Patent Application
20160340742
The present invention relates generally to methods of diagnosing cancer and more specifically to diagnosing and determining the prognosis of cancer patients using a biomarker based on fibroblast growth factor receptors.
Without limiting the scope of the invention, its background is described in connection with diagnosing, treating and determining the prognosis of cancer. Cancer is a generic name for a wide range of cellular malignancies characterized by unregulated proliferation, lack of differentiation, and the ability to invade local tissues and metastasize. These neoplastic malignancies affect, with various degrees of prevalence, every tissue and organ in the body. Fibroblast growth factors (FGFs) and their receptors (FGFR) are expressed at increased levels in several tissues and cell lines and overexpression is believed to contribute to the malignant phenotype. FGFs and FGFRs are a highly conserved group of proteins with instrumental roles in angiogenesis, vasculogenesis, and wound healing, as well as tissue patterning and limb formation in embryonic development. FGFs and FGFRs affect cell migration, proliferation, and survival, providing wide-ranging impacts on health and disease.
The FGFR family comprises four major types of receptors, FGFR1, FGFR2, FGFR3, and FGFR4. These receptors are transmembrane proteins having an extracellular domain, a transmembrane domain, and an intracytoplasmic domain. Each of the extracellular domains contains either two or three immunoglobulin (Ig) domains. Transmembrane FGFRs are monomeric tyrosine kinase receptors, activated by dimerization, which occurs at the cell surface in a complex of FGFR dimers, FGF ligands, and heparin glycans or proteoglycans. Extracellular FGFR activation by FGF ligand binding to an FGFR initiates a cascade of signaling events inside the cell, beginning with the receptor tyrosine kinase activity.
For example, U.S. Pat. No. 8,377,636, entitled, “Biological markers predictive of anti-cancer response to kinase inhibitors,” discloses diagnostic and prognostic methods for predicting the effectiveness of treatment of a cancer patient with inhibitors of EGFR kinase, PDGFR kinase, or FGFR kinase. Based on tumors cells having undergone an EMT, while being mesenchymal-like, still express characteristics of both epithelial and mesenchymal cells, and that such cells have altered sensitivity to inhibition by receptor protein-tyrosine kinase inhibitors, in that they have become relatively insensitive to EGFR kinase inhibitors, but have frequently acquired sensitivity to inhibitors of other receptor protein-tyrosine kinases such as PDGFR or FGFR, methods have been devised for determining levels of specific epithelial and mesenchymal biomarkers that identify such “hybrid” tumor cells (e.g. determination of co-expression of vimentin and epithelial keratins), and thus predict the tumor's likely sensitivity to inhibitors of EGFR kinase, PDGFR kinase, or FGFR kinase.
U.S. Pat. No. 7,982,014, entitled, “FGFR3-IIIc fusion proteins,” discloses FGFR fusion proteins, methods of making them, and methods of using them to treat proliferative disorders, including cancers and disorders of angiogenesis. The FGFR fusion molecules can be made in CHO cells and may comprise deletion mutations in the extracellular domains of the FGFRs which improve their stability. These fusion proteins inhibit the growth and viability of cancer cells in vitro and in vivo. The combination of the relatively high affinity of these receptors for their ligand FGFs and the demonstrated ability of these decoy receptors to inhibit tumor growth is an indication of the clinical value of the compositions and methods provided herein.
U.S. Patent Application Publication No. 2013/0345234, entitled, “FGFR and ligands thereof as biomarkers for breast cancer in HR positive subjects,” discloses methods for diagnosing, treating and determining the prognosis of breast cancer HR+ patient, the methods including detecting the amplification of one or more biomarkers comprising a FGFR ligand such as FGF3, FGF4, FGF19, and/or a FGFR, such as for example FGFR1 in a subject; determining an FGFR1 inhibitor for treating the subject based on the amplification of the one or more biomarkers in the subject; administering to the subject in need thereof the FGFR1 inhibitor and using the one or more biomarkers to indicate prognosis of the subject treated with the FGFR1 inhibitor.
The present invention provides a method of characterizing a cancer by obtaining a sample from a subject suspected of having cancer; and determining whether a fibroblast growth factor receptor (FGFR) fusion is present in the sample, wherein the FGFR fusion comprises a FGFR locus, thereby characterizing the cancer based on the presence or absence of the FGFR fusion.
The present invention provides a method for detecting a fibroblast growth factor receptor (FGFR) translocation event in one or more cancer cells by contacting a sample suspected of comprising one or more cancer cells with a plurality of distinguishably labeled probes capable of hybridizing to a portion of a fibroblast growth factor receptor (FGFR) fusion in the one or more cancer cells; hybridizing a first probe to a first region to form a first hybridization complex; hybridizing a second probe to a second region to form a second hybridization complex; and analyzing the first hybridization complex and the second hybridization complex to identify the presence of a FGFR fusion.
The present invention provides a method for identifying the response of a proliferative disorder responsive to treatment by detecting one or more FGFR biomarkers selected for a FGFR-fusion that is indicative of the prognosis of a subject.
For a more complete understanding of the features and advantages of the present invention, reference is now made to the detailed description of the invention along with the accompanying figures and in which:
While the making and using of various embodiments of the present invention are discussed in detail below, it should be appreciated that the present invention provides many applicable inventive concepts that can be embodied in a wide variety of specific contexts. The specific embodiments discussed herein are merely illustrative of specific ways to make and use the invention and do not delimit the scope of the invention.
To facilitate the understanding of this invention, a number of terms are defined below. Terms defined herein have meanings as commonly understood by a person of ordinary skill in the areas relevant to the present invention. Terms such as “a”, “an” and “the” are not intended to refer to only a singular entity, but include the general class of which a specific example may be used for illustration. The terminology herein is used to describe specific embodiments of the invention, but their usage does not delimit the invention, except as outlined in the claims.
The present invention provides methods of diagnosing, treating and determining the prognosis of a disease or condition comprising abnormal cell growth, the disease or condition comprising abnormal cell growth in one embodiment is a cancer. The present invention is directed to methods for diagnosing, selecting for treatment and determining the prognosis cancer patients using a biomarker based on fibroblast growth factor receptors and determining which patients will most benefit from treatment with inhibitors of receptor protein-tyrosine kinases.
