103. Early Real-World Experience Monitoring Circulating Tumor DNA in Resected Early-Stage Non-Small Cell Lung Cancer
Massachusetts General Hospital
Boston, MA
United States - Contact Me
Uma Sachdeva is a thoracic surgeon at Massachusetts General Hospital and Assistant Professor of Surgery at Harvard Medical School. She received her MD and PhD in cell and molecular biology through the Medical Scientist Training Program from the University of Pennsylvania after completing her undergraduate degree in Biochemical Sciences from Harvard College. She is a graduate of the General Surgery and Cardiothoracic Surgery training programs at Massachusetts General Hospital and specializes in thoracic oncology, focusing on esophageal and lung cancers using minimally invasive and robotic approaches. Her lab studies molecular pathways underlying the development of esophageal cancers and precursor lesions, including Barrett’s esophagus, and personalized medicine approaches using 3D cellular models. She received the 2020 Carolyn E. Reed Traveling Fellowship from the Thoracic Surgery Foundation and Women in Thoracic Surgery, as well as the 2021 F. Griffith Pearson Fellowship from the American Association for Thoracic Surgery. She is also the recipient of the 2nd David C. Sabiston Research Scholarship from the American Association for Thoracic Surgery and the 2021 Research Scholarship from the Thoracic Surgery Foundation. She was recently selected to the 2023 cohort of the National Cancer Institute's Early-stage Surgeon-Scientist Program.
UNTHSC
Dallas, TX
United States - Contact Me
Travis Martin is a fourth-year medical student at the University of North Texas Health Science Center Texas College of Osteopathic Medicine. He received his MS in medical sciences from the University of North Texas Health Science Center after completing his undergraduate degree in Health Science Studies from Baylor University. He recently matched at the Divinity Health East Valley General Surgery residency in Chandler, AZ where he will begin his surgical internship this summer. After general surgery residency, he is focused on pursuing a fellowship in Cardiothoracic surgery.
Abstract
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.