循环瘤DNA完善了新辅助疗法耐药乳腺瘤的风险分层
Mark Jesus M Magbanua1, Nayelis A Manon2, Denise M Wolf2
1Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA. mark.magbanua@ucsf.edu.
Nature communications
|December 9, 2025
概括
在新辅助疗法 (NAT) 后检测循环瘤DNA (ctDNA) 可以改善早期乳腺癌患者的风险评估. 监测ctDNA可以预测治疗反应和复发风险,指导更好的临床决策.
科学领域:
- 在瘤学瘤学.
- 分子诊断学 分子诊断学
- 癌症基因组学 癌症基因组学
背景情况:
- 对新辅助疗法 (NAT) 耐药的早期乳腺癌由于显著的残留癌症负担 (RCB) 存在转移性复发的高风险.
- 准确的风险分层和预测治疗反应对于优化这些患者的管理策略至关重要.
研究的目的:
- 评估通过瘤知情测试检测到的循环瘤DNA (ctDNA) 在改善耐NAT乳腺癌 (RCB-II/RCB-III) 患者风险分层方面的实用性.
- 评估ctDNA对包括免疫疗法在内的NAT治疗反应的预测价值.
- 了解在抗NAT瘤中ctDNA脱落的动态及其对临床决策的影响.
主要方法:
- 利用瘤告知循环瘤DNA (ctDNA) 试验分析了接受NAT治疗的早期乳腺癌患者的样本.
- 评估治疗前和后NAT中的ctDNA状态,以及治疗期间的ctDNA动态.
- 与剩余癌症负担 (RCB) 和转移性复发风险相关联的ctDNA发现.
- 在耐NAT瘤上进行序列突变分析,以随着时间的推移追踪ctDNA变异.
主要成果:
- ctDNA检测改善了NAT抗性瘤 (RCB-II/RCB-III) 患者的风险分层,识别了转移性复发风险降低的患者.
- 到第3周的ctDNA清除预测了NAT对包括免疫疗法在内的受体亚型的良好反应.
- 只有不到20%的耐NAT瘤患者在NAT后是ctDNA阳性,但随着时间的推移,患者特异的ctDNA变异仍然可以检测到,即使在NAT后的ctDNA阴性病例中.
结论:
- ctDNA监测为完善风险分层和预测早期乳腺癌患者的治疗反应提供了有价值的工具.
- 了解NAT抗性瘤中ctDNA分泌动态可以指导治疗决策,以潜在地预防或延迟转移性复发.
- 对ctDNA作用的进一步研究可以优化高风险乳腺癌患者的治疗策略.
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