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ctDNA Detection Predicted Recurrence or Progression after ICI

Category:

Advanced-stage Cancer Studies

Source:

JCO Oncology Advances

Cancer type:

Lung Cancer

Patients with advanced non-small cell lung cancer (NSCLC), immune checkpoint inhibitors (ICIs) have transformed treatment outcomes. Yet, even in cases where imaging suggests remission, microscopic disease may persist. In such scenarios, circulating tumor DNA (ctDNA) offers oncologists a powerful tool to detect recurrence before clinical or radiographic signs emerge. This is the story of a 60-year-old man with stage IV NSCLC, whose case demonstrates how ctDNA monitoring predicted disease progression ahead of imaging, offering a critical opportunity for earlier intervention.

Patient ZML514 A 60-year-old woman

ctDNA Monitoring: The Early Warning System

While imaging in July 2023 suggested complete response, ctDNA testing told a different story:

Jul 2023: ctDNA was positive at 0.14%, indicating minimal residual disease (MRD) despite negative imaging.
Dec 2023: The patient presented with pleural effusion and new liver lesions. CT confirmed radiologic recurrence. ctDNA remained positive (0.12%).
May 2024: ctDNA increased to 0.31%, correlating with disease progression. Chemotherapy was initiated.

What Made Genomic Profiling and ctDNA Valuable in This Case?

ctDNA is an early indicator of recurrence, even in patients with radiologic complete response.
KRAS/TP53 co-mutation may suggest increased risk of recurrence despite initial immunotherapy benefit. (1)
Longitudinal ctDNA monitoring post-ICI is valuable for high-risk patients or those discontinuing treatment prematurely.

ctDNA positivity preceded radiologic progression by ~6 months — a window in which earlier intervention may have been considered. Without ctDNA data, the patient might have been considered disease-free until symptomatic or radiographic recurrence. The molecular signature offered lead-time to prepare for potential relapse.

References:

Liang Y, Maeda O, Kondo C, Nishida K, Ando Y. Effects of KRAS, STK11, KEAP1, and TP53 mutations on the clinical outcomes of immune checkpoint inhibitors among patients with lung adenocarcinoma. PLoS ONE. 2024;19(7):e0307580. doi:10.1371/journal.pone.0307580

The case of a 66-year-old woman with metastatic lung cancer, illustrates how genomic profiling and ctDNA monitoring together provide a sharper, more dynamic view of tumor evolution — even when conventional markers appear to improve.

The case of a 65-year-old woman with EGFR-mutant illustrates how genomic profiling and ctDNA monitoring work hand-in-hand to guide therapy and track response — well before imaging changes become apparent.

The story of Rajesh, a 75-year-old man diagnosed with stage IA lung adenocarcinoma, reminds us that while CT scans remain a staple in surveillance, molecular recurrence can emerge well before structural changes are visible.

This real-world case of Long, a 46-year-old man diagnosed with stage III sigmoid colon cancer, illustrates how both approaches informed risk stratification and a tailored adjuvant treatment strategy.

Meet Maya, a 35-year-old woman diagnosed with HER2-positive breast cancer. Her story highlights the real-world impact of using both technologies to personalize treatment, track progress, and achieve long-term disease control.

The K-CONNECT Platform creates as a collaborative initiative that brings together leading oncologists and researchers from across the region. The platform serves as a bridge between cutting-edge technology and expert practitioners, aiming to unlock the potential of ctDNA-MRD for precision and personalized oncology.

Terms and Conditions

ctDNA Detection Predicted Recurrence or Progression after ICI

Table of Contents

ctDNA Monitoring: The Early Warning System

What Made Genomic Profiling and ctDNA Valuable in This Case?

References:

Table of Contents

Patient ZML512

Patient ZML513

Patient ZMB501

Patient ZMC502

Patient ZMB501

ctDNA Detection Predicted Recurrence or Progression after ICI

Table of Contents

ctDNA Monitoring: The Early Warning System

What Made Genomic Profiling and ctDNA Valuable in This Case?

References:

Table of Contents

Patient ZML512

Patient ZML513

Patient ZMB501

Patient ZMC502

Patient ZMB501

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