Larribère Lionel, Martens Uwe M
Department of Hematology and Oncology, Cancer Center Heilbronn-Franken, SLK Clinics Heilbronn GmbH, 74078 Heilbronn, Germany.
Skin Cancer Unit, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
Cancers (Basel). 2021 Nov 14;13(22):5698. doi: 10.3390/cancers13225698.
The ability to detect minimal residual disease (MRD) after a curative-intent surgery or treatment is of paramount importance, because it offers the possibility to help guide the clinical decisions related adjuvant therapy. Thus, the earlier MRD is detected, the earlier potentially beneficial treatment can be proposed to patients who might need it. Liquid biopsies, and in particular the next-generation sequencing of circulating tumor DNA (ctDNA) in the blood, have been the focus of an increasing amount of research in the past years. The ctDNA detection at advanced cancer stages is practicable for several solid tumors, and complements molecular information on acquired therapy resistance. In the context of MRD, it is by definition more challenging to detect ctDNA, but it is technically achievable and provides information on treatment response and probability of relapse significantly earlier than standard imaging methods. The clinical benefit of implementing this new technique in the routine is being tested in interventional clinical trials at the moment. We propose here an update of the current use of ctDNA detection by NGS as a tool to assess the presence of MRD and improve adjuvant treatment of solid tumors. We also discuss the main limitations and medium-term perspectives of this process in the clinic.
在进行根治性手术或治疗后检测微小残留病（MRD）的能力至关重要，因为它为指导与辅助治疗相关的临床决策提供了可能性。因此，MRD检测得越早，就可以越早地向可能需要的患者提出潜在有益的治疗方案。液体活检，尤其是血液中循环肿瘤DNA（ctDNA）的下一代测序，在过去几年中一直是越来越多研究的焦点。在晚期癌症阶段检测ctDNA对于几种实体瘤是可行的，并且补充了关于获得性治疗耐药性的分子信息。在MRD的背景下，检测ctDNA在定义上更具挑战性，但在技术上是可以实现的，并且比标准成像方法更早地提供有关治疗反应和复发概率的信息。目前，在介入性临床试验中正在测试将这种新技术应用于常规临床的临床益处。我们在此提出对当前通过NGS检测ctDNA作为评估MRD存在和改善实体瘤辅助治疗工具的最新应用情况。我们还讨论了该过程在临床中的主要局限性和中期前景。
