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Conci S, Catalano G, Roman D, Zecchetto C, Lucin E, De Bellis M, Tripepi M, Guglielmi A, Milella M, Ruzzenente A. Current Role and Future Perspectives of Immunotherapy and Circulating Factors in Treatment of Biliary Tract Cancers. Int J Med Sci 2023; 20:858-869. [PMID: 37324191 PMCID: PMC10266048 DOI: 10.7150/ijms.82008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/07/2023] [Indexed: 06/17/2023] Open
Abstract
Biliary tract cancers (BTCs) are a heterogenous group of malignancies arising from the epithelial cells of the biliary tree and the gallbladder. They are often locally advanced or already metastatic at the time of the diagnosis and therefore prognosis remains dismal. Unfortunately, the management of BTCs has been limited by resistance and consequent low response rate to cytotoxic systemic therapy. New therapeutic approaches are needed to improve the survival outcomes for these patients. Immunotherapy, one of the newest therapeutic options, is changing the approach to the oncological treatment. Immune checkpoint inhibitors are by far the most promising group of immunotherapeutic agents: they work by blocking the tumor-induced inhibition of the immune cellular response. Immunotherapy in BTCs is currently approved as second-line treatment for patients whose tumors have a peculiar molecular profile, such as high levels of microsatellites instability, PD-L1 overexpression, or high levels of tumor mutational burden. However, emerging data from ongoing clinical trials seem to suggest that durable responses can be achieved in other subsets of patients. The BTCs are characterized by a highly desmoplastic microenvironment that fuels the growth of cancer tissue, but tissue biopsies are often difficult to obtain or not feasible in BTCs. Recent studies have hence proposed to use liquid biopsy approaches to search the blood circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA) to use as biomarkers in BTCs. So far studies are insufficient to promote their use in clinical management, however trials are still in progress with promising preliminary results. Analysis of blood samples for ctDNA to research possible tumor-specific genetic or epigenetic alterations that could be linked to treatment response or prognosis was already feasible. Although there are still few data available, ctDNA analysis in BTC is fast, non-invasive, and could also represent a way to diagnose BTC earlier and monitor tumor response to chemotherapy. The prognostic capabilities of soluble factors in BTC are not yet precisely determined and more studies are needed. In this review, we will discuss the different approaches to immunotherapy and tumor circulating factors, the progress that has been made so far, and the possible future developments.
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Affiliation(s)
- Simone Conci
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Giovanni Catalano
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Diletta Roman
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Eleonora Lucin
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Mario De Bellis
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Marzia Tripepi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Michele Milella
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
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Caputo V, Ciardiello F, Corte CMD, Martini G, Troiani T, Napolitano S. Diagnostic value of liquid biopsy in the era of precision medicine: 10 years of clinical evidence in cancer. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:102-138. [PMID: 36937316 PMCID: PMC10017193 DOI: 10.37349/etat.2023.00125] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/13/2022] [Indexed: 03/06/2023] Open
Abstract
Liquid biopsy is a diagnostic repeatable test, which in last years has emerged as a powerful tool for profiling cancer genomes in real-time with minimal invasiveness and tailoring oncological decision-making. It analyzes different blood-circulating biomarkers and circulating tumor DNA (ctDNA) is the preferred one. Nevertheless, tissue biopsy remains the gold standard for molecular evaluation of solid tumors whereas liquid biopsy is a complementary tool in many different clinical settings, such as treatment selection, monitoring treatment response, cancer clonal evolution, prognostic evaluation, as well as the detection of early disease and minimal residual disease (MRD). A wide number of technologies have been developed with the aim of increasing their sensitivity and specificity with acceptable costs. Moreover, several preclinical and clinical studies have been conducted to better understand liquid biopsy clinical utility. Anyway, several issues are still a limitation of its use such as false positive and negative results, results interpretation, and standardization of the panel tests. Although there has been rapid development of the research in these fields and recent advances in the clinical setting, many clinical trials and studies are still needed to make liquid biopsy an instrument of clinical routine. This review provides an overview of the current and future clinical applications and opening questions of liquid biopsy in different oncological settings, with particular attention to ctDNA liquid biopsy.
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Affiliation(s)
- Vincenza Caputo
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Napoli, Italy
| | - Fortunato Ciardiello
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Napoli, Italy
| | - Carminia Maria Della Corte
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Napoli, Italy
| | - Giulia Martini
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Napoli, Italy
| | - Teresa Troiani
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Napoli, Italy
| | - Stefania Napolitano
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Napoli, Italy
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Haselmann V, Hedtke M, Neumaier M. Liquid Profiling for Cancer Patient Stratification in Precision Medicine—Current Status and Challenges for Successful Implementation in Standard Care. Diagnostics (Basel) 2022; 12:diagnostics12030748. [PMID: 35328301 PMCID: PMC8947441 DOI: 10.3390/diagnostics12030748] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 12/13/2022] Open
Abstract
Circulating tumor DNA (ctDNA), accurately described by the term liquid profiling (LP), enables real-time assessment of the tumor mutational profile as a minimally invasive test and has therefore rapidly gained traction, particular for the management of cancer patients. By LP, tumor-specific genetic alterations can be determined as part of companion diagnostics to guide selection of appropriate targeted therapeutics. Because LP facilitates longitudinal monitoring of cancer patients, it can be used to detect acquired resistant mechanisms or as a personalized biomarker for earlier detection of disease recurrence, among other applications. However, LP is not yet integrated into routine care to the extent that might be expected. This is due to the lack of harmonization and standardization of preanalytical and analytical workflows, the lack of proper quality controls, limited evidence of its clinical utility, heterogeneous study results, the uncertainty of clinicians regarding the value and appropriate indications for LP and its interpretation, and finally, the lack of reimbursement for most LP tests. In this review, the value proposition of LP for cancer patient management and treatment optimization, the current status of implementation in standard care, and the main challenges that need to be overcome are discussed in detail.
