Platinbasierte Chemotherapie ist die effektivste Chemotherapie für das fortgeschrittene Nebennierenrindenkarzinom (ACC). Excision repair cross complementing group 1 (ERCC1) spielt eine entscheidende Rolle bei der Reparatur durch Platin entstandener DNA-Schäden. Zwei Studien die die Rolle von ERCC1 per Immunhistochemie als prädiktiver Marker für das Ansprechen auf platinbasierte Chemotherapie beim ACC untersuchten kamen zu sich widersprechenden Ergebnissen. Beide Studien nutzten den ERCC1-Antikörper Klon 8F1 der sich später als nicht spezifisch herausstellte. Das Ziel der Doktorarbeit war die Evaluation von ERCC1 mit einem neuen hoch spezifischen Antikörper in einer großen Kohorte von Patienten mit ACC. Material und Methoden: 146 Patienten mit verfügbaren FFPE-Schnitten wurden eingeschlossen. Alle Patienten erhielten eine platinbasierte Chemotherapie im Median für 6 Zyklen, nämlich Cisplatin (n=131) oder Carboplatin (n=15), in den meisten Fällen in Kombination mit Etoposid (n=144 , Doxorubicin (n=131) und Mitotane (n=131). Die Immunhistochemische Färbung wurde mit dem neuen Antikörper Klon 4F9 durchgeführt. Der Zusammenhang zwischen ERCC1-Expression und klinischen Parametern, Therapieansprechen, progressionsfreiem Überleben und Gesamtüberleben wurde analysiert. Ergebnisse: Eine hohe ERCC1-Expression wurde in 66% der Tumorproben beobachtet. Während der Chemotherapie zeigte sich bei 43 Pateinten ein Therapieansprechen (29,5%), bei 49 Patienten eine Stabilisierung der Erkrankung (33,6%), bei 8 Patienten ein gemischtes Ansprechen (5,5%) und bei 46 Pateinten ein Krankheitsprogress (31,5%), ohne Zusammenhang zur ERCC1-Expression. Auch zeigte sich kein signifikanter Zusammenhanf zwischen der ERCC1-Expression und dem progressionsfreien Überleben (Median 6.5 vs. 6 Monate, P=0.33, HR=1.23, 95%CI=0.82-2.0) oder dem Gesamtüberleben. Zusammenfassung: Es besteht kein Zusammenhang zwischen der ERCC1-Expression und der Platinsensitivität beim Nebennierenrindenkarzinom. Somit werden andere Biomarker zur Therapieentscheidung benötigt. / Objective: Platinum-based chemotherapy (PBC) is the most effective cytotoxic treatment for advanced adrenocortical carcinoma (ACC). Excision repair cross complementing group 1 (ERCC1) plays a critical role in the repair of platinum-induced DNA damage. Two studies investigating the role of ERCC1 immunostaining as a predictive marker for the response to PBC in ACC had reported conflicting results. Both studies used the ERCC1-antibody clone 8F1 that later turned out to be not specific. The aim of this study was to evaluate the predictive role of ERCC1 with the new specific antibody in a larger series of ACC. Design and methods: 146 ACC patients with available FFPE slides were investigated. All patients underwent PBC (median cycles=6), including cisplatin (n=131) or carboplatin (n=15), in most cases combined with etoposide (n=144), doxorubicin (n=131) and mitotane (n=131). Immunostaining was performed with the novel ERCC1-antibody clone 4F9. The relationship between ERCC1 expression and clinico-pathological parameters, as well as best objective response to therapy and progression-free survival (PFS) during PBC was evaluated. Results: High ERCC1 expression was observed in 66% of ACC samples. During PBC, 43 patients experienced objective response (29.5%), 49 stable disease (33.6%), 8 mixed response (5.5%) and 46 progressive disease (31,5%) without any relationship with the ERCC1 immunostaining. No significant correlation was also found between ERCC1 expression and progression-free survival (median 6.5 vs 6 months, P=0.33, HR=1.23, 95%CI=0.82-2.0). Conclusion: ERCC1 expression is not directly associated with sensitivity to PBC in ACC. Thus, other predictive biomarkers are required to support treatment decisions in patients with ACC.

