151
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Herbreteau G, Vallée A, Charpentier S, Normanno N, Hofman P, Denis MG. Circulating free tumor DNA in non-small cell lung cancer (NSCLC): clinical application and future perspectives. J Thorac Dis 2019; 11:S113-S126. [PMID: 30775034 DOI: 10.21037/jtd.2018.12.18] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Major advances in the treatment of non-small cell lung cancer (NSCLC) patients have been obtained during the last decade. Molecular testing of tumor samples is therefore mandatory in routine clinical practice. Tumor DNA is also present as cell-free molecules in blood, which is therefore a very useful and convenient source of tumor DNA. In this review, we discuss pre-analytical and analytical aspects of circulating tumor DNA (ctDNA) analysis. We also describe the use of ctDNA analysis in routine clinical practice, and discuss the potential use of ctDNA monitoring both to identify minimal residual disease and as a potential tool to early identify patients' response to treatment.
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Affiliation(s)
- Guillaume Herbreteau
- Department of Biochemistry, Nantes University Hospital, 9 quai Moncousu, F-44093 Nantes Cedex, France
| | - Audrey Vallée
- Department of Biochemistry, Nantes University Hospital, 9 quai Moncousu, F-44093 Nantes Cedex, France
| | - Sandrine Charpentier
- Department of Biochemistry, Nantes University Hospital, 9 quai Moncousu, F-44093 Nantes Cedex, France
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", Naples, Italy
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Inserm U1081/CNRS 7284, Université Côte d'Azur, CHU Nice and FHU OncoAge, and Hospital-Integrated Biobank (BB-0033-00025), Pasteur Hospital, Nice, France
| | - Marc G Denis
- Department of Biochemistry, Nantes University Hospital, 9 quai Moncousu, F-44093 Nantes Cedex, France
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152
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Noronha V, Rajendra A, Joshi A, Patil V, Menon N, Prabhash K. Epidermal growth factor receptor-mutated non-small-cell lung cancer: A primer on contemporary management. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_51_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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153
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Pisapia P, Malapelle U, Troncone G. Liquid Biopsy and Lung Cancer. Acta Cytol 2018; 63:489-496. [PMID: 30566947 DOI: 10.1159/000492710] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
Abstract
The identification of non-small cell lung cancer (NSCLC) patients potentially responsive to targeted therapies relies on a number of relevant biomarkers, including EGFR, ALK, ROS-1, and PD-L1. Biomarker identification is most commonly based on surgical sample collection. However, when tissues are difficult to reach or when multiple analyses are necessary to monitor tumor progression and treatment response, liquid biopsy is a valid noninvasive alternative. This analysis, which is preferentially performed on circulating tumor DNA (ctDNA) extracted from plasma samples, has the major advantage of reducing the inherent risks and discomfort of tissue biopsy. However, a major disadvantage is that it yields only a low number of ctDNA targets. Thus, to avoid false-positive and false-negative results, it is important to adopt and validate technologies with high sensitivity and specificity in the pre-analytical phase of sampling. This review succinctly addresses the principal methodologies for analyzing plasma-derived ctDNA in NSCLC patients.
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Affiliation(s)
- Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy,
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154
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Lee JS, Hur JY, Kim IA, Kim HJ, Choi CM, Lee JC, Kim WS, Lee KY. Liquid biopsy using the supernatant of a pleural effusion for EGFR genotyping in pulmonary adenocarcinoma patients: a comparison between cell-free DNA and extracellular vesicle-derived DNA. BMC Cancer 2018; 18:1236. [PMID: 30526536 PMCID: PMC6288853 DOI: 10.1186/s12885-018-5138-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND EGFR genotyping in pulmonary adenocarcinoma patients who develop pleural effusions is mostly performed using cytology or cell block slides with low sensitivity. Liquid biopsy using the supernatant of pleural effusions may be more effective because they contain many components released by cancer cells. Extracellular vesicles (EVs) are known to carry oncogenic double-stranded DNA that is considered a notable biomarker. Here, we investigate the efficiency of liquid biopsy using cell-free DNA (cfDNA) and extracellular vesicle-derived DNA (EV-derived DNA) from the supernatant of pleural effusions for EGFR genotyping in patients with pulmonary adenocarcinoma. METHODS Fifty pleural effusion samples from patients with pulmonary adenocarcinoma were evaluated. The supernatant, after removing the cell pellet by centrifugation, was used for liquid biopsy, and EVs were isolated from the pleural effusion by ultracentrifugation. EV-derived DNA and cfDNA were extracted separately, and EGFR genotyping was performed by the PNA clamping method. RESULTS Among 32 patients who were EGFR-tyrosine kinase inhibitor (TKI) naïve with a known tissue EGFR genotype, liquid biopsy using EV-derived DNA from the pleural effusion supernatant showed 100% matching results with tissue EGFR genotyping in 19 EGFR mutant cases and detected three additional EGFR mutations in patients with wild-type (WT) tissue. Liquid biopsy using cfDNA from pleural effusion supernatants missed two cases of tissue-based EGFR mutations and found two additional EGFR mutation cases. In 18 patients who acquired resistance to EGFR-TKI, EGFR genotyping using EV-derived DNA from the pleural effusion supernatant detected the T790 M mutation in 13 of 18 (72.2%) patients, and this mutation was detected in 11 (61.1%) patients using cfDNA. By contrast, only three patients were found to present the T790 M mutation when using cell block or cytology slides. CONCLUSIONS Liquid biopsy using the supernatant of pleural effusions showed significantly improved results for EGFR genotyping compared to those using conventional cell block or cytology samples. Liquid biopsy using EV-derived DNA is promising for EGFR genotyping, including T790 M detection in pulmonary adenocarcinoma patients who develop pleural effusions.
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Affiliation(s)
- Jong Sik Lee
- Department of Pulmonary, Lung Cancer Center, Konkuk University Medical Center and Medicine, Konkuk University School of Medicine, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea
| | - Jae Young Hur
- Department of Pulmonary, Lung Cancer Center, Konkuk University Medical Center and Medicine, Konkuk University School of Medicine, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea.,Department of Pathology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - In Ae Kim
- Department of Pulmonary, Lung Cancer Center, Konkuk University Medical Center and Medicine, Konkuk University School of Medicine, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea
| | - Hee Joung Kim
- Department of Pulmonary, Lung Cancer Center, Konkuk University Medical Center and Medicine, Konkuk University School of Medicine, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea.,Department of Pulmonary Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chang Min Choi
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Oncology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Chol Lee
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Oncology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kye Young Lee
- Department of Pulmonary, Lung Cancer Center, Konkuk University Medical Center and Medicine, Konkuk University School of Medicine, 120-1 Hwayang-dong, Gwangjin-Gu, Seoul, 05030, Republic of Korea. .,Department of Pulmonary Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea.
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155
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Stewart CM, Tsui DWY. Circulating cell-free DNA for non-invasive cancer management. Cancer Genet 2018; 228-229:169-179. [PMID: 29625863 PMCID: PMC6598437 DOI: 10.1016/j.cancergen.2018.02.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 01/06/2023]
Abstract
Cell-free DNA (cfDNA) was first identified in human plasma in 1948 and is thought to be released from cells throughout the body into the circulatory system. In cancer, a portion of the cfDNA originates from tumour cells, referred to as circulating-tumour DNA (ctDNA), and can contain mutations corresponding to the patient's tumour, for instance specific TP53 alleles. Profiling of cfDNA has recently become an area of increasing clinical relevance in oncology, in particular due to advances in the sensitivity of molecular biology techniques and development of next generation sequencing technologies, as this allows tumour mutations to be identified and tracked non-invasively. This has opened up new possibilities for monitoring tumour evolution and acquisition of resistance, as well as for guiding treatment decisions when tumour biopsy tissue is insufficient or unavailable. In this review, we will discuss the biology of cell-free nucleic acids, methods of analysis, and the potential clinical uses of these techniques, as well as the on-going clinical development of ctDNA assays.
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Affiliation(s)
- Caitlin M Stewart
- Marie-José and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 20, New York, NY 10065, USA; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dana W Y Tsui
- Marie-José and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 20, New York, NY 10065, USA; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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156
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Complexity of genome sequencing and reporting: Next generation sequencing (NGS) technologies and implementation of precision medicine in real life. Crit Rev Oncol Hematol 2018; 133:171-182. [PMID: 30661654 DOI: 10.1016/j.critrevonc.2018.11.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/23/2018] [Indexed: 12/17/2022] Open
Abstract
The finalization of the Human Genome Project in 2003 paved the way for a deeper understanding of cancer, favouring a faster progression towards "personalized" medicine. Research in oncology has progressively focused on the sequencing of cancer genomes, to better understand the genetic basis of tumorigenesis and identify actionable alterations to guide cancer therapy. Thanks to the development of next-generation-sequencing (NGS) techniques, sequencing of tumoral DNA is today technically easier, faster and cheaper. Commercially available NGS panels enable the detection of single or global genomic alterations, namely gene mutation and mutagenic burden, both on germline and somatic DNA, potentially predicting the response or resistance to cancer treatments. Profiling of tumor DNA is nowadays a standard in cancer research and treatment. In this review we discuss the history, techniques and applications of NGS in cancer care, under a "personalized tailored therapy" perspective.
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157
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Li H, Yan S, Liu X, Liu Y, Ma L, Wang Y, Liu Y, Cheng Y. [Disparities of EGFR mutations between Biopsy and Rebiopsy in Non-small Cell Lung Cancer Patients]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:821-827. [PMID: 30454543 PMCID: PMC6246999 DOI: 10.3779/j.issn.1009-3419.2018.11.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
背景与目的 表皮生长因子受体(epidermal growth factor receptor, EGFR)靶向治疗能够显著提高EGFR突变的晚期肺腺癌患者预后生存,但治疗及异质性等因素可导致初次和疾病进展时EGFR基因状态发生改变。为了探讨真实世界中EGFR基因突变在疾病进展和基线时的差异,我们开展了此项研究。 方法 收集2015年1月-2017年12月在吉林省肿瘤医院进行EGFR基因检测的61例配对标本数据并进行分析。标本取材时间为治疗前和疾病进展时,所有标本均经病理学或细胞学证实,标本来源为肿瘤组织﹑恶性胸腔积液和血浆,患者为初治,一线接受化疗或靶向治疗,采用扩增阻滞突变系统法(Amplification Refractory Mutation System, ARMS)对29种EGFR基因突变进行检测。 结果 初次和再次活检相比(n=61),肿瘤组织、恶性胸腔积液和血浆标本所占的比例分别为90.2% vs 88.5%、6.6% vs 6.6%和3.2% vs 4.9%,其中标本类型前后一致的患者(n=50)EGFR突变差异率为72.0%,标本类型不一致患者(n=11)为36.3%;治疗前EGFR突变率为95.1%,治疗后为91.8%,二者的差异率为63.9%;化疗患者(n=13)治疗前EGFR突变率为69.2%,治疗后为92.3%,二者差异率为46.1%;靶向治疗患者(n=48)治疗前EGFR突变率为100%,治疗后为91.7%,二者差异率为70.8%。EGFR基因变化类型有4类:野生型变为突变型(4.9%)、突变消失(8.2%)、敏感突变类型互变(1.6%)和突变种类增加(49.1%)。 结论 临床实践中,晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者由于标本取材部位和类型及治疗的影响,治疗前后EGFR基因突变具有较大差异性,动态检测并明确EGFR基因状态,可以为临床医生选择精准的后续靶向治疗方案提供参考。
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Affiliation(s)
- Hui Li
- Translational Medical Research Lab, Jilin Provincial Cancer Hospital,
Changchun 130012, China
| | - Shi Yan
- Translational Medical Research Lab, Jilin Provincial Cancer Hospital,
Changchun 130012, China
| | - Xianhong Liu
- Department of Medical Oncology, Jilin Provincial Cancer Hospital,
Changchun 130012, China
| | - Ying Liu
- Department of Medical Oncology, Jilin Provincial Cancer Hospital,
Changchun 130012, China
| | - Lixia Ma
- Department of Medical Oncology, Jilin Provincial Cancer Hospital,
Changchun 130012, China
| | - Ying Wang
- Department of Medical Oncology, Jilin Provincial Cancer Hospital,
Changchun 130012, China
| | - Yan Liu
- Translational Medical Research Lab, Jilin Provincial Cancer Hospital,
Changchun 130012, China
| | - Ying Cheng
- Department of Medical Oncology, Jilin Provincial Cancer Hospital,
Changchun 130012, China
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158
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Su KY, Tseng JS, Liao KM, Yang TY, Chen KC, Hsu KH, Yang PC, Yu SL, Chang GC. Mutational monitoring of EGFR T790M in cfDNA for clinical outcome prediction in EGFR-mutant lung adenocarcinoma. PLoS One 2018; 13:e0207001. [PMID: 30444875 PMCID: PMC6239293 DOI: 10.1371/journal.pone.0207001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/23/2018] [Indexed: 12/14/2022] Open
Abstract
Several ultra-sensitive methods for T790M in plasma cell-free DNA (cfDNA) have been developed for lung cancer. The correlation between mutation-allele frequency (MAF) cut-off, drug responsiveness, and outcome prediction is an unmet needs and not fully addressed. An innovative combination of peptide nucleic acid (PNA) and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) was used to proof of concept for monitoring cfDNA T790M in EGFR-mutant patients. Mutant enrichment by PNA was optimized and the detection limit was evaluated through serial dilutions. The cut-off value was identified by receiver-operating-characteristic (ROC) curve analysis utilizing serial sampled plasmas of patients from EGFR-tyrosine kinase inhibitor (TKI) pretreatment to progressive-disease (PD). Results, comparisons, and objective response rate (ORR) were analyzed in 103 patients’ tumor and cfDNA T790M, with 20 of them receiving an additional COBAS test. The detection limit was 0.1% MAF. The cut-off for PD and imminent PD was 15% and 5% with an ROC area under the curve (AUC) of 0.96 and 0.82 in 2 ml plasma. Detection sensitivity of cfDNA T790M was 67.4% and overall concordance was 78.6%. ORR was similar in T790M-positive cfDNA (69.6%) and tumor samples (70.6%) treated with osimertinib. Among 65 T790M-positive tumors, 15 were negative in cfDNA (23.1%). Seven of 38 T790M-positive cfDNA samples were negative in the tumors (18.4%). PNA-MALDI-TOF MS had a higher detection rate than COBAS. In conclusion, identification of T790M cut-off value in cfDNA improves cancer managements. We provide a strategy for optimizing testing utility, flexibility, quality, and cost in the clinical practice.