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Žvirblytė J, Mažutis L. Microfluidics for Cancer Biomarker Discovery, Research, and Clinical Application. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1379:499-524. [DOI: 10.1007/978-3-031-04039-9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Albulescu A, Plesa A, Fudulu A, Iancu IV, Anton G, Botezatu A. Epigenetic approaches for cervical neoplasia screening (Review). Exp Ther Med 2021; 22:1481. [PMID: 34765022 PMCID: PMC8576616 DOI: 10.3892/etm.2021.10916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus (HPV) infection is the leading cause of cervical cancer. The Papanicolaou cytology test is the usually employed type of screening for this infection; however, its sensibility is limited. Only a small percentage of women infected with high-risk HPV develop cervical cancer with an array of genetic and epigenetic modifications. Thus, it is necessary to develop rapid, reproducible and minimally invasive technologies for screening. DNA methylation has gained attention as an alternative method for molecular diagnosis and prognosis in HPV infection. The aim of the present review was to highlight the potential of DNA methylation in cervical neoplasia screening for clinical applications. It was observed that the methylation human and viral genes was correlated with high-grade lesions and cancer. Methylation biomarkers have shown a good capacity to discriminate between high-grade lesions with a transformative potential and cervical cancer, being able to detect these modifications at an early stage. With further research, the epigenetic profiles and subtypes of the tumors could be elaborated, which would aid in therapy selection by opening avenues in personalized precision medicine. Response to therapy could also be evaluated through such methods and the accessibility of liquid biopsies would allow a constant monitoring of the patient's status without invasive sampling techniques.
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Affiliation(s)
- Adrian Albulescu
- Department of Molecular Virology, Stefan S. Nicolau Institute of Virology, Bucharest 030304, Romania.,Pharmacology Department, National Institute for Chemical Pharmaceutical Research and Development, Bucharest 031299, Romania
| | - Adriana Plesa
- Department of Molecular Virology, Stefan S. Nicolau Institute of Virology, Bucharest 030304, Romania
| | - Alina Fudulu
- Department of Molecular Virology, Stefan S. Nicolau Institute of Virology, Bucharest 030304, Romania
| | - Iulia Virginia Iancu
- Department of Molecular Virology, Stefan S. Nicolau Institute of Virology, Bucharest 030304, Romania
| | - Gabriela Anton
- Department of Molecular Virology, Stefan S. Nicolau Institute of Virology, Bucharest 030304, Romania
| | - Anca Botezatu
- Department of Molecular Virology, Stefan S. Nicolau Institute of Virology, Bucharest 030304, Romania
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Naidoo M, Piercey O, Tie J. Circulating Tumour DNA and Colorectal Cancer: the Next Revolutionary Biomarker? Curr Oncol Rep 2021; 23:140. [PMID: 34735665 DOI: 10.1007/s11912-021-01137-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Improving outcomes for patients with colorectal cancer in both the adjuvant and metastatic setting has been challenging. Here, we review the current and future directions for using ctDNA in clinical practice. RECENT FINDINGS Circulating tumour DNA (ctDNA) with its ability to detect minimal residual disease is beginning to refine the way we assess recurrence risk in the adjuvant setting. We can potentially tailor treatments to reduce recurrence risk and minimize treatment toxicity. In the metastatic setting, ctDNA can provide a less invasive method of detecting clinically important genetic changes to guide molecularly targeted treatment and to identify mechanisms of molecular resistance. ctDNA can be a surrogate marker for treatment response and help guide the timing of anti-EGFR rechallenge. We await the results of the randomized clinical trials assessing clinical utility of ctDNA in both the adjuvant and metastatic setting before incorporating ctDNA into clinical practice.
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Affiliation(s)
- Mahendra Naidoo
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Parkville Melbourne, VIC 3000, Australia.
