# Improved EGFR mutation detection using combined exosomal RNA and circulating tumor DNA in NSCLC patient plasma

Source: https://onco.cc/key-papers/paper-krug-exosomal-rna-ctdna-egfr-ann-oncol-2018/  
OnCo record `paper-krug-exosomal-rna-ctdna-egfr-ann-oncol-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A lung cancer study that read EGFR mutations from vesicle RNA and cell-free DNA together, finding more mutations than from DNA alone, most of all in patients whose cancer sheds little.

## Summary

In 84 patients, sensitivity was 98 per cent for activating EGFR mutations and 90 per cent for T790M with combined exosomal RNA and cell-free DNA, against 82 and 84 per cent for circulating tumour DNA by BEAMing. In patients with intrathoracic disease (M0/M1a, 21 patients), sensitivity rose from 26 to 74 per cent for activating mutations (P = 0.003) and from 19 to 31 per cent for T790M (P = 0.5).

## Fields

- Kind: Key paper
- Last checked: 2026-11-04
- Journal: Annals of Oncology
- Year: 2018
- DOI: 10.1093/annonc/mdx765
- Authors: Krug AK, Enderle D, Karlovich C, et al.
- Findings: Activating EGFR: 98% combined against 82% ctDNA alone.; Low-shedding subgroup: 26% to 74% (P = 0.003).
- What it means: The clearest measured case that RNA from the same blood draw adds tumour signal where DNA runs short, though in advanced disease far above residual disease levels.
- Caveats: Advanced cancer; sensitivity, not molecule counts; company authors.

## Sources

- Krug et al., Ann Oncol 2018: https://doi.org/10.1093/annonc/mdx765
- PubMed: https://pubmed.ncbi.nlm.nih.gov/29216356/

## Connected records

- cancers: [EGFR-mutated non-small-cell lung cancer](https://onco.cc/cancers/egfr-mutant-nsclc/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/)
- technologies: [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Liquid RNA biopsy (cell-free, vesicle and platelet RNA)](https://onco.cc/technologies/liquid-rna-biopsy/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/)
- bottlenecks: [Naming which clone or phenotype is left after treatment](https://onco.cc/bottlenecks/b-subclone-attribution-residual-disease/)
- ideas: [Read tumour RNA and tumour DNA from the same blood draw to find and type residual cancer](https://onco.cc/ideas/idea-stack-ctdna-and-tumour-rna-residual-disease/)

---
JSON: https://onco.cc/api/v1/entities/paper-krug-exosomal-rna-ctdna-egfr-ann-oncol-2018.json