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Affiliation(s)
- Kang-Yi Su
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan
- Genome and systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Jeng-Sen Tseng
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Keng-Mao Liao
- Genome and systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Tsung-Ying Yang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Chieh Chen
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Hsuan Hsu
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pan-Chyr Yang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sung-Liang Yu
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pathology and Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
- * E-mail:
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159
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Goldman JW, Karlovich C, Sequist LV, Melnikova V, Franovic A, Gadgeel SM, Reckamp KL, Camidge DR, Pérol M, Ou SHI, Liu SV, Yu HA, Soria JC, Socinski MA, Mekhail TM, Solomon BJ, Natale RB, Otterson GA, Papadimitrakopoulou V, Langer CJ, Neal JW, Despain D, Yurasov S, Litten JB, Erlander M, Raponi M, Wakelee HA. EGFR Genotyping of Matched Urine, Plasma, and Tumor Tissue in Patients With Non–Small-Cell Lung Cancer Treated With Rociletinib, an EGFR Tyrosine Kinase Inhibitor. JCO Precis Oncol 2018; 2:1-13. [DOI: 10.1200/po.17.00116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose Liquid biopsies represent an attractive alternative to tissue biopsies, particularly rebiopsies, in determining patient eligibility for targeted therapies. Clinical utility of urine genotyping, however, has not been explored extensively. We evaluated epidermal growth factor receptor ( EGFR) T790M detection in matched urine, plasma, and tissue and the clinical outcomes of patients with advanced non–small-cell lung cancer treated with rociletinib. Methods Tissue (n = 540), plasma (n = 482), and urine (n = 213) were collected from evaluable patients enrolled in TIGER-X, a phase I/II study. Genotyping was performed by therascreen EGFR testing in tissue, BEAMing in plasma, and a quantitative short footprint assay (Trovera) in urine, which was used to further examine discordant samples. Results Positive percent agreement with tissue T790M results was similar for urine (82%; 142 of 173) and plasma (81%; 313 of 387) genotyping. Urine and plasma together identified more patients who were T790M positive (92%) than tissue alone (83%) among matched samples (n = 177). The ability to identify mutations in plasma was strongly associated with M stage ( P < .001); rate of T790M detection for patients with M1a/M0 disease increased from 54% for plasma alone to 85% when urine and plasma were both examined. Objective response rates of patients who were T790M positive were comparable between tumor (34%), plasma (32%), and urine (37%). Conclusion Clinical response to rociletinib was comparable irrespective of whether T790M status was identified by liquid or tissue biopsy. Combined, urine and plasma identified a higher percentage of patients who were T790M positive than tumor genotyping alone and improved detection of T790M, particularly in the absence of distant metastases. These findings support the noninvasive analysis of urine and plasma before tumor rebiopsy when assessing T790M status.
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Affiliation(s)
- Jonathan W. Goldman
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Chris Karlovich
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Lecia V. Sequist
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Vlada Melnikova
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Aleksandra Franovic
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Shirish M. Gadgeel
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Karen L. Reckamp
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - D. Ross Camidge
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Maurice Pérol
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Sai-Hong Ignatius Ou
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Stephen V. Liu
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Helena A. Yu
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Jean-Charles Soria
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Mark A. Socinski
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Tarek M. Mekhail
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Benjamin J. Solomon
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Ronald B. Natale
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Gregory A. Otterson
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Vassiliki Papadimitrakopoulou
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Corey J. Langer
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Joel W. Neal
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Darrin Despain
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Sergey Yurasov
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Jason B. Litten
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Mark Erlander
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Mitch Raponi
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Heather A. Wakelee
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
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160
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Sacher AG. Fundamental Concepts in the Application of Plasma Genotyping (Liquid Biopsy) to EGFR Mutation Detection in Non–Small-Cell Lung Cancer. JCO Precis Oncol 2018; 2:1-12. [DOI: 10.1200/po.17.00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Plasma genotyping has rapidly evolved from an investigational technology into a standard-of-care tool used to direct therapy in metastatic non–small-cell lung cancer (NSCLC). Multiple testing platforms exist for plasma genotyping, each with unique test characteristics and scientific validation. The optimal use and interpretation of plasma genotyping requires understanding of cell-free DNA biology, the assay characteristics of the available testing technologies, and the application of testing in each clinical scenario. Current recommendations for plasma genotyping in metastatic NSCLC are limited to patients with newly diagnosed disease and those with acquired resistance to targeted therapy, in particular, epidermal growth factor receptor (EGFR) kinase inhibitors. In newly diagnosed metastatic NSCLC, under certain circumstances, plasma genotyping is useful for the detection of targetable genomic alterations or nontargetable driver alterations (eg, KRAS) that are mutually exclusive with targetable alterations. In patients with acquired resistance to therapy, such as EGFR T790M-mediated acquired resistance to EGFR kinase inhibitors, plasma genotyping may detect resistance mutations missed by standard tissue genotyping because of tumor heterogeneity. In both scenarios, the high specificity and positive predictive value of validated plasma genotyping assays allow for the reliable selection of therapy on the basis of a positive plasma genotyping result. However, the modest sensitivity of these assays requires that negative results be confirmed by tissue genotyping with repeat biopsy, if necessary. There is considerable potential for plasma genotyping in the detection of early-stage disease, for patients at risk for disease recurrence, and as an integrated biomarker of therapeutic response in clinical trials of novel therapies.
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Affiliation(s)
- Adrian G. Sacher
- Adrian G. Sacher, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario
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161
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Nanjo S, Bivona TG. Circulating tumor DNA analysis in patients with EGFR mutant lung cancer. J Thorac Dis 2018; 10:S4061-S4064. [PMID: 30631555 PMCID: PMC6297447 DOI: 10.21037/jtd.2018.09.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/19/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Shigeki Nanjo
- Department of Medicine, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Trever G. Bivona
- Department of Medicine, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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162
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Fettke H, Kwan EM, Azad AA. Cell-free DNA in cancer: current insights. Cell Oncol (Dordr) 2018; 42:13-28. [PMID: 30367445 DOI: 10.1007/s13402-018-0413-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The field of liquid biopsies in oncology is rapidly expanding, with the application of cell-free circulating tumour DNA (ctDNA) showing promise in this era of precision medicine. Compared with traditional clinical and radiographic tumour monitoring methods, the analysis of ctDNA provides a minimally-invasive and technically feasible approach to assess temporal and spatial molecular evolutions of the tumour landscape. The constantly advancing technological platforms available for ctDNA extraction and analysis allow greater analytical sensitivities than ever before. The potential translational impact of ctDNA as a blood-based biomarker for the identification, characterization and monitoring of cancer has been demonstrated in numerous proof-of-concept studies, with ctDNA analysis beginning to be applied clinically across multiple facets of oncology. CONCLUSIONS In this review we discuss the biology, recent advancements, technical considerations and clinical implications of ctDNA in the context of cancer, and highlight important challenges and future directions for the integration of ctDNA into standardised patient care.
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Affiliation(s)
- Heidi Fettke
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.
| | - Edmond M Kwan
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Medical Oncology, Monash Health, Melbourne, Australia
| | - Arun A Azad
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Medical Oncology, Monash Health, Melbourne, Australia
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163
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Wu YL, Lee V, Liam CK, Lu S, Park K, Srimuninnimit V, Wang J, Zhou C, Appius A, Button P, Hooper G, Palma JF, Schulze K, Scudder S, Shames DS, Yin AY, Zhang G, Mok T. Clinical utility of a blood-based EGFR mutation test in patients receiving first-line erlotinib therapy in the ENSURE, FASTACT-2, and ASPIRATION studies. Lung Cancer 2018; 126:1-8. [PMID: 30527172 DOI: 10.1016/j.lungcan.2018.10.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/29/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Patients with advanced non-small-cell lung cancer (NSCLC) with an adenocarcinoma component are recommended to undergo epidermal growth factor receptor (EGFR) mutation testing when being considered for EGFR targeted therapy. We conducted an exploratory analysis to inform the clinical utility of EGFR mutation testing in blood cell-free DNA using the cobas®EGFR Mutation Test v2. MATERIALS AND METHODS Two EGFR mutation tests, a tissue-based assay (cobas® v1) and a tissue- and blood-based assay (cobas® v2) were used to analyze matched biopsy and blood samples (897 paired samples) from three Asian studies of first-line erlotinib with similar intent-to-treat populations. ENSURE was a phase III comparison of erlotinib and gemcitabine/platinum, FASTACT-2 was a phase III study of gemcitabine/platinum plus erlotinib or placebo, and ASPIRATION was a single-arm phase II study of erlotinib. Agreement statistics were evaluated, based on sensitivity and specificity between the two assays in subgroups of patients with increasing tumor burden. RESULTS Patients with discordant EGFR (tissue+/plasma-) mutation status achieved longer progression-free and overall survival than those with concordant (tissue+/plasma+) mutation status. Tumor burden was significantly greater in patients with concordant versus discordant mutations. Pooled analyses of data from the three studies showed a sensitivity of 72.1% (95% confidence interval [CI] 67.8-76.1) and a specificity of 97.9% (95% CI 96.0-99.0) for blood-based testing; sensitivity was greatest in patients with larger baseline tumors. CONCLUSIONS Blood-based EGFR mutation testing demonstrated high specificity and good sensitivity, and offers a convenient and easily accessible diagnostic method to complement tissue-based tests. Patients with a discordant mutation status in plasma and tissue, had improved survival outcomes compared with those with a concordant mutation status, which may be due to their lower tumor burden. These data help to inform the clinical utility of this blood-based assay for the detection of EGFR mutations.
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Affiliation(s)
- Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Victor Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Shun Lu
- Department of Shanghai Lung Cancer, Shanghai Chest Hospital, Shanghai, China.
| | - Keunchil Park
- Division of Haematology-Oncology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | | | - Jie Wang
- Beijing Cancer Hospital, Beijing, China.
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | | | | | - Gregory Hooper
- Pharmaceutical Development Oncology, Roche Products Ltd., Welwyn Garden City, UK.
| | | | | | | | | | - Anny-Yue Yin
- CStone Pharmaceuticals (Suzhou) Co., Ltd., Shanghai, China.
| | - Guili Zhang
- Roche Molecular Systems, Pleasanton, CA, USA.
| | - Tony Mok
- State Key Laboratory of South China, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China.
