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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 406-407

Authors' reply to Dubey et al. and Bhattacharyya et al.


1 Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
2 Department of Molecular Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
3 Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission06-Apr-2020
Date of Decision12-Apr-2020
Date of Acceptance20-Apr-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_128_20

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How to cite this article:
Kapoor A, Noronha V, Shetty O, Chougule A, Chandrani P, Patil VM, Joshi A, Menon N, Kumar R, Gurav M, Kumar A, Prabhash K. Authors' reply to Dubey et al. and Bhattacharyya et al. Cancer Res Stat Treat 2020;3:406-7

How to cite this URL:
Kapoor A, Noronha V, Shetty O, Chougule A, Chandrani P, Patil VM, Joshi A, Menon N, Kumar R, Gurav M, Kumar A, Prabhash K. Authors' reply to Dubey et al. and Bhattacharyya et al. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Sep 18];3:406-7. Available from: http://www.crstonline.com/text.asp?2020/3/2/406/287205



We thank Dubey et al.[1] for their comments and appreciation of our second article in the Molecular Tumor Board section which focused on the evolution of resistance in anaplastic lymphoma kinase (ALK)-driven non-small-cell lung carcinoma (NSCLC).[2] They pointed out the role of stereotactic body radiotherapy (SBRT) in oligoprogressive disease and the advantage of SBRT to sites of oligoprogression in decreasing the load of the resistant tumor clones and thus providing a window of opportunity to continue the same systemic therapy. In a retrospective study by Gan et al., the median total duration of crizotinib was 28 months for patients who received SBRT for oligoprogressive disease as compared to 10 months in those who progressed and were not suitable for local ablative therapy.[3] In the PROFILE 1014 study, of 25 patients who had intracranial progression alone, 14 received cranial radiotherapy. The median crizotinib duration beyond intracranial progressive disease was 20.4 weeks.[4]

We thank Bhattacharyya et al.[5] for their interest in the article and providing a very important comment on the use of liquid biopsy which can demonstrate more accumulation of ALK mutations during sequential treatment with next-generation ALK inhibitors. The most important advantages of liquid biopsy are that it is noninvasive, easily repeatable, and can provide monitoring for early detection of mutation onset in ALK-driven NSCLC.[6] It is also useful in cases of a lower percentage of tumor cells in biopsied tissue or poor quality of extracted RNA. The commercially available Guardant360 assay utilizes next-generation sequencing to detect alterations in 73 genes from cell-free tumor DNA obtained from blood plasma.[7] Noninvasive versus invasive lung evaluation was a multicenter prospective study which involved 282 patients with newly diagnosed advanced NSCLC.[8] The study's primary endpoint was to identify the proportion of tumor genomic alterations in at least 1 of 7 predictive biomarkers (i.e., EGFR, ALK, ROS1, BRAF, MET, ERBB2, and RET). With the Guardant360 assay and tissue-based genotyping assay, 77 and 60 patients were found to harbor 1 of the 7 genetic alterations, respectively (P < 0.0001). Besides, the study reported concordance between Guardant360 and tissue testing to be >90%. Other salient points of the study were completion of guideline-recommended biomarker testing in 95% of patients with Guardant360 versus 31% with standard-of-care tissue testing besides a turnaround time for the Guardant360 assay being 9 days versus 15 days for the tissue testing. However, it should be noted that in another study published in JAMA Oncology, Torga and Pienta compared two commercially available tests: the Guardant360 from Guardant Health Inc. and PlasmaSELECT-R64 from Personal Genome Diagnostics.[9] These tests sequenced 73 and 64 genes, respectively, to identify the genomic alterations in the blood sample. Interestingly, identical samples from the same blood draw were sent to the two companies for genomic testing. There was a complete match in only 3 of 40 patients, which raises the concern that patients could have been prescribed different treatments based on the commercial provider the physician used for the analysis and not the actual mutation in the tumor itself.[9] This lack of concordance at the cost of around $4000 per analysis seems unjustifiable, especially in our resource-limited settings. It should be understood that though liquid biopsy is a promising technology, it continues to evolve and hopefully will be able to give dependable answers at a more affordable cost in the near future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dubey AP, Swamy S, Rathore A, Kaushik MR. Anaplastic lymphoma kinase-positive metastatic non-small-cell lung cancer: Emerging resistance and treatment options. Cancer Res Stat Treat 2020;3:403-4.  Back to cited text no. 1
  [Full text]  
2.
Kapoor A, Noronha V, Shetty O, Chougule A, Chandrani P, Patil VM, et al. Molecular tumor board: Case 2 – Evolution of resistance in anaplastic lymphoma kinase driven non-small-cell lung carcinoma. Cancer Res Stat Treat 2020;3:89-92.  Back to cited text no. 2
  [Full text]  
3.
Gan GN, Weickhardt AJ, Scheier B, Doebele RC, Gaspar LE, Kavanagh BD, et al. Stereotactic radiotherapy can safely and durably control sites of extra-cns oligoprogressive disease in ALK-positive lung cancer patients on crizotinib. Int J Radiat Oncol Biol Phys 2014;88:892-8.  Back to cited text no. 3
    
4.
Solomon BJ, Cappuzzo F, Felip E, Blackhall FH, Costa DB, Kim DW, et al. Intracranial efficacy of crizotinib versus chemotherapy in patients with advanced ALK-positive non-small-cell lung cancer: Results from PROFILE 1014. J Clin Oncol 2016;34:2858-65.  Back to cited text no. 4
    
5.
Bhattacharyya GS, Agarwala V, Chandrakanth MV. ALK inhibitors fuel ALK-resistance mutation: Precision medicine takes on drug resistance. Cancer Res Stat Treat 2020;3:405-6.  Back to cited text no. 5
  [Full text]  
6.
Hofman P. ALK status assessment with liquid biopsies of lung cancer patients. Cancers (Basel) 2017;9:106.  Back to cited text no. 6
    
7.
Guardant. Available from: https://guardanthealth.com/solutions/. [Last accessed 2020 Apr 05].  Back to cited text no. 7
    
8.
Leighl NB, Page RD, Raymond VM, Daniel BD, Divers SG, Reckamp KL, et al. Clinical utility of comprehensive cell-free DNA analysis to identify genomic biomarkers in patients with newly diagnosed metastatic non-small cell lung cancer. Clin Cancer Res 2019;25:4691-700.  Back to cited text no. 8
    
9.
Torga G, Pienta KJ. Patient-paired sample congruence between 2 commercial liquid biopsy tests. JAMA Oncol 2018;4:868-70.  Back to cited text no. 9
    




 

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