung carcinoma subtypes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7088.

Utility of Immunohistochemistry in the Subtyping of Lung Carcinoma on Small Biopsies

Background: Hamstring tendon auto grafts in the form of quadrupled Background and objectives: In the era of precision medicine, the important task of today’s pathologist is to classify lung carcinoma into specific histologic subtypes. Thus enables the scope to identify the molecular target for targeted therapy. Hematoxylin and eosin stain alone cannot subtype lung carcinoma when particularly it exhibits solid pattern of growth. This challenge becomes more pronounced when working with small biopsy samples. Methodology and result: A retrospective cross-sectional study was conducted to evaluate small biopsies obtained by image guided lung core or bronchoscopy over three years, from 2020-2022. Tumour morphology was evaluated, and immunohistochemistry was performed in 132 cases of lung carcinoma. In this study a small panel of three markers (TTF-1, p63 and synaptophysin) was applied as an initial approach to classify different subtypes of lung carcinoma. Additional markers (such as NapsinA, p40, CK5/6, CD56, INSM1, CK7, CK20, etc.) were incorporated based on factors like morphological characteristics, clinical information, imaging data, and the results of the initial marker panel. The largest group observed in this study comprised 67% of adenocarcinomas that showed positivity for either TTF-1 or NapsinA. Squamous cell carcinomas, identified either through p63 expression or other markers such as p40/CK5/6, accounted for 26% of cases. Additionally, 10% of cases demonstrated reactivity to neuroendocrine markers, indicating the presence of neuroendocrine tumors. Notably, immunohistochemistry successfully identified the metastatic site for 10 adenocarcinomas that were negative for both TTF-1 and NapsinA. Conclusion: A small panel of immunomarkers can classify the lung cancer reliably and increases the confidence at all level of lung cancer management. Pulse Vol.15, 2023 P: 16-21

Plasma EBV quantification is associated with the efficacy of immune checkpoint blockade and disease monitoring in patients with primary pulmonary lymphoepithelioma-like carcinoma.

Primary pulmonary lymphoepithelioma-like carcinoma (PLELC) is a subtype of lung carcinoma associated with the Epstein-Barr virus (EBV). The clinical predictive biomarkers of immune checkpoint blockade (ICB) in PLELC require further investigation. We prospectively analysed EBV levels in the blood and immune tumor biomarkers of 31 patients with ICB-treated PLELC. Viral EBNA-1 and BamHI-W DNA fragments in the plasma were quantified in parallel using quantitative polymerase chain reaction. Progression-free survival (PFS) was significantly longer in EBNA-1 high or BamHI-W high groups. A longer PFS was also observed in patients with both high plasma EBNA-1 or BamHI-W and PD-L1 ≥ 1%. Intriguingly, the tumor mutational burden was inversely correlated with EBNA-1 and BamHI-W. Plasma EBV load was negatively associated with intratumoral CD8+ immune cell infiltration. Dynamic changes in plasma EBV DNA level were in accordance with the changes in tumor volume. An increase in EBV DNA levels during treatment indicated molecular progression that preceded the imaging progression by several months. Plasma EBV DNA could be a useful and easy-to-use biomarker for predicting the clinical activity of ICB in PLELC and could serve to monitor disease progression earlier than computed tomography imaging.

Concentration of Secreted Frizzled-Related Proteins (SFRPs) in Non-Small Cell Lung Carcinoma Subtypes-A Preliminary Study.

Non-small cell lung carcinoma (NSCLC) is the most common lung cancer worldwide. Secreted frizzled-related proteins (SFRPs) are important tumour suppressors and antagonists of the Wnt signalling pathway, which is linked with cancer development. The aim of this study was to evaluate the concentrations of SFRP1, SFRP2, and SFRP5 proteins in tumour and non-tumour (NT) samples obtained from 65 patients with primary NSCLC. An enzyme-linked immunosorbent assay (ELISA) was used to measure the concentrations of SFRPs in the tissue homogenates. A significantly lower SFRP2 protein concentration was found in the total NSCLC tumour samples and the following NSCLC subtypes: squamous cell carcinoma (SCC) and adenocarcinoma (AC) (p > 0.05, p = 0.028 and p = 0.001, respectively). AC tumour samples had a higher SFRP1 level than NT samples (p = 0.022), while the highest SFRP1 concentration was found in NSCLC samples from patients with clinical stage T4 cancer. Increased concentrations of SFRP1 and SFRP5 were present in stage III NSCLC samples, while the tumour samples with high pleural invasion (PL2) had an increased level of SFRP2. The results from this study suggest that the tumour suppressor or oncogenic roles of SFRPs could be connected with the NSCLC subtype. The levels of SFRPs varied according to the clinicopathological parameters of NSCLC.

