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Lommen K, Feng Z, Oberije CJ, van de Wetering AJP, Odeh S, Koch A, Aarts MJB, van Roermund JG, Schouten LJ, Oosterwijk E, Vaes N, Masclee AAM, Carvalho B, Meijer GA, Zeegers MP, Herman JG, Tjan-Heijnen VC, Melotte V, van Engeland M, Smits K. Abstract A62: Clinical translation of liquid biopsy DNA methylation biomarkers: Lessons from two systematic reviews. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.liqbiop20-a62] [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: 11/16/2022]
Abstract
Abstract
Background: Very few (<0.1%) of DNA methylation biomarkers are eventually translated into clinical practice, even though over 5,000 have been published over the last decades. In an attempt to create an overview of the current evidence on these markers, we performed two systematic reviews on diagnostic DNA methylation biomarkers in liquid biopsies, for colorectal cancer (CRC) and renal cell carcinoma (RCC) (1). Here, we present the evidence of these systematic reviews and provide novel recommendations to improve the current clinical translation of DNA methylation biomarkers.
Methods: For CRC, we identified 109 bodily fluid biomarker studies published before January 2019 in PubMed, Embase, Cochrane Library, or Google Scholar. For RCC, we identified 6 liquid biopsy studies up to January 2019 in these databases. Data extraction (study design, patient characteristics, disease stage, tumor location, technical assays, diagnostic measures) was performed on published reports. STARD criteria and Level of Evidence (LoE) were registered to assess reporting quality and strength for clinical translation, and forest plots were generated to summarize diagnostic performance of the biomarkers.
Findings: Our systematic literature search revealed multiple issues that hamper the development of DNA methylation biomarkers for RCC and CRC diagnosis, including methodologic and technical heterogeneity and lack of validation or clinical translation. Among the most important issues were a lack of translation from tissue into liquid biopsy; for CRC 88/389 (23%) CRC markers were studied in liquid biopsies, and for RCC these numbers were 15/44 (34%). In addition, results showed a lack of independent validation, with 37/88 (42%) CRC markers and 9/15 (60%) RCC markers in liquid biopsies studied in more than one study or study population. Also, inappropriate marker identification and primer design, lack of true clinical need definition, and low reporting quality were issues that were recognized in our systematic literature searches. These issues all hamper the development of the field, keep the LoE low, and hinder the translation of DNA methylation biomarkers into clinical tests.
Interpretation: Our systematic literature searches revealed that major requirements to develop clinically relevant diagnostic DNA methylation markers are often lacking. To avoid the resulting research waste, clinical needs, intended biomarker use, and independent validation should be better considered prior to study design. In addition, improved reporting quality would facilitate meta-analysis, thereby increasing LoE and enabling clinical translation.
Reference: 1. Lommen et al. Eur Urol Oncol 2019; https://doi.org/10.1016/j.euo.2019.07.011.
Citation Format: Kim Lommen, Zheng Feng, Cary J.G. Oberije, Alouisa J. P. van de Wetering, Selena Odeh, Alexander Koch, Maureen J. B. Aarts, Joep G. van Roermund, Leo J. Schouten, Egbert Oosterwijk, Nathalie Vaes, Ad A. M. Masclee, Beatriz Carvalho, Gerrit A. Meijer, Maurice P. Zeegers, James G. Herman, Vivianne C. Tjan-Heijnen, Veerle Melotte, Manon van Engeland, Kim Smits. Clinical translation of liquid biopsy DNA methylation biomarkers: Lessons from two systematic reviews [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr A62.
