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Kim IA, Hur JY, Kim HJ, Kim WS, Lee KY. Extracellular Vesicle-Based Bronchoalveolar Lavage Fluid Liquid Biopsy for EGFR Mutation Testing in Advanced Non-Squamous NSCLC. Cancers (Basel) 2022; 14:cancers14112744. [PMID: 35681723 PMCID: PMC9179452 DOI: 10.3390/cancers14112744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/18/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
To overcome the limitations of the tissue biopsy and plasma cfDNA liquid biopsy, we performed the EV-based BALF liquid biopsy of 224 newly diagnosed stage III-IV NSCLC patients and compared it with tissue genotyping and 110 plasma liquid biopsies. Isolation of EVs from BALF was performed by ultracentrifugation. EGFR genotyping was performed through peptide nucleic acid clamping-assisted fluorescence melting curve analysis. Compared with tissue-based genotyping, BALF liquid biopsy demonstrated a sensitivity, specificity, and concordance rates of 97.8%, 96.9%, and 97.7%, respectively. The performance of BALF liquid biopsy was almost identical to that of standard tissue-based genotyping. In contrast, plasma cfDNA-based liquid biopsy (n = 110) demonstrated sensitivity, specificity, and concordance rates of 48.5%, 86.3%, and 63.6%, respectively. The mean turn-around time of BALF liquid biopsy was significantly shorter (2.6 days) than that of tissue-based genotyping (13.9 days; p < 0.001). Therefore, the use of EV-based BALF shortens the time for confirmation of EGFR mutation status for starting EGFR-TKI treatment and can hence potentially improve clinical outcomes. As a result, we suggest that EV-based BALF EGFR testing in advanced lung NSCLC is a highly accurate rapid method and can be used as an alternative method for lung tissue biopsy.
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Affiliation(s)
- In Ae Kim
- Precision Medicine Lung Cancer Center, Konkuk University Medical Center, Seoul 05030, Korea; (I.A.K.); (J.Y.H.); (H.J.K.); (W.S.K.)
| | - Jae Young Hur
- Precision Medicine Lung Cancer Center, Konkuk University Medical Center, Seoul 05030, Korea; (I.A.K.); (J.Y.H.); (H.J.K.); (W.S.K.)
- Department of Pulmonary Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Hee Joung Kim
- Precision Medicine Lung Cancer Center, Konkuk University Medical Center, Seoul 05030, Korea; (I.A.K.); (J.Y.H.); (H.J.K.); (W.S.K.)
- Department of Pathology, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Wan Seop Kim
- Precision Medicine Lung Cancer Center, Konkuk University Medical Center, Seoul 05030, Korea; (I.A.K.); (J.Y.H.); (H.J.K.); (W.S.K.)
- Department of Pulmonary Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Kye Young Lee
- Precision Medicine Lung Cancer Center, Konkuk University Medical Center, Seoul 05030, Korea; (I.A.K.); (J.Y.H.); (H.J.K.); (W.S.K.)
- Department of Pathology, Konkuk University School of Medicine, Seoul 05030, Korea
- Exosignal, Inc., Seoul 05030, Korea
- Correspondence: ; Tel.: +82-2-2030-7784
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Mao L, Zhao W, Li X, Zhang S, Zhou C, Zhou D, Ou X, Xu Y, Tang Y, Ou X, Hu C, Ding X, Luo P, Yu S. Mutation Spectrum of EGFR From 21,324 Chinese Patients With Non-Small Cell Lung Cancer (NSCLC) Successfully Tested by Multiple Methods in a CAP-Accredited Laboratory. Pathol Oncol Res 2021; 27:602726. [PMID: 34257561 PMCID: PMC8262202 DOI: 10.3389/pore.2021.602726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/01/2021] [Indexed: 01/02/2023]
Abstract
Genotyping epidermal growth factor receptor (EGFR) gene in patients with advanced non-small cell lung cancers (NSCLC) is essential for identifying those patients who may benefit from targeted therapies. Systemically evaluating EGFR mutation detection rates of different methods currently used in clinical setting will provide valuable information to clinicians and laboratory scientists who take care of NSCLC patients. This study retrospectively reviewed the EGFR data obtained in our laboratory in last 10 years. A total of 21,324 NSCLC cases successfully underwent EGFR genotyping for clinical therapeutic purpose, including 5,244 cases tested by Sanger sequencing, 13,329 cases tested by real-time PCR, and 2,751 tested by next-generation sequencing (NGS). The average EGFR mutation rate was 45.1%, with 40.3% identified by Sanger sequencing, 46.5% by real-time PCR and 47.5% by NGS. Of these cases with EGFR mutations identified, 93.3% of them harbored a single EGFR mutation (92.1% with 19del or L858R, and 7.9% with uncommon mutations) and 6.7% harbored complex EGFR mutations. Of the 72 distinct EGFR variants identified in this study, 15 of them (single or complex EGFR mutations) were newly identified in NSCLC. For these cases with EGFR mutations tested by NGS, 65.3% of them also carried tumor-related variants in some non-EGFR genes and about one third of them were considered candidates of targeted drugs. NGS method showed advantages over Sanger sequencing and real-time PCR not only by providing the highest mutation detection rate of EGFR but also by identifying actionable non-EGFR mutations with targeted drugs in clinical setting.
