Mali Barbi, Medical Oncologist at Northwell Health, shared a post on X:
“Stop treating pCR as the definitive finish line. Recent data confirms that ctDNA status after neoadjuvant therapy (NAT) is a more precise prognostic indicator than pCR. In HER2+ cohorts, patients who remained ctDNA+ after surgery were 5.5x more likely to recur, regardless of whether they achieved pCR.
The Reality Check: Prognostic vs. Predictive: We can identify high-risk patients (Prognostic), but we haven’t proven yet that changing therapy based on that signal alone improves survival (Predictive). The “Low-Shedder” Floor: Especially in ER+ disease, a negative draw may just be the assay’s sensitivity limit. We can’t safely de-escalate yet.
Clinical Mandate: Use ctDNA to prioritize high-risk surveillance and trial enrollment. Don’t go rogue on SOC until we have prospective utility data.”
Title: ctDNA Detected after Neoadjuvant Therapy for HER2-Positive Breast Cancer Is Associated with Inferior Outcomes and May Inform Adjuvant Therapy
Authors: Po-Han Lin, Li-Wei Tsai, Chiao Lo, Sung-Hsin Kuo, Chia-Chun Ni, Chih-Hao Yu, Chiun-Sheng Huang
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