RESUMO
PURPOSE: The advent of circulating tumor DNA (ctDNA) technology has provided a convenient and noninvasive means to continuously monitor cancer genomic data, facilitating personalized cancer treatment. This study aimed to evaluate the supplementary benefits of plasma ctDNA alongside traditional tissue-based next-generation sequencing (NGS) in identifying targetable mutations and tumor mutational burden (TMB) in colorectal cancers (CRC). METHODS: Our study involved 76 CRC patients, collecting both tissue and plasma samples for NGS. We assessed the concordance of gene mutational status between ctDNA and tissue, focusing on actionable genes such as KRAS, NRAS, PIK3CA, BRAF, and ERBB2. Logistic regression analysis was used to explore variables associated with discordance and positive mutation rates. RESULTS: In total, 26 cancer-related genes were identified. The most common variants in tumor tissues and plasma samples were in APC (57.9% vs 19.7%), TP53 (55.3% vs 22.4%) and KRAS (47.4% vs 43.4%). Tissue and ctDNA showed an overall concordance of 73.53% in detecting actionable gene mutations. Notably, plasma ctDNA improved detection for certain genes and gene pools. Variables significantly associated with discordance included gender and peritoneal metastases. TMB analysis revealed a higher detection rate in tissues compared to plasma, but combining both increased detection. CONCLUSIONS: Our study highlights the importance of analyzing both tissue and plasma for detecting actionable mutations in CRC, with plasma ctDNA offering added value. Discordance is associated with gender and peritoneal metastases, and TMB analysis can benefit from a combination of tissue and plasma data. This approach provides valuable insights for personalized CRC treatment.
Assuntos
DNA Tumoral Circulante , Neoplasias Colorretais , Sequenciamento de Nucleotídeos em Larga Escala , Mutação , Humanos , Neoplasias Colorretais/genética , Neoplasias Colorretais/sangue , Neoplasias Colorretais/patologia , Masculino , Feminino , DNA Tumoral Circulante/sangue , DNA Tumoral Circulante/genética , Pessoa de Meia-Idade , Idoso , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Proteínas Proto-Oncogênicas B-raf/genética , GTP Fosfo-Hidrolases/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Classe I de Fosfatidilinositol 3-Quinases/genética , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/sangue , Adulto , Idoso de 80 Anos ou mais , Proteína Supressora de Tumor p53/genética , Receptor ErbB-2/genética , Proteína da Polipose Adenomatosa do Colo/genética , Proteínas de Membrana/genética , Proteínas de Membrana/sangueRESUMO
Colorectal cancer represents the third most common cancer and about 20% are diagnosed with synchronous metastatic disease. From a historical point of view, surgery remains the mainstream treatment for resectable colorectal liver metastases (CRLM). Furthermore, disease outcomes are improving due significant advances in systemic treatments and diagnostic methods. However, the optimal timing for neoadjuvant chemotherapy or upfront surgery for CRLM has not yet been established and remains an open question. Thus, patient selection combining image workouts, time of recurrence, positive lymph nodes, and molecular biomarkers can improve the decision-making process. Nevertheless, molecular profiling is rising as a promising field to be incorporated in the multimodal approach and guide patient selection and sequencing of treatment. Tumor biomakers, genetic profiling, and circulating tumor DNA have been used to offer as much personalized treatment as possible, based on the precision oncology concept of tailored care rather than a guideline-based therapy. This review article discusses the role of molecular pathology and biomarkers as prognostic and predictor factors in the diagnosis and treatment of resectable CRLM.
RESUMO
Background: Gliomas are the most common primary malignant neoplasms of the central nervous system and their characteristic genetic heterogeneity implies in a prominent complexity in their management. The definition of the genetic/molecular profile of gliomas is currently essential for the classification of the disease, prognosis, choice of treatment, and it is still dependent on surgical biopsies, which in many cases become unfeasible. Liquid biopsy with detection and analysis of biomarkers such as deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) from the tumor and circulating in the bloodstream or cerebrospinal fluid (CSF) has emerged as a minimally invasive alternative to aid in diagnosis, follow-up, and response to treatment of gliomas. Methods: Through a systematic search in the PubMed MEDLINE, Cochrane Library, and Embase databases, we reviewed the evidence on the use of liquid biopsy to detect tumor DNA/RNA in the CSF of patients diagnosed with central nervous system gliomas. Results: After a systematic review applying all inclusion and exclusion criteria, as well as a double review by independent authors, 14 studies specifically addressing the detection of tumor DNA/RNA in the CSF of patients diagnosed with central nervous system glioma were selected in the final analysis. Conclusion: Sensitivity and specificity of liquid biopsy in CSF are still very variable depending on factors such as the diagnostic method, collection timing, biomarker (DNA and RNA), tumor type, extension and volume of the tumor, collection method, and contiguity from neoplasm to CSF. Despite the technical limitations that still exist and prevent the routine and validated use of liquid biopsy in CSF, the growing number of studies around the world is increasingly improving this technic, resulting in promising prospects for its use in diagnosis, evolutionary follow-up, and response to the treatment of complex diseases such as central nervous system gliomas.