The terms “receptor tyrosine kinase” and “RTK” are used interchangeably herein to refer to the family of membrane receptors that phosphorylate tyrosine residues. Many play significant roles in development or cell division. Receptor tyrosine kinases possess an extracellular ligand binding domain, a transmembrane domain and an intracellular catalytic domain. The extracellular domains bind cytokines, growth factors or other ligands and are generally comprised of one or more identifiable structural motifs, including cysteine-rich regions, fibronectin III-like domains, immunoglobulin-like domains, EGF-like domains, cadherin-like domains, kringle-like domains, Factor VIII-like domains, glycine-rich regions, leucine-rich regions, acidic regions and discoidin-like domains. Activation of the intracellular kinase domain is achieved by ligand binding to the extracellular domain, which induces dimerization of the receptors. A receptor activated in this way is able to autophosphorylate tyrosine residues outside the catalytic domain, facilitating stabilization of the active receptor conformation. The phosphorylated residues also serve as binding sites for proteins which will then transduce signals within the cell. Examples of RTKs include, but are not limited to, Kit receptor (also known as Stem Cell Factor receptor or SCF receptor), fibroblast growth factor (FGF) receptors, hepatocyte growth factor (HGF) receptors, insulin receptor, insulin-like growth factor-1 (IGF-1) receptor, nerve growth factor (NGF) receptor, vascular endothelial growth factor (VEGF) receptors, PDGF-receptor-.alpha., PDGF-receptor-.beta., CSF-1-receptor (also known as M-CSF-receptor or Fms), and the F1t3-receptor (also known as F1k2).
As used herein, the term “subject” is intended to include human and non-human animals. Non-human animals include all vertebrates, e.g. mammals and non-mammals, such as non-human primates, sheep, dogs, cats, cows, horses, chickens, amphibians, and reptiles.
An “FGFR fusion protein” is a protein typically comprising a sequence of amino acids corresponding to the extracellular domain of an FGFR polypeptide or a biologically active fragment thereof, and a fusion partner. The fusion partner may be joined to either the N-terminus or the C-terminus of the FGFR polypeptide and the FGFR may be joined to either the N-terminus or the C-terminus of the fusion partner. An FGFR fusion protein can be a product resulting from splicing strands of recombinant DNA and expressing the hybrid gene. An FGFR fusion protein may comprise a fusion partner comprising amino acid residues that represent some or all of, one or more fragments of, one or more genes. The FGFR fusion molecules of the invention comprise a first polypeptide that comprises an extracellular domain (ECD) of an FGFR polypeptide and a fusion partner. The FGFR polypeptide can be any of FGFR1, FGFR2, FGFR3, and FGFR4, including all their variants and isoforms. Hence, the family of FGFR polypeptides suitable for use in the invention includes FGFR1, FGFR1-IIIb, FGFR1-IIIc, FGFR2, FGFR2-IIIb, FGFR2-IIIc, FGFR3, FGFR3-IIIb, FGFR3-IIIc, FGFR4 and FGFR5, for example. The extracellular domain of the FGFR can be the entire ECD or a portion thereof.
A “fusion partner” is any component of a fusion molecule in addition to the extracellular domain of an FGFR or fragment thereof. A fusion partner may comprise a polypeptide, such as a fragment of an immunoglobulin molecule, or a non-polypeptide moiety, for example, polyethylene glycol. The fusion partner may comprise an oligomerization domain such as an Fc domain of a heavy chain immunoglobulin.
Patients with cholangiocarcinoma often present with locally advanced or metastatic disease. At present, there is a need for more effective traditional chemotherapeutic or targeted therapy strategies to treat patients with cholangiocarcinoma. 152 cholangiocarcinomas and 4 intraductal papillary biliary neoplasms of the bile duct were evaluated for presence of FGFR2 translocations by fluorescence in situ hybridization (FISH) and characterized the clinical, pathologic and immunohistochemical features of cases with FGFR2 translocations. In addition, 100 cholangiocarcinomas were assessed for ERBB2 amplification and ROS1 translocations, of which 3 (3%) and 1 (1%) where positive, respectively. Eight percent (13 of 156) of biliary tumors harbored FGFR2 translocations, including 12 intrahepatic cholangiocarcinomas and 1 intraductal papillary neoplasm of the bile duct. Thirteen percent (12/96) of intrahepatic cholangiocarcinomas harbored a FGFR2 translocation. FGFR2 translocations were also associated with a female predominance, longer disease-free and overall survival, and lack of underlying fibrotic liver disease. Lesions with FGFR2 translocations were frequently associated with weak and patchy expression of CK19. Markers of stem cell phenotype in cholangiocarcinoma, HepPar1 and CK20, were negative in all cases. This is the largest known study of cholangiocarcinomas assessing for FGFR2 translocations and confirms that FGFR2, ERRB2, and ROS1 alterations are potential therapeutic targets in cases of intrahepatic cholangiocarcinoma, with FGFR2 present at the highest frequency.
The present invention provides a fluorescent in situ hybridization (FISH) break-apart assay to detect fusions involving fibroblast growth factor receptor 2 (FGFR2) in patients with cholangiocarcinoma. The assay is able to discern true positive (in 3 of 3 RNA-Seq/Sanger-polymerase chain reaction validated cases) and true negative cases (in 3 of 3 RNA-Seq/Sanger-polymerase chain reaction validated cases). The present invention allows for rapid and reliable detection of cholangiocarcinoma patients with FGFR2 fusions for treatment with fibroblast growth factor receptor inhibitors.
The present invention provides molecular techniques which have led to the identification of therapeutic targets for various tumors, e.g., identified fibroblast growth factor receptor gene (FGFR2) translocations in cholangiocarcinoma which benefited from FGFR targeted therapy. FGFR2 and ROS1 Fluorescence In Situ Hybridization (FISH). Using the hematoxylin and cosin-stained slides as a guide, unstained 5 micron thick glass slides from a selected paraffin block were etched to indicate the areas of tumor for subsequent molecular testing. Slides were placed in an oven at 90° C. for 10 minutes and then pretreated with xylene at room temperature for two consecutive 15 minute intervals. Slides were then immersed in 100% ethanol for 5 minutes and allowed to air dry at 30° C. for 3 minutes. Acid treatment was then performed for 45 minutes using 10mM of citric acid at 80° C. This was followed by SSC pretreatment for 5 minutes at 37° C. and pepsin digestion (0.2%) for 48 minutes. The slides were then dehydrated in serial ethanol baths of increasing concentration and air dried for 5 minutes. FGFR2 break-apart FISH probe (Abbott Molecular Diagnostics, Des Plaines, Ill.) containing Spectrum Orange and Spectrum Green probes were used.
Three to 10 uL of FGFR2 break-apart FISH probe (Abbott Molecular Diagnostics, Des Plaines, Ill.) containing Spectrum Orange and Spectrum Green probes flanking the region of interest was then applied to the etched area of the slide and cover slipped. Hybridization was performed on a HYBRITE™ (Abbott Molecular Inc.) by denaturing at 80° C. for 3 minutes and hybridizing for 12 hours at 37° C. The slides were then removed from the HYBRITE™ and placed in 0.1% NP40/2×SSC at 74° C. for 2 minutes and transferred to a room temperature solution of 0.1% NP40/2×SSC for an additional 2 minutes. DAPI-I counterstain was applied to the sections and the slides were cover slipped.
