CN106119398B - 预测乳腺癌患者对吡咯替尼治疗反应性的生物标记物 - Google Patents
预测乳腺癌患者对吡咯替尼治疗反应性的生物标记物 Download PDFInfo
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Abstract
本发明公开了PIK3CA基因和/或TP53基因上的特定位点在制备用于预测HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性的试剂盒中的用途。本发明通过对患者进行基因分型,分析PIK3CA基因和/或TP53基因上的特定位点和吡咯替尼对治疗反应性的相关性,发现通过鉴定PIK3CA基因和/或TP53基因上的特定位点是属于野生型还是突变型,即可判断HER2阳性晚期乳腺癌患者对吡咯替尼的治疗反应性。本发明的研究成果为HER2阳性晚期乳腺癌患者治疗方案的确定提供了一种可靠、灵敏的方式。
Description
技术领域
本发明属于生物医学领域,涉及一种预测乳腺癌患者对吡咯替尼治疗反应性的生物标记物及其用途。
背景技术
HER2阳性乳腺癌是凶险程度很高的一类乳腺癌亚型,20%-30%左右的乳腺癌患者为HER2阳性。
HER2又称人表皮生长因子受体-2,是一种原癌基因,在细胞膜上表达为HER2蛋白,负责传导信号促进细胞生长分裂。当HER2基因过度表达时,过多HER2蛋白出现在这些癌细胞表面,促进癌细胞分裂生长,形成HER2阳性肿瘤。HER2阳性往往预示着肿瘤进展快、容易发生淋巴结或血道转移,对内分泌治疗不敏感,预后不佳。据统计,HER2阳性乳腺癌患者即使接受放化疗等常规综合治疗,生存时间也仅为HER2阴性患者的一半。
吡咯替尼是一种新型口服不可逆HER1/HER2受体酪氨酸激酶抑制剂。研究表明,吡咯替尼可以用于治疗HER2表达阳性乳腺癌,但是临床疗效存在着显著的个体差异。由于晚期乳腺癌患者生存期很有限,因此尽早选择最可能有效的药物治疗对延长患者生存尤为重要。加之吡咯替尼为代表的靶向治疗药物比较昂贵,价格是普通化疗的数十倍,从卫生经济学的角度也要求选择最可能获益的患者接受靶向治疗。因此,寻找吡咯替尼疗效预测指标,指导个体化靶向治疗,是目前亟待解决的关键性临床问题。
发明内容
本发明提供了一种PIK3CA基因和/或TP53基因在制备用于预测HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性的试剂盒中的用途。
进一步,所述试剂盒通过检测PIK3CA基因和/或TP53基因特定位点的基因型来预测HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性。
本发明的研究结果表明,PIK3CA基因的特定位点和/或所述TP53基因特定位点的基因型为野生型时,则预测该HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性好;所述PIK3CA基因的特定位点和/或所述TP53基因特定位点的基因型为突变型时,则预测该HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性差。
进一步,上面所述的PIK3CA基因的特定位点选自以下位点组成的群组中的一个或者多个:c.3140、c.1035;所述TP53基因的特定位点选自以下位点组成的群组中的一个或者多个:c.706、c.659、c.375+2、c.318、c.497、c.392。
在本发明中,PIK3CA基因c.3140位点的野生型基因型为AA,突变型基因型为AG;PIK3CA基因c.1035位点的野生型基因型为TT,突变型基因型为TA;TP53基因c.706位点的野生型基因型为TT,突变型基因型为TA;TP53基因c.659位点的野生型基因型为AA,突变型基因型为AG;TP53基因c.375+2位点的野生型基因型为TT,突变型基因型为TG;TP53基因c.318位点的野生型基因型为CC,突变型基因型为CG;TP53基因c.497位点的野生型基因型为CC,突变型基因型为CG;TP53基因c.392位点的野生型基因型为AA,突变型基因型为AG。
进一步,所述试剂盒中包括检测PIK3CA基因和/或TP53基因特定位点的基因型的试剂。所述试剂可以为采用本领域已知的任何技术检测基因上的位点所需的试剂,只要其能够检测样本中PIK3CA基因、TP53基因的特定位点基因型即可。
现有技术中常用的用于检测基因上的位点基因型的方法,包括但不限于,限制性片断长度多态性分析、测序、单链构象多态性分析、错配的化学裂解、变性高效液相色谱、聚合酶链反应、阵列或其组合。所述阵列包括微阵列,包括(但不限于)平面微阵列或珠粒阵列;基因阵列;PCR阵列,包括TaqMan OpenArray。
本发明提供了一种预测HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性的试剂盒,所述试剂盒包括检测PIK3CA基因和/或TP53基因特定位点的基因型的试剂。所述试剂可以为采用本领域已知的任何技术检测基因上的位点所需的试剂,只要其能够检测样本中PIK3CA基因、TP53基因的特定位点基因型即可。
进一步,所述试剂盒中包括利用限制性片断长度多态性分析、测序、单链构象多态性分析、错配的化学裂解、变性高效液相色谱、聚合酶链反应、阵列来检测PIK3CA基因和/或TP53基因特定位点的基因型的过程中使用的试剂。
进一步,本发明中,PIK3CA基因的特定位点选自以下位点组成的群组中的一个或者多个:c.3140、c.1035;所述TP53基因的特定位点选自以下位点组成的群组中的一个或者多个:c.706、c.659、c.375+2、c.318、c.497、c.392。
