[What future for circulating tumor DNA? Current data and prospects in colorectal, non-small cell lung and pancreatic
Daniel Pietrasz1, Nicolas Pécuchet2, Elizabeth Fabre2
1Université Paris Sorbonne Cité, centre universitaire des Saints-Pères, CNRS SNC5014, Inserm UMR-S1147 MEPPOT, 75006 Paris, France; Assistance publique-Hôpitaux de Paris, groupe hospitalier Pitié-Salpêtrière, service de chirurgie digestive et hépato-biliaire, 75013 Paris, France.
Abstract:
Ten years after the discovery of the predictive value of KRAS status for anti-EGFR antibodies, other genes involved in oncogenesis and therapeutic responses were identified and are now systematically sought. Molecular diagnosis often requires invasive procedures, sometimes iatrogenic, and is limited by feasibility problems, quantity and quality of samples. Identifying these mutations from blood biomarkers would reduce costs and diagnostic delay. The circulating tumor DNA (ctDNA) is one of the most promising blood biomarkers. In this review, we report and discuss the latest results obtained with ctDNA in colorectal cancer, non-small cell lung cancer, and adenocarcinoma of the pancreas. If the methods highlighting appear very heterogeneous, the correlation between mutations found in tumor and those identified in the blood exceeds 95 % specificity in numerous studies. The detection sensitivity is in turn strongly related to tumor stage patients. The presence of ctDNA appears as a prognostic factor for progression-free survival and overall survival. Finally, recent studies have shown that the changing rate ctDNA during systemic treatments had a predictive value for therapeutic efficacy. These results allow to consider the use of ctDNA in monitoring patients to identify early recurrence or progression.
Insights
Circulating tumor DNA (ctDNA) analysis offers a less invasive method for detecting cancer mutations, improving diagnostic speed and reducing costs. This blood biomarker shows high accuracy and prognostic value across multiple cancer types.
Area of Science:
- Oncology
- Molecular Diagnostics
- Biomarker Research
Context:
- The identification of oncogenic mutations is crucial for targeted cancer therapies.
- Traditional molecular diagnostics rely on invasive tissue biopsies, posing challenges in sample acquisition and patient safety.
- Circulating tumor DNA (ctDNA) has emerged as a promising non-invasive biomarker for cancer mutation detection.
Purpose:
- To review the latest advancements and applications of ctDNA analysis in colorectal cancer, non-small cell lung cancer, and pancreatic cancer.
- To evaluate the diagnostic accuracy, prognostic significance, and predictive value of ctDNA in various solid tumors.
- To discuss the potential of ctDNA as a tool for monitoring treatment response and detecting early disease recurrence.
Summary:
- ctDNA analysis demonstrates high concordance (>95% specificity) with tumor mutations across multiple cancer types, though sensitivity varies with disease stage.
- The presence and dynamics of ctDNA serve as significant prognostic factors for progression-free and overall survival.
- Changes in ctDNA levels during systemic treatment correlate with therapeutic efficacy, suggesting its utility in treatment monitoring.
Impact:
- ctDNA analysis can reduce the need for invasive procedures, lowering healthcare costs and diagnostic delays.
- ctDNA offers a powerful tool for prognostic stratification and personalized treatment selection in oncology.
- Monitoring ctDNA dynamics can enable early detection of treatment resistance, recurrence, or disease progression, facilitating timely clinical intervention.
