1
|
Kramer A, Schuuring E, Vessies DCL, van der Leest P, Geerlings MJ, Rozendal P, Lanfermeijer M, Linders TC, van Kempen LC, Fijneman RJA, Ligtenberg MJL, Meijer GA, van den Broek D, Retèl VP, Coupé VMH. A Micro-Costing Framework for Circulating Tumor DNA Testing in Dutch Clinical Practice. J Mol Diagn 2023; 25:36-45. [PMID: 36402278 DOI: 10.1016/j.jmoldx.2022.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 07/11/2022] [Accepted: 10/04/2022] [Indexed: 11/18/2022] Open
Abstract
Circulating tumor DNA (ctDNA) is a promising new biomarker with multiple potential applications in cancer care. Estimating total cost of ctDNA testing is necessary for reimbursement and implementation, but challenging because of variations in workflow. We aimed to develop a micro-costing framework for consistent cost calculation of ctDNA testing. First, the foundation of the framework was built, based on the complete step-wise diagnostic workflow of ctDNA testing. Second, the costing method was set up, including costs for personnel, materials, equipment, overhead, and failures. Third, the framework was evaluated by experts and applied to six case studies, including PCR-, mass spectrometry-, and next-generation sequencing-based platforms, from three Dutch hospitals. The developed ctDNA micro-costing framework includes the diagnostic workflow from blood sample collection to diagnostic test result. The framework was developed from a Dutch perspective and takes testing volume into account. An open access tool is provided to allow for laboratory-specific calculations to explore the total costs of ctDNA testing specific workflow parameters matching the setting of interest. It also allows to straightforwardly assess the impact of alternative prices or assumptions on the cost per sample by simply varying the input parameters. The case studies showed a wide range of costs, from €168 to €7638 ($199 to $9124) per sample, and generated information. These costs are sensitive to the (coverage of) platform, setting, and testing volume.
Collapse
Affiliation(s)
- Astrid Kramer
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Ed Schuuring
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daan C L Vessies
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Paul van der Leest
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Pim Rozendal
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mirthe Lanfermeijer
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Theodora C Linders
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Léon C van Kempen
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Remond J A Fijneman
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marjolijn J L Ligtenberg
- Department of Human Genetics, Radboudumc, Nijmegen, the Netherlands; Department of Pathology, Radboudumc, Nijmegen, the Netherlands
| | - Gerrit A Meijer
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Daan van den Broek
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Valesca P Retèl
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Shi Y, Pei R, Liu S. Osimertinib versus platinum-pemetrexed in patients with previously treated EGFR T790M advanced non-small cell lung cancer: An updated AURA3 trial-based cost-effectiveness analysis. Front Oncol 2022; 12:833773. [DOI: 10.3389/fonc.2022.833773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundA recently overall survival (OS) analysis from the AURA3 trial indicated that osimertinib improves median OS versus platinum-pemetrexed for patients with previously treated epidermal growth factor receptor (EGFR) T790M advanced non-small cell lung cancer (NSCLC). Here, we assessed the cost-effectiveness of second-line osimertinib versus platinum-pemetrexed, from the perspectives of the United States payer and the Chinese health care system.MethodsA Markov model was constructed to compare the costs and health outcomes of osimertinib versus platinum-pemetrexed in second-line treatment of EGFR T790M advanced NSCLC. Life years (LYs), quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) were calculated. One-way and probabilistic sensitivity analyses assessed the robustness of the model. Cost-effectiveness was examined in the intention-to-treat (ITT) population and central nervous system (CNS) metastases population.ResultsIn the United States, compared with platinum-pemetrexed, osimertinib yielded additional effectiveness of 0.43 QALYs and -0.12 QALYs, with incremental costs of $67,588 and $16,465 in the ITT population and CNS metastases population, respectively. The ICERs of osimertinib over platinum-pemetrexed were $159,126/QALY and $-130,830/QALY, respectively. The probability of osimertinib being cost-effective was 37% and 5.76%, respectively, at the willingness-to-pay (WTP) threshold of $150,000/QALY. In China, osimertinib showed incremental effectiveness of 0.34 QALYs and -0.14 QALYs, with incremental costs of $1,663 and $-505, resulting in ICERs of $4,950/QALY and $3,754/QALY in the ITT population and CNS metastases population, respectively. At the WTP threshold of $37,489/QALY, there was a 100% and 26% likelihood that osimertinib was cost-effective in the ITT population and CNS metastases population.ConclusionIn the United States, second-line osimertinib treatment for EGFR T790M advanced NSCLC is not cost-effective compared to platinum-pemetrexed under the current WTP threshold. When the osimertinib price reduces, the economic outcome may become favorable. In China, assuming a WTP threshold of $37,489/QALY, osimertinib is the dominant treatment strategy compared with platinum-pemetrexed in the ITT population and provides cost savings for CNS metastases patients.
Collapse
|
3
|
Dermody SM, Bhambhani C, Swiecicki PL, Brenner JC, Tewari M. Trans-Renal Cell-Free Tumor DNA for Urine-Based Liquid Biopsy of Cancer. Front Genet 2022; 13:879108. [PMID: 35571046 PMCID: PMC9091346 DOI: 10.3389/fgene.2022.879108] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Cancer biomarkers are a promising tool for cancer detection, personalization of therapy, and monitoring of treatment response or recurrence. “Liquid biopsy” commonly refers to minimally invasive or non-invasive sampling of a bodily fluid (i.e., blood, urine, saliva) for detection of cancer biomarkers such as circulating tumor cells or cell-free tumor DNA (ctDNA). These methods offer a means to collect frequent tumor assessments without needing surgical biopsies. Despite much progress with blood-based liquid biopsy approaches, there are limitations—including the limited amount of blood that can be drawn from a person and challenges with collecting blood samples at frequent intervals to capture ctDNA biomarker kinetics. These limitations are important because ctDNA is present at extremely low levels in plasma and there is evidence that measuring ctDNA biomarker kinetics over time can be useful for clinical prediction. Additionally, blood-based assays require access to trained phlebotomists and often a trip to a healthcare facility. In contrast, urine is a body fluid that can be self-collected from a patient’s home, at frequent intervals, and mailed to a laboratory for analysis. Multiple reports indicate that fragments of ctDNA pass from the bloodstream through the kidney’s glomerular filtration system into the urine, where they are known as trans-renal ctDNA (TR-ctDNA). Accumulating studies indicate that the limitations of blood based ctDNA approaches for cancer can be overcome by measuring TR-ctDNA. Here, we review current knowledge about TR-ctDNA in urine as a cancer biomarker approach, and discuss its clinical potential and open questions in this research field.
