Abstract | BACKGROUND: A clinical assay was implemented to perform next-generation sequencing (NGS) of genes commonly mutated in multiple cancer types. This report describes the feasibility and diagnostic yield of this assay in 381 consecutive patients with non-small cell lung cancer (NSCLC). METHODS: Clinical targeted sequencing of 23 genes was performed with DNA from formalin-fixed, paraffin-embedded (FFPE) tumor tissue. The assay used Agilent SureSelect hybrid capture followed by Illumina HiSeq 2000, MiSeq, or HiSeq 2500 sequencing in a College of American Pathologists-accredited, Clinical Laboratory Improvement Amendments-certified laboratory. Single- nucleotide variants and insertion/deletion events were reported. This assay was performed before methods were developed to detect rearrangements by NGS. RESULTS: Two hundred nine of all requisitioned samples (55%) were successfully sequenced. The most common reason for not performing the sequencing was an insufficient quantity of tissue available in the blocks (29%). Excisional, endoscopic, and core biopsy specimens were sufficient for testing in 95%, 66%, and 40% of the cases, respectively. The median turnaround time (TAT) in the pathology laboratory was 21 days, and there was a trend of an improved TAT with more rapid sequencing platforms. Sequencing yielded a mean coverage of 1318×. Potentially actionable mutations (ie, predictive or prognostic) were identified in 46% of 209 samples and were most commonly found in KRAS (28%), epidermal growth factor receptor (14%), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (4%), phosphatase and tensin homolog (1%), and BRAF (1%). Five percent of the samples had multiple actionable mutations. A targeted therapy was instituted on the basis of NGS in 11% of the sequenced patients or in 6% of all patients. CONCLUSIONS: NGS-based diagnostics are feasible in NSCLC and provide clinically relevant information from readily available FFPE tissue. The sample type is associated with the probability of successful testing.
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Authors | Ian S Hagemann, Siddhartha Devarakonda, Christina M Lockwood, David H Spencer, Kalin Guebert, Andrew J Bredemeyer, Hussam Al-Kateb, TuDung T Nguyen, Eric J Duncavage, Catherine E Cottrell, Shashikant Kulkarni, Rakesh Nagarajan, Karen Seibert, Maria Baggstrom, Saiama N Waqar, John D Pfeifer, Daniel Morgensztern, Ramaswamy Govindan |
Journal | Cancer
(Cancer)
Vol. 121
Issue 4
Pg. 631-9
(Feb 15 2015)
ISSN: 1097-0142 [Electronic] United States |
PMID | 25345567
(Publication Type: Journal Article)
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Copyright | © 2014 American Cancer Society. |
Chemical References |
- DNA, Neoplasm
- Fixatives
- KRAS protein, human
- Proto-Oncogene Proteins
- Formaldehyde
- BRAF protein, human
- Proto-Oncogene Proteins B-raf
- Proto-Oncogene Proteins p21(ras)
- ras Proteins
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Topics |
- Adult
- Aged
- Carcinoma, Non-Small-Cell Lung
(diagnosis, genetics)
- DNA, Neoplasm
(analysis)
- Feasibility Studies
- Female
- Fixatives
- Formaldehyde
- Gene Deletion
- High-Throughput Nucleotide Sequencing
- Humans
- Lung Neoplasms
(diagnosis, genetics)
- Male
- Middle Aged
- Mutagenesis, Insertional
- Paraffin Embedding
- Polymorphism, Single Nucleotide
- Proto-Oncogene Proteins
(genetics)
- Proto-Oncogene Proteins B-raf
(genetics)
- Proto-Oncogene Proteins p21(ras)
- Sequence Analysis, DNA
(methods)
- ras Proteins
(genetics)
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