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Nayak L, Bettegowda C, Scherer F, Galldiks N, Ahluwalia M, Baraniskin A, von Baumgarten L, Bromberg JEC, Ferreri AJM, Grommes C, Hoang-Xuan K, Kühn J, Rubenstein JL, Rudà R, Weller M, Chang SM, van den Bent MJ, Wen PY, Soffietti R. Liquid biopsy for improving diagnosis and monitoring of CNS lymphomas: a RANO review. Neuro Oncol 2024:noae032. [PMID: 38598668 DOI: 10.1093/neuonc/noae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The utility of liquid biopsies is well documented in several extracranial and intracranial (brain/leptomeningeal metastases, gliomas) tumors. METHODS The RANO (Response Assessment in Neuro-Oncology) group has set up a multidisciplinary Task Force to critically review the role of blood and CSF-liquid biopsy in central nervous system lymphomas, with a main focus on primary central nervous system lymphomas (PCNSL). RESULTS Several clinical applications are suggested: diagnosis of PCNSL in critical settings (elderly or frail patients, deep locations, steroids responsiveness), definition of minimal residual disease, early indication of tumor response or relapse following treatments and prediction of outcome. CONCLUSIONS Thus far, no clinically validated circulating biomarkers for managing both primary and secondary CNS lymphomas exist. There is need of standardization of biofluid collection, choice of analytes and type of technique to perform the molecular analysis. The various assays should be evaluated through well organized central testing within clinical trials.
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Affiliation(s)
- Lakshmi Nayak
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Chetan Bettegowda
- Johns Hopkins University School of Medicine, Department of Neurosurgery
| | - Florian Scherer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Norbert Galldiks
- Department of Neurology, University of Cologne, Medical Faculty and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), and Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Manmeet Ahluwalia
- Rose and Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland OH and Miami Cancer Institute, Baptist Health South Florida, International University, Miami FL, USA
| | - Alexander Baraniskin
- Department of Hematology, Oncology and Palliative Care, Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Ludwig-Maximilians-University of Munich, Munich, Germany & German Cancer Consortium, Partner Site Munich, Munich, Germany
| | | | - Andrés J M Ferreri
- Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Christian Grommes
- Christian Grommes, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York and Department of Neurology, Weill Cornell Medical College, New York, USA
| | - Khê Hoang-Xuan
- APHP, Department of Neuro-oncology, Groupe Hospitalier Pitié-Salpêtrière; Sorbonne Université; Paris Brain Institute ICM; Paris France
| | - Julia Kühn
- Department of Medicine I, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - James L Rubenstein
- UCSF Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center San Francisco, CA, USA
| | - Roberta Rudà
- Division of Neuro-Oncology, Dept. Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Susan M Chang
- Department of Neurosurgery and Division of Neuro-Oncology, University of California, San Francisco, USA
| | | | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Riccardo Soffietti
- Department of Neuroscience 'Rita Levi Montalcini' University of Turin (R.S.); Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
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Schorb E, Isbell LK, Kerkhoff A, Mathas S, Braulke F, Egerer G, Röth A, Schliffke S, Borchmann P, Brunnberg U, Kroschinsky F, Möhle R, Rank A, Wellnitz D, Kasenda B, Pospiech L, Wendler J, Scherer F, Deckert M, Henkes E, von Gottberg P, Gmehlin D, Backenstraß M, Jensch A, Burger-Martin E, Grishina O, Fricker H, Malenica N, Orbán A, Duyster J, Ihorst G, Finke J, Illerhaus G. High-dose chemotherapy and autologous haematopoietic stem-cell transplantation in older, fit patients with primary diffuse large B-cell CNS lymphoma (MARTA): a single-arm, phase 2 trial. Lancet Haematol 2024; 11:e196-e205. [PMID: 38301670 DOI: 10.1016/s2352-3026(23)00371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Available treatments for older patients with primary diffuse large B-cell CNS lymphoma (PCNSL) offer progression-free survival of up to 16 months. We aimed to investigate an intensified treatment of high-dose chemotherapy and autologous haematopoietic stem-cell transplantation (HSCT) in older patients with PCNSL. METHODS MARTA was a prospective, single-arm, phase 2 study done at 15 research hospitals in Germany. Patients aged 65 years or older with newly diagnosed, untreated PCNSL were enrolled if they had an Eastern Cooperative Oncology Group performance status of 0-2 and were fit for high-dose chemotherapy and autologous HSCT. Induction treatment consisted of two 21-day cycles of high-dose intravenous methotrexate 3·5 g/m2 (day 1), intravenous cytarabine 2 g/m2 twice daily (days 2 and 3), and intravenous rituximab 375 mg/m2 (days 0 and 4) followed by high-dose chemotherapy with intravenous rituximab 375 mg/m2 (day -8), intravenous busulfan 3·2 mg/kg (days -7 and -6), and intravenous thiotepa 5 mg/kg (days -5 and -4) plus autologous HSCT. The primary endpoint was progression-free survival at 12 months in all patients who met eligibility criteria and started treatment. The study was registered with the German clinical trial registry, DRKS00011932, and recruitment is complete. FINDINGS Between Nov 28, 2017, and Sept 16, 2020, 54 patients started induction treatment and 51 were included in the full analysis set. Median age was 71 years (IQR 68-75); 27 (53%) patients were female and 24 (47%) were male. At a median follow-up of 23·0 months (IQR 16·8-37·4), 23 (45%) of 51 patients progressed, relapsed, or died. 12-month progression-free survival was 58·8% (80% CI 48·9-68·2; 95% CI 44·1-70·9). During induction treatment, the most common grade 3-5 toxicities were thrombocytopenia and leukopenia (each in 52 [96%] of 54 patients). During high-dose chemotherapy and autologous HSCT, the most common grade 3-5 toxicity was leukopenia (37 [100%] of 37 patients). Treatment-related deaths were reported in three (6%) of 54 patients, all due to infectious complications. INTERPRETATION Although the primary efficacy threshold was not met, short induction followed by high-dose chemotherapy and autologous HSCT is active in selected older patients with PCNSL and could serve as a benchmark for comparative trials. FUNDING Else Kröner-Fresenius Foundation, Riemser Pharma, and Medical Center-University of Freiburg.
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Affiliation(s)
- Elisabeth Schorb
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Lisa Kristina Isbell
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Kerkhoff
- Medizinische Klinik A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Stephan Mathas
- Charité-Universitätsmedizin Berlin, Haematology, Oncology and Cancer Immunology, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Group Biology of Malignant Lymphomas, Berlin, Germany; Experimental and Clinical Research Center, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany; Department of Haematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Gerlinde Egerer
- Department of Haematology and Oncology, Heidelberg University, Heidelberg, Germany
| | - Alexander Röth
- Department of Haematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Simon Schliffke
- Department of Oncology and Haematology, BMT with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Uta Brunnberg
- Department of Internal Medicine II, Haematology and Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Robert Möhle
- Department of Haematology and Oncology, University of Tübingen, Tübingen, Germany
| | - Andreas Rank
- Department of Haematology and Oncology, Augsburg Medical Center, Augsburg, Germany
| | - Dominique Wellnitz
- Department of Internal Medicine II-Haematology and Oncology, University Clinics Schleswig Holstein-Campus Kiel, Kiel, Germany
| | - Benjamin Kasenda
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Lisa Pospiech
- Department of Haematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Julia Wendler
- Department of Haematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Elina Henkes
- Clinic for Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Dennis Gmehlin
- Institute for Clinical Psychology, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Antje Jensch
- Stuttgart Cancer Center-Tumorzentrum Eva Mayr-Stihl, Klinikum Stuttgart, Stuttgart, Germany
| | - Elvira Burger-Martin
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Olga Grishina
- Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heidi Fricker
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natalie Malenica
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - András Orbán
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Finke
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerald Illerhaus
- Department of Haematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
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Lauer EM, Riegler E, Mutter JA, Alig SK, Bleul S, Kuehn J, Ranganathan L, Klingler C, Demerath T, Würtemberger U, Rau A, Weiß J, Eisenblaetter M, Bamberg F, Prinz M, Finke J, Duyster J, Illerhaus G, Diehn M, Alizadeh AA, Schorb E, Reinacher PC, Scherer F. Improved early outcome prediction by MRI-based 3D tumor volume assessment in patients with CNS lymphomas. Neuro Oncol 2024; 26:374-386. [PMID: 37713267 PMCID: PMC10836777 DOI: 10.1093/neuonc/noad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Central nervous system lymphomas (CNSL) display remarkable clinical heterogeneity, yet accurate prediction of outcomes remains challenging. The IPCG criteria are widely used in routine practice for the assessment of treatment response. However, the value of the IPCG criteria for ultimate outcome prediction is largely unclear, mainly due to the uncertainty in delineating complete from partial responses during and after treatment. METHODS We explored various MRI features including semi-automated 3D tumor volume measurements at different disease milestones and their association with survival in 93 CNSL patients undergoing curative-intent treatment. RESULTS At diagnosis, patients with more than 3 lymphoma lesions, periventricular involvement, and high 3D tumor volumes showed significantly unfavorable PFS and OS. At first interim MRI during treatment, the IPCG criteria failed to discriminate outcomes in responding patients. Therefore, we randomized these patients into training and validation cohorts to investigate whether 3D tumor volumetry could improve outcome prediction. We identified a 3D tumor volume reduction of ≥97% as the optimal threshold for risk stratification (=3D early response, 3D_ER). Applied to the validation cohort, patients achieving 3D_ER had significantly superior outcomes. In multivariate analyses, 3D_ER was independently prognostic of PFS and OS. Finally, we leveraged prognostic information from 3D MRI features and circulating biomarkers to build a composite metric that further improved outcome prediction in CNSL. CONCLUSIONS We developed semi-automated 3D tumor volume measurements as strong and independent early predictors of clinical outcomes in CNSL patients. These radiologic features could help improve risk stratification and help guide future treatment approaches.
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Affiliation(s)
- Eliza M Lauer
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ella Riegler
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jurik A Mutter
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Sabine Bleul
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Kuehn
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lavanya Ranganathan
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Klingler
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Urs Würtemberger
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
- Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakob Weiß
- Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Eisenblaetter
- Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, Medical Faculty, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Jürgen Finke
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerald Illerhaus
- Department of Hematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford School of Medicine, Stanford, CA, USA
| | - Ash A Alizadeh
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Elisabeth Schorb
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Cite Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Scherer F, Beule AG, Lütkenhöner B, Heitkötter F, Rudack C. Measurement of Ocular Vestibular Evoked Myogenic Potentials: Nasion Reference Montage as an Alternative to the Clinical Standard Montage. Otol Neurotol 2024; 45:e57-e65. [PMID: 38085768 DOI: 10.1097/mao.0000000000004046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To compare two novel electrode montages for ocular, vestibular evoked myogenic potential using single-nasion reference electrodes with the clinical standard montage. STUDY DESIGN Randomized crossover experiment. SETTING Tertiary referral center. PARTICIPANTS Sixty healthy participants. INTERVENTION Normal hearing and vestibular function were confirmed with an extensive test-battery. All ocular, vestibular evoked myogenic potential settings were measured with air-conducted tone bursts at 100-dB normal hearing level and a frequency of 500 Hz. Three electrode montages were measured in randomized order: the clinical standard montage ("S"), the nasion reference montage ("N"), and the nasion reference montage with a more lateral active electrode ("L"). Upgaze was standardized to 35 degrees. MAIN OUTCOME MEASURES Detection rate, latency of N1 and P1, peak-to-peak amplitude of N1 and P1, signal-to-noise ratio (SNR), asymmetry ratio (AR), concordance of expert assessment, and reliability. RESULTS All electrode montages showed detection rates greater than 90%. Latencies for "L" were shorter than for "S" and "N." Amplitudes and SNR for "S" and "N" were higher than for "L," whereas the values for "S" and "N" did not differ significantly. For AR, no significant differences between the montages were assessed. Concordance of experts ranged from 78% for "L" and 89.8% for "N." All montages provided excellent day-to-day reliability (intraclass correlation coefficient ≥0.9) for amplitudes and SNR. CONCLUSIONS Montage N could be a useful alternative to the clinical standard montage: although results are roughly equivalent, montage N requires one less electrode to do so.
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Affiliation(s)
- Florian Scherer
- Department of Otorhinolaryngology, University Hospital Münster, Münster
| | | | - Bernd Lütkenhöner
- Department of Otorhinolaryngology, University Hospital Münster, Münster
| | - Felix Heitkötter
- Department of Otorhinolaryngology, University Hospital Münster, Münster
| | - Claudia Rudack
- Department of Otorhinolaryngology, University Hospital Münster, Münster
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5
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Mozaffari Jovein M, Ihorst G, Duque-Afonso J, Wäsch R, Bertz H, Wehr C, Duyster J, Zeiser R, Finke J, Scherer F. Long-term follow-up of patients with acute myeloid leukemia undergoing allogeneic hematopoietic stem cell transplantation after primary induction failure. Blood Cancer J 2023; 13:179. [PMID: 38071327 PMCID: PMC10710471 DOI: 10.1038/s41408-023-00953-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Primary induction failure (PIF) in acute myeloid leukemia (AML) patients is associated with poor outcome, with allogeneic hematopoietic stem cell transplantation (HCT) being the sole curative therapeutic option. Here, we retrospectively evaluated long-term outcomes of 220 AML patients undergoing allogeneic HCT after PIF who never achieved remission, and identified clinical and molecular risk factors associated with treatment response and ultimate prognosis. In this high-risk population, disease-free survival was 25.2% after 5 years and 18.7% after 10 years, while overall survival rates were 29.8% and 21.6% after 5 and 10 years of HCT, respectively. 10-year non-relapse mortality was 32.5%, and 48.8% of patients showed disease relapse within 10 years after allogeneic HCT. Adverse molecular risk features determined at initial diagnosis, poor performance status at the time of allogeneic HCT, and long diagnosis-to-HCT intervals were associated with unfavorable prognosis. Collectively, our data suggests that immediate allogeneic HCT after PIF offers long-term survival and cure in a substantial subset of cases and that high-risk AML patients who never achieved complete response during induction might benefit from early donor search.
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Affiliation(s)
- Miriam Mozaffari Jovein
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Biometry and Statistics, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jesús Duque-Afonso
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Bertz
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claudia Wehr
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Zeiser
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Finke
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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6
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Isbell LK, Uibeleisen R, Friedl A, Burger E, Dopatka T, Scherer F, Orban A, Lauer E, Malenica N, Semenova I, Vreden A, Valk E, Wendler J, Neumaier S, Fricker H, El Rabih AAH, Gloggengießer C, Hilbig D, Bleul S, Weis J, Gmehlin D, Backenstrass M, Wirtz S, Ihorst G, Finke J, Illerhaus G, Schorb E. Age-adjusted high-dose chemotherapy followed by autologous stem cell transplantation or conventional chemotherapy with R-MP as first-line treatment in elderly primary CNS lymphoma patients - the randomized phase III PRIMA-CNS trial. BMC Cancer 2023; 23:767. [PMID: 37596517 PMCID: PMC10436648 DOI: 10.1186/s12885-023-11193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Older primary central nervous system lymphoma (PCNSL) patients have an inferior prognosis compared to younger patients because available evidence on best treatment is scarce and treatment delivery is challenging due to comorbidities and reduced performance status. High-dose chemotherapy and autologous stem cell transplantation (HCT-ASCT) after high-dose methotrexate (MTX)-based immuno-chemotherapy has become an increasingly used treatment approach in eligible elderly PCNSL patients with promising feasibility and efficacy, but has not been compared with conventional chemotherapy approaches. In addition, eligibility for HCT-ASCT in elderly PCNSL is not well defined. Geriatric assessment (GA) may be helpful in selecting patients for the best individual treatment choice, but no standardized GA exists to date. A randomized controlled trial, incorporating a GA and comparing age-adapted HCT-ASCT treatment with conventional chemotherapy is needed. METHODS This open-label, multicenter, randomized phase III trial with two parallel arms will recruit 310 patients with newly diagnosed PCNSL > 65 years of age in 40 centers in Germany and Austria. The primary objective is to demonstrate that intensified chemotherapy followed by consolidating HCT-ASCT is superior to conventional chemotherapy with rituximab, MTX, procarbazine (R-MP) followed by maintenance with procarbazine in terms of progression free survival (PFS). Secondary endpoints include overall survival (OS), event free survival (EFS), (neuro-)toxicity and quality of life (QoL). GA will be conducted at specific time points during the course of the study. All patients will be treated with a pre-phase rituximab-MTX (R-MTX) cycle followed by re-assessment of transplant eligibility. Patients judged transplant eligible will be randomized (1:1). Patients in arm A will be treated with 3 cycles of R-MP followed by maintenance therapy with procarbazine for 6 months. Patients in arm B will be treated with 2 cycles of MARTA (R-MTX/AraC) followed by busulfan- and thiotepa-based HCT-ASCT. DISCUSSION The best treatment strategy for elderly PCNSL patients remains unknown. Treatments range from palliative to curative but more toxic therapies, and there is no standardized measure to select patients for the right treatment. This randomized controlled trial will create evidence for the best treatment strategy with the focus on developing a standardized GA to help define eligibility for an intensive treatment approach. TRIAL REGISTRATION German clinical trials registry DRKS00024085 registered March 29, 2023.
