Resultados del estudio Concordance: Relevancia clínica de la determinación del ADNtc mediante la tecnología BEAMing. Ana Vivancos

Transcription

1 Resultados del estudio Concordance: Relevancia clínica de la determinación del ADNtc mediante la tecnología BEAMing Ana Vivancos

2 Circulating tumor DNA extended RAS mutational analysis as a surrogate of mutational status of tumor samples in metastatic colorectal cancer and its impact on patient selection for anti-egfr therapy. Julieta Grasselli 1,3, Elena Elez 1,2, Ginevra Caratù 4, Judit Matito 4, Cristina Santos 3, Teresa Macarulla 1,2, Joana Vidal 5, Margarita Garcia 3 José María Viéitez 6, David Paéz 7, Esther Falcó 8, Carlos Lopez Lopez 9, Enrique Aranda 10,Frederick Jones 11, Vishal Sikri 11, Paolo Nuciforo 12, Rodrigo Dienstmann 1,13, Clara Montagut 4, Josep Tabernero 1,2, Daniel Azuara 14, Ramon Salazar 3, Ana Vivancos Department of Medical Oncology, Vall d Hebron Institute of Oncology, Barcelona, Spain; 2-Department of Medical Oncology, Vall d Hebron University Hospital, Barcelona, Spain; 3-Department of Medical Oncology, Catalan Institute of Oncology, L Hospitalet, Barcelona, Spain; 4- Cancer Genomics Group,Vall d Hebron Institute of Oncology, Barcelona, Spain; 5-Department of Medical Oncology, Del Mar University Hospital, Barcelona, Spain; 6-Department of Medical Oncology, Asturias University Hospital, Oviedo, Spain; 7-Department of Medical Oncology, Santa Creu i Sant Pau University Hospital, Barcelona, Spain; 8- Department of Medical Oncology, Son Llatzer University Hospital, Palma de Mallorca Spain; 9- Department of Medical Oncology, Marques de Valdecilla University Hospital, Santander, Spain; 10- Department of Medical Oncology, Reina Sofía University Hospital, Córdoba, Spain; 11-Sysmex Inostics, Illinois, United States; 12-Molecular Oncology Group, Vall d Hebron Institute of Oncology, Barcelona, Spain; 13- Oncology Data Science Group, Vall d Hebron Institute of Oncology, Barcelona, Spain; 14-Traslational Research Laboratory, Catalan Institute of Oncology, L Hospitalet, Barcelona, Spain. Accepted for publication, Annals of Oncology

3 Liquid biopsy and ctdna Circulating-free DNA (cfdna) is a naturally occuring DNA that is present in the bloodstream. We can isolate it from the plasmatic fraction of blood. Circulating-free tumor DNA (ctdna) is a part of cfdna, cell-free DNA released from a solid tumor and, therefore, carries mutations or other genomic alterations. Liquid biopsy refers to the ability to detect mutations / alterations present in a patient s tumor from a blood sample. ctdna: circulating tumor DNA Derives from tumour cells Crowley, E. et al. (2013) Liquid biopsy: monitoring cancer-genetics in the blood Nat. Rev. Clin. Oncol. doi: /nrclinonc

4 Critical aspects in primary vs plasma concordance rates mcrc ctdna shedding Intratumor heterogeneity Targeted therapies Tumor load Met locations Necrosis, other biological processes Clonality mcrc: APC, KRAS vs BRAF, PIK3CA Lung: EGFR indel 19 vs T790M vs C797S Selection mcrc: anti-egfr, RAS clones Lung: EGFR T790M

5 Liquid biopsy analysis in mcrc BEAMing RAS PANEL (BEAMing) BEAMing has an analytically validated CE kit for plasma, OncoBEAM Gene Exon Mutation KRAS 2 G12S/R/C/D/A/V 2 G13D 3 A59T 3 Q61L/H/R 4 K117N 4 A146T/V NRAS 2 G12S/R/C/D/A/V 2 G13D/R/V 3 A59T 3 Q61K/L/R/H 4 K117N 4 A146T

6 Design and Objectives DESIGN Retrospective and multicentric (n=150) RAS testing SoC* tumor (Sens 1-5%) BEAMing tumor (Sens 1%) BEAMing plasma (Sens %) Primary OBJECTIVES Concordance analysis defined as plasma and tissue based RAS mutation testing to establish the eligibility for anti-egfr therapy. M U T SoC tumor BEAMing tumor BEAMin g plasma Secondary PFS description by tumor and plasma determination in patients who received anti-egfr therapies OS description by tumor and plasma determination *The real-time conventional assay (qpcr) was performed using the real-time PCR machine Light Cycler 480 (Roche Life Science) using a custom panel of TaqMan probes to detect point mutations in exons 2/3/4 of KRAS and NRAS.

