The Digester

An investigator-initiated, multicentre trial shows that longitudinal ctDNA monitoring can stratify patients during treatment of locoregionally advanced nasopharyngeal carcinoma and enable real-time escalation or de-escalation of therapy, with biological, quality-of-life and economic analyses reported.

The multicentre EP-STAR trial used serial circulating tumour DNA measurements during induction and concurrent chemoradiotherapy to define low, intermediate and high ctDNA risk states.
Clinicians adapted treatment intensity in real time, escalating therapy for patients with persistent ctDNA and de-escalating for those with rapid clearance.
The ctDNA-guided risk-adaptive strategy was evaluated against a preplanned nonrandomized external cohort that received standard-of-care treatment without adaptation.
Single-cell and bulk biology analyses linked ctDNA-defined risk groups to distinct tumour immune and cell state changes after induction chemotherapy.
Quality-of-life and cost-effectiveness analyses were reported alongside clinical results to assess the broader impact of the adaptive strategy.
De-identified participant-level data are publicly available at Mendeley Data and sequencing data were obtained from the CNGB Sequence Archive, with source data provided with the paper.

Dynamic ctDNA guides risk-adaptive therapy in nasopharyngeal carcinoma

Articles