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Del Re M, Addeo A, Passaro A, Petrini I, van Schaik RH, Danesi R. Circulating tumor DNA and the future of EGFR-mutant lung cancer treatment. Pharmacogenomics 2020; 20:1255-1257. [PMID: 31829835 DOI: 10.2217/pgs-2019-0150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Marzia Del Re
- Department of Clinical & Experimental Medicine, Unit of Clinical Pharmacology & Pharmacogenetics, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Addeo
- Department of Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Iacopo Petrini
- Department of Translational Research & New Technologies in Surgery & Medicine, General Pathology, University of Pisa, Pisa, Italy
| | - Ron Hn van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Romano Danesi
- Department of Clinical & Experimental Medicine, Unit of Clinical Pharmacology & Pharmacogenetics, University Hospital of Pisa, Pisa, Italy
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Del Re M, Crucitta S, Gianfilippo G, Passaro A, Petrini I, Restante G, Michelucci A, Fogli S, de Marinis F, Porta C, Chella A, Danesi R. Understanding the Mechanisms of Resistance in EGFR-Positive NSCLC: From Tissue to Liquid Biopsy to Guide Treatment Strategy. Int J Mol Sci 2019; 20:ijms20163951. [PMID: 31416192 PMCID: PMC6720634 DOI: 10.3390/ijms20163951] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023] Open
Abstract
Liquid biopsy has emerged as an alternative source of nucleic acids for the management of Epidermal Growth Factor Receptor (EGFR)-mutant non-Small Cell Lung Cancer (NSCLC). The use of circulating cell-free DNA (cfDNA) has been recently introduced in clinical practice, resulting in the improvement of the identification of druggable EGFR mutations for the diagnosis and monitoring of response to targeted therapy. EGFR-dependent (T790M and C797S mutations) and independent (Mesenchymal Epithelial Transition [MET] gene amplification, Kirsten Rat Sarcoma [KRAS], Phosphatidyl-Inositol 4,5-bisphosphate 3-Kinase Catalytic subunit Alpha isoform [PI3KCA], and RAF murine sarcoma viral oncogene homolog B1 [BRAF] gene mutations) mechanisms of resistance to EGFR tyrosine kinase inhibitors (TKIs) have been evaluated in plasma samples from NSCLC patients using highly sensitive methods (i.e., digital droplet PCR, Next Generation Sequencing), allowing for the switch to other therapies. Therefore, liquid biopsy is a non-invasive method able to detect the molecular dynamic changes that occur under the pressure of treatment, and to capture tumor heterogeneity more efficiently than is allowed by tissue biopsy. This review addresses how liquid biopsy may be used to guide the choice of treatment strategy in EGFR-mutant NSCLC.
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Affiliation(s)
- Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giulia Gianfilippo
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology, 20141 Milano, Italy
| | - Iacopo Petrini
- General Pathology, Department of Translational Research & New Technologies in Surgery and Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giuliana Restante
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Angela Michelucci
- Unit of Molecular Genetics, Department of Laboratory Medicine, University Hospital, 56126 Pisa, Italy
| | - Stefano Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, 20141 Milano, Italy
| | - Camillo Porta
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Division of Translational Oncology, I.R.C.C.S. Istituti Clinici Scientifici Maugeri, 27100 Pavia, Italy
| | - Antonio Chella
- Unit of Respiratory Medicine, Department of Critical Area and Surgical, Medical and Molecular Pathology, University Hospital, 56126 Pisa, Italy
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Del Re M, Rofi E, Cappelli C, Puppo G, Crucitta S, Valeggi S, Chella A, Danesi R, Petrini I. The increase in activating EGFR mutation in plasma is an early biomarker to monitor response to osimertinib: a case report. BMC Cancer 2019; 19:410. [PMID: 31039766 PMCID: PMC6492432 DOI: 10.1186/s12885-019-5604-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/12/2019] [Indexed: 12/23/2022] Open
Abstract
Background Systemic treatment of advanced non-small cell lung cancer (NSCLC) has changed dramatically since the introduction of targeted therapies. The analysis of circulating tumor DNA (ctDNA) is a valuable approach to monitor the clonal evolution of tumors during treatment with EGFR-tyrosine kinase inhibitors (TKIs) and to detect resistance mutations. Case presentation A NSCLC patient with exon 19 deletion (ex19del) of EGFR was treated with osimertinib after multiple lines of treatment and obtained a partial response that lasted over 26 months. Blood was collected at each visit and ctDNA was extracted to monitor ex19del by digital droplet PCR. Within a few weeks from the beginning of osimertinib, ex19del disappeared from plasma but appeared again and steadily increased a few months later anticipating tumor progression. Interestingly, the change in ex19del was much more pronounced than other mutations, since T790M appeared 3 months after the increase of ex19del, and C797S was detectable a few weeks before clinical disease progression. Then the patient received cytotoxic chemotherapy, which was associated with a decrease in ex19del and disappearance of T790M and C797S; however, at disease progression, all EGFR mutations increased again in plasma together with MET amplification which was detected by NGS. Conclusions The measurement of ex19del changes in ctDNA is a simple and sensitive approach to monitor clinical outcome to osimertinib and, potentially, to other therapeutic interventions.
