Isolated metastasis of an EGFR-L858R-mutated NSCLC of the meninges: the potential impact of CXCL12/CXCR4 axis in EGFRmut NSCLC in diagnosis, follow-up and treatment
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Florian Lüke1, Raquel Blazquez1, Rezan Fahrioglu Yamaci2, Xin Lu2, Benedikt Pregler3, Stefan Hannus4, Karin Menhart5, Dirk Hellwig5, Hans-Jürgen Wester6, Saskia Kropf7, Daniel Heudobler1, Jirka Grosse5, Jutta Moosbauer5, Markus Hutterer8,9,10, Peter Hau8,9, Markus J. Riemenschneider11, Michaela Bayerlová12, Annalen Bleckmann12,13, Bernhard Polzer14, Tim Beißbarth12, Christoph A. Klein2,14 and Tobias Pukrop1
1Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
2Chair of Experimental Medicine and Therapy Research, University of Regensburg, Regensburg, Germany
3Institute of Radiology, University Hospital Regensburg, Regensburg, Germany
4Intana Bioscience GmbH, Martinsried, Germany
5Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
6Chair of Pharmaceutical Radiochemistry, Technische Universität München, Munich, Germany
7SCINTOMICS GmbH, Fuerstenfeldbruck, Germany
8Department of Neurology, University Hospital Regensburg, Regensburg, Germany
9Wilhelm Sander-Neurooncology Unit, University Hospital Regensburg, Regensburg, Germany
10Department of Neurology 1, NeuroMed Campus, Kepler University Hospital Linz, Linz, Austria
11Department of Neuropathology, University Hospital Regensburg, Regensburg, Germany
12University Medical Center Göttingen, Department of Medical Statistics, Göttingen, Germany
13University Medical Center Göttingen, Department of Hematology and Oncology, Göttingen, Germany
14Division Personalized Tumor Therapy, Fraunhofer Institute for Toxicology and Experimental Medicine, Regensburg, Germany
Tobias Pukrop, email: [email protected]
Keywords: NSCLC; brain metastasis; pentixafor PET/CT; CXCR4; fluorescence cross correlation spectroscopy
Received: November 16, 2017 Accepted: February 27, 2018 Published: April 10, 2018
Brain and leptomeningeal metastasis (LMM) of non-small cell lung cancer is still associated with poor prognosis. Moreover, the current diagnostic standard for LMM often yields false negative results and the scientific progress in this field is still unsatisfying.
We present a case of a 71-year old patient with an isolated LMM. While standard diagnostics could only diagnose a cancer of unknown primary, the use of [68Ga]-Pentixafor-PET/CT (CXCR4-PET/CT, a radiotracer targeting CXCR4) and a liquid biopsy of the cerebrospinal fluid revealed the primary NSCLC. The detection of L858R-EGFR, a common driver mutation in NSCLC, enabled us to treat the patient with Afatinib and monitor treatment using [68Ga]-Pentixafor PET/CT. To estimate the impact of CXCR4 signaling and its ligands in NSCLC brain metastasis we looked at their expression and correlation with EGFR mutations in a primary and brain metastasis data set and investigated the previously described binding of extracellular ubiquitin to CXCR4.
In conclusion, we describe a novel approach to improve diagnostics towards LMM and underline the impact of the CXCL12/CXCR4 axis in brain metastasis in a subset of NSCLC patients. We cannot confirm a correlation of CXCR4 expression with EGFR mutations or the binding of extracellular ubiquitin as previously reported.
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