Blood Test May Guide Breast Cancer Treatment Decisions in Older Women | News-Medical.net

A blood test analyzing circulating tumor DNA (ctDNA) may help determine the most appropriate treatment course for women age 70 and over with estrogen receptor-positive breast cancer who are considering hormone therapy alone, according to a study published today in Clinical Cancer Research.

Researchers at UPMC Hillman Cancer Center and the University of Pittsburgh School of Medicine found that the presence or absence of ctDNA – little fragments of genetic material shed by cancer cells – could help identify patients unlikely to benefit from endocrine therapy without surgery or radiation. The study focused on identifying an early decision window, rather than evaluating treatment effectiveness.

“We are learning that not every patient needs the same treatment based simply on their diagnosis, and instead, care should be right-sized for each individual,” said Priscilla F. McAuliffe, M.D., Ph.D., a breast surgical oncologist at UPMC Hillman and associate professor of surgery at Pitt’s School of Medicine.

Patients with negative ctDNA results, either at the start of treatment or after beginning endocrine therapy, were more likely to experience stable disease or tumor shrinkage, suggesting that more aggressive interventions like surgery and radiation – which carry risks of side effects including scarring, chronic swelling, infection, and nerve damage – may not be necessary. Conversely, those whose ctDNA remained positive while on endocrine therapy were more likely to observe tumor growth, indicating a potential demand for surgery or alternative treatments.

The study’s design prioritized patient convenience. Blood samples were frequently collected from patients’ homes, reducing travel burdens and enabling enrollment from across the UPMC Hillman network, including sites at UPMC Passavant Cranberry, UPMC Jameson, and UPMC St. Margaret, according to Neil Carleton, M.D., Ph.D., a post-doctoral fellow at Pitt and lead author of the study. “Making care more convenient for patients, including access to clinical trials, is a priority at UPMC Hillman Cancer Center,” he said.

Researchers also incorporated feedback from patients and their caregivers, a demographic often underrepresented in clinical trials. More than 80% of patients surveyed reported that ctDNA test results could improve their understanding of treatment decisions, particularly within the first six to twelve months of care. Caregivers highlighted the significant impact of supporting loved ones with breast cancer, often requiring them to prioritize caregiving over work and other commitments.

The researchers suggest that the at-home monitoring option offered by ctDNA testing could be particularly valuable for caregivers. They emphasized the importance of thorough patient education and shared decision-making throughout the treatment process for both patients and those supporting them.

The study involved fewer than 50 patients, and researchers caution that the findings are preliminary and not yet ready for routine clinical application. Larger studies are needed to validate the approach. UPMC Hillman Cancer Center, founded as the University of Pittsburgh Cancer Institute in 1984, is internationally recognized for its cancer research and treatment, and was first designated an NCI Comprehensive Cancer Center in 1990.

Funding for the study was provided by the Hillman Cancer Center Developmental Pilot Program, the Shear Family Foundation, and the National Institutes of Health.