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Affiliation(s)
- Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Eleonora Rofi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Carla Cappelli
- Unit of Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University Hospital of Pisa, Pisa, Italy
| | - Gianfranco Puppo
- Unit of Respiratory Medicine, Department of Critical Area and Surgical, Medical and Molecular Pathology, University Hospital of Pisa, Pisa, Italy
| | - Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Simona Valeggi
- Unit of Respiratory Medicine, Department of Critical Area and Surgical, Medical and Molecular Pathology, University Hospital of Pisa, Pisa, Italy
| | - Antonio Chella
- Unit of Respiratory Medicine, Department of Critical Area and Surgical, Medical and Molecular Pathology, University Hospital of Pisa, Pisa, Italy
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy.
| | - Iacopo Petrini
- Unit of Respiratory Medicine, Department of Critical Area and Surgical, Medical and Molecular Pathology, University Hospital of Pisa, Pisa, Italy
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Neri E, Del Re M, Paiar F, Erba P, Cocuzza P, Regge D, Danesi R. Radiomics and liquid biopsy in oncology: the holons of systems medicine. Insights Imaging 2018; 9:915-924. [PMID: 30430428 PMCID: PMC6269342 DOI: 10.1007/s13244-018-0657-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/10/2018] [Accepted: 08/28/2018] [Indexed: 12/15/2022] Open
Abstract
Abstract Radiomics is a process of extraction and analysis of quantitative features from diagnostic images. Liquid biopsy is a test done on a sample of blood to look for cancer cells or for pieces of tumourigenic DNA circulating in the blood. Radiomics and liquid biopsy have great potential in oncology, since both are minimally invasive, easy to perform, and can be repeated in patient follow-up visits, enabling the extraction of valuable information regarding tumour type, aggressiveness, progression, and response to treatment. Both methods are in their infancy, with major evidence of application in lung and gastrointestinal cancer, while still undergoing evaluation in other cancer types. In this paper, the main oncologic applications of radiomics and liquid biopsy are reviewed, and a synergistic approach incorporating both tests for cancer diagnosis and follow-up is discussed within the context of systems medicine. Teaching Points • Radiomics is a process of extraction and analysis of quantitative features from diagnostic images. • Most clinical applications of radiomics are in the field of oncologic imaging. • Radiomics applies to all imaging modalities. • A cluster of radiomic features is a “radiomic signature”. • Machine learning may improve the efficacy of radiomics analysis.
