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The feasibility of tumor recurrence detection in liver post-transplantation for patients with hepatocellular carcinoma via personalized, tumor-informed ctDNA testing
Background
Hepatocellular carcinoma (HCC) is an aggressive malignancy for which liver transplantation can be curative. Unfortunately, ∼8-20% of HCC patients will go on to relapse post-transplantation. Personalized and tumor-informed circulating tumor DNA (ctDNA) testing (SignateraTM, bespoke mPCR NGS assay) has been validated to accurately predict relapse across solid tumors, ahead of radiological imaging. Here, we demonstrate the feasibility of ctDNA testing for monitoring relapse in HCC patients who underwent liver transplantation with curative intent.
Methods
A total of 10 HCC patients, stage I-IV, who underwent curative liver transplantation with longitudinal ctDNA monitoring were included in the analysis. Alpha-fetoprotein (AFP) levels and images were measured during surveillance in a subset of patients.
Results
In this cohort of 10 patients, 2 (20%) tested ctDNA positive during surveillance, both of whom relapsed. Of these, one tested ctDNA positive two months prior to imaging. Of the 8 patients who did not test ctDNA positive during surveillance, all remained disease-free by imaging. Two patients had elevated AFP, neither of whom relapsed. Of the 2 patients who relapsed, AFP levels were available for one patient and fell within the normal range.
Conclusions
Our study illustrated the feasibility of performing longitudinal ctDNA assessment in patients with HCC (post-transplantation) during surveillance. ctDNA status but not AFP was associated with recurrence and was able to inform disease status ahead of imaging. To facilitate clinical decision-making, specifically with adjuvant therapy and immunosuppression management, additional studies with larger patient cohorts will be needed to validate the clinical utility of ctDNA testing in HCC.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
A. He: Advisory / Consultancy: Genentech, AstraZeneca; Speaker Bureau / Expert testimony: BMS, Eisai; Research grant / Funding (self): Genentech, Merck. H. Dhani: Full / Part-time employment: Natera. V. Aushev: Travel / Accommodation / Expenses: Natera, Inc.; Shareholder / Stockholder / Stock options: Natera, Inc.; Full / Part-time employment: Natera, Inc. A. Jurdi: Shareholder / Stockholder / Stock options: Natera; Full / Part-time employment: Natera. J. Starr: Honoraria (self): Natera; Advisory / Consultancy: Natera; Travel / Accommodation / Expenses: Natera. P. Gauthier: Shareholder / Stockholder / Stock options: Natera, Inc; Full / Part-time employment: Natera, Inc. All other authors have declared no conflicts of interest.