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164
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Jin Y, Shi X, Zhao J, He Q, Chen M, Yan J, Ou Q, Wu X, Shao YW, Yu X. Mechanisms of primary resistance to EGFR targeted therapy in advanced lung adenocarcinomas. Lung Cancer 2018; 124:110-116. [DOI: 10.1016/j.lungcan.2018.07.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/21/2018] [Accepted: 07/28/2018] [Indexed: 12/13/2022]
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165
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Castelli J, Cabel L, Bidard FC, Duvergé L, Bachet JB. ADN tumoral circulant : principes, applications actuelles en radiothérapie et développement futur. Cancer Radiother 2018; 22:653-659. [DOI: 10.1016/j.canrad.2018.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 11/17/2022]
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166
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Zhang Y, Ye L, Zhang H, Chen X, Ji H, Chen G, Zhang L, Zhang T, Jin M. A combined subtype of small cell lung cancer and adenocarcinoma with epidermal growth factor receptor ( EGFR) mutation responds to EGFR tyrosine kinase inhibitors. J Thorac Dis 2018; 10:E739-E743. [PMID: 30505514 DOI: 10.21037/jtd.2018.09.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yong Zhang
- Pulmonary Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ling Ye
- Pulmonary Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Huijun Zhang
- Pulmonary Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xuehua Chen
- Pulmonary Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Haiying Ji
- Pulmonary Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Gang Chen
- Pulmonary Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lu Zhang
- Burning Rock Biotech, Guangzhou 510000, China
| | | | - Meiling Jin
- Pulmonary Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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167
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Yang K, Li J, Zhao J, Ren P, Wang Z, Wei B, Dong B, Sun R, Wang X, Groen HJM, Ma J, Guo Y. Developing Ultrasensitive Library-Aliquot-Based Droplet Digital PCR for Detecting T790M in Plasma-Circulating Tumor DNA of Non-small-Cell-Lung-Cancer Patients. Anal Chem 2018; 90:11203-11209. [PMID: 30156405 DOI: 10.1021/acs.analchem.8b01776] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A T790M secondary mutation in epidermal-growth-factor receptor (EGFR) is the most well-established EGFR-tyrosine-kinase-inhibitor (TKI) resistance marker in non-small-cell lung cancer (NSCLC). The current methods to rapidly and accurately detect T790M in clinical practice are not satisfactory because of several obstacles, including the unavailability of tumor-tissue rebiopsies and the low DNA copy number of T790M in circulating tumor DNA (ctDNA). Here, we develop library-aliquot-based droplet digital PCR (LAB-ddPCR) to increase detection sensitivity without affecting accuracy. This new LAB-ddPCR method is performed using aliquots of the ctDNA precapture next-generation-sequencing (NGS) library, in which the isolated ctDNA was amplified and enriched. We show that the LAB-ddPCR can precisely distinguish between T790M wild-type and mutation alleles without introducing extra false-positive signals. In a cohort of 70 post-TKI NSCLC patients, the LAB-ddPCR identified 41 T790M-positive cases (sensitivity 58.57%), but ddPCR only detected T790M in 27 cases (sensitivity 38.57%). Taking the ARMS-PCR result from matched tumor rebiopsies into consideration, the LAB-ddPCR method is better than ddPCR. In conclusion, the LAB-ddPCR ctDNA test offers a feasible and flexible option for the rapid and accurate detection of the T790M secondary mutation, which is helpful in dynamically monitoring drug response and disease progression throughout the therapeutic regimen.
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Affiliation(s)
- Ke Yang
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Jun Li
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Jiuzhou Zhao
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Pengfei Ren
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Zhizhong Wang
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Bing Wei
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Bing Dong
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Rui Sun
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Xiaoyan Wang
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Harry J M Groen
- Department of Pulmonary Diseases , University of Groningen and University Medical Center Groningen , Groningen 9700 RB , The Netherlands
| | - Jie Ma
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
| | - Yongjun Guo
- Department of Molecular Pathology , The Affiliated Cancer Hospital of Zhengzhou University , 127 Dongming Road , Zhengzhou 450003 , China
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168
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Park CK, Cho HJ, Choi YD, Oh IJ, Kim YC. A Phase II Trial of Osimertinib in the Second-Line Treatment of Non-small Cell Lung Cancer with the EGFR T790M Mutation, Detected from Circulating Tumor DNA: LiquidLung-O-Cohort 2. Cancer Res Treat 2018; 51:777-787. [PMID: 30189719 PMCID: PMC6473264 DOI: 10.4143/crt.2018.387] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/05/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Administering the best treatment after failure of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy requires knowledge of resistance status. In this trial, treatment efficacy of osimertinib was assessed in patients with non-small cell lung carcinoma (NSCLC) harboring the T790M resistance mutation, detected from circulating tumor DNA (ctDNA) with unknown tumor mutation status. Materials and Methods To extract ctDNA from plasma, 15 mL of peripheral blood was withdrawn and centrifuged immediately before storage. Cobas ver. 2 and PANA Mutyper were used for ctDNA genotyping. Patients with T790M, detected from ctDNA, were enrolled and they received a oncedaily administration of osimertinib 80 mg. The primary endpoint was objective response rate (ORR), and secondary endpoints were ctDNA test sensitivity, progression-free survival (PFS), duration of response (DoR), and safety. RESULTS Eighty patients with acquired resistance to prior EGFR-TKI therapies were screened. ctDNA of 21 patients showed T790M positivity, and 19 patients were enrolled. In the responseevaluable population (n=15), ORR was 66.7% (10/15). Median PFS was 8.3 months (95% confidence interval [CI], 7.9 to 8.7) and median DoR was 6.8 months (95% CI, 5.3 to 8.3) in the intent-to-treat population (n=19). No subject experienced drug-related adverse event of grades ≥ 3 or required dose reduction. The sensitivity of the ctDNA tests was 56.8% using both methods and 45.9% with either method from the estimated T790M-positive cases. CONCLUSION Osimertinib has favorable efficacy in patients with NSCLC harboring T790M, detected from ctDNA with unknown tumor mutation status, in whom disease had progressed during prior EGFR-TKI therapy.
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Affiliation(s)
- Cheol-Kyu Park
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyun-Ju Cho
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
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169
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Clinical Application of Genomic Profiling With Circulating Tumor DNA for Management of Advanced Non–Small-cell Lung Cancer in Asia. Clin Lung Cancer 2018; 19:e601-e608. [DOI: 10.1016/j.cllc.2018.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/07/2018] [Accepted: 04/24/2018] [Indexed: 11/21/2022]
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170
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Suryavanshi M, Mehta A, Panigrahi MK, Jaipuria J, Saifi M, Jain K, Kumar D, Verma H, Sharma SK, Batra U, Dutta K, Talwar V, Doval DC. The detection of primary and secondary EGFR mutations using droplet digital PCR in patients with nonsmall cell lung cancer. Lung India 2018; 35:384-389. [PMID: 30168456 PMCID: PMC6120312 DOI: 10.4103/lungindia.lungindia_472_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We share our experience of using droplet digital polymerase chain reaction (DdPCR) in liquid biopsy specimens for detecting primary and secondary epidermal growth factor receptor (EGFR) mutations among patients with nonsmall-cell lung cancer who had tissue biopsy initially analyzed for del19, L858R and T790M. MATERIALS AND METHODS Three groups of patients were chosen: Group 1: patients positive for EGFR mutation (del 19 or L858R) by conventional tissue biopsy that were treatment naïve, Group 2: patients positive for EGFR mutation (del 19 or L858R) by conventional tissue biopsy with acquired resistance to tyrosine kinase inhibitor (TKI) therapy, documented by radiology, and Group 3: no known EGFR mutation detected on primary tissue biopsy and treatment naive. RESULTS One hundred and thirty-three patients were included in the study. Group 1 had 40 cases, of which 21 (52.5%) and 19 (47.5%) were positive for del19 and L858R mutations, respectively, by tissue biopsy. DdPCR detected primary mutation in all but 5 cases. DdPCR additionally found four patients to have T790M mutation. Group 2 had 73 cases and DdPCR detected T790M mutation in 39 (53.4%) cases. Liquid biopsy also picked the original primary mutation in 56/73 cases. Secondary tissue biopsy for T790M mutation status was performed in 11 patients and while it detected mutation in 2 out of 11 cases, DdPCR detected the same in 7 cases, thus providing significantly superior yield (46% difference, McNemar's test, P value 0.063). Tissue biopsy additionally detected c-MET amplification in a patient who had T790M mutation on liquid biopsy. Group 3 had 20 patients and none were falsely positive for EGFR mutation on liquid biopsy. Overall, DdPCR had a Cohen's kappa of 0.82 (standard error 0.074, 95% CI 0.68-0.97) indicating "very good agreement" with conventional tissue biopsy. CONCLUSION DdPCR demonstrated 87.5% sensitivity and 100% specificity in detecting primary EGFR mutations in patients who were treatment naïve with overall positive and negative predictive value of 100% and 80%, respectively. DdPCR demonstrated T790M mutation postprogression on TKI therapy in 53.4% patients.
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Affiliation(s)
- Moushumi Suryavanshi
- Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anurag Mehta
- Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manoj Kumar Panigrahi
- Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Jiten Jaipuria
- Department of Urogynaeoncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mumtaz Saifi
- Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kavita Jain
- Department of Pathology, Action Balaji Hospital, New Delhi, India
| | - Dushyant Kumar
- Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Haristuti Verma
- Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sanjeev Kumar Sharma
- Molecular Diagnostics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kumardeep Dutta
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vineet Talwar
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Zhou R, Cai Y, Li Z, Shen S, Sha M, Head SR, Wang Y. A digital PCR assay development to detect EGFR T790M mutation in NSCLC patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.flm.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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172
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Sorber L, Zwaenepoel K, De Winne K, Van Casteren K, Augustus E, Jacobs J, Zhang XH, Galdermans D, De Droogh E, Lefebure A, Morel AM, Saenen E, Bustin F, Demedts I, Himpe U, Pieters T, Germonpré P, Derijcke S, Deschepper K, Van Meerbeeck JP, Rolfo C, Pauwels P. A Multicenter Study to Assess EGFR Mutational Status in Plasma: Focus on an Optimized Workflow for Liquid Biopsy in a Clinical Setting. Cancers (Basel) 2018; 10:E290. [PMID: 30150518 PMCID: PMC6162772 DOI: 10.3390/cancers10090290] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 12/02/2022] Open
Abstract
A multicenter study was performed to determine an optimal workflow for liquid biopsy in a clinical setting. In total, 549 plasma samples from 234 non-small cell lung cancer (NSCLC) patients were collected. Epidermal Growth Factor Receptor (EGFR) circulating cell-free tumor DNA (ctDNA) mutational analysis was performed using digital droplet PCR (ddPCR). The influence of (pre-) analytical variables on ctDNA analysis was investigated. Sensitivity of ctDNA analysis was influenced by an interplay between increased plasma volume (p < 0.001) and short transit time (p = 0.018). Multistep, high-speed centrifugation both increased plasma generation (p < 0.001) and reduced genomic DNA (gDNA) contamination. Longer transit time increased the risk of hemolysis (p < 0.001) and low temperatures were shown to have a negative effect. Metastatic sites were found to be strongly associated with ctDNA detection (p < 0.001), as well as allele frequency (p = 0.034). Activating mutations were detected in a higher concentration and allele frequency compared to the T790M mutation (p = 0.003, and p = 0.002, respectively). Optimization of (pre-) analytical variables is key to successful ctDNA analysis. Sufficient plasma volumes without hemolysis or gDNA contamination can be achieved by using multistep, high-speed centrifugation, coupled with short transit time and temperature regulation. Metastatic site location influenced ctDNA detection. Finally, ctDNA levels might have further value in detecting resistance mechanisms.
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Affiliation(s)
- Laure Sorber
- Center for Oncological Research Antwerp (CORE), University of Antwerp, 2610 Wilrijk, Belgium.
- Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
| | - Karen Zwaenepoel
- Center for Oncological Research Antwerp (CORE), University of Antwerp, 2610 Wilrijk, Belgium.
- Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
| | - Koen De Winne
- Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
| | - Kaat Van Casteren
- Center for Oncological Research Antwerp (CORE), University of Antwerp, 2610 Wilrijk, Belgium.
- Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
- Biomedical Quality Assurance Research Unit, KU Leuven, 3000 Leuven, Belgium.
| | - Elien Augustus
- Center for Oncological Research Antwerp (CORE), University of Antwerp, 2610 Wilrijk, Belgium.
- Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
| | - Julie Jacobs
- Center for Oncological Research Antwerp (CORE), University of Antwerp, 2610 Wilrijk, Belgium.
- Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
| | - Xiang Hua Zhang
- Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
| | - Daniëlla Galdermans
- Pneumology, ZNA Middelheim, 2020 Antwerp, Belgium.
- Thoracic Oncology Group Antwerp (TOGA), University of Antwerp, 2610 Wilrijk, Belgium.
| | - Els De Droogh
- Pneumology, ZNA Middelheim, 2020 Antwerp, Belgium.
- Thoracic Oncology Group Antwerp (TOGA), University of Antwerp, 2610 Wilrijk, Belgium.
| | - Anneke Lefebure
- Thoracic Oncology Group Antwerp (TOGA), University of Antwerp, 2610 Wilrijk, Belgium.
- Pneumology, ZNA STER, 2140 Antwerp, Belgium.
| | - Ann-Marie Morel
- Thoracic Oncology Group Antwerp (TOGA), University of Antwerp, 2610 Wilrijk, Belgium.
- Pneumology, AZ Sint-Jozef, 2880 Bornem, Belgium.
| | - Erika Saenen
- Thoracic Oncology Group Antwerp (TOGA), University of Antwerp, 2610 Wilrijk, Belgium.
- Lung diseases/Allergology, AZ Heilige Familie, 2840 Reet, Belgium.
| | | | - Ingel Demedts
- Department of Pulmonary diseases, AZ Delta, 8800 Roeselare, Belgium.
| | - Ulrike Himpe
- Department of Pulmonary diseases, AZ Delta, 8800 Roeselare, Belgium.
| | - Thierry Pieters
- Pneumology, Cliniques Universitaires Saint-Luc, 1200 Bruxelles, Belgium.
| | - Paul Germonpré
- Thoracic Oncology Group Antwerp (TOGA), University of Antwerp, 2610 Wilrijk, Belgium.
- Pneumology, AZ Maria Middelares, 9000 Gent, Belgium.
| | - Sofie Derijcke
- Pneumology-Thoracic Oncology, AZ Groeninge, 8500 Kortrijk, Belgium.
| | - Koen Deschepper
- Thoracic Oncology Group Antwerp (TOGA), University of Antwerp, 2610 Wilrijk, Belgium.
- Pneumology, AZ Nikolaas, 9100 Sint-Niklaas, Belgium.
| | - Jan P Van Meerbeeck
- Center for Oncological Research Antwerp (CORE), University of Antwerp, 2610 Wilrijk, Belgium.
- Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
- Thoracic Oncology Group Antwerp (TOGA), University of Antwerp, 2610 Wilrijk, Belgium.
| | - Christian Rolfo
- Center for Oncological Research Antwerp (CORE), University of Antwerp, 2610 Wilrijk, Belgium.
- Oncology & Phase I Unit-Early Clinical Trials, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
- Marlene and Steward Greenebaum Comprehensive Cancer Center, Thoracic Medical Oncology & Early Clinical Trials, Baltimore, MD 12116, USA.
| | - Patrick Pauwels
- Center for Oncological Research Antwerp (CORE), University of Antwerp, 2610 Wilrijk, Belgium.
- Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
- Thoracic Oncology Group Antwerp (TOGA), University of Antwerp, 2610 Wilrijk, Belgium.
- Antwerp University Hospital (UZA), Tumor Bank, 2650 Edegem, Belgium.
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Prabhash K, Parikh PM, Rajappa SJ, Noronha V, Joshi A, Aggarwal S, Bondarde S, Patil S, Desai C, Dattatreya PS, Naik R, Anand S, Chacko RT, Biswas G, Sahoo TP, Dabkara D, Patil V, Chandrakant MV, Das PK, Vaid AK, Doval DC. Patterns of epidermal growth factor receptor testing across 111 tertiary care centers in India: Result of a questionnaire-based survey. South Asian J Cancer 2018; 7:203-206. [PMID: 30112342 PMCID: PMC6069335 DOI: 10.4103/sajc.sajc_30_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: We conducted a survey of 111 medical oncologists across India to understand the current pattern of epidermal growth factor receptor (EGFR) mutation testing at their respective centers. Methods: Medical oncologists from 111 institutes across India were interviewed face to face using a structured questionnaire. They were divided into two groups – Group 1 with in-house EGFR testing and Group 2 who send samples to central/commercial laboratories outside their institutions. Answers of the two groups were analyzed to see the prevailing patterns of EGFR testing and differences between the two groups if any. Results: Ninety-five percent (105/111) of medical oncologists recommended testing for EGFR mutations in patients with adenocarcinoma histology and 40% (44/111) recommended EGFR testing in squamous cell histology. The average time duration to get EGFR test results was 10 days in Group 1 centers versus 18 days in Group 2 centers. Ninety-six percent (106/111) of the medical oncologists from Group 1 centers requested for factoring additional sample for biomarker testing compared to 69% (77/111) of the oncologists from Group 2 centers. Sixty-nine percent (77/111) of medical oncologists in Group 1 centers would prefer to wait for the test results before initiating treatment compared to 46% (51/111) in Group 2. EGFR tyrosine-kinase inhibitors were used in only approximately 60% of patients with diagnosed EGFR mutation in the first line. For patients in whom chemotherapy was initiated while waiting for test results, 50% (56/111) of medical oncologists would prefer to complete 4–6 cycles before switching to targeted therapy. At the time of progression, rebiopsy was possible in approximately 25% of the patients. Conclusions: Turnaround time for molecular testing should improve so that eligible patients can benefit from targeted therapies in the first line. There is a need to increase the awareness among pulmonologists, oncologists, and interventional radiologists regarding the importance of adequate samples required for molecular tests.
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Affiliation(s)
- Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hosptial, Mumbai, Maharashtra, India
| | - Purvish M Parikh
- Department of Medical Oncology, Asian Institute of Oncology, Mumbai, Maharashtra, India
| | - Senthil J Rajappa
- Department of Medical Oncology, Indo American Hospital, Hyderabad, Telangana, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hosptial, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hosptial, Mumbai, Maharashtra, India
| | - Shyam Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - Shailesh Bondarde
- Department of Medical Oncology, Shatabdi Hospital, Nasik, Maharashtra, India
| | - Shekar Patil
- Department of Medical Oncology, HCG Hospital, Bengaluru, Karnataka, India
| | - Chirag Desai
- Department of Medical Oncology, Vendant Hospital, Ahmedabad, Gujarat, India
| | | | - Rajesh Naik
- Department of Oncology/Respiratory Medical Affairs Boehringer Ingelheim India Pvt. Ltd., Mumbai, Maharashtra, India
| | - Sohit Anand
- Department of Oncology/Respiratory Medical Affairs Boehringer Ingelheim India Pvt. Ltd., Mumbai, Maharashtra, India
| | - Raju Titus Chacko
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ghanshyam Biswas
- Department of Medical Oncology, Sparsh Hospital, Bhubaneswar, Odisha, India
| | - Tarini P Sahoo
- Department of Medical Oncology, Chirayu Hospital, Bhopal, Madhya Pradesh, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hosptial, Mumbai, Maharashtra, India
| | - M V Chandrakant
- Department of Medical Oncology, Narayana Superspeciality Hospital, Kolkata, West Bengal, India
| | - Pratap K Das
- Department of Medical Oncology, Apollo Hospitals, New Delhi, India
| | - Ashok K Vaid
- Department of Medical Oncology, Medanta - The Medicity, Gurugram, Haryana, India
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174
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International pilot external quality assessment scheme for analysis and reporting of circulating tumour DNA. BMC Cancer 2018; 18:804. [PMID: 30092778 PMCID: PMC6085634 DOI: 10.1186/s12885-018-4694-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/25/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Molecular analysis of circulating tumour DNA (ctDNA) is becoming increasingly important in clinical treatment decisions. A pilot External Quality Assessment (EQA) scheme for ctDNA analysis was organized by four European EQA providers under the umbrella organization IQN Path, in order to investigate the feasibility of delivering an EQA to assess the detection of clinically relevant variants in plasma circulating cell-free DNA (cfDNA) and to analyze reporting formats. METHODS Thirty-two experienced laboratories received 5 samples for EGFR mutation analysis and/or 5 samples for KRAS and NRAS mutation analysis. Samples were artificially manufactured to contain 3 mL of human plasma with 20 ng/mL of fragmented ctDNA and variants at allelic frequencies of 1 and 5%. RESULTS The scheme error rate was 20.1%. Higher error rates were observed for RAS testing when compared to EGFR analysis, for allelic frequencies of 1% compared to 5%, and for cases including 2 different variants. The reports over-interpreted wild-type results and frequently failed to comment on the amount of cfDNA extracted. CONCLUSIONS The pilot scheme demonstrated the feasibility of delivering a ctDNA EQA scheme and the need for such a scheme due to high error rates in detecting low frequency clinically relevant variants. Recommendations to improve reporting of cfDNA are provided.
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175
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Kessler MD, Pawar NR, Martin SS, Antalis TM, O'Connor TD. Improving Cancer Detection and Treatment with Liquid Biopsies and ptDNA. Trends Cancer 2018; 4:643-654. [PMID: 30149882 DOI: 10.1016/j.trecan.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 12/30/2022]
Abstract
Liquid biopsy, or the capacity to noninvasively isolate and analyze plasma tumor DNA (ptDNA) using blood samples, represents an important tool for modern oncology that enables increasingly safe, personalized, and robust cancer diagnosis and treatment. Here, we review advances in the development and implementation of liquid biopsy approaches, and we focus on the capacity of liquid biopsy to noninvasively detect oncological disease and enhance early detection strategies. In addition to noting the distinctions between mutation-targeted and mutation-agnostic approaches, we discuss the potential for genomic analysis and longitudinal testing to identify somatic lesions early and to guide intervention at more manageable disease stages.
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Affiliation(s)
- Michael D Kessler
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore MD 21201, USA.
| | - Nisha R Pawar
- Department of Medicine, University of Maryland School of Medicine, Baltimore MD 21201, USA; University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore MD 21201, USA
| | - Stuart S Martin
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore MD 21201, USA; Department of Physiology, University of Maryland School of Medicine, Baltimore MD 21201, USA
| | - Toni M Antalis
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore MD 21201, USA; Department of Physiology, University of Maryland School of Medicine, Baltimore MD 21201, USA
| | - Timothy D O'Connor
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore MD 21201, USA; University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore MD 21201, USA
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176
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Bracht JWP, Mayo-de-Las-Casas C, Berenguer J, Karachaliou N, Rosell R. The Present and Future of Liquid Biopsies in Non-Small Cell Lung Cancer: Combining Four Biosources for Diagnosis, Prognosis, Prediction, and Disease Monitoring. Curr Oncol Rep 2018; 20:70. [PMID: 30030656 DOI: 10.1007/s11912-018-0720-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Liquid biopsies have potential as tools for diagnosis, prognosis, and prediction of response to therapy. Herein, we will extensively review four liquid biosources, tumor-educated platelets (TEPs), cell-free DNA (cfDNA), circulating tumor cells (CTCs), and extracellular vesicles (EVs) and we will clarify their optimal application in non-small cell lung cancer (NSCLC) diagnosis and therapy. RECENT FINDINGS Liquid biopsies are a minimally invasive alternative to tissue biopsies-especially important in NSCLC patients-since tumor tissue is often unavailable or insufficient for complete genetic analysis. The main advantages of liquid biopsies include the possibility for repeated sampling, the lower cost, and the fact that they can reflect the complete molecular status of the patient better than a single-site biopsy. This is specifically important for lung adenocarcinoma patients since the detection of specific genetic alterations can predict response to targeted therapies. Molecular analysis is currently cardinal for therapy decision-making and disease monitoring in lung cancer patients. Liquid biopsies can make easier our daily clinical practice and if prospectively tested and validated may serve as a means for lung cancer early detection.
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Affiliation(s)
| | - Clara Mayo-de-Las-Casas
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain
| | - Jordi Berenguer
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain
| | - Niki Karachaliou
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain. .,Instituto Oncológico Dr Rosell (IOR), University Hospital Sagrat Cor, QuironSalud Group, Viladomat 288, 08029, Barcelona, Spain.
| | - Rafael Rosell
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain. .,Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain. .,Institut d'Investigació en Ciències Germans Trias i Pujol, Camí de les Escoles, s/n, 08916, Badalona, Barcelona, Spain. .,Instituto Oncológico Dr Rosell (IOR), Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain.
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177
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Wang Z, Cheng Y, An T, Gao H, Wang K, Zhou Q, Hu Y, Song Y, Ding C, Peng F, Liang L, Hu Y, Huang C, Zhou C, Shi Y, Zhang L, Ye X, Zhang M, Chuai S, Zhu G, Hu J, Wu YL, Wang J. Detection of EGFR mutations in plasma circulating tumour DNA as a selection criterion for first-line gefitinib treatment in patients with advanced lung adenocarcinoma (BENEFIT): a phase 2, single-arm, multicentre clinical trial. THE LANCET RESPIRATORY MEDICINE 2018; 6:681-690. [PMID: 30017884 DOI: 10.1016/s2213-2600(18)30264-9] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Detection of EGFR mutations in tumour tissue is the gold-standard approach to ascertain if a patient will benefit from treatment with an EGFR tyrosine kinase inhibitor. However, if tissue is scant, another strategy is to use circulating tumour DNA (ctDNA), but this method needs validation in clinical trials. We did a prospective clinical trial to assess ctDNA-based EGFR mutation detection as a selection criterion for patients with lung adenocarcinoma receiving gefitinib as first-line treatment. METHODS BENEFIT is a multicentre, single-arm, phase 2 clinical trial at 15 centres in China. Patients aged 18-75 years with stage IV metastatic lung adenocarcinoma and EGFR mutations detected in ctDNA were given oral gefitinib 250 mg once daily as first-line treatment. The primary endpoint was the proportion achieving an objective response. Secondary endpoints included median progression-free survival and safety. Next-generation sequencing (NGS) of a 168-gene panel was used for genetic analysis of baseline blood samples. The primary efficacy analysis was done by intention to treat in patients who had at least one post-baseline tumour assessment. The safety analysis was done in all patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, number NCT02282267. FINDINGS Between Dec 25, 2014, and Jan 16, 2016, 426 patients were screened for the trial, of whom 188 with EGFR mutations in ctDNA were enrolled and received gefitinib. 183 patients had one or more post-baseline tumour assessment and were included in the primary efficacy analysis. Median follow-up was 14·5 months (IQR 12·2-16·5). At the time of data cutoff (Jan 31, 2017), 152 patients had progressive disease or had died. The proportion achieving an objective response was 72·1% (95% CI 65·0-78·5). Median progression-free survival was 9·5 months (95% CI 9·07-11·04). Of 167 patients with available blood samples, 147 (88%) showed clearance of EGFR mutations in ctDNA at week 8, and median progression-free survival was longer for these patients than for the 20 patients whose EGFR mutations persisted at week 8 (11·0 months [95% CI 9·43-12·85] vs 2·1 months [1·81-3·65]; hazard ratio [HR] 0·14, 95% CI 0·08-0·23; p<0·0001). From baseline NGS data in 179 patients, we identified three subgroups of patients: those with EGFR mutations only (n=58), those with mutations in EGFR and tumour-suppressor genes (n=97), and those with mutations in EGFR and oncogenes (n=24). Corresponding median progression-free survival in these subgroups was 13·2 months (95% CI 11·5-15·0), 9·3 months (7·6-11·0), and 4·7 months (1·9-9·3), respectively (EGFR mutations only vs mutations in EGFR and tumour-suppressor genes, HR 1·78, 95% CI 1·23-2·58; p=0·002; EGFR mutations only vs mutations in EGFR and oncogenes, 2·66, 1·58-4·49; p=0·0003). The most common grade 3 or 4 adverse events were hepatic function abnormalities (n=24). Serious adverse events were reported in 17 (9%) patients. No unexpected safety events for gefitinib were recorded. INTERPRETATION Detection of EGFR mutations in ctDNA is an effective method to identify patients who might benefit from first-line gefitinib treatment. Further analyses of dynamic alterations of EGFR mutations and accompanying gene aberrances could predict resistance to gefitinib. FUNDING Guangdong Association of Clinical Trials, AstraZeneca, National Natural Sciences Foundation Key Programme, and National Key Research and Development Programme of China.