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Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Pisa, Italy.
| | - Marzia Del Re
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabiola Paiar
- Radiation Oncology Unit, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Paola Erba
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Paola Cocuzza
- Radiation Oncology Unit, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Daniele Regge
- Radiology Unit, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Turin, Italy
| | - Romano Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Stockley T, Souza CA, Cheema PK, Melosky B, Kamel-Reid S, Tsao MS, Spatz A, Karsan A. Evidence-based best practices for EGFR T790M testing in lung cancer in Canada. ACTA ACUST UNITED AC 2018; 25:163-169. [PMID: 29719432 DOI: 10.3747/co.25.4044] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Epidermal growth factor receptor (egfr) tyrosine kinase inhibitors (tkis) are recommended as first-line systemic therapy for patients with non-small-cell lung cancer (nsclc) having mutations in the EGFR gene. Resistance to tkis eventually occurs in all nsclc patients treated with such drugs. In patients with resistance to tkis caused by the EGFR T790M mutation, the third-generation tki osimertinib is now the standard of care. For optimal patient management, accurate EGFR T790M testing is required. A multidisciplinary working group of pathologists, laboratory medicine specialists, medical oncologists, a respirologist, and a thoracic radiologist from across Canada was convened to discuss best practices for EGFR T790M mutation testing in Canada. The group made recommendations in the areas of the testing algorithm and the pre-analytic, analytic, and post-analytic aspects of clinical testing for both tissue testing and liquid biopsy circulating tumour dna testing. The recommendations aim to improve EGFR T790M testing in Canada and to thereby improve patient care.
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Affiliation(s)
- T Stockley
- Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network; and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - C A Souza
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON
| | - P K Cheema
- William Osler Health System, Brampton; and Department of Medicine, University of Toronto, Toronto, ON
| | - B Melosky
- Department of Oncology, BC Cancer, Vancouver, BC
| | - S Kamel-Reid
- Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network; and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON.,Department of Medical Biophysics, University of Toronto, Toronto, ON
| | - M S Tsao
- Department of Pathology, University Health Network; and Princess Margaret Cancer Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - A Spatz
- Lady Davis Institute for Medical Research; McGill University Health Centre; and Department of Pathology, McGill University, Montreal, QC
| | - A Karsan
- Centre for Clinical Genomics, Michael Smith Genome Sciences Centre, BC Cancer Research Centre; and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
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Bronte G, Bravaccini S, Bronte E, Burgio MA, Rolfo C, Delmonte A, Crinò L. Epithelial-to-mesenchymal transition in the context of epidermal growth factor receptor inhibition in non-small-cell lung cancer. Biol Rev Camb Philos Soc 2018; 93:1735-1746. [PMID: 29671943 DOI: 10.1111/brv.12416] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 12/12/2022]
Abstract
The identification of oncogenic driver mutations in non-small-cell lung cancer (NSCLC) has led to the development of targeted drugs. Tyrosine kinase inhibitors (TKIs) directed against the epidermal growth factor receptor (EGFR) target lung tumours bearing EGFR-activating mutations. This new therapeutic strategy has greatly improved tumour response rates. However, drug resistance invariably occurs during TKI-based treatment. Epithelial-to-mesenchymal transition (EMT) is one of the resistance mechanisms identified in EGFR-mutated NSCLC treated with TKIs. In this review we gather together the most important findings on this phenomenon in relation to cancer stem cells and cancer epigenetics. We also outline the correlation between the effects of stromal factors from the microenvironment, the transcription factors activated, the epigenetic changes in chromatin, and the evolution of cellular behaviour. Notably, EMT has already been shown to be the link between benign lung diseases such as chronic obstructive pulmonary disease and lung carcinogenesis. The various mechanisms of acquired resistance to EGFR-TKIs are also briefly described to provide background information on EMT. Our extensive review of the scientific literature serves to highlight the cellular and molecular events that lead to the onset of EMT in NSCLC cells treated with EGFR-TKIs. Finally, we put forward a hypothesis to explain why, in some cases, EMT rather than other known mechanisms is involved in resistance to TKIs.
