Integrating ctDNA into the New Zealand healthcare system

The research had multiple aspects, including bioinformatics, laboratory science, clinical studies, and engagement with patient groups, Māori communities, Pasifika researchers and clinicians.

The laboratory work established that ctDNA was able to provide an accurate measure of tumour burden and clearly show a patient’s response to treatment, while also revealing details about how tumours evolve in individual patients – providing new biological understanding that can be used to improve future patient care.

The clinical utility of ctDNA as a near-real time marker of treatment response was demonstrated and the research also showed that, with the addition of an appropriate transport buffer, blood samples were stable for 10 to 14 days, opening the opportunity for better care of rural populations.

Engagement to understand diverse views surrounding the technology led to an appreciation for the importance of data security, a preference amongst Māori for community-based services and the need for wider education around the benefits of early cancer detection.

The next steps for this research are to:

• demonstrate the economic gains and cost-efficiencies made when specific ctDNA applications are integrated into clinical workflows;
• initiate community-driven projects to establish ctDNA-based cancer screening;
• develop ctDNA methodology to provide accurate data on a cancer’s anatomical location; and
• increase the sensitivity of ctDNA technology to allow even earlier detection of new or relapsing cancers.

This project generated a research platform (molecular protocols, clinical networks and bioinformatic pipelines) now being used by early and mid-career researchers to investigate applications for ctDNA in: early diagnosis of colorectal, lung, endometrial and prostate cancers; markers for lung cancer drug response; minimal residual disease in head and neck cancer; and the correlation between ctDNA levels, immune markers and treatment response.