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Affiliation(s)
- Zhijie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Cheng
- Jilin Cancer Hospital, Division of Thoracic Oncology, Jilin Province Cancer Hospital, Changchun, China
| | - Tongtong An
- Department of Thoracic Medical Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China
| | - Hongjun Gao
- The 307th Hospital of Chinese People's Liberation Army, Beijing Shi, China
| | - Kai Wang
- Department of Respiratory Medicine, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanping Hu
- Department of Oncology, Hubei Cancer Hospital, Hubei, China
| | - Yong Song
- Nanjing General Hospital of Nanjing Military Command and PLA Bayi Hospital, Nanjing, China
| | - Cuimin Ding
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Hebei, China
| | - Feng Peng
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Li Liang
- Peking University Third Hospital, Beijing, China
| | - Yi Hu
- Chinese People's Liberation Army General Hospital, Beijing, China
| | - Cheng Huang
- Department of Medical Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University, Teaching Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Caicun Zhou
- Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Yuankai Shi
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin Ye
- IMED Asia, AstraZeneca, Shanghai, China
| | - Meizhuo Zhang
- Research and Development Information, AstraZeneca, Shanghai, China
| | | | | | - Jin Hu
- Kun Tuo Medical Research and Development, Beijing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Mlika M, Dziri C, Zorgati MM, Ben Khelil M, Mezni F. Liquid Biopsy as Surrogate to Tissue in Lung Cancer for Molecular Profiling: A Meta-Analysis. CURRENT RESPIRATORY MEDICINE REVIEWS 2018; 14:48-60. [PMID: 30271314 PMCID: PMC6128071 DOI: 10.2174/1573398x14666180430144452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 12/17/2022]
Abstract
Background: The accurate microscopic diagnosis of lung cancer has become insufficient due to the concept of personalized medicine. Tissue samples are used not only for microscopic diagnosis but also for the assessment of the different targets. Biopsies are performed in 80% of the patients and they are not sufficient for molecular diagnosis in 30% of the cases. Liquid biopsy (LB) has been reported as a possible surrogate to tissue samples and has been introduced in the management scheme of the patients since 2014. We aimed to highlight the diagnostic value of liquid biopsy in assessing the molecular profile of non small cell carcinomas in comparison with tissue biopsy. Methods: We retracted eligible articles from PubMed, Embase and Cochrane databases. We calculated the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). A summary receiver operating characteristic curve (SROC) and area under curve (AUC) were used to evaluate the overall diagnostic performance using the Meta-Disc software 5.1.32. The heterogeneity was assessed using I square statistics. A meta-regression was performed in case of heterogeneity. In case of absence of covariates, a sensitivity analysis was done in order to assess publications that induced a statistical bias. Results: 39 eligible studies involving 4782 patients were included. The overall statistical studies showed heterogeneity in the SEN, SPE, PLR, NLR and DOR. No threshold effect was revealed. The meta-regression incorporating the ethnicity, the test, the technique used in tissue and plasma and the use of plasma or serum as covariates showed no impact of these factors. A sensitivity analysis allowed achieving the homogeneity in the SPE and DOR. The overall pooled SEN and SPE were 0.61 and 0.95 respectively. The PLR was 9.51, the NLR was 0.45 and DOR was 24.58. The SROC curve with AUC of 0,93 indicated that the liquid biopsy is capable of identifying wild type samples from mutated ones with a relatively high accuracy. Conclusion: This meta-analysis suggested that detection of molecular mutations by cfDNA is of adequate diagnostic accuracy in association to tissues. The high specificity and the moderate sensitivity highlight the value of LB as a screening test
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Affiliation(s)
- Mona Mlika
- 1Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia; 2University Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; 3Department of General Surgery B, Charles Nicolle Hospital, Tunis, Tunisia; 4Medical Center of ABM, Military College, Qatar
| | - Chadli Dziri
- 1Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia; 2University Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; 3Department of General Surgery B, Charles Nicolle Hospital, Tunis, Tunisia; 4Medical Center of ABM, Military College, Qatar
| | - Mohamed Majdi Zorgati
- 1Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia; 2University Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; 3Department of General Surgery B, Charles Nicolle Hospital, Tunis, Tunisia; 4Medical Center of ABM, Military College, Qatar
| | - Mehdi Ben Khelil
- 1Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia; 2University Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; 3Department of General Surgery B, Charles Nicolle Hospital, Tunis, Tunisia; 4Medical Center of ABM, Military College, Qatar
| | - Faouzi Mezni
- 1Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia; 2University Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; 3Department of General Surgery B, Charles Nicolle Hospital, Tunis, Tunisia; 4Medical Center of ABM, Military College, Qatar
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179
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Indian consensus statement for treatment of advanced non small cell lung cancer: First line, maintenance, and second line. Indian J Cancer 2018; 54:89-103. [PMID: 29199671 DOI: 10.4103/ijc.ijc_136_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming complex with the identification of driver mutations and targeted therapies. The expert group of academic medical oncologists used data from published literature, practical experience to arrive at practical consensus recommendations to treat advanced NSCLC for use by the community oncologists.
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180
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Zhang S, Zhu L, Chen X, Zhang X, Chen E, Fang H, Feng Y, Li Y, Wang X, Jiang Z, Wang Y, Zhang Z, He H, Ma S. ctDNA assessment of EGFR mutation status in Chinese patients with advanced non-small cell lung cancer in real-world setting. J Thorac Dis 2018; 10:4169-4177. [PMID: 30174861 DOI: 10.21037/jtd.2018.06.166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background The prevalence of EGFR mutations in circulating free tumor-derived DNA (ctDNA) was still unknown in China. This large-scale study (NCT02623257) aimed to explore the prevalence of epidermal growth factor receptor (EGFR) mutations and determine the correlation of EGFR mutation status with clinical characteristics. Methods Plasma DNA samples from 1,001 patients with stage III/IV NSCLC who received ≤1st line chemotherapy were collected from 65 hospitals. EGFR mutations were tested by amplification refractory mutation system (ARMS) method. The EGFR mutation rate was calculated and the associations between EGFR status and patients' demographic data, disease status as well as treatment pattern were explored. Results EGFR mutations were detected in 251 of 1,001 (25.1%) patients, 26.8% in adenocarcinoma and 11.7% in squamous carcinoma. A total of 189 harbored sensitizing mutations alone, 28 had resistance mutations alone, 3 had a combination of activating mutations, and 31 had a combination of activating and resistance mutations. Higher detection rate was observed in chemotherapy-naïve patients than those received 1st line chemotherapy (27.0% vs. 18.0%; P=0.006). Of which, the mutation rate of exon 19 deletion was 9.31% for naïve patients and 7.37% for the 1st chemotherapy patients; while the mutation rate of L858R decreased obviously from 10.20% (naïve) to 3.69% (1st line). We also noticed the mutation rate was 37.1% in patients with ≥2 organ metastases. Multivariate analysis showed female, chemotherapy-naïve, or ≥2 metastatic organs patients had higher EGFR mutation rate. Conclusions ctDNA based EGFR mutation test is feasible and could be a surrogate when tissue biopsy is not available.
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Affiliation(s)
- Shirong Zhang
- Department of Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Lucheng Zhu
- Department of Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.,Department of Oncology, Hangzhou Cancer Hospital, Hangzhou 310002, China
| | - Xueqin Chen
- Department of Oncology, Hangzhou Cancer Hospital, Hangzhou 310002, China
| | - Xiaochen Zhang
- Department of Medical Oncology, The 1st Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Enguo Chen
- Department of Respiratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Hongming Fang
- Department of Oncology, Zhejiang Xiaoshan Hospital, Hangzhou 311202, China
| | - Yuejuan Feng
- Department of Respiratory, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - Yuping Li
- Department of Respiratory, The First Affiliated Hospital of Wenzhou Medical University, Hangzhou 325000, China
| | - Xi Wang
- Department of Oncology, the 117th Hospital of PLA, Hangzhou 310013, China
| | - Zhongyu Jiang
- Department of Oncology, Zhejiang Quhua Hospital, Quhua 324004, China
| | - Yina Wang
- Department of Medical Oncology, The 1st Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Zhihao Zhang
- Department of Oncology, Wujing Zhejiang Hospital, Hangzhou 310051, China
| | - Huijuan He
- Department of Oncology, Quzhou People's Hospital, Quzhou 324000, China
| | - Shenglin Ma
- Department of Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
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181
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Cabanero M, Tsao MS. Circulating tumour DNA in EGFR-mutant non-small-cell lung cancer. ACTA ACUST UNITED AC 2018; 25:S38-S44. [PMID: 29910646 DOI: 10.3747/co.25.3761] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The advent of targeted therapy in non-small-cell lung cancer (nsclc) has made the routine molecular diagnosis of EGFR mutations crucial for optimal patient management. Obtaining tumour tissue for biomarker testing, especially in the setting of re-biopsy, can present many challenges. A potential alternative source of tumour dna is circulating cell-free tumour-derived dna (ctdna). Although ctdna is present in low quantities in plasma, the convenience of sample acquisition and the increasing reliability of detection methods make this approach a promising one. The various performance characteristics of both digital and nondigital platforms are still variable, and a standardized approach is needed that will make those platforms reliable clinical tools for the detection of EGFR sensitizing mutations and resistance mutations, including the T790M resistance mutation. Information derived from ctdna can be used to assess tumour burden, to identify genomic-based resistance mechanisms, and to track dynamic changes during therapy.
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Affiliation(s)
- M Cabanero
- Princess Margaret Cancer Centre, University Health Network, and.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - M S Tsao
- Princess Margaret Cancer Centre, University Health Network, and.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
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182
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Ishiba T, Hoffmann AC, Usher J, Elshimali Y, Sturdevant T, Dang M, Jaimes Y, Tyagi R, Gonzales R, Grino M, Pinski JK, Barzi A, Raez LE, Eberhardt WE, Theegarten D, Lenz HJ, Uetake H, Danenberg PV, Danenberg K. Frequencies and expression levels of programmed death ligand 1 (PD-L1) in circulating tumor RNA (ctRNA) in various cancer types. Biochem Biophys Res Commun 2018; 500:621-625. [PMID: 29679564 PMCID: PMC9165692 DOI: 10.1016/j.bbrc.2018.04.120] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Precision medicine and prediction of therapeutic response requires monitoring potential biomarkers before and after treatment. Liquid biopsies provide noninvasive prognostic markers such as circulating tumor DNA and RNA. Circulating tumor RNA (ctRNA) in blood is also used to identify mutations in genes of interest, but additionally, provides information about relative expression levels of important genes. In this study, we analyzed PD-L1 expression in ctRNA isolated from various cancer types. Tumors inhibit antitumor response by modulating the immune checkpoint proteins programmed death ligand 1 (PD-L1) and its cognate receptor PD1. The expression of these genes has been implicated in evasion of immune response and resistance to targeted therapies. METHODS Blood samples were collected from gastric (GC), colorectal (CRC), lung (NSCLC), breast (BC), prostate cancer (PC) patients, and a healthy control group. ctRNA was purified from fractionated plasma, and following reverse transcription, levels of PD-L1 expression were analyzed using qPCR. RESULTS PD-L1 expression was detected in the plasma ctRNA of all cancer types at varying frequencies but no PD-L1 mRNA was detected in cancer-free individuals. The frequencies of PD-L1 expression were significantly different among the various cancer types but the median relative PD-L1 expression values were not significantly different. In 12 cases where plasma and tumor tissue were available from the same patients, there was a high degree of concordance between expression of PD-L1 protein in tumor tissues and PD-L1 gene expression in plasma, and both methods were equally predictive of response to nivolumab. CONCLUSIONS PD-L1 mRNA can be detected and quantitated in ctRNA of cancer patients. These results pave the way for further studies aimed at determining whether monitoring the levels of PD-L1 mRNA in blood can identify patients who are most likely to benefit from the conventional treatment.