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Affiliation(s)
- Giuseppe Bronte
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Sara Bravaccini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Enrico Bronte
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marco Angelo Burgio
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Christian Rolfo
- Phase I Early Clinical Trials Unit, Department of Oncology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Angelo Delmonte
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Lucio Crinò
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
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Very early response of circulating tumour-derived DNA in plasma predicts efficacy of nivolumab treatment in patients with non-small cell lung cancer. Eur J Cancer 2017; 86:349-357. [PMID: 29078173 DOI: 10.1016/j.ejca.2017.09.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Immunotherapy has become a treatment option for lung cancer. The utility of nivolumab as second-line treatment for non-small cell lung cancer has been proven, but predictive biomarkers influencing its efficacy remain unknown. METHODS This study involved 14 patients who were treated with nivolumab from February 1 to September 30, 2016. The early response of the level of circulating tumour DNA (ctDNA) after starting nivolumab was evaluated to ascertain whether it could predict treatment outcome. RESULTS Of the 14 patients, six were responders and eight were non-responders. DNA was analysed in both tumour tissue and plasma samples. Only somatic mutations confirmed by analysis of tumour tissue were defined as ctDNA. ctDNA was detected more often in the serial plasma samples of patients with high tumour volume (TV) (p = 0.02). ctDNA was detected in seven cases; basal and serial ctDNA analysis revealed that a decrease in allelic frequency (AF) of ctDNA showed high-level correspondence with a good durable response. When "2 weeks" was set as a clinically significant time point, changes in representative mutations of each case, defined as one of the highest baseline AF, showed 100% concordance with the response. CONCLUSIONS In patients with high TV, plasma analysis of ctDNA, as validated by tumour tissue, suggested that a durable good response to nivolumab could be predicted within 2 weeks.
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Del Re M, Tiseo M, Bordi P, D'Incecco A, Camerini A, Petrini I, Lucchesi M, Inno A, Spada D, Vasile E, Citi V, Malpeli G, Testa E, Gori S, Falcone A, Amoroso D, Chella A, Cappuzzo F, Ardizzoni A, Scarpa A, Danesi R. Contribution of KRAS mutations and c.2369C > T (p.T790M) EGFR to acquired resistance to EGFR-TKIs in EGFR mutant NSCLC: a study on circulating tumor DNA. Oncotarget 2017; 8:13611-13619. [PMID: 26799287 PMCID: PMC5355124 DOI: 10.18632/oncotarget.6957] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/29/2015] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION KRAS oncogene mutations (MUTKRAS) drive resistance to EGFR inhibition by providing alternative signaling as demonstrated in colo-rectal cancer. In non-small cell lung cancer (NSCLC), the efficacy of treatment with EGFR tyrosine kinase inhibitors (EGFR-TKIs) depends on activating EGFR mutations (MUTEGFR). However, inhibition of EGFR may select resistant cells displaying alternative signaling, i.e., KRAS, or restoration of EGFR activity due to additional MUTEGFR, i.e., the c.2369C > T (p.T790MEGFR). AIM The aim of this study was to investigate the appearance of MUTKRAS during EGFR-TKI treatment and their contribution to drug resistance. METHODS This study used cell-free circulating tumor DNA (cftDNA) to evaluate the appearance of codon 12 MUTKRAS and p.T790MEGFR mutations in 33 advanced NSCLC patients progressing after an EGFR-TKI. RESULTS p.T790MEGFR was detected in 11 (33.3%) patients, MUTKRAS at codon 12 in 3 (9.1%) while both p.T790MEGFR and MUTKRAS codon 12 were found in 13 (39.4%) patients. Six patients (18.2%) were KRAS wild-type (WTKRAS) and negative for p.T790MEGFR. In 8 subjects paired tumor re-biopsy/plasma samples were available; the percent concordance of tissue/plasma was 62.5% for p.T790MEGFR and 37.5% for MUTKRAS. The analysis of time to progression (TTP) and overall survival (OS) in WTKRAS vs. MUTKRAS were not statistically different, even if there was a better survival with WTKRAS vs. MUTKRAS, i.e., TTP 14.4 vs. 11.4 months (p = 0.97) and OS 40.2 vs. 35.0 months (p = 0.56), respectively. CONCLUSIONS MUTKRAS could be an additional mechanism of escape from EGFR-TKI inhibition and cftDNA is a feasible approach to monitor the molecular development of drug resistance.
