The clinical utility of molecular residual disease testing in early-stage breast cancer
Molecular residual disease (MRD) testing using circulating tumor DNA assays shows promise in early-stage breast cancer by detecting disease recurrence earlier than traditional imaging. In this Special Report article, published in Expert Review of Anticancer Therapy, the authors delve into results from several studies that have explored MRD testing in the context of treating and monitoring early-stage breast cancer.
Abstract
Introduction
Breast cancer is the most commonly-diagnosed malignancy among women. Currently, radiologic imaging is indicated for defined surveillance periods and to assess or corroborate patient symptomatology. More recently, the advent of circulating tumor DNA (ctDNA) assays has conferred a potential enhancement in disease monitoring via the evaluation of molecular residual disease (MRD).
Areas covered
Studies have shown that MRD testing reportedly eventuates in a lead-time predictive benefit in diagnosing progressive disease compared to traditional assessment. In particular, the Signatera test has compelling advantages compared to many of the available MRD tests, especially given the reported clinical data with MRD testing in early-stage breast cancer. In the current review, we recount the results from several studies on the topic of MRD testing in the treatment and surveillance of breast cancer.
Expert opinion
MRD testing in early-stage breast cancer theoretically confers a significant clinical benefit with adjuvant therapy and during patient surveillance. However, there are concerns with the potential for aggressive or prolonged treatment, not to mention the specific approach to managing patients who are ctDNA positive but remain asymptomatic.
Article highlights
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Numerous studies have shown that the detection of MRD is strongly associated with disease recurrence.
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The results from MRD testing studies have suggested that evidence of positive ctDNA levels confer a lead-time disease progression detection benefit of approximately 6 to 11 months prior to evidence of clinical relapse.
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While many of the MRD tests have high sensitivity and specificity rates, Signatera has compelling relative advantages, namely their mature clinical data in early-stage breast cancer.