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Yeh WC, Tu YC, Hsu PL, Lee CW, Yu HH, Su BC. Combination of Vismodegib and Paclitaxel Enhances Cytotoxicity via Bak-mediated Mitochondrial Damage in EGFR-Mutant Non-Small Cell Lung Cancer Cells. Cell Biochem Biophys 2024:10.1007/s12013-024-01438-y. [PMID: 39030332 DOI: 10.1007/s12013-024-01438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
Half of NSCLC patients harbor epidermal growth factor receptor (EGFR) mutations, and their therapeutic responses are remarkably different from patients with wild-type EGFR (EGFR-WT) NSCLC. We previously demonstrated that the hedgehog inhibitor vismodegib (Vis) potentiates paclitaxel (PTX)-induced cytotoxicity via suppression of Bax phosphorylation, which promotes accumulation of mitochondrial damage and apoptosis in EGFR-WT NSCLC cells. In this study, we further delineated the anticancer activity and underlying mechanisms of this combination treatment in EGFR-mutant NSCLC cells. MTS/PMS activity and trypan blue exclusion assays were used to assess cell viability. Apoptosis was monitored by chromosome condensation, annexin V staining, and cleavage of PARP and caspase-3. Western blots were conducted to track proteins of interest after treatment. Reactive oxygen species (ROS) level was monitored by 2',7'-dichlorodihydrofluorescein diacetate. Mitochondrial status was analyzed by tetramethylrhodamine, ethyl ester. Hedgehog signaling was induced by PTX, which rendered H1975 and PC9 cells insensitive to PTX-induced mitochondrial apoptosis via suppression of Bak. However, Vis enhanced PTX-induced Bak activation, leading to mitochondrial damage, ROS accumulation, and subsequent apoptosis. Our findings suggest that the combination of Vis and PTX could be a potential therapeutic strategy to increase PTX sensitivity of EGFR-mutant NSCLC.
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Affiliation(s)
- Wei-Chen Yeh
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yun-Chieh Tu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pei-Ling Hsu
- Department of Anatomy, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan
| | - Chu-Wan Lee
- Department of Nursing, National Tainan Junior College of Nursing, 78, Section 2, Minzu Road, West Central District, Tainan, 70007, Taiwan
| | - Hsin-Hsien Yu
- Division of General Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Bor-Chyuan Su
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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2
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Cheema P, Cho BC, Freitas H, Provencio M, Chen YM, Kim SW, Wu YL, Passaro A, Martin C, Tiseo M, Chang GC, Park K, Solomon B, Burghuber O, Laskin J, Wang Z, Lee SY, Hu Y, Vansteenkiste J, Zhang HL, Hanrahan E, Geldart T, Taylor R, Servidio L, Li J, Marinis FD. A real-world study of second or later-line osimertinib in patients with EGFR T790M-positive NSCLC: the final ASTRIS data. Future Oncol 2023; 19:61-75. [PMID: 36656302 DOI: 10.2217/fon-2022-0919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aim: Report the final analysis from ASTRIS, the largest real-world study of second-/later-line osimertinib in advanced/metastatic EGFR T790M non-small-cell lung cancer (NSCLC). Methods: Patients with advanced/metastatic EGFR T790M NSCLC and prior EGFR-TKI treatment, received once-daily osimertinib 80 mg. Primary end point: overall survival (OS); secondary end points: progression-free survival (PFS), time-to-treatment discontinuation (TTD) and response rate. Safety was also recorded. Results: In 3014 patients, median OS: 22.8 months (21.6-23.8), median PFS: 11.1 months (11.0-12.0), median TTD: 13.5 months (12.6-13.9), and response rate: 57.3% (55.5-59.2). All end points reported with 95% CIs . Numerically longer median OS was observed in patients with baseline WHO performance status <2 versus 2 (24.0 vs 11.1 months) and those without versus with brain/leptomeningeal metastases (25.4 vs 18.0 months). No new safety signals were identified. Conclusion: Second-/later-line osimertinib demonstrated real-world clinical benefit and safety in advanced/metastatic EGFR T790M NSCLC. Clinical Trial Registration: NCT02474355 (ClinicalTrials.gov).
