- Botta, Gregory;
- Abdelrahim, Maen;
- Drengler, Ronald;
- Aushev, Vasily;
- Esmail, Abdullah;
- Laliotis, George;
- Brewer, Chris;
- George, Giby;
- Abbate, Steven;
- Chandana, Sreenivasa;
- Tejani, Mohamedtaki;
- Malla, Midhun;
- Bansal, Dhruv;
- Rivero-Hinojosa, Samuel;
- Spickard, Erik;
- McCormick, Nicole;
- Cecchini, Michael;
- Lacy, Jill;
- Fei, Naomi;
- Kasi, Pashtoon;
- Kasi, Anup;
- Dayyani, Farshid;
- Hanna, Diana;
- Sharma, Shruti;
- Malhotra, Meenakshi;
- Aleshin, Alexey;
- Liu, Minetta;
- Jurdi, Adham
INTRODUCTION: Personalized and tumor-informed circulating tumor DNA (ctDNA) testing is feasible and allows for molecular residual disease (MRD) identification in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: In this retrospective analysis of commercial cases from multiple US institutions, personalized, tumor-informed, whole-exome sequenced, and germline-controlled ctDNA levels were quantified and analyzed in patients with PDAC. Plasma samples (n = 1329) from 298 clinically validated patients were collected at diagnosis, perioperatively (MRD-window; within 2-12 weeks after surgery, before therapy), and during surveillance (>12 weeks post-surgery if no ACT or starting 4 weeks post-ACT) from November 2019 to March 2023. RESULTS: Of the initially diagnosed patients with stages I-III PDAC who went for resection, the median follow-up time from surgery was 13 months (range 0.1-214). Positive ctDNA detection rates were 29% (29/100) and 29.6% (45/152) during the MRD and surveillance windows, respectively. Positive ctDNA detection was significantly associated with shorter DFS within the MRD window (median DFS of 6.37 months for ctDNA-positive vs 33.31 months for ctDNA-negative patients; HR: 5.45, P < .0001) as well as during the surveillance period (median DFS: 11.40 months for ctDNA-positive vs NR for ctDNA-negative; HR: 12.38, P < .0001). Additionally, DFS was significantly better with KRAS wildtype status followed by KRASG12R (HR: 0.99, P = .97), KRASG12D (HR: 1.42, P = .194), and worse with KRASG12V (HR: 2.19, P = .002) status. In multivariate analysis, ctDNA detection at surveillance was found to be the most significant prognostic factor for recurrence (HR: 24.28, P < .001). CONCLUSIONS: Perioperative tumor-informed ctDNA detection in PDAC is feasible across all stages and is associated with patient survival outcomes.