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Zollinger DR, Rivers E, Fine A, Huang Y, Son J, Kalyan A, Gray W, Baharian G, Hammond C, Ram R, Ringman L, Hafez D, Savel D, Patel V, Dantone M, Guo C, Childress M, Xu C, Johng D, Wallden B, Pokharel P, Camara W, Hegde PS, Hughes J, Carter C, Davarpanah N, Degaonkar V, Gupta P, Mariathasan S, Powles T, Ferree S, Dennis L, Young A. Analytical validation of a novel comprehensive genomic profiling informed circulating tumor DNA monitoring assay for solid tumors. PLoS One 2024; 19:e0302129. [PMID: 38753705 PMCID: PMC11098318 DOI: 10.1371/journal.pone.0302129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/28/2024] [Indexed: 05/18/2024] Open
Abstract
Emerging technologies focused on the detection and quantification of circulating tumor DNA (ctDNA) in blood show extensive potential for managing patient treatment decisions, informing risk of recurrence, and predicting response to therapy. Currently available tissue-informed approaches are often limited by the need for additional sequencing of normal tissue or peripheral mononuclear cells to identify non-tumor-derived alterations while tissue-naïve approaches are often limited in sensitivity. Here we present the analytical validation for a novel ctDNA monitoring assay, FoundationOne®Tracker. The assay utilizes somatic alterations from comprehensive genomic profiling (CGP) of tumor tissue. A novel algorithm identifies monitorable alterations with a high probability of being somatic and computationally filters non-tumor-derived alterations such as germline or clonal hematopoiesis variants without the need for sequencing of additional samples. Monitorable alterations identified from tissue CGP are then quantified in blood using a multiplex polymerase chain reaction assay based on the validated SignateraTM assay. The analytical specificity of the plasma workflow is shown to be 99.6% at the sample level. Analytical sensitivity is shown to be >97.3% at ≥5 mean tumor molecules per mL of plasma (MTM/mL) when tested with the most conservative configuration using only two monitorable alterations. The assay also demonstrates high analytical accuracy when compared to liquid biopsy-based CGP as well as high qualitative (measured 100% PPA) and quantitative precision (<11.2% coefficient of variation).
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Affiliation(s)
| | | | - Alexander Fine
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - Yanmei Huang
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - Joseph Son
- Natera, Austin, TX, United States of America
| | | | - Wren Gray
- Natera, Austin, TX, United States of America
| | | | | | - Rosalyn Ram
- Natera, Austin, TX, United States of America
| | | | - Dina Hafez
- Natera, Austin, TX, United States of America
| | | | - Vipul Patel
- Natera, Austin, TX, United States of America
| | | | - Cui Guo
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | | | - Chang Xu
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - Dorhyun Johng
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - Brett Wallden
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - Prapti Pokharel
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - William Camara
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - Priti S. Hegde
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - Jason Hughes
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - Corey Carter
- Roche/Genentech, South San Francisco, CA, United States of America
| | | | - Viraj Degaonkar
- Roche/Genentech, South San Francisco, CA, United States of America
| | - Pratyush Gupta
- Roche/Genentech, South San Francisco, CA, United States of America
| | | | - Thomas Powles
- Barts Cancer Institute, Barts Experimental Cancer Medicine Centre, Queen Mary University of London, Barts Health, London, United Kingdom
| | - Sean Ferree
- Natera, Austin, TX, United States of America
| | - Lucas Dennis
- Foundation Medicine Inc, Cambridge, MA, United States of America
| | - Amanda Young
- Foundation Medicine Inc, Cambridge, MA, United States of America
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2
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Gong J, Fu F, Ma X, Wang T, Ma X, You C, Zhang Y, Peng W, Chen H, Gu Y. Hybrid deep multi-task learning radiomics approach for predicting EGFR mutation status of non-small cell lung cancer in CT images. Phys Med Biol 2023; 68:245021. [PMID: 37972417 DOI: 10.1088/1361-6560/ad0d43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