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Affiliation(s)
- Toshiyuki Ishiba
- NantHealth, Inc., 9920 Jefferson Blvd, Culver City, CA, United States; Department of Biochemistry and Molecular Medicine, Keck-USC School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, United States; Department of Surgical Specialties, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Andreas-Claudius Hoffmann
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen, Germany
| | - Joshua Usher
- NantHealth, Inc., 9920 Jefferson Blvd, Culver City, CA, United States; Keck School of Medicine at USC, Division of Biostatistics, 1975 Zonal Ave, Los Angeles, CA, United States
| | - Yahya Elshimali
- NantHealth, Inc., 9920 Jefferson Blvd, Culver City, CA, United States
| | - Todd Sturdevant
- NantHealth, Inc., 9920 Jefferson Blvd, Culver City, CA, United States
| | - Mai Dang
- NantHealth, Inc., 9920 Jefferson Blvd, Culver City, CA, United States
| | - Yolanda Jaimes
- NantHealth, Inc., 9920 Jefferson Blvd, Culver City, CA, United States
| | - Rama Tyagi
- NantHealth, Inc., 9920 Jefferson Blvd, Culver City, CA, United States
| | - Ronald Gonzales
- NantHealth, Inc., 9920 Jefferson Blvd, Culver City, CA, United States
| | - Mary Grino
- NantHealth, Inc., 9920 Jefferson Blvd, Culver City, CA, United States
| | - Jacek K Pinski
- Department of Medicine, Division of Oncology, Keck School of Medicine, Norris Comprehensive Cancer Center, 1975 Zonal Ave, Los Angeles, CA, United States
| | - Afsaneh Barzi
- Department of Medicine, Division of Oncology, Keck School of Medicine, Norris Comprehensive Cancer Center, 1975 Zonal Ave, Los Angeles, CA, United States
| | - Luis E Raez
- Memorial Cancer Institute, 801 N Flamingo Road Suite 11, Pembroke Pines, FL, United States
| | - Wilfried E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen, Germany
| | - Heinz-Josef Lenz
- Department of Biochemistry and Molecular Medicine, Keck-USC School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, United States; Department of Medicine, Division of Oncology, Keck School of Medicine, Norris Comprehensive Cancer Center, 1975 Zonal Ave, Los Angeles, CA, United States
| | - Hiroyuki Uetake
- Department of Surgical Specialties, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Peter V Danenberg
- Department of Biochemistry and Molecular Medicine, Keck-USC School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, United States.
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183
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Morán T, Felip E, Bosch-Barrera J, de Aguirre I, Ramirez JL, Mesia C, Carcereny E, Roa D, Sais E, García Y, Blanco R, Sanchez S, Villacorta CR, Queralt C, Velarde JM, Rosell R. Monitoring EGFR-T790M mutation in serum/plasma for prediction of response to third-generation EGFR inhibitors in patients with lung cancer. Oncotarget 2018; 9:27074-27086. [PMID: 29930751 PMCID: PMC6007479 DOI: 10.18632/oncotarget.25478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/02/2018] [Indexed: 12/16/2022] Open
Abstract
Background Osimertinib is efficacious in lung cancer patients with epidermal growth factor receptor (EGFR) mutations and acquired resistance (AR) to EGFR tyrosine kinase inhibitors due to EGFR-T790M mutation (T790M). We sought to describe T790M changes in serum/plasma during osimertinib therapy and correlate these changes with treatment outcomes. Material and methods Serum/plasma from EGFR-mutant lung cancer patients with T790M-AR was collected before and during osimertinib treatment. Changes in T790M were evaluated using a peptide-nucleic acid-PCR assay, and correlated with clinical and radiographic response. Results Thirteen patients were included. Median time on osimertinib treatment was 10.6 months with a median progression-free survival of 13.6 months. Best response to osimertinib was partial response (PR), stable disease (SD) or progression (PD) in 46.1%, 30.8% and 23.1% of patients, respectively. Most of the patients were paucisymptomatic at baseline. Symptom improvement was reported in 66.6% of responder patients; while symptoms remained stable in 75% of patients with SD, and 66% of patients with PD had clinical deterioration. Three patterns of T790M changes during osimertinib treatment were identified. T790 remained detectable with PD or a short-lasting SD in 15.4% of the patients. T790M disappeared in 69.2% of patients with PR or SD. T790M disappeared, despite clinical and/or radiographic progression in 15.4% of the patients. Conclusion Changes of T790M in serum/plasma in EGFR-mutant lung cancer patients with T790M-AR might be a useful marker of symptomatic and radiographic outcome to osimertinib. Longer follow-up is needed to establish if subsequent emergence of T790M could be a marker of resistance.
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Affiliation(s)
- Teresa Morán
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eudald Felip
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joaquim Bosch-Barrera
- Medical Oncology Department, Catalan Institute of Oncology-Girona, Hospital Universitari Doctor Trueta Girona, Girona, Spain
| | - Itziar de Aguirre
- Molecular Biology Laboratory of Cancer Dr. Rosell, Can Ruti Campus: Institute Germans Trias i Pujol (IGTP), Catalan Institute of Oncology, Badalona, Spain
| | - Jose Luis Ramirez
- Molecular Biology Laboratory of Cancer Dr. Rosell, Can Ruti Campus: Institute Germans Trias i Pujol (IGTP), Catalan Institute of Oncology, Badalona, Spain
| | - Carles Mesia
- Medical Oncology Department, Catalan Institute of Oncology - Hospital Duran i Reynalds, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Enric Carcereny
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Diana Roa
- Medical Oncology Department, Catalan Institute of Oncology-Girona, Hospital Universitari Doctor Trueta Girona, Girona, Spain
| | - Elia Sais
- Medical Oncology Department, Catalan Institute of Oncology-Girona, Hospital Universitari Doctor Trueta Girona, Girona, Spain
| | - Yolanda García
- Medical Oncology Department, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Remei Blanco
- Medical Oncology Department, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Silvia Sanchez
- Research Nurse Team, Catalan Institute of Oncology - Badalona, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Claudia Rosa Villacorta
- Research Nurse Team, Catalan Institute of Oncology - Badalona, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristina Queralt
- Molecular Biology Laboratory of Cancer Dr. Rosell, Can Ruti Campus: Institute Germans Trias i Pujol (IGTP), Catalan Institute of Oncology, Badalona, Spain
| | | | - Rafael Rosell
- Molecular Biology Laboratory of Cancer Dr. Rosell, Can Ruti Campus: Institute Germans Trias i Pujol (IGTP), Catalan Institute of Oncology, Badalona, Spain
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184
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Tsui DWY, Murtaza M, Wong ASC, Rueda OM, Smith CG, Chandrananda D, Soo RA, Lim HL, Goh BC, Caldas C, Forshew T, Gale D, Liu W, Morris J, Marass F, Eisen T, Chin TM, Rosenfeld N. Dynamics of multiple resistance mechanisms in plasma DNA during EGFR-targeted therapies in non-small cell lung cancer. EMBO Mol Med 2018; 10:e7945. [PMID: 29848757 PMCID: PMC5991591 DOI: 10.15252/emmm.201707945] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022] Open
Abstract
Tumour heterogeneity leads to the development of multiple resistance mechanisms during targeted therapies. Identifying the dominant driver(s) is critical for treatment decision. We studied the relative dynamics of multiple oncogenic drivers in longitudinal plasma of 50 EGFR-mutant non-small-cell lung cancer patients receiving gefitinib and hydroxychloroquine. We performed digital PCR and targeted sequencing on samples from all patients and shallow whole-genome sequencing on samples from three patients who underwent histological transformation to small-cell lung cancer. In 43 patients with known EGFR mutations from tumour, we identified them accurately in plasma of 41 patients (95%, 41/43). We also found additional mutations, including EGFR T790M (31/50, 62%), TP53 (23/50, 46%), PIK3CA (7/50, 14%) and PTEN (4/50, 8%). Patients with both TP53 and EGFR mutations before treatment had worse overall survival than those with only EGFR Patients who progressed without T790M had worse PFS during TKI continuation and developed alternative alterations, including small-cell lung cancer-associated copy number changes and TP53 mutations, that tracked subsequent treatment responses. Longitudinal plasma analysis can help identify dominant resistance mechanisms, including non-druggable genetic information that may guide clinical management.
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Affiliation(s)
- Dana Wai Yi Tsui
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
| | - Muhammed Murtaza
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Alvin Seng Cheong Wong
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Oscar M Rueda
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
| | - Christopher G Smith
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
| | - Dineika Chandrananda
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
- Cancer Science Institute, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
| | | | - Boon Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
- Cancer Science Institute, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Health Partners, Cambridge, UK
| | - Tim Forshew
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
| | - Davina Gale
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
| | - Wei Liu
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
| | - James Morris
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
| | - Francesco Marass
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
| | - Tim Eisen
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Health Partners, Cambridge, UK
- Oncology Early Clinical Development, AstraZeneca, Cambridge, UK
| | - Tan Min Chin
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
- Cancer Science Institute, Centre for Translational Medicine, National University of Singapore, Singapore, Singapore
- Raffles Cancer Centre, Raffles Hospital, Singapore, Singapore
| | - Nitzan Rosenfeld
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Center - Cambridge, Cambridge, UK
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185
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Abstract
Liquid biopsy provides the opportunity of detecting and analyzing cancer in various body fluids. In peripheral blood, apart from circulating cell free DNA, circulating cancer cells and other tumor-associated compounds such as extracellular vesicles are also emerging candidates for detection. Compared to conventional tissue or cytology samples, liquid biopsy is non-invasive, safe, and easy to repeat. In view of tumor heterogeneity, it is also suggested that circulating cell free DNA may be more representative of the whole tumor cells population than a biopsy or cytology sample. In addition to assisting in the initial diagnosis, liquid biopsy can also be tailored for disease monitoring, detecting resistance mutation, tumor recurrence, and perhaps for screening in the future. The accuracy of this test is greatly facilitated by the advances of molecular techniques, from PCR-based methods, DNA sequencing, Digital PCR, to the more state-of-the-art next generation sequencing technologies. Despite the tremendous potential of liquid biopsy, there are limitations and not all clinical relevant cancer biomarkers can be detected in liquid biopsy at the present moment. The clinical utility of many of the tests derived from liquid biopsy required further investigations and clinical validation. This review provides an overview of the concept of liquid biopsy, its clinical applications, and discuss the multifaceted advances in this field.
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Affiliation(s)
- Alvin Ho-Kwan Cheung
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Oncology in South China, Sir Y.K. Pao Cancer Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chit Chow
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Oncology in South China, Sir Y.K. Pao Cancer Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Fai To
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Oncology in South China, Sir Y.K. Pao Cancer Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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186
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Ou SHI, Nagasaka M, Zhu VW. Liquid Biopsy to Identify Actionable Genomic Alterations. Am Soc Clin Oncol Educ Book 2018; 38:978-997. [PMID: 30231331 PMCID: PMC6865813 DOI: 10.1200/edbk_199765] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Liquid biopsy has been used extensively in solid malignancies to detect actionable driver mutations, to monitor treatment response, to detect recurrence, to identify resistance mechanisms, and to prognosticate outcome. Although many liquid biopsy sequencing platforms are being used, only five test kits have received government approval. We review representative literature on these government-approved liquid biopsy kits, which are primarily used to detect EGFR mutation in lung cancer and RAS ( KRAS, NRAS, BRAF) mutations in colorectal carcinoma. Another emerging use of single-gene liquid biopsy is to detect PIK3CA mutations and to understand resistance to hormonal blockade in breast and prostate cancers. The two most commonly used next-generation sequencing (NGS) liquid biopsy tests (Guardant 360, Guardant Health; FoundationACT, Foundation Medicine Inc.) are discussed. The ability and the applicability of NGS platform to detect tumor mutation burden are also addressed. Finally, the use of circulating tumor DNA (ctDNA) to detect minimal residual disease may be the most important use of ctDNA in the setting of tumor heterogeneity. The ability to identify "shedders" and "nonshedders" of ctDNA may provide important insight into the clinicopathologic characteristics of the tumor and portend important prognostic significance regarding survival.
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Affiliation(s)
- Sai-Hong Ignatius Ou
- From Chao Family Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, CA; Karmanos Cancer Center, Wayne State University, Detroit, MI; Hematology/Oncology Section, Veterans Affairs Long Beach Healthcare System, Long Beach, CA
| | - Misako Nagasaka
- From Chao Family Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, CA; Karmanos Cancer Center, Wayne State University, Detroit, MI; Hematology/Oncology Section, Veterans Affairs Long Beach Healthcare System, Long Beach, CA
| | - Viola W Zhu
- From Chao Family Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, CA; Karmanos Cancer Center, Wayne State University, Detroit, MI; Hematology/Oncology Section, Veterans Affairs Long Beach Healthcare System, Long Beach, CA
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187
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Cabel L, Proudhon C, Buecher B, Pierga JY, Bidard FC. Circulating tumor DNA detection in hepatocellular carcinoma. Ann Oncol 2018; 29:1094-1096. [PMID: 29635453 DOI: 10.1093/annonc/mdy111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- L Cabel
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud; Circulating Tumor Biomarkers Laboratory, Institut Curie, PSL Research University, Paris; UVSQ, Paris Saclay University, Saint Cloud
| | - C Proudhon
- Circulating Tumor Biomarkers Laboratory, Institut Curie, PSL Research University, Paris
| | - B Buecher
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud
| | - J-Y Pierga
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud; Circulating Tumor Biomarkers Laboratory, Institut Curie, PSL Research University, Paris; Paris Descartes University, Paris, France
| | - F-C Bidard
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud; Circulating Tumor Biomarkers Laboratory, Institut Curie, PSL Research University, Paris; UVSQ, Paris Saclay University, Saint Cloud.
