Analysis of circulating tumour DNA to identify patients with epidermal growth factor receptor-positive non-small cell lung cancer who might benefit from sequential tyrosine kinase inhibitor treatment.

Provencio, MarianoSerna-Blasco, RobertoFranco, FabioCalvo, VirginaRoyuela, AnaAuglytė, MildaSánchez-Hernández, Alfredode Julián Campayo, MaríaGarcía-Girón, CarlosDómine, ManuelBlasco, AnaSánchez, José MOramas, JuanaBosch-Barrera, JoaquimSala, María ÁSereno, MaríaOrtega, Ana LChara, LuisHernández, BertaPadilla, AiramCoves, JuanBlanco, RemediosBalsalobre, JoséMielgo, XabierBueno, CoraliaJantus-Lewintre, EloisaMolina-Vila, Miguel ÁRomero, Atocha2023-02-092023-02-092021-04-05http://hdl.handle.net/10668/17547Survival data support the use of first-line osimertinib as the standard of care for epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer (NSCLC). However, it remains unclear whether upfront osimertinib is superior to sequential first- or second-generation tyrosine kinase inhibitors (TKIs) followed by osimertinib for all patients. It is impossible to predict which patients are at high risk of progression, and this constitutes a major limitation of the sequential TKI approach. A total of 830 plasma samples from 228 patients with stage IV, EGFR-positive NSCLC who were treated with first-line TKIs were analysed by digital polymerase chain reaction (dPCR). The circulating tumour DNA (ctDNA) levels helped to identify patients with significantly improved survival rate, regardless of the treatment. Patients treated with first- or second-generation TKIs (N = 189) with EGFR mutations in plasma at a mutant allele frequency (MAF) Pre-treatment ctDNA levels identify low-risk patients, who may benefit from sequential TKI treatment. Information regarding EGFR mutation clearance can help to improve patient selection.enAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/EGFRNSCLCOsimertinibTKIctDNAAcrylamidesAgedAniline CompoundsAntineoplastic AgentsBiomarkers, TumorCarcinoma, Non-Small-Cell LungCirculating Tumor DNAClinical Decision-MakingCross-Sectional StudiesDNA Mutational AnalysisErbB ReceptorsFemaleHumansLung NeoplasmsMaleMiddle AgedMutationNeoplasm StagingPolymerase Chain ReactionPredictive Value of TestsProspective StudiesProtein Kinase InhibitorsSpainTime FactorsTreatment OutcomeAnalysis of circulating tumour DNA to identify patients with epidermal growth factor receptor-positive non-small cell lung cancer who might benefit from sequential tyrosine kinase inhibitor treatment.research article33831609open access10.1016/j.ejca.2021.02.0311879-0852http://www.ejcancer.com/article/S0959804921001386/pdf