Belinda Lee, MBBS, on Early-Stage Pancreatic Cancer: New Data on Guiding Adjuvant Chemotherapy

I'm here today to talk to you about the DYNAMIC-Pancreas clinical trial. This was a non-randomized phase 2 study looking at the potential role of circulating tumor DNA testing after upfront surgery to guide adjuvant chemotherapy for early-stage pancreatic cancer patients. In this study, we explored the feasibility and clinical utility of tumor-informed ctDNA testing for patients after surgery to see if we could guide their treatment. This study confirmed that the prognostic significance of ctDNA as a biomarker after surgery in early-stage pancreatic cancer. Even when ctDNA is not detected after surgery, there is still a high risk of recurrence that remains. We enrolled 102 patients from 26 Australian cancer centers exploring the feasibility and clinical utility of circulating tumor DNA. We looked to ask questions like, can the use of ctDNA inform us about the risk of recurrence in our patients, and can we use ctDNA to guide the use of adjuvant chemotherapy comparing three versus six months duration of chemotherapy, as well as comparing the use of different intensities of chemotherapy looking at triplet versus doublet chemotherapy in our patients? What we found was that ctDNA does indeed provide prognostic significance in early-stage pancreatic cancer. However, even in the negative ctDNA cohort, the risk of relapse remains. We would still advise that you give six months of adjuvant chemotherapy treatment. While ctDNA-negative indicates as low risk of recurrence, patients should still undergo their adjuvant chemotherapy treatment, and future studies should incorporate the use of ctDNA after treatments from surgery, as well as after adjuvant chemotherapy. Changes in ctDNA may be used to track the changes in the patient's tumor burden throughout their treatment. We could also use ctDNA to integrate ctDNA into new studies looking at novel agents as well.