Santiago de Chile, September 6 th, 2018

Transcription

1 Reinhard Buettner Institute for Pathology CIO Cologne Bonn Innovative Biomarkers and Immune Profiling: PD-L1, TMB, and other protein immunohistochemistry. 1506LA Santiago de Chile, September 6 th, 2018 Reinhard.Buettner@uk-koeln.de

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3 Disclosures Lectures and Advisory boards for: AstraZeneca, Bayer, BMS, Illumina, Lilly, MSD, Boehringer-Ingelheim, Novartis, Qiagen, Roche, Pfizer Co-Founder and Scientific Advisor for Targos Mol. Pathol. GmbH Testifying Advisor for MSD in GBA-assessment for Pembrolizumab

4 Wahrscheinlichkeit Überleben Lung Cancer serves as a Paradigm The differences between chemotherapy regimens are negligible... E cisplatin/paclitaxel cisplatin/gemcitabine cisplatin/docetaxel carboplatin/paclitaxel months Schiller, et al. NEJM 2002

5 Options for Personalised Therapies for NSCLC Adenocarcinoma HER2 PIK3CA BRAF ALK EGFR PIK3CAmut MET RET ROS KRAS KRASmut unknow n Sqamous cell carcinoma DDR2mut Gene Alteration Frequency EGFR Mutation 10 15% ALK Rearrangement 3 4% ROS Rearrangement 1% MET * Ampl/Mut/Rearr. 2-4% BRAF Mutation 1-3% HER2 Ampl/Mutation 2-4% DDR2 Mutation 4% RET Rearrangement 1% MEK1 Mutation 1% FGFR1 Amplification 10% KRAS Mutation 15-25% NRAS Mutation 1% < < * Approval pending < < < PTENloss unknown PTENmut FGFR1amp PIK3CA Mutation 1-3% PTEN Deletion 4% drugs approved in NSCLC drugs approved in other cancer drugs in clinical development NTRKfusions, NRG-1 Immune checkpoint inhibitors PD-1,PD-L1, CTLR4 DLL3-conjugate

6 Detection of Gene Fusions by Hybrid-Capture Panels Heydt et al., Ann Oncol 2016

7 Detection of Gene Amplification by Hybrid Capture Panels Magenkarzinom, FGFR2amp, Ratio 45,5 Adenokarzinom Lunge, HER2amp, Ratio 11,55 adenosquamöses Lungenkarzinom, FGFR1amp, Ratio 3,67 - Analysis by CNVkit: - Reference: WT DNA from FFPE

8 Heterogeneity NSCLC, Adenocarcinoma Gene Mutation Tissue Liquor Plasma EGFR Exon 19: p.e746_a750del 33,7% 41,2% 9,29% EGFR Exon 20: p.t790m 24,3% - 3,45% TP53 Exon 5: p.g154v 66,0% 82,1% 4,51% CTNNB1 Exon 3: p.d32h - - 5,77% KRAS Exon 2: p.g12r ,20% NGS: EGFR Exon 19 NGS: KRAS Exon 2 ddpcr: EGFR Exon 20 Mut p.t790m p.e746_a750del p.g12r Wt

9 rbel Söhlke Facebook tps://de-de.facebook.com/barbel.sohlke O-KölnBonn

10 Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. Antonia SJ et al. PACIFIC Investigators. N Engl J Med Nov 16;377(20):

11 PD-L1 Harmonization-Study Cologne 09/2016 Results of the first German Harmonization-Study PD-L1 IHC 09/2016 Institute of Pathology, University Cologne Scheel AH et al., Mod Pathol, July2016 Scheel AH et al., Histopathology, accepted Scheel AH et al., Der Pathologe, 2016

12 Prevalence of PD-L1 positivity and ORR by quartiles of PD-L1 proportion score Almost linearity between ORR and PD-L1 expression

13 PD-L1 Harmonisation trial Cologne Hamburg Göttingen Kassel Heidelberg Jena Munich (LMU / TU) 10 pathological institutions Berlin Dresden Pathologists: Reinhard Büttner Gustavo Baretton Manfred Dietel Lukas Heukamp Korinna Jöhrens Thomas Kirchner Iver Petersen Simone Reu Josef Rüschoff Andreas Scheel Hans-Ulrich Schildhaus Peter Schirmacher Markus Tiemann Arne Warth Wilko Weichert Industry partners: BMS MSD Roche AstraZeneca Ventana Dako / Agilent Targos Molecular Pathology

14 PD-L1 Scoring 1% 50% Scheel AH et al., Der Pathologe (6):

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16 Scheel, AH et al. Mod Pathol 2016

17 Quantitation by digitalization and image-analysis IHC: PD-L1 DAB Positive mask Manual selection Hematoxylin Colordeconvolution - Per core: analysis of 200x - Invasive carcinoma manually selected - Color-deconvolution - Read-outs: Hem. intensity, DAB-area relative to area of invasive carcinoma DAB, 3'-diaminobenzidine; IHC, immunohistochemistry.

