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Guo N, Zhou Q, Chen X, Zeng B, Wu S, Zeng H, Sun F. Circulating tumor DNA as prognostic markers of relapsed breast cancer: a systematic review and meta-analysis. JOURNAL OF THE NATIONAL CANCER CENTER 2024; 4:63-73. [PMID: 39036387 PMCID: PMC11256521 DOI: 10.1016/j.jncc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 07/23/2024] Open
Abstract
Objective Circulating tumor DNA (ctDNA) is increasingly being used as a potential prognosis biomarker in patients of breast cancer. This review aims to assess the clinical value of ctDNA in outcome prediction in breast cancer patients throughout the whole treatment cycle. Methods PubMed, Web of Science, Embase, Cochrane Library, Scopus, and clinical trials.gov were searched from January 2016 to May 2022. Conference abstracts published in last three years were also included. The following search terms were used: ctDNA OR circulating tumor DNA AND breast cancer OR breast carcinoma. Only studies written in English languages were included. The following pre-specified criteria should be met for inclusion: (1) observational studies (prospective or retrospective), randomized control trials, case-control studies and case series studies; (2) patients with breast cancer; (3) ctDNA measurement; (4) clinical outcome data such as objective response rate (ORR), pathological complete response (pCR), relapse-free survival (RFS), overall survival (OS), and so on. The random-effect model was preferred considering the potential heterogeneity across studies. The primary outcomes included postoperative short-term outcomes (ORR and pCR) and postoperative long-term outcomes (RFS, OS, and relapse). Secondary outcomes focused on ctDNA detection rate. Results A total of 30 studies, comprising of 19 cohort studies, 2 case-control studies and 9 case series studies were included. The baseline ctDNA was significantly negatively associated with ORR outcome (Relative Risk [RR] = 0.65, 95% confidence interval [CI]: 0.50-0.83), with lower ORR in the ctDNA-positive group than ctDNA-negative group. ctDNA during neoadjuvant therapy (NAT) treatment was significantly associated with pCR outcomes (Odds Ratio [OR] = 0.15, 95% CI: 0.04-0.54). The strong association between ctDNA and RFS or relapse outcome was significant across the whole treatment period, especially after the surgery (RFS: Hazard Ratio [HR] = 6.74, 95% CI: 3.73-12.17; relapse outcome: RR = 7.11, 95% CI: 3.05-16.53), although there was heterogeneity in these results. Pre-operative and post-operative ctDNA measurements were significantly associated with OS outcomes (pre-operative: HR = 2.03, 95% CI: 1.12-3.70; post-operative: HR = 6.03, 95% CI: 1.31-27.78). Conclusions In this review, ctDNA measurements at different timepoints are correlated with evaluation indexes at different periods after treatment. The ctDNA can be used as an early potential postoperative prognosis biomarker in breast cancer, and also as a reference index to evaluate the therapeutic effect at different stages.
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Affiliation(s)
- Na'na Guo
- Hebei Province Centers for Disease Control and Prevention, Shijiazhuang, China
| | - Qingxin Zhou
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Xiaowei Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Baoqi Zeng
- Department of Science and Education, Peking University Binhai Hospital, Tianjin, China
| | - Shanshan Wu
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongmei Zeng
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Major Disease Epidemiology, Ministry of Education (Peking University), Beijing, China
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Di Cosimo S, Cappelletti V, Pruneri G. Advancing Circulating Tumor DNA for Recurrent Breast Cancer. JCO Precis Oncol 2023; 7:e2200596. [PMID: 36701652 DOI: 10.1200/po.22.00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Serena Di Cosimo
- Serena Di Cosimo, MD, PhD, Vera Cappelletti, MSc, and Giancarlo Pruneri, MD, Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Vera Cappelletti
- Serena Di Cosimo, MD, PhD, Vera Cappelletti, MSc, and Giancarlo Pruneri, MD, Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giancarlo Pruneri
- Serena Di Cosimo, MD, PhD, Vera Cappelletti, MSc, and Giancarlo Pruneri, MD, Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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La Rocca E, De Santis MC, Silvestri M, Ortolan E, Valenti M, Folli S, de Braud FG, Bianchi GV, Scaperrotta GP, Apolone G, Daidone MG, Cappelletti V, Pruneri G, Di Cosimo S. Early stage breast cancer follow-up in real-world clinical practice: the added value of cell free circulating tumor DNA. J Cancer Res Clin Oncol 2022; 148:1543-1550. [PMID: 35396978 PMCID: PMC9114063 DOI: 10.1007/s00432-022-03990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
Purpose Physical examinations and annual mammography (minimal follow-up) are as effective as laboratory/imaging tests (intensive follow-up) in detecting breast cancer (BC) recurrence. This statement is now challenged by the availability of new diagnostic tools for asymptomatic cases. Herein, we analyzed current practices and circulating tumor DNA (ctDNA) in monitoring high-risk BC patients treated with curative intent in a comprehensive cancer center. Patients and methods Forty-two consecutive triple negative BC patients undergoing neoadjuvant therapy and surgery were prospectively enrolled. Data from plasma samples and surveillance procedures were analyzed to report the diagnostic pattern of relapsed cases, i.e., by symptoms, follow-up procedures and ctDNA. Results Besides minimal follow-up, 97% and 79% of patients had at least 1 non-recommended imaging and laboratory tests for surveillance purposes. During a median follow-up of 5.1(IQR, 4.1–5.9) years, 13 events occurred (1 contralateral BC, 1 loco-regional recurrence, 10 metastases, and 1 death). Five recurrent cases were diagnosed by intensive follow-up, 5 by symptoms, and 2 incidentally. ctDNA antedated disseminated disease in all evaluable cases excepted two with bone-only and single liver metastases. The mean time from ctDNA detection to suspicious findings at follow-up imaging was 3.81(SD, 2.68), and to definitive recurrence diagnosis 8(SD, 2.98) months. ctDNA was undetectable in the absence of disease and in two suspected cases not subsequently confirmed. Conclusions Some relapses are still symptomatic despite the extensive use of intensive follow-up. ctDNA is a specific test, sensitive enough to detect recurrence before other methods, suitable for clarifying equivocal imaging, and exploitable for salvage therapy in asymptomatic BC survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-022-03990-7.
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Affiliation(s)
- E La Rocca
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiation Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M C De Santis
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiation Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Silvestri
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - E Ortolan
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Valenti
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - S Folli
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Breast Cancer Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - F G de Braud
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - G V Bianchi
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G P Scaperrotta
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M G Daidone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - V Cappelletti
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Pruneri
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy.,Department of Pathology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - S Di Cosimo
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
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