Presence of circulating tumour DNA in surgically resected renal cell carcinoma is associated with advanced disease and poor patient prognosis

Presence of circulating tumour DNA in surgically resected renal cell carcinoma is associated with advanced disease and poor patient prognosis

abstracts 109P Cell-Free DNA to detect focal versus non-focal MET amplification in metastatic colorectal cancer patients: Combined analysis from Jap...

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109P

Cell-Free DNA to detect focal versus non-focal MET amplification in metastatic colorectal cancer patients: Combined analysis from Japan and the United States

M. Saori1, A. Kawazoe1, Y. Nakamura1, J.I. Odegaard2, M.I. Lefterova2, R. Lanman2, T. Yoshino1, J.H. Strickler3 1 Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan, 2 Clinical Development, Guardant Health, Redwood City, CA, USA, 3Medicine, Duke Cancer Center, Durham, NC, USA Background: MET amplification (amp) is rare in untreated metastatic colorectal cancer (mCRC), but cell-free DNA (cfDNA) analysis identifies it in 20% with anti-EGFR monoclonal antibody (mAb)-refractory disease. CfDNA analysis reveals both focal gene amp and gene copy number gain due to chromosomal aneuploidy (non-focal MET amp). We analyzed cfDNA from Japanese (JPN) and United States (US) patients (pts) with anti-EGFR mAb-refractory mCRC to investigate the prevalence of focal and non-focal MET amp. Methods: We studied MET amp in pts with mCRC in the Nationwide Cancer Genome Screening Project in JPN (GOZILA; UMIN000029315; JPN cohort) and in a phase I/II trial of cabozantinib (C) þ/- panitumumab (P) in pts with RAS wild-type mCRC (NCT02008383; US cohort). MET amp was detected with the Guardant360 assay. Focal MET amp was defined as either the only amp on chromosome (chr) 7q or MET copy number 34. Non-focal MET amp was defined as co-amp with 31 other genes (CDK6 or BRAF) located on chr 7q and MET copy number <4. Results: 244 JPN cohort pts were analyzed from 2/2018-12/2018, and 81 pts in the US cohort, from 8/2014-2/2018. In pts with prior anti-EGFR mAb (JPN: n ¼ 184; US: n ¼ 70), focal and non-focal MET amp were detected in 8 (4.3%) and 30 (16.3%) pts in the JPN cohort, and in 9 (12.9%) and 4 (5.7%) US pts. Without prior anti-EGFR mAb (JPN: n ¼ 60; US: n ¼ 11), focal and non-focal MET amp were detected in 1 (1.7%) and 4 (6.7%) pts in the JPN cohort, and 0 (0%) and 1 (9.1%) US pts. The focal MET amp rate combined was 6.7% (17/254) with prior anti-EGFR mAb. In the US cohort, 4/6 pts with focal MET amp treated with C or CþP had a reduction in RECIST lesions as best response, with one PR, while 2 pts with non-focal MET amp had tumor growth as best response. Conclusions: The prevalence of focal MET amp detected by cfDNA analysis in mCRC pts was similar in the JPN and US cohorts. Given preliminary efficacy results from the US trial, focal MET amp may be a [A1] predictor of benefit from a MET inhibitor. A clinical trial evaluating a MET inhibitor in mCRC pts with focal MET amp is underway. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A. Kawazoe: Honoraria (self), Research grant / Funding (institution): Ono Oharmaceutical; Honoraria (self), Research grant / Funding (institution): Taiho Pharmaceutical; Research grant / Funding (institution): Dainippon Sumitomo Pharma; Research grant / Funding (institution): Takeda Pharmaceutical; Research grant / Funding (institution): Astellas Pharmaceutical; Research grant / Funding (institution): MSD. Y. Nakamura: Research grant / Funding (institution): Ono Pharmaceutical; Research grant / Funding (institution): Taiho

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Pharmaceutical. J.I. Odegaard: Full / Part-time employment: Guardant Health. M.I. Lefterova: Full / Part-time employment: Guardant Health. R. Lanman: Full / Part-time employment: Guardant Health. T. Yoshino: Research grant / Funding (institution): Novartis Pharma K.K.; Research grant / Funding (institution): MSD.K.K.; Research grant / Funding (institution): Sumitomo Dainippon Pharma Co., Ltd.; Research grant / Funding (institution): CHUGAI PHARMACEUTICAL CO., LTD.; Research grant / Funding (institution): Sanofi K.K.; Research grant / Funding (institution): DAIICHI SANKYO COMPANY, LIMITED; Research grant / Funding (institution): PAREXEL International Inc.; Research grant / Funding (institution): ONO PHARMACEUTICAL CO., LTD.. J.H. Strickler: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Amgen; Honoraria (self), Advisory / Consultancy: Bayer; Honoraria (self): Chugai; Honoraria (institution), Advisory / Consultancy, Research grant / Funding (institution): Seattle Genetics; Advisory / Consultancy, Research grant / Funding (institution): Genentech/Roche; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy, Leadership role, Research grant / Funding (institution): OncoMed; Advisory / Consultancy: Celgene; Advisory / Consultancy: Proteus Digital Health; Advisory / Consultancy: Chengdu Kanghong Biotechnology Co., Ltd; Research grant / Funding (institution): Exelixis; Research grant / Funding (institution): Sanofi; Research grant / Funding (institution): Nektar; Research grant / Funding (institution): Abbvie; Research grant / Funding (institution): Gilead Sciences; Research grant / Funding (institution): Macrogenics; Research grant / Funding (institution): Leap Therapeutics; Research grant / Funding (institution): MedImmune. All other authors have declared no conflicts of interest.

