Sebastien Couraud

Circulating free DNA concentration is an independent prognostic biomarker in lung cancer.

Plasma circulating cell-free (cf)DNA is of interest in oncology because it has been shown to contain tumour DNA and may thus be used as liquid biopsy. In nonsmall cell lung cancer (NSCLC), cfDNA quantification has been proposed for the monitoring and follow-up of patients. However, available studies are limited and need to be confirmed by studies with larger sample sizes and including patients who receive more homogenous treatments. Our objective was to assess the predictive and prognostic value of plasma cfDNA concentration in a large series of patients with NSCLC and treated with a standard chemotherapy regimen. We included samples from lung cancer patients recruited into the Pharmacogenoscan study. The cfDNA of 218 patients was extracted and quantified by fluorometry before and after two or three cycles of platinum-based chemotherapy. The association between baseline and post-chemotherapy concentrations and treatment response, assessed by RECIST (response evaluation criteria in solid tumours) or patient survival was analysed. Patients with high cfDNA concentrations (highest tertile) at baseline had a significantly worse disease-free and overall survival than those with lower concentrations (lowest and middle tertiles) (median overall survival 10 months (95% CI 10.7–13.9) versus 14.2 months (95% CI 12.6–15.8), respectively; p=0.001). In multivariate analysis, increased baseline concentration of cfDNA was an independent prognostic factor. However, we did not find any association between cfDNA concentration and response to treatment. cfDNA may be a biomarker for the assessment of prognosis in NSCLC. However, total concentration of cfDNA does not appear to predict chemotherapy response. Total cell-free DNA is not associated with chemotherapy response in advanced nonsmall cell lung cancer http://ow.ly/Qpqyx

Bronchial mucous gland adenoma revealed following acute pneumonia

A 54-year old male, current smoker, was admitted to the emergency unit with lingular pneumonia. The follow-up chest CT and bronchoscopy showed an airway-blocking intrabronchial tumour. After surgical resection, pathological examination established the diagnosis of a bronchial mucous gland adenoma. The bronchial mucous gland adenoma is an extremely rare and benign lung tumour. It is composed of mucus-containing acini lined with cuboidal cells without pleomorphism. Total surgical resection is usually required for complete diagnosis and treatment. The main differential diagnoses are a low-grade mucoepidermoid carcinoma and a mucinous cystadenoma of the lung. This case highlights the importance of a complete lung workup after acute pneumonia in patients with a history of smoking, including the CT scan and bronchoscopy.