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

For women aged 70 and over newly diagnosed with estrogen receptor-positive breast cancer, navigating treatment options can be particularly complex. A fresh study suggests a blood test analyzing circulating tumor DNA (ctDNA) may offer a way to personalize treatment decisions, potentially sparing some patients from the side effects of surgery and radiation. The research, published in Clinical Cancer Research, focuses on identifying which patients are unlikely to benefit from hormone therapy alone, offering a less invasive approach to guiding care.

Understanding ctDNA and its Role in Treatment Decisions

The study centers around circulating tumor DNA, or ctDNA. This refers to small fragments of genetic material released by cancer cells into the bloodstream. Researchers at UPMC Hillman Cancer Center and the University of Pittsburgh School of Medicine analyzed blood samples to detect the presence of these fragments. The goal wasn’t to diagnose cancer – the patients already had a diagnosis – but to predict how they would respond to endocrine therapy, as well known as hormone-blocking therapy. This type of treatment is often a first-line option for estrogen receptor-positive breast cancer, a common subtype of the disease.

“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,” explained Dr. Priscilla McAuliffe, a breast surgical oncologist at UPMC Hillman and associate professor of surgery at Pitt’s School of Medicine. This concept of “right-sizing” treatment – tailoring it to the individual patient’s needs and risk – is gaining traction in oncology.

How the Blood Test Performed in the Study

The study involved fewer than 50 patients, a relatively small cohort. Researchers found that patients whose ctDNA tests were negative – meaning no cancer DNA fragments were detected – either at the start of treatment or after beginning endocrine therapy, were more likely to experience stable disease or even tumor shrinkage. This suggests that for these patients, the benefits of surgery and radiation – which can include scarring, chronic swelling, infection, and nerve damage – may not outweigh the risks.

Conversely, patients whose ctDNA remained positive after starting hormone therapy were more likely to spot their tumors grow despite treatment. This indicates that more aggressive interventions, such as surgery or alternative therapies, might be necessary to control the cancer in these cases. It’s important to note that the study didn’t directly evaluate the effectiveness of these different treatments; rather, it aimed to identify a way to predict which patients would respond to hormone therapy alone.

Convenience and Patient-Centered Research at UPMC Hillman

A key aspect of the study was its focus on accessibility and patient convenience. Blood samples were often collected from patients’ homes, reducing the burden of frequent hospital visits. This was a deliberate effort to include patients from across the UPMC Hillman network, not just those who could easily travel to the main facility in Shadyside. As lead author Dr. Neil Carleton noted, “Making care more convenient for patients, including access to clinical trials, is a priority at UPMC Hillman Cancer Center.” The research team actively included patients from UPMC Passavant Cranberry, UPMC Jameson, and UPMC St. Margaret, expanding participation beyond the academic medical center. UPMC Hillman Cancer Center is designated as a comprehensive cancer center by the National Cancer Institute.

The Importance of Patient and Caregiver Perspectives

The researchers also incorporated feedback from both patients and their caregivers – a group often underrepresented in clinical trials. Over 80% of patients surveyed reported that ctDNA test results could help them feel more informed about their treatment decisions, particularly in the initial six to twelve months of care. Caregivers highlighted the significant impact of supporting a loved one through breast cancer treatment, often requiring them to prioritize caregiving responsibilities over operate and other commitments. This underscores the importance of considering the needs of both patients and their support systems when making treatment plans.

What Does This Mean for Breast Cancer Care?

The findings suggest that ctDNA testing could become a valuable tool for personalizing breast cancer treatment for older women considering endocrine therapy. By identifying patients who are unlikely to respond to hormone therapy alone, clinicians may be able to avoid unnecessary surgery and radiation, minimizing side effects and improving quality of life. Yet, it’s crucial to remember that this was a small study, and the results are not yet ready for widespread clinical leverage.

Larger studies are needed to validate these findings and determine the optimal way to incorporate ctDNA testing into routine clinical practice. Further research will also be necessary to understand how ctDNA levels change over time and how this information can be used to adjust treatment plans. The UPMC Hillman Cancer Center is internationally recognized for its leadership in cancer research, as highlighted on their website: https://hillmanresearch.upmc.edu/. The center is also dedicated to educating the next generation of cancer researchers and physicians.

Looking Ahead: Ongoing Research and Clinical Trials

Researchers caution that this study represents an early step in a promising area of research. The next phase will involve larger, multi-center clinical trials to confirm these findings in a more diverse population of patients. These trials will also explore the potential of ctDNA testing to predict response to other types of breast cancer treatments. The National Institutes of Health provided funding for this study, supporting ongoing efforts to advance cancer research. Learn more about research at the University of Pittsburgh’s Department of Medicine.

the goal is to develop a more precise and personalized approach to breast cancer care, ensuring that each patient receives the treatment that is most likely to benefit them while minimizing unnecessary side effects. This research highlights the potential of blood-based tests to play a key role in achieving that goal.