ctDNA associated with poor outcomes in triple-negative breast cancer

Body: Much of oncology research hinges on the type of cancer and other patient-specific factors. Researchers from several institutions set out in 2014 to establish whether genomically directed therapy administered after preoperative chemotherapy was useful in women treated for triple negative breast cancer. A preplanned analysis of this study checked on whether circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs) after surgery are associated with inferior outcomes for patients with early-stage disease, and the answer appears to be yes. This analysis of 196 female patients from NCT 02101385 was a preplanned secondary analysis, and was conducted from March 26, 2014, to Dec. 18, 2018. The researchers randomized patients with early-stage disease who had residual disease after neoadjuvant chemotherapy to undergo post-neoadjuvant, genomically directed therapy or a treatment of the patient’s and physician’s choosing. Blood samples collected for ctDNA and CTCs at time of treatment assignment. The analysis of ctDNA with survival was performed for 142 patients, while the CTC analysis with survival was performed for 123 patients. Median clinical follow-up was roughly 17 months. For the study population, detection of ctDNA was significantly associated with inferior distant disease-free survival, reaching 56% for the ctDNA-positive patients, while 81% of ctDNA-negative patients reached that mark. The authors said detection of ctDNA was similarly associated with poorer outcomes for disease-free survival (hazard ratio of 2.67) as well as overall survival (hazard ratio of 4.16). The numbers were worse yet for patients who were positive for both ctDNA and CTCs, however, and the authors said their study “represents an important stratification factor for future post-neoadjuvant trials.” This study appeared July 9, 2020, in JAMA Oncology.

Protons beat IMRT for locally advanced esophageal cancer

Intensity-modulated radiation therapy (IMRT) has had the radiotherapy field to itself for some time where some cancers are concerned. But a recent study suggests that proton beam therapy deserves another look where locally advanced esophageal cancer is concerned. A recently published study randomized 145 patients equally to these two modalities starting in 2012, although only 107 were evaluable as of an interim analysis commenced in March 2019. Median follow-up time was slightly more than 44 months for the 46 proton and 61 IMRT-evaluable patients, although 51 patients in total (21 proton patients) had to undergo esophagectomy. Progression-free survival at three years was similar between the two arms (50.8% for protons and 51.2% for IMRT), while overall three-year survival was identical between the two arms at 44.5%. However, the posterior mean total toxicity burden was 2.3 times higher in the IMRT group at 39.9, vs. 17.4 for proton therapy, while the post-operative complications score was greater than 19 for IMRT, but only 2.5 for proton therapy. The authors concluded that for locally advanced esophageal cancer, proton therapy “reduced the risk and severity of [adverse events] compared with IMRT while maintaining similar” rates of progression-free survival. This study appeared in the July 25, 2020, issue of the Journal of Clinical Oncology.

Study affirms cancer patients avoiding clinical care

Patient visits with health care providers have anecdotally taken a hit across a range of disease states, but the data to support those notions have been slow to accumulate. That has changed, however, thanks to the efforts of researchers in the U.S. and the U.K. Using data drawn from the Trinetx platform, the researchers combed through data from 20 health care institutions said to have “relevant, up-to-date encounter data” to offer. They compared data from the first four months of 2019 and 2020 for all patients diagnosed with any type of neoplasticity, including benign tumors, in one analysis, while other analyses focused on more restrictive criteria. However, the data also included those who received a negative return after undergoing cancer screening. The authors said the most significant drop in clinical encounters was seen in April 2020 for those with established cancer, although the drop was less conspicuous in lung and colorectal cancers compared with breast and prostate cancers. The largest drop was in melanoma, where a 51% drop was seen in April 2020, but perhaps equally troubling was that breast and colorectal cancer screenings plummeted by 89.2% and 84.5%, respectively. The authors said the cratering of screenings and new diagnoses seen in the first four months of 2020 suggest “the possibility of a future increase in patients with later-stage cancer being seen initially as well as an increased demand for cancer screening procedures as delayed tests are rescheduled.” These findings are spelled out in more detail in JCO Clinical Cancer Informatics.

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