Monitoring of cancer patients via next‐generation sequencing of patient‐derived circulating tumor cells and tumor DNA

摘要

Liquid biopsy of circulating tumor cells (CTC) and circulating tumor DNA (ctDNA) is gaining attention as a method for real‐time monitoring in cancer patients. Conventional methods based upon epithelial cell adhesion molecule (EpCAM) expression have a risk of missing the most aggressive CTC subpopulations due to epithelial‐mesenchymal transition and may, thus, underestimate the total number of actual CTC present in the bloodstream. Techniques utilizing a label‐free inertial microfluidics approach (LFIMA) enable efficient capture of CTC without the need for EpCAM expression. In this study, we optimized a method for analyzing genetic alterations using next‐generation sequencing (NGS) of extracted ctDNA and CTC enriched using an LFIMA as a first‐phase examination of 30 patients with head and neck cancer, esophageal cancer, gastric cancer and colorectal cancer (CRC). Seven patients with advanced CRC were enrolled in the second‐phase examination to monitor the emergence of alterations occurring during treatment with epidermal growth factor receptor (EGFR)‐specific antibodies. Using style="fixed-case">LFIMA, we effectively captured style="fixed-case">CTC (median number of style="fixed-case">CTC, 14.5 cells/mL) from several types of cancer and detected missense mutations via style="fixed-case">NGS of style="fixed-case">CTC and ct style="fixed-case">DNA. We also detected time‐dependent genetic alterations that appeared during anti– style="fixed-case">EGFR therapy in style="fixed-case">CTC and ct style="fixed-case">DNA from style="fixed-case">CRC patients. The results of style="fixed-case">NGS analyses indicated that alterations in the genomic profile revealed by the liquid biopsy could be expanded by using a combination of assays with style="fixed-case">CTC and ct style="fixed-case">DNA. The study was registered with the University Hospital Medical Information Network Clinical Trials Registry ( style="fixed-case">ID: style="fixed-case"> UMIN000014095).