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Biopsie Liquide Récapitulatif Des Études Cliniques Réalisées

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Biopsie Liquide Récapitulatif Des Études Cliniques Réalisées Biopsie Liquide Récapitulatif des études cliniques réalisées Dr. Tarik MARZOUKI [email protected] Publications et Etudes cliniques réalisées Dr. Tarik MARZOUKI France Communiqué de presse du CHU DE LYON Communiqué du CHU DE LYON Hospices Civils de Lyon - mardi 03 mai 2016 Cancer du poumon : une simple prise sang remplace la biopsie Etablir un diagnostic, affiner le traitement, accéder à des thérapies ciblées plus efficaces, la biopsie de la tumeur ou d’une de ses métastases a longtemps été considérée comme une pièce maîtresse du traitement. Mais ce geste restait complexe, invasif et douloureux surtout quand il était pratiqué de manière répétée, particulièrement chez des patients fragiles et/ou âgés. De plus, l’échantillon prélevé était parfois de trop petite taille pour permettre des analyses moléculaires approfondies. Grâce aux nouvelles techniques de biologie moléculaire, élaborées par le CHU de Lyon, il est désormais possible de retrouver de petites quantités de fragments d’ADN de la tumeur dans le sang. Pour certains cancers du poumon, les équipes du CHU de Lyon repèrent désormais dans une simple prise de sang certaines mutations et sont capables d’analyser les caractéristiques du cancer en évitant au patient une nouvelle biopsie : c’est la biopsie liquide. Pour que chaque patient de la région bénéficie de cette innovation, un réseau de prescripteurs a été déployé en Auvergne-Rhône- Alpes. Depuis novembre 2015, près de 120 prélèvements issus de cancer du poumon ont été pris en charge par les HCL dont la moitié proviennent des établissements publics et privés hors HCL. Ce projet a reçu le financement Innov’RA 2016 du Cancéropôle Régional CLARA. Outre le cancer du poumon, cette biopsie du futur devrait bientôt être indiquée dans la plupart des cancers. Actuellement, elle est testée dans lest umeurs neuroendocrines et les cancers du côlon. La biopsie liquide a été conçue dans le cadre du projet CIRCAN (CIRculating CANcer) Portée par le CHU de Lyon, CIRCAN veut accélérer le transfert entre la recherche sur les biomarqueurs circulant du cancer et leur utilisation en pratique. Ce programme innovant dispose de moyens de séquençage de nouvelle génération, de techniques de PCR digitale, d’un personnel spécialement formé. Il s’appuie sur les compétences d’un conseil scientifique multidisciplinaire. L’initiative est soutenue par l’Institut de Cancérologie des Hospices Civils de Lyon. CIRCAN a récemment conclu un partenariat exclusif en France avec une société américaine pour la mise à disposition de la méthode de biologie moléculaire appelée PCR (Réaction en Chaîne par Polymérase) digitale optimisée (BEAMing). La livraison de l’automate est prévue fin avril 2016. Contact : Hospices civils de Lyon Mme Marion Chereul, Directeur de Cabinet et de la Communication . Tel : 0825 0825 69 Email : [email protected] Site : http://www.chu-lyon.fr Standard : 0820 0820 69 France Institut Curie Pr Jean Yves Pierga Chef de département de l’oncologie médical Pr Jean-Yves Pierga. Chef de département de l’oncologie médicale Institut Curie-France La détection de ’ADN tumoral circulant dans le sang "l’équivalent d’une biopsie liquide", prend également de plus en plus d’importance. Les cellules cancéreuses, comme n’importe quelle cellule, se dégradent naturellement au fil du temps. Ce faisant, elles laissent s’échapper une partie de leur matériel génétique dans le sang. Si l’on parvient à identifier cet ADN tumoral circulant, on peut affirmer qu’une tumeur cancéreuse se trouve quelque part dans l’organisme. Cela pourrait aussi permettre de suivre l’évolution de la masse tumorale ou de rechercher l’apparition de marqueurs de résistance au traitement. Toute la difficulté consiste à identifier cet ADN circulant comme tumoral. Pour ce faire, il faut repérer les anomalies génétiques typiques de la tumeur. Pour le Pr. Jean-Yves Pierga, "Au-delà d’être moins invasive, moins douloureuse et plus économique, la recherche des anomalies dans l’ADN tumoral circulant est une alternative fiable aux biopsies classiques parfois peu réalisables (surtout au niveau pulmonaire ou de certaines métastases). Les équipes de Marc-Henri Stern et Olivier Lantz ont montré pour la première fois qu’il était possible de détecter de l’ADN tumoral circulant dans le sang de patients atteints de mélanome de l’œil métastatique. Sa présence révèle l’existence d’une tumeur et sa quantité reflète sa taille: ceci en fait un nouveau biomarqueur susceptible de repérer très tôt la présence d’une tumeur ou d’une récidive. Bien que réalisée sur un nombre limité de patients atteints d'une maladie rare, cette étude publiée dans Clinical Cancer Research est une preuve de concept de la faisabilité et de l’intérêt clinique de la détection et de la quantification de l'ADN tumoral dans le sang. Récemment les chercheurs ont également démontré la supériorité de la détection de l’ADN tumoral sur celle des CTC dans le cas du mélanome de l’œil. Cette