Collapse
Affiliation(s)
- Sarah M. Dermody
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Chandan Bhambhani
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Paul L. Swiecicki
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, United States
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - J. Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Muneesh Tewari
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI, United States
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
- Center for Computational Biology and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Muneesh Tewari,
| |
Collapse
|
4
|
Shah P, Sands J, Normanno N. The expanding capability and clinical relevance of molecular diagnostic technology to identify and evaluate EGFR mutations in advanced/metastatic NSCLC. Lung Cancer 2021; 160:118-126. [PMID: 34500194 DOI: 10.1016/j.lungcan.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
Epidermal growth factor receptor (EGFR) mutation testing in advanced non-small-cell lung cancer (NSCLC) has evolved rapidly over the past decade, largely triggered by the introduction of the targeted EGFR tyrosine kinase inhibitors (TKIs). Initially used to detect common EGFR mutations and determine the most appropriate first-line therapy at diagnosis, testing methodologies have expanded to test for multiple mutations at multiple time points throughout the disease course. Here we review the current mutation testing approaches, including types of biopsies, and the available assays commonly used in the clinic. Specific application of these approaches in advanced NSCLC, including current guideline recommendations, and potential future developments are discussed.
Collapse
Affiliation(s)
- Parth Shah
- Dartmouth-Hitchcock Medical Centre, 1 Medical Center Dr, Lebanon, NH 03766, USA.
| | - Jacob Sands
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola 52, 80131 Naples, Italy.
| |
Collapse
|
5
|
Urine as a Source of Liquid Biopsy for Cancer. Cancers (Basel) 2021; 13:cancers13112652. [PMID: 34071230 PMCID: PMC8199052 DOI: 10.3390/cancers13112652] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Tissue biopsy is essential for diagnosis and characterization of a tumor. Recently circulating tumor cells and other tumor-derived nucleic acid can be detected from blood, which is called liquid biopsy. Now this concept has been expanded to many other body fluids including urine. Urine is the least invasive method to obtain a liquid biopsy and can be done anywhere, which allows longitudinal repeated sampling. Here, we review the latest update on urine liquid biopsy in urological and non-urological cancers. Abstract Tissue biopsy is the gold standard for diagnosis and morphological and immunohistochemical analyses to characterize cancer. However, tissue biopsy usually requires an invasive procedure, and it can be challenging depending on the condition of the patient and the location of the tumor. Even liquid biopsy analysis of body fluids such as blood, saliva, gastric juice, sweat, tears and cerebrospinal fluid may require invasive procedures to obtain samples. Liquid biopsy can be applied to circulating tumor cells (CTCs) or nucleic acids (NAs) in blood. Recently, urine has gained popularity due to its less invasive sampling, ability to easily repeat samples, and ability to follow tumor evolution in real-time, making it a powerful tool for diagnosis and treatment monitoring in cancer patients. With the development and advancements in extraction methods of urinary substances, urinary NAs have been found to be closely related to carcinogenesis, metastasis, and therapeutic response, not only in urological cancers but also in non-urological cancers. This review mainly highlights the components of urine liquid biopsy and their utility and limitations in oncology, especially in non-urological cancers.
Collapse
|
6
|
Zhang L, Li N, Liu M, Zheng B, Wu Z, Cai H. Cost-Effectiveness Analysis of Dacomitinib versus Gefitinib in the First-Line Treatment of EGFR-Positive Advanced or Metastatic Non-Small Cell Lung Cancer. Cancer Manag Res 2021; 13:4263-4270. [PMID: 34093040 PMCID: PMC8168962 DOI: 10.2147/cmar.s293983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background The objective of the study was to evaluate the economics of dacomitinib and gefitinib in the first-line treatments for EGFR-positive advanced or metastatic non-small cell lung cancer (NSCLC) from a US payer perspective. Methods We developed the partition survival model to compare the lifetime cost and health outcomes of dacomitinib versus gefitinib. Transition probabilities were collected from the ARCHER 1050 trial. The model only considered the direct medical costs. Utility values were taken from published research. Results Compared to gefitinib, dacomitinib increased 0.706 QALY and the cost increased $232,359.32. The incremental cost-effectiveness ratio (ICER) was $329,120.85 per QALY in the base case. One-way sensitivity analysis showed that the cost of drugs and the utility had more influence on the results than other parameters. Probability sensitivity analysis reflected that the parameters had little effect on the results. Conclusion Dacomitinib could improve the health benefits and increase the overall costs. In this simulation, dacomitinib is not likely to be economical for first-line therapy of EGFR-mutated NSCLC.