FISH analyses were then performed in blinded fashion. In order to be considered positive, separate Spectrum Orange and/or Spectrum Green signals were present in greater than 20% of nuclei throughout the tumor. Cases not meeting these criteria were considered negative. All cases with FGFR2 translocation and a subset of cases without translocation were reviewed blindly by a second reviewer. For the ROS-1 break-apart probe, the same method was used. Cholangiocarcinomas (N=3) with FGFR2 translocations and FGFR2 overexpression from global transcriptome sequencing along with cholangiocarcinomas without FGFR2 translocations (N=5) were also evaluated as control specimens in a blinded fashion with this FISH strategy to verify accuracy of the FISH probes.
HER2 Immunohistochemistry and FISH. Five micron unstained sections from the chosen paraffin block were used for HER2 immunohistochemistry using the HercepTest kit (Dako, Carpinteria, Calif.) and following the manufacturer-provided protocol. The slides were reviewed by two pathologists and classified as negative, 1+, 2+ or 3+ based on previously published guidelines by the College of American Pathologists (CAP) and American Society for Clinical Oncologists (ASCO). In all 2+ or 3+ positive cases, the invasive tumor with immunoreactivity was circled and the sections were selected for HER2 FISH.
Immunohistochemistry using commercially available antibodies directed to cytokeratin 7 (clone OV-TL 12/30; 1:200, Dako, Calif.), cytokeratin 19 (clone RCK 108; 1:20,Dako, Calif.), cytokeratin 20 (clone Ks 20.8, 1:200, Dako, Calif.), CD56 (clone 123C3; 1:100; Dako, Calif.), KIT (rabbit polyclonal; 1:500; Dako, Calif.) and HepPar 1 (clone OCH1E5; predilute; Ventana, Ariz.) was performed using 30-32 minute pretreatment and standard methods on each of the cases of cholangiocarcinoma with an FGFR2 translocation.
Statistical Analysis. The associations between the occurrence of FGFR2 rearrangements and clinicopathologic results were assessed using JMP 9.0 software and Wilcoxon test and Fisher Exact tests, as appropriate. Kaplan-Meier curves were plotted, and survival was compared using the log-rank value. All reported p values were 2 sided and p values <0.05 were considered significant.
One hundred and fifty-six specimens were evaluated including 152 cholangiocarcinomas and 4 IPNB. Patients ranged from 28 to 83 years of age with a median age of 62 years. The study included 80 males and 76 females. The 152 cholangiocarcinomas in this surgical series were predominantly intrahepatic (n=96; 63%), but also included hilar (n=25; 16%) and extrahepatic (n=31; 20%) tumors. The 4 IPNB specimens included 2 intrahepatic and 2 extrahepatic neoplasms. Two of the IPBN featured low grade dysplasia and the other 2 displayed features of high grade dysplasia. The median maximum dimension of the cholangiocarcinomas was 4.75 cm (range 0.5-14.0 cm) and the median maximum tumor size for the IPNB was 3.15 cm (range 1.8-7.5 cm).
Using FISH, FGFR2 translocations were identified in 12 cholangiocarcinomas and 1 IPNB for an overall frequency of 8% (13/156;
Morphologically, cases harboring FGFR2 translocations could be divided into 2 architectural groups; cases (8/13, 62%) which were characterized by prominent intraluminal growth in bile ducts (bile duct invasion/extension) and cases which did not (5/13, 38%). Of the former group, 3 cases were composed predominantly of solid nodules, 4 showed a predominantly trabecular pattern and the other was the case of an intestinal type IPNB. The cases with solid nodules were characterized either by syncytial neoplastic cells with indistinct cell membranes or alternatively by cells with distinct cell membranes. The cases with a trabecular pattern typically featured 2 cell populations including a) a peripheral rim of smaller cells with scant cytoplasm and nuclear hyperchromasia and b) central cells with more cytoplasm, round nuclei and open chromatin. In 2 cases, there were overlapping features including areas with a trabecular growth pattern and a two cell population, and solid areas without the two cell population.
While the IPNB with FGFR2 translocation showed intraluminal growth by definition, it did not harbor solid nodules or trabeculae but instead was composed of back to back anastomosing tubular glands with abundant goblet cells as shown in
The second group of FGFR2 translocated tumors (5 of 13) included cases which were all composed of anastomosing tubular structures accompanied by desmoplasia. In 2 of the 5 cases, multiple foci of intratubular growth (i.e. glands within a gland) were seen and in the remaining 3 cases the anastomosing tubules coalesced to form solid or syncytial areas in places.
By immunohistochemistry, all of the FGFR2-translocated cases were strongly positive for CK7. In 3 cases (23%), CK7 expression was patchy (approximately 10%-50% neoplastic cells positive) while in the remaining 10 cases (77%), CK7 expression was diffuse. Only 3 cases (23%) were diffusely positive for CK19. Six cases (46%) showed weak patchy reactivity for CK19, 3 (23%) revealed focal CK19 expression (<10% neoplastic cells) which was very weak. In a single case, a strong luminal pattern of CK19 expression was seen. Examples of CK19 immunoreactivity are shown in
For cholangiocarcinoma cases, clinical follow up was available for 99% (151/152) of patients up to 169 months after surgical resection. For the 139 cases without FGFR2 translocations, 77 patients (55%) developed metastases or local recurrence and 99 patients (71%) died during clinical follow up. Of the 99 patients who died, 69 died of disease (70%), 7 died of other causes (7%) and the cause of death was unknown for 23 patients (23%). The median cancer-specific survival interval for the group without FGFR2 translocations was estimated at 37 months (95% CI: lower limit=24 months, upper limit=49 months) and the median disease free interval was estimated at 26 months (95% CI: lower limit=19 months, upper limit=42 months). Six of the 12 (50%) patients whose tumors harbored FGFR2 translocations died during clinical follow up and 6 patients were alive without evidence of disease. Only 3 patients (25%) developed metastases or local recurrence. The median cancer-specific survival interval for patients with FGFR2 translocations was estimated at 123 months (95% CI: lower limit=51 months, upper limit=123 months) and was significantly longer (p=0.039) than patients without FGFR2 translocations. The disease free intervals for the 3 cases were 26 months, 63 months, and 125 months. Relative to the cases without FGFR2 translocations, this was also significant (p=0.007).
FISH ROS1 testing was also performed on a group of 100 overlapping cases and was successful in 98 cases. Only a single case revealed a ROS1 translocation, resulting in a rearrangement frequency of 1%. This case was previously reported as harboring an IDH1 mutation. FGFR2 was not translocated in this case. The patient was a 63-year-old woman without underlying liver disease who presented with a localized intrahepatic tumor and is alive with no evidence of disease 66 months after surgery.