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Affiliation(s)
- Lisa K Isbell
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Roswitha Uibeleisen
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Alexander Friedl
- Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Prießnitzweg 24, 70374, Bad Cannstatt, Germany
| | - Elvira Burger
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Tatja Dopatka
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Florian Scherer
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Andras Orban
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Eliza Lauer
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Natalie Malenica
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Inna Semenova
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Annika Vreden
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Elke Valk
- Stuttgart Cancer Center - Tumorzentrum Eva Mayer-Stihl, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Julia Wendler
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Simone Neumaier
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Heidi Fricker
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Abed Al Hadi El Rabih
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Cora Gloggengießer
- Stuttgart Cancer Center - Tumorzentrum Eva Mayer-Stihl, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Daniela Hilbig
- Stuttgart Cancer Center - Tumorzentrum Eva Mayer-Stihl, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Sabine Bleul
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Joachim Weis
- Endowed Professorship Self-Help Research, Comprehensive Cancer Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Dennis Gmehlin
- Institute for Clinical Psychology, Klinikum Stuttgart, Prießnitzweg 24, 70374, Bad Cannstatt, Germany
| | - Matthias Backenstrass
- Institute for Clinical Psychology, Klinikum Stuttgart, Prießnitzweg 24, 70374, Bad Cannstatt, Germany
| | - Sebastian Wirtz
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Straße 2, 79110, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Straße 2, 79110, Freiburg, Germany
| | - Jürgen Finke
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Gerald Illerhaus
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Elisabeth Schorb
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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7
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Foerster AK, Lauer EM, Scherer F. Clinical applications of circulating tumor DNA in central nervous system lymphoma. Semin Hematol 2023; 60:150-156. [PMID: 37442670 DOI: 10.1053/j.seminhematol.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Detection and characterization of circulating tumor DNA (ctDNA) in body fluids have the potential to revolutionize management of patients with lymphoma. Minimal access to malignant DNA through a simple blood draw or lumbar puncture is particularly appealing for CNS lymphomas (CNSL), which cannot be easily or repeatedly sampled without invasive surgeries. Profiling of ctDNA provides a real-time snapshot of the genetic composition in patients with CNSL and enables ultrasensitive quantification of lymphoma burden at any given time point during the course of the disease. Here, we broadly review technical challenges of ctDNA identification in CNSL, recent advances of innovative liquid biopsy technologies, potential clinical applications of ctDNA and how it may improve CNSL risk stratification, outcome prediction, and monitoring of measurable residual disease. Finally, we discuss clinical trials and scenarios in which ctDNA could be implemented to guide risk-adapted and personalized treatment decisions.
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Affiliation(s)
- Anna Katharina Foerster
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eliza M Lauer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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8
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Schroers-Martin JG, Soo J, Brisou G, Scherer F, Kurtz DM, Sworder BJ, Khodadoust MS, Jin MC, Bru A, Liu CL, Stehr H, Vineis P, Natkunam Y, Teras LR, Song JY, Nadel B, Diehn M, Roulland S, Alizadeh AA. Tracing Founder Mutations in Circulating and Tissue-Resident Follicular Lymphoma Precursors. Cancer Discov 2023; 13:1310-1323. [PMID: 36939219 PMCID: PMC10239329 DOI: 10.1158/2159-8290.cd-23-0111] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 03/21/2023]
Abstract
Follicular lymphomas (FL) are characterized by BCL2 translocations, often detectable in blood years before FL diagnosis, but also observed in aging healthy individuals, suggesting additional lesions are required for lymphomagenesis. We directly characterized early cooperating mutations by ultradeep sequencing of prediagnostic blood and tissue specimens from 48 subjects who ultimately developed FL. Strikingly, CREBBP lysine acetyltransferase (KAT) domain mutations were the most commonly observed precursor lesions, and largely distinguished patients developing FL (14/48, 29%) from healthy adults with or without detected BCL2 rearrangements (0/13, P = 0.03 and 0/20, P = 0.007, respectively). CREBBP variants were detectable a median of 5.8 years before FL diagnosis, were clonally selected in FL tumors, and appeared restricted to the committed B-cell lineage. These results suggest that mutations affecting the CREBBP KAT domain are common lesions in FL cancer precursor cells (CPC), with the potential for discriminating subjects at risk of developing FL or monitoring residual disease. SIGNIFICANCE Our study provides direct evidence for recurrent genetic aberrations preceding FL diagnosis, revealing the combination of BCL2 translocation with CREBBP KAT domain mutations as characteristic committed lesions of FL CPCs. Such prediagnostic mutations are detectable years before clinical diagnosis and may help discriminate individuals at risk for lymphoma development. This article is highlighted in the In This Issue feature, p. 1275.
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Affiliation(s)
- Joseph G. Schroers-Martin
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
| | - Joanne Soo
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
| | - Gabriel Brisou
- Aix-Marseille University, CNRS, INSERM, Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Florian Scherer
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
| | - David M. Kurtz
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
| | - Brian J. Sworder
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
| | - Michael S. Khodadoust
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
| | - Michael C. Jin
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
| | - Agnès Bru
- Aix-Marseille University, CNRS, INSERM, Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Chih Long Liu
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
| | - Henning Stehr
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College, London, UK
| | - Yasodha Natkunam
- Department of Pathology, Stanford University Medical Center, Stanford, CA
| | | | - Joo Y. Song
- City of Hope Cancer Research Hospital, Duarte, CA
| | - Bertrand Nadel
- Aix-Marseille University, CNRS, INSERM, Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California, USA
- Stanford Cancer Institute, Stanford University, Stanford, California, USA
| | - Sandrine Roulland
- Aix-Marseille University, CNRS, INSERM, Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Ash A. Alizadeh
- Department of Medicine, Divisions of Hematology & Oncology, Stanford University Medical Center, Stanford, CA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California, USA
- Stanford Cancer Institute, Stanford University, Stanford, California, USA
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9
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Mutter JA, Alig SK, Esfahani MS, Lauer EM, Mitschke J, Kurtz DM, Kühn J, Bleul S, Olsen M, Liu CL, Jin MC, Macaulay CW, Neidert N, Volk T, Eisenblaetter M, Rauer S, Heiland DH, Finke J, Duyster J, Wehrle J, Prinz M, Illerhaus G, Reinacher PC, Schorb E, Diehn M, Alizadeh AA, Scherer F. Circulating Tumor DNA Profiling for Detection, Risk Stratification, and Classification of Brain Lymphomas. J Clin Oncol 2023; 41:1684-1694. [PMID: 36542815 PMCID: PMC10419411 DOI: 10.1200/jco.22.00826] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/26/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Clinical outcomes of patients with CNS lymphomas (CNSLs) are remarkably heterogeneous, yet identification of patients at high risk for treatment failure is challenging. Furthermore, CNSL diagnosis often remains unconfirmed because of contraindications for invasive stereotactic biopsies. Therefore, improved biomarkers are needed to better stratify patients into risk groups, predict treatment response, and noninvasively identify CNSL. PATIENTS AND METHODS We explored the value of circulating tumor DNA (ctDNA) for early outcome prediction, measurable residual disease monitoring, and surgery-free CNSL identification by applying ultrasensitive targeted next-generation sequencing to a total of 306 tumor, plasma, and CSF specimens from 136 patients with brain cancers, including 92 patients with CNSL. RESULTS Before therapy, ctDNA was detectable in 78% of plasma and 100% of CSF samples. Patients with positive ctDNA in pretreatment plasma had significantly shorter progression-free survival (PFS, P < .0001, log-rank test) and overall survival (OS, P = .0001, log-rank test). In multivariate analyses including established clinical and radiographic risk factors, pretreatment plasma ctDNA concentrations were independently prognostic of clinical outcomes (PFS HR, 1.4; 95% CI, 1.0 to 1.9; P = .03; OS HR, 1.6; 95% CI, 1.1 to 2.2; P = .006). Moreover, measurable residual disease detection by plasma ctDNA monitoring during treatment identified patients with particularly poor prognosis following curative-intent immunochemotherapy (PFS, P = .0002; OS, P = .004, log-rank test). Finally, we developed a proof-of-principle machine learning approach for biopsy-free CNSL identification from ctDNA, showing sensitivities of 59% (CSF) and 25% (plasma) with high positive predictive value. CONCLUSION We demonstrate robust and ultrasensitive detection of ctDNA at various disease milestones in CNSL. Our findings highlight the role of ctDNA as a noninvasive biomarker and its potential value for personalized risk stratification and treatment guidance in patients with CNSL. [Media: see text].
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Affiliation(s)
- Jurik A. Mutter
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- University of Freiburg, Faculty of Biology, Freiburg, Germany
| | - Stefan K. Alig
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Mohammad S. Esfahani
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Eliza M. Lauer
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Mitschke
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David M. Kurtz
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Julia Kühn
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sabine Bleul
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mari Olsen
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Chih Long Liu
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Michael C. Jin
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Charles W. Macaulay
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Nicolas Neidert
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme for Clinician Scientists Medical Center, University of Freiburg, Freiburg, Germany
| | - Timo Volk
- Department of Neurology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Eisenblaetter
- Department of Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Rauer
- Department of Neurology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter H. Heiland
- Department of Neurosurgery, Medical Center—University of Freiburg, Freiburg, Germany
| | - Jürgen Finke
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julius Wehrle
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, Medical Faculty, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Gerald Illerhaus
- Department of Hematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Peter C. Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Elisabeth Schorb
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford School of Medicine, Stanford, CA
| | - Ash A. Alizadeh
- Divisions of Oncology and Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Florian Scherer
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
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10
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Rassner M, Waldeck S, Follo M, Jilg S, Philipp U, Jolic M, Wehrle J, Jost PJ, Peschel C, Illert AL, Duyster J, Scherer F, von Bubnoff N. Development of Highly Sensitive Digital Droplet PCR for Detection of cKIT Mutations in Circulating Free DNA That Mediate Resistance to TKI Treatment for Gastrointestinal Stromal Tumors (GISTs). Int J Mol Sci 2023; 24:ijms24065411. [PMID: 36982486 PMCID: PMC10049191 DOI: 10.3390/ijms24065411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Mutations in cKIT or PDGFRA are found in up to 90% of patients with gastrointestinal stromal tumors (GISTs). Previously, we described the design, validation, and clinical performance of a digital droplet (dd)PCR assay panel for the detection of imatinib-sensitive cKIT and PDFGRA mutations in circulating tumor (ct)DNA. In this study, we developed and validated a set of ddPCR assays for the detection of cKIT mutations mediating resistance to cKIT kinase inhibitors in ctDNA. In addition, we cross-validated these assays using next generation sequencing (NGS). Methods: We designed and validated five new ddPCR assays to cover the most frequent cKIT mutations mediating imatinib resistance in GISTs. For the most abundant imatinib-resistance-mediating mutations in exon 17, a drop-off, probe-based assay was designed. Dilution series (of decreasing mutant (MUT) allele frequency spiked into wildtype DNA) were conducted to determine the limit of detection (LoD). Empty controls, single wildtype controls, and samples from healthy individuals were tested to assess specificity and limit of blank (LoB). For clinical validation, we measured cKIT mutations in three patients and validated results using NGS. Results: Technical validation demonstrated good analytical sensitivity, with a LoD ranging between 0.006% and 0.16% and a LoB ranging from 2.5 to 6.7 MUT fragments/mL. When the ddPCR assays applied to three patients, the abundance of ctDNA in serial plasma samples reflected the individual disease course, detected disease activity, and indicated resistance mutations before imaging indicated progression. Digital droplet PCR showed good correlation to NGS for individual mutations, with a higher sensitivity of detection. Conclusions: This set of ddPCR assays, together with our previous set of cKIT and PDGFRA mutations assays, allows for dynamic monitoring of cKIT and PDGFRA mutations during treatment. Together with NGS, the GIST ddPCR panel will complement imaging of GISTs for early response evaluation and early detection of relapse, and thus it might facilitate personalized decision-making.
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Affiliation(s)
- Michael Rassner
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Silvia Waldeck
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Marie Follo
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Stefanie Jilg
- III Medical Department for Hematology and Oncology, Klinikum Rechts der Isar, Technische Universität München, 80333 Munich, Germany
- Onkologie Erding, 85435 Erding, Germany
| | - Ulrike Philipp
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Martina Jolic
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Julius Wehrle
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Philipp J. Jost
- III Medical Department for Hematology and Oncology, Klinikum Rechts der Isar, Technische Universität München, 80333 Munich, Germany
- Department of Clinical Oncology, Division of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Christian Peschel
- III Medical Department for Hematology and Oncology, Klinikum Rechts der Isar, Technische Universität München, 80333 Munich, Germany
| | - Anna Lena Illert
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Nikolas von Bubnoff
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Hematology and Oncology, Medical Center, University of Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- Correspondence: ; Tel.: +49-451-500-44195; Fax: +49-451-500-44154
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11
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Isbell LK, Tschuch C, Doostkam S, Waldeck S, Andrieux G, Shoumariyeh K, Lenhard D, Schaefer HE, Reinacher PC, Bartsch I, Pantic M, Vinnakota JM, Kakkassery V, Schorb E, Scherer F, Frey AV, Boerries M, Illerhaus G, Duyster J, Schueler J, von Bubnoff N. Patient-derived xenograft mouse models to investigate tropism to the central nervous system and retina of primary and secondary central nervous system lymphoma. Neuropathol Appl Neurobiol 2023; 49:e12899. [PMID: 36879456 DOI: 10.1111/nan.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
AIMS How and why lymphoma cells home to the central nervous system and vitreoretinal compartment in primary diffuse large B-cell lymphoma of the central nervous system remain unknown. Our aim was to create an in vivo model to study lymphoma cell tropism to the central nervous system. METHODS We established a patient-derived central nervous system lymphoma xenograft mouse model and characterised xenografts derived from 4 primary and 4 secondary central nervous system lymphoma patients using immunohistochemistry, flow cytometry and nucleic acid sequencing technology. In reimplantation experiments, we analysed dissemination patterns of orthotopic and heterotopic xenografts and performed RNA sequencing of different involved organs to detect differences at the transcriptome level. RESULTS We found that xenografted primary central nervous system lymphoma cells home to the central nervous system and eye after intrasplenic transplantation, mimicking central nervous system and primary vitreoretinal lymphoma pathology, respectively. Transcriptomic analysis revealed distinct signatures for lymphoma cells in the brain in comparison to the spleen as well as a small overlap of commonly regulated genes in both primary and secondary central nervous system lymphoma. CONCLUSION This in vivo tumour model preserves key features of primary and secondary central nervous system lymphoma and can be used to explore critical pathways for the central nervous system and retinal tropism with the goal to find new targets for novel therapeutic approaches.
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Affiliation(s)
- Lisa Kristina Isbell
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cordula Tschuch
- Charles River Discovery Research Services GmbH, Freiburg, Germany
| | - Soroush Doostkam
- Institute for Neuropathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Silvia Waldeck
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Geoffroy Andrieux
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), partner site Freiburg, Germany and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), partner site Freiburg, Germany and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dorothee Lenhard
- Charles River Discovery Research Services GmbH, Freiburg, Germany
| | | | - Peter Christoph Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Faculty, University of Freiburg, Freiburg, Germany.,Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Ingrid Bartsch
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Milena Pantic
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Janaki Manoja Vinnakota
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vinodh Kakkassery
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany
| | - Elisabeth Schorb
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), partner site Freiburg, Germany and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Verena Frey
- Institute of Surgical Pathology, University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine (IBSM), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), partner site Freiburg, Germany and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gerald Illerhaus
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), partner site Freiburg, Germany and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julia Schueler
- Charles River Discovery Research Services GmbH, Freiburg, Germany
| | - Nikolas von Bubnoff
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), partner site Freiburg, Germany and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Germany
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12
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Wendler J, Fox CP, Valk E, Steinheber C, Fricker H, Isbell LK, Neumaier S, Okosun J, Scherer F, Ihorst G, Cwynarski K, Schorb E, Illerhaus G. Optimizing MATRix as remission induction in PCNSL: de-escalated induction treatment in newly diagnosed primary CNS lymphoma. BMC Cancer 2022; 22:971. [PMID: 36088292 PMCID: PMC9464101 DOI: 10.1186/s12885-022-09723-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary diffuse large B-cell lymphoma (DLBCL) of the central nervous system (PCNSL) is a rare disorder with an increasing incidence over the past decades. High-level evidence has been reported for the MATRix regimen (high-dose methotrexate (HD-MTX), high-dose AraC (HD-AraC), thiotepa and rituximab) followed by high-dose chemotherapy and autologous stem cell transplantation (HCT-ASCT) supporting this approach to be considered a standard therapy in newly diagnosed PCNSL patients ≤ 70 years. However, early treatment-related toxicities (predominantly infectious complications), occurring in up to 28% per MATRix cycle, diminish its therapeutic success. Furthermore, sensitivity to first-line treatment is an independent prognostic factor for improved overall survival (OS) in PCNSL. Thus, patients achieving early partial remission (PR) after 2 cycles of MATRix might be over-treated with 4 cycles, in the context of consolidation HCT-ASCT. METHODS This is an open-label, multicentre, randomized phase III trial with two parallel arms. 326 immunocompetent patients with newly diagnosed PCNSL will be recruited from 37 German, 1 Austrian and 12 UK sites. Additional IELSG (International Extranodal Lymphoma Study Group) sites are planned. The objective is to demonstrate superiority of a de-escalated and optimised remission induction treatment strategy, followed by HCT-ASCT. Randomization (1:1) will be performed after completion of all screening procedures. Patients in Arm A (control treatment) will receive 4 cycles of MATRix. Patients in Arm B (experimental treatment) will receive a pre-phase (R/HD-MTX), followed by 2 cycles of MATRix. Patients in both arms achieving PR or better will proceed to HCT-ASCT (BCNU, thiotepa). The primary endpoint of the study is event-free-survival (EFS), defined as time from randomization to premature end of treatment due to any reason, lymphoma progression or death whichever occurs first. Secondary endpoints include OS, progression free survival (PFS), toxicity, neurocognitive impairment and quality of life. Minimal follow-up is 24 months. DISCUSSION Current treatment options for PCNSL in patients ≤ 70 years have improved remarkably over recent years. However, the potential efficacy benefits are offset by an increased incidence of short-term toxicities which can impact on treatment delivery and hence on survival outcomes. In patients ≤ 70 years with newly diagnosed PCNSL addressing the need to reduce treatment-related toxicity by de-escalating and optimising the induction phase of treatment, is a potentially attractive treatment strategy. TRIAL REGISTRATION German clinical trials registry DRKS00022768 registered June 10th, 2021.
