Journal
CLINICAL LUNG CANCER
Volume 20, Issue 2, Pages 124-+Publisher
CIG MEDIA GROUP, LP
DOI: 10.1016/j.cllc.2018.11.014
Keywords
CTC; EGFR-TKI; Prediction; Non-small-cell lung cancer
Categories
Funding
- National Natural Science Foundation of China [81672286, 81772467, 81874036]
- Chronic Diseases Program of Shanghai Shen Kang Pharmaceutical Development Co Ltd [SHDC 12015314]
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We prospectively investigated the dynamic monitoring and predictive value of circulating tumor cells (CTCs) in epidermal growth factor receptor (EGFR)-mutated advanced non small-cell lung cancer (NSCLC) patients treated with first-line EGFR tyrosine kinase inhibitors (TKIs). Folate receptor-positive CTC counts can be used for both the dynamic monitoring and prediction of outcome in EGFR-mutated NSCLC patients treated with EGFR-TKIs, which could serve as an alternative or supplement to computed tomographic scanning. Background: There is an urgent need to develop a convenient and less invasive technique to monitor the efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in patients with EGFR-mutated non-smallcell lung cancer (NSCLC). We proposed folate receptor-based assay to count circulating tumor cells (CTCs) to predict and dynamically monitor the therapeutic response to first-line EGFR-TKIs in patients with EGFR-mutated NSCLC. Patients and Methods: Eligible patients were enrolled, and 3 mL of blood was obtained before initial treatment, 1 month after treatment, and every 2 months thereafter. CTCs were isolated on the basis of negative enrichment by immunomagnetic beads and detected by a ligand-targeted PCR method. Results: A total of 232 patients with EGFR-mutated NSCLC and treated with first-line EGFR-TKIs were included. Patients with low baseline CTC count had a markedly longer progression-free survival (hazard ratio = 0.48; P < .001) and overall survival (hazard ratio = 0.52; P =.002) than those with high count. This difference remained significant in multivariate analysis. Dynamic change of CTC count was significantly associated with partial response (P = .042) and stable disease/progressive disease (P = .032). Notably, dynamic monitoring of CTC provided evidence of resistance to EGFR-TKIs before computed tomographic scanning with a median lead time of 113 days (range, 45-169 days). Conclusion: The current evidence suggests that folate receptor-positive CTC counts can be used for both the dynamic monitoring and prediction of outcome in EGFR-mutated NSCLC patients treated with EGFR-TKIs, which could serve as an alternative or supplement to computed tomographic scanning. (C) 2018 Elsevier Inc. All rights reserved.
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