| | - Oliver Piercey
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Parkville Melbourne, VIC 3000, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Parkville Melbourne, VIC 3000, Australia.,Division of Personalised Oncology, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, 3052, Australia.,Department of Medical Oncology, Western Health, Melbourne, VIC, 3021, Australia.,Sir Peter MacCallum, Department of Oncology, The University of Melbourne, Melbourne, VIC, 3010, Australia
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CRISPR/Cas13-Based Platforms for a Potential Next-Generation Diagnosis of Colorectal Cancer through Exosomes Micro-RNA Detection: A Review. Cancers (Basel) 2021; 13:cancers13184640. [PMID: 34572866 PMCID: PMC8466426 DOI: 10.3390/cancers13184640] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Colorectal cancer is one of the most prevalent cancers, whereas a significant number of cases are diagnosed in late cancer stages, and survival rates drop dramatically. Micro-RNAs (miRNAs) from cancer-derived exosomes have shown promising diagnosis potential. Our review aims to present CRISPR/Cas-based molecular platforms as an inexpensive, swift, and robust detection tool of cancer-derived exosome micro-RNAs to streamline future applications based on the novel CRISPR/Cas-based platforms to achieve early CRC diagnosis. Abstract Colorectal cancer (CRC) is the third most prevalent cancer with the second highest mortality rate worldwide. CRC is a heterogenous disease with multiple risk factors associated, including obesity, smoking, and use of alcohol. Of total CRC cases, 60% are diagnosed in late stages, where survival can drop to about 10%. CRC screening programs are based primarily on colonoscopy, yet this approach is invasive and has low patient adherence. Therefore, there is a strong incentive for developing molecular-based methods that are minimally invasive and have higher patient adherence. Recent reports have highlighted the importance of extracellular vesicles (EVs), specifically exosomes, as intercellular communication vehicles with a broad cargo, including micro-RNAs (miRNAs). These have been syndicated as robust candidates for diagnosis, primarily for their known activities in cancer cells, including immunoevasion, tumor progression, and angiogenesis, whereas miRNAs are dysregulated by cancer cells and delivered by cancer-derived exosomes (CEx). Quantitative polymerase chain reaction (qPCR) has shown good results detecting specific cancer-derived exosome micro-RNAs (CEx-miRNAs) associated with CRC, but qPCR also has several challenges, including portability and sensitivity/specificity issues regarding experiment design and sample quality. CRISPR/Cas-based platforms have been presented as cost-effective, ultrasensitive, specific, and robust clinical detection tools in the presence of potential inhibitors and capable of delivering quantitative and qualitative real-time data for enhanced decision-making to healthcare teams. Thereby, CRISPR/Cas13-based technologies have become a potential strategy for early CRC diagnosis detecting CEx-miRNAs. Moreover, CRISPR/Cas13-based platforms’ ease of use, scalability, and portability also showcase them as a potential point-of-care (POC) technology for CRC early diagnosis. This study presents two potential CRISPR/Cas13-based methodologies with a proposed panel consisting of four CEx-miRNAs, including miR-126, miR-1290, miR-23a, and miR-940, to streamline novel applications which may deliver a potential early diagnosis and prognosis of CRC.
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Liquid biopsy enters the clinic - implementation issues and future challenges. Nat Rev Clin Oncol 2021; 18:297-312. [PMID: 33473219 DOI: 10.1038/s41571-020-00457-x] [Citation(s) in RCA: 547] [Impact Index Per Article: 182.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
Historically, studies of disseminated tumour cells in bone marrow and circulating tumour cells in peripheral blood have provided crucial insights into cancer biology and the metastatic process. More recently, advances in the detection and characterization of circulating tumour DNA (ctDNA) have finally enabled the introduction of liquid biopsy assays into clinical practice. The FDA has already approved several single-gene assays and, more recently, multigene assays to detect genetic alterations in plasma cell-free DNA (cfDNA) for use as companion diagnostics matched to specific molecularly targeted therapies for cancer. These approvals mark a tipping point for the widespread use of liquid biopsy in the clinic, and mostly in patients with advanced-stage cancer. The next frontier for the clinical application of liquid biopsy is likely to be the systemic treatment of patients with 'ctDNA relapse', a term we introduce for ctDNA detection prior to imaging-detected relapse after curative-intent therapy for early stage disease. Cancer screening and diagnosis are other potential future applications. In this Perspective, we discuss key issues and gaps in technology, clinical trial methodologies and logistics for the eventual integration of liquid biopsy into the clinical workflow.
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Feng C, Wang J, Yang X, Zang X, Zhou H, Zhang E, Li H, Liu B, Chen S, Wang Y, Wang P, Gao L, Liu J. Construction and Characterization of KRAS Immune Lipid Magnetic Balls for Colorectal Cancer Circulating Tumor Cells. Cancer Manag Res 2020; 12:10067-10075. [PMID: 33116863 PMCID: PMC7568589 DOI: 10.2147/cmar.s258565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022] Open
Abstract
Objective The purpose of this study was to prepare and characterize a lipid magnetic ball modified with KRAS antibodies on the surface and to isolate circulating tumor cells of colorectal cancer with KRAS mutations. Methods The microemulsion method was used to form lipid bilayers to encapsulate Fe3O4 nanoparticles with superparamagnetism to form lipid magnetic balls, and KRAS antibodies were formed on the surface to form KRAS immune lipid magnetic balls. Results Compared with traditional EpCAM antibody-modified lipid magnetic balls, it can effectively improve the capture ability of colorectal cancer circulating tumor cells with KRAS mutation, the capture rate reaches 92.9%, and the capture results are consistent with clinical diagnosis and pathology. Conclusion Our results showed that KRAS antibody-modified lipid magnetic balls can be used in the diagnosis and treatment of KRAS colorectal cancer.
