In the continuing evolution of personalized medicine, a new Yale study has found evidence to support the value of a tool that measures the presence of cancer-derived molecules in the blood of patients with lung cancer years after their treatment.
This tool is a type of molecular residual disease (MRD)detector, which is used after patients have completed their primary treatment in order to monitor their cancer status. Researchers say it could inform clinical intervention, including whether to restart or intensify treatment.
“MRD detection is the future — allowing us to monitor patients in real-time,” said the study’s first author, Dr. Roy Herbst, deputy director of Yale Cancer Center and chief of medical oncology and hematology at Yale School of Medicine. “The data is strong and we’re excited that our approach can now be incorporated into future studies.”
The study findings, published in Nature Medicine on March 17, were based on patients from the ADAURA clinical trial of the targeted therapy osimertinib for patients with non-small cell lung cancer (NSCLC) with epidermal growth factor (EGFR)-activated mutations. The ADAURA trial findings showed a significant benefit in disease-free survival with osimertinib, compared to placebo, making it the recommended standard of treatment for patients up to three years after surgery.
“We know patients benefited from osimertinib in the ADAURA trial, but we want to know if they are cured or whether their cancer will come back,” said Herbst, who is also the assistant dean for translational research at Yale School of Medicine. “MRD detection is a more personalized approach for patients with EGFR mutations in the adjuvant setting [after the primary treatment has completed], and now we’re understanding at what point patients start to benefit and how we can more precisely target their therapy.”
As noted in the discussion portion of the Nature Medicine report, if MRD proves valid for clinical purposes it could improve outcomes by identifying high-risk patients who might benefit from intensifying or restarting treatment. Conversely, MRD could also identify patients with low risk of recurrence, possibly sparing them from further treatment and any associated drug toxicities as a result.
Joining Herbst was co-senior author Yi-Long Wu from the Guangdong Lung Cancer Institute. Research reported in this release and the ADAURA study was funded by AstraZeneca.