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188
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Implementing liquid biopsies into clinical decision making for cancer immunotherapy. Oncotarget 2018; 8:48507-48520. [PMID: 28501851 PMCID: PMC5564665 DOI: 10.18632/oncotarget.17397] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/04/2017] [Indexed: 02/06/2023] Open
Abstract
During the last decade, novel immunotherapeutic strategies, in particular antibodies directed against immune checkpoint inhibitors, have revolutionized the treatment of different malignancies leading to an improved survival of patients. Identification of immune-related biomarkers for diagnosis, prognosis, monitoring of immune responses and selection of patients for specific cancer immunotherapies is urgently required and therefore areas of intensive research. Easily accessible samples in particular liquid biopsies (body fluids), such as blood, saliva or urine, are preferred for serial tumor biopsies. Although monitoring of immune and tumor responses prior, during and post immunotherapy has led to significant advances of patients’ outcome, valid and stable prognostic biomarkers are still missing. This might be due to the limited capacity of the technologies employed, reproducibility of results as well as assay stability and validation of results. Therefore solid approaches to assess immune regulation and modulation as well as to follow up the nature of the tumor in liquid biopsies are urgently required to discover valuable and relevant biomarkers including sample preparation, timing of the collection and the type of liquid samples. This article summarizes our knowledge of the well-known liquid material in a new context as liquid biopsy and focuses on collection and assay requirements for the analysis and the technical developments that allow the implementation of different high-throughput assays to detect alterations at the genetic and immunologic level, which could be used for monitoring treatment efficiency, acquired therapy resistance mechanisms and the prognostic value of the liquid biopsies.
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189
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Gorgannezhad L, Umer M, Islam MN, Nguyen NT, Shiddiky MJA. Circulating tumor DNA and liquid biopsy: opportunities, challenges, and recent advances in detection technologies. LAB ON A CHIP 2018; 18:1174-1196. [PMID: 29569666 DOI: 10.1039/c8lc00100f] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Cell-free DNA (cfDNA) refers to short fragments of acellular nucleic acids detectable in almost all body fluids, including blood, and is involved in various physiological and pathological phenomena such as immunity, coagulation, aging, and cancer. In cancer patients, a fraction of hematogenous cfDNA originates from tumors, termed circulating tumor DNA (ctDNA), and may carry the same mutations and genetic alterations as those of a primary tumor. Thus, ctDNA potentially provides an opportunity for noninvasive assessment of cancer. Recent advances in ctDNA analysis methods will potentially lead to the development of a liquid biopsy tool for the diagnosis, prognosis, therapy response monitoring, and tracking the rise of new mutant sub-clones in cancer patients. Over the past few decades, cancer-specific mutations in ctDNA have been detected using a variety of untargeted methods such as digital karyotyping, personalized analysis of rearranged ends (PARE), whole-genome sequencing of ctDNA, and targeted approaches such as conventional and digital PCR-based methods and deep sequencing-based technologies. More recently, several chip-based electrochemical sensors have been developed for the analysis of ctDNA in patient samples. This paper aims to comprehensively review the diagnostic, prognostic, and predictive potential of ctDNA as a minimally invasive liquid biopsy for cancer patients. We also present an overview of current advances in the analytical sensitivity and accuracy of ctDNA analysis methods as well as biological and technical challenges, which need to be resolved for the integration of ctDNA analysis into routine clinical practice.
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Affiliation(s)
- Lena Gorgannezhad
- School of Environment and Science, Griffith University, Nathan Campus, QLD 4111, Australia. and Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Muhammad Umer
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Md Nazmul Islam
- School of Environment and Science, Griffith University, Nathan Campus, QLD 4111, Australia. and Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Nam-Trung Nguyen
- Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Muhammad J A Shiddiky
- School of Environment and Science, Griffith University, Nathan Campus, QLD 4111, Australia. and Queensland Micro- and Nanotechnology Centre, Griffith University, Nathan Campus, QLD 4111, Australia
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190
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The value of radial endobronchial ultrasound-guided bronchial brushing in peripheral non-squamous non-small cell lung cancer. Sci Rep 2018; 8:5837. [PMID: 29643378 PMCID: PMC5895614 DOI: 10.1038/s41598-018-24300-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022] Open
Abstract
Radial endobronchial ultrasound (R-EBUS) is one important diagnostic approach in non-small cell lung cancers (NSCLC). However, the small samples obtained from R-EBUS-guided transbronchial biopsies are sometimes insufficient for pathological and molecular diagnosis. Herein, we investigated the suitability of R-EBUS-guided bronchial brushing specimens for NSCLC diagnosis and EGFR genotyping. We enrolled 941 consecutive patients with peripheral pulmonary lesions who underwent R-EBUS. Cytology-positive brushing specimens from non-squamous NSCLC patients were tested for EGFR mutations. Non-squamous NSCLC was diagnosed in 624 patients (66.3%). Positive cytology was documented in the brushing samples of 376 patients (60.3%). Higher diagnostic yields were obtained in patients exhibiting bronchus signs on chest tomography, and those with R-EBUS probe located within the lesion. EGFR genotyping was successfully performed in 363 samples (96.5% of cytology-positive brushing samples). EGFR genotyping concordance between brushing specimens and matched tissue samples was 88.7% (kappa = 0.745, P < 0.001). Furthermore, 144 non-squamous NSCLC patients (23.1%) with failed pathological diagnosis or EGER sequencing by R-EBUS-guided transbronchial biopsy required repeat biopsies. However, it was achieved successfully from the brushing specimens of 57 patients (39.6%). In conclusion, for patients with peripheral lung cancer, R-EBUS-guided bronchial brushing could provide an additional sampling method for diagnosis and EGFR genotyping.
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191
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Abstract
A tissue biopsy is the "golden standard" for molecular profiling that is essential in decision-making regarding treatment for malignant tumors, including primary lung cancer. However, tumor biopsies are associated with several limitations, including invasiveness and difficulty in achieving access. Liquid biopsies have several potential advantages over tissue biopsies, and recent advances in molecular technologies have enabled liquid biopsies to be introduced into daily clinical practice. Cell-free blood-based liquid biopsies to detect mutations in the epidermal growth factor receptor (EGFR) gene in the plasma have been approved and may be useful in selecting patients for treatment with tyrosine kinase inhibitors of EGFR. We herein describe blood-based liquid biopsies and review the current status and future perspectives of plasma genotyping in primary lung cancer.
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192
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Qu L, Li L, Zheng X, Fu H, Tang C, Qin H, Li X, Wang H, Li J, Wang W, Yang S, Wang L, Zhao G, Lv P, Lei Y, Zhang M, Gao H, Song S, Liu X. Circulating plasma microRNAs as potential markers to identify EGFR mutation status and to monitor epidermal growth factor receptor-tyrosine kinase inhibitor treatment in patients with advanced non-small cell lung cancer. Oncotarget 2018; 8:45807-45824. [PMID: 28496005 PMCID: PMC5542229 DOI: 10.18632/oncotarget.17416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/17/2017] [Indexed: 12/29/2022] Open
Abstract
We aimed to identify a panel of circulating plasma microRNAs that can predict EGFR mutation status and monitor epidermal growth factor receptor-tyrosine kinase inhibitor treatment in patients with non-small cell lung cancer. Microarrays were performed for the preliminary screening of dysregulated microRNAs in 9 EGFR mutation-positive patients versus healthy controls. MiR-107 was upregulated and miR-195 was downregulated in the exon 19 deletion versus wild-type group. The areas under the receiver operating characteristic curves for miR-107, miR-195, and a panel of these 2 microRNAs were 0.72, 0.75, and 0.74, with sensitivities and specificities of 64.7% and 76.6%, 71.8% and 69.1%, and 71.7% and 78.9%, respectively. MiR-122 was significantly upregulated in the p.L858R versus wild-type group. An area under the receiver operative characteristic curve of 0.75 suggests that miR-122 might be a specific biomarker for patients with the p.L858R mutation. In addition, dynamic changes in these 3 microRNAs were also found to correlate with responses to epidermal growth factor receptor-tyrosine kinase inhibitor treatment, indicating that circulating plasma microRNAs may represent potential biomarkers for monitoring epidermal growth factor receptor-tyrosine kinase inhibitor treatment. This study demonstrates the prospective application of circulating plasma microRNAs as potential non-invasive, convenient biomarkers for patients with EGFR-sensitive mutations.
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Affiliation(s)
- Lili Qu
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Liangliang Li
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Xiaofei Zheng
- Institute of Radiation Medicine, Academy of Military Medical Science, Beijing, China
| | - Hanjiang Fu
- Institute of Radiation Medicine, Academy of Military Medical Science, Beijing, China
| | - Chuanhao Tang
- Department of Oncology, Peking University International Hospital, Beijing, China
| | - Haifeng Qin
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Xiaoyan Li
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Hong Wang
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Jianjie Li
- Department of Medical Oncology, Beijing Cancer Hospital, Beijing, China
| | - Weixia Wang
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Shaoxing Yang
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Lin Wang
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Guanhua Zhao
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Panpan Lv
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Yangyang Lei
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Min Zhang
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Hongjun Gao
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Santai Song
- Department of Breast Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
| | - Xiaoqing Liu
- Department of Lung Cancer, Affiliated Hospital of the Academy of Military Medical Science, Beijing, China
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193
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Comparison of plasma ctDNA and tissue/cytology-based techniques for the detection of EGFR mutation status in advanced NSCLC: Spanish data subset from ASSESS. Clin Transl Oncol 2018; 20:1261-1267. [PMID: 29623586 PMCID: PMC6153859 DOI: 10.1007/s12094-018-1855-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/02/2018] [Indexed: 11/25/2022]
Abstract
Purpose The analysis of epidermal growth factor receptor (EGFR) mutations in many patients with advanced non-small-cell lung cancer (aNSCLC) has provided the opportunity for successful treatment with specific, targeted EGFR tyrosine kinase inhibitors. However, this therapeutic decision may be challenging when insufficient tumor tissue is available for EGFR mutation testing. Therefore, blood surrogate samples for EGFR mutation analysis have been suggested. Methods Data were collected from the Spanish cohort of patients in the large, non-interventional, diagnostic ASSESS study (NCT01785888) evaluating the utility of circulating free tumor-derived DNA from plasma for EGFR mutation testing. The incidence of EGFR mutation in Spain and the level of concordance between matched tissue/cytology and plasma samples were evaluated. Results In a cohort of 154 eligible patients, EGFR mutations were identified in 15.1 and 11.0% of tumor and plasma samples, respectively. The most commonly used EGFR mutation testing method for the tumor tissue samples was the QIAGEN Therascreen® EGFR RGQ PCR kit (52.1%). Fragment Length Analysis + PNA LNA Clamp was used for the plasma samples. The concordance rate for EGFR mutation status between the tissue/cytology and plasma samples was 88.8%; the sensitivity was 45.5%, and the specificity was 96.7%. Conclusions The high concordance between the different DNA sources for EGFR mutation testing supports the use of plasma samples when tumor tissue is unavailable. Electronic supplementary material The online version of this article (10.1007/s12094-018-1855-y) contains supplementary material, which is available to authorized users.
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194
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Levy B. Cell-Free DNA Utility and Value of Recommendation. Arch Pathol Lab Med 2018; 142:785-786. [PMID: 29607664 DOI: 10.5858/arpa.2018-0064-ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Benjamin Levy
- From Medical Oncology, Upper Aerodigestive Disease Program, Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, Washington, DC
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195
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Abstract
Therapeutics that block kinases, transcriptional modifiers, immune checkpoints and other biological vulnerabilities are transforming cancer treatment. As a result, many patients achieve dramatic responses, including complete radiographical or pathological remission, yet retain minimal residual disease (MRD), which results in relapse. New functional approaches can characterize clonal heterogeneity and predict therapeutic sensitivity of MRD at a single-cell level. Preliminary evidence suggests that iterative detection, profiling and targeting of MRD would meaningfully improve outcomes and may even lead to cure.
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Affiliation(s)
- Marlise R. Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA,
| | - Mark A. Murakami
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA,
| | - Scott R. Manalis
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA
- Corresponding authors: (S. R. M.) and (D. M. W.)
| | - David M. Weinstock
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA,
- Broad Institute of MIT and Harvard University, Cambridge, Massachusetts, 02142, USA
- Corresponding authors: (S. R. M.) and (D. M. W.)
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196
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Condello V, Macerola E, Ugolini C, De Napoli L, Romei C, Materazzi G, Elisei R, Basolo F. Analysis of circulating tumor DNA does not improve the clinical management of patients with locally advanced and metastatic papillary thyroid carcinoma. Head Neck 2018; 40:1752-1758. [PMID: 29566452 DOI: 10.1002/hed.25155] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 12/15/2017] [Accepted: 02/08/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Circulating cell-free tumor DNA (ctDNA) in plasma is a promising noninvasive instrument for cancer monitoring. Detection of BRAFV600E on ctDNA of patients with papillary thyroid carcinoma (PTC) may represent an indicator of tumor aggressiveness and progression. METHODS Eighty-three plasma samples were collected from 70 patients with thyroid nodules undergoing surgery and from 13 patients with PTC causing distant metastases. A total of 59 PTCs from both groups were evaluated for BRAF mutation on tumor tissue and on ctDNA from plasma samples by real-time polymerase chain reaction (PCR) and digital PCR. RESULTS Of 59 PTCs, 22 were BRAFV600E mutated (37.3%). The corresponding ctDNA was negative by using both techniques. CONCLUSION Although highly sensitive techniques were used, in our study, circulating BRAFV600E alleles were never detected in the plasma of patients with PTC; therefore, our results raise the question about the clinical usefulness of BRAFV600E analysis on ctDNA of patients with PTC.
