Douglas Flora, Executive Medical Director of Yung Family Cancer Center at St. Elizabeth Healthcare, President-Elect of the Association of Cancer Care Centers, and Editor in Chief of AI in Precision Oncology, shared a post on LinkedIn:
“For every patient who finished treatment and still wondered: is it really gone?
‘And the end of all our exploring / Will be to arrive where we started / And know the place for the first time.’
– T.S. Eliot, Little Gidding, 1942
Every patient finishing chemotherapy carries one question out of the clinic. Is it really gone? For fifty years, oncology answered that question with a population statistic that belonged to no one in particular.
Hematologists solved a version of this problem twenty years ago — quietly, in leukemia units, by treating a molecular signal in the blood before any scan confirmed what it was saying. What they learned is now being applied to solid tumors. The science is further along than most people realize. The limitations are real and worth understanding. And where it goes next is more ambitious than the current conversation suggests.
This was a conceptual revolution dressed in technical clothing, and its consequences were enormous. MRD-guided therapy became the standard of care for acute lymphoblastic leukemia, for multiple myeloma, and for chronic lymphocytic leukemia. Transplant decisions, maintenance therapy duration, and the timing of treatment de-escalation, all of it increasingly indexed to molecular measurements that had no radiologic correlate. Hematology learned, through two decades of careful prospective study, that the blood carried continuous dispatches from the interior of the disease, and that reading them early enough could change what happened next.
Solid tumor oncology watched this from across the hallway…
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