Ivermectin induces nonprotective autophagy by downregulating PAK1 and apoptosis in lung adenocarcinoma cells.

LUAD (Lung adenocarcinoma), the most common subtype of lung carcinoma and one of the highest incidences and mortality cancers in the world remains still a substantial treatment challenge. Ivermectin, an avermectin derivative, has been traditionally used as an antiparasitic agent in human and veterinary medicine practice during the last few decades. Though ivermectin has been shown to be effective against a variety of cancers, however, there is few available data reporting the antitumor effects of ivermectin in LUAD. The effect of ivermectin on cell viability and proliferative ability of LUAD cells was evaluated using CCK-8 and colony formation assay. Apoptosis rate and autophagy flux were detected using flow cytometry based on PI/Annexin V staining and confocal laser scanning microscope based on LC3-GFP/RFP puncta, respectively. Western blotting experiment was conducted to verify the results of changes in apoptosis and autophagy. LUAD-TCGA and GEO databases were used to analyse the expression and predictive value of PAK1 in LUAD patients. Xenograft model and immumohistochemical staining were used for verification of the inhibitor effect of ivermectin in vivo. Ivermectin treatment strikingly impeded the colony formation, and the viability of the cell, along with cell proliferation, and caused the apoptosis and enhanced autophagy flux in LUAD cells. In addition, ivermectin-induced nonprotective autophagy was confirmed by treating LUAD cells with 3-MA, an autophagy inhibitor. Mechanistically, we found that ivermectin inhibited PAK1 protein expression in LUAD cells and we confirmed that overexpression of PAK1 substantially inhibited ivermectin-induced autophagy in LUAD cells. Based on TCGA and GEO databases, PAK1 was highly expressed in LUAD tissues as compared with normal tissues. Furthermore, LUAD patients with high PAK1 level have poor overall survival. Finally, in vivo experiments revealed that ivermectin efficiently suppressed the cellular growth of LUAD among nude mice. This study not only revealed the mechanism of ivermectin inhibited the growth of LUAD but also supported an important theoretical basis for the development of ivermectin during the therapy for LUAD.

Significance of Immunohistochemistry Testing in the Diagnosis and Subtyping of Lung Carcinomas- A Retrospective Study from a Tertiary Care Centre in Southern Rajasthan

Introduction: In the present era, the classification of lung carcinoma is not confined to Small Cell Lung Carcinoma (SCLC) and Non Small Cell Lung Carcinoma (NSCLC). Precise subtyping of lung carcinoma has a direct impact on patient management and prognosis. Further molecular study helps in identifying adenocarcinoma receptors, such as Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK), which are useful in targeted therapy. Aim: To assess the role of Immunohistochemistry (IHC) in accurate diagnosis and subtyping of lung carcinoma and to analyse the prevalence of EGFR mutations and ALK rearrangement in lung adenocarcinoma. Materials and Methods: A retrospective hospital-based, observational study was conducted at the Department of Pathology of American International Institute of Medical Sciences, Udaipur, Rajasthan from January 2020 to August 2021. Total of 105 cases of guided core needle biopsies from lung and bronchoscopic biopsies were included. IHC markers were applied based on histopathological diagnosis from a panel of p63, Cytokeratin 7 (CK7), AE1/AE3, Thyroid Transcription Factor (TTF1), Napsin A, p40, synaptophysin, chromogranin, CD56 and Ki67. Adenocarcinoma cases were further analysed for EGFR mutations and ALK rearrangements. Data was tabulated and analysed statistically using Microsoft Excel to determine the percentage frequency distribution of cases. Results: Among 105, there were 88 males and 17 females and the mean age of the population was 60.57 years. The most prevalent subtype of lung malignancy was squamous cell carcinoma (44.7%) followed by adenocarcinoma (29.5%). The diagnostic accuracy of squamous cell carcinomas and adenocarcinomas on morphology was 93.1% and 84.6%, respectively and for small cell carcinoma it was 100%. Amongst 28 cases of adenocarcinoma, EGFR mutation was found in 46.42% cases whereas ALK mutation was found only in 21.42% cases. Conclusion: The study highlights the importance of IHC, and a substantial prevalence of EGFR mutations was found in patients with lung carcinoma.

