Clinical and radiometabolic correlatives of ddPCR liquid biopsy for BRAF V600 mutated melanoma.

e15046 Background: BRAF V600 is the most common driver mutation in melanoma, seen in ≈50% of patients. Recently, the use of liquid biopsy assays that are based on circulating tumor DNA (ctDNA) has become widespread for diagnosis and residual disease monitoring. We have previously reported on our droplet digital PCR (ddPCR) test as a liquid biopsy for BRAF mutant (BRAFm) melanoma. Here we report the correlation between clinical and radiological parameters and ddPCR test results. Methods: Using the department of laboratory medicine archives, we have identified all biopsy proven BRAFm melanoma patients that were tested with the BRAF V600 ddPCR assay at our institution over the years 2018-2024. All patients had blood samples collected, and cell free DNA (cfDNA) was extracted from plasma using the Qiagen QIAamp Circulating Nucleic Acid Kit. cfDNA was evaluated with a BioRad QX200 droplet digital PCR platform assessing for BRAF V600E/K mutations. Clinical and demographic data were collected from medical records. Radiometabolic features including volumetric data and FDG PET SUV values were collected and analyzed using the MIM software (MIM Software Inc., Beachwood, OH, USA). Univariate and multivariate analyses were used to assess correlations between baseline variables and test results. Results: 71 patients were identified. The median age was 59 (26-85), 54% were males. 46 patients (65%) had a positive test result which was based on a cut-off of ≥4 mutant copies per ml. 65 patients (92%) had active disease on imaging studies, of which those with a positive test result were younger (p = 0.047), had a higher proportion of osseous metastases (p = 0.02) and had a higher number of lesions (p = 0.006). There was no difference in the median overall survival between the groups (11 months vs. 33 months for positive and negative result respectively, log-rank test; p = 0.15). Total tumor volume on PET-CT (in ml) was predictive of the quantitative ddPCR test result (in copies per ml), with every increase in 10 ml of tumor leading to an expected increase of 370 copies per ml (p < 0.001). Multivariate models have failed to show a correlation between baseline parameters and the quantitative ddPCR test result. When performing the analyses using logistic regression models with the binary ddPCR test result as the outcome, osseous metastases were predictive in a univariate model (OR = 4.3, 95% CI 1.4-15.4). The best fit multivariate model showed that higher burden of disease with ≥6 lesions (OR = 6.57, 95% CI 1.24-44.3) and elevated LDH (OR = 8.8, 95% CI 1.83-56.91) were associated with an increased risk for a positive result, while younger age was associated with decreased risk for a positive result (OR = 0.92, 95% CI 0.86-0.97). Conclusions: The results of ddPCR testing for BRAF mutation are correlated with the radiological and volumetric extent of the disease. This test could be useful in patients presenting with high-burden disease when a fast turnaround time is needed.