PIK3CA mutations frequently coexist with EGFR/KRAS mutations in non-small cell lung cancer and suggest poor prognosis in EGFR/KRAS wildtype subgroup

PLoS One. 2014 Feb 12;9(2):e88291. doi: 10.1371/journal.pone.0088291. eCollection 2014.

Abstract

Purpose: PIK3CA gene encoding a catalytic subunit of the phosphatidylinositol-3-kinase (PI3K) is mutated and/or amplified in various neoplasia, including lung cancer. Here we investigated PIK3CA gene alterations, the expression of core components of PI3K pathway, and evaluated their clinical importance in non-small cell lung cancer (NSCLC).

Materials and methods: Oncogenic mutations/rearrangements in PIK3CA, EGFR, KRAS, HER2, BRAF, AKT1 and ALK genes were detected in tumors from 1117 patients with NSCLC. PIK3CA gene copy number was examined by fluorescent in situ hybridization and the expression of PI3K p110 subunit alpha (PI3K p110α), p-Akt, mTOR, PTEN was determined by immunohistochemistry in PIK3CA mutant cases and 108 patients without PIK3CA mutation.

Results: PIK3CA mutation was found in 3.9% of squamous cell carcinoma and 2.7% of adenocarcinoma. Among 34 PIK3CA mutant cases, 17 tumors harbored concurrent EGFR mutations and 4 had KRAS mutations. PIK3CA mutation was significantly associated with high expression of PI3K p110α (p<0.0001), p-Akt (p = 0.024) and mTOR (p = 0.001), but not correlated with PIK3CA amplification (p = 0.463). Patients with single PIK3CA mutation had shorter overall survival than those with PIK3CA-EGFR/KRAS co-mutation or wildtype PIK3CA (p = 0.004). A significantly worse survival was also found in patients with PIK3CA mutations than those without PIK3CA mutations in the EGFR/KRAS wildtype subgroup (p = 0.043).

Conclusions: PIK3CA mutations frequently coexist with EGFR/KRAS mutations. The poor prognosis of patients with single PIK3CA mutation in NSCLC and the prognostic value of PIK3CA mutation in EGFR/KRAS wildtype subgroup suggest the distinct mutation status of PIK3CA gene should be determined for individual therapeutic strategies in NSCLC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Carcinoma, Non-Small-Cell Lung / genetics*
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Class I Phosphatidylinositol 3-Kinases
  • DNA Mutational Analysis
  • Disease-Free Survival
  • ErbB Receptors / genetics*
  • Exons
  • Female
  • Genes, ras*
  • Humans
  • Lung Neoplasms / genetics*
  • Lung Neoplasms / mortality
  • Male
  • Middle Aged
  • Mutation*
  • Phosphatidylinositol 3-Kinases / genetics*
  • Positron-Emission Tomography
  • Prognosis
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Phosphatidylinositol 3-Kinases
  • Class I Phosphatidylinositol 3-Kinases
  • PIK3CA protein, human
  • EGFR protein, human
  • ErbB Receptors

Grant support

This study was supported by grants from Key Construction Program of the National “985” Project (Grant No. 985III-YFX0102), National Natural Science Foundation of China (Grants No. 81172218 and 81101761), the Science and Technology Commission of Shanghai Municipality (Program of Shanghai Subject Chief Scientist; Grant No. 12XD1402000), the Foundation of Shanghai Health Administration (Grant No. 20114206), and a Grant from Shanghai Hospital Development Center (Grant No. SHDC12012308). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.