Case Report

Subclonal Therapy by Two EGFR TKIs Guided by Sequential Plasma Cell-free DNA in EGFR-Mutated Lung Cancer

Disclosure: Dr. Peled serves as an adviser to and receives honoraria from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Lilly, Merck Sharp and Dohme, Novartis, Pfizer, Roche, Foundation Medicine, NovellusDx, and Gaurdant360. Dr. Roisman reports personal fees (honoraria for talks) from Roche and Pfizer during the conduct of the study. Dr. Miron was an employee of NovellusDx during the conduct of the study. Dr. Lanman reports being an employee with stock options of Guardant Health, Inc., during the conduct of the study. Dr. Ilouze reports personal fees from Pfizer outside the submitted work. Dr. Dvir reports other from Teva Pharmaceuticals, outside the submitted work. Dr. Soussan-Gutman reports being an employee of Oncotest-Teva during the conduct of the study. Dr. Barlesi reports personal fees from Astra-Zeneca, Bristol-Myers Squibb, Boehringer-Ingelheim, Clovis Oncology, Eli Lilly Oncology, F. Hoffmann–La Roche Ltd., Novartis, Merck, Merck Sharp and Dohme, Pierre Fabre, and Pfizer outside the submitted work. Dr. Tarcic reports personal fees from NovellusDx outside the submitted work. Dr. Edelheit is an employee of NovellusDx during the conduct of the study. Dr. Gandara reports receiving grants from and serving as a consultant to AstraZeneca, Clovis, Genentech, Lilly, Merck, and Novartis; receiving grants from Bristol-Myers Squibb and Johnson and Johnson; and serving as a consultant to Bayer, Boehringer Ingleheim, Celgene, Guardant Health, Liquid Genomics, Mirati, Peregrine, Pfizer, Synta, and Trovogene during the conduct of the study. Dr. Elkabetz reports nonfinancial support from French Friends of Tel Aviv University during the conduct of the study and nonfinancial support from Ramot-IP Company of Tel Aviv University outside the submitted work. Dr. Elkabetz is the brother of the patient reported in the study; however, apart for simply increasing the author's interest and enthusiasm in helping the group decipher the mechanisms underlying the progression of disease in order to bring relief, seek for a cure, and help other patients down the road, this relationship has not been affected by any conflicts of interest. The process of obtaining scientific findings (plasma cell–free DNA analysis) was funded privately by the family, and the findings were provided in parallel to clinicians/authors and were, in any case, not affected by the family. Similarly, the recording and processing of clinical disease measures were funded by insurance companies and/or privately by family. A complete separation was made between these and the decisions on treatments made by clinician and patient. The remaining author declares no conflict of interest.