Personalized Cancer Monitoring Assay for the Detection of ctDNA in Patients with Solid Tumors.

BACKGROUND: Highly sensitive molecular assays have been developed to detect plasma-based circulating tumor DNA (ctDNA), and emerging evidence suggests their clinical utility for monitoring minimal residual disease and recurrent disease, providing prognostic information, and monitoring therapy responses in patients with solid tumors. The Invitae Personalized Cancer Monitoring™ assay uses a patient-specific, tumor-informed variant signature identified through whole exome sequencing to detect ctDNA in peripheral blood of patients with solid tumors. METHODS: The assay's tumor whole exome sequencing and ctDNA detection components were analytically validated using 250 unique human specimens and nine commercial reference samples that generated 1349 whole exome sequencing and cell-free DNA (cfDNA)-derived libraries. A comparison of tumor and germline whole exome sequencing was used to identify patient-specific tumor variant signatures and generate patient-specific panels, followed by targeted next-generation sequencing of plasma-derived cfDNA using the patient-specific panels with anchored multiplex polymerase chain reaction chemistry leveraging unique molecular identifiers. RESULTS: Whole exome sequencing resulted in overall sensitivity of 99.8% and specificity of > 99.9%. Patient-specific panels were successfully designed for all 63 samples (100%) with ≥ 20% tumor content and 24 (80%) of 30 samples with ≥ 10% tumor content. Limit of blank studies using 30 histologically normal, formalin-fixed paraffin-embedded specimens resulted in 100% expected panel design failure. The ctDNA detection component demonstrated specificity of > 99.9% and sensitivity of 96.3% for a combination of 10 ng of cfDNA input, 0.008% allele frequency, 50 variants on the patient-specific panels, and a baseline threshold. Limit of detection ranged from 0.008% allele frequency when utilizing 60 ng of cfDNA input with 18-50 variants in the patient-specific panels (> 99.9% sensitivity) with a baseline threshold, to 0.05% allele frequency when using 10 ng of cfDNA input with an 18-variant panel with a monitoring threshold (> 99.9% sensitivity). CONCLUSIONS: The Invitae Personalized Cancer Monitoring assay, featuring a flexible patient-specific panel design with 18-50 variants, demonstrated high sensitivity and specificity for detecting ctDNA at variant allele frequencies as low as 0.008%. This assay may support patient prognostic stratification, provide real-time data on therapy responses, and enable early detection of residual/recurrent disease.

Tracking early lung cancer metastatic dissemination in TRACERx using ctDNA.

Circulating tumour DNA (ctDNA) can be used to detect and profile residual tumour cells persisting after curative intent therapy1. The study of large patient cohorts incorporating longitudinal plasma sampling and extended follow-up is required to determine the role of ctDNA as a phylogenetic biomarker of relapse in early-stage non-small-cell lung cancer (NSCLC). Here we developed ctDNA methods tracking a median of 200 mutations identified in resected NSCLC tissue across 1,069 plasma samples collected from 197 patients enrolled in the TRACERx study2. A lack of preoperative ctDNA detection distinguished biologically indolent lung adenocarcinoma with good clinical outcome. Postoperative plasma analyses were interpreted within the context of standard-of-care radiological surveillance and administration of cytotoxic adjuvant therapy. Landmark analyses of plasma samples collected within 120 days after surgery revealed ctDNA detection in 25% of patients, including 49% of all patients who experienced clinical relapse; 3 to 6 monthly ctDNA surveillance identified impending disease relapse in an additional 20% of landmark-negative patients. We developed a bioinformatic tool (ECLIPSE) for non-invasive tracking of subclonal architecture at low ctDNA levels. ECLIPSE identified patients with polyclonal metastatic dissemination, which was associated with a poor clinical outcome. By measuring subclone cancer cell fractions in preoperative plasma, we found that subclones seeding future metastases were significantly more expanded compared with non-metastatic subclones. Our findings will support (neo)adjuvant trial advances and provide insights into the process of metastatic dissemination using low-ctDNA-level liquid biopsy.