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Affiliation(s)
- Julia Wendler
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Christopher P Fox
- Russell Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, City Campus, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Elke Valk
- Stuttgart Cancer Center - Tumorzentrum Eva Mayer-Stihl, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Cora Steinheber
- Stuttgart Cancer Center - Tumorzentrum Eva Mayer-Stihl, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Heidi Fricker
- Department Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Lisa K Isbell
- Department Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Simone Neumaier
- Stuttgart Cancer Center - Tumorzentrum Eva Mayer-Stihl, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Florian Scherer
- Department Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Straße 2, 79110, Freiburg, Germany
| | - Kate Cwynarski
- Department of Haematology, University College of London Hospitals, NHS Foundation Trust, London, UK
| | - Elisabeth Schorb
- Department Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Gerald Illerhaus
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
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13
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Lauer EM, Mutter J, Scherer F. Circulating tumor DNA in B-cell lymphoma: technical advances, clinical applications, and perspectives for translational research. Leukemia 2022; 36:2151-2164. [PMID: 35701522 PMCID: PMC9417989 DOI: 10.1038/s41375-022-01618-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 12/22/2022]
Abstract
Noninvasive disease monitoring and risk stratification by circulating tumor DNA (ctDNA) profiling has become a potential novel strategy for patient management in B-cell lymphoma. Emerging innovative therapeutic options and an unprecedented growth in our understanding of biological and molecular factors underlying lymphoma heterogeneity have fundamentally increased the need for precision-based tools facilitating personalized and accurate disease profiling and quantification. By capturing the entire mutational landscape of tumors, ctDNA assessment has some decisive advantages over conventional tissue biopsies, which usually target only one single tumor site. Due to its non- or minimal-invasive nature, serial and repeated ctDNA profiling provides a real-time picture of the genetic composition and facilitates quantification of tumor burden any time during the course of the disease. In this review, we present a comprehensive overview of technologies used for ctDNA detection and genotyping in B-cell lymphoma, focusing on pre-analytical and technical requirements, the advantages and limitations of various approaches, and highlight recent advances around improving sensitivity and suppressing technical errors. We broadly review potential applications of ctDNA in clinical practice and for translational research by describing how ctDNA might enhance lymphoma subtype classification, treatment response assessment, outcome prediction, and monitoring of measurable residual disease. We finally discuss how ctDNA could be implemented in prospective clinical trials as a novel surrogate endpoint and be utilized as a decision-making tool to guide lymphoma treatment in the future.
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Affiliation(s)
- Eliza M Lauer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jurik Mutter
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- German Cancer Consortium (DKTK) partner site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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14
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Mack M, Broche J, George S, Hajjari Z, Janke F, Ranganathan L, Ashouri M, Bleul S, Desuki A, Engels C, Fliedner SM, Hartmann N, Hummel M, Janning M, Kiel A, Köhler T, Koschade S, Lablans M, Lambarki M, Loges S, Lueong S, Meyer S, Ossowski S, Scherer F, Schroeder C, Skowronek P, Thiede C, Uhl B, Vehreschild JJ, von Bubnoff N, Wagner S, Werner TV, Westphalen CB, Fresser P, Sültmann H, Tinhofer I, Winter C. The DKTK EXLIQUID consortium – exploiting liquid biopsies to advance cancer precision medicine for molecular tumor board patients. J LAB MED 2022. [DOI: 10.1515/labmed-2022-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Abstract
Testing for genetic alterations in tumor tissue allows clinicians to identify patients who most likely will benefit from molecular targeted treatment. EXLIQUID – exploiting liquid biopsies to advance cancer precision medicine – investigates the potential of additional non-invasive tools for guiding therapy decisions and monitoring of advanced cancer patients. The term “liquid biopsy” (LB) refers to non-invasive analysis of tumor-derived circulating material such as cell-free DNA in blood samples from cancer patients. Although recent technological advances allow sensitive and specific detection of LB biomarkers, only few LB assays have entered clinical routine to date. EXLIQUID is a German Cancer Consortium (DKTK)-wide joint funding project that aims at establishing LBs as a minimally-invasive tool to analyze molecular changes in circulating tumor DNA (ctDNA). Here, we present the structure, clinical aim, and methodical approach of the new DKTK EXLIQUID consortium. Within EXLIQUID, we will set up a multicenter repository of high-quality LB samples from patients participating in DKTK MASTER and local molecular tumor boards, which use molecular profiles of tumor tissues to guide targeted therapies. We will develop LB assays for monitoring of therapy efficacy by the analysis of tumor mutant variants and tumor-specific DNA methylation patterns in ctDNA from these patients. By bringing together LB experts from all DKTK partner sites and exploiting the diversity of their particular expertise, complementary skills and technologies, the EXLIQUID consortium addresses the challenges of translating LBs into the clinic. The DKTK structure provides EXLIQUID a unique position for the identification of liquid biomarkers even in less common tumor types, thereby extending the group of patients benefitting from non-invasive LB testing. Besides its scientific aims, EXLIQUID is building a valuable precision oncology cohort and LB platform which will be available for future collaborative research studies within the DKTK and beyond.
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Affiliation(s)
- Matthias Mack
- School of Medicine , Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich , Munich , Germany
- German Cancer Consortium (DKTK), Partner Site Munich , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Julian Broche
- Institute of Medical Genetics and Applied Genomics, University of Tübingen , Tübingen , Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Stephen George
- Department of Radiooncology and Radiotherapy , Charité University Hospital Berlin , Berlin , Germany
- German Cancer Consortium (DKTK), Partner Site Berlin , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Zahra Hajjari
- West German Cancer Center , Bridge Institute of Experimental Tumor Therapy, University Hospital Essen , Essen , Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Florian Janke
- Division of Cancer Genome Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany
- German Cancer Consortium (DKTK) , Heidelberg , Germay
| | - Lavanya Ranganathan
- Department of Medicine I , Medical Center – University of Freiburg , Freiburg , Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Mohammadreza Ashouri
- School of Medicine , Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich , Munich , Germany
- German Cancer Consortium (DKTK), Partner Site Munich , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Sabine Bleul
- Department of Medicine I , Medical Center – University of Freiburg , Freiburg , Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Alexander Desuki
- University Cancer Center (UCT), University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Cecilia Engels
- Charité University Hospital Berlin , Berlin , Germany
- German Cancer Consortium (DKTK), Partner Site Berlin , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Stephanie M.J. Fliedner
- University Cancer Center Schleswig-Holstein, University Medical Center Schleswig-Holstein , Kiel/Lübeck , Germany
| | - Nils Hartmann
- Institute of Pathology, University Medical Center JGU Mainz , Mainz , Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Michael Hummel
- Charité University Hospital Berlin , Berlin , Germany
- German Cancer Consortium (DKTK), Partner Site Berlin , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Melanie Janning
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim , Mannheim , Germany
- Division of Personalized Medical Oncology (A420) , German Cancer Research Center (DKFZ) , Heidelberg , Germany
- Department of Personalized Oncology, Medical Faculty Mannheim , University Hospital Mannheim, University of Heidelberg , Mannheim , Germany
| | - Alexander Kiel
- Complex Data Processing in Medical Informatics , University Medical Center Mannheim , Mannheim , Germany
- German Cancer Consortium (DKTK); and Federated Information Systems , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Thomas Köhler
- Complex Data Processing in Medical Informatics , University Medical Center Mannheim , Mannheim , Germany
- German Cancer Consortium (DKTK); and Federated Information Systems , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Sebastian Koschade
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz , German Cancer Research Center (DKFZ) , Heidelberg , Germany
- Department of Medicine, Hematology/Oncology , Goethe University , Frankfurt , Germany
| | - Martin Lablans
- Complex Data Processing in Medical Informatics , University Medical Center Mannheim , Mannheim , Germany
- German Cancer Consortium (DKTK); and Federated Information Systems , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Mohamed Lambarki
- Complex Data Processing in Medical Informatics , University Medical Center Mannheim , Mannheim , Germany
- German Cancer Consortium (DKTK); and Federated Information Systems , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Sonja Loges
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim , Mannheim , Germany
- Division of Personalized Medical Oncology (A420) , German Cancer Research Center (DKFZ) , Heidelberg , Germany
- Department of Personalized Oncology, Medical Faculty Mannheim , University Hospital Mannheim, University of Heidelberg , Mannheim , Germany
| | - Smiths Lueong
- West German Cancer Center , Bridge Institute of Experimental Tumor Therapy, University Hospital Essen , Essen , Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Sandra Meyer
- University Hospital Frankfurt , Frankfurt , Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics, University of Tübingen , Tübingen , Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Florian Scherer
- Department of Medicine I , Medical Center – University of Freiburg , Freiburg , Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Christopher Schroeder
- Institute of Medical Genetics and Applied Genomics, University of Tübingen , Tübingen , Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Patrick Skowronek
- Complex Data Processing in Medical Informatics , University Medical Center Mannheim , Mannheim , Germany
- German Cancer Consortium (DKTK); and Federated Information Systems , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Christian Thiede
- Department of Medicine I , University Hospital Carl Gustav Carus , Dresden , Germany
- German Cancer Consortium (DKTK), Partner Site Dresden , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Barbara Uhl
- University Hospital Frankfurt , Frankfurt , Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Jörg Janne Vehreschild
- University Hospital Frankfurt , Frankfurt , Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Nikolas von Bubnoff
- University Cancer Center Schleswig-Holstein, University Medical Center Schleswig-Holstein , Kiel/Lübeck , Germany
| | - Sebastian Wagner
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz , German Cancer Research Center (DKFZ) , Heidelberg , Germany
- Department of Medicine, Hematology/Oncology , Goethe University , Frankfurt , Germany
| | - Tamara V. Werner
- Medical Center, Medical Faculty , Institute for Surgical Pathology, University of Freiburg , Freiburg , Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - C. Benedikt Westphalen
- Comprehensive Cancer Center Munich & Department of Medicine III , Ludwig Maximilian University of Munich , Munich , Germany
- German Cancer Consortium (DKTK), Partner Site Munich , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Patrizia Fresser
- School of Medicine , Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich , Munich , Germany
- German Cancer Consortium (DKTK), Partner Site Munich , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Holger Sültmann
- Division of Cancer Genome Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany
- German Cancer Consortium (DKTK) , Heidelberg , Germay
| | - Ingeborg Tinhofer
- Department of Radiooncology and Radiotherapy , Charité University Hospital Berlin , Berlin , Germany
- German Cancer Consortium (DKTK), Partner Site Berlin , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Christof Winter
- School of Medicine , Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich , Munich , Germany
- German Cancer Consortium (DKTK), Partner Site Munich , German Cancer Research Center (DKFZ) , Heidelberg , Germany
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15
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Waterhouse M, Pennisi S, Pfeifer D, Scherer F, Zeiser R, Duyster J, Bertz H, Finke J, Duque-Afonso J. Monitoring of Measurable Residual Disease Using Circulating DNA after Allogeneic Hematopoietic Cell Transplantation. Cancers (Basel) 2022; 14:cancers14143307. [PMID: 35884368 PMCID: PMC9323743 DOI: 10.3390/cancers14143307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary The major cause of treatment failure after allogeneic stem cell transplantation (allo-HSCT) is due to relapse of the underlying disease. Novel methods and strategies are needed to detect early relapse after allo-HSCT. The present study reports the clinical utility of monitoring measurable residual disease (MRD) and mixed chimerism (MC) by droplet-digital PCR in circulating cell-free DNA (cfDNA) in 62 patients with myeloid malignancies undergoing allo-HSCT. MC in circulating cfDNA at an optimal threshold of 18% discriminated patients with hematological relapse from patients in complete remission after allo-HSCT. Most of the mutations identified using a targeted next-generation sequencing (NGS) panel were detected in cfDNA at relapse and were suitable for the monitoring of MRD. In several cases, mutations were detected earlier in cfDNA than in peripheral blood mononuclear cells. In conclusion, longitudinal analysis of cfDNA for MRD and MC can be used as a complementary tool for early detection of relapse in patients after allo-HSCT and could be used to guide clinical interventions. Abstract Relapse of the underlying disease is a frequent complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this study, we describe the clinical utility of measurable residual disease (MRD) and mixed chimerism (MC) assessment in circulating cell-free DNA (cfDNA) analysis to detect earlier relapse in patients with hematological malignancies after allo-HSCT. A total of 326 plasma and peripheral blood mononuclear cell (PBMCs) samples obtained from 62 patients with myeloid malignancies were analyzed by droplet-digital PCR (median follow-up: 827 days). Comparison of MC in patients at relapse and in complete remission identified an optimal discriminating threshold of 18% of recipient-derived cfDNA. After performing a targeted next-generation sequencing (NGS) panel, 136 mutations in 58 patients were detected. In a total of 119 paired samples, the putative mutations were detected in both cfDNA and PBMCs in 73 samples (61.3%). In 45 samples (37.8%) they were detected only in cfDNA, and in only one patient (0.9%) were they detected solely in DNA from PBMCs. Hence, in 6 out of 23 patients (26%) with relapse after allo-HSCT, MRD positivity was detected earlier in cfDNA (mean 397 days) than in DNA derived from PBMCs (mean 451 days). In summary, monitoring of MRD and MC in cfDNA might be useful for earlier relapse detection in patients with myeloid malignancies after allo-HSCT.
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Affiliation(s)
- Miguel Waterhouse
- Department of Hematology Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, 79106 Freiburg, Germany; (S.P.); (D.P.); (F.S.); (R.Z.); (J.D.); (H.B.); (J.F.)
- Correspondence: (M.W.); (J.D.-A.); Tel.: +49-761-270-36000 (M.W. & J.D.-A.)
| | - Sandra Pennisi
- Department of Hematology Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, 79106 Freiburg, Germany; (S.P.); (D.P.); (F.S.); (R.Z.); (J.D.); (H.B.); (J.F.)
- Faculty of Biology, Albert Ludwigs University of Freiburg, 79104 Freiburg, Germany
| | - Dietmar Pfeifer
- Department of Hematology Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, 79106 Freiburg, Germany; (S.P.); (D.P.); (F.S.); (R.Z.); (J.D.); (H.B.); (J.F.)
| | - Florian Scherer
- Department of Hematology Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, 79106 Freiburg, Germany; (S.P.); (D.P.); (F.S.); (R.Z.); (J.D.); (H.B.); (J.F.)
| | - Robert Zeiser
- Department of Hematology Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, 79106 Freiburg, Germany; (S.P.); (D.P.); (F.S.); (R.Z.); (J.D.); (H.B.); (J.F.)
| | - Justus Duyster
- Department of Hematology Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, 79106 Freiburg, Germany; (S.P.); (D.P.); (F.S.); (R.Z.); (J.D.); (H.B.); (J.F.)
| | - Hartmut Bertz
- Department of Hematology Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, 79106 Freiburg, Germany; (S.P.); (D.P.); (F.S.); (R.Z.); (J.D.); (H.B.); (J.F.)
| | - Jürgen Finke
- Department of Hematology Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, 79106 Freiburg, Germany; (S.P.); (D.P.); (F.S.); (R.Z.); (J.D.); (H.B.); (J.F.)
| | - Jesús Duque-Afonso
- Department of Hematology Oncology and Stem Cell Transplantation, University of Freiburg Medical Center, 79106 Freiburg, Germany; (S.P.); (D.P.); (F.S.); (R.Z.); (J.D.); (H.B.); (J.F.)
- Correspondence: (M.W.); (J.D.-A.); Tel.: +49-761-270-36000 (M.W. & J.D.-A.)
