Francisco J. Esteva: Is ctDNA Ready to Guide Treatment in Real Time?
Francisco J. Esteva, Chief of the Division of Hematology and Medical Oncology at Lenox Hill Hospital and a Professor of Medicine at the Zucker School of Medicine, shared a post on LinkedIn:
“Is ctDNA ready to guide treatment in real time? The phase 3 SERENA-6 trial says yes. And it may change how we treat advanced breast cancer.
In patients with HR-positive, HER2-negative disease, detecting an ESR1 mutation via ctDNA triggered an early switch in endocrine therapy—from an aromatase inhibitor to camizestrant—while continuing CDK4/6 inhibition. The result? A median PFS of 16.0 months versus 9.2 months. That’s a 56% reduction in progression risk.
Before any radiographic or clinical signs of progression. This study challenges the long-standing paradigm of waiting for clinical progression. It raises an urgent question: should we act at the molecular level before symptoms appear? If a SERD (e.g., camizestrant) is approved based on early identification of ESR1 mutations, ctDNA testing will become a frontline decision-making companion diagnostic.
A new era of precision monitoring may be just beginning. To learn more see video.”
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