Researchers at City of Hope published data pointing to the limitations of a popular liquid biopsy that is used to detect the recurrence of colorectal cancer in patients who who have undergone surgical resection. The findings were published in JAMA Network Open by Marwan Fakih, MD, and colleagues.
“A liquid biopsy measuring circulating tumor DNA is a novel way to test for residual disease in patients who have recently received curative resection for colon cancer. Identifying early disease recurrence is important, as it may allow for potential curative interventions,” said Dr. Fakih, Co-Director of City of Hope’s Gastrointestinal Cancer Program.
Marwan Fakih, MD
Study Methods
City of Hope researchers evaluated 48 study participants who underwent resection for their colorectal cancer. The scientists sought to identify which technique might be superior in identifying residual disease and early cancer recurrence by comparing the use of Signatera’s circulating tumor DNA (ctDNA) analysis, which is often used to screen for colorectal cancer, to the standard-of-care recommended by the National Comprehensive Cancer Network® (NCCN): X-rays via computed tomography (CT) scan and a carcinoembryonic antigen (CEA) test, which measures a tumor marker via a blood draw.
Fifteen patients experienced colorectal cancer recurrence. Within this group, standard-of-care surveillance was better at identifying early disease; for example, ctDNA did not identify patients who had early recurrence in the lungs. Three patients received a negative ctDNA test, but standard-of-care surveillance techniques identified disease recurrence in their lungs.
“Imaging remains the most important surveillance assay in the follow-up of resected colorectal cancers. Clinicians should continue to abide by NCCN guidelines. For those who decide to implement ctDNA into their surveillance algorithm, they should be aware of the limitations associated with this assay,” Dr. Fakih said, referencing current clinical trials elsewhere where clinicians are de-intensifying chemotherapy based on a negative ctDNA test by Signatera.
It may be premature to base treatment decisions solely on ctDNA results “given the limitations of Signatera sensitivity,” said Dr. Fakih, the Judy & Bernard Briskin Distinguished Director of Clinical Research and a Professor in City of Hope’s Department of Medical Oncology & Therapeutics Research.
Dr. Fakih added that using liquid biopsies to identify disease recurrence is an attractive, noninvasive option. Liquid biopsy is convenient and, unlike CT, does not expose patients to low doses of radiation. However, scientists are still working to develop a reliable and sensitive liquid biopsy to detect colorectal cancer recurrence.
“ctDNA was able to identify several recurrences in the liver and lymph nodes ahead of imaging,” Dr. Fakih said. “For now, ctDNA can be considered, if any at all, as a complement to the standard approach recommended by the NCCN, but one must be cognizant of its limitations.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
