Clinical Implications of Plasma-Based Genotyping With the Delivery of Personalized Therapy in Metastatic Non-Small Cell Lung Cancer
Charu Aggarwal, Jeffrey C Thompson, Taylor A Black, Sharyn I Katz, Ryan Fan, Stephanie S Yee, Austin L Chien, Tracey L Evans, Joshua M Bauml, Evan W Alley, Christine A Ciunci, Abigail T Berman, Roger B Cohen, David B Lieberman, Krishna S Majmundar, Samantha L Savitch, Jennifer J D Morrissette, Wei-Ting Hwang, Kojo S J Elenitoba-Johnson, Corey J Langer, Erica L Carpenter, Charu Aggarwal, Jeffrey C Thompson, Taylor A Black, Sharyn I Katz, Ryan Fan, Stephanie S Yee, Austin L Chien, Tracey L Evans, Joshua M Bauml, Evan W Alley, Christine A Ciunci, Abigail T Berman, Roger B Cohen, David B Lieberman, Krishna S Majmundar, Samantha L Savitch, Jennifer J D Morrissette, Wei-Ting Hwang, Kojo S J Elenitoba-Johnson, Corey J Langer, Erica L Carpenter
Abstract
Importance: The clinical implications of adding plasma-based circulating tumor DNA next-generation sequencing (NGS) to tissue NGS for targetable mutation detection in non-small cell lung cancer (NSCLC) have not been formally assessed.
Objective: To determine whether plasma NGS testing was associated with improved mutation detection and enhanced delivery of personalized therapy in a real-world clinical setting.
Design, setting, and participants: This prospective cohort study enrolled 323 patients with metastatic NSCLC who had plasma testing ordered as part of routine clinical management. Plasma NGS was performed using a 73-gene commercial platform. Patients were enrolled at the Hospital of the University of Pennsylvania from April 1, 2016, through January 2, 2018. The database was locked for follow-up and analyses on January 2, 2018, with a median follow-up of 7 months (range, 1-21 months).
Main outcomes and measures: The number of patients with targetable alterations detected with plasma and tissue NGS; the association between the allele fractions (AFs) of mutations detected in tissue and plasma; and the association of response rate with the plasma AF of the targeted mutations.
Results: Among the 323 patients with NSCLC (60.1% female; median age, 65 years [range, 33-93 years]), therapeutically targetable mutations were detected in EGFR, ALK, MET, BRCA1, ROS1, RET, ERBB2, or BRAF for 113 (35.0%) overall. Ninety-four patients (29.1%) had plasma testing only at the discretion of the treating physician or patient preference. Among the 94 patients with plasma testing alone, 31 (33.0%) had a therapeutically targetable mutation detected, thus obviating the need for an invasive biopsy. Among the remaining 229 patients who had concurrent plasma and tissue NGS or were unable to have tissue NGS, a therapeutically targetable mutation was detected in tissue alone for 47 patients (20.5%), whereas the addition of plasma testing increased this number to 82 (35.8%). Thirty-six of 42 patients (85.7%) who received a targeted therapy based on the plasma result achieved a complete or a partial response or stable disease. The plasma-based targeted mutation AF had no correlation with depth of Response Evaluation Criteria in Solid Tumors response (r = -0.121; P = .45).
Conclusions and relevance: Integration of plasma NGS testing into the routine management of stage IV NSCLC demonstrates a marked increase of the detection of therapeutically targetable mutations and improved delivery of molecularly guided therapy.
Conflict of interest statement
Conflict of Interest Disclosures: Dr Aggarwal reported consulting or advisory roles with Genentech, Inc, Bristol-Myers Squibb, Eli Lilly and Company, and Celgene Corporation and institutional research funding from Genetech/Roche, Incyte Corporation, MacroGenics, Inc, and Merck Sharp & Dohme. Dr Thompson reported a consulting or advisory role with OncoCyte Corporation. Dr Katz reported research funding from Novartis International AG. Dr Evans reported consulting or advisory roles with Genentech, Inc, and Celgene Corporation; honoraria from Genentech, Inc, and Celgene Corporation; a role on the speakers bureau for Genentech, Inc; and travel, accommodations, or expenses from Genentech, Inc, and Celgene Corporation. Dr Bauml reported consulting or advisory roles with Clovis Oncology, Bristol-Myers Squibb, Merck Sharp & Dohme, AstraZeneca, Genentech, Inc, Celgene Corporation, Boehringer Ingelheim, and Guardant Health and institutional research funding from Merck Sharp & Dohme, Carevive Systems, Inc, Novartis International AG, Incyte Corporation, Bayer, and Janssen Pharmaceuticals. Dr Berman reported research funding from LingaMed, LLC. Dr Cohen reported honoraria from Bristol-Myers Squibb; a consulting or advisory role with Heat Biologics, Inc, Takeda Pharmaceutical Company Ltd, Zymeworks, Inc, and Pfizer, Inc; institutional research funding from Heat Biologics, Inc, MacroGenetics, Inc, Merck Sharp & Dohme, Takeda Pharmaceutical Company Ltd, Cleave Biosciences, and Celldex Therapeutics, Inc; and travel, accommodations, or expenses from Heat Biologics, Inc, Takeda Pharmaceutical Company Ltd, Zymeworks, Inc, Bristol-Meyers Squibb, and Pfizer, Inc. Dr Morrissette reported a consulting or advisory role with Novartis International AG; participation on the speakers bureau for Cambridge Healthtech Institute; and travel, accommodations, or expenses from Cambridge Healthtech Institute. Dr Elenitoba-Johnson reported stock or other ownership of Genomenon, Inc. Dr Langer reported honoraria from Bristol-Myers Squibb, Genentech/Roche, and Lilly/ImClone; a consulting or advisory role with Genentech/Roche, Lilly/ImClone, Merck Sharp & Dohme, Abbott Biotherapeutics, Inc, Bayer/Onyx, Clariant, Clovis Oncology, Celgene Corporation, Cancer Support Community, Bristol-Myers Squibb, Ariad Pharmaceuticals, Inc, Takeda Pharmaceutical Company Ltd, and AstraZeneca; institutional research funding from Merck Sharp & Dohme, Advantagene, Inc, Clovis Oncology, Celgene Corporation, Inovio Pharmaceuticals, Ariad Pharmaceuticals, Inc, GlaxoSmithKline, Genentech/Roche, and Stemcentrx, Inc; and other relationships with Eli Lilly and Company, Amgen, Inc, Peregrine Pharmaceuticals, Inc, and Synta Pharmaceuticals, Inc. Dr Carpenter reported honoraria from Imedex; research funding from Janssen Pharmaceuticals and Merck Sharp & Dohme; a patent, royalties, or intellectual property interest from Children’s Hospital of Philadelphia; and travel, accommodations, or expenses from VPS Hospitals in United Arab Emirates. No other disclosures were reported.
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Source: PubMed