title: Actionable gene expression-based patient stratification for molecular targeted therapy in hepatocellular carcinoma.
abstract: BACKGROUND
  The effectiveness of molecular targeted agents is modest in hepatocellular carcinoma (HCC). Efficacy of molecular targeted therapies has been better in cancer patients with high expression of actionable molecules defined as cognate target molecules. However, patient stratification based on the actionable molecules dictating the effectiveness of targeted drugs has remained understudied in HCC. EXPERIMENTAL DESIGN & RESULTS: Paired tumor and non-tumoral tissues derived from a total of 130 HCC patients were studied. Real-time RT-PCR was used to analyze the mRNA expression of actionable molecules in the tissues. mRNA levels of EGFR, VEGFR2, PDGFRβ, FGFR1, and mTOR were up-regulated in tumors compared to non-tumors in 35.4, 42.3, 61.5, 24.6, and 50.0% of patients, respectively. Up-regulation of EGFR was observed at early stage and tended to gradually decrease toward late stages (BCLC stage A: 41.9%; B: 30.8%; C: 17.6%). Frequency of VEGFR2 expression in tumors at stage C was lower than that in the other stages (BCLC stage A: 45.9%; B: 41.0%; C: 29.4%). PDGFRβ and mTOR were observed to be up-regulated in more than 50% of tumors in all the stages whereas FGFR1 was up-regulated in only about 20% of HCC irrespective of stages. A cluster analysis of actionable gene expression revealed that HCC can be categorized into different subtypes that predict the effectiveness of molecular targeted agents and combination therapies in clinical trials. Analysis of in vitro sensitivity to sorafenib demonstrated that HCC cells with up-regulation of PDGFRβ and c-Raf mRNA are more susceptible to sorafenib treatment in a dose and time-dependent manner than cells with low expression of the genes.
  
  
  CONCLUSIONS
  mRNA expression analysis of actionable molecules could provide the rationale for new companion diagnostics-based therapeutic strategies in the treatment of HCC.
authors.affiliation: Cbs Bioscience Inc., Daejeon, Korea.
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Kwon
authors.forename: Namgyu
authors.initials: N
authors.lastname: Lee
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Park
authors.forename: Yun Suk
authors.initials: YS
authors.lastname: Yu
authors.forename: Jin Pyo
authors.initials: JP
authors.lastname: Kim
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Shin
authors.forename: Dong-Sik
authors.initials: DS
authors.lastname: Kim
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Joh
authors.forename: Dae Shick
authors.initials: DS
authors.lastname: Kim
authors.forename: Kwan Yong
authors.initials: KY
authors.lastname: Choi
authors.forename: Koo-Jeong
authors.initials: KJ
authors.lastname: Kang
authors.forename: Gundo
authors.initials: G
authors.lastname: Kim
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Moon
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000494:pharmacology*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D045744:Cell Line, Tumor; D016000:Cluster Analysis; D005260:Female; D015972:Gene Expression Regulation, Neoplastic / Q000187:drug effects*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009367:Neoplasm Staging; D009536:Niacinamide / Q000031:analogs & derivatives / Q000494:pharmacology; D010671:Phenylurea Compounds / Q000494:pharmacology; D047428:Protein Kinase Inhibitors / Q000494:pharmacology; D012333:RNA, Messenger / Q000235:genetics; D000077157:Sorafenib; D059467:Transcriptome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D012333:RNA, Messenger; D009536:Niacinamide; D000077157:Sorafenib