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Using ctDNA to Inform Adjuvant Therapy for Urologic Malignancies.

Rajvi Goradia1, Taylor Goodstein2, Debasish Sundi1

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Summary
This summary is machine-generated.

Circulating tumor DNA (ctDNA) shows promise for guiding adjuvant therapy in genitourinary cancers. This liquid biopsy biomarker can refine treatment decisions, potentially improving outcomes for bladder, kidney, and prostate cancer patients.

Keywords:
adjuvant therapybladder cancerctDNAkidney cancerprostate cancer

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Area of Science:

  • Oncology
  • Genitourinary Cancers
  • Molecular Diagnostics

Background:

  • Adjuvant therapy decisions for genitourinary (GU) cancers rely on clinicopathologic factors that incompletely predict individual recurrence risk.
  • Current approaches lead to imprecise patient selection, resulting in both overtreatment and undertreatment of GU malignancies.
  • Minimal residual disease (MRD) detection is crucial for optimizing adjuvant treatment strategies.

Purpose of the Study:

  • To review the evidence for using circulating tumor DNA (ctDNA) to guide adjuvant therapy decisions in bladder, kidney, and prostate cancers.
  • To highlight disease-specific applications of ctDNA in the post-neoadjuvant, post-cystectomy, and post-prostatectomy settings.
  • To explore the potential of ctDNA as a biomarker for MRD in GU malignancies.

Main Methods:

  • Literature review summarizing current evidence on ctDNA in GU cancer adjuvant therapy.
  • Analysis of ctDNA's role in detecting MRD and predicting oncologic outcomes.
  • Exploration of ctDNA applications across different GU cancer types and treatment settings.

Main Results:

  • ctDNA detection indicates persistent tumor and can precede radiographic recurrence.
  • ctDNA negativity is consistently linked to favorable oncologic outcomes.
  • Evidence supports ctDNA's utility in refining adjuvant treatment decisions for bladder, kidney, and prostate cancers.

Conclusions:

  • ctDNA offers a minimally invasive approach to assess MRD in GU malignancies.
  • ctDNA may facilitate a paradigm shift towards biologically informed escalation and de-escalation of adjuvant therapy.
  • Prospective validation in biomarker-driven clinical trials is essential to confirm ctDNA's role in clinical practice.