Thay đổi nồng độ DNA plasma mang đột biến EGFR trong những giờ đầu của liệu pháp nhắm mục tiêu cho phép dự đoán phản ứng khối u ở bệnh nhân ung thư phổi do EGFR điều khiển

International Journal of Clinical Oncology - Tập 27 Số 5 - Trang 850-862 - 2022
Moiseyenko, Fedor V.1,2, Kuligina, Ekaterina S.2,3, Zhabina, Albina S.1, Belukhin, Sergey A.1, Laidus, Tatiana A.2,3, Martianov, Aleksandr S.2,3, Zagorodnev, Kirill A.3, Sokolova, Tatyana N.2, Chuinyshena, Svetlana A.2,3, Kholmatov, Maxim M.2, Artemieva, Elizaveta V.1, Stepanova, Ekaterina O.1, Shuginova, Tatiana N.1, Volkov, Nikita M.1, Yanus, Grigoriy A.2,3, Imyanitov, Evgeny N.2,3,4
1City Cancer Center, Saint Petersburg, Russia
2Laboratory of Molecular Oncology, Department of Tumor Biology, N.N. Petrov Institute of Oncology, St.-Petersburg, Russia
3St. Petersburg Pediatric Medical University, Saint Petersburg, Russia
4I.I. Mechnikov North-Western Medical University, Saint Petersburg, Russia

Tóm tắt

Nghiên cứu này nhằm phân tích sự thay đổi trong nồng độ plasma của DNA khối u chi circulat mang đột biến EGFR (ctDNA) xảy ra ngay sau khi bắt đầu điều trị bằng các chất ức chế kinase tyrosine EGFR (TKIs). Mẫu máu plasma được thu thập theo chuỗi từ 30 bệnh nhân mắc ung thư phổi không tế bào nhỏ do EGFR điều khiển trước khi uống viên thuốc đầu tiên và tại các thời điểm 0.5, 1, 2, 3, 6, 12, 24, 36 và 48 giờ sau khi bắt đầu điều trị. Nội dung các allele EGFR (deletion exon 19 hoặc L858R) trong ctDNA đã được đo bằng ddPCR. ctDNA được phát hiện tại cơ sở ở 25/30 (83%) bệnh nhân. Mười hai (50%) trong số 24 bệnh nhân thông tin cho thấy sự giảm > 25% nồng độ ctDNA tại thời điểm 48 giờ; tất cả những bệnh nhân này đều thể hiện kiểm soát bệnh sau 4 và 8–12 tuần điều trị. 12 cá thể còn lại cho thấy nồng độ ctDNA mang đột biến EGFR ổn định (n = 5) hoặc sự gia tăng nồng độ ctDNA (n = 7). 10 trong số 12 bệnh nhân với mức ctDNA tăng hoặc ổn định đạt được phản ứng khách quan sau 4 tuần, nhưng chỉ có 5 trong số 10 bệnh nhân có thể đánh giá vẫn thể hiện kiểm soát bệnh sau 8–12 tuần (p = 0.032, so với nhóm có giảm ctDNA). Sự suy giảm số lượng bản sao đột biến EGFR trong tuần hoàn tại 48 giờ cũng có mối tương quan với thời gian sống không bị tiến triển lâu hơn (14.7 tháng so với 8.5 tháng, p = 0.013). So sánh nồng độ ctDNA mang đột biến EGFR tại cơ sở và tại thời điểm 48 giờ sau khi bắt đầu điều trị có khả năng dự đoán thời gian hiệu quả của TKIs.

Từ khóa


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