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Affiliation(s)
- Marzia Del Re
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Armida D'Incecco
- Medical Oncology Unit, AUSL6, Istituto Toscano Tumori, Livorno, Italy
| | - Andrea Camerini
- Medical Oncology Unit, AUSL12, Istituto Toscano Tumori, Lido di Camaiore, Italy
| | - Iacopo Petrini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Maurizio Lucchesi
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | | | - Daniele Spada
- Medical Oncolgy Unit, Ospedale Santa Maria della Misericordia, Urbino, Italy
| | - Enrico Vasile
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Valentina Citi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Malpeli
- ARC-NET Research Centre and Department of Pathology and Diagnostics, Azienda Ospedaliero-Universitaria, Verona, Italy
| | - Enrica Testa
- Medical Oncolgy Unit, Ospedale Santa Maria della Misericordia, Urbino, Italy
| | - Stefania Gori
- Medical Oncology Unit, Ospedale Sacro Cuore, Negrar, Italy
| | - Alfredo Falcone
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Domenico Amoroso
- Medical Oncology Unit, AUSL12, Istituto Toscano Tumori, Lido di Camaiore, Italy
| | - Antonio Chella
- Lung Diseases Unit, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Federico Cappuzzo
- Medical Oncology Unit, AUSL6, Istituto Toscano Tumori, Livorno, Italy
| | - Andrea Ardizzoni
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Aldo Scarpa
- ARC-NET Research Centre and Department of Pathology and Diagnostics, Azienda Ospedaliero-Universitaria, Verona, Italy
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Ni J, Weng L, Liu Y, Sun Z, Bai C, Wang Y. Dynamic monitoring of EGFR mutations in circulating cell-free DNA for EGFR-mutant metastatic patients with lung cancer: Early detection of drug resistance and prognostic significance. Oncol Lett 2017; 13:4549-4557. [PMID: 28599456 DOI: 10.3892/ol.2017.6022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 02/13/2017] [Indexed: 12/28/2022] Open
Abstract
Detecting genetic mutations in circulating cell-free DNA (cfDNA) is a promising approach of liquid biopsy. Between June 2014 and May 2015, 168 plasma samples were collected monthly from 20 patients with metastatic lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutation receiving gefitinib therapy. Clinically relevant EGFR mutations, including exon 19 deletion, L858R and T790M, were quantified using droplet digital polymerase chain reaction. In baseline samples, 19 (95.0%) patients had the same mutation with the matched tumors, and pretreatment T790M mutations were also detected in 3 (15.0%) patients. The dynamics of EGFR mutations were generally associated with treatment response for patients with or without measurable disease. For patients with immeasurable tumor deposits, monitoring disease evolution using cfDNA-based mutation quantification appeared to be more reliable compared with measuring the diameters of target tumor lesions. In addition, molecular progressive disease, defined as a ≥20% increase of EGFR mutation concentration compared with the lowest concentration recorded during treatment, was tracked up to 8 months prior to objective progression. In survival analysis, sex (P=0.005), pretreatment T790M mutation status (P=0.006), T790M mutation status at the disease progression (P=0.043) and growth rate of EGFR mutations (P=0.023), had a significant impact on median progression-free survival. In conclusion, dynamic monitoring of EGFR mutations in cfDNA is feasible and appears to be useful in early prediction of drug resistance for patients with lung cancer receiving EGFR tyrosine kinase inhibitors.
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Affiliation(s)
- Jianjiao Ni
- Department of Medical Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Linqian Weng
- Department of Medical Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Yi Liu
- Translational Medicine Center, Laboratory of Oncology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Zhao Sun
- Department of Medical Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China.,Institute of Basic Medical Sciences, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Yingyi Wang
- Department of Medical Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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Deig CR, Mendonca MS, Lautenschlaeger T. Blood-Based Nucleic Acid Biomarkers as a Potential Tool to Determine Radiation Therapy Response in Non-Small Cell Lung Cancer. Radiat Res 2017; 187:333-338. [PMID: 28186469 DOI: 10.1667/rr14613.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Lung cancer is the leading cause of cancer deaths worldwide, with smoking as the main risk factor. The use of low-dose computed tomography (LDCT) as a screening method has shown a 20% lung cancer specific mortality benefit; however, widespread implementation is estimated to add $1.3-$2.0 billion in annual national health care expenditures. Blood-based microRNAs (miRNAs) have been investigated in detail and found to be potentially useful biomarkers indicating the presence of lung cancer, especially when used as a companion test to LDCT. Testing for miRNAs and circulating tumor DNA (ct-DNA) in the blood are anticipated to become more affordable in the near future, and therefore these potentially sensitive methods could serve as first-line screening modalities prior to obtaining LDCT and definitive diagnostic tests for lung cancer. Furthermore, miRNAs may shed light not only on the tumor burden, but also perhaps on tumor aggressiveness, histology, treatment response and the patient's overall survival. In the near future, analysis of ct-DNA may reveal somatic mutations beyond EGFR, tumor burden and the presence of occult progression of disease. In theory, these biomarkers may also help oncologists to elucidate the tumor response to radiotherapy, and in the future, may assist the radiation oncologist in making data-driven treatment decisions and providing patients with quantitative information regarding their treatment response.
