Cell-free DNA BRAF V600E measurements during BRAF inhibitor therapy of metastatic melanoma: long-term analysis

OBJECTIVE

We assessed the status of the BRAF V600E mutation in cell-free circulating tumor DNA (cfDNA) isolated from the plasma of patients with metastatic melanoma treated with the BRAF inhibitor vemurafenib, collected at different time points during therapy to evaluate the sensitivity and specificity of quantitative polymerase chain reaction and droplet digital polymerase chain reaction (ddPCR) and the correlation between the level of plasma cfDNA p.V600E and the long-term clinical outcome.

METHODS

cfDNA in patients with BRAF-mutated melanoma (n = 62) was analyzed at baseline and at 4-8 weeks from the start of vemurafenib therapy. BRAF mutations were assessed using tumor tissue-derived DNA and circulating cfDNA from plasma samples. Quantification of BRAF V600E was performed in cfDNA using ddPCR.

RESULTS

cfDNA V600E was detected in the plasma of 48/62 (77%) patients at baseline and in 18/62 (29%) patients after 4-8 weeks of treatment. Patients positive for BRAF mutations in cfDNA at baseline had shorter progression-free survival (PFS) and overall survival (OS) compared with patients with undetectable cfDNA BRAF mutations. Undetectable cfDNA p.V600E at baseline and after 4-8 weeks of therapy was associated with the best prognosis. When treated as a continuous variable, the log-transformed concentration of baseline cfDNA p.V600E was significantly associated with both PFS and OS. This effect was retained in the multivariate OS Cox model adjusted for Eastern Cooperative Oncology Group performance status, the presence of brain metastases, patient age, and previous systemic treatment.

CONCLUSIONS

Monitoring of plasma BRAF p.V600E cfDNA concentrations in patients with metastatic melanoma on targeted therapy may have prognostic value. Undetectable cfDNA p.V600E before and during treatment was associated with a favorable prognosis.

BRCA1 founder mutations and beyond in the Polish population: A single-institution BRCA1/2 next-generation sequencing study

Hereditary mutations in BRCA1/2 genes increase the risk of breast cancer by 60–80% and ovarian cancer by about 20–40% in female carriers. Detection of inherited mutations in asymptomatic carriers allows for the implementation of appropriate preventive measures. BRCA1/2 genotyping is also important for poly(adenosine diphosphate)-ribose polymerase (PARP) inhibitor administration. This work addresses the need for next-generation sequencing (NGS) technology for the detection of BRCA1/2 mutations in Poland where until recently mostly founder mutations have been tested, and whether BRCA diagnostics should be extended beyond the panel of founder mutations in this population. The study comprises 2931 patients who were referred for genetic counseling and tested for founder and recurrent mutations in BRCA1 (5382insC (c.5266dupC; p.Gln1756Profs), c.5370C>T (c.5251C>T; p.R1751*), 300T>G (c.181T>G; p.Cys61Gly), 185delAG (c.68_69delAG; p.Glu23Valfs), and 4153delA (c.4035delA; p.Glu1346Lysfs)) by high-resolution melting/Sanger sequencing. A total of 103 (3.5%) mutations were detected, including 53 (51%) in healthy subjects and 50 (49%) in cancer patients. Then, based on more stringent clinical and pedigree criteria, sequencing of all BRCA1/2 exons was performed in 454 (16%) patients without founder mutations by NGS, which detected 58 mutations (12.8%), 40 (8.8%) of which were pathogenic. In 14 (3.1%) subjects, variants of uncertain significance (VUS) were detected, and in four (0.9%) subjects, the detected mutations were benign. In total, 161 mutations were detected using our two-step algorithm (founder test and NGS), of which 64% were founder mutations, 25% were NGS-detected pathogenic mutations, 9% were VUS, and 2% were benign. In addition, 38 mutations not yet reported in the Polish population were detected. In total, founder mutations accounted for only 64% of all detected mutations, and the remaining mutations (36%) were dispersed across the BRCA1/2 gene sequences. Thus, in Poland, testing for constitutional mutations in BRCA1/2 should be carried out in two stages, where NGS is performed in qualifying subjects if founder mutations are not identified.

