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번호	년도	제목	저널명	링크
28	2025	Pairwise analysis of plasma cell-free DNA before and after palliative second-line paclitaxel plus ramucirumab treatment in patients with metastatic gastric cancer Abstract Background This study compared plasma cell-free DNA (cfDNA) and tumor tissue DNA (ttDNA) to explore the clinical applicability of cfDNA in patients with metastatic gastric cancer (mGC) receiving palliative second-line paclitaxel + ramucirumab treatment. Methods Targeted sequencing of 106 genes was conducted using germline DNA and cfDNA at baseline (baseline-cfDNA) and progressive disease (PD-cfDNA). The results were compared with those of ttDNA-based cancer panel data. Results Of 76 consecutive patients, 46 (27 males; median age 57.5 [range, 32–73] years) who had all three samples were included. Combined analysis of ttDNA and baseline-cfDNA revealed that TP53 (58.7%) was the most frequently mutated gene, followed by CDH1 (26.1%), KRAS (21.7%), and APC (13.0%). For these genes, the sensitivity and positive predictive value of baseline-cfDNA over ttDNA were 71.8% and 51.9%, respectively. When baseline-cfDNA and PD-cfDNA results were combined, 34 patients (73.9%) were found to have additional mutations compared with ttDNA results alone. PD-cfDNA analysis revealed 14 novel pathogenic mutations in ten patients (21.7%). At baseline, patients with a high circulating tumor DNA fraction concentration showed a significantly shorter progression-free survival (PFS) (P = 0.016) in univariable and multivariable analyses. High maximal variant allele frequency (VAF) (P = 0.022), high sum of VAF (P = 0.028), and high TP53 VAF (P = 0.022) were associated with worse PFS in univariable analysis. Conclusions Although cfDNA alone cannot replace ttDNA entirely, cfDNA analysis revealed additional mutations. Notably, PD-cfDNA analysis revealed novel pathogenic mutations that emerged during treatment. Moreover, the baseline circulating tumor DNA fraction concentration and VAF values were associated with longer PFS. Pairwise analysis of plasma cell-free DNA before and after palliative second-line paclitaxel plus ramucirumab treatment in patients with metastatic gastric cancer 링크보기	Gastric Cancer	링크보기
27	2025	Blood Circulating Tumor DNA‐based Genomic Profiling and Serial Analysis in Patients With Advanced Biliary Tract Cancer Abstract Background/Aim: This study aimed to identify mutation profile similarities between tissue and circulating tumor DNA (ctDNA) and to explore driver mutations as potential prognostic or predictive biomarkers or druggable targets in patients with advanced biliary tract cancer (BTC). Patients and Methods: We prospectively enrolled 18 patients with advanced BTC and analyzed next-generation sequencing data fr\|om 60 ctDNA samples using AlphaLiquid® 100. This assay screens up to 118 genes for single-nucleotide variants (SNVs) and insertion or deletions (INDELs), 27 genes for copy number alterations (CNAs), and 10 genes for fusions. We examined the intra-patient tissue-ctDNA concordance and studied the association between ctDNA variant allele frequency (VAF) and survival. Results: A total of seven gallbladder cancer cases, six intrahepatic cholangiocarcinoma cases, and five extrahepatic cholangiocarcinoma cases were observed. Among these cases, tumor tissues were available for 16 patients. Genetic alterations were detected in 88% (14/16) of tissue DNA samples and 89% (16/18) of samples with ctDNA at baseline. The most common genes altered in ctDNA were TP53 (n=11), ERBB3 (n=3), and KRAS (n=3). There was a 29% overlap in somatic SNVs/INDELs and a 60% overlap in CNAs between tissue DNA and ctDNA, while no fusion variant was detected. The sensitivity and positive predictive value of ctDNA for all types of somatic mutations were 47% and 43%, respectively. Among the 14 patients whose serial ctDNA was analyzed, 10 showed changes in ctDNA. A high pre-treatment VAF (>4.0%) was associated with poor overall survival. Conclusion: ctDNA sequencing can successfully identify molecular genetic alterations in patients with advanced BTC, providing insights into potential biomarkers and therapeutic targets. Blood Circulating Tumor DNA‐based Genomic Profiling and Serial Analysis in Patients With Advanced Biliary Tract Cancer 링크보기	Anticancer Research	링크보기
26	2025	An open-label, phase IB/II study of abemaciclib with paclitaxel for tumors with CDK4/6 pathway genomic alterations Abstract Background Disruption of cyclin D-dependent kinases (CDKs), particularly CDK4/6, drives cancer cell proliferation via abnormal protein phosphorylation. This open-label, single-arm, phase Ib/II trial evaluated the efficacy of the CDK4/6 inhibitor, abemaciclib, combined with paclitaxel against CDK4/6-activated tumors. Patients and methods Patients with locally advanced or metastatic solid tumors with CDK4/6 pathway aberrations were included. Based on phase Ib, the recommended phase II doses were determined as abemaciclib 100 mg twice daily and paclitaxel 70 mg/m2 on days 1, 8, and 15, over 4-week-long cycles. The primary endpoint for phase II was the overall response rate (ORR). The secondary endpoints included the clinical benefit rate (CBR), progression-free survival (PFS), overall survival (OS), and safety. Tissue-based next-generation sequencing and exploratory circulating tumor DNA analyses were carried out. Results Between