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Ferreira D, Miranda J, Martins-Lopes P, Adega F, Chaves R. Future Perspectives in Detecting EGFR and ALK Gene Alterations in Liquid Biopsies of Patients with NSCLC. Int J Mol Sci 2021; 22:ijms22083815. [PMID: 33916986 PMCID: PMC8067613 DOI: 10.3390/ijms22083815] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/28/2021] [Accepted: 04/03/2021] [Indexed: 02/07/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) is a major cause of death worldwide. Alterations in such genes as EGFR and ALK are considered important biomarkers in NSCLC due to the existence of targeted therapies with specific tyrosine kinase inhibitors (TKIs). However, specific resistance-related mutations can occur during TKI treatment, which often result in therapy inefficacy. Liquid biopsies arise as a reliable tool for the early detection of these types of alterations, allowing a non-invasive follow-up of the patients. Furthermore, they can be essential for cancer screening, initial diagnosis and to check surgery success. Despite the great advantages of liquid biopsies in NSCLC and the high input that next-generation sequencing (NGS) approaches can provide in this field, its use in oncology is still limited. With improvement of assay sensitivity and the establishment of clinical guidelines for liquid biopsy analysis, it is expected that they will be used in routine procedures. This review focuses on the usefulness of liquid biopsies of NSCLC patients as a means to detect alterations in EGFR and ALK genes and in disease management, highlighting the impact of NGS methods.
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Affiliation(s)
- Daniela Ferreira
- Biosystems and Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa, 1749-016 Lisbon, Portugal; (D.F.); (J.M.); (P.M.-L.); (F.A.)
| | - Juliana Miranda
- Biosystems and Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa, 1749-016 Lisbon, Portugal; (D.F.); (J.M.); (P.M.-L.); (F.A.)
| | - Paula Martins-Lopes
- Biosystems and Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa, 1749-016 Lisbon, Portugal; (D.F.); (J.M.); (P.M.-L.); (F.A.)
- Department of Genetics and Biotechnology (DGB), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | - Filomena Adega
- Biosystems and Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa, 1749-016 Lisbon, Portugal; (D.F.); (J.M.); (P.M.-L.); (F.A.)
| | - Raquel Chaves
- Biosystems and Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisboa, 1749-016 Lisbon, Portugal; (D.F.); (J.M.); (P.M.-L.); (F.A.)
- Correspondence: ; Tel.: +351-259-350936
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Gilson P, Merlin JL, Harlé A. Detection of Microsatellite Instability: State of the Art and Future Applications in Circulating Tumour DNA (ctDNA). Cancers (Basel) 2021; 13:cancers13071491. [PMID: 33804907 PMCID: PMC8037825 DOI: 10.3390/cancers13071491] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Microsatellite instability (MSI) is a molecular fingerprint for defects in the mismatch repair system (dMMR) and is associated with higher risks of cancers. MSI/dMMR tumours are characterized by the accumulation of mutations throughout the genome, and particularly in microsatellite (MS) DNA repeat sequences. MSI stands as a major biomarker for familial cancer risk assessment, cancer prognosis, and therapeutic choices. Standard-of-care classification of MSI/dMMR tumours is most frequently achieved using immunohistochemistry or PCR-based assay directed against a set of five MS regions. However, novel molecular methods based on tumour tissue or plasma samples have been developed and could enter in the future trends of MSI testing. Here, we provide insights into these emerging approaches and discuss their advantages and limitations. Abstract Microsatellite instability (MSI) is a molecular scar resulting from a defective mismatch repair system (dMMR) and associated with various malignancies. MSI tumours are characterized by the accumulation of mutations throughout the genome and particularly clustered in highly repetitive microsatellite (MS) regions. MSI/dMMR status is routinely assessed in solid tumours for the initial screening of Lynch syndrome, the evaluation of cancer prognosis, and treatment decision-making. Currently, pentaplex PCR-based methods and MMR immunohistochemistry on tumour tissue samples are the standard diagnostic methods for MSI/dMMR. Other tissue methods such as next-generation sequencing or real-time PCR-based systems have emerged and represent viable alternatives to standard MSI testing in specific settings. The evolution of the standard molecular techniques has offered the opportunity to extend MSI determination to liquid biopsy based on the analysis of cell-free DNA (cfDNA) in plasma. This review aims at synthetizing the standard and emerging techniques used on tumour tissue samples for MSI/dMMR determination. We also provide insights into the MSI molecular techniques compatible with liquid biopsy and the potential clinical consequences for patients with solid cancers.
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Affiliation(s)
- Pauline Gilson
- Correspondence: ; Tel.: +33-(0)3-8365-6035; Fax: +33-(0)3-8365-6152
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Zhang X, Li C, Ye M, Hu Q, Hu J, Gong Z, Li J, Zhao X, Xu Y, Zhang D, Hou Y, Zhang X. Bronchial Washing Fluid Versus Plasma and Bronchoscopy Biopsy Samples for Detecting Epidermal Growth Factor Receptor Mutation Status in Lung Cancer. Front Oncol 2021; 11:602402. [PMID: 33828971 PMCID: PMC8020887 DOI: 10.3389/fonc.2021.602402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Bronchial washing fluid (BWF) is a common specimen collected during bronchoscopy and has been suggested to contain both tumor cells and cell-free DNA. However, there is no consensus on the feasibility of BWF in epidermal growth factor receptor (EGFR) genetic analysis because of the limited sample size and varying results in previous studies. This study compared the feasibility, sensitivity, and specificity of detecting EGFR mutation using BWF, bronchoscopy biopsy, and plasma samples in patients with lung cancer (LC). Materials and Methods A total of 144 patients (110 with LC and 34 without LC) were enrolled in the study. During diagnostic bronchoscopy for suspected LC lesions, bronchial washing with saline was performed directly or through a guide sheath. BWF was collected as well as paired bronchoscopy biopsy and plasma samples, and EGFR mutation testing was performed via highly sensitive blocker polymerase chain reaction. The EGFR mutation status of histologic samples was set as the standard reference. Results Compared with the histologic samples, the sensitivity, specificity, and concordance rate of EGFR mutation detected in BWF samples were 92.5%, 100%, and 97.9%, respectively. Moreover, BWF showed a higher sensitivity in EGFR mutation testing than both plasma (100% [8/8] vs. 62.5% [5/8], p = 0.095) and bronchoscopy biopsy samples (92.5% [37/40] vs. 77.5% [31/40], p = 0.012) and identified EGFR mutations in 6 cases whose biopsy failed to establish an LC diagnosis. The diameter of the target lesion and its contact degree with BWF were positive predictive factors for EGFR testing results. Conclusions BWF yields a high sensitivity in EGFR mutation testing, having high concordance with histologic samples, and presenting the benefit of rapid EGFR mutation detection in LC patients.
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Affiliation(s)
- Xinyu Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Li
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Maosong Ye
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qin Hu
- Department of Pathology Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziying Gong
- Department of R&D, Shanghai Yunying Medical Technology, Co. Ltd., Shanghai, China.,Department of R&D, Jiaxing Yunying Medical Inspection Co., Ltd., Jiaxing, China
| | - Jieyi Li
- Department of R&D, Shanghai Yunying Medical Technology, Co. Ltd., Shanghai, China.,Department of R&D, Jiaxing Yunying Medical Inspection Co., Ltd., Jiaxing, China
| | - Xiaokai Zhao
- Department of R&D, Shanghai Yunying Medical Technology, Co. Ltd., Shanghai, China.,Department of R&D, Jiaxing Yunying Medical Inspection Co., Ltd., Jiaxing, China
| | - Yiqing Xu
- Division of Hematology and Oncology, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States
| | - Daoyun Zhang
- Department of R&D, Shanghai Yunying Medical Technology, Co. Ltd., Shanghai, China.,Department of R&D, Jiaxing Yunying Medical Inspection Co., Ltd., Jiaxing, China
| | - Yingyong Hou
- Department of Pathology Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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Lei Y, Li X, Huang Q, Zheng X, Liu M. Progress and Challenges of Predictive Biomarkers for Immune Checkpoint Blockade. Front Oncol 2021; 11:617335. [PMID: 33777757 PMCID: PMC7992906 DOI: 10.3389/fonc.2021.617335] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/15/2021] [Indexed: 02/05/2023] Open
Abstract
Over the past decade, immune checkpoint blockade (ICB) therapy has revolutionized the outlook for oncology with significant and sustained improvement in the overall patient survival. Unlike traditional cancer therapies, which target the cancer cells directly, ICB acts on the immune system to enhance anti-tumoral immunity. However, the response rate is still far from satisfactory and most patients are refractory to such treatment. Unfortunately, the mechanisms underlying such heterogeneous responses between patients to ICB therapy remain unclear. In addition, escalating costs of cancer care and unnecessary immune-related adverse events also are pertinent considerations with applications of ICB. Given these issues, identifying explicit predictive biomarkers for patient selection is an urgent unmet need to increase the efficacy of ICB therapy. The markers can be classified as tumor related and non-tumor-related biomarkers. Although substantial efforts have been put into investigating various biomarkers, none of them has been found to be sufficient for effectively stratifying patients who may benefit from immunotherapy. The present write up is an attempt to review the various emerging clinically relevant biomarkers affecting the efficacy of immune checkpoint inhibitors, as well as the limitations associated with their clinical application.
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Affiliation(s)
- Yanna Lei
- Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoying Li
- Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Huang
- Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiufeng Zheng
- Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Abdominal Oncology, West China Hospital, Sichuan University, Chengdu, China
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Pérez-Barrios C, Sánchez-Herrero E, Garcia-Simón N, Barquín M, Clemente MB, Provencio M, Romero A. ctDNA from body fluids is an adequate source for EGFR biomarker testing in advanced lung adenocarcinoma. Clin Chem Lab Med 2021; 59:1221-1229. [PMID: 33691348 DOI: 10.1515/cclm-2020-1465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/01/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Epidermal growth factor receptor (EGFR) biomarker testing using blood-based liquid biopsies remains challenging due to the low concentration of circulating tumor DNA (ctDNA) in certain plasma samples. The aim of this study is to evaluate the usefulness for EGFR biomarker testing of ctDNA from pleural effusions, cerebrospinal fluids, ascites and pericardial effusions obtained during the clinical management of lung adenocarcinoma patients. METHODS For comparison purposes, 23 paired plasma and body fluid samples were collected from 17 patients with EGFR-positive lung adenocarcinoma. After circulating free DNA (cfDNA) isolation, samples were evaluated for the initial EGFR-sensitizing mutation and the p.T790M resistance mutation by array-based digital PCR (dPCR). RESULTS Body fluids had more cfDNA than plasma samples (1.90 vs. 0.36 ng/µL; p=0.0130), and more samples tested positive for EGFR mutations (21 vs. 16 samples), with a total of 28 vs. 22 variants detected. Furthermore, mutant allele frequencies (MAFs) observed in body fluids were significantly higher than those assessed in the paired plasma samples for EGFR-sensitizing mutations (median MAFs = 15.8 vs. 0.8%; p=0.0004) as well as for the p.T790M resistance mutation (median MAFs = 8.69 vs. 0.16%; p=0.0390). Importantly, two patients who had progressed on first-generation EGFR-tyrosine kinase inhibitors with a dubious result for p.T790M plasma (MAFs = 0.11%) had an indisputably positive result in their respective body fluid samples (MAFs = 10.25 and 9.66%). CONCLUSIONS ctDNA derived from body fluids is an informative source for EGFR biomarker testing, with greater sensitivity than plasma samples.
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Affiliation(s)
- Clara Pérez-Barrios
- Laboratory Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Estela Sánchez-Herrero
- Molecular Oncology Laboratory, Biomedical Sciences Research Institute, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Natalia Garcia-Simón
- Laboratory Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Miguel Barquín
- Molecular Oncology Laboratory, Biomedical Sciences Research Institute, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Mariola Blanco Clemente
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Atocha Romero
- Molecular Oncology Laboratory, Biomedical Sciences Research Institute, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.,Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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56
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Satapathy S, Singh V, Nambirajan A, Malik PS, Tanwar P, Mehta A, Suryavanshi M, Thulkar S, Mohan A, Jain D. EGFR mutation testing on plasma and urine samples: A pilot study evaluating the value of liquid biopsy in lung cancer diagnosis and management. Curr Probl Cancer 2021; 45:100722. [PMID: 33712318 DOI: 10.1016/j.currproblcancer.2021.100722] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 11/30/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cell free DNA (cfDNA) shed by cancer cells into blood and body fluids is a potential substrate for molecular testing. While plasma is approved for EGFR mutation testing in certain clinical settings, mutation testing on urine is not well explored in lung cancer. In this study, we assess the feasibility and diagnostic accuracy of EGFR mutation analysis on plasma and urine samples. METHODS Matched plasma and urine were collected prospectively from TKI-naïve lung adenocarcinoma (ADCA) patients (Group A) with available tumor tissue. Only plasma was collected from TKI-treated, known EGFR mutant ADCA patients developing TKI resistance (Group B). qPCR (tumor tissue) or digital droplet-PCR (urine/plasma) was performed for exon 19 deletions, exon 21 L858R and exon 20 T790M. RESULTS Eighty-one patients (60 Group A, 21 Group B) were included. In Group A, EGFR mutations were detected in tissue in 34/60 (57%) patients. Mutations were detected in matched plasma in 24 (24/34, 70.5% sensitivity), and in matched urine in 15 (15/25, 60% sensitivity) of the 34 EGFR mutant cases, with no false positives (100% positive predictive value). Plasma and urine mutation results showed moderate agreement (70%) with a combined sensitivity of 88% (22/25). In Group B, new T790M mutations were detected in plasma in 61% (13/21) patients. CONCLUSION Liquid biopsies show moderate sensitivity (plasma > urine) with 100% positive predictive rates for EGFR mutations. Testing of more than one type of liquid biopsy sample increases sensitivity. In TKI-resistant settings, liquid biopsies can obviate need for invasive biopsies in >60% patients.
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Affiliation(s)
| | - Varsha Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Pranay Tanwar
- Department of Laboratory Oncology, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Anurag Mehta
- Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Moushumi Suryavanshi
- Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiology, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
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Mojica W, Cwiklinski K, Jin X, Liu W, Yergeau D. Core needle biopsy wash as a tool for acquiring additional diagnostic material for laboratory testing. J Clin Pathol 2021; 75:345-349. [PMID: 33649141 DOI: 10.1136/jclinpath-2020-207318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 11/04/2022]
Abstract
AIMS To determine if a simple prewash step added to the processing workflow of tissue procurement by a core needle biopsy device will recover enough cells to expand the laboratory testing armamentarium. METHODS Tissue was obtained from unfixed resection specimens using a core needle device and washed in a buffered solution before fixation. This creates a liquid aliquot from which dislodged cells can be kept and separated from the tissue specimen, the latter of which can then undergo traditional formalin-fixed, paraffin-embedded processing. RESULTS Cells dislodged from the tissue during the biopsy procedure are recoverable, are representative of the tissue section and of sufficient quantities for additional laboratory testing. CONCLUSIONS The core needle biopsy wash is an under-recognised and underutilised approach to extending the diagnostic capabilities of the limited amount of targeted material obtained during this common procedure. The ability to recover supplemental amounts of diagnostic material yields great potential as a substrate for a multitude of current and developing laboratory assays.
