Haystack’s minimal residual disease (MRD) detection technology was featured in 2 presentations at the 2024 American Society of Clinical Oncology (ASCO) annual meeting this June in Chicago. Dr Andrea Cercek of Memorial Sloan Kettering Cancer Center presented exciting results for a PD-1 blockade drug in treating mismatch repair–deficient rectal cancers, while Dr Jeanne Tie of the Peter MacCallum Cancer Center shared a 5-year update from the DYNAMIC study, which used MRD testing to guide adjuvant chemo decisions.
Circulating tumor DNA (ctDNA) detection with Haystack’s MRD technology was the fastest indicator of time to clinical response in rectal cancer drug study
Dr Andrea Cercek, MD, of Memorial Sloan Kettering Cancer Center in New York, presented results of a drug trial in her talk, “Durable complete responses to PD-1 blockade alone in dMMR locally advanced rectal cancer.” The presentation described a study that tested whether mismatch repair–deficient (dMMR) rectal cancers could be treated with a specific drug in place of chemotherapy, radiation, and/or surgery.
The drug, dostarlimab, is a monoclonal antibody that inhibits an immune checkpoint protein known as programmed death 1 (PD-1). In the study, dostarlimab was used as neoadjuvant therapy in 48 patients diagnosed with dMMR locally advanced rectal cancer.
Dr Cercek reported that of the 42 patients who completed the course of dostarlimab, 100% had clinical complete response (cCR)—that is, no clinical signs of cancer—after a median of 6.2 months, as measured by the study’s 2 endpoints, endoscopy and rectal MRI. None of the patients required chemotherapy, radiation, or surgery. After 2 years, these patients still have no signs of cancer. 1
Response to the drug was also evaluated with several exploratory biomarkers, including circulating tumor DNA (ctDNA) analyzed by Haystack Oncology. Dr Cercek described Haystack’s ctDNA detection as having “incredibly high sensitivity,” as 97% of the 30 patients who underwent ctDNA testing were positive for ctDNA at the beginning of the study.1
Haystack’s ctDNA detection was the fastest indicator of cCR among the methods used in the study, with a median time to cCR of only 1.38 months—around 4.8 months faster than by endoscopy or rectal MRI.1 These data support previous studies showing that ctDNA-based MRD testing can detect recurrence earlier than traditional methods.2-8
A global study, AZUR1, is ongoing for confirming the use of dostarlimab in dMMR rectal cancer.
Read Dr Cercek’s abstract and watch her video presentation.*
5-year DYNAMIC trial update shows continued benefit for patients with ctDNA-guided treatment
An update to the DYNAMIC trial, which showed that adjuvant chemotherapy could be reduced without compromising patient survival, was presented by Dr Jeanne Tie, MD, of the Peter MacCallum Cancer Center and the Eliza Hall Institute of Medical Research in Melbourne.
DYNAMIC is a randomized, prospective trial to determine whether ctDNA-based MRD testing can be used to guide adjuvant chemotherapy decisions in patients with stage II colorectal cancer. Patients who had tumor-removal surgery were randomly assigned to have their adjuvant chemo decisions based on either ctDNA testing or on the current standard of care, which is for clinicians to choose based on conventional criteria such as clinicopathological features of the tumor.
Previous results showed that when ctDNA was used to guide adjuvant chemo decisions, patients were able to avoid chemotherapy ~50% of the time without reducing 2-year recurrence-free survival.9
In the update presented at this year’s ASCO meeting, Dr Tie shared that 5-year recurrence-free survival was similar between patients who had ctDNA-guided treatment (88%) and those who received standard care (87%). In addition, overall survival was roughly equivalent (93.8% for ctDNA-guided treatment and 93.3% for standard care).10
In other words, patients whose chemo decisions were guided by ctDNA received 50% less chemo but continued to fare as well after 5 years, in terms of both recurrence-free and overall survival, as those who received standard care.
