Virginia Kaklamani, MD, DSc
Virginia Kaklamani, MD, DSc, Professor of Medicine and Head of the Breast Cancer Program at UT Health San Antonio MD Anderson Cancer Center, moderated a press conference where Milan Radovich, PhD, reported the robust ability of circulating tumor DNA (ctDNA) and circulating tumor cells to predict outcomes in triple-negative breast cancer. She said the findings “should impact clinical research for now” but not clinical practice. “We don’t have predictive data as to how to act on these data and improve patient outcomes. What we need is exactly the trial the investigators have designed [PERSEVERE] to see whether these results can further help us in treating our patients and improving their outcomes,” stated Dr. Kaklamani.
Without more information, the way to apply this approach in practice remains unclear, Dr. Kaklamani maintained. “I don’t like disclosing results to patients when I can’t act on them. That’s why we need these trials, so we can figure out if we can salvage these patients [who are ctDNA-positive] with novel therapies,” she said.
The Need to Demonstrate Clinical Utility
Minetta Liu, MD
Minetta Liu, MD, Professor and Research Chair in the Department of Oncology at Mayo Clinic, Rochester, Minnesota, has spearheaded research in circulating tumor cell and cell-free DNA testing for the monitoring and detection of a variety of cancers and was also asked to comment on Dr. Radovich’s study for The ASCO Post. “Many investigators are interested in the ability to use blood as a means of looking at tumor-related material, both in the metastatic and early stages, across many malignancies. The primary focus in this study was to identify patients at highest risk for recurrence after neoadjuvant therapy. As expected, those with tumor-related material in the blood did have a higher risk of recurrence,” she said.
“The question now is whether we should act on this information. Will survival improve if we intervene with treatment earlier when prompted by the detection of ctDNA and/or circulating tumor cells, vs at the time of usual presentation with symptoms or radiographic findings? Detection does not guarantee a patient will have a recurrence, and not dectecting it does not mean the patient is cured. I believe someday these blood-based assays will be part of the standard of care, but we are not quite there yet,” Dr. Liu offered.
DISCLOSURE: Dr. Kaklamani has served as a speaker for Pfizer, Celgene, Genentech, Genomic Health, Puma, Eisai, and Novartis and has served as a consultant for Amgen, Eisai, Puma, Celldex Therapeutics, AstraZeneca, and Athenex. Dr. Liu has received institutional research funding from Eisai, Grail, Janssen Diagnostics, Merck, Novartis, Roche/Genentech, Seattle Genetics, and Tesaro; and has been reimbursed for travel, accommodations, or other expenses by AstraZeneca, Genomic Health, Grail, Ionis Pharmaceuticals, Menarini-Silicon Biosystems, Merck, Pfizer, and RareCyte.
In early triple-negative breast cancer, the presence of circulating tumor DNA (ctDNA) and circulating tumor cells after neoadjuvant chemotherapy may enable risk stratification of patients for disease recurrence and may predict outcomes, according to a preplanned correlative analysis of the phase II ...