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Table of Contents
Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 8-9

Opening new boundaries in biomarker detection: Awakening of middle east and North Africa Region

1 Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
2 Department of Public Health, University Federico II, Naples, Italy

Date of Web Publication24-Jan-2019

Correspondence Address:
Dr. Christian Rolfo
Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JIPO.JIPO_27_18

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How to cite this article:
Rolfo C, Malapelle U. Opening new boundaries in biomarker detection: Awakening of middle east and North Africa Region. J Immunother Precis Oncol 2019;2:8-9

How to cite this URL:
Rolfo C, Malapelle U. Opening new boundaries in biomarker detection: Awakening of middle east and North Africa Region. J Immunother Precis Oncol [serial online] 2019 [cited 2020 Feb 27];2:8-9. Available from: http://www.jipoonline.org/text.asp?2019/2/1/8/250811

Biomarker detection represents a new approach to better define the clinical management in lung cancer patients.[1],[2] In recent years, several new biomarkers were introduced in clinical practice. In addition to epidermal growth factor receptor (EGFR) analysis, ALK, ROS1, BRAF, MET, and other biomarkers and the inclusion of PDL1 assessment are giving our patients the possibility to be treated with so-called “tailored therapy” or personalized therapy, thereby improving the opportunities of disease control.[3]

The frequency of some aberrations in nonsmall-cell lung cancer (NSCLC) can be different according to the ethnicity and geographical area, mainly in EGFR mutation. This is crucial information when selecting the right patient to receive the right treatment.

The retrospective study by Jazieh et al.[4] included a cohort of 566 patients with NSCLC from different institutions in the Middle East and North Africa (MENA) region. This cohort was analyzed to determine the frequency of these targets, their prevalence rate, and the challenges for testing in this region of the world.[5],[6],[7] The molecular analysis was performed using polymerase chain reactions for EGFR mutations and fluorescencein situ hybridization for ALK-EML4 translocations. Molecular tests for EGFR were conducted for a subgroup of 164 patients with all stages of NSCLC, and ALK-EML4 fusions' evaluation was performed on a subgroup of 161 patients. Results showed EGFR mutation in 30 out of 96 patients (31.3%) with metastatic disease and in 12 out of 68 patients (17.6%) with Stages I–III. ALK-EML4 fusion was positive in 7 out of 89 patients (7.8%) with all stages and only 3 out of 52 patients (5.8%) with metastatic disease. This study indicates the necessity to open the way of molecular testing in the MENA region, but the study has several limitations. The first limitation is represented by a small number of patients on which molecular analysis could be performed; in fact, only 59% of the patients met the guideline of EGFR testing in a community setting. In the other cases, physicians did not know where to send the test (62.3%). In addition, the lack of funding to perform the test (11.1%), insufficient tissue (10.1%), and other reasons (16.6%) represent the most important limitations to performing molecular analysis. It is important to highlight that this is, to our knowledge, the first data collection about the molecular aberrations in NSCLC from this geographic area. As additional extra value, this study highlights the challenges in the molecular analysis application, a common problem in several geographical areas, giving insights to better understand the logistical and technical problems while offering the potential solutions to be adopted, with an emphasis on networking among the physicians. Successful models have been used in the Spanish Lung Cancer Group or the French Cooperative Thoracic Intergroup. This kind of approach is translated into an improvement of the opportunities for patients.[4]

With the increasing number of biomarkers to be tested in clinical practice, we are facing another problem: the quantity and quality of the tissue and the importance to select the appropriate technology to assess their presence. Tissue samples obtained in clinical trials have “ideal” conditions (quantity, quality, and time point) and do not reflect the limitation that affects diagnostic samples in real-world clinical practice. To overcome this issue, we have new generation technologies, such as next-generation sequencing platforms or the color-code–barcode nanofluidic approach, recently introduced in a diagnostic setting for molecular analysis. Finally, a liquid biopsy is coming to integrate the knowledge and complement the information required to better characterize patients with lung cancer.[8] A high level of knowledge is required to get the full benefit of the newest technology.[8],[9],[10] In the future, a wide disposal to all these innovations could allow to break the barriers for equal access in the different geographic areas around the world.

Financial support and sponsorship

The authors disclosed no funding related to this article.

Conflicts of interest

The authors disclosed no conflicts of interest related to this article.

  References Top

Naing A. Being realistic and optimistic in curing cancer. J Immunother Precis Oncol 2018;1:53-5.  Back to cited text no. 1
Mazzone PJ, Sears CR, Arenberg DA, et al. Evaluating molecular biomarkers for the early detection of lung cancer: When is a biomarker ready for clinical use? An official American Thoracic Society Policy Statement. Am J Respir Crit Care Med 2017;196:e15-29.  Back to cited text no. 2
VanderLaan PA, Rangachari D, Majid A, et al. Tumor biomarker testing in non-small-cell lung cancer: A decade of change. Lung Cancer 2018;116:90-5.  Back to cited text no. 3
Jazieh AR, Bounedjar A, Al Dayel F, et al. The study of druggable targets in nonsquamous nonsmall-cell lung cancer in the Middle East and North Africa. J Immunother Prec Oncol 2019;2:4-7.  Back to cited text no. 4
Errihani H, Inrhaoun H, Boukir A, et al. Frequency and type of epidermal growth factor receptor mutations in Moroccan patients with lung adenocarcinoma. J Thorac Oncol 2013;8:1212-4.  Back to cited text no. 5
Naderi S, Ghorra C, Haddad F, et al. EGFR mutation status in Middle Eastern patients with non-squamous non-small cell lung carcinoma: A single institution experience. Cancer Epidemiol 2015;39:1099-102.  Back to cited text no. 6
Fakhruddin N, Mahfouz R, Farhat F, et al. Epidermal growth factor receptor and KRAS mutations in lung adenocarcinoma: A retrospective study of the Lebanese population. Oncol Rep 2014;32:2223-9.  Back to cited text no. 7
Rolfo C, Mack PC, Scagliotti GV, et al. Liquid biopsy for advanced non-small cell lung cancer (NSCLC): A statement paper from the IASLC. J Thorac Oncol 2018;13:1248-68.  Back to cited text no. 8
Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011;6:244-85.  Back to cited text no. 9
Gerber DE, Gandhi L, Costa DB. Management and future directions in non-small cell lung cancer with known activating mutations. Am Soc Clin Oncol Educ Book 2014;e353-65. doi: 10.14694/EdBook_AM.2014.34.e353.  Back to cited text no. 10


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