Biomarker Discovery and Outcomes for Comprehensive Cell-Free Circulating Tumor DNA Versus Standard-of-Care Tissue Testing in Advanced Non-Small-Cell Lung Cancer.

PURPOSE: Treatment guidelines for advanced non-small-cell lung cancer (aNSCLC) recommend broad molecular profiling for targeted therapy selection. This study prospectively assessed comprehensive next-generation sequencing (NGS) of cell-free circulating tumor DNA (cfDNA) compared with standard-of-care (SOC) tissue-based testing to identify guideline-recommended alterations in aNSCLC. PATIENTS AND METHODS: Patients with treatment-naïve aNSCLC were tested using a well-validated NGS cfDNA panel, and results were compared with SOC tissue testing. The primary objective was noninferiority of cfDNA vs. tissue analysis for the detection of two guideline-recommended biomarkers (EGFR and ALK) and an additional six actionable biomarkers. Secondary analyses included tissue versus cfDNA biomarker discovery, overall response rate (ORR), progression-free survival (PFS) to targeted therapy, and positive predictive value (PPV) of cfDNA. RESULTS: The primary objective was met with cfDNA identifying actionable mutations in 46 patients versus 48 by tissue (P < .05). In total, 0/186 patients were genotyped for all eight biomarkers with tissue, compared with 90.8% using cfDNA. Targetable alterations or KRAS were identified in 80.7% when cfDNA was used first versus 57.1% when tissue was used first. PPV for cfDNA-detected EGFR was 100.0% (25/25). ORR and PFS in patients receiving targeted therapy based on tissue or cfDNA were similar to those previously reported. CONCLUSION: This prospective study confirms a previous report that comprehensive cfDNA testing is noninferior to SOC tissue testing in detecting aNSCLC-recommended biomarkers. Furthermore, cfDNA-based first-line therapy produced outcomes similar to tissue-based testing, demonstrating the clinical utility of comprehensive cfDNA genotyping as the initial genotyping modality in patients with treatment-naïve aNSCLC when tissue is insufficient or when all actionable biomarkers cannot be rapidly assessed.

Non-neural regions of the adult human eye: a potential source of neurons?

PURPOSE: Because it is known that both melanocytes and neurons are generated from neural crest stem cells and their derived precursors, the current study was undertaken to evaluate whether adult human ocular tissues, containing melanocytes, have the capacity to generate neuronlike cells in vitro. METHODS: Choroid and Sclera cells from adult human eyes were separately dissociated and cultivated in the presence of epidermal growth factor and 10% fetal bovine serum. No retinal pigmented epithelial cells were detected. After cell growth, cells were transferred under conditions known to induce neuronal differentiation. Cells were plated on laminin in the presence of fibroblast growth factor-2 or brain-derived neurotrophic factor. RESULTS: Cells derived from the sclera and the choroid of 15 donors proliferated to attain a 10(8)-fold increase in the number of cells within 4 months. At each passage, groups of cells differentiated into cells with neuronal morphology, expressing neuronal markers confirmed by immunocytochemistry and RT-PCR analyses, such as beta-tubulin-III, neurofilament, and tau. Parallel to neuronlike formation, glialike cells, revealed by expression of vimentin and P0, were generated in large amounts. Although, absent from choroid and sclera tissues, nondifferentiated cells appeared in cultures. CONCLUSIONS: The adult human eye conserves cells able to recapitulate certain neural developmental features. This observation opens new perspectives to study human neurogenesis and to provide an important source of neurons for transplantation studies in the retina and other regions of the central nervous system.