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Affiliation(s)
- Parneet Cheema
- William Osler Health System, University of Toronto, Toronto, ON, L6R 3J7, Canada
| | - Byoung Chul Cho
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Helano Freitas
- Department of Medical Oncology, AC Camargo Cancer Center, São Paulo, 01509-001, Brazil
| | - Mariano Provencio
- Department of Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, IDHIPSA, Universidad Autónoma de Madrid, 28222, Madrid, Spain
| | - Yuh Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, & School of Medicine, National Yang-Ming Medical University, 112, Taipei, Taiwan
| | - Sang-We Kim
- Department of Oncology, Brain Tumor Center, Center for Personalized Cancer Medicine, Lung Cancer Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, & Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, 71013, Italy
| | - Claudio Martin
- Department of Oncology, Instituto Alexander Fleming, Buenos Aires, C1426, Argentina
| | - Marcello Tiseo
- Department of Medicine & Surgery, University of Parma, & Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, Parma, 43126, Italy
| | - Gee-Chen Chang
- School of Medicine, & Institute of Medicine, Chung Shan Medical University, Division of Pulmonary Medicine, Taichung, 40201, Taiwan.,Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, 40201, Taiwan.,Department of Internal Medicine, Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, 40705, Taiwan
| | - Keunchil Park
- Division of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Otto Burghuber
- Department of Respiratory & Critical Care Medicine, & Ludwig Boltzmann Institute of COPD & Respiratory Epidemiology, Otto Wagner Hospital, & Sigmund Freud University Medical School, Vienna, 1140, Austria
| | - Janessa Laskin
- Division of Medical Oncology, BC Cancer, Vancouver, V5Z 4E6, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - Ziping Wang
- Department of Thoracic Medical Oncology, Beijing Cancer Hospital, Beijing, 100142, People's Republic of China
| | - Sung Yong Lee
- Department of Internal Medicine, Division of Pulmonary, Allergy, & Critical Care Medicine, Korea University Guro Hospital, Seoul, 08308, Republic of Korea
| | - Yanping Hu
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan, 430079, People's Republic of China
| | - Johan Vansteenkiste
- Respiratory Oncology Unit, University Hospitals KU Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - He-Long Zhang
- Department of Oncology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710024, People's Republic of China
| | - Emer Hanrahan
- Department of Medical Oncology, St Vincent's University Hospital, & Cancer Trials Ireland, Dublin, D04 T6F4, Ireland
| | - Thomas Geldart
- Department of Oncology, University Hospitals Dorset, Bournemouth, BH7 7DW, UK
| | - Rosemary Taylor
- Biometrics & Information Sciences, AstraZeneca, Cambridge, CB2 0AA, UK
| | - Leslie Servidio
- Global Medical Affairs, Oncology Business Unit, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Jingyi Li
- Global Medical Affairs, Oncology Business Unit, AstraZeneca, Gaithersburg, MD 20878, USA
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, 71013, Italy
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3
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Guo K, Shao C, Han L, Liu H, Ma Z, Yang Y, Feng Y, Pan M, Santarpia M, Carmo-Fonseca M, Silveira C, Lee KY, Han J, Li X, Yan X. Detection of epidermal growth factor receptor ( EGFR) mutations from preoperative circulating tumor DNA (ctDNA) as a prognostic predictor for stage I-III non-small cell lung cancer (NSCLC) patients with baseline tissue EGFR mutations. Transl Lung Cancer Res 2021; 10:3213-3225. [PMID: 34430359 PMCID: PMC8350110 DOI: 10.21037/tlcr-21-530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
Background Plasma circulating tumor DNA (ctDNA) may be a surrogate, minimally invasive approach to tissue-based epidermal growth factor receptor (EGFR) mutation detection in non-small cell lung cancer (NSCLC) patients. However, the predictive ability of preoperative ctDNA EGFR mutation test on long-term postoperative survival and tumor metastasis development has not been extensively investigated. Methods Stage I–III NSCLC patients with tissue EGFR mutations were enrolled in this study (n=174). The ctDNA EGFR mutations were identified in paired preoperative plasma samples. EGFR mutation testing was performed using Scorpion amplified refractory mutation system (ARMS) technology. The correlation between ctDNA EGFR mutation status and clinicopathologic parameters was analyzed. By combining at least 5 years of follow-up data, we assessed the relationship between ctDNA EGFR mutation status and disease-free survival (DFS) and overall survival (OS). Results Plasma-based ctDNA EGFR mutations were detected in 27 patients. The mutation types were exactly matched with those in paired tissue samples. Blood test sensitivity was closely associated with N stages, tumor-node-metastasis (TNM) stages and tumor differentiation (P<0.001). The overall 5-year survival rate was 18.5% versus 76.9% for ctDNA EGFR mutation-positive and ctDNA EGFR mutation-negative patients, respectively. For patients with ctDNA EGFR mutation positive, the median OS and DFS were 29.00±2.55 and 19.00±2.50 months, respectively, which were both significantly better than those in the ctDNA EGFR mutation-negative subgroup (P<0.001). ctDNA EGFR mutation was an independent risk factor of OS and DFS [hazard ratio (HR) 3.289, 95% confidence interval (CI), 1.816–5.956, P<0.001; HR, 4.860, 95% CI, 2.660–8.880, P<0.001]. For stage III patients with exon 19 deletion or L858R mutations in both tissue and plasma samples, tyrosine kinase inhibitor (TKI) therapy showed significantly better OS (P=0.025) and possible DFS benefit (P=0.060) than did chemotherapy. Conclusions EGFR mutation testing using the Scorpion-ARMS method in preoperative plasma could be a strong predictor for postoperative survival and metastasis of NSCLC patients. Thus, the subset of this population may be benefit from targeted strategies and management.
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Affiliation(s)
- Kai Guo
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China.,Department of Thoracic Surgery, Shaanxi Provincial People's Hospital, Xi'an, China.,The Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Changjian Shao
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Lu Han
- Department of Ultrasound, Xi'an Central Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Honggang Liu
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Zhiqiang Ma
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Yang Yang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yingtong Feng
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Minghong Pan
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Mariacarmela Santarpia
- Medical Oncology Unit, Department of Human Patology "G. Barresi", University of Messina, Messina, Italy
| | - Maria Carmo-Fonseca
- Instituto de Medicina Molecular João Lobo Antunes, University of Lisbon Medical School, Lisbon, Portugal
| | | | - Kye Young Lee
- Precision Medicine Lung Cancer Center, Konkuk University Medical Center, Seoul, Korea
| | - Jing Han
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xiaolong Yan
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
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4
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Wang M, Huang X, Li X, Guo Q, Xu W, Zhao M, Wang X, Wang L, Lou J. Performance comparison of commercial kits for isolating and detecting circulating tumor DNA. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:276-281. [PMID: 33999736 DOI: 10.1080/00365513.2020.1821394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Circulating tumor DNA (ctDNA), a fraction of cell-free DNA (cfDNA) in the circulatory system, is released from tumor cells and thus carries tumor-specific genetic signatures. Using blood-derived ctDNA to detect somatic mutations has shown great value in guiding cancer targeted therapy. Isolation and detection efficiencies are the key factors affecting the performance of ctDNA detection. To optimize and standardize our clinical practice, in this study, we analyzed the isolation efficiency of four commercial cfDNA purification kits: QIAamp circulating nucleic acid kit, AmoyDx® Circulating DNA kits, Microdiag® circulating DNA isolation kit, and MagMAX cell-free DNA isolation kit; and the detection efficiency of two mainstream domestic EGFR gene mutation detection kits: MicroDiag EGFR gene mutation detection kit and Fluorometric real-time PCR Detection Kit for the analysis of EGFR gene mutations. Reference materials and plasma samples collected from lung cancer patients and healthy volunteers were used for the analysis. Our results showed that QIAamp circulating nucleic acid kit and Microdiag® circulating DNA kit had the highest recovery rate (up to 21.25 ng/mL) for short DNA fragments of about 173 bp which is the peak length of ctDNA. For ctDNA detection, the MicroDiag® EGFR gene mutation detection kit showed the highest detection rate and sensitivity for detecting EGFR mutations at a mutant frequency of 0.5%. This work provides a reliable choice of commercial kits for the clinical application of ctDNA.
