ROLE OF cfDNA AND ctDNA TO IMPROVE THE RISK STRATIFICATION AND THE DISEASE FOLLOW-UP IN PATIENTS WITH ENDOMETRIAL CANCER: TOWARDS THE CLINICAL APPLICATION

ABSTRACT Introduction In the past years, there has been a rise on advanced endometrial cancers (EC) patients resulting in mortality increase. To overcome this trend, it is essential to improve the stratification of the risk of post-surgery recurrence and to anticipate the development of disease relapse and resistance to treatment. Liquid biopsy analyses represent a promising tool to address these clinical challenges, however, the best strategy to efficiently apply them in the context of EC must be better defined. Therefore, the study was designed to determine the value of cfDNA/ctDNA monitoring to improve the clinical management of patients with localized and recurrent disease. Material HR=9,25) and DSS (p-value<0.0001; HR=11,20). Importantly, this approach remains clinically significant when stratifying tumours based on histopathological risk factors, highlighting its additional value to identify patient with a poor evolution. In fact, cfDNA/ctDNA analysis served to identify patients who showed early post-surgery relapse. Moreover, longitudinal analyses of cfDNA/ctDNA proved to be a powerful asset to identify patients undergoing relapse, months prior to the arisen of any clinical evidence. Conclusion This study represents the most comprehensive study on cfDNA/ctDNA characterization in EC and demonstrates its value to improve the risk stratification and anticipate the disease relapse in patients with localized disease. Besides, the dynamic ctDNA assessment showed utility to complement the current strategies to monitor disease evolution and the response to treatment. Implementation of cfDNA/ctDNA monitoring into the clinical routine will provide an unique opportunity to improve EC management. GRAPHICAL ABSTRACT