Association of EGFR L858R Mutation in Circulating Free DNA With Survival in the EURTAC Trial.
Por:
Karachaliou N, Mayo-de las Casas C, Queralt C, de Aguirre I, Melloni B, Cardenal F, Garcia-Gomez R, Massuti B, Sánchez JM, Porta R, Ponce-Aix S, Moran T, Carcereny E, Felip E, Bover I, Insa A, Reguart N, Isla D, Vergnenegre A, de Marinis F, Gervais R, Corre R, Paz-Ares L, Morales-Espinosa D, Viteri S, Drozdowskyj A, Jordana-Ariza N, Ramirez-Serrano JL, Molina-Vila MA and Rosell R
Publicada:
1 may 2015
Categoría:
Medicine (miscellaneous)
Resumen:
IMPORTANCE: The EURTAC trial demonstrated the greater efficacy of erlotinib compared with chemotherapy for the first-line treatment of European patients with advanced non-small-cell lung cancer (NSCLC) harboring oncogenic epidermal growth factor receptor (EGFR) mutations (exon 19 deletion or L858R mutation in exon 21) in tumor tissue. OBJECTIVE: To assess the feasibility of using circulating free DNA (cfDNA) from blood samples as a surrogate for tumor biopsy for determining EGFR mutation status and to correlate EGFR mutations in cfDNA with outcome. DESIGN, SETTING, AND PARTICIPANTS: This prespecified analysis was a secondary objective of the EURTAC trial using patients included in the EURTAC trial from 2007 to 2011 with available baseline serum or plasma samples. Patients had advanced NSCLC, oncogenic EGFR mutations in the tumor, and no prior chemotherapy for metastatic disease and were treated with erlotinib or chemotherapy. EGFR mutations were examined in cfDNA isolated from 97 baseline blood samples by our novel peptide nucleic acid-mediated 5´ nuclease real-time polymerase chain reaction (TaqMan) assay. MAIN OUTCOMES AND MEASURES: Overall survival (OS), progression-free survival (PFS), and response to therapy were correlated with type of EGFR mutations in cfDNA. RESULTS: In samples from 76 of 97 (78%) patients with usable blood samples, EGFR mutations in cfDNA were detected. Median OS was shorter in patients with the L858R mutation in cfDNA than in those with the exon 19 deletion (13.7 [95% CI, 7.1-17.7] vs 30.0 [95% CI, 19.3-37.7] months; P < .001). Univariate analyses of patients with EGFR mutations in cfDNA identified the L858R mutation in tumor tissue or in cfDNA as a marker of shorter OS (hazard ratio [HR], 2.70 [95% CI, 1.60-4.56]; P < .001) and PFS (HR, 2.04 [95% CI, 1.20-3.48]; P = .008). For patients with the L858R mutation in tissue, median OS was 13.7 (95% CI, 7.1-17.7) months for patients with the L858R mutation in cfDNA and 27.7 (95% CI, 16.1-46.2) months for those in whom the mutation was not detected in cfDNA (HR, 2.22 [95% CI, 1.09-4.52]; P = .03). In the multivariate analysis of the 76 patients with EGFR mutations in cfDNA, only erlotinib treatment remained an independent predictor of longer PFS (HR, 0.41 [95% CI, 0.23-0.74]; P = .003). CONCLUSIONS AND RELEVANCE: The peptide nucleic acid-mediated 5´ nuclease real-time polymerase chain reaction (TaqMan) assay used in this study can be used to efficiently assess EGFR mutations in cfDNA. The L858R mutation in cfDNA may be a novel surrogate prognostic marker. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00446225.
Filiaciones:
Karachaliou N:
Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain
Mayo-de las Casas C:
Laboratory of Molecular Biology, Pangaea Biotech, Barcelona, Spain
Queralt C:
Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
de Aguirre I:
Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
Melloni B:
Service de Pathologie Respiratoire et d'Allergologie, Hôpital du Cluzeau, Limoges, France
Cardenal F:
Medical Oncology Service, Catalan Institute of Oncology, Hospital Duran i Reynals, L'Hospitalet, Spain
Garcia-Gomez R:
Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
:
Medical Oncology Service, Hospital General de Alicante, Alicante, Spain
Sánchez JM:
Medical Oncology Service, Hospital 12 de Octubre, Madrid, Spain
Porta R:
Medical Oncology Service, Catalan Institute of Oncology, Hospital Dr Josep Trueta, Girona, Spain
Ponce-Aix S:
Medical Oncology Service, Hospital La Paz, Madrid, Spain
Moran T:
Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
Carcereny E:
Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
Felip E:
Medical Oncology Service, Hospital Vall d'Hebron, Barcelona, Spain
Bover I:
Medical Oncology Service, Hospital Son Llatzer, Palma de Mallorca, Spain
Insa A:
Medical Oncology Service, Hospital Clínic de Valencia, Valencia, Spain
Reguart N:
Medical Oncology Service, Hospital Clínic, Barcelona, Spain
Isla D:
Medical Oncology Service, Hospital Lozano Blesa, Zaragoza, Spain
Vergnenegre A:
Service de Pathologie Respiratoire et d'Allergologie, Hôpital du Cluzeau, Limoges, France
de Marinis F:
Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy17European Institute of Oncology, Milan, Italy
Gervais R:
Medical Oncology Service, Centre François Baclesse, Caen, France
Corre R:
CHU Rennes Hopital Ponchaillou, Rennes, France
Paz-Ares L:
Medical Oncology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Morales-Espinosa D:
Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain
Viteri S:
Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain
Drozdowskyj A:
Pivotal, Madrid, Spain
Jordana-Ariza N:
Laboratory of Molecular Biology, Pangaea Biotech, Barcelona, Spain
Ramirez-Serrano JL:
Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
Molina-Vila MA:
Laboratory of Molecular Biology, Pangaea Biotech, Barcelona, Spain
Rosell R:
Instituto Oncológico Dr Rosell, Quiron-Dexeus University Hospital, Barcelona, Spain3Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain22MORe Foundation, Barcelona, Spain23Cancer Therapeutic Innovation Group, New York, New York
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