Ballinger Tarah J, Smith Mary Lou, Railey Elda, Zimet Greg, Schneider Bryan P
Indiana University School of Medicine, Indianapolis, IN, USA.
Research Advocacy Network, Plano, USA.
NPJ Breast Cancer. 2024 Oct 8;10(1):89. doi: 10.1038/s41523-024-00701-y.
The impact of knowledge of circulating tumor DNA (ctDNA) status on patient decisions in high-risk triple-negative breast cancer (TNBC) weighing benefit and toxicity is unknown. Here, 286 women with a history of non-metastatic breast cancer who had received chemotherapy completed a survey mimicking scenarios of residual TNBC after chemotherapy and unknown, negative, or positive ctDNA status to determine the shift in the decision to receive adjuvant therapy. Participants were then presented scenarios mimicking possible post-neoadjuvant therapies and rated acceptability. A general linear model with repeated measures determined contributions of risk reduction and toxicity. When the hypothetical risk of recurrence mimicked ctDNA negativity, significantly less participants were accepting of adjuvant capecitabine versus no therapy. When presented with ctDNA positivity and increased recurrence risk, the degree of benefit impacted acceptability more than the toxicity profile. As genomic technology advances and ctDNA assays become commercially available, it is imperative to understand the impact on patient decision-making.
循环肿瘤DNA（ctDNA）状态的知识对权衡获益与毒性的高危三阴性乳腺癌（TNBC）患者决策的影响尚不清楚。在此，286名有非转移性乳腺癌病史且接受过化疗的女性完成了一项调查，该调查模拟化疗后残留TNBC以及ctDNA状态未知、阴性或阳性的情况，以确定接受辅助治疗决策的转变。然后向参与者呈现模拟新辅助治疗后可能情况的场景，并对可接受性进行评分。采用重复测量的一般线性模型确定降低风险和毒性的作用。当假设的复发风险模拟ctDNA阴性时，与不治疗相比，接受辅助卡培他滨治疗的参与者明显减少。当呈现ctDNA阳性和复发风险增加时，获益程度对可接受性的影响大于毒性特征。随着基因组技术的进步以及ctDNA检测变得商业化，了解其对患者决策的影响至关重要。