Objective.Epidermal growth factor receptor (EGFR) mutation genotyping plays a pivotal role in targeted therapy for non-small cell lung cancer (NSCLC). We aimed to develop a computed tomography (CT) image-based hybrid deep radiomics model to predict EGFR mutation status in NSCLC and investigate the correlations between deep image and quantitative radiomics features.Approach.First, we retrospectively enrolled 818 patients from our centre and 131 patients from The Cancer Imaging Archive database to establish a training cohort (N= 654), an independent internal validation cohort (N= 164) and an external validation cohort (N= 131). Second, to predict EGFR mutation status, we developed three CT image-based models, namely, a multi-task deep neural network (DNN), a radiomics model and a feature fusion model. Third, we proposed a hybrid loss function to train the DNN model. Finally, to evaluate the model performance, we computed the areas under the receiver operating characteristic curves (AUCs) and decision curve analysis curves of the models.Main results.For the two validation cohorts, the feature fusion model achieved AUC values of 0.86 ± 0.03 and 0.80 ± 0.05, which were significantly higher than those of the single-task DNN and radiomics models (allP< 0.05). There was no significant difference between the feature fusion and the multi-task DNN models (P> 0.8). The binary prediction scores showed excellent prognostic value in predicting disease-free survival (P= 0.02) and overall survival (P< 0.005) for validation cohort 2.Significance.The results demonstrate that (1) the feature fusion and multi-task DNN models achieve significantly higher performance than that of the conventional radiomics and single-task DNN models, (2) the feature fusion model can decode the imaging phenotypes representing NSCLC heterogeneity related to both EGFR mutation and patient NSCLC prognosis, and (3) high correlations exist between some deep image and radiomics features.
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Affiliation(s)
- Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 20003, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Fangqiu Fu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Department of Thoracic Surgery and State key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
| | - Xiaowen Ma
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 20003, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Ting Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 20003, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xiangyi Ma
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Department of Thoracic Surgery and State key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 20003, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yang Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Department of Thoracic Surgery and State key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 20003, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Haiquan Chen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
- Department of Thoracic Surgery and State key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 20003, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
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Jiang Y, Lin Y, Fu W, He Q, Liang H, Zhong R, Cheng R, Li B, Wen Y, Wang H, Li J, Li C, Xiong S, Chen S, Xiang J, Mann MJ, He J, Liang W. The impact of adjuvant EGFR-TKIs and 14-gene molecular assay on stage I non-small cell lung cancer with sensitive EGFR mutations. EClinicalMedicine 2023; 64:102205. [PMID: 37745018 PMCID: PMC10511786 DOI: 10.1016/j.eclinm.2023.102205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background Currently, the role of EGFR-TKIs as adjuvant therapy for stage I, especially IA NSCLC, after surgical resection remains unclear. We aimed to compare the effect of adjuvant EGFR-TKIs with observation in such patients by incorporating an established 14-gene molecular assay for risk stratification. Methods This retrospective cohort study was conducted at the First Affiliated Hospital of Guangzhou Medical University (Study ID: ChNCRCRD-2022-GZ01). From March 2013 to February 2019, completely resected stage I NSCLC (8th TNM staging) patients with sensitive EGFR mutation were included. Patients with eligible samples for molecular risk stratification were subjected to the 14-gene prognostic assay. Inverse probability of treatment weighting (IPTW) was employed to minimize imbalances in baseline characteristics. Findings A total of 227 stage I NSCLC patients were enrolled, with 55 in EGFR-TKI group and 172 in the observation group. The median duration of follow-up was 78.4 months. After IPTW, the 5-year DFS (HR = 0.30, 95% CI, 0.14-0.67; P = 0.003) and OS (HR = 0.26, 95% CI, 0.07-0.96; P = 0.044) of the EGFR-TKI group were significantly better than the observation group. For subgroup analyses, adjuvant EGFR-TKIs were associated with favorable 5-year DFS rates in both IA (100.0% vs. 84.5%; P = 0.007), and IB group (98.8% vs. 75.3%; P = 0.008). The 14-gene assay was performed in 180 patients. Among intermediate-high-risk patients, EGFR-TKIs were associated with a significant improvement in 5-year DFS rates compared to observation (96.0% vs. 70.5%; P = 0.012), while no difference was found in low-risk patients (100.0% vs. 94.9%; P = 0.360). Interpretation Our study suggested that adjuvant EGFR-TKI might improve DFS and OS of stage IA and IB EGFR-mutated NSCLC, and the 14-gene molecular assay could help patients that would benefit the most from treatment. Funding This work was supported by China National Science Foundation (82022048, 82373121).