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Affiliation(s)
- Chengbao Feng
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Jingjing Wang
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Xue Yang
- Baoding Children's Hospital, Baoding City, People's Republic of China
| | - Xuefang Zang
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Haikun Zhou
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Erying Zhang
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Haifei Li
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Bo Liu
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Shumin Chen
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Ying Wang
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Peng Wang
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Lixue Gao
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
| | - Jinyan Liu
- Department of Medical Oncology, No. 2 Hospital of Baoding, Baoding City, People's Republic of China
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Liu Y, Li L, Tian Y, Zhu X, Sun A, Sun Y, Qiao Y, Qi X, Wang T. Analysis of KRAS mutations in circulating tumor DNA and colorectal cancer tissue. Biotech Histochem 2020; 96:376-383. [PMID: 32876508 DOI: 10.1080/10520295.2020.1810775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The mutation status of KRAS is important for anti-EGFR therapy in colorectal cancer (CRC) patients; however, detection of KRAS mutations in circulating tumor DNA (ctDNA) is problematic. We investigated tissue and plasma assays for KRAS mutations in CRC patients. The KRAS status of 407 CRC patients was evaluated using integration of amplification refractory mutation system polymerase chain reaction (PCR), melting curves and wild type DNA blocking (IAMB) in tissue and plasma samples. Disparate cases were re-evaluated by Sanger sequencing of tissue samples. General characteristics and tumor biomarkers including CEA, CA19-9 and CA125 were characterized. The prevalence of KRAS mutations was 40.8% in plasma and 49.1% in tissue. The overall percent agreement, positive percent agreement and negative percent agreement were 82.3, 76.3 and 90.8%, respectively. Older patients and higher TNM stage exhibited increased sensitivity for detecting KRAS mutations in plasma. We found 54.1% of patients with KRAS mutations using parallel analysis of tissue and plasma; only 36.4% of patients were detected by series analysis. We found that plasma based KRAS detection with IAMB technology is an alternative to tissue based KRAS testing. KRAS mutations can be identified more easily when both assays are used together.
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Affiliation(s)
- Yankui Liu
- Department of Pathology, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Longhai Li
- Department of Epidemiology and Biostatistics, Jiangnan University School of Medicine, Wuxi, China
| | - Yu Tian
- Department of Epidemiology and Biostatistics, Jiangnan University School of Medicine, Wuxi, China
| | - Xiao Zhu
- Department of Good Clinical Practice, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Aijuan Sun
- Key Laboratory of PreMed Precision Medicine, Soochow University, Suzhou, China
| | - Yulong Sun
- Key Laboratory of PreMed Precision Medicine, Soochow University, Suzhou, China
| | - Yan Qiao
- Key Laboratory of PreMed Precision Medicine, Soochow University, Suzhou, China
| | - Xiaowei Qi
- Department of Pathology, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Tao Wang
- Key Laboratory of PreMed Precision Medicine, Soochow University, Suzhou, China
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Rizzo A, Ricci AD, Tavolari S, Brandi G. Circulating Tumor DNA in Biliary Tract Cancer: Current Evidence and Future Perspectives. Cancer Genomics Proteomics 2020; 17:441-452. [PMID: 32859625 PMCID: PMC7472453 DOI: 10.21873/cgp.20203] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
Peripheral blood of cancer patients "physiologically" presents cells and cellular components deriving from primary or metastatic sites, including circulating tumor cells (CTCs), circulating free DNA (cfDNA) and exosomes containing proteins, lipids and nucleic acids. The term circulating tumor DNA (ctDNA) indicates the part of cfDNA which derives from primary tumors and/or metastatic sites, carrying tumor-specific genetic or epigenetic alterations. Analysis of ctDNA has enormous potential applications in all stages of cancer management, including earlier diagnosis of cancer, identification of driver alterations, monitoring of treatment response and detection of resistance mechanisms. Thus, ctDNA has the potential to profoundly change current clinical practice, by moving from tissue to peripheral blood as a source of information. Herein, we review current literature regarding the potential role for ctDNA in biliary tract cancer (BTC) patients, with a particular focus on state-of-the-art techniques and future perspectives of this highly aggressive disease.
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Affiliation(s)
- Alessandro Rizzo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Angela Dalia Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Simona Tavolari
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Wang R, Zhao A, Cao N, Li Z, Zhang G, Liu F. The value of circulation tumor DNA in predicting postoperative recurrence of colorectal cancer: a meta-analysis. Int J Colorectal Dis 2020; 35:1463-1475. [PMID: 32572601 DOI: 10.1007/s00384-020-03667-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical resection is the primary treatment for patients with nonmetastatic colorectal cancer (CRC). However, even after undergoing radical resection procedure, 30-50% of patients will still experience relapse. Circulation tumor DNA (ctDNA), deriving from tumor cells, is shed into the bloodstream and is a potential predictive biomarker of recurrence in CRC. This meta-analysis was performed to identify the clinical value of ctDNA in predicting the recurrence of CRC patients in post-operative. METHODS PubMed, Embase, The Cochrane Library, and Web of Science were comprehensively searched to identify the studies that reported the function of ctDNA for predicting recurrence in CRC patients. The eligible studies were pooled to calculate the relative risk (RR) of recurrence in ctDNA positive and negative groups. The data of ctDNA on recurrence-free survival (RFS) were extracted and computed in hazard ratio (HR) and 95% confident interval (CI). Subgroup analyses were also performed. RESULTS A total of 7 studies including 424 patients were included and analyzed in our meta-analysis. The results showed that pooled RR was 4.65 (95%CI: 2.68-8.08, P < 0.05), indicating ctDNA positive could predict the recurrence of CRC after curative surgical. The pooled HR demonstrated strong connection between ctDNA positive and RFS in patients with CRC (HR = 9.14, 95%CI: 4.02-20.75, P < 0.05). CONCLUSION Evidence from the meta-analysis suggested that ctDNA is a promising potential biomarker for predicting postoperative recurrence of CRC. Given the inherent limitations of this study, we look forward to more well-designed clinical studies to validate and update this analysis in the future.