RESUMO
Pediatric tumors share few recurrent mutations and are instead characterized by copy number alterations (CNAs). The cell-free DNA (cfDNA) is a prominent source for the detection of cancer-specific biomarkers in plasma. We profiled CNAs in the tumor tissues for further evaluation of alterations in 1q, MYCN and 17p in the circulating tumor DNA (ctDNA) in the peripheral blood at diagnosis and follow-up using digital PCR. We report that among the different kinds of tumors (neuroblastoma, Wilms tumor, Ewing sarcoma, rhabdomyosarcoma, leiomyosarcoma, osteosarcoma and benign teratoma), neuroblastoma presented the greatest amount of cfDNA, in correlation with tumor volume. Considering all tumors, cfDNA levels correlated with tumor stage, metastasis at diagnosis and metastasis developed during therapy. In the tumor tissue, at least one CNA (at CRABP2, TP53, surrogate markers for 1q and 17p, respectively, and MYCN) was observed in 89% of patients. At diagnosis, CNAs levels were concordant between tumor and ctDNA in 56% of the cases, and for the remaining 44%, 91.4% of the CNAs were present only in cfDNA and 8.6% only in the tumor. Within the cfDNA, we observed that 46% and 23% of the patients had MYCN and 1q gain, respectively. The use of specific CNAs as targets for liquid biopsy in pediatric patients with cancer can improve diagnosis and should be considered for monitoring of the disease response.
RESUMO
Despite significant advances in the surgical and systemic therapy of colorectal cancer (CRC) in recent decades, recurrence rates remain high. Apart from microsatellite instability status, the decision to offer adjuvant chemotherapy to patients with CRC is solely based on clinicopathologic factors, which offer an inaccurate risk stratification of patients who derive benefit from adjuvant therapy. Owing to the recent improvements of molecular techniques, it has been possible to detect small allelic fractions of circulating tumor DNA (ctDNA), and therefore, to identify patients with minimal residual disease (MRD) after curative-intent therapies. The incorporation of ctDNA identifying MRD in clinical practice may dramatically change the standard of care of CRC, refining the selection of patients who are candidates for escalation and de-escalation of adjuvant chemotherapy, and even for organ-preservation strategies in rectal cancer. In the present review, we describe the current standard of care and the DNA sequencing methodologies and assays, present the data from completed clinical studies and list ongoing potential landmark clinical trials whose results are eagerly awaited, as well as the impact and perspectives for the near future. The discussed data bring optimism for the future of oncologic care through the hope of refined utilization of adjuvant therapies with higher efficacy and safety for patients with both localized and advanced CRC.
Assuntos
Neoplasias Colorretais , Neoplasias Retais , Humanos , Neoplasia Residual/patologia , Neoplasias Colorretais/genética , Neoplasias Colorretais/terapia , Neoplasias Colorretais/patologia , Terapia Combinada , Quimioterapia AdjuvanteRESUMO
PURPOSE: Some patients with histologically confirmed primary mCRC and mutated RAS reported undetectable RAS mutant clones in plasma after receiving anti-VEGF treatment. The aim was to prospectively assess it with its potential therapeutic implications. METHODS: RAS mutant genes in solid biopsy (before first-line treatment: FOLFOX/CAPOX + bevacizumab) were compared in liquid biopsy (before second-line treatment: panitumumab + FOLFIRI), using Idylla™ system. Discordant results between solid/liquid biopsies were assessed by the next-generation sequencing (NGS) test (solid/liquid biopsies). RESULTS: Twenty-three patients were assessed (seven had RAS mutant discrepancies between solid/liquid biopsies). The NGS test confirmed that 3/23 (13%) patients had undetectable RAS mutant clones in liquid biopsy and 3/23 (13%) presented discrepancies in solid biopsy (Idylla™ system vs. NGS test). CONCLUSION: Thirteen percentage of patients had undetectable RAS mutant clones in liquid biopsy after first-line treatment. However, some discrepancies between solid and liquid biopsies have been observed. These results suggest a need to improve accuracy of RAS analyses, especially in solid biopsies.