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16
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Ravi VM, Will P, Kueckelhaus J, Sun N, Joseph K, Salié H, Vollmer L, Kuliesiute U, von Ehr J, Benotmane JK, Neidert N, Follo M, Scherer F, Goeldner JM, Behringer SP, Franco P, Khiat M, Zhang J, Hofmann UG, Fung C, Ricklefs FL, Lamszus K, Boerries M, Ku M, Beck J, Sankowski R, Schwabenland M, Prinz M, Schüller U, Killmer S, Bengsch B, Walch AK, Delev D, Schnell O, Heiland DH. Spatially resolved multi-omics deciphers bidirectional tumor-host interdependence in glioblastoma. Cancer Cell 2022; 40:639-655.e13. [PMID: 35700707 DOI: 10.1016/j.ccell.2022.05.009] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/30/2021] [Accepted: 05/13/2022] [Indexed: 12/11/2022]
Abstract
Glioblastomas are malignant tumors of the central nervous system hallmarked by subclonal diversity and dynamic adaptation amid developmental hierarchies. The source of dynamic reorganization within the spatial context of these tumors remains elusive. Here, we characterized glioblastomas by spatially resolved transcriptomics, metabolomics, and proteomics. By deciphering regionally shared transcriptional programs across patients, we infer that glioblastoma is organized by spatial segregation of lineage states and adapts to inflammatory and/or metabolic stimuli, reminiscent of the reactive transformation in mature astrocytes. Integration of metabolic imaging and imaging mass cytometry uncovered locoregional tumor-host interdependence, resulting in spatially exclusive adaptive transcriptional programs. Inferring copy-number alterations emphasizes a spatially cohesive organization of subclones associated with reactive transcriptional programs, confirming that environmental stress gives rise to selection pressure. A model of glioblastoma stem cells implanted into human and rodent neocortical tissue mimicking various environments confirmed that transcriptional states originate from dynamic adaptation to various environments.
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Affiliation(s)
- Vidhya M Ravi
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany; Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
| | - Paulina Will
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jan Kueckelhaus
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany; Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), Department of Neurosurgery, RWTH University of Aachen, Aachen, Germany
| | - Na Sun
- Research Unit Analytical Pathology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Kevin Joseph
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
| | - Henrike Salié
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medicine II: Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, Medical Center - University of Freiburg, Freiburg, Germany
| | - Lea Vollmer
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ugne Kuliesiute
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany; The Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Jasmin von Ehr
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jasim K Benotmane
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Nicolas Neidert
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Marie Follo
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medicine I, Medical Center - University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medicine I, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jonathan M Goeldner
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Simon P Behringer
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Pamela Franco
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mohammed Khiat
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Junyi Zhang
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ulrich G Hofmann
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Neuroelectronic Systems, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christian Fung
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franz L Ricklefs
- Department of Neurosurgery, University Hospital Eppendorf, Hamburg, Germany; Laboratory for Brain Tumor Biology, University Hospital Eppendorf, Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Hospital Eppendorf, Hamburg, Germany; Laboratory for Brain Tumor Biology, University Hospital Eppendorf, Hamburg, Germany
| | - Melanie Boerries
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, Freiburg, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany
| | - Manching Ku
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for NeuroModulation (NeuroModul), University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
| | - Roman Sankowski
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Neuropathology, Medical Center - University of Freiburg, Freiburg, German
| | - Marius Schwabenland
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Neuropathology, Medical Center - University of Freiburg, Freiburg, German
| | - Marco Prinz
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for NeuroModulation (NeuroModul), University of Freiburg, Freiburg, Germany; Institute of Neuropathology, Medical Center - University of Freiburg, Freiburg, German; Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Ulrich Schüller
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Research Institute Children's Cancer Center, Hamburg, Germany; Department of Pediatric Hematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Saskia Killmer
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medicine II: Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, Medical Center - University of Freiburg, Freiburg, Germany
| | - Bertram Bengsch
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Medicine II: Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, Medical Center - University of Freiburg, Freiburg, Germany; Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Axel K Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Daniel Delev
- Neurosurgical Artificial Intelligence Laboratory Aachen (NAILA), Department of Neurosurgery, RWTH University of Aachen, Aachen, Germany; Department of Neurosurgery, RWTH University of Aachen, Aachen, Germany
| | - Oliver Schnell
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Translational NeuroOncology Research Group, Medical Center - University of Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany
| | - Dieter Henrik Heiland
- Microenvironment and Immunology Research Laboratory, Medical Center - University of Freiburg, Freiburg, Germany; Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), partner site Freiburg, Freiburg, Germany; Center of Advanced Surgical Tissue Analysis (CAST), University of Freiburg, Freiburg, Germany.
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17
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Strüßmann T, Wäsch R, Scherer F, Mutter JA, Pfeifer D, Bartsch I, Giesler S, Graziani G, Duyster J, Finke J, Marks R. A patient with refractory high-grade B-cell lymphoma and rapid progression under CAR-T-cell therapy was successfully salvaged with inotuzumab- ozogamicin. Leuk Lymphoma 2022; 63:2260-2262. [DOI: 10.1080/10428194.2022.2074991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T. Strüßmann
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R. Wäsch
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F. Scherer
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J. A. Mutter
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - D. Pfeifer
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - I. Bartsch
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S. Giesler
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - G. Graziani
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J. Duyster
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J. Finke
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R. Marks
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Kurtz DM, Soo J, Co Ting Keh L, Alig S, Chabon JJ, Sworder BJ, Schultz A, Jin MC, Scherer F, Garofalo A, Macaulay CW, Hamilton EG, Chen B, Olsen M, Schroers-Martin JG, Craig AFM, Moding EJ, Esfahani MS, Liu CL, Dührsen U, Hüttmann A, Casasnovas RO, Westin JR, Roschewski M, Wilson WH, Gaidano G, Rossi D, Diehn M, Alizadeh AA. Enhanced detection of minimal residual disease by targeted sequencing of phased variants in circulating tumor DNA. Nat Biotechnol 2021; 39:1537-1547. [PMID: 34294911 PMCID: PMC8678141 DOI: 10.1038/s41587-021-00981-w] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/11/2021] [Indexed: 12/11/2022]
Abstract
Circulating tumor-derived DNA (ctDNA) is an emerging biomarker for many cancers, but the limited sensitivity of current detection methods reduces its utility for diagnosing minimal residual disease. Here we describe phased variant enrichment and detection sequencing (PhasED-seq), a method that uses multiple somatic mutations in individual DNA fragments to improve the sensitivity of ctDNA detection. Leveraging whole-genome sequences from 2,538 tumors, we identify phased variants and their associations with mutational signatures. We show that even without molecular barcodes, the limits of detection of PhasED-seq outperform prior methods, including duplex barcoding, allowing ctDNA detection in the ppm range in participant samples. We profiled 678 specimens from 213 participants with B cell lymphomas, including serial cell-free DNA samples before and during therapy for diffuse large B cell lymphoma. In participants with undetectable ctDNA after two cycles of therapy using a next-generation sequencing-based approach termed cancer personalized profiling by deep sequencing, an additional 25% have ctDNA detectable by PhasED-seq and have worse outcomes. Finally, we demonstrate the application of PhasED-seq to solid tumors.
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Affiliation(s)
- David M Kurtz
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Joanne Soo
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Lyron Co Ting Keh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Stefan Alig
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jacob J Chabon
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA
- Foresight Diagnostics, Aurora, CO, USA
| | - Brian J Sworder
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Andre Schultz
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Michael C Jin
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Florian Scherer
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Garofalo
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Charles W Macaulay
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Emily G Hamilton
- Program in Cancer Biology, Stanford University, Stanford, CA, USA
| | - Binbin Chen
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Mari Olsen
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Joseph G Schroers-Martin
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Alexander F M Craig
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Everett J Moding
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Mohammad S Esfahani
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Chih Long Liu
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ulrich Dührsen
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center Essen, University Hospital Essen, Essen, Germany
| | - Andreas Hüttmann
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center Essen, University Hospital Essen, Essen, Germany
| | | | - Jason R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Maximilian Diehn
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA.
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
| | - Ash A Alizadeh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA.
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA.
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA.
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19
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Schlenker F, Kipf E, Deuter M, Höffkes I, Lehnert M, Zengerle R, von Stetten F, Scherer F, Wehrle J, von Bubnoff N, Juelg P, Hutzenlaub T, Borst N. Stringent Base Specific and Optimization-Free Multiplex Mediator Probe ddPCR for the Quantification of Point Mutations in Circulating Tumor DNA. Cancers (Basel) 2021; 13:cancers13225742. [PMID: 34830896 PMCID: PMC8616434 DOI: 10.3390/cancers13225742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Cancer treatment strategies and their follow-up monitoring are changing to personalized therapies, based on molecular genetic information from the individual person. Liquid biopsy, where this molecular information is derived from body fluids such as blood, has the potential to provide a systemic fingerprint of cancer dynamics, and, compared to tissue biopsy, is much less invasive for the patient. We used the previously published mediator probe PCR technology for liquid biopsy detection of several mutations in one reaction, so-called digital multiplex PCR. Quantification of point mutations in plasma eluates from follow-up patients using 4-plex digital assays showed a comparable performance to reference 2-plex assays. As a key feature, the presented multiplex assays require no laborious optimization as they use the same concentrations and cycling conditions for all targets. This allows for flexible design and interchangeable target panels, thus the assay is easily adaptable for individual patient monitoring and reduces sample consumption. Abstract There is an increasing demand for optimization-free multiplex assays to rapidly establish comprehensive target panels for cancer monitoring by liquid biopsy. We present the mediator probe (MP) PCR for the quantification of the seven most frequent point mutations and corresponding wild types (KRAS and BRAF) in colorectal carcinoma. Standardized parameters for the digital assay were derived using design of experiments. Without further optimization, the limit of detection (LoD) was determined through spiking experiments with synthetic mutant DNA in human genomic DNA. The limit of blank (LoB) was measured in cfDNA plasma eluates from healthy volunteers. The 2-plex and 4-plex MP ddPCR assays showed a LoB of 0 copies/mL except for 4-plex KRAS G13D (9.82 copies/mL) and 4-plex BRAF V600E (16.29 copies/mL) and allele frequencies of 0.004% ≤ LoD ≤ 0.38% with R2 ≥ 0.98. The quantification of point mutations in patient plasma eluates (18 patients) during follow-up using the 4-plex MP ddPCR showed a comparable performance to the reference assays. The presented multiplex assays need no laborious optimization, as they use the same concentrations and cycling conditions for all targets. This facilitates assay certification, allows a fast and flexible design process, and is thus easily adaptable for individual patient monitoring.
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Affiliation(s)
- Franziska Schlenker
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (F.S.); (E.K.); (I.H.); (M.L.); (R.Z.); (F.v.S.); (P.J.); (T.H.)
| | - Elena Kipf
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (F.S.); (E.K.); (I.H.); (M.L.); (R.Z.); (F.v.S.); (P.J.); (T.H.)
| | - Max Deuter
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.D.); (F.S.); (J.W.); (N.v.B.)
| | - Inga Höffkes
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (F.S.); (E.K.); (I.H.); (M.L.); (R.Z.); (F.v.S.); (P.J.); (T.H.)
| | - Michael Lehnert
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (F.S.); (E.K.); (I.H.); (M.L.); (R.Z.); (F.v.S.); (P.J.); (T.H.)
| | - Roland Zengerle
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (F.S.); (E.K.); (I.H.); (M.L.); (R.Z.); (F.v.S.); (P.J.); (T.H.)
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Felix von Stetten
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (F.S.); (E.K.); (I.H.); (M.L.); (R.Z.); (F.v.S.); (P.J.); (T.H.)
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.D.); (F.S.); (J.W.); (N.v.B.)
| | - Julius Wehrle
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.D.); (F.S.); (J.W.); (N.v.B.)
| | - Nikolas von Bubnoff
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.D.); (F.S.); (J.W.); (N.v.B.)
- Department of Hematology and Oncology, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lübeck, Germany
| | - Peter Juelg
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (F.S.); (E.K.); (I.H.); (M.L.); (R.Z.); (F.v.S.); (P.J.); (T.H.)
| | - Tobias Hutzenlaub
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (F.S.); (E.K.); (I.H.); (M.L.); (R.Z.); (F.v.S.); (P.J.); (T.H.)
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Nadine Borst
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (F.S.); (E.K.); (I.H.); (M.L.); (R.Z.); (F.v.S.); (P.J.); (T.H.)
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Correspondence: ; Tel.: +49-761-203-73208
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20
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Waldeck S, Mitschke J, Wiesemann S, Rassner M, Andrieux G, Deuter M, Mutter J, Lüchtenborg AM, Kottmann D, Titze L, Zeisel C, Jolic M, Philipp U, Lassmann S, Bronsert P, Greil C, Rawluk J, Becker H, Isbell L, Müller A, Doostkam S, Passlick B, Börries M, Duyster J, Wehrle J, Scherer F, von Bubnoff N. Early assessment of circulating tumor DNA after curative-intent resection predicts tumor recurrence in early-stage and locally advanced non-small-cell lung cancer. Mol Oncol 2021; 16:527-537. [PMID: 34653314 PMCID: PMC8763652 DOI: 10.1002/1878-0261.13116] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/31/2021] [Accepted: 10/13/2021] [Indexed: 12/28/2022] Open
Abstract
Circulating tumor DNA (ctDNA) has demonstrated great potential as a noninvasive biomarker to assess minimal residual disease (MRD) and profile tumor genotypes in patients with non‐small‐cell lung cancer (NSCLC). However, little is known about its dynamics during and after tumor resection, or its potential for predicting clinical outcomes. Here, we applied a targeted‐capture high‐throughput sequencing approach to profile ctDNA at various disease milestones and assessed its predictive value in patients with early‐stage and locally advanced NSCLC. We prospectively enrolled 33 consecutive patients with stage IA to IIIB NSCLC undergoing curative‐intent tumor resection (median follow‐up: 26.2 months). From 21 patients, we serially collected 96 plasma samples before surgery, during surgery, 1–2 weeks postsurgery, and during follow‐up. Deep next‐generation sequencing using unique molecular identifiers was performed to identify and quantify tumor‐specific mutations in ctDNA. Twelve patients (57%) had detectable mutations in ctDNA before tumor resection. Both ctDNA detection rates and ctDNA concentrations were significantly higher in plasma obtained during surgery compared with presurgical specimens (57% versus 19% ctDNA detection rate, and 12.47 versus 6.64 ng·mL−1, respectively). Four patients (19%) remained ctDNA‐positive at 1–2 weeks after surgery, with all of them (100%) experiencing disease progression at later time points. In contrast, only 4 out of 12 ctDNA‐negative patients (33%) after surgery experienced relapse during follow‐up. Positive ctDNA in early postoperative plasma samples was associated with shorter progression‐free survival (P = 0.013) and overall survival (P = 0.004). Our findings suggest that, in early‐stage and locally advanced NSCLC, intraoperative plasma sampling results in high ctDNA detection rates and that ctDNA positivity early after resection identifies patients at risk for relapse.
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Affiliation(s)
- Silvia Waldeck
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Mitschke
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Wiesemann
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Rassner
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Geoffroy Andrieux
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Max Deuter
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jurik Mutter
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anne-Marie Lüchtenborg
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Kottmann
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laurin Titze
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Zeisel
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martina Jolic
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrike Philipp
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Silke Lassmann
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Greil
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justyna Rawluk
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heiko Becker
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lisa Isbell
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Müller
- Institute for Neuropathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Soroush Doostkam
- Institute for Neuropathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Melanie Börries
- German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julius Wehrle
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nikolas von Bubnoff
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Lübeck, Germany
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21
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Waterhouse M, Pennisi S, Pfeifer D, Deuter M, von Bubnoff N, Scherer F, Strüssmann T, Wehr C, Duyster J, Bertz H, Finke J, Duque-Afonso J. Correction: Colon and liver tissue damage detection using methylated SESN3 and PTK2B genes in circulating cell-free DNA in patients with acute graft-versus-host disease. Bone Marrow Transplant 2021; 56:2616. [PMID: 34413471 PMCID: PMC8486665 DOI: 10.1038/s41409-021-01405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Miguel Waterhouse
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany.
| | - Sandra Pennisi
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Dietmar Pfeifer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Max Deuter
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Nikolas von Bubnoff
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany.,Department of Hematology and Oncology, Medical Center, University of Schleswig Holstein, Lübeck, Germany
| | - Florian Scherer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Tim Strüssmann
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Claudia Wehr
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Justus Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Hartmut Bertz
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Jürgen Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Jesus Duque-Afonso
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany.