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Affiliation(s)
- Rui Wang
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Aiguang Zhao
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Nida Cao
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Zhaoyan Li
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Guangtao Zhang
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Feng Liu
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
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Amrollahi P, Rodrigues M, Lyon CJ, Goel A, Han H, Hu TY. Ultra-Sensitive Automated Profiling of EpCAM Expression on Tumor-Derived Extracellular Vesicles. Front Genet 2019; 10:1273. [PMID: 31921310 PMCID: PMC6928048 DOI: 10.3389/fgene.2019.01273] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022] Open
Abstract
Extracellular vesicles (EVs) are abundant in most biological fluids and considered promising biomarker candidates, but the development of EV biomarker assays is hindered, in part, by their requirement for prior EV purification and the lack of standardized and reproducible EV isolation methods. We now describe a far-field nanoplasmon-enhanced scattering (FF-nPES) assay for the isolation-free characterization of EVs present in small volumes of serum (< 5 µl). In this approach, EVs are captured with a cancer-selective antibody, hybridized with gold nanorods conjugated with an antibody to the EV surface protein CD9, and quantified by their ability to scatter light when analyzed using a fully automated dark-field microscope system. Our results indicate that FF-nPES performs similarly to EV ELISA, when analyzing EV surface expression of epithelial cell adhesion molecule (EpCAM), which has clinical significant as a cancer biomarker. Proof-of-concept FF-nPES data indicate that it can directly analyze EV EpCAM expression from serum samples to distinguish early stage pancreatic ductal adenocarcinoma patients from healthy subjects, detect the development of early stage tumors in a mouse model of spontaneous pancreatic cancer, and monitor tumor growth in patient derived xenograft mouse models of pancreatic cancer. FF-nPES thus appears to exhibit strong potential for the direct analysis of EV membrane biomarkers for disease diagnosis and treatment monitoring.
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Affiliation(s)
- Pouya Amrollahi
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States.,School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Meryl Rodrigues
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States.,School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Christopher J Lyon
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States.,School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Ajay Goel
- Baylor Research Institute and Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, United States
| | - Haiyong Han
- Molecular Medicine Division, The Translational Genomics Research Institute, Phoenix, AZ, United States
| | - Tony Y Hu
- Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States.,School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
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14
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Mirtavoos-Mahyari H, Ghadami M, Khosravi A, Esfahani-Monfared Z, Seifi S, Motevaseli E, Pourabdollah M, Modarressi M. Cell Free Tumoral DNA Versus Paraffin Block Epidermal Growth Factor Receptor Mutation Detection in Patients with Non-Small Cell Lung Cancer. Asian Pac J Cancer Prev 2019; 20:3591-3596. [PMID: 31870098 PMCID: PMC7173361 DOI: 10.31557/apjcp.2019.20.12.3591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/09/2019] [Indexed: 01/03/2023] Open
Abstract
Increasing knowledge about the molecular profile of tumors has led to personalized treatment for achieving better outcomes in patients with nonsmall cell lung cancer (NSCLC). Currently, finding exact somatic genomic changes of tumor has gained great importance. On the other hand, crescendoing needs to actual tumor tissue at different time points during cancer treatment may produce major discomfort for NSCLC patients. Tumor genomes can be reconstructed by information obtained from circulating cell-free deoxyribonucleic acid (cfDNA) of peripheral blood. cfDNA may be represented as a suitable alternative test for epidermal growth factor receptor (EGFR) mutation detection in these patients. This study aimed to assess validity of cfDNA in somatic EGFR mutation identification in Iranian NSCLC cases. METHODS Somatic mutation of EGFR gene was studied in both tissue specimens and plasma. Then, mutations were detected by polymerase chain reaction(PCR) and sequencing. RESULTS We observed a high concordance (90%) between tissue samples and cfDNA for EGFR gene mutation. The sensitivity, accuracy, and positive precision value were 90%, 90% and 100%, respectively. A false negative rate of 10% was also demonstrated in this study. CONCLUSION We established sensitive methods for detecting EGFR gene mutation which may be very useful in clinical practice. .
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Affiliation(s)
| | - Mohsen Ghadami
- Department of Medical Genetics, Faculty of Medicine, Tehran University of Medical Sciences,
| | | | - Zahra Esfahani-Monfared
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences,
| | - Sharareh Seifi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences,
| | - Elaheh Motevaseli
- Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran. Iran.
| | - Mihan Pourabdollah
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences,
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15
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Solomon JP, Hechtman JF. Detection of NTRK Fusions: Merits and Limitations of Current Diagnostic Platforms. Cancer Res 2019; 79:3163-3168. [PMID: 31196931 DOI: 10.1158/0008-5472.can-19-0372] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/15/2019] [Accepted: 03/27/2019] [Indexed: 12/13/2022]
Abstract
Oncogenic fusions involving NTRK1, NTRK2, and NTRK3 with various partners are diagnostic of infantile fibrosarcoma and secretory carcinoma yet also occur in lower frequencies across many types of malignancies. Recently, targeted small molecular inhibitor therapy has been shown to induce a durable response in a high percentage of patients with NTRK fusion-positive cancers, which has made the detection of NTRK fusions critical. Several techniques for NTRK fusion diagnosis exist, including pan-Trk IHC, FISH, reverse transcription PCR, DNA-based next-generation sequencing (NGS), and RNA-based NGS. Each of these assays has unique features, advantages, and limitations, and familiarity with these assays is critical to appropriately screen for NTRK fusions. Here, we review the details of each existing methodology.