Cholangiocarcinoma is a malignancy of the biliary tree and arises within the liver (intrahepatic), at the hilum (central) or within the extrahepatic biliary tree. This anatomic classification is supported in embryology with the extrahepatic bile ducts arising in continuity with the intrahepatic bile ducts but from different cell populations. This classification separates biliary tree malignancies into groups with different mutational spectra and also informs surgical approach. Most cholangiocarcinomas are not amenable to surgical resection at diagnosis and the prognosis is poor. There are currently no FDA-approved targeted therapies for cholangiocarcinoma, a clear unmet clinical need. The present invention provides FISH testing of FGFR2, ERRB2, and ROS1 for the identification of patients whose tumors are candidates for targeted therapies. This is consistent with recent studies suggesting that cholangiocarcinomas harbor mutations that may benefit from tyrosine kinase targeted therapies.
FGFR2, located at chromosome 10q26, is a member of the fibroblast growth factor family of receptors including FGFR1, FGFR3 and FGFR4 and the encoded proteins share highly conserved amino acid sequences. Full length FGFR2, like the other members of the family, is composed of 3 extracellular immunoglobulin domains, an intramembranous segment and a cytoplasmic tyrosine kinase. It interacts with a variety of ligands and the activity of FGFR2 influences proliferation and cellular differentiation. Physiologically, FGFR2 is distributed in ectodermal, endodermal and mesenchymal structures. Point mutations in FGFR2 are associated with congenital craniosynostosis due to abnormal bone development. FGFR2 translocations were identified in a prospective clinical sequencing program in cholangiocarcinoma, breast and prostatic carcinoma. This novel oncogenic mechanism for FGFR2 was validated functionally30 and was subsequently noted by others. As would be expected from their sequence homology, alterations in FGFR1, FGFR3 and FGFR4 have also been demonstrated as oncogenic drivers in various malignancies. Interestingly, prior to the discovery of FGFR2 translocations in cholangiocarcinoma, it was noted that FGFR2 was expressed in 2 cholangiocarcinoma cell lines and that FGFR2 activity not only stimulated neoplastic cell migration but confirmed that inhibition of FGFR2 impaired neoplastic cell migration in the presence of the ligand for FGFR2. Recently, a group identified FGFR2 translocations as a targetable alteration in approximately 15% intrahepatic cholangiocarcinomas which were wild type for KRAS and BRAF and did not harbor ROS1 translocations. FGFR2 is strongly implicated in the development of a subset of cholangiocarcinomas. In this large series of cholangiocarcinomas in patients from the United States, we confirmed the finding of FGFR2 translocations in 13% of intrahepatic tumors. This evidence supports that FGFR2 is a potential therapeutic target in intrahepatic cholangiocarcinoma.
Cholangiocarcinomas with FGFR2 translocations can be grouped morphologically into 2 clusters. The first of which was a group of tumors characterized by intraluminal growth (large duct invasion) by neoplastic cells. Within this group of tumors, 4 tumors formed predominantly solid compact nodules including two cases in which the neoplastic cells were characterized by indistinct cell borders, appeared syncytial in growth pattern and were accompanied by a neutrophilic infiltrate; 3 formed a nested architecture also including a case with a syncytial appearance to the neoplastic cells and were composed of a dual population of cells including a peripheral rim of cells with hyperchromasia and there was a single case of an intraductal papillary biliary neoplasm. The second group of cases (5 of 13) did not reveal large duct invasion and were characterized by anastomosing tubular structures with variable architectural complexity accompanied by a desmoplastic stroma and in 3 of these cases, a prominent neutrophilic infiltrate. It is not clear whether there are biological differences between tumors from these 2 morphologic groups. None of the described features could be used to distinguish cases harboring FGFR2 translocations from cases without FGFR2 translocations.
For some tumor types, morphologic characteristics may be suggestive of underlying molecular alterations. This is illustrated by the presence of abundant tumor infiltrating lymphocytes, signet ring cells and mucinous histology in microsatellite unstable colorectal carcinoma. High grade, triple negative, basal-like breast carcinomas are frequently poorly differentiated with a syncytial pattern of growth and abundant necrosis. Predominantly solid histology has been shown in KRAS mutated lung adenocarcinomas and others have recognized a distinctive recurrent morphologic constellation of features including chromophobe cytoplasm, abrupt anaplasia and pseudocysts in hepatocellular carcinomas with an unusual molecular cytogenetic phenotype. However, none of these morphologic features is sufficiently specific to act as a sole marker for the molecular alterations in routine practice.
Interestingly, a subset of the FGFR2-rearranged cases display stem-cell like features. Together with the physiologic role of FGFR2 in stem cell differentiation in organogenesis, this raised the possibility that tumors with FGFR2 translocations may display a stem cell phenotype. However, the markers of stem cell phenotype in cholangiocarcinomas, CD56 and KIT, were negative. While this argues against a stem cell phenotype, it is worth pointing out that the search for novel markers of stem cells in liver tumors is ongoing and additional robust markers are still needed. Importantly though, 69% (9 of 13) of cholangiocarcinomas harboring FGFR2 translocations showed significantly diminished expression of CK19 suggesting that they were primitive. CK19 is expressed in hepatic progenitor cells in early embryogenesis. At 10 weeks gestation, the expression of CK19 is downregulated in hepatocytes but continues in intrahepatic and extrahepatic bile ducts. This forms the biological basis for CK19 as a marker of pancreatobiliary tumors. Several large studies have reported that CK19 is diffusely positive in 80-100% of cholangiocarcinomas. Therefore, only focal and weak CK19 expression in most of the cases with FGFR2 translocations suggests that this subset of cholangiocarcinomas is enriched for tumors with primitive characteristics. This is also supported by the fact that most tumors revealed solid, syncytial or trabecular growth. Taken together, our data suggests that FGFR2 translocations are associated with intrahepatic neoplasms which display a duct invasive or weakly duct-forming phenotype with predominantly primitive morphologic features.
Both cholangiocarcinomas and hepatocellular carcinomas may arise in the setting of underlying disease or in apparently normal livers. 102 cholangiocarcinomas, 149 colorectal carcinomas, 212 gastric carcinomas and almost 100 hepatocellular carcinomas have been studied for FGFR2 translocations by RT-PCR. They found 5 of 11 total cases (including 1 colorectal carcinoma and 1 hepatocellular carcinoma) with FGFR2 translocations occurred in patients with viral hepatitis B or C. They do not comment on the features of the background liver in the 9 cholangiocarcinoma cases but they compare the rate of viral hepatitis in cases with FGFR2 translocations to control cases and found a statistically significant increase in the rate of viral hepatitis carriage. Two of 16 tested patients were positive for viral hepatitis C and only one of these was associated with fibrosis of the background liver. There were no cases with cirrhosis or primary sclerosing cholangitis. From these data, it is not clear if underlying liver disease or viral hepatitis are important contributors to the pathogenesis of FGFR2 translocation-associated cholangiocarcinomas.