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Affiliation(s)
- Kim Lommen
- 1Department of Pathology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Zheng Feng
- 1Department of Pathology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Cary J.G. Oberije
- 2Department of Pathology & Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Alouisa J. P. van de Wetering
- 3Division of Gastroenterology and Hepatology, Department of Internal Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Selena Odeh
- 1Department of Pathology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Alexander Koch
- 1Department of Pathology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Maureen J. B. Aarts
- 4Department of Medical Oncology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Joep G. van Roermund
- 5Department of Urology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Leo J. Schouten
- 6Department of Epidemiology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Egbert Oosterwijk
- 7Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands,
| | - Nathalie Vaes
- 1Department of Pathology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Ad A. M. Masclee
- 8Division of Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Beatriz Carvalho
- 9Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands,
| | - Gerrit A. Meijer
- 9Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands,
| | - Maurice P. Zeegers
- 10Department of Complex Genetics, NUTRIM School of Nutrition and Translational Research in Metabolism & CAPHRI – Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - James G. Herman
- 11Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Vivianne C. Tjan-Heijnen
- 4Department of Medical Oncology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Veerle Melotte
- 1Department of Pathology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Manon van Engeland
- 1Department of Pathology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
| | - Kim Smits
- 1Department of Pathology, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands,
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Ankolekar A, Vanneste BGL, Bloemen-van Gurp E, van Roermund JG, van Limbergen EJ, van de Beek K, Marcelissen T, Zambon V, Oelke M, Dekker A, Roumen C, Lambin P, Berlanga A, Fijten R. Development and validation of a patient decision aid for prostate Cancer therapy: from paternalistic towards participative shared decision making. BMC Med Inform Decis Mak 2019; 19:130. [PMID: 31296199 PMCID: PMC6624887 DOI: 10.1186/s12911-019-0862-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 03/26/2019] [Accepted: 07/02/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Patient decision aids (PDAs) can support the treatment decision making process and empower patients to take a proactive role in their treatment pathway while using a shared decision-making (SDM) approach making participatory medicine possible. The aim of this study was to develop a PDA for prostate cancer that is accurate and user-friendly. METHODS We followed a user-centered design process consisting of five rounds of semi-structured interviews and usability surveys with topics such as informational/decisional needs of users and requirements for PDAs. Our user-base consisted of 8 urologists, 4 radiation oncologists, 2 oncology nurses, 8 general practitioners, 19 former prostate cancer patients, 4 usability experts and 11 healthy volunteers. RESULTS Informational needs for patients centered on three key factors: treatment experience, post-treatment quality of life, and the impact of side effects. Patients and clinicians valued a PDA that presents balanced information on these factors through simple understandable language and visual aids. Usability questionnaires revealed that patients were more satisfied overall with the PDA than clinicians; however, both groups had concerns that the PDA might lengthen consultation times (42 and 41%, respectively). The PDA is accessible on http://beslissamen.nl/ . CONCLUSIONS User-centered design provided valuable insights into PDA requirements but challenges in integrating diverse perspectives as clinicians focus on clinical outcomes while patients also consider quality of life. Nevertheless, it is crucial to involve a broad base of clinical users in order to better understand the decision-making process and to develop a PDA that is accurate, usable, and acceptable.
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Affiliation(s)
- Anshu Ankolekar
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Ben G. L. Vanneste
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Esther Bloemen-van Gurp
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Joep G. van Roermund
- Department of Urology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Evert J. van Limbergen
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Kees van de Beek
- Department of Urology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Matthias Oelke
- Department of Urology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- St. Antonius-Hospital Gronau, Gronau, Germany
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Cheryl Roumen
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Adriana Berlanga
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Rianne Fijten
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
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Joosten SC, Deckers IA, Aarts MJ, Hoeben A, van Roermund JG, Smits KM, Melotte V, van Engeland M, Tjan-Heijnen VC. Prognostic DNA methylation markers for renal cell carcinoma: a systematic review. Epigenomics 2017; 9:1243-1257. [PMID: 28803494 DOI: 10.2217/epi-2017-0040] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM Despite numerous published prognostic methylation markers for renal cell carcinoma (RCC), none of these have yet changed patient management. Our aim is to systematically review and evaluate the literature on prognostic DNA methylation markers for RCC. MATERIALS & METHODS We conducted an exhaustive search of PubMed, EMBASE and MEDLINE up to April 2017 and identified 49 publications. Studies were reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, assessed for their reporting quality using the Reporting Recommendations for Tumor Marker Prognostic Studies (REMARK) criteria, and were graded to determine the level of evidence (LOE) for each biomarker. RESULTS We identified promoter methylation of BNC1, SCUBE3, GATA5, SFRP1, GREM1, RASSF1A, PCDH8, LAD1 and NEFH as promising prognostic markers. Extensive methodological heterogeneity across the included studies was observed, which hampers comparability and reproducibility of results, providing a possible explanation why these biomarkers do not reach the clinic. CONCLUSION Potential prognostic methylation markers for RCC have been identified, but they require further validation in prospective studies to determine their true clinical value.
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Affiliation(s)
- Sophie C Joosten
- Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Ivette Ag Deckers
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Maureen J Aarts
- Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Ann Hoeben
- Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Joep G van Roermund
- Department of Urology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Kim M Smits
- Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.,Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Veerle Melotte
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Manon van Engeland
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Vivianne C Tjan-Heijnen
- Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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