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Affiliation(s)
- Vincenzo Condello
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Clara Ugolini
- Division of Surgical Pathology, University Hospital of Pisa, Pisa, Italy
| | - Luigi De Napoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Cristina Romei
- Department of Clinical and Experimental Medicine (Endocrine Unit), University Hospital of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine (Endocrine Unit), University Hospital of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
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197
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Heydt C, Michels S, Thress KS, Bergner S, Wolf J, Buettner R. Novel approaches against epidermal growth factor receptor tyrosine kinase inhibitor resistance. Oncotarget 2018; 9:15418-15434. [PMID: 29632655 PMCID: PMC5880615 DOI: 10.18632/oncotarget.24624] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The identification and characterization of molecular biomarkers has helped to revolutionize non-small-cell lung cancer (NSCLC) management, as it transitions from target-focused to patient-based treatment, centered on the evolving genomic profile of the individual. Determination of epidermal growth factor receptor (EGFR) mutation status represents a critical step in the diagnostic process. The recent emergence of acquired resistance to "third-generation" EGFR tyrosine kinase inhibitors (TKIs) via multiple mechanisms serves to illustrate the important influence of tumor heterogeneity on prognostic outcomes in patients with NSCLC. DESIGN This literature review examines the emergence of TKI resistance and the course of disease progression and, consequently, the clinical decision-making process in NSCLC. RESULTS Molecular markers of acquired resistance, of which T790M and HER2 or MET amplifications are the most common, help to guide ongoing treatment past the point of progression. Although tissue biopsy techniques remain the gold standard, the emergence of liquid biopsies and advances in analytical techniques may eventually allow "real-time" monitoring of tumor evolution and, in this way, help to optimize targeted treatment approaches. CONCLUSIONS The influence of inter- and intra-tumor heterogeneity on resistance mechanisms should be considered when treating patients using resistance-specific therapies. New tools are necessary to analyze changes in heterogeneity and clonal composition during drug treatment. The refinement and standardization of diagnostic procedures and increased accessibility to technology will ultimately help in personalizing the management of NSCLC.
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Affiliation(s)
- Carina Heydt
- Molecular Pathological Diagnostics, Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Center of Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
| | - Sebastian Michels
- Center of Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Köln-Bonn, University Hospital of Cologne, Cologne, Germany
| | | | - Sven Bergner
- Medical Affairs, AstraZeneca Oncology, Wedel, Germany
| | - Jürgen Wolf
- Center of Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Köln-Bonn, University Hospital of Cologne, Cologne, Germany
| | - Reinhard Buettner
- Molecular Pathological Diagnostics, Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Center of Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
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198
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Andriamanampisoa CL, Bancaud A, Boutonnet-Rodat A, Didelot A, Fabre J, Fina F, Garlan F, Garrigou S, Gaudy C, Ginot F, Henaff D, Laurent-Puig P, Morin A, Picot V, Saias L, Taly V, Tomasini P, Zaanan A. BIABooster: Online DNA Concentration and Size Profiling with a Limit of Detection of 10 fg/μL and Application to High-Sensitivity Characterization of Circulating Cell-Free DNA. Anal Chem 2018; 90:3766-3774. [PMID: 29498256 DOI: 10.1021/acs.analchem.7b04034] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We describe a technology to perform sizing and concentration analysis of double stranded DNA with a sensitivity of 10 fg/μL in an operating time of 20 min. The technology is operated automatically on a commercial capillary electrophoresis instrument using electro-hydrodynamic actuation. It relies on a new capillary device that achieves online concentration of DNA at the junction between two capillaries of different diameters, thanks to viscoelastic lift forces. Using a set of DNA ladders in the range of 100-1500 bp, we report a sizing accuracy and precision better than 3% and a concentration quantification precision of ∼20%. When the technology is applied to the analysis of clinical samples of circulating cell-free DNA (cfDNA), the measured cfDNA concentrations are in good correlation with those measured by digital PCR. Furthermore, the cfDNA size profiles indicate that the fraction of low molecular weight cfDNA in the range of 75-240 bp is a candidate biomarker to discriminate between healthy subjects and cancer patients. We conclude that our technology is efficient in analyzing highly diluted DNA samples and suggest that it will be helpful in translational and clinical research involving cfDNA.
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Affiliation(s)
| | - Aurélien Bancaud
- LAAS-CNRS , Université de Toulouse, CNRS , 7 Avenue du Colonel Roche , 31400 Toulouse , France
| | | | - Audrey Didelot
- INSERM UMR-S1147, CNRS SNC5014 , Paris Descartes University , 45 rue des Saints-Pères , Paris , France
| | - Jacques Fabre
- Picometrics Technologies , 478 rue de la Découverte , 31 670 Labège , France
| | - Frédéric Fina
- Laboratoire de Biologie Médicale, Unité de développement technologique , Timone, Assistance Publique Hôpitaux de Marseille , 13005 Marseille , France.,ID-Solutions , 310 rue Louis Pasteur , 34790 Grabels , France.,Service d'Anatomie Pathologique et Neuropathologie, Timone II , Assistance Publique Hôpitaux de Marseille , 13005 Marseille , France
| | - Fanny Garlan
- INSERM UMR-S1147, CNRS SNC5014 , Paris Descartes University , 45 rue des Saints-Pères , Paris , France
| | - Sonia Garrigou
- INSERM UMR-S1147, CNRS SNC5014 , Paris Descartes University , 45 rue des Saints-Pères , Paris , France
| | - Caroline Gaudy
- Service de Dermatologie, Vénéréologie et Cancérologie cutanée , Timone, Assistance Publique Hôpitaux de Marseille , 13005 Marseille , France
| | - Frédéric Ginot
- Picometrics Technologies , 478 rue de la Découverte , 31 670 Labège , France
| | - Daniel Henaff
- ID-Solutions , 310 rue Louis Pasteur , 34790 Grabels , France
| | - Pierre Laurent-Puig
- INSERM UMR-S1147, CNRS SNC5014 , Paris Descartes University , 45 rue des Saints-Pères , Paris , France.,Department of Digestive Oncology , European Georges Pompidou Hospital, AP-HP , 20 Rue Leblanc , 75015 Paris , France
| | - Arnaud Morin
- Picometrics Technologies , 478 rue de la Découverte , 31 670 Labège , France
| | - Vincent Picot
- Picometrics Technologies , 478 rue de la Découverte , 31 670 Labège , France
| | - Laure Saias
- Picometrics Technologies , 478 rue de la Découverte , 31 670 Labège , France
| | - Valérie Taly
- INSERM UMR-S1147, CNRS SNC5014 , Paris Descartes University , 45 rue des Saints-Pères , Paris , France
| | - Pascale Tomasini
- Multidisciplinary Oncology & Therapeutic Innovations Department , Aix Marseille University, Assistance Publique Hôpitaux de Marseille , Hôpital Nord, 13015 Marseille , France
| | - Aziz Zaanan
- INSERM UMR-S1147, CNRS SNC5014 , Paris Descartes University , 45 rue des Saints-Pères , Paris , France.,Department of Digestive Oncology , European Georges Pompidou Hospital, AP-HP , 20 Rue Leblanc , 75015 Paris , France
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199
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Merker JD, Oxnard GR, Compton C, Diehn M, Hurley P, Lazar AJ, Lindeman N, Lockwood CM, Rai AJ, Schilsky RL, Tsimberidou AM, Vasalos P, Billman BL, Oliver TK, Bruinooge SS, Hayes DF, Turner NC. Circulating Tumor DNA Analysis in Patients With Cancer: American Society of Clinical Oncology and College of American Pathologists Joint Review. Arch Pathol Lab Med 2018; 142:1242-1253. [PMID: 29504834 DOI: 10.5858/arpa.2018-0901-sa] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE.— Clinical use of analytical tests to assess genomic variants in circulating tumor DNA (ctDNA) is increasing. This joint review from the American Society of Clinical Oncology and the College of American Pathologists summarizes current information about clinical ctDNA assays and provides a framework for future research. METHODS.— An Expert Panel conducted a literature review on the use of ctDNA assays for solid tumors, including preanalytical variables, analytical validity, interpretation and reporting, and clinical validity and utility. RESULTS.— The literature search identified 1338 references. Of those, 390, plus 31 references supplied by the Expert Panel, were selected for full-text review. There were 77 articles selected for inclusion. CONCLUSIONS.— The evidence indicates that testing for ctDNA is optimally performed on plasma collected in cell stabilization or EDTA tubes, with EDTA tubes processed within 6 hours of collection. Some ctDNA assays have demonstrated clinical validity and utility with certain types of advanced cancer; however, there is insufficient evidence of clinical validity and utility for the majority of ctDNA assays in advanced cancer. Evidence shows discordance between the results of ctDNA assays and genotyping tumor specimens, and supports tumor tissue genotyping to confirm undetected results from ctDNA tests. There is no evidence of clinical utility and little evidence of clinical validity of ctDNA assays in early-stage cancer, treatment monitoring, or residual disease detection. There is no evidence of clinical validity or clinical utility to suggest that ctDNA assays are useful for cancer screening, outside of a clinical trial. Given the rapid pace of research, reevaluation of the literature will shortly be required, along with the development of tools and guidance for clinical practice.
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Affiliation(s)
- Jason D Merker
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Geoffrey R Oxnard
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Carolyn Compton
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Maximilian Diehn
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Patricia Hurley
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Alexander J Lazar
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Neal Lindeman
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Christina M Lockwood
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Alex J Rai
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Richard L Schilsky
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Apostolia M Tsimberidou
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Patricia Vasalos
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Brooke L Billman
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Thomas K Oliver
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Suanna S Bruinooge
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Daniel F Hayes
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Nicholas C Turner
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; hristina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
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Merker JD, Oxnard GR, Compton C, Diehn M, Hurley P, Lazar AJ, Lindeman N, Lockwood CM, Rai AJ, Schilsky RL, Tsimberidou AM, Vasalos P, Billman BL, Oliver TK, Bruinooge SS, Hayes DF, Turner NC. Circulating Tumor DNA Analysis in Patients With Cancer: American Society of Clinical Oncology and College of American Pathologists Joint Review. J Clin Oncol 2018; 36:1631-1641. [PMID: 29504847 DOI: 10.1200/jco.2017.76.8671] [Citation(s) in RCA: 586] [Impact Index Per Article: 97.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Clinical use of analytical tests to assess genomic variants in circulating tumor DNA (ctDNA) is increasing. This joint review from ASCO and the College of American Pathologists summarizes current information about clinical ctDNA assays and provides a framework for future research. Methods An Expert Panel conducted a literature review on the use of ctDNA assays for solid tumors, including pre-analytical variables, analytical validity, interpretation and reporting, and clinical validity and utility. Results The literature search identified 1,338 references. Of those, 390, plus 31 references supplied by the Expert Panel, were selected for full-text review. There were 77 articles selected for inclusion. Conclusion The evidence indicates that testing for ctDNA is optimally performed on plasma collected in cell stabilization or EDTA tubes, with EDTA tubes processed within 6 hours of collection. Some ctDNA assays have demonstrated clinical validity and utility with certain types of advanced cancer; however, there is insufficient evidence of clinical validity and utility for the majority of ctDNA assays in advanced cancer. Evidence shows discordance between the results of ctDNA assays and genotyping tumor specimens and supports tumor tissue genotyping to confirm undetected results from ctDNA tests. There is no evidence of clinical utility and little evidence of clinical validity of ctDNA assays in early-stage cancer, treatment monitoring, or residual disease detection. There is no evidence of clinical validity and clinical utility to suggest that ctDNA assays are useful for cancer screening, outside of a clinical trial. Given the rapid pace of research, re-evaluation of the literature will shortly be required, along with the development of tools and guidance for clinical practice.
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Affiliation(s)
- Jason D Merker
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Geoffrey R Oxnard
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Carolyn Compton
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Maximilian Diehn
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Patricia Hurley
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Alexander J Lazar
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Neal Lindeman
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Christina M Lockwood
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Alex J Rai
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Richard L Schilsky
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Apostolia M Tsimberidou
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Patricia Vasalos
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Brooke L Billman
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Thomas K Oliver
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Suanna S Bruinooge
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Daniel F Hayes
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Nicholas C Turner
- Jason D. Merker and Maximilian Diehn, Stanford University School of Medicine; Stanford, CA; Geoffrey R. Oxnard, Dana Farber Cancer Institute and Harvard Medical School; Neal Lindeman, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Carolyn Compton, Arizona State University, Tempe, AZ; Patricia Hurley, Richard L. Schilsky, Thomas K. Oliver, and Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Alexander J. Lazar and Apostolia M. Tsimberidou, The University of Texas MD Anderson Cancer Center, Houston, TX; Christina M. Lockwood, University of Washington, Seattle, WA; Alex J. Rai, Columbia University Medical Center, New York, NY; Patricia Vasalos and Brooke L. Billman, College of American Pathologists, Northfield, IL; Daniel F. Hayes, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Nicholas C. Turner, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
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