No description available.

Melanoma is a highly aggressive tumour with a poor prognosis for patients with advanced disease because it is resistant to current therapies. Therefore, the development of novel strategies for melanoma treatment is important. The characterization of the molecular mechanisms underlying melanoma proliferation, progression, and survival could help the development of novel targeted melanoma treatments. The MAPK and PI3K pathways both play important roles in melanoma progression. In the MAPK pathway, DUSP6, which acts as a phosphatase to negatively control the activation of ERK1/2, is involved in the development of human cancers. The MAPK pathway also regulates expression of the DNA repair gene ERCC1 following EGF treatment. ERCC1 is essential for nucleotide excision repair, which is one of the major systems for removal of cisplatin induced DNA lesions. The aims of this project were: 1, to investigate the molecular changes in our immortal mouse melanocyte cell lines that were needed for them to form tumours in a xenograft model; 2, to investigate whether the MAPK pathway regulates ERCC1 following cisplatin treatment and protects melanoma cells from death. Through comparison of the RAS/RAF/MEK/ERK (MAPK) and the PI3K/AKT (AKT) signalling pathways between our immortal mouse melanocyte cell lines and their tumour derivatives in our xenograft model, we identified a molecularly distinct subtype of mouse melanoma characterized by reduced ERK and AKT activity and increased expression of DUSP6. Functional analyses employing ectopic overexpression indicated that increased expression of DUSP6 enhanced anchorage independent growth ability and invasive ability in our mouse melanocytes, suggesting that increased DUSP6 expression may contribute to melanoma formation in the xenograft assay. We also demonstrated that higher expression of p-ERK suppressed invasion, but not anchorage independent growth, in our subtype of mouse melanoma by enforced expression of constitutively active MEK1 and MEK2. In addition, the role of DUSP6 in classical human melanoma was investigated in this Genetic changes in melanoma progression study. Inhibition of anchorage independent growth and invasion were observed after exogenous expression of DUSP6 in human melanoma cells. This suggested that DUSP6 played different roles in classic human melanoma than in our distinct subtype of mouse melanoma. Our study also investigated the phosphorylation level of ERK1/2 and the mRNA and protein level of ERCC1 and its partner XPF in the human melanoma cell line following cisplatin treatment. Significant increases in expression of p-ERK, ERCC1 and XPF were found in cisplatin treated cells. Moreover, a MEK inhibitor inhibited ERCC1 induction by cisplatin, but did not significantly affect XPF induction. This suggested that the MAPK pathway was involved in regulation of ERCC1 but not XPF. Furthermore, the DUSP6 level decreased after cisplatin treatment and overexpression of DUSP6 inhibited ERCC1 and XPF induction and reduced resistance to cisplatin. DUSP6 seems to play a crucial role in resistance of melanoma to cisplatin. In addition, a novel larger ERCC1 transcript was identified in human cell lines and was found to be upregulated by cisplatin. The ratio of larger ERCC1 transcript relative to the normal ERCC1 transcript increased following cisplatin treatment. The functions of this larger ERCC1 transcript in cisplatin resistance deserve further study.

