The Added Value of Baseline Circulating Tumor DNA Profiling in Patients with Molecularly Hyperselected, Left-sided Metastatic Colorectal Cancer

Purpose: The routine use of liquid biopsy is not recommended
for the choice of initial treatment for patients with metastatic
colorectal cancer (mCRC).
Experimental Design: We included patients with left-sided,
RAS/BRAF wild-type, HER2-negative, and microsatellite stable
mCRC, treated with upfront panitumumab/FOLFOX-4 in the
Valentino study. We performed amplicon-based genomic profiling
of 14 genes in baseline plasma samples and compared these data
with tumor tissue ultra-deep sequencing results. Specific gene
mutations in circulating tumor DNA (ctDNA) and their clonality
were associated with progression-free survival (PFS), overall
survival (OS), and radiological dynamics.
Results: Ten and 15 of 120 patients had a mutation of RAS and
PIK3CA in ctDNA, with a positive concordance with tissue deep
sequencing of only 31.3% and 47.1%, respectively. Presence of
RAS or PIK3CA mutations in baseline ctDNA was associated
with worse median PFS [8 vs. 12.8 months; HR, 2.49; 95%
confidence interval (CI), 1.28–4.81; P ¼ 0.007 and 8.5 vs.
12.9 months; HR, 2.86; 95% CI, 1.63–5.04; P < 0.001] and
median OS (17.1 vs. 36.5 months; HR, 2.26; 95% CI, 1.03–
4.96; P ¼ 0.042 and 21.1 vs. 38.9 months; HR, 2.18; 95% CI,
1.16–4.07; P ¼ 0.015). RAS mutations in ctDNA were associated
with worse RECIST response, early tumor shrinkage, and depth
of response, while PIK3CA mutations were not. Patients with
higher levels of RAS/PIK3CA variant allele fraction (VAF) in
ctDNA had the worst outcomes (VAF ≥ 5% vs. all wild-type:
median PFS, 7.7 vs. 13.1 months; HR, 4.02; 95% CI, 2.03–7.95;
P < 0.001 and median OS, 18.8 vs. 38.9 months; HR, 4.07; 95%
CI, 2.04–8.12; P < 0.001).
Conclusions: Baseline ctDNA profiling may add value to tumor
tissue testing to refine the molecular hyperselection of patients with
mCRC for upfront anti-EGFR–based strategies