[Debbie L.]

Lani, you beat me to it, I saved this yesterday, intending to post it. Here's a link to the full text .

A big caution, discussed by the authors, is that this was a very small study (20 women). For example, all but 1 of the 20 cancers were ER+, and only two were HER2+. All the women who didn't recur had negative nodes (6 of the 14 who recurred had negative nodes). Not a particularly representative sample. I think they are showcasing the potential of the technology, without (yet) knowing much about how it might actually be used. Still, the results are intriguing. I especially like that it might someday be possible to identify those who abolutely will not recur, and spare them toxic treatments.

However, I see several issues with the potential use of it to detect a recurrence. First of all, it would be a huge paradigm shift, and require much evidence of actual benefit (chance of cure or improved OS), to treat someone who, by our current standards, is NED. Acquiring that evidence would take quite awhile, not to mention the cost. There is no mention that this test assesses response to treatment -- so we wouldn't even know if we'd hope for the test results to change (indicating response?), plus there would be no other way to monitor response -- talk about being in limbo! How would treatment decisions (changes, stopping, etc) be made?

Secondly, it is possible that these women would simply endure treatment (toxicities and decreased QOL) for more years than their counterparts whose mets were detected by current means, without actually living any longer. As the authors note, there is not even a hint, so far, that catching mets "earlier" improves OS.

I'd label this one as interesting and hopeful but (sadly) far from being of use in the trenches. But maybe I'm missing something? Much of the genomic discussion and detail was (way) over my head.

Debbie Laxague