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Affiliation(s)
- Mengyan Wang
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xia Huang
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Li
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qiaomei Guo
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wanxing Xu
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mingna Zhao
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xueqing Wang
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Wang
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiatao Lou
- Department of Laboratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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5
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Cervena K, Vodicka P, Vymetalkova V. Diagnostic and prognostic impact of cell-free DNA in human cancers: Systematic review. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2019; 781:100-129. [DOI: 10.1016/j.mrrev.2019.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023]
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6
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Genome-Wide Plasma Cell-Free DNA Methylation Profiling Identifies Potential Biomarkers for Lung Cancer. DISEASE MARKERS 2019; 2019:4108474. [PMID: 30867848 PMCID: PMC6379867 DOI: 10.1155/2019/4108474] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/04/2018] [Accepted: 12/16/2018] [Indexed: 12/18/2022]
Abstract
As a noninvasive blood testing, the detection of cell-free DNA (cfDNA) methylation in plasma has raised an increasing interest due to diagnostic applications. Although extensively used in cfDNA methylation analysis, bisulfite sequencing is less cost-effective. In this study, we investigated the cfDNA methylation patterns in lung cancer patients by MeDIP-seq. Compared with the healthy individuals, 330 differentially methylated regions (DMRs) at gene promoters were identified in lung cancer patients with 33 hypermethylated and 297 hypomethylated regions, respectively. Moreover, these hypermethylated genes were validated with the publicly available DNA methylation data, yielding a set of ten significant differentially methylated genes in lung cancer, including B3GAT2, BCAR1, HLF, HOPX, HOXD11, MIR1203, MYL9, SLC9A3R2, SYT5, and VTRNA1-3. Our study demonstrated MeDIP-seq could be effectively used for cfDNA methylation profiling and identified a set of potential biomarker genes with clinical application for lung cancer.
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7
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Feng LX, Wang J, Yu Z, Song SA, Zhai WX, Dong SH, Yu HS, Zhang Y. Clinical significance of serum EGFR gene mutation and serum tumor markers in predicting tyrosine kinase inhibitor efficacy in lung adenocarcinoma. Clin Transl Oncol 2019; 21:1005-1013. [DOI: 10.1007/s12094-018-02014-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
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8
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Zhang Z, Zhou S. Serum EGFR gene mutation status via second-generation sequencing and clinical features of patients with advanced lung cancer. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:3551-3558. [PMID: 31949733 PMCID: PMC6962891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/25/2018] [Indexed: 06/10/2023]
Abstract
Objective: To detect the serum epithelial growth factor receptor (EGFR) gene mutation status in patients with lung cancer via second-generation sequencing and to analyze its correlations with the clinical features of patients and its therapeutic effects. Methods: A total of 110 patients with non-small cell lung cancer (NSCLC) treated in our hospital were recruited as subjects of our study. The distribution of the EGFR gene mutation in patients was detected via second-generation sequencing and then patients were divided into mutant-type EGFR group (n=37) and wild-type EGFR group (n=73). The clinical features and therapeutic effects were compared between the two groups of patients. Results: A total of 5 kinds of EGFR gene mutation [19del (45.95%), L858R (43.24%), L861Q (5.41%), S768I (2.70%), and G719X (2.70%)] were detected via second-generation sequencing. In the mutant-type EGFR group, the proportions of female patients, patients with adenocarcinoma, and those with no history of smoking were high, and the differences were statistically significant (P<0.05). Moreover, there were statistically significant differences in gender, type of cancer, tumor-node-metastasis (TNM) staging, and smoking history between the mutant-type EGFR group and the wild-type EGFR group (P<0.05). Results of a multivariate logistic regression analysis showed that the EGFR gene mutation status was significantly associated with the type of cancer, gender, TNM staging, and smoking history of patients with NSCLC (P<0.05). The clinical effective rate of patients in the mutant-type EGFR group was significantly higher than that in the wild-type EGFR group (54.05% vs. 19.18%) while progression-free survival (PFS) was significantly longer than that in the wild-type EGFR group [(9.75±1.64) months vs. (5.51±0.40) months] (P<0.05). The expression level of carcinoembryonic antigen (CEA) in patients in the mutant-type EGFR group was apparently higher than that in the wild-type EGFR group, but the levels of carbohydrate antigen 125 (CA125), CY21-1 and squamous cell carcinoma-related antigen (SCC-Ag) were apparently lower than those in the wild-type EGFR group. There were statistically significant differences in the expression levels of serum tumor markers between the two groups (P<0.05). Conclusion: EGFR mutation status is closely related to the clinical features of NSCLC patients, such as gender, type of cancer, tumor staging, smoking history, and clinical effect. The second-generation sequencing is an important detection method to identify EGFR gene mutation status, which provides an applicable scaffold for the clinical treatment of patients.
