4.6 Article

Comprehensive Analysis of the Discordance of EGFR Mutation Status between Tumor Tissues and Matched Circulating Tumor DNA in Advanced Non-Small Cell Lung Cancer

Journal

JOURNAL OF THORACIC ONCOLOGY
Volume 12, Issue 9, Pages 1376-1387

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jtho.2017.05.011

Keywords

Epidermal growth factor receptor mutation; Non-small cell lung cancer; Circulating tumor DNA; Discordance of mutation; Heterogeneity

Funding

  1. National Natural Sciences Foundation Key Program [81630071, 81330062]
  2. National Key Research and Development Project Precision Medicine Special Research [2016YFC0902300]
  3. National High Technology Research and Development Program 863 [SS2015AA020403]

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Introduction: This study aimed to address the underlying reasons for and clinical significance of the discordant EGFR mutation (EGFRm) status between tumor tissue (TT) and circulating tumor DNA (ctDNA). Methods: Three groups of EGFR tyrosine kinase inhibitor (EGFR TKI)-treated patients whose EGFRm status was determined by the amplification refractory mutation system (ARMS) were included (group A, TT-positive/ctDNA-positive EGFRm status; group B, TT-negative/ctDNA-positive EGFRm status; and group C, TT-positive/ctDNA-negative EGFRm status). Patients with discordant EGFRm status were reevaluated by droplet digital polymerase chain reaction (ddPCR) and next-generation sequencing. Meanwhile, surgical tumor specimens were microdissected for EGFRm detection by ddPCR. Results: Of the 2463 patients with matched TT and ctDNA specimens, 1017 patients carried EGFRm in TT and/or ctDNA by the ARMS. Of these 1017 patients, 472 received EGFR TKIs, including 264, 28, and 180 in groups A, B, and C, respectively. The median progression-free survivals of those receiving EGFR TKIs across the three groups were similar (p = 0.062). Through ddPCR and next-generation sequencing of biopsy specimens (n = 22) and micro dissected surgical specimens (n = 5), 27 patients in group B were identified as harboring EGFRm. After reevaluation by ddPCR, 64 patients in group C tested positive for EGFRm in their ctDNA. ctDNA as a screen for EGFRm then tissues as supplement (ctDNA TT pattern) had similar detection efficiency and saved about 30% of TT compared with TT for initial EGFRm detection followed by ctDNA (TT -> ctDNA pattern). Conclusions: Intratumor heterogeneity and the relatively low sensitivity of the ARMS contributed to discordant EGFRm status between TT specimens and ctDNA. The ctDNA -> TT pattern might be a rational clinical procedure for EGFRm determination. (C) 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

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