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Affiliation(s)
- Christopher R Deig
- Department of a Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Marc S Mendonca
- Department of a Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202.,b Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Tim Lautenschlaeger
- Department of a Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202
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Matikas A, Syrigos KN, Agelaki S. Circulating Biomarkers in Non-Small-Cell Lung Cancer: Current Status and Future Challenges. Clin Lung Cancer 2016; 17:507-516. [PMID: 27373516 DOI: 10.1016/j.cllc.2016.05.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 12/18/2022]
Abstract
Despite recent advances, non-small-cell lung cancer remains a devastating disease and carries a grim prognosis. Major contributing factors include difficulties in diagnosing the disease early in its course during the asymptomatic stage and the poor understanding of the biology underlying disease progression. Liquid biopsies, noninvasive blood tests that detect circulating biomarkers such as circulating tumor cells and tumor-derived nucleic acid fragments, are in a rapidly evolving field of research that could provide answers to both of these unmet needs. Herein, we review the relevant data concerning the diagnostic, predictive, and prognostic significance of 3 distinct but potentially complementary circulating biomarkers in non-small-cell lung cancer: circulating tumor cells, cell-free DNA, and microRNAs.
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Affiliation(s)
- Alexios Matikas
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Konstantinos N Syrigos
- Oncology Unit, 3rd Department of Internal Medicine, Sotiria General Hospital, National & Kapodistrian University, Athens School of Medicine, Athens, Greece
| | - Sofia Agelaki
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece; Laboratory of Translational Oncology, University of Crete, School of Medicine, Heraklion, Crete, Greece.
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Remon J, Planchard D. AZD9291 in EGFR-mutant advanced non-small-cell lung cancer patients. Future Oncol 2015; 11:3069-81. [DOI: 10.2217/fon.15.250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) patients whose tumors have an EGFR-activating mutation develop acquired resistance after a median of 9–11 months from the beginning of treatment with erlotinib, gefitinib and afatinib. T790M mutation is the cause of this resistance in approximately 60% of cases. AZD9291 is an oral, irreversible, mutant-selective EGF receptor (EGFR) tyrosine kinase inhibitor (TKI) developed to have potency against EGFR mutations, including T790M mutation, while sparing wild-type EGFR. A Phase I trial of AZD9291 in EGFR-mutant NSCLC patients, demonstrated high activity, essentially among T790M-mutant tumors, with a manageable tolerability profile. Ongoing Phase III trials are evaluating AZD9291 in EGFR-mutant patients as first-line treatment compared with erlotinib and gefitinib; and as second-line treatment compared with chemotherapy after progression on EGFR TKI in T790M-mutant tumors. Better identification of T790M-mutant tumors post EGFR TKI relapse and mechanisms of resistance to AZD9291 are the future challenges. This article reviews the emerging data regarding AZD9291 in the treatment of patients with advanced NSCLC.
