Research Papers:

Folic acid phenotype (FAP) is a superior biomarker predicting response to pemetrexed-based chemotherapy in malignant pleural mesothelioma

Fabian Dominik Mairinger _, Claudia Vollbrecht, Elena Flom, Daniel Christian Christoph, Kurt-Werner Schmid, Jens Kollmeier, Helmut Hans Popper, Thomas Mairinger and Robert Fred Henry Walter

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Oncotarget. 2017; 8:37502-37510. https://doi.org/10.18632/oncotarget.16398

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Fabian Dominik Mairinger1, Claudia Vollbrecht2,3,4, Elena Flom1, Daniel Christian Christoph5, Kurt-Werner Schmid1, Jens Kollmeier6, Helmut Hans Popper7, Thomas Mairinger8 and Robert Fred Henry Walter1,9

1Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

2Institute of Pathology, Division of Molecular Pathology, Charité, Berlin, Germany

3German Cancer Consortium (DKTK), Germany

4German Cancer Research Center (DKFZ), Heidelberg, Germany

5Department of Medical Oncology, West German Cancer Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

6Department of Pneumology, Helios Klinikum Emil von Behring, Berlin, Germany

7Department of Pathology, Division of Molecular Lung- and Pleurapathology, Medical University of Graz, Graz, Austria

8Department of Pathology, Helios Klinikum Emil von Behring, Berlin, Germany

9Ruhrlandklinik, West German Lung Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

Correspondence to:

Fabian Dominik Mairinger, email: [email protected]

Keywords: pleural mesothelioma, pemetrexed, thymidylate synthethase, folylpolyglutamate synthase, personalized therapy

Received: October 12, 2016    Accepted: March 01, 2017    Published: March 21, 2017


Background: Malignant pleural mesothelioma (MPM) is a rare tumor linked to a dismal prognosis. Even the most effective chemotherapeutical regime of pemetrexed combined with cisplatin leads to a remission-rate of only about 40%. The reasons for the rather poor efficacy remain largely unknown.

Results: Phenotypes were significantly associated with progression (p=0.0279) and remission (p=0.0262). Cox-regression revealed significant associations between SLC19A1/TYMS-ratio (p=0.0076) as well as FPGS/TYMS-ratio (p=0.0026) and OS. For differentiation by risk-groups, COXPH identified a strong correlation (p=0.0008).

Methods: 56 MPM specimens from patients treated with pemetrexed were used for qPCR analysis. Phenotypes and risk groups were defined by their expression levels of members of the folic acid metabolism and correlated to survival and objective response.

Conclusion: Our results indicate that the balance between folic acid uptake, activation and metabolism plays a crucial role in response to pemetrexed-based chemotherapy and the prognosis of MPM patients. Implementing this marker profile in MPM stratification may help to individualize MPM-therapy more efficiently.

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