title: Circulating cell-free DNA: a novel biomarker for response to therapy in ovarian carcinoma.
abstract: BACKGROUND
  Cell-free DNA (CFDNA) is a reflection of both normal and tumor-derived DNA released into the circulation through cellular necrosis and apoptosis. We sought to determine whether tumor-specific plasma DNA could be used as a biomarker for tumor burden and response to therapy in an orthotopic ovarian cancer model.
  
  
  METHODS
  Female nude mice injected intraperitoneally with HeyA8 ovarian cancer cells were treated with either docetaxel alone or in combination with anti-angiogenic agents (AEE788-dual VEGFR and EGFR antagonist or EA5-monoclonal antibody against ephrin A2). Following DNA extraction from plasma, quantification of tumor-specific DNA was performed by real-time PCR using human specific beta-actin primers. The number of genome equivalents (GE/ml) were determined from a standard curve. Apoptosis was assessed by TUNEL staining of treated tumors.
  
  
  RESULTS
  The levels of tumor-specific DNA in plasma increased progressively with increasing tumor burden (R2=0.8, p<0.01). Additionally, tumor-specific plasma DNA levels varied following treatment with chemotherapy. In mice with established tumors (19 days following tumor injection), tumor-specific plasma DNA levels increased by 63% at 24 hours following a single dose of docetaxel (15 mg/kg), and then declined to 20% below baseline at 72 hours and were 83% lower than baseline 10 days following therapy. In addition, docetaxel treatment resulted in a significant increase in the apoptotic index at 24 hours (p<0.01). Moreover, in two separate therapy experiments using a combination of cytotoxic chemotherapy with anti-angiogenic agents, tumor-specific plasma DNA levels were significantly higher in mice treated with vehicle compared to the treatment groups. The correlation between tumor weight and tumor-specific DNA in these experiments was 0.71-0.76 (p<0.01).
  
  
  CONCLUSIONS
  Our results indicate that tumor-specific CFDNA levels correlate with increasing tumor burden and decline following therapy. Thus, tumor-specific DNA may be a useful surrogate biomarker of therapeutic response and should be evaluated in future clinical trials.
authors.affiliation: Department of Gynecologic Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, Texas 77230-1439, USA.
authors.forename: Aparna A
authors.initials: AA
authors.lastname: Kamat
authors.forename: Farideh Z
authors.initials: FZ
authors.lastname: Bischoff
authors.forename: Dianne
authors.initials: D
authors.lastname: Dang
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Baldwin
authors.forename: Liz Y
authors.initials: LY
authors.lastname: Han
authors.forename: Yvonne G
authors.initials: YG
authors.lastname: Lin
authors.forename: William M
authors.initials: WM
authors.lastname: Merritt
authors.forename: Charles N
authors.initials: CN
authors.lastname: Landen
authors.forename: Chunhua
authors.initials: C
authors.lastname: Lu
authors.forename: David M
authors.initials: DM
authors.lastname: Gershenson
authors.forename: Joe L
authors.initials: JL
authors.lastname: Simpson
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sood
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000494:pharmacology; D014408:Biomarkers, Tumor / Q000032:analysis; D002474:Cell-Free System; D004273:DNA, Neoplasm / Q000032:analysis*; D015195:Drug Design; D005260:Female; D006801:Humans; D051379:Mice; D008819:Mice, Nude; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000235:genetics*; D014183:Transplantation, Heterologous
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D004273:DNA, Neoplasm