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Dal Bello MG, Filiberti RA, Alama A, Orengo AM, Mussap M, Coco S, Vanni I, Boccardo S, Rijavec E, Genova C, Biello F, Barletta G, Rossi G, Tagliamento M, Maggioni C, Grossi F. The role of CEA, CYFRA21-1 and NSE in monitoring tumor response to Nivolumab in advanced non-small cell lung cancer (NSCLC) patients. J Transl Med 2019; 17:74. [PMID: 30849967 PMCID: PMC6408784 DOI: 10.1186/s12967-019-1828-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/01/2019] [Indexed: 01/16/2023] Open
Abstract
Background CEA, CYFRA21-1 and NSE are tumor markers used for monitoring the response to chemotherapy in advanced adenocarcinoma, squamous cell carcinoma and small-cell lung cancer, respectively. Their role in cancer immunotherapy needs to be elucidated. Methods Patients with advanced non-small cell lung cancer (NSCLC) were treated with nivolumab 3 mg/kg every 2 weeks within the Italian Nivolumab Expanded Access Program. Blood samples were collected at baseline, at each cycle up to cycle 5 and then every two cycles until patient’s withdrawn from the study. All patients underwent a CT-scan after every 4 cycles of treatment and responses were classified according to RECIST 1.1. The biomarkers serum levels were measured with a chemiluminescent microparticle immunoassay for CEA and with an immuno radiometric assay for CYFRA21-1 and NSE. The markers values at baseline and after 4 cycles were used to analyze the relationship between their variation over baseline and the tumor response, evaluated as disease control rate (DCR: CR + PR + SD), and survival (PFS and OS). Results A total of 70 patients were evaluable for the analysis. Overall, a disease control was obtained in 24 patients (35.8%, 4 PR + 20 SD). After 4 cycles of nivolumab a CEA or CYFRA21-1 reduction ≥ 20% over the baseline was significantly associated with DCR (CEA, p = 0.021; CYFRA21-1, p < 0.001), PFS (CEA, p = 0.028; CYFRA21-1, p < 0.001) and OS (CEA, p = 0.026; CYFRA21-1, p = 0.019). Multivariate analysis confirmed the ability of CYFRA21-1 reduction ≥ 20% to predict DCR (p = 0.002) and PFS (p < 0.001). Conclusion The reduction in serum level of CYFRA21-1 or CEA might be a reliable biomarker to predict immunotherapy efficacy in NSCLC patients. NSE was not significant for monitoring the efficacy of nivolumab.
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Affiliation(s)
- M G Dal Bello
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy.
| | - R A Filiberti
- Clinical Epidemiology Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - A Alama
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - A M Orengo
- Nuclear Medicine Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - M Mussap
- Laboratory Medicine Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - S Coco
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - I Vanni
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - S Boccardo
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - E Rijavec
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - C Genova
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Genova, Italy
| | - F Biello
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - G Barletta
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - G Rossi
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - M Tagliamento
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - C Maggioni
- Lung Cancer Unit, IRCCS-Ospedale Policlinico San Martino, Genova, Italy
| | - F Grossi
- Division of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Wei L, Wu W, Han L, Yu W, Du Y. A quantitative analysis of the potential biomarkers of non-small cell lung cancer by circulating cell-free DNA. Oncol Lett 2018; 16:4353-4360. [PMID: 30250538 PMCID: PMC6144435 DOI: 10.3892/ol.2018.9198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 07/10/2018] [Indexed: 01/02/2023] Open
Abstract
The study was conducted to ascertain whether the quantification of circulating cell-free DNA (cfDNA) in serum has value as a diagnostic or for monitoring the progression of non-small cell lung cancer (NSCLC). The serum/plasma cfDNA concentration was quantified by absolute qPCR of long interspersed nuclear element-1 (LINE1) in 60 NSCLC patients and 68 controls in good health. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic utility and cut-off levels of cfDNA, CEA, and CYFRA21-1 in NSCLC patients. Correlations between cfDNA and age, sex, tumour stage and progression-free survival (PFS) were analysed. A follow-up study was conducted on 4 NSCLC patients, and serum cfDNA, CEA, and CYFRA21-1 were quantified throughout disease progression. Serum cfDNA levels were significantly higher in NSCLC patients than those in normal controls. Elevated serum cfDNA concentration was also significantly associated with advanced tumour stage. Serum cfDNA had a ROC area under the curve comparable to that of CEA and CYFRA21-1 for the diagnosis of NSCLC, and the combined cfDNA/CEA/CYFRA21-1 indicator had the highest diagnostic efficiency. Moreover, increased serum cfDNA levels were strongly correlated with tumour progression and poor PFS. This study preliminarily confirmed that cfDNA can monitor disease progression in NSCLC patients, and the lead time was 1–7 months compared with clinical medical imaging. Serum cfDNA may be useful in monitoring NSCLC progression, suggesting that the non-invasive quantification of serum cfDNA by LINE1 qPCR is a viable option for predicting progression and disease severity when repeated invasive tissue biopsy is not possible.
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Affiliation(s)
- Lirong Wei
- Department of Laboratory Medicine, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201306, P.R. China.,Department of Laboratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, East Campus, Shanghai 201306, P.R. China
| | - Wangxi Wu
- Department of Laboratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, East Campus, Shanghai 201306, P.R. China
| | - Liming Han
- Department of Laboratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, East Campus, Shanghai 201306, P.R. China
| | - Weimo Yu
- Department of Laboratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, East Campus, Shanghai 201306, P.R. China
| | - Yuzhen Du
- Department of Laboratory Medicine, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201306, P.R. China.,Department of Laboratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, East Campus, Shanghai 201306, P.R. China
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