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Affiliation(s)
- Wilfrido Mojica
- Pathology and Anatomical Sciences, University at Buffalo, Buffalo, New York, USA
| | | | - Xiaobing Jin
- Pathology and Anatomical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Weiguo Liu
- Pathology, New York University Medical Center, New York City, New York, USA
| | - Donald Yergeau
- NYS Center of Excellence in Bioinformatics and Life Sciences, UB Genomics and Bioinformatics Core, Buffalo, New York, USA
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Park C, Lee S, Lee JC, Choi C, Lee SY, Jang T, Oh I, Kim Y. Phase II open-label multicenter study to assess the antitumor activity of afatinib in lung cancer patients with activating epidermal growth factor receptor mutation from circulating tumor DNA: Liquid-Lung-A. Thorac Cancer 2021; 12:444-452. [PMID: 33270375 PMCID: PMC7882376 DOI: 10.1111/1759-7714.13763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Mutation analysis of circulating tumor DNA (ctDNA) is used for diagnosing lung cancer. This trial aimed to assess the efficacy of afatinib in treatment-naïve patients with lung cancer harboring epidermal growth factor receptor mutations (EGFRm, exon 19 deletions or exon 21 point mutations) detected based on ctDNA. METHODS The primary objective was the objective response rate (ORR) in the response evaluable (RE) population. EGFRm analysis of ctDNA was performed using PANA Mutype. Of the 331 patients screened, ctDNA was positive in 21% (68/331) in the detection of activating EGFRm. Among 81 subjects with tumor EGFRm, 48 showed matched EGFRm in their ctDNA (59% sensitivity). RESULTS Therapy with afatinib 40 mg was initiated in 21 (female, 17; adenocarcinoma, 20) patients (intention-to-treat, ITT); dose modifications were made in 15 (71%). The ORR was 74% in the RE population (14/19); 11 patients showed EGFRm only in ctDNA (Group A), whereas 10 exhibited the same EGFRm in their ctDNA and tumor DNA (Group B). There was no significant difference in ORR between Groups A and B (80% and 67% RE, respectively). Median progression-free survival (PFS) was 12.0 months, and no significant difference was observed according to the final afatinib dose, type of EGFRm, and Group A versus B. After progression, T790M mutation was found in 40% (6/15) of patients, and osimertinib was used as a second-line treatment. CONCLUSIONS Afatinib showed similar ORR and PFS in patients with lung cancer harboring EGFRm in their ctDNA regardless of tumor EGFRm results. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Afatinib showed favorable ORR and PFS regardless of the tumor EGFR mutation status results, similar to the findings of previous trials assessing afatinib as first-line treatment of EGFR-mutated non-small cell lung cancer based on tumor genotyping. WHAT THIS STUDY ADDS Our findings emphasize that the survival benefit of afatinib treatment can be achieved not only by appropriate dose reduction with frequent and detailed monitoring of toxicities, but also by using noninvasive (ctDNA) assays in a real-world setting.
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Affiliation(s)
- Cheol‐Kyu Park
- Department of Internal MedicineChonnam National University Medical School and CNU Hwasun HospitalHwasunJeonnamKorea
| | - Sung‐Yong Lee
- Department of Internal MedicineKorea University Guro HospitalSeoulKorea
| | - Jae Cheol Lee
- Department of Oncology, Pulmonary and Critical Care MedicineCollege of Medicine, University of Ulsan, Asan Medical CenterSeoulKorea
| | - Chang‐Min Choi
- Department of Oncology, Pulmonary and Critical Care MedicineCollege of Medicine, University of Ulsan, Asan Medical CenterSeoulKorea
| | - Shin Yup Lee
- Department of Internal Medicine, School of MedicineKyungpook National UniversityDaeguKorea
| | - Tae‐Won Jang
- Department of Internal Medicine, School of MedicineKosin University Gospel HospitalPusanKorea
| | - In‐Jae Oh
- Department of Internal MedicineChonnam National University Medical School and CNU Hwasun HospitalHwasunJeonnamKorea
| | - Young‐Chul Kim
- Department of Internal MedicineChonnam National University Medical School and CNU Hwasun HospitalHwasunJeonnamKorea
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Vasantharajan SS, Eccles MR, Rodger EJ, Pattison S, McCall JL, Gray ES, Calapre L, Chatterjee A. The Epigenetic landscape of Circulating tumour cells. Biochim Biophys Acta Rev Cancer 2021; 1875:188514. [PMID: 33497709 DOI: 10.1016/j.bbcan.2021.188514] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/31/2022]
Abstract
Cancer metastasis is the main reason for the high mortality in patients, contributing to 90% of cancer-related deaths. Biomarkers for early detection and therapeutic monitoring are essential to improve cancer outcomes. Circulating tumour cells (CTCs) arise from solid tumours and are capable of metastatic dissemination via the bloodstream or lymphatic system. Thus, CTCs can potentially be developed as a minimally invasive biomarker for early detection and therapeutic monitoring. Despite its clinical potential, research on CTCs remains limited, and this is likely due to their low numbers, short half-life, and the lack of robust methods for their isolation. There is also a need for molecular characterisation of CTCs to identify tumour-specific features, such as epigenetic signatures of metastasis. This review provides an overview of the epigenetic landscape of CTCs. We discuss the role of epigenetic modifications in CTC dissemination,metastatic tumour formation and progression and highlight its clinical implications.
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Affiliation(s)
| | - Michael R Eccles
- Department of Pathology, Otago Medical School-Dunedin Campus, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, Level 2, 3A Symonds Street, Auckland 1010, New Zealand.
| | - Euan J Rodger
- Department of Pathology, Otago Medical School-Dunedin Campus, New Zealand.
| | - Sharon Pattison
- Department of Medicine, Otago Medical School-Dunedin Campus, New Zealand.
| | - John L McCall
- Department of Surgical Sciences, Otago Medical School-Dunedin Campus, New Zealand.
| | - Elin S Gray
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia.
| | - Leslie Calapre
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia.
| | - Aniruddha Chatterjee
- Department of Pathology, Otago Medical School-Dunedin Campus, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, Level 2, 3A Symonds Street, Auckland 1010, New Zealand.
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60
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Nesvet JC, Antilla KA, Pancirer DS, Lozano AX, Preiss JS, Ma W, Fu A, Park SM, Gambhir SS, Fan AC, Neal JW, Padda SK, Das M, Li T, Wakelee HA, Wang SX. Giant Magnetoresistive Nanosensor Analysis of Circulating Tumor DNA Epidermal Growth Factor Receptor Mutations for Diagnosis and Therapy Response Monitoring. Clin Chem 2021; 67:534-542. [PMID: 33393992 DOI: 10.1093/clinchem/hvaa307] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Liquid biopsy circulating tumor DNA (ctDNA) mutational analysis holds great promises for precision medicine targeted therapy and more effective cancer management. However, its wide adoption is hampered by high cost and long turnaround time of sequencing assays, or by inadequate analytical sensitivity of existing portable nucleic acid tests to mutant allelic fraction in ctDNA. METHODS We developed a ctDNA Epidermal Growth Factor Receptor (EGFR) mutational assay using giant magnetoresistive (GMR) nanosensors. This assay was validated in 36 plasma samples of non-small cell lung cancer patients with known EGFR mutations. We assessed therapy response through follow-up blood draws, determined concordance between the GMR assay and radiographic response, and ascertained progression-free survival of patients. RESULTS The GMR assay achieved analytical sensitivities of 0.01% mutant allelic fraction. In clinical samples, the assay had 87.5% sensitivity (95% CI = 64.0-97.8%) for Exon19 deletion and 90% sensitivity (95% CI = 69.9-98.2%) for L858R mutation with 100% specificity; our assay detected T790M resistance with 96.3% specificity (95% CI = 81.7-99.8%) with 100% sensitivity. After 2 weeks of therapy, 10 patients showed disappearance of ctDNA by GMR (predicted responders), whereas 3 patients did not (predicted nonresponders). These predictions were 100% concordant with radiographic response. Kaplan-Meier analysis showed responders had significantly (P < 0.0001) longer PFS compared to nonresponders (N/A vs. 12 weeks, respectively). CONCLUSIONS The GMR assay has high diagnostic sensitivity and specificity and is well suited for detecting EGFR mutations at diagnosis and noninvasively monitoring treatment response at the point-of-care.
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Affiliation(s)
- Jared C Nesvet
- Department of Chemistry, Stanford University, Stanford, CA, USA
| | - Katie A Antilla
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Danielle S Pancirer
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexander X Lozano
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jordan S Preiss
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Weijie Ma
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | | | - Seung-Min Park
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.,Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Sanjiv S Gambhir
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.,Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA.,Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Alice C Fan
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joel W Neal
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Sukhmani K Padda
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Millie Das
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,VA Palo Alto Healthcare System, Department of Medicine, Palo Alto, CA, USA
| | - Tianhong Li
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Heather A Wakelee
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shan X Wang
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA.,Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Electrical Engineering, Stanford University, Stanford, CA, USA
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61
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Liquid Biopsies: New Technology and Evidence. Lung Cancer 2021. [DOI: 10.1007/978-3-030-74028-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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62
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Prabhash K. Treatment of advanced nonsmall cell lung cancer: First line, maintenance and second line - Indian consensus statement update. South Asian J Cancer 2020; 8:1-17. [PMID: 30766843 PMCID: PMC6348782 DOI: 10.4103/sajc.sajc_227_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming increasingly complex with the identification of driver mutations/rearrangements and development/availability of appropriate targeted therapies. In 2017, an expert group of medical oncologists with expertise in treating lung cancer used data from published literature and experience to arrive at practical consensus recommendations on treatment of advanced NSCLC for use by the community oncologists. This was published subsequently in the Indian Journal of Cancer with a plan to be updated annually. The present document is an update to the 2017 document.
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Affiliation(s)
- Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Tomasini P, Barlesi F, Gilles S, Nanni-Metellus I, Soffietti R, Denicolai E, Pellegrino E, Bialecki E, Ouafik L, Metellus P. Comparative genomic analysis of primary tumors and paired brain metastases in lung cancer patients by whole exome sequencing: a pilot study. Oncotarget 2020; 11:4648-4654. [PMID: 33400739 PMCID: PMC7747858 DOI: 10.18632/oncotarget.27837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022] Open
Abstract
Lung cancer brain metastases (BMs) are frequent and associated with poor prognosis despite a better knowledge of lung cancer biology and the development of targeted therapies. The inconstant intracranial response to systemic treatments is partially due to tumor heterogeneity between the primary lung tumor (PLT) and BMs. There is therefore a need for a better understanding of lung cancer BMs biology to improve treatment strategies for these patients. We conducted a study of whole exome sequencing of paired BM and PLT samples. The number of somatic variants and chromosomal alterations was higher in BM samples. We identified recurrent mutations in BMs not found in PLT. Phylogenic trees and lollipop plots were designed to describe their functional impact. Among the 13 genes mutated in ≥ 1 BM, 7 were previously described to be associated with invasion process, including 3 with recurrent mutations in functional domains which may be future targets for therapy. We provide with some insights about the mechanisms leading to BMs. We found recurrent mutations in BM samples in 13 genes. Among these genes, 7 were previously described to be associated with cancer and 3 of them (CCDC178, RUNX1T1, MUC2) were described to be associated with the metastatic process.
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Affiliation(s)
- Pascale Tomasini
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology & Therapeutic Innovations Department, Marseille, France.,Predictive Oncology Laboratory, Centre de Recherche en Cancérologie de Marseille, Inserm UMR1068, CNRS UMR7258, Aix-Marseille Université UM105, Marseille, France
| | - Fabrice Barlesi
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology & Therapeutic Innovations Department, Marseille, France.,Predictive Oncology Laboratory, Centre de Recherche en Cancérologie de Marseille, Inserm UMR1068, CNRS UMR7258, Aix-Marseille Université UM105, Marseille, France
| | - Sophie Gilles
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, CHU Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - Isabelle Nanni-Metellus
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, CHU Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - Riccardo Soffietti
- Department of Neuro Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Emilie Denicolai
- Predictive Oncology Laboratory, Centre de Recherche en Cancérologie de Marseille, Inserm UMR1068, CNRS UMR7258, Aix-Marseille Université UM105, Marseille, France
| | - Eric Pellegrino
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, CHU Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - Emilie Bialecki
- Ramsay Santé, Hôpital Privé Clairval, Département de Neurochirurgie, Marseille, France
| | - L'Houcine Ouafik
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, CHU Nord, Service de Transfert d'Oncologie Biologique, Marseille, France.,Aix-Marseille University, CNRS UMR 7051, Institut de Neurophysiopathologie, Marseille, France
| | - Philippe Metellus
- Ramsay Santé, Hôpital Privé Clairval, Département de Neurochirurgie, Marseille, France.,Aix-Marseille University, CNRS UMR 7051, Institut de Neurophysiopathologie, Marseille, France
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Siggillino A, Ulivi P, Pasini L, Reda MS, Chiadini E, Tofanetti FR, Baglivo S, Metro G, Crinó L, Delmonte A, Minotti V, Roila F, Ludovini V. Detection of EGFR Mutations in Plasma Cell-Free Tumor DNA of TKI-Treated Advanced-NSCLC Patients by Three Methodologies: Scorpion-ARMS, PNAClamp, and Digital PCR. Diagnostics (Basel) 2020; 10:diagnostics10121062. [PMID: 33297595 PMCID: PMC7762356 DOI: 10.3390/diagnostics10121062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Analysis of circulating cell-free tumor DNA (cftDNA) has emerged as a specific and sensitive blood-based approach to detect epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) patients. Still, there is some debate on what should be the preferential clinical method for plasma-derived cftDNA analysis. We tested 31 NSCLC patients treated with anti-EGFR tyrosine kinase inhibitors (TKIs), at baseline and serially during therapy, by comparing three methodologies in detecting EGFR mutations (L858R, exon 19 deletion, and T790M) from plasma: scorpions-amplification refractory mutation system (ARMS) methodology by using EGFR Plasma RGQ PCR Kit-QIAGEN, peptide nucleic acid (PNA) clamp and PANA RealTyper integration by using PNAClamp EGFR-PANAGENE, and digital real time PCR by using QuantStudio 3D Digital PCR System-Thermo Fisher Scientific. Specificity was 100% for all three mutations, independently from the platform used. The sensitivity for L858R (42.86%) and T790M (100%) did not change based on the method, while the sensitivity for Del 19 differed markedly (Scorpion-ARMS 45%, PNAClamp 75%, and Digital PCR 85%). The detection rate was also higher (94.23%) as measured by Digital PCR, and when we monitored the evolution of EGFR mutations over time, it evidenced the extreme inter-patient heterogeneity in terms of levels of circulating mutated copies. In our study, Digital PCR showed the best correlation with tissue biopsy and the highest sensitivity to attain the potential clinical utility of monitoring plasma levels of EGFR mutations.
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Affiliation(s)
- Annamaria Siggillino
- Medical Oncology Division, S. Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.S.); (M.S.R.); (F.R.T.); (S.B.); (G.M.); (V.M.); (F.R.); (V.L.)
| | - Paola Ulivi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (P.U.); (E.C.)
| | - Luigi Pasini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (P.U.); (E.C.)