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Affiliation(s)
- James P Solomon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jaclyn F Hechtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
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16
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Cimadamore A, Gasparrini S, Massari F, Santoni M, Cheng L, Lopez-Beltran A, Scarpelli M, Montironi R. Emerging Molecular Technologies in Renal Cell Carcinoma: Liquid Biopsy. Cancers (Basel) 2019; 11:cancers11020196. [PMID: 30736478 PMCID: PMC6407029 DOI: 10.3390/cancers11020196] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/26/2019] [Accepted: 02/04/2019] [Indexed: 12/26/2022] Open
Abstract
Liquid biopsy, based on the circulating tumor cells (CTCs) and cell-free nucleic acids has potential applications at multiple points throughout the natural course of cancer, from diagnosis to follow-up. The advantages of doing ctDNA assessment vs. tissue-based genomic profile are the minimal procedural risk, the possibility to serial testing in order to monitor disease-relapse and response to therapy over time and to reduce hospitalization costs during the entire process. However, some critical issues related to ctDNA assays should be taken into consideration. The sensitivity of ctDNA assays depends on the assessment technique and genetic platforms used, on tumor-organ, stage, tumor heterogeneity, tumor clonality. The specificity is usually very high, whereas the concordance with tumor-based biopsy is generally low. In patients with renal cell carcinoma (RCC), qualitative analyses of ctDNA have been performed with interesting results regarding selective pressure from therapy, therapeutic resistance, exceptional treatment response to everolimus and mutations associated with aggressive behavior. Quantitative analyses showed variations of ccfDNA levels at different tumor stage. Compared to CTC assay, ctDNA is more stable than cells and easier to isolate. Splice variants, information at single-cell level and functional assays along with proteomics, transcriptomics and metabolomics studies can be performed only in CTCs.
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Affiliation(s)
- Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, I-60126 Ancona, Italy.
| | - Silvia Gasparrini
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, I-60126 Ancona, Italy.
| | - Francesco Massari
- Division of Oncology, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
| | - Matteo Santoni
- Oncology Unit, Macerata Hospital, 62100 Macerata, Italy.
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, USA.
| | | | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, I-60126 Ancona, Italy.
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, I-60126 Ancona, Italy.
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17
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Kruger S, Heinemann V, Ross C, Diehl F, Nagel D, Ormanns S, Liebmann S, Prinz-Bravin I, Westphalen C, Haas M, Jung A, Kirchner T, von Bergwelt-Baildon M, Boeck S, Holdenrieder S. Repeated mutKRAS ctDNA measurements represent a novel and promising tool for early response prediction and therapy monitoring in advanced pancreatic cancer. Ann Oncol 2018; 29:2348-2355. [DOI: 10.1093/annonc/mdy417] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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18
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Yang YC, Wang D, Jin L, Yao HW, Zhang JH, Wang J, Zhao XM, Shen CY, Chen W, Wang XL, Shi R, Chen SY, Zhang ZT. Circulating tumor DNA detectable in early- and late-stage colorectal cancer patients. Biosci Rep 2018; 38:BSR20180322. [PMID: 29914973 PMCID: PMC6066652 DOI: 10.1042/bsr20180322] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022] Open
Abstract
Characterization, diagnosis, and treatment of colorectal cancers (CRC) is difficult due to limited biopsy information, impracticality of repeated biopsies, and cancer biomarker fallibility. Circulating tumor DNA (ctDNA) has recently been investigated as a non-invasive way to gain representative gene mutations in tumors, in addition to monitoring disease progression and response to treatment. We analyzed ctDNA mutations and concentrations in 47 early- and late-stage CRC patients using a targetted sequencing approach using a panel that covers 50 cancer-related genes. ctDNA mutations in 37 genes were identified in 93.6% of the patients (n=47). The results showed that TP53, PIK3CA, APC, and EGFR were the most frequently mutated genes. Stage IV patients had significantly higher ctDNA concentration than Stage I patients, and increased ctDNA concentration correlated with increased tumor size. Additionally, ctDNA detection was found to be a greater predictor of disease when compared with five known commonly used tumor biomarkers. The present study supports the use of ctDNA as a liquid biopsy to gain clinical tumor information that may facilitate early diagnosis and treatment and improve CRC patient prognosis.
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Affiliation(s)
- Ying-Chi Yang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Dong Wang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Lan Jin
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Hong-Wei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Jing-Hui Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Jin Wang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Xiao-Mu Zhao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing 100050, China
| | - Chun-Ying Shen
- San Valley Biotechnology Incorporated, Beijing 100094, China
| | - Wei Chen
- San Valley Biotechnology Incorporated, Beijing 100094, China
| | - Xue-Liang Wang
- San Valley Biotechnology Incorporated, Beijing 100094, China
| | - Rong Shi
- San Valley Biotechnology Incorporated, Beijing 100094, China
| | - Si-Yi Chen
- Departments of Molecular Microbiology and Immunology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, U.S.A
| | - Zhong-Tao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing 100050, China
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19
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Kastrisiou M, Zarkavelis G, Kampletsas E, Panopoulou E, Goussia A, Nasioulas G, Papadopoulou E, Tsaousi C, Pentheroudakis G. Clonal evolution of colorectal cancer in a patient with serially resected metastases and liquid biopsies: a case report and discussion of the literature. ESMO Open 2018; 3:e000329. [PMID: 29942663 PMCID: PMC6012565 DOI: 10.1136/esmoopen-2018-000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 01/13/2023] Open
Abstract
Background Metastatic colorectal cancer represents a striking example of clonal heterogeneity and tumour evolution, which generates acquired resistance to therapy. Once hard to perform, the study of clonal heterogeneity is now significantly aided by the use of liquid biopsies. Method We herein report a case of a patient with colorectal cancer and serial development of multiple metastases which were all resected and genotyped. A rare point mutation was identified in the primary tumour (but not in any of the organ metastatic sites), as well as in the first and the last out of three consecutive liquid biopsies. The review of the literature offered some insight in the evolution of the patient’s tumour and general directions on how to interpret liquid biopsy results. Conclusions This patient case emphasises the need for large prospective studies designed to bridge liquid biopsy data with useful clinical endpoints, in order to optimally integrate this revolutionary tool in everyday practice.
