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The Role of Circulating Tumor DNA in Renal Cell Carcinoma

  • Genitourinary Cancers (N Agarwal, Section Editor)
  • Published:
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Opinion statement

Next-generation sequencing (NGS) of circulating tumor DNA (ctDNA) is a novel technology that can complement tumor tissue NGS and has the potential to influence diagnosis and treatment of both localized and metastatic renal cell carcinoma (mRCC). ctDNA NGS is an attractive alternative to tumor tissue NGS because it circumvents the need for repeated, invasive tissue biopsies while providing a contemporary mutational profile of a patient’s tumors. While the role of ctDNA NGS in non-small cell lung cancer and colorectal cancer is well established, studies of ctDNA NGS in mRCC are only hypothesis-generating to date. In the localized RCC setting, ctDNA has demonstrated potential as a surveillance biomarker for disease recurrence. Earlier detection of mRCC, prior to the onset of symptoms, may lead to improved clinical outcomes. NGS of ctDNA in mRCC is even more promising in patients with metastatic disease. The majority of patients with mRCC have detectable ctDNA. Thus, ctDNA could be used to select patients for biomarker-guided clinical trials, such as savolitinib in MET-positive papillary RCC. Furthermore, studies have shown that the mutational profile of mRCC in ctDNA evolves after treatment progression. The most exciting potential role for ctDNA in mRCC is as a predictive biomarker for response to immunotherapy. Studies have shown that tumor mutational burden (TMB) is predictive of response to immune checkpoint inhibitors, and hypermutated ctDNA can act as a surrogate biomarker for TMB and response to immunotherapy. While studies of ctDNA in RCC are still in their infancy, there are many promising roles for ctDNA in localized and metastatic RCC.

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Authors and Affiliations

  1. Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA

    Paulo G. Bergerot MD, Cristiane Decat Bergerot PhD, Jeremy Jones PhD & Sumanta Kumar Pal MD

  2. Department of Internal Medicine, University of Utah, 30 N 1900 E, Rm 4C104, Salt Lake City, UT, 84132, USA

    Andrew W. Hahn MD

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Conflict of Interest

Paulo G. Bergerot declares that he has no conflict of interest.

Andrew W. Hahn declares that he has no conflict of interest.

Cristiane D. Bergerot declares that she has no conflict of interest.

Jeremy Jones declares that he has no conflict of interest.

Sumanta K. Pal has received compensation from Genentech, Aveo, Eisai, Roche, Pfizer, Novartis, Exelexis, Ipsen, Bristol-Myers Squibb, and Astellas for service as a consultant and has also received honoraria from Genentech.

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Bergerot, P.G., Hahn, A.W., Bergerot, C.D. et al. The Role of Circulating Tumor DNA in Renal Cell Carcinoma. Curr. Treat. Options in Oncol. 19, 10 (2018). https://doi.org/10.1007/s11864-018-0530-4

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