News & Publications

Foresight Diagnostics' PhasED-Seq ctDNA assay detects response to acalabrutinib as early as seven days in patients with aggressive B-cell lymphomas

  • PhasED-Seq ctDNA detection results were highly correlated with CT imaging
  • PhasED-Seq ctDNA detection may predict response to targeted agents as early as seven days
  • One patient with improved symptoms showed 20-fold drop in ctDNA despite no changes on CT imaging, suggesting that ctDNA changes may precede CT changes in some cases
  • Podium presentation at the American Society of Hematology Annual Meeting & Exposition

AURORA, COLORADO, December 13, 2021 (GLOBE NEWSWIRE) --  Foresight Diagnostics, in collaboration with the National Cancer Institute (NCI), part of the National Institutes of Health, today announced results from an ongoing phase 2 clinical trial of the lymphoma drug acalabrutinib that included Foresight’s proprietary circulating tumor DNA (ctDNA) detection and minimum residual disease (MRD) monitoring assay, Phased variant Enrichment and Detection Sequencing (PhasED-Seq).  Detection of ctDNA levels with PhasED-Seq was highly correlated with CT imaging and rapidly detected changes in tumor burden in newly diagnosed aggressive B-cell lymphoma patients treated with the drug. The study (abstract #524) was described in a podium presentation at the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition.

“Despite significant advances in how we treat patients with B-cell lymphomas, we still monitor disease burden and response to therapy primarily through CT imaging,” said Mark Roschewski, M.D., Lymphoid Malignancies Branch, Center for Cancer Research, NCI, National Institutes of Health, Bethesda, MD., and principal investigator of the study “This study found that changes in MRD levels may predict response to acalabrutinib treatment in as few as seven days and also suggested that ctDNA quantification by PhasED-Seq may demonstrate clinical response prior to CT scans in some cases. In routine clinical care, using a tool like PhasED-Seq to study treatment response in real-time could enable physicians to direct management decisions earlier in the treatment process.”

The open label trial is evaluating patients with newly diagnosed aggressive B-cell lymphoma and is designed such that patients first received the BTK inhibitor acalabrutinib for up to 14 days. Responders, as assessed by CT imaging, continued on acalabrutinib plus chemotherapy. Non-responders received chemotherapy only. Patients’ tumor burden was evaluated by both CT imaging and ctDNA quantification via Foresight’s MRD assay from the start of the trial to the end of therapy.

The study includes early results from 39 patients, 18 of which (46%) responded to acalabrutinib while 21 (54%) did not based on CT imaging. MRD measurements assessed using PhasED-Seq were strongly predictive of CT response as the log-fold change in ctDNA at the end of the acalabrutinib window correlated with change on CT (r=0.75, p=0.0013). PhasED-Seq results at only seven days, earlier than planned CT imaging, were also highly correlated with the change in tumor burden on CT (r=0.82, p=0.00006). One patient with improved symptoms showed a 20-fold drop in ctDNA even with no corresponding CT changes, suggesting that PhasED-Seq may measure response earlier and with greater sensitivity than CT.

“Response to Acalabrutinib in this window study was much better predicted by very early ctDNA dynamics than by the tumor molecular profile, including cell-of-origin subtype,” said Ash Alizadeh, M.D., Ph.D., scientific advisor and co-founder of Foresight Diagnostics and a contributor to the study. “This stands in contrast to other BTK inhibitors where cell-of-origin and tumor genotype can be a strong biomarker. This observation seems to suggest the utility of sensitive MRD methods to quickly test activity of novel agents in the frontline setting in similar window studies, including with other BTK inhibitors.” 

David Kurtz, M.D., Ph.D., scientific advisor and co-founder of Foresight Diagnostics and a contributor to the study said, “Our PhasED-Seq ctDNA liquid biopsy platform is designed to produce actionable results sooner by detecting MRD with higher sensitivity than other ctDNA assays. The un-matched sensitivity and accuracy of PhasED-Seq for MRD measurement during treatment demonstrated in this study adds to the accumulating data on the platform’s performance. This includes our recent peer reviewed publication in Nature Biotechnology in which PhasED-Seq demonstrated superior minimal residual disease detection in B-cell lymphoma patients compared to other liquid biopsy approaches. We believe that Foresight’s PhasED-Seq MRD platform holds great promise to offer clinicians a better, more individualized approach to managing B-cell lymphoma patients.”

In addition to this study showcasing Foresight’s MRD technology, several other presentations at 2021 ASH meeting highlight the utility of ctDNA in diverse lymphoma types. These include the use of PhasED-Seq in Primary Central Nervous System Lymphomas to be presented in the Plenary Session (abstract #6), in frontline immunochemotherapy of Hodgkin Lymphomas (abstract #233), and for DLBCL subtype classification using EPIC-Seq (abstract #37).


About Foresight Diagnostics

Foresight Diagnostics is a privately held cancer diagnostics company and CLIA-registered laboratory. The company has developed a novel liquid biopsy testing platform for the measurement of minimal residual disease (MRD) that is significantly more sensitive (with a detection limit below 0.0001%, or one part-per-million) than existing tests. The improved sensitivity of the Foresight lymphoma MRD assay can provide actionable information to physicians and biopharmaceutical companies to enable more personalized treatment approaches for patients with B-cell malignancies. Foresight is developing an MRD assay for other tumor types based on the same technology. For more information, please visit and follow us on Twitter and LinkedIn


About PhasED-Seq

The Foresight MRD platform is based on the Phased variant Enrichment and Detection by Sequencing (PhasED-Seq) technology. PhasED-Seq lowers the error profile of mutation detection in sequencing data by requiring the concordant detection of two separate non-reference events in an individual DNA molecule. By detecting more than one mutation, PhasED-Seq can more accurately distinguish tumor-derived cell free DNA (i.e., ctDNA) from healthy cell free DNA – enabling detection of ctDNA at levels below one part-per-million (<0.0001%). PhasED-Seq has been extensively validated in hundreds of patients with B-cell lymphomas. 

 Foresight Contact 
 Name: Mukul Agarwal
 Phone: 720-443-3658

 Media Contact
 Robert Flamm, Ph.D.
 Burns McClellan

Back to all