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ESMO recommendations on the use of circulating tumour DNA assays for patients with cancer: A report from the ESMO Precision Medicine Working Group

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Pascual, J., Attard, G., Bidard, F.-C., Curigliano, G., De Mattos-Arruda, L., Diehn, M., Italiano, A., Lindberg, J. +12 more·2022·Annals of Oncology

Abstract

Circulating tumour DNA (ctDNA) assays conducted on plasma are rapidly developing a strong evidence base for use in patients with cancer. The European Society for Medical Oncology convened an expert working group to review the analytical and clinical validity and utility of ctDNA assays. For patients with advanced cancer, validated and adequately sensitive ctDNA assays have utility in identifying actionable mutations to direct targeted therapy, and may be used in routine clinical practice, provided the limitations of the assays are taken into account. Tissue-based testing remains the preferred test for many cancer patients, due to limitations of ctDNA assays detecting fusion events and copy number changes, although ctDNA assays may be routinely used when faster results will be clinically important, or when tissue biopsies are not possible or inappropriate. Reflex tumour testing should be considered following a non-informative ctDNA result, due to false-negative results with ctDNA testing. In patients treated for early-stage cancers, detection of molecular residual disease or molecular relapse, has high evidence of clinical validity in anticipating future relapse in many cancers. Molecular residual disease/molecular relapse detection cannot be recommended in routine clinical practice, as currently there is no evidence for clinical utility in directing treatment. Additional potential applications of ctDNA assays, under research development and not recommended for routine practice, include identifying patients not responding to therapy with early dynamic changes in ctDNA levels, monitoring therapy for the development of resistance mutations before clinical progression, and in screening asymptomatic people for cancer. Recommendations for reporting of results, future development of ctDNA assays and future clinical research are made.

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Crossref · 10.1016/j.annonc.2022.05.520

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  • Biological variation is a major reason why biomarker development in sarcoma has progressed more slowly than in common epithelial malignancies.

    “This biological variation is a major reason why biomarker development in sarcoma has progressed more slowly than in common epithelial malignancies [ 5 ].”
  • Across early-stage solid tumors, postoperative or post-treatment ctDNA detection is consistently associated with a higher risk of recurrence.

    “Across early-stage solid tumors, postoperative or post-treatment ctDNA detection is consistently associated with a higher risk of recurrence”
  • MRD detection requires greater analytical sensitivity than baseline genotyping or advanced-disease resistance monitoring because tumor-derived DNA may represent only a very small fraction of total cell-free DNA after definitive therapy.

    “MRD detection requires greater analytical sensitivity than baseline genotyping or advanced-disease resistance monitoring, because tumor-derived DNA may represent only a very small fraction of total cell-free DNA after definitive therapy [ 5 , 9 ].”
  • Across solid tumors, ctDNA fraction varies according to tumor burden, anatomical site, proliferation, apoptosis, necrosis, inflammation, treatment exposure, vascularity, microenvironment, and host-related factors.

    “Across solid tumors, ctDNA fraction varies according to tumor burden, anatomical site, proliferation, apoptosis, necrosis, inflammation, treatment exposure, vascularity, microenvironment, and host-related factors [ 5 ].”
  • MRD detection requires substantially greater analytical sensitivity than baseline genotyping because tumor-derived DNA may be present at very low levels after surgery or definitive therapy.

    “MRD detection is the most clinically ambitious use of ctDNA in sarcoma. It requires substantially greater analytical sensitivity than baseline genotyping because tumor-derived DNA may be present at very low levels after surgery or definitive therapy [ 5 , 9 , 10 , 11 , 12 ].”

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  1. [17]17. [Markus H, Contente-Cuomo T, Farooq M, et al. Evaluation of preanalytical factors affecting plasma DNA analysis. Sci Rep . 2018;8: 7375.](http://refhub.elsevier.com/S0923-7534(22)01721-5/sref17)

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Authors
Pascual, J., Attard, G., Bidard, F.-C., Curigliano, G., De Mattos-Arruda, L., Diehn, M., Italiano, A., Lindberg, J., Merker, J. D., Montagut, C., Normanno, N., Pantel, K., Pentheroudakis, G., Popat, S., Reis-Filho, J. S., Tie, J., Seoane, J., Tarazona, N., Yoshino, T., & Turner, N. C.
Affiliations
  • Hospital Clínico Universitario Virgen de la Victoria (ES)
  • University College London (GB)
  • Université de Versailles Saint-Quentin-en-Yvelines (FR)
  • University of Milan (IT)
  • Stanford Medicine (US)
  • Université de Bordeaux (FR)
  • Karolinska Institutet (SE)
  • University of North Carolina at Chapel Hill (US)
  • Universitat Pompeu Fabra (ES)
  • Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT)
  • University Medical Center Hamburg-Eppendorf (DE)
  • European Society for Medical Oncology (CH)
  • Institute of Cancer Research (GB)
  • Memorial Sloan Kettering Cancer Center (US)
  • Walter and Eliza Hall Institute of Medical Research (AU)
  • Universitat Autònoma de Barcelona (ES)
  • Universitat de València (ES)
  • National Cancer Center Hospital East (JP)
Corresponding author
Turner, N.C.
Venue
Annals of Oncology
Publisher
Elsevier BV
Published
2022-08
Volume
33
Issue
8
Pages
750-768
ISSN
0923-7534 (ISSN-L)
OpenAlex
W4284706731
Cited by
783
References
163
Citations by year
2026: 234 · 2025: 215 · 2024: 163 · 2023: 148 · 2022: 23
FWCI
57.84
Type
journal article
Language
en
Open access
Locations
  • Annals of Oncology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, cc-by-nc-nd)
  • RISalud Institutional Health Repository of Andalucía (submittedVersion, cc-by-nc-nd)
  • HAL (submittedVersion, cc-by-nc-nd)
  • UCL Discovery (University College London) (submittedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc-nd)
  • Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion, cc-by-nc-nd)
Funders
  • Mesothelioma Applied Research Foundation
  • Amgen
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca
  • GlaxoSmithKline
  • Sanofi
  • Ariad Pharmaceuticals
  • Celgene
  • Merck KGaA
  • Les Laboratories Pierre Fabre
  • Roche Innovation Center Zurich
  • European Society for Medical Oncology
  • Servier
  • Genentech
  • Chugai Pharmaceutical
  • National Cancer Institute (R01CA254179, R01CA244526, P50CA257911, R01CA257655)
  • Daiichi Sankyo Europe
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer Genomics and Diagnostics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › BRCA gene mutations in cancer
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
Keywords
circulating tumor DNA, liquid biopsy, actionable mutations, targeted therapy, molecular residual disease, molecular relapse, early-stage cancer, treatment response monitoring, resistance mutations, cancer screening, false-negative results
MeSH terms
Circulating Tumor DNA, Humans, Mutation, Neoplasm Recurrence, Local, Biomarkers, Tumor, Precision Medicine

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