- Correspondence:
| | - Maria Sole Reda
- Medical Oncology Division, S. Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.S.); (M.S.R.); (F.R.T.); (S.B.); (G.M.); (V.M.); (F.R.); (V.L.)
| | - Elisa Chiadini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (P.U.); (E.C.)
| | - Francesca Romana Tofanetti
- Medical Oncology Division, S. Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.S.); (M.S.R.); (F.R.T.); (S.B.); (G.M.); (V.M.); (F.R.); (V.L.)
| | - Sara Baglivo
- Medical Oncology Division, S. Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.S.); (M.S.R.); (F.R.T.); (S.B.); (G.M.); (V.M.); (F.R.); (V.L.)
| | - Giulio Metro
- Medical Oncology Division, S. Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.S.); (M.S.R.); (F.R.T.); (S.B.); (G.M.); (V.M.); (F.R.); (V.L.)
| | - Lucio Crinó
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (L.C.); (A.D.)
| | - Angelo Delmonte
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (L.C.); (A.D.)
| | - Vincenzo Minotti
- Medical Oncology Division, S. Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.S.); (M.S.R.); (F.R.T.); (S.B.); (G.M.); (V.M.); (F.R.); (V.L.)
| | - Fausto Roila
- Medical Oncology Division, S. Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.S.); (M.S.R.); (F.R.T.); (S.B.); (G.M.); (V.M.); (F.R.); (V.L.)
| | - Vienna Ludovini
- Medical Oncology Division, S. Maria della Misericordia Hospital, 06132 Perugia, Italy; (A.S.); (M.S.R.); (F.R.T.); (S.B.); (G.M.); (V.M.); (F.R.); (V.L.)
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65
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Taylor C, Chacko S, Davey M, Lacroix J, MacPherson A, Finn N, Wajnberg G, Ghosh A, Crapoulet N, Lewis SM, Ouellette RJ. Peptide-Affinity Precipitation of Extracellular Vesicles and Cell-Free DNA Improves Sequencing Performance for the Detection of Pathogenic Mutations in Lung Cancer Patient Plasma. Int J Mol Sci 2020; 21:E9083. [PMID: 33260345 PMCID: PMC7730179 DOI: 10.3390/ijms21239083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
Liquid biopsy is a minimally-invasive diagnostic method that may improve access to molecular profiling for non-small cell lung cancer (NSCLC) patients. Although cell-free DNA (cf-DNA) isolation from plasma is the standard liquid biopsy method for detecting DNA mutations in cancer patients, the sensitivity can be highly variable. Vn96 is a peptide with an affinity for both extracellular vesicles (EVs) and circulating cf-DNA. In this study, we evaluated whether peptide-affinity (PA) precipitation of EVs and cf-DNA from NSCLC patient plasma improves the sensitivity of single nucleotide variants (SNVs) detection and compared observed SNVs with those reported in the matched tissue biopsy. NSCLC patient plasma was subjected to either PA precipitation or cell-free methods and total nucleic acid (TNA) was extracted; SNVs were then detected by next-generation sequencing (NGS). PA led to increased recovery of DNA as well as an improvement in NGS sequencing parameters when compared to cf-TNA. Reduced concordance with tissue was observed in PA-TNA (62%) compared to cf-TNA (81%), mainly due to identification of SNVs in PA-TNA that were not observed in tissue. EGFR mutations were detected in PA-TNA with 83% sensitivity and 100% specificity. In conclusion, PA-TNA may improve the detection limits of low-abundance alleles using NGS.
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Affiliation(s)
- Catherine Taylor
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
| | - Simi Chacko
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
| | - Michelle Davey
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
| | - Jacynthe Lacroix
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
| | - Alexander MacPherson
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
| | - Nicholas Finn
- Dr Léon-Richard Oncology Center, Moncton, NB E1C 8X3, Canada;
| | - Gabriel Wajnberg
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
| | - Anirban Ghosh
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
| | - Nicolas Crapoulet
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
| | - Stephen M. Lewis
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
- Department of Chemistry & Biochemistry, Université de Moncton, Moncton, NB E1A 3E9, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, NS B3H 4R2, Canada
| | - Rodney J. Ouellette
- Atlantic Cancer Research Institute, Moncton, NB E1C 8X3, Canada; (C.T.); (S.C.); (M.D.); (J.L.); (A.M.); (G.W.); (A.G.); (N.C.); (S.M.L.)
- Department of Chemistry & Biochemistry, Université de Moncton, Moncton, NB E1A 3E9, Canada
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66
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The Role of the Liquid Biopsy in Decision-Making for Patients with Non-Small Cell Lung Cancer. J Clin Med 2020; 9:jcm9113674. [PMID: 33207619 PMCID: PMC7696948 DOI: 10.3390/jcm9113674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022] Open
Abstract
Liquid biopsy is a rapidly emerging tool of precision oncology enabling minimally invasive molecular diagnostics and longitudinal monitoring of treatment response. For the clinical management of advanced stage lung cancer patients, detection and quantification of circulating tumor DNA (ctDNA) is now widely adopted into clinical practice. Still, interpretation of results and validation of ctDNA-based treatment decisions remain challenging. We report here our experience implementing liquid biopsies into the clinical management of lung cancer. We discuss advantages and limitations of distinct ctDNA assay techniques and highlight our approach to the analysis of recurrent molecular alterations found in lung cancer. Moreover, we report three exemplary clinical cases illustrating the complexity of interpreting liquid biopsy results in clinical practice. These cases underscore the potential and current limitations of liquid biopsy, focusing on the difficulty of interpreting discordant findings. In our view, despite all current limitations, the analysis of ctDNA in lung cancer patients is an essential and highly versatile complementary diagnostic tool for the clinical management of lung cancer patients in the era of precision oncology.
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67
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Marcu LG. Imaging Biomarkers of Tumour Proliferation and Invasion for Personalised Lung Cancer Therapy. J Pers Med 2020; 10:jpm10040222. [PMID: 33198090 PMCID: PMC7711676 DOI: 10.3390/jpm10040222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 12/28/2022] Open
Abstract
Personalised treatment in oncology has seen great developments over the last decade, due to both technological advances and more in-depth knowledge of radiobiological processes occurring in tumours. Lung cancer therapy is no exception, as new molecular targets have been identified to further increase treatment specificity and sensitivity. Yet, tumour resistance to treatment is still one of the main reasons for treatment failure. This is due to a number of factors, among which tumour proliferation, the presence of cancer stem cells and the metastatic potential of the primary tumour are key features that require better controlling to further improve cancer management in general, and lung cancer treatment in particular. Imaging biomarkers play a key role in the identification of biological particularities within tumours and therefore are an important component of treatment personalisation in radiotherapy. Imaging techniques such as PET, SPECT, MRI that employ tumour-specific biomarkers already play a critical role in patient stratification towards individualized treatment. The aim of the current paper is to describe the radiobiological challenges of lung cancer treatment in relation to the latest imaging biomarkers that can aid in the identification of hostile cellular features for further treatment adaptation and tailoring to the individual patient’s needs.
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Affiliation(s)
- Loredana G. Marcu
- Faculty of Informatics and Science, University of Oradea, 410087 Oradea, Romania;
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
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68
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Silveira AB, Bidard FC, Kasperek A, Melaabi S, Tanguy ML, Rodrigues M, Bataillon G, Cabel L, Buecher B, Pierga JY, Proudhon C, Stern MH. High-Accuracy Determination of Microsatellite Instability Compatible with Liquid Biopsies. Clin Chem 2020; 66:606-613. [PMID: 32176763 DOI: 10.1093/clinchem/hvaa013] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/30/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Microsatellite instability (MSI) has recently emerged as a predictive pan-tumor biomarker of immunotherapy efficacy, stimulating the development of diagnostic tools compatible with large-scale screening of patients. In this context, noninvasive detection of MSI from circulating tumor DNA stands as a promising diagnostic and posttreatment monitoring tool. METHODS We developed drop-off droplet-digital PCR (ddPCR) assays targeting BAT-26, activin A receptor type 2A (ACVR2A), and defensin beta 105A/B (DEFB105A/B) microsatellite markers. Performances of the assays were measured on reconstitution experiments of various mutant allelic fractions, on 185 tumor samples with known MSI status, and on 72 blood samples collected from 42 patients with advanced colorectal or endometrial cancers before and/or during therapy. RESULTS The 3 ddPCR assays reached analytical sensitivity <0.1% variant allelic frequency and could reliably detect and quantify MSI in both tumor and body fluid samples. High concordance between MSI status determination by the three-marker ddPCR test and the reference pentaplex method were observed (100% for colorectal tumors and 93% for other tumor types). Moreover, the 3 assays showed correlations with r ≥ 0.99 with other circulating tumor DNA markers and their dynamic during treatment correlated well with clinical response. CONCLUSIONS This innovative approach for MSI detection provides a noninvasive, cost-effective, and fast diagnostic tool, well suited for large-scale screening of patients that may benefit from immunotherapy agents, as well as for monitoring treatment responses.
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Affiliation(s)
- Amanda Bortolini Silveira
- Circulating Tumor Biomarkers Laboratory, Institut Curie, PSL Research University, INSERM CIC 1428, Paris, France
| | - François-Clément Bidard
- Circulating Tumor Biomarkers Laboratory, Institut Curie, PSL Research University, INSERM CIC 1428, Paris, France.,Department of Medical Oncology, Institut Curie, Paris, France.,Versailles Saint Quentin en Yvelines University, Paris Saclay University, Saint Cloud, Paris, France
| | - Amélie Kasperek
- Circulating Tumor Biomarkers Laboratory, Institut Curie, PSL Research University, INSERM CIC 1428, Paris, France
| | - Samia Melaabi
- Department of Biopathology, Institut Curie, Paris, France
| | | | - Manuel Rodrigues
- Department of Medical Oncology, Institut Curie, Paris, France.,Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.) team, Equipe labellisée par la Ligue Nationale Contre le Cancer, Institut Curie, Paris, France
| | | | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Paris, France.,Versailles Saint Quentin en Yvelines University, Paris Saclay University, Saint Cloud, Paris, France
| | - Bruno Buecher
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Jean-Yves Pierga
- Circulating Tumor Biomarkers Laboratory, Institut Curie, PSL Research University, INSERM CIC 1428, Paris, France.,Department of Medical Oncology, Institut Curie, Paris, France.,Paris University, Paris, France
| | - Charlotte Proudhon
- Circulating Tumor Biomarkers Laboratory, Institut Curie, PSL Research University, INSERM CIC 1428, Paris, France
| | - Marc-Henri Stern
- Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.) team, Equipe labellisée par la Ligue Nationale Contre le Cancer, Institut Curie, Paris, France
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69
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Cecchini MJ, Yi ES. Liquid biopsy is a valuable tool in the diagnosis and management of lung cancer. J Thorac Dis 2020; 12:7048-7056. [PMID: 33282410 PMCID: PMC7711358 DOI: 10.21037/jtd.2020.04.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Liquid biopsy refers to the use of various body fluids to test for circulating biological elements derived from the tumor. Liquid biopsy has taken on an increasingly important role in lung cancer diagnosis, molecular characterization, surveillance, monitoring, and determining mechanisms of resistance. These assays can utilize various sources of cell-free DNA (cfDNA) including blood, pleural fluid, urine, and others to detect tumor associated alterations. With the increasing power of next-generation sequencing technologies and the development of assays such as digital droplet PCR, rare tumor alleles can be detected in cfDNA to determine key characteristics of the tumor. Current assays, while effective, are still challenged by limited sensitivity and capacity to single genes or small panels of genes, though this is rapidly expanding. Nevertheless, testing of cfDNA has been shown to be valuable in detecting resistance to targeted inhibitors, particularly for detection of T790M in EGFR and monitoring response to therapy. With the continued development of more powerful and sensitive assays, these techniques will empower clinicians to better characterize early stage disease and can be used in the screening of high-risk patients, which may eliminate the requirement for tissue diagnosis in some settings. That said, since the majority of these alterations are not specific to lung cancer, there will continue to be a need for tissue in at least the initial diagnosis. Used in conjugation with tissue sampling, these assays will assist the treating clinician and the pathologist to better characterize individual tumors, even in the setting of limited tissue.
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Affiliation(s)
- Matthew J Cecchini
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Eunhee S Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
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Lamy PJ, van der Leest P, Lozano N, Becht C, Duboeuf F, Groen HJM, Hilgers W, Pourel N, Rifaela N, Schuuring E, Alix-Panabières C. Mass Spectrometry as a Highly Sensitive Method for Specific Circulating Tumor DNA Analysis in NSCLC: A Comparison Study. Cancers (Basel) 2020; 12:cancers12103002. [PMID: 33081150 PMCID: PMC7602843 DOI: 10.3390/cancers12103002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022] Open
Abstract
Simple Summary We compared the UltraSEEK™ Lung Panel on the MassARRAY® System (Agena Bioscience) with the FDA-approved Cobas® EGFR Mutation Test v2 for the detection of EGFR mutations in liquid biopsies of NSCLC patients, accompanied with preanalytical sample assessment using the novel Liquid IQ® Panel. For the detection of relevant predictive mutations using the UltraSEEK™ Lung Panel, an input of over 10 ng showed 100% concordance with Cobas® EGFR Mutation Test v2 and detection of all tissue confirmed mutations. In case of lower ccfDNA input, the risk of missing clinically relevant mutations should be considered. The use of a preanalytical ccfDNA quality control assay such as the Liquid IQ® Panel is recommended to confidently interpret results, avoiding bias induced by non-specific genomic DNA and low input of specific tumoral ccfDNA fragments. Abstract Plasma-based tumor mutational profiling is arising as a reliable approach to detect primary and therapy-induced resistance mutations required for accurate treatment decision making. Here, we compared the FDA-approved Cobas® EGFR Mutation Test v2 with the UltraSEEK™ Lung Panel on the MassARRAY® System on detection of EGFR mutations, accompanied with preanalytical sample assessment using the novel Liquid IQ® Panel. 137 cancer patient-derived cell-free plasma samples were analyzed with the Cobas® and UltraSEEK™ tests. Liquid IQ® analysis was initially validated (n = 84) and used to determine ccfDNA input for all samples. Subsequently, Liquid IQ® results were applied to harmonize ccfDNA input for the Cobas® and UltraSEEK™ tests for 63 NSCLC patients. The overall concordance between the Cobas® and UltraSEEK™ tests was 86%. The Cobas® test detected more EGFR exon19 deletions and L858R mutations, while the UltraSEEK™ test detected more T790M mutations. A 100% concordance in both the clinical (n = 137) and harmonized (n = 63) cohorts was observed when >10 ng of ccfDNA was used as determined by the Liquid IQ® Panel. The Cobas® and UltraSEEK™ tests showed similar sensitivity in EGFR mutation detection, particularly when ccfDNA input was sufficient. It is recommended to preanalytically determine the ccfDNA concentration accurately to ensure sufficient input for reliable interpretation and treatment decision making.
