ctDNA in the Clinic: What to Know for Monitoring GE Cancer Recurrence

In an interview with Targeted Oncology, Rutika Mehta, MD, MPH, associate professor of medicine and attending physician at Weill Cornell Medicine and NewYork-Presbyterian Hospital, outlines key practical factors clinicians should consider when deciding to use circulating tumor DNA (ctDNA) or minimal residual disease (MRD) testing in managing patients with gastroesophageal cancer.

Watch part 1, part 2, and part 3 of Dr Mehta’s interview.

One major consideration is how to interpret and communicate the added information these tests provide. While ctDNA/MRD testing can yield valuable molecular insights, current evidence does not yet support changing treatments based solely on these results. Mehta emphasizes the importance of having thorough discussions with patients about the potential benefits, limitations, and uncertainties, ensuring they understand that test results might not immediately alter their therapy.

Financial and logistical issues also play a role. Although many insurers currently support approval of these tests, coverage can vary by payer and practice setting, posing possible access challenges.

Another practical challenge is determining how to respond to rising ctDNA levels. Mehta explains that an increase in ctDNA might prompt earlier imaging, even if routine scans are not yet scheduled. However, the ideal “lead time” between molecular progression and radiographic evidence remains unknown. This uncertainty highlights the need for prospective clinical trials to clarify how early molecular detection aligns with imaging and, critically, whether early intervention based on ctDNA improves patient outcomes.

Overall, while ctDNA/MRD testing holds promise for improving surveillance and treatment personalization in gastroesophageal cancer, Mehta advises cautious, informed integration into clinical practice until further prospective data become available.

Read the full interview here.