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Blood samples as surrogates for tumor biopsies in patients with lung cancer

Date:
February 26, 2015
Source:
The JAMA Network Journals
Summary:
A study examined the feasibility of using circulating free DNA from blood samples of patients with advanced non-small-cell lung cancer as a surrogate for tumor biopsies to determine tumor-causing epidermal growth factor receptor mutations and then correlate that with expected patient outcomes, according to a new study.
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A study examined the feasibility of using circulating free DNA (cfDNA) from blood samples of patients with advanced non-small-cell lung cancer as a surrogate for tumor biopsies to determine tumor-causing epidermal growth factor receptor (EGFR) mutations and then correlate that with expected patient outcomes, according to a study published online by JAMA Oncology.

The analysis was a secondary objective of the EURTAC trial, which demonstrated the efficacy of erlotinib compared with standard chemotherapy for the first-line treatment of European patients with advanced non-small-cell lung cancer (NSCLC) with oncogenic EGFR mutations (exon 19 deletion or L858R mutations in exon 21) in tumor tissue.

Rafael Rosell, M.D., of the Hospital Germans Trias I Pujol, Badalona, Spain, and coauthors examined EGFR mutations in cfDNA isolated from 97 baseline blood samples.

Results show that in 76 samples from 97 (78 percent) patients, EGFR mutations in cfDNA were detected. Median overall survival was shorter in patients with the L858R mutation in cfDNA than in those with the exon 19 deletion (13.7 vs. 30 months). For patients with the L858R mutation in tissue, median overall survival was 13.7 months for patients with the L858R mutation in cfDNA and 27.7 months for those in whom the mutation was not detected in cfDNA. For the 76 patients with EGFR mutations in cfDNA, only erlotinib treatment was an independent predictor of longer disease progression-free survival.

"Testing of tumor tissue remains the recommended method for detecting the presence of oncogenic EGFR mutations; however, the amount of tumor tissue obtained by biopsy is often insufficient, especially in advanced NSCLC, raising the question of whether cfDNA may be used as a surrogate liquid biopsy for the noninvasive assessment of EGFR mutations," the study notes.

Editorial: EGFR Mutations in Non-Small-Cell Lung Cancer

In a related commentary, Roy S. Herbst, M.D., Ph.D., of the Yale School of Medicine, New Haven, Conn., and coauthors write: "In conclusion, the updated EURTAC study demonstrates that mutations detected in cfDNA are prognostic and consistent with data obtained from tumor biopsies. … More broadly, the potential benefits of liquid biopsies include a better evaluation of the tumor genome landscape with the identification of a comprehensive set of targetable mutations and the serial noninvasive monitoring, which may allow the detection of additional mutations from emerging subclones, including those involved in the development of acquired resistance. Finally, the presence of specific mutations in cfDNA may help identify populations of patients who are likely to have worse (or better) outcomes and who may require alternative treatments."


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Journal References:

  1. Niki Karachaliou, Clara Mayo-de las Casas, Cristina Queralt, Itziar de Aguirre, Boris Melloni, Felipe Cardenal, Ramon Garcia-Gomez, Bartomeu Massuti, José Miguel Sánchez, Ruth Porta, Santiago Ponce-Aix, Teresa Moran, Enric Carcereny, Enriqueta Felip, Isabel Bover, Amelia Insa, Noemí Reguart, Dolores Isla, Alain Vergnenegre, Filippo de Marinis, Radj Gervais, Romain Corre, Luis Paz-Ares, Daniela Morales-Espinosa, Santiago Viteri, Ana Drozdowskyj, Núria Jordana-Ariza, Jose Luis Ramirez-Serrano, Miguel Angel Molina-Vila, Rafael Rosell. Association ofEGFRL858R Mutation in Circulating Free DNA With Survival in the EURTAC Trial. JAMA Oncology, 2015; DOI: 10.1001/jamaoncol.2014.257
  2. Daniel Morgensztern, Katerina Politi, Roy S. Herbst. EGFRMutations in Non–Small-Cell Lung Cancer. JAMA Oncology, 2015; DOI: 10.1001/jamaoncol.2014.278

Cite This Page:

The JAMA Network Journals. "Blood samples as surrogates for tumor biopsies in patients with lung cancer." ScienceDaily. ScienceDaily, 26 February 2015. <www.sciencedaily.com/releases/2015/02/150226122433.htm>.
The JAMA Network Journals. (2015, February 26). Blood samples as surrogates for tumor biopsies in patients with lung cancer. ScienceDaily. Retrieved May 23, 2017 from www.sciencedaily.com/releases/2015/02/150226122433.htm
The JAMA Network Journals. "Blood samples as surrogates for tumor biopsies in patients with lung cancer." ScienceDaily. www.sciencedaily.com/releases/2015/02/150226122433.htm (accessed May 23, 2017).

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