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J Cancer. 2016 Oct 25;7(15):2165-2172. eCollection 2016.

Massive parallel sequencing and digital gene expression analysis reveals potential mechanisms to overcome therapy resistance in pulmonary neuroendocrine tumors.

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Ruhrlandklinik, West German Lung Center, University Hospital Essen, University of Duisburg-Essen;; Institute of Pathology, Charité Universitaetsmedizin, Berlin.
Institute of Pathology, Charité Universitaetsmedizin, Berlin.
Department of Oncology, University Hospital Essen, University of Duisburg-Essen.
Institute of Pathology, Helios Klinikum Emil von Behring, Berlin.
Ruhrlandklinik, West German Lung Center, University Hospital Essen, University of Duisburg-Essen.
Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Alexandra Hospital, Athens, Greece.
2nd Department of Pulmonary Medicine, "Sotiria" Hospital of Chest Diseases, Athens, Greece.
Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Medical Clinic I,''Fuerth'' Hospital, University of Erlangen, Fuerth, Germany.


Background: Lung cancer is the leading cause of cancer-related deaths worldwide. 25% show neuroendocrine differentiation (typical/atypical carcinoids, large-/small-cell neuroendocrine carcinomas). Carcinoids present with long survival rates, but metastatic carcinoids correlate with decreased survival and are commonly insensitive to standard chemotherapy or radiation. Therefore, novel therapeutic strategies are urgently needed. Material and methods: 70 representative tumor specimens were used for next-generation sequencing analysis of 14 genes related to therapy response. Additionally, mRNA-expression profiles of 60 matching samples were determined for 13 selected drug targets by using the NanoString nCounter technology. Results: A number of features known to sensitize tumors for different targeted therapies could be identified, which hopefully improve the clinical management of this subgroup of lung neoplasias. In particular, EGFR expression was observed in the investigated tumors in a noteworthy manner. Additionally, MDM2 was strongly expressed in the majority of all samples whereas the expression of its physiological inhibitor, CDKN2A, was nearly absent in all low-grade tumors. TP53 showed a high frequency of variants in high-grade tumors but mutations were rare in carcinoids. Conclusion: Based on our results, therapeutic approaches with MDM2-inhibitors and monoclonal anti-EGFR antibodies may be promising in pulmonary carcinoid tumors.


NanoString; biomarkers; lung cancer.; next-generation sequencing; personalized therapy

Conflict of interest statement

All authors disclose any affiliations that are considered to be relevant and important with any organization that to our knowledge has any direct interest in the subject matter discussed.

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