SOHO 2023 | The remaining hurdles for using ctDNA in lymphoma

One of the things that is difficult to answer is that it’s an analyte that can do so many different things, it’s so versatile that the answer is really it depends. It depends on which lymphoma, and it depends on which questions we want to ask. At least right now, what I think is the most ready to investigate further is as a test of MRD at the end of therapy, when the goal is cure. So what we’re talking about is how do we currently define remission? Remission is a term we use to define patients that have achieved a complete response. But the tools we have, such as imaging scans, they’re too insensitive to give us, you know, precision. What we want is other tests that can complement those PET scans and CT scans to tell us, okay, which patients still have some residual disease even though you’re at the end of therapy, and those are the patients that are going to need additional therapy if the goal remains cure. So this is a potential way to update the response criteria to modernize the response criteria and use all the available tools. But it’s not the only thing for circulating tumor DNA. Then we’ll have to think about, well, can we use it at the beginning of therapy, in the middle of therapy? And how do these principles apply to other lymphoma subtypes? Maybe the goal isn’t cure in those subtypes, so can it be used? And so these are all going to have to be teased out in various clinical trials in the proper context before we can really have a good sense for how to use it.