Melanoma is one of the most common cancers in the world. For primary melanoma, early diagnosis and surgical excision are effective treatments but, despite the new targeted therapies and immunotherapies, there is still a need for more effective treatment options to improve overall survival for patients with metastatic melanoma. Chemotherapy with genotoxic agents remains the main approach for most cancers, but DNA repair pathways in cancer cells reduce their effectiveness. So disruption of key DNA repair pathways, such as nucleotide excision repair (NER), could be an effective option to combine with chemotherapy for melanoma. The structure-specific endonuclease ERCC1-XPF, which heterodimerises through the C-terminal helix-hairpin-helix (HhH)2 domains of both proteins, is essential for NER. The aim of my project was to determine the mechanism involved in regulating the level of the ERCC1-XPF heterodimer with a view to disrupting NER activity. The project started by determining the ERCC1 and XPF response in six melanoma cell lines to the chemotherapeutic cisplatin at the mRNA and protein levels. Although the mRNA and protein levels of both ERCC1 and XPF increased, there was variable consistency between the cell lines, raising the possibility that post translational modification may play an important role in the regulation of ERCC1- XPF activity. We chose to focus on ubiquitination, because it can affect a protein’s activity at both expression and activation levels and several examples of ubiquitinated DNA repair proteins were known. In the pilot study we found that ERCC1 was accumulated after proteasome inhibitor treatment and decreased by treatment with a translation inhibitor in two melanoma cell lines, suggesting that ERCC1 may be ubiquitinated. By cotransfecting His-tagged ubiquitin and non-tagged ERCC1 constructs into melanoma cells and performing an ubiquitin assay, we found that ERCC1 was degraded by the proteasome system through polyubiquitination or multiple monoubiquitination. To determine the nature of the ubiquitination type, we mutated each of the seven Lys residues on ubiquitin and carried out additional assays with ubiquitin single and combination mutants, and discovered that Lys33 was most likely involved in the proteasome dependent degradation of ERCC1. By immunoprecipitation with an antibody to linear ubiquitin from melanoma cell extracts containing a ubiquitin construct with all seven Lys residues mutated to Arg, we found that the N-Met of ubiquitin was also most likely involved in ERCC1 ubiquitination. To determine which Lys of ERCC1 is used by ubiquitin, we did another series of in vivo ubiquitin assays with full length and truncated ERCC1 constructs and found that the key amino acid is most likely within the C-terminal XPF binding domain of ERCC1. By cotransfecting the full length ERCC1 and ERCC1 truncation constructs together with full length XPF, we showed that the ubiquitination of ERCC1 was not an artefact resulting from overexpression of ERCC1 alone and that the stability of XPF was dependent on the overexpression and stability of ERCC1. We then made single lysine and lysine combination mutants in the XPF binding domain of ERCC1 and found that none of the lysines were essential for ubiquitination of ERCC1, indicating that a non- lysine amino acid might be used for ubiquitination. However, using a transfection-based NER assay in ERCC1-deficient cells, we found that ubiquitination of Lys 295 could be involved in regulating the DNA repair activity of ERCC1-XPF. The in vivo ubiquitin assay result after cotransfection of ERCC1 and XPF, which showed that XPF was dependent on the presence of ERCC1 for stability, but not vice versa, was inconsistent with previous published data suggesting that heterodimerization was essential for the stability of both proteins. Instead we hypothesised that homodimerization of ERCC1 might be another mechanism to keep ERCC1 stable and obtained evidence for this at the overexpression level by immunoprecipitation following cotransfection of Myc-tagged ERCC1 and Flag-tagged ERCC1 or ERCC1 truncations, which was supported at the endogenous expression level by size exclusion chromatography on melanoma cell extracts to identify ERCC1 in different molecular weight fractions. In the previous in vivo ubiquitin assay, we found that levels of transfected full length ERCC1 and XPF were dramatically reduced by cotransfection with the Flag-tagged ERCC1 (220-297) construct that just contains the XPF binding domain of ERCC1. This led to another hypothesis, that the ERCC1 (220-297) peptide can decrease endogenous levels of ERCC1 and XPF and so be a potential drug in combination with cisplatin chemotherapy. This hypothesis was verified in stable transgenic cell lines expressing ERCC1 (220-297) which showed reduced levels of ERCC1 and XPF and of NER and increased sensitivity to cisplatin and UV irradiation. Based on the above results and supporting bioinformatics analysis we have made the following conclusions: ERCC1 is regulated by the ubiquitin-proteasome degradation pathway through linkages most likely involving Lys33 and N-Met; the XPF binding domain is most likely the key domain for ERCC1 ubiquitination; XPF stability is dependent on the presence of ERCC1 and seems affected by ERCC1 ubiquitination; ERCC1 seems to be ubiquitinated in a non-conventional lysine-independent manner and ubiquitination of Lys 295 might be involved in the regulation of the DNA repair activity of ERCC1- XPF; homodimerization is most likely a novel mechanism to keep ERCC1 stable; the ERCC1 (220-297) peptide can destabilise both ERCC1 and XPF and could be a potential drug in combination with genotoxic therapies.

