In our exciting work to identify and collect groundbreaking medical innovation from all over the world, we not only find astonishing new solutions but also numerous tragic stories that could and should have found very different endings. My coworker told me one of these stories, starting with the very important question “Why is it impossible for people my age (30 years) to get proper cancer screenings on a regular basis, especially when you are living in a country that is known for a well-working healthcare and insurance system?”. Background is the sad case of an apparently healthy young woman she knew, who, at the age of 31 suddenly experienced a severe loss of weight. After a while she consulted her doctor and was diagnosed with stomach cancer in a very advanced stage. Not even six months later she died.
We, of course, know it’s all about the statistics, but medical innovation already has the power to put the individual in the center of care, only therefore our systems need to be disrupted. In this case, the key might be liquid biopsy.
Liquid biopsy diagnostics (in a narrow sense) is the molecular analysis of tumor-derived nucleic acids from body fluids, particularly blood. The actual quantum leap is driven by a high degree of sensitivity in innovative analytical methods, such as parallel sequencing (NGS), digital PCR and single-catalysis.
Fluіd bіорѕу detects the following:
- Tumor-derived nucleic acids can be found in the blood in the form of circulating tumor cells (CTCs)
- Cell-free tumor DNA or cfDNA for short
- Very small vesicles (exosomes): Exosomes are of particular interest because of their content of characteristic microRNAs
Especially in the USA, many start-ups focus their business exclusively on this technology and its commercial exploitation. One of the famous players in this field is the company GRAIL, which is supported by Bill Gates. The company is on its way to solve the issue of early cancer detection via blood and received a financing of US $ 100 million.
I am a process engineer and therefore contemplate technologies from the perspective of application within the medical service chain. My expectation in implementing this technology in clinics is immense. Liquid biopsy will not just improve the diagnosis of tumors, but precision medicine in general.
Let’s begin with early tumor detection. Today, the diagnosis of cancer takes place in very different stages of the disease. Cancer detection often occurs at a time when any help is too late. Next to the costs, a reason for this is the invasive, painful or even potentially risky procedure in cancer detection. These аrе kеу advantages of the use of liquid biopsy. „Going tо thе ѕоurсе“ is nоt an issue anymore compared to a tіѕѕuе bіорѕу. In contrast to the tissue sample, only a few milliliters of blood are taken, from which the DNA is isolated and molecularly analyzed.
The procedure will enable us to simply perform a cancer screening within regular blood testing. In the near future, cancer can be detected much earlier and the chances of curing the illness can be moved onto a whole different level. Liquid biopsy diagnostics will conquer the diagnostic work of oncology, which currently relies on pathology and radiology.
The next big thing linked to liquid biopsy is the support of the cancer therapy. To treat a cancer with targeted drugs, the doctor must first analyze a sample of the tumor. For this purpose, they usually take a tissue sample and analyze the genetic material.
“On the basis of the mutations detected therein, the physician chooses the appropriate therapy. The possibilities of conventional tissue biopsy are limited here. Molecular abnormalities and mutations in tumors change over time and under treatment. In addition, conventional biopsy is a much more invasive and sometimes even risky procedure“, explains Professor Holger Sültmann, head of the cancer research group at the DKFZ.
Liquid biopsy can help to solve this problem: Dying cells release their DNA into the blood. This is referred to as „cell-free DNA“. сfDNA established thе роѕѕіbіlіtу tо track аnd ѕсrееn tumors in a nоn-іntruѕіvе wау, so that the selection of effective drugs is much easier to identify and more precisely.
Tumor monitoring through liquid biopsy is particularly interesting, as recurrent tumors can be detected at a very early stage and their possibly altered molecular profile can be deciphered. In case of resistant mutations under the first-line therapy, the patient’s survival can be significantly improved by a switch within the targeted therapy. The cfDNA of tumor cells during therapy show the mutations of the tumor. They can be detected from the blood sample through PCR and subsequent sequencing. The adjustment of drugs can be installed now almost in real time – simultaneously to the change of the tumor, with the result of a more effective therapy.
If you would like to get more insights on the most innovative developments in healthcare and medicine, don’t miss our interactive XPOMET© Convention in March 2018.
Text by Ulrich Pieper & Team
Picture by BBC.com