Implementing circulating tumor DNA as a prognostic biomarker in resectable non-small cell lung cancer

IF 14.3 1区 医学 Q1 ONCOLOGY Trends in cancer Pub Date : 2024-06-04 DOI:10.1016/j.trecan.2024.04.004
Chris Abbosh, Darren Hodgson, Gary J. Doherty, Davina Gale, James R.M. Black, Leora Horn, Jorge S. Reis-Filho, Charles Swanton
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Abstract

Systemic treatment of resectable non-small cell lung cancer (NSCLC) is evolving with emerging neoadjuvant, perioperative, and adjuvant immunotherapy approaches. Circulating tumor DNA (ctDNA) detection at clinical diagnosis, during neoadjuvant therapy, or after resection may discern high-risk patients who might benefit from therapy escalation or switch. This Review summarizes translational implications of data supporting ctDNA-based risk determination in NSCLC and outstanding questions regarding ctDNA validity/utility as a prognostic biomarker. We discuss emerging ctDNA capabilities to refine clinical tumor–node–metastasis (TNM) staging in lung adenocarcinoma, ctDNA dynamics during neoadjuvant therapy for identifying patients deriving suboptimal benefit, and postoperative molecular residual disease (MRD) detection to escalate systemic therapy. Considering differential relapse characteristics in landmark MRD-negative/MRD-positive patients, we propose how ctDNA might integrate with pathological response data for optimal postoperative risk stratification.

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将循环肿瘤 DNA 作为可切除非小细胞肺癌的预后生物标记物
可切除非小细胞肺癌(NSCLC)的全身治疗正随着新辅助、围手术期和辅助免疫疗法方法的出现而不断发展。在临床诊断、新辅助治疗期间或切除术后进行循环肿瘤DNA(ctDNA)检测,可发现可能从治疗升级或转换中获益的高危患者。本综述总结了支持基于ctDNA确定NSCLC风险的数据的转化意义,以及有关ctDNA作为预后生物标记物的有效性/效用的未决问题。我们讨论了新出现的ctDNA功能,以完善肺腺癌的临床肿瘤-结节-转移(TNM)分期;新辅助治疗期间ctDNA的动态变化,以确定获得次优疗效的患者;以及术后分子残留病(MRD)检测,以升级全身治疗。考虑到地标性 MRD 阴性/MRD 阳性患者的不同复发特征,我们提出了如何将 ctDNA 与病理反应数据相结合,以优化术后风险分层。
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来源期刊
Trends in cancer
Trends in cancer Medicine-Oncology
CiteScore
28.50
自引率
0.50%
发文量
138
期刊介绍: Trends in Cancer, a part of the Trends review journals, delivers concise and engaging expert commentary on key research topics and cutting-edge advances in cancer discovery and medicine. Trends in Cancer serves as a unique platform for multidisciplinary information, fostering discussion and education for scientists, clinicians, policy makers, and patients & advocates.Covering various aspects, it presents opportunities, challenges, and impacts of basic, translational, and clinical findings, industry R&D, technology, innovation, ethics, and cancer policy and funding in an authoritative yet reader-friendly format.
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