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Affiliation(s)
- Zhen Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin’s Clinical Research Center for Cancer, Tianjin’s Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for CancerTianjin, China
| | - Shengyu Zhou
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China
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9
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Kim DM, Kim DH, Jung W, Lee KY, Kim DE. Fluorometric detection of EGFR exon 19 deletion mutation in lung cancer cells using graphene oxide. Analyst 2018; 143:1797-1804. [PMID: 29561562 DOI: 10.1039/c8an00098k] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Mutations in epidermal growth factor receptor (EGFR) are known as biomarkers that cause non-small cell lung cancer. Particularly, approximately 45% of non-small cell lung cancer patients possess a deletion in exon 19 of the EGFR gene. A less invasive method for detecting the EGFR mutation is required; thus, we developed a simple polymerase chain reaction (PCR)-based method for detecting EGFR exon 19 deletion by using a quencher-free fluorescent probe DNA and graphene oxide (GO). In the presence of the exon 19 deletion mutation, the fluorophore-labeled DNA probe was designed to be fully complementary to the mutant sequences. The fully annealed DNA probe was degraded by the 5' to 3' exonuclease activity of Taq DNA polymerase during PCR, releasing the fluorophore from the probe DNA. In contrast, a wild-type gene only allowed partial annealing of the probe DNA to the amplicon because of the absence of the deletion sequences, with Taq polymerase digestion releasing unannealed fragments of probe DNA. When GO was added to each reaction solution, starkly different fluorescence signals were obtained; enhanced fluorescence was observed because of the released fluorophore from the probe DNA that was not adsorbed onto GO, whereas fluorescence was quenched when the fragmented single-stranded probe DNA was readily adsorbed onto GO. Our method enabled the detection of as low as 49 pg of EGFR exon 19 deletion DNA with a detection limit of 0.1% when the mutant genomic DNA was mixed with wild-type DNA.
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Affiliation(s)
- Dong-Min Kim
- Department of Bioscience and Biotechnology, Konkuk University, Gwangjin-gu, Seoul 05029, Republic of Korea.
| | - Dong Ho Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Nowon-gu, Seoul 01812, Republic of Korea
| | - Woong Jung
- Department of Emergency Medicine, Kyung Hee University Hospital, Kangdong-gu, Seoul 05278, Republic of Korea
| | - Kye Young Lee
- Department of Internal Medicine, Konkuk University Medical Center, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Dong-Eun Kim
- Department of Bioscience and Biotechnology, Konkuk University, Gwangjin-gu, Seoul 05029, Republic of Korea.
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10
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Krug AK, Enderle D, Karlovich C, Priewasser T, Bentink S, Spiel A, Brinkmann K, Emenegger J, Grimm DG, Castellanos-Rizaldos E, Goldman JW, Sequist LV, Soria JC, Camidge DR, Gadgeel SM, Wakelee HA, Raponi M, Noerholm M, Skog J. Improved EGFR mutation detection using combined exosomal RNA and circulating tumor DNA in NSCLC patient plasma. Ann Oncol 2018; 29:700-706. [PMID: 29216356 PMCID: PMC5889041 DOI: 10.1093/annonc/mdx765] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background A major limitation of circulating tumor DNA (ctDNA) for somatic mutation detection has been the low level of ctDNA found in a subset of cancer patients. We investigated whether using a combined isolation of exosomal RNA (exoRNA) and cell-free DNA (cfDNA) could improve blood-based liquid biopsy for EGFR mutation detection in non-small-cell lung cancer (NSCLC) patients. Patients and methods Matched pretreatment tumor and plasma were collected from 84 patients enrolled in TIGER-X (NCT01526928), a phase 1/2 study of rociletinib in mutant EGFR NSCLC patients. The combined isolated exoRNA and cfDNA (exoNA) was analyzed blinded for mutations using a targeted next-generation sequencing panel (EXO1000) and compared with existing data from the same samples using analysis of ctDNA by BEAMing. Results For exoNA, the sensitivity was 98% for detection of activating EGFR mutations and 90% for EGFR T790M. The corresponding sensitivities for ctDNA by BEAMing were 82% for activating mutations and 84% for T790M. In a subgroup of patients with intrathoracic metastatic disease (M0/M1a; n = 21), the sensitivity increased from 26% to 74% for activating mutations (P = 0.003) and from 19% to 31% for T790M (P = 0.5) when using exoNA for detection. Conclusions Combining exoRNA and ctDNA increased the sensitivity for EGFR mutation detection in plasma, with the largest improvement seen in the subgroup of M0/M1a disease patients known to have low levels of ctDNA and poses challenges for mutation detection on ctDNA alone. Clinical Trials NCT01526928.
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Affiliation(s)
- A K Krug
- Exosome Diagnostics GmbH, Martinsried, Germany
| | - D Enderle
- Exosome Diagnostics GmbH, Martinsried, Germany
| | | | | | - S Bentink
- Exosome Diagnostics GmbH, Martinsried, Germany
| | - A Spiel
- Exosome Diagnostics GmbH, Martinsried, Germany
| | - K Brinkmann
- Exosome Diagnostics GmbH, Martinsried, Germany
| | - J Emenegger
- Exosome Diagnostics GmbH, Martinsried, Germany
| | - D G Grimm
- Exosome Diagnostics GmbH, Martinsried, Germany
| | | | - J W Goldman
- University of California Los Angeles, Los Angeles
| | | | - J-C Soria
- Institut Gustave Roussy, Villejuif; University Paris-Sud, Paris, France
| | | | - S M Gadgeel
- Karmanos Cancer Institute, Detroit; Wayne State University, Detroit
| | | | - M Raponi
- Clovis Oncology Inc., San Francisco
| | - M Noerholm
- Exosome Diagnostics GmbH, Martinsried, Germany
| | - J Skog
- Exosome Diagnostics Inc, Waltham.
