# Prognostic and predictive value of circulating tumor DNA during neoadjuvant chemotherapy for triple negative breast cancer

Source: https://onco.cc/key-papers/paper-cavallone-tnbc-ctdna-neoadjuvant-sci-rep-2020/  
OnCo record `paper-cavallone-tnbc-ctdna-neoadjuvant-sci-rep-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In 26 women having chemotherapy before surgery for triple-negative cancer, tumour DNA in the blood fell after the first cycle in those heading for a complete response and rose again before surgery in those with cancer left behind.

## Summary

Tumour and serial blood samples from 26 TNBC patients were collected before, during and after neoadjuvant chemotherapy. Individual droplet digital PCR assays were developed for 121 tumour variants (average five per patient), detecting ctDNA in 96% at baseline; baseline mutant allele frequency tracked clinical features. Levels fell sharply after one cycle, especially in eventual pCR patients, then rose significantly before surgery in patients with substantial residual tumour (P 0.0001). Detection early in treatment and at the end before surgery predicted residual tumour, though absence was less predictive of pCR when only TP53 variants were used; end-of-chemotherapy detection indicated worse relapse-free and overall survival.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Scientific Reports
- Year: 2020
- DOI: 10.1038/s41598-020-71236-y
- Authors: Cavallone L, Aguilar-Mahecha A, Lafleur J, et al.
- Findings: ctDNA detectable in 96% at baseline with multi-variant droplet PCR.; Rise before surgery predicted residual tumour (P 0.0001); end-of-chemotherapy detection predicted worse survival.
- What it means: Multi-variant tracking beats a TP53-only assay in TNBC and supports response-adapted designs that read ctDNA mid-chemotherapy.
- Caveats: 26 patients; single centre.; Absence of ctDNA did not reliably predict pCR.

## Sources

- Cavallone et al., Sci Rep 2020: ctDNA during neoadjuvant chemotherapy in 26 TNBC patients: https://doi.org/10.1038/s41598-020-71236-y
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32895401/

## Connected records

- biomarkers: [ctDNA MRD positivity (molecular residual disease after curative treatment)](https://onco.cc/biomarkers/ctdna-mrd-positive/)
- cancers: [Early triple-negative breast cancer](https://onco.cc/cancers/tnbc-early/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- technologies: [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/)
- targets: [TP53](https://onco.cc/targets/tp53/)
- terms: [Circulating tumour DNA (ctDNA)](https://onco.cc/terms/ctdna/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/)

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