Dr Ganesan on the Use of ctDNA Assays For MRD Detection in Cancer Care

Shridar Ganesan, MD, PhD, section chief, Molecular Oncology, associate director, Translational Science, Omar Boraie Chair, Genomic Science, professor, medicine, Rutgers Cancer Institute of New Jersey, RWJBarnabas Health, discusses the current limitations and advantages of leveraging circulating-tumor DNA (ctDNA) to detect minimal residual disease (MRD) in patients with cancer, as well as how ctDNA assays may address mechanisms of resistance in clinical practice.

MRD detection has generated considerable interest in the oncology community due to its ability to assist in identifying which patients are at risk for disease recurrence and its ability to guide subsequent therapeutic decisions, Ganesan begins. Various technologies are being developed to harness the potential of MRD detection, such as tumor-informed assays, tumor-independent assays, and DNA methylation assays, he details. Early data suggest that these approaches have prognostic value, Ganesan says, adding that researchers are still investigating how this information may be strategically employed to optimize therapy and enhance outcomes.

Ganesan continues by stating that efforts to integrate MRD data into treatment strategies, particularly in the context of acquired resistance to targeted therapeutics in advanced settings, are ongoing. With the expansion of targeted therapies in the current armamentarium, addressing mechanisms of acquired resistance becomes paramount, he emphasizes. Accordingly, this research aims to develop additional approaches to the treatment of patients with disease resistance that do not involve the immediate use of traditional chemotherapy following prior treatment cessation, Ganesan states. Notably, ctDNA emeraging as a promising tool in this arena, as it could provide a non-invasive means of monitoring disease status and detecting acquired resistance mechanisms, he explains.

The evolving landscape of tools to address resistance mechanisms indicates a growing sophistication in cancer care, Ganesan says. As these tools are successfully implemented in clinical settings, clinicians may move beyond conventional treatment paradigms and tailor interventions based on the specific molecular characteristics of each patient's disease. This ongoing exploration of MRD and its integration into therapeutic decision-making represents an exciting frontier in oncology, promising more refined and personalized approaches to improve patient outcomes, Ganesan concludes.