Detecting Molecular Relapse in Breast Cancer: Serial Postoperative ctDNA Assessment

By: Julia Cipriano, MS
Posted: Monday, July 22, 2024

According to Jacqueline A. Shaw, PhD, of the University of Leicester, United Kingdom, and colleagues, in patients with primary breast cancer, serial postoperative circulating tumor DNA (ctDNA) assessment has strong prognostic value and may enable more effective monitoring than current clinical tests. The results of the multicenter EBLIS cohort study, which were published in JCO Precision Oncology, provide a potential window for the design of trials to assess the impact of earlier therapeutic interventions.

“Our study provides evidence that those with serially negative ctDNA tests have superior clinical outcomes, providing reassurance to patients with breast cancer,” the investigators commented. “For select cases with hormone receptor–positive disease, decisions about treatment management might require serial monitoring, despite the positive ctDNA result.”

A total of 156 patients were monitored both clinically and via semiannual blood sampling for up to 12 years after surgery and adjuvant chemotherapy. The personalized, tumor-informed assay was found to detect plasma ctDNA ahead of clinical or radiologic disease recurrence in 30 of the 34 patients who experienced a relapse, with a patient-level sensitivity of 88.2%. Relapse was predicted with a lead interval of up to 38 months (median: 10.5 months), and ctDNA positivity seemed to be associated with shorter durations of relapse-free (P < .0001) and overall (P < .0001) survival.

All patients with triple-negative disease who experienced a relapse (n = 7 of 23) had a positive ctDNA test within a median of 8 months; at a median follow-up of 58 months, their counterparts who did not experience a relapse reportedly remained ctDNA-negative. Despite persistent ctDNA negativity, four patients with hormone receptor–positive breast cancer were found to develop recurrent disease. Conversely, the investigators noted, 5 of the 122 patients who did not experience a relapse of hormone receptor–positive disease had one or two positive ctDNA samples.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

JCO Precision Oncology