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Affiliation(s)
- Linlin Mao
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Weiwei Zhao
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Xiaoxia Li
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Shangfei Zhang
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Changhong Zhou
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Danyan Zhou
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Xiaohua Ou
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China.,Institute of KingMed Translational Medicine, Guangzhou, China
| | - Yanyan Xu
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Yuanxiao Tang
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Xiaoyong Ou
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Changming Hu
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China
| | - Xiangdong Ding
- Department of Pathology, KingMed Diagnostics, Guangzhou, China
| | - Pifu Luo
- Department of Pathology, KingMed Diagnostics, Guangzhou, China
| | - Shihui Yu
- Clinical Genome Center, KingMed Diagnostics, Guangzhou, China.,Institute of KingMed Translational Medicine, Guangzhou, China
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Chiang AC, Fernandes AW, Pavilack M, Wu JW, Laliberté F, Duh MS, Chehab N, Subramanian J. EGFR mutation testing and treatment decisions in patients progressing on first- or second-generation epidermal growth factor receptor tyrosine kinase inhibitors. BMC Cancer 2020; 20:356. [PMID: 32345265 PMCID: PMC7189688 DOI: 10.1186/s12885-020-06826-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 10/25/2019] [Accepted: 04/05/2020] [Indexed: 12/23/2022] Open
Abstract
Background The objective of this study was to investigate real-world EGFR mutation testing in patients with metastatic non-small cell lung cancer (NSCLC) upon progression on first−/second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI), and subsequent treatments received. Methods Flatiron Health electronic health records-derived database was used to identify adult patients with metastatic NSCLC treated with first−/second-generation EGFR-TKI from 11/2015–09/2017, with start of first EGFR-TKI defined as the index date. Patients were stratified by receipt of EGFR-TKI as first-line (1 L) or later-line (2 L+) treatment. Mutation testing and subsequent therapies following first−/second-generation EGFR-TKI were described. Results Overall, 782 patients (1 L = 435; 2 L+ =347) were included. Median age was 69.0 years, 63.6% were female, 56.3% were white, 87.1% were treated in community-based practices, and 30.1% of patients died during the study period; median follow-up was 309.0 days. Among the 294 (1 L = 160; 2L+ =134) patients who received subsequent therapies, treatments included chemotherapy only (1 L = 15.6%; 2L+ =21.6%), immunotherapy only (1 L = 13.8%; 2 L+ =41.0%), and targeted therapies (1 L = 70.0%; 2 L+ =36.6%). Specifically, 40 (25.0%) 1 L patients and 7 (5.2%) 2 L+ patients received osimertinib as subsequent therapy. Before the start of subsequent therapy, EGFR T790M resistance mutation testing was performed in 88 (29.9%) patients (1 L = 63 [39.4%]; 2 L+ =25 [18.7%]). Of these patients, 25 (28.4%) were T790M positive, among whom 24 (96.0%) received osimertinib. Conclusions A third of patients received subsequent therapies on disease progression; only 30% of these were tested for EGFR-TKI resistance mutation, prior to receiving subsequent therapies. These results highlight the importance of choosing treatments in the 1 L setting that optimize benefits for patients with EGFR-mutated NSCLC.
