Dr Vikas on the Benefit of Utilizing MRD Detection in Breast Cancer Treatment

Praveen Vikas, MBBS, clinical associate professor, Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation, Department of Medicine, Carver College of Medicine, University of Iowa Health Care, discusses the benefits associated with utilizing minimal residual disease (MRD) detection in breast cancer.

Several ongoing clinical trials are utilizing MRD-positivity determined by circulating tumor DNA (ctDNA) as a criterion for patient inclusion, including the phase 2 LEADER (NCT03285412) and the DARE (NCT04567420) trials, Vikas begins. These studies primarily focus on the detection of ctDNA as an indicator of disease, Vikas notes. Upon confirming ctDNA positivity, patients become eligible for randomization into treatment groups that may involve the administration of CDK4/6 inhibitors, Vikas explains. This presents a promising scenario for conducting such tests.

Vikas says that he occasionally employs these tests for patients who are considered high risk, such as those with an elevated risk of relapse. Conventional imaging studies frequently fail to yield positive results for extended periods. In these instances, tests are often repeatedly conducted, Vikas details. Additionally, a clinician’s actions can be limited in a clinical trial setting, especially regarding patient enrollment, Vikas notes. Therefore it is important to exercise caution, Vikas emphasizes.

Additionally, ctDNA tests can offer valuable insights for patients undergoing prolonged treatment in the maintenance setting, Vikas says. Certain patients, such as those with triple-negative breast cancer, are on long-term maintenance treatment. This typically consists of immunotherapy or an immune checkpoint inhibitor, Vikas continues. The optimal duration for maintaining such therapies is still a subject of debate. Patients may express fatigue or encounter logistical challenges, such as extensive travel to treatment centers, when receiving prolonged treatment in the maintenance setting. Results from ctDNA testing can influence the decision to continue or discontinue treatment. However, this approach is not yet universally applicable, Vikas notes.

Overall, there is a growing body of evidence demonstrating the efficacy of ctDNA tests, Vikas says. Various studies have shown that ctDNA can detect cancer approximately 9 to 10 months before it is detected using other imaging modalities, Vikas concludes.