Monitoring Tumor Burden in Response to FOLFIRINOX Chemotherapy Via Profiling Circulating Cell-Free DNA in Pancreatic Cancer

Molecular Cancer Therapeutics - Tập 18 Số 1 - Trang 196-203 - 2019
Tao Wei1,2, Qi Zhang1,2, Xiang Li1,2, Wei Su1,2, Guogang Li1,2, Tao Ma1,2, Shunliang Gao1,2, Jianying Lou1,2, Risheng Que1,2, Lei Zheng3, Xueli Bai1,2, Qi Zhang1,2
11Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
22Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.
33Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Tóm tắt

Abstract We aimed to explore the application of circulating cell-free DNA (cfDNA) profiling in monitoring tumor burden in patients with pancreatic ductal adenocarcinoma (PDAC). Thirty-eight patients with advanced PDAC receiving first-line FOLFIRINOX chemotherapy were prospectively enrolled. Next-generation sequencing for a panel of 560 genes covering a wide range of cancer-related loci was performed to profile cfDNA. In total, 25 patients (65.8%) had at least one common driver gene alterations (KRAS, TP53, SMAD4, CDKN2A) detected within cfDNA. In contrast, no above tumor-related recurrent mutations were found in plasma from 13 healthy individuals. Concordant alterations in plasma cfDNA and tumor tissue DNA was confirmed in two of three patients with available tissues. Further analysis showed that mutant allele fraction (MAF) for altered loci in cfDNA correlated with tumor stage, metastatic burden, and overall survival. Serial blood samples were collected from 17 patients after chemotherapy. We found that allele fraction for specific altered loci declined in chemotherapy-responding subjects. For cases who were resistant to this therapeutic regimen, increased ctDNA MAF was observed at the time of disease progression. Meanwhile, the dynamics of total cfDNA concentration correlated with tumor burden following chemotherapy. Collectively, we provide evidence that pretreatment ctDNA level correlates with tumor burden in PDAC, and serial cfDNA analysis is a robust tool for monitoring cancer response to chemotherapy.

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Tài liệu tham khảo

Wood, 2007, The genomic landscapes of human breast and colorectal cancers, Science (New York, NY), 318, 1108, 10.1126/science.1145720

Waddell, 2015, Whole genomes redefine the mutational landscape of pancreatic cancer, Nature, 518, 495, 10.1038/nature14169

Pectasides, 2018, Genomic heterogeneity as a barrier to precision medicine in gastroesophageal adenocarcinoma, Cancer Discov, 8, 37, 10.1158/2159-8290.CD-17-0395

Wan, 2017, Liquid biopsies come of age: towards implementation of circulating tumour DNA, Nat Rev Cancer, 17, 223, 10.1038/nrc.2017.7

Abbosh, 2017, Phylogenetic ctDNA analysis depicts early-stage lung cancer evolution, Nature, 545, 446, 10.1038/nature22364

Tie, 2015, Circulating tumor DNA as an early marker of therapeutic response in patients with metastatic colorectal cancer, Ann Oncol, 26, 1715, 10.1093/annonc/mdv177

Fribbens, 2018, Tracking evolution of aromatase inhibitor resistance with circulating tumour DNA analysis in metastatic breast cancer, Ann Oncol, 29, 145, 10.1093/annonc/mdx483

Murtaza, 2015, Multifocal clonal evolution characterized using circulating tumour DNA in a case of metastatic breast cancer, Nat Commun, 6, 8760, 10.1038/ncomms9760

Kimura, 2006, Detection of epidermal growth factor receptor mutations in serum as a predictor of the response to gefitinib in patients with non-small-cell lung cancer, Clin Cancer Res, 12, 3915, 10.1158/1078-0432.CCR-05-2324

Hadano, 2016, Prognostic value of circulating tumour DNA in patients undergoing curative resection for pancreatic cancer, Br J Cancer, 115, 59, 10.1038/bjc.2016.175

Murtaza, 2013, Non-invasive analysis of acquired resistance to cancer therapy by sequencing of plasma DNA, Nature, 497, 108, 10.1038/nature12065

Fu, 2016, Improving the performance of somatic mutation identification by recovering circulating tumor DNA mutations, Cancer Res, 76, 5954, 10.1158/0008-5472.CAN-15-3457

