Rapid Tissue Donation Promotes Research of Lung Cancer Evolution
By Dr. Theresa Boyle
The thoracic department at the Moffitt Cancer Center initiated the rapid tissue donation (RTD) program in 2015. RTD is the donation of tissue for research from deceased patients to help future patients. People with cancer cannot always be organ donors in the usual way but can donate their tumor tissue for research. RTD allows people to leave the legacy gift of tissue to enable research offering many opportunities to increase the understanding of cancer and the development of new therapies.
The samples donated to the RTD program are collected from different tumor sites in the body after death. This donated tissue supports many kinds of research that would not be otherwise possible. Very little tissue is collected during clinical care of patients with advanced lung cancer and this tissue is mostly used up for clinical testing. Without human lung cancer tissue, researchers are limited to studying cell lines and mouse models. Access to human lung cancer samples provides researchers with a resource to more directly translate their research to help people with lung cancer.
As an example, Moffitt Cancer Center scientists recently described their study of the genetic and protein composition of lung cancer at different sites using tissue donated to RTD in the journal Cancer Medicine. Important findings included the identification of an AGK-BRAF fusion in the tissue donated by one patient who had a known EML4-ALK fusion and had been treated with ALK inhibitor therapy. An exploratory hypothesis is that the AGK-BRAF fusion may have developed as a resistance mechanism to the ALKK inhibitor therapy. This finding emphasizes the significance of broad genetic testing of lung cancer specimens to identify changes such as AGK-BRAF because it opens the possibility of adapting therapy to target the AGK-BRAF change.
Another important observation was that PD-L1 protein expression can be quite different at different tumor sites in the same patient. Analysis of different tumor sites for PD-L1, a biomarker for immunotherapy, demonstrated that PD-L1 can vary up to 55% between the primary tumor site and metastatic sites. It was found that 20-60% of individuals studied would have a different “positive” versus “negative” PD-L1 result based on tumor site tested. This finding illustrates the need for caution and importance for considering the entire clinical scenario when considering immunotherapy, beyond consideration of only the PD-L1 result. This study was supported by Moffitt’s Lung Cancer Center of Excellence, the National Cancer Institute and Novartis and the RTD program is currently supported by Bristol-Meyers Squibb (BMS).
Researchers at Moffitt Cancer Center genuinely appreciate the altruism of the patients who participate in the RTD program to promote a better understanding of lung cancer and development of better therapies for future patients. If you are interested in more information about the RTD program, please talk with your oncologist, a member of your clinical team, or you may call the RTD coordinator Gina Nazario at 813-745-2926.