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Affiliation(s)
- Pierre-Jean Lamy
- Biopathologie et Génétique des Cancers, Institute d’Analyse Médicale Imagenome, Inovie, 6 Rue Fontenille, 34000 Montpellier, France;
- Correspondence: ; Tel.: +33-430-053-100
| | - Paul van der Leest
- Department of Pathology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (P.v.d.L.); (N.R.); (E.S.)
| | - Nicolas Lozano
- Biopathologie et Génétique des Cancers, Institute d’Analyse Médicale Imagenome, Inovie, 6 Rue Fontenille, 34000 Montpellier, France;
| | - Catherine Becht
- Oncologie Médicale, Clinique Clémenville, 25 rue Clémenville, 34000 Montpellier, France; (C.B.); (F.D.)
| | - Frédérique Duboeuf
- Oncologie Médicale, Clinique Clémenville, 25 rue Clémenville, 34000 Montpellier, France; (C.B.); (F.D.)
| | - Harry J. M. Groen
- Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Werner Hilgers
- Oncologie Médicale, Institute Sainte Catherine, 250 Chemin de Baigne Pieds, 84918 Avignon, France; (W.H.); (N.P.)
| | - Nicolas Pourel
- Oncologie Médicale, Institute Sainte Catherine, 250 Chemin de Baigne Pieds, 84918 Avignon, France; (W.H.); (N.P.)
| | - Naomi Rifaela
- Department of Pathology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (P.v.d.L.); (N.R.); (E.S.)
| | - Ed Schuuring
- Department of Pathology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (P.v.d.L.); (N.R.); (E.S.)
| | - Catherine Alix-Panabières
- Laboratoire de Cellules Rares Circulantes, University Medical Center of Montpellier, 641, Avenue du Doyen Gaston GIRAUD, 34093 Montpellier, France;
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Park CK, Cho HJ, Choi YD, Oh IJ, Kim YC. A Phase II Trial of Osimertinib as the First-Line Treatment of Non-Small Cell Lung Cancer Harboring Activating EGFR Mutations in Circulating Tumor DNA: LiquidLung-O-Cohort 1. Cancer Res Treat 2020; 53:93-103. [PMID: 32972042 PMCID: PMC7812005 DOI: 10.4143/crt.2020.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/17/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Osimertinib is a potent, irreversible third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor for both EGFR-activating and T790M resistant mutation. The treatment efficacy of osimertinib was assessed in previously untreated patients with metastatic non–small cell lung carcinoma (NSCLC) harboring activating EGFR mutations in circulating tumor DNA (ctDNA) as well as tumor DNA. Materials and Methods Patients with activating EGFR mutations in their tumor DNA underwent screening with ctDNA analysis using Mutyper and Cobas v2 assays. Enrolled subjects received osimertinib 80 mg, once daily. Primary endpoint was objective response rate (ORR) and secondary endpoints were ctDNA test sensitivity, progression-free survival (PFS), duration of response (DoR), and safety. Results Among 39 screened patients, 29 were ctDNA positive for activating EGFR mutations and 19 were enrolled (ex19del, n=11; L858R/L861Q, n=7; G719A, n=1). Median age was 70 and most patients had brain metastases (15/19, 79%). ctDNA test sensitivity for activating EGFR mutations was 74% using both methods and 62% (Mutyper) or 64% (Cobas v2) for individual methods. ORR was 68% (13/19), median PFS was 11.1 months (95% confidence interval [CI], 0.0 to 26.7), and median DoR was 17.6 months (95% CI, 3.5 to 31.7). ORR and median PFS were significantly superior with ex19del (91%; 21.9 months; 95% CI, 5.5 to 38.3) than with L858R/L861Q (43%; 5.1 months; 95% CI, 2.3 to 7.9). One patient discontinued the drug because of drug-related interstitial pneumonitis. Conclusion Osimertinib had favorable efficacy in the first-line treatment of metastatic NSCLC harboring activating EGFR mutations in ctDNA as well as tumor DNA.
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Affiliation(s)
- Cheol-Kyu Park
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyun-Ju Cho
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
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72
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Beyond tissue biopsy: a diagnostic framework to address tumor heterogeneity in lung cancer. Curr Opin Oncol 2020; 32:68-77. [PMID: 31714259 DOI: 10.1097/cco.0000000000000598] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The objective of this review is to discuss the strength and limitations of tissue and liquid biopsy and functional imaging to capture spatial and temporal tumor heterogeneity either alone or as part of a diagnostic framework in non-small cell lung cancer (NSCLC). RECENT FINDINGS NSCLC displays genetic and phenotypic heterogeneity - a detailed knowledge of which is crucial to personalize treatment. Tissue biopsy often lacks spatial and temporal resolution. Thus, NSCLC needs to be characterized by complementary diagnostic methods to resolve heterogeneity. Liquid biopsy offers detection of tumor biomarkers and for example, the classification and monitoring of EGFR mutations in NSCLC. It allows repeated sampling, and therefore, appears promising to address temporal aspects of tumor heterogeneity. Functional imaging methods and emerging image analytic tools, such as radiomics capture temporal and spatial heterogeneity. Further standardization of radiomics is required to allow introduction into clinical routine. SUMMARY To augment the potential of precision therapy, improved diagnostic characterization of tumors is pivotal. We suggest a comprehensive diagnostic framework combining tissue and liquid biopsy and functional imaging to address the known aspects of spatial and temporal tumor heterogeneity on the example of NSCLC. We envision how this framework might be implemented in clinical practice.
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Mildner F, Sopper S, Amann A, Pircher A, Pall G, Köck S, Naismith E, Wolf D, Gamerith G. Systematic review: Soluble immunological biomarkers in advanced non-small-cell lung cancer (NSCLC). Crit Rev Oncol Hematol 2020; 153:102948. [PMID: 32645684 DOI: 10.1016/j.critrevonc.2020.102948] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 01/05/2023] Open
Abstract
In the highly dynamic field of advanced malignancies, biomarkers from liquid samples are urgently needed to improve treatment tailoring. However, the heterogenic data lack direct comparison of assays, vectors and relevant validations are rarely found. Therefore, we classified the available studies based on three categories: Measured vectors, applied technique and detected biomarker. High blood tumor mutational burden and low baseline levels of soluble programmed cell death 1 ligand 1 (PD-L1) appear to predict treatment responses to immunotherapy. A high PD-1+ CD4+ T-cell count was associated with poor overall survival, PD-1+CD8+ T-cells connect to a favorable outcome. Circulating tumor cells expressing PD-L1 were mainly associated with poor overall survival and treatment failure. CONCLUSION: Measurement of immunological factors as liquid biomarkers is feasible and has shown promising results. The use of coherent nomenclatures, cross-platform assay comparisons and validations through appropriate powered clinical trials are urgently required to push this auspicious field.
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Affiliation(s)
- Finn Mildner
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A- 6020, Innsbruck, Austria; Tiroler Krebsforschung Institut (TKFI), Innrain 66, A-6020, Innsbruck, Austria
| | - Sieghart Sopper
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A- 6020, Innsbruck, Austria; Tiroler Krebsforschung Institut (TKFI), Innrain 66, A-6020, Innsbruck, Austria
| | - Arno Amann
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A- 6020, Innsbruck, Austria; Tiroler Krebsforschung Institut (TKFI), Innrain 66, A-6020, Innsbruck, Austria
| | - Andreas Pircher
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A- 6020, Innsbruck, Austria
| | - Georg Pall
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A- 6020, Innsbruck, Austria
| | - Stefan Köck
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A- 6020, Innsbruck, Austria; Tiroler Krebsforschung Institut (TKFI), Innrain 66, A-6020, Innsbruck, Austria
| | - Erin Naismith
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A- 6020, Innsbruck, Austria
| | - Dominik Wolf
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A- 6020, Innsbruck, Austria; Internal Medicine 3, Oncology, Hematology, Immunoncology, Rheumatology, University Hospital Bonn (UKB), Venusberg-Campus 1, 53127, Bonn, Germany; Tiroler Krebsforschung Institut (TKFI), Innrain 66, A-6020, Innsbruck, Austria
| | - Gabriele Gamerith
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A- 6020, Innsbruck, Austria; Tiroler Krebsforschung Institut (TKFI), Innrain 66, A-6020, Innsbruck, Austria.
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Li M, Hou X, Zhou C, Feng W, Jiang G, Long H, Yang S, Chen J, Wang N, Wang K, Chen L. Prevalence and Clinical Impact of Concomitant Mutations in Anaplastic Lymphoma Kinase Rearrangement Advanced Non-small-Cell Lung Cancer (Guangdong Association of Thoracic Oncology Study 1055). Front Oncol 2020; 10:1216. [PMID: 32974126 PMCID: PMC7471725 DOI: 10.3389/fonc.2020.01216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/15/2020] [Indexed: 12/02/2022] Open
Abstract
Background: In patients with anaplastic lymphoma kinase (ALK) rearrangement-positive advanced non–small-cell lung cancer (NSCLC), ALK inhibitors are now the standard treatment, but their clinical efficacy varies widely for each patient. In this multicenter retrospective study, we evaluated the clinical efficacy of crizotinib according to the ALK rearrangement variants and concomitant mutations present. Patients and Methods: A total 132 patients with ALK rearrangement advanced NSCLC from 4 centers in Guangdong province, China were evaluated. All patients received crizotinib treatment and their ALK rearrangement status was identified by next-generation sequencing (NGS). Results: The median progression-free survival (PFS) in patients with EML4-ALK rearrangement (n = 121), non-EML4-ALK rearrangement (n = 5), and EML4-ALK arrangement accompanied by non-EML4-ALK rearrangement (n = 6) was 12.8, 7.5, and 7.4 months, respectively, with no significant difference between them (p = 0.1554). Similarly, among patients with various EML4-ALK variants (variant 1, variant 3a/b, and other variants), the median PFS values were again comparable. According to baseline NGS data, the median PFS in patients who had ALK rearrangement only, ALK rearrangement and concomitant tumor-suppressor gene mutations, and ALK rearrangement and concomitant oncogene mutations was 14.2, 10.9, and 4.9 months, respectively; (p = 0.0002). A multivariable analysis indicated that concomitant oncogene mutations and tumor-suppressor gene mutations were both negative factors influencing the efficacy of crizotinib in ALK rearrangement NSCLC. Conclusion: Concomitant oncogene mutations and tumor-suppressor gene mutations had negative effects on the efficacy of crizotinib, while various ALK variants had a similar influence.
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Affiliation(s)
- Meichen Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weineng Feng
- Department of Head and Neck/Thoracic Medical Oncology, The First People's Hospital of Foshan, Foshan, China
| | | | - Hao Long
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuang Yang
- Department of Head and Neck/Thoracic Medical Oncology, The First People's Hospital of Foshan, Foshan, China
| | - Jing Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Na Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Kaicheng Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Likun Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Plasma Cell-Free Human Papillomavirus Oncogene E6 and E7 DNA Predicts Outcome in Oropharyngeal Squamous Cell Carcinoma. J Mol Diagn 2020; 22:1333-1343. [PMID: 32822851 DOI: 10.1016/j.jmoldx.2020.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
Abstract
Persistent human papillomavirus (HPV) infection is associated with the development of oropharyngeal squamous cell carcinoma (OPSCC), and increasing incidences of OPSCC are reported. The generally favorable treatment outcome in patients with HPV-driven OPSCC has brought de-escalation of treatment into discussion. Nevertheless, 13% to 25% develop a relapse within two years after current standard treatment. New biomarkers are urgently required to monitor therapy response, tumor burden, and minimal residual disease during follow-up. This observational study examined 50 patients with OPSCC to investigate plasma cell-free (cf) HPV-DNA derived from tumor cells before therapy and during follow-up. Real-time PCR was applied to quantify the DNA concentration of HPV oncogenes E6 and E7. A total of 85.7% of pretreatment samples from patients with HPV-driven OPSCC (n = 28) were positive for at least one marker, and cfHPV-DNA concentration increased with tumor size. Virtually no signals were detected in HPV-negative OPSCC patients (n = 20; P ≤ 0.001). Patients without clinical evidence of recurrence had significantly reduced cfHPV-DNA concentrations after therapy (P ≤ 0.001). Conversely, cfHPV-DNA levels increased or remained above threshold in five patients who had residual disease or developed recurrence. In conclusion, plasma cfHPV-DNA detection correlates with the clinical course of disease in patients with HPV-driven OPSCC. Consequently, extensive clinical investigation should be considered if cfHPV-DNA is detected during follow-up of patients with HPV-driven OPSCC.
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Xu J, Qu S, Sun N, Zhang W, Zhang J, Song Q, Lin M, Gao W, Zheng Q, Han M, Na C, Xu R, Chang X, Yang X, Huang J. Construction of a reference material panel for detecting KRAS/ NRAS/ EGFR/ BRAF/ MET mutations in plasma ctDNA. J Clin Pathol 2020; 74:314-320. [PMID: 32817175 PMCID: PMC8070650 DOI: 10.1136/jclinpath-2020-206745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/24/2022]
Abstract
Background The absence of high-quality next-generation sequencing (NGS) reference material (RM) has impeded the clinical use of liquid biopsies with plasma cell-free DNA (cfDNA) in China. Objective This study aimed to develop a national RM panel for external quality assessment and performance evaluation during kit registration of non-small-cell lung cancer (NSCLC)-related Kirsten rat sarcoma viral oncogene (KRAS)/neuroblastoma ras oncogene (NRAS)/epidermal growth factor receptor (EGFR)/B-type Raf kinase (BRAF)/mesenchymal–epithelial transition factor (MET) genetic assays using plasma circulating tumor DNA (ctDNA). Methods Mutation cell lines detected by NGS and validated by Sanger sequencing were selected to establish the RM. Cell line genomic DNA was sheared and used to spike basal plasma cfDNA at 10% concentration. Then, the calibration accuracy was determined by four sequencing platforms. Average values were adopted and diluted to 0.1%, 0.3%, 1% and 3% concentrations with basal plasma as the RM panel. Then, five manufacturers were invited to evaluate the performance of the RM panel. Results 20 cell lines with 23 clinically important mutations were selected, including six mutations in KRAS, two mutations in NRAS, three in BRAF, four in phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), six in EGFR, one EGFR Gain (4-5 copy) and one MET Gain (2-5 copy). The RM panel consisted of 87 samples, including these 21 mutations at four concentrations (0.1%, 0.3%, 1% and 3%), one MET gain, one EGFR gain and one wild type. The detection rate was 100% for the 3%, 1% and 0.3% samples at all five companies. For the 0.1% concentration, 15 samples had inconsistent results, but at least three companies had correct results for each mutation. Conclusion RM for a KRAS/NRAS/EGFR/BRAF/MET mutation panel for plasma ctDNA was developed, which will be essential for quality control of the performance of independent laboratories.
