Prognostic value of ctDNA detection in patients with early breast cancer undergoing neoadjuvant therapy: A systematic review and meta-analysis

Papakonstantinou, Andri; Gonzalez, N. Saoudi; Pimentel, Isabel; Suñol, Anna; Zamora, Esther; Ortiz, Carolina; Espinosa-Bravo, Martín; Peg, Vicente; Vivancos, Ana; Saura, Cristina; Villacampa, Guillermo; Oliveira, Mafalda

doi:10.1016/j.ctrv.2022.102362

Cited by 55 publications

(38 citation statements)

References 29 publications

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“…Of note, since disease free survival (DFS: from the date of surgery to the date of recurrence or any cause of death) and RFS share the similar endpoints, they were analyzed together as one outcome, RFS ( 19 , 20 ).…”

Section: Methodsmentioning

confidence: 99%

Detection of asymptomatic recurrence following curative surgery improves survival in patients with gastric cancer: A systematic review and meta-analysis

et al. 2022

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BackgroundTo date, there is no evidence that intensive follow-up provides survival benefit in gastric cancer patients undergoing curative gastrectomy. The aim of this study is to investigate the efficacy of detection of asymptomatic recurrence using intensive surveillance strategy in long-term survival after curative gastric cancer surgery.MethodsA systematic review of electronic databases including PubMed, Embase, Web of Science, the Cochrane Library and China National Knowledge Infrastructure, Clinical Trials Registry and Google Scholar was performed up to April 2022. The primary outcomes were survival outcomes: overall survival, recurrence-free survival and post-recurrence survival. The secondary endpoints were clinicopathological features, recurrence patterns and treatment after recurrence. The registration number of this protocol is PROSPERO CRD42022327370.ResultsA total of 11 studies including 1898 participants were included. In the pooled analysis, the detection of asymptomatic recurrence was significantly associated with an improved overall survival compared to patients showing symptoms of recurrence (HR=0.67; 95%CI: 0.57-0.79; P<0.001), which was primarily driven by the prolongation of post-recurrence survival (HR=0.51; 95%CI: 0.42-0.61; P<0.001), since there was no significant difference observed in recurrence-free survival (HR=1.12; 95%CI: 0.81-1.55; P=0.48) between the two groups. Meanwhile, male sex and advanced T stage were more frequently observed in the symptomatic recurrence group. Furthermore, patients in the symptomatic recurrence group had a higher proportion of peritoneal relapse but lower proportion of distant lymph node metastasis. Additionally, patients in the symptomatic recurrence group were less likely to receive surgery treatment and post-recurrence chemotherapy.ConclusionThe detection of asymptomatic recurrence using intensive follow-up was associated with an appreciable improvement in overall survival. However, more robust data from high-quality studies are still required to verify this issue.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327370, identifier CRD42022327370.

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Section: Methodsmentioning

confidence: 99%

Detection of asymptomatic recurrence following curative surgery improves survival in patients with gastric cancer: A systematic review and meta-analysis

et al. 2022

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“…Liquid biopsy is a non-invasive method of obtaining information on tumour characteristics and thus informing on prognosis through the analysis of circulating material present in blood, including circulating tumour DNA (ctDNA) and circulating tumour cells 101 . In particular, findings from the past 10 years support the use of ctDNA sequencing as a feasible technique for use in patients with early-stage breast cancer 101 , 102 and an increasing amount of emerging data are now suggesting its clinical utility in this setting 103 , 104 . Thus, as liquid biopsy has shown promise to predict early disease relapse before imaging 103 , 104 , it could become an important tool to be implemented in study designs, to select patients requiring additional treatments and, ultimately, to guide treatment escalation or de-escalation in the post-neoadjuvant setting.…”

Section: Entering the Post-genomic Eramentioning

confidence: 99%

Systemic therapy for early-stage breast cancer: learning from the past to build the future

2022

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The treatment of breast cancer has improved dramatically over the past century, from a strictly surgical approach to a coordinated one, including local and systemic therapies. Systemic therapies for early-stage disease were initially tested against observation or placebo only in adjuvant trials. Subsequent clinical trials focusing on treatment ‘fine-tuning’ had a marked increase in cohort size, duration and costs, leading to a growing interest in the neoadjuvant setting in the past decade. Neoadjuvant trial designs have the advantages of enabling the direct evaluation of treatment effects on tumour diameter and offer unique translational research opportunities through the comparative analysis of tumour biology before, during and after treatment. Current technologies enabling the identification of better predictive biomarkers are shaping the new era of (neo)adjuvant trials. An urgent need exists to reinforce collaboration between the pharmaceutical industry and academia to share data and thus establish large databases of biomarker data coupled with patient outcomes that are easily accessible to the scientific community. In this Review, we summarize the evolution of (neo)adjuvant trials from the pre-genomic to the post-genomic era and provide critical insights into how neoadjuvant studies are currently designed, discussing the need for better end points and treatment strategies that are more personalized, including in the post-neoadjuvant setting.

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“…However, the role of ctDNA analysis in NAC has not been well established, and there is controversial information about it in the literature. A recent meta-analysis did not find a significant association between ctDNA detection and pCR [ 125 ]. Therefore, further elucidation is needed before this biomarker can be introduced in clinical practice in patients receiving NAC.…”

Section: Applications Of Liquid Biopsy In Clinical Practicementioning

confidence: 99%

Liquid Biopsy as a Tool for the Diagnosis, Treatment, and Monitoring of Breast Cancer

Freitas

Causin

Varuzza

et al. 2022

IJMS

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Breast cancer (BC) is a highly heterogeneous disease. The treatment of BC is complicated owing to intratumoral complexity. Tissue biopsy and immunohistochemistry are the current gold standard techniques to guide breast cancer therapy; however, these techniques do not assess tumoral molecular heterogeneity. Personalized medicine aims to overcome these biological and clinical complexities. Advances in techniques and computational analyses have enabled increasingly sensitive, specific, and accurate application of liquid biopsy. Such progress has ushered in a new era in precision medicine, where the objective is personalized treatment of breast cancer, early screening, accurate diagnosis and prognosis, relapse detection, longitudinal monitoring, and drug selection. Liquid biopsy can be defined as the sampling of components of tumor cells that are released from a tumor and/or metastatic deposits into the blood, urine, feces, saliva, and other biological substances. Such components include circulating tumor cells (CTCs), circulating tumor DNA (ctDNA) or circulating tumor RNA (ctRNA), platelets, and exosomes. This review aims to highlight the role of liquid biopsy in breast cancer and precision medicine.

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Prognostic value of ctDNA detection in patients with early breast cancer undergoing neoadjuvant therapy: A systematic review and meta-analysis

Cited by 55 publications

References 29 publications

Detection of asymptomatic recurrence following curative surgery improves survival in patients with gastric cancer: A systematic review and meta-analysis

Detection of asymptomatic recurrence following curative surgery improves survival in patients with gastric cancer: A systematic review and meta-analysis

Systemic therapy for early-stage breast cancer: learning from the past to build the future

Liquid Biopsy as a Tool for the Diagnosis, Treatment, and Monitoring of Breast Cancer

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