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22
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Mutter JA, Alig S, Lauer EM, Esfahani MS, Mitschke J, Kurtz DM, Olsen M, Liu CL, Jin MC, Bleul S, Macaulay CW, Neidert NN, Heiland DH, Finke J, Duyster J, Wehrle J, Prinz M, Illerhaus G, Reinacher PC, Schorb E, Diehn M, Alizadeh AA, Scherer F. MATRIX INDUCTION FOLLOWED BY AUTOLOGOUS STEM CELL TRANSPLANT OR WHOLE‐BRAIN IRRADIATION IN PRIMARY CNS LYMPHOMA. 7‐YEAR RESULTS OF THE IELSG32 RANDOMIZED TRIAL. Hematol Oncol 2021. [DOI: 10.1002/hon.47_2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- J. A. Mutter
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - S. Alig
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - E. M. Lauer
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - M. S. Esfahani
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - J. Mitschke
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - D. M. Kurtz
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - M. Olsen
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - C. L. Liu
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - M. C. Jin
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - S. Bleul
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - C. W. Macaulay
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - N. N. Neidert
- University Medical Center Freiburg Department of Neurosurgery Freiburg Germany
| | - D. H. Heiland
- University Medical Center Freiburg Department of Neurosurgery Freiburg Germany
| | - J. Finke
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - J. Duyster
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - J. Wehrle
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - M. Prinz
- University Medical Center Freiburg Institute of Neuropathology Freiburg Germany
| | - G. Illerhaus
- Klinikum Stuttgart Department of Hematology/Oncology and Palliative Care Stuttgart Germany
| | - P. C. Reinacher
- University Medical Center Freiburg Department of Stereotactic and Functional Neurosurgery Freiburg Germany
| | - E. Schorb
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
| | - M. Diehn
- Stanford University Department of Radiation Oncology Stanford California USA
| | - A. A. Alizadeh
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - F. Scherer
- University Medical Center Freiburg Department of Hematology Oncology, and Stem Cell Transplantation Freiburg Germany
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23
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Mutter JA, Alig S, Lauer EM, Esfahani MS, Mitschke J, Kurtz DM, Olsen M, Liu CL, Jin MC, Bleul S, Macaulay CW, Neidert NN, Heiland DH, Finke J, Duyster J, Wehrle J, Prinz M, Illerhaus G, Reinacher PC, Schorb E, Diehn M, Alizadeh AA, Scherer F. NONINVASIVE DETECTION, CLASSIFICATION, AND RISK STRATIFICATION OF PRIMARY CNS LYMPHOMAS BY CTDNA PROFILING. Hematol Oncol 2021. [DOI: 10.1002/hon.46_2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. A. Mutter
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - S. Alig
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - E. M. Lauer
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - M. S. Esfahani
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - J. Mitschke
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - D. M. Kurtz
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - M. Olsen
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - C. L. Liu
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - M. C. Jin
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - S. Bleul
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - C. W. Macaulay
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - N. N. Neidert
- University Medical Center Freiburg Department of Neurosurgery Freiburg Germany
| | - D. H. Heiland
- University Medical Center Freiburg Department of Neurosurgery Freiburg Germany
| | - J. Finke
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - J. Duyster
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - J. Wehrle
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - M. Prinz
- University Medical Center Freiburg Institute of Neuropathology Freiburg Germany
| | - G. Illerhaus
- Klinikum Stuttgart Department of Hematology/Oncology and Palliative Care Stuttgart Germany
| | - P. C. Reinacher
- University Medical Center Freiburg Department of Stereotactic and Functional Neurosurgery Freiburg Germany
| | - E. Schorb
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
| | - M. Diehn
- Stanford University Department of Radiation Oncology Stanford California USA
| | - A. A. Alizadeh
- Stanford University Division of Oncology Department of Medicine Stanford California USA
| | - F. Scherer
- University Medical Center Freiburg Department of Hematology, Oncology and Stem Cell Transplantation Freiburg Germany
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24
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Kurtz DM, Chabon JJ, Soo J, Co Ting Keh L, Alig S, Schultz A, Jin MC, Scherer F, Craig AFM, Liu CL, Dührsen U, Hüttmann A, Casasnovas R, Westin JR, Roschewski M, Wilson WH, Gaidano G, Rossi D, Diehn M, Alizadeh AA. PHASED VARIANTS IMPROVE DLBCL MINIMAL RESIDUAL DISEASE DETECTION AT THE END OF THERAPY. Hematol Oncol 2021. [DOI: 10.1002/hon.25_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- D. M Kurtz
- Stanford University, Medicine Division of Oncology Stanford California USA
| | - J. J Chabon
- Foresight Diagnostics Research and Development Aurora Colorado USA
| | - J Soo
- Stanford University, Medicine Division of Oncology Stanford California USA
| | - L Co Ting Keh
- Stanford University, Medicine Division of Oncology Stanford California USA
| | - S Alig
- Stanford University, Medicine Division of Oncology Stanford California USA
| | - A Schultz
- Stanford University, Medicine Division of Oncology Stanford California USA
| | - M. C Jin
- Stanford University, Medicine Division of Oncology Stanford California USA
| | - F Scherer
- Freiburg University Medical Center Hematology Freiburg Germany
| | - A. F. M Craig
- Stanford University, Medicine Division of Oncology Stanford California USA
| | - C. L Liu
- Stanford University, Medicine Division of Oncology Stanford California USA
| | - U Dührsen
- University Hospital Essen Hematology Essen Germany
| | - A Hüttmann
- University Hospital Essen Hematology Essen Germany
| | - R.‐O Casasnovas
- Hopital F. Mitterrand CHU. Dijon and INSERM 1231 Hematology Dijon France
| | - J. R Westin
- MD Anderson Cancer Center Department of Lymphoma/Myeloma Houston Texas USA
| | - M Roschewski
- National Cancer Institute Lymphoid Malignancies Branch Bethesda Maryland USA
| | - W. H Wilson
- National Cancer Institute Lymphoid Malignancies Branch Bethesda Maryland USA
| | - G Gaidano
- University of Eastern Piedmont Division of Hematology, Department of Translational Medicine Novara Italy
| | - D Rossi
- Oncology Institute of Southern Switzerland and Institute of Oncology Research Hematology Bellinzona Switzerland
| | - M Diehn
- Stanford University Radiation Oncology Stanford California USA
| | - A. A Alizadeh
- Stanford University, Medicine Division of Oncology Stanford California USA
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25
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Kurtz DM, Chabon JJ, Soo J, Co Ting Keh L, Alig S, Schultz A, Jin MC, Scherer F, Craig AF, Liu CL, Duehrsen U, Huettmann A, Casasnovas RO, Westin J, Roschewski MJ, Wilson WH, Gaidano G, Rossi D, Diehn M, Alizadeh AA. Phased variants improve DLBCL minimal residual disease detection at the end of therapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7565 Background: Detection of circulating tumor DNA (ctDNA) has prognostic value in diverse tumors, including DLBCL. Despite uses for assessing molecular response to therapy, current methods using immunoglobulin or hybrid-capture sequencing have suboptimal sensitivity, particularly when disease-burden is low. This contributes to a high false negative rate at key milestones such as at the end of therapy (EOT; Kumar A, ASH 2020). We explored the utility of detecting multiple mutations (phased variants, PVs) on individual cell-free DNA (cfDNA) strands to improve MRD in DLBCL. Methods: We applied Phased Variant Enrichment and Detection Sequencing to track PVs from 485 specimens from 117 DLBCL patients undergoing first-line therapy. We sequenced cfDNA prior to, during, and after therapy to assess the prognostic value of MRD. We compared the performance of PhasED-Seq to current techniques, including SNV-based CAPP-Seq and duplex sequencing. Results: To establish its detection limit for ctDNA, we compared the background error-profile of of PVs and SNVs in cfDNA sequencing from healthy subjects. PV-detection by PhasED-Seq demonstrated a lower background profile than SNVs, even when considering duplex molecules (n = 12; 8.0e-7 vs 3.3e-5 and 1.2e-5; P < 0.0001). We also assessed analytical sensitivity within a ctDNA limiting dilution series from 3 patients, simulating tumor fractions from 0.1% to 0.00005% (1:2,000,000). PhasED-Seq outperformed SNV-based methods and duplex sequencing for recovery of expected tumor content below 0.01% (P < 0.0001 and P = 0.005 respectively by paired t-test). We then explored disease detection in clinical samples. We identified SNVs and PVs from pretreatment tumor or plasma and followed these variants in serial cfDNA. Using SNV-based methods, 40% and 59% of patients had undetectable ctDNA after 1 or 2 cycles (n = 82 and 88). However, 24% and 25% of these cases had detectable ctDNA by PhasED-Seq. Importantly, MRD detection by PhasED-Seq was prognostic for event-free survival even in patients with undetectable ctDNA by SNVs. We next explored the utility of PhasED-Seq at the EOT in 19 subjects, 5 of whom experienced eventual disease progression. While only 2/5 cases with progression had detectable disease at EOT using SNVs, PhasED-Seq detected all 5/5 cases. PhasED-Seq also correctly identified all patients (14/14) without clinical relapse as having no residual disease, including one patient who discontinued therapy after 1 cycle due to toxicity, but remains in remission > 5 years after this single treatment. This resulted in superior classification of patients for EFS using PVs compared with SNVs (C-statistic: 0.98 vs 0.60, P = 0.02). Conclusions: Tracking PVs results in significantly lower background rates than SNV-based approaches, enabling detection to parts per million range. PhasED-Seq improves on disease detection in DLBCL at the EOT, allowing possible MRD-driven consolidative approaches.
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Affiliation(s)
| | | | - Joanne Soo
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Stefan Alig
- Stanford University Medical Center, Stanford, CA
| | | | | | - Florian Scherer
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - Ulrich Duehrsen
- Department of Hematology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | | | | | - Jason Westin
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma/Myeloma, Houston, TX
| | | | | | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Davide Rossi
- Università Della Svizzera Italiana, Institute of Oncology Research, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Ash A. Alizadeh
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
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26
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Alig S, Macaulay CW, Kurtz DM, Dührsen U, Hüttmann A, Schmitz C, Jin MC, Sworder BJ, Garofalo A, Shahrokh Esfahani M, Nabet BY, Soo J, Scherer F, Craig AFM, Casasnovas O, Westin JR, Gaidano G, Rossi D, Roschewski M, Wilson WH, Meignan M, Diehn M, Alizadeh AA. Short Diagnosis-to-Treatment Interval Is Associated With Higher Circulating Tumor DNA Levels in Diffuse Large B-Cell Lymphoma. J Clin Oncol 2021; 39:2605-2616. [PMID: 33909455 DOI: 10.1200/jco.20.02573] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Patients with Diffuse Large B-cell Lymphoma (DLBCL) in need of immediate therapy are largely under-represented in clinical trials. The diagnosis-to-treatment interval (DTI) has recently been described as a metric to quantify such patient selection bias, with short DTI being associated with adverse risk factors and inferior outcomes. Here, we characterized the relationships between DTI, circulating tumor DNA (ctDNA), conventional risk factors, and clinical outcomes, with the goal of defining objective disease metrics contributing to selection bias. PATIENTS AND METHODS We evaluated pretreatment ctDNA levels in 267 patients with DLBCL treated across multiple centers in Europe and the United States using Cancer Personalized Profiling by Deep Sequencing. Pretreatment ctDNA levels were correlated with DTI, total metabolic tumor volumes (TMTVs), the International Prognostic Index (IPI), and outcome. RESULTS Short DTI was associated with advanced-stage disease (P < .001) and higher IPI (P < .001). We also found an inverse correlation between DTI and TMTV (RS = -0.37; P < .001). Similarly, pretreatment ctDNA levels were significantly associated with stage, IPI, and TMTV (all P < .001), demonstrating that both DTI and ctDNA reflect disease burden. Notably, patients with shorter DTI had higher pretreatment ctDNA levels (P < .001). Pretreatment ctDNA levels predicted short DTI independent of the IPI (P < .001). Although each risk factor was significantly associated with event-free survival in univariable analysis, ctDNA level was prognostic of event-free survival independent of DTI and IPI in multivariable Cox regression (ctDNA: hazard ratio, 1.5; 95% CI [1.2 to 2.0]; IPI: 1.1 [0.9 to 1.3]; -DTI: 1.1 [1.0 to 1.2]). CONCLUSION Short DTI largely reflects baseline tumor burden, which can be objectively measured using pretreatment ctDNA levels. Pretreatment ctDNA levels therefore have utility for quantifying and guarding against selection biases in prospective DLBCL clinical trials.
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Affiliation(s)
- Stefan Alig
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA
| | - Charles W Macaulay
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA
| | - David M Kurtz
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA
| | - Ulrich Dührsen
- Department of Hematology, University Hospital of Essen, Essen, Germany
| | - Andreas Hüttmann
- Department of Hematology, University Hospital of Essen, Essen, Germany
| | - Christine Schmitz
- Department of Hematology, University Hospital of Essen, Essen, Germany
| | - Michael C Jin
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA
| | - Brian J Sworder
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA
| | - Andrea Garofalo
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA
| | | | - Barzin Y Nabet
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA
| | - Joanne Soo
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA
| | - Florian Scherer
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA.,Department Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander F M Craig
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA
| | - Olivier Casasnovas
- Hematology Department, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
| | - Jason R Westin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Davide Rossi
- Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Mark Roschewski
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Wyndham H Wilson
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA.,Stanford Cancer Institute, Institute for Stem Cell Biology & Regenerative Medicine, Stanford, CA
| | - Ash A Alizadeh
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, CA.,Stanford Cancer Institute, Institute for Stem Cell Biology & Regenerative Medicine, Stanford, CA
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27
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Hoefflin R, Lazarou A, Hess ME, Reiser M, Wehrle J, Metzger P, Frey AV, Becker H, Aumann K, Berner K, Boeker M, Buettner N, Dierks C, Duque-Afonso J, Eisenblaetter M, Erbes T, Fritsch R, Ge IX, Geißler AL, Grabbert M, Heeg S, Heiland DH, Hettmer S, Kayser G, Keller A, Kleiber A, Kutilina A, Mehmed L, Meiss F, Poxleitner P, Rawluk J, Ruf J, Schäfer H, Scherer F, Shoumariyeh K, Tzschach A, Peters C, Brummer T, Werner M, Duyster J, Lassmann S, Miething C, Boerries M, Illert AL, von Bubnoff N. Transitioning the Molecular Tumor Board from Proof of Concept to Clinical Routine: A German Single-Center Analysis. Cancers (Basel) 2021; 13:1151. [PMID: 33800365 PMCID: PMC7962829 DOI: 10.3390/cancers13051151] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023] Open
Abstract
Molecular precision oncology faces two major challenges: first, to identify relevant and actionable molecular variants in a rapidly changing field and second, to provide access to a broad patient population. Here, we report a four-year experience of the Molecular Tumor Board (MTB) of the Comprehensive Cancer Center Freiburg (Germany) including workflows and process optimizations. This retrospective single-center study includes data on 488 patients enrolled in the MTB from February 2015 through December 2018. Recommendations include individual molecular diagnostics, molecular stratified therapies, assessment of treatment adherence and patient outcomes including overall survival. The majority of MTB patients presented with stage IV oncologic malignancies (90.6%) and underwent an average of 2.1 previous lines of therapy. Individual diagnostic recommendations were given to 487 patients (99.8%). A treatment recommendation was given in 264 of all cases (54.1%) which included a molecularly matched treatment in 212 patients (43.4%). The 264 treatment recommendations were implemented in 76 patients (28.8%). Stable disease was observed in 19 patients (25.0%), 17 had partial response (22.4%) and five showed a complete remission (6.6%). An objective response was achieved in 28.9% of cases with implemented recommendations and for 4.5% of the total population (22 of 488 patients). By optimizing the MTB workflow, case-discussions per session increased significantly while treatment adherence and outcome remained stable over time. Our data demonstrate the feasibility and effectiveness of molecular-guided personalized therapy for cancer patients in a clinical routine setting showing a low but robust and durable disease control rate over time.
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Affiliation(s)
- Rouven Hoefflin
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Adriana Lazarou
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Maria Elena Hess
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Meike Reiser
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Julius Wehrle
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Patrick Metzger
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Anna Verena Frey
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Heiko Becker
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Konrad Aumann
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Kai Berner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Obstetrics and Gynaecology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Martin Boeker
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Medical Biometry and Statistics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Nico Buettner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christine Dierks
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Jesus Duque-Afonso
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Michel Eisenblaetter
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Freiburg, Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Thalia Erbes
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Obstetrics and Gynaecology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Ralph Fritsch
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Isabell Xiang Ge
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Obstetrics and Gynaecology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Anna-Lena Geißler
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Markus Grabbert
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Urology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Steffen Heeg
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Dieter Henrik Heiland
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Simone Hettmer
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Pediatric Hematology and Oncology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Gian Kayser
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Alexander Keller
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Anita Kleiber
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Alexandra Kutilina
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Leman Mehmed
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Clinical Cancer Registry, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Frank Meiss
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Dermatology and Venerology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Philipp Poxleitner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Oral and Maxillofacial Surgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Justyna Rawluk
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Juri Ruf
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Nuclear Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Henning Schäfer
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Department of Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
| | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andreas Tzschach
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute of Human Genetics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christoph Peters
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Center for Biological Signaling Studies BIOSS, University of Freiburg, 79104 Freiburg, Germany
| | - Tilman Brummer
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Molecular Medicine and Cell Research, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany
- Center for Biological Signaling Studies BIOSS, University of Freiburg, 79104 Freiburg, Germany
| | - Martin Werner
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Silke Lassmann
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute for Surgical Pathology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Center for Biological Signaling Studies BIOSS, University of Freiburg, 79104 Freiburg, Germany
| | - Cornelius Miething
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Melanie Boerries
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Anna L. Illert
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Nikolas von Bubnoff
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (R.H.); (A.L.); (J.W.); (H.B.); (C.D.); (J.D.-A.); (R.F.); (A.K.); (A.K.); (A.K.); (J.R.); (F.S.); (K.S.); (J.D.); (C.M.); (N.v.B.)