Collapse
Affiliation(s)
- Longfeng Zhang
- Department of Thoracic Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian Province, People's Republic of China
| | - Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Zhijuan Wu
- Department of Physiology and Pathophysiology, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| | - Hongfu Cai
- Department of Pharmacy, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China
| |
Collapse
|
7
|
Wang Z, Li X, Zhang L, Xu Y, Wang M, Liang L, Jiao P, Li Y, He S, Du J, He L, Tang M, Sun M, Yang L, Di J, Zhu G, Li L, Liu D. Sputum cell-free DNA: Valued surrogate sample for the detection of EGFR exon 20 p.T790M mutation in patients with advanced lung adenocarcinoma and acquired resistance to EGFR-TKIs. Cancer Med 2021; 10:3323-3331. [PMID: 33932095 PMCID: PMC8124129 DOI: 10.1002/cam4.3817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sputum cell-free DNA (cfDNA) is a valuable surrogate sample for assessing EGFR-sensitizing mutations in patients with advanced lung adenocarcinoma. Detecting EGFR exon 20 p.T790 M (p.T790 M) is much more challenging due to its limited availability in tumor tissues. Exploring sputum cfDNA as an alternative for liquid-based sample type in detecting p.T790 M requires potential improvement in clinical practice. METHODS A total of 34 patients with EGFR-sensitive mutation-positive lung adenocarcinoma and acquired resistance to the first generation of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) were enrolled. The sputum samples, and paired tumors and/or plasma samples were tested for p.T790 M mutation and concordance of p.T790 M status among the three sample types was analyzed. RESULTS The overall concordance rate of p.T790 M mutation between sputum cfDNA and tumor tissue samples was 85.7%, with a sensitivity of 66.7% and a specificity of 100%. The sensitivity for detecting p.T790 M in sputum cfDNA was 100%, 66.7%, and 0% in the three sputum groups of malignant, satisfactory but no malignant cells, and unsatisfactory, respectively. The combined results of plasma cfDNA testing and sputum cfDNA testing further increased the sensitivity to 100% for p.T790 M detection in satisfactory but no malignant cells sputum group. CONCLUSION These findings revealed that cfDNA from malignant or satisfied but no malignant cells sputum is considered suitable for detecting p.T790 M mutation in patients with acquired resistance to first or second-generation EGFR-TKIs. The sputum cytological pathological evaluation-guided sputum cfDNA testing assists in significantly improving the sensitivity of p.T790 M detection, bringing significant value for the maximal application of third-generation EGFR-TKIs in second-line treatment.
Collapse
Affiliation(s)
- Zheng Wang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Xiaoguang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Lin Zhang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Li Liang
- Department of Cancer chemotherapy and Radiation sickness, Peking University Third Hospital, Beijing, P.R. China
| | - Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Yuanming Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Shurong He
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Jun Du
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Lei He
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Min Tang
- Department of Medical Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Mingjun Sun
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Li Yang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Jing Di
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | | | - Lin Li
- Department of Medical Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Dongge Liu
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| |
Collapse
|
8
|
Hayashi Y, Fujita K. Toward urinary cell-free DNA-based treatment of urothelial carcinoma: a narrative review. Transl Androl Urol 2021; 10:1865-1877. [PMID: 33968675 PMCID: PMC8100839 DOI: 10.21037/tau-20-1259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Liquid biopsy technique targeting urinary cell-free DNA (cfDNA) is getting a lot of attention to overcome limitations of the present treatment strategy for urothelial carcinoma, including urothelial bladder carcinoma (UBC) and upper tract urothelial carcinoma (UTUC). Analysis of tumor-derived DNA in urine focusing either on genomic or epigenomic alterations, holds great potential as a noninvasive method for the detection of urothelial carcinoma with high accuracy. It is also predictive of prognosis and response to drugs, and reveals the underlying characteristics of different stages of urothelial carcinoma. Although cfDNA methylation analyses based on a combination of several methylation profiles have demonstrated high sensitivity for UBC diagnosis, there have been few reports involving epigenomic studies of urinary cfDNA. In mutational analyses, frequent gene mutations (TERT promoter, TP53, FGFR3, PIK3CA, RAS, etc.) have been detected in urine supernatant by using remarkable technological innovations such as next-generation sequencing and droplet digital PCR. These methods allow highly sensitive detection of rare mutation alleles while minimizing artifacts. In this review, we summarize the current insights into the clinical applications of urinary cfDNA from patients with urothelial carcinoma. Although it is necessary to conduct prospective multi-institutional clinical trials, noninvasive urine biopsy is expected to play an important role in the realization of precision medicine in patients with urothelial carcinoma in the near future.
Collapse
Affiliation(s)
- Yujiro Hayashi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Kindai University Faculty of Medicine, Osakasayama, Japan
| |
Collapse
|
9
|
Chen X, Li K, Liu Z, Gai F, Zhu G, Lu S, Che N. Multigene PCR using both cfDNA and cfRNA in the supernatant of pleural effusion achieves accurate and rapid detection of mutations and fusions of driver genes in patients with advanced NSCLC. Cancer Med 2021; 10:2286-2292. [PMID: 33656807 PMCID: PMC7982639 DOI: 10.1002/cam4.3769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 01/29/2023] Open
Abstract
Background Pleural effusion from patients with advanced non‐small cell lung cancer (NSCLC) has been proved valuable for molecular analysis, especially when the tissue sample not available. However, simultaneous detection of multiple driver gene alterations especially the fusions is still challenging. Methods In this study, 77 patients with advanced NSCLC and pleural effusion were enrolled, 49 of whom had matched tumor tissues. Supernatants, cell sediments, and cell blocks were prepared from pleural effusion samples for detection of driver alterations by a PCR‐based 9‐gene mutation detection kit. Results Mutations in EGFR, KRAS, and HER2 were detected in DNA and cfDNA, fusions in ALK was detected in RNA and cfRNA. Compared with matched tumor tissue, the supernatant showed the highest overall sensitivity (81.3%), with 81.5% for SNV/Indels by cfDNA and 80% for fusions by cfRNA, followed by cell blocks (71.0%) and the cell sediments (66.7%). Within the group of treatment‐naïve patients or malignant cells observed in the cell sediments, supernatant showed higher overall sensitivity (89.5% and 92.3%) with both 100% for fusions. Conclusions CfDNA and cfRNA derived from pleural effusion supernatant have been successfully tested with a PCR‐based multigene detection kit. Pleural effusion supernatant seems a preferred material for detection of multigene alterations to guide treatment decision of advanced NSCLC.
