Circulating Tumor DNA in the Surgical Management of Cancer: A Review of Clinical Trials to Understand Future Impact on Multidisciplinary Practice

Abstract

Background

Circulating tumor DNA (ctDNA) has been proposed as a surrogate for solid tumor tissue biopsies. Our study evaluated trends of clinical trials that assess the role of ctDNA in surgical oncology.

Methods

The ClinicalTrials.gov database was queried for clinical trial that evaluated the use of ctDNA in the management of patients who underwent curative resections for solid tumor malignancies. Studies were categorized based on the phase of operative care were ctDNA was assessed and further stratified based on surgical application. Descriptive statistics were utilized to describe trends of included trials.

Results

Of 382,298 clinical trials, our study identified 68 trials (2014-2021). The majority of these trials were phase 2 (82.4%) and actively recruiting (63.2%). The most commonly studied malignancies were breast (20.0%), colon (17.1%) and lung (14.3%) cancers. Majority of trials assessed ctDNA utility in preoperative prognostication (52.9%) and in postoperative adjuvant therapy candidacy (16.2%).

Discussion

There have been significant strides in the use of ctDNA in surgical oncology including preoperative prognostication, postoperative surveillance, and risk stratification for adjuvant therapy. In recognizing the dynamic landscape of clinical trials, multidisciplinary oncology teams can be better informed to anticipate the clinical implications of ctDNA within their practice.