February 2021 and April 2022, 30 patients received abemaciclib/paclitaxel (median follow-up: 15.7 months), and 27 were included in the efficacy analysis. CDK4/6 amplification (50%) and CCND1/3 amplification (20%) were common activating mutations. The ORR was 7.4%, with two partial responses, and the CBR was 66.7% (18/27 patients). The median OS and PFS were 9.9 months [95% confidence interval (CI) 5.7-14.0 months] and 3.5 months (95% CI 2.6-4.3 months), respectively. Grade 3 adverse events (50%, 21 events) were mainly hematologic. Genetic analysis revealed a ‘poor genetic status’ subgroup characterized by mutations in key signaling pathways (RAS, Wnt, PI3K, and NOTCH) and/or CCNE amplification, correlating with poorer PFS. Conclusion Abemaciclib and paclitaxel showed moderate clinical benefits for CDK4/6-activated tumors. We identified a poor genetic group characterized by bypass signaling pathway activation and/or CCNE amplification, which negatively affected treatment response and survival. Future studies with homogeneous patient groups are required to validate these findings. An open-label, phase IB/II study of abemaciclib with paclitaxel for tumors with CDK4/6 pathway genomic alterations 링크보기	ESMO Open	링크보기
25	2025	Enhanced Detection of Actionable Mutations in NSCLC Through Pleural Effusion Cell-Free DNA Sequencing: A Prospective Study Abstract Background: Inadequate tumour samples often hinder molecular testing in non-small cell lung cancer (NSCLC). Plasma-based cell-free DNA (cfDNA) sequencing has shown promise in bypassing these tissue limitations. Nevertheless, pleural effusion (PE) samples may offer a richer cfDNA source for mutation detection in patients with malignant PE. Methods: This prospective study enrolled newly diagnosed advanced NSCLC patients with malignant PE. PE samples were collected for cfDNA NGS analysis. Meanwhile, PE cell pellet RNA was extracted for reverse transcription polymerase chain reaction (RT-PCR) for clinically relevant actionable mutations and then confirmed by Sanger sequencing. The concordance between PE cell pellet RT-PCR and PE cfDNA NGS analyses was analysed. Results: Fifty patients were enrolled. The median age was 68.5 years, and the female-to-male ratio was 29:21. Most patients (74%) were non-smokers. Notably, 45/50 patients (90%) had actionable mutations, including EGFR exon 19 deletions (24%), EGFR L858R mutations (36%), HER2 exon20 insertions (10%), ROS1 rearrangements (4%), EGFR exon20 insertions (2%), ALK rearrangements (4%), RET rearrangements (2%), KRAS G12C mutations (2%), and CD74-NRG1 fusions (2%). Among the 50 enrolled patients, actionable mutations were detected in 44 (88%) by PE cfDNA NGS, 39 (78%) by PE cell pellet Sanger sequencing, and 33 (66%) by clinical tissue genetic testing (P=0.031). The detection of actionable mutations fr\|om PE cfDNA NGS remained consistently high across M1a to M1c stages. Conclusions: PE cfDNA genotyping has clinical applicability for NSCLC patients and can serve as an additional source for molecular testing. Incorporating PE NGS cfDNA analysis into genetic testing enhances diagnostic yield and aids in identifying actionable mutations in clinical practice. Enhanced Detection of Actionable Mutations in NSCLC Through Pleural Effusion Cell-Free DNA Sequencing: A Prospective Study 링크보기	European Journal of Cancer	링크보기
24	2024	A phase II study of tepotinib in patients with advanced solid cancers harboring MET exon 14 skipping mutations or amplification (KCSG AL19-17) Abstract Background We evaluated the efficacy and safety of tepotinib in patients with various solid cancers harboring MET exon 14 skipping mutation (METex14) or MET gene amplification. Patients and methods A phase II, multicenter study was conducted in patients with advanced or metastatic solid cancers who progressed after standard treatment, harboring either METex14 or MET amplification detected in tissue-based next-generation sequencing (NGS). The primary endpoint was objective response rate (ORR). For exploratory analyses, we analyzed the gene profiles using plasma NGS test. Results Thirty-five patients were enrolled. The ORR was 57.6% for all patients, 52.2% for those with METex14, and 70% for those with MET amplification. Median progression-free survival (PFS) was 8 months [95% confidence interval (CI) 4.5-11.5 months] and median overall survival (OS) was 14 months (95% CI 7.8-20.2 months) in all patients. For patients with non-small-cell lung cancer with METex14, the median PFS was 9 months (95% CI 4.7-13.4 months) and the median OS was 17 months [95% CI not applicable (NA)-NA]. For patients with MET amplification, the median PFS was 7 months (95% CI 1.5-12.5 months) and the median OS was 10 months (95% CI 5.8-14.2 months). The ORR of patients with MET dysregulation detected by plasma NGS was 72.2%, whereas the ORR was 30% in those without detection. The most common adverse events were peripheral edema, asthenia, transaminase elevation, and anorexia, mostly grade 1 or 2. Conclusions Tepotinib demonstrated consistent antitumor activity in patients with METex14, and promising antitumor activity in various cancers with MET amplification. Detection of MET dysregulation by plasma NGS may predict the response to tepotinib. A phase II study of tepotinib in patients with advanced solid cancers harboring MET exon 14 skipping mutations or amplification (KCSG AL19-17) 링크보기	ESMO Open	링크보기