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11
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Bennett CW, Berchem G, Kim YJ, El-Khoury V. Cell-free DNA and next-generation sequencing in the service of personalized medicine for lung cancer. Oncotarget 2018; 7:71013-71035. [PMID: 27589834 PMCID: PMC5342606 DOI: 10.18632/oncotarget.11717] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/11/2016] [Indexed: 12/13/2022] Open
Abstract
Personalized medicine has emerged as the future of cancer care to ensure that patients receive individualized treatment specific to their needs. In order to provide such care, molecular techniques that enable oncologists to diagnose, treat, and monitor tumors are necessary. In the field of lung cancer, cell free DNA (cfDNA) shows great potential as a less invasive liquid biopsy technique, and next-generation sequencing (NGS) is a promising tool for analysis of tumor mutations. In this review, we outline the evolution of cfDNA and NGS and discuss the progress of using them in a clinical setting for patients with lung cancer. We also present an analysis of the role of cfDNA as a liquid biopsy technique and NGS as an analytical tool in studying EGFR and MET, two frequently mutated genes in lung cancer. Ultimately, we hope that using cfDNA and NGS for cancer diagnosis and treatment will become standard for patients with lung cancer and across the field of oncology.
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Affiliation(s)
- Catherine W Bennett
- Department of Oncology, Luxembourg Institute of Health, L-1526 Luxembourg, Luxembourg
| | - Guy Berchem
- Department of Oncology, Luxembourg Institute of Health, L-1526 Luxembourg, Luxembourg.,Centre Hospitalier de Luxembourg, L-1210 Luxembourg, Luxembourg
| | - Yeoun Jin Kim
- Department of Oncology, Luxembourg Institute of Health, L-1526 Luxembourg, Luxembourg
| | - Victoria El-Khoury
- Department of Oncology, Luxembourg Institute of Health, L-1526 Luxembourg, Luxembourg
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Wu K, Yu S, Liu Q, Bai X, Zheng X, Wu K. The clinical significance of CXCL5 in non-small cell lung cancer. Onco Targets Ther 2017; 10:5561-5573. [PMID: 29200871 PMCID: PMC5702175 DOI: 10.2147/ott.s148772] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
As a CXC-type chemokine, ENA78/CXCL5 is an important attractant for granulocytes by binding to its receptor CXCR2. Recent studies proved that CXCL5/CXCR2 axis plays an oncogenic role in many human cancers. However, the exact clinical significance of CXCL5 in lung cancer has not been well defined. Here, we found that the serum protein expression of CXCL5 was significantly increased in non-small cell lung cancer (NSCLC) compared with that in healthy volunteers. Immunohistochemistry staining revealed that CXCL5 protein was higher in various lung cancer tissues compared with normal tissues. Moreover, CXCL5 expression correlated with histological grade, tumor size, and TNM stage in NSCLC. Elevated CXCL5 protein abundance predicted poor overall survival in adenocarcinoma patients. Further meta-analysis demonstrated that CXCL5 mRNA expression was also positively associated with tumor stage, lymph node metastasis, and worse survival. Kaplan–Meier plot analyses indicated high CXCL5 was associated with short overall survival and progression-free survival. Together, these results indicated that CXCL5 may be a potential biomarker for NSCLC.
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Affiliation(s)
- Kongju Wu
- Medical School of Pingdingshan University, Pingdingshan, Henan
| | - Shengnan Yu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Qian Liu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xianguang Bai
- Medical School of Pingdingshan University, Pingdingshan, Henan
| | - Xinhua Zheng
- Medical School of Pingdingshan University, Pingdingshan, Henan
| | - Kongming Wu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) of Yunnan in southwestern China. Oncotarget 2017; 8:15023-15033. [PMID: 28107191 PMCID: PMC5362464 DOI: 10.18632/oncotarget.14706] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/18/2016] [Indexed: 12/11/2022] Open
Abstract
To investigate the Epidermal Growth Factor Receptor (EGFR) mutation status in non-small cell lung cancer (NSCLC) in Yunnan province in southwestern China, we detected EGFR mutation by Amplification Refractory Mutation System (ARMS) polymerase chain reaction (PCR) using DNA samples from 447 pathologically confirmed NSCLC specimens (175 tissue, 256 plasma and 16 cytologic samples). The relationship between EGFR mutations and demographic and clinical factors were further explored. Subgroup analyses according to sample type (tissue and plasma) and histological type (adenocarcinoma) were done. We found the mutation rate was 34.9% in overall patients (42.3%, 29.7%, and 37.5% for tissue, plasma, and cytologic samples respectively). We found female (p < 0.0001), no smoking (p = 0.001), adenocarcinoma (p < 0.0001), and tissue specimen (p = 0.026) were associated with higher EGFR mutation rate. The most common mutations were exon 19 deletions (40%) and L858R point (30%) mutation. Interestingly, NSCLC patients from Xuanwei harbored a strikingly divergent mutational pattern for EGFR when compared with non-Xuanwei patients (higher G719X, G719X+S768I mutations, but lower 19 deletion and L858R mutations). Generally, EGFR mutation rate and pattern in Yunnan province was in accord with other Asian populations. However, Xuanwei subgroup showed strikingly divergent EGFR mutation spectrum from other general population. Our analysis also indicated that cftDNA analysis for EGFR mutations detection was feasibility for the patients lacking sufficient tissue for molecular analyses.
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Yohe S, Thyagarajan B. Review of Clinical Next-Generation Sequencing. Arch Pathol Lab Med 2017; 141:1544-1557. [PMID: 28782984 DOI: 10.5858/arpa.2016-0501-ra] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Next-generation sequencing (NGS) is a technology being used by many laboratories to test for inherited disorders and tumor mutations. This technology is new for many practicing pathologists, who may not be familiar with the uses, methodology, and limitations of NGS. OBJECTIVE - To familiarize pathologists with several aspects of NGS, including current and expanding uses; methodology including wet bench aspects, bioinformatics, and interpretation; validation and proficiency; limitations; and issues related to the integration of NGS data into patient care. DATA SOURCES - The review is based on peer-reviewed literature and personal experience using NGS in a clinical setting at a major academic center. CONCLUSIONS - The clinical applications of NGS will increase as the technology, bioinformatics, and resources evolve to address the limitations and improve quality of results. The challenge for clinical laboratories is to ensure testing is clinically relevant, cost-effective, and can be integrated into clinical care.