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Affiliation(s)
- Jun Xu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Shoufang Qu
- Division of Diagnostic for Non-infectious Disease, National Institutes for Food and Drug Control, Beijing, China
| | - Nan Sun
- Division of Diagnostic for Non-infectious Disease, National Institutes for Food and Drug Control, Beijing, China
| | - Wenxin Zhang
- Division of Diagnostic for Non-infectious Disease, National Institutes for Food and Drug Control, Beijing, China
| | - Juanli Zhang
- Department of Invitro Diagnostic Reagents Testing, Henan Medical Equipment Inspection Institute, Zhengzhou, China
| | - Qingtao Song
- R&D Center, Amoy Diagnostics Co., Ltd, Xiamen, China
| | - Mufei Lin
- Oncology Business Unit, BGI Geonmics Co., Ltd, Shenzhen, China
| | - Wei Gao
- R&D Center, Geneplus-Beijing Institute, Beijing, China
| | - Qiaosong Zheng
- R&D Center, Genetron Health (Beijing) Co, Beijing, China
| | - Mipeng Han
- R&D Center, Berry Genomics Co., Ltd, Beijing, China
| | - Chenglong Na
- R&D Center, Nanjing Geneseeq Technology Inc, Nanjing, China
| | - Ren Xu
- R&D Center, Shanghai Yuanqi Bio-Pharmaceutical Co. Ltd, Shanghai, China
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| | - Xuexi Yang
- School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Jie Huang
- Division of Diagnostic for Non-infectious Disease, National Institutes for Food and Drug Control, Beijing, China
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Tran VT, Phan TT, Nguyen ST, Tran BT, Ho TT, Pho SP, Nguyen TB, Pham TTB, Le AT, Le VT, Nguyen HT. Smoking habit and chemo-radiotherapy and/or surgery affect the sensitivity of EGFR plasma test in non-small cell lung cancer. BMC Res Notes 2020; 13:367. [PMID: 32746896 PMCID: PMC7398354 DOI: 10.1186/s13104-020-05209-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/28/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This study aimed to identify the influential factors for the sensitivity of epidermal growth factor receptor (EGFR) plasma test in non-small cell lung cancer (NSCLC). The mutations were detected in tumor tissue and matched plasma samples from 125 newly diagnosed adenocarcinoma, clinical-stage IIIB-IV patients, and compared the diagnostic values of EGFR plasma test between groups of clinical characteristics. The influential factors for the sensitivity were identified and assessed by logistic regression. RESULTS EGFR mutations were detected in 65 (52.0%) tumor tissue and 50 (40.0%) matched plasma samples (P = 0.028). Compared to the tissue method, the concordance rate, sensitivity, and specificity of the EGFR plasma test were 86.4%, 75.4%, and 98.3%, respectively. Notably, we found that sensitivity of the test is higher in non-smokers (84.1%) compared to smokers (57.1%, P = 0.018), and in treatment naïve subjects (85.7%) compared to whom undergone chemo-radiotherapy with/without surgery before testing (56.5%, P = 0.009). Furthermore, the highest sensitivity was attained in patients without these two factors (90.3%), whilst the lowest value was noted in those with both factors (40.0%, P = 0.004). The multivariable analysis confirmed that smoking habit and treatment history have independently negative impacts on sensitivity (OR = 0.24, P = 0.019, and OR = 0.36, P = 0.047, respectively).
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Affiliation(s)
- Vinh Thanh Tran
- The Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Dist. 5, Ho Chi Minh City, 700000, Vietnam
| | - Thang Thanh Phan
- The Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Dist. 5, Ho Chi Minh City, 700000, Vietnam.
- Faculty of Biology-Biotechnology, University of Science, VNU-HCM, Ho Chi Minh City, 700000, Vietnam.
| | - Son Truong Nguyen
- The Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Dist. 5, Ho Chi Minh City, 700000, Vietnam
- Department of the Vice Minister, Ministry of Health, Hanoi City, 100000, Vietnam
| | - Bich-Thu Tran
- Faculty of Biology-Biotechnology, University of Science, VNU-HCM, Ho Chi Minh City, 700000, Vietnam
| | - Toan Trong Ho
- The Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Dist. 5, Ho Chi Minh City, 700000, Vietnam
| | - Suong Phuoc Pho
- The Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Dist. 5, Ho Chi Minh City, 700000, Vietnam
| | - Tran Bao Nguyen
- The Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Dist. 5, Ho Chi Minh City, 700000, Vietnam
| | - Tuyen Thi Bich Pham
- The Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Dist. 5, Ho Chi Minh City, 700000, Vietnam
| | - Anh Tuan Le
- Department of Chemo-Radiotherapy, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City, 700000, Vietnam
| | - Vu Thuong Le
- Department of Thoracic Disease, Cho Ray Hospital, Ho Chi Minh City, 700000, Vietnam
| | - Hang Thuy Nguyen
- Department of Clinical Pathology, Cho Ray Hospital, Ho Chi Minh City, 700000, Vietnam
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Pender A, Hughesman C, Law E, Kristanti A, McNeil K, Wong S, Tucker T, Bosdet I, Young S, Laskin J, Karsan A, Yip S, Ho C. EGFR circulating tumour DNA testing: identification of predictors of ctDNA detection and implications for survival outcomes. Transl Lung Cancer Res 2020; 9:1084-1092. [PMID: 32953487 PMCID: PMC7481591 DOI: 10.21037/tlcr-19-581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background EGFR T790M testing is the standard of care for activating EGFR mutation (EGFRm) non-small cell lung cancer (NSCLC) progressing on 1st/2nd generation TKIs to select patients for osimertinib. Despite sensitive assays, detection of circulating tumour deoxyribonucleic acid (ctDNA) is variable and influenced by clinical factors. The number and location of sites of progressive disease at time of testing were reviewed to explore the effect on EGFR ctDNA detection. The prognostic value of EGFR ctDNA detection on survival outcomes was assessed. Methods Following extraction of cell-free DNA from plasma using the QIAamp Circulating Nucleic Acid Kit, custom droplet digital polymerase chair reaction (ddPCR) assays were used to assess EGFR ctDNA using the Bio-Rad QX200 system. The ddPCR assay has a limit of detection of ≤0.15% variant allele fraction. Baseline characteristics and imaging reports at time of EGFR ctDNA testing were reviewed retrospectively for a 1 year period. Results The study included 177 patients who had an EGFR ctDNA test. Liver (aOR 3.13) or bone (aOR 2.76) progression or 3–5 sites of progression (aOR 2.22) were predictive of EGFR ctDNA detection. The median OS from first ctDNA test after multiple testing iterations was 12.3 m undetectable EGFR ctDNA, 7.6 m for original EGFR mutation only and 24.1 m with T790M (P=0.001). Conclusions Patients with liver or bone progression and 3–5 progressing sites are more likely to have informative EGFR ctDNA testing. Detection of EGFR ctDNA is a negative prognostic indicator in the absence of a T790M resistance mutation, potentially reflecting the disease burden in the absence of targeted therapy options.
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Affiliation(s)
- Alexandra Pender
- Department of Medical Oncology, Royal Free London NHS Foundation Trust and North Middlesex University Hospital, London, UK
| | - Curtis Hughesman
- Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, Canada
| | - Elaine Law
- Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, Canada
| | - Amadea Kristanti
- Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, Canada
| | - Kelly McNeil
- Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, Canada
| | - Selina Wong
- Department of Medical Oncology, BC Cancer, Vancouver, Canada
| | - Tracy Tucker
- Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, Canada
| | - Ian Bosdet
- Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, Canada
| | - Sean Young
- Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, Canada
| | - Janessa Laskin
- Department of Medical Oncology, BC Cancer, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Aly Karsan
- University of British Columbia, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, Canada
| | - Stephen Yip
- Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, Canada.,University of British Columbia, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, BC Cancer, Vancouver, Canada
| | - Cheryl Ho
- Department of Medical Oncology, BC Cancer, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
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Bruno R, Fontanini G. Next Generation Sequencing for Gene Fusion Analysis in Lung Cancer: A Literature Review. Diagnostics (Basel) 2020; 10:E521. [PMID: 32726941 PMCID: PMC7460167 DOI: 10.3390/diagnostics10080521] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 02/07/2023] Open
Abstract
Gene fusions have a pivotal role in non-small cell lung cancer (NSCLC) precision medicine. Several techniques can be used, from fluorescence in situ hybridization and immunohistochemistry to next generation sequencing (NGS). Although several NGS panels are available, gene fusion testing presents more technical challenges than other variants. This is a PubMed-based narrative review aiming to summarize NGS approaches for gene fusion analysis and their performance on NSCLC clinical samples. The analysis can be performed at DNA or RNA levels, using different target enrichment (hybrid-capture or amplicon-based) and sequencing chemistries, with both custom and commercially available panels. DNA sequencing evaluates different alteration types simultaneously, but large introns and repetitive sequences can impact on the performance and it does not discriminate between expressed and unexpressed gene fusions. RNA-based targeted approach analyses and quantifies directly fusion transcripts and is more accurate than DNA panels on tumor tissue, but it can be limited by RNA quality and quantity. On liquid biopsy, satisfying data have been published on circulating tumor DNA hybrid-capture panels. There is not a perfect method for gene fusion analysis, but NGS approaches, though still needing a complete standardization and optimization, present several advantages for the clinical practice.
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Affiliation(s)
- Rossella Bruno
- Unit of Pathological Anatomy, University Hospital of Pisa, Via Roma 67, 56126 Pisa, Italy;
| | - Gabriella Fontanini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Via Savi 10, 56126 Pisa, Italy
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Li F, Wei F, Huang WL, Lin CC, Li L, Shen MM, Yan Q, Liao W, Chia D, Tu M, Tang JH, Feng Z, Kim Y, Su WC, Wong DTW. Ultra-Short Circulating Tumor DNA (usctDNA) in Plasma and Saliva of Non-Small Cell Lung Cancer (NSCLC) Patients. Cancers (Basel) 2020; 12:E2041. [PMID: 32722209 PMCID: PMC7464208 DOI: 10.3390/cancers12082041] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/19/2022] Open
Abstract
Mutations identified in the epidermal growth factor receptor (EGFR) predict sensitivity to EGFR-targeted therapy for non-small cell lung carcinoma (NSCLC). We previously reported that Electric Field-Induced Release and Measurement (EFIRM)-based liquid biopsy could detect EGFR ctDNA with >94% concordance with tissue-based genotyping. A side-by-side comparison of concordance of EFIRM and droplet digital PCR (ddPCR) for the detection of the two front-line actionable EFGR mutations was performed with paired plasma and saliva samples from 13 NSCLC patients. Deep sequencing analysis based on single-strand DNA library preparation was employed to determine the size distributions of EGFR L858R ctDNA in plasma and saliva samples. EFIRM detected both EGFR mutations with 100% sensitivity in both plasma and saliva samples, whereas ddPCR detected EGFR mutations with sensitivities of 84.6% and 15.4%, respectively. In saliva samples, the majority of EGFR L858R ctDNA fragments detected were <80 bp. Deep sequencing analysis of ctDNA enriched for the EGFR L858R mutation revealed the significant presence of EGFR L858R ctDNA as ultra-short circulating tumor DNA (usctDNA) with the size of 40-60 bp in patient plasma and saliva. Most of usctDNAs are not amplifiable with the current ddPCR assay. Further examination using cell lines and patient biofluids revealed that the majority of usctDNAs were predominately localized in the exosomal fraction. Our study revealed the abundant existence of EGFR ctDNA in the plasma and saliva of NSCLC patients is usctDNA. usctDNA is a novel type of targets for liquid biopsy that can be efficiently detected by EFIRM technology.
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Affiliation(s)
- Feng Li
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
| | - Fang Wei
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
| | - Wei-Lun Huang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (W.-L.H.); (C.-C.L.)
| | - Chien-Chung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (W.-L.H.); (C.-C.L.)
| | - Liang Li
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
- Institute of Diagnostics in Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Macy M. Shen
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
| | - Qingxiang Yan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Q.Y.); (Z.F.)
| | - Wei Liao
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
| | - David Chia
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
| | - Michael Tu
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
| | - Jason H. Tang
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
| | - Ziding Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Q.Y.); (Z.F.)
| | - Yong Kim
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
| | - Wu-Chou Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (W.-L.H.); (C.-C.L.)
| | - David T. W. Wong
- School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.W.); (L.L.); (M.M.S.); (W.L.); (D.C.); (M.T.); (J.H.T.); (Y.K.)
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Wang N, Zhang X, Wang F, Zhang M, Sun B, Yin W, Deng S, Wan Y, Lu W. The Diagnostic Accuracy of Liquid Biopsy in EGFR-Mutated NSCLC: A Systematic Review and Meta-Analysis of 40 Studies. SLAS Technol 2020; 26:42-54. [PMID: 32659150 DOI: 10.1177/2472630320939565] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epidermal growth factor receptor (EGFR) mutations are the most common carcinogenic driver mutations in non-small-cell lung cancer (NSCLC) patients, while invasive tissue biopsy has certain inherent defects. PubMed, Ovid Medline, Embase, and the Cochrane Library were systematically searched on January 4, 2020, using the keywords "liquid biopsy," "EGFR," and "NSCLC." The pooled sensitivity and specificity of EGFR mutations in paired tissue and blood were calculated. The accuracy was assessed by receiver operating characteristic curve. The meta-regression of the subgroup was performed to analyze the heterogeneity. Hazard ratio (HR) and 95% confidence interval (CI) were combined for evaluating the impact of EGFR mutation in tissue and liquid blood biopsy. A total of 40 studies with 5,995 patients were involved in the study. The pooled sensitivity was 68% (95% CI = 60-75%), and the specificity was 98% (95% CI = 95-99%). The diagnostic odds ratio was 88 (95% CI = 40-195), and the area under the curve was 0.91 (95% CI = 0.88-0.93). In the meta-regression, the sensitivity and specificity remain lower in the Asian studies than non-Asian studies (sensitivity: 66% vs. 73%, P = 0.04; specificity: 96% vs. 97%, P = 0.03, respectively). The EGFR mutation was associated with a better progression-free survival than wild type in both tissue (HR = 0.54, 95% CI = 0.34-0.85, P = 0.007) and blood (HR = 0.81, 95% CI = 0.71-0.92, P = 0.001) detection. Peripheral blood liquid biopsy had a better specificity for detecting EGFR mutation in NSCLC patients, while tissue biopsy still needs to be undertaken for negative blood biopsy patients due to its lower sensitivity.
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Affiliation(s)
- Naiqun Wang
- Hospital Infection Management Department, The People's Hospital of Yichun City, Yichun, Jiangxi, China
| | - Xiaolian Zhang
- Laboratory Department, The People's Hospital of Yichun City, Yichun, Jiangxi, China
| | - Feilong Wang
- Thoracic Surgery Department, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Min Zhang
- Department of Stomatology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Bo Sun
- Thoracic Surgery Department, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Weihua Yin
- Oncology Department, The People's Hospital of Yichun City, Yichun, Jiangxi, China
| | - Shaorong Deng
- Blood Transfusion Department, The People's Hospital of Yichun City, Yichun, Jiangxi, China
| | - Ying Wan
- Thoracic Surgery Department, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Wei Lu
- Thoracic Surgery Department, Jining No. 1 People's Hospital, Jining, Shandong, China
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82
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Haentschel M, Boeckeler M, Ehab A, Wagner R, Spengler W, Steger V, Boesmueller H, Horger M, Lewis RA, Fend F, Kanz L, Bonzheim I, Hetzel J. A reply to "A modern approach to Advanced Non-Small Cell Lung Cancer: Minimally-invasive procedures and in parallel multiple DNA/RNA high-throughput sequencing". Lung Cancer 2020; 146:389-390. [PMID: 32653234 DOI: 10.1016/j.lungcan.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Maik Haentschel
- Department of Medical Oncology and Pneumology, Eberhard Karls University, Tuebingen, Germany.
| | - Michael Boeckeler
- Department of Medical Oncology and Pneumology, Eberhard Karls University, Tuebingen, Germany
| | - Ahmed Ehab
- Department of Pneumology, Klinik Loewenstein, Loewenstein, Germany
| | - Robert Wagner
- Department of Diabetology, Endocrinology and Nephrology, Eberhard Karls University, Tuebingen, Germany
| | - Werner Spengler
- Department of Medical Oncology and Pneumology, Eberhard Karls University, Tuebingen, Germany
| | - Volker Steger
- Department of Thoracic and Cardiovascular Surgery, Eberhard Karls University, Tuebingen, Germany
| | - Hans Boesmueller
- Institute of Pathology and Neuropathology, Eberhard Karls University, Tuebingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tuebingen, Germany
| | | | - Falko Fend
- Institute of Pathology and Neuropathology, Eberhard Karls University, Tuebingen, Germany
| | - Lothar Kanz
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, Eberhard-Karls-University, Tuebingen, Germany
| | - Irina Bonzheim
- Institute of Pathology and Neuropathology, Eberhard Karls University, Tuebingen, Germany
| | - Juergen Hetzel
- Department of Medical Oncology and Pneumology, Eberhard Karls University, Tuebingen, Germany; Division of Pulmonology, Cantonal Hospital Winterthur, Zurich, Switzerland
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83
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Coombs CC, Dickherber T, Crompton BD. Chasing ctDNA in Patients With Sarcoma. Am Soc Clin Oncol Educ Book 2020; 40:e351-e360. [PMID: 32598183 DOI: 10.1200/edbk_280749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Liquid biopsies are new technologies that allow cancer profiling of tumor fragments found in body fluids, such as peripheral blood, collected noninvasively from patients with malignancies. These assays are increasingly valuable in clinical oncology practice as prognostic biomarkers, as guides for therapy selection, for treatment monitoring, and for early detection of disease progression and relapse. However, application of these assays to rare cancers, such as pediatric and adult sarcomas, have lagged. In this article, we review the technical challenges of applying liquid biopsy technologies to sarcomas, provide an update on progress in the field, describe common pitfalls in interpreting liquid biopsy data, and discuss the intersection of sarcoma clinical care and commercial assays emerging on the horizon.
