Sam Klempner, MD, spoke about clinical management and ctDNA for gastrointestinal cancers.
At the 2022 International Gastric Cancer Conference, Sam Klempner, MD, of Massachusetts General Hospital, spoke to CancerNetwork® about circulating tumor DNA (ctDNA) use in nonmetastatic esophageal and gastric cancers and how prospective studies should be established to examine the practice in this population.
The current status of ctDNA in nonmetastatic gastric and esophageal cancers is investigational. That’s the 1-word summary. There’s much interest and a lot of potential applications, but before we incorporate these things into routine clinical management, it’s important to establish some benchmarks and ultimately some prospective trial designs to study these questions. Almost all, if not all, of the existing data is built on retrospective analyses from relatively small cohorts. We don’t even have great benchmarking to say, “how common is cell free DNA from tumors detected in a newly diagnosed patient with stomach cancer whose [disease is] stage II or stage III?” These are important things to determine if you’re going to design your study. The overall message does appear relatively consistent that patients who have residual ctDNA after curative-intent therapy have increased risk of recurrence. In some cases, [they are] seemingly destined to recur in a relatively short period of time. It appears to be quite prognostic. There is some suggestion that clearance during neoadjuvant therapy is also predictive of favorable outcome. These are encouraging signals, but we just need larger series and prospective trial collections to really validate this.