The characterization of rodent cell mutants hypersensitive to UV light has led to the identification of at least 10 complementation groups all defective in some aspect of the first step in the excision repair of UV damaged DNA. The phenotypic properties of these mutants are thus of considerable importance to our understanding of DNA repair. In recent years five different excision repair cross complementing (ERCC) human genes have been isolated which correct the DNA repair deficiency in a number of Chinese Hamster Ovary (CHO) cell mutants and at least three of these genes also complement the repair deficiency in cells from patients suffering from xeroderma pigmentosum (XP), Cockayne syndrome (CS) and/or Trichothiodystrophy (TTD). Adenovirus (Ad) infection of rodent cells is generally semi-permissive and does not give rise to viral progeny, such that Ad reactivation in CHO cells has not previously been reported. This study utilizes the ability of CHO cells and human cells to replicate viral DNA in order to examine the reactivation of Ad in several CHO as well as human cell DNA repair mutants. Unirradiated and UV-irradiated suspensions of Ad were assayed for their ability to synthesize viral DNA following the infection of several CHO and human cell DNA repair mutants. The cell types examined included CHO cell mutants from complementation groups 1, 2, 3, 4, 5, 6, 9, 10 as well as human XP and tumour cells. The survival of viral DNA synthesis for UV-irradiated Ad was significantly reduced in several of the CHO and human cell mutants compared to that in normal cells. Cell mutants showing a reduced UV survival for this viral function included CHO cell mutants from complementation groups 1 to 6, XP cells and the 2 human tumour cell lines examined. This reduced host cell reactivation (HCR) for Ad indicates a reduced capacity for the repair of viral DNA in these cell types. DNA replication for unirradiated virus was also reduced for some of the mutants, especially the UV20 CHO cell mutant from complementation group 1, suggesting a deficiency for both DNA replication and repair in these cells. This study also used the recombinant viruses Ad5(denV) and Ad5(ERCC1) as vectors to examine the effect of the bacteriophage T 4 denV gene and the human ERCC1 gene on viral reactivation in the various cell mutants. UV survival of Ad5(denV) was increased compared to that of the control Ad5(LacZ) following infection of all the CHO and human cell types examined, indicating the denV gene product increases repair of Ad in both repair-proficient and repair-deficient cells. UV survival of Ad5(ERCC1) was increased compared to that of control Ad5(LacZ) following infection of the CHO mutant UV20 from complementation group 1, as well as all CHO cell types having normal HCR for AdS. However, UV survival of Ad5(ERCC1) was not increased compared to Ad5(LacZ) following infection of CHO mutants from complementation groups 2 to 6 and 10. These results support a specific complementation of the UV20 repair defect by ERCC1 and suggest that the human ERCC1 gene is more efficient than its hamster counterpart in repair-proficient CHO cells or that the ERCC 1 product is rate-limiting for the excision repair process in CHO cells. UV survival of Ad5(ERCC1) was also increased compared to Ad5(LacZ) in the normal human fibroblast cells and human tumour cells, but not in the XP (group D) cells. The kinetics of viral DNA synthesis and viral protein synthesis for unirradiated Ad5(denV) and Ad5(ERCC1) was also investigated following the infection of human and rodent cells. The deficiency in viral DNA synthesis and viral protein synthesis found for AdS(LacZ) following infection of rodent compared to human cells is partially complemented by either denV or ERCC1. The more marked deficiency in viral DNA synthesis of the UV20 CHO mutant was also complemented by either ERCC1 or denV, suggesting an ability of these genes to function in both repair and replication of viral DNA. / Thesis / Master of Science (MS)

