How have you incorporated ctDNA into the clinical management of patients with gynecologic cancers?

ctDNA certainly is increasing rapidly in oncology and has been led by several other disease sites. I think right now, GYN oncology is figuring out how to incorporate this in our care to meaningfully impact our patients. I have not incorporated ctDNA in my practice routinely, but do see the role of it for select individuals for prognostic counseling and potentially a role in driving some decisions in the future.

The main questions I have for ctDNA today:

1. Am I going to change my management based on ctDNA? Are there options to escalate their care, or do I feel comfortable de-escalating in the case of a negative ctDNA result? If it's not going to drive my decisions, then why check it?
2. Does identifying minimal residual disease or early ctDNA re...

I agree with Casey's points but would be cautious to reduce maintenance outside of a clinical trial situation, other than toxicity issues as he suggests. Treating asymptomatic disease recurrence is another great area for prospective study now that we have several targeted therapy options and taxol/pembro option in ovarian cancer that theoretically could produce better results with minimum residual disease than bulky recurrence. A negative ctDNA drawn after surgery has false negative potential (maybe 5-10%?), but sequentially negative is prognostically good, and conversion to positive with sequential rise almost always results in clinical relapse. Clearly retrospective observational studies in several solid tumors show that clinicians increa...