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Affiliation(s)
- Sophia Yohe
- From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Bharat Thyagarajan
- From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
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Abstract
OBJECTIVE Noninvasive liquid biopsies of circulating tumor DNA (ctDNA) can be used to assess non-small cell lung cancer (NSCLC), but previous work focused on patients with advanced-stage cancer. Thus, we evaluated the feasibility and their potential clinical application of circulating tumor DNA approached for surgical patients with NSCLC. METHOD Consecutive patients with suspected lung cancer who underwent curative-intent lung resection were enrolled prospectively in this study. Targeted DNA sequencing with a next-generation sequencing platform was used to identify a series of somatic mutations in matched tumor tissue DNA (tDNA) and plasma ctDNA samples. Plasma was collected before, during, and after surgery. Concordance was defined as matched tDNA and ctDNA with the same identified mutations or with no mutations. RESULTS In the enrolled 76 patients with lung cancer who were included, 31 had concordant mutations and 21 had no mutation in both ctDNA and tDNA, yielding an overall concordance of 68.4%. ctDNA samples obtained before and during surgery had the same mutations with a low variance in mutation frequency (1.2%) that was reduced to an average of 0.28% after surgery (P < .001). More patients were positive as assayed by ctDNA (48; 63.2%) than with serum tumor protein markers (36; 49.3%). The area under the curve was greater in ctDNA (0.887, 95% confidence interval [CI], 0.788-0.986) than for the 2 prediction models (0.803, 95% CI, 0.647-0.959; 0.69, 95% CI, 0.512-0.869) for estimating malignancy of solitary pulmonary nodules. CONCLUSION ctDNA mutation analysis for stage I-III surgical patients with NSCLC is feasible. More studies are needed to investigate its clinical application.
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Ohira T, Sakai K, Matsubayashi J, Kajiwara N, Kakihana M, Hagiwara M, Hibi M, Yoshida K, Maeda J, Ohtani K, Nagao T, Nishio K, Ikeda N. Tumor volume determines the feasibility of cell-free DNA sequencing for mutation detection in non-small cell lung cancer. Cancer Sci 2017; 107:1660-1666. [PMID: 27575703 PMCID: PMC5132294 DOI: 10.1111/cas.13068] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/24/2016] [Accepted: 08/27/2016] [Indexed: 12/13/2022] Open
Abstract
Next‐generation sequencing (NGS) and digital PCR technologies allow analysis of the mutational profile of circulating cell‐free DNA (cfDNA) in individuals with advanced lung cancer. We have now evaluated the feasibility of cfDNA sequencing for mutation detection in patients with non‐small cell lung cancer at earlier stages. A total of 150 matched tumor and serum samples were collected from non‐small cell lung cancer patients at stages IA–IIIA. Amplicon sequencing with DNA extracted from tumor tissue detected frequent mutations in EGFR (37% of patients), TP53 (39%), and KRAS (10%), consistent with previous findings. In contrast, NGS of cfDNA identified only EGFR,TP53, and PIK3CA mutations in three, five, and one patient, respectively, even though adequate amounts of cfDNA were extracted (median of 4936 copies/mL serum). Next‐generation sequencing showed a high accuracy (98.8%) compared with droplet digital PCR for cfDNA mutation detection, suggesting that the low frequency of mutations in cfDNA was not due to a low assay sensitivity. Whereas the yield of cfDNA did not differ among tumor stages, the cfDNA mutations were detected in seven patients at stages IIA–IIIA and at T2b or T3. Tumor volume was significantly higher in the cfDNA mutation‐positive patients than in the negative patients at stages T2b–T4 (159.1 ± 58.0 vs. 52.5 ± 9.9 cm3, P = 0.014). Our results thus suggest that tumor volume is a determinant of the feasibility of mutation detection with cfDNA as the analyte.
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Affiliation(s)
- Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuko Sakai
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | | | | | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaaki Hibi
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Koichi Yoshida
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Junichi Maeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Keishi Ohtani
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
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17
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Ansari J, Yun JW, Kompelli AR, Moufarrej YE, Alexander JS, Herrera GA, Shackelford RE. The liquid biopsy in lung cancer. Genes Cancer 2017; 7:355-367. [PMID: 28191282 PMCID: PMC5302037 DOI: 10.18632/genesandcancer.127] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The incidence of lung cancer has significantly increased over the last century, largely due to smoking, and remains the most common cause of cancer deaths worldwide. This is often due to lung cancer first presenting at late stages and a lack of curative therapeutic options at these later stages. Delayed diagnoses, inadequate tumor sampling, and lung cancer misdiagnoses are also not uncommon due to the limitations of the tissue biopsy. Our better understanding of the tumor microenvironment and the systemic actions of tumors, combined with the recent advent of the liquid biopsy, may allow molecular diagnostics to be done on circulating tumor markers, particularly circulating tumor DNA. Multiple liquid biopsy molecular methods are presently being examined to determine their efficacy as surrogates to the tumor tissue biopsy. This review will focus on new liquid biopsy technologies and how they may assist in lung cancer detection, diagnosis, and treatment.
