As ARMS is very sensitive, routinely being able to detect at least 1% mutant in a background of normal DNA, XL184 nmr this may reduce the need for macro-dissection which eliminates a labour-intensive, time-consuming step in the analysis process. By coupling ARMS with real-time PCR product detection the analysis process is further shortened as PCR products

do not have to be processed, for example by agarose gel electrophoresis, and PCR product contamination is eliminated as reaction tubes do not need to be opened after the experiment is complete. As ARMS is sensitive it can also be used on samples where the tumour content is very low, for example circulating free (cf) tumour DNA shed from the tumour into the blood [19, 20] and in cytology samples [21, 22]. This can be an advantage when a tumour sample is not available, for example if the tumour is inoperable or so badly processed that no DNA is extractable. However, in our experience, the mutation detection rates using alternative sources of tumour such as cf DNA tend JQEZ5 ic50 to be lower than from a tumour biopsy. In this study we have evaluated ARMS and DNA sequencing only; however, there are a growing number of alternative methods being established that may merit evaluation. All methods have their own merits and are chosen according to the task e.g. clinical trial methodology may be different to those employed in the diagnostic setting for sensitivity, cost, availability and a variety of other reasons.

Test choice will differ as tests evolve and it is important to keep abreast of all available methods. In our experience, ARMS is more sensitive and robust at detecting defined somatic mutations

than DNA sequencing on clinical samples where the predominant sample type was FF-PET. Future developments in the field of mutation detection will be followed with anticipation as such technologies will be key to support personalised healthcare approaches that select patients for targeted treatments based on tumour mutation results. Acknowledgements We thank all the study investigators and patients involved in study D1532C00003 and the Iressa Survival Evaluation in Lung Cancer (ISEL) trial. Considerable thanks go to Brian Holloway Dichloromethane dehalogenase (formerly of AstraZeneca) for his major contribution to the ISEL study and to John Morten (AstraZeneca) who contributed to the writing of the article. We thank Annette Smith, PhD, from Complete Medical Communications, who provided editing assistance funded by AstraZeneca. References 1. Schilsky RL: Personalized medicine in oncology: the future is now. Nat Rev Drug Discov 2010, 9: 363–366.PubMedCrossRef 2. Brambilla E, Gazdar A: Pathogenesis of lung cancer signalling pathways: roadmap for therapies. Eur Respir J 2009, 33: 1485–1497.PubMedCrossRef 3. Koshiba M, Ogawa K, Hamazaki S, Sugiyama T, Ogawa O, Kitajima T: The effect of formalin fixation on DNA and the extraction of high-molecular-weight DNA from fixed and embedded tissues. Pathol Res Pract 1993, 189: 66–72.PubMed 4.