- Comprehensive Cancer Center Freiburg, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.E.H.); (M.R.); (A.V.F.); (K.A.); (K.B.); (M.B.); (N.B.); (M.E.); (T.E.); (I.X.G.); (A.-L.G.); (M.G.); (S.H.); (D.H.H.); (S.H.); (G.K.); (L.M.); (F.M.); (P.P.); (J.R.); (H.S.); (A.T.); (C.P.); (T.B.); (M.W.); (S.L.); (M.B.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Hussung S, Akhoundova D, Hipp J, Follo M, Klar RFU, Philipp U, Scherer F, von Bubnoff N, Duyster J, Boerries M, Wittel U, Fritsch RM. Longitudinal analysis of cell-free mutated KRAS and CA 19-9 predicts survival following curative resection of pancreatic cancer. BMC Cancer 2021; 21:49. [PMID: 33430810 PMCID: PMC7802224 DOI: 10.1186/s12885-020-07736-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background Novel biomarkers and molecular monitoring tools hold potential to improve outcome for patients following resection of pancreatic ductal adenocarcinoma (PDAC). We hypothesized that the combined longitudinal analysis of mutated cell-free plasma KRAS (cfKRASmut) and CA 19–9 during adjuvant treatment and follow-up might more accurately predict disease course than hitherto available parameters. Methods Between 07/2015 and 10/2018, we collected 134 plasma samples from 25 patients after R0/R1-resection of PDAC during adjuvant chemotherapy and post-treatment surveillance at our institution. Highly sensitive discriminatory multi-target ddPCR assays were employed to screen plasma samples for cfKRASmut. cfKRASmut and CA 19–9 dynamics were correlated with recurrence-free survival (RFS) and overall survival (OS). Patients were followed-up until 01/2020. Results Out of 25 enrolled patients, 76% had undergone R0 resection and 48% of resected PDACs were pN0. 17/25 (68%) of patients underwent adjuvant chemotherapy. Median follow-up was 22.0 months, with 19 out of 25 (76%) patients relapsing during study period. Median RFS was 10.0 months, median OS was 22.0 months. Out of clinicopathologic variables, only postoperative CA 19–9 levels and administration of adjuvant chemotherapy correlated with survival endpoints. cfKRASmut. was detected in 12/25 (48%) of patients, and detection of high levels inversely correlated with survival endpoint. Integration of cfKRASmut and CA 19–9 levels outperformed either individual marker. cfKRASmut outperformed CA 19–9 as dynamic marker since increase during adjuvant chemotherapy and follow-up was highly predictive of early relapse and poor OS. Conclusions Integrated analysis of cfKRASmut and CA 19–9 levels is a promising approach for molecular monitoring of patients following resection of PDAC. Larger prospective studies are needed to further develop this approach and dissect each marker’s specific potential. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07736-x.
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Affiliation(s)
- Saskia Hussung
- Department of Medicine I (Hematology, Oncology and Stem Cell Transplantation), Freiburg University Medical Center, Freiburg, Germany.,Department of Medical Oncology and Hematology, Zurich University Hospital, Raemistrasse 100, 8091, Zürich, Switzerland
| | - Dilara Akhoundova
- Department of Medical Oncology and Hematology, Zurich University Hospital, Raemistrasse 100, 8091, Zürich, Switzerland
| | - Julian Hipp
- Department of Surgery, Freiburg University Medical Center, Freiburg, Germany
| | - Marie Follo
- Department of Medicine I (Hematology, Oncology and Stem Cell Transplantation), Freiburg University Medical Center, Freiburg, Germany
| | - Rhena F U Klar
- Department of Medicine I (Hematology, Oncology and Stem Cell Transplantation), Freiburg University Medical Center, Freiburg, Germany
| | - Ulrike Philipp
- Department of Medicine I (Hematology, Oncology and Stem Cell Transplantation), Freiburg University Medical Center, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I (Hematology, Oncology and Stem Cell Transplantation), Freiburg University Medical Center, Freiburg, Germany
| | - Nikolas von Bubnoff
- Department of Medicine I (Hematology, Oncology and Stem Cell Transplantation), Freiburg University Medical Center, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I (Hematology, Oncology and Stem Cell Transplantation), Freiburg University Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK), partner site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Melanie Boerries
- German Cancer Consortium (DKTK), partner site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Medical Bioinformatics and Systems Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uwe Wittel
- Department of Surgery, Freiburg University Medical Center, Freiburg, Germany
| | - Ralph M Fritsch
- Department of Medicine I (Hematology, Oncology and Stem Cell Transplantation), Freiburg University Medical Center, Freiburg, Germany. .,Department of Medical Oncology and Hematology, Zurich University Hospital, Raemistrasse 100, 8091, Zürich, Switzerland. .,Comprehensive Cancer Center Freiburg (CCCF), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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29
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Waterhouse M, Pennisi S, Pfeifer D, Deuter M, von Bubnoff N, Scherer F, Strüssmann T, Wehr C, Duyster J, Bertz H, Finke J, Duque-Afonso J. Colon and liver tissue damage detection using methylated SESN3 and PTK2B genes in circulating cell-free DNA in patients with acute graft-versus-host disease. Bone Marrow Transplant 2020; 56:327-333. [PMID: 33082554 PMCID: PMC8376639 DOI: 10.1038/s41409-020-01090-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/01/2020] [Accepted: 10/08/2020] [Indexed: 11/24/2022]
Abstract
Cell-free DNA (cfDNA) has been investigated in acute graft-versus-host disease (aGvHD) following allogeneic cell transplantation (HSCT). Identifying the tissue of origin of cfDNA in patients with aGvHD is relevant particularly when a biopsy is not feasible. We investigate the cfDNA tissue of origin in patients with aGvHD using methylated gene biomarkers. Patients with liver, colon, or skin aGvHD (n = 28) were analyzed. Liver- and colon-derived cfDNA was measured using a colon- (SESN3) and liver (PTK2B)-specific methylation marker with digital droplet PCR. A statistically significant difference (p < 0.001) in PTK2B and SESN3 concentration was observed between patients with colon or liver GvHD and the control group. For SESN3 and PTK2B the area under the curve in the receiver-operating characteristic (ROC) space was 0.952 (95% CI, 0.888–1 p < 0.001) and 0.971 (95% CI, 0.964–1 p < 0.001), respectively. Thresholds to differentiate aGvHD from non-aGvHD in colon were 0 (sensitivity: 0.905; specificity: 0.989) and liver 1.5 (sensitivity: 0.928; specificity: 0.910). Clinical improvement of liver or colon aGvHD resulted in PTK2B and SESN3 reduced concentration. Whereas, in those patients without improvement the PTK2B and SESN3 level remained stable or increased. The PTK2B liver-specific marker and the SESN3 colon-specific marker and their longitudinal analysis might improve aGvHD detection.
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Affiliation(s)
- Miguel Waterhouse
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany.
| | - Sandra Pennisi
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Dietmar Pfeifer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Max Deuter
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Nikolas von Bubnoff
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany.,Department of Hematology and Oncology, Medical Center, University of Schleswig Holstein, Lübeck, Germany
| | - Florian Scherer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Tim Strüssmann
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Claudia Wehr
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Justus Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Hartmut Bertz
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Jürgen Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - Jesus Duque-Afonso
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany.
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30
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Wehrle J, Philipp U, Jolic M, Follo M, Hussung S, Waldeck S, Deuter M, Rassner M, Braune J, Rawluk J, Greil C, Waller CF, Becker H, Duque-Afonso J, Illert AL, Fritsch RM, Meiss F, Duyster J, von Bubnoff N, Scherer F. Personalized Treatment Selection and Disease Monitoring Using Circulating Tumor DNA Profiling in Real-World Cancer Patient Management. Diagnostics (Basel) 2020; 10:E550. [PMID: 32748806 PMCID: PMC7459590 DOI: 10.3390/diagnostics10080550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Circulating tumor DNA (ctDNA) in the blood plasma of cancer patients is an emerging biomarker used across oncology, facilitating noninvasive disease monitoring and genetic profiling at various disease milestones. Digital droplet PCR (ddPCR) technologies have demonstrated high sensitivity and specificity for robust ctDNA detection at relatively low costs. Yet, their value for ctDNA-based management of a broad population of cancer patients beyond clinical trials remains elusive. METHODS We developed mutation-specific ddPCR assays that were optimized for their use in real-world cancer management, covering 12 genetic aberrations in common cancer genes, such as EGFR, BRAF, KIT, KRAS, and NRAS. We assessed the limit of detection (LOD) and the limit of blank (LOB) for each assay and validated their performance for ctDNA detection using matched tumor sequencing. RESULTS We applied our custom ddPCR assays to 352 plasma samples from 96 patients with solid tumors. Mutation detection in plasma was highly concordant with tumor sequencing, demonstrating high sensitivity and specificity across all assays. In 20 cases, radiographic cancer progression was mirrored by an increase of ctDNA concentrations or the occurrence of novel mutations in plasma. Moreover, ctDNA profiling at diagnosis and during disease progression reflected personalized treatment selection through the identification of actionable gene targets in 20 cases. CONCLUSION Collectively, our work highlights the potential of ctDNA assessment by sensitive ddPCR for accurate disease monitoring, robust identification of resistance mutations, and upfront treatment selection in patients with solid tumors. We envision an increasing future role for ctDNA profiling within personalized cancer management in daily clinical routine.
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Affiliation(s)
- Julius Wehrle
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Ulrike Philipp
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Martina Jolic
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Marie Follo
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Saskia Hussung
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
- Department of Medical Oncology and Hematology, Zurich University Hospital, 8091 Zurich, Switzerland
| | - Silvia Waldeck
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Max Deuter
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Michael Rassner
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Jan Braune
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Justyna Rawluk
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Christine Greil
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Cornelius F. Waller
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Heiko Becker
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Jesús Duque-Afonso
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Anna L. Illert
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Ralph M. Fritsch
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
- Department of Medical Oncology and Hematology, Zurich University Hospital, 8091 Zurich, Switzerland
| | - Frank Meiss
- Department of Dermatology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
| | - Justus Duyster
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
| | - Nikolas von Bubnoff
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Florian Scherer
- Department Medicine I, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.W.); (U.P.); (M.J.); (M.F.); (S.H.); (S.W.); (M.D.); (M.R.); (J.B.); (J.R.); (C.G.); (C.F.W.); (H.B.); (J.D.-A.); (A.L.I.); (R.M.F.); (J.D.)
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Hussung S, Follo M, Klar RF, Michalczyk S, Fritsch K, Nollmann F, Hipp J, Duyster J, Scherer F, von Bubnoff N, Boerries M, Wittel U, Fritsch RM. Development and Clinical Validation of Discriminatory Multitarget Digital Droplet PCR Assays for the Detection of Hot Spot KRAS and NRAS Mutations in Cell-Free DNA. J Mol Diagn 2020; 22:943-956. [DOI: 10.1016/j.jmoldx.2020.04.206] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/21/2020] [Accepted: 04/13/2020] [Indexed: 12/22/2022] Open
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Lauer EM, Waterhouse M, Braig M, Mutter J, Bleul S, Duque‐Afonso J, Duyster J, Marks R, Reinacher PC, Prinz M, Illerhaus G, Finke J, Schorb E, Scherer F. Ibrutinib in patients with relapsed/refractory central nervous system lymphoma: A retrospective single‐centre analysis. Br J Haematol 2020; 190:e110-e114. [DOI: 10.1111/bjh.16759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eliza M. Lauer
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
| | - Miguel Waterhouse
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
| | - Moritz Braig
- Department of Radiology Medical Physics Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
| | - Jurik Mutter
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
| | - Sabine Bleul
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
| | - Jesús Duque‐Afonso
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
| | - Justus Duyster
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ) HeidelbergGermany
| | - Reinhard Marks
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
| | - Peter C. Reinacher
- Department of Stereotactic and Functional Neurosurgery Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
- Fraunhofer Institute for Laser Technology AachenGermany
| | - Marco Prinz
- Institute of Neuropathology Faculty of Medicine University of Freiburg FreiburgGermany
- Center for Basics in NeuroModulation (NeuroModulBasics) Faculty of Medicine University of Freiburg FreiburgGermany
- Signaling Research Centres BIOSS and CIBSS University of Freiburg FreiburgGermany
| | - Gerald Illerhaus
- Department of Hematology/Oncology and Palliative Care Stuttgart Germany
| | - Jürgen Finke
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
| | - Elisabeth Schorb
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
| | - Florian Scherer
- Department of Medicine I Medical Center – University of Freiburg Faculty of Medicine University of Freiburg FreiburgGermany
- German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ) HeidelbergGermany
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Abstract
Most malignancies are characterized by remarkable molecular heterogeneity. The understanding of genetic and epigenetic processes underlying tumor heterogeneity has become increasingly important for the clinical management of cancer patients. This includes the identification of patients who likely benefit from conventional or targeted therapies, classification of patients into risk groups based on their mutational landscape, and the detection of molecular mechanisms that drive treatment resistance and cancer progression. Detection of tumor heterogeneity by tumor tissue genotyping is hampered by the fact that tissue sampling is often insufficient for comprehensive genetic assessment and is associated with a higher risk of surgical complications. Detection and profiling of circulating tumor DNA (ctDNA) have emerged as a promising alternative to direct tumor genotyping. It potentially enables noninvasive and quantitative characterization of the full genetic landscape and identification of clonal evolution during treatment and towards disease progression in cancer patients. In the present chapter, we explore the role of noninvasive genotyping and ctDNA profiling for accurate and robust characterization of various types of tumor heterogeneity and its relevance for management of patients with hematologic and solid cancers.
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Affiliation(s)
- Florian Scherer
- Department of Hematology, Oncology, and Stem Cell Transplantation, University Medical Center Freiburg, Albert-Ludwigs-University, Hugstetter Straße 55, 79106, Freiburg, Germany.
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Pazdiora R, Pazdiora B, Ferreira E, Muniz I, Andrade E, Siqueira J, Scherer F, Venturoso O, Souza P. Digestibilidade, comportamento ingestivo e desempenho de ovinos alimentados com resíduos de agroindústrias processadoras de frutas. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-10706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivou-se avaliar o consumo, a digestibilidade e o desempenho de ovinos, arraçoados com dietas isoproteicas, contendo 75% de resíduos da agroindústria frutífera (abacaxi, acerola, maracujá e cupuaçu), uma dieta com feno de tifton e 25% de concentrado, em delineamento inteiramente ao acaso. A participação do resíduo de maracujá na dieta proporcionou os maiores níveis de consumo de matéria seca (1170,6g d-1) em relação aos resíduos de abacaxi (693,8g d-1), acerola (644,2g d-1), cupuaçu (452,9g d-1) e feno de tifton (962,7g d-1), o que se relaciona aos seus níveis de digestibilidade (77,8; 63,1; 59,1; 61,7 e 71,8%, respectivamente). Tal resultado gerou diferenças significativas, destacando-se o resíduo de maracujá quanto à conversão alimentar (8,3), e o ganho médio diário de peso (141,5g d-1). Apesar de ter tido a mesma conversão observada para o feno de tifton (13,2), apresentou maior ganho médio diário (75,6g d-1). Os demais resíduos apresentaram efeitos sobrepostos, contudo o resíduo de acerola ficou com a pior conversão (51,4) e o menor ganho médio diário (15,6g d-1), sendo esse sem diferença em relação ao cupuaçu (23,0g d-1). Os resíduos podem ser utilizados como alternativa para a alimentação de ovinos.
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Affiliation(s)
| | | | | | - I.M. Muniz
- Universidade Federal de Rondônia, Brazil
| | | | | | - F. Scherer
- Universidade Federal de Rondônia, Brazil
| | | | - P.J. Souza
- Universidade Federal de Rondônia, Brazil
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35
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O'Connor T, Zhou X, Kosla J, Adili A, Garcia Beccaria M, Kotsiliti E, Pfister D, Johlke AL, Sinha A, Sankowski R, Schick M, Lewis R, Dokalis N, Seubert B, Höchst B, Inverso D, Heide D, Zhang W, Weihrich P, Manske K, Wohlleber D, Anton M, Hoellein A, Seleznik G, Bremer J, Bleul S, Augustin HG, Scherer F, Koedel U, Weber A, Protzer U, Förster R, Wirth T, Aguzzi A, Meissner F, Prinz M, Baumann B, Höpken UE, Knolle PA, von Baumgarten L, Keller U, Heikenwalder M. Age-Related Gliosis Promotes Central Nervous System Lymphoma through CCL19-Mediated Tumor Cell Retention. Cancer Cell 2019; 36:250-267.e9. [PMID: 31526758 DOI: 10.1016/j.ccell.2019.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 06/05/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
How lymphoma cells (LCs) invade the brain during the development of central nervous system lymphoma (CNSL) is unclear. We found that NF-κB-induced gliosis promotes CNSL in immunocompetent mice. Gliosis elevated cell-adhesion molecules, which increased LCs in the brain but was insufficient to induce CNSL. Astrocyte-derived CCL19 was required for gliosis-induced CNSL. Deleting CCL19 in mice or CCR7 from LCs abrogated CNSL development. Two-photon microscopy revealed LCs transiently entering normal brain parenchyma. Astrocytic CCL19 enhanced parenchymal CNS retention of LCs, thereby promoting CNSL formation. Aged, gliotic wild-type mice were more susceptible to forming CNSL than young wild-type mice, and astrocytic CCL19 was observed in both human gliosis and CNSL. Therefore, CCL19-CCR7 interactions may underlie an increased age-related risk for CNSL.
