Dr. Huelster on next steps for ctDNA in upper tract urothelial carcinoma


In this video, Heather L. Huelster, MD, discusses next steps for ctDNA in upper tract urothelial carcinoma following the recent European Urology study “Novel Use of Circulating Tumor DNA to Identify Muscle-invasive and Non–organ-confined Upper Tract Urothelial Carcinoma.” Huelster is an assistant professor of urology at Indiana University School of Medicine in Indianapolis.


What are next steps for ctDNA in this space?

Specifically with regard to determining the prognostic value of ctDNA for invasive UTUC, this is a small cohort that we've examined this in, and this particular panel-based approach needs validation in a larger cohort. The big picture next steps in a perfect world, we would be doing a multi-armed trial evaluating ctDNA positivity, in conjunction with neoadjuvant chemotherapy administration to assess its utility as a predictive biomarker. However, given the rarity of upper tract urothelial carcinoma and variability in administration of neoadjuvant chemotherapy for both clinician and patient reasons, that study is unlikely to happen and unlikely to accrue, so sort of more feasibly, and currently being investigated both with our group and others around the country is better elucidating the genomic landscape specific to upper tract urothelial carcinoma, and further optimizing next-generation sequencing assays for diagnosis, staging, and then also the detection of residual disease after surgery, with a goal of improving outcomes and survival in this relatively rare disease space.

This transcription was edited for clarity.

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