Assuntos
Neoplasias do Colo , Neoplasias Colorretais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Células Clonais/patologia , Neoplasias do Colo/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Fluoruracila/uso terapêutico , Humanos , Mutação , Panitumumabe/uso terapêuticoRESUMO
O carcinoma de células renais (CCR) é o sétimo tipo de câncer mais comum no ocidente e vêm apresentando um aumento em sua prevalência. A classificação histológica dos CCRs é a abordagem mais utilizada para determinar o subtipo da doença, bem como prognosticar o paciente. Cerca de 70-80% dos CCRs é do subtipo células claras (ccRCC), o qual representa o subtipo mais prevalente e agressivo da doença. A escolha do tratamento difere para cada paciente, sendo a ressecção cirúrgica a terapia mais efetiva nos casos de doença localizada. Apesar de ser um tratamento já estabelecido, estudos mostram uma certa heterogeneidade entre massas renais detectadas, onde cerca de 20% apresentam um perfil benigno, 60% são considerados tumores indolentes, sugerindo desta forma que, entender de forma mais detalhada este tumor pode auxiliar na escolha de um tratamento mais direcionado para o paciente. Sendo assim, o presente trabalho buscou selecionar genes potencialmente alterados em CCR com o intuito de customizar um painel multigênico capaz de identificar variantes somáticas, específicas do tumor, e avaliar as variantes específicas do tumor de forma personalizada em amostras de ctDNA (DNA tumoral circulante) extraídas de plasma e dos dois componentes da urina (sedimento e sobrenadante) coletados no momento da cirurgia (baseline). Neste contexto, dentro de nossa proposta, construímos um painel com 28 genes associados com CCR e sequenciamos 89 casos de tumores renais, juntamente com as amostras de leucócitos. Identificamos que dentre os tumores analisados, 59 apresentavam pelo menos uma variante somática, ou seja, o painel customizado apresentou uma sensibilidade para identificar variantes somáticas em 66% dos casos. Com relação aos 45 tumores classificados como ccRCC em 38 casos identificamos pelo menos uma marca tumoral, ou seja, nosso painel foi capaz de detectar variantes somáticas específicas do tumor em 84,4% desses casos. Um total de 105 variantes somáticas foram identificadas, e os genes mais frequentemente mutados nessa coorte de pacientes foram os genes VHL, PBRM1, BAP1, SETD2. Dos 59 casos em que identificamos variante somática, 44 casos foram avaliados as amostras baseline de plasma e 29 casos de urina (sobrenadante e sedimento), e encontramos pelo menos uma marca tumoral em um dos fluidos corpóreos em 11 pacientes, 6 em amostras de plasma e 6 amostras de urina. Através do desenvolvimento deste estudo, confirmamos que o subtipo ccRCC é o CCR mais bem caracterizado genomicamente e que é importante continuar a investigação genômica principalmente nos subtipos não ccRCC. Além disso o estudo demonstra a viabilidade de utilizar biópsia líquida ctDNA tanto no plasma quanto na urina para fins de diagnóstico e prognóstico.