The median disease free and cancer-specific survivals of cases without FGFR2 translocation were 26 and 37 months, respectively, compared to 125 and 123 months respectively for the patients whose tumors harbored FGFR2 translocations. In retrospective studies of patients treated with various combinations of therapy and not matched for performance status and other characteristics, it is difficult to determine the generalizability of survival data. The younger patients, feasibility of resection, unique tumor biology and lack of underlying liver disease may have contributed to the improved survival of patients whose tumors harbored FGFR2 translocations.
Clinically, detecting FGFR2 translocations is relevant because this appears to represent a targetable alteration. Wu et al. identified FGFR2 fusions in 2 cholangiocarcinoma specimens. Arai et al. showed the functional significance of FGFR2 translocations in cholangiocarcinoma including activation of the MAPK pathway and also provided data that FGFR2 inhibition led to diminished MAPK pathway activity. They also performed studies in murine avatars confirming the tractability of FGFR2 translocations in cholangiocarcinomas. If the studies are summed, 27 of 287 biliary neoplasms have been found to harbor FGFR2 translocations which comprise approximately 10% of cases studied and include exclusively intrahepatic tumors. In addition, rare cases with HER2 amplification and ROS1 translocation were identified. These targetable alterations were mutually exclusive of FGFR2 translocation and their molecular biology has already been characterized. FGFR2 translocations in intrahepatic cholangiocarcinoma are associated with a primitive phenotype, apparent female predominance, apparent tendency to longer disease free and overall survival and lack of underlying fibrotic liver disease. As such, FISH testing may be a useful clinical test for the detection of tyrosine kinase receptor rearrangements in patients with cholangiocarcinoma. Lastly, increasing data suggests that targeted therapy for FGFR2, ERBB2 and ROS1 chromosomal alterations are exciting potential treatments for this group of patients who currently have an overall unfavorable prognosis.
For example, advanced cholangiocarcinoma continues to harbor a difficult prognosis and limited therapeutic options. For example, biliary tract cancers (BTC) comprise malignant tumors of the intrahepatic and extrahepatic bile ducts. Known risk factors for BTC are the liver flukes O. viverrini and C. sinensis in high prevalence endemic regions in southeast Asia [1-3], as well as primary sclerosing cholangitis [4-7], Caroli's disease [8], hepatitis B and hepatitis C [9-14], obesity [13], hepatolithiasis [15,16] and thorotrast contrast exposure [17,18]. Surgical approaches such as resection and liver transplantation represent the only curative treatment approaches for BTC [19]. Unfortunately, most patients present with surgically unresectable and/or metastatic disease at diagnosis. Systemic therapy with gemcitabine and cisplatin has been established as the standard of care for patients with advanced disease, but is only palliative, [20] emphasizing the imminent need for novel therapies.
Mutations/allelic loss of known cancer genes in BTC [21-39] have been reported and recently, a prevalence set of 46 patients was used to validate 15 of these genes including: TP53, KRAS, CDKN2A and SMAD4 as well as MLL3, ROBO2, RNF43, GNAS, PEG3, XIRP2, PTEN, RADIL, NCD80, LAMA2 and PCDHA13. Recurrent mutations in IDH1 (codon 132) and IDH2 (codons 140 and 172) have been reported with a prevalence of 22-23% associated with clear cell/poorly differentiated histology and intrahepatic primary [40,41]. Fusions with oncogenic potential involving the kinase gene ROS1 have been identified in patients with BTC with a prevalence of 8.7% [42]. Less frequently, mutations in sporadic BTC have been reported in EGFR [43,44], BRAF [45], NRAS [40,46], PIK3CA [40,46,47], APC [40], CTNNB1 [40], AKT1 [40], PTEN [40], ABCB4 [48], ABCB11 [49,50], and CDH1 [51] as well as amplifications in ERRB2 [52]. FGFR fusions have also been seen in cholangiocarcinoma, e.g. a single case with FGFR2-AHCYL1 [53] as well as several cases identifying FGFR2-BICC1 fusions [53,54]. For example, FGFR2 fusions in a cohort of 102 cholangiocarcinoma patients showed that the fusions occurred exclusively in the intrahepatic cases with a prevalence of 13.6% [53]. Overexpression of the FGFR2-BICC1 and other selected fusions resulted in altered cell morphology and increased cell proliferation [54]. These data led to the conclusion that the fusion partners are facilitating oligomerization, resulting in FGFR kinase activation in tumors possessing FGFR fusions. In addition, in vitro and in vivo assessment of the sensitivity of cell lines containing an FGFR2 fusion to a FGFR inhibitor demonstrated sensitivity to treatment only in the fusion containing cells [53,54], suggesting the presence of FGFR fusions may be a useful predictor of tumor response to FGFR inhibitors.
To comprehensively evaluate the genetic basis of sporadic intrahepatic cholangiocarcinoma (SIC), with emphasis on elucidation of therapeutically relevant targets, integrated whole genome and whole transcriptome analyses was performed on tumors from 6 patients with advanced, sporadic intrahepatic cholangiocarcinoma (SIC). Notably, recurrent fusions involving the oncogene FGFR2 (n=3) were identified.
Table 3 (submitted on CD and incorporated herein) is a table of the somatic point mutations, insertions and deletions identified in all samples. Genes with mutations in more than one case included CSPG4 (n=2), GRIN3A (n=2) and PLXBN3 (n=2); with half of these predicted to be potentially damaging by SIFT [55], Polyphen [56], Mutation Assessor [57] and Mutation Taster [58]. While there was overlap in the somatic landscape of SIC with liver-fluke associated cholangiocarcinoma, hepatocellular cancer and pancreatic cancer, most of the aberrations detected in our study were distinct. Table 4 is a comparison of mutation frequency in cholangiocarcinoma, pancreatic and liver caners.
BAP1 (R60*) presented with a truncating mutation that has been previously reported in skin, but have not been reported in biliary cancers. Somatic BAP1 mutations have been identified in a number of tumor types including: Breast, endometrium, eye, kidney, large intestine, lung, ovary, pleura, prostate, skin, and urinary tract. A deubiquitinating enzyme and possible tumor suppressor, BAP1, plays a critical role in the regulation of chromatin modulation and transcription. Furthermore, the loss of BAP1 has been associated with tamoxifen resistance in breast cancer, aggressive and metastatic disease in uveal melanomas.
