WCLC Sept 2021 | The application of liquid biopsy ctDNA analysis in NSCLC
Maria Arcila, MD, Memorial Sloan Kettering Cancer Center, New York, NY, provides an overview of liquid biopsy circulating tumor DNA (ctDNA) testing for tumor profiling and some of the potential applications in patients with non-small cell lung cancer (NSCLC). The emergence of ctDNA analysis using technologies such as next-generation sequencing (NGS) offers a non-invasive method to detect small amounts of tumor from the circulation and identify genetic alterations for diagnostic purposes, as well as during the monitoring of patients being treated with targeted therapies. This interview took place at the World Conference on Lung Cancer (WCLC) 2021.
Transcript (edited for clarity)
cfDNA has actually emerged as a very important and valuable score for tumor profiling in patients with advanced non-small cell carcinoma. And the technology has developed in such a way that now we’re able to detect very small proportion of tumor that may be circulating at any one time. So with this new technology, and you can either use next-generation sequencing or digital PCR depending on the extent of the information that you want, but you’re able to detect genomic alterations, such as mutation, chromosomal rearrangements, copy number alterations, and you can even detect characteristic epigenetics, epigenetic alterations like methylation patterns of different DNA fragment lengths...
cfDNA has actually emerged as a very important and valuable score for tumor profiling in patients with advanced non-small cell carcinoma. And the technology has developed in such a way that now we’re able to detect very small proportion of tumor that may be circulating at any one time. So with this new technology, and you can either use next-generation sequencing or digital PCR depending on the extent of the information that you want, but you’re able to detect genomic alterations, such as mutation, chromosomal rearrangements, copy number alterations, and you can even detect characteristic epigenetics, epigenetic alterations like methylation patterns of different DNA fragment lengths. So this information that is tumor-specific can be obtained either on tissue, the way that has been done historically. But now we know that these tumors actually shed this genetic information into circulation in small fragments so that you can actually detect them and you may be sparing the patient from a biopsy that they may not be readily available to have done when they’re diagnosed.
So I think that at a higher level the one thing that is enticing about this type of technology is that if a patient cannot have a biopsy done, or a patient had a biopsy that had insufficient tumor to be able to test it, you can spare the patient from a biopsy and have this be the diagnostic sample where you can detect the genetic alterations that may be targetable. But in addition to this outside of the primary diagnosis, this is the type of information that is now being used for patients that are put on a targeted therapy and need to be monitored when that targeted therapy is instituted. So this again, spares the patient from additional biopsies for monitoring.
And then of course, another use is to be able not to monitor the disease, whether it is the amount of disease coming up or going down, but also to monitor the absence of disease and potential emergence of this disease again. So that monitoring is quite important for the targeted therapy that is being given, so this is an important use. So I think that at this point, diagnosis and monitoring of the patient are the major uses that I would think about.
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Disclosures
Maria Arcila has has participated in a consulting or advisory role for Janssen Global Services, Bristol-Myers Squibb & AstraZeneca. She has also received speaker honoraria from Biocartis, Invivoscribe Inc, Physician Educational Resources, PeerView Institute for Medical Education, Clinical Care Options & RMEI Medical Education.