Renal cell carcinoma (RCC) is the seventh most common type of cancer in the West and its prevalence is increasing. The histological classification of RCCs is the most used approach to determine the disease subtype as well as the patient's prognosis. About 70% of RCCs are of the clear cell Renal Cell Carcinoma subtype (ccRCC), which represents the most prevalent and aggressive subtype of the disease. The choice of treatment is different for each patient. Resection is one of the most effective therapies in cases of localized disease. Despite being an established treatment, studies show a certain heterogeneous profile studied. In this profile, up to 20% even present a benign treatment, helping the indolent, thus suggesting that understanding this tumor in detail can help to choose a more targeted treatment for the patient. Therefore, the present work aimed to select potentially altered genes in CCR in order to customize a multigene panel capable of identifying somatic, tumor-specific variants, and to evaluate the tumor-specific variants in a personalized way in ctDNA (circulating tumor DNA) samples extracted from plasma and from two components of urine (sediment and supernatant) collected at the time of surgery (baseline). In this context, within our proposal, we built a panel with 28 genes associated with CCR and sequenced 89 cases of renal tumors, together with leukocyte samples. We identified that among the analyzed tumors, 59 had at least one somatic variant, that is, the customized panel showed sensitivity to identify somatic variants in 66% of cases. Of the 45 classified as ccRCC in 38 cases we identified at least one tumor marker, that is, our panel was able to detect tumor-specific somatic variants in 84.4%. A total of 105 somatic variants were identified, and the genes most frequently mutated in this cohort of patients were the VHL, PBRM1, BAP1, SETD2 genes. Among 59 cases in which we identified somatic variant, 44 cases were evaluated in baseline plasma samples and 29 cases in urine (supernatant and sediment), and we found at least one tumor mark in one of the body fluids in 11 patients, 6 in plasma samples and 6 urine samples. Through the development of this study, we confirm that the ccRCC subtype is the best genomically characterized CCR and that it is important to continue genomic investigation, especially in the non-ccRCC subtypes. Furthermore, the study demonstrates the feasibility of using ctDNA liquid biopsy in both plasma and urine for diagnostic and prognostic purposes.
Assuntos
Humanos , Masculino , Feminino , DNA Tumoral Circulante , Biópsia Líquida , Neoplasias Renais , Carcinoma de Células RenaisRESUMO
INTRODUCTION: Breast cancer (BC) is the malignant neoplasm with the highest mortality rate in women and female dogs are good models to study BC. OBJECTIVE: We investigated the efficacy of liquid biopsy to detect gene mutations in the diagnosis and follow-up of women and female dogs with BC. MATERIALS AND METHODS: In this study, 57 and 37 BC samples were collected from women and female dogs, respectively. After core biopsy and plasma samples were collected, the DNA and ctDNA of the tumor fragments and plasma were processed for next generation sequencing (NGS) assay. After preprocessing of the data, they were submitted to the Genome Analysis ToolKit (GATK). RESULTS: In women, 1788 variants were identified in tumor fragments and 221 variants in plasma; 66 variants were simultaneously detected in tumors and plasma. Conversely, in female dogs, 1430 variants were found in plasma and 695 variants in tumor fragments; 59 variants were simultaneously identified in tumors and plasma. The most frequently mutated genes in the tumor fragments of women were USH2A, ATM, and IGF2R; in female dogs, they were USH2A, BRCA2, and RRM2. Plasma of women showed the most frequent genetic variations in the MAP3K1, BRCA1, and GRB7 genes, whereas plasma from female dogs had variations in the NF1, ERBB2, and KRT17 genes. Mutations in the AKT1, PIK3CA, and BRIP genes were associated with tumor recurrence, with a highly pathogenic variant in PIK3CA being particularly prominent. We also detected a gain-of-function mutation in the GRB7, MAP3K1, and MLH1 genes. CONCLUSION: Liquid biopsy is useful to identify specific genetic variations at the beginning of BC manifestation and may be accompanied over the entire follow-up period, thereby supporting the clinicians in refining interventions.
RESUMO
Cancer genomics has evolved over the years from understanding the pathogenesis of cancer to screening the future possibilities of cancer occurrence. Understanding the genetic profile of tumors holds a prognostic as well as a predictive value in this era of therapeutic surveillance, molecular remission, and precision medicine. Identifying molecular markers in tumors is the current standard of approach, and requires an efficient combination of an accessible sample type and a profoundly sensitive technique. Liquid biopsy or cell-free DNA has evolved as a novel sample type with promising results in recent years. Although cell-free DNA has significant role in various cancer types, this review focuses on its application in Non-Hodgkin's Lymphoma. Beginning with the current concept and clinical relevance of minimal residual disease in Non-Hodgkin's lymphoma, we discuss the literature on circulating DNA and its evolving application in the realm of cutting-edge technology.
