Liquid Biopsy-Driven Treatment Switch Enhances Outcomes in Breast Cancer Recurrence

A recent large-scale clinical trial has demonstrated that utilizing liquid biopsy blood tests to detect early treatment-resistant mutations in breast cancer, followed by a shift to an innovative experimental medication, significantly prolongs tumor control and improves patient outcomes. The SERENA-6 study, published in the New England Journal of Medicine and presented at the American Society for Clinical Oncology's annual meeting, involved multiple leading research centers across Europe, East Asia, and the United States, including Weill Cornell Medical College and affiliated NewYork-Presbyterian hospitals.

This investigation primarily focused on patients with advanced estrogen receptor-positive, HER2-negative breast cancer, a subtype driven by overactive estrogen receptors on tumor cells. While standard treatment involves drugs called aromatase inhibitors that suppress estrogen production, cancers often develop resistance due to mutations in the ESR1 gene, maintaining receptor activity despite hormone suppression.

The study enrolled over 3,300 patients across 23 countries, screening for ESR1 mutations through liquid biopsies. Those with detectable mutations but no visible disease progression were randomized to either cease aromatase inhibitors and begin treatment with camizestrant— an experimental drug targeting estrogen receptors—or continue standard therapy. Results showed that patients switching to camizestrant experienced a median tumor-free period of 16 months, compared to 9.2 months in the standard treatment group. Additionally, their quality of life and overall health declined less rapidly, with median times to deterioration of 23 months versus 6.4 months, respectively.

Dr. Massimo Cristofanilli, a prominent oncologist involved in the study, highlighted that liquid biopsy technology enables earlier intervention at lower tumor burden stages, leading to better outcomes. He also emphasized the broader applicability of this approach, as many cancer types harbor resistance mutations detectable early with such techniques.

These findings suggest that proactive monitoring with liquid biopsies and swift treatment adaptation could revolutionize management strategies for ER-positive breast cancer, offering hope for extended remission and improved survival rates.