Objective: To evaluate the prognostic significance of detectable circulating cell-free DNA (cfDNA) V600E/K mutations in patients with advanced melanoma enrolled in a clinical trial without -targeted therapy.
Patients And Methods: V600E/K mutation status was determined on archived tissue and pretreatment stored plasma from 149 patients with unresectable stage IV melanoma who were enrolled between May 5, 2010 and May 2, 2014 in the North Central Cancer Treatment Group/Alliance N0879 randomized phase 2 clinical trial. Results were reported as presence or absence of cfDNA V600E/K detection of assay vs tissue. Progression-free survival (PFS) and overall survival (OS) were assessed for patients with and without detectable mutation.
Results: In total, 63 of 149 (42.3%) patients had V600E/K results for tissue and blood, and 20 of 63 (31.7%) patients had tissue-diagnosed mutant . Of these, 11 of 20 (55.0%) patients had detectable plasma cfDNA . Among patients with tissue-mutant V600E/K, PFS and OS were shorter for those with corresponding cfDNA mutations (PFS, 5.8 vs 12.0 months; =.051; OS, 9.2 vs 27.1 months; =.054). Our assay demonstrated sensitivity of 55% (95% CI, 0.322 to 0.768), specificity of 97.7% (95% CI, 0.932 to 1.000), positive predictive value of 91.7% (95% CI, 0.760 to 1.000), and negative predictive value of 82.4% (95% CI, 0.719 to 0.928).
Conclusion: In advanced melanoma, detectable cfDNA V600E/K mutation is present in about half the patients with stage IV with -mutant melanoma tumor tissue and appears to confer a poorer prognosis when detectable. Given the poorer prognosis, cfDNA can be used to risk-stratify patients with metastatic melanoma in practice or clinical trials. clinicaltrials.gov Identifier: NCT00976573.
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| http://dx.doi.org/10.1016/j.mayocpiqo.2021.05.003 | DOI Listing |
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