Excision Repair Cross-Complementation group 1 (ERCC1) est une enzyme de réparation de l’ADN fréquemment déficiente dans le cancer bronchique non-à-petites cellules. Bien qu’une expression faible d’ERCC1 soit prédictive de réponse aux sels de platine, l’efficacité des chimiothérapies à base de platine est limitée par leur toxicité et l’apparition de résistance, justifiant la nécessité de stratégies thérapeutiques alternatives. Par ailleurs, l’absence de test compagnon diagnostic permettant d’évaluer la fonctionnalité d’ERCC1 dans la pratique clinique empêche actuellement toute thérapie personnalisée basée sur le statut ERCC1.Afin d’identifier de nouvelles stratégies thérapeutiques pour les tumeurs ERCC1-déficientes en exploitant le concept de létalité synthétique, des screens à haut-débit , utilisant des composés pharmaceutiques ou par ARN interférence, ont été réalisés dans un modèle isogénique de CBNPC déficient en ERCC1. Cette approche a permis d’identifier plusieurs inhibiteurs de poly(ADP-ribose) polymerase 1 et 2 (PARP1/2), tels l’opalarib (AZD2281), le niraparib (MK-24827) et BMN 673 comme sélectifs pour les cellules ERCC1-déficientes. Les mécanismes sous-tendant cette sensibilité sélective ont été étudiés, et les résultats suivants ont été mis en évidence : (i) les cellules ERCC1-déficientes présentent un blocage prolongé en phase G2/M après exposition à l’olaparib ; (ii) l’isoforme 202 d’ERCC1, dont le rôle a été récemment mis en évidence dans la résistance aux sels de platine, module également la sensibilité aux inhibiteurs de PARP ; (iii) la déficience en ERCC1 est épistatique avec les défauts de recombinaison homologue (RH), malgré une capacité normale des cellules ERCC1-déficientes à former des foyers RAD51 ; ceci suggère qu’ERCC1 pourrait intervenir dans la réparation d’une lésion de l’ADN induite par l’inhibiteur de PARP1/2 en amont de l’invasion du brin d’ADN lors de la RH ; (iv) l’inhibition de l’expression de PARP1 par ARN interférence permet de restaurer la résistance aux inhibiteurs de PARP1/2, dans les cellules ERCC1-déficientes uniquement. Ces résultats suggèrent que les inhibiteurs de PARP1/2 pourraient représenter une nouvelle stratégie thérapeutique chez les patients dont la tumeur est déficiente en ERCC1 et un essai clinique va être mis en place pour évaluer cette hypothèse.Afin d’explorer la présence de biomarqueurs de la fonctionnalité d’ERCC1, quatre approches ont été entreprises en parallèle dans le modèle isogénique de CBNPC déficient en ERCC1: (i) irradiation aux UV, afin d’évaluer la voie NER (Nucleotide Excision Repair); (ii) séquençage d’exome, dans le but de rechercher une signature génomique (ADN) ; (iii) analyse du transcriptome cellulaire, pour identifier des modifications d’expression d’ARN ; et (iv) SILAC (Stable Isotope Labeling by Amino acids in Cell culture) afin de comparer le protéome des cellules ERCC1-déficientes et ERCC1-proficientes. Ces approches ont permis d’identifier une potentielle signature génomique, ainsi que de biomarqueurs d’activité – guanine deaminase (GDA) et nicotinamide phosphoribosyltransferase (NAMPT). De plus amples validations et investigations mécanistiques de ces observations préliminaires sont actuellement requises. / Excision Repair Cross-Complementation group 1 (ERCC1) is a DNA repair enzyme that is frequently deficient in non-small cell lung cancer (NSCLC). Although low ERCC1 expression correlates with platinum sensitivity, the clinical effectiveness of platinum therapy is limited - mainly by toxicities and occurrence of resistance - highlighting the need for alternative treatment strategies. In addition, the lack of a reliable assay evaluating ERCC1 functionality in the clinical setting currently precludes personalising therapy based on ERCC1 status. To discover new synthetic lethality-based therapeutic strategies for ERCC1-defective tumours, high-throughput drug and siRNA screens in an isogenic NSCLC model of