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Provencio M, Serna-Blasco R, Franco F, Calvo V, Royuela A, Auglytė M, Sánchez-Hernández A, de Julián Campayo M, García-Girón C, Dómine M, Blasco A, Sánchez JM, Oramas J, Bosch-Barrera J, Sala MÁ, Sereno M, Ortega AL, Chara L, Hernández B, Padilla A, Coves J, Blanco R, Balsalobre J, Mielgo X, Bueno C, Jantus-Lewintre E, Molina-Vila MÁ, Romero A. Analysis of circulating tumour DNA to identify patients with epidermal growth factor receptor-positive non-small cell lung cancer who might benefit from sequential tyrosine kinase inhibitor treatment. Eur J Cancer 2021; 149:61-72. [PMID: 33831609 DOI: 10.1016/j.ejca.2021.02.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/05/2021] [Accepted: 02/24/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Survival data support the use of first-line osimertinib as the standard of care for epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer (NSCLC). However, it remains unclear whether upfront osimertinib is superior to sequential first- or second-generation tyrosine kinase inhibitors (TKIs) followed by osimertinib for all patients. It is impossible to predict which patients are at high risk of progression, and this constitutes a major limitation of the sequential TKI approach. PATIENTS AND METHODS A total of 830 plasma samples from 228 patients with stage IV, EGFR-positive NSCLC who were treated with first-line TKIs were analysed by digital polymerase chain reaction (dPCR). RESULTS The circulating tumour DNA (ctDNA) levels helped to identify patients with significantly improved survival rate, regardless of the treatment. Patients treated with first- or second-generation TKIs (N = 189) with EGFR mutations in plasma at a mutant allele frequency (MAF) <7% before treatment initiation (low-risk patients) or who were ctDNA negative after 3 or 6 months of treatment and with an MAF <7% at diagnosis (high responders) had two-thirds lower risk of death than patients in the opposite situation (adjusted hazard ratio [HR] = 0.38; 95% confidence interval [CI]: 0.23-0.64 and HR = 0.22; 95% CI: 0.12-0.42, respectively). The median overall survival (OS) for low-risk patients and high responders treated with first- or second-generation TKIs was 34.2 months and not reached, respectively, regardless of second-line treatment. There were no significant difference in OS between low-risk or high-responder patients treated upfront with osimertinib (N = 39) and those treated under a sequential approach with osimertinib (N = 60). Median OS was not reached in both cases. CONCLUSIONS Pre-treatment ctDNA levels identify low-risk patients, who may benefit from sequential TKI treatment. Information regarding EGFR mutation clearance can help to improve patient selection.
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Affiliation(s)
- Mariano Provencio
- Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain.
| | - Roberto Serna-Blasco
- Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - Fabio Franco
- Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - Virgina Calvo
- Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Hospital Universitario Puerta de Hierro- Majadahonda, CIBERESP, Majadahonda, Madrid, Spain
| | - Milda Auglytė
- Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | | | - María de Julián Campayo
- Medical Oncology, Hospital Provincial Centre de Castelló, Castellón de La Plana, Castellón, Spain
| | | | - Manuel Dómine
- Medical Oncology, Fundación Jiménez Díaz, Madrid, Madrid, Spain
| | - Ana Blasco
- Medical Oncology, Hospital General Universitario Valencia, Valencia, Valencia, Spain
| | - José M Sánchez
- Medical Oncology, Hospital de La Princesa, Madrid, Madrid, Spain
| | - Juana Oramas
- Medical Oncology, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | | | - María Á Sala
- Medical Oncology, Hospital Basurto, Bilbao, Vizcaya, Spain
| | - María Sereno
- Medical Oncology, Hospital Universitario Infanta Sofía, San Sebastián de Los Reyes, Madrid, Spain
| | - Ana L Ortega
- Medical Oncology, Consorcio Hospitalario de Jaén, Jaén, Jaén, Spain
| | - Luis Chara
- Medical Oncology, Hospital Universitario de Guadalajara, Guadalajara, Guadalajara, Spain
| | - Berta Hernández
- Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Airam Padilla
- Medical Oncology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Santa Cruz de Tenerife, Spain
| | - Juan Coves
- Medical Oncology, Hospital Son Llàtzer, Palma, Islas Baleares, Spain
| | - Remedios Blanco
- Medical Oncology, Consorci Sanitari Terrassa, Terrassa, Barcelona, Spain
| | - José Balsalobre
- Medical Oncology, Hospital General Universitario Santa Lucia, Cartagena, Murcia, Spain
| | - Xabier Mielgo
- Medical Oncology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Coralia Bueno
- Medical Oncology, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
| | - Eloisa Jantus-Lewintre
- Mixed Unit TRIAL, Príncipe Felipe Research Center & General University Hospital of Valencia Research Foundation, Valencia, Spain
| | - Miguel Á Molina-Vila
- Laboratory of Oncology/Pangaea Oncology, Quirón-Dexeus University Hospital, Barcelona, Spain
| | - Atocha Romero
- Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain.
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