Collapse
Affiliation(s)
- Xuejing Chen
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis And Thoracic Tumor Research Institute, Beijing, China
| | - Kun Li
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis And Thoracic Tumor Research Institute, Beijing, China
| | - Zichen Liu
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis And Thoracic Tumor Research Institute, Beijing, China
| | - Fei Gai
- Medical Department, Amoy Diagnostics Co., Ltd., Xiamen, China
| | - Guanshan Zhu
- Medical Department, Amoy Diagnostics Co., Ltd., Xiamen, China
| | - Shun Lu
- Department of Oncology, Shanghai Chest Hospital Shanghai Jiaotong University, Shanghai, China
| | - Nanying Che
- Department of Pathology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis And Thoracic Tumor Research Institute, Beijing, China
| |
Collapse
|
10
|
Guan G, Wang Y, Sun Q, Wang L, Xie F, Yan J, Huang H, Liu H. Utility of urinary ctDNA to monitoring minimal residual disease in early breast cancer patients. Cancer Biomark 2021; 28:111-119. [PMID: 32176625 DOI: 10.3233/cbm-190523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cancer recurrence for patients with early breast cancer is significant. Patients will benefit from more non-invasive modes of monitoring and we aim to study the feasibility of urinary circulating tumor DNA (ctDNA) to monitor for residual disease (MRD). METHODS In this longitudinal study, 300 early breast cancer patients were recruited prospectively. Measurements were taken prior to treatment and at different time points thereafter for a total of 8 measurements. Comparisons were made with healthy volunteers and patients without detectable mutations in urine specimens. Disease free relapse were correlated to both urinary DNA quantity and ctDNA concentration. RESULTS Baseline index measurements showed 38% of patients with detectable mutations. The concordance with biopsy tissues was 97.3%. Overall, breast cancer patients had higher urinary DNA compared with healthy volunteers. Over time, fluctuations in urinary DNA was negligible in healthy volunteers, indicating the stability of the marker. Among the patients with detectable mutations, we observed that higher urinary DNA quantity measurements at 6-month and patients with positive mutations were associated with greater risk of relapse. Hazard ratios for patients in this category was 1.65 (95% CI 1.26-2.16) and 1.98 (95% CI 1.48-2.63) respectively. CONCLUSION Urinary DNA offers non-invasive probing and real-time monitoring of breast cancer relapse. Our results demonstrated clear clinical relevance in breast cancer and significant risk profiling of early breast cancer patients. This potentially aids to complement current cancer relapse monitoring and may help in early intervention.
Collapse
Affiliation(s)
- Gege Guan
- Department of Oncology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.,Department of Oncology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yuehua Wang
- Department of Oncology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.,Department of Oncology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Qiushi Sun
- Department of Oncology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Ling Wang
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Fei Xie
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Jiayin Yan
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Huajun Huang
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Huijie Liu
- Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| |
Collapse
|
11
|
Wang Y, Li J, Huang J, Wu C, Li L, Gong P. Mutation differences in circulating tumor DNAs from non-small cell lung cancer patients between Uygur and Han populations. Medicine (Baltimore) 2021; 100:e24159. [PMID: 33530206 PMCID: PMC7850657 DOI: 10.1097/md.0000000000024159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/01/2020] [Accepted: 12/04/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The incidence of non-small cell lung cancer (NSCLC) in Uygur population is gradually increasing recently. In view of the great diagnostic and prognostic values of cell-free DNAs (cfDNA) detection, this study focus on a liquid biopsy to explore the value of cfDNA mutation in healthy and NSCLC patients in 2 ethnicities. METHODS The concentration and sequencing of cfDNA in NSCLC and healthy subjects was assessed with a standard information analysis procedure, including detection, annotation, and statistical analysis. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were conducted to analyze the function of mutant genes and related pathways. Totally, 133 subjects, including 35 Uygur NSCLC patients, 10 Uygur healthy subjects, 63 cases of Han NSCLC patients and 25 Han health control, were admitted to the hospital. RESULTS There were a lower proportion of adenocarcinoma and higher percentage of smoking rate for Uygur patients. For cfDNA level between NSCLC and healthy subjects, Han patients exhibited sharp increase while there was no statistical difference in Uygur population. In addition, the mutation frequency of cfDNA in Han patients (72.6%) was significantly higher than Uygur patients (45.7%). There were 5 gene mutations only found in Han patients and ABCC11 showed a higher mutation frequency in Uygur population as a common one. Finally, Go and Kyoto Encyclopedia of Genes and Genomes analysis showed apprent functional enrichments and pathway changes between 2 ethnicities. CONCLUSION There existed distinct distributions of cancer subtypes, smoking proportion, cfDNA level, and mutation patterns between Han and Uygur patients. The results may be a useful tool in NSCLC patients' diagnosis as well as individualized therapy between ethnicities in future.
Collapse
Affiliation(s)
- Yuli Wang
- Department of Oncology, Ganzhou People's Hospital, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou
| | - Jing Li
- Department of Oncology, Shihezi University School of Medicine, the First Affiliated Hospital, Shihezi
| | - Jian Huang
- Department of Hematology, Wenzhou Central Hospital, Theorem Clinical College, Wenzhou Medical University, Wenzhou
| | | | - Li Li
- Department of Respirology and Intensive Care Unit, the First People's Hospital of Kashi District, Kashi, Chain
| | - Ping Gong
- Department of Oncology, Shihezi University School of Medicine, the First Affiliated Hospital, Shihezi
| |
Collapse
|
12
|
Abstract
Application of next generation sequencing techniques in the field of liquid biopsy, in particular urine, requires specific bioinformatics methods in order to deal with its peculiarity. Many aspects of cancer can be explored starting from nucleic acids, especially from cell-free DNA and circulating tumor DNA in order to characterize cancer. It is possible to detect small mutations, as single nucleotide variants, small insertions and deletions, copy-number alterations, and epigenetic profiles. Due to the low fraction of circulating tumor DNA over the whole cell-free DNA, some methods have been exploited. One of them is the application of unique barcodes to each DNA fragment in order to lower the limit of detection of cancer-related variants. Some bioinformatics workflows and tools are the same of a classic analysis of tumor tissue, but there are some steps in which specific algorithms have to be introduced.
