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Evaluating ctDNA Dynamics as Prognostic Biomarkers in Advanced HR+ HER2- Breast CancerRibociclib and Letrozole Show Promise for Advanced Breast Cancer

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Key Takeaway
ctDNA clearance and stable mutation profiles at early time points correlate with improved progression-free survival.

In this prospective Phase IIIb clinical trial, 263 postmenopausal patients with HR+ HER2- advanced breast cancer were treated with a first-line regimen of ribociclib and letrozole. The study aimed to evaluate the prognostic value of ctDNA alterations and their evolution over time as indicators of treatment response.

The median progression-free survival (PFS) for the cohort was 23.4 months. Analysis revealed that patients without detectable mutations at the start of treatment experienced a significantly better prognosis compared to those with initial mutations present.

Furthermore, early clearance of ctDNA—specifically by cycle 1 day 15 or cycle 2 day 1—correlated with improved PFS outcomes. The absence of new mutations between baseline and the first imaging session also demonstrated a lower risk of disease progression.

While these findings suggest that ctDNA dynamics may serve as promising prognostic and predictive biomarkers, the study notes that further research is required to validate their clinical utility in routine practice.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in monitoring tools for HR+/HER2- advanced breast cancer by identifying ctDNA dynamics as potential prognostic markers. While previous coverage highlighted different biomarkers like DeSTIL-positive status in HER2+ patients (HR 0.09) and the use of IHC panels to differentiate metastatic breast cancer from gastric cancer, this study focuses on the predictive value of ctDNA mutations for ribociclib and letrozole therapy.

Researchers studied 263 postmenopausal women with a specific type of advanced breast cancer. These patients received a first-line treatment consisting of two medications: ribociclib and letrozole. The study tracked the progression of the disease over a period of about 23 months.

The study looked at circulating tumor DNA, which are fragments of genetic material found in the blood. The results showed that certain patterns in these markers were linked to better outcomes. Specifically, patients who did not have detectable mutations at the start or those whose mutations cleared quickly during early treatment showed a lower risk of their cancer progressing.

While these findings suggest that tracking DNA markers could be a helpful way to predict how well a patient responds to therapy, more research is needed. The study notes that these markers are currently considered promising but require further validation before they can be used routinely in clinical practice.

What this means for you:
Tracking certain genetic markers in the blood may help predict treatment success for some patients with advanced breast cancer.

Common questions

What did the study find about treatment for advanced breast cancer?

The study followed 263 postmenopausal women with HR+ and HER2- advanced breast cancer. Patients received ribociclib and letrozole as a first-line treatment. The median progression-free survival was found to be 23.4 months.

How do DNA markers help in this type of treatment?

The study looked at ctDNA, which are genetic fragments in the blood. Patients with no detectable mutations at the start or those who cleared mutations early in treatment showed a lower risk of progression. These findings suggest these markers could be useful for predicting how well a patient responds to therapy.

Is this new method ready to use in clinics?

The study describes these DNA markers as promising prognostic and predictive biomarkers. However, the researchers stated that further studies are needed to fully validate their clinical use before they can be used routinely to guide treatment decisions.

Study Details

Study typePhase3
Sample sizen = 263
EvidenceLevel 2
Follow-up23.4 mo
PublishedJun 2026
View Original Abstract ↓
PURPOSE: This phase IIIb study prospectively evaluated the prognostic and predictive value of baseline and dynamic circulating tumor DNA (ctDNA) in postmenopausal patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) treated with first-line ribociclib/letrozole. EXPERIMENTAL DESIGN: A total of 287 patients were enrolled, with ctDNA analyzed at baseline (n = 263), day 15 of cycle 1 (C1D15; n = 238), C2D1 (n = 241), and first imaging (n = 206). The primary objective was to identify ctDNA alterations, characterize their evolution across treatment time points, and assess their association with progression-free survival (PFS). RESULTS: Median PFS was 23.4 months (95% confidence interval, 20.8 to not estimable). At baseline, the most frequently altered genes were PIK3CA (22.1%) and TP53 (15.5%). Alterations in TP53, MYC, and HER- and cyclin-dependent kinase 4/6- pathway genes were linked to early progression. Absence of a detectable mutation at baseline (n = 150, 57%) was associated with a better prognosis [hazard ratio (HR) = 0.41]. Among patients with a detectable mutation at baseline (n = 104), early clearance (mutation undetectability) was observed in 47.1% at C1D15 and 52.4% at C2D1 and was associated with improved PFS (C1D15, HR = 0.51; C2D1, HR = 0.44). In patients without a detectable mutation at baseline, 22.7% (n = 34) developed new mutations at C1D15, C2D1, or first imaging. Patients without new mutations had a lower risk of progression (HR = 0.45). CONCLUSIONS: Pretreatment and early dynamics of ctDNA represent promising prognostic and predictive biomarkers in patients with HR+/HER2- ABC treated with ribociclib/letrozole. Early ctDNA dynamics seem to be a promising surrogate biomarker for treatment. Further studies are warranted to validate their clinical utility.
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