110P

Presence of circulating tumour DNA in surgically resected renal cell carcinoma is associated with advanced disease and poor patient prognosis

A. Correa1, D.C. Connolly2, M. Balcioglu3, H-T. Wu3, S. Dashner3, S. Shchegrova3, E. Kalashnikova4, H. Pawar3, R.G. Uzzo5, Y. Gong6, D. Kister5, M. Collins5, M. Donovan5, R. Winters2, A. Aleshin4, H. Sethi3, R. Salari3, M. Louie4, B. Zimmermann3, P. Abbosh7 1 Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA, 2Biosample Repository Facility, Fox Chase Cancer Center, Philadelphia, PA, USA, 3R&D, Natera, Inc., San Carlos, CA, USA, 4Oncology, Natera, Inc., San Carlos, CA, USA, 5Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA, 6Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA, 7Kidney, Bladder, and Prostate Cancer TRDG Member, Fox Chase Cancer Center, Philadelphia, PA, USA Background: Circulating tumor DNA (ctDNA) is a promising, non-invasive biomarker for preclinical detection and monitoring of various cancers. The utility of ctDNA assessment in renal cell carcinoma (RCC) in not well established. Here, we evaluate the potential of a bespoke, multiplex PCR, whole exome sequencing (WES)-based approach for ctDNA detection. Methods: The cohort consisted of 42 patients with stage Ib-IV RCC who underwent complete surgical resection. ctDNA was measured in plasma samples drawn pre-surgery (n ¼ 34; baseline) and at post-operative time points (n ¼ 41) using the bespoke assay targeting patient-specific tumor variants. Results: A median of 11.7 ng (1.4-175 ng) of cfDNA was extracted from a median plasma volume of 3.2 mL (1.2-3.8 mL). ctDNA was detected with a mean mutant molecules/mL of 5.3 (0.22-62). Baseline ctDNA was detected in 41% (14/34) of patients. Presence of ctDNA was significantly associated with increased tumor size (mean 9.7 vs 7.1cm, p < 0.05), advanced tumor stage (stage III-IV vs I-II, p < 0.05) and poorly differentiated tumors (grade III-IV vs II, p < 0.0001). In the postoperative setting, 8/8 ctDNA-positive patients relapsed (positive predictive value (PPV¼100%), while 16/33 ctDNA-negative patients relapsed (NPV¼52%). Positive ctDNA status was associated with reduced relapse-free survival at post-surgical timepoints (HR: 2.8; 95% CI:1.26.6). None of the post-surgical samples from a control cohort of 17 non-relapsing patients were ctDNA-positive (specificity of 100%; median follow up of 64 months). Conclusions: Presence of presurgical ctDNA strongly correlates with advanced stage RCC. Despite low plasma volumes, the bespoke assay detected ctDNA in 41% of baseline samples. Postoperative ctDNA presence is correlated with clinical relapse. However, absence of ctDNA does not preclude recurrence as RCC is known to shed limited amounts of ctDNA. Higher sample volumes and multiregion tumor biopsies could enhance detection rates. This personalized approach has the potential to be used for ctDNA-based detection of relapse in patients with advanced stage RCC. Legal entity responsible for the study: Natera, Inc.; Fox Chase Cancer Center. Funding: Natera, Inc.; Fox Chase Cancer Center. Disclosure: M. Balcioglu: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. H. Wu: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/ options to stock.: Natera, Inc. S. Dashner: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. S. Shchegrova: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. E. Kalashnikova: Full / Part-time employment: Natera, Inc. H. Pawar: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. R.G. Uzzo: Advisory / Consultancy: Janssen; Advisory / Consultancy: Pfizer; Advisory / Consultancy: Novartis; Advisory / Consultancy: Argos. A. Aleshin: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. H. Sethi: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. R. Salari: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. M. Louie: Shareholder / Stockholder / Stock options, Full / Part-time employment, I am an employee of Natera and own stock/ options to stock.: Natera, Inc. B. Zimmermann: Shareholder / Stockholder / Stock options, Full / Parttime employment, I am an employee of Natera and own stock/options to stock.: Natera, Inc. P. Abbosh: Advisory / Consultancy, Advisory: Janssen; Advisory / Consultancy, Advisory: AstraZeneca. All other authors have declared no conflicts of interest.

