11+ min ago (164+ words) Expert explores innovative strategies for managing early stage breast cancer, focusing on minimal residual disease and potential treatment adjustments. The primary recommendation for these patients is enrollment in clinical trials designed to test the efficacy of intensified or switched systemic therapies, with the goal of achieving MRD clearance and preventing overt recurrence. Unfortunately, there are no currently available data or guidelines to support the safe de-escalation or cessation of treatment based on ctDNA clearance or sustained negativity in the early-stage setting. The concept is highly promising but remains hypothetical and requires validation through prospective trials. In summary, ctDNA remains a powerful prognostic marker driving research, but its use as a directive for escalation or de-escalation of treatment is currently confined to the context of clinical trials. In an interview with Targeted Oncology, Stefania Morganti, MD, PhD, research fellow at the…...

12+ min ago (230+ words) Targeted Oncology connects oncology professionals with updates on immunotherapy, biomarkers, cancer pathways, and targeted precision medicine strategies. The field of circulating tumor DNA (ctDNA) for minimal residual disease (MRD) testing is experiencing rapid technological advancement, with new assays demonstrating increasing sensitivity by orders of magnitude compared to previous generations. This progress has generated significant excitement regarding its potential to revolutionize breast cancer management. The central challenge, however, remains the lack of proven clinical utility. While ctDNA is highly promising, particularly across the neoadjuvant, adjuvant, and even metastatic settings, its current function is primarily prognostic. Standard clinical practice currently relies on a probabilistic approach, estimating a patient's general risk of recurrence but it fails to provide the precise, individual-level risk stratification needed for personalized therapy selection. MRD testing offers the potential to move beyond probabilistic risk to a single-patient-level assessment of…...

15+ min ago (395+ words) A recent study confirms that the venetoclax and obinutuzumab combination is a cost-effective treatment for chronic lymphocytic leukemia in Canada. An economic evaluation in PharmacoEconomics " Open determined that the fixed-duration combination of venetoclax (Venclexta) plus obinutuzumab (Gazyva; VEN+O) is a cost-effective treatment option for previously untreated, fit patients with chronic lymphocytic leukemia (CLL) in Canada.1 The determination was made based on the potential health benefits and cost savings associated with VEN+O against most comparator treatments, including BTK inhibitors, venetoclax plus ibrutinib (Imbruvica; VEN+I), and chemoimmunotherapies. For other treatments not evaluated in the CLL13 trial, data were obtained from a systematic literature review of clinical trials. Additional treatments examined included fixed-duration VEN+I, as well as the treat-to-progression regimens of ibrutinib, acalabrutinib (Calquence), and zanubrutinib (Brukinsa). In terms of costs, the total cost per patient incurred over a 40-year lifetime horizon for…...

23+ hour, 42+ min ago (234+ words) Early-stage breast cancer patients face challenges with ctDNA detection, highlighting the need for clinical trials to improve outcomes and reduce recurrence risks. In an interview with Targeted Oncology, Stefania Morganti, MD, PhD, research fellow at the Dana-Farber Cancer Institute, addressed the current clinical utility and inherent limitations of using circulating tumor DNA (ctDNA) for minimal residual disease (MRD) detection in early-stage breast cancer. A primary concern is the high risk of false-negative results due to the potentially very low amounts of ctDNA present in this patient population. Clinicians must stress this limitation to patients, according to Morganti, highlighting that a negative result may not equate to the absence of disease. Furthermore, the limit of detection varies significantly across different ctDNA assays. Tests with a lower limit of detection offer a decreased chance of a false negative, while those with a…...

1+ day, 3+ hour ago (314+ words) Emerging research highlights the challenges and potential of ctDNA in managing minimal residual disease in breast cancer, paving the way for innovative treatment strategies. The presence of minimal residual disease (MRD), specifically circulating tumor DNA (ctDNA) positivity, in patients achieving complete remission (CR) poses a significant clinical challenge. Currently, standard follow-up imaging (CT/PET) is not approved for early-stage breast cancer, creating a diagnostic dilemma for MRD-positive but image-negative patients.1 For these MRD-positive patients without detectable metastatic disease on imaging, the current recommendation is enrollment in clinical trials exploring the addition of novel therapeutic agents, aiming for MRD eradication. The use of MRD to guide treatment de-escalation is promising but lacks current data for widespread clinical recommendation. Trials are being considered to explore de-escalation, or treatment breaks in both the early-stage and metastatic settings, such as using sustained ctDNA clearance…...

