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From validity to clinical utility: the influence of circulating tumor DNA on melanoma patient management in a real‐world setting

Melanoma currently lacks a reliable blood‐based biomarker of disease activity, although circulating tumor DNA (ctDNA) may fill this role. We investigated the clinical utility (i.e., impact on clinical outcomes and interpretation of radiographic data) of measuring ctDNA in patients with metastatic or...

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Autores principales: Rowe, Steven P., Luber, Brandon, Makell, Monique, Brothers, Patricia, Santmyer, JoAnn, Schollenberger, Megan D., Quinn, Hannah, Edelstein, Daniel L., Jones, Frederick S., Bleich, Karen B., Sharfman, William H., Lipson, Evan J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165998/
https://www.ncbi.nlm.nih.gov/pubmed/30113761
http://dx.doi.org/10.1002/1878-0261.12373
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author Rowe, Steven P.
Luber, Brandon
Makell, Monique
Brothers, Patricia
Santmyer, JoAnn
Schollenberger, Megan D.
Quinn, Hannah
Edelstein, Daniel L.
Jones, Frederick S.
Bleich, Karen B.
Sharfman, William H.
Lipson, Evan J.
author_facet Rowe, Steven P.
Luber, Brandon
Makell, Monique
Brothers, Patricia
Santmyer, JoAnn
Schollenberger, Megan D.
Quinn, Hannah
Edelstein, Daniel L.
Jones, Frederick S.
Bleich, Karen B.
Sharfman, William H.
Lipson, Evan J.
author_sort Rowe, Steven P.
collection PubMed
description Melanoma currently lacks a reliable blood‐based biomarker of disease activity, although circulating tumor DNA (ctDNA) may fill this role. We investigated the clinical utility (i.e., impact on clinical outcomes and interpretation of radiographic data) of measuring ctDNA in patients with metastatic or high‐risk resected melanoma. Patients were prospectively accrued into ≥ 1 of three cohorts, as follows. Cohort A: patients with radiographically measurable metastatic melanoma who underwent comparison of ctDNA measured by a BEAMing digital PCR assay to tissue mutational status and total tumor burden; when appropriate, determinations about initiation of targeted therapy were based on ctDNA data. Cohorts B and C: patients with BRAF‐ or NRAS‐mutant melanoma who had either undergone surgical resection of high‐risk disease (cohort B) or were receiving or had received medical therapy for advanced disease (cohort C). Patients were followed longitudinally with serial ctDNA measurements with contemporaneous radiographic imaging to ascertain times to detection of disease activity and progressive disease, respectively. The sensitivity and specificity of the ctDNA assay were 86.8% and 100%, respectively. Higher tumor burden and visceral metastases were found to be associated with detectable ctDNA. In two patients in cohort A, ctDNA test results revealed a targetable mutation where tumor testing had not; both patients experienced a partial response to targeted therapy. In four of 30 patients with advanced melanoma, ctDNA assessments indicated evidence of melanoma activity that predicted radiographic evidence of disease progression by 8, 14, 25, and 38 weeks, respectively. CtDNA was detectable in three of these four patients coincident with radiographic evaluations that alone were interpreted as showing no evidence of neoplastic disease. Our findings provide evidence for the clinical utility of integrating ctDNA data in managing patients with melanoma in a real‐world setting.
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spelling pubmed-61659982018-10-04 From validity to clinical utility: the influence of circulating tumor DNA on melanoma patient management in a real‐world setting Rowe, Steven P. Luber, Brandon Makell, Monique Brothers, Patricia Santmyer, JoAnn Schollenberger, Megan D. Quinn, Hannah Edelstein, Daniel L. Jones, Frederick S. Bleich, Karen B. Sharfman, William H. Lipson, Evan J. Mol Oncol Research Articles Melanoma currently lacks a reliable blood‐based biomarker of disease activity, although circulating tumor DNA (ctDNA) may fill this role. We investigated the clinical utility (i.e., impact on clinical outcomes and interpretation of radiographic data) of measuring ctDNA in patients with metastatic or high‐risk resected melanoma. Patients were prospectively accrued into ≥ 1 of three cohorts, as follows. Cohort A: patients with radiographically measurable metastatic melanoma who underwent comparison of ctDNA measured by a BEAMing digital PCR assay to tissue mutational status and total tumor burden; when appropriate, determinations about initiation of targeted therapy were based on ctDNA data. Cohorts B and C: patients with BRAF‐ or NRAS‐mutant melanoma who had either undergone surgical resection of high‐risk disease (cohort B) or were receiving or had received medical therapy for advanced disease (cohort C). Patients were followed longitudinally with serial ctDNA measurements with contemporaneous radiographic imaging to ascertain times to detection of disease activity and progressive disease, respectively. The sensitivity and specificity of the ctDNA assay were 86.8% and 100%, respectively. Higher tumor burden and visceral metastases were found to be associated with detectable ctDNA. In two patients in cohort A, ctDNA test results revealed a targetable mutation where tumor testing had not; both patients experienced a partial response to targeted therapy. In four of 30 patients with advanced melanoma, ctDNA assessments indicated evidence of melanoma activity that predicted radiographic evidence of disease progression by 8, 14, 25, and 38 weeks, respectively. CtDNA was detectable in three of these four patients coincident with radiographic evaluations that alone were interpreted as showing no evidence of neoplastic disease. Our findings provide evidence for the clinical utility of integrating ctDNA data in managing patients with melanoma in a real‐world setting. John Wiley and Sons Inc. 2018-09-08 2018-10 /pmc/articles/PMC6165998/ /pubmed/30113761 http://dx.doi.org/10.1002/1878-0261.12373 Text en © 2018 The Authors. Published by FEBS Press and John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Articles
Rowe, Steven P.
Luber, Brandon
Makell, Monique
Brothers, Patricia
Santmyer, JoAnn
Schollenberger, Megan D.
Quinn, Hannah
Edelstein, Daniel L.
Jones, Frederick S.
Bleich, Karen B.
Sharfman, William H.
Lipson, Evan J.
From validity to clinical utility: the influence of circulating tumor DNA on melanoma patient management in a real‐world setting
title From validity to clinical utility: the influence of circulating tumor DNA on melanoma patient management in a real‐world setting
title_full From validity to clinical utility: the influence of circulating tumor DNA on melanoma patient management in a real‐world setting
title_fullStr From validity to clinical utility: the influence of circulating tumor DNA on melanoma patient management in a real‐world setting
title_full_unstemmed From validity to clinical utility: the influence of circulating tumor DNA on melanoma patient management in a real‐world setting
title_short From validity to clinical utility: the influence of circulating tumor DNA on melanoma patient management in a real‐world setting
title_sort from validity to clinical utility: the influence of circulating tumor dna on melanoma patient management in a real‐world setting
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165998/
https://www.ncbi.nlm.nih.gov/pubmed/30113761
http://dx.doi.org/10.1002/1878-0261.12373
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