Dr. David Page reviewed MRD ctDNA assays in early breast cancer, highlighting improved assay sensitivity and their value for risk stratification, treatment monitoring, and recurrence surveillance.

Dr. Jo Chien argued ctDNA MRD testing is not ready for routine early breast cancer care, citing limited prospective evidence, assay sensitivity concerns, and lack of NCCN/ASCO endorsement despite prognostic value.

Dr. Lajos Pusztai highlighted the SERENA-6 strategy of switching endocrine therapy early for emerging resistant clones, improving progression-free survival and delaying chemotherapy despite no overall survival benefit.

Dr. Sarah Sammons reviewed PADA-1 and SERENA-6, noting improved progression-free survival with early therapy changes based on ESR1 mutations but no overall survival benefit, underscoring the need for further validation.

Dr. Pedram Razavi highlighted personalized ctDNA assays for metastatic breast cancer, showing early ctDNA decline predicts outcomes and may enable AI-guided, response-adapted treatment strategies.

Panelists discussed ctDNA-guided treatment, emphasizing that better therapies, multiomics biomarkers, and cost-effective testing are needed to improve survival and enable earlier, more precise cancer care.