ERCC1 deficiency were performed. This approach identified multiple clinical poly(ADP-ribose) polymerase 1 and 2 (PARP1/2) inhibitors such as olaparib (AZD-2281), niraparib (MK-4827) and BMN 673 as being selective for ERCC1 deficiency. The mechanism underlying ERCC1-selective effects was dissected by studying molecular biomarkers of tumour cell response, and revealed that: (i) ERCC1-deficient cells displayed a significant delay in double-strand break repair associated with a profound and prolonged G2/M arrest following PARP1/2 inhibitor treatment; (ii) ERCC1 isoform 202, which has recently been shown to mediate platinum sensitivity, also modulated PARP1/2 sensitivity; (iii) ERCC1-deficiency was epistatic with homologous recombination deficiency, although ERCC1-deficient cells did not display a defect in RAD51 foci formation. This suggests that ERCC1 might be required to process PARP1/2 inhibitor induced DNA lesions prior to DNA strand invasion; and (iv) PARP1 silencing restored PARP1/2 inhibitor resistance in ERCC1-deficient cells but had no effect in ERCC1-proficient cells, supporting the hypothesis that PARP1 might be required for the ERCC1 selectivity of PARP1/2 inhibitors. This study indicated that PARP1/2 inhibitors as a monotherapy could represent a novel therapeutic strategy for NSCLC patients with ERCC1-deficient tumours, and a clinical protocol is being written to evaluate this hypothesis.To investigate whether a surrogate biomarker of ERCC1 functionality could be developed, four parallel approaches were undertaken in the ERCC1-isogenic NSCLC model: (i) UV irradiation, to evaluate the Nucleotide Excision Repair (NER) pathway; (ii) whole exome sequencing, to look for an ERCC1-associated genomic scar at the DNA level; (iii) transcriptomic analysis, to investigate changes at the RNA expression level; and (iv) SILAC (Stable Isotope Labeling by Amino acids in Cell culture) analysis, to compare proteomic profiles between ERCC1-proficient and ERCC1-deficient cells. These approaches allowed the identification of putative genomic signature and potential metabolic surrogate biomarkers - guanine deaminase (GDA) and nicotinamide phosphoribosyltransferase (NAMPT). Further validation and mechanistic investigations of these latter preliminary observations are warranted.

Nucleotide excision repair (NER) is one of the major repair systems for removal of DNA lesions. The NER pathway has evolved mainly to repair UV-induced DNA damage and is also active against a broad range of endogenously generated oxidative lesions. Defects in NER result in the human inherited disorder xeroderma pigmentosum (XP), which is characterised by UV hypersensitivity and a 1000-fold increased risk of skin cancer. ERCC1 is essential for the NER pathway where it acts in a complex with the XPF protein to make the incision 5' to the DNA lesion. The normal 1.1kb Ercc1 transcript is expressed in all tissues. Our group has discovered a second larger 1.5 kb transcript, which initiates from an alternative promoter, and is the most abundant Ercc1 transcript in mouse skin. The aims of this project were: 1, To investigate the role of ERCC1 and of the 1.5kb skin specific Ercc1 transcript in protecting the skin against UV-induced DNA damage. 2, To study the importance of ERCC1 in melanoma skin cancer and investigate ERCC1as a possible target for therapy against melanoma. Using a panel of Ercc1 wild-type and deficient cells, we established a quantitative western blotting system to study the expression of ERCC1 in a range of mouse tissues and mouse and human cell types. Although the skin-specific Ercc1 transcript was found to be present at much higher levels in the skin of albino compared to pigmented mouse strains, this did not result in an elevated level of ERCC1 protein. We were also unable to demonstrate that UV-irradiation, or other stress-inducing treatments resulted in increased levels of ERCC1 protein in cultured mouse keratinocytes. We investigated the DNA