Article Text

Download PDFPDF

EP159/#1534  Leveraging personalized circulating tumor DNA monitoring to predict treatment response and recurrence in high-risk endometrial cancer
  1. Melissa Pham1,
  2. Carly Bess Scalise2,
  3. Ekaterina Kalashnikova2,
  4. Punashi Dutta2,
  5. Xi Chen3,
  6. Subrina Narcisse1,
  7. Kelly Rangel1,
  8. Diana Urbauer3,
  9. Adam Elnaggar2,
  10. Shannon Westin1,
  11. Amir Jazaeri1,
  12. Karen Lu1 and
  13. Pamela Soliman1
  1. 1The University of Texas MD Anderson Cancer Center, Gynecologic Oncology and Reproductive Medicine, Houston, USA
  2. 2Natera, Inc, Translational Medicine, Austin, USA
  3. 3The University of Texas MD Anderson Cancer Center, Biostatistics, Houston, USA


Introduction Adjuvant therapy is often used in high risk endometrial cancer (HREC) due to increased risk of recurrence. Histology alone does not accurately predict recurrence. Circulating tumor DNA (ctDNA) is a validated prognostic biomarker for many solid tumors, yet its utility in HREC is unclear.

Methods In an ongoing, prospective registry, serial plasma samples were collected pre- and post-hysterectomy, and post-adjuvant treatment (AT) from 25 patients with newly diagnosed HREC treated with primary surgery. CtDNA was detected using a tumor-informed assay (SignateraTM Natera, Inc.) and correlated with recurrence-free survival (RFS).

Results Personalized ctDNA assays were successfully designed for 24/25 patients. Median age was 63 years (range: 30–74). Pre-operatively, ctDNA was detectable in 60.87% patients (median 1.3 mean tumor molecules/mL), with 55% and 80% in stage I and II-IV, respectively. ctDNA cleared with surgery in 83% (10/12) patients; only one (10%) of these patients recurred. Three patients were ctDNA-positive post-operatively; 2/3 remained ctDNA-positive post-AT and recurred; 1/3 cleared ctDNA post-AT and remained disease-free. Seven patients recurred; ctDNA-positivity was observed in 43% (3/7) pre-operatively, 33% (2/6) post-operatively, and 29% (2/7) post-AT. There was no association between pre-operative ctDNA and recurrence (p=0.27). Post-AT, ctDNA-positivity was significantly associated with shorter RFS compared to ctDNA-negativity (p=0.02; HR=7.92; 95%CI: 1.43–43.73).

Conclusion/Implications Post-AT ctDNA negativity and/or clearance were associated with better response and RFS in HREC patients. ctDNA detection was feasible across multiple timepoints in early-stage HREC patients. Future studies will determine whether the addition of ctDNA to other molecular/histologic characteristics can identify patients who may benefit from escalation/de-escalation of AT.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.