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July 2024 | George M. Pikler, M.D., Ph.D., FACP, Lead Oncology Advocate N1X10

A Liquid Biopsy Can Predict the Risk of Breast Cancer Recurrence

Tests that can detect circulating tumor DNA (ctDNA) in a blood sample, known as liquid biopsies, have generated immense excitement. Some of these tests are already being integrated into cancer care for monitoring how tumors are responding to treatment or whether a cancer is coming back after earlier successful treatment and others are being studied as a way to screen people for many types of cancer. See previous articles on these tests on N1X10’s Blog (July 2023, June 2024).

The idea is that finding tumor DNA in the blood probably means that cancer cells are still present somewhere in the body, even at a low level. These tests are starting to be used in a variety of cancers — and for the most part, clinicians agree that if the test is positive, the cancer will likely recur.

At the American Society of Clinical Oncology (ASCO) annual meeting in Chicago last month, investigators at the Breast Cancer Now Toby Robins research center in London reported that a personalized, ultra-sensitive, liquid biopsy detecting minuscule amounts of cancer DNA (ctDNA) in the bloodstream could accurately predict the risk of a breast cancer recurrence months or even years before the usual signs on scans or symptoms start to emerge. This new test uses whole genome sequencing (WGS) and searches for 1,800 mutations, making it much more sensitive than the whole exome sequencing (WES) that typically looks for between 16 and 50 mutations. The test findings may help reveal which women need preventive therapy and which patients can be spared it.

“Breast cancer cells can remain in the body after surgery and other treatments but there can be so few of these cells that they are undetectable on follow-up scans,” said Isaac Garcia-Murillas, the study’s lead author at the Institute of Cancer Research (ICR). “These cells can cause breast cancer patients to relapse many years after their initial treatment.”

Out of a cohort of 76 women, the test correctly identified all 10 women who relapsed during the five-year trial. The average time to relapse was 15 months; the longest 41 months. All 60 women in whom the test did not find ctDNA did not relapse, meaning there were also no false negatives. Three patients had ctDNA detected in follow-up but had not relapsed at the time of data cut off. The ICR did not provide full data for the remaining four patients.

J Clin Oncol 42, 2024 (suppl 16, abstr 1010)
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.