Early Real-World Experience Monitoring Circulating Tumor DNA in Resected Early-Stage Non-Small Cell Lung Cancer
Presented During:
Sunday, May 7, 2023: 7:45AM - 8:00AM
Los Angeles Convention Center
Posted Room Name:
408B
Abstract No:
103
Submission Type:
Abstract Submission
Authors:
Aaron Dinerman (1), Travis Martin (2), Emy Smith (1), Leonidas Tapias Vargas (3), Eitan Podgaetz (1), Gary Schwartz (1)
Institutions:
(1) Baylor University Medical Center, Dallas, TX, (2) UNTHSC, Dallas, TX, (3) University Hospitals Cleveland Medical Center, Cleveland, OH
Submitting Author:
Aaron Dinerman
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Baylor University Medical Center
Baylor University Medical Center
Co-Author(s):
Travis MArtin
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Emy Smith
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Baylor University Medical Center
Baylor University Medical Center
Leonidas Tapias Vargas
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University Hospitals Cleveland Medical Center
University Hospitals Cleveland Medical Center
Eitan Podgaetz
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Baylor University Medical Center
Baylor University Medical Center
Gary Schwartz
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Baylor University Medical Center
Baylor University Medical Center
Presenting Author:
Travis MArtin
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UNTHSC
Abstract:
Objective: To evaluate the impact of circulating tumor DNA (ctDNA) on detection and management of recurrence in patients with resected early-stage non-small cell lung cancer (NSCLC).
Methods: In October 2021, post-operative ctDNA was monitored for all surgically resected lung cancer patients at a tertiary care referral center. Peripheral blood was collected for ctDNA at 3-month intervals utilizing a third-party company. Results were tracked prospectively and clinical data was retrospectively obtained from chart review. The primary outcome measure was an abnormal ctDNA result. The secondary outcome measure was changes in practice after abnormal ctDNA: (1) new referral for consideration of adjuvant therapy or (2) more aggressive radiographic surveillance. Patients with Stage III lung cancer, a history of other malignancies, and patients who had a known recurrence prior to initiation of ctDNA monitoring were excluded from this study.
Results: 76 patients were included for analysis with a mean age of 67.3 years. VATS accounted for 92.1% of cases with lobectomy accounting for 89.5% of cases. Adenocarcinoma was present in 75% of patients. 17.1% of patients received adjuvant chemotherapy for Stage II disease. 10.5% of patients (8/76) were positive for ctDNA. 75% (6/8) of ctDNA-positive patients had a biopsy-proven recurrence and were directed into therapy. 25% (2/8) have not demonstrated radiographic evidence of recurrence but were directed into earlier interval surveillance. 33% (2/6) of positive ctDNA patients with biopsy-proven recurrence received adjuvant chemotherapy after surgery (but before positive ctDNA) due to stage II disease. 1 patient was found to have recurrent disease (brain metastases) with a negative ctDNA level. Post-operative clinical care was altered in 87.5% (7/8) of ctDNA positive patients with 62.5% (5/8) receiving an earlier surveillance CT scan and 75% (6/8) receiving early PET-CT scan.
Conclusion: Serial monitoring of ctDNA following resection of early-stage NSCLC resulted in early detection of recurrent cancer leading to early surveillance and/or unexpected medical oncology referral in 87.5% (7/8) of patients with a positive ctDNA. One patient demonstrated recurrence (brain metastases) with a negative ctDNA level. Our study exemplifies real live utilization of ctDNA and its impact on surveillance and management in early-stage resected NSCLC. Further multicenter studies are required to determine protocol-specific best practices.
Methods: In October 2021, post-operative ctDNA was monitored for all surgically resected lung cancer patients at a tertiary care referral center. Peripheral blood was collected for ctDNA at 3-month intervals utilizing a third-party company. Results were tracked prospectively and clinical data was retrospectively obtained from chart review. The primary outcome measure was an abnormal ctDNA result. The secondary outcome measure was changes in practice after abnormal ctDNA: (1) new referral for consideration of adjuvant therapy or (2) more aggressive radiographic surveillance. Patients with Stage III lung cancer, a history of other malignancies, and patients who had a known recurrence prior to initiation of ctDNA monitoring were excluded from this study.
Results: 76 patients were included for analysis with a mean age of 67.3 years. VATS accounted for 92.1% of cases with lobectomy accounting for 89.5% of cases. Adenocarcinoma was present in 75% of patients. 17.1% of patients received adjuvant chemotherapy for Stage II disease. 10.5% of patients (8/76) were positive for ctDNA. 75% (6/8) of ctDNA-positive patients had a biopsy-proven recurrence and were directed into therapy. 25% (2/8) have not demonstrated radiographic evidence of recurrence but were directed into earlier interval surveillance. 33% (2/6) of positive ctDNA patients with biopsy-proven recurrence received adjuvant chemotherapy after surgery (but before positive ctDNA) due to stage II disease. 1 patient was found to have recurrent disease (brain metastases) with a negative ctDNA level. Post-operative clinical care was altered in 87.5% (7/8) of ctDNA positive patients with 62.5% (5/8) receiving an earlier surveillance CT scan and 75% (6/8) receiving early PET-CT scan.
Conclusion: Serial monitoring of ctDNA following resection of early-stage NSCLC resulted in early detection of recurrent cancer leading to early surveillance and/or unexpected medical oncology referral in 87.5% (7/8) of patients with a positive ctDNA. One patient demonstrated recurrence (brain metastases) with a negative ctDNA level. Our study exemplifies real live utilization of ctDNA and its impact on surveillance and management in early-stage resected NSCLC. Further multicenter studies are required to determine protocol-specific best practices.
Categories:
Lung Cancer
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