Dr Advani on the Advantages of Liquid Biopsy in Metastatic Breast Cancer

Pooja Advani, MBBS, MD, hematologist/oncologist, Mayo Clinic Comprehensive Cancer Center, discusses the advantages of utilizing a liquid biopsy in metastatic breast cancer, as well as highlights unanswered questions on how to most effectively utilize circulating tumor DNA (ctDNA) assays to improve patient outcomes in this space.

Liquid biopsy plays a crucial role in the development of management strategies for patients with metastatic disease, particularly those with hormone receptor (HR)–positive, HER2-negative breast cancer, Advani begins. It enables the detection of mutations for which targeted therapies are available. This includes ESR1 mutations, where elacestrant (Orserdu) can be used; PIK3CA mutations, which can be treated with alpelisib (Piqray) plus fulvestrant (Faslodex); and AKT mutations, which can be treated with capivasertib (Truqap) in combination with fulvestrant.

Moreover, liquid biopsy facilitates patient enrollment in biomarker-specific clinical trials, Advani continues. By detecting specific biomarkers in liquid biopsy, clinicians can refer patients to relevant clinical trials, optimizing their treatment options and potential outcomes, she explains.

Compared with traditional tissue biopsies, liquid biopsies offer several advantages, including ease of collection and better clonal representation, Advani states. However, the primary challenge lies in utilizing ctDNA for minimal residual disease (MRD) detection and monitoring, she explains. Clinicians are exploring the feasibility of tests with high sensitivity, specificity, and predictive value that can be performed in a serial or longitudinal fashion for MRD assessment, Advani says. Additionally, determining how to act upon these MRD detection findings remains a significant consideration, Advani notes.

Although liquid biopsy holds promise for personalized cancer management and clinical trial enrollment, further research is needed to refine its role in MRD detection and to determine optimal strategies for acting upon MRD findings to enhance patient care, Advani concludes.