357P Molecular stratification of small cell lung carcinoma subtypes by immunoexpression of ASCL1, NEUROD1, POU2F3 and YAP1 with clinicopathological correlation

Recently, molecular studies in small cell lung carcinoma (SCLC) have identified 4 subtypes defined by RNA expression of achaete-scute homologue 1 (ASCL1), neurogenic differentiation factor 1 (NEUROD1), POU class 2 homeobox 3 (POU2F3) and yes-associated protein 1 (YAP1) transcriptional regulators. However, there is scant literature regarding expression of these markers at protein/immunohistochemistry (IHC) level along with its prognostic implications. These molecular subtypes might define distinct therapeutic implications.

Role of histopathological and immunohistochemical technique in diagnosis of lung carcinoma

Background: Lung cancer is currently the most frequently diagnosed major cancer and the most common cause of cancer mortality worldwide. Most lung cancers are associated with a well-known Carcinogen i.e., Cigarette Smoking. Immunohistochemistry helps in the sub typing of the lung neoplasm into different categories which have a therapeutic and prognostic importance. Materials and Methods: The present study is both retrospective and prospective study done at Pathology Department over a period of 1 year (October 2021 to September 2022). The present study was carried out on 50 patients presented with lung mass in radiological examination and undergone biopsy procedure and samples of the same were received at Histopathological section of Pathology Department, Shri M.P. Shah Govt. medical college, Jamnagar. Cases were diagnosed by histopathological examination and subtyping were done by Immunohistochemistry.Aims and ObjectivesTo determine the incidence of lung carcinoma with respect to age and sex of patients.To correlate between incidence and associated risk factors for lung carcinoma like smoking.To use Immunohistochemistry for subtyping of lung carcinoma.Results: In present study, out of 50 cases, most common histological type of lung carcinoma was Adenocarcinoma (n=23 cases,46%) followed by Squamous cell Carcinoma (n=20 cases,40%) and Small Cell Carcinoma (n=7 cases, 14%). There was male preponderance (96%) and male to female ratio was 25:1. Right sided Lung was most commonly involved (60%) than Left sided Lung (40%).Conclusion: As subtyping is important for different treatment modalities, the present study highlights the importance of histopathological and immunohistochemical study in diagnosis and subtyping of lung carcinoma. In this study we found that adenocarcinoma was most common subtype of lung carcinoma in Saurashtra region than other subtypes and majority of them were smokers.

Diagnostic criteria and evolving molecular characterisation of pulmonary neuroendocrine carcinomas.

Neuroendocrine carcinomas of the lung are currently classified into two categories: small-cell lung carcinoma and large-cell neuroendocrine carcinoma. Diagnostic criteria for small-cell and large-cell neuroendocrine carcinoma are based solely on tumour morphology; however, overlap in histologic and immunophenotypic features between the two types of carcinomas can potentially make their classification challenging. Accurate diagnosis of pulmonary neuroendocrine carcinomas is paramount for patient management, as clinical course and treatment differ between small-cell and large-cell neuroendocrine carcinoma. Molecular-genetic, transcriptomic, and proteomic data published over the past decade suggest that small-cell and large-cell neuroendocrine carcinomas are not homogeneous categories but rather comprise multiple groups of distinctive malignancies. Nuances in the susceptibility of small-cell lung carcinoma subtypes to different chemotherapeutic regimens and the discovery of targetable mutations in large-cell neuroendocrine carcinoma suggest that classification and treatment of neuroendocrine carcinomas may be informed by ancillary molecular and protein expression testing going forward. This review summarizes the current diagnostic criteria, prognostic and predictive correlates of classification, and evidence of previously unrecognised subtypes of small-cell and large-cell neuroendocrine carcinoma.

