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Zulato E, Del Bianco P, Nardo G, Attili I, Pavan A, Boscolo Bragadin A, Marra L, Pasello G, Fassan M, Calabrese F, Guarneri V, Conte PF, Indraccolo S, Bonanno L. Longitudinal liquid biopsy anticipates hyperprogression and early death in advanced non-small cell lung cancer patients treated with immune checkpoint inhibitors. Br J Cancer 2022; 127:2034-2042. [PMID: 36175621 PMCID: PMC9681746 DOI: 10.1038/s41416-022-01978-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionised treatment of advanced non-small cell lung cancer (aNSCLC), but a proportion of patients had no clinical benefit and even experienced detrimental effects. This study aims to characterise patients experiencing hyperprogression (HPD) and early death (ED) by longitudinal liquid biopsy. METHODS aNSCLC receiving ICIs were prospectively enrolled. Plasma was collected at baseline (T1) and after 3/4 weeks of treatment, according to the treatment schedule (T2). Cell-free DNA (cfDNA) was quantified and analysed by NGS. cfDNA quantification and variant allele fraction (VAF) of tumour-associated genetic alterations were evaluated for their potential impact on outcome. The genetic alteration with the highest VAF (maxVAF) at baseline was considered as a reference. RESULTS From March 2017 to August 2019, 171 patients were enrolled. Five cases matched criteria for HPD and 31 ED were recorded; one overlapped. Quantification of cfDNA at T2 and its absolute and relative variation (T2-T1) were significantly associated with the risk of ED (P = 0.012, P = 0.005, P = 0.009). MaxVAF relative change (T2-T1/T1) was significantly associated with the risk of HPD (P = 0.02). After identifying optimal cut-off values, a two-step risk assessment model was proposed. DISCUSSION Liquid biopsy performed early during treatment has the potential to identify patients at high risk of ED and HPD.
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Affiliation(s)
- Elisabetta Zulato
- grid.419546.b0000 0004 1808 1697Basic and Translational Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Paola Del Bianco
- grid.419546.b0000 0004 1808 1697Clinical Research Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Giorgia Nardo
- grid.419546.b0000 0004 1808 1697Basic and Translational Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Ilaria Attili
- grid.5608.b0000 0004 1757 3470Department of Surgery, Oncology and Gastroeneterology, Università degli Studi di Padova, Padova, Italy
| | - Alberto Pavan
- grid.5608.b0000 0004 1757 3470Department of Surgery, Oncology and Gastroeneterology, Università degli Studi di Padova, Padova, Italy
| | - Andrea Boscolo Bragadin
- grid.419546.b0000 0004 1808 1697Immunology and Molecular Oncology Diagnostics Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Ludovica Marra
- grid.419546.b0000 0004 1808 1697Immunology and Molecular Oncology Diagnostics Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Giulia Pasello
- grid.5608.b0000 0004 1757 3470Department of Surgery, Oncology and Gastroeneterology, Università degli Studi di Padova, Padova, Italy ,grid.419546.b0000 0004 1808 1697Medical Oncology 2, Istituto Oncologico Veneto IOV IRCSS, Padova, Italy
| | - Matteo Fassan
- grid.5608.b0000 0004 1757 3470Surgical Pathology Unit, Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Fiorella Calabrese
- grid.5608.b0000 0004 1757 3470Surgical Pathology Unit, Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Valentina Guarneri
- grid.5608.b0000 0004 1757 3470Department of Surgery, Oncology and Gastroeneterology, Università degli Studi di Padova, Padova, Italy ,grid.419546.b0000 0004 1808 1697Medical Oncology 2, Istituto Oncologico Veneto IOV IRCSS, Padova, Italy
| | - Pier Franco Conte
- grid.5608.b0000 0004 1757 3470Department of Surgery, Oncology and Gastroeneterology, Università degli Studi di Padova, Padova, Italy ,grid.419546.b0000 0004 1808 1697Medical Oncology 2, Istituto Oncologico Veneto IOV IRCSS, Padova, Italy
| | - Stefano Indraccolo
- grid.419546.b0000 0004 1808 1697Basic and Translational Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy ,grid.5608.b0000 0004 1757 3470Department of Surgery, Oncology and Gastroeneterology, Università degli Studi di Padova, Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IOV IRCSS, Padova, Italy.
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