The first liquid biopsy test approved. Is it a new era of mutation testing for non-small cell lung cancer?

Dorota Kwapisz, Dorota Kwapisz

Abstract

Specific mutations in epidermal growth factor receptor (EGFR) gene are predictive for response to the EGFR tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer patients (NSCLC). According to international guidelines, the molecular testing in patients with advanced NSCLC of a non-squamous subtype is recommended. However, obtain a tissue sample could be challenging. Liquid biopsy allows to determine patients suitable for EGFR-targeted therapy by analysis of circulating-free tumor DNA (cfDNA) in peripheral blood samples and might replace tissue biopsy. It allows to acquire a material in convenient minimally invasive manner, is easily repeatable, could be used for molecular identification and molecular changes monitoring. Many studies show a high concordance rate between tissue and plasma samples testing. When U.S. Food and Drug Administration (FDA) approved the first liquid biopsy test, analysis of driver gene mutation from cfDNA becomes a reality in clinical practice for patients with NSCLC.

Keywords: Liquid biopsy; circulating-free tumor DNA; epidermal growth factor receptor; non-small cell lung cancer.

Conflict of interest statement

Conflicts of Interest: The author has no conflicts of interest to declare.

References

    1. Siegel R, Naishadham D, Jemal A. Cancer statistics 2013. CA Cancer J Clin 2013;63:11-30. 10.3322/caac.21166
    1. Reck M, Popat S, Reinmuth N, et al. Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25:iii27-iii39. 10.1093/annonc/mdu199
    1. Lindeman NI, Cagle PT, Beasle MB, et al. Molecular Testing Guideline for Selection of Lung Cancer Patients for EGFR and ALK Tyrosine Kinase Inhibitors: Guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology. J Thorac Oncol 2013;8:823-59. 10.1097/JTO.0b013e318290868f
    1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011;61:69-90. 10.3322/caac.20107
    1. Rosell R, Moran T, Queralt C, et al. Screening for epidermal growth factor receptor mutations in lung cancer. N Engl J Med 2009;361:958-67. 10.1056/NEJMoa0904554
    1. Shigematsu H, Lin L, Takahashi T, et al. Clinical and biological features associated with epidermal growth factor receptor gene mutations in lung cancers. J Natl Cancer Inst 2005;97:339-46. 10.1093/jnci/dji055
    1. Wu YL, Zhong WZ, Li LY, et al. Epidermal growth factor receptor mutations and their correlation with gefitinib therapy in patients with non-small cell lung cancer: a meta-analysis based on updated individual patient data from the six medical centers in mainland China. J Thorac Oncol 2007;2:430-9. 10.1097/01.JTO.0000268677.87496.4c
    1. Wu YL, Zhou C, Liam CK, et al. First-line erlotinib versus gemcitabine/cisplatin in patients with advanced EGFR mutation-positive non-small-cell lung cancer: analyses from the phase III, randomized, open-label, ENSURE study. Ann Oncol 2015;26:1883-9. 10.1093/annonc/mdv270
    1. Rosell R, Carcereny E, Gervais R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol 2012;13:239-46. 10.1016/S1470-2045(11)70393-X
    1. Costa C, Molina-Vila M, Drozdowskyj A, et al. The impact of EGFR T790M mutations and BIM mutant NSCLC treated with erlotinib or chemotherapy in the randomized phase III EURTAC trial. Clin Cancer Res 2014;20:2001-10. 10.1158/1078-0432.CCR-13-2233
    1. Zhou C, Wu YL, Chen G, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. Lancet Oncol 2011;12:735-42. 10.1016/S1470-2045(11)70184-X