Histopathologic Analysis of CT-Guided Core Needle Biopsy in Radiologically Detected Suspicious Mediastinal and Lung Mass: Two Years’ Study in Tertiary Hospital

Background: Pulmonary nodule ranges from infective to neoplastic lesion and thus at times remain diagnostic challenge for the management of patient. Therefore, proper diagnosis is very essential for appropriate treatment. Biopsy and FNAC plays important role in diagnosing these cases. After 2004 with establishment of therapeutic implication of distinguishing histologic subtypes of lung carcinoma with immunohistochemistry, lung biopsy has become inevitable even for molecular analysis as well. We studied our institution’s experience with percutaneous CT guided biopsy of lung nodules to determine the impact of this procedure in diagnosis of disease. Methods: This is hospital based descriptive study, of two years’ duration (March 2019 to April 2021), carried out at Department of Pathology, B&C Medical College Teaching Hospital and Research Centre Pvt. Ltd., Birtamode, Jhapa. Total 97 cases of CT guided biopsy were performed. Histopathologic analysis was performed and data were analyzed. Results: The most common malignancy diagnosed was Non-small cell carcinoma (NSCC), lung comprising 43.7% which required further immunohistochemistry testing for subcategorization. All infective cases were of Tuberculosis constituting 9.37% of all the cases. Benign cases were of mature cystic teratoma, thymoma and fibroma. Conclusions: Nowadays biopsy of lung in suspicious lesion is mandatory to establish diagnosis for appropriate management, moreover in malignancy cases for which most of the cases require immunohistochemistry and molecular analysis.

Inferring gene expression from cell-free DNA fragmentation profiles.

Profiling of circulating tumor DNA (ctDNA) in the bloodstream shows promise for noninvasive cancer detection. Chromatin fragmentation features have previously been explored to infer gene expression profiles from cell-free DNA (cfDNA), but current fragmentomic methods require high concentrations of tumor-derived DNA and provide limited resolution. Here we describe promoter fragmentation entropy as an epigenomic cfDNA feature that predicts RNA expression levels at individual genes. We developed 'epigenetic expression inference from cell-free DNA-sequencing' (EPIC-seq), a method that uses targeted sequencing of promoters of genes of interest. Profiling 329 blood samples from 201 patients with cancer and 87 healthy adults, we demonstrate classification of subtypes of lung carcinoma and diffuse large B cell lymphoma. Applying EPIC-seq to serial blood samples from patients treated with PD-(L)1 immune-checkpoint inhibitors, we show that gene expression profiles inferred by EPIC-seq are correlated with clinical response. Our results indicate that EPIC-seq could enable noninvasive, high-throughput tissue-of-origin characterization with diagnostic, prognostic and therapeutic potential.

Detection of lung carcinoma arising from ground glass opacities (GGO) after 5 years - A retrospective review

Pure ground glass opacities (GGO) may indicate pre-invasive subtypes of lung carcinoma. These neoplasms typically demonstrate indolent patterns of growth; Fleischner Society guidelines recommend up to five years of serial imaging. Our aim was to determine the frequency of diagnosed carcinoma arising from GGO detected beyond 5 years of surveillance. We reviewed pathologic diagnoses of lung carcinoma (n = 442) between 2016 and 2018 of a tertiary academic hospital and National Cancer Institute-designated cancer center to identify all cancers that arose from ground glass opacities detected on CT scan. Of the 442 cases of lung carcinoma, 32 (7%) were found that arose from pure GGOs and were ultimately diagnosed as cancer. Among the subgroup of GGOs, 78% (n = 25) were diagnosed within five years of surveillance, but up to 22% (n = 7) required between five and twelve years of serial follow up prior to definitive diagnosis. In order to detect 95% of cancers, GGOs would need to be followed for 7.9–12.7 years based upon a Kaplan-Meier estimate (p = 0.05). No patients who had lung carcinoma arising from GGOs died (0/32) within a follow-up time of one to three years. These data suggest that a greater number of lung carcinomas would be detected upon routine follow up of GGOs that extended beyond the current recommendation of five years. The overall survival of the cohort was 100%, consistent with existing data that these cancers are indolent. It is unknown whether a higher detection rate from longer interval follow up would impact overall survival.

Sanguinarine Represses the Growth and Metastasis of Non-small Cell Lung Cancer by Facilitating Ferroptosis.