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Affiliation(s)
- Anne C Chiang
- Yale School of Medicine, 20 York Street, New Haven, CT, 06510, USA.
| | | | | | - Jennifer W Wu
- Groupe d'analyse, Ltée, Deloitte Tower, 1190 Avenue des Canadiens-de-Montréal Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - François Laliberté
- Groupe d'analyse, Ltée, Deloitte Tower, 1190 Avenue des Canadiens-de-Montréal Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Mei Sheng Duh
- Analysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Nabil Chehab
- AstraZeneca US, 950 Wind River Ln, Gaithersburg, MD, 20878, USA
| | - Janakiraman Subramanian
- Saint Luke's Cancer Institute, 4321 Washington St, Medical Plaza III, Ste 4000, Kansas City, MO, 64111, USA
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Zhao J, Ye X, Xu Y, Chen M, Zhong W, Sun Y, Yang Z, Zhu G, Gu Y, Wang M. EGFR mutation status of paired cerebrospinal fluid and plasma samples in EGFR mutant non-small cell lung cancer with leptomeningeal metastases. Cancer Chemother Pharmacol 2016; 78:1305-10. [PMID: 27770237 DOI: 10.1007/s00280-016-3155-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Central nervous system (CNS) is the prevalent site for metastases in epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI)-relapsed NSCLC patients. To understand the EGFR mutation status in paired cerebrospinal fluid (CSF) and plasma samples after EGFR-TKI treatment failure might be useful to guide the treatment of intra- and extracranial tumors in those patients. METHODS Paired CSF and plasma samples were collected from seven NSCLC patients with CNS metastases after EGFR-TKI failure. EGFR mutations were tested by amplification refractory mutation system (ARMS) and droplet digital PCR (ddPCR) methods. Gefitinib concentrations were evaluated by high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS). RESULTS EGFR mutations were detected in all seven CSF samples, including three of E19-Del, three of L858R and one of E19-Del&T790M by both methods. On the other hand, majority of the matched plasma samples (5/7) were negative for EGFR mutations by both methods. The other two plasma samples were positive for E19-Del&T790M by ddPCR, and one of them had undetectable T790M by ARMS. Gefitinib concentration in CSF was much lower than that in plasma (mean CSF/plasma ratio: 1.8 %). CONCLUSIONS After EGFR-TKI failure, majority of the NSCLC patients with CNS metastases remained positive detection of EGFR sensitive mutations in CSF, but much less detection in the matched plasma. Significantly low exposure of gefitinib in CSF might explain the intracranial protection of the EGFR sensitive mutation positive tumor cells.
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Vázquez S, Casal J, Afonso Afonso FJ, Fírvida JL, Santomé L, Barón F, Lázaro M, Pena C, Amenedo M, Abdulkader I, González-Arenas C, Fachal L, Vega A. EGFR testing and clinical management of advanced NSCLC: a Galician Lung Cancer Group study (GGCP 048-10). Cancer Manag Res 2016; 8:11-20. [PMID: 26893581 PMCID: PMC4745839 DOI: 10.2147/cmar.s85173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR) gene in non-small-cell lung cancer (NSCLC) patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. Patients and methods All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens) and serum samples. Results Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6%) had EGFR mutations (84% sensitizing mutations). EGFR mutation was found in serum in 14 (8.1%) patients (of 174 evaluable). Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52%, respectively. All but two patients received gefitinib. Median progression-free survival and overall survival were 10 (95% confidence interval: 4.8–15.3) months and 17.8 (95% confidence interval: 13.9–21.6) months, respectively, in patients carrying sensitizing mutations. Conclusion The incidence of EGFR mutations in Galicia is consistent with previous data in Spain. Our results also support the feasibility of EGFR testing to guide treatment decision making using tumor tissue or cytology samples, or serum samples if tumor specimens are unavailable. These findings also confirm that first-line gefitinib is an active treatment option in Caucasians with EGFR mutation-positive NSCLC.
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Affiliation(s)
- Sergio Vázquez
- Medical Oncology Department, Lucus Augusti University Hospital, Lugo, Spain
| | - Joaquín Casal
- Medical Oncology Department, University Hospital Complex of Vigo, Pontevedra, Spain
| | | | - José Luis Fírvida
- Medical Oncology Department, University Hospital Complex of Ourense, Ourense, Spain
| | - Lucía Santomé
- Medical Oncology Department Povisa Hospital, Vigo, Spain
| | - Francisco Barón
- Medical Oncology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Martín Lázaro
- Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Carolina Pena
- Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, Spain
| | - Margarita Amenedo
- Medical Oncology Department, Oncology Center of Galicia, A Coruña, Spain
| | - Ihab Abdulkader
- Anatomical Pathology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Laura Fachal
- Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain
| | - Ana Vega
- Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain
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