methylation status of the normal Ercc1 promoter and that of two potential upstream promoter regions that were candidates for the source of the 1.5kb skin-specific Ercc1 transcript. We found no evidence that they were the source and, instead, used 5' RACE analysis to locate the skin-specific promoter to a polymorphic region 500bp upstream of the normal initiation site. In albino strains this region contains a SINE element, which we hypothesize could be involved in the production of the skin-specific Ercc1 transcript. We also investigated the protein level of ERCC1 and other DNA repair proteins, including XPF, MSH2, MSH6 and MLH1 in human melanoma cells and ovarian tumour cells. Significantly elevated protein levels of ERCC1 and XPF, as well as the mismatch repair protein MLH1 were found in melanoma cells. This could possibly contribute to the higher resistance to chemotherapy in melanoma, although the melanoma cell lines we tested did not show increased resistance to UV and cisplatin compared to the ovarian cancer cells tested. When Ercc1 proficient mouse melanoma cells were xenografted into nude mice the xenografts grew rapidly. Cisplatin treatment caused an initial shrinkage of the tumours, but re-growth rapidly followed. Cells re-isolated into culture from cisplatin treated xenografts had significantly higher levels of ERCC1 protein than either input cells, or cells re-isolated from untreated xenografts. An isogenic Ercc1 deficient derivative of the Ercc1 proficient mouse melanoma cell line grew as rapidly as the parent line in vitro, but grew much more slowly as xenografts. In addition, the xenografts shrank completely following cisplatin treatment and did not recover. This suggests that ERCC1 could be a drug target for melanoma therapy.

No description available.

No description available.

INTRODUÇÃO: O carcinoma de pulmão de pequenas células (CPPC) e o carcinoma neuroendócrino (CNE) extra-pulmonar apresentam características histopatológicas e tratamentos similares, porém os desfechos encontrados nos dois grupos podem ser diferentes. Avaliamos a expressão de alguns biomarcadores e a associação destes com taxa de resposta (TR) à quimioterapia baseada em platina e sobrevida global (SG) nos dois grupos. METODOS: Realizamos estudo retrospectivo de pacientes com CPPC e CNE extra-pulmonares tratados com quimioterapia baseada em platina. Todas as amostras tumorais foram revisadas pelo mesmo patologista (R.S.S.M.) e analisadas quanto a expressão imunoistoquímica de Ki-67, ERCC1, Bcl-2 e Lin28a, a qual foi determinada através do H-escore (calculado multiplicando o produto da intensidade da coloração - 0 a 3 - com a porcentagem de células positivas - 0 a 100 -, podendo variar de 0 a 300 - positivo quando >= 200). Os biomarcadores foram analisados tanto como variáveis contínuas quanto categóricas e a TR foi determinada por RECIST 1.1. A associação entre a expressão de cada biomarcador e a TR foi avaliada através do teste de qui-quadrado ou teste exato de Fisher para variáveis categóricas e regressão logística simples para variáveis contínuas. Sobrevida global foi estimada por Kaplan-Meier e as curvas foram comparadas por log-rank. O modelo de regressão de cox foi utilizado para avaliar associação entre SG e a expressão de biomarcadores como variável contínua. RESULTADOS: Entre Julho de 2006 e Julho de 2014, 142 pacientes foram identificados: N=82 (57,7%) com CPPC e N=60 (42,3%) com CNE extra-pulmonar. As características clínicas eram semelhantes em ambos os grupos. Mediana de ki67 foi de 60% (7-100) no CPPC e de 50% (20-95%) no segundo grupo (p=0,858). Com uma mediana de 5 ciclos por paciente (N=123 elegíveis para análise de TR), a TR foi de 86,8% no CPPC, enquanto nos com CNE extra-pulmonar, foi de 44,6% (p < 0.001). A mediana de SG (N=132 elegíveis para análise da SG) foi similar entre os grupos (10,3 meses em CPPC e 11,1 meses em CNE extra-pulmonar; p=0,069). Não houve diferença no padrão de expressão do ERCC1 (p=0,277) e