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Affiliation(s)
- Junaid Ansari
- Feist Weiller Cancer Center, LSU Health Shreveport, LA, USA; Department of Molecular and Cellular Physiology, LSU Health Sciences Center, Shreveport, LA, USA
| | - Jungmi W Yun
- Department of Molecular and Cellular Physiology, LSU Health Sciences Center, Shreveport, LA, USA
| | | | | | - Jonathan S Alexander
- Department of Molecular and Cellular Physiology, LSU Health Sciences Center, Shreveport, LA, USA
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18
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A Comparison of Cell-Free DNA Isolation Kits: Isolation and Quantification of Cell-Free DNA in Plasma. J Mol Diagn 2016; 19:162-168. [PMID: 27865784 DOI: 10.1016/j.jmoldx.2016.09.009] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/02/2016] [Accepted: 09/16/2016] [Indexed: 12/13/2022] Open
Abstract
The analysis of cell-free DNA (cfDNA) as a sensitive biomarker for cancer diagnosis and monitoring has resulted in a need for efficient and standardized cfDNA isolation. In this study, we compared the isolation efficiency of the QIAamp circulating nucleic acid kit (QIA) with four other cfDNA isolation kits: the PME free-circulating DNA Extraction Kit (PME), the Maxwell RSC ccfDNA Plasma Kit (RSC), the EpiQuick Circulating Cell-Free DNA Isolation Kit (EQ), and two consecutive versions of the NEXTprep-Mag cfDNA Isolation Kit (NpMV1/2). cfDNA was isolated from 10 plasma samples, of which five contained KRAS mutated cell-free tumor DNA (ctDNA). Digital droplet PCR was used to quantify the total cfDNA concentration as well as the KRAS mutated ctDNA fraction. cfDNA integrity was assessed with real-time quantitative PCR. The QIA and the RSC kits displayed similar isolation efficiencies of both KRAS mutated ctDNA and nonmutated cfDNA, whereas the yield generated by the PME and NpMV2 kits was significantly lower. Real-time quantitative PCR indicated the presence of digital droplet PCR inhibiting agents in the eluates of the NpMV1 and EQ kits. To conclude, this study presents two highly efficient isolation kits for cfDNA isolation, of which the RSC kit has the advantage of a fully automated protocol over the labor-intensive QIA kit.
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He Y, Zhang X, Wang L, Tian Z, Liu Q, Yao J, Liu Y, Li C, Min L, Shan B. Detection of cancer specific mutations in early-stage non-small cell lung cancer using cell-free DNA by targeted sequencing. Int J Oncol 2016; 49:2351-2358. [DOI: 10.3892/ijo.2016.3731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/05/2016] [Indexed: 11/06/2022] Open
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20
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Alegre E, Fusco JP, Restituto P, Salas-Benito D, Rodríguez-Ruiz ME, Andueza MP, Pajares MJ, Patiño-García A, Pio R, Lozano MD, Gúrpide A, Lopez-Picazo JM, Gil-Bazo I, Perez-Gracia JL, Gonzalez A. Total and mutated EGFR quantification in cell-free DNA from non-small cell lung cancer patients detects tumor heterogeneity and presents prognostic value. Tumour Biol 2016; 37:13687-13694. [PMID: 27473086 DOI: 10.1007/s13277-016-5282-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/15/2016] [Indexed: 11/26/2022] Open
Abstract
Mutation analysis of epidermal growth factor receptor (EGFR) gene is essential for treatment selection in non-small cell lung cancer (NSCLC). Analysis is usually performed in tumor samples. We evaluated the clinical utility of EGFR analysis in plasma cell-free DNA (cfDNA) from patients under treatment with EGFR inhibitors. We selected 36 patients with NSCLC and EGFR-activating mutations. Blood samples were collected at baseline and during treatment with EGFR inhibitors. Wild-type EGFR, L858R, delE746-A750, and T790M mutations were quantified in cfDNA by droplet digital PCR. Stage IV patients had higher total circulating EGFR copy levels than stage I (3523 vs. 1003 copies/mL; p < 0.01). There was high agreement for activating mutations between baseline cfDNA and tumor samples, especially for L858R mutation (kappa index = 0.679; p = 0.001). In 34 % of advanced NSCLC patients, we detected mutations in cfDNA not previously detected in tumor samples and double mutations in 17 %. Patients with baseline total EGFR copy levels above the median presented decreased overall survival (OS) (341 vs. 870 days, p < 0.05) and progression-free survival (PFS) (238 vs. 783 days; p < 0.05) compared with those with total EGFR copy levels below the median. Patients with baseline concentrations of activating mutations above the median (94 copies/mL) had lower OS (317 vs. 805 days; p < 0.05) and PFS (195 vs. 724 days; p < 0.05). During follow-up, T790M resistance mutation was detected in 53 % of patients. Total and mutated EGFR analysis in cfDNA seems a relevant tool to characterize the molecular profile and prognosis of NSCLC patients harboring EGFR mutations.
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Affiliation(s)
- E Alegre
- Clinical Chemistry Department, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
- Department of Biochemistry and Genetics, Universidad de Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
| | - J P Fusco
- Department of Oncology, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - P Restituto
- Clinical Chemistry Department, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
| | - D Salas-Benito
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Department of Oncology, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - M E Rodríguez-Ruiz
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Department of Oncology, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - M P Andueza
- Department of Oncology, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - M J Pajares
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Program in Solid Tumors and Biomarkers|, Centro de Investigación Médica Aplicada (CIMA), Av Pio XII, 55 31008, Pamplona, Spain
- Department of Histology, Universidad de Navarra, Irunlarrea 1, 31008, Pamplona, Spain
| | - A Patiño-García
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Department of Pediatrics and CIMA LAB Diagnostics, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - R Pio
- Department of Biochemistry and Genetics, Universidad de Navarra, Irunlarrea 1, 31008, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Program in Solid Tumors and Biomarkers|, Centro de Investigación Médica Aplicada (CIMA), Av Pio XII, 55 31008, Pamplona, Spain
| | - M D Lozano
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Department of Pathology, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - A Gúrpide
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Department of Oncology, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - J M Lopez-Picazo
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Department of Oncology, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - I Gil-Bazo
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Department of Oncology, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - J L Perez-Gracia
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain
- Department of Oncology, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain
| | - A Gonzalez
- Clinical Chemistry Department, Clínica Universidad de Navarra, Av Pio XII 36, 31008, Pamplona, Spain.
