How Close Are We to Decreasing Cancer Mortality?

Liquid biopsies could increase early cancer detection and help provide more successful cancer treatments.

Imagine a world where Elizabeth Holmes’ company, Theranos, was successful and had the intended positive impact. That day may be closer than we think with new innovations in liquid biopsies and this is no hoax.

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The shock of getting a call to be informed that late stage cancer was found in a loved one is too hard to put to words. Too many people reading this could speak to the experience of cancer appearing and disrupting lives.

As a collective and unified force, people and companies around the world are in the fight against cancer and working towards solutions and steps to help decrease the sad reality of cancer mortality.

The WHO confirms that cancer is a leading cause of death worldwide, accounting for an astounding 10 million deaths in 2020. In Canada, approximately one in two Canadians are expected to be diagnosed with cancer at some point in their life, with one in four being terminal.

As cancer research is constantly evolving, early detection and treatment stands out as a key factor in changing the course of many life threatening diagnoses.

Between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. Many cancers have a high chance of being cured if diagnosed early and treated appropriately.

With a focus on cancer detection, this article dives into an approach full of potential and gaining attention called, liquid biopsies. With further exploration into why it’s promising, how it works, what’s trending, and what the future looks like.

Between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. (Tweet this)

Why is this important?

According to research presented at the American Society of Clinical Oncologists (ASCO), a liquid biopsy test could detect cancer years before symptoms are noticeable, which could lead to dramatic changes in cancer treatment.

Liquid biopsies have the potential to lead to a long list of positive affects with main focuses including:

  • Helps with early detection, which increases chances of being cured
  • Gives doctors more information and insight on the spread of cancer and what is working
  • Allows for more effective action plans for patients and the cancer therapies being used
  • Improves patient care by limiting invasive and sometimes painful procedures to get accurate information.
Image Credit: https://www.nature.com/articles/s41571-020-00457-x?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+nrclinonc%2Frss%2Fcurrent+%28Nature+Reviews+Clinical+Oncology+-+Issue%29

A liquid biopsy test could detect cancer years before symptoms are noticeable, which could lead to dramatic changes in cancer treatment. (Tweet this)

What is it, actually?

Liquid biopsy is a test done with bodily fluids that gives researchers the ability to look at the unique characteristics of a cancer cell, without performing an invasive procedure.

Credit:https://www.ctg.queensu.ca/docs/newinv/2019/Presentation_Workshop/Penary%204%20CCTG%20New%20Investigator%20Course%20-%20CtDNA%20CESCON%202019.pdf

How does it work?

Helpful context when understanding a liquid biopsy is understanding biomarkers and how they are used. The Breast Cancer Society describes biomarkers like “molecular flags that help doctors decide on a course of action for each patient. A biomarker can be a gene, protein, or other measurable marker and should consistently mean the same thing.”

Cancerous tumors release a variety of biomolecules into the bloodstream which can be biomarkers. A liquid biopsy targets two components which can be collected through a sample of blood or urine, then separated from the plasma and studied. The two components are:

  1. ctDNA: the circulating tumor DNA
  2. CTCs: the intact circulating tumor cells

By watching these biomarkers through liquid biopsy tests there is an increased chance of discovering new, timely and helpful information which results in earlier, better, and more targeted treatment.

Image Credit: https://www.healio.com/hematology-oncology/learn-genomics/introduction-to-liquid-biopsies/what-is-a-liquid-biopsy

Patient Care

A critical argument for liquid biopsies is that they could help prioritize patient care as they reduce the need for the current approaches to detect cancer. These mainly being tissue biopsies which are invasive and sometimes painful. Not to mention it could minimize the need to go in for the current and constant imaging and screening appointments to determine the tumor’s response to current therapies.

Image Credit: https://www.biochain.com/general/a-tale-of-two-biopsies-liquid-biopsy-vs-tissue-biopsy/

It’s trending

The hype around liquid biopsies is not exclusive to the molecular diagnostics world. In 2016, spotlight shone when Bill Gates and Jeff Bezos backed biotechnology company Illumina, in committing more than $100 million to launch Grail, with the goal to develop liquid biopsies.

The global market analysis, the liquid biopsy market is projected to reach $12. 9 billion globally, by 2030. (Tweet this)

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There are several key players in the industry that are currently offering liquid biopsies as a service including GUARDANT HEALTH, Biocept, Bio-Rad Laboratories, Cynvenio Biosystems, Chronix Biomedical, Illumina and Neogenomics Laboratories.

The Current

Covid-19 had a harsh effect on the liquid biopsy market since priorities changed for patients when fighting the coronavirus but progress is still in motion. One of the pioneers, NeoGenomics, launched three liquid biopsy tests for non-small cell lung cancer, solid tumour types, and specific breast cancer in June 2020. Companies like this play an essential role in the market’s growth.

A review, in August 2020, reports that the FDA approved liquid biopsy tests which can evaluate many different genes at the same time. Before this, approved liquid biopsy tests could only identify specific changes in single genes.The two newest approved tests use a technique called next-generation sequencing (NGS). By combining two powerful technologies — liquid biopsy and NGS — the new tests more easily provide enhanced genetic information about tumors and help determine whether targeted cancer drugs can be used to treat the tumors.

The FDA approved these tests for use only in advanced cancer patients, but researchers and companies are developing more liquid biopsy NGS tests that may eventually help other cancer patients. These tests could show whether cancer cells remain after treatment and if cancer has returned. Other future tests could find cancer at early stages and may one day serve as screening tests. At least three companies are currently developing tests for these applications.

Credit: https://www.researchgate.net/figure/Current-applications-and-future-development-of-NGS-based-liquid-biopsy-in-lung-cancer_fig2_320581544

While liquid biopsies continue to become commercially available, they are relatively new, and their use involves several important considerations. More research is needed to fully understand the benefits and limitations of these tests.

The Future

When looking to the future there is continual transformation of the market ahead as new innovations roll out, and more companies enter the market.

Liquid biopsy services have been mainly focused on oncology settings and limited to select cancers (breast cancer, cervical cancer, prostate cancer for prognosis). However, with the emergence of new players in the market, liquid biopsies are set to become important in other areas of practice including transplant rejection assessment services and infectious disease services.

With the first step being cancer treatment, the positive impact is looking promising and on the near horizon. Improved screening and early detection techniques for a variety of cancers could have a large impact on the stage at which a diagnosis is made.

When detected early enough, current therapies can be more successful for many (while metastatic disease remains incurable with very few exceptions). As noted by the Canadian Cancer Society, the early detection of cancer is crucial for several reasons:

  • the cancer can usually be treated with less aggressive treatment
  • treatment is more effective
  • survival rates tend to be higher.

When caught early enough, the tumour may be able to be removed by surgery rather than requiring treatment with chemotherapy or radiation.

“This is potentially the holy grail of cancer research, to find cancers that are currently hard to cure at an earlier stage when they are easier to cure, and we hope this test could save many lives,” lead author Eric Klein, an oncologist at the Cleveland Clinic in Ohio, tells The Telegraph. The test “gives us the opportunity to find them months or years before someone would develop symptoms and be diagnosed.”

This is potentially the holy grail of cancer research (Tweet this)

While the use of liquid biopsies for cancer screening is still an evolving area and needs development, there is significant progress in the technologies being used. It will be an exciting journey to see the impact that liquid biopsies have and if they can live up to their potential in becoming a cornerstone in oncology and early detection.

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Tedx Speaker | E-Commerce | Marketing Director | Advocate for Authentic Leadership | Board Member @ Opportunity International