January 26, 2015 | by Nicole White
As treatments for lung cancer become more targeted and effective, the need for better technology to detect lung cancer mutations becomes increasingly important. A new clinical study at City of Hope is examining the feasibility of using blood and urine tests to detect lung cancer mutations, potentially allowing for targeted cancer treatments without an invasive biopsy.
The trial, a collaboration with Trovagene Inc., focuses specifically on mutations that make EGFR proteins (for epidermal growth factor receptor) grow and divide faster than they should. The protein is normally found on the surface of cells, but nonsmall cell lung cancer cells can have too much of this protein.
Sometimes, a patient can require two procedures to obtain an adequate biopsy that determines the presence of EGFR mutation. In this first clinical study, patients who have been biopsied will also get specific blood and urine tests to determine if those tests are as effective as a traditional biopsy to determine an EGFR mutation.
“Tracking various alterations in the EGFR oncogene has potential to improve therapeutic strategies for treating patients with nonsmall cell lung cancer,” said Mihaela Cristea, M.D., lead investigator and associate professor in City of Hope's Lung Cancer and Thoracic Oncology Program. “We look forward to evaluating Trovagene’s molecular diagnostics for the monitoring of circulating tumor DNA found in both urine and blood, with the goal of delivering highly personalized cancer treatment to improve patient outcomes.”
The clinical study is expected to enroll 75 patients with lung cancer. The main objective of the study is to determine if the combined tests are effective in identifying EGFR mutations using circulating tumor DNA in the blood and urine when compared to using tumor tissue. Additionally, study investigators will use urine and blood specimens to see if they can measure response to therapy over time. Investigators are also hoping the tests will be able to identify a specific mutation known as T790M that drives treatment resistance in nonsmall cell lung cancer patients.
The EGFR mutation is a fairly common one in lung cancer – and tends to affect nonsmokers who get lung cancer. For example, among Chinese patients with lung cancer who were never-smokers, as many as 60 percent have this specific mutation. In Caucasian never-smokers, the mutation appears in about 20 percent of patients.
“This is a first step in the right direction,” Cristea said. “We hope that we prove this test is effective enough to warrant larger studies. In the future, we hope, for lung cancer and other cancers, we can detect these mutations in blood and urine, saving people the trouble of biopsies."
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