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Affiliation(s)
- Myrto Kastrisiou
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN), Ioannina, Greece.,Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | - George Zarkavelis
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN), Ioannina, Greece.,Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Eleni Panopoulou
- Department of Pathology, Medical School, University of Ioannina, Ioannina, Greece
| | - Anna Goussia
- Department of Pathology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | - Christina Tsaousi
- Haematology Laboratory, Ioannina University Hospital, Ioannina, Greece
| | - George Pentheroudakis
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN), Ioannina, Greece.,Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
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20
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de Melo Gagliato D, Fontes Jardim DL. Noninvasive cancer biomarkers in solid malignancies: circulating tumor DNA-clinical utility, current limitations and future perspectives. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:233. [PMID: 30023396 DOI: 10.21037/atm.2018.05.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Kodahl AR, Ehmsen S, Pallisgaard N, Jylling AMB, Jensen JD, Lænkholm A, Knoop AS, Ditzel HJ. Correlation between circulating cell-free PIK3CA tumor DNA levels and treatment response in patients with PIK3CA-mutated metastatic breast cancer. Mol Oncol 2018; 12:925-935. [PMID: 29689598 PMCID: PMC5983134 DOI: 10.1002/1878-0261.12305] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/31/2018] [Accepted: 04/06/2018] [Indexed: 01/14/2023] Open
Abstract
Liquid biopsies focusing on the analysis of cell-free circulating tumor DNA (ctDNA) may have important clinical implications for personalized medicine, including early detection of cancer, therapeutic guidance, and monitoring of recurrence. Mutations in the oncogene, PIK3CA, are frequently observed in breast cancer and have been suggested as a predictive biomarker for PI3K-selective inhibitor treatment. In this study, we analyzed the presence of PIK3CA mutations in formalin-fixed, paraffin-embedded, metastatic tissue and corresponding ctDNA from serum of patients with advanced breast cancer using a highly sensitive, optimized droplet digital PCR (ddPCR) assay. We found 83% of patients with PIK3CA mutation in the metastatic tumor tissue also had detectable PIK3CA mutations in serum ctDNA. Patients lacking the PIK3CA mutation in corresponding serum ctDNA all had nonvisceral metastatic disease. Four patients with detectable PIK3CA-mutated ctDNA were followed with an additional serum sample during oncological treatment. In all cases, changes in PIK3CA ctDNA level correlated with treatment response. Our results showed high concordance between detection of PIK3CA mutations in tumor tissue and in corresponding serum ctDNA and suggest that serum samples from patients with advanced breast cancer and ddPCR may be used for PIK3CA mutation status assessment to complement imaging techniques as an early marker of treatment response.
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Affiliation(s)
| | - Sidse Ehmsen
- Department of Cancer and InflammationInstitute of Molecular MedicineUniversity of Southern DenmarkOdenseDenmark
| | | | | | | | | | - Ann S. Knoop
- Department of OncologyRigshospitaletCopenhagenDenmark
| | - Henrik J. Ditzel
- Department of OncologyOdense University HospitalDenmark
- Department of Cancer and InflammationInstitute of Molecular MedicineUniversity of Southern DenmarkOdenseDenmark
- Academy of Geriatric Cancer Research (AgeCare)Odense University HospitalDenmark
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22
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Kodahl AR, Ehmsen S, Pallisgaard N, Jylling AMB, Jensen JD, Laenkholm AV, Knoop AS, Ditzel HJ. Correlation between circulating cell-free PIK3CA tumor DNA levels and treatment response in patients with PIK3CA-mutated metastatic breast cancer. Mol Oncol 2018. [PMID: 29689598 DOI: 10.1002/1878‐0261.12305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Liquid biopsies focusing on the analysis of cell-free circulating tumor DNA (ctDNA) may have important clinical implications for personalized medicine, including early detection of cancer, therapeutic guidance, and monitoring of recurrence. Mutations in the oncogene, PIK3CA, are frequently observed in breast cancer and have been suggested as a predictive biomarker for PI3K-selective inhibitor treatment. In this study, we analyzed the presence of PIK3CA mutations in formalin-fixed, paraffin-embedded, metastatic tissue and corresponding ctDNA from serum of patients with advanced breast cancer using a highly sensitive, optimized droplet digital PCR (ddPCR) assay. We found 83% of patients with PIK3CA mutation in the metastatic tumor tissue also had detectable PIK3CA mutations in serum ctDNA. Patients lacking the PIK3CA mutation in corresponding serum ctDNA all had nonvisceral metastatic disease. Four patients with detectable PIK3CA-mutated ctDNA were followed with an additional serum sample during oncological treatment. In all cases, changes in PIK3CA ctDNA level correlated with treatment response. Our results showed high concordance between detection of PIK3CA mutations in tumor tissue and in corresponding serum ctDNA and suggest that serum samples from patients with advanced breast cancer and ddPCR may be used for PIK3CA mutation status assessment to complement imaging techniques as an early marker of treatment response.
