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Clin Cancer Res. 2018 Jun 25. doi: 10.1158/1078-0432.CCR-17-3717. [Epub ahead of print]

TERT Promoter Mutation Detection in Cell-Free Tumor-Derived DNA in Patients with IDH Wild-Type Glioblastomas: A Pilot Prospective Study.

Author information

1
Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Tareq.Juratli@uniklinikum-dresden.de Christian.Thiede@uniklinikum-dresden.de.
2
Department of Medicine I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
3
Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
4
AgenDix GmbH, Dresden, Germany.
5
Institute of Neuroradiology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
6
Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
7
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
8
Neuropathology, Institute of Pathology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
9
German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.
10
Department of Medicine I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Tareq.Juratli@uniklinikum-dresden.de Christian.Thiede@uniklinikum-dresden.de.
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Contributed equally

Abstract

Purpose: We conducted a pilot study to assess the feasibility and the potential implications of detecting TERT promoter (TERTp)-mutant cell-free tumor-derived DNA (tDNA) in the cerebrospinal fluid (CSF) and plasma of glioblastoma patients.Experimental Design: Matched CSF and plasma samples were collected in 60 patients with glial tumors. The CSF collection was obtained during surgery, before any surgical manipulation of the tumor. The extracted tDNA and corresponding tumor DNA samples were analyzed for TERTp and isocitrate dehydrogenase (IDH) hotspot mutations. In addition, the variant allele frequency (VAF) of TERTp mutation in the CSF-tDNA was correlated with tumor features and patients' outcome.Results: Thirty-eight patients had TERTp-mutant/IDH wild-type glioblastomas. The matched TERTp mutation in the CSF-tDNA was successfully detected with 100% specificity (95% CI, 87.6-100%) and 92.1% sensitivity (95% CI, 78.6-98.3%) (n = 35/38). In contrast, the sensitivity in the plasma-tDNA was far lower [n = 3/38, 7.9% (95% CI, 1.6-21.4%)]. We concordantly observed a longer overall survival of patients with low VAF in the CSF-tDNA when compared with patients with high VAF, irrespective of using the lower quartile VAF [11.45%; 14.0 mo. (95% confidence interval, CI, 10.3-17.6) vs. 8.6 mo. (95% CI, 4.1-13.2), P = 0.035], the lower third VAF [13%; 15.4 mo. (95% CI, 11.6-19.2) vs. 8.3 mo. (95% CI, 2.3-14.4), P = 0.008], or the median VAF [20.3%; 14.0 mo. (95% CI, 9.2-18.7) vs. 8.6 mo. (95% CI, 7.5-9.8), P = 0.062] to dichotomize the patients.Conclusions: This pilot study highlights the value of CSF-tDNA for an accurate and reliable detection of TERTp mutations. Furthermore, our findings suggest that high TERTp mutation VAF levels in the CSF-tDNA may represent a suitable predictor of poor survival in glioblastoma patients. Further studies are needed to complement the findings of our exploratory analysis. Clin Cancer Res; 1-10. ©2018 AACR.

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