Newman, 2014, An ultrasensitive method for quantitating circulating tumor DNA with broad patient coverage, 548

Li, 2017, Modified-FOLFIRINOX in metastatic pancreatic cancer: a prospective study in Chinese population, Cancer Lett, 406, 22, 10.1016/j.canlet.2017.07.012

Eisenhauer, 2009, New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1), Eur J Cancer, 45, 228, 10.1016/j.ejca.2008.10.026

Schwaederle, 2016, Use of liquid biopsies in clinical oncology: pilot experience in 168 patients, Clin Cancer Res, 22, 5497, 10.1158/1078-0432.CCR-16-0318

Chung, 2017, Hybrid capture-based genomic profiling of circulating tumor DNA from patients with estrogen receptor-positive metastatic breast cancer, Ann Oncol, 28, 2866, 10.1093/annonc/mdx490

Takai, 2015, Clinical utility of circulating tumor DNA for molecular assessment in pancreatic cancer, Sci Rep, 5, 18425, 10.1038/srep18425

Pietrasz, 2017, Plasma circulating tumor DNA in pancreatic cancer patients is a prognostic marker, Clin Cancer Res, 23, 116, 10.1158/1078-0432.CCR-16-0806

Zill, 2015, Cell-Free DNA next-generation sequencing in pancreatobiliary carcinomas, Cancer Discov, 5, 1040, 10.1158/2159-8290.CD-15-0274

Cohen, 2017, Combined circulating tumor DNA and protein biomarker-based liquid biopsy for the earlier detection of pancreatic cancers, PNAS, 114, 10202, 10.1073/pnas.1704961114

Barault, 2018, Discovery of methylated circulating DNA biomarkers for comprehensive non-invasive monitoring of treatment response in metastatic colorectal cancer, Gut, 67, 1995, 10.1136/gutjnl-2016-313372

Cheng, 2017, Analysis of ctDNA to predict prognosis and monitor treatment responses in metastatic pancreatic cancer patients, Int J Cancer, 140, 2344, 10.1002/ijc.30650

Conroy, 2011, FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer, N Engl J Med, 364, 1817, 10.1056/NEJMoa1011923

Luo, 2017, Potential biomarkers in lewis negative patients with pancreatic cancer, Ann Surg, 265, 800, 10.1097/SLA.0000000000001741

Diehl, 2008, Circulating mutant DNA to assess tumor dynamics, Nat Med, 14, 985, 10.1038/nm.1789

Bailey, 2016, Genomic analyses identify molecular subtypes of pancreatic cancer, Nature, 531, 47, 10.1038/nature16965

2017, Integrated genomic characterization of pancreatic ductal adenocarcinoma, Cancer Cell, 32, 185, 10.1016/j.ccell.2017.07.007

Bejar, 2016, Splicing factor mutations in cancer, Adv Exp Med Biol, 907, 215, 10.1007/978-3-319-29073-7_9

Goodall, 2017, Circulating Cell-Free DNA to guide prostate cancer treatment with PARP inhibition, Cancer Discov, 7, 1006, 10.1158/2159-8290.CD-17-0261

Valpione, 2017, Plasma total cell-free DNA (cfDNA) is a surrogate biomarker for tumour burden and a prognostic biomarker for survival in metastatic melanoma patients, Eur J Cancer, 88, 1, 10.1016/j.ejca.2017.10.029

Scherer, 2016, Distinct biological subtypes and patterns of genome evolution in lymphoma revealed by circulating tumor DNA, Sci Transl Med, 8, 364ra155, 10.1126/scitranslmed.aai8545

Quigley, 2017, Analysis of circulating cell-free DNA identifies multiclonal heterogeneity of BRCA2 reversion mutations associated with Resistance to PARP Inhibitors, Cancer Discov, 7, 999, 10.1158/2159-8290.CD-17-0146

Goyal, 2017, Polyclonal secondary FGFR2 mutations drive acquired resistance to FGFR inhibition in patients with FGFR2 fusion-positive cholangiocarcinoma, Cancer Discov, 7, 252, 10.1158/2159-8290.CD-16-1000