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Affiliation(s)
- Yu Jiang
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuechun Lin
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhai Fu
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qihua He
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ran Zhong
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ran Cheng
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bingliang Li
- Department of Cardiac Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yaokai Wen
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Huiting Wang
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianfu Li
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Caichen Li
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shan Xiong
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Michael J. Mann
- Department of Surgery, Division of Cardiothoracic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jianxing He
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou, China
- Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Grant MJ, Woodard GA, Goldberg SB. The Evolving Role for Systemic Therapy in Resectable Non-small Cell Lung Cancer. Hematol Oncol Clin North Am 2023; 37:513-531. [PMID: 37024389 DOI: 10.1016/j.hoc.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
During the last 2 decades, the understanding of non-small cell lung cancer (NSCLC) has evolved from a purely histologic classification system to a more complex model synthesizing clinical, histologic, and molecular data. Biomarker-driven targeted therapies have been approved by the United States Food and Drug Administration for patients with metastatic NSCLC harboring specific driver alterations in EGFR, HER2, KRAS, BRAF, MET, ALK, ROS1, RET, and NTRK. Novel immuno-oncology agents have contributed to improvements in NSCLC-related survival at the population-level. However, only in recent years has this nuanced understanding of NSCLC permeated into the systemic management of patients with resectable tumors.
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Affiliation(s)
- Michael J Grant
- Yale Cancer Center, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA; Department of Medicine (Medical Oncology), Yale School of Medicine, 330 Cedar Street, Rm BB 205, New Haven, CT 06520, USA.
| | - Gavitt A Woodard
- Yale Cancer Center, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA; Department of Surgery, Yale School of Medicine, PO Box 208028, New Haven, CT 06520, USA
| | - Sarah B Goldberg
- Yale Cancer Center, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA; Department of Medicine (Medical Oncology), Yale School of Medicine, 330 Cedar Street, Rm BB 205, New Haven, CT 06520, USA
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5
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[Consensus on Postoperative Recurrence Prediction of Non-small Cell Lung Cancer
Based on Molecular Markers]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:701-714. [PMID: 36285390 PMCID: PMC9619343 DOI: 10.3779/j.issn.1009-3419.2022.102.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Significant progress has been made in lung cancer screening, surgery, chemoradiation, targeted therapy, and immunotherapy recently. Surgical resection is the most important treatment for localized non-small cell lung cancer (NSCLC) so far, but there are still many patients who develop local recurrence or distant metastases within 5 years of surgery. Currently, the risk factors of recurrence in patients with NSCLC are mainly based on clinical and pathological features, which hardly identify patients at high risk of recurrence accurately. With the development of new detection technologies, a number of molecular markers that may have a predictive risk of recurrence in NSCLC have been discovered over the years. In order to summarize the molecular markers related to postoperative recurrence in NSCLC patients, we have formulated a consensus on the prediction of postoperative recurrence of NSCLC based on molecular markers. This consensus mainly focuses on the early stage NSCLC patients, discusses and summarizes the risk factors of disease recurrence from the molecular level. It is hoped that more and more valuable information can be provided for the management of patients, so as to provide more guidance for the perioperative management of the patients with early stage NSCLC in the future.
