What is ctDNA guided cancer treatment?
What is the purpose of the National ctDNA research center?
The cancer field is lacking biomarkers for personalized risk-stratification. Consequently clinical practice today is dominated by “one size fits all” strategies e.g. for treatment- and post-treatment surveillance. This is often leading to massive overtreatment and a waste of resources following up non-relapsing patients.
Circulating Tumor DNA
Technological advances have recently enabled development of circulating tumor DNA (ctDNA) based strategies for personal risk assessment. The ctDNA is fragments of DNA shedded from the cancer cells as the tumor grows and develops. These DNA fragments have a short lifetime of only a few hours in the blood stream and thus if ctDNA can be detected in the blood, it is a very good real-time indicator of the presence and quantity of cancer cells in the body.
Detection of ctDNA is rapidly emerging as an important and minimally invasive diagnostic approach, that can be applied to practically all body fluids. Several studies have shown that ctDNA analysis is more sensitive than conventional imagingin detecting cancer. This hasopened up for new strategies tomanage cancer, e.g. to screen for cancer in asymptomatic individuals, for monitoring response to cancer treatment, andforrelapse surveillance. CtDNA also provides information about the cancer genome, including information about mutations and epigenetic patterns. This information can be used to guide therapy decisions.What is now needed areprospective clinical studies promoting the translation of the many promising ctDNA-based research results into clinical practice.
In January 2020 the National Danish ctDNA Research Center was established. The objective of the center is to provide an effective and vital framework for optimal implementation of evidence-based ctDNA usage in cancer patient management in Denmark.
With the center all Danish clinicians and researchers with an interest in using ctDNA based analysis for monitoring and decision making are brought together to facilitate ctDNA based research and clinical implementation of ctDNA guided patient stratification.
From research to clinic
The center aims to offer participation in evidence generating clinical trials to all relevant Danish cancer patients. Such trials will explore the clinical utility of using ctDNA for e.g. detection of cancer in asymptomatic individuals, post-operative detection of residual disease to guide adjuvant treatment decisions, detection of residual disease after adjuvant therapy in order to guide imaging surveillance intensity, for blood-based recurrence surveillance, for monitoring therapy response (neoadjuvant, adjuvant and in treatment of metastatic disease), detection of actionable targets for guiding therapy choice etc.
If the results confirm our hypotheses: that ctDNA guided management has clinical benefit compared to the present standard, and that ctDNA guided management is cost-effective, then we shall provide business analyses and other decision and implementation supporting information to the hospitals and health regions. We anticipate timely and relatively straight forward implementation of ctDNA guided cancer management at a national scale in Denmark, since the conducted studies will be national with participation from the majority of the clinical centers treating cancer patients in Denmark.