technique va bien au-delà du mélanome de l’œil, puisqu’elle pourrait s’appliquer à tous les cancers chez lesquels une mutation spécifique a été identifiée. La détection de l’ADN circulant apporte des réponses complémentaires à celles des cellules tumorales circulantes aux cliniciens, Cette recherche s’inscrit également dans les programmes de médecine personnalisée de l’Institut Curie comme l’étude SHIVA dirigé par le Dr Christophe , la détection des anomalies moléculaires guidant le traitement ciblé sur la biopsie d’une métastase est également recherché dans l’ADN tumoral circulant. ASCO 2016 Résumés des études cliniques publiés CANCER/ASCO16 le 4 juin 2016 : les « biopsies liquides » ou comment mieux traiter les cancers grâce à une prise de sang. Pour diagnostiquer un cancer et en suivre l’évolution il faut recouru à des prélèvements de tissus, des biopsies, qui imposent des gestes pas toujours simples et souvent douloureux. Une avancée technologique importante est en train de changer les choses, la biopsie liquide. C’est souvent un très mauvais souvenir pour une femme chez laquelle on suspectait un cancer du sein. Les biopsies faites à travers la peau pour aller chercher des fragments de tissus ne laissent généralement pas un excellent souvenir. Et quand il faut les refaire parce que la tumeur a métastasé vers le foie, par exemple, il y a des moments pénibles. Mais les progrès technologiques font qu’on développe depuis quelques années des outils biologiques qui permettent de mettre en évidence dans le sang des éléments provenant de la tumeur. Des éléments qu’on peut analyser très finement et qui permettent donc de réaliser ce qu’on appelle une « biopsie liquide ». Que va-t-on rechercher dans ces prélèvements sanguins ? Soit des cellules tumorales, soit de l’ADN venu des cellules cancéreuses. Mais grâce aux outils génétiques comme le séquençage de nouvelle génération (Next Generation Sequencing ou NGS) on peut détecter sur cet ADN des modifications sur les gènes de la tumeur et ainsi réagir rapidement concernant le traitement des patients. Dans un certain type de cancer du poumon par exemple, celui dans lequel il y a une mutation du gène EGFR qui représente 15 % des tumeurs broncho-pulmonaires, Une étude américaine présentée aujourd’hui à l’ASCO et qui a concerné 15191 patients, on a pu montrer une très bonne corrélation entre les prélèvements tissulaires et les prélèvements sanguins pour la mise en évidence de la mutation. Mais l’analyse de l’ADN a aussi pu montrer rapidement la présence d’une mutation particulière appelée T790M et qui entraine une résistance au traitement par les médicaments de thérapie ciblée appelés inhibiteurs de tyrosine kinase. L’apparition de cette mutation sur l’ADN permet donc de modifier le traitement de venu inefficace et d’autant plus toxique. On sait également rechercher sur ce ctADN des anomalies d’un gène, ESR1, impliqué dans la résistance aux traitements hormonaux du cancer du sein. Si ces analyses permettent de réagir rapidement et de corriger les choix thérapeutiques en cas de mise en évidence de résistance, elles ne remplaceront pas la pratique des biopsies tissulaires classiques, notamment pour le diagnostic initial de cancer, elles sont complémentaires. La biopsie tissulaire a en effet un intérêt majeur puisqu’elle permet d’avoir des informations sur le microenvironnement de la tumeur. Une information essentielle notamment avec le développement de l’immunothérapie. Voir quelles sont les cellules de défenses présentes et en quelle quantité est une information que seule la biopsie classique peut apporter. Etudes cliniques Sensibilité, et seuil de détection de la biopsie liquide Mutation detection in cell free DNA from healthy donors. (PATHWAY GENOMICS laboratory) Sub-category: Circulating Biomarkers Category: Tumor Biology Meeting: 2016 ASCO Annual Meeting Abstract No: e23054 Citation: J Clin Oncol 34, 2016 (suppl; abstr e23054) Author(s): Anja Kammesheidt, Aaron Chen, Sean Li, Jair Jaboni, Megan Anselmo, Troy Viloria, Julie A Neidich, Glenn D Braunstein; Pathway Genomics, San Diego, CA Abstract Disclosures Abstract: Background: Tumor cells release small DNA fragments into the bloodstream as circulating tumor DNA (ctDNA), a subset of cell-free DNA (cfDNA). CancerIntercept Detect is a CLIA validated, laboratory-developed blood test that can be used by physicians as a screening tool for the detection of biomarkers associated with specific cancer types in high-risk patients without a cancer diagnosis. The assay detects the presence of 96 mutations in nine genes (BRAF, CTNNB1, EGFR, FOXL2, GNAS, KRAS, NRAS, PIK3CA, TP53). To investigate the positive mutation rate in an unselected, general population, we initiated a small IRB-approved study in August 2015. Methods: Subjects were asymptomatic, had no personal history of cancer and filled out a health questionnaire. Ages ranged from 20-71 (mean 40 years); 55 females and 47 males participated. 20 ml of blood was collected in cfDNA blood tubes, plasma was separated, cfDNA isolated from 5 ml of plasma, and ctDNA enriched and then sequenced via next-generation methods.
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