Chinese multidisciplinary expert consensus on the management of adverse drug reactions associated with savolitinib / 中华肿瘤杂志

MET gene is a proto-oncogene, which encodes MET protein with tyrosine kinase activity. After binding to its ligand, hepatocyte growth factor, MET protein can induce MET dimerization and activate downstream signaling pathways, which plays a crucial role in tumor formation and metastasis. Savolitinib, as a specific tyrosine kinase inhibitor (TKI) targeting MET, selectively inhibits the phosphorylation of MET kinase with a significant inhibitory effect on tumors with MET abnormalities. Based on its significant efficacy shown in the registration studies, savolitinib was approved for marketing in China on June 22, 2021 for the treatment of advanced non-small cell lung cancer with MET 14 exon skipping mutations. In addition, many studies have shown that MET TKIs are equally effective in patients with advanced solid tumors with MET gene amplification or MET protein overexpression, and relevant registration clinical studies are ongoing. The most common adverse reactions during treatment with savolitinib include nausea, vomiting, peripheral edema, pyrexia, and hepatotoxicity. Based on two rounds of extensive nationwide investigations to guide clinicians, the consensus is compiled to use savolitinib rationally, prevent and treat various adverse reactions scientifically, and improve the clinical benefits and quality of life of patients. This consensus was prepared under the guidance of multidisciplinary experts, especially including the whole-process participation and valuable suggestions of experts in Traditional Chinese Medicine, thus reflecting the clinical treatment concept of integrated Chinese and western medicines.

Expert Consensus on Targeted Therapy of NSCLC with MET Exon 14 Skipping Mutation / 中国肺癌杂志

The mesenchymal-epithelial transition factor (MET) exon 14 skipping mutation is mainly caused by the loss of c-Cbl tyrosine binding site. This mutation could result in a decrease in the degradation rate of proteasome-mediated MET proteins, trigger continuous activation of downstream pathways, and ultimately lead to tumorigenesis. The incidence of MET exon 14 skipping mutation in patients with non-small cell lung cancer (NSCLC) is 0.9% to 4.0%. Patients with advanced NSCLC are recommended to test MET exon 14 skipping mutations who may benefit from MET inhibitors-targeted therapy. MET inhibitors have a high objective response rate and good safety profiles, which could prolong the survival of NSCLC patients with MET exon 14 skipping mutations. The Lung Cancer Specialty Committee of Chinese Elderly Health Care Association organized multidisciplinary experts to give suggestions on the important issues of clinical aspects for targeted therapy of MET exon 14 skipping mutation in NSCLC according to the clinical practice experiences and evidences based medicine. "Expert Consensus on Targeted Therapy of NSCLC with MET Exon 14 Skipping Mutation" is proposed, aiming to provide standardized guidances for the clinical practice of Chinese physicians.
.

MET overexpression and intratumor heterogeneity in esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma (ESCC) is among the ten most frequent and deadly cancers, without effective therapies for most patients. More recently, drugs targeting deregulated growth factor signaling receptors have been developed, such as HGF-MET targeted therapy. We assessed MET and HGF genetic alterations and gene and protein expression profiles in ESCC patients from the Brazilian National Cancer Institute and publicly available datasets, as well as the intratumor heterogeneity of the alterations found. Our analyses showed that HGF and MET genetic alterations, both copy number and mutations, are not common in ESCC, affecting 5 and 6% of the cases, respectively. HGF showed a variable mRNA expression profile between datasets, with no alterations (GSE20347), downregulation (GSE45670), and upregulation in ESCC (our dataset and GSE75241). On the other hand, MET was found consistently upregulated in ESCC compared to non-tumor surrounding tissue, with median fold-changes of 5.96 (GSE20347), 3.83 (GSE45670), 6.02 (GSE75241), and 5.0 (our dataset). Among our patients, 84% of the tumors showed at least a two-fold increase in MET expression. This observation was corroborated by protein levels, with 55% of cases exhibiting positivity in 100% of the tumor cells. Intratumor heterogeneity was evaluated in at least four tumor biopsies from five patients and two cases showed a consistent increase in MET expression (at least two-fold) in all tumor samples. Our data suggested that HGF-MET signaling pathway was likely to be overactivated in ESCC, representing a potential therapeutic target, but eligibility for this therapy should consider intratumor heterogeneity.

Incremento en la expresión del ARNm del receptor c-Met en el cáncer gástrico / Increased expression of the c-Met receptor mRNA in gastric cancer

El cáncer gástrico es una de las patologías malignas más frecuentes en el mundo. En las últimas décadas la atención se ha centrado en posibles alteraciones de factores genéticos que incluyen la activación de proto-oncogenes y/o la inactivación de genes supresores tumorales. El producto del C-MET proto-oncogen y su ligando, el factor de crecimiento del hepatocito (HGF), han sido implicados en la proliferación y migración celular en el cáncer gástrico. En este estudio se analizó a nivel molecular la amplificación del ARNm del receptor c-Met a partir del tejido tumoral gástrico de pacientes a quienes se les practicó gastrectomías, utilizando el método del ácido guanidina-tiocianato-fenol-cloroformo, y el método semicuantitativo de la Reacción en Cadena de la Polimerasa con Transcriptasa Reversa (RT-PCR), encontrándose que los elevados niveles del ARNm del receptor c-Met en las muestras tumorales de los pacientes están relacionados con mayor invasión en la profundidad de la pared gástrica (r = 0,762, p<0,01), incremento en la metástasis a los ganglios linfáticos (r = 0,766, p<0,01), alta frecuencia en tumores pocos diferenciados o indiferenciados (r = 0,912, p<0,001), aumento en el estadiaje del cáncer gástrico (r = 0,838, p<0,001), y en la sobreexpresión por el método inmunohistoquímico (IHQ) de la estreptavidina-biotina marcada de su receptor a nivel proteico (r = 0,858, p<0,001). La amplificación del ARNm y/o la sobreexpresión a nivel proteico del receptor c-Met, pudieran ser utilizados como factores pronósticos en el cáncer gástrico.