Assuntos
DNA Tumoral Circulante/sangue , Linfoma não Hodgkin/genética , Linfoma não Hodgkin/patologia , Biomarcadores Tumorais/sangue , Ácidos Nucleicos Livres/sangue , Citometria de Fluxo , Marcadores Genéticos , Técnicas de Genotipagem , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Biópsia Líquida , Linfoma/sangue , Linfoma/genética , Linfoma não Hodgkin/sangue , Linfoma não Hodgkin/diagnóstico por imagem , Mutação , Neoplasia Residual/sangue , Neoplasia Residual/genética , Neoplasia Residual/patologia , Reação em Cadeia da Polimerase/métodos , Tomografia por Emissão de Pósitrons , Medicina de Precisão , Prognóstico , Transcriptoma , Translocação GenéticaRESUMO
The objective of this review is to address the barriers limiting access to next-generation sequencing (NGS) of circulating tumor DNA (ctDNA) for metastatic nonsquamous non-small cell lung cancer in Brazil and to propose its implementation in practice. A selected panel of lung cancer experts was provided with relevant prompts to address at a conference; a paper was then compiled on the topic. The authors propose specific and realistic recommendations for implementing access to ctDNA NGS. Further, the authors address all barriers and impediments mentioned within this review. There is a great need to increase ctDNA NGS for cancer care in Brazil. Adapting the current cancer testing framework is essential to expanding the use of this tool.
Assuntos
Biomarcadores Tumorais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/genética , DNA Tumoral Circulante , Sequenciamento de Nucleotídeos em Larga Escala , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Brasil , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/terapia , Tomada de Decisão Clínica , Análise Mutacional de DNA , Gerenciamento Clínico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/terapia , Terapia de Alvo Molecular/efeitos adversos , Terapia de Alvo Molecular/métodos , Mutação , Estadiamento de Neoplasias , Padrões de Prática Médica , Resultado do TratamentoRESUMO
BACKGROUND/OBJECTIVES: Until now, no meta-analysis has been published to evaluate the diagnostic performance of next-generation sequencing (NGS) panel using circulating tumor (ctDNA) in patients with advanced non-small cell lung cancer (aNSCLC). The aim of the study was to carry out a systematic review and a meta-analysis in order to determine the accuracy of NGS of ctDNA to detect six oncogenic driver alterations: epidermal growth factor receptor (EGFR); anaplastic lymphoma kinase (ALK); ROS proto-oncogene 1, receptor tyrosine kinase (ROS-1); serine/threonine-protein kinase B-RAF (BRAF); RET proto-oncogene (RET); and MET proto-oncogene, receptor tyrosine kinase (MET) exon 14 in patients with aNSCLC. METHODS: MEDLINE/PubMed, Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), and Centre for Reviews and Dissemination databases and articles obtained from other sources were searched for relevant studies that evaluate the accuracy (sensitivity and specificity) of NGS using ctDNA in patients with aNSCLC. The studies were eligible when NGS of ctDNA was compared with tissue tests to detect at least one of the six oncogenic driver alterations. Diagnostic measures (sensitivity and specificity) were pooled with a bivariate diagnostic random effect. All statistical analyses were performed with software R, v.4.0.0. RESULTS: Ten studies were eligible for data extraction. The overall pooled estimates of sensitivity and specificity were 0.766 (95% CI: 0.678-0.835); 0.999 (95% CI: 0.990-1.000), respectively. CONCLUSIONS: The analysis has demonstrated that the NGS panel using ctDNA has a high accuracy to identify the six actionable oncogenic driver alterations in patients with aNSCLC. Therefore, it can be considered a reliable alternative to guide the patients with aNSCLC to the right treatment who cannot undergo an invasive procedure or have insufficient tissue material for molecular tests.
RESUMO
Detection of circulating tumor DNA is a new noninvasive technique with potential roles in diagnostic, follow-up, and prognostic evaluation of patients with many types of solid tumors. We aimed to evaluate the role of circulating tumor DNA in the setting of metastatic ovarian carcinoma. A prospective cohort of patients with metastatic ovarian cancer who were referred to systemic therapy was enrolled. Blood samples were collected before the start of treatment and monthly thereafter for 6 months. Circulating tumor DNA was quantified by real-time quantitative reverse transcription polymerase chain reaction of different lengths of Arthrobacter luteus elements as described by Umetani et al. A total of 11 patients were included, 2 for primary disease and 9 for recurrent disease. After the first cycle of chemotherapy, patients whose circulating tumor DNA levels increased from baseline were more likely to respond to chemotherapy than those whose circulating tumor DNA levels did not increase (p = 0.035). Furthermore, patients whose circulating tumor DNA levels rose after the first cycle of chemotherapy also had improved disease-free survival compared to those whose circulating tumor DNA levels did not increase (p = 0.0074). We conclude that the increase in circulating tumor DNA values collected in peripheral blood after the first cycle of systemic treatment in patients with advanced ovarian cancer is associated with an early response to systemic treatment and correlates with superior disease-free survival in this population. Circulating tumor DNA might be a specific, noninvasive, and cost-effective new biomarker of early response to systemic treatment in these patients.