18 Harmonization of PD-L1 Assays in German Pathology Scheel AH, Harmonized PD-L1 immunohistochemistry for pulmonary squamous-cell and adenocarcinomas. Mod Pathol Oct 29. Scheel AH, Interlaboratory-concordance of PD-L1 immunohistochemistry for non-small cell lung cancer. Histopathology Aug 29. Scheel AH, Current state of the art and experiences of the first German harmonization study. Pathologe Nov. Review. German. George J.. Scheel AH, Genomic Amplification of (CD274/ PD-L1) in Small-Cell Lung Cancer. Clin Cancer Res Mar 1. Buettner R, Tsao M. PD-L1 immunohistochemistry testing: a review on analytical assays and clinical implementation in non-small cell lung cancer. J Clin Oncol, Dec 1, Scheel AH: Berlin - Cologne - Dresden - Erlangen - Halle - Hannover - Heidelberg - Munich Targos/Kassel; QuIP/Berlin

19 Cancer Gene Panel vs. Whole exome sequencing What are the disadvantages of whole exome sequencing in daily practice? - analysis of normal tissue is required for data evaluation - from FFPE tissue, 200 ng DNA are neccessary - not yet possible on cytology Which questions have to be resolved before using panel sequencing for TMB analysis? - is it possible to calculate TMB from less than WES (38 Mb)? - if yes, what is the required size of the panel? Are only exonic regions important or can intronic regions be included in calculation? - are sensitivity and specificity of panel testing comparable to WES? - what is the cut-off? Are different cut-offs neccessary for each entity? - is the selection of genes important? - which genes should be included?

20 What is the panel size required? comparison of TMB measured by gene panel to TMB measured by WES simulation of deviation from actual TMB (by WES) when different numbers of megabases are sequenced and compared measurements of TMB from comprehensive genomic profiling are strongly reflective of measurements from whole exome sequencing model that below 0.5 Mb the variance in measurement increases significantly for reliable TMB calculation, a size of at least 1 Mb is essential Chalmers et al., Genome Med 2017

21 Cancer Gene Panel academic panel based on a hybrid-capture panel developed in Cologne driver mutations for different tumor entities included, as well as translocations and CNVs technology: DNA-based with Agilent reagents, use of molecular barcodes basic panel, following genes were added: - specific for GI, Gyn, Uro and lung - contained in CancerCensus database - genes with highest number of mutation in COSMIC database - DNA repair genes associated with point mutations and indels - genes still missing from FO panel (few!!) panel now includes 367 genes, 1.1 Mb

22 Cancer Gene Panel: Overview academic Illumina Thermo NEOplus v2 Qiagen F one exonic region 1.1 Mb 1.9 Mb 1.7 Mb 1.2 Mb 1.3 Mb 1.1 Mb drivers no no fusions microsatellites no input 50 ng 40 ng 20 ng 50 ng ng 200 ng neg. predictors unknown resistance mutations unknown repair pathway genes unknown sensitivity unknown unknown unknown unknown unknown 78,6% specificity unknown unknown unknown unknown unknown 70,6% wet lab tested ongoing ongoing ongoing kit locally available no bioinformatics loccally available no not yet tested no not yet tested no data from Campesato et al., Oncotarget 2016

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24 PerMed 1.0 Development of Molecular Diagnostics PerMed 2.0 Development of More durable TKIs PerMed 3.0 Development of Immune Image Platform (Univ Cologne, Klaus Brinker-Hamm, Miltenyi)

25 UK-Köln: Patho, Jürgen Wolf, Christiane Bruns, Jens Klussmann Miltenyi FHS-Hamm-Lippe: Klaus Brinker

26 CD3 (0-2000/mm 2 ): PD1

27 Personalized Approaches for Targeted Therapy of Lung Cancer Comprehensive Molecular Pathology to select targeted therapies to select immune checkpoint inhibitor therapies to discover the relevant immune pathways in the tumor micromilieu

28 Task Force 1a/b Mol. Diagnostics QC Task Force 2 Documentation Evaluation Task Force 3 Medical Reports Councelling Task Force 4 Clinical Trials Task Force 5 Reimbursement HC Providers Task Force 6 Research

29 Before the start (of first-line therapy) 1. Histological evaluation 2. Deep molecular evaluation 3. PD-L1 staining, TMB evaluation 4. Future: Evaluation of inflammatory Tumor Micro-Environment

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31 Thank you for your attention Molecular Pathology Diagnostics Group Cologne Jürgen Wolf, Roman Thomas, Martin Sos, Daniel Rauh DKH, BMBF, LifeSciences-NRW