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Circulating tumor DNA level is associated with time to clinical recurrence in Merkel cell carcinoma: Implications for patient management.

Circulating tumor DNA level is associated with time to clinical recurrence in Merkel cell carcinoma: Implications for patient management. Journal of the American Academy of Dermatology Akaike, T., Thakuria, M., Silk, A. W., Hippe, D. S., Ch'en, P. Y., Park, S. Y., Urman, N. M., Chiu, M. W., Kim, H., Kim, E. Y., Hall, E. T., Bhatia, S., Reddy, S., Krainock, M., Aleshin, A., Choi, J. S., Tsai, K., Yom, S. S., Yu, S. S., Choi, J., Chandra, S., Nghiem, P. T., Zaba, L. C. 2025

Abstract

Merkel cell carcinoma (MCC) recurs in 40% of patients. Circulating tumor DNA (ctDNA) is an emerging blood-based biomarker for early MCC recurrence detection.To evaluate the timing and prognostic significance of ctDNA levels relative to clinical recurrence.This multicenter prospective study analyzed 669 tumor-informed ctDNA tests from 215 MCC patients (stage I-IV) without clinically evident disease after treatment.Patients with at least one positive ctDNA test were more likely to experience recurrence compared to ctDNA-negative patients (hazard ratio: 18.1, 95% CI: 8.9-36.7), with 77% developing clinically evident disease by one year. The median interval between the first positive ctDNA and clinical recurrence was 2.7 months. Clinical recurrences usually occurred within 3 months for ctDNA levels above 10 molecules/mL, within 6 months for levels between 1-10 molecules/mL, and within 9 months for levels below 1 molecule/mL.In this real-world study, there was variability in timing and frequency of follow-up examinations, imaging, and ctDNA testing, although most patients were followed with both ctDNA and imaging.A positive ctDNA test detects MCC recurrence approximately 3 months earlier than imaging. Negative ctDNA can help reduce imaging frequency through serial ctDNA monitoring, while positive ctDNA warrants closer patient follow-up.

View details for DOI 10.1016/j.jaad.2025.10.032

View details for PubMedID 41077138