Javier Pascual, Consultant Medical Oncologist at University Hospital Virgen de la Victoria, shared a post on LinkedIn:
“Happy to share co-first authorship with Iseult Browne on a new Clinical Cancer Research AACR Journals publication exploring the prognostic and predictive value of ctDNA in advanced breast cancer.
In this work, ctDNA was tested with Guardant Health assay across different patient cohorts from the plasmaMATCH trial and validated in the GEICAM – Spanish Breast Cancer Group PEARL study.
- Prognostic: Baseline ctDNA levels were associated with survival.
- Predictive: Early on-treatment ctDNA suppression identified optimal responders across different targeted therapies, with complete ctDNA clearance emerging as a strong surrogate of good outcomes, irrespective of molecular alteration or treatment type.
Our work and that of others has consistently shown early ctDNA suppression as a promising tool for rapid therapy tailoring in patients with advanced breast cancer treated with different CDK4/6i combinations, chemotherapy or immunotherapy. However, the idea of a universal optimal threshold for treatment decisions seems highly unlikely, as the specific therapy appears to be a key determinant of overall PFS—an issue recently highlighted by François-Clément Bidard in patients from EMBER-3.
That said, I believe we now have sufficient evidence to consider complete ctDNA clearance as an endpoint for first-generation adaptive trials, at least in patients with advanced breast cancer. This comes with the caveat that a subset of patients with intermediate ctDNA suppression—who might still benefit from treatment de-escalation—will need to be carefully addressed.
Overall, these findings further support liquid biopsy as a cornerstone of precision oncology, enabling real-time disease monitoring and more personalized treatment strategies.”
More posts about Breast Cancer.