BillionToOne's Northstar Response Predicts Survival in 12 Tumor Types With HR 5.3
BLLN•Northstar Response ctDNA assay emerged as the dominant independent predictor of survival with a hazard ratio of 5.3 across 12 solid tumor types in 142 patients, outperforming standard RECIST imaging. Combined molecular-plus-imaging assessment delivered the highest discrimination (hazard ratios 13.8 and 19.7) and flagged progression 62 days earlier.
1. Study Design and Cohorts
The peer-reviewed study enrolled 142 patients with advanced solid tumors across two prospective cohorts spanning 12 tumor types, including lung, colorectal and melanoma. Samples were collected through serial blood draws to evaluate tissue-free ctDNA dynamics over the course of immunotherapy or combination treatments.
2. Predictive Performance of Northstar Response
In a multivariate analysis combining Northstar Response and blinded central radiographic review using RECIST criteria, molecular progression emerged as the dominant independent predictor of survival with a hazard ratio of 5.3, substantially outweighing radiographic progression alone.
3. Combined Molecular and Imaging Approach
Patients whose disease progressed on both molecular and imaging assessments had the poorest outcomes (hazard ratio 13.8 at landmark assessment and 19.7 with continued monitoring), and the integrated approach identified progression a median of 62 days before clinicoradiographic methods.
4. Serial Monitoring Reveals Rebound Patterns
One in four patients exhibited a molecular rebound pattern—an early reduction followed by a subsequent rise in ctDNA—highlighting the limitation of single-timepoint assessments and underscoring the value of longitudinal sampling for accurate response evaluation.
