ctDNA May Help Predict Lung Cancer Outcomes, Guide Treatment


Patients with non-small cell lung cancer who cleared 50% or more of cancerous DNA from their blood by their fourth treatment cycle tended to have better outcomes on maintenance therapy, research showed.

Circulating tumor DNA (ctDNA) — which is cancerous DNA found on a blood test — may be a helpful tool in predicting outcomes and adjusting maintenance treatment regimens for patients with advanced non-small cell lung cancer, according to recent research presented at the 2023 American Society of Clinical Oncology Annual Meeting.

Study author Dr. Bruna Pellini, a thoracic oncologist at Moffitt Cancer Center in Tampa, Florida, explained that she and her team analyzed data from 98 patients who were treated with four or six cycles of induction Tecentriq (atezolizumab) plus carboplatin plus nab-paclitaxel and followed by maintenance treatment with Tecentriq in an effort to prevent the cancer from returning.

The findings showed that if patients cleared 50% or more ctDNA from their baseline by cycle 4 day 1 — meaning that there is half or less than half as much cancer DNA found compared to the amount observed at baseline — they tended to have better outcomes. As such, when a 50% or more decrease in ctDNA is not found, it could indicate that a patient is at higher risk for poorer outcomes when it comes to survival and maintenance therapy. With that, these patients may need to have their treatment regimen adjusted to something more aggressive.


What we found is that when you detect ctDNA, regardless if it is from (treatment) cycle 2, cycle 3 or cycle 4, this is a prognostic biomarker of worse outcomes. So, patients that have that positive ctDNA, they will do worse in terms of survival and response to therapy.

One thing that happens a lot of times is that patients will not always have a baseline blood sample collected for ctDNA analysis. But what our study allowed was that even if you only have one sample and one time point, that can still be used to potentially personalize your maintenance therapy. So it's not like you need several samples, although we did analyze several samples, but we identified that ctDNA clearance are a significant decrease of 50% or more was prognostic — so as long as you clear or you significantly decrease the ctDNA levels this patients will do better.

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