Sociality, exotic ectoparasites, and fitness in the plural breeding rodent Octodon degus.

Social animals are susceptible to high infection levels by contact-transmitted parasites due to increased conspecific interaction. Exotic parasites are known to have adverse consequences on native hosts. We examined the relationship between social group size and exotic ectoparasite loads, and adult infection levels with per capita fitness and offspring survival in the plural breeding rodent Octodon degus in central Chile. Degus at our site were almost entirely infected by two exotic ectoparasites: the fleas Leptopsylla segnis and Xenopsylla cheopis. Neither group size nor number of females per group predicted the abundance of either exotic flea species. The per capita number of pups (per capita fitness) that emerged from burrow systems used by known social groups was negatively correlated with abundance of L. segnis but not X. cheopis. On adults, X. cheopis abundance was three times greater than L. segnis but was not significantly correlated with per capita fitness. In females, L. segnis abundance was negatively correlated with peak body mass during pregnancy. Adult ectoparasite load was not correlated with offspring survival. Based on these results, we hypothesize that high infection levels of L. segnis result in decreased reproductive fitness of adult female degus but are not a cost of sociality because parasite loads are not predicted by social group size. Further work is needed to experimentally test this hypothesis and to determine if L. segnis serves as a vector for a deleterious pathogen. Lastly, the lack of native ectoparasites may explain why a previous study at our site determined that behavioral adaptations needed to cope with high ectoparasite burdens (e.g., grooming) are not extensive in degus; they simply have not had the coevolutionary time needed for selection of these behaviors.

Burrow limitations and group living in the communally rearing rodent, Octodon degus.

Group living is thought to evolve whenever individuals attain a net fitness advantage due to reduced predation risk or enhanced foraging efficiency, but also when individuals are forced to remain in groups, which often occurs during high-density conditions due to limitations of critical resources for independent breeding. The influence of ecological limitations on sociality has been studied little in species in which reproduction is more evenly shared among group members. Previous studies in the caviomorph rodent Octodon degus (a New World hystricognath) revealed no evidence that group living confers an advantage and suggest that burrow limitations influence formation of social groups. Our objective was to examine the relevance of ecological limitations on sociality in these rodents. Our 4-year study revealed no association between degu density and use of burrow systems. The frequency with which burrow systems were used by degus was not related to the quality of these structures; only in 1 of the 4 years did the frequency of burrow use decrease with decreasing abundance of food. Neither the number of females per group nor total group size (related measures of degu sociality) changed with yearly density of degus. Although the number of males within social groups was lower in 2008, this variation was not related clearly to varying density. The percentage of females in social groups that bred was close to 99% and did not change across years of varying density. Our results suggest that sociality in degus is not the consequence of burrow limitations during breeding. Whether habitat limitations contribute to variation in vertebrate social systems is discussed.

Seasonal variation in the range areas of the diurnal rodent Octodon degus.

Both breeding activity and abundance and quality of available food are expected to influence daily movements of animals. Animals are predicted to range over large areas to meet high energy demands associated with reproduction (females) or to increase mating success (males). However, animals should expand their range areas whenever food conditions deteriorate. To examine the extent to which breeding activity versus food availability influence space use, we compared the size and location of range areas (home ranges) of the degu (Octodon degus), a diurnal rodent from semiarid environments of north-central Chile, during the austral winter and summer seasons. Degus produce young during the austral spring (September-October) when high-quality food is readily available. In contrast, degus do not breed during the austral summer (January-March) when food is scarce and of low quality. We predicted that degus would range over smaller areas in winter if the availability of food has a greater influence on space than breeding activity. Individuals were radiotracked in winter and the following summer over a 3-year period. Surveys of herbaceous cover were conducted during winter and summer to determine seasonal changes in the abundance and quality of primary food. In summer degus expanded and moved the location of their range areas to locations with available food. Given that preferred food was less abundant in summer than winter, we suggest that degu range areas are strongly influenced by food conditions.