Assuntos
Biomarcadores Tumorais , DNA Tumoral Circulante , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/genética , Idoso , Gerenciamento Clínico , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/terapia , Projetos Piloto , Prognóstico , Tempo para o Tratamento , Resultado do TratamentoRESUMO
Background: Anti-EGFR antibodies are a standard care for advanced KRAS-wild type colorectal cancers. Circulating tumor DNA (ctDNA) monitoring during therapy can detect emergence of KRAS mutant clones and early resistance to therapy. Case Presentation: We describe a 61-years-old man presenting a metastatic and recurrent rectal cancer treated with different chemotherapy regimens. His tumor was KRAS wild-type based on tissue analysis and he was treated sequentially with cetuximab-based chemotherapy, chemotherapy alone and panitumumab-based chemotherapy. We performed sequential analysis of ctDNA using droplet digital PCR (ddPCR) and a commercial assay designed for the detection of frequent KRAS mutations during his clinical follow-up. Prior to the first cetuximab-based chemotherapy ctDNA analysis demonstrated an absence of KRAS mutations. Emergence of KRAS mutations in ctDNA occurred ~3 months after treatment initiation and preceded clinical and imaging progression in about 2 months. Fractional abundance of KRAS mutation rapidly increased to 70.7% immediately before a chemotherapy alone regimen was initiated. Interestingly, KRAS mutation abundance decreased significantly during the first two months of chemotherapy, reaching a fractional abundance of 3.0%, despite minimal clinical benefit with this therapy. Re-challenge with a different anti-EGFR antibody was attempted as later line, but high levels of KRAS mutations in ctDNA before therapy correlated with an absence of clinical benefit. Conclusions: The monitoring of resistance mutations in KRAS using ctDNA during the treatment of KRAS wild-type advanced colorectal cancers can detect the emergence of resistant clones prior to clinical progression. Dynamics of resistant clones may alter during periods on and off anti-EGFR antibodies, detecting window of opportunities for a re-challenge with these therapies.
RESUMO
A biópsia líquida é uma ferramenta diagnóstica e prognóstica já aplicada em diversos estudos com pacientes oncológicos humanos, apresentando potencial para aplicação em oncologia veterinária. Ela se baseia na detecção de produtos tumorais variados na circulação e apresenta a vantagem de ser realizada a partir de amostra de sangue e de ser pouco invasiva ao paciente, permitindo a análise do tumor em tempo real e complementando as informações da biópsia tecidual. Nesta revisão, são abordados os conceitos gerais de biópsia líquida, suas diferentes metodologias e os diferentes produtos tumorais, incluindo células tumorais circulantes, ácidos nucleicos, englobando o DNA, micro-RNA e RNA mensageiro tumorais e exossomos. São abordadas as utilidades da biópsia líquida como ferramenta prognóstica, diagnóstica, preditiva e de direcionamento de tratamento já aplicadas em estudos de medicina humana, bem como as limitações e desafios à sua implementação em larga escala. A biópsia líquida é uma ferramenta pouco conhecida em medicina veterinária até o momento, com escassos estudos publicados.
Liquid biopsy is a diagnostic and prognostic tool already reported in several studies with human oncologic patients, and shows potential for application in veterinary oncology. However, liquid biopsy is not a widely known technique in veterinary medicine, and related research is sparse. Liquid biopsy is based on the analysis of blood samples for detection of various tumoral products in circulation. It is a non-invasive technique, and provides results in real time. Information obtained from liquid biopsies can complement the information obtained from the analysis of tissue biopsy. In this review of literature, we present the background principles of liquid biopsy, its methodology, and the tumoral products that can currently be detected with this tool. In addition to circulating tumor cells, liquid biopsies allow detection of nucleic acids, including tumor DNA, micro-RNA, messenger RNA and exosomes. We present the value of liquid biopsy as a diagnostic and prognostic tool, its predictive value in tumor progression and treatment success, and usefulness to assist treatment choice. We discuss its limitations, and the challenges to implement its use in a large scale.