Volume 30 | Supplement 5 | October 2019

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Honoraria (self): Lilly; Honoraria (self): Teijin Pharma; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Shire; Honoraria (self), Research grant / Funding (institution): Ono Pharmaceutical; Honoraria (self), Research grant / Funding (institution): Merck Serono; Research grant / Funding (institution): Daiichi Sankyo; Research grant / Funding (institution): Eisai; Research grant / Funding (institution): MSD; Research grant / Funding (institution): NanoCarrier; Research grant / Funding (institution): Dainippon Sumitomo Pharma; Research grant / Funding (institution): Incyte; Research grant / Funding (institution): ASLAN Pharmaceuticals. T. Nishina: Honoraria (self), Research grant / Funding (institution): Taiho pharmaceutinal; Honoraria (self), Research grant / Funding (institution): Chugai Pharma; Honoraria (self), Research grant / Funding (self): Merck Serono; Honoraria (self), Research grant / Funding (institution): Bristol-Myers Suibb; Honoraria (self): Nihonkayaku; Honoraria (self), Research grant / Funding (institution): Lilly Japan; Honoraria (self), Research grant / Funding (institution): Ono Pharmaceutical; Research grant / Funding (institution): Dainippon Sumitomo Pharma; Research grant / Funding (institution): MSD; Research grant / Funding (institution): Diichi Sankyo. E. Oki: Speaker Bureau / Expert testimony: Taiho Pham; Speaker Bureau / Expert testimony: Yakult Honsha; Speaker Bureau / Expert testimony: Merck; Speaker Bureau / Expert testimony: Chugai Pham; Speaker Bureau / Expert testimony: Takeda Pharm; Speaker Bureau / Expert testimony: Eli Lilly; Speaker Bureau / Expert testimony: Bayer. T. Denda: Speaker Bureau / Expert testimony: DAIICHI SANKYO COMPANY, LIMITED. T. Mizukami: Advisory / Consultancy, Speaker Bureau / Expert testimony, Research grant / Funding (institution): Eli Lilly Japan; Advisory / Consultancy: Bristol-Myers Squibb Company; Speaker Bureau / Expert testimony: Takeda Pharmaceutical; Research grant / Funding (institution): TAIHO Pharmaceutical. N. Okano: Honoraria (self): Taiho Pharmaceutical; Honoraria (self): Merck Serono; Honoraria (self): Eisai; Honoraria (self): Ono Pharmaceutical; Honoraria (self): Yakult Honsha; Honoraria (self): Takeda; Honoraria (self): J-Pharma; Honoraria (self): Kyowa Hakko Kirin. M.I. Lefterova: Shareholder / Stockholder / Stock options, Full / Part-time employment: Guardant Health. J.I. Odegaard: Shareholder / Stockholder / Stock options, Full / Part-time employment: Guardant Health. H. Taniguchi: Honoraria (self): Chugai; Honoraria (self), Research grant / Funding (self): Takeda; Honoraria (self): Taiho; Honoraria (self): Eli Lilly; Research grant / Funding (self): Daiichi-Sankyo; Research grant / Funding (self): Sysmex. C. Morizane: Honoraria (self), Research grant / Funding (institution): Pfizer; Honoraria (self), Advisory / Consultancy: Novartis; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Yakult Honsha; Honoraria (self): Lilly; Honoraria (self), Research grant / Funding (institution): Nobelpharma; Honoraria (self): Fujifilm; Honoraria (self): Teijin Pharma; Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Taiho Pharmaceutical; Honoraria (self), Research grant / Funding (institution): Eisai; Advisory / Consultancy: Abbvie; Research grant / Funding (institution): ONO PHARMACEUTICAL; Research grant / Funding (institution): J-Pharma. T. Yoshino: Research grant / Funding (self): Novartis Pharma K.K.; Research grant / Funding (self): MSD.K.K.; Research grant / Funding (self): Sumitomo Dainippon Pharma Co., Ltd.; Research grant / Funding (self): CHUGAI PHARMACEUTICAL Co., Ltd.; Research grant / Funding (self): Sanofi K.K.; Research grant / Funding (self): DAIICHI SANKYO Co., Ltd.; Research grant / Funding (self): PAREXEL International Inc.; Research grant / Funding (self): ONO PHARMACEUTICAL Co., Ltd. All other authors have declared no conflicts of interest.

Annals of Oncology