A nonsynonymous mutation observed in PTK2 (P926S) occurs in a region of the gene whose protein product interacts with TGFB1I1 and ARHGEF28. PTK2, also known as focal adhesion kinase (FAK), is a tyrosine kinase involved in the regulation of cell migration, proliferation, adhesion, microtubule stabilization and actin cytoskeleton. Furthermore, FAK interacts with multiple signaling molecules and in multiple pathways suggesting the possible use of therapeutic treatments directly targeting these interactions or targeting downstream targets of PTK2 such as PI3K or mTOR.
A serine/threonine p21 protein-activated kinase 1 (PAK1) gene contains a nonsynonymous (R371C) mutation located in the protein kinase domain. The location of this mutation could potentially lead to loss of the critical protein kinase domain. While PAK1 is expressed in many normal tissues, it is highly-expressed in ovarian, breast, and bladder cancers. PAK1 plays a role in cell motility, proliferation, survival, and death although, the ability to therapeutically target PAK1 will require further study by tumor type as breast cancer subpopulations have shown response to PAK1 inhibition while non-small cell lung cancer has proven resistant. K5-rTA::tet-KRASG12D mice wildtype for Pak1, responded to treatment with PAK or MEK inhibitors, but did not respond to AKT inhibitors.
Tables 5 (submitted on CD and incorporated herein) 6 and 7 attached hereto are tables showing genes carrying single nucleotide or frameshift variations, or aberrant in copy number were annotated and clustered by GO term functional classes, some of which are known to play a role in Cancer. Proteins predicted to be integral to the membrane and involved in transport, as well as transcriptional regulators were among the most abundant class in all of the patients affected by small scale sequence variations and copy number variations. Variations specifically affecting the EGFR or FGFR gene families were prevalent in Patients 4, 5, and 6 and are highlighted in the figure with the gene name provided in parenthesis next to the pathway name. Comparative pathway analysis of genes carrying small scale nucleotide variations (SsNVs) has implicated several major pathways, possibly interacting as a network, that are predicted to underlie disease in biliary carcinoma patients. These shared pathways include EGFR, EPHB, PDGFR-beta, Netrin-mediated and Beta 1 integrin mediated signaling pathways. Interestingly, most of these pathways have known roles in mediating epithelial-to-mesenchymal cell transitions, which occur frequently during development as well as tumorigenesis. Cell growth and motility is inherent to the successful progression of both biological processes. Studies of the nervous system and lung development have shown that Netrins act to inhibit FGF7 and FGF10 mediated growth or cell guidance [60]. In addition, Netrin-1 has a known role in mediating cell migration during pancreatic organogenesis [60]. Furthermore, Netrin-1 acts as a ligand for α3β1 and α6β4 integrins, both of which are involved in supporting adhesion of developing pancreatic epithelial cells with Netrin-1 although it is thought that α6β4 plays the principle role during this process [60]. Interestingly, α3β1 has been hypothesized to play a role during the process of angiogenesis, when chemoattractants and chemorepellents act to guide filopodia during migration [60]. The α3β1 integrin receptor may act together with additional pathways proposed to play a role during angiogenesis such as VEGF, PDGFR-beta [61], and EphrinB [62] as well as tumorigenesis [60]. Patients 3 and 4 also shared several genes acting in cadherin signaling pathways (see Tables 6-7 submitted on CD and incorporated herein), which are important for maintaining cell-cell adhesion and are known to be intimately integrated with EGFR and FGFR signaling pathways [63].
In addition to the variations identified in genes acting in EGFR, and/or FGFR signaling pathways, multiple sSNVs, and copy number variations (CNVs) (
Patient 4 is a 62 year-old white female found to have a left-sided intrahepatic mass with satellite lesions, with metastasis to regional lymph nodes. Table 9 shows the clinical characteristics of 6 advanced, sporadic biliary tract cancer patients
A biopsy of the liver mass revealed the presence of a poorly differentiated adenocarcinoma that was consistent with intrahepatic cholangiocarcinoma (CK7+, CEA+, CK20+, Hep-par 1−, TTF-1−). Table 10 shows the pathological characteristics of 6 advanced, sporadic biliary tract cancer patients.
She received gemcitabine and cisplatin and obtained clinical benefit in the form of stable disease for 6 months, followed by disease progression. She was re-treated with gemcitabine and capecitabine systemic therapy and attained stable disease for 6 months, followed by disease progression. A clinical trial of pegylated hyaluronidase (PEGPH20) produced only stable disease for 4 months, followed again by disease progression. At this juncture, she underwent a liver biopsy to obtain tissue for whole genome characterization of her tumor.
Evaluation of pre-treatment immunohistochemistry demonstrated increased expression of FGFR2 and FGFR3 (
The FGFR2 fusion partner observed in this patient, MGEA5, is an enzyme responsible for the removal of O-GlcNAc from proteins [66]. Interestingly, soft tissue tumors myxoinflammatory fibroblastic sarcoma (MIFS) and hemosiderotic fibrolipomatous tumor (HFLT) both share a translocation event resulting in rearrangements in TGFBR3 and MGEA5 [67,68]. Associated with this translocation event is the upregulation of NPM3 and FGF8 [68], of which both genes are upregulated in this patient (fold change: NPM3=6.17865, FGF8=1.79769e+308). In breast cancer, grade III tumors had significantly lower MGEA5 expression than grade I tumors with a trend of decreasing expression observed with increasing tumor grade [66]. MGEA5 may play an important role in carcinogenesis as an FGFR fusion partner.
Patient 6 is a 43 year-old white female who underwent a right salpingo-oophorectomy and endometrial ablation in the context of a ruptured ovarian cyst (Table 9). Postoperatively she developed dyspnea and was found to have pulmonary nodules as well as a 5 cm left sided liver mass. Pathological evaluation of the liver mass was consistent with a moderately differentiated intrahepatic cholangiocarcinoma (CK7+, CK20−, TTF-1−) in the absence of any known risk factors (Table 10). She was treated systemically with gemcitabine and cisplatin and had stable disease for approximately 6 months, but was subsequently found to have disease progression. She was treated with FOLFOX for 7 months and again attained stable disease as best response to therapy but eventually experienced disease progression. Transcriptome analysis revealed the presence of an FGFR2-TACC3 fusion (Table 11). Further evaluation of phosphorylation of downstream targets FRS2 Y436, and ERK(MAPK) revealed strong expression of pERK and moderate expression of pFRS2 Y436 (
The FGFR2 fusion partner observed in this patient's tumor, TACC3, is overexpressed in many tumor types with enhanced cell proliferation, migration, and transformation observed in cells overexpressing TACC3 [70]. Furthermore regulation of ERK and PI3K/AKT by TACC3 may contribute in part to epithelial-mesenchymal transition (EMT) in cancer [70], a significant contributor to carcinogenesis.
