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06-08-2022 | Translational Research

ctDNA for Risk of Recurrence Assessment in Patients Treated with Neoadjuvant Treatment: A Systematic Review and Meta-analysis

Authors: Mikail Gögenur, MD, Noor Al-Huda Hadi, MS, Camilla Qvortrup, MD, PhD, Claus Lindbjerg Andersen, PhD, Ismail Gögenur, MD, DMSc

Published in: Annals of Surgical Oncology | Issue 13/2022

Abstract

Background

We wanted to investigate the association between circulating tumor DNA (ctDNA) detection at baseline, during and after neoadjuvant treatment, after surgery, and recurrence, in patients with nonmetastatic cancer.

Patients and Methods

In this systematic review and meta-analysis, we included studies that investigated patients undergoing neoadjuvant treatment for nonmetastatic cancer and provided recurrence indices stratified for ctDNA status at the following timepoints: baseline, during treatment, posttreatment, and postsurgery. Study quality was reported with the Newcastle–Ottawa scale, REMARK checklist, and GRADE approach. PubMed, Embase, Cochrane Library, and Web of Science were our data sources (inception to 3 June 2021). The main outcome was risk of recurrence.

Results

We identified ten studies including 727 patients with rectal, breast, gastric, and bladder cancer. All studies reported posttreatment ctDNA analysis, while seven, four, and six reported baseline, during treatment, and postsurgery ctDNA analysis, respectively. ctDNA detection was associated to recurrence across all timepoints [baseline: risk ratio (RR) 2.86, 95% confidence interval (CI) 1.33–6.14, during treatment: RR 3.81, 95% CI 2.09–6.92, posttreatment: RR 4.29, 95% CI 2.79–6.60, postsurgery: RR 8.03, 95% CI 3.16–20.43]. Heterogeneity was low to moderate.

Conclusions

This meta-analysis of observational studies found that ctDNA detection in patients undergoing neoadjuvant treatment for nonmetastatic cancer was associated with recurrence. A stronger association was evident in posttreatment and postsurgery timepoints. However, some studies reported low negative predictive value (NPV) of pathological complete response, showing that ctDNA-detection-guided escalation and de-escalation studies following neoadjuvant treatment regimens are needed before its role as a treatment guidance can be affirmed.

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Title: ctDNA for Risk of Recurrence Assessment in Patients Treated with Neoadjuvant Treatment: A Systematic Review and Meta-analysis
Authors: Mikail Gögenur, MD
Noor Al-Huda Hadi, MS
Camilla Qvortrup, MD, PhD
Claus Lindbjerg Andersen, PhD
Ismail Gögenur, MD, DMSc
Publication date: 06-08-2022
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-022-12366-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

ctDNA for Risk of Recurrence Assessment in Patients Treated with Neoadjuvant Treatment: A Systematic Review and Meta-analysis

Abstract

Background

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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