Circulating tumor DNA in blood - a tool to evaluate the efficacy of chemotherapy?
The MONDRIAN (My OwN cIRculating biomarker tumour DNA) clinical trial evaluated the clinical utility of analyzing circulating tumor DNA (ctDNA) for an early identification of chemotherapy response for patients with triple negative metastatic breast cancer.
Right now, the performance evaluation of a new chemotherapy is mainly based on radiological exams which can take months. Monitoring quantitative variations of ctDNA molecules in blood could allow us to rapidly find out whether a cancer is responding or not to the chemotherapy.
How does it work?
The study is from the 2nd line of treatment and is organized in 2 stages. The first stage validates the efficacy of the detection test (during the 2nd line of treatment) and the 2nd stage is interventional (during the 3rd line of treatment).
- A personalized ctDNA detection test is developed using the characteristics of the tumor (using an existing biopsy).
- The 1st blood test is carried out before starting a new chemotherapy.
- The 2nd blood test is carried out 2 weeks after the start of the chemotherapy.
- The personalized test detects ctDNA in the blood and provides the necessary elements for the study committee to recommend whether to continue on with this treatment.
This innovative trial could radically modify the way metastatic disease is cared for: reducing the efficacy evaluation time of a treatment avoids radiation and gives clinicians a headstart to be able to suggest new chemotherapies before the cancer progresses.
ctDNA monitoring also allows us to shelf chemotherapies that aren't efficient enought for a given cancer reducing extended exposure and side-effects.
An original protocol discussed with the SIRIC patient representative committee
The discussions between the members of the SIRIC patient representative committee (Françoise Apiou and Laure Guéroult Accolas, founder of Patients en Réseau) and the clinical team allowed us to evolve towards an explanatory video for patients.
This video, presented by Luc Cabel, principal investigator of the study, explains the objectives, the methodology, the phases of the trial and the expected benefits. This communication tool seemed particularly important to our patient representatives to ensure a perfect understanding of the protocol.
This original approach is a first for Institut Curie and could lead to the inclusion of more videos in protocols.
Treatment resistance: at the heart of the SIRIC program
The ambition of Institut Curie's SIRIC program is to resolve the question of anti-cancer treatment resistance with an integrated approach in 3 key pathologies: breast cancers, pediatric cancers and uveal melanoma.
This trial, supported by SIRIC, is fully in line with this approach.
Watch the video where François-Clément Bidard, coordinator of both the MONDRIAN trial and the SIRIC breast cancer program, presents the MONDRIAN project in 2019 :