Interestingly, TACC3 has been identified as a fusion partner to FGFR3 in bladder cancer, squamous cell lung cancer, oral cancer, head and neck cancer and glioblastoma multiforme [54].
Integrated analysis of sporadic intrahepatic cholangiocarcinoma (SIC) genomic and transcriptomic data led to the discovery of FGFR2 fusion products in three of six assessed patients. Members of the FGFR family (FGFR-1-4) have been associated with mutations, amplifications and translocation events with oncogenic potential [71]. FGFR fusions with oncogenic activity have been previously identified in bladder cancer (FGFR3) [72], lymphoma (FGFR1 and FGFR3) [73,74], acute myeloid leukemia (FGFR1) [75], multiple myeloma [76], myeloproliferative neoplasms [77], and most recently glioblastoma multiforme (FGFR1 and FGFR3) [78]. FGFR2, FGFR3 and FGFR4 have been found to be overexpressed in IDH1/IDH2 mutant biliary cancers [79], a context seen within Patient 1 in our study; although, no fusion events were depicted in these studies or in Patient 1. Table 13 shows differential gene expression of fibroblast growth factor receptor pathway family members in 5 patients with advanced sporadic biliary tract cancer.
Although the gene partner fused to FGFR2 was different for each Patient (MGEA5, BICC1 and TACC3), the breakpoints in FGFR2 all occurred within the last intron distal to the last coding exon and terminal protein tyrosine kinase domain. All three fusions were validated at the DNA and/or RNA level of FGFR2 (Table 13) fusions in 3 Patients with advanced sporadic biliary tract cancer.
Amongst these fusions, the FGFR2-BICC1 fusion has recently been independently identified in SIC [53,54]. For this particular fusion product we observed, and validated, the presence of two fusion isoforms (FGFR2-BICC1 and BICC1-FGFR2). Interestingly, BICC1 is a negative regulator of Wnt signaling [80] and when comparing expression of tumor and normal tissue we observed differentially expressed Wnt signaling genes, APC (fold change −4.75027), GSK3B (fold change −3.35309), and CTNNB1 (fold change −1.73148), yet when the expression was compared to other cholangiocarincomas, no difference was observed.
The FGFR genes encode multiple structural variants through alternative splicing. Notably, RNASeq data revealed that the FGFR2-IIIb isoform was present in all fusions detected in our study and has been shown to have selectivity for epithelial cells as opposed to the FGFR2-IIIc isoform, which is found selectively in mesenchymal cells [81]. Paradoxically, wildtype FGFR2-IIIb has been described as a tumor suppressor in pre-clinical systems of bladder cancer and prostate cancer [82,83]. As such, FGFR signaling appears context-dependent and exhibits variability in disparate tumor types.
Comparative pathway analysis of genes carrying mutations/aberrant in copy number identified additional potential therapeutic targets belonging to, or intimately integrated with, the EGFR and FGFR signaling pathways (
Whole genome sequencing for Patients 1, 3, 4, and 5. 1.1 μg genomic DNA was used to generate separate long insert whole genome libraries for each sample using Illumina's (San Diego, Calif.) TruSeq DNA Sample Prep Kit (catalog #FC-121-2001). In summary, genomic DNAs are fragmented to a target size of 900-1000 bp on the Covaris E210. 100 ng of the sample was run on a 1% TAE gel to verify fragmentation. Samples were end repaired and purified with Ampure XP beads using a 1:1 bead volume to sample volume ratio, and ligated with indexed adapters. Samples are size selected at approximately 1000 bp by running samples on a 1.5% TAE gel and purified using Bio-Rad Freeze 'n Squeeze columns and Ampure XP beads. Size selected products are then amplified using PCR and products were cleaned using Ampure XP beads. Whole genome sequencing for Patient 2. 300 ng genomic tumor and normal DNA was used to create whole genome libraries. Samples were fragmented on the Covaris E210 to a target size of 200-300 bp and 50 ng of the fragmented product was run on a 2% TAE gel to verify fragmentation. Whole genome libraries were prepared using Illumina's TruSeq DNA Sample Prep Kit.
Exome sequencing for Patients 1 and 3. 1.1μg genomic DNA for each sample was fragmented to a target size of 150-200 bp on the Covaris E210. 100 ng of fragmented product was run on TAE gel to verify fragmentation. The remaining 1 μg of fragmented DNA was prepared using Agilent's SureSelectXT and SureSelectXT Human All Exon 50 Mb kit (catalog #G7544C). Exome sequencing for Patient 2. 50ng genomic tumor and normal DNA was used to create exome libraries using Illumina's Nextera Exome Enrichment kit (catalog #FC-121-1204) following the manufacturer's protocol. Exome sequencing for Patients 4 and 5. 1 μg of each tumor and germline DNA sample was used to generate separate exome libraries. Libraries were prepared using Illumina's TruSeq DNA Sample Prep Kit and Exome Enrichment Kit (catalog #FC-121-1008) following the manufacturer's protocols. Exome sequencing for Patient 6. 3 μg of genomic tumor and normal DNA was fragmented on the Covaris E210 to a target size of 150-200 bp. Exome libraries were prepared with Agilent's (Santa Clara, Calif.) SureSelectXT Human All Exon V4 library preparation kit (catalog #5190-4632) and SureSelectXT Human All Exon V4+UTRs (catalog #5190-4637) following the manufacturer's protocols.
RNA sequencing for Patients 1, 2 and 3. 50 ng total RNA was used to generate whole transcriptome libraries for RNA sequencing. Using the Nugen Ovation RNA-Seq System v2 (catalog #7102), total RNA was used to generate double stranded cDNA, which was subsequently amplified using Nugen's SPIA linear amplification process. Amplified products were cleaned using Qiagen's QIAquick PCR Purification Kit and quantitated using Invitrogen's Quant-iT Picogreen. 1 μg of amplified cDNA was fragmented on the Covaris E210 to a target size of 300 bp. Illumina's TruSeq DNA Sample Preparation Kit was used to prepare libraries from 1 μg amplified cDNA.
RNA sequencing for Patients 4, 5 and 6. 1μg of total RNA for each sample was used to generate RNA sequencing libraries using Illumina's TruSeq RNA Sample Prep Kit V2 (catalog #RS-122-2001) following the manufacturer's protocol.
Paired End Sequencing. Libraries with a 1% phiX spike-in were used to generate clusters on HiSeq Paired End v3 flowcells on the Illumina cBot using Illumina's TruSeq PE Cluster Kit v3 (catalog #PE-401-3001). Clustered flowcells were sequenced by synthesis on the Illumina HiSeq 2000 using paired-end technology and Illumina's TruSeq SBS Kit.