La biopsia líquida es una herramienta diagnóstica y pronóstica que ya ha sido aplicada en varios estudios oncológicos humanos, con potenciales aplicaciones en oncología veterinaria. Esta técnica se fundamenta en la detección de varios tipos de productos tumorales circulantes, con la ventaja de que puede ser realizada a partir de una muestra de sangre, además de ser poco invasiva para el paciente, permitiendo el análisis del tumor en tiempo real y que sirve como complemento para las informaciones obtenidas en la biopsia de tejidos convencional. Esta revisión aborda conceptos generales de la biopsia líquida, sus diferentes métodos y los productos que pueden ser detectados, incluyendo células circulantes, ácidos nucleicos (ADN, micro ADN y ARN mensajero tumorales) y exosomas. También se discuten la utilidad de la biopsia líquida como herramienta pronostica, diagnóstica, predictiva y como información para direccionar el tratamiento de acuerdo a la experiencia en estudios de medicina humana, así como también las limitaciones y desafíos de su implementación a gran escala. La biopsia líquida es una herramienta poco conocida en medicina veterinaria, con pocos estudios publicados.
Assuntos
Animais , Biópsia/métodos , Biópsia/veterinária , Células Neoplásicas Circulantes , DNA de Neoplasias/sangue , Exossomos , RNA Mensageiro , Técnicas e Procedimentos Diagnósticos/veterináriaRESUMO
A biópsia líquida é uma ferramenta diagnóstica e prognóstica já aplicada em diversos estudos com pacientes oncológicos humanos, apresentando potencial para aplicação em oncologia veterinária. Ela se baseia na detecção de produtos tumorais variados na circulação e apresenta a vantagem de ser realizada a partir de amostra de sangue e de ser pouco invasiva ao paciente, permitindo a análise do tumor em tempo real e complementando as informações da biópsia tecidual. Nesta revisão, são abordados os conceitos gerais de biópsia líquida, suas diferentes metodologias e os diferentes produtos tumorais, incluindo células tumorais circulantes, ácidos nucleicos, englobando o DNA, micro-RNA e RNA mensageiro tumorais e exossomos. São abordadas as utilidades da biópsia líquida como ferramenta prognóstica, diagnóstica, preditiva e de direcionamento de tratamento já aplicadas em estudos de medicina humana, bem como as limitações e desafios à sua implementação em larga escala. A biópsia líquida é uma ferramenta pouco conhecida em medicina veterinária até o momento, com escassos estudos publicados.(AU)
Liquid biopsy is a diagnostic and prognostic tool already reported in several studies with human oncologic patients, and shows potential for application in veterinary oncology. However, liquid biopsy is not a widely known technique in veterinary medicine, and related research is sparse. Liquid biopsy is based on the analysis of blood samples for detection of various tumoral products in circulation. It is a non-invasive technique, and provides results in real time. Information obtained from liquid biopsies can complement the information obtained from the analysis of tissue biopsy. In this review of literature, we present the background principles of liquid biopsy, its methodology, and the tumoral products that can currently be detected with this tool. In addition to circulating tumor cells, liquid biopsies allow detection of nucleic acids, including tumor DNA, micro-RNA, messenger RNA and exosomes. We present the value of liquid biopsy as a diagnostic and prognostic tool, its predictive value in tumor progression and treatment success, and usefulness to assist treatment choice. We discuss its limitations, and the challenges to implement its use in a large scale.(AU)
La biopsia líquida es una herramienta diagnóstica y pronóstica que ya ha sido aplicada en varios estudios oncológicos humanos, con potenciales aplicaciones en oncología veterinaria. Esta técnica se fundamenta en la detección de varios tipos de productos tumorales circulantes, con la ventaja de que puede ser realizada a partir de una muestra de sangre, además de ser poco invasiva para el paciente, permitiendo el análisis del tumor en tiempo real y que sirve como complemento para las informaciones obtenidas en la biopsia de tejidos convencional. Esta revisión aborda conceptos generales de la biopsia líquida, sus diferentes métodos y los productos que pueden ser detectados, incluyendo células circulantes, ácidos nucleicos (ADN, micro ADN y ARN mensajero tumorales) y exosomas. También se discuten la utilidad de la biopsia líquida como herramienta pronostica, diagnóstica, predictiva y como información para direccionar el tratamiento de acuerdo a la experiencia en estudios de medicina humana, así como también las limitaciones y desafíos de su implementación a gran escala. La biopsia líquida es una herramienta poco conocida en medicina veterinaria, con pocos estudios publicados.(AU)
Assuntos
Animais , Biópsia/métodos , Biópsia/veterinária , Células Neoplásicas Circulantes , DNA de Neoplasias/sangue , RNA Mensageiro , Exossomos , Técnicas e Procedimentos Diagnósticos/veterináriaRESUMO
Liquid biopsies have great promise for precision medicine as they provide information about primary and metastatic tumors via a minimally invasive method. In gastric cancer patients, a large number of blood-based biomarkers have been reported for their potential role in clinical practice for screening, early diagnosis, prognostic evaluation, recurrence monitoring and therapeutic efficiency follow-up. This current review focuses on blood liquid biopsies' role and their clinical implications in gastric cancer patients, with an emphasis on circulating tumor cells (CTCs), circulating tumor DNA (ctDNA) and circulating non-coding RNAs (ncRNAs). We also provide a brief discussion of the potential and limitations of liquid biopsies use and their future use in the routine clinical care of gastric cancer.
