03 September 2018

Researchers are working on a blood test that can predict treatment response in patients with diffuse large B cell lymphoma by measuring circulating tumour DNA.

Lead researcher, Dr Ash Alizadeh of the Stanford University School of Medicine, USA, said: "Although conventional therapy can cure the majority of patients with even advanced B cell lymphomas, some don't respond to initial treatment.

"But we don't know which ones until several months have passed. Now we can predict non-responders within 21 days after the initiation of treatment by tracking the levels of circulating tumour DNA in a patient's blood. We can look earlier and make a reliable prediction about outcome."

Circulating tumour DNA (ctDNA) is released into the blood by dying cancer cells, and the researchers say its levels could give important insights into the course of the disease and the effectiveness of therapy.

The latest study adds to earlier research on ctDNA, by showing that the speed of the drop in ctDNA levels correlated with patient outcome following chemotherapy in a group of 217 people with diffuse large B cell lymphoma, which affects around 5,000 people each year in the UK.

Patients whose ctDNA levels dropped more than 100-fold after the first cycle of treatment, or over 300-fold after the second treatment cycle, were significantly more likely to be disease free 24-month after treatment, compared to those whose ctDNA levels dropped more slowly. Crucially, these measures of ctDNA response were able to predict the outlook for patients independent of existing prognostic measures, such as the International Prognostic Index.

The team believe that their findings "speak to the power and likely utility of using circulating tumour DNA to assess how well cancer treatments are working in an individual patient." They are currently planning a clinical trial based on these results.

Dr Maximilian Diehn, who co-led the study, said: "We are very hopeful that the approach will ultimately be extensible to most if not all cancer types."

The research was published in the Journal of Clinical Oncology.

Source: Kurtz, D. M., Scherer, F., Jin, M. C., Soo, J., Craig, A. F. M., Esfahani, M. S., Chabon, J. J., Stehr, H.,  Liu, C. L., Tibshirani, R., Maeda, L. S., Gupta, N. K., Khodadoust, M. S., Advani, R. H., Levy, R., Newman, A. M., Dührsen, U., Hüttmann, A., Meignan, M., Casasnovas, R-O., Westin, J. R., Roschewski, M., Wilson, W. H., Gaidano, G., Rossi, D., Diehn, M., and Alizadeh, A. A. (2018) ‘Circulating Tumor DNA Measurements As Early Outcome Predictors in Diffuse Large B-Cell Lymphoma’, Journal of Clinical Oncology, 36, Available at doi:10.1200/JCO.2018.78.5246


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