本发明优点和有益效果如下:
(1)本发明首次发现了PIK3CA基因和/或TP53基因特定位点与HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性具有相关性,为临床患者的个体化靶向治疗提供了预测指标。
(2)本发明预测吡咯替尼治疗反应性的方法简单,核酸样本来源方便,抽取外周血即可进行检测。该方法对检测设备要求低、成本低廉,有利于临床推广。
附图说明
图1显示PIK3CA和TP53野生型患者与PIK3CA或TP53突变患者的Kaplan-Meier曲线。
具体的实施方式
下面通过具体的实施例进一步说明本发明,应注意,如无特别指出,本发明的实施例仅用于解释本发明,并不意味着限定本发明的保护范围。
实施例1基因位点与吡咯替尼药效的相关性
1.研究对象:HER2阳性晚期乳腺癌患者97例。入选的患者经组织学或细胞学确证为HER2阳性晚期乳腺癌患者,所有患者均提供了知情同意书。
2.用药方法:吡咯替尼400mg,每日一次,口服。28天为1周期,每2周期复查影像学检查,评价疗效。
3.实验方法
3.1血浆游离DNA提取
3.1.1外周血样本分离
(1)采集患者外周血1-2管(5mL/管)于EDTA抗凝管中,轻柔上下颠倒(防止细胞破裂)6-8次充分混匀,在采血当天4-6小时内进行以下处理;
(2)在4℃条件下1600g离心10分钟,离心后将上清(血浆)分装到多个1.5mL/2mL离心管中,在吸取过程中不能吸到中间层白细胞;
(3)在4℃条件下16000g离心10分钟,去除残余细胞,将上清(血浆)转移到新的1.5mL/2mL离心管中,不能吸到管底白细胞,即得到分离后所需血浆;
(4)血浆样本处理完后,分离得到的血浆及剩余血细胞均保存到-80℃冰箱中,避免反复冻融。
3.1.2血浆游离DNA提取(采用QIAamp Circulating Nucleic Acid Kit)
(1)加30μL蛋白酶K至1.5mL离心管中;
(2)加入300μL血浆;
(3)加入240μL Buffer ACL和1.68μL Carrier RNA(0.2μg/μL),涡旋振荡30s,60℃温浴30min,温浴期间适当取出振荡;
(4)加入540μL Buffer ACB,涡旋振荡15-30s,冰上或-20℃冰箱放置5min;
(5)取700μL血浆混合物加入过滤柱中,7500rpm离心30s;
(6)过滤柱空甩8000rpm,1min;
(7)加入600μL Buffer ACW1,8000rpm,1min离心洗涤;
(8)加入700μL Buffer ACW2,8000rpm,1min离心洗涤;
(9)加入700μL无水乙醇,8000rpm,1min离心洗涤;
(10)过滤柱空甩14.000rpm,3min;
(11)把过滤柱放入新收集管中,打开盖子,56℃金属浴10min;
(12)将柱子放入新离心管汇总,加入60μL Buffer AVE回溶3min;
(13)14.000rpm离心1min,Qubit(Invitrogen,the Quant-iTTMdsDNA HS AssayKit)定量质控所提取的血浆游离DNA。
3.2文库制备及超高深度测序
对DNA片段进行末端修复;
对DNA片段末端加A;
连接Adapter文库接头:文库接头(Adapter)是指经过设计的一段碱基序列,作用在于DNA文库扩增时与引物相结合,使DNA扩增进行,并且在上机测序时与Standard Anchor相结合,利于探针与待测序位点结合辅助DNA测序进行。
文库进行第一轮PCR扩增;
扩增后文库质控并进行目标区域探针捕获杂交;
杂交文库进行第二轮PCR扩增;
其中,引物序列为文库扩增的通用接头引物:
上游引物:
5’-AATGATACGGCGACCACCGAGATCTACACTCTTTCCCTACACGACGCTCTTCCGATCT-3’;
下游引物:
5’-CAAGCAGAAGACGGCATACGAGATGTGACTGGAGTTCAGACGTGTGCTCTTCCGATCT-3’。
探针是针对TP53和PIK3CA所有外显子序列,探针序列是根据两个基因序列设计,长度120bp,探针设计是本领域技术人员熟知的技术。
文库定量及质控;Illumina HiSeq3000上机测序
3.3下机数据生物信息分析
获得下机数据后需进行如下生物信息分析,得到最终的变异结果
SOAPnuke filter:去除低质量reads;
与reference序列比对,产生bam文件;
标记重复序列;
比对结果不好的序列重新比对,并校正质量值;
去除错配序列;
分析下机数据QC:统计芯片的捕获效率、有效reads数、平均深度、重复率、覆盖度及未被覆盖的区间等信息;
寻找变异:Call SNV/InDel/SV/CNV:
用mutect、varScan、somVar流程call somatic SNV变异;
用gatk、varScan、somVar流程call somatic InDel变异;
用contra.py流程call CNV;
用somVar流程call SV;
4.实验结果
4.1基因分型
97例患者中PIK3CA基因和TP53基因上存在的位点突变的统计情况如表1所示:
表1位点突变信息
| 基因 | cHGVS | pHGVS_ad | 所占比例 |
| PIK3CA | c.[3140A>G] | p.[H1047R] | 23/27 |
| PIK3CA | c.[1035T>A] | p.[N345K] | 4/27 |
