The detection and significance of EGFR and BRAF in cell-free DNA of peripheral blood in NSCLC.

Yang Yang,Lifeng Wang,Jie Shen,Lixia Yu,Rutian Li,Baorui Liu,Hang Zhang,Xiaoyan Shen

doi:10.18632/oncotarget.17937

Abstract

ObjectiveAlthough driver mutation status is crucial to targeted therapy decision-making in non-small cell lung cancer (NSCLC), due to unavailable or inadequate biopsies, there are still many patients with unknown mutation status. A promising way to solve this problem is liquid biopsy, such as cell-free DNA (cfDNA) in peripheral blood. Additionally, due to the little amount of cfDNA, detecting methods with high sensitivity, specificity and economy are required in clinical practice. Here, we explored the feasibility of Competitive Allele-Specific TaqMan® PCR (CastPCR) detecting driver mutations in cfDNA from plasma in lung adenocarcinoma patients.ResultsSensitivity, specificity, concordance, PPV and NPV of CastPCR detecting EGFR mutations in cfDNA was 56.4% (31/55), 94.2% (49/52), 74.8% (80/107), 91.2% (31/34) and 67.1% (49/73), respectively. Notably, specificity and PPV for p.T790M both reached 100.0%. For BRAF detection, it was 28.6% (2/7), 93.0% (93/100), 88.8% (95/107), 22.2% (2/9) and 94.9% (93/98), respectively.Materials and MethodsPlasma specimens of 107 lung adenocarcinoma patients and their matched tumor formalin fixed paraffin embedded (FFPE) samples were analyzed. CastPCR was used to detect EGFR (c.2235_2249del, c.2236_2250del, c.2369C>T p.T790M, c.2573T>G p.L858R) and BRAF (c.1406G>C p.G469A, c.1799T>A p.V600E, c.1781A>G p.D594G) mutations. Mutation results of tumor tissue was set as gold standard, and the sensitivity, specificity, concordance, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each mutation.ConclusionsFor patients whose tumor tissue is unavailable or inadequate, EGFR mutation detection in cfDNA with CastPCR could be first choice. Mutation positive results may provide reference for further clinical medication. While negative results indicate that detection in tissue should be considered as the following step. In this way, tumor tissue could be economized to the maximum extent and the risk of repeated percutaneous transthoracic lung biopsy could also be lowered to the maximum extent. For BRAF detection in cfDNA, CastPCR is a specific method while the sensitivity needs further exploration.

Highlights

Thanks to EGFR tyrosine kinase inhibitors (EGFRTKIs), the treatment pattern of metastatic non-small cell lung cancer (NSCLC) has been revolutionized
For BRAF detection in cell-free DNA (cfDNA), Competitive Allele-Specific TaqMan® PCR (CastPCR) is a specific method while the sensitivity needs further exploration
According to Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA), to predict therapeutic response of Iressa®, the use of circulating tumor DNA obtained from a blood sample has been allowed to assess EGFR mutation status in patients where a tumor sample is not an option[13].cfDNA was shown to be useful in dynamic monitoring of acquired resistance and prediction of relapse in various cancers, including NSCLC [26,27,28,29,30]

Summary

Introduction

Thanks to EGFR tyrosine kinase inhibitors (EGFRTKIs), the treatment pattern of metastatic NSCLC has been revolutionized. In clinical practice, detection of driver mutations in tumor tissue is often not enough. Repeated biopsy is not practically feasible in clinical work for its invasiveness and risk Liquid biopsy such as cfDNA from plasma [10,11,12] has come into the picture. According to Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) , to predict therapeutic response of Iressa® (gefitinib), the use of circulating tumor DNA obtained from a blood sample has been allowed to assess EGFR mutation status in patients where a tumor sample is not an option[13].cfDNA was shown to be useful in dynamic monitoring of acquired resistance and prediction of relapse in various cancers, including NSCLC [26,27,28,29,30]. We evaluated the use of CastPCR detecting EGFR mutations (c.2235_2249del, c.2236_2250del, p.T790M, and p.L858R) in cfDNA form plasma in adenocarcinoma patients

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Discussion

Conclusion