do Lin28a (p=0,051) entre os grupos. Bcl2 foi expresso em 38 pacientes (46,3%) com CPPC e em 17 pacientes (28,3%) com CNE extra-pulmonar (p=0,030). Apenas no grupo com CNE extra-pulmonar, a alta expressão do Bcl2 foi associada com pior prognóstico (8,0 meses vs 14,7 meses; p=0,025). A expressão dos demais marcadores em CNE extra-pulmonar e dos quatro em CPPC não apresentou influência sobre a SG, não havendo também associação entre estes e a taxa de resposta à quimioterapia. Dentre os pacientes com CNE extra-pulmonar, não houve diferença na SG ou na TR entre os pacientes com carcinoma bem diferenciado (N=13;) e com carcinoma pouco diferenciado (N=47). CONCLUSÃO: Apesar do CPPC e do CNE extra-pulmonar serem tratados de forma semelhante, nesta coorte a taxa de resposta entre os grupos foi significativamente diferente. Quando comparado com CPPC, os pacientes com CNE extra-pulmonar apresentam uma menor responsividade à quimioterapia baseada em platina, mas com tendência a maior SG. Dentre os CNE extra-pulmonares, a alta expressão de Bcl-2 foi associada a pior prognóstico. Os demais biomarcadores não apresentaram papel preditor de resposta ou prognóstico / INTRODUCTION: Small cell lung cancer (SCLC) and high-grade extrapulmonary neuroendocrine carcinomas (EPNEC) share similar histopathological features and treatment, but outcomes may differ. We evaluated the expression of biomarkers and their association with response rate (RR) to platin-based chemotherapy and overall survival (OS) in these entities. METHODS: We conducted a retrospective analysis of patients with advanced EPNEC and SCLC treated with platinum-based chemotherapy. A single pathologist (R.S.S.M.) revised all samples. Paraffin-embedded tumor samples were tested for Ki-67, ERCC1, Bcl-2 and Lin28a expression by immunohistochemistry (IHC). Final IHC score (H-score) was calculated multiplying the intensity of staining by grading (0-300, with >= 200 considered positive). Biomarkers were analyzed as both categorical and continuous variables. RR was determined by RECIST 1.1. Associations between each biomarkers expression and RR were assessed using Chi-square or Fisher\'s exact test for categorical variables and univariate logistic regression for continuous variables. OS was estimated by the Kaplan-Meier method and curves were compared by log-rank. Cox regression analysis was used to evaluate any association between biomarkers expression (continuous variables) and OS. RESULTS: From July 2006 to July 2014, 142 patients were identified: N=82 (57,7%) with SCLC and N=60 (42,3%) with EPNEC. Baseline clinical characteristics were similar. Median Ki67 was 60% (7-100) among SCLC patients and 50% (20-95%) in EPNEC (p=0,858). With a median of 5 cycles per patient in both groups (N=123 evaluable patients), the RR was significantly higher in the SCLC group (86,8% vs 44.6%; p < 0.001). Median OS (N=132 evaluable patients) was similar between the groups (10.3 months in SCLC and 11.1 months in EPNEC; p=0,069). In the EPNEC group, there wasn\'t any difference in OS or RR between the patients with welldifferentiated (N=13) and poorly differentiated carcinoma (N=47). ERCC1 (p=0.277) and Lin28a (p=0.051) were similarly expressed between the groups. Bcl2 was expressed in 38 SCLC patients (46.3%) and in 17 EPNEC patients (28.3%; p=0.030). Only in the EPNEC group, Bcl2 high expression was associated with worse survival (8.0 months vs 14.7 months; p = 0.025). RR to chemotherapy was not influenced by the expression of the ERCC1, Lin28a, Bcl-2, Ki-67 in either EPNEC or SCLC groups. CONCLUSION: Even though SCLC and EPNEC are treated similarly, in this cohort, the rate response differed significantly. When compared with SCLC, patients with EPNEC apparently had tumors less responsive to platin-based chemotherapy, but tended to live longer. In EPNEC treated with platin, high expression of Bcl2 was associated with poor prognosis. We could not identify additional predictive or prognostic biomarkers