Liquid Biopsies: New Benchmark For Cancer Diagnostics

Liquid biopsies are a relatively new technology in cancer diagnostics, but have shown great potential in their ability to detect cancer early. This has led to a significant improvement in the chances of successful treatment. However, the process has a long way to go before doctors can rely on it.

What Are Liquid Biopsies?

It is a non-invasive method for the early detection of tumour as well as the monitoring of tumour during cancer treatment. It provides data concerning the relapse of a tumour long before any symptoms can be observed. Liquid biopsies analyse bodily fluids (mainly blood) for identifying various biomarkers including proteins, such as:

  • circulating tumour cells (CTCs);
  • circulating tumour DNA (ctDNA);
  • cell-free DNA (cfDNA); and
  • proteins biomarkers, exosomes, mRNA, and miRNA

The liquid biopsy global market is about to reach $3 billion by 2022 at a compound annual growth rate of 26%, predominantly due to the increasing number of cancer diagnoses and favourable government initiatives.

CTCs, which are the precursor to metastasis, are often useful as the biomarker in liquid biopsies. The Food and Drug Administration (FDA) has also approved CTCs to predict the outcome of a cancer case. Veridex’s CellSearch is applicable for clinical use in breast, colorectal and prostate cancer patients. However, research focuses on using CTCs for various other forms of cancer as well.

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ctDNA as a New Biomarker

Alternatively, ctDNA is a relatively new biomarker which has many advantages over CTCs. Tumours continuously shed DNA into the bloodstream by apoptosis; ctDNA is popular for tumour mutation and therefore may provide the required information for a suitable course of treatment. ctDNA is preferable to other biomarkers in terms of clinical correlation, as its half-life is approximately two hours and it therefore provides real-time analysis of tumours.

cfDNA is now into the market about for some time, but its detection and isolation has become possible only recently, thanks to advancements in sequencing technologies. Since it is in its early stages, cfDNA must overcome many obstacles before it can be commercialised. Most of the patent filings in this domain focus on isolating ctDNA from the large amount of cfDNA available in plasma, which requires ultrasensitive detection. Patent filings also focus on detecting suitable markers for the identification of cancer.

Protein specific for cancers, such as carcinoembryonic antigen and carbohydrate antigen 19-9, were among the first analytes as biomarkers for blood tests based cancer detections. These biomarkers now help in assessing tumor burden in patients already diagnosed with cancer, particularly during therapy in patients with advanced cancer.

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Biomarker for Liquid Biopsies for Cancer Diagnostics

It is debatable which available biomarker is most suitable for the diagnosis of cancer. However, a liquid biopsy undeniably offers the following advantages over a standard biopsy:

  • Biopsy is a surgical procedure and therefore poses a higher risk to patients in comparison to a blood sample.
  • Under-representation of the heterogeneity of a tumour and poor sample availability means that tissue biopsies are of limited value for the assessment of tumours in the advanced stages of cancer.
  • Tracking tumour-associated genetic aberrations in the blood helps in assessing the presence of residual disease, recurrence, relapse and resistance.

Key players in the liquid biopsy domain include:

  • Roche Diagnostics;
  • Qiagen;
  • Adaptive Biotechnologies;
  • GRAIL;
  • Guardant Health;
  • Illumina;
  • Janssen Diagnostics;
  • Myriad Genetics; and
  • Trovagene

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Why are Liquid Biopsies a Benchmark for Cancer Diagnostics?

The process is far away from being the stand alone method for cancer detection. The information provided in present liquid biopsies is sometimes incomplete and non-reproducible. For now, liquid biopsy method complements a tissue biopsy method and monitors the tumour during treatment.

Before adopting liquid biopsies for cancer diagnostics, one requires to go through the following information:

  • the standardisation of techniques;
  • an assessment of reproducibility and cost-effectiveness; and
  • an assessment prospective validation in clinical trials.

In future, liquid biopsies may provide diagnostics tests for other diseases, as well as prenatal diagnostics. It will be interesting to see its adaptation in healthcare industry and the potential innovation in liquid biopsy.

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– Yogesh Soam and The Editorial Team

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