Circulating Tumour DNA Dynamics During Alternating Chemotherapy and Hormonal Therapy in Patients With Metastatic Breast Cancer
TAKE-HOME MESSAGE
- In this study, patients with HR+ advanced breast cancer, who had received at least one line of chemotherapy in the metastatic setting, were prospectively evaluated using serial circulating tumour DNA (ctDNA) testing while receiving alternating 9-week treatment regimens with eribulin and an aromatase inhibitor. Although this was a small trial of only 8 patients, changes in ctDNA levels predicted radiologic response to therapy.
- ctDNA testing shows promise as a monitoring strategy for patients with metastatic breast cancer. With further study, ctDNA analysis may allow clinicians to determine response to therapy while decreasing reliance on radiologic assessments.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
Although changes in circulating tumour DNA (ctDNA) in breast cancer are well described, the kinetics of their fluctuations has not been described over short timescales. We investigated ctDNA dynamics during alternating cycles of chemotherapy and hormonal treatment in pre-treated patients with oestrogen receptor-positive metastatic breast cancer.
METHODS
Patients received alternating, 9-week cycles of eribulin and aromatase inhibitors (AIs). The clinical primary endpoint, progression-free survival (PFS), was monitored at 3, 6 and 9 months; secondary endpoints, clinical benefit rate (CBR), safety and tolerability profiles, were also assessed. Importantly, ctDNA fluctuations were monitored using the Oncomine™ Breast cfDNA assay to test whether biomarkers may change rapidly between chemotherapy and aromatase inhibitor (AI) treatment in the setting of advanced breast cancer, potentially reflecting disease dynamics.
RESULTS
The median PFS was 202 days (95% CI: 135-undefined) and 235 days (95% CI: 235-undefined) at 6 and 9 months, respectively, with a 50% CBR at both 6 and 9 months. Dynamic changes in ctDNA were observed in short timescales between chemotherapy and AI treatment and support the clinical benefit (CB) seen in individual patients and, critically, appear informative of acquired resistance in real time.
CONCLUSION
Changes in ctDNA can occur rapidly and reflect changes in patients' clinical tumour responses (NCT02681523).
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Additional Info
Disclosure statements are available on the authors' profiles:
Circulating tumour DNA dynamics during alternating chemotherapy and hormonal therapy in metastatic breast cancer: the ALERT study
Breast Cancer Res Treat 2024 Apr 06;[EPub Ahead of Print], RC Allsopp, Q Guo, K Page, S Bhagani, A Kasim, P Badman, L Kenny, J Stebbing, JA ShawFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Patients live in an acute state of panic when they are about to undergo their next scan and then wait for the results — scanxiety, for sure. Likely, patients experience a similar level of anxiety while waiting for circulating tumour cell test results to be released, questioning their accuracy and wondering what they hold in store for staying on their current treatment or switching to a new treatment.