| TP53 | c.[706T>A] | p.[Y236N] | 5/32 |
| TP53 | c.[659A>G] | p.[Y220C] | 6/32 |
| TP53 | c.[375+2T>G] | 3/32 | |
| TP53 | c.[318C>G] | p.[S106R] | 4/32 |
| TP53 | c.[497C>G] | p.[S166*] | 8/32 |
| TP53 | c.[392A>G] | p.[N131S] | 6/32 |
4.2基因位点突变与HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性的相关性分析
结果显示,27例PIK3CA突变患者的吡咯替尼缓解率(ORR=CR+PR)为0%,70例PIK3CA野生型患者的ORR为45.7%(32/70;p=0.114卡方检验)。同样,32例TP53突变患者的ORR为0%,65例TP53野生型患者的ORR为49.2%(32/65;p=0.054卡方检验)。联合PIK3CA与TP53结果分析,PIK3CA或TP53突变型患者的ORR为0%,而PIK3CA及TP53均为野生型患者的ORR为60.0%(p=0.013,卡方检验),且二者mPFS存在显著差异(14.9vs.46.1周,p=0.015,log-rank test),结果见表2和图1所示。
表2分析结果
上述实施例的说明只是用于理解本发明的方法及其核心思想。应当指出,对于本领域的普通技术人员来说,在不脱离本发明原理的前提下,还可以对本发明进行若干改进和修饰,这些改进和修饰也将落入本发明权利要求的保护范围内。
Claims (3)
1.检测PIK3CA基因和/或TP53基因的SNP位点基因型的试剂在制备用于预测HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性的试剂盒中的用途,其特征在于,PIK3CA基因的SNP位点选自以下SNP位点组成的群组中的一个或者多个:c.3140、c.1035;TP53基因的SNP位点选自以下SNP位点组成的群组中的一个或者多个:c.706、c.659、c.375+2、c.318、c.497、c.392;PIK3CA基因的SNP位点和/或TP53基因的SNP位点的基因型为野生型时,则预测该HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性好;PIK3CA基因的SNP位点和/或TP53基因的SNP位点的基因型为突变型时,则预测该HER2阳性晚期乳腺癌患者对吡咯替尼治疗反应性差;PIK3CA基因c.3140位点的野生型基因型为AA,突变型基因型为AG;PIK3CA基因c.1035位点的野生型基因型为TT,突变型基因型为TA;TP53基因c.706位点的野生型基因型为TT,突变型基因型为TA;TP53基因c.659位点的野生型基因型为AA,突变型基因型为AG;TP53基因c.375+2位点的野生型基因型为TT,突变型基因型为TG;TP53基因c.318位点的野生型基因型为CC,突变型基因型为CG;TP53基因c.497位点的野生型基因型为CC,突变型基因型为CG;TP53基因c.392位点的野生型基因型为AA,突变型基因型为AG。
2.根据权利要求1所述的用途,其特征在于,所述试剂盒中包括检测PIK3CA基因和/或TP53基因SNP位点的基因型的试剂。
3.根据权利要求2所述的用途,其特征在于,所述试剂盒中包括利用限制性片断长度多态性分析、测序、单链构象多态性分析、错配的化学裂解、变性高效液相色谱、聚合酶链反应、阵列来检测PIK3CA基因和/或TP53基因SNP位点的基因型的过程中使用的试剂。
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Non-Patent Citations (3)
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| Clinical implications of genomic profiles in metastatic breast cancer with a focus on TP53 and PIK3CA,the most frequently mutated genes;Ji-Yeon Kim等;《Oncotarget》;20170303;第8卷(第17期);第27997-28007页 * |
| Phase I study and biomarker analysis of pyrotinib, a novel irreversible Pan-ErbB receptor tyrosine kinase inhibitor,in patients with human epidermal growth factor receptor 2-postive metastatic breast cancer;Ma F等;《J clin oncol》;20170512;第35卷(第27期);第3105-3112页 * |
| PIK3CA and TP53 gene mutations in human breast cancer tumors frequently detected by lon Torrent DNA sequencing;Xusheng Bai等;《PLOS ONE》;20140611;第9卷(第6期);第e99306页 * |
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