Collapse
|
13
|
Mesquita A, Costa JL, Schmitt F. Utility of Circulating Tumor DNA in Different Clinical Scenarios of Breast Cancer. Cancers (Basel) 2020; 12:E3797. [PMID: 33339259 PMCID: PMC7766337 DOI: 10.3390/cancers12123797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022] Open
Abstract
Breast cancer is a complex disease whose molecular mechanisms are not completely understood. Developing target therapies is a promising approach. Therefore, understanding the biological behavior of the tumor is a challenge. Tissue biopsy in the metastatic setting remains the standard method for diagnosis. Nevertheless, it has been associated with some disadvantages: It is an invasive procedure, it may not represent tumor heterogeneity, and it does not allow for treatment efficacy to be assessed or early recurrences to be detected. Analysis of circulating tumor DNA (ctDNA) may help to overcome this as it is a non-invasive method of monitoring the disease. In early-stage disease, it can detect early recurrences and monitor tumors' genomic profiles, identifying the emergence of new genetic alterations which can be related to tumor-acquired resistance. In the metastatic setting, the analysis of ctDNA may also allow for the anticipation of clinical and radiological progression of the disease, selection of targeted therapies, and for a photogram of tumor heterogeneity to be provided. It may also detect disease progression earlier in locally advanced tumors submitted to neoadjuvant treatment, and identify minimal residual disease. ctDNA analysis may guide clinical decision-making in different scenarios, in a precision medicine era, once it acts as a repository of genetic tumor material, allowing for a comprehensive mutation profiling analysis. In this review, we focused on recent advances towards the implementation of ctDNA in a clinical routine for breast cancer.
Collapse
Affiliation(s)
- Alexandra Mesquita
- Medical Oncology Department, Hospital Pedro Hispano, Unidade Local Saúde Matosinhos, 4464-513 Senhora da Hora, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.L.C.); (F.S.)
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - José Luís Costa
- Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.L.C.); (F.S.)
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal; (J.L.C.); (F.S.)
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| |
Collapse
|
14
|
Chen N, Zhang W, Tang X, Ming Z, Xiao X. Branch migration-based polymerase chain reaction combined with endonuclease IV-assisted target recycling probe/blocker system for detection of low-abundance point mutations. Analyst 2020; 145:1355-1361. [PMID: 31970369 DOI: 10.1039/c9an02209k] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sensitive detection of low-abundance point mutations in blood or tissue may provide a great opportunity for the minimally invasive diagnosis of cancer and other related diseases. We demonstrate a novel method for ultra-sensitive detection of point mutations at low abundance by combination of branch migration-based PCR with endonuclease IV-assisted target recycling probe/blocker system. The method is able to identify the point mutations at abundances down to 0.01-0.02%. We anticipate this method to be widely adopted in clinical diagnosis and molecular research.
Collapse
Affiliation(s)
- Na Chen
- Institute of Reproductive Health, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China.
| | | | | | | | | |
Collapse
|
15
|
Zhang P, Wu X, Tang M, Nie X, Li L. Detection of EGFR gene mutation status from pleural effusions and other body fluid specimens in patients with lung adenocarcinoma. Thorac Cancer 2019; 10:2218-2224. [PMID: 31602787 PMCID: PMC6885423 DOI: 10.1111/1759-7714.13201] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 12/25/2022] Open
Abstract
Background Epidermal growth factor receptor (EGFR) gene mutation status is essential to the optimal management of lung adenocarcinoma. Liquid biopsy has advantages such as noninvasiveness, speediness, and convenience. This study aimed to detect EGFR gene mutations using next‐generation sequencing (NGS) from different types of body fluids from patients with lung adenocarcinoma. Methods This was a prospective study of 20 patients with lung adenocarcinoma recruited between January 2017 and December 2018 at the Beijing Hospital. All patients had adenocarcinoma with confirmed sensitizing EGFR mutations. Body fluid specimens included pleural effusion, ascites, pericardial effusion, and cerebrospinal fluid. NGS was conducted to test for nine lung cancer‐related gene in body fluid supernatant free DNA, sedimentary tumor cells, and plasma free DNA. Results The EGFR gene mutation abundance of body fluid supernatant free DNA was higher than that of body fluid sedimentary tumor cells and plasma free DNA specimens (100% vs. 90% vs. 80%, respectively, all P < 0.05). The results of EGFR mutation from the body fluid supernatants were consistent with the results from the tissue biopsy. Conclusions This study showed that compared with body fluid sediment tumor cells and plasma free DNA samples, body fluid supernatant free DNA has a higher detection rate and sensitivity of tumor‐specific mutations. Free DNA obtained from body fluid supernatants could be used as high‐quality specimens for gene mutation detection in patients with lung cancer. This could be applied in treatment decisions and patient management.
Collapse
Affiliation(s)
- Ping Zhang
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Xiaonan Wu
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Min Tang
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Xin Nie
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Lin Li
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China
| |
Collapse
|
16
|
Tong L, Ding N, Tong X, Li J, Zhang Y, Wang X, Xu X, Ye M, Li C, Wu X, Bao H, Zhang X, Hong Q, Song Y, Shao YW, Bai C, Zhou J, Hu J. Tumor-derived DNA from pleural effusion supernatant as a promising alternative to tumor tissue in genomic profiling of advanced lung cancer. Theranostics 2019; 9:5532-5541. [PMID: 31534501 PMCID: PMC6735385 DOI: 10.7150/thno.34070] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/12/2019] [Indexed: 12/30/2022] Open
Abstract
Pleural effusion (PE) is commonly observed in advanced lung cancer and was suggested to contain both cell-free tumor DNA and tumor cells. Molecular profiling of PE represents a minimally invasive approach of detecting tumor driver mutations for clinical decision making, especially when tumor tissues are not available. The objective of this study is to investigate the efficacy and precision of detecting gene alterations in PE samples to address the feasibility in clinical use. Methods: Sixty-three metastatic lung cancer patients with (n=30, cohort 1) or without (n=33, cohort 2) matched tumor tissues were enrolled in this study. PE and plasma samples of each patient were collected simultaneously. Supernatant and cell precipitate of PE were processed separately to extract cfDNA (PE-cfDNA) and sediment DNA (sDNA). All samples were subjected to targeted next-generation sequencing (NGS) of 416 cancer-related genes. Results: PE supernatants contain more abundant tumor DNA than PE sediments and plasma samples, suggested by higher mutant allele frequencies (MAF) and elevated mutation detection rate in PE-cfDNA (98.4% vs. 90.5% in PE sDNA vs. 87% in plasma cfDNA). In Cohort 1 with matched tumor tissue, tumor mutational burden (TMB) of PE-cfDNA was similar as tumor tissues (6.4 vs. 5.6), but significantly higher than PE sDNA (median TMB: 3.3) and plasma cfDNA (median TMB: 3.4). Ninety-three percent (27 out of 29) of tissue-determined driver mutations were detected in PE-cfDNA, including alterations in ALK, BRAF, EGFR, ERBB2, KRAS, NF1, PIK3CA, and RET, while only 62% were captured in plasma cfDNA. PE-cfDNA also has the highest detection rate of EGFR driver mutations in the full cohort (71% vs. 68% in PE sDNA vs. 59% in plasma cfDNA). Mutation detection from cytological negative and hemorrhagic PE is challenging. Comparatively, PE-cfDNA demonstrated absolute superiority than PE sDNA in such a scenario, suggesting that it is an independent source of tumor DNA and therefore less influenced by the abundance of tumor cells. Conclusion: Genomic profiling of PE-cfDNA offers an alternative, and potentially more meticulous approach in assessing tumor genomics in advanced lung cancer when tumor tissue is not available. Our data further demonstrate that in hemorrhagic or cytologically negative PE samples, PE-cfDNA has higher mutation detection sensitivity than sDNA and plasma cfDNA, and therefore is a more reliable source for genetic testing.
