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Editorial
. 2023 Jun 13;29(12):2176-2178.
doi: 10.1158/1078-0432.CCR-23-0420.

ctDNA Monitoring for Small Cell Lung Cancer: Ready for Prime Time?

Bruna Pellini  1   2 , Aadel A Chaudhuri  3   4   5   6   7   8
Affiliations
Editorial

ctDNA Monitoring for Small Cell Lung Cancer: Ready for Prime Time?

Bruna Pellini et al. Clin Cancer Res. .

Abstract

Small cell lung cancer (SCLC) is the deadliest form of lung cancer and has few precision medicine approaches available. A recent study analyzed circulating tumor DNA (ctDNA) in 33 patients with extensive-stage SCLC and showed that ctDNA levels and response patterns correlate strongly with clinical response and survival outcomes. See related article by Sivapalan et al., p. 2310.

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Conflict of interest statement

Disclosure of Potential Conflicts of Interest: B.P. receives research support to the institution from Bristol Myers Squibb, has received speaker honoraria from BioAscend, Merck, MJH Life Science, Play to Know AG, Grupo Pardini, and has done consulting/advisory board work with Guidepoint, Guardant Health, Illumina, Regeneron, and AstraZeneca. B.P. reports funding from the Bristol Myers Squibb Foundation/the Robert A. Winn Diversity in Clinical Trials Awards Program, outside of the submitted work. A.A.C. has patent filings related to cancer biomarkers, and has licensed technology to Droplet Biosciences, LiquidCell Dx, Tempus Labs, and Biocognitive Labs. A.A.C. has served as a consultant/advisor to Roche, Tempus, Geneoscopy, NuProbe, Illumina, Daiichi Sankyo, AstraZeneca, AlphaSights, DeciBio, and Guidepoint. A.A.C. has received honoraria from Roche, Foundation Medicine, and Dava Oncology. A.A.C. has stock options in Geneoscopy, research support from Roche, Illumina and Tempus Labs, and ownership interests in Droplet Biosciences and LiquidCell Dx.

Figures

Figure 1.
Figure 1.. Proposed clinical trial design for extensive-stage small cell lung cancer using ctDNA to personalize treatment decision-making.
Patients treated with first-line chemotherapy + immunotherapy that have persistence of ctDNA will be randomized to standard maintenance immunotherapy vs. initiating approved second-line therapies or novel investigational agents. Patients who become ctDNA(+) after initial elimination (molecular response followed by recrudescence) during the 2 years of standard of care ICI maintenance will be randomized to continue standard immunotherapy vs. initiate approved second-line therapies or novel investigational agents. Patients that sustain complete elimination of ctDNA (molecular response) will be randomized to continue standard of care immunotherapy for up to 2 years vs. undergo close surveillance. ChemoIO, chemotherapy + immunotherapy; ctDNA, circulating tumor DNA; ES-SCLC, extensive-stage small-cell lung cancer; ICI, immune check point inhibitor; OS, overall survival; PFS, progression-free survival; SOC, standard of care. (Figure created with BioRender.com.)
See this image and copyright information in PMC

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References

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