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Krantz SB, Zeeshan K, Kuchta KM, Hensing TA, Mangold KA, Zheng SL, Xu J. Germline mutations in high penetrance genes are associated with worse clinical outcomes in patients with non-small cell lung cancer. JTCVS OPEN 2022; 12:399-409. [PMID: 36590722 PMCID: PMC9801288 DOI: 10.1016/j.xjon.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 01/04/2023]
Abstract
Objective To determine the frequency of pathogenic mutations in high-penetrance genes (HPGs) in patients with non-small cell lung cancer (NSCLC) and identify whether such mutations are associated with clinicopathologic outcomes. Methods Patients with NSCLC who had consented to participate in a linked clinical database and biorepository underwent germline DNA sequencing using a next-generation sequencing panel that included cancer-associated HPGs and cancer risk-associated single nucleotide polymorphisms (SNPs). These data were linked to the clinical database to assess for associations between germline variants and clinical phenotype using Fisher's exact test and multivariable logistic and Cox regression. Results We analyzed 151 patients, among whom 33% carried any pathogenic HPG mutation and 23% had a genetic risk score (GRS) >1.5. Among the patients without any pathogenic mutation, 31% were at cancer stage II or higher, compared with 55% of those with 2 types of HPG mutations (P = .0293); 40% of patients with both types of HPG mutations had cancer recurrence, compared with 21% of patients without both types (P = .0644). In multivariable analysis, the presence of 2 types of HPG mutations was associated with higher cancer stage (odds ratio [OR], 3.32; P = .0228), increased recurrence of primary tumor (OR, 2.93; P = .0527), shorter time to recurrence (hazard ratio [HR], 3.03; P = .0119), and decreased cancer-specific (HR, 3.53; P = .0039) and overall survival (HR, 2.44; P = .0114). Conclusions The presence of mutations in HPGs is associated with higher cancer stage, increased risk of recurrence, and worse cancer-specific and overall survival in patients with NSCLC. Further large studies are needed to better delineate the role of HPGs in cancer recurrence and the potential benefit of adjuvant treatment in patients harboring such mutations.
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Affiliation(s)
- Seth B. Krantz
- Department of Surgery, NorthShore University HealthSystem, Evanston, Ill,Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill,Address for reprints: Seth B. Krantz, MD, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Suite 2507, Evanston, IL 60201.
| | - Kanwal Zeeshan
- Department of Surgery, NorthShore University HealthSystem, Evanston, Ill
| | - Kristine M. Kuchta
- Department of Bioinformatics and Research Core, NorthShore University HealthSystem, Evanston, Ill
| | - Thomas A. Hensing
- Department of Medicine, NorthShore University HealthSystem, Evanston, Ill,Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Kathy A. Mangold
- Department of Pathology, NorthShore University HealthSystem, Evanston, Ill,Department of Pathology, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - S. Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, Ill
| | - Jianfeng Xu
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill,Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Ill
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Li S, Deng J, She Y, Hou L, Chen C. Clinical Thoughts on the Predictive Value of the Newly Proposed Grading System of Invasive Pulmonary Adenocarcinoma. J Thorac Oncol 2022; 17:e28-e29. [PMID: 35216734 DOI: 10.1016/j.jtho.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Shenghui Li
- Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Jiajun Deng
- Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Yunlang She
- Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Likun Hou
- Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Chang Chen
- Department of Pathology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
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Gupta AR, Woodard GA, Jablons DM, Mann MJ, Kratz JR. Improved outcomes and staging in non-small-cell lung cancer guided by a molecular assay. Future Oncol 2021; 17:4785-4795. [PMID: 34435876 PMCID: PMC9039775 DOI: 10.2217/fon-2021-0517] [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] [Indexed: 01/02/2023] Open
Abstract
There remains a critical need for improved staging of non-small-cell lung cancer, as recurrence and mortality due to undetectable metastases at the time of surgery remain high even after complete resection of tumors currently categorized as ‘early stage.’ A 14-gene quantitative PCR-based expression profile has been extensively validated to better identify patients at high-risk of 5-year mortality after surgical resection than conventional staging – mortality that almost always results from previously undetectable metastases. Furthermore, prospective studies now suggest a predictive benefit in disease-free survival when the assay is used to guide adjuvant chemotherapy decisions in early-stage non-small-cell lung cancer patients. There is a need for improvement in the way early-stage non-small-cell lung cancers are staged and treated because many patients with ‘early-stage’ disease suffer high rates of cancer recurrence after surgery. In recent years, a specialized test has been developed to allow better characterization of a tumor's risk of recurrence based on the genes being expressed by tumor cells. Use of this test, in conjunction with standard staging methods, is better able to identify patients at high risk of cancer recurrence after surgery. Evidence suggests that giving chemotherapy to patients at high risk of recurrence after surgery reduces recurrence rates and improves long-term patient survival.
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Affiliation(s)
- Alexander R Gupta
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Gavitt A Woodard
- Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - David M Jablons
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Michael J Mann
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Johannes R Kratz
- Department of Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
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