Francisco J. Esteva: Emerging technologies are set to revolutionize the detection and application of biomarkers in cancer treatment
Francisco J. Esteva, Chief of the Division of Hematology and Medical Oncology at Lenox Hill Hospital, shared a post on LinkedIn:
“Emerging technologies like next-generation sequencing (NGS), liquid biopsies, and molecular imaging are set to revolutionize the detection and application of biomarkers in cancer treatment. Additionally, artificial intelligence and machine learning algorithms are being developed to analyze complex biomarker data, offering more precise and comprehensive insights into cancer biology and treatment responses.
In metastatic breast cancer, ctDNA testing is clinically useful. For example, relevant mutations, such as ESR1 and PIK3CA, can inform treatment selection. Another application of ctDNA is to monitor treatment response, in combination with imaging studies.
In early-stage breast cancer the use of circulating biomarkers, including ctDNA is controversial. While highly sensitive tests might identify mutations earlier, whether this translates into improved clinical outcomes is not yet clear. The concern lies in the potential for false reassurance from negative tests and the uncertainty in management following positive results. At a dedicated Clinical Science Symposium held at the 2024 Annual Meeting of the American Society of Clinical Oncology (ASCO), experts recommend using these tests within clinical trials until their benefits are clearly demonstrated.
Novel approaches such as studying methylation profiles in ctDNA for molecular subtyping, or the development of ultra-sensitive methods are promising.
Barriers to the application of NGS and liquid biopsies in routine clinical practice globally include 1) accessibility and cost and 2) complexity of interpretation of biomarker data. These tests are not available in all regions and health systems.
Practical Considerations for Clinicians
- Patient Counseling: Clearly explain the benefits and limitations of ctDNA testing to patients.
- Clinical Trials: Encourage participation in clinical trials to further validate the utility of ctDNA testing.
- Interpretation of Results: Use ctDNA results in conjunction with other clinical findings and imaging studies.
- Ongoing Research: Stay updated with the latest research to integrate new findings into clinical practice effectively.
In conclusion, while ctDNA testing holds great promise, its integration into routine clinical practice requires careful validation and evidence of clinical utility.”
Source: Francisco J. Esteva/LinkedIn