RESUMO
The success of immunotherapies brings hope for the future of cancer treatment. Even so, we are faced with a new challenge, that of understanding which patients will respond initially and, possibly, develop resistance. The examination of the immune profile, especially approaches related to the immunoscore, may foretell which tumors will have a positive initial response. Ideally, the mutation load would also be analyzed, helping to reveal tumor associated antigens that are predictive of an effective cytolytic attack. However, the response may be hindered by changes induced in the tumor and its microenvironment during treatment, perhaps stemming from the therapy itself. To monitor such alterations, we suggest that minimally invasive approaches should be explored, such as the analysis of circulating tumor DNA. When testing new drugs, the data collected from each patient would initially represent an N of 1 clinical trial that could then be deposited in large databases and mined retrospectively for trends and correlations between genetic alterations and response to therapy. We expect that the investment in personalized approaches that couple molecular analysis during clinical trials will yield critical data that, in the future, may be used to predict the outcome of novel immunotherapies.
Assuntos
Imunoterapia/tendências , Neoplasias/imunologia , Neoplasias/terapia , Ensaios Clínicos como Assunto , DNA/sangue , Genes cdc , Humanos , Imunoterapia/efeitos adversos , Imunoterapia/métodos , Neoplasias/tratamento farmacológico , Neoplasias/genética , Medicina de Precisão , Microambiente TumoralRESUMO
Background: In a series of 224 patients with advanced renal cell carcinoma (RCC), we have previously reported circulating tumor DNA (ctDNA) detection in 79% of patients. Clinical factors associated with detection are unknown. Methods: Data was obtained from patients with radiographically confirmed stage IV RCC who received ctDNA profiling as a part of routine clinical care using a CLIA-certified platform evaluating 73 genes. Detailed clinical annotation was performed, including assessment of International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk score, previous and current treatments and calculation of tumor burden using scan data most proximal to ctDNA assessment. Tumor burden was equated to the sum of longest diameter (SLD) of all measurable lesions. Results: Thirty-four patients were assessed (18 male and 16 female) with a median age of 62 (range, 34-84). Twenty-six patients, 4 patients and 4 patients had clear cell, sarcomatoid and papillary histologies, respectively. IMDC risk was good, intermediate and poor in 14, 19 and 1 patient, respectively. ctDNA was detected in 18 patients (53%) with a median of 2 genomic alterations (GAs) per patient. No associations were found between IMDC risk, histology or treatment type and presence/absence of ctDNA. However, patients with detectable ctDNA had a higher SLD compared to patients with no detectable ctDNA (8.81 vs 4.49âcm; Pâ=â0.04). Furthermore, when evaluated as a continuous variable, number of GAs was correlated with SLD (Pâ=â0.01). Conclusions: With the caveat of a limited sample size, it appears that SLD (a surrogate for tumor burden) is higher in mRCC patients with detectable ctDNA. Confirmation of these findings in larger series is ongoing and may suggest a capability for ctDNA to either complement or supplant radiographic assessment.
RESUMO
There are very few biomarkers used to diagnose bladder cancer and no clinically approved biomarkers for prediction or prognostication of this disease. All currently available biomarkers are based on urine tests, and thus, they may not be applicable to patients with extravesical tumors. Biopsy of metastatic sites requires an invasive procedure, whereas serum-based markers, which can be easily obtained and serially measured, thus have obvious merit. These deficiencies may be overcome with advances in genome sequencing, identification of circulating tumor cells, and RNA-, protein-, and DNA-based biomarkers. Here, progress in circulating biomarkers in both superficial and invasive bladder cancer is described.