7 Main inclusion criteria

8 Gender Male Female Patient demographics n (%) 107 (73) 40 (27) Age median (range) 65y (30-86) Stage at diagnosis Early Advanced Primary site Right Left Colon unspecified Rectum Tumor tissue for RAS testing Primary Metastatic Number of metastatic sites at ctdna collection Metastatic site at ctdna collection Liver Lung Node Peritoneal Other 46 (31) 101 (69) 36 (25) 33 (22) 31 (21) 47 (32) 122 (85) 22 (15) 66 (45) 54 (37) 27 (18) 101 (69) 60 (41) 46 (31) 31 (21) 27 (18)

9 Treatment Description Number therapies metastatic setting prior to ctdna collection Received anti-egfr therapy after to ctdna collection Number Percentage % % % % Yes 68 46% No 79 54% 7.3 m (4.5-not reached) 7.7 m ( ) 17.7 m (13.8-not reached) n= 13 n=20 n=35 Median (CI95%) Median overall survival in metastatic setting All patients 35.9 m ( ) Median time from tumor to ctdna collection Median (range) Not exposed to therapy 1.2 m (0-34) Exposed to therapy 20.4 m ( )

10 Concordance analysis SoC tumor/beaming plasma Overall concordance % % % BEAMing plasma SoC tumor BEAMing tumor M U T

11 Concordance analysis SoC tumor/beaming plasma SoC tumor 40.1 % RAS mut BEAMing plasma 36.7 % RAS mut SoC tumor BEAMing plasma WT wild-type/ mut mutated

12 Discordant: mutations detected only in plasma

13 Discordant: mutations detected only in tumor

14 Clinical relevance: PFS in RAS wild-type population PFS 2nd and 3rd line RAS WT by SoC tumor PFS 2nd and 3rd line RAS WT by BEAMing plasma Median 8.7m ( ) Median 8.7m ( ) SoC (n=51) PFS 8.7 m ( ) n=51 n=47 Irinotecan backbone regimen WT wild-type

15 Clinical relevance: Overall survival OS in metastatic setting by SoC tumor OS in metastatic setting by BEAMing plasma 39.1 m (32.1-not reached) 42.9 m (36.5-not reached) 28.7 m ( ) 27.8 m ( ) n= 147 n= 147 HR=1.65 (95%CI: ) HR=1.92 (95%CI: ) WT wild-type mut mutated

16 MAF analysis plasma vs tumor

17 MAF analysis: distribution of alleles in plasma RAS mutant samples= 61 High sensitivity is required for reliable cfdna profiling MAFs 39% 11% 21% 29% % 0.1-1% >1% >5% 50% of patients show ctdna at <1% fraction

18 MAF analysis

19 Conclusions A concordance rate of 89.7% was achieved between ctdna RAS testing and standard techniques for patients eligible to anti-egfr-based therapy performed in house in a real world population In this retrospective study, plasma RAS determination by BEAMing captures a population responding to anti-egfr therapy at the same level as SoC RAS testing in tumor Discordant samples could be explained due technical sensitivity, temporal or spatial heterogeneity and low tumor burden that could affect ctdna release Sensitivity is the crucial technical aspect in ctdna analysis The feasibility and practicability of ctdna analysis may translate into significant impact in clinical practice for anti-egfr treatment selection

20 Vivancos Lab (VHIO) Ginevra Caratù Judit Matito Vall D Hebron Hospital Elena Elez Paolo Nuciforo Rodrigo Dienstmann Nuria Pardo Enriqueta Felip Josep Tabernero Thanks!!! Julieta Grasselli (Institut Català d Oncologia) Frederick Jones (Sysmex) Vishal Sikri (Sysmex) Enrique Aranda (Hospital Universitario Reina Sofía, Córdoba) Clara Montagut (Hospital Mar) Daniel Azuara (Institut Català d Oncologia) Ramon Salazar (Institut Català d Oncologia)

21 Pregunta 1 La Concordancia entre plasma y tejido depende de: 1- la liberación de ctdna o shedding 2- la clonalidad de la mutación objeto de estudio 3- los tratamientos previos dirigidos que haya recibido el paciente 4- todos los anteriores

22 Pregunta 2 El uso de tecnologías ultrasensibles para la biopsia líquida es debido a: 1- estas técnicas permiten secuenciar muchos genes 2- el ctdna puede estar presente en fracciones alélicas muy pequeñas en plasma 3- las mutaciones en RAS en colon son subclonales 4- todas las anteriores