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Affiliation(s)
- Jordi Remon
- Gustave Roussy, Medical Oncology Department, Villejuif, France
| | - David Planchard
- Gustave Roussy, Medical Oncology Department, Villejuif, France
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Non-invasive approaches to monitor EGFR-TKI treatment in non-small-cell lung cancer. J Hematol Oncol 2015; 8:95. [PMID: 26227959 PMCID: PMC4521383 DOI: 10.1186/s13045-015-0193-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 07/20/2015] [Indexed: 01/10/2023] Open
Abstract
Tyrosine kinase inhibitors of epidermal growth factor receptor (EGFR-TKIs) are standard treatments for advanced non-small-cell lung cancer (NSCLC) patients harboring activating epidermal growth factor receptor (EGFR) mutations. Nowadays, tumor tissues acquired by surgery or biopsy are the routine materials for EGFR mutation analysis. However, the accessibility of tumor tissues is not always satisfactory in advanced NSCLC. Moreover, a high proportion of NSCLC patients will eventually develop resistance to EGFR-TKIs. Invasive procedures, such as surgery or biopsy, are impractical to be performed repeatedly to assess the evolution of EGFR-TKI resistance. Thus, exploring some convenient and less invasive techniques to monitor EGFR-TKI treatment is urgently needed. Circulating cell-free tumor DNA (ctDNA) has a high degree of specificity to detect EGFR mutations in NSCLC. Besides, ctDNA is capable of monitoring the disease progression during EGFR-TKI treatment. Certain serum microRNAs that correlate with EGFR signaling pathway, such as miR-21 and miR-10b, have been demonstrated to be helpful in evaluating the efficiency of EGFR-TKI therapeutics. A commercialized serum-based proteomic test, named VeriStrat test, has shown an outstanding ability to predict the clinical outcome of NSCLC patients receiving EGFR-TKIs. Analysis of EGFR mutations in circulating tumor cells (CTCs) is feasible, and CTCs represent a promising material to predict EGFR-TKI-treatment efficacy and resistance. These evidences suggested that non-invasive techniques based on serum or plasma samples had a great potential for monitoring EGFR-TKI treatment in NSCLC. In this review, we summarized these non-invasive approaches and considered their possible applications in EGFR-TKI-treatment monitoring.
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Ilie M, Hofman V, Long E, Bordone O, Selva E, Washetine K, Marquette CH, Hofman P. Current challenges for detection of circulating tumor cells and cell-free circulating nucleic acids, and their characterization in non-small cell lung carcinoma patients. What is the best blood substrate for personalized medicine? ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:107. [PMID: 25489581 DOI: 10.3978/j.issn.2305-5839.2014.08.11] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/13/2014] [Indexed: 12/29/2022]
Abstract
The practice of "liquid biopsy" as a diagnostic, prognostic and theranostic tool in non-small cell lung cancer (NSCLC) patients is an appealing approach, at least in theory, since it is noninvasive and easily repeated. In particular, this approach allows patient monitoring during treatment, as well as the detection of different genomic alterations that are potentially accessible to targeted therapy or are associated with treatment resistance. However, clinical routine practice is slow to adopt the liquid biopsy. Several reasons may explain this: (I) the vast number of methods described for potential detection of circulating biomarkers, without a consensus on the ideal technical approach; (II) the multiplicity of potential biomarkers for evaluation, in particular, circulating tumor cells (CTCs) vs. circulating tumor DNA (ctDNA); (III) the difficulty in controlling the pre-analytical phase to obtain robust and reproducible results; (IV) the present cost of the currently available techniques, which limits accessibility to patients; (V) the turnaround time required to obtain results that are incompatible with the urgent need for delivery of treatment. The purpose of this review is to describe the main advances in the field of CTC and ctDNA detection in NSCLC patients and to compare the main advantages and disadvantages of these two approaches.
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Affiliation(s)
- Marius Ilie
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Véronique Hofman
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Elodie Long
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Olivier Bordone
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Eric Selva
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Kevin Washetine
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Charles Hugo Marquette
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
| | - Paul Hofman
- 1 INSERM U1081/CNRS UMR7284, Team 3, University of Nice Sophia Antipolis, Antoine Lacassagne Cancer Center, Institute for Research on Cancer and Aging, Nice (IRCAN), Nice, France ; 2 Human Biobank, 3 Laboratory of Clinical and Experimental Pathology, Pasteur Hospital, Nice, France ; 4 Cancer Research Association (ARC) Labelled Team, Villejuif, France ; 5 Department of Pneumology, Pasteur Hospital, Nice, France
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