In addition, testing positive for ctDNA after surgery continued to be a significant predictor of survival at the 5-year mark. Overall survival was 85.6% in treated ctDNA-positive patients and 95.3% in untreated ctDNA-negative patients.10
The promising results presented in this update continue to demonstrate the benefits of using ctDNA-based MRD testing to guide adjuvant chemotherapy decisions in patients with stage II colorectal cancer.
Read Dr Tie’s abstract and watch her presentation.*
*Accessing the video presentation requires ASCO login and current registration.
About Haystack MRD
Next-generation ctDNA detection with exquisite sensitivity and specificity for precise MRD reporting
Haystack MRD is a tumor-informed ctDNA detection test for postsurgical measurement of residual disease in solid tumor settings. The test is powered by sequencing chemistry that significantly reduces noise to detect even the least-abundant ctDNA molecules in blood. This unique ability translates to better minimal residual disease (MRD) detection for greater confidence when making key clinical decisions.
Purpose-built MRD technology developed by pioneers of cancer research
Haystack MRD was designed specifically for ultrasensitive ctDNA detection when testing for residual, recurrent, and resistant disease. Better sensitivity means the right patients are more likely to receive the right treatment at the right time, which can significantly improve outcomes and quality of life for patients who have been diagnosed with cancer.
Backed by the power of Quest
Haystack MRD offers end-to-end MRD test reliability, powered by Quest Diagnostics credentialed staff, labs, logistics, service, reporting, and technology. Plus, the transition between Haystack MRD and Quest’s other advanced oncology testing is seamless, providing ease and convenience in the testing process for doctors and patients.
References
1. Cercek A. Durable complete responses to PD-1 blockade alone in mismatch repair deficient locally advanced rectal cancer. Abstract and talk presented at: American Society of Clinical Oncology Annual Meeting. June 3, 2024; Chicago, Illinois.
2. Coombes RC, Page K, Salari R, et al. Personalized detection of circulating tumor DNA antedates breast cancer metastatic recurrence. Clin Cancer Res. 2019;25(14):4255-4263. doi:10.1158/1078-0432.ccr-18-3663
3. Gale D, Heider K, Ruiz-Valdepenas A, et al. Residual ctDNA after treatment predicts early relapse in patients with early-stage non-small cell lung cancer. Ann Oncol. 2022;33(5):500-510. doi:10.1016/j.annonc.2022.02.007
4. Qiu B, Guo W, Zhang F, et al. Dynamic recurrence risk and adjuvant chemotherapy benefit prediction by ctDNA in resected NSCLC. Nat Commun. 2021;12(1):1-11. doi:10.1038/s41467-021-27022-z
5. Reinert T, Schøler LV, Thomsen R, et al. Analysis of circulating tumour DNA to monitor disease burden following colorectal cancer surgery. Gut. 2016;65(4):625-634. doi:10.1136/gutjnl-2014-308859
6. Tie J, Wang Y, Tomasetti C, et al. Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer. Sci Transl Med. 2016;8(346):346ra92. doi:10.1126/scitranslmed.aaf6219
7. Wang Y, Li L, Cohen JD, et al. Prognostic potential of circulating tumor DNA measurement in postoperative surveillance of nonmetastatic colorectal cancer. JAMA Oncol. 2019;5(8):1118. doi:10.1001/jamaoncol.2019.0512
8. Yang J, Gong Y, Lam VK, et al. Deep sequencing of circulating tumor DNA detects molecular residual disease and predicts recurrence in gastric cancer. Cell Death Dis. 2020;11(5):1-9. doi:10.1038/s41419-020-2531-z
9. Haystack MRD uses a highly advanced version of the ctDNA detection technology used in the DYNAMIC study, which was the first study of its kind to assess the clinical benefit of MRD testing to guide adjuvant therapy: Tie J, Cohen JD, Lahouel K, et al. Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer. N Engl J Med. 2022;386(24):2261-2272. doi:10.1056/NEJMoa2200075
10. Tie J. Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer: Overall survival and updated 5-year results from the randomized DYNAMIC trial. Abstract and talk presented at: American Society of Clinical Oncology Annual Meeting. June 3, 2024; Chicago, IL.
