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.

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Shridar Ganesan, MD, PhD, discusses the current limitations and advantages of leveraging circulating-tumor DNA to detect minimal residual disease in patients with cancer, as well as how ctDNA assays may address mechanisms of resistance in clinical practice.

Shridar Ganesan, MD, PhD, Chief, Molecular Oncology and Associate Director for Translational Research at Rutgers Cancer Institute of New Jersey, and attending physician at Robert Wood Johnson University Hospital, discusses improvements in precision medicine and the need to enroll patients with different molecular subtypes into specifically designed clinical trials.

Molecular features of each patient’s cancer are now being incorporated into the classification of the disease, according to Ganesan. Treatment decisions are now being guided by information pertaining to molecular features in addition to primary tumor location and appearance under a microscope, Ganesan adds.

The ability to identify alterations and develop effective targeted therapies has significantly impacted cancer care, Ganesan says. Although these advancements have moved the needle forward, designing meaningful clinical trials remains a challenge, Ganesan explains.

Clinical trials for patients with cancer must now focus on incorporating patients with different molecular subtypes of each cancer, Ganesan explains. Designing and effectively enrolling patients to these trials is necessary to adequately evaluate emerging approaches, especially second- and third-generation agents and novel combinations, Ganesan concludes.

Shridar Ganesan, MD, PhD, discusses improvements in precision medicine and the need to enroll patients with different molecular subtypes into specifically designed clinical trials.

Shridar Ganesan, MD, PhD

Articles

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

Dr. Ganesan on Leveraging Precision Medicine to Improve Cancer Care