Yeah, I think this is going to emerge as a very standard approach for us, particularly on the heels of the Serena 6 trial. In contemporary or recent clinical practice, most people would look at ctDNA at the time of clinical or radiographic progression. But I think we’re learning more and more about how valuable ctDNA dynamics can be, even for patients actively on treatment...
Yeah, I think this is going to emerge as a very standard approach for us, particularly on the heels of the Serena 6 trial. In contemporary or recent clinical practice, most people would look at ctDNA at the time of clinical or radiographic progression. But I think we’re learning more and more about how valuable ctDNA dynamics can be, even for patients actively on treatment. Now, that could be comparing a baseline ctDNA to one to two cycles in to see how well we’re engaging with the target. For example, dynamic drops in ESR1 for patients who have this type of breast cancer. Or it can be the reverse. Patients who are doing well on therapy and we’re watching over time for the emergence of alterations like ESR1 to predict when we should change therapy, for example, like in the Serena 6 study. I think your question is a very important and practical one. We don’t yet have a lot of experience in clinic doing circulating tumor DNA analysis on treatment in the absence of clinical or radiographic progression. That’s going to require some changes to the guidelines. It’s going to require which patients, like we were just discussing, might have the best tumor response, but also to predict the emergence of resistance before patients develop symptoms or develop radiographic or clinical changes. So I think we have more work to do. I hope that we’re going to be able to get there and that we’re going to see a paradigm shift in the way we think about ctDNA as not just a tool for treatment selection at progression or at new development of symptoms, but as a monitoring tool to look at on-treatment effect or emergence of resistance.
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