Early prediction of response to tyrosine kinase inhibitors by quantification of EGFR mutations in plasma of NSCLC patients

Antonio Marchetti, John F. Palma, Lara Felicioni, Tommaso M. De Pas, Rita Chiari, Maela Del Grammastro, Giampaolo Filice, Vienna Ludovini, Alba A. Brandes, Antonio Chella, Francesco Malorgio, Flavio Guglielmi, Michele De Tursi, Armando Santoro, Lucio Crinò, Fiamma Buttitta

Research output: Contribution to journalArticlepeer-review


Introduction: The potential to accurately quantify epidermal growth factor receptor (EGFR) mutations in plasma from non-small-cell lung cancer patients would enable more rapid and more frequent analyses to assess disease status; however, the utility of such analyses for clinical purposes has only recently started to explore. Methods: Plasma samples were obtained from 69 patients with EGFR-mutated tumors and 21 negative control cases. EGFR mutations in plasma were analyzed by a standardized allele-specific polymerase chain reaction (PCR) test and ultra-deep next-generation sequencing (NGS). A semiquantitative index (SQI) was derived from dilutions of known EGFR mutation copy numbers. Clinical responses were evaluated by Response Evaluation Criteria in Solid Tumors 1.1 criteria and expressed as percent tumor shrinkage. Results: The sensitivity and specificity of the PCR test and NGS assay in plasma versus tissue were 72% versus 100% and 74% versus 100%, respectively. Quantitative indices by the PCR test and NGS were significantly correlated (p <0.001). EGFR testing at baseline and serially at 4 to 60 days during tyrosine kinase inhibitor therapy revealed a progressive decrease in SQI, starting from day 4, in 95% of cases. The rate of SQI decrease correlated with percent tumor shrinkage at 2 months (p <0.0001); at 14 days, it was more than 50% in 70% of patients (rapid responders). In two patients with slow response, an early increase in the circulating levels of the T790M mutation was observed. No early T790M mutations were seen in plasma samples of rapid responders. Conclusions: Quantification of EGFR mutations from plasma with a standardized PCR test is feasible. To our knowledge, this is the first study showing a strong correlation between the EGFR SQI in the first days of treatment and clinical response with relevant implications for patient management.

Original languageEnglish
Pages (from-to)1437-1443
Number of pages7
JournalJournal of Thoracic Oncology
Issue number10
Publication statusPublished - Oct 1 2015


  • EGFR mutations
  • Next-generation sequencing
  • Plasma
  • Predictive medicine

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine


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