Ethnopharmacological relevance: Sanguinarine (SAG), a natural benzophenanthridine alkaloid derived from the root of Sanguinaria canadensis Linn. (Bloodroot), possesses a potential anticancer activity. Lung carcinoma is the chief cause of malignancy-related mortality in China. Non-small cell lung carcinoma (NSCLC) is the main subtype of lung carcinoma and accounts for about eighty-five percent of this disease. Current treatment in controlling and curing NSCLC remains deficient. The role and underlying mechanism of SAG in repressing the growth and metastasis of NSCLC were explored. The role of SAG in regulating the proliferation and invasion of NSCLC cells was evaluated in vitro and in a xenograft model. After treatment with SAG, Fe2+ concentration, reactive oxygen species (ROS) levels, malondialdehyde (MDA), and glutathione (GSH) content in NSCLC cells were assessed to evaluate the effect of SAG on facilitating ferroptosis. SAG exhibited a dose- and time-dependent cytotoxicity in A549 and H3122 cells. SAG treatment effectively repressed the growth and metastasis of NSCLC in a xenograft model. We, for the first time, verified that SAG triggered ferroptosis of NSCLC cells, as evidenced by increased Fe2+ concentration, ROS level, and MDA content, and decreased GSH content. Mechanistically, SAG decreased the protein stability of glutathione peroxide 4 (GPX4) through E3 ligase STUB1-mediated ubiquitination and degradation of endogenous GPX4. GPX4 overexpression restored the proliferation and invasion of NSCLC cells treated with SAG through inhibiting ferroptosis. SAG inhibits the growth and metastasis of NSCLC by regulating STUB1/GPX4-dependent ferroptosis.

Classification of subtypes including LCNEC in lung cancer biopsy slides using convolutional neural network from scratch

Identifying the lung carcinoma subtype in small biopsy specimens is an important part of determining a suitable treatment plan but is often challenging without the help of special and/or immunohistochemical stains. Pathology image analysis that tackles this issue would be helpful for diagnoses and subtyping of lung carcinoma. In this study, we developed AI models to classify multinomial patterns of lung carcinoma; ADC, LCNEC, SCC, SCLC, and non-neoplastic lung tissue based on convolutional neural networks (CNN or ConvNet). Four CNNs that were pre-trained using transfer learning and one CNN built from scratch were used to classify patch images from pathology whole-slide images (WSIs). We first evaluated the diagnostic performance of each model in the test sets. The Xception model and the CNN built from scratch both achieved the highest performance with a macro average AUC of 0.90. The CNN built from scratch model obtained a macro average AUC of 0.97 on the dataset of four classes excluding LCNEC, and 0.95 on the dataset of three subtypes of lung carcinomas; NSCLC, SCLC, and non-tumor, respectively. Of particular note is that the relatively simple CNN built from scratch may be an approach for pathological image analysis.

Detection of differential expression of miRNAs in computerized tomography-guided lung biopsy.

Nonsmall-cell lung carcinoma comprises 85% of lung malignancies and is usually associated with a poor prognosis due to diagnosis at advanced stages. Molecular diagnosis of computerized tomography (CT)-guided biopsy has the potential to identify subtypes of lung carcinoma like adenocarcinoma (AC) and squamous cell carcinoma (SCC) along with its molecular stratification. This approach will help predict the genetic signature of lung cancer in individual patients. Histopathologically proved a CT-guided biopsy sample of lung cancer cases was used to screen for the expression of microRNA (miRNA) earlier quantitated in blood plasma. Primers against hsa-miR2114, hsa-miR2115, hsa-miR2116, hsa-miR2117, hsa-miR449c, and hsa-miR548q with control RNU6 were used to screen 30 AC, 30 SCC, 5 nonspecific granulomatous inflammation, and 8 control samples. Reverse transcription polymerase chain reaction (RT-PCR) data revealed expression of hsa-miR2114 and hsa-miR548q in AC as well as SCC. RT-PCR data revealed that the expression of hsa-miR2116 and hsa-miR449c was found upregulated in AC while hsa-miR2117 was expressed in SCC cases. Bioinformatic analysis revealed that genes, where these miRNAs are located, were also upregulated while targets of these miRNAs were downregulated. miRNAs expression pattern in the CT-guided biopsy samples can be used as a potential tool to differentially diagnose lung cancer subtypes. The expression pattern of miRNAs matches very well in blood plasma and tissue samples, albeit levels were very low in the earlier case than later. This approach can also be used for screening mutations and other molecular markers in a personalized manner for the management of lung cancer patients.