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Affiliation(s)
| | | | - Brian D Crompton
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
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84
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Schwartzberg LS, Horinouchi H, Chan D, Chernilo S, Tsai ML, Isla D, Escriu C, Bennett JP, Clark-Langone K, Svedman C, Tomasini P. Liquid biopsy mutation panel for non-small cell lung cancer: analytical validation and clinical concordance. NPJ Precis Oncol 2020; 4:15. [PMID: 32596507 PMCID: PMC7314769 DOI: 10.1038/s41698-020-0118-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 04/09/2020] [Indexed: 01/09/2023] Open
Abstract
Molecular testing for genomic variants is recommended in advanced non-small cell lung cancer (NSCLC). Standard tissue biopsy is sometimes infeasible, procedurally risky, or insufficient in tumor tissue quantity. We present the analytical validation and concordance study of EGFR variants using a new 17-gene liquid biopsy assay (NCT02762877). Of 144 patients enrolled with newly diagnosed or progressive stage IV nonsquamous NSCLC, 140 (97%) had liquid assay results, and 117 (81%) had both EGFR blood and tissue results. Alterations were detected in 58% of liquid samples. Overall tissue-liquid concordance for EGFR alterations was 94.0% (95% CI 88.1%, 97.6%) with positive percent agreement of 76.7% (57.7%, 90.1%) and negative percent agreement of 100% (95.8%, 100%). Concordance for ALK structural variants was 95.7% (90.1%, 98.6%). This assay detected alterations in other therapeutically relevant genes at a rate similar to tissue analysis. These results demonstrate the analytical and clinical validity of this 17-gene assay.
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Affiliation(s)
- Lee S. Schwartzberg
- West Cancer Center & Research Institute, 7945 Wolf River Boulevard, Germantown, TN 38138 USA
| | - Hidehito Horinouchi
- National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - David Chan
- Cancer Care Associates TMPN (now Hunt Cancer Center), 3285 Skypark Dr, Torrance, CA 90505 USA
| | - Sara Chernilo
- Instituto Nacional del Tórax, José Manuel Infante 717, segundo piso, Providencia, 7500691 Santiago, Chile
| | - Michaela L. Tsai
- Virginia Piper Cancer Institute, Minnesota Oncology, 800 E 28th St., Suite 602, Minneapolis, MN 55407 USA
| | - Dolores Isla
- University Hospital Lozano Blesa, Avda. S. Juan Bosco no 15, 50009 Zaragoza, Spain
| | - Carles Escriu
- The Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, CH63 4JK UK
| | - John P. Bennett
- Genomic Health, Inc. (now Exact Sciences Corp.), 301 Penobscot Dr, Redwood City, CA 94063 USA
| | - Kim Clark-Langone
- Genomic Health, Inc. (now Exact Sciences Corp.), 301 Penobscot Dr, Redwood City, CA 94063 USA
| | - Christer Svedman
- Genomic Health, Inc. (now Exact Sciences Corp.), 301 Penobscot Dr, Redwood City, CA 94063 USA
| | - Pascale Tomasini
- Assistance Publique Hôpitaux de Marseille, and Centre de Recherche en Cancérologie de Marseille, Inserm UMR1068, CNRS UMR7258, Aix-Marseille Université, UM105 Marseille, France
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85
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Eslami-S Z, Cortés-Hernández LE, Cayrefourcq L, Alix-Panabières C. The Different Facets of Liquid Biopsy: A Kaleidoscopic View. Cold Spring Harb Perspect Med 2020; 10:a037333. [PMID: 31548226 PMCID: PMC7263091 DOI: 10.1101/cshperspect.a037333] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The current limitations of cancer diagnosis and molecular profiling based on invasive tissue biopsies or clinical imaging have led to the development of the liquid biopsy field. Liquid biopsy includes the isolation of circulating tumor cells (CTCs), circulating free or tumor DNA (cfDNA or ctDNA), extracellular vesicles (EVs), and tumor-educated platelets (TEPs) from body fluid samples and their molecular characterization to identify biomarkers for early cancer diagnosis, prognosis, therapeutic prediction, and follow-up. These innovative biosources show similar features as the primary tumor from where they originated or interacted. This review describes the different technologies and methods used for processing these biosources as well as their main clinical applications with their advantages and limitations.
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Affiliation(s)
- Zahra Eslami-S
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Centre of Montpellier, 34093 Montpellier, France
| | - Luis Enrique Cortés-Hernández
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Centre of Montpellier, 34093 Montpellier, France
| | - Laure Cayrefourcq
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Centre of Montpellier, 34093 Montpellier, France
| | - Catherine Alix-Panabières
- Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Centre of Montpellier, 34093 Montpellier, France
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86
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Russano M, Napolitano A, Ribelli G, Iuliani M, Simonetti S, Citarella F, Pantano F, Dell'Aquila E, Anesi C, Silvestris N, Argentiero A, Solimando AG, Vincenzi B, Tonini G, Santini D. Liquid biopsy and tumor heterogeneity in metastatic solid tumors: the potentiality of blood samples. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2020; 39:95. [PMID: 32460897 PMCID: PMC7254767 DOI: 10.1186/s13046-020-01601-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022]
Abstract
In a large number of cancer types, treatment selection depends on the presence of specific tumor biomarkers. Due to the dynamic nature of cancer, very often these predictive biomarkers are not uniformly present in all cancer cells. Tumor heterogeneity represents indeed one of the main causes of therapeutic failure, and its decoding remains a major ongoing challenge in the field. Liquid biopsy is the sampling and analysis of non-solid biological tissue often through rapid and non-invasive methods, which allows the assessment in real-time of the evolving landscape of cancer. Samples can be obtained from blood and most other bodily fluids. A blood-based liquid biopsy can capture circulating tumor cells and leukocytes, as well as circulating tumor-derived nucleic acids. In this review, we discuss the current and possibly future applications of blood-based liquid biopsy in oncology, its advantages and its limitations in clinical practice. We specifically focused on its role as a tool to capture tumor heterogeneity in metastatic cancer patients.
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Affiliation(s)
- Marco Russano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Andrea Napolitano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Giulia Ribelli
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy.
| | - Michele Iuliani
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Sonia Simonetti
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Fabrizio Citarella
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Emanuela Dell'Aquila
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Cecilia Anesi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, IRCCS-Istituto Tumori "Giovanni Paolo II" of Bari, 70124, Bari, Italy.,Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', 70124, Bari, Italy
| | - Antonella Argentiero
- Medical Oncology Unit, IRCCS-Istituto Tumori "Giovanni Paolo II" of Bari, 70124, Bari, Italy
| | - Antonio Giovanni Solimando
- Medical Oncology Unit, IRCCS-Istituto Tumori "Giovanni Paolo II" of Bari, 70124, Bari, Italy.,Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine 'G. Baccelli', University of Bari Medical School, 70124, Bari, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Álvaro del Portillo, 21, 00128, Rome, Italy
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87
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Beagan JJ, Bach S, van Boerdonk RA, van Dijk E, Thunnissen E, van den Broek D, Weiss J, Kazemier G, Pegtel DM, Bahce I, Ylstra B, Heideman DAM. Circulating tumor DNA analysis of EGFR-mutant non-small cell lung cancer patients receiving osimertinib following previous tyrosine kinase inhibitor treatment. Lung Cancer 2020; 145:173-180. [PMID: 32460198 DOI: 10.1016/j.lungcan.2020.04.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/19/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Circulating tumor (ct)DNA analysis is rapidly gaining acceptance as a diagnostic tool to guide clinical management of advanced non-small cell lung cancer (NSCLC). Clinically-actionable EGFR mutations can be detected in ctDNA before or after first-line EGFR-Tyrosine Kinase Inhibitor (TKI) treatment, but data are limited for patients with a complex treatment history. This study aimed to explore the feasibility of ctDNA testing in a clinical setting of NSCLC patients receiving osimertinib as a second or third line EGFR-TKI. MATERIALS AND METHODS Twenty EGFR T790M-positive NSCLC patients, who had received osimertinib as a second or third line EGFR-TKI and had donated blood samples while attending routine follow-up consultations between April and November 2016, were retrospectively selected to test plasma cfDNA for tumor-guided EGFR mutations. We used EGFR mutations previously identified in tumor-tissue to retrospectively test plasma ctDNA from 20 patients who had received osimertinib as a second or third line EGFR-TKI. Both EGFR-TKI sensitising and T790 M resistance mutations were analysed by droplet digital PCR (ddPCR) in plasma taken alongside routine consultations and ctDNA detection was correlated with response under osimertinib. Follow-up solid-tissue biopsies were obtained after disease progression. RESULTS CtDNA was detected under osimertinib treatment in four out of the eight patients (50 %) who showed no response, two out of the seven (29 %) who showed an initial response and none of the five patients (0 %) who showed an ongoing response. The fraction of EGFR-mutant ctDNA in plasma tended to be higher in non-responders (0.1-68 %), compared to the initial responders (0.2-1.1 %). Blood samples were donated up to 34, 27 and 49 weeks after the start of osimertinib for the non-, initial and ongoing responders, respectively. CONCLUSIONS These findings support a potential role for ctDNA analysis in response monitoring of NSCLC patients with a complex EGFR-TKI treatment history. The weak trend between ctDNA detection and disease progression warrants larger studies to further investigate potential clinical utility.
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Affiliation(s)
- Jamie J Beagan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Sander Bach
- Amsterdam UMC, Vrije Universiteit Amsterdam, Surgery, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Robert A van Boerdonk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Erik van Dijk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Erik Thunnissen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Daan van den Broek
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Janneke Weiss
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Genetics, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Geert Kazemier
- Amsterdam UMC, Vrije Universiteit Amsterdam, Surgery, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - D Michiel Pegtel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Idris Bahce
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Diseases, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Bauke Ylstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Daniëlle A M Heideman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
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88
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Liam CK, Mallawathantri S, Fong KM. Is tissue still the issue in detecting molecular alterations in lung cancer? Respirology 2020; 25:933-943. [PMID: 32335992 DOI: 10.1111/resp.13823] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/23/2020] [Accepted: 03/29/2020] [Indexed: 02/07/2023]
Abstract
Molecular biomarker testing of advanced-stage NSCLC is now considered standard of care and part of the diagnostic algorithm to identify subsets of patients for molecular-targeted treatment. Tumour tissue biopsy is essential for an accurate initial diagnosis, determination of the histological subtype and for molecular testing. With the increasing use of small biopsies and cytological specimens for diagnosis and the need to identify an increasing number of predictive biomarkers, proper management of the limited amount of sampling materials available is important. Many patients with advanced NSCLC do not have enough tissue for molecular testing and/or do not have a biopsy-amenable lesion and/or do not want to go through a repeat biopsy given the potential risks. Molecular testing can be difficult or impossible if the sparse material from very small biopsy specimens has already been exhausted for routine diagnostic purposes. A limited diagnostic workup is recommended to preserve sufficient tissue for biomarker testing. In addition, tumour biopsies are limited by tumour heterogeneity, particularly in the setting of disease resistance, and thus may yield false-negative results. Hence, there have been considerable efforts to determine if liquid biopsy in which molecular alterations can be non-invasively identified in plasma cell-free ctDNA, a potential surrogate for the entire tumour genome, can overcome the issues with tissue biopsies and replace the need for the latter.
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Affiliation(s)
- Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Kwun M Fong
- Thoracic Medicine, The Prince Charles Hospital, The University of Queensland Thoracic Research Centre at TPCH, Brisbane, QLD, Australia
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89
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Novel Liquid Biomarker Panels for A Very Early Response Capturing of NSCLC Therapies in Advanced Stages. Cancers (Basel) 2020; 12:cancers12040954. [PMID: 32290637 PMCID: PMC7226444 DOI: 10.3390/cancers12040954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/28/2022] Open
Abstract
Computed tomography (CT) scans are the gold standard to measure treatment success of non-small cell lung cancer (NSCLC) therapies. Here, we investigated the very early tumor response of patients receiving chemotherapy or targeted therapies using a panel of already established and explorative liquid biomarkers. Blood samples from 50 patients were taken at baseline and at three early time points after therapy initiation. DNA mutations, a panel of 17 microRNAs, glycodelin, glutathione disulfide, glutathione, soluble caspase-cleaved cytokeratin 18 (M30 antigen), and soluble cytokeratin 18 (M65 antigen) were measured in serum and plasma samples. Baseline and first follow-up CT scans were evaluated and correlated with biomarker data. The detection rate of the individual biomarkers was between 56% and 100%. While only keratin 18 correlated with the tumor load at baseline, we found several individual markers correlating with the tumor response to treatment for each of the three time points of blood draws. A combination of the five best markers at each time point resulted in highly significant marker panels indicating therapeutic response (R2 = 0.78, R2 = 0.71, and R2 = 0.71). Our study demonstrates that an early measurement of biomarkers immediately after therapy start can assess tumor response to treatment and might support an adaptation of treatment to improve patients’ outcome.