Collapse
Affiliation(s)
- Lin Tong
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Ning Ding
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Xiaoling Tong
- Translational Medicine Research Institute, Geneseeq Technology Inc., Toronto, Ontario, M5G 1L7, Canada
| | - Jiamin Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Yong Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Xiaodan Wang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Xiaobo Xu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Maosong Ye
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Chun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Xue Wu
- Translational Medicine Research Institute, Geneseeq Technology Inc., Toronto, Ontario, M5G 1L7, Canada
| | - Hairong Bao
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, 210032, China
| | - Xin Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Qunying Hong
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Yang W. Shao
- Medical Department, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, 210032, China
- School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Jian Zhou
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| | - Jie Hu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Respiratory Research Institute, Shanghai, 200032, China
| |
Collapse
|
17
|
Jain S, Lin SY, Song W, Su YH. Urine-Based Liquid Biopsy for Nonurological Cancers. Genet Test Mol Biomarkers 2019; 23:277-283. [PMID: 30986103 DOI: 10.1089/gtmb.2018.0189] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIMS The use of circulating cell-free DNA for detection of cancer genetics has been studied extensively. Liquid biopsy often refers to the use of blood as a minimally invasive source of body fluid for detecting circulating tumor DNA (ctDNA). However, urine collection, which is completely noninvasive, has been shown to also have great promise to serve as an alternate body fluid source for ctDNA. In this review article, we focus on the clinical utility of urine for genetic liquid biopsy of nonurological cancers. CONCLUSION Although still in early stages as compared with blood-based liquid biopsy, recent studies have demonstrated the value of urine-based liquid biopsies for: nonurological cancer screening; early detection; monitoring for recurrence and metastasis; and therapeutic efficacy. Overall, the completely noninvasive and patient-friendly nature of the urine-based biopsy warrants further development and offers a promising alternative to blood-based biopsies.
Collapse
Affiliation(s)
- Surbhi Jain
- 1 JBS Science, Inc., Doylestown, Pennsylvania
| | | | - Wei Song
- 1 JBS Science, Inc., Doylestown, Pennsylvania
| | - Ying-Hsiu Su
- 2 Department of Translational Medical Science, The Baruch S. Blumberg Institute, Doylestown, Pennsylvania
| |
Collapse
|
18
|
Abstract
Urine cell-free DNA is an important source of diagnostic markers for different diseases (e.g., cancer and prenatal diagnosis). It is important to achieve a simple and fast protocol to maximize the recovery of DNA from urine supernatant and to assess its quality. Here we describe a simple approach from urine collection to DNA quality assessment for downstream analyses.
Collapse
|
19
|
Muluhngwi P, Valdes Jr R, Fernandez-Botran R, Burton E, Williams B, Linder MW. Cell-free DNA diagnostics: current and emerging applications in oncology. Pharmacogenomics 2019; 20:357-380. [DOI: 10.2217/pgs-2018-0174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Liquid biopsy is a noninvasive dynamic approach for monitoring disease over time. It offers advantages including limited risks of blood sampling, opportunity for more frequent sampling, lower costs and theoretically non-biased sampling compared with tissue biopsy. There is a high degree of concordance between circulating tumor DNA mutations versus primary tumor mutations. Remote sampling of circulating tumor DNA can serve as viable option in clinical diagnostics. Here, we discuss the progress toward broad adoption of liquid biopsy as a diagnostic tool and discuss knowledge gaps that remain to be addressed.
Collapse
Affiliation(s)
- Penn Muluhngwi
- Department of Pathology & Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Roland Valdes Jr
- Department of Pathology & Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Rafael Fernandez-Botran
- Department of Pathology & Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Eric Burton
- Department of Neurology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Brian Williams
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Mark W Linder
- Department of Pathology & Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA
| |
Collapse
|
20
|
Alimirzaie S, Bagherzadeh M, Akbari MR. Liquid biopsy in breast cancer: A comprehensive review. Clin Genet 2019; 95:643-660. [PMID: 30671931 DOI: 10.1111/cge.13514] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/04/2019] [Accepted: 01/11/2019] [Indexed: 12/11/2022]
Abstract
Breast cancer is the most common cancer among women worldwide. Due to its complexity in nature, effective breast cancer treatment can encounter many challenges. Traditional methods of cancer detection such as tissue biopsy are not comprehensive enough to capture the entire genomic landscape of breast tumors. However, with the introduction of novel techniques, the application of liquid biopsy has been enhanced, enabling the improvement of various aspects of breast cancer management including early diagnosis and screening, prediction of prognosis, early detection of relapse, serial sampling and efficient longitudinal monitoring of disease progress and response to treatment. Various components of tumor cells released into the blood circulation can be analyzed in liquid biopsy sampling, some of which include circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), cell-free RNA, tumor-educated platelets and exosomes. These components can be utilized for different purposes. As an example, ctDNA can be sequenced for genetic profiling of the tumors to enhance individualized treatment and longitudinal screening. CTC plasma count analysis or ctDNA detection after curative tumor resection surgery could facilitate early detection of minimal residual disease, aiding in the initiation of adjuvant therapy to prevent recurrence. Furthermore, CTC plasma count can be assessed to determine the stage and prognosis of breast cancer. In this review, we discuss the advantages and limitations of the various components of liquid biopsy used in breast cancer diagnosis and will expand on aspects that require further focus in future research.
