Dr Alexey Aleshin Highlights the Diagnostic Benefits of ctDNA in Early-Stage Breast Cancer

Circulating tumor DNA (ctDNA) has a host of benefits in treating and managing patients with early-stage disease, especially in monitoring patients both in the neoadjuvant setting and during treatment, noted Alexey Aleshin, MD, senior medical director of Oncology at biotech giant Natera.

Transcript

Why is ctDNA so important as an indicator in breast cancer?

So, breast cancer is a unique disease in that monitoring for response is critical for making management decisions. The ability to assess pathological CR [complete response] after completion of neoadjuvant therapy has really, really changed our approach to treating and managing patients with early-stage disease. However, the big limitation is, path CR can only be assessed after completing therapy. There's really a big need in the field for better biomarkers that can be dynamically monitored not only just in the neoadjuvant space, but also post surgically, as well as during surveillance.

In what ways does ctDNA proactively inform treatment in oncology?

The ctDNA space is multifaceted and rapidly evolving. So we really like to think about ctDNA as kind of really being a continuum of use cases. I think one really exciting and evolving use case is early cancer detection. So that's identifying cancer before histological diagnosis is made using circulating tumor DNA. On the other side of the continuum is the use case that I think many oncologists are familiar with, and that's using ctDNA to identify actionable or targetable mutations, so-called comprehensive or complete genomic profiling, typically reserved for patients in the advanced or metastatic setting.

I think really, the focus of today is really the middle of the spectrum. And that's really where Natera has focused on with their Signatera assay. And this is the minimal residual disease or molecular residual disease space, which really means identification of extremely low levels of ctDNA in the perioperative setting, both for assessment of residual disease after surgery, but also for treatment response monitoring in, for example, the neoadjuvant setting.