{Reference Type}: Journal Article
{Title}: Association of personalized and tumor-informed ctDNA with patient survival outcomes in pancreatic adenocarcinoma.
{Author}: Botta GP;Abdelrahim M;Drengler RL;Aushev VN;Esmail A;Laliotis G;Brewer CM;George GV;Abbate SM;Chandana SR;Tejani MA;Malla M;Bansal D;Rivero-Hinojosa S;Spickard E;McCormick N;Cecchini M;Lacy J;Fei N;Kasi PM;Kasi A;Dayyani F;Hanna DL;Sharma S;Malhotra M;Aleshin A;Liu MC;Jurdi A;
{Journal}: Oncologist
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jul 17
{Factor}: 5.837
{DOI}: 10.1093/oncolo/oyae155
{Abstract}: <B>BACKGROUND: </B>Personalized and tumor-informed circulating tumor DNA (ctDNA) testing is feasible and allows for molecular residual disease (MRD) identification in patients with pancreatic ductal adenocarcinoma (PDAC).<BR><B>METHODS: </B>In this retrospective analysis of commercial cases from multiple US institutions, personalized, tumor-informed, whole-exome sequenced, and germline-controlled ctDNA levels were quantified and analyzed in patients with PDAC. Plasma samples (n = 1329) from 299 clinically validated patients were collected at diagnosis, perioperatively (MRD-window; within 2-12 weeks after surgery, before therapy), and during surveillance (>12 weeks post-surgery if no ACT or starting 4 weeks post-ACT) from November 2019 to March 2023.<BR><B>RESULTS: </B>Of the initially diagnosed patients with stages I-III PDAC who went for resection, the median follow-up time from surgery was 13 months (range 0.1-214). Positive ctDNA detection rates were 29% (29/100) and 29.6% (45/152) during the MRD and surveillance windows, respectively. Positive ctDNA detection was significantly associated with shorter DFS within the MRD window (median DFS of 6.37 months for ctDNA-positive vs 33.31 months for ctDNA-negative patients; HR: 5.45, P < .0001) as well as during the surveillance period (median DFS: 11.40 months for ctDNA-positive vs NR for ctDNA-negative; HR: 12.38, P < .0001). Additionally, DFS was significantly better with KRAS wildtype status followed by KRASG12R (HR: 0.99, P = .97), KRASG12D (HR: 1.42, P = .194), and worse with KRASG12V (HR: 2.19, P = .002) status. In multivariate analysis, ctDNA detection at surveillance was found to be the most significant prognostic factor for recurrence (HR: 24.28, P < .001).<BR><B>CONCLUSIONS: </B>Perioperative tumor-informed ctDNA detection in PDAC is feasible across all stages and is associated with patient survival outcomes.