Collapse
Affiliation(s)
- Sahar Alimirzaie
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.,Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Bagherzadeh
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad R Akbari
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Goldman JW, Karlovich C, Sequist LV, Melnikova V, Franovic A, Gadgeel SM, Reckamp KL, Camidge DR, Pérol M, Ou SHI, Liu SV, Yu HA, Soria JC, Socinski MA, Mekhail TM, Solomon BJ, Natale RB, Otterson GA, Papadimitrakopoulou V, Langer CJ, Neal JW, Despain D, Yurasov S, Litten JB, Erlander M, Raponi M, Wakelee HA. EGFR Genotyping of Matched Urine, Plasma, and Tumor Tissue in Patients With Non–Small-Cell Lung Cancer Treated With Rociletinib, an EGFR Tyrosine Kinase Inhibitor. JCO Precis Oncol 2018; 2:1-13. [DOI: 10.1200/po.17.00116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose Liquid biopsies represent an attractive alternative to tissue biopsies, particularly rebiopsies, in determining patient eligibility for targeted therapies. Clinical utility of urine genotyping, however, has not been explored extensively. We evaluated epidermal growth factor receptor ( EGFR) T790M detection in matched urine, plasma, and tissue and the clinical outcomes of patients with advanced non–small-cell lung cancer treated with rociletinib. Methods Tissue (n = 540), plasma (n = 482), and urine (n = 213) were collected from evaluable patients enrolled in TIGER-X, a phase I/II study. Genotyping was performed by therascreen EGFR testing in tissue, BEAMing in plasma, and a quantitative short footprint assay (Trovera) in urine, which was used to further examine discordant samples. Results Positive percent agreement with tissue T790M results was similar for urine (82%; 142 of 173) and plasma (81%; 313 of 387) genotyping. Urine and plasma together identified more patients who were T790M positive (92%) than tissue alone (83%) among matched samples (n = 177). The ability to identify mutations in plasma was strongly associated with M stage ( P < .001); rate of T790M detection for patients with M1a/M0 disease increased from 54% for plasma alone to 85% when urine and plasma were both examined. Objective response rates of patients who were T790M positive were comparable between tumor (34%), plasma (32%), and urine (37%). Conclusion Clinical response to rociletinib was comparable irrespective of whether T790M status was identified by liquid or tissue biopsy. Combined, urine and plasma identified a higher percentage of patients who were T790M positive than tumor genotyping alone and improved detection of T790M, particularly in the absence of distant metastases. These findings support the noninvasive analysis of urine and plasma before tumor rebiopsy when assessing T790M status.
Collapse
Affiliation(s)
- Jonathan W. Goldman
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Chris Karlovich
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Lecia V. Sequist
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Vlada Melnikova
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Aleksandra Franovic
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Shirish M. Gadgeel
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Karen L. Reckamp
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - D. Ross Camidge
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Maurice Pérol
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Sai-Hong Ignatius Ou
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Stephen V. Liu
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Helena A. Yu
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Jean-Charles Soria
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Mark A. Socinski
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Tarek M. Mekhail
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Benjamin J. Solomon
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Ronald B. Natale
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Gregory A. Otterson
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Vassiliki Papadimitrakopoulou
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Corey J. Langer
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Joel W. Neal
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Darrin Despain
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Sergey Yurasov
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Jason B. Litten
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Mark Erlander
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Mitch Raponi
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| | - Heather A. Wakelee
- Jonathan W. Goldman, University of California Los Angeles; Ronald B. Natale, Cedars-Sinai Medical Center, Los Angeles; Vlada Melnikova, Aleksandra Franovic, and Mark Erlander, Trovagene, San Diego; Karen Reckamp, City of Hope Comprehensive Cancer Center, Duarte; Sai-Hong Ignatius Ou, University of California Irvine School of Medicine, Orange; Joel W. Neal and Heather A. Wakelee, Stanford University, Stanford, CA; Chris Karlovich, Darrin Despain, Sergey Yurasov, Jason B. Litten, and Mitch Raponi, Clovis
| |
Collapse
|
22
|
Wu B, Gu X, Zhang Q, Xie F. Cost-Effectiveness of Osimertinib in Treating Newly Diagnosed, Advanced EGFR-Mutation-Positive Non-Small Cell Lung Cancer. Oncologist 2018; 24:349-357. [PMID: 30257889 DOI: 10.1634/theoncologist.2018-0150] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/24/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The objective of this study was to assess cost and effectiveness of osimertinib in treating newly diagnosed advanced non-small cell lung cancer with an epidermal growth factor receptor (EGFR) mutation from a public payer's perspective in the U.S. and China. MATERIALS AND METHODS Markov models were developed to compare three treatment strategies: first-line use of osimertinib, first-line use of the standard first-generation EGFR-tyrosine kinase inhibitor (EGFR-TKI) followed by the second-line use of osimertinib, and the standard first-generation EGFR-TKI therapy (standard care [SOC]). Clinical data, cost, and utility data were mainly derived from published literatures. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the incremental cost per quality-adjusted life year (QALY) between the treatments. RESULTS The resultant incremental cost per QALY gained for the first-line osimertinib versus SOC was $312,903 in the U.S. and $41,512 in China. The incremental cost per QALY for the second-line osimertinib versus SOC was $284,532 in the U.S. and $38,860 in China. The probability of the SOC strategy being cost-effective is 1.0 if the willingness to pay threshold is below $150,000/QALY in the U.S. and below $30,000/QALY in China. CONCLUSION Osimertinib as first-line treatment could gain more health benefits in comparison with standard EGFR-TKIs or second-line use of osimertinib. However, because of the high cost of treatment, the cost-effectiveness analyses were not in favor of the first-line use of osimertinib from a public payer's perspective in the U.S. and China. IMPLICATIONS FOR PRACTICE Osimertinib as first-line treatment yielded the greatest health outcomes but is not a cost-effective strategy for lung cancer in the U.S. and China. The price of osimertinib has a substantial impact on economic outcomes.