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90
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Son SM, Woo CG, Han HS, Lee KH, Lim YH, Lee OJ. Analysis of EGFR mutation status in malignant pleural effusion and plasma from patients with advanced lung adenocarcinoma. Clin Chem Lab Med 2020; 58:1547-1555. [PMID: 32229655 DOI: 10.1515/cclm-2019-1139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/17/2020] [Indexed: 11/15/2022]
Abstract
Background Cell-free DNA (cfDNA) is emerging as a surrogate sample type for mutation analyses. We investigated the suitability of malignant pleural effusion (MPE) and plasma as a biomaterial for analyzing epidermal growth factor receptor (EGFR) mutation by peptide nucleic acid (PNA) clamping-assisted fluorescence melting curve (PANAMutyper™) analysis. Methods Matched tissue, MPE cell block (MPE-CB), MPE supernatant, and plasma samples were collected from patients with advanced lung adenocarcinoma who had a MPE at the time of diagnosis. EGFR mutation was assessed by PANAMutyper™. Results Mutation analyses in matched tumor tissues, MPE-CB, MPE supernatant, and/or plasma samples were available for 67 patients. In comparison with tumor tissue and MPE-CB, MPE supernatant exhibited 84.4% sensitivity, 97.1% specificity, 96.4% positive predictive value (PPV), and 87.2% negative predictive value (NPV). In the same comparison, plasma exhibited 70.6% sensitivity, 100.0% specificity, 100.0% PPV, and 73.7% NPV. When sorted by mutation type, MPE supernatant had better sensitivity than plasma for the detection of two major EGFR mutations: 93.8% vs. 75.0% for exon 19 deletion and 73.3% vs. 60.0% for L858R. Conclusions In this cohort of patients with MPEs, MPE supernatant demonstrated superior diagnostic performance compared with plasma using a PNA-based real-time PCR method.
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Affiliation(s)
- Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Chang Gok Woo
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hye Sook Han
- Chungbuk National University College of Medicine, Cheongju, Republic of Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ki Hyeong Lee
- Chungbuk National University College of Medicine, Cheongju, Republic of Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Young Hyun Lim
- Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ok-Jun Lee
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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91
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Lan J, Lu Y, Guan Y, Chang L, Yu Z, Qian H. Identification of circulating tumor DNA using a targeted 545-gene next generation sequencing panel in patients with gastric cancer. Oncol Lett 2020; 19:2251-2257. [PMID: 32194723 PMCID: PMC7039113 DOI: 10.3892/ol.2020.11305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 06/05/2019] [Indexed: 12/26/2022] Open
Abstract
Gastric cancer (GC) is characterized by unique genetic aberrations. Some of these mutations may be used to predict tumor prognosis or to guide patient therapy. Cell-free circulating tumor DNA (ctDNA) has been considered a promising alternative to biopsy to identify genome aberrations. However, no standardized methods to detect ctDNA variations in patients with GC are currently available. In the present study, the targeted sequencing of 545 genes was used to identify somatic alterations in tissues and matched plasma samples of nine patients with GC. Driver gene mutations were detected in matched tissues and plasma ctDNA. The mutated reads concordance rate of ctDNA in GC tissues with matched tissues was 45%. A true positive copy number gain of human epidermal growth factor receptor 2 in plasma from patients with GC was identified. Furthermore, the ctDNA fraction in plasma cell-free DNA (cfDNA) was positively correlated with metastasis lymph node number and with lactate dehydrogenase level. In conclusion, results from the present study suggested that targeted sequencing of plasma ctDNA may be considered a potential option for the clinical monitoring of GC.
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Affiliation(s)
- Jing Lan
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Yaping Lu
- Research and Development Department, Geneplus-Beijing Institute, Beijing 102206, P.R. China
| | - Yanfang Guan
- Research and Development Department, Geneplus-Beijing Institute, Beijing 102206, P.R. China
| | - Lianpeng Chang
- Research and Development Department, Geneplus-Beijing Institute, Beijing 102206, P.R. China
| | - Zhengyuan Yu
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Haixin Qian
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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92
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Buttitta F, Felicioni L, Lorito AD, Cortellini A, Irtelli L, Brocco D, Marino PD, Traisci D, D'Ostilio N, Paolo AD, Malorgio F, Assalone P, Felice SD, Fabbri F, Cianci G, Tursi MD, Marchetti A. Early prediction of resistance to tyrosine kinase inhibitors by plasma monitoring of EGFR mutations in NSCLC: a new algorithm for patient selection and personalized treatment. Oncotarget 2020; 11:982-991. [PMID: 32215186 PMCID: PMC7082112 DOI: 10.18632/oncotarget.27517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
Abstract
In Non-Small-Cell Lung Cancer (NSCLC) patients treated with Tyrosine Kinase-Inhibitors (TKIs) therapy, the emergence of acquired resistance can be investigated by plasma monitoring of circulating tumor DNA (ctDNA). A series of 116 patients with EGFR-positive lung adenocarcinomas were treated with first/second generation EGFR TKIs. At clinical progression, 64 (55%) EGFR T790M plasma positive patients were subjected to second line-treatment with osimertinib and strictly monitored during the first month of therapy. Plasma analysis by the EGFR Cobas test showed in 57 (89%) cases a substantial decrease in the levels of the sensitizing EGFR mutant allele (sEGFRma), down to a not detectable value. These patients were defined as plasmatic good responders (PGR). In 7 (11%) patients, the sEGFRma did not drop to zero (plasmatic poor responders, PPR). In these latter cases, Massive Parallel Sequencing (MPS) analysis at the end of the first month and at clinical progression showed the presence of resistant-inducing mutations, including MET and HER2 gene amplification, KRAS and PIK3CA gene mutations. PPR showed disease progression in 5 (71%) cases, stable disease in 2 (29%) cases, and a shorter median Progression-free survival (PFS) (4.3 ± 1.1 months) than that observed in PGR (13.3 ± 1.2 months) (P < 0.0001). Our data indicate that plasma monitoring by a simple RT-PCR-based EGFR mutation test in the first month of treatment may be useful for a rapid identification of patients to be subjected to further characterization by MPS. A diagnostic algorithm for an early detection of resistance-inducing mutations and patient management is reported.
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Affiliation(s)
- Fiamma Buttitta
- Laboratory of Diagnostic Molecular Oncology, Center for Advanced Studies and Technology (CAST), University of Chieti, Chieti, Italy.,Department of Medical and Oral Sciences and Biotechnologies, University of Chieti, Chieti, Italy.,Department of Pathology, SS Annunziata Clinical Hospital, Chieti, Italy
| | - Lara Felicioni
- Department of Pathology, SS Annunziata Clinical Hospital, Chieti, Italy
| | - Alessia Di Lorito
- Department of Medical and Oral Sciences and Biotechnologies, University of Chieti, Chieti, Italy
| | | | - Luciana Irtelli
- Department of Oncology, SS Annunziata Clinical Hospital, Chieti, Italy
| | - Davide Brocco
- Department of Oncology, SS Annunziata Clinical Hospital, Chieti, Italy
| | - Pietro Di Marino
- Department of Oncology, SS Annunziata Clinical Hospital, Chieti, Italy
| | | | - Nicola D'Ostilio
- Department of Oncology, Floraspe Renzetti Hospital, Lanciano, Italy
| | | | | | - Pasquale Assalone
- Department of Oncology, "S.S. Giovanni Paolo II" Veneziale Hospital, Isernia, Italy
| | - Sonia Di Felice
- Department of Oncology, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Francesca Fabbri
- Department of Oncology, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Giovanni Cianci
- Department of Oncology, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Michele De Tursi
- Department of Medical and Oral Sciences and Biotechnologies, University of Chieti, Chieti, Italy.,Department of Oncology, SS Annunziata Clinical Hospital, Chieti, Italy
| | - Antonio Marchetti
- Laboratory of Diagnostic Molecular Oncology, Center for Advanced Studies and Technology (CAST), University of Chieti, Chieti, Italy.,Department of Medical and Oral Sciences and Biotechnologies, University of Chieti, Chieti, Italy.,Department of Pathology, SS Annunziata Clinical Hospital, Chieti, Italy
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93
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Li C, He Q, Liang H, Cheng B, Li J, Xiong S, Zhao Y, Guo M, Liu Z, He J, Liang W. Diagnostic Accuracy of Droplet Digital PCR and Amplification Refractory Mutation System PCR for Detecting EGFR Mutation in Cell-Free DNA of Lung Cancer: A Meta-Analysis. Front Oncol 2020; 10:290. [PMID: 32195189 PMCID: PMC7063461 DOI: 10.3389/fonc.2020.00290] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Epidermal growth factor receptor (EGFR) mutation testing in plasma cell-free DNA (cfDNA) from advanced lung cancer patients is an emerging clinical tool. This meta-analysis was designed to determine the diagnostic accuracy of two common PCR systems, droplet digital PCR (ddPCR) and amplification refractory mutation system PCR (ARMS-PCR), for detecting EGFR mutation in cfDNA. Materials and methods: A systematic search was carried out based on PubMed, Web of science, Embase and the Cochrane library. Data from eligible studies were extracted and pooled to calculate the sensitivity, specificity, diagnostic odds ratio (DOR), area under the summary receiver-operating characteristic curve (AUROC), using tissue biopsy results as the standard method. Subgroup analyses were performed regarding EGFR mutation type, tumor stage, and EGFR-TKI treatment. Results: Twenty-five studies involving 4,881 cases were included. The plasma testing sensitivity, specificity, DOR, and AUROC, compared with the matched tumor tissues, were 72.1%, 95.6%, 38.5, 0.89 for ddPCR, and 65.3%, 98.2%, 52.8, 0.71 for ARMS-PCR, respectively, through indirect comparison, significant differences were found in sensitivity (P = 0.003) and specificity (P = 0.007). Furthermore, significant difference was found in sensitivity between tumor stage subgroups (IIIB–IV subgroup vs. IA–IV subgroup) in ARMS-PCR (73.7 vs. 64.2%, P = 0.008), but not in ddPCR (72.5 vs. 71.2%, P = 0.756). Conclusions: This study demonstrates that ddPCR and ARMS-PCR have a high specificity with a practical sensitivity for detecting EGFR mutation in cfDNA, which supports their application as a supplement or a conditional-alternative to tissue biopsy in clinical practice for genotyping. It seems that ddPCR has a higher sensitivity than ARMS-PCR, especially in early stages.
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Affiliation(s)
- Caichen Li
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qihua He
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bo Cheng
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianfu Li
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shan Xiong
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yi Zhao
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Minzhang Guo
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhichao Liu
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Randrian V, Adenis A, Desrame J, Barbier E, Di Fiore F, Lièvre A, Dahan L, Laurent-Puig P, Mineur L, Breysacher G, Roquin G, Louafi S, Lopez A, Louvet C, Borg C, Metges JP, Faroux R, Gaba L, Manfredi S, Tougeron D. Nal-IRI/LV5-FU versus paclitaxel as second-line therapy in patients with metastatic esophageal squamous cell carcinoma (OESIRI)-PRODIGE 62: A multicentre, randomised, non-comparative phase II study. Dig Liver Dis 2020; 52:347-350. [PMID: 31899122 DOI: 10.1016/j.dld.2019.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/11/2022]
Abstract
Half of patients newly diagnosed with esophageal squamous cell cancer (ESCC) have metastatic disease (mESCC) and therefore a poor prognosis. Furthermore, half of patients with initial loco-regional disease present disease recurrence after surgery and/or chemoradiation. In mESCC, the recommended first-line treatment combines 5-fluorouracil and cisplatin, although this has not been validated by a phase III trial. Patients with disease progression or recurrence after platinum-based chemotherapy and good performance status probably benefit from second-line chemotherapy. Several molecules have been evaluated in phase I/II trials or retrospective studies (docetaxel, paclitaxel and irinotecan) but no randomised studies are available. OESIRI is a multicentre, randomised, open-label phase II trial designed to evaluate efficacy and safety of liposomal irinotecan (nal-IRI) plus 5-FU versus paclitaxel as second-line therapy in patients with mESCC. The main inclusion criteria are histologically proven mESCC in progression after first-line platinum-based chemotherapy. Patients with initial resectable disease can be included if recurrence occurred within 6 months. The primary objective is to evaluate the percentage of patients alive 9 months after randomisation. Secondary endpoints are progression-free survival, overall survival, response rate, safety and quality of life. In addition, circulating tumour DNA will be monitored to assess its prognostic value.
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Affiliation(s)
- Violaine Randrian
- Gastroenterology Department, Centre Hospitalo-Universitaire de Poitiers, University of Poitiers, Poitiers, France
| | - Antoine Adenis
- Medical Oncology Department, Institut Régional Du Cancer de Montpellier (ICM), Université de Montpellier, France
| | - Jérôme Desrame
- Medical Oncology Department, Hôpital Privé Jean du Cancer de Mermoz, Lyon, France
| | - Emilie Barbier
- FFCD EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche-Comté, Dijon, France
| | | | - Astrid Lièvre
- Gastroenterology Department, Centre Hospitalo-Universitaire Pontchaillou, Rennes 1 University, Rennes, France
| | - Laetitia Dahan
- Digestive Oncology Department, AP-HM, La Timone Hospital, Aix-Marseille Université, Marseille, France
| | - Pierre Laurent-Puig
- Biology Department, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Paris, France
| | - Laurent Mineur
- Digestive Oncology Department, Institut Sainte Catherine, Avignon, France
| | | | - Guillaume Roquin
- Gastroenterology & Digestive Oncology Department, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Samy Louafi
- Gastroenterology Department, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France; Gastroenterology Department, Groupe Hospitalier Nord Essonne, Longjumeau, France
| | - Anthony Lopez
- Gastroenterology and Hepatology Department, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Christophe Louvet
- Medical Oncology Department, Institut Mutualiste Montsouris, Paris, France
| | - Christophe Borg
- Medical Oncology Department, Centre Hospitalo-Universitaire de Besançon, Besançon, France
| | - Jean Philippe Metges
- Medical Oncology Department, Centre Hospitalier Régional Universitaire de Brest-Hôpital Morvan, Brest, France
| | - Roger Faroux
- Gastroenterology Department, Centre Hospitalier de La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Lila Gaba
- FFCD EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche-Comté, Dijon, France
| | - Sylvain Manfredi
- Gastroenterology Department, Centre Hospitalo-Universitaire de Dijon, EPICAD INSERM LNC-UMR 1231, University of Bourgogne-Franche Comté, Dijon, France
| | - David Tougeron
- Gastroenterology Department, Centre Hospitalo-Universitaire de Poitiers, University of Poitiers, Poitiers, France.
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95
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Deng Q, Fang Q, Sun H, Singh AP, Alexander M, Li S, Cheng H, Zhou S. Detection of plasma EGFR mutations for personalized treatment of lung cancer patients without pathologic diagnosis. Cancer Med 2020; 9:2085-2095. [PMID: 31991049 PMCID: PMC7064093 DOI: 10.1002/cam4.2869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Next-generation sequencing (NGS) and digital polymerase chain reaction (PCR) based platforms have been used to detect EGFR mutations in plasma circulating tumor DNA (ctDNA) with high accuracy. Generally, molecular testing is performed after histopathological analysis. However, many patients with suspected advanced nonsmall cell lung cancer are unable to undergo biopsy thus forgoing potential treatment with highly effective tyrosine kinase inhibitors (TKIs) in patients with sensitizing EGFR mutations. We examined the utility of ctDNA testing to detect EGFR mutations in patients' plasma, where tissue biopsy is not feasible. METHODS We conducted a single-center, prospective study of 30 Chinese patients with suspected advanced lung cancer, who were unable to undergo a biopsy for initial diagnosis due to comorbidities or poor performance status. Patients with plasma EGFR sensitizing mutations were treated with first-generation EGFR TKIs. RESULTS Twenty of 30 patients enrolled had sensitizing EGFR mutations in ctDNA and were started on EGFR TKIs. After a median follow-up of 12 months, median progression-free survival (PFS) was 10 months and median overall survival (OS) was not reached. The median OS for the 10 untreated patients was 3 months. CONCLUSIONS In our study, patients with plasma EGFR mutations treated with TKIs showed disease control rate (DCR) and PFS similar to historical controls that were treated based on tissue testing. This is the first prospective study showing that ctDNA genotyping provides a feasible diagnostic approach for frail lung cancer patients who are unable to undergo biopsy, which subsequently leads to EGFR-targeted therapy, and improved outcomes in this subgroup of patients.