Everything Old Is New Again: Drug Repurposing Approach for Non-Small Cell Lung Cancer Targeting MAPK Signaling Pathway.

Non-small cell lung cancer (NSCLC) is a prominent subtype of lung carcinoma that accounts for the majority of cancer-related deaths globally, and it is responsible for about 80% to 85% of lung cancers. Mitogen-Activated Protein Kinase (MAPK) signaling pathways are a vital aspect of NSCLC, and have aided in the advancement of therapies for this carcinoma. Targeting the Ras/Raf/MEK/ERK pathway is a promising and alternative method in NSCLC treatment, which is highlighted in this review. The introduction of targeted medicines has revolutionized the treatment of patients with this carcinoma. When combined with current systems biology-driven stratagems, repurposing non-cancer drugs into new therapeutic niches presents a cost-effective and efficient technique with enhancing outcomes for discovering novel pharmacological activity. This article highlights the successful cutting-edge techniques while focusing on NSCLC targeted therapies. The ultimate challenge will be integrating these repurposed drugs into the therapeutic regimen of patients affected with NSCLC to potentially increase lung cancer cure rates.

Molecular profiling and utility of cell-free DNA in nonsmall carcinoma of the lung: Study in a tertiary care hospital.

Lung carcinoma accounts to the most common cause of cancer globally. Optimal management of nonsmall cell lung carcinoma (NSCLC) requires prognostic biomarkers that help in targeted therapy and identification of tumor subsets with a distinctive molecular profile that can foretell response to therapy. Quantitative analysis of circulating cell-free DNA is considered as a possible aid for lung cancer screening. The main aim of our study was detection of the clinicopathological spectrum of NSCLC, immunohistochemical (IHC) study of lung adenocarcinoma with epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and molecular expression of EGFR mutation using Formalin fixed paraffin embedded tissue (FFPE) and cell-free DNA (cfDNA) from blood samples. It was a prospective and observational study conducted in the Department of Pathology in association with the Department of Chest Medicine in a tertiary care hospital for 18 months, done on 50 patients. Histological subtyping of lung carcinomas was done, followed by IHC analysis using P40, thyroid transcription factor (TTF1), EGFR, and ALK. Molecular analysis for EGFR mutation was done using FFPE and cfDNA from the patient's blood samples. On histological subtyping, majority (66%) of the cases were found to be adenocarcinoma. All adenocarcinoma (66%) cases show TTF1 positivity and all squamous cell carcinoma (32%) cases show P40 positivity. All the ALK-positive (6%) cases were never smokers and histologically diagnosed as adenocarcinoma. About 58% of the NSCLC cases were found to be EGFR IHC positive. Formalin-fixed paraffin tissue (FFPE) showed EGFR mutation in 32% cases, of which majority were deletion (19, 28%) and rest (4%) of the cases involving mutation in exon 21. From cfDNA, mutations were noticed in 16% of the cases where majority involved deletion 19 (12%), whereas the rest of the cases were positive for missense mutation in exon 21 of the EGFR gene (2%) and compound heterozygous mutation involving deletion 19 and missense mutation for exon 21 (2%). On correlation of EGFR mutation studies from FFPE with that of cfDNA analysis, the study was statistically significant (P = 0.000). This study reports clinicopathological, immunochemical, and molecular analysis of EGFR among NSCLC cases. EGFR mutation detection from cfDNA has its advantage of being a noninvasive technique to avoid rebiopsy in cases of the progressive disease to detect resistance to a drug and emergence of a newer mutation. Mutation detection from FFPE samples still remains the gold standard for targeted therapy using EGFR tyrosine kinase inhibitors. ALK rearrangement detection using IHC serves as an adjunct to EGFR diagnosis.

AAV-Containing Exosomes as a Novel Vector for Improved Gene Delivery to Lung Cancer Cells.

