The Promise of Liquid Biopsies to Improve Health Equity in Lung Cancer

With headlines like these, it is clear that liquid biopsies have some major implications for lung cancers:

Fast, Precise Cancer Care Is Coming to a Hospital Near You
Liquid biopsy and non-small cell lung cancer: are we looking at the tip of the iceberg?
The Quest for Cancer-Detecting Blood Tests Speeds Up

Now several years after the initial race to create a simpler blood test for cancer patients, where do we stand today and what does this mean for the daily race against the clock for curing lung cancer?

Dr. Kam Kafi, Imagia Canexia Health’s VP of Oncology, is here to break down the use of liquid biopsy in lung cancer patients and its future potential.

 

I) What is Liquid Biopsy? 

Liquid biopsies are minimally invasive tests that are capable of detecting cancer cells or genetic material that are released into the blood from a tumor. 

Source: https://directorsblog.nih.gov/2018/01/30/new-liquid-biopsy-shows-early-promise-in-detecting-cancer/ 

Collecting tumor tissue through biopsies is considered the gold standard for diagnosing and treating cancer. However, a tissue biopsy has always had its limits—it’s painful, and sometimes when a doctor takes a sample, they miss the spot where the cancer is.

Blood tests could obviate the need for surgeons to cut tissue samples from suspicious lumps and lesions and make it possible to reveal cancer lurking in places needles and scalpels cannot safely reach. They could also determine what type of cancer is taking root and what treatment might work best to squash it.  Furthermore, they are easily repeatable making them attractive in monitoring patients that are diagnosed and treated, where traditionally you require repeated imaging which is less sensitive and comes with radiation exposure. 

What makes the search difficult is that in certain types of cancer, there might not be a lot of DNA being released. It is like finding a needle in a haystack because the shed DNA from cancer represents just 0.1% of all cell-free DNA floating around in the blood. Although far from perfect, recent advances in technology and growing number of patients tested is helping overcome these limitations. 

 

II) Impact of liquid biopsy in lung cancer

Lung cancer is one of the deadliest cancers in the world and the National Cancer Institute estimates it will kill over 150,000 people a year, despite a growing number of novel therapies. Part of the problem is there are a lot of different mutations that can cause the most common form of it and while the genetic profile of a tumor can tell doctors which treatment to prescribe, finding the mutation is an exercise in trial and error. Screen for the most common mutation, then try that drug. If it doesn’t work, screen again and try something else. It can take weeks or even months to find a treatment that’s optimal, taking time patients don’t have.

Currently liquid biopsies are not used to diagnose cancer but rather to monitor disease progression or to detect genetic mutations in the tumor that could suggest which drug should be used to treat the disease.

Source: https://www.nature.com/articles/s41416-022-01777-8 

Historically, the first clinical application of liquid biopsy was in advanced Non-Small Cell Lung Cancer (NSCLC). These pioneer studies were followed by the advent and adoption of next-generation sequencing (NGS) which widened the spectrum of detectable mutations leading to different opportunities. 

First, whenever a druggable alteration was found, matched therapy with specific medication might be offered. Second, the presence of certain mutations or co-mutations could provide prognostic and predictive information, helping oncologist decide on next steps (such as simply monitor or add additional treatments). Last, the detection of tumor-specific genetic alterations at baseline and the measurement of their variation during treatment could be useful to monitor the effectiveness of treatment early on and follow the course of the disease. If we see the amount of cancer dna in the blood go down, it’s good, and if it starts coming back up we have a early warning signal.

 

III) What’s next? Future implications for monitoring, screening and health equity

Innovations in the development of liquid biopsy platforms over the past decade have led to a growing number of regulatory approvals for blood-based tests that are transforming precision cancer care for patients with advanced disease. These tests have increased their range of clinical applications in cancer treatment to now include monitoring cancer growth, detecting genetic mutations, identifying signs of relapse, and predicting sensitivity to immunotherapy. 

Over the next 5 years, liquid biopsy will be much more about enabling standards of care in oncology for new applications, including the detection of molecular measurable residual disease (MRD) and in cancer screening and treatment selection in earlier-stage disease, where you can improve survival for patients.

Source: https://www.nature.com/articles/s41416-022-01777-8

In 2020, the FDA approved two comprehensive genomic profiling liquid biopsy tests. And the number of regulatory approvals continues to grow. 

Despite the increasing popularity of liquid biopsy testing in oncology care, currently their use is limited to a handful of commercial offerings that are mostly available in the U.S,  still expensive, and not widely used in community care settings where the majority of patients are treated.   

What we need now is to leverage the existing infrastructure to enable access to liquid biopsies in-house at the point of care. This is exactly what we’re working on at ICH. By adapting a distributed testing model, we provide community cancer centers with all the know-how and technology (AI, Bioinformatics, Reporting) to bring testing in-house so that they can provide cutting edge testing to their patients using the infrastructure that is in place. 

Through this approach, we are able to reduce the disparities in cancer testing by bringing down the price of liquid biopsies, speed up turnaround times as samples don’t need to get shipped out, and ensure greater patient data privacy as all the information stays within the institute. 

As technology is democratized and becomes more affordable, it directly increases health equity by providing accessibility to larger populations that traditionally don’t have the same resources at top-tier hospitals in major cities. And it’s getting noticed…

The growing adoption of the technology across the globe, from Asia to the Middle-east to South-America signals a brighter future for cancer patients across the globe.

To learn more about Imagia Canexia Health solutions and how you can bring quality NGS testing in-house, get in touch with us by writing to bd@canexiahealth.com.

 

References used:

https://www.nature.com/articles/s41416-022-01777-8
https://www.scientificamerican.com/article/the-quest-for-cancer-detecting-blood-tests-speeds-up/
https://www.wired.com/story/fast-precise-cancer-care-is-coming-to-a-hospital-near-you/
https://www.nytimes.com/2016/06/05/health/liquid-cancer-test-offers-hope-for-alternative-to-painful-biopsies.html
https://www.theguardian.com/science/2017/jun/04/cancer-detection-liquid-biopsies
https://peterattiamd.com/maxdiehn/
https://ascopost.com/issues/october-10-2021/the-evolution-of-liquid-biopsy-in-cancer-care 

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