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Experts: Circulating tumor DNA may guide therapy for HCC

In a recently released editorial, experts speculated on whether the results of a Japanese study could have implications for circulating tumor DNA serving as a biomarker and guiding care of patients with hepatocellular carcinoma.

In the study, Japanese researchers found that circulating tumor DNA in a patient’s bloodstream may assist doctors in determining the rate for recurrence after surgery and determine personalized treatment for HCC.

In the accompanying editorial, Larissa V. Furtado, MD, director of clinical genomics and molecular diagnostics laboratories, University of Chicago Medical Center, and Jeremy P. Segal, MD, PhD, assistant director, division of genomic and molecular pathology, University of Chicago Medical Center, stated the data of Chayama and colleagues has important implications.

Larissa V. Furtado

“It is apparent that [circulating tumor] DNA levels reflect the cancer progression and therapy effects on HCC and that the TACE procedure is capable of enriching [circulating tumor] DNA in cell-free DNA in blood,” the authors of the editorial wrote. “These data demonstrate the potential utility of [circulating tumor] DNA as a biomarker for individualized management of [HCC]. With further validation, the determination of HCC genome profiles through [circulating tumor] DNA analysis may help guide individualized therapy selection and monitoring without requiring percutaneous biopsies.”

Jeremy P. Segal

In a new press release, Kazuaki Chayama, MD, PhD, department of gastroenterology and metabolism, Institute of Biomedical and Health Sciences, Hiroshima University, said: “Doctors need noninvasive methods that will allow them to safely study cancer progression and characterize the genomic features of a patient's tumor. … Testing for these circulating DNA fragments may be a much easier and safer way of doing this than conventional liver biopsy.”

Chayama and colleagues from Hiroshima University, RIKEN Center for Integrative Medical Sciences and the University of Tokyo investigated whether circulating tumor DNA (ctDNA) was detectable among 46 patients with HCC who underwent hepatectomy or liver transplantation. The researchers then used personally designed assays to target somatic rearrangements of each tumor to measure ctDNA.

Kazuaki Chayama

CtDNA was detected in 100 μL of serum samples in seven of 46 patients before surgery, which increased with disease progression.

Among the patients with positive ctDNA, the cumulative incidence of recurrence and extrahepatic metastasis within 2 years after hepatic resection were worse (P = .0102) compared with patients without detectable ctDNA (P = .0386).

“We found that the level of ctDNA correlated with progression of HCC and the treatment,” Chayama said.

Eleven patients had HCC with microscopic vascular invasion to portal vein (VP). Multivariate analysis showed ctDNA to be the only independent predictor of VP (OR = 6.10; 95% CI, 1.11–33.33; P = .038).

Chayama and colleagues concluded: “The presence of ctDNA reflects tumor progression, and detection of ctDNA can predict VP and recurrence, especially extrahepatic metastasis within 2 years. Our study demonstrated the usefulness of ctDNA detection and sequencing analysis of cell-free DNA for personalized treatment of liver cancer.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.