Journal of the American Academy of Dermatology · 2025
Circulating tumor DNA level is associated with time to clinical recurrence in Merkel cell carcinoma: Implications for patient management.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Akaike Tomoko, Thakuria Manisha, Silk Ann W, Hippe Daniel S, Ch'en Peter Y, Park Song Youn, Urman Nicole M, Chiu Meliea W, Kim Hannah, Kim Emily Y, Hall Evan T, Bhatia Shailender, Reddy Sunil, Krainock Michael, Aleshin Alexey, Choi Jacob S, Tsai Kenneth Y, Yom Sue S, Yu Siegrid S, Choi Jaehyuk, Chandra Sunandana, Nghiem Paul T, Zaba Lisa C
Аннотация
BACKGROUND: Merkel cell carcinoma (MCC) recurs in 40% of patients. Circulating tumor DNA (ctDNA) is an emerging blood-based biomarker for early MCC recurrence detection.
OBJECTIVE: To evaluate the timing and prognostic significance of ctDNA levels relative to clinical recurrence.
METHODS: This multicenter prospective study analyzed 669 tumor-informed ctDNA tests from 215 MCC patients (stage I-IV) without clinically evident disease after treatment.
RESULTS: Patients with at least 1 positive ctDNA test were more likely to experience recurrence compared to ctDNA-negative patients (hazard ratio: 18.1, 95% CI: 8.9-36.7), with 77% developing clinically evident disease by 1 year. The median lead time between the first positive ctDNA and clinical recurrence was 2.7 months. Clinical recurrences usually occurred within 3 months for ctDNA levels above 10 molecules/mL, within 6 months for levels between 1-10 molecules/mL, and within 9 months for levels below 1 molecule/mL.
LIMITATIONS: In this real-world study, there was variability in timing and frequency of follow-up examinations, imaging, and ctDNA testing, although most patients were followed with both ctDNA and imaging.
CONCLUSIONS: A positive ctDNA test detects MCC recurrence approximately 3 months earlier than imaging. Negative ctDNA can help reduce imaging frequency through serial ctDNA monitoring, while positive ctDNA warrants closer patient follow-up.
OBJECTIVE: To evaluate the timing and prognostic significance of ctDNA levels relative to clinical recurrence.
METHODS: This multicenter prospective study analyzed 669 tumor-informed ctDNA tests from 215 MCC patients (stage I-IV) without clinically evident disease after treatment.
RESULTS: Patients with at least 1 positive ctDNA test were more likely to experience recurrence compared to ctDNA-negative patients (hazard ratio: 18.1, 95% CI: 8.9-36.7), with 77% developing clinically evident disease by 1 year. The median lead time between the first positive ctDNA and clinical recurrence was 2.7 months. Clinical recurrences usually occurred within 3 months for ctDNA levels above 10 molecules/mL, within 6 months for levels between 1-10 molecules/mL, and within 9 months for levels below 1 molecule/mL.
LIMITATIONS: In this real-world study, there was variability in timing and frequency of follow-up examinations, imaging, and ctDNA testing, although most patients were followed with both ctDNA and imaging.
CONCLUSIONS: A positive ctDNA test detects MCC recurrence approximately 3 months earlier than imaging. Negative ctDNA can help reduce imaging frequency through serial ctDNA monitoring, while positive ctDNA warrants closer patient follow-up.