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Review
. 2020 Dec;8(23):1603.
doi: 10.21037/atm-20-1175.

Circulating tumor DNA-based predictive biomarkers in breast cancer clinical trials: a narrative review

Oraianthi Fiste  1 , Michael Liontos  1 , Konstantinos Koutsoukos  1 , Evangelos Terpos  1 , Meletios A Dimopoulos  1 , Flora Zagouri  1
Affiliations
Review

Circulating tumor DNA-based predictive biomarkers in breast cancer clinical trials: a narrative review

Oraianthi Fiste et al. Ann Transl Med. 2020 Dec.

Abstract

Breast carcinoma is the most frequent and the second leading cause of cancer mortality in women worldwide. Current treatment decisions are based on tumor profiling of the initial tissue biopsy. Cancer though evolves both spatially and temporarily in a significant percentage of patients during treatment. However, sequential biopsies from the primary tumor or its metastatic sites are not either convenient or feasible in the majority of cases. In the era of precision medicine, analysis of circulating blood-based biomarkers in the field of liquid biopsies provides an insight into the dynamic molecular profiling of the primary tumor and its metastases, in a relatively non-invasive way. The latter permits not only patient stratification but also longitudinal evaluation of treatment response, when incorporated into clinical trials. This review summarizes the results from recent and ongoing circulating tumor DNA (ctDNA)-based biomarker-driven clinical trials, with respect to ctDNA analysis' predictive role, both in adjuvant, neo-adjuvant, and metastatic setting. Furthermore, current challenges in ctDNA analysis applications are critically discussed, including pre-analytical and analytical issues, and future perspectives in this field, through the conduct of well-designed, multicenter, randomized, large-scale, biomarker-stratified trials, with robust statistical methods. Despite in its infancy, ctDNA analysis holds great promise as a minimally invasive tool regarding tailored, personalized treatment guidance for breast cancer patients.

Keywords: Breast cancer; circulating tumor DNA (ctDNA); clinical trials; predictive biomarkers.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-1175). ML reports personal fees from Roche, Astra Zeneca, Astellas, MSD, Ipsen, Jansen, BMS, GSK, outside the submitted work; Spouse is Pfizer employee. KK reports personal fees from Roche, BMS, MSD, IPSEN, outside the submitted work. ET reports grants, personal fees and non-financial support from JANSSEN, personal fees from CELGENE, grants, personal fees and non-financial support from TAKEDA, grants, personal fees and non-financial support from AMGEN, grants, personal fees and non-financial support from GENESIS PHARMA, personal fees from BMS, outside the submitted work. MAD reports personal fees from Janssen, Celgene, Takeda, Amgen, Genesis Pharma, BMS, outside the submitted work. FZ reports personal fees from Astra Zeneca, Daiichi, Eli-Lilly, Merck, Novartis, Pfizer, Roche, outside the submitted work. OF has no conflicts of interest to declare.

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