Histopathological and genotypic characterization of metastatic colorectal carcinoma with PD-L1 (CD274)-expression: Possible roles of tumour micro environmental factors for CD274 expression

Aberrant PD-L1 (CD274) expression has been described in different types of tumour and linked to tumour aggressiveness and a poor prognosis. In primary colorectal carcinomas (CRCs), CD274 expression was reported to be associated with mismatch repair (MMR)-deficiency, BRAF mutation, and "stem-like" immunophenotype defined by down-regulation of homeobox protein CDX2 and membranous expression of activated leukocyte cell adhesion molecule (ALCAM). However, the immunophenotype and genotype of CD274-positive metastatic CRC have not been extensively analysed. In this study, 189 CRC metastases were evaluated immunohistochemically for CD274, MMR proteins, CDX2, and ALCAM expression. Immunostaining for CD4, CD8, and FOXP3 was also performed to characterize tumour-associated immune cells. In addition, 34 arbitrarily selected lesions were genotyped using Sanger- and next-generation sequencing. Univariate analyses showed no clear association between CD274 expression and clinicopathological parameters including MMR-deficiency or "stem-like" immunophenotype after adjustment for multiple testing. Comparison of the clinicopathological profiles of CD274-positive primary and metastatic tumours revealed in the latter younger age of occurrence (60.9 ± 13.3 versus 72.6 ± 13.1 years, p = 0.001), cytoplasm-dominant CD274 expression (p < 0.001), infrequent MMR-deficiency (p < 0.001), and common KRAS mutations (54%, p < 0.001). In five cultured colon cancer cell lines, CD274 was expressed and modulated after exogenous exposure to IFNγ and TGF-β1. Thus, CD274 regulation mechanisms might include tumour micro environmental factors. Based on significantly different characteristics in CD274-positive metastatic and primary CRCs, evaluation of metastases should also be considered when planning immune checkpoint inhibitor therapy.

Accurate and low jitter time-interval generators based on phase shifting method

The paper describes two time-interval generators based on the phase shifting method. The first one utilizes the digital clock manager units integrated in a field programmable gate array (FPGA) device and has jitter below 65 ps (rms) over the range of 4 ns-50 ms, while the second one utilizes a separate direct digital synthesizer and has jitter below 15 ps (rms) over the range of 10.2 ns-50 ms. The phase shifting method can be used to design new low-cost and high-precision time-interval generators using the popular FPGA technology.

[Microbiological evaluation of ciprofloxacin efficacy for treatment of urinary tract infections]

An attempt has been undertaken to evaluate the aetiology of urinary tract infections in a large group of patients and to determine the resistance to ciprofloxacin during therapy, and the efficacy of the drug in treating of urinary tract infections. 52 patients with urinary tract infections were treated with ciprofloxacin. Ciprobay by BAYER was used in coated 500 mg tablets twice a day and intravenous solutions in 200 mg dosages every 12 hours for 10-14 days depending on the clinical condition. Microbiological tests were made according to general methods. Sensitivity evaluation to ciprofloxacin was done using E-tests by AB Biodisk and dilution tests. The most common a etiology of urinary tract infections were Gram-negative Enterobacteriaceae rods, mainly E. coli. Ciprofloxacin gave the best results against Enterobacteriaceae rods (100% eradications). In other infections, effective therapy was possible after determining of the sensitivity in vitro. S. haemolyticus bacteria tended significantly towards resistance to ciprofloxacin during therapy.

[Effect of subinhibitory doses of some antibiotics on bacteria in vitro]

The study was aimed at observation of influence of subinhibitory doses of selected beta-lactam antibiotics (cefuroxime, ceftazidime, thienamycin) and of ciprofloxacin on morphology and physiology of S. aureus and E. coli. The bacteria were subjected to action of these antibiotics in various subinhibitory concentrations in fluid Mueller-Hinton medium at 37 degrees C for 18 hours, and morphological changes in bacterial cells were observed in light and electronic microscope. In case of E. coli changes appeared as presence of elongated forms, while S. aureus formed giant cells with changes in staining. It was found that intensity of these morphological changes was proportional to concentrations of antibiotics. For determination of influence of tested antibiotics on growth of bacteria they were cultured in the fluid Mueller-Hinton medium containing antibiotics in concentrations of 4, 1 1/4 MIC. The culture lasted for 6 hours, and number of bacterial cells in 1 ml of the medium was periodically determined. Distinct inhibition of growth of bacterial cells was proportional to the used concentrations of antibiotics. Described in this paper morphological changes of bacteria found confirmation in change of their physiology expressed as inhibition of bacterial cell growth.