By: Allen Wilbanks
Date: September 27,2023
In a recent presentation, Elizabeth Brem, MD shared her perspective on the utilization of minimal residual disease (MRD) technology in clinical trials and its potential to transform patient care. She emphasized the various applications of MRD, including its role in guiding time-limited therapies to reduce toxicity, intensifying or extending therapy based on patient needs, and altering therapy strategies, especially in conditions like CLL. Dr. Brem noted that solid tumor colleagues have been more advanced in utilizing MRD technology clinically, while the lymphoma community is catching up to leverage it for patient care improvements.
Dr. Brem also discussed the potential impact of MRD assays in large B-cell lymphoma, highlighting the association between the presence or amount of circulating tumor DNA (CTD) at specific time points and prognosis. She suggested that MRD assessment could play a crucial role after CAR T-cell therapy and raised questions about whether therapy changes should be initiated solely based on detectable CTD and what the appropriate next-line therapy should be.
Furthermore, Dr. Brem mentioned the ongoing study, S2114, led by Brian Hess, which aims to address these questions by examining patients who receive commercial CAR T cells and assessing their responses at day thirty post-treatment. Patients with suboptimal responses are randomized into different treatment arms to explore the impact of early intervention on outcomes.
Dr. Brem also highlighted the potential utility of MRD technology in CNS lymphoma, a challenging disease to assess for treatment response. She discussed the ability to detect circulating tumor DNA in both the cerebrospinal fluid and peripheral blood, emphasizing the potential for MRD technology to enhance treatment monitoring and response evaluation in this context.
Overall, Dr. Elizabeth Brem’s presentation highlighted the evolving role of MRD technology in guiding treatment decisions and improving patient outcomes in various lymphoma settings.