NGS in Gallbladder Cancer and Response to Treatment

NCT ID: NCT05404347

Last Updated: 2024-08-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-01-01

Study Completion Date

2026-12-31

Brief Summary

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Evidence suggests distinct models of molecular and pathologic progression, and a growing body of genetics data points to a heterogeneous collection of underlying mutations in key oncogenes and tumor suppressor genes. Although tumor genetics have been used to tailor individual treatment regimens and guide clinical decision making in other cancers, these principles have not been applied in gallbladder malignancy. Recent clinical trials with targeted therapies seem promising, although the relationships between subsets of patients with positive responses to therapy and tumor genetics remain unexplored.

Detailed Description

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Gallbladder carcinoma (GBC) is the most common type of biliary tract carcinoma and the third commonest digestive tract malignancy in India. GBC arises in the setting of chronic inflammation and the commonest source is cholesterol gallstones (in more than 75% patients). Other causes of chronic inflammation include primary sclerosing cholangitis, ulcerative colitis, liver flukes, chronic Salmonella typhi and paratyphi infections, and Helicobacter infection. Many other factors have also been identified such as ingestion of certain chemicals, exposures through water pollution, heavy metals and radiation exposure. Only a small fraction of GBC are associated with hereditary syndromes like Gardner syndrome, neurofibromatosis type I and hereditary non-polyposis colon cancer.

Of the multiple molecular alterations observed in GBC, it has not yet been possible to pinpoint which ones are the "driver" genes or controllers of the neoplastic process and to differentiate them from the "passenger" genes, those observed mainly in sporadic malignant tumors like GBC in which epigenetic alterations predominate. The most frequently mutated genes in GBC are: TP53 (41%), CDKN2A (28%) KRAS (19%), TERT (8%), CTNNB1 (8%) and PI3K (7%). The signalling pathway of the ERBB family is one of the most frequently mutated in GBC. These receptors participate in regulating cell proliferation, differentiation and survival. Their amplification mainly translates into protein over expression. The receptor HER2/NEU, after dimerization activates a large variety of downstream pathways such as RAS-RAF-MEK-ERK1/2 or PI3k-AKT-MTOR with great influence on cell proliferation. On the other hand, PTEN (phosphatase and tensin homolog) is a tumor suppressor gene that encodes a protein with phosphatase function that inactivates substrates like PI3K The absence of the PTEN functional protein permits the activation of PI3k with an even greater intensity than the activating mutation of PI3K itself. The uncontrolled production of PIP3 is one of the most important effectors of the PI3K/AKT pathway with mTOR stimulating protein synthesis that regulate apoptosis. The immunohistochemical expression of the PTEN protein is considered a good way to evaluate the functional state of the gene.

1. Comprehensive history and physical examination of the patients and all the details will be recorded in the preset proforma. All routine investigations as indicated including a biopsy to establish a diagnosis and CT/MRI/MRCP of the abdomen to measure the tumor dimensions and stage the disease before initiation of treatment will be recorded.
2. The archival tissue will be studied for expression of gene mutation by molecular analysis using Next Generation Sequencing. Patients treated between 2017-2020 where NGS information is available will also be included in retrospect. Their data will be extracted from the Medical records, and attempts will be made to contact them for follow-up.

Conditions

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Gallbladder Cancer

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Gallbladder Cancer

Patients with confirmed diagnosis of gallbladder cancer

Next generation sequencing

Intervention Type DIAGNOSTIC_TEST

NGS is carried out on DNA isolated from paraffin embedded tissue

Interventions

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Next generation sequencing

NGS is carried out on DNA isolated from paraffin embedded tissue

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Treatment naïve patients with histologically proven carcinoma of the gallbladder.

Exclusion Criteria

* No histological evidence of malignancy
* Pregnant and lactating women
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Banaras Hindu University

OTHER

Sponsor Role lead

Responsible Party

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Manoj Pandey

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Manoj Pandey, Ms, PhD

Role: PRINCIPAL_INVESTIGATOR

Banaras Hindu University

Locations

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Banaras Hindu University

Varanasi, Uttar Pradesh, India

Site Status RECRUITING

Countries

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India

Central Contacts

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Manoj Pandey, MS, PhD

Role: CONTACT

S K Singh, MD, DM

Role: CONTACT

Facility Contacts

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Manoj Pandey, MS, PhD

Role: primary

Manoj Pandey, MS, PhD

Role: backup

References

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Sanders G, Kingsnorth AN. Gallstones. BMJ. 2007 Aug 11;335(7614):295-9. doi: 10.1136/bmj.39267.452257.AD. No abstract available.

