Roughly 275,000 patients are diagnosed with breast cancer every year,1 and many receive NAC — the preoperative treatment of cancer with chemotherapy, radiation therapy, or endocrine therapy — which has become a standard of care for patients with locally advanced breast cancer. The primary goal of NAC is to downstage the tumor and allow for breast conserving surgery in those whose tumors are responsive to treatment. However, according to the National Comprehensive Cancer Network's clinical practice guidelines,2 "the accurate assessment of in-breast tumor or regional lymph node response to preoperative systemic therapy is difficult."
Furthermore, a minority of patients receiving NAC achieve pathologic complete response (pCR), which occurs when there are no discernable tumor cells in the surgically resected tissue after NAC. These patients are known to enjoy very low risk of metastatic recurrence3 and may avoid additional treatment after surgery. In fact, the FDA considers pCR as a surrogate endpoint for drug efficacy. Among non-pCR patients, however, studies show that 20-25% will experience metastatic recurrence.3 Since there are currently no accurate biomarkers available for further risk stratification, most non-pCR patients receive additional systemic therapy after surgery.
"The I-SPY 2 Trial was designed to use novel biomarkers to help accelerate drug development and improve clinical outcomes," said
The study analyzed 291 plasma samples from 84 patients who received neoadjuvant treatment. Serial blood samples were collected before treatment (T0), during treatment (T1, T2), and after treatment but before surgery (T3), with detailed clinical outcomes collected up to 6 years post-surgery. Key findings from the study include:
- Early clearance of ctDNA during treatment (at T1) was significantly associated with the increased likelihood of achieving pCR (P = 0.012)
- Among the 43 patients who did not achieve pCR, 86% were ctDNA-negative after NAC (T3) and achieved distant relapse-free survival of 93%, almost the same as those who achieved pCR
- Among those patients who were ctDNA-positive after NAC (T3), 67% experienced metastatic recurrence
"Breast cancer patients who achieve pCR after NAC have been shown to enjoy a significant survival advantage over those who do not," said
Signatera is a custom-built circulating tumor DNA (ctDNA) test for treatment monitoring and molecular residual disease (MRD) assessment in patients previously diagnosed with cancer. The test is available for clinical and research use, and in 2019, it was granted Breakthrough Device Designation by the FDA. The Signatera test is personalized and tumor-informed, providing each individual with a customized blood test tailored to fit the unique signature of clonal mutations found in that individual's tumor. This maximizes accuracy for detecting the presence or absence of residual disease in a blood sample, even at levels down to a single tumor molecule in a tube of blood. Unlike a standard liquid biopsy, Signatera is not intended to match patients with any particular therapy; rather, it is intended to detect and quantify how much cancer is left in the body, to detect recurrence earlier and to help optimize treatment decisions. Signatera test performance has been clinically validated in multiple cancer types including colorectal, non-small cell lung, breast, and bladder cancers. Signatera has been developed and its performance characteristics determined by Natera, the CLIA-certified laboratory performing the test. The test has not been cleared or approved by the
Natera is a pioneer and global leader in cell-free DNA testing. The mission of the company is to change the management of disease worldwide with a focus on women's health, oncology, and organ health. Natera operates an ISO 13485-certified and CAP-accredited laboratory certified under the Clinical Laboratory Improvement Amendments (CLIA) in
All statements other than statements of historical facts contained in this press release are forward-looking statements and are not a representation that Natera's plans, estimates, or expectations will be achieved. These forward-looking statements represent Natera's expectations as of the date of this press release, and Natera disclaims any obligation to update the forward-looking statements. These forward-looking statements are subject to known and unknown risks and uncertainties that may cause actual results to differ materially, including with respect to our efforts to develop and commercialize new product offerings, our ability to successfully increase demand for and grow revenues for our product offerings, whether the results of clinical or other studies will support the use of our product offerings, our expectations of the reliability, accuracy and performance of our screening tests, or of the benefits of our screening tests and product offerings to patients, providers and payers. Additional risks and uncertainties are discussed in greater detail in "Risk Factors" in Natera's recent filings on Forms 10-K and 10-Q and in other filings Natera makes with the
- Cancer Stat Facts: Female Breast Cancer.
National Cancer Institute. https://seer.cancer.gov/statfacts/html/breast.html
- Breast Cancer Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network. https://www2.tri-kobe.org/nccn/guideline/breast/english/breast.pdf. Published
July 15, 2020.
- Magbanua MJM, et al. Circulating tumor DNA in neoadjuvant-treated breast cancer reflects response and survival. Ann. Oncol.
November 20, 2020. https://doi.org/10.1016/j.annonc.2020.11.007.
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