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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 866-867

Authors' reply to Raja and Suryavanshi


Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission19-Nov-2020
Date of Decision24-Nov-2020
Date of Acceptance24-Nov-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Anuradha Chougule
Medical Oncology Molecular Laboratory, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_354_20

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How to cite this article:
Chougule A, Noronha V, Prabhash K. Authors' reply to Raja and Suryavanshi. Cancer Res Stat Treat 2020;3:866-7

How to cite this URL:
Chougule A, Noronha V, Prabhash K. Authors' reply to Raja and Suryavanshi. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 18];3:866-7. Available from: https://www.crstonline.com/text.asp?2020/3/4/866/305013



We thank Dr. Raja[1] and Dr. Suryavanshi[2] for appreciating our article titled, “Concordance of epidermal growth factor receptor mutation detection in bodily fluids other than blood with tissue biopsy: A retrospective analysis” and providing their valuable inputs for the same.[3],[4]

As mentioned in the article, approximately 15% of the patients at the time of diagnosis and 10%–50% at some point during the course of the disease in the lung develop various malignant fluids such as the cerebrospinal fluid, pleural effusion, and ascites. These bodily fluids have a higher concentration of circulating tumor DNA (ctDNA) than plasma, and therefore, can enable the early detection of mutations like T790M.

In future, brain metastasis will most likely be managed through targeting the tumor-specific molecular pathways such as those associated with angiogenesis, cell adhesion, and blood–brain barrier transgression. The identification of suitable cancer biomarkers through molecular profiling by next-generation sequencing paves the way toward tangible personalized medicine. It allows for longitudinal testing and serial monitoring of treatment response and disease progression.

Several other studies have also shown that ctDNA can be detected with greater sensitivity in other bodily fluids than plasma, which is likely due to the enrichment of the tumor DNA in these bodily fluids.[5] This enrichment could be because of the direct contact between the cancerous cells and the surrounding bodily fluids at the site of metastasis. Moreover, as vascular invasion likely occurs during the later stages of tumorigenesis, it may be responsible for the lower sensitivity of ctDNA detection in plasma.

Liquid biopsy using bodily fluids other than blood has immense potential in large-scale screening of local neoplasms because of the close proximity of these fluids to the tumor, the ease and noninvasive nature of the technique, and its cost-effectiveness. Moreover, the noncancerous DNA inevitably dilutes the ctDNA in the plasma, and this phenomenon may be augmented during inflammation and injury.

In conclusion, our study suggests that tumor DNA circulating in bodily fluids other than blood has the potential to allow for serial sampling and disease monitoring using less invasive techniques and can better represent tumor heterogeneity and response to treatment. Nevertheless, larger prospective studies on patients with advanced non-small cell lung cancer will provide more promising results that will set the footprint to utilize liquid biopsy for molecular profiling in clinical oncology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Raja T. Expanding opportunities in precision oncology. Cancer Res Stat Treat 2020;3:863-4.   Back to cited text no. 1
  [Full text]  
2.
Suryavanshi M. Liquid biopsy of body fluids: A rich resource of genomic information. Cancer Res Stat Treat 20203:864-6.  Back to cited text no. 2
  [Full text]  
3.
Chougule A, Pange P, Kale S, Jagtap V, Nambiar K, Nikam A, et al. Concordance of epidermal growth factor receptor mutation detection in bodily fluids other than blood with tissue biopsy: A retrospective analysis. Cancer Res Stat Treat 2020;3:475-80.  Back to cited text no. 3
  [Full text]  
4.
Addeo A, Friedlaender A. Circulating tumor DNA in non-small-cell lung cancer: A step beyond blood. Cancer Res Stat Treat 2020;3:577-9.  Back to cited text no. 4
  [Full text]  
5.
Villatoro S, Mayo-de-Las-Casas C, Jordana-Ariza N, Viteri-Ramárez S, Garzón-Ibañez M, Moya-Horno I, et al. Prospective detection of mutations in cerebrospinal fluid, pleural effusion, and ascites of advanced cancer patients to guide treatment decisions. Mol Oncol 2019;13:2633-45.  Back to cited text no. 5
    




 

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