Combined genomic and epigenomic assessment of cell-free circulating tumor DNA (cfDNA) for cancer diagnosis and recurrence-risk assessment in early-...

Date 30 September 2019
Event ESMO 2019 Congress
Session Poster Display session 3
Topics Translational Research
Thoracic Malignancies
Presenter Junghee Lee
Citation Annals of Oncology (2019) 30 (suppl_5): v25-v54. 10.1093/annonc/mdz239
Authors J. Lee1, I. Kim2, J.H. Cho1, H.K. Kim1, J. Lee3, S. Lee4, M. Shultz2, A. Jaimovich2, J. Odegaard2, S. Olsen2, A. Talasaz2, J. Kim1
  • 1Department Of Thoracic And Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351 - Seoul/KR
  • 2Guardant Health, Inc., 94063 - Redwood City/US
  • 3Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351 - Seoul/KR
  • 4Division Of Hematology-oncology, Department Of Medicine, Samsung Medical Center, Seoul/KR



Circulating tumor DNA (ctDNA) analysis has been successfully applied to therapy selection and treatment monitoring in advanced cancer patients. However, it is not yet established whether ctDNA can be used clinically for early cancer detection or recurrence prediction in early stage lung cancer patients.


We analyzed pre-operative plasma samples from 55 early stage NSCLC patients (stages I-IIIA) using next-generation sequencing assay incorporating somatic and epigenomic analysis, and a bioinformatic classifier to filter non-tumor derived variants.Table: 111P

Cell typeStageSomatic mutationEpigenetic patternTotal numberRecurrence+, n (%)Site of recurrence
Adenocarcinomastage 1ctDNA-methylation-91 (11)Lung
n = 17methylation+62 (33.3)Stump, bone
ctDNA+21 (50)lung
stage 2ctDNA-methylation-00 (0)
n = 2methylation+00(0)
ctDNA+11 (100)multiple
stage 3ctDNA-methylation-00 (0)
n = 4methylation+20 (0)
ctDNA+22 (100)brain, multiple
Sqaumous cell carcinomastage1ctDNA-methylation-00 (0)
n = 7methylation+30 (0)
ctDNA+41 (25)multiple
stage2ctDNA-methylation-00 (0)
n = 9methylation+00 (0)
ctDNA+92 (22.2)multiple, lung
stage3ctDNA-methylation-00 (0)
n = 4methylation+10 (0)
ctDNA+31 (33.3)Mediastinal LNs


Somatic mutation analysis alone detected ctDNA in 42% (23/55) of patients, whereas combined mutational and epigenomic analysis detected ctDNA in 67% (37/55). ctDNA detection rate varied by pathological subtypes; using combined approach, ctDNA was detected in all squamous cell carcinoma patients, while only 55% (12/22) in adenocarcinoma (ADC) (p=0.006). Within the ADC subgroup, ctDNA detection rates using the combined approach were dependent on disease stage: 47% (8/17) in stage I, 100% (2/2) in stage II, and 100% (2/2) in stage IIIA. Importantly, within 2 years of follow-up, pre-operative ctDNA status was correlated with tumor recurrence after resection; among 17 stage I ADC patients, three of eight (38%) ctDNA-positive cases showed recurrence, while only one of nine (11%) ctDNA-negative cased did (p=0.29). Interestingly, patients with somatic mutation in their ctDNA have shown higher recurrence rate.


Utilizing a plasma-only sequencing assay incorporating somatic genomic and epigenomic analysis, ctDNA detection rate in early stage lung cancer (stage I-III) can far outperform the detection rate of somatic sequence variant detection alone. And, the presence of pre-operative ctDNA in patients with early stage lung adenocarcinoma may identify those who are more likely to have disease recurrence.

Legal entity responsible for the study: Guradant Health, Inc.

Clinical trial identification

Editorial acknowledgement


Guardant Health, Redwood City, CA, USA.


I. Kim: Full / Part-time employment, Officer / Board of Directors: Guardant Health. M. Shultz: Officer / Board of Directors: Guardant Health. A. Jaimovich: Officer / Board of Directors: Guardant Health. J. Odegaard: Officer / Board of Directors: Guardant health, Inc. S. Olsen: Officer / Board of Directors: Guardant Health, Inc. A. Talasaz: Officer / Board of Directors: Guardant health. J. Kim: Research grant / Funding (self): Guardant health, Inc. All other authors have declared no conflicts of interest.