    1. cobas EGFR Mutation Test v2. 2016. Available online:
    1. Spicer J, Tischer B, Peters M. EGFR mutation testing and oncologist treatment choice in advanced NSCLC: global trends and differences. Ann Oncol 2015;26:i57-i61. 10.1093/annonc/mdv128.04
    1. Reck M, Hagiwara K, Han B, et al. ctDNA determination of EGFR mutation status in European and Japanese patients with advanced NSCLC: The ASSESS study. J Thorac Oncol 2016;11:1682-9. 10.1016/j.jtho.2016.05.036
    1. Thress KS, Paweletz CP, Felip E, et al. Acquired EGFR C797S mutation mediates resistance to AZD9291 in non-small cell lung cancer harboring EGFR T790M. Nat Med 2015;21:560-2. 10.1038/nm.3854
    1. FDA approves new pill to treat certain patients with non-small cell lung cancer. 2015. Available on:
    1. Chabon JJ, Simmons AD, Lovejoy AF, et al. Circulating tumour DNA profiling reveals heterogeneity of EGFR inhibitor resistance mechanisms in lung cancer patients. Nature Communications 2016;7:11815. 10.1038/ncomms11815
    1. Piotrowska Z, Niederst MJ, Karlovich CA, et al. Heterogeneity Underlies the Emergence of EGFRT790 Wild-Type Clones Following Treatment of T790M-Positive Cancers with a Third-Generation EGFR Inhibitor. Cancer Discov 2015;5:713-22. 10.1158/-15-0399
    1. Reckamp KL, Melnikova VO, Karlovich C, et al. A highly sensitive and quantitative test platform for detection of NSCLC EGFR mutations in urine and plasma. J Thorac Oncol 2016;11:1690-700. 10.1016/j.jtho.2016.05.035
    1. He C, Liu M, Zhou C, et al. Detection of epidermal growth factor receptor mutations in plasma by mutant-enriched PCR assay for prediction of the response to gefitinib in patients with non-small-cell lung cancer. Int J Cancer 2009;125:2393-9. 10.1002/ijc.24653
    1. Yung TK, Chan KC, Mok TS, et al. Single-molecule detection of epidermal growth factor receptor mutations in plasma by microfluidics digital PCR in non-small cell lung cancer patients. Clin Cancer Res 2009;15:2076-84. 10.1158/1078-0432.CCR-08-2622
    1. Kuang Y, Rogers BY, Yeap L, et al. Noninvasive detection of EGFR T790M in gefitinib or erlotnib resistant on-small cell lung cancer. Clin Cancer Res 2009;15:2630-6. 10.1158/1078-0432.CCR-08-2592
    1. Taniguchi K, Uchida J, Nishino T, et al. Quantitative detection of EGFR mutations in circulating tumor DNA derived from lung adenocarcinomas. Clin Cancer Res 2011;17:7808-15. 10.1158/1078-0432.CCR-11-1712
    1. Brevet M, Johnson ML, Azzoli CG, et al. Detection of EGFR mutations in plasma DNA from lung cancer patients by mass spectrometry genotyping is predictive of tumor EGFR status and response to EGFR inhibitors. Lung Cancer 2011;73:96-102. 10.1016/j.lungcan.2010.10.014
    1. Yam I, Lam DC, Chan K, et al. EGFR array: uses in the detection of plasma EGFR mutations in non-small cell lung cancer patients. J Thorac Oncol. 2012;7:1131-40. 10.1097/JTO.0b013e3182558198
    1. Nakamura T, Sueoka-Aragane N, Iwanaga K, et al. Application of a highly sensitive detection system for epidermal growth factor receptor mutations in plasma DNA. J Thorac Oncol 2012;7:1369-81. 10.1097/JTO.0b013e31825f2821
    1. Liu X, Lu Y, Zhu G, et al. The diagnostic accuracy of pleural effusion and plasma samples versus tumour tissue for detection of EGFR mutation in patients with advanced non-small cell lung cancer: comparison of methodologies. J Clin Pathol 2013;66:1065-9. 10.1136/jclinpath-2013-201728