Alignment and variant calling for whole genome and whole exome. For whole genome and exome sequencing fastq files were aligned with BWA 0.6.2 to GRCh37.62 and the SAM output were converted to a sorted BAM file using SAMtools 0.1.18. BAM files were then processed through indel realignment, mark duplicates, and recalibration steps in this order with GATK 1.5 where dpsnp135 was used for known SNPs and 1000 Genomes' ALL.wgs.low_coverage_vqsr.20101123 was used for known indels. Lane level sample BAMs were then merged with Picard 1.65 if they were sequenced across multiple lanes. Comparative variant calling for exome data was conducted with Seurat [105].
Previously described copy number and translocation detection were applied to the whole genome long insert sequencing data [59]. Copy number detection was based on a log 2 comparison of normalized physical coverage (or clonal coverage) across tumor and normal whole genome long-insert sequencing data, where physical coverage was calculated by considering the entire region a paired-end fragment spans on the genome, then the coverage at 100 bp intervals was kept. Normal and tumor physical coverage was then normalized, smoothed and filtered for highly repetitive regions prior to calculating the log 2 comparison. Translocation detection was based on discordant read evidence in the tumor whole genome sequencing data compared to its corresponding normal data. In order for the structural variant to be called there needs to be greater than 7 read pairs mapping to both sides of the breakpoint. The unique feature of the long-insert whole-genome sequencing was the long overall fragment size (˜1 kb), where by two 100 bp reads flank a region of ˜800 bp. The separation of forward and reverse reads increases the overall probability that the read pairs do not cross the breakpoint and confound mapping.
For RNA sequencing, lane level fastq files were appended together if they were across multiple lanes. These fastq files were then aligned with TopHat 2.0.6 to GRCh37.62 using ensemb1.63.genes.gtf as GTF file. Changes in transcript expression were calculated with Cuffdiff 2.0.2. For novel fusion discovery reads were aligned with TopHat-Fusion 2.0.6 [106] (Patients 2, 3, 4 and 6). In addition, Chimerascan 0.4.5 [107] was used to detect fusions in Patient 1, deFuse 5.0 [108] used in Patients 2, 3 and 5 and SnowShoes [109] for Patients 2 and 5.
Briefly, slides were dewaxed, rehydrated and antigen retrieved on-line on the BONDMAX™ autostainer (Leica Microsystems, INC Bannockburn, Ill.). Slides were then subjected to heat-induced epitope retrieval using a proprietary EDTA-based retrieval solution. Endogenous peroxidase was then blocked and slides were incubated with the following antibodies: FGFR2 (BEK, Santa Cruz, catalog #sc-20735), FGFR3 (C-15, Santa Cruz, catalog #sc-123), panAKT (Cell Signaling Technology, catalog #4685, pAKT (Cell Signaling Technology, catalog #4060), EGFR (Cell Signaling Technology, catalog #4267, pEGFR (Cell Signaling Technology, catalog #2234), MAPK/ERK1/2 (Cell Signaling Technology, catalog #4695), pMAPK/pERK (Cell Signaling Technology, catalog #4376) and pFRS2 Y436 (Abcam, catalog #ab78195). Sections were visualized using the Polymer Refine Detection kit (Leica) using diaminobenzidine chromogen as substrate.
Fluorescent in-situ hybridization (FISH) was performed on formalin-fixed paraffin-embedded (FFPE) specimens using standard protocols and dual-color break-apart rearrangement probes specific to the FGFR2 gene (Abbott Molecular, Inc. Des Plaines, Ill.) located at 10 q26. The 5′ FGFR2 signal was labeled with Spectrum Orange (orange) and the 3′ FGFR2 signal was labeled with Spectrum Green (green).
In some embodiments, homology, sequence identity or complementarity, is between the antisense compound and target is from about 40% to about 60%. In some embodiments, homology, sequence identity or complementarity, is from about 60% to about 70%. In some embodiments, homology, sequence identity or complementarity, is from about 70% to about 80%. In some embodiments, homology, sequence identity or complementarity, is from about 80% to about 90%. In some embodiments, homology, sequence identity or complementarity, is about 90%, about 92%, about 94%, about 95%, about 96%, about 97%, about 98%, about 99% or about 100%.
Examples of cancers (including solid tumors) which may be treated (or inhibited) include, but are not limited to, a carcinoma, for example a carcinoma of the bladder, breast, colon (e.g. colorectal carcinomas such as colon adenocarcinoma and colon adenoma), kidney, epidermis, liver, lung, for example adenocarcinoma, small cell lung cancer and non-small cell lung carcinomas, oesophagus, gall bladder, ovary, pancreas e.g. exocrine pancreatic carcinoma, stomach, cervix, endometrium, thyroid, prostate, or skin, for example squamous cell carcinoma; a hematopoietic tumour of lymphoid lineage, for example leukemia, acute lymphocytic leukemia, chronic lymphocytic leukemia, B-cell lymphoma, T-cell lymphoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, hairy cell lymphoma, or Burkett's lymphoma; a hematopoietic tumour of myeloid lineage, for example leukemias, acute and chronic myelogenous leukemias, myeloproliferative syndrome, myelodysplastic syndrome, or promyelocytic leukemia; multiple myeloma; thyroid follicular cancer; a tumour of mesenchymal origin, for example fibrosarcoma or rhabdomyosarcoma; a tumour of the central or peripheral nervous system, for example astrocytoma, neuroblastoma, glioma or schwannoma; melanoma; seminoma; teratocarcinoma; osteosarcoma; xeroderma pigmentosum; keratoctanthoma; thyroid follicular cancer; or Kaposi's sarcoma.
It will be understood that particular embodiments described herein are shown by way of illustration and not as limitations of the invention. The principal features of this invention can be employed in various embodiments without departing from the scope of the invention. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, numerous equivalents to the specific procedures described herein. Such equivalents are considered to be within the scope of this invention and are covered by the claims.
The use of the word “a” or “an” when used in conjunction with the term “comprising” in the claims and/or the specification may mean “one,” but it is also consistent with the meaning of “one or more,” “at least one,” and “one or more than one.” The use of the term “or” in the claims is used to mean “and/or” unless explicitly indicated to refer to alternatives only or the alternatives are mutually exclusive, although the disclosure supports a definition that refers to only alternatives and “and/or.” Throughout this application, the term “about” is used to indicate that a value includes the inherent variation of error for the device, the method being employed to determine the value, or the variation that exists among the study subjects.
As used in this specification and claim(s), the words “comprising” (and any form of comprising, such as “comprise” and “comprises”), “having” (and any form of having, such as “have” and “has”), “including” (and any form of including, such as “includes” and “include”) or “containing” (and any form of containing, such as “contains” and “contain”) are inclusive or open-ended and do not exclude additional, unrecited elements or method steps.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US2015/014518 | 2/4/2015 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 61935578 | Feb 2014 | US |