Gastric cancer is one of the most common malignancies in the world. In the last decades, the attention has been focused in possible alterations of genetic factors that include proto-oncogene activation and/or the tumor suppressor gene inactivation. The product of the proto-oncogene c-MET and its ligand, hepatocyte growth factor (HGF), have been implicated in cell proliferation and migration in gastric cancer. In this study we analyzed at the molecular level, the amplification of c-Met receptor mRNA from gastric tumor tissue of patients who underwent gastrectomy, using the acid guanidinium-thiocyanate-phenol-chloroform method and the semiquantitative Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) method. It was found that high levels of c-Met receptor mRNA in tumor samples from patients are associated with greater depth of invasion in the gastric wall (r = 0.762, p<0.01), increase in metastases to lymph nodes (r = 0.766, p<0.01), high frequency of poorly differentiated or undifferentiated tumors (r = 0.912, p<0.001), increase in the gastric cancer staging (r = 0.838, p<0.001), and the overexpression, by the immunohistochemistry method (IHC) of the labeled streptavidin-biotin, of the c-Met receptor at the protein level (r = 0.858, p<0.001). The amplification of mRNA and/or protein level overexpression of the c-Met receptor could be used as prognostic factors in gastric cancer.

Expresión de marcadores de proliferación celular e invasión tisular en cáncer papilar del tiroides y su asociación con metástasis ganglionares / Expression of proliferation and invasion markers in papilary thyroid carcinoma with and without lymph node involvement

Background: Several molecules that may have a role in tumor proliferation, differentiation and invasion, have been detected in thyroid carcinoma. Some of these molecules are NIS, c-MET, TIMP1 an ephrinB2. Aim: To detect the presence of these molecules in tissue samples of thyroid carcinoma and relate their expression to the biological behavior of the tumor. Material and Methods: Tissue samples were prospectively obtained from 35 patients operated for a papillary thyroid carcinoma. Twelve patients had regional lymph node involvement. NIS, c-MET, TIMP1 and EphrinB2 were detected by real time polymerase chain reaction(RT-PCR) and immunohistochemistry. Results: The expression of markers by RT-PCR was non significantly higher among tumors with lymph node involvement. Immunohistochemistryshowed a significantly lower nuclear expression and a higher cytoplasmatic expression of EphrinB2 in tumors with lymph node involvement. Conclusions: Immunohistochemical expression of EphrinB2 could be useful for the initial staging of papillary thyroid carcinoma.

Presence of autocrine hepatocyte growth factor-Met signaling and its role in proliferation and migration of SNU-484 gastric cancer cell line

Autocrine stimulation via coexpression of hepatocyte growth factor (HGF) and its receptor (Met) has been reported in many human sarcomas, but few in carcinomas. In this report, we found that one gastric cancer cell line, SNU-484, among 11 gastric cell lines tested has an autocrine HGF- Met stimulation. RT-PCR, ELISA and scattering assay using MDCK cells revealed that SNU-484 cells secreted a significant amount of active HGF (about 1.25 +/- 0.41 ng/24 h/106 cells) into conditioned medium. Resultantly, Met in this cell line was constitutively phosphorylated. Neutralizing antibodies against HGF reduced the tyrosine phosphorylation of Met, resulting in the inhibition of cell proliferation and migration (P <0.005). To the best of our knowledge, this is the first report on autocrine HGF-Met signaling in a gastric cancer cell line. Our observations with SNU-484 cells suggest that HGF is involved in the development and/or progression of some gastric carcinoma through an autocrine mechanism.

Transforming variant of Met receptor confers serum independence and anti-apoptotic property and could be involved in the mouse thymic lymphomagenesis

Met tyrosine kinase receptor, the receptor of hepatocyte growth factor/scatter factor (HGF/SF), is present in mouse tissues as two major isoforms differing by a 47-aminoacid segment in the juxtamembrane domain via alternative splicing of exon 14. We found that the smaller isoform of Met (Sm-Met) was highly transformable in both in vitro and in vivo tumorigenesis assays. In this report, close examination of the transforming activity of the Sm-Met showed that the expression of Sm-Met conferred the cells serum independence and anti- apoptotic property when treated with doxorubicin. These properties of Sm-Met seemed to be originated from its far longer maintenance of tyrosine kinase activity after the binding of HGF/SF. Interestingly, the longer maintenance of activated status was accompanied with more increase of tyrosine phosphorylation of Stat3 protein. Moreover, we have tried to find (an) animal tumorigenesis model(s) showing the increase in the expression of this transforming variant of Met. In gamma-ray-induced mouse thymic lymphoma model, the expression of the mRNAs for Sm-Met was significantly increased as well as those of wild type Met and HGF/SF, suggesting a possible role of the Sm-Met in tumorigenesis in vivo.