A R Thierry1,2,3,4, S El Messaoudi1,2,3,4, C Mollevi1,2,3,4,5, J L Raoul6, R Guimbaud7, D Pezet8, P Artru9, E Assenat10, C Borg11, M Mathonnet12, C De La Fouchardière13, O Bouché14, C Gavoille15, C Fiess16, B Auzemery1,2,3,4, R Meddeb1,2,3,4, E Lopez-Crapez1,2,3,4, C Sanchez1,2,3,4, B Pastor1,2,3,4, M Ychou1,2,3,4,16. 1. IRCM, Institute of Research in Oncology of Montpellier, Montpellier. 2. INSERM, U1194, Montpellier. 3. Department of Oncology, Montpellier University, Montpellier. 4. Regional Institute of Cancer of Montpellier, Montpellier. 5. Biometry Unit, Regional Institute of Cancer of Montpellier, Montpellier. 6. Department of Medical Oncology, Paoli Calmettes Institute, Marseille. 7. Department of Oncology, University Hospital Center of Toulouse - Hospital Rangueil-Purpan, Toulouse. 8. Digestive Oncology Unit, Department of Digestive Surgery, University Hospital Center of Clermont-Ferrand, UMR Inserm/Auvergne University U1071, Clermont-Ferrand. 9. Jean-Mermoz Private Hospital, Lyon. 10. CHRU Montpellier, St. Eloi Hospital, Montpellier. 11. CHRU Jean MINJOZ, Besançon. 12. Digestive Surgery Department, Clinical Investigation Centre, University Hospital Center of Limoges, INSERM 0801, Limoges. 13. Cancer Centre Léon Bérard, Lyon. 14. CHU Robert Debré, Reims. 15. Alexis Vautrin Oncology Institute of Lorraine, Nancy. 16. Digestive Oncology Department, Regional Institute of Cancer of Montpellier, Montpellier, France.
Abstract
BACKGROUND: While tumor-tissue remains the 'gold standard' for genetic analysis in cancer patients, it is challenged with the advent of circulating cell-free tumor DNA (ctDNA) analysis from blood samples. Here, we broaden our previous study on the clinical validation of plasma DNA in metastatic colorectal cancer patients, by evaluating its clinical utility under standard management care. PATIENTS AND METHODS: Concordance and data turnaround-time of ctDNA when compared with tumor-tissue analysis were studied in a real-time blinded prospective multicenter clinical study (n = 140 metastatic colorectal patients). Results are presented according to STARD criteria and were discussed in regard with clinical outcomes of patients. RESULTS: Much more mutations were found by ctDNA analysis: 59%, 11.8% and 14.4% of the patients were found KRAS, NRAS and BRAF mutant by ctDNA analysis instead of 44%, 8.8% and 7.2% by tumor-tissue analysis. Median tumor-tissue data turnaround-time was 16 days while 2 days for ctDNA analysis. Discordant samples analysis revealed that use of biopsy, long delay between tumor-tissue and blood collection and resection of the tumor at time of blood draw, tumor site, or type of tissue analyzed seem to affect concordance. Altogether, the clinical data with respect to the anti-epidermal growth factor receptor response (RAS status) and the prognosis (BRAF status) of those discordant patients do not appear contradictory to the mutational status as determined by plasma analysis. Lastly, we present the first distribution profile of the RAS and BRAF hotspot mutations as determined by ctDNA analysis (n = 119), revealing a high proportion of patients with multiple mutations (45% of the population and up to 5 mutations) and only 24% of WT scored patients for both genes. Mutation profile as determined from ctDNA analysis with using various detection thresholds highlights the importance of the test sensitivity. CONCLUSION: Our study showed that ctDNA could replace tumor-tissue analysis, and also clinical utility of ctDNA analysis by considerably reducing data turnaround time.
BACKGROUND: While tumor-tissue remains the 'gold standard' for genetic analysis in cancer patients, it is challenged with the advent of circulating cell-free tumor DNA (ctDNA) analysis from blood samples. Here, we broaden our previous study on the clinical validation of plasma DNA in metastatic colorectal cancer patients, by evaluating its clinical utility under standard management care. PATIENTS AND METHODS: Concordance and data turnaround-time of ctDNA when compared with tumor-tissue analysis were studied in a real-time blinded prospective multicenter clinical study (n = 140 metastatic colorectal patients). Results are presented according to STARD criteria and were discussed in regard with clinical outcomes of patients. RESULTS: Much more mutations were found by ctDNA analysis: 59%, 11.8% and 14.4% of the patients were found KRAS, NRAS and BRAF mutant by ctDNA analysis instead of 44%, 8.8% and 7.2% by tumor-tissue analysis. Median tumor-tissue data turnaround-time was 16 days while 2 days for ctDNA analysis. Discordant samples analysis revealed that use of biopsy, long delay between tumor-tissue and blood collection and resection of the tumor at time of blood draw, tumor site, or type of tissue analyzed seem to affect concordance. Altogether, the clinical data with respect to the anti-epidermal growth factor receptor response (RAS status) and the prognosis (BRAF status) of those discordant patients do not appear contradictory to the mutational status as determined by plasma analysis. Lastly, we present the first distribution profile of the RAS and BRAF hotspot mutations as determined by ctDNA analysis (n = 119), revealing a high proportion of patients with multiple mutations (45% of the population and up to 5 mutations) and only 24% of WT scored patients for both genes. Mutation profile as determined from ctDNA analysis with using various detection thresholds highlights the importance of the test sensitivity. CONCLUSION: Our study showed that ctDNA could replace tumor-tissue analysis, and also clinical utility of ctDNA analysis by considerably reducing data turnaround time.
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