Lung carcinoma is the most common type of cancer and the leading cause of cancer-related death worldwide. Among the numerous therapeutic strategies for the treatment of lung cancer, adeno-associated virus (AAV)-mediated gene transfer has been demonstrated to have the potential to effectively suppress tumor growth or reverse the progression of the disease in a number of preclinical studies. AAV vector has a safety profile; however, the relatively low delivery efficacy to particular subtypes of lung carcinoma has limited its prospective clinical translation. Exosomes are nanosized extracellular vesicles secreted from nearly all known cell types. Exosomes have a membrane-enclosed structure carrying a range of cargo molecules for efficient intercellular transfer of functional entities, thus are considered as a superior vector for drug delivery. In the present study, we developed a novel strategy to produce and purify AAV-containing exosomes (AAVExo) from AAV-packaging HEK 293T cells. The cellular uptake capacity of exosomes assisted and enhanced AAV entry into cells and protected AAV from antibody neutralization, which was a serious challenge for AAV in vivo application. We tested a list of lung cancer cell lines representing non-small-cell lung cancer and small-cell lung cancer and found that AAVExo apparently improved the gene transfer efficiency compared to conventional AAV vector. Our in vitro results were supported in vivo in a lung cancer xenograft rodent model. Additionally, we evaluated the gene delivery efficiency in the presence of neutralizing antibody on lung cancer cells. The results demonstrated that AAVExo-mediated gene transfer was not impacted, while the AAV vectors were significantly blocked by the neutralizing antibody. Taken together, we established an efficient methodology for AAVExo purification, and the purified AAVExo largely enhanced gene delivery to lung cancer cells with remarkable resistance to antibody neutralization.

New Insights on Old Biomarkers Involved in Tumor Microenvironment Changes and Their Diagnostic Relevance in Non-Small Cell Lung Carcinoma.

Background: Lung cancer is a multifactorial disease with a heterogeneous tumor group that hampers diagnostic and therapeutic approaches, as well as understanding of the processes that underlie its pathogenesis. Current research efforts are focused on examining alterations in the tumor microenvironment, which may affect the pathogenesis and further malignant progression in lung cancer. The aim of this study was to investigate changes in the levels of biomarkers involved in the lung tumor microenvironment and their diagnostic utility in differentiating lung cancer subtypes and stages. Methods: This study comprised 112 lung cancer patients, 50 with adenocarcinoma, 35 with squamous cell carcinoma, 13 with other non-small cell lung carcinoma subtypes, and 14 with other lung neoplasms than non-small cell lung carcinoma. Tumor markers (CEA, CYFRA 21-1, and NSE) were measured in the patients’ sera and plasmas, along with IL-6, TNF-α, SAA1, CRP, MMP-2, MMP-9, glucose, lactate, and LDH, utilizing enzyme-linked immunosorbent assays, enzyme immunoassays, and automated clinical chemistry and turbidimetry systems. The results were statistically analyzed across patient groups based on the subtype and stage of lung cancer. Results: Glucose concentrations showed statistically significant (p < 0.05) differences both between lung cancer subtypes and stages, with the highest levels in patients with other lung neoplasms (me = 130.5 mg/dL) and in patients with stage IIB lung cancer (me = 132.0 mg/dL). In patients with advanced lung cancer, IL-6 and LDH had considerably higher concentration and activity. There was also a significant positive correlation between IL-6 and MMP-9 in adenocarcinoma and SqCC, with correlation coefficients of 0.53 and 0.49, respectively. The ROC analyses showed that the best single biomarkers for distinguishing adenocarcinoma from squamous cell carcinoma are glucose, CRP, and CYFRA 21-1; however, their combination did not significantly improve sensitivity, specificity, and the AUC value. The combinations of IL-6, glucose, LDH and CEA, IL-6, SAA1, MMP-9, and lactate can distinguish patients with stage IIB lung cancer from those with stage IIA with 100% sensitivity, 100% specificity, and with an AUC value of 0.8333 and 1.0000, respectively, whereas the combination of CEA, IL-6, and LDH can identify patients with stage IIIA lung cancer from those with stage IIB with 72.73% sensitivity, 94.44% specificity, and an AUC value of 0.8686. Conclusion: There is a link between biomarkers of tumor microenvironment changes and tumor markers, and combinations of these markers may be clinically useful in the differential diagnosis of adenocarcinoma and squamous cell carcinoma, as well as lung cancer stages IIB and IIA, and IIIA and IIB.