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Affiliation(s)
| | - Sidse Ehmsen
- Department of Cancer and Inflammation, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | | | | | | | - Ann S Knoop
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik J Ditzel
- Department of Oncology, Odense University Hospital, Denmark.,Department of Cancer and Inflammation, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Denmark
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23
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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: 574] [Impact Index Per Article: 95.7] [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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Fleshner P, Braunstein GD, Ovsepyan G, Tonozzi TR, Kammesheidt A. Tumor-associated DNA mutation detection in individuals undergoing colonoscopy. Cancer Med 2017; 7:167-174. [PMID: 29125240 PMCID: PMC5773968 DOI: 10.1002/cam4.1249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 02/06/2023] Open
Abstract
The majority of colorectal cancers (CRC) harbor somatic mutations and epigenetic modifications in the tumor tissue, and some of these mutations can be detected in plasma as circulating tumor DNA (ctDNA). Precancerous colorectal lesions also contain many of these same mutations. This study examined plasma for ctDNA from patients undergoing a screening or diagnostic colonoscopy to determine the sensitivity and specificity of the ctDNA panel for detecting CRC and precancerous lesions. Two hundred patients without a history of nonskin cancer had blood drawn before a colonoscopy. Plasma ctDNA was measured with a 96 mutation panel for nine cancer driver genes. The ctDNA results were correlated with the findings at colonoscopy. Of the 200 patients, 176 (88%) had wild‐type DNA, 12 (6%) had mutations detected, and 12 (6%) had indeterminate results. Colonoscopy was normal in 80% of the patients and 20% were found to have polyps. No CRC was found in this study, precluding a determination of true‐positive rate for CRC detection. Our ctDNA panel was positive in 13.2% of patients with colonic polyps found at colonoscopy, while 4.7% of patients with normal colonoscopy also had ctDNA detected, which may represent ctDNA released from a benign process, an occult tumor, or an acquired somatic mutation from clonal hematopoiesis.
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Affiliation(s)
- Phillip Fleshner
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, 90048
| | | | - Gayane Ovsepyan
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, 90048
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Matikas A, Voutsina A, Lagoudaki E, Hatzidaki D, Trypaki M, Stoupis G, Tzardi M, Mavroudis D, Georgoulias V. Detection of KRAS Exon 2 Mutations in Circulating Tumor Cells Isolated by the ISET System from Patients with RAS Wild Type Metastatic Colorectal Cancer. Transl Oncol 2017; 10:693-698. [PMID: 28692881 PMCID: PMC5503828 DOI: 10.1016/j.tranon.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION: The presence of KRAS mutations in patients with metastatic colorectal cancer (mCRC) predicts poor response to agents targeting the EGFR. Even in patients with RAS wild type (WT) tumors, resistance eventually develops due to multiple mechanisms, including the expansion of previously undetected KRAS mutated clones. In this feasibility study, we aimed to detect KRAS exon 2 mutations in serial samples of circulating tumor cells (CTCs) of RAS WT patients with mCRC captured by the Isolation by Size of Epithelial Tumor cells (ISET) system. METHODS: CTC isolation using the ISET system was performed from prospectively collected blood samples obtained from patients with RAS and BRAF WT mCRC prior to first-line therapy initiation, at first imaging assessment and on disease progression. CTCs were enumerated using hematoxylin & eosin and CD45 double stain on a single membrane spot. DNA was extracted from 5 spots and KRAS exon 2 mutations were detected using a custom quantitative Polymerase Chain Reaction (qPCR) assay. RESULTS: Fifteen patients were enrolled and 28 blood samples were analyzed. In 9 (60%) patients, at least one sample was positive for the presence of a KRAS exon 2 mutation. In 11 out of 28 samples (39.2%) with detectable CTCs a KRAS mutation was detected; the corresponding percentages for baseline and on progression samples were 27% and 37.5%, respectively. The most commonly detected mutations were G13D and G12C (n = 3). The presence of KRAS mutated CTCs at baseline was not prognostic for either PFS (P = .950) or OS (P = .383). CTC kinetics did not follow tumor response patterns. CONCLUSION: The results demonstrate that using a qPCR-based assay, KRAS exon 2 mutations could be detected in CTCs captured by the ISET system from patients with RAS WT primary tumors. However, the clinical relevance of these CTCs remains to be determined in future studies.
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Affiliation(s)
- Alexios Matikas
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Medical Oncology, University Hospital of Heraklion, Greece.
| | - Alexandra Voutsina
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Heraklion, Greece
| | - Eleni Lagoudaki
- Department of Pathology, University Hospital of Heraklion, Greece
| | - Dora Hatzidaki
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Heraklion, Greece
| | - Maria Trypaki
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Heraklion, Greece
| | - Giannis Stoupis
- Department of Medical Oncology, University Hospital of Heraklion, Greece
| | - Maria Tzardi
- Department of Pathology, University Hospital of Heraklion, Greece
| | - Dimitrios Mavroudis
- Laboratory of Translational Oncology, School of Medicine, University of Crete, Heraklion, Greece; Department of Medical Oncology, University Hospital of Heraklion, Greece
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