title: Real-time monitoring efficiency and toxicity of chemotherapy in patients with advanced lung cancer.
abstract: BACKGROUND
  The Response Evaluation Criteria in Solid Tumors (RECIST) guideline and Common Terminology Criteria for Adverse Events (CTCAE) criteria are used to assess chemotherapy efficiency and toxicity in patients with advanced lung cancer. However, no real-time, synchronous indicators that can evaluate chemotherapy outcomes are available. We wanted to evaluate tumor response and toxicity in advanced lung cancer chemotherapy by using a novel synchronous strategy.
  
  
  RESULTS
  We enrolled 316 patients with advanced lung cancer who were treated with cisplatin-based therapy and followed up them for 3 years. Plasma was obtained before and after every chemotherapy cycle. We quantitative assayed total plasma DNA and methylation of the APC/RASSF1A genes. Four parameters were assessed: methylation level before chemotherapy (meth0 h), methylation level 24 h after chemotherapy (meth24 h), total plasma DNA concentration before chemotherapy (DNA0 h), and total plasma DNA concentration 24 h after chemotherapy (DNA24 h). When meth24 h > meth0 h of at least one gene was used to predict tumor response, the correct prediction rate was 82.4 %. Additionally, patients for whom DNA24 h/DNA0 h ≤ 2 had mild toxicities. Therefore, meth24 h > meth0 h and DNA24 h/DNA0 h ≤ 2 were defined as criteria for better tumor response and fewer adverse events with a high correct prediction rate (84.7 %).
  
  
  CONCLUSIONS
  Quantitative analysis of total plasma DNA and plasma APC/RASSF1A methylation provide a real-time synchronous rapid monitoring indicator for therapeutic outcomes of advanced lung cancer, which could be a reference or supplementary guidelines in evaluating chemotherapy effects.
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Bingfeng
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Dan
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Wenying
authors.initials: W
authors.lastname: Xia
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Jiexin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Jian
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Meijuan
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Lixia
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Yachun
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Geng
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Peijun
authors.initials: P
authors.lastname: Huang
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.
authors.forename: Puwen
authors.initials: P
authors.lastname: Huang
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 China.|National Key Clinical Department of Laboratory Medicine, Nanjing, 210029 China.
authors.forename: Shiyang
authors.initials: S
authors.lastname: Pan
keywords: APC; Advanced lung cancer; Circulating DNA; Hypermethylation; RASSF1A