Until about 25 years ago, treating people with HIV was difficult and uncertain—and the disease itself was practically a death sentence. Improved diagnostics and technology that could detect viral load guided newer therapies and HIV became a treatable disease. A similar paradigm has occurred in blood cancer; the advent of monitoring minimal residual disease (MRD) to guide innovative therapeutics is changing this area of medicine. The ability to assess depth of remission is providing physicians with a more accurate and reliable way to manage therapy and improve outcomes.
The real-world impact of the use of Adaptive’s clonoSEQ® Assay is exciting for physicians and patients alike. It is the first and only FDA-cleared test that measures MRD in select blood cancers including multiple myeloma, chronic lymphocytic leukemia (CLL) and B-cell acute lymphoblastic leukemia (ALL). With proper input material it can find one residual cancer cell amongst a million healthy cells.
The ongoing generation of evidence is critical to advancing the clinical adoption of MRD testing, and we recently shared a significant amount of new research at the American Society of Hematology (ASH) 2020 conference. The bottom line from the more than 45 abstracts including clonoSEQ data being discussed at the meeting is this: when clinicians use precise MRD assessment to make treatment decisions, patient outcomes get better and overall costs go down.
Why is that? When doctors are able to get more specific and accurate information about a patient’s disease status or how that patient is responding to treatment, they can have more robust conversations with the patient about treatment goals, treatment effectiveness and future prognosis. Those conversations, combined with the insights provided by the MRD results, enable clinicians to better tailor their management approach to achieve the most optimal outcome for the patient. Put simply, this puts patients and their providers in the driver’s seat when it comes to managing their disease.
The advancements clonoSEQ is bringing to the table today are indeed comparable to viral load testing for HIV, which was introduced in the 1990s and is now standard of care. The ability to measure and track disease load validated paradigm-shifting therapies in a way that had never been done before. This has become increasingly true for hematology as well.
Data presented at ASH this year adds measurably to the ever-growing body of evidence validating MRD as a critical measure of outcomes in patients with blood cancers. This has become especially important as novel drugs are making deeper responses and longer-lasting remissions possible for more and more blood cancer patients. Clinicians are and should be using MRD results to help make sense of their options and how to best deploy them.
As with all developments in medical science, we still have much to learn. How can MRD testing advance the ways we have traditionally monitored certain cancers? One example is imaging, which can be expensive and lacking in specificity while also exposing patients to radiation. Any developments that could reduce the need for imaging would be important for physicians, patients and the overall healthcare system. In certain B-cell lymphomas, early evidence suggests that MRD may be able to deliver on this promise, whether by replacing the need for imaging in some settings or by empowering a strategy of “MRD-guided imaging” in others.
For a clinician like me, it is really encouraging to see that patients are seeing the benefits of MRD testing not only in clinical trials, but also in current clinical practice. Patients do not want to wait, nor should they, for a highly precise diagnostic tool that gives them greater potential for successful treatment – and a fuller life.