    1. Lv C, Ma Y, Feng Q, et al. A pilot study: sequential gemcitabine/cisplatin and icotinib as induction therapy for stage IIB to IIIA non-small-cell lung adenocarcinoma. World J Surg Oncol 2013;11:96. 10.1186/1477-7819-11-96
    1. Zhang H, Liu D, Li S, et al. Comparison of EGFR signaling pathway somatic DNA mutations derived from peripheral blood and corresponding tumor tissue of patients with advanced non-small-cell lung cancer using liquidchip technology. J Mol Diagn 2013;15:819-26. 10.1016/j.jmoldx.2013.06.006
    1. Zhao X, Han RB, Zhao J, et al. Comparison of epidermal growth factor receptor mutation statuses in tissue and plasma in stage I-IV non-small cell lung cancer patients. Respiration 2013;85:119-25. 10.1159/000338790
    1. Kim HR, Lee SY, Hyun DS., et al. Detection of EGFR mutations in circulating free DNA by PNA-mediated PCR clamping. J Exp Clin Cancer Res 2013;32:50. 10.1186/1756-9966-32-50
    1. Li X, Ren R, Ren S, et al. Peripheral blood for epidermal growth factor receptor mutation detection in non-small cell lung cancer patients. Transl Oncol 2014;7:341-8. 10.1016/j.tranon.2014.04.006
    1. Douillard JY, Ostoros G, Cobo M, et al. Gefitinib treatment in EGFR mutated Caucasian of EGFR status. J Thorac Oncol 2014;9:1345-53. 10.1097/JTO.0000000000000263
    1. Weber B, Meldgaard P, Hager H, et al. Detection of EGFR mutations in plasma and biopsies from non-small cell lung cancer patients by allele-specific PCR assays. BMC Cancer 2014;14:294. 10.1186/1471-2407-14-294
    1. Duan H, Lu J, Lu T, et al. Comparison of EGFR mutation status between plasma and tumor tissue in non-small cell lung cancer using the Scorpion ARMS method and the possible prognostic significance of plasma EGFR mutation status. Int J Clin Exp Pathol 2015;8:13136-45.
    1. Jiang T, Shengxiang R, Zhou C. Role of circulating-tumor DNA analysis in non-small cell lung cancer. Lung Cancer 2015;90:128-34. 10.1016/j.lungcan.2015.09.013
    1. Buder A, Tomuta C, Filipits M. The potential of liquid biopsies. Curr Opin Oncol 2016;28:130-4. 10.1097/CCO.0000000000000267
    1. Thress KS, Brant R, Carr TH, et al. EGFR mutation detection in ctDNA from NSCLC patient plasma: a cross-platform comparison of leading technologies to suport the clinical development of AZD9291. Lung Cancer 2015;90:509-15. 10.1016/j.lungcan.2015.10.004
    1. Sundaresan TK, Sequist LV, Heymach JV, et al. Detection of T790M, the Acquired Resistance EGFR Mutation, by Tumor Biopsy versus Noninvasive Blood-Based Analyses. Clin Cancer Res 2016;22:1103-10. 10.1158/1078-0432.CCR-15-1031
    1. Uchida J, Imamura F, Kukita Y, et al. Dynamics of circulating tumor DNA represented by the activating and resistant mutations in epidermal growth factor receptor tyrosine kinase inhibitor treatment. Cancer Sci 2016;107:353-8. 10.1111/cas.12860
    1. cobas® EGFR Mutation Test–P120019. Available online:
    1. cobas® EGFR Mutation Test v2 - P150047. Available on:
    1. Kwapisz D. ‘Signalling pathways in cancer’ — a report from the European Society for Medical Oncology symposium. Oncol Clin Pract 2016;12:63-6.
    1. cobas® EGFR Mutation Test v2. PMA P120019/S007: FDA Summary of Safety and Effectiveness Data. Available on:
    1. Clinical Trials. Available on: .
    1. Janku F, Huang HJ, Claes B, et al. BRAF Mutation Testing in Cell-Free DNA from the Plasma of Patients with Advanced Cancers Using a Rapid, Automated Molecular Diagnostics System. Mol Cancer Ther 2016;15:1397-404. 10.1158/1535-7163.MCT-15-0712
    1. Illumina Forms New Company to Enable Early Cancer Detection via Blood-Based Screening. 2016. Available on:

Source: PubMed

3
Suscribir