Collapse
Affiliation(s)
- Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Xiaohua Gu
- Department of Respiratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Qiang Zhang
- Department of Oncology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Feng Xie
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- The Research Institute of St. Joe's Hamilton, Ontario, Canada
- Program for Health Economics and Outcome Measures, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, Hamilton, Ontario, Canada
| |
Collapse
|
23
|
Volckmar AL, Sültmann H, Riediger A, Fioretos T, Schirmacher P, Endris V, Stenzinger A, Dietz S. A field guide for cancer diagnostics using cell-free DNA: From principles to practice and clinical applications. Genes Chromosomes Cancer 2017; 57:123-139. [DOI: 10.1002/gcc.22517] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Anna-Lena Volckmar
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | - Holger Sültmann
- Division of Cancer Genome Research; German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK); Heidelberg Germany
| | - Anja Riediger
- Division of Cancer Genome Research; German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK); Heidelberg Germany
| | - Thoas Fioretos
- Department of Clinical Genetics; Lund University; Lund Sweden
- Department of Clinical Genetics; University and Regional Laboratories; Region Skåne Lund Sweden
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | - Volker Endris
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg; Heidelberg Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, and German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Steffen Dietz
- Division of Cancer Genome Research; German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK); Heidelberg Germany
| |
Collapse
|
24
|
Wu B, Gu X, Zhang Q. Cost-Effectiveness of Osimertinib for EGFR Mutation-Positive Non-Small Cell Lung Cancer after Progression following First-Line EGFR TKI Therapy. J Thorac Oncol 2017; 13:184-193. [PMID: 29101057 DOI: 10.1016/j.jtho.2017.10.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/02/2017] [Accepted: 10/21/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the cost-effectiveness of osimertinib for the treatment of advanced NSCLC with an EGFR T790M mutation after the failure of first-line EGFR tyrosine kinase inhibitor (TKI) therapy. METHODS A mathematical model was established by combining a decision tree and the Markov approach to project the cost-effectiveness of osimertinib versus standard chemotherapy for the treatment of patients who harbor an EGFR T790M mutation and have disease progression after first-line EGFR TKI therapy with or without metastases to the central nervous system. The clinical and outcome data were derived from randomized clinical trials and published reports. The health outcome data included quality-adjusted life-years (QALY). The cost data were estimated from the perspectives of the payer in the United States and the health care system in the People's Republic of China. All costs and incremental cost-effectiveness ratios (ICERs) were presented in 2017 U.S. dollars. Sensitivity and scenario analyses with three different settings of T790M mutation testing were performed. RESULTS Compared with chemotherapy, molecular testing in plasma and tissue followed by osimertinib treatment yielded an additional 0.359 and 0.313 QALYs in the entire U.S. population and the population of those with central nervous system metastases and an EGFR T790M mutation. For these populations, the incremental costs were $83,515 and $74,924 per patient, respectively, and the ICERs were $232,895 and $239,274 per QALY, respectively. For the entire Chinese population and the Chinese population with central nervous system metastases, the ICERs were $48,081 and $53,244 per QALY, respectively. For those with a known T790M mutation, the ICERs of osimertinib over chemotherapy also exceeded the willingness-to-pay threshold. The most influential parameter was the price of osimertinib. CONCLUSION Osimertinib treatment for T790M mutation NSCLC is unlikely to be cost-effective from the perspectives of the United States and the People's Republic of China. If the price of osimertinib could be decreased, the economic outcome might become favorable.
Collapse
Affiliation(s)
- Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China.
| | - Xiaohua Gu
- Department of Respiratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Qiang Zhang
- Department of Oncology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| |
Collapse
|
25
|
Franovic A, Raymond VM, Erlander MG, Reckamp KL. Urine test for EGFR analysis in patients with non-small cell lung cancer. J Thorac Dis 2017; 9:S1323-S1331. [PMID: 29184671 DOI: 10.21037/jtd.2017.06.144] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Precision medicine approaches in oncology are reliant on the accurate genomic characterization of tumors. While tissue remains the mainstay specimen for molecular testing, tumor biopsies are riddled with challenges and limitations due to their invasive and site-specific nature. Tumor inaccessibility and intratumoral heterogeneity, in particular, represent significant obstacles to the identification of actionable genetic alterations and hence effective mono- and combination therapy strategies. Proof-of-concept studies indicate that circulating tumor DNA (ctDNA) released from multiple tumor regions and anatomical locations is more reflective of intra- and intertumoral heterogeneity. Non-invasive liquid biopsy approaches that allow for the analysis of ctDNA are thus being increasingly implemented in routine patient care for the detection and monitoring of cancer-associated mutations. Indeed, the use of plasma testing to screen for epidermal growth factor receptor (EGFR) T790M mutant positive non-small cell lung cancer (NSCLC) patients eligible for treatment with third-generation EGFR inhibitors was recently approved by the U.S. Food and Drug Administration and is incorporated into the most recent version of the National Comprehensive Cancer Center guidelines as an alternative to tissue biopsy. Urine represents another liquid biopsy specimen that is distinguished by its ease of collection, option for home collection, and lack of temporal and volumetric collection restrictions. Importantly, there is an accumulating body of evidence supporting the clinical validity of urinary EGFR mutant testing for the identification and stratification of patients likely to benefit from EGFR-directed therapies and as a means to assess patient response, the presence of residual disease, and emergence of resistant tumor cell populations.
Collapse
|