- Department of Biochemistry and Genetics, Universidad de Navarra, Irunlarrea 1, 31008, Pamplona, Spain.
- IdiSNA, Navarra Institute for Health Research, Irunlarrea 3, 31008, Pamplona, Spain.
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Sorber L, Zwaenepoel K, Deschoolmeester V, Van Schil PEY, Van Meerbeeck J, Lardon F, Rolfo C, Pauwels P. Circulating cell-free nucleic acids and platelets as a liquid biopsy in the provision of personalized therapy for lung cancer patients. Lung Cancer 2016; 107:100-107. [PMID: 27180141 DOI: 10.1016/j.lungcan.2016.04.026] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 12/12/2022]
Abstract
Lung cancer is the predominant cause of cancer-related mortality in the world. The majority of patients present with locally advanced or metastatic non-small-cell lung cancer (NSCLC). Treatment for NSCLC is evolving from the use of cytotoxic chemotherapy to personalized treatment based on molecular alterations. Unfortunately, the quality of the available tumor biopsy and/or cytology material is not always adequate to perform the necessary molecular testing, which has prompted the search for alternatives. This review examines the use of circulating cell-free nucleic acids (cfNA), consisting of both circulating cell-free (tumoral) DNA (cfDNA-ctDNA) and RNA (cfRNA), as a liquid biopsy in lung cancer. The development of sensitive and accurate techniques such as Next-Generation Sequencing (NGS); Beads, Emulsion, Amplification, and Magnetics (BEAMing); and Digital PCR (dPCR), have made it possible to detect the specific genetic alterations (e.g. EGFR mutations, MET amplifications, and ALK and ROS1 translocations) for which targeted therapies are already available. Moreover, the ability to detect and quantify these tumor mutations has enabled the follow-up of tumor dynamics in real time. Liquid biopsy offers opportunities to detect resistance mechanisms, such as the EGFR T790M mutation in the case of EGFR TKI use, at an early stage. Several studies have already established the predictive and prognostic value of measuring ctNA concentration in the blood. To conclude, using ctNA analysis as a liquid biopsy has many advantages and allows for a variety of clinical and investigational applications.
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Affiliation(s)
- L Sorber
- Center for Oncological Research (CORE), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Pathology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium.
| | - K Zwaenepoel
- Center for Oncological Research (CORE), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Pathology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - V Deschoolmeester
- Center for Oncological Research (CORE), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Pathology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - P E Y Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - J Van Meerbeeck
- Center for Oncological Research (CORE), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Thoracic Oncology/MOCA, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - F Lardon
- Center for Oncological Research (CORE), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - C Rolfo
- Oncology & Phase I Unit-Early Clinical Trials, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - P Pauwels
- Center for Oncological Research (CORE), University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Pathology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium
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Chen LY, Molina-Vila MA, Ruan SY, Su KY, Liao WY, Yu KL, Ho CC, Shih JY, Yu CJ, Yang JCH, Rosell R, Yang PC. Coexistence of EGFR T790M mutation and common activating mutations in pretreatment non-small cell lung cancer: A systematic review and meta-analysis. Lung Cancer 2016; 94:46-53. [PMID: 26973206 DOI: 10.1016/j.lungcan.2016.01.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/31/2015] [Accepted: 01/26/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Previous studies have indicated that EGFR exon 19 deletions in non-small cell lung cancer (NSCLC) are associated with better outcomes to tyrosine kinase inhibitors (TKIs) than the L858R mutation. This study aimed to evaluate whether T790M, a resistant mutation, is more likely to coexist with L858R mutation than with exon 19 deletions in pretreatment NSCLC patients. MATERIALS AND METHOD We searched MEDLINE and EMBASE up to Nov 30th, 2015 to identify randomized controlled trials (RCTs) and observational studies that reported pretreatment T790M and EGFR-activating mutation. A meta-analysis was performed using a random-effects model. The primary outcome was odds ratio (OR) of pretreatment T790M mutation in NSCLC co-existing with L858R mutation and exon 19 deletions. Stratified analysis was performed based on sensitivity of mutation detection methods for T790M. RESULTS We identified 15 observational studies and 3 RCTs for analysis. Pretreatment T790M was more frequent in L858R than in exon 19 mutated patients. The association of T790M and L858R was statistically significant in observational studies (OR, 1.65, 95% CI, 1.17-2.32), with less precision in RCTs (OR, 1.84, 95% CI, 0.96-3.52). In the stratified analysis based on the sensitivity of the mutation detection methods, the association was observed in the studies using intermediately (detection limit <5% and ≥ 0.1%; OR, 2.23, 95% CI, 1.19-4.17) and highly sensitive methods (detection limit <0.1%; OR, 1.74, 95% CI, 1.10-2.73), but not in those using low sensitivity methods (detection limit >5%; OR, 1.28, 95% CI, 0.74-2.23). CONCLUSIONS Pretreatment EGFR T790M mutation is more likely to coexist with L858R mutation than with exon 19 deletions in NSCLC. This association was observed only in studies using sensitive mutation detection methods (<5%).
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Affiliation(s)
- Li-Yang Chen
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan
| | - Miguel A Molina-Vila
- Breakthrough Cancer Research Unit, Pangaea Biotech S.L, Sabino Arana, 5-19, Barcelona 08028, Spain
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan
| | - Kang-Yi Su
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, 1 Chang-Te Street, Taipei 100, Taiwan
| | - Wei-Yu Liao
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan
| | - Kai-Lun Yu
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan.
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan
| | - James Chih-Hsin Yang
- Graduate Institute of Oncology and Cancer Research Centre, College of Medicine, National Taiwan University, 7 Chung Shan South Road, Taipei 100, Taiwan
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916 Badalona, Spain
| | - Pan-Chyr Yang
- National Taiwan University, 1 Roosevelt Road Sec. 4, Taipei 100, Taiwan
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