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Affiliation(s)
- Tracy O'Connor
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany.
| | - Xiaolan Zhou
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, 81377 Munich, Germany; Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jan Kosla
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Arlind Adili
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Maria Garcia Beccaria
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Elena Kotsiliti
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Dominik Pfister
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Anna-Lena Johlke
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Ankit Sinha
- Experimental Systems Immunology, Max Planck Institute of Biochemistry, Munich, Germany
| | - Roman Sankowski
- Institute of Neuropathology, Medical Faculty, University of Freiburg, 79085 Freiburg, Germany
| | - Markus Schick
- III. Medical Department, Technical University of Munich, 81675 Munich, Germany
| | - Richard Lewis
- III. Medical Department, Technical University of Munich, 81675 Munich, Germany
| | - Nikolaos Dokalis
- Institute of Neuropathology, Medical Faculty, University of Freiburg, 79085 Freiburg, Germany
| | - Bastian Seubert
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Bastian Höchst
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Donato Inverso
- Division of Vascular Oncology and Metastasis, German Cancer Research Center Heidelberg (DKFZ-ZMBH Alliance), 69120 Heidelberg, Germany
| | - Danijela Heide
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Wenlong Zhang
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, 81377 Munich, Germany
| | - Petra Weihrich
- Institute for Physiological Chemistry, University of Ulm, 89081 Ulm, Germany
| | - Katrin Manske
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Dirk Wohlleber
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Martina Anton
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Alexander Hoellein
- III. Medical Department, Technical University of Munich, 81675 Munich, Germany
| | - Gitta Seleznik
- Institute of Neuropathology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Juliane Bremer
- Institute of Neuropathology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Sabine Bleul
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Albert-Ludwigs University, 79106 Freiburg, Germany
| | - Hellmut G Augustin
- Division of Vascular Oncology and Metastasis, German Cancer Research Center Heidelberg (DKFZ-ZMBH Alliance), 69120 Heidelberg, Germany; European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Florian Scherer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Albert-Ludwigs University, 79106 Freiburg, Germany
| | - Uwe Koedel
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, 81377 Munich, Germany
| | - Achim Weber
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Ulrike Protzer
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Reinhold Förster
- Institute of Immunology, Hannover Medical School, 30625 Hannover, Germany
| | - Thomas Wirth
- Institute for Physiological Chemistry, University of Ulm, 89081 Ulm, Germany
| | - Adriano Aguzzi
- Institute of Neuropathology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Felix Meissner
- Experimental Systems Immunology, Max Planck Institute of Biochemistry, Munich, Germany
| | - Marco Prinz
- Institute of Neuropathology, Medical Faculty, University of Freiburg, 79085 Freiburg, Germany; Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany; Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Baumann
- Institute for Physiological Chemistry, University of Ulm, 89081 Ulm, Germany
| | - Uta E Höpken
- Max Delbrück Center for Molecular Medicine, 13092 Berlin, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, 81377 Munich, Germany
| | - Ulrich Keller
- III. Medical Department, Technical University of Munich, 81675 Munich, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany; Hematology and Oncology, Charité - Universitätsmedizin Campus Benjamin Franklin, 12200 Berlin, Germany
| | - Mathias Heikenwalder
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany.
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36
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Kurtz DM, Esfahani MS, Scherer F, Soo J, Jin MC, Liu CL, Newman AM, Dührsen U, Hüttmann A, Casasnovas O, Westin JR, Ritgen M, Böttcher S, Langerak AW, Roschewski M, Wilson WH, Gaidano G, Rossi D, Bahlo J, Hallek M, Tibshirani R, Diehn M, Alizadeh AA. Dynamic Risk Profiling Using Serial Tumor Biomarkers for Personalized Outcome Prediction. Cell 2019; 178:699-713.e19. [PMID: 31280963 DOI: 10.1016/j.cell.2019.06.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/19/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
Abstract
Accurate prediction of long-term outcomes remains a challenge in the care of cancer patients. Due to the difficulty of serial tumor sampling, previous prediction tools have focused on pretreatment factors. However, emerging non-invasive diagnostics have increased opportunities for serial tumor assessments. We describe the Continuous Individualized Risk Index (CIRI), a method to dynamically determine outcome probabilities for individual patients utilizing risk predictors acquired over time. Similar to "win probability" models in other fields, CIRI provides a real-time probability by integrating risk assessments throughout a patient's course. Applying CIRI to patients with diffuse large B cell lymphoma, we demonstrate improved outcome prediction compared to conventional risk models. We demonstrate CIRI's broader utility in analogous models of chronic lymphocytic leukemia and breast adenocarcinoma and perform a proof-of-concept analysis demonstrating how CIRI could be used to develop predictive biomarkers for therapy selection. We envision that dynamic risk assessment will facilitate personalized medicine and enable innovative therapeutic paradigms.
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Affiliation(s)
- David M Kurtz
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA; Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Mohammad S Esfahani
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Florian Scherer
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Joanne Soo
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Michael C Jin
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Chih Long Liu
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Aaron M Newman
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA
| | - Ulrich Dührsen
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - Andreas Hüttmann
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - Olivier Casasnovas
- Department of Hematology, Hopital F. Mitterrand, CHU Dijon and INSERM 1231, Dijon, France
| | - Jason R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthais Ritgen
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Sebastian Böttcher
- Department III of Internal Medicine, University Hospital Rostock, Rostock, Germany
| | - Anton W Langerak
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Jasmin Bahlo
- German CLL Study Group, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- German CLL Study Group, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany; Cologne Cluster of Excellence on Cellular Stress Responses in Aging-Related Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Robert Tibshirani
- Department Statistics, Stanford University, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Maximilian Diehn
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA; Stanford Cancer Institute, Stanford University, Stanford, CA, USA; Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
| | - Ash A Alizadeh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA; Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA; Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
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37
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Newman AM, Steen CB, Liu CL, Gentles AJ, Chaudhuri AA, Scherer F, Khodadoust MS, Esfahani MS, Luca BA, Steiner D, Diehn M, Alizadeh AA. Determining cell type abundance and expression from bulk tissues with digital cytometry. Nat Biotechnol 2019; 37:773-782. [PMID: 31061481 PMCID: PMC6610714 DOI: 10.1038/s41587-019-0114-2] [Citation(s) in RCA: 1912] [Impact Index Per Article: 382.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
Single-cell RNA-sequencing has emerged as a powerful technique for characterizing cellular heterogeneity, but it is currently impractical on large sample cohorts and cannot be applied to fixed specimens collected as part of routine clinical care. We previously developed an approach for digital cytometry, called CIBERSORT, that enables estimation of cell type abundances from bulk tissue transcriptomes. We now introduce CIBERSORTx, a machine learning method that extends this framework to infer cell-type-specific gene expression profiles without physical cell isolation. By minimizing platform-specific variation, CIBERSORTx also allows the use of single-cell RNA-sequencing data for large-scale tissue dissection. We evaluated the utility of CIBERSORTx in multiple tumor types, including melanoma, where single-cell reference profiles were used to dissect bulk clinical specimens, revealing cell-type-specific phenotypic states linked to distinct driver mutations and response to immune checkpoint blockade. We anticipate that digital cytometry will augment single-cell profiling efforts, enabling cost-effective, high-throughput tissue characterization without the need for antibodies, disaggregation or viable cells.
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Affiliation(s)
- Aaron M Newman
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA. .,Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.
| | - Chloé B Steen
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Department of Informatics, University of Oslo, Oslo, Norway
| | - Chih Long Liu
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Andrew J Gentles
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Center for Cancer Systems Biology, Stanford University, Stanford, CA, USA.,Stanford Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Aadel A Chaudhuri
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA.,Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Florian Scherer
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Division of Hematology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Michael S Khodadoust
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Mohammad S Esfahani
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.,Center for Cancer Systems Biology, Stanford University, Stanford, CA, USA.,Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Bogdan A Luca
- Stanford Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - David Steiner
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Maximilian Diehn
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA.,Stanford Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA.,Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Ash A Alizadeh
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA. .,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA. .,Center for Cancer Systems Biology, Stanford University, Stanford, CA, USA. .,Stanford Cancer Institute, Stanford University, Stanford, CA, USA. .,Division of Hematology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
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Kurtz DM, Scherer F, Jin MC, Soo J, Craig AFM, Esfahani MS, Chabon JJ, Stehr H, Liu CL, Tibshirani R, Maeda LS, Gupta NK, Khodadoust MS, Advani RH, Newman AM, Dührsen U, Hüttmann A, Meignan M, Casasnovas O, Westin JR, Roschewski M, Wilson WH, Gaidano G, Rossi D, Diehn M, Alizadeh AA. Reply to J. Wang et al. J Clin Oncol 2019; 37:755-757. [PMID: 30753108 DOI: 10.1200/jco.18.01907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David M Kurtz
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Florian Scherer
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Michael C Jin
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Joanne Soo
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Alexander F M Craig
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Mohammad S Esfahani
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Jacob J Chabon
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Henning Stehr
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Chih Long Liu
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Robert Tibshirani
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Lauren S Maeda
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Neel K Gupta
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Michael S Khodadoust
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Ranjana H Advani
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Aaron M Newman
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Ulrich Dührsen
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Andreas Hüttmann
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Michel Meignan
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Olivier Casasnovas
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Jason R Westin
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Mark Roschewski
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Wyndham H Wilson
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Gianluca Gaidano
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Davide Rossi
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Maximilian Diehn
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
| | - Ash A Alizadeh
- David M. Kurtz, MD, PhD; Florian Scherer, MD; Michael C. Jin; Joanne Soo; Alexander F.M. Craig, MPhil; Mohammad S. Esfahani, PhD; Jacob J. Chabon, PhD; Henning Stehr, PhD; Chih Long Liu, PhD; Robert Tibshirani, PhD; Lauren S. Maeda, MD; Neel K. Gupta, MD; Michael S. Khodadoust, MD, PhD; Ranjana H. Advani, MD; and Aaron M. Newman, PhD, Stanford University, Stanford, CA; Ulrich Dührsen, MD; and Andreas Hüttmann, MD, University Hospital Essen, Essen, Germany; Michel Meignan, MD, PhD, Hôpitaux Universitaires Henri Mondor, Creteil, France; Olivier Casasnovas, MD, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski, MD; and Wyndham H. Wilson, MD, PhD, National Institutes of Health, Bethesda, MD; Gianluca Gaidano, MD, PhD; and Davide Rossi, MD, PhD, University of Eastern Piedmont, Novara, Italy, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland; and Maximilian Diehn, MD, PhD; and Ash A. Alizadeh, MD, PhD, Stanford University, Stanford, CA
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Kurtz DM, Scherer F, Jin MC, Soo J, Craig AFM, Esfahani MS, Chabon JJ, Stehr H, Liu CL, Tibshirani R, Maeda LS, Gupta NK, Khodadoust MS, Advani RH, Levy R, Newman AM, Dührsen U, Hüttmann A, Meignan M, Casasnovas RO, Westin JR, Roschewski M, Wilson WH, Gaidano G, Rossi D, Diehn M, Alizadeh AA. Circulating Tumor DNA Measurements As Early Outcome Predictors in Diffuse Large B-Cell Lymphoma. J Clin Oncol 2018; 36:2845-2853. [PMID: 30125215 DOI: 10.1200/jco.2018.78.5246] [Citation(s) in RCA: 273] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Outcomes for patients with diffuse large B-cell lymphoma remain heterogeneous, with existing methods failing to consistently predict treatment failure. We examined the additional prognostic value of circulating tumor DNA (ctDNA) before and during therapy for predicting patient outcomes. PATIENTS AND METHODS We studied the dynamics of ctDNA from 217 patients treated at six centers, using a training and validation framework. We densely characterized early ctDNA dynamics during therapy using cancer personalized profiling by deep sequencing to define response-associated thresholds within a discovery set. These thresholds were assessed in two independent validation sets. Finally, we assessed the prognostic value of ctDNA in the context of established risk factors, including the International Prognostic Index and interim positron emission tomography/computed tomography scans. RESULTS Before therapy, ctDNA was detectable in 98% of patients; pretreatment levels were prognostic in both front-line and salvage settings. In the discovery set, ctDNA levels changed rapidly, with a 2-log decrease after one cycle (early molecular response [EMR]) and a 2.5-log decrease after two cycles (major molecular response [MMR]) stratifying outcomes. In the first validation set, patients receiving front-line therapy achieving EMR or MMR had superior outcomes at 24 months (EMR: EFS, 83% v 50%; P = .0015; MMR: EFS, 82% v 46%; P < .001). EMR also predicted superior 24-month outcomes in patients receiving salvage therapy in the first validation set (EFS, 100% v 13%; P = .011). The prognostic value of EMR and MMR was further confirmed in the second validation set. In multivariable analyses including International Prognostic Index and interim positron emission tomography/computed tomography scans across both cohorts, molecular response was independently prognostic of outcomes, including event-free and overall survival. CONCLUSION Pretreatment ctDNA levels and molecular responses are independently prognostic of outcomes in aggressive lymphomas. These risk factors could potentially guide future personalized risk-directed approaches.
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Affiliation(s)
- David M Kurtz
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Florian Scherer
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Michael C Jin
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Joanne Soo
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Alexander F M Craig
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Mohammad Shahrokh Esfahani
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Jacob J Chabon
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Henning Stehr
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Chih Long Liu
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Robert Tibshirani
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Lauren S Maeda
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Neel K Gupta
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Michael S Khodadoust
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Ranjana H Advani
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Ronald Levy
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Aaron M Newman
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Ulrich Dührsen
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Andreas Hüttmann
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Michel Meignan
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - René-Olivier Casasnovas
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Jason R Westin
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Mark Roschewski
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Wyndham H Wilson
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Gianluca Gaidano
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Davide Rossi
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Maximilian Diehn
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Ash A Alizadeh
- David M. Kurtz, Florian Scherer, Michael C. Jin, Joanne Soo, Alexander F.M. Craig, Mohammad Shahrokh Esfahani, Jacob J. Chabon, Henning Stehr, Chih Long Liu, Robert Tibshirani, Lauren S. Maeda, Neel K. Gupta, Michael S. Khodadoust, Ranjana H. Advani, Ronald Levy, Aaron M. Newman, Maximilian Diehn, and Ash A. Alizadeh, Stanford University, Stanford, CA; Florian Scherer, University Medical Center Freiburg, Freiburg; Ulrich Dührsen and Andreas Hüttmann, University Hospital Essen, Essen, Germany; Michel Meignan, Hôpitaux Universitaires Henri Mondor, Creteil; René-Olivier Casasnovas, Hôpital Le Bocage, Centre Hospitalier Universitaire, Dijon, France; Jason R. Westin, University of Texas MD Anderson Cancer Center, Houston, TX; Mark Roschewski and Wyndham H. Wilson, National Cancer Institute, National Institutes of Health, Bethesda, MD; Gianluca Gaidano and Davide Rossi, University of Eastern Piedmont, Novara, Italy; and Davide Rossi, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
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40
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Chaudhuri AA, Chabon JJ, Lovejoy AF, Newman AM, Stehr H, Azad TD, Khodadoust MS, Esfahani MS, Liu CL, Zhou L, Scherer F, Kurtz DM, Say C, Carter JN, Merriott DJ, Dudley JC, Binkley MS, Modlin L, Padda SK, Gensheimer MF, West RB, Shrager JB, Neal JW, Wakelee HA, Loo BW, Alizadeh AA, Diehn M. Early Detection of Molecular Residual Disease in Localized Lung Cancer by Circulating Tumor DNA Profiling. Cancer Discov 2017; 7:1394-1403. [PMID: 28899864 DOI: 10.1158/2159-8290.cd-17-0716] [Citation(s) in RCA: 606] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/07/2017] [Accepted: 08/31/2017] [Indexed: 12/15/2022]
Abstract
Identifying molecular residual disease (MRD) after treatment of localized lung cancer could facilitate early intervention and personalization of adjuvant therapies. Here, we apply cancer personalized profiling by deep sequencing (CAPP-seq) circulating tumor DNA (ctDNA) analysis to 255 samples from 40 patients treated with curative intent for stage I-III lung cancer and 54 healthy adults. In 94% of evaluable patients experiencing recurrence, ctDNA was detectable in the first posttreatment blood sample, indicating reliable identification of MRD. Posttreatment ctDNA detection preceded radiographic progression in 72% of patients by a median of 5.2 months, and 53% of patients harbored ctDNA mutation profiles associated with favorable responses to tyrosine kinase inhibitors or immune checkpoint blockade. Collectively, these results indicate that ctDNA MRD in patients with lung cancer can be accurately detected using CAPP-seq and may allow personalized adjuvant treatment while disease burden is lowest.Significance: This study shows that ctDNA analysis can robustly identify posttreatment MRD in patients with localized lung cancer, identifying residual/recurrent disease earlier than standard-of-care radiologic imaging, and thus could facilitate personalized adjuvant treatment at early time points when disease burden is lowest. Cancer Discov; 7(12); 1394-403. ©2017 AACR.See related commentary by Comino-Mendez and Turner, p. 1368This article is highlighted in the In This Issue feature, p. 1355.
