Real World Use of Circulating Tumor DNA (CTDNA) in Colorectal Cancer (CRC): A Targeted Literature Review (TLR)

Speaker(s)

Jones G1, Bagga S2, Sood P2, Hariprasad E2, Mangla B3, Soni P2, Sharma N2, Jain A2, Goswami A2, Singh P2, Kumar S2, Kothari S1
1Merck & Co. Inc.,, Kenilworth, NJ, USA, 2Complete HEOR Solutions (CHEORS), North Wales, PA, USA, 3Complete HEOR Solutions (CHEORS), Mehrauli, DL, India

Presentation Documents

OBJECTIVES:

ctDNA represents a novel biomarker with clinical utility in early and advanced cancers; however, it is unclear how ctDNA testing is being utilized in CRC. The aim of this study was to characterize the uptake and use of ctDNA testing in real-world (RW) treatment of CRC.

METHODS:

We followed Cochrane’s Rapid Review methodology. English-language, full-text peer-reviewed articles from Embase, Medline and Cochrane were reviewed. No time or geographic limits were imposed, and RW studies focusing on adult CRC patients with no restriction on intervention or comparator were included.

RESULTS:

82 full-text articles and conference abstracts met inclusion criteria. Most common study design was prospective observational (n=60) followed by retrospective (n=22). 52 studies reported on molecular profiling and 30 on molecular residual disease (MRD). Most studies (n=52) reported on advanced cancer (stage III/IV), 26 studies reported across different stages (I-IV), 4 studies did not specify stage.

Molecular profiling studies demonstrated that mutations in CRC such as KRAS, NRAS, EGFR, RAS, BRAF, identified via ctDNA testing can guide treatment decisions. Patients with KRAS, BRAF, EGFR mutations detected in plasma presented with lower overall and progression-free survival. Studies on MRD demonstrate that ctDNA can benefit postoperative management of CRC patients through early relapse detection of patients at high risk of recurrence. Studies show presence of ctDNA (positive MRD status) post-treatment remains a positive predictor of recurrence.

Limited studies captured information on ctDNA testing rates in CRC in the real-world setting. One study used recent data (till 2021) from Foundation Medicine Flatiron clinical-genomics database and observed minimal testing rates for ctDNA testing in metastatic CRC (approximately 8%).

CONCLUSIONS:

Literature supports ctDNA as an important tool in molecular profiling of CRC when tumor tissue may not be accessible or available and understanding MRD but lacks studies on testing rates in the real-world setting.

Code

MT46

Topic

Medical Technologies, Study Approaches

Topic Subcategory

Diagnostics & Imaging, Literature Review & Synthesis

Disease

Oncology