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Affiliation(s)
- Qinfang Deng
- Department of OncologyThe Third Affiliated Hospital of Soochow UniversityChangzhouChina
- Department of OncologyShanghai Pulmonary HospitalTongji University School of MedicineShanghaiChina
| | - Qiyu Fang
- Department of OncologyThe Third Affiliated Hospital of Soochow UniversityChangzhouChina
- Department of OncologyShanghai Pulmonary HospitalTongji University School of MedicineShanghaiChina
| | - Hui Sun
- Department of OncologyShanghai Pulmonary HospitalTongji University School of MedicineShanghaiChina
| | - Aditi P. Singh
- Department of OncologyMontefiore Medical CenterAlbert Einstein College of MedicineBronxNYUSA
| | - Mariam Alexander
- Department of OncologyMontefiore Medical CenterAlbert Einstein College of MedicineBronxNYUSA
| | - Shenduo Li
- Department of MedicineJacobi Medical CenterBronxNYUSA
| | - Haiying Cheng
- Department of OncologyMontefiore Medical CenterAlbert Einstein College of MedicineBronxNYUSA
| | - Songwen Zhou
- Department of OncologyShanghai Pulmonary HospitalTongji University School of MedicineShanghaiChina
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96
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Torres S, González Á, Cunquero Tomas AJ, Calabuig Fariñas S, Ferrero M, Mirda D, Sirera R, Jantus-Lewintre E, Camps C. A profile on cobas® EGFR Mutation Test v2 as companion diagnostic for first-line treatment of patients with non-small cell lung cancer. Expert Rev Mol Diagn 2020; 20:575-582. [PMID: 32011193 DOI: 10.1080/14737159.2020.1724094] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Among non-small cell lung cancer (NSCLC) patients, there is one molecularly defined subgroup harboring activating mutations in the epidermal growth factor receptor gene (EGFR), which results in constitutive activation of its intrinsic kinase activity. Consistent data have demonstrated that these patients have a better outcome when treated with specific tyrosine-kinase inhibitors (EGFR-TKIs). Therefore, analysis of EGFR mutational status for treatment guidance is mandatory in this context. AREAS COVERED Herein we review the clinical development and technical features of cobas® EGFR Mutation Test v2 as a companion diagnostic test (CDx) for therapy with EGFR-TKIs, such as gefitinib, in advanced NSCLC. We also discuss the pros and cons of the current version of the CDx and its performance in both tissue and plasma samples. EXPERT OPINION The RT-PCR based cobas® EGFR Mutation Test v2 is a reliable and rapid solution for EGFR mutational status assessment at the time of diagnosis in advanced NSCLC that allows eligibility of patients for EGFR-TKI treatment. This test determines EGFR mutations with acceptable sensitivity in tissue or plasma samples. Pre-analytical considerations like tumor cell content, tumor burden or location of metastasis should be considered to better interpret results in the clinical contexture.
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Affiliation(s)
- Susana Torres
- Molecular Oncology Laboratory, General University Hospital Research Foundation , Valencia, Spain.,CIBERONC , Madrid, Spain.,Mixed Unit TRIAL CIPF-FIHGUV , Valencia, Spain
| | - Álvaro González
- Molecular Oncology Laboratory, General University Hospital Research Foundation , Valencia, Spain
| | | | - Silvia Calabuig Fariñas
- Molecular Oncology Laboratory, General University Hospital Research Foundation , Valencia, Spain.,CIBERONC , Madrid, Spain.,Mixed Unit TRIAL CIPF-FIHGUV , Valencia, Spain.,Department of Pathology, Universitat de València , Valencia, Spain
| | - Macarena Ferrero
- Molecular Oncology Laboratory, General University Hospital Research Foundation , Valencia, Spain
| | - Danielle Mirda
- George Washington University School of Medicine and Health Sciences , Washington, DC, USA
| | - Rafael Sirera
- CIBERONC , Madrid, Spain.,Mixed Unit TRIAL CIPF-FIHGUV , Valencia, Spain.,Department of Biotechnology, Universitat Politècnica de València , Valencia, Spain
| | - Eloisa Jantus-Lewintre
- Molecular Oncology Laboratory, General University Hospital Research Foundation , Valencia, Spain.,CIBERONC , Madrid, Spain.,Mixed Unit TRIAL CIPF-FIHGUV , Valencia, Spain.,Department of Biotechnology, Universitat Politècnica de València , Valencia, Spain
| | - Carlos Camps
- Molecular Oncology Laboratory, General University Hospital Research Foundation , Valencia, Spain.,CIBERONC , Madrid, Spain.,Mixed Unit TRIAL CIPF-FIHGUV , Valencia, Spain.,Medical Oncology Department, General University Hospital of Valencia , Valencia, Spain.,Department of Medicine, Universitat de València , Valencia, Spain
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97
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Wulandari L, Soegiarto G, Febriani A, Fatmawati F, Sahrun. Comparison of Detection of Epidermal Growth Factor Receptor (EFGR) Gene Mutation in Peripheral Blood Plasma (Liquid Biopsy) with Cytological Specimens in Lung Adenocarcinoma Patients. Indian J Surg Oncol 2020; 12:65-71. [PMID: 33994730 DOI: 10.1007/s13193-020-01046-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022] Open
Abstract
The ctDNA plasma testing is one of the methods to examine biomarkers for lung adenocarcinoma in order to detect a mutation of epidermal growth factor receptor (EGFR) gene. The advantages of ctDNA testing over tissue biopsy and lung tumor cytology include less invasive, faster result, cheaper, and minimum risk of complication for the patient. We analyzed and compare the detection of EFGR mutation in peripheral blood plasma (liquid biopsy) with cytological specimens of patients with lung adenocarcinoma. We conducted ctDNA plasma testing in 124 lung adenocarcinoma patients who visited our hospital from January to December 2018. The ctDNA testing results were compared with the results of EGFR detection from the previous cytological specimen examination. Most of the patients were males, aged 55-59 years, nonsmokers, and had stage IVA lung adenocarcinoma, with most metastasis found in the pleura. We found a correlation between EGFR prevalence with nonsmoking status and patient's age. The ctDNA plasma testing detected 27.4% common EGFR mutation and 72.6% wild-type EGFR. The figures of EGFR mutation detection from cytological specimens were 47.6% and 52.4%, respectively. Compared to cytological specimens, the EGFR mutation detection in ctDNA had a sensitivity of 48.3%, with a specificity of 90.9%, PPV of 82.35%, NPV of 66.7%, and 70.97% concordance rate. EGFR mutation with cytological specimen examination was more accurate than ctDNA.
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Affiliation(s)
- Laksmi Wulandari
- Thoracic Oncology Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Jl. Mayjen Prof. Dr. Moestopo no. 6-8, Surabaya, 60286 Indonesia
| | - Gatot Soegiarto
- Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Anna Febriani
- Thoracic Oncology Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Jl. Mayjen Prof. Dr. Moestopo no. 6-8, Surabaya, 60286 Indonesia
| | - Farah Fatmawati
- Thoracic Oncology Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Jl. Mayjen Prof. Dr. Moestopo no. 6-8, Surabaya, 60286 Indonesia
| | - Sahrun
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
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Pasquale R, Forgione L, Roma C, Fenizia F, Bergantino F, Rachiglio AM, De Luca A, Gallo M, Maiello MR, Palumbo G, Morabito A, Azzaro R, Normanno N. Targeted sequencing analysis of cell-free DNA from metastatic non-small-cell lung cancer patients: clinical and biological implications. Transl Lung Cancer Res 2020; 9:61-70. [PMID: 32206554 PMCID: PMC7082281 DOI: 10.21037/tlcr.2020.01.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Sequencing artifacts, clonal hematopoietic mutations of indeterminate potential (CHIP) and tumor heterogeneity have been hypothesized to contribute to the low concordance between tissue and cell-free DNA (cfDNA) molecular profiling with targeted sequencing. Methods We analyzed by targeted sequencing cfDNA from 30 healthy individuals, and cfDNA and matched tumor samples from 30 EGFR-mutant and 77 EGFR wild-type metastatic non-small-cell lung cancer (mNSCLC) patients. Discordant cases were solved by droplet digital PCR (ddPCR). Results By testing cfDNA from healthy donors, we developed an algorithm to recognize sequencing artifacts. Applying this method to cfDNA from mNSCLC patients, EGFR mutations were detected with a good sensitivity (76.7%) and specificity (97.4%). In contrast, sensitivity and specificity for KRAS variants were 61.5% and 93.8%, respectively. All EGFR and KRAS variants detected in plasma but not in tissue were confirmed by ddPCR, thus excluding sequencing artifacts. In a fraction of cases, KRAS mutations found in plasma samples were confirmed in tumor tissue suggesting tumor heterogeneity. KRAS variants were found to be more likely sub-clonal as compared with EGFR mutations, and a correlation between clonal origin and frequency of detection in plasma was found. In a case with both EGFR and KRAS variants in cfDNA, we could demonstrate the presence of the KRAS variant in tumor tissue associated with lack of response to tyrosine kinase inhibitors (TKIs). Conclusions Although sequencing artifacts can be identified in targeted sequencing of cfDNA, tumor heterogeneity and CHIP are likely to influence the concordance between plasma and tissue testing.
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Affiliation(s)
- Raffaella Pasquale
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Laura Forgione
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Cristin Roma
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Francesca Fenizia
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Francesca Bergantino
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Anna M Rachiglio
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Antonella De Luca
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Marianna Gallo
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Monica R Maiello
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Giuliano Palumbo
- Medical Oncology, Ospedale Santa Maria della Pietà, Casoria, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Department of Hemathology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Rosa Azzaro
- Transfusion Service, Department of Hemathology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Via M. Semmola, Naples, Italy
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99
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Nicoś M, Wojas-Krawczyk K, Krawczyk P, Chmielewska I, Wojcik-Superczyńska M, Reszka K, Kieszko R, Góra-Florek A, Dudek M, Świniuch D, Papiewski W, Całka P, Ciesielka M, Ramlau R, Milanowski J. Assessment of EGFR gene mutations in circulating free DNA in monitoring of response to EGFR tyrosine kinase inhibitors in patients with lung adenocarcinoma. Arch Med Sci 2020; 16:1496-1500. [PMID: 33224359 PMCID: PMC7667428 DOI: 10.5114/aoms.2019.89217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/14/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Marcin Nicoś
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
- Science for Life Laboratory, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Wojas-Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
- Lublin Foundation for Cancer Patients “JestemnaTak”, Poland
| | - Paweł Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
- Polish Society of Clinical Oncology, Warsaw, Poland
| | - Izabela Chmielewska
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | | | - Katarzyna Reszka
- Lublin Foundation for Cancer Patients “JestemnaTak”, Poland
- GENIM LCC, Institute of Genetics and Immunology, Lublin, Poland
| | - Robert Kieszko
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Anna Góra-Florek
- Independent Public Provincial Hospital named Jan Boży, Lublin, Poland
| | - Małgorzata Dudek
- Independent Public Provincial Hospital named Jan Boży, Lublin, Poland
| | - Daria Świniuch
- Department of Oncology, Poznan University of Medical Science, Poznan, Poland
| | - Wojciech Papiewski
- Department of Pulmonology and Pulmonary Oncology of Mazovian Specialist Hospital, Radom, Poland
| | - Paulina Całka
- Department of Forensic Medicine, Medical University of Lublin, Lublin, Poland
| | - Marzanna Ciesielka
- Department of Forensic Medicine, Medical University of Lublin, Lublin, Poland
| | - Rodryg Ramlau
- Department of Oncology, Poznan University of Medical Science, Poznan, Poland
| | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
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100
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Porter A, Natsuhara M, Daniels GA, Patel SP, Sacco AG, Bykowski J, Banks KC, Cohen EEW. Next generation sequencing of cell free circulating tumor DNA in blood samples of recurrent and metastatic head and neck cancer patients. Transl Cancer Res 2020; 9:203-209. [PMID: 35117174 PMCID: PMC8798156 DOI: 10.21037/tcr.2019.12.70] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/04/2019] [Indexed: 11/06/2022]
Abstract
Background Effective targeted therapy is lacking in head and neck cancer (HNC). The use of next generation sequencing (NGS) has been suggested as a way to potentially expand therapeutic options and improve outcomes. This study was performed in order to further characterize blood sample cell-free circulating tumor DNA (ctDNA) in advanced HNC patients, to determine its ability to identify actionable mutations, and to elucidate its potential role in patient management. Methods Retrospective analysis of 60 patients with recurrent and metastatic (R/M) HNCs who underwent molecular profiling of blood samples utilizing Guardant360, a 70-gene ctDNA NGS platform. ctDNA sequencing data was compared to tumor NGS data, when available. Best response to therapy was assessed using RECIST measures. Results The most common tumor type was oropharyngeal squamous cell carcinoma (n=21). Other cancer types included salivary gland (n=8) and thyroid (n=4). The most common mutations identified by blood analysis were TP53 (68% of patients), PIK3CA (34% of patients), NOTCH1 (20% of patients), and ARID1A (15% of patients). These findings were consistent with results from tumor sequencing data (n=30) where TP53 (48%) and PIK3CA (24%) were also the most common. Seventy-three percent (n=22) of patients had alterations identified in blood that were not present in tumor specimens. In patients with squamous cell carcinoma, 66% had an off-label option identified and 90% had a trial option identified, while 50% of patients with salivary primaries had off-label option identified and 75% had trial options identified. All patients (n=3, 100%) with thyroid primaries had off-label and clinical trial options identified. Of patients with actionable mutations, 13% (n=8) received matched targeted therapy (MTT). Three patients had stable disease (37.5%), 3 had progressive disease (37.5%), and 2 (25%) were not evaluated at the time of follow up. Of those who did not receive targeted therapy (n=21), 11 patients had stable disease (52.4%), 9 had progressive disease (42.9%), and 1 had a complete response (4.8%). Conclusions Alterations identified by ctDNA may help inform management decisions in advanced HNC. The majority of patients had unique mutations identified on ctDNA. The role of NGS of ctDNA should be explored in future studies.
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Affiliation(s)
- Ashleigh Porter
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mandy Natsuhara
- Division of Hematology/Oncology, Moores Cancer Center, La Jolla, CA, USA
| | - Gregory A Daniels
- Division of Hematology/Oncology, Moores Cancer Center, La Jolla, CA, USA
| | | | | | - Julie Bykowski
- Division of Hematology/Oncology, Moores Cancer Center, La Jolla, CA, USA
| | - Kimberly C Banks
- Department of Medical Affairs, Guardant Health, Inc., Redwood City, CA, USA
| | - Ezra E W Cohen
- Division of Hematology/Oncology, Moores Cancer Center, La Jolla, CA, USA
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