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Affiliation(s)
- Aadel A Chaudhuri
- Department of Radiation Oncology, Stanford University, Stanford, California.,Stanford Cancer Institute, Stanford University, Stanford, California
| | - Jacob J Chabon
- Stanford Cancer Institute, Stanford University, Stanford, California.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California
| | - Alexander F Lovejoy
- Department of Radiation Oncology, Stanford University, Stanford, California.,Stanford Cancer Institute, Stanford University, Stanford, California
| | - Aaron M Newman
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California.,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Henning Stehr
- Stanford Cancer Institute, Stanford University, Stanford, California
| | - Tej D Azad
- Stanford Cancer Institute, Stanford University, Stanford, California
| | - Michael S Khodadoust
- Stanford Cancer Institute, Stanford University, Stanford, California.,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | | | - Chih Long Liu
- Stanford Cancer Institute, Stanford University, Stanford, California.,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Li Zhou
- Stanford Cancer Institute, Stanford University, Stanford, California.,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Florian Scherer
- Stanford Cancer Institute, Stanford University, Stanford, California.,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - David M Kurtz
- Stanford Cancer Institute, Stanford University, Stanford, California.,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California.,Department of Bioengineering, Stanford University, Stanford, California
| | - Carmen Say
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Justin N Carter
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - David J Merriott
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Jonathan C Dudley
- Stanford Cancer Institute, Stanford University, Stanford, California.,Department of Pathology, Stanford University, Stanford, California
| | - Michael S Binkley
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Leslie Modlin
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Sukhmani K Padda
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | | | - Robert B West
- Department of Pathology, Stanford University, Stanford, California
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford School of Medicine, Stanford University, Stanford, California
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Ash A Alizadeh
- Stanford Cancer Institute, Stanford University, Stanford, California. .,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California.,Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, California. .,Stanford Cancer Institute, Stanford University, Stanford, California.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California
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41
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Chaudhuri AA, Chabon JJ, Lovejoy AF, Newman AM, Stehr H, Azad TD, Zhou L, Liu CL, Scherer F, Kurtz DM, Esfahani MS, Say C, Carter JN, Merriott D, Dudley J, Binkley MS, Modlin L, Padda SK, Gensheimer M, West RB, Shrager JB, Neal JW, Wakelee HA, Billy, Loo W, Alizadeh AA, Diehn M. (S012) Circulating Tumor DNA Detects Residual Disease and Anticipates Tumor Progression Earlier Than CT Imaging. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Jin MC, Kurtz DM, Esfahani MS, Scherer F, Craig AF, Soo J, Khodadoust MS, Saganty RS, Chabon JJ, Schroers-Martin J, Stehr H, Advani RH, Rossi D, Gaidano G, Westin JR, Diehn M, Alizadeh AA. Noninvasive detection of clinically relevant copy number alterations in diffuse large B-cell lymphoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7507 Background: Somatic copy number alterations (SCNAs) are common and clinically important genomic events in lymphomas. For example, MYC and BCL2 amplifications are associated with adverse outcomes (Quesada, ASH 2016), while PD-L1 ( CD274) amplifications are associated with improved response to checkpoint inhibitors (Ansell, NEJM 2015). However, noninvasive detection of these events from circulating tumor DNA (ctDNA) remains difficult. Using CAPP-Seq, a targeted high-throughput sequencing platform, we developed a method to profile both focal and broad SCNAs from plasma. Methods: We profiled plasmas from a cohort of 75 pretreatment diffuse large B-cell lymphoma patients and 48 healthy controls. Focal SCNAs were evaluated at ultra-high depths (~10,000x), allowing for detection of lesions at ~1% ctDNA fraction. Thresholds were tuned to allow a false positive rate of 1%, which was empirically validated in an independent healthy cohort (n = 15), yielding a panel-wide false discovery rate of ~2.3% (0% in our genes of interest). Sequencing reads outside the targeted regions were separately pooled and analyzed to evaluate arm and chromosome level SCNAs. Results: We detected SCNAs in clinically relevant genes at the frequencies reported in literature, including amplifications in MYC (8.0%), BCL2 (24.0%), and BCL6 (14.7%) and deletions in TP53 (13.3%) and CDKN2A (9.3%). Remarkably, 26.7% of the cohort demonstrated amplification of both PD-L1 and PD-L2 ( PDCD1LG2). Furthermore, we discovered amplifications in PD-L2, but not PD-L1, in 13.3% of our patients. Interestingly, PD-L1 amplifications were more common in patients with relapsed lymphoma than in those with treatment-naïve disease (43.5% vs 19.2%, p = 0.02). Most PD-L1 amplifications were focal (65%) while the remainder typically involved > 80% of Chr9p. Corresponding tissue profiling data is in progress and will also be presented. Conclusions: Noninvasive sampling of lymphoma ctDNA enables detection of both focal and broad SCNAs, including amplifications of MYC, BCL2, and PD-L1. The ability to noninvasively profile copy number altered regions allows for biopsy-free discovery of clinically significant structural alterations in lymphoma patients.
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Affiliation(s)
- Michael C. Jin
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - Florian Scherer
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Joanne Soo
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | | | | | - Davide Rossi
- Division of Hematology, Department of Clinical and Experimental Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Jason R. Westin
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Soo J, Kurtz DM, Scherer F, Craig AF, Jin MC, Westin JR, Rossi D, Gaidano G, Advani RH, Diehn M, Alizadeh AA. Elucidation of distinct mutational patterns between diffuse large B cell lymphoma subtypes utilizing circulating tumor DNA. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7538 Background: Patients with diffuse large B cell lymphoma (DLBCL) exhibit significant differences in clinical outcome based on cell-of-origin (COO). Patients are categorized as having germinal-center-like (GCB) or activated-B-cell-like (ABC) disease based on RNA microarray and histopathological analyses of tumor biopsies. We recently described an accurate sequencing-based method for determination of COO in DLBCL utilizing stereotyped differences in mutations (Scherer et al., 2016). Here, we further explore the mutational patterns in patients with differing molecular subtypes of DLBCL based on sequencing of circulating tumor DNA. Methods: We applied cancer personalized profiling by deep sequencing (CAPP-Seq) to pretreatment plasma samples and matched germline from a cohort of 115 patients with DLBCL. We then identified somatic alterations, which were used to determine COO molecular subtypes as previously described. Finally, we compared mutational patterns in patients with GCB and non-GCB DLBCL. Results: We detected a significantly greater number of total mutations (GCB: 1766 ± 160 mutations per Mb of targeted sequencing; non-GCB: 1364 ± 150 mutations per Mb of targeted sequencing; p < 0.05) and coding mutations (GCB: 145 ± 21 mutations per Mb of targeted sequencing; non-GCB: 28 ± 8.5 mutations per Mb of targeted sequencing; p < 0.001), particularly in immunoglobulin (Ig) regions (p < 0.05). In addition, GCB and non-GCB samples exhibited distinct mutational patterns within Ig regions. GCB samples were enriched for mutations in regions of switch mu (Sμ) (p < 0.01) and IGHV2-70 (p < 0.01), while non-GCB samples were enriched for mutations in regions of IGHG3 (p < 0.03), IGHV4-34 (p < 0.03), and IGLL5 (p < 0.05). GCB samples were also significantly enriched for coding mutations in SOCS1 (p < 0.01), a gene not included in our original COO classifier. Conclusions: Patients with GCB and non-GCB DLBCL exhibit distinct mutational patterns across both Ig and non-Ig loci of the genome. These differences in mutational patterns can be used to classify molecular subtypes noninvasively, potentially providing further utility to noninvasive genotyping and liquid biopsies.
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Affiliation(s)
- Joanne Soo
- Duke University School of Medicine, Durham, NC
| | | | - Florian Scherer
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Michael C. Jin
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Jason R. Westin
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Davide Rossi
- Division of Hematology, Department of Clinical and Experimental Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
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44
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Scherer F, Kurtz DM, Newman AM, Stehr H, Craig AFM, Esfahani MS, Lovejoy AF, Chabon JJ, Klass DM, Liu CL, Zhou L, Glover C, Visser BC, Poultsides GA, Advani RH, Maeda LS, Gupta NK, Levy R, Ohgami RS, Kunder CA, Diehn M, Alizadeh AA. Distinct biological subtypes and patterns of genome evolution in lymphoma revealed by circulating tumor DNA. Sci Transl Med 2016; 8:364ra155. [PMID: 27831904 PMCID: PMC5490494 DOI: 10.1126/scitranslmed.aai8545] [Citation(s) in RCA: 318] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/19/2016] [Indexed: 12/11/2022]
Abstract
Patients with diffuse large B cell lymphoma (DLBCL) exhibit marked diversity in tumor behavior and outcomes, yet the identification of poor-risk groups remains challenging. In addition, the biology underlying these differences is incompletely understood. We hypothesized that characterization of mutational heterogeneity and genomic evolution using circulating tumor DNA (ctDNA) profiling could reveal molecular determinants of adverse outcomes. To address this hypothesis, we applied cancer personalized profiling by deep sequencing (CAPP-Seq) analysis to tumor biopsies and cell-free DNA samples from 92 lymphoma patients and 24 healthy subjects. At diagnosis, the amount of ctDNA was found to strongly correlate with clinical indices and was independently predictive of patient outcomes. We demonstrate that ctDNA genotyping can classify transcriptionally defined tumor subtypes, including DLBCL cell of origin, directly from plasma. By simultaneously tracking multiple somatic mutations in ctDNA, our approach outperformed immunoglobulin sequencing and radiographic imaging for the detection of minimal residual disease and facilitated noninvasive identification of emergent resistance mutations to targeted therapies. In addition, we identified distinct patterns of clonal evolution distinguishing indolent follicular lymphomas from those that transformed into DLBCL, allowing for potential noninvasive prediction of histological transformation. Collectively, our results demonstrate that ctDNA analysis reveals biological factors that underlie lymphoma clinical outcomes and could facilitate individualized therapy.
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Affiliation(s)
- Florian Scherer
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - David M Kurtz
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Aaron M Newman
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
| | - Henning Stehr
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
| | - Alexander F M Craig
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | | | - Alexander F Lovejoy
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Jacob J Chabon
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
| | - Daniel M Klass
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
| | - Chih Long Liu
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
| | - Li Zhou
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
| | - Cynthia Glover
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Brendan C Visser
- Division of Surgical Oncology, Department of Surgery, Stanford University, Stanford, CA 94305, USA
| | - George A Poultsides
- Division of Surgical Oncology, Department of Surgery, Stanford University, Stanford, CA 94305, USA
| | - Ranjana H Advani
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Lauren S Maeda
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Neel K Gupta
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Ronald Levy
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Robert S Ohgami
- Department of Pathology, Stanford University, Stanford, CA 94305, USA
| | | | - Maximilian Diehn
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA.
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Ash A Alizadeh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA.
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305, USA
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45
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Chabon JJ, Simmons AD, Lovejoy AF, Esfahani MS, Newman AM, Haringsma HJ, Kurtz DM, Stehr H, Scherer F, Karlovich CA, Harding TC, Durkin KA, Otterson GA, Purcell WT, Camidge DR, Goldman JW, Sequist LV, Piotrowska Z, Wakelee HA, Neal JW, Alizadeh AA, Diehn M. Circulating tumour DNA profiling reveals heterogeneity of EGFR inhibitor resistance mechanisms in lung cancer patients. Nat Commun 2016; 7:11815. [PMID: 27283993 PMCID: PMC4906406 DOI: 10.1038/ncomms11815] [Citation(s) in RCA: 452] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/03/2016] [Indexed: 12/20/2022] Open
Abstract
Circulating tumour DNA (ctDNA) analysis facilitates studies of tumour heterogeneity. Here we employ CAPP-Seq ctDNA analysis to study resistance mechanisms in 43 non-small cell lung cancer (NSCLC) patients treated with the third-generation epidermal growth factor receptor (EGFR) inhibitor rociletinib. We observe multiple resistance mechanisms in 46% of patients after treatment with first-line inhibitors, indicating frequent intra-patient heterogeneity. Rociletinib resistance recurrently involves MET, EGFR, PIK3CA, ERRB2, KRAS and RB1. We describe a novel EGFR L798I mutation and find that EGFR C797S, which arises in ∼33% of patients after osimertinib treatment, occurs in <3% after rociletinib. Increased MET copy number is the most frequent rociletinib resistance mechanism in this cohort and patients with multiple pre-existing mechanisms (T790M and MET) experience inferior responses. Similarly, rociletinib-resistant xenografts develop MET amplification that can be overcome with the MET inhibitor crizotinib. These results underscore the importance of tumour heterogeneity in NSCLC and the utility of ctDNA-based resistance mechanism assessment.
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Affiliation(s)
- Jacob J. Chabon
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, California 94305, USA
| | | | - Alexander F. Lovejoy
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, California 94305, USA
| | - Mohammad S. Esfahani
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, California 94305, USA
| | - Aaron M. Newman
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, California 94305, USA
| | | | - David M. Kurtz
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California 94305, USA
- Department of Bioengineering, Stanford University, Stanford, California 94305, USA
| | - Henning Stehr
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, California 94305, USA
| | - Florian Scherer
- Stanford Cancer Institute, Stanford University, Stanford, California 94305, USA
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California 94305, USA
| | | | | | - Kathleen A. Durkin
- Molecular Graphics and Computation Facility, College of Chemistry, University of California, Berkeley, California 94720, USA
| | | | - W. Thomas Purcell
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - D. Ross Camidge
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Jonathan W. Goldman
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095, USA
| | - Lecia V. Sequist
- Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Zofia Piotrowska
- Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Heather A. Wakelee
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California 94305, USA
| | - Joel W. Neal
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California 94305, USA
| | - Ash A. Alizadeh
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, California 94305, USA
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California 94305, USA
- Division of Hematology, Department of Medicine, Stanford University, Stanford, California 94305, USA
| | - Maximilian Diehn
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, USA
- Stanford Cancer Institute, Stanford University, Stanford, California 94305, USA
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA
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46
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Newman AM, Lovejoy AF, Klass DM, Kurtz DM, Chabon JJ, Scherer F, Stehr H, Liu CL, Bratman SV, Say C, Zhou L, Carter JN, West RB, Sledge GW, Shrager JB, Loo BW, Neal JW, Wakelee HA, Alizadeh AA, Diehn M. Integrated digital error suppression for noninvasive detection of circulating tumor DNA in NSCLC. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Aaron M. Newman
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Jacob J. Chabon
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford, CA
| | - Florian Scherer
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Chih Long Liu
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - Li Zhou
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Robert B. West
- Department of Pathology, Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Joel W. Neal
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
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47
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Kurtz DM, Scherer F, Newman AM, Craig AF, Khodadoust MS, Lovejoy AF, Klass DM, Chabon JJ, Glover C, Zhou L, Liu CL, Gupta NK, Maeda LS, Advani RH, Levy R, Diehn M, Alizadeh AA. Prediction of therapeutic outcomes in DLBCL from circulating tumor DNA dynamics. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Florian Scherer
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Aaron M. Newman
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - Jacob J. Chabon
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford, CA
| | - Cynthia Glover
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Li Zhou
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Chih Long Liu
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Neel K. Gupta
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - Ronald Levy
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
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48
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Chabon JJ, Simmons A, Newman AM, Lovejoy AF, Esfahani MS, Haringsma H, Kurtz DM, Stehr H, Scherer F, Durkin KA, Otterson GA, Purcell WT, Camidge DR, Goldman JW, Sequist LV, Piotrowska Z, Wakelee HA, Neal JW, Alizadeh AA, Diehn M. Inter- and intra-patient heterogeneity of resistance mechanisms to the mutant EGFR selective inhibitor rociletinib. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jacob J. Chabon
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford, CA
| | | | - Aaron M. Newman
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | | | - Florian Scherer
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | | | | | | | | | - Joel W. Neal
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
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49
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Scherer F, Kurtz DM, Newman AM, Stehr H, Craig AF, Esfahani MS, Lovejoy AF, Chabon JJ, Klass DM, Liu CL, Zhou L, Glover C, Advani RH, Maeda LS, Gupta NK, Levy R, Ohgami RS, Kunder C, Diehn M, Alizadeh AA. Noninvasive molecular subtyping and risk stratification of DLBCL. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Florian Scherer
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | - Aaron M. Newman
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - Jacob J. Chabon
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford, CA
| | | | - Chih Long Liu
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Li Zhou
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Cynthia Glover
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - Neel K. Gupta
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Ronald Levy
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Robert S. Ohgami
- Department of Pathology, Stanford University Medical Center, Stanford, CA
| | - Christian Kunder
- Department of Pathology, Stanford University Medical Center, Stanford, CA
| | | | - Ash A. Alizadeh
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
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50
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Scherer F, van der Burgt M, Kiełbasa SM, Bertinetti-Lapatki C, Dühren von Minden M, Mikesch K, Zirlik K, de Wreede L, Veelken H, Navarrete MA. Selection patterns of B-cell receptors and the natural history of follicular lymphoma. Br J Haematol 2015; 175:972-975. [PMID: 26687432 DOI: 10.1111/bjh.13901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Florian Scherer
- Department of Haematology and Oncology, University Medical Centre Freiburg, Freiburg, Germany
| | - Marlon van der Burgt
- Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Szymon M Kiełbasa
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Marcus Dühren von Minden
- Centre for Biological Signalling Studies (BIOSS), Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Kristina Mikesch
- Department of Haematology and Oncology, University Medical Centre Freiburg, Freiburg, Germany
| | - Katja Zirlik
- Department of Haematology and Oncology, University Medical Centre Freiburg, Freiburg, Germany
| | - Liesbeth de Wreede
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hendrik Veelken
- Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marcelo A Navarrete
- Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands.,School of Medicine, University of Magallanes, Punta Arenas, Chile
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