1+ day, 3+ hour ago (171+ words) Targeted Oncology connects oncology professionals with updates on immunotherapy, biomarkers, cancer pathways, and targeted precision medicine strategies. This concluding segment brings together expert reflections on the practical use of combination immunotherapies in newly diagnosed advanced melanoma. Panelists share their clinical impressions regarding efficacy, safety, and patient-reported outcomes, underscoring the importance of individualized care. They discuss encouraging results with dual checkpoint blockade and how emerging regimens have expanded the therapeutic window for more patients. A key focus is the role of patient characteristics'such as tumor burden, comorbidities, and immune-related risk factors'in guiding regimen selection. Panelists emphasize that effective treatment requires a nuanced understanding of the interplay between disease biology and immune modulation. Looking ahead, they identify biomarker development and neoadjuvant therapy as areas of growing importance. Advances in predictive testing, molecular profiling, and perioperative immunotherapy are expected to enhance precision and…...

1+ day, 3+ hour ago (182+ words) Minimal residual disease (MRD) assays based on circulating tumor DNA (ctDNA) fall into 2 main categories: tumor-informed and tumor-agnostic. Tumor-agnostic assays are computational. They do not require primary tumor tissue. Instead, they use algorithms to estimate the proportion of ctDNA within the total cell-free DNA . These assays are "universal" for all patients but are currently considered less sensitive. The choice of assay should be dictated by the clinical question. For trials investigating therapy de-escalation, ultra-sensitive, new-generation tumor-informed assays are recommended to confidently detect low levels of MRD. For studies focused on treatment escalation, a less sensitive assay might suffice. Crucially, there is currently no proven clinical utility for any MRD assay in early-stage breast cancer, and they should not be used routinely in standard clinical practice. Their main role is currently within clinical trials designed to establish this utility. In an…...

1+ day, 3+ hour ago (240+ words) In an interview with Targeted Oncology ", Stefania Morganti, MD, PhD, research fellow at the Dana-Farber Cancer Institute, addressed the current clinical utility and inherent limitations of using ... In an interview with Targeted Oncology, Stefania Morganti, MD, PhD, research fellow at the Dana-Farber Cancer Institute, addressed the current clinical utility and inherent limitations of using circulating tumor DNA (ctDNA) for minimal residual disease (MRD) detection in early-stage breast cancer. A primary concern is the high risk of false-negative results due to the potentially very low amounts of ctDNA present in this patient population. Clinicians must stress this limitation to patients, according to Morganti, highlighting that a negative result may not equate to the absence of disease. Furthermore, the limit of detection varies significantly across different ctDNA assays. Tests with a lower limit of detection offer a decreased chance of a false…...

1+ day, 12+ hour ago (164+ words) Expert explores innovative strategies for managing early stage breast cancer, focusing on minimal residual disease and potential treatment adjustments. The primary recommendation for these patients is enrollment in clinical trials designed to test the efficacy of intensified or switched systemic therapies, with the goal of achieving MRD clearance and preventing overt recurrence. Unfortunately, there are no currently available data or guidelines to support the safe de-escalation or cessation of treatment based on ctDNA clearance or sustained negativity in the early-stage setting. The concept is highly promising but remains hypothetical and requires validation through prospective trials. In summary, ctDNA remains a powerful prognostic marker driving research, but its use as a directive for escalation or de-escalation of treatment is currently confined to the context of clinical trials. In an interview with Targeted Oncology, Stefania Morganti, MD, PhD, research fellow at the…...

2+ day, 3+ hour ago (179+ words) Panelists reflect on clinical experience with immunotherapy combinations, the role of biomarkers, and the future of personalized melanoma treatment. This concluding segment brings together expert ... This concluding segment brings together expert reflections on the practical use of combination immunotherapies in newly diagnosed advanced melanoma. Panelists share their clinical impressions regarding efficacy, safety, and patient-reported outcomes, underscoring the importance of individualized care. They discuss encouraging results with dual checkpoint blockade and how emerging regimens have expanded the therapeutic window for more patients. A key focus is the role of patient characteristics'such as tumor burden, comorbidities, and immune-related risk factors'in guiding regimen selection. Panelists emphasize that effective treatment requires a nuanced understanding of the interplay between disease biology and immune modulation. Looking ahead, they identify biomarker development and neoadjuvant therapy as areas of growing importance. Advances in predictive testing, molecular profiling, and…...