Reference Type BACKGROUND
PMID: 17690370 (View on PubMed)

Hsing AW, Gao YT, Han TQ, Rashid A, Sakoda LC, Wang BS, Shen MC, Zhang BH, Niwa S, Chen J, Fraumeni JF Jr. Gallstones and the risk of biliary tract cancer: a population-based study in China. Br J Cancer. 2007 Dec 3;97(11):1577-82. doi: 10.1038/sj.bjc.6604047. Epub 2007 Nov 13.

Reference Type BACKGROUND
PMID: 18000509 (View on PubMed)

Ishiguro S, Inoue M, Kurahashi N, Iwasaki M, Sasazuki S, Tsugane S. Risk factors of biliary tract cancer in a large-scale population-based cohort study in Japan (JPHC study); with special focus on cholelithiasis, body mass index, and their effect modification. Cancer Causes Control. 2008 Feb;19(1):33-41. doi: 10.1007/s10552-007-9067-8. Epub 2007 Sep 30.

Reference Type BACKGROUND
PMID: 17906958 (View on PubMed)

Trajber HJ, Szego T, de Camargo HS Jr, Mester M, Marujo WC, Roll S. Adenocarcinoma of the gallbladder in two siblings. Cancer. 1982 Sep 15;50(6):1200-3. doi: 10.1002/1097-0142(19820915)50:63.0.co;2-a.

Reference Type BACKGROUND
PMID: 7104965 (View on PubMed)

Weiss KM, Ferrell RE, Hanis CL, Styne PN. Genetics and epidemiology of gallbladder disease in New World native peoples. Am J Hum Genet. 1984 Nov;36(6):1259-78.

Reference Type BACKGROUND
PMID: 6517051 (View on PubMed)

Begnami MD, Fukuda E, Fregnani JH, Nonogaki S, Montagnini AL, da Costa WL Jr, Soares FA. Prognostic implications of altered human epidermal growth factor receptors (HERs) in gastric carcinomas: HER2 and HER3 are predictors of poor outcome. J Clin Oncol. 2011 Aug 1;29(22):3030-6. doi: 10.1200/JCO.2010.33.6313. Epub 2011 Jun 27.

Reference Type BACKGROUND
PMID: 21709195 (View on PubMed)

Tafe LJ, Tsongalis GJ. The human epidermal growth factor receptor 2 (HER2). Clin Chem Lab Med. 2011 Sep 15;50(1):23-30. doi: 10.1515/CCLM.2011.707.

Reference Type BACKGROUND
PMID: 21919545 (View on PubMed)

Ocana A, Vera-Badillo F, Al-Mubarak M, Templeton AJ, Corrales-Sanchez V, Diez-Gonzalez L, Cuenca-Lopez MD, Seruga B, Pandiella A, Amir E. Activation of the PI3K/mTOR/AKT pathway and survival in solid tumors: systematic review and meta-analysis. PLoS One. 2014 Apr 28;9(4):e95219. doi: 10.1371/journal.pone.0095219. eCollection 2014.

Reference Type BACKGROUND
PMID: 24777052 (View on PubMed)

Lavorato-Rocha AM, Anjos LG, Cunha IW, Vassallo J, Soares FA, Rocha RM. Immunohistochemical assessment of PTEN in vulvar cancer: best practices for tissue staining, evaluation, and clinical association. Methods. 2015 May;77-78:20-4. doi: 10.1016/j.ymeth.2014.12.017. Epub 2015 Jan 3.

Reference Type BACKGROUND
PMID: 25562748 (View on PubMed)

Sakr RA, Barbashina V, Morrogh M, Chandarlapaty S, Andrade VP, Arroyo CD, Olvera N, King TA. Protocol for PTEN expression by immunohistochemistry in formalin-fixed paraffin-embedded human breast carcinoma. Appl Immunohistochem Mol Morphol. 2010 Jul;18(4):371-4. doi: 10.1097/PAI.0b013e3181d50bd5.

Reference Type BACKGROUND
PMID: 20216404 (View on PubMed)

Djordjevic B, Hennessy BT, Li J, Barkoh BA, Luthra R, Mills GB, Broaddus RR. Clinical assessment of PTEN loss in endometrial carcinoma: immunohistochemistry outperforms gene sequencing. Mod Pathol. 2012 May;25(5):699-708. doi: 10.1038/modpathol.2011.208. Epub 2012 Feb 3.

Reference Type BACKGROUND
PMID: 22301702 (View on PubMed)

Rajput M, Chigurupati S, Purwar R, Shukla M, Pandey M. MAP kinase and mammalian target of rapamycin are main pathways of gallbladder carcinogenesis: results from bioinformatic analysis of next generation sequencing data from a hospital-based cohort (NCT05404347). Mol Biol Rep. 2022 Nov;49(11):10153-10163. doi: 10.1007/s11033-022-07874-4. Epub 2022 Aug 26.

Reference